The B-cell non-Hodgkin’s lymphoma: An enigma to diagnose

Non-Hodgkin’s lymphoma is a heterogeneous group of malignancies characterized by an abnormal clonal proliferation of T-cells, B-cells, or both. Sometimes, tuberculosis and lymphoma presentation can share common symptoms and features. In this case report, we present the case of a 28-year-old female patient who came with a chief complaint of swelling on the right side of the face for the past 6 months. Initially, it was not associated with pain but gradually developed severe pain over the region and reduced salivary flow. The patient was planned for surgery with a differential diagnosis of salivary gland pathology. Post-operatively, the histopathological report showed atypical cells which were diffusely positive for cluster of differentiation (CD)20. Focally positive for CD45 and CD3 which was positive in reactive T lymphocytes. Immunohistochemistry pattern favors the diagnosis of B-cell type NHL. Through this case report, we want to share our experience in treating an aggressive tumor that mimics salivary gland pathology.

Risk of malignancy in thyroid nodules classified as Bethesda categories III, III - subcategories and IV: 2.5 years study

Introduction: Thyroid fine-needle aspiration cytology (FNAC) has gained significance as a quick, safe, and relatively simple method to differentiate malignant from benign thyroid nodules and is regarded as the gold-standard first-line diagnostic test in the evaluation of thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) established a standardized, category-based reporting system for thyroid FNAC with each category having an implied cancer risk. However, the optimal management of thyroid nodules in the Bethesda III and IV categories is controversial, given the variable malignancy rates. Aims/Objectives: (1) Analysis of the cytomorphological characteristics of patients with categories III and IV of “TBSRTC.” (2) Assessment of risk of malignancy of TBSRTC category III, IV, and substratification of TBSRTC category III. Materials and Methods: A retrospective and prospective study of cases categorized under TBSRTC as category III and IV at a tertiary-care center. Cytological along with their histological results were compared. Results: We identified an overall malignancy rate of 33% for nodules belonging to Bethesda category III and a malignancy rate between 19% and 33% for Bethesda category IV. Also, a significantly higher risk of malignancy in subcategories with nuclear and architectural atypia (66.6%) than only architectural atypia (28.7%). Conclusion: Although surgery is recommended in most of these cases, cytomorphology helps to predict the final histopathological findings with greater accuracy. Substratification of category III into subgroups may help reduce the heterogeneity of the atypia of undetermined significance/follicular lesion of undetermined significance category and more.

Diagnostic value of thyroid imaging report and data system combined with BRAF V600E mutation detection for thyroid fine needle puncture cytological uncertain nodules / 肿瘤研究与临床

Objective:To investigate the diagnostic value of thyroid imaging report and data system (TIRADS) combined with BRAF V600E mutation detection in differentiating uncertain thyroid nodules by using fine needle aspiration cytology (FNAC), and to analyze the role of TIRADS classification in screening the nodules needed to be routinely detected for BRAF V600E mutation.Methods:The clinicopathological data of 337 thyroid nodules patients diagnosed with TIRADS classification, FNAC Bethesda classification, BRAF V600E mutation detection and postoperative histopathology from the Second Hospital of Hebei Medical University between January 2018 and August 2021 were retrospectively analyzed. The role of TIRADS classification, FNAC Bethesda classification and BRAF V600E mutation detection alone and the combined detection in the differentiation of benign and malignant thyroid nodules was also analyzed.Results:The postoperative histopathological result was regarded as the gold standard. The sensitivity of TIRADS classification, FNAC Bethesda classification and BRAF V600E mutation for thyroid cancer diagnosis was 76.0%, 88.1% and 80.4% respectively, and the corresponding specificity was 84.0%, 96.0% and 100.0%, respectively. Histologically, 37 (62.7%) of 59 nodules with FNAC uncertainty were malignant nodules after the surgery. The sensitivity and accuracy of BRAF V600E mutation detection in the diagnosis of FNAC uncertain nodules were 51.4% and 69.5%, respectively, while the sensitivity and accuracy of BRAF V600E mutation detection combined with TIRADS classification were 86.5% and 84.7%, respectively. The sensitivity and accuracy of BRAF V600E mutation detection combined with TIRADS classification were both improved ( P values were 0.002 and 0.049, respectively). The positive rate of BRAF V600E mutation in thyroid nodules increased step by step with the rise of risk degree in TIRADS classification, and the type 3 cases were lower than those in type 4a cases [14.3% (1/7) vs. 68.6% (24/35), P = 0.012], and there were no statistically significant differences among the adjacent groups above 4a (all P > 0.05). Conclusions:TIRADS combined with BRAF V600E mutation detection can improve the sensitivity and accuracy in the diagnosis of FNAC uncertain thyroid nodules. The BRAF V600E mutation rate of TIRADS 4a and above nodules is high, so routine detection is recommended.

Histopathological Approach To The Diagnosis Of Benign Peripheral Nerve Sheath Tumors At Uncommon Location

PARIPEX - INDIAN JOURNAL F RESEARCH |O December - 202Volume - 11 | Issue - 12 | 2 | PRINT ISSN No. 2250 - 1991 | DOI : 10.36106/paripex ABSTRACT Peripheral nerve sheath tumors are relatively common lesions that exhibit a wide morphological and biological spectrum. In the presence of classical morphological and immunohistochemical features, the histological diagnosis is usually straightforward, but they may represent diagnostic challenges. Schwannoma is a slow growing encapsulated tumor of neuroectodermal derivation that originates from the Schwann cells of the neural sheath. Most commonly presents as cerebellopontine angle mass but extracranial sites are known and needs to be considered in the differential diagnosis. Intraparotid and penile schwannomas are extremely rare. Their diagnosis could be missed on cytology due to cystic changes. Isolated plexiform neurofibroma of the tongue is again a rare tumor. Plexiform pattern recognition is important for the pathologist as these varients might show malignant transformation. Overall Fine needle aspiration cytology though inconclusive at times, help a lot initially to delineate between benign Vs malignant lesions. Moreover its minimally invasive so can be performed easily at the uncommon locations. Histopathology remains the gold standard. Clinicopathological and imaging correlation is must for definite diagnosis and treatment.

AN ANALYSIS OF CYTOLOGICAL SPECTRUM OF SALIVARY GLAND LESIONS IN A TERTIARY CARE HOSPITAL IN SOUTH INDIA

Introduction: Salivary gland tumors are uncommon neoplasm of head and neck tumors. FNAC can provide cytological categorization of salivary gland lesions for guiding the surgeons to make treatment decisions. This study is intended to analyze the cytological spectrum of salivary gland lesions in Aims and Objectives: correlation with age, gender, and site of the lesion. A total of 222 cases are included in this study spanning a period Methods: from January 2015 to December 2018. The clinical data pertaining to patients' age, sex and anatomical site were recorded. Cytological smears were reviewed. The clinical features, imaging ?ndings, cytopathology and histopathology ?ndings were analyzed. In this three year study period, out of 222 cases, 129 cases were non-neoplastic and 93 cases were Results: neoplastic. Commonest gland involved was parotid gland followed by submandibular gland. Malignant lesions accounted for about 17.2% of the neoplastic lesions. In our study, majority of lesions are non-neoplastic. Among them Conclusion: sialadenitis was the most commonly encountered lesion. Among benign neoplasm, pleomorphic adenoma was the most common neoplasm with slight female preponderance. Among malignant tumors, mucoepidermoid carcinoma was the most common malignant tumor

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.

Role of Computed Tomography-guided Fine-needle Aspiration Cytology/Biopsy in Management of Lung Lesions: Experience of a Tertiary Care Oncology Hospital

Background: Fine-needle aspiration cytology (FNAC) and biopsy are routinely used methods for the diagnosis of lung lesions. In sampling of lung lesions, computed tomography (CT) is used to provide direction to the needle. The procedure is related with few complications. Methods: In this retrospective study, records of 247 patients who underwent CT-guided FNAC and/or biopsy at our tertiary care oncology-specific hospital during a calendar year (2015) were analyzed. The pretest coagulation profiles, predisposing emphysematous conditions on CT, and patient demographics were recorded. Lesion demographics included site, size, and depth. Postprocedure complications and diagnosis on cytology, histopathology, and immunohistochemistry (IHC) were tabulated. Results: Out of 247 patients, 160 (64.8%) were males. Most patients belonged to 51� years age group. Adenocarcinoma was the most common primary tumor of lung whereas carcinoma breast was the most common secondary diagnosed. Thirty (12.1%) patients developed complications after the procedure, with 29 of these having pneumothorax. Conclusions: Computed tomography-guided FNAC and/or biopsy is a safe and reliable tool to diagnose lung lesions.

STUDY OF FINE NEEDLE ASPIRATION CYTOLOGY IN PALPABLE BREAST LUMPS AT TERTIARY CARE HOSPITAL, SURYAPET, TELANGANA

Introduction: Breast carcinoma is the second most common malignancy in India preceded by cervical carcinoma. Palpable breast lumps either self detected or identi?ed by clinician are common, ef?cient evaluation and prompt diagnosis are necessary to rule out malignancy. Clinical examination, radiological evaluation and tissue sampling – Triple assessment needed for de?nitive diagnosis. FNAC has a good sensitivity, speci?city and accuracy in the diagnosis of both neoplastic and non-neoplastic breast lumps. The present study is aimed to analyse the incidence and various cytomorphological sprectrum of breast lesions done by FNAC. Materials & Methods: This is retrospective observational study conducted in Department of Pathology, Government Medical College/ Government General Hospital, Suryapet, Telangana from January 2020 to December 2021 (2years). Clinical history was taken and FNAC done. Smears are stained with H&E stain and assessed. Results: In our study, 87 female patients were analysed. Age group of patients ranged from 15years to 70years. There was slight preponderance in right breast lesions 45cases(51.7%). Most common lesion in our study was ?broadenoma which constituted 36 cases (41.3%), peak incidence in 21-30year age group. Second most common lesion was duct cell carcinoma accounting for 27cases(31%), peak incidence seen in 41-50years age group. Conclusion FNAC is a simple, safe, cost effective procedure which is a component of triple assessment. It helps to differentiate benign from malignant lesions in majority of cases when combined with clinical and radiological examination for de?nitive management.

Grayscale, subjective color Doppler, combined grayscale with subjective color Doppler in predicting thyroid carcinoma: a retrospective analysis / Escala de cinza, doppler colorido subjetivo, combinação de escala de cinza com doppler colorido subjetivo na previsão de carcinoma da tireoide: uma análise retrospectiva

Abstract Introduction: Fine needle aspiration cytology is preferred for thyroid nodules preoperatively, but has disadvantages of false-negative and false-positive results. Objective: To compare the diagnostic performance of grayscale ultrasound, subjective color Doppler ultrasound, and combined features of grayscale ultrasound and subjective color Doppler ultrasound in predicting thyroid carcinoma, using results of the fine needle aspiration cytology as the reference standard. Methods: Data from gray-scale ultrasound images, subjective color Doppler ultrasound images, and the fine needle aspiration cytology of 325 nodules of 250 patients (age ≥ 18 years) were collected and analyzed. Hypo-echogenicity than adjacent strap muscle, micro-lobulated or irregular margins, micro- or mixed calcifications, and taller-than-wide shapes were considered as a suspicious malignant nodule in grayscale ultrasound. Marked vascularity was considered as a suspicious malignant nodule in color Doppler ultrasound. The Bethesda system for classification of thyroid nodules was used for cytopathology. Results: With respect to the results of fine-needle aspiration cytology for detecting suspicious malignant nodules, for grayscale ultrasound, subjective color Doppler ultrasound, and combined gray-scale with subjective color Doppler ultrasound, sensitivities were 0.564, 0.600 and 0.691, respectively and accuracies were 0.926, 0.919 and 0.959, respectively. Suspicious malignant nodules detectability for grayscale ultrasound, subjective color Doppler ultrasound, and combined gray-scale with subjective color Doppler ultrasound were 0.09-0.56 diagnostic confidence, 0.08-0.61 diagnostic confidence, and 0.063-0.7 diagnostic confidence, respectively. Conclusion: The combined gray-scale with subjective color Doppler ultrasound-guided fine-needle aspiration biopsies are recommended for the diagnosis of thyroid carcinoma. Level of Evidence: III.

Resumo Introdução: A citologia da punção aspirativa com agulha fina é preferida para nódulos tireoidianos no pré-operatório, mas apresenta desvantagens de resultados falso-negativos e falso-positivos. Objetivo: Comparar o desempenho diagnóstico da ultrassonografia em escala de cinza, do doppler colorido subjetivo e da combinação dos recursos da ultrassonografia em escala de cinza e do doppler colorido subjetivo na previsão do carcinoma da tireoide com os resultados da citologia da punção aspirativa com agulha fina como padrão de referência. Método: Dados de imagens de ultrassonografia em escala de cinza, imagens subjetivas da ultrassonografia com doppler colorido e citologia da punção aspirativa com agulha fina de 325 nódulos de 250 pacientes (idade ≥ 18 anos) foram coletados e analisados. A hipoecogenicidade da musculatura adjacente, as margens microlobuladas ou irregulares, as microcalcificações ou calcificações mistas e os formatos mais altos do que largos foram considerados como um nódulo maligno suspeito na ultrassonografia em escala de cinza. A vascularização acentuada foi considerada um nódulo maligno suspeito na ultrassonografia com doppler colorido. O sistema Bethesda para classificação de nódulos tireoidianos foi usado para a citopatologia. Resultados: Com relação aos resultados da citologia por punção aspirativa com agulha fina para detecção de nódulos malignos suspeitos, as sensibilidades foram de 0,564, 0,600 e 0,691 para a ultrassonografia em escala de cinza, ultrassonografia com doppler colorido subjetivo e escala de cinza combinada com ultrassonografia com doppler colorido subjetivo, respectivamente, e as acurácias foram 0,926, 0,919 e 0,959, respectivamente. A detectabilidade de nódulos suspeitos malignos para ultrassonografia em escala de cinza, ultrassonografia com doppler colorido subjetivo e escala de cinza combinada com ultrassonografia com doppler colorido subjetivo foram de 0,09-0,56, 0,08-0,61 e 0,063-0,7 de confiança diagnóstica, respectivamente. Conclusões: A ultrassonografia em escala de cinza combinada com o doppler colorido subjetivo e biópsias por punção aspirativa com agulha fina guiadas por ultrassonografia são recomendados para o diagnóstico de carcinoma da tireoide. Nível de evidência: III.

Diagnostic Pitfall in Fine Needle Aspiration Cytology of Pilomatrixoma with Unusual Clinical Presentation

@#Pilomatrixoma (PMX) is a benign skin adnexal tumour with matrical differentiation. It frequently presents as a painless and slow growing solitary skin nodule primarily at the head, face and neck regions. Although there is increasing understanding on the clinical presentations and morphological features of PMX, difficulties are still expected in establishing the clinical and cytological diagnosis. We report a young girl who presented with a painless post-auricular swelling for one year with sudden increased in size. Computed Tomography (CT) scan and fine needle aspiration cytology (FNAC) findings were suggestive of a malignancy. Diagnosis of PMX was established and confirmed by tissue histopathological examination. The purpose of this study is to demonstrate the diagnostic pitfall of PMX in FNAC specimens, especially in patients with unusual clinical presentations.

Focal myositis associated with Leishmania spp. infection in a dog - diagnostic approach / Miosite focal associada à infecção por Leishmania spp. em um cão - abordagem diagnóstica

ABSTRACT: Canine visceral leishmaniasis is a systemic, zoonotic disease widely spread in several countries. The disease is caused by Leishmania spp., and the dog is the main reservoir of this parasite. Clinical signs in the muscle skeletal system consist of muscle atrophy, weakness, lameness, abnormal locomotion, osteitis, polyarthritis, heat and swelling of the joints, enlarged local lymph nodes and pain. In this note, a case of canine myositis of the lumbar region associated with Leishmania spp. infection is reported. Clinical signs included weakness, fever, mild dehydration, enlarged mandibular, pre-scapular and popliteal lymph nodes and a large palpable soft mass in the lumbar region, semi-adhered and not painful. Serologic diagnosis resulted reagent by indirect immunofluorescence reaction method. Findings of ultrasonography of the lower back are described, revealing the misalignment of muscle fibers, interspersed with anechoic areas compatible with edema. Local fine needle aspiration cytology was crucial for a definitive diagnosis, revealing amastigote forms. In endemic areas of leishmaniasis, clinicians should consider this disease as a differential diagnosis in the presence of musculoskeletal injuries with no apparent cause.

RESUMO: A leishmaniose canina visceral é uma doença sistêmica, zoonótica e amplamente difundida causada por parasitas do gênero Leishmania spp., sendo o cão importante hospedeiro. Os sinais clínicos de leishmaniose no sistema músculo esquelético se constituem em atrofia muscular, fraqueza, claudicação, locomoção anormal, osteíte, poliartrite, hipertermia, dor e edema das articulações. A presente nota descreve um caso de miosite lombar em cão associada à infecção por Leishmania spp. Os sinais clínicos incluíram fraqueza, febre, desidratação leve, aumento dos linfonodos mandibulares, pré-escapulares e poplíteos e uma grande massa macia palpável na região lombar, semi-aderida e não dolorosa. O diagnóstico sorológico resultou em reagente pelo método da reação de imunofluorescência indireta totalmente diluída. Os achados da ultrassonografia da região lombar são descritos, revelando o desalinhamento das fibras musculares, intercaladas com áreas anecóicas, compatíveis com edema. A citologia local de aspiração por agulha fina foi crucial para o diagnóstico definitivo, revelando formas amastigotas. Nas áreas endêmicas da leishmaniose, deve-se considerar esta doença como diagnóstico diferencial na presença de lesões musculoesqueléticas sem causa aparente.

A comparative clinicopathological study between ultrasonography, mammography, fine needle aspiration cytology and core needle biopsy of breast lump

Background: Early presentation and prompt diagnosis is the essential key in treatment of different variety of neoplastic as well as non-neoplastic breast disease. In this study usefulness of high-resolution ultrasonography (HRUSG), mammography, fine needle aspiration cytology (FNAC) and core needle biopsy in correlation with histopathological pattern, was assessed.Methods: After matching the criteria, 212 cases, were taken for this prospective, single center, observational study.Results: Out of 212 cases, 163 (76.88%) were benign lesions, 49 (23.11%) were malignant and 1 (0.47%) were of inflammatory pathology. Benign to malignant breast disease ratio was 3.3:1. Out of 49 malignant cases, 45 (91.83%) were ductal cell carcinoma and 4 (8.16%) was apocrine carcinoma. Maximum numbers of cancer patients were found in the 51-60-year age groups. The sensitivity, specificity, positive predictive value and negative predictive value of mammography in detecting carcinoma breast were 87.76%, 64.71%, 87.76% and 64.71% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of HRUSG in detecting carcinoma breast were 85.71%, 90.18%, 72.41% and 95.45% respectively. Among benign lesions, 47 (28.83%) were diagnosed by mammography and 147 (90.18%) were diagnosed by HRUSG. When these modalities were combined, >95% of the lesions was diagnosed accurately.Conclusions: Ultra sound used liberally as an adjunct to mammography, increase the cancer detection rate. Core needle biopsy is found more accurate but FNAC have limited value in evaluation of benign breast lump. This study also proves that preoperative categorization of breast lesions is utmost important for management of the patient and this will help to avoid unnecessary surgical treatment.

Diagnostic utility of fine needle aspiration cytology in thyroid lesions

Background: Thyroid fine needle aspiration cytology (FNAC) is an important screening tool and thereby dictates clinical management. The exclusion of non-invasive follicular variant of papillary carcinoma (NIFVPTC) from thyroid malignancies and its reclassification as non-malignant entity i.e., non-invasive follicular thyroid neoplasm with papillary like nuclear features (NIFTP) has added a new dimension. Aim of this study was to study the role of fine needle aspiration cytology in screening thyroid lesions by correlation with histopathological examination and to calculate diagnostic accuracy of FNAC considering NIFTP as non-malignant and compare it with pre NIFTP era.Methods: It was an observational study done over a period of 2 years (2017-2018). It included the cases where FNAC was followed subsequently by histopathology. FNAC results were correlated with histopathological diagnosis established thereof.Results: A total of 107 patients were included in this study. Considering NIFTP as non-malignant, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 92.97%, 100%, 100%, 92.73% and 96.23% respectively, that is significantly higher if authors considered NIFTP as malignant.Conclusions: FNAC plays an indispensable role in making preliminary diagnosis in thyroid lesions. There is a notable increase in diagnostic accuracy of FNAC in thyroid lesions and significant decrease in risk of malignancy by considering NIFTP as non-malignant.

Clinical profile of carcinoma breast patients in working women population in a metro city

Background: In India, breast cancer is the second most common malignancy among women next to carcinoma of cervix. Since it present as a painless lump patient often neglect and present to hospital late. With increasing prominence and greater visibility in country specific health profiles around the world, breast cancer and its prevention detection and treatment will continue to emerge as a major priority and challenge for health system. As carcinoma of breast is a quite common clinical problem encountered in clinical practice, this study was an attempt to study clinical presentation modes of management of the disease.Methods: 50 patients who were admitted with a diagnosis of carcinoma breast were studied though history taking, clinical examination, relevant investigations depending on the stage of the disease. After completion, the results were analysed using Microsoft excel software and are compared with other studies.Results: Majority of patients belonging to age group 41-50 years (42%) with lump as major complaint at the time of presentation (78%). Disease in most patients was on upper outer quadrant (78%). Majority of patients belong to stage II (84%) of the disease clinically.Conclusions: The simple and effective methods of detecting the disease early like self-breast examination, clinical breast examination, ultrasonography, mammography, fine needle aspiration cytology should be made aware among the people for early detection and effective treatment of the disease.

A rare case of isolated tubercular epididymitis

Isolated tuberculous epididymitis (ITE), defined as tuberculous epididymitis without clinical signs of kidney. Here we present a middle-aged man who presented with swelling in the right scrotum since, 45 days. On clinical examination, mild tenderness was noted in the right scrotal region, a course of oral antibiotics was started but again patient presented with same complaints after 15 days. Fine needle aspiration cytology of testicular swelling was performed which was confirmatory of tuberculous epididymitis. The patient was advised anti-tuberculosis treatment, which he continued for a duration of 6 months. Following the anti-tubercular treatment, there was no evidence of recurrence.

Computed Tomography Guided Fine Needle Aspiration Cytology of Clinically Suspected Lung Neoplasm: An Institutional Experience in Kumaun Region of Uttarakhand

Intrduction: Lung carcinoma is the most common causeof cancer related mortality worldwide. Lung carcinoma ismalignant lung neoplasm characterized by uncontrolledcell proliferation in lung tissue. Primary lung cancers arederived from epithelial cells. This present study was designedand conducted with an aim to evaluate demographics,imaging characteristics, staging of lung cancer by MDCT,cytopathological spectrum of lung cancers in Kumaun regionof Uttarakhand and to assess the diagnostic accuracy of CTguided FNAC in evaluation of suspected lung masses.Material and methods: This institution based prospectivecross-sectional study was conducted at Government medicalCollege and Swami Ram Cancer Hospital, Haldwani from2018 to 2020 for two years. Computed tomography guidedFNAC was done in 102 patients. After proper history andthrough clinical examination, patients were subjected to CTguided aspiration using aseptic precautions. Air-dried smearswere stained with May–Grunwald–Giemsa stain (MGG).Alcohol fixed smears were stained using routine Papanicolaou(Pap) and Hematoxyline & Eosine (H & E) method.Results: The study consisted of 102 patients in age groupof 33-86 years. There were 81 males (79.41%) and 21females (20.58%) and adequate sample was obtained in 94patients giving adequacy rate of 92.15%. The most commoncytological presentation was squamous cell carcinoma in 49patients (52.12%) followed by adenocarcinoma in 23 patients(24.46%). Pneumothorax was seen in 8 patients (7.84%) ofpatients and no patient required chest tube insertion. In ourstudy computed tomography (CT) guided FNAC was foundsuccessful in making the diagnosis in 91 cases (89.21%).Conclusion: Computed tomography (CT) guided FNAC is areliable, safe, less expensive, less time consuming, minimallyinvasive procedure with a high diagnostic accuracy forevaluation of suspected lung neoplasm.

Frequency of early post operative complications of modified radical mastectomy within period of four weeks

Background: Most of the complications are developed after modified radical mastectomy in breast cancer patients, hence to avoid and reduces the postoperative complications, this study is performed to identify the frequency of early post-operative complications of modified Radical Mastectomy within the period of four weeks.Methods: Cross-sectional case series using non-probability convenient sampling technique was conducted in surgical unit I of Tertiary care hospital, for 1 year from 15 January 2018 to 14 January 2019. 89 patients FNAC proved breast cancer were included, patients that received neoadjuvant chemo or radiotherapy or with inflammatory breast cancer, metastasis and with co-morbid were excluded. After taking consent patients were operated by senior consultant. Follow up was taken daily 7th post-operative day and then followed in OPD on weekly basis fourth week and final outcome was noted. SPSS version 23 was used for data analysis. Quantitative data was reported as frequency in percentages.Results: Total 31 patients developed complications during the study, accounts 34% of total patients. The most common complication was breast seroma in 12(13.48%) of cases with an increased risk in cases of age >50 yr, size of tumor >8 cm, weight >70 kg and increased number of lymph nodes [3 or above] palpable after wards hematoma in 6(6.74%), lymphedema in 5(5.62%), wound infection 4(4.49%) and shoulder dysfunction in 4(4.49%) patients, no patient was found scar hypertrophy.Conclusions: Seroma formation, hematoma were found most common early complications after modified radical mastectomy, lymphedema, wound infection and shoulder dysfunction were observed in small number of patients.

A Correlative Study of Fine Needle Aspiration Cytology with Histopathology of Female Breast Lesions.

Breast lesions remain a major public health problem worldwide. Fine needle aspiration cytology (FNAC) has become one of the first-line investigations for the diagnosis of breast lumps. Although one of the major goals of FNAC is to differentiate benign from malignant lesions, in certain cases, this may not possible due to a lack of uniformity with regards to the reporting terminology used in breast cytology by pathologists worldwide, resulting in poor communication of results among health‑care providers. The present study aims to evaluate the role and diagnostic accuracy of FNAC in the evaluation of breast lesions using the National Cancer Institute (NCI) recommended terminology by correlating with histopathological examination (HPE) results.METHODSIn this retrospective study conducted over a period of two years, a total of 382 female patients with breast lesions underwent FNAC and was categorized according to the NCI guidelines. Of these, 156 cases had histopathological follow‑up and their FNAC diagnoses were compared. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) along with 95% confidence interval (95% CI) and accuracy of FNAC were calculated.RESULTSAmong the 156 cases, none were unsatisfactory (C1); 105 (67.1%) were benign (C2); 7 (4.4%) were atypical but probably benign (C3); 2 (1.1%) were suspicious favouring malignancy (C4); 43 (27.4%) were malignant (C5). Cyto-histopathological correlation was carried out. Of categories C2 and C3 (total of 112 cases), 109 were confirmed as benign (true negative) and the remaining 3 cases turned out to be malignant (false negative). Of categories C4 and C5 (total of 45 cases), all cases were confirmed as malignant (true positive) and none were benign (false positive). The present study showed a sensitivity, specificity, PPV, NPV and accuracy of 93.62% (95% CI, 82.46%–98.66%), 100% (95% CI, 96.67%–100%), 100% (95% CI, 92.5%–99.6%), 97.32% (95% CI, 92.4%–99.09%) and 98.08% respectively.CONCLUSIONSOur study concluded that FNAC is a rapid and effective method, and reporting of smears using NCI guidelines highly correlated with the histopathological diagnosis.

Ultrasonography guided fine needle aspiration cytology in patients with laryngo-hypopharyngeal lesions / Punção aspirativa por agulha fina guiada por ultrassonografia em pacientes com lesões laríngeo-hipofaríngeas

Abstract Introduction: Laryngeal lesions are usually evaluated by microlaryngoscopy/direct laryngoscopy under anaesthesia for disease mapping and tissue diagnosis. However patients with anticipated airway compromise due to laryngeal mass may require either a protective tracheotomy or emergency tracheotomy to secure the airway. To minimise risk of unplanned tracheotomy and expedite the diagnosis we performed ultrasound-guided transcutaneous fine needle aspiration cytology. Objective: To evaluate the feasibility and performance of ultrasound-guided transcutaneous fine needle aspiration cytology of suspicious/recurrent laryngo-hypopharyngeal masses. Methods: Fine needle aspiration cytology was performed under ultrasound guidance. Twenty- four patients were recruited, of which 17 had a pure laryngeal lesion; 6 patients had laryngo-pharyngeal, and one patient had a base tongue lesion with supra-glottis extension. Results: Out of 24 patients, 21 had positive cytology for squamous cell carcinoma, 2 patients had non-diagnostic cytology (atypical cells) and the other had inadequate tissue for definitive diagnosis. Patients with negative and inconclusive cytology underwent direct laryngoscopy biopsy, which was positive for squamous malignancy. All patients tolerated the procedure well and no adverse events were noted. Conclusion: Although direct laryngoscopy remains the standard of care in evaluation of laryngo-hypopharyngeal lesions, this pilot study has shown that ultrasound-guided transcutaneous fine needle aspiration cytology was feasible as an out-patient procedure, employing safe and sensitive technique enabling rapid diagnosis and avoiding the need for direct laryngoscopy under GA for tissue diagnosis.

Resumo Introdução: As lesões laríngeas são geralmente avaliadas por microlaringoscopia/laringoscopia direta sob anestesia para mapeamento da doença e diagnóstico tecidual. No entanto, em pacientes com comprometimento prévio das vias aéreas devido à lesão laríngea, pode ser necessária uma traqueostomia protetora ou traqueostomia de emergência para assegurar as vias aéreas. Para minimizar o risco de uma traqueostomia não planejada e facilitar o diagnóstico, realizamos punção aspirativa por agulha fina guiada por ultrassonografia transcutânea. Objetivo: Avaliar a viabilidade e o desempenho da punção aspirativa por agulha fina guiada por ultrassonografia transcutânea em lesões laríngeo-hipofaríngeas suspeitas/recorrentes. Método: A punção aspirativa por agulha fina foi realizada sob orientação ultrassonográfica. Foram recrutados 24 pacientes, 17 com lesão laríngea apenas, 6 com lesão laríngeo-faríngea e um com lesão na base da língua com extensão supraglótica. Resultados: Dos 24 pacientes, 21 apresentaram citologia positiva para carcinoma espinocelular, 2 citologia não diagnóstica (células atípicas) e o outro tecido inadequado para o diagnóstico definitivo. Os pacientes com citologia negativa e inconclusiva foram submetidos à biópsia através de laringoscopia direta, que foi positiva para lesão maligna espinocelular. Todos os pacientes toleraram bem o procedimento e nenhum evento adverso foi observado. Conclusão: Embora a laringoscopia direta continue a ser o padrão de cuidado na avaliação das lesões laríngeo-hipofaríngeas, este estudo piloto demonstrou que a punção aspirativa por agulha fina guiada por ultrassonografia transcutânea é uma técnica viável, ambulatorial, segura e sensível, permite rápido diagnóstico e evita a necessidade de laringoscopia direta sob anestesia geral para diagnóstico tecidual.

A Study of Clinical Profile and Management of Nodular Goiter

Introduction: Nodular goiters are enlargements of the thyroid gland. In the absence of thyroid dysfunction, autoimmune thyroid disease, thyroiditis, and thyroid malignancy, they constitute an entity described as non-toxic nodular goiter, which occur both endemically and sporadically. Aim: The aim of the study was to study the clinical presentation and management of patients with nodular goiter. Materials and Methods: In this prospective observational study, patients admitted with nodular goiter – solitary or multinodular were included in the study. The patients diagnosed as a case of solitary or multinodular will undergo detailed history taking, clinical examination, and investigations such as complete blood count, thyroid profile, fine-needle aspiration cytology, X-ray chest and neck, and ultrasonography of the neck. Histopathology of the excised specimens was studied to evaluate the incidence of malignancy. Results: A total of 18 patients were included, 68% of cases were in 21–40 years age group, all patients had swelling, 33% had pain, 22% had difficulty in swallowing, 16 patients were euthyroid, and 2 patients had hypothyroidism. The incidence of malignancy was found to be 8%, 42% of the patients had benign follicular adenomas. The incidence of inflammatory goiter was 11% and 3% of patients showed evidence of toxicity. Preoperatively, regional lymph node metastasis evaluated and hemithyroidectomy in adenoma thyroid and colloid nodules, subtotal and total thyroidectomy in multinodular goiters and total thyroidectomy in carcinoma thyroid were done. About 89% had an uneventful post-operative period. Conclusion: Nodular goiter of the thyroid was found to be more common in young and middle-aged patients. The majority of nodular goiter was found to be a benign lesion. The incidence of malignancy was found to be 8% overall, 12.5% nodules in female were malignant.