Diagnostic efficacy of fine needle aspiration cytology in soft tissue tumors and cytohistological correlation

Background: Soft tissues are the supportive tissue of various organ as well as the nonepithelial, extraskeletal structure. Fine needle aspiration cytology (FNAC) is a rapid diagnostic technique with limited patient morbidity for diagnosing soft tissue tumours. However, FNAC of soft tissue lesion has not been widely used because of concern about its diagnostic accuracy. The difficulties arise in exact typing and diagnosis of low-grade sarcomas. This study was undertaken to study the acceptability and diagnostic efficacy of cytodiagnosis as compared conventional histological diagnosis and determine distribution of soft tissue tumours according to age and sex. Methods: The study was conducted in the department of pathology, RNT Medical College, Udaipur for period of 1 year. FNAC was done in 77 cases of suspected soft tissue tumors. In 51 cases biopsy resorted and HPE carried out. On the correlation of FNAC diagnosis with histopathological diagnosis the sensitivity, specificity, accuracy and positive predictive were calculated. Results: Maximum number of cases noted were in 40 to 60 years of age with wide range of 11 months to 81 years. Male to female ratio was 1.8:1. Out of total 51 cases 38 found benign and rest were found malignant. Lipomas were the commonest soft tissue tumors. Overall sensitivity obtained in the study using cytology as compared to histopathology was 100%, specificity was 67%, positive predictive value was 54%, negative predictive value was 100%. Conclusions: Cytology though with pitfall, can serve as a diagnostic tool especially when a rapid diagnosis is required.

A CLINICOPATHOLOGICAL STUDY OF PATIENTS WITH CERVICAL LYMPHADENOPATHY BY FNAC AND ITS HISTOPATHOLOGICAL CORRELATION

Background- Cervical lymphadenopathy is one of the most frequent clinical presentation of patients attending out patient department and also the most common manifestations of underlying pathology of the head and neck region, with numerous differential diagnoses such as neoplasms and infections Fine needle aspiration cytology (FNAC) is considered as a safe, easy, quick and also the first line diagnostic technique for evaluation of cervical lymphadenopathy. The study comprised of 150 Materials and methodpatients clinically presenting with cervical lymph node swelling coming for FNAC to the department of pathology. Out of 150 patients, 25 patients underwent surgery and histopathological correlation was done for these patients. Results: Among the 150 cases majority of the patients were males 70 % with M:F ratio 2.33:1.Age of the patients ranged from 1 to 90 years with a mean age of 40.44 years.Most of the lymph node lesions were seen in the age group of 21-30 years(20.67%). Level IIb lymph node was most commonly affected(36%).In FNAC 63.70 % cases were benign and 36.29 % cases were malignant.Among the benign lesions Reactive lymphoid hyperplasia was most common(25.9%) and in the malignant lesions metastatic carcinoma was most common(19.25%). In HPE 82.5% were benign and 17.5% were malignant.There was a strong correlation among the FNAC and HPE findings where reactive lymphoid hyperplasia was found to be most common benign lesion. Conclusion: Fine Needle Aspiration Cytology is a rapid, safe, efficient, cost-effective and the first line investigation for diagnosis of cervical lymph node lesions. Histopathological examination however remains the gold standard for definitive diagnosis of in certain malignant lymph node lesion.

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.

Eccrine porocarcinoma from the abdominal wall in an elderly female: a case report

Eccrine porocarcinoma (EPC) is a rare malignancy arising from the sweat gland. It is commonly seen in elderly female patients. There is no characteristic appearance for this malignancy and so making a clinical diagnosis is difficult. The diagnosis is confirmed by histopathological examination (HPE). Authors present a case of a 53-year-old female who presented with an ulceroproliferative lesion on the left side of the abdominal wall. After the lesion was radiologically ascertained to be localized and having a diagnosis of porocarcinoma from wedge biopsy, a wide local excision was done.  The HPE confirmed the diagnosis of EPC.

Gliomatosis peritonei arising in setting of immature teratoma of ovary: a case report

A 14 years old girl presented to the gynecology OPD with pain abdomen and huge abdominal lump since 2 months. On clinical examination, a large mass of 20x15 cm size was found extended upto the xiphoid process. Serum studies showed rise of CA-125 up to 406.9U/mL and LDH up to 310U/L. USG shows right ovarian cyst of 14.8x14.1x12.8 cm with internal calcification. MRI revealed a well encapsulated mass of 21x19x17cm with solid and cystic mass and upward peritoneal extension. Exploratory laparotomy was performed with right sided salpingo- ophorectomy with infracolic omentectomy, as the omentum appeared granular. She had an uneventful post-operative recovery. Subsequently HPE showed immature teratoma NORRIS grade 3 with co-existent peritoneal gliomatosis (grade 0). She is under regular follow-up and decided to give six cycles of combination chemotherapy with BEP at regional cancer hospital.

Hysteroscopy: a boon in abnormal uterine bleeding

Background: Aim of the study was to analyze retrospectively the efficacy of hysteroscopy in the diagnosis of abnormal uterine bleeding (AUB).Methods: Eighty-six women in the reproductive and perimenopausal age group (20-50 years) visiting the gynaecology OPD from March 2018 to February 2019 with the complaints of abnormal uterine bleeding were enrolled in the study. All the patients who underwent hysteroscopic examination were subjected to endometrial curettage; which was sent for histopathological examination (HPE). The hysteroscopic findings were then corelated and compared with HPE.Results: Mean age of the patients was 37.2 years. Around 60.46% patients presented within six months of complaints. Clinically, 54.65% were diagnosed as menorrhagia, 37.2% as polymenorrhoea and 8.13% as intermenstrual bleeding. On hysteroscopy, 44.1% showed abnormal pathology. The positive findings including polyps (8.13%), calcification (3.48%), submucous myoma (12.79%), necrotic mass and forgotten IUCD (2.32%) and adhesions in one case. On the other hand, the findings of histopathology; 56 patients (65.11%) had normal / proliferative / atrophic endometrium, 17 (19.76%) had hyperplasia, 10 (11.62%) had polyps and 3 (3.48%) had calcified endometrium. There was no significant difference between two modalities for normal / proliferative / atrophic endometrium. The HPE diagnosed slightly higher patients of hyperplasia as compared to hysteroscopy. Hysteroscopy diagnosed a higher number of patients with submucous myoma and necrotic mass.Conclusions: Hysteroscopy provided additional visual information for some pathologies which otherwise would remain undiagnosed by HPE.

Role of Rigid Thoracoscopy in Undiagnosed Pleural Effusion: A Prospective Study

Background: Medical thoracoscopy is a minimally invasive, safe, and cost-effective procedure that allows complete visualizationof pleural space, enabling diagnostic and therapeutic procedures such as pleural biopsy and talc insufflations. Conservativeestimates suggest that 25% of patients seen in general pulmonologist’s practice involve pleura, of these 25% are unable to beattributed to a specific diagnosis, even after thoracentesis and closed pleural biopsy.Aim: The aim of this study was to evaluate the diagnostic yield of rigid thoracoscopy in undiagnosed pleural effusion.Methods: This prospective observational descriptive study was conducted in Thanjavur Medical College Hospital, Tamil Nadu,in the Department of Thoracic Medicine between July 2017 and December 2018. Rigid thoracoscopy equipment was used forinvestigation. 12 undiagnosed pleural effusion patients after thoracentesis who fulfilled inclusion and exclusion criteria wereincluded in the study.Results: Of the 12 patients, six were male and six were female; seven had right-sided pleural effusion and five had left sidedpleural effusion. Investigation reports were inconclusive except for suggesting an exudative effusion. Cytological examinationsof pleural fluid were inconclusive in all the patients. After thoracoscopy, tuberculosis was diagnosed in five cases, metastasesin three cases, mesothelioma in two cases, and inflammatory pathology in two cases.Conclusion: Thoracoscopy is a safe procedure with high diagnostic yield in undiagnosed exudative pleural effusion (EPE).Asimple, minimally invasive low-cost investigation reduces the need for more invasive and much more expensive thoracotomy.Our study proved that rigid thoracoscopy remains the investigation of choice in all undiagnosed EPE for accurate diagnosisand management.

A Case of Hydrophilic Polymer Embolism after TEVAR / 日本心臓血管外科学会雑誌

Hydrophilic polymer embolism (HPE) associated with endovascular therapy has steadily gained attention. We report a case of a 70-year-old man who had undergone one-debranched TEVAR. He had a history of distal arch replacement for dissecting aortic aneurysm 14 years earlier. Pseudoaneurysm at the proximal site of graft anastomosis was found on computed tomography (CT) angiogram during the follow-up. 1 debranching TEVAR was performed using the pull-through technique. Fourth days after the procedure, a skin rash appeared in the right lower extremity around the access site. Skin biopsy with pathological examination revealed HPE. We decided to observe a patient because there was no symptom of limb ischemia. Skin lesions improved and he was discharged on the 27th postoperative day. Hydrophilic polymers are widely used in the endovascular devices and there is an urgent need to better understand the complication of HPE.

Ultrasonography (USG) and multi-detector computerized tomography (MDCT) evaluation of thyroid swellings

Background: Thyroid ultrasound has undergone a dramatic transformation from the cryptic deflections on an oscilloscope produced in A-mode scanning, to barely recognizable B-mode images, followed by initial low resolution gray scale, and now modern high resolution images. Aim: The aim of the present study was to evaluate the diagnostic role of ultrasonography (USG) and multi-detector computed tomography (MDCT) in thyroid swellings, compare the ultrasonographic findings with multi-detector computed tomographic findings and to correlate the radiological findings with histopathological examination (HPE). Materials and methods: The present study was carried out in the Department of Radiology, Kamineni Institute of Medical Sciences, Narketpally. In this study, 50 patients with thyroid gland swellings diagnosed clinically, referred to Radiology Department were selected during the period from October 2008 to September 2010. Histopathological examination was acquired in 35 cases. The study was carried out to observe the sensitivity, specificity and diagnostic accuracy of USG and MDCT in thyroid gland swellings. Results: Maximum number of patients belonged to the age group of 21-40 years that was 27 cases (54.00%) and maximum number of patients were females – 41 cases (82.00%). Most common diagnosis was multi-nodular goitre on USG-16 cases (32.00%) and MDCT- 14 cases (28.00%), solitary thyroid nodule is common in the right lobe of thyroid by USG -5 cases (62.50%) and MDCT5 cases (62.50%). Most common malignancy was papillary carcinoma of thyroid -5 cases (62.50%) and most common inflammatory disorder was hashimoto’s thyroiditis -5 cases (10.00%). Naveen Kumar S, Vidyadhara Rani P. Ultrasonography (USG) and multi-detector computerized tomography (MDCT) evaluation of thyroid swellings. IAIM, 2017; 4(9): 145-155. Page 146 Conclusion: The present study has concluded that USG is the fast and cost-effective modality of imaging investigation of choice in thyroid diseases and for differential diagnosis of thyroid nodules. MDCT is superior to ultrasound in evaluating retrosternal extension, relations and infiltrations in large lesions. It is also very helpful in evaluating extra-capsular, mediastinal, vascular invasion, lymph nodal involvement and metastasis. MDCT is very crucial in preoperative planning in malignancies of thyroid and large benign lesions.

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]

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

“Giant breast lipoma” an unusual presentation: a rare case report.

Lipomas are most common benign tumour derived from adipose tissue. Lipoma breast is somewhat difficult to diagnose clinically because of fatty consistency of breast. So preoperative diagnostic work up like FNAC, USG, mammography are important to confirm the diagnosis. Lipoma breast measuring more than 10cm in diameter or weighining more than 1kg is called giant lipoma of breast are tumour infrequently observed. Because of rarity, size & location we presented a case report of giant breast lipoma including USG, mammographic FNAC and intraoperative finding with review of literature.

Scar Endometriosis in a Caesarean Section Scar-A Case Report

Endometriosis is presence of functioning endometrial tissue outside the uterine cavity. It can be primary or secondary. It is one of the most frequently misdiagnosed condition. It can pose a diagnostic dilemma and should be included in the differential diagnosis of lumps in abdomen in females. Diagnosis is made by cytological and histological examination. This report evaluates the incidence, path physiology, course, diagnosis, treatment and prevention of this condition. This is a case report of abdominal wall endometriosis following caesarean section.

Benefits and limitations of FNAC in thyroid diseases: our institutional experience.

Background: To assess sensitivity and specificity of FNAC as a preoperative diagnostic tool for thyroid pathology. Methods: Relevant clinical data (demographic- age, sex, place, occupation) including history was obtained from the patient. A detailed clinical examination was performed. All these patients were subjected to various investigations which include thyroid function test and FNAC. Then the patients were subjected to routine line of management and followed up. The main component of this study FNAC was performed as per prescribed standard technique; these findings were then correlated with histopathological diagnosis. Results: Out of 150 patients, Eighty eight percent of the patients (132 cases) in our study were females and the rest 12% of the patients were males (18 cases). 72.73% of the females had benign swellings and 27.27% had malignant tumours of thyroid gland whereas 61.11% of male patients in our study had benign swellings and 38.89 % had malignant tumours of thyroid gland. The sensitivity and specificity of FNAC were 84.48%and 78.26%respectively. The positive and negative predictive values were 90.74%and 66.67% respectively. Conclusion: FNAC is safe, simple with economical and cost effective procedure. It gives a reliable pre-operative cytological diagnosis based on which surgical procedures can be confidently executed. An attempt is made hereby to compare our results with worldwide documented literature. The primary purpose is to avoid the false negative cytological reports in thyroid carcinoma as negative report gives a clinician a false sense of security that is harmful in the interest of both the patient and surgeon.

Experimental evaluation of anticonvulsant effect of human placental extract in pentylenetetrazole induced convulsions in mice.

Background: Human placental extract (HPE) is used in different clinical conditions. Human placental extract (HPE), a folklore medicine, prepared from fresh, healthy human placenta has been in use, as single dose therapy in the treatment of epilepsy in some parts of India. Hence, present study was carried out to explore anticonvulsant property of Human placental extract (HPE) in Pentylenetetrazole (PTZ) induced convulsions in albino mice. Methods: Effects of human placental extract (HPE) (1.0, 1.2 and 1.4 ml / 100 gm body weight) as test drug, sodium valproate (150 mg / kg body weight) as standard and distilled water as control were studied in pentylenetetrazole (PTZ) induced convulsions in albino mouse model. Failure to observe even a single episode of tonic spasm for 5 sec. duration for 1 hour was taken as index of anticonvulsant activity. Onset, duration, complete recovery from convulsion and percent protection was calculated and statistical analysis was carried out using student ‘t’ test. Results: Pretreatment with human placental extract (HPE) administered in the dose of 1.0 ml / 100 gm body weight provided 33.33% and in the doses of 1.2 and 1.4 ml / 100 gm body weight and sodium valproate provided 100% protection from convulsions induced by Pentylenetetrazole in albino mice. Conclusion: Human placental extract (HPE) has shown promising anticonvulsant effect on Pentylenetetrazole induced mouse model.

The Effect of Human Placental Extract on Rheumatoid Arthritis in an Animal Model

OBJECTIVE: To assess the efficacy of human placental extract (HPE) in an animal model of rheumatoid arthritis (RA). METHOD: We used (i) KRN C57BL/6 TCR transgenic x NOD mice (KBx/N) serum transfer arthritis and (ii) collagen-induced arthritis (CIA) mice to evaluate the effi cacy of HPE (1 ul or 100 ul, intra-peritoneal, three times per week) on RA. Incidence, severity of arthritis, and hind-paw thickness were quantifi ed. Joint destruction was analyzed using modifi ed mammographic imaging. Histopathological analysis for inflammation, cartilage, and osteoclasts was performed using Hematoxylin-eosin (H-E), safranin-O, and tartrate-resistant acidic phosphatase (TRAP). ELISAs were used for detection of various cytokines in serum and joint tissue. RESULTS: There were no significant differences in incidence of arthritis, clinical scores of arthritis, and hind-paw thickness between HPE-treated and vehicle-treated groups for up to 2 weeks in the KBx/N serum transfer arthritis model. Histopathological analysis also showed no differences 2 weeks after treatment. Levels of TNF-alpha, IL-1beta, IL-6, IL-10, and RANKL in serum and joint tissues were similar in all groups. Furthermore, there were no differences in clinical, radiological, and histological parameters between HPE-treated and vehicle-treated group for 3 weeks in the CIA model. CONCLUSION: Systemic treatment with HPE has no beneficial effects on arthritis in animal models of RA. Therefore, indiscreet use of HPE in RA should be forbidden.

The Effect of Human Placental Extract on Rheumatoid Arthritis in an Animal Model

OBJECTIVE: To assess the efficacy of human placental extract (HPE) in an animal model of rheumatoid arthritis (RA). METHOD: We used (i) KRN C57BL/6 TCR transgenic x NOD mice (KBx/N) serum transfer arthritis and (ii) collagen-induced arthritis (CIA) mice to evaluate the effi cacy of HPE (1 ul or 100 ul, intra-peritoneal, three times per week) on RA. Incidence, severity of arthritis, and hind-paw thickness were quantifi ed. Joint destruction was analyzed using modifi ed mammographic imaging. Histopathological analysis for inflammation, cartilage, and osteoclasts was performed using Hematoxylin-eosin (H-E), safranin-O, and tartrate-resistant acidic phosphatase (TRAP). ELISAs were used for detection of various cytokines in serum and joint tissue. RESULTS: There were no significant differences in incidence of arthritis, clinical scores of arthritis, and hind-paw thickness between HPE-treated and vehicle-treated groups for up to 2 weeks in the KBx/N serum transfer arthritis model. Histopathological analysis also showed no differences 2 weeks after treatment. Levels of TNF-alpha, IL-1beta, IL-6, IL-10, and RANKL in serum and joint tissues were similar in all groups. Furthermore, there were no differences in clinical, radiological, and histological parameters between HPE-treated and vehicle-treated group for 3 weeks in the CIA model. CONCLUSION: Systemic treatment with HPE has no beneficial effects on arthritis in animal models of RA. Therefore, indiscreet use of HPE in RA should be forbidden.

Anti-Influenza A Virus Effect of Hypericum perforatum L. Extract / 中国病毒学·英文版

To study the antiviral effect of Hypericum perforatum L. extract (HPE) on influenza A virus (IAV) (H1N1) in vitro and in vivo. Cytopathic effect (CPE) and neutral red (NR) dye uptake were used to examine the antiviral effect of HPE on Madin Darby Canine Kidney (MDCK) cells which were infected with IAV in vitro. HPE was effective against influenza A virus (IAV) in vitro, with a 50% effective concentration (EC50) of 40 μg/mL. The mean 50% cytotoxic concentration (CC50) in the MDCK used in these experiments was 1.5 mg/mL. Ribavirin was run in parallel with EC50 values of 5.0 μg/mL; the mean CC50 for ribavirin was 520 μg/mL. Oral gavage administrations of HPE or ribavirin to mice infected with the IAV were highly effective in preventing death, slowing the decline of arterial oxygen saturation, inhibiting lung consolidation and reducing lung virus titers. The minimum effective dose of HPE in these studies was 31.25 mg/kg/day, which was administered twice daily for 5 d beginning 4 h prior to virus exposure. Below a dosage of 2000 mg/kg/day, almost all treated mice survived, which suggests that HPE is of low toxicity. Ribavirin's minimum effective dose was 40 mg/kg/day with the LD50 determined to be 200 mg/kg/day. Delay of the initiation of either HPE or ribavirin therapy, using approximately 1/3 LD50 dose each time, could still be protective as late as 48 h after exposure to the IAV. While both agents appeared to have similar efficacy against IAV infections, HPE was considered to be less toxic and may warrant further evaluation as a possible therapy for influenza.