Significance of eosinophils in diagnosing Hashimoto's thyroiditis on fine-needle aspiration cytology.

Background: Hashimoto's thyroiditis (HT) is the most common cause of hypothyroidism in those areas of the world where iodine levels are sufficient. Fine-needle aspiration cytology (FNAC) can accurately diagnose this lesion in most of the patients. However, a small percentage of cases may be missed due to inherent limitations of this procedure. Therefore, cytologic clues to increase sensitivity of diagnosis need to be searched for. Aims: To assess whether an eosinophilic infiltration of the thyroid gland has a higher association with HT than colloid goiter. Materials and Methods: The study was a case-control study. Smears obtained by FNAC of 50 case, each of HT (which served as cases) and colloid goiter (which served as controls) were observed. The number of eosinophils and neutrophils per high-power field (HPF) was counted in all the smears. The eosinophil-neutrophil ratio in the smears, diagnosed as HT, was then compared with that of colloid goiter using unpaired t-test. Results: Smears diagnosed as HT was found to have a significantly higher eosinophil-neutrophil ratio than smears diagnosed as colloid goiter (P value 0.0001). Conclusion: Eosinophilic infiltration of the thyroid gland has higher association with Hashimoto thyroiditis.

Pseudoglandular pattern of basaloid cells in pilomatrixoma in the needle aspiration cytology: a case report.

A varied cytomorphology of pilomatrixoma often results in diagnostic dilemma. Here, we report a case of pilomatrixoma that presented with prominent gland like arrangement of basaloid cells on cytologic smears causing diagnostic problem. Clinical diagnosis in the present case was cervical lymphadenitis and the cytologic smears showed a strikingly varied morphology with few loose clusters of basaloid cells exhibiting pseudoglandular pattern. A possibility of metastatic carcinoma was considered. However, following histopathologic diagnosis of pilomatrixoma, when cytologic smears were reviewed, it was realized that the ghost cells were overlooked as anucleate squames. Our case highlights the importance of careful clinical and cytologic interpretation of pilomatrixoma. Awareness of the cytomorphologic characteristics of ghost cells and their identification in cytologic smears is highly criticalfor an accurate diagnosis. A prominent basaloid cell component of pilomatrixoma with a pseudoglandular pattern, which has not been described earlier, may easily lead to a false positive diagnosis.

Chronic myeloid leukemia presenting with avascular necrosis of femur head.

We report the case of a 15 years girl in whom avascular necrosis (AVN) of right femur head was the presenting feature of chronic stable phase of chronic myeloid leukemia (CML). To date, only three case of CML with AVN have been reported. So, in view of rarity of this condition, a similar case of CML presenting as AVN of femur head is being reported.