A STUDY OF THE CLINICAL, RADIOLOGICAL, CYTOLOGICAL AND HISTOPATHOLOGICAL CORRELATION OF SOLITARY THYROID NODULE

Background: Solitary thyroid lesions are a common presentation in the surgical OPD. The signi?cance of solitary nodule is its malignant potential. Thyroid nodule is an elusive clinical problem. Surgeons and Physicians are often required to make a diagnostic or management decision in its treatment. To study the Aim and Objectives: correlation between Clinical, Radiological, Cytological and Histopathological ?nding in patients who presented with “solitary thyroid nodule”. A prospective observational study, Ramakrishna Mission Materials and Methods:Study design: Study area: Seva Pratishthan Hospital, Kolkata, July 2019 to June 2022(3 years), 40 patients, Inclusion criteria: Study period: Sample size: Patients presenting with solitary thyroid nodule, Patients with multinodular goitre, patients with carcinoma Exclusion criteria: thyroid with distant metastasis, paediatric patients and those unwilling. Thorough history, clinical examination, Methodology: investigation (FNAC/USG/Isotope Scan, TSH), appropriate surgical intervention and HPE of excised specimen was done. Results: In our study of 40 cases, 28(70.0%) were colloid goiter, 7(17.5%) were papillary carcinoma, 2(5%) were follicular adenoma, 1(2.5%) was follicular carcinoma, 1(2.5%) was adenomatoid hyperplasia and 1(2.5%) was Hashimoto thyroiditis. 28(70%) cases underwent hemithyroidectomy, 11(27.5%) underwent total thyroidectomy and 1(2.5%) underwent hemithyroidectomy followed by revision total thyroidectomy. 2 cases of papillary carcinoma with enlarged neck nodes underwent total thyroidectomy with neck node dissection. Solitary nodule is most common in woman and in third Conclusion: and fourth decade of life, more common in the right lobe. USG and FNAC are common modalities of investigations with high speci?city and sensitivity. Isotope scan is only indicated to con?rm the toxic nodule. Malignancy reported in my study was 20%. Early diagnosis and prompt treatment will cure the disease since carcinoma thyroid is more curable amongst all cancers.

Cytomorphological Study of Thyroid Lesions Using the Bethesda System for Reporting Thyroid Cytology and Its Correlation with Thyroid Function Test.

Fine-needle aspiration cytology of thyroid is a simple, minimally invasive, cost effective, readily available, reliable, time saving and an easy to perform outpatient procedure.1 The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a six category scheme of thyroid cytopathology reporting.2 FNAC in conjunction with thyroid hormonal profile helps in assessing stage of the disease as hyperthyroid, hypothyroid or euthyroid3. It is very helpful in deciding the treatment options for the patient.METHODSThis is a prospective study of 125 fine needle aspirations (FNA) of thyroid nodules. All fine needle aspiration cytology (FNAC) diagnosis were classified according to age and gender, cytological findings and TBSRTC categories. All TBSRTC categories were correlated with thyroid function test results.RESULTSThe distribution of various categories from 125 evaluated thyroid nodules was as follows: 6.4% Non-Diagnostic or Unsatisfactory (ND/UNS), 80% benign, 2.4% Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance (AUS/FLUS), 4% Follicular Neoplasm (FN), 4% Suspicious for Malignancy (SFM), and 3.2% Malignant. Maximum cases with altered TFT were found in category II. Whereas in category V (5/5) & in category VI (4/4), all cases were euthyroid & not a single case of altered Thyroid Function Test (TFT) was found. Among the 16 cases of thyroiditis, majority of the cases was hypothyroid.CONCLUSIONSTBSRTC is an excellent reporting system for thyroid FNA. It also provides clear management guidelines to clinicians to go for follow-up FNAC or surgery. Diagnostic challenges arise when aspirate samples are quantitatively or qualitatively suboptimal and, in such situations, clinical and TFT correlations are immensely helpful. Alteration in thyroid function tests is associated with benign conditions mostly in thyroiditis in which hypothyroid state can aid in the diagnosis of the benign lesions.

Uncommon affliction of a common disease - primary tuberculosis of thyroid gland

Tuberculosis (TB) continues to be a major public health problem in India. With an annual incidence rate of 2.8 million new cases, India accounts for a quarter of the global TB burden. Primary thyroid TB still remains a rare entity even in this era of global TB pandemic. Here we discuss a case of primary thyroid TB in a 22-year-old immunocompetent male patient presenting with a thyroid swelling followed by non-healing sinus tract after fine-needle aspiration cytology (FNAC) procedure. TB is a known common cause for development of chronic sinuses and ulcers. However, the primary involvement of thyroid gland along with formation of non-healing sinus tract post FNAC make it a most unusual case posing a diagnostic challenge to the unsuspecting physician.

Role of Cell Block Preparation in Cytopathological Diagnosis

Introduction: Though Fine needle Aspiration Cytology(FNAC) is good method for diagnosis of lesions, sometimes itdoes not provide precise diagnosis due to inadequate material.Present study was based on use of residual FNAC materialto make cell block in order to find out utility of cell blockpreparation of FNAC.Material and Methods: The two years prospective studycarried out in a tertiary Heath care hospital of central India,included 360 patients referred for FNAC of the lesions fromall body sites. After making the conventional FNAC smears,the remaining material in the needle hub and syringe wasobtained by flushing it with 10% alcohol –formalin. Aftercentrifugation the supernatant was decanted and depositfixed in freshly prepared 10% alcohol-formalin. After halfan hour alcohol-formalin was drained, cell button was takenon whatman-filter paper and processed as surgical tissue inautomated tissue processing machine. FNAC smears andcell block sections were examined separately for cellularity,reporting done and results correlated with histopathology.Results: Of 360 cases FNAC smears and cell blockswere adequate in 324(90%) and 313(86.94%) casesrespectively. Statastical analysis was done in 98 cases inwhich histopathology available. Sensitivity of FNAC was88.06%,specificity of 92.86% and accuracy of 89.47%.Sensitivity of cell block was 90.91%, specificity of 92.86%and accuracy of 91.47%. Sensitivity of combined FNAC andcell block technique was increased to 98.53% with specificityof 93.33% and accuracy of 96.94%.Conclusion: Cell blocks as an adjuvant to FNAC smears isvery effective technique in cytology to reach the definitivediagnosis.

Ultrasound evaluation of non-cystic renal masses and correlation with ultrasound guided fine needle aspiration cytology/biopsy

Background: The purpose of present study was to identify sonologically, the cystic and non-cystic renal mass lesions, to attempt differentiating benign lesions from the malignant ones and to correlate ultrasound findings with ultra sonographically guided cytological or pathological findings.Methods: In this hospital based prospective observational study, all the patients with confirmed renal mass were subjected to USG guided fine needle aspiration cytology (FNAC). All the patients presenting with lump in abdomen, haematuria or pain in abdomen, wherein the clinical diagnosis of renal mass was being considered by the clinician, were enrolled for the study. Total 54 participants were enrolled. Those with confirmed renal mass were subjected to USG guided FNAC and which was carried out in supine position by transabdominal route in all patients.Results: About 42 participants were retained for final analysis; since FNAC was not possible in 12 patients. Pain in abdomen (36, 85.7%), mass in abdomen (34, 81%) were the most predominant clinical findings. Mixed echogenicity was the commonest echo pattern (42, 77.7%) on ultrasonography. Histopathologic/cytologic examination of the 39 malignant cases confirmed renal cell carcinoma (18, 46.5%) to be the commonest malignancy, followed by Wilms’ tumour (10, 26%). Out of the 39 cases in which clinico-radiological diagnoses were correlated with histo-cytological diagnoses, it was found to be consistent in 30 (77%) cases and inconsistent in 9 (23.1%) cases.Conclusions: Fine needle aspiration cytology/biopsy performed under ultrasonography guidance demonstrates high diagnostic accuracy. It is hence recommended as part of fundamental approach to the diagnosis of non-cystic renal mass.

Analysis of inconclusive cytology reports on fine needle aspiration samples – A descriptive five-year study in Medical College Hospital in Southern India

Background: Reactive lymphocytes can be presented with a different number of morphologies. The significance of evaluation of lymphocytes on peripheral smear tests and its clinical correlation are still neglected. Materials and methods: Clinical details along with other clinical investigations like cell counter results of patients presented with lymphocytosis and other hematological parameters including hemoglobin, total WBC count and platelet count, were collected from Department of Pathology, Dhanalakshmi Srinvasan Medical College and Hospital, India. Results: A total number of 120 cases were studied, out of which 82 patients showed absolute lymphocyte count more than 4000/ul. Out of the 120 patients, a total of 31 patients had history of smoking/tobacco chewing. 18(58%) of them showed reactive/ atypical lymphocyte morphology and 13(41%) of them showed mature lymphocytes. Of the 10 patients with alcoholism history, only 4 of them showed a normal morphology of lymphocytes, other 6 patients showed reactive lymphocyte morphology. Only one patient in the study population showed atypical lymphocytes and in peripheral smear and subjected to lymph node biopsy and rest of the patient failed to follow up after advised biopsy. Conclusions: Current study also reports that, lymphocytosis with reactive lymphocytes have a correlation with acute stress, smoking, and other ailments.

Diagnostic correlation of palpable breast masses by cytology and histopathology: A prospective study

Introduction: Fine needle aspiration cytology (FNAC) has revolutionized the approach to diagnosis and management of breast and various other lesions. Its accuracy in many situations avoids any unnecessary surgical procedures. The aim of this study was to analyze and correlate the diagnosis of breast lesions on cytology with histopathology. Materials and methods: This prospective study was done at Government Medical College, Nizamabad, and Telangana State (TS) during June 2016 to May 2018 and total numbers of cases included were 200. A detail clinical and family history was taken before the procedure of FNAC and examination of both the breast was done. Results: The study included 200 breast masses/ cases, which were diagnosed on cytology. The age group included in this study was between 16 years and 75 years. Most of the cases in this study were in the age group 16- 30 years (91 cases) followed by 31- 45 years group (66 cases), followed by 46-60 years (34 cases) and least numbers of cases were noted in 61-75 years age group (09 cases). In this study, most common diagnosis was Fibroadenoma and least common diagnosis given on cytological examination was tubular Adenoma. Conclusion: FNAC is an important diagnostic adjunct in the management of patient with a breast lump. Recently FNAC popularity has grown many folds and has become a most valuable tool in the diagnosis of palpable breast masses owing to its distinct advantages of being sensitive, specific, expedient, economical and safe. Lack of local or general anesthesia makes the procedure more comfortable for the patient and the pathologist.

Accuracy of fine needle aspiration cytology with histopathology of thyroid lesions – 15 years study at Government ENT hospital, Hyderabad, Telangana

Background: Swellings of thyroid gland are common in most parts of the world, including countries like India where iodine deficiency is endemic. Its prevalence ranges from 4% to 10% in the general adult population and from 0.2% to 1.2% in children, affecting females more commonly than males. Aim and objective: To evaluate diagnostic accuracy of Fine needle aspiration cytology of thyroid lesions, to categorize thyroid lesions as per the Bethesda system, to correlate cytomorphology with histopathology, to determine the accuracy of FNAC in terms of sensitivity, specificity, positive predictive value and negative predictive value in comparison with histopathology in the diagnosis of a thyroid lesions. Materials and methods: It was a retrospective study undertaken over a period of one and half years from October 2016 to March 2017 in the Department of Pathology, Government ENT Hospital, Hyderabad. FNAC was performed with 26 gauge needle; smears were fixed in ether-95% alcohol solution and stained with Haematoxylin and Eosin stain. Different types of excised thyroid specimens received were subjected to routine processing, cutting, staining and histopathological features were analysed. Results: The sensitivity, specificity, positive predictive value, and negative predictive value of aspiration cytology in detecting all the benign and malignant lesions of thyroid were 67.4%, 99.2%, N. Sreemani Kumari, Madhavi Parigi, Seema Afroze. Accuracy of fine needle aspiration cytology with histopathology of thyroid lesions - 1.5 years study at Government ENT hospital, Hyderabad, Telangana. IAIM, 2017; 4(8): 49-63. Page 50 93.9%, and 94.2% respectively. The diagnostic accuracy of detecting thyroid lesions by FNAC was 94.1%. Conclusion: Fine needle aspiration cytology is a minimally invasive, simple, reliable, safe and cost effective gold standard cytology technique with minimal discomfort and complications to the patient. FNAC avoids unnecessary thyroidectomies for benign thyroid pathologies.

An Open, Retrospective Study Of Comparison Of Fine Needle Aspiration Cytology (FNAC) And Histopathology Findings In 75 Cases Of Solitary Thyroid Nodule.

Background and objectives: Solitary thyroid nodule(STN} is a common clinical entity encountered in routine clinical practice.STN is defined as a single swelling involving either lobe of thyroid or isthmus of thyroid gland. Present study was undertaken to know distribution of lesion according to age and sex, and also to evaluate efficacy of FNAC in diagnosis of clinically obvious and palpable solitary thyroid nodule. Method: This study was done on 75cases operated in our hospital from May 2012 to May 2016. All patients included in the study were submitted to FNAC and ultrasonography. All patients were subjected to surgery and histopathology examination was obtained. Results: Out of 75 cases of thyroid lesions, 63 cases were benign (84%), 6 cases were malignant (8%) and 6 cases were suspicious(8%) on FNAC. On Histopathological examination, 60 cases were benign(80%) and 15 cases were malignant(20%). Conclusion: FNAC is a single best investigation for preoperative evaluation for STN to differentiate between benign and malignant nodules with 88% accuracy rate.[Doshi H NJIRM2016; 7(5):53-55]

Efficacy of FNAC in early diagnosis of prostatic carcinoma

Background: Prostatic carcinoma is one of the most important causes of mortality in elderly men mainly because of the late detection despite of the fact that it is a potentially curable disease. Fine needle aspiration cytology (FNAC) is an easy to perform outpatient procedure requiring no expensive equipment or anesthesia. Objectives: The present study was carried out in an attempt to evaluate the fine needle aspiration cytology in the diagnosis of carcinoma prostate. Materials and methods: The present study was performed on 27 patients admitted in the surgical wards, with complaints suggestive of prostatic disease, in whom there was found to be a suspicion of malignancy of the prostate gland. Results: Among 27 patients, 14 patients were diagnosed as prostatic malignancy on per rectal FNAC whereas, 19 patients were confirmed with prostatic cancer histologically. Out of 19 histologically confirmed cancer cases, 16 were also positive on FNAC i.e. 84.21% accuracy of FNAC in detecting prostatic malignancy. Conclusion: Fine needle aspiration cytology is easily available and inexpensive procedure. It is a reliable method in the diagnosis of prostatic cancer. Its positive results are relatively more reliable than the negative ones. It is an effective method in follow up of the cancer cases.

A descriptive study on solitary nodular goitre

Background: Solitary nodular goitre is clinically defined as a single nodule in otherwise normal thyroid gland. It can be benign or malignant. Solitary nodule has a higher risk of malignancy (15- 20%) when compared to multi-nodular goitre (3-5%). Aim: We conducted a study to evaluate the clinical and radiological factors associated with occurrence of malignancy in Solitary Nodular Goitre (SNG); to find out the incidence of SNG in this part of North Chennai; to analyze the correlation of preoperative cytological and postoperative histopathological results. Materials and methods: It was a prospective study on fifty patients who were clinically diagnosed as SNG. All patients were evaluated with an Ultrasonogram (USG) Thyroid and Fine Needle Aspiration Cytology (FNAC). After surgery, the Histopathological Examination (HPE) reports were compared with the FNAC findings. Results: SNG was more common in the age group of 21-40 years. 86% of SNG patients were females. The incidence of malignancy in SNG this study was 12% which commonly involved males. Among the malignancies, papillary carcinoma was the most common and Hashimoto’s thyroiditis was found to be associated with it. The presence of microcalcifications and paratracheal nodes in USG were more in favour of malignancy. The FNAC report correlated well with the HPE reports, the accuracy of FNAC being 90% in this study. Conclusion: SNG has a high risk of malignancy, especially in males and the most common type being papillary carcinoma. FNAC is the gold standard pre-operative investigation that is well correlated with post operative HPE results

Fine needle aspiration cytology role in head and neck lesions.

Introduction: Fine Needle Aspiration Cytology (FNAC) is a simple, quick and inexpensive method in the head and neck region. It also affords a practicable and means of rationally planning surgery and causes minimal trauma to the patient and carries no risk of complications. Aim and objectives: The aim of this study was to see the frequency of various pathological conditions detected on FNAC in patients presenting with head and neck swellings and to evaluate the role of FNAC in diagnosis of head and neck swelling. Material and methods: A retrospective study was conducted in Department of Pathology, SMIMER Medical College, Surat from July 2014 to June 2015which included 250 patients with head and neck swellings presenting to Outpatient clinics. Fine Needle Aspiration Diagnosis was correlated with detail of relevant clinical findings and investigation. Results: Maximum incidence was observed in the age group 31-40 years with higher incidence among males. Out of 250 cases, 160 cases of lymph node lesions were diagnosed of which non- specific lymphadenitis was the commonest diagnosis (47%) followed by Tuberculous lymphadentities (25%). 57 cases of thyroid lesions were diagnosed, in which incidence rate of benign thyroid lesions was (84%). 12 cases of salivary gland lesions were found, among which pleomorphic adenoma was common (67%). Conclusion: It was concluded that non-Specific lymphadenitis is the commonest condition in patients presenting with neck swellings. FNAC is a simple, safe and inexpensive tool for the assessment of patients with head and neck swellings. It could differentiate the infective process from neoplastic one and avoids unnecessary surgeries. Thus, FNAC can be recommended as a first line of investigation in the diagnosis of head and neck swellings.

Role of FNAC in diagnosis of gouty tophi-A case report.

Periarticular nodules may not be recognized as tophi because the clinical diagnosis of gout in many instances is not straightforward. In such a setting, fine needle aspiration cytology (FNAC) of gouty tophi would facilitate the clinical diagnosis and treatment. FNAC is valuable in confirming the nature of periarticular nodules especially in case of gouty tophi as compared to the histopathology. Thus FNAC is the gold standard for the diagnosis of gouty tophi presenting as periarticular nodules.

Spectrum of thyroid lesions on fine needle aspiration cytology.

The incidence of thyroid lesions is increasing significantly nowadays. Many a times, differentiation between physiological, inflammatory, autoimmune, hyperfunctioning and hypofunctioning of thyroid gland, benign and malignant tumor poses diagnostic difficulty. Fine needle aspiration cytology (FNAC) with clinical correlation, along with ultrasonography and thyroid function tests are done in relevant cases. Final diagnosis requires morphological examination of the lesions. FNAC is widely accepted and has become the cornerstone in evaluation of the thyroid lesions, as unnecessary surgery can be avoided. We studied a total of 251 cases in the age range of 3 years to 72 years, who presented with thyroid swelling over a period of one year and got a spectrum of thyroid lesions on cytology. Incidence was more in females 230 cases (91.63%) compared to males 21 cases (8.36%). Nodular goiter was the commonest disease constituting 127 cases (50.59%) followed by Hashimoto’s thyroiditis 93 cases (33.05%) and malignancy was reported in 7 cases (2.78%). USG guided FNAC for optimization of results is necessary for the location of target lesion. Careful searching for malignant cells and repeat FNAC are the key to a successful diagnosis and to plan a proper surgical procedure. Follow-up is necessary in case of a benign mass.

Fine needle aspiration cytology in head and neck swellings: a diagnostic and therapeutic procedure.

Background: Fine Needle Aspiration Cytology (FNAC) is a very simple, quick, inexpensive and minimally invasive technique used to diagnose different types of swellings like lymph node, thyroid, soft tissue and salivary glands in head and neck region. These swellings frequently encountered in general practice. It may be inflammatory, reactive, benign or malignant lesion. The objective was to assess the frequency and incidence of different sites, age, sex and distribution of reactive, benign and malignant lesion. Methods: A prospective study was conducted at Geetanjali Medical College & Hospital, from January 2014 to August 2014.Fine needle aspiration diagnosis was correlated with details of relevant clinical findings and investigations. Patients aged between 1 and 75 years were included in the study. A total of 200 patients were enrolled in the study with their name, age, sex, profession, address and contact. Results: Out of 200 fine needle aspiration procedures 42% were of lymph node, 18.5% were of thyroid, 15.5% from salivary gland, 8% from soft tissue, scalp and forehead swellings and 5.5% from lips and oral cavity lesion. Lymphnodes were the commonest organ involved in which reactive were 16% and 15% granulomatous lesion. There were 2.5% cases of non specific inflammatory lesion from lymph nodes. Conclusions: Our study found that FNAC is simple, quick, inexpensive and minimally invasive technique to diagnose different types of head and neck swellings. It could differentiate the infective and benign process from neoplastic one and avoids unnecessary surgeries and expenses.

Alveolar rhabdomyosarcoma in children with histomorphological review.

Rhabdomyosarcomas (RMS) are aggressive malignant neoplasm of mesenchymal origin, related to skeletal muscle lineage. These are the most common soft tissue tumors in children. The diagnosis is made by microscopic analysis and ancillary techniques like immunohistochemistry, electron microscopy, cytogenetics and molecular biology. We encountered a case of a 03 years old child who presented with a tender, reddish, soft swelling over cheek for three weeks. The FNAC was reported as a small round cell tumor, Probably Primitive Neuroectodermal Tumor (PNET). The biopsy of tumor revealed a small round cell tumor with an alveolar pattern. Tumor giant cells were absent and mitotic figures were infrequent. Hence, differentials of alveolar rhabdomyosarcoma and PNET were rendered. Immunohistochemistry (IHC) demonstrated desmin positivity. Thus, a final diagnosis of alveolar rhabdomyosarcoma was offered.

Efficacy of aspiration cytology in suspected metastatic neck lymph nodes.

Background: Fine needle aspiration of neck nodes is quick, safe and convenient method for the diagnosis of various lesions. The procedure is well tolerated by the patients, has minimal complications and repeatable. Because of its minimally invasive characteristic, this technique is now being used routinely for quick and accurate diagnosis. Enlarged lymph nodes are one of the most frequently sampled tissues. The diagnostic accuracy of FNAC in neck node malignancy is high. Aims & Objective: To study efficacy of aspiration cytology in suspected metastatic neck lymph nodes. Material and Methods: A prospective hospital based study was conducted among patients attending cytology lab in Department of Pathology, of a tertiary care centre in this region over a period of three years. All new patients having clinically suspected neck lymph nodes were included in the study. All previously treated patients and those with recurrence were excluded from the study. Cervical lymph nodes were aspirated, and smears were prepared & processed following standard techniques. Findings were correlated with previous studies. A total number of 225 cases were examined. Results: A total of 225 cases of lymph node aspirates were examined. Out of these, 190 cytologically diagnosed cases, as metastatic cervical lymph nodes were further evaluated. Most number of cases was seen in males, in the age group of 45-76 years. Higher number of patients had known primary sites, seen in oral cavity. Confirmatory cytological diagnosis could be made in maximum number of cases. Conclusion: Fine needle aspiration cytology is a safe, rapid and highly accurate method for diagnosis of superficially palpable lymph nodes. It is now considered as a routine OPD procedure, and most convenient method for confirmation of suspected metastatic nodes.

Role of FNAC in diagnosis of cervical lymphadenopathy.

Background: Fine Needle Aspiration Cytology (FNAC) is simple, quick, inexpensive and minimally invasive OPD technique used to diagnose different types of swellings located in the neck. Aims & Objective: (1) To assess the distribution of various cytomorphological patterns of cervical lymphadenopathy; (2) To assess the age specific distribution of various cytomorphological patterns of cervical lymphadenopathy. Materials and Methods: This study was carried out at GMERS Medical College and Hospital, Valsad, on 196 clinically diagnosed cases of cervical lymphadenopathy over a period of two years from January 2010 to December 2011.FNAC was carried out in all these patients. Fine Needle Aspiration Diagnosis was correlated with details of relevant clinical findings and investigation. Results: Total 196 cases were studied, out of these 173 (88.26%) were found inflammatory and 23 (11.73%) were neoplastic. Tuberculosis was the most common disease found in 109 (55.61%) patient followed by chronic nonspecific lymphadenitis 49 (25.00%), Metastatic tumours 21 (10.71%), acute lymphadenitis 15 (7.65%), Lymphoma 2 (1.02%). Highest incidence of cervical lymphadenopathy was found inpatients of 11 to 30 years age group. Conclusion: Fine Needle Aspiration Cytology is easy, simple, safe, reliable and non-invasive procedure for diagnosis of cervical lymphadenopathy and easy way for surgeon to decide whether to go for surgery or not.

Synovial Cyst with Fungal Granuloma.

Synovial cysts are frequently seen and are most commonly seen at the back of the knee where it is known as popliteal cyst. But synovial cyst with fungal granuloma is rather rare. This case report illustrates an occurrence of synovial cyst with fungal granuloma, in a 40 years old male at the dorsal aspect of the right ankle joint. Clinical examination revealed lesion about 4x4x4cms in size over the dorsal aspect of the right ankle joint. Simple excision of the lesion was done with the clinical diagnosis of lipoma. Microscopic examination revealed synovial lining hyperplasia and subintimal tissue showed granulomatous reaction with foreign body giant cells and black colored fungal colonies. Patients did not attend further, so follow up was not available.