Correlation of ultrasonography and fine needle aspiration cytology in diagnosis of hepatic space occupying lesions at Bankura Sammilani Medical College and Hospital

Background: USG can differentiate various types of liver lesions based on their echo features and vascularity on CD then FNAC can be done only for those selected patients who needs further evaluation. Thus, patients with benign lesions based on USG and color Doppler, will be exempted from invasive, painful and time-consuming procedure of FNAC. Methods: It was an evaluation study of a diagnostic test and was cross sectional in design. Results: A total of 100 patients with focal hepatic lesions were included in our study group, with 47 cases diagnosed as abscesses, 2 cases were diagnosed as adenoma, 1 case was diagnosed as hepatic cyst, 1 case was diagnosed as cholangiocarcinoma, 22 cases were diagnosed as HCC and 21 cases were diagnosed as metastasis on FNAC. In diagnosis of abscess by USG, sensitivity was 87.23%, specificity was 93.33%, PPV was 93.18%, NPV was 87.5%, diagnostic accuracy was 90.21%. In diagnosis of HCC by USG, sensitivity was 63.64%, specificity was 84.28%, PPV was 56%, NPV was 88.05%, diagnostic accuracy was 79.34%. In diagnosis of metastasis by USG, sensitivity was 52.38%, specificity was 85.91%, PPV was 52.38, NPV was 85.91%, diagnostic accuracy was78.26%. Conclusions: Our study showed more than 75% diagnostic accuracy in diagnosing the commonest focal liver lesions like abscess, hepatocellular carcinoma and metastatic lesions, by USG as compared to FNAC diagnosis which was considered as confirmatory in our institution.

Robinson抯 cytological grading of breast carcinoma: it抯 prognostic implications and correlation with bloom Richardson抯 histological grading of breast cancer

Background: Cytological grading on aspirates of breast carcinoma is a useful tool for surgical maneuver and prognosis. The aim of the study is to find out the utility of grading in malignant breast tumors using Robinson抯 cytological grading on FNAC and correlating it with modified bloom-Richardson抯 histopathological grading of breast carcinoma along with lymph node status assessment post-operatively by histopathological examination. Methods: This prospective study was carried out in 40 cases of invasive duct carcinoma of breast for a period of one and half year duration from December-2019 to July-2021. This study was done in department of pathology, Surat municipal institute of medical education and research (SMIMER), Surat. In all these cases the cytological diagnosis was confirmed by histological examination. All cases were graded by using Robinson抯 grading system. All these cases were also correlate with bloom Richardson抯 grading system on histopathology in mastectomy specimen. Result: Robinson抯 cytological grading correlated well with bloom Richardson抯 histopathological grading. In this study of forty cases, thirty-three cases (82.5%) show concordance between cytologic and histologic grading system. Rest of the seven cases (17.5%) show discrepancy. Conclusions: Thus, In the most of the cases, cytological grading of breast carcinomas correlate with histopathological grading and may be useful as a prognostic marker. It was concluded that the cytological grading should be included in all FNAC reports. So that appropriate decision regarding the preoperative neoadjuvant chemotherapy can be made and overtreatment of low-grade cancers has been avoided.

Six senses while considering hydatid cyst as a differential for a swelling at nape of the neck: a case report

While cervical swellings usually are located in anterior midline like thyroglossal cyst, thyroid swellings, or in antero-lateral aspect of neck like cold abscess, branchial cyst, lymphangioma, cervical lymphadenopathy etc. Nape of the neck swelling is even less common with differentials including lipoma, sebaceous cyst, lymphangioma, etc. Hydatid cyst (HC) is often missed as a differential resulting in intraoperative surprises. This case report might change the mind of the readers to keep HC in back of their minds while approaching a case of swelling of the neck. Here we report a case of 15 years’ female who presented with swelling of nape of neck which on evaluation was inclining towards lipoma/epidermal cyst. With an intention for surgical exploration and excision, the patient was taken for operation, where we discovered it to be HC and the same was later confirmed by histopathology as well. Because of its rare presentation the primary diagnosis of HC is often missed out in spite of having sensitive cytology and imaging modalities. Hence, by reporting this case we intend to emphasize six facts a clinician, a radiologist and also a pathologist must consider while keeping primary HC at an unusual site as a differential diagnosis.

Uncharted territory: endometeriosis explored in the left canal of Nuck

In this captivating exploration, we unravel a perplexing case of endometriosis taking root within the enigmatic left canal of Nuck. A 33-year-old woman with a tenacious groin mass, manifesting occasional discomfort during menstruation, led us down a diagnostic rabbit hole. Through ultrasound and MRI revelations, a mass emerged, stretching through the left inguinal canal into the pubic domain. The subsequent cytological analysis solidified the diagnosis. While endometriosis, characterized by extrinsic endometrial tissue, typically confines its grip to the pelvic arena, this singular case defies convention. The canal of Nuck, a developmental vestige, reveals itself as a potential portal for endometrial cells under enigmatic conditions. Amid diagnostic intricacies, ultrasound and MRI step forth as guiding imaging tools. In a medical landscape rife with the known, this expedition into the uncharted expands our understanding and beckons us to probe further into the remarkable intricacies of Nuck's canal endometriosis.

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.

A 6-year retrospective study of fine needle aspiration cytology pattern of otorhinolaryngological cases of patients referred to national ear care centre Kaduna (2013-2018)

Background: This study was carried out to obtain the retrospective study of FNAC cases referred to NECC; and review occurrences of ortorhinolaryngological swellings and demographic studies of patients for a period of 6 years (2013-2018). Records of FNAC were obtained from the laboratory department’s unit’s register alongside the biodata of patients for demographic studies. Methods: FNAC samples were treated for diagnosis according to the unit’s standard operating procedure for cytology. A total of three hundred and fifty-three 353 cases were reported and tables were then plotted to present the study cases using simple descriptive statistics. Results: Highest age distribution was between thirty to thirty-nine (30-39) years with a total of ninety-five cases 95(26.9%) followed by the range of forty to forty-nine (40-49) years with a value of eighty 80(22.6%). Females had the highest frequency of one hundred and thirty-three 133 (62.3%) compared to their male patient counterpart with a value of two hundred and twenty 220 (37.6%). The site of sample collection had ANS with the highest value of eighty-one 81 (42.4%) compared to other sites. The year 2016 had the highest number of FNAC cases and finally ninety 6 cases 96 (27.2%) of cases were inflammatory, two hundred and thirty-two 232 (65.7%) were benign while twenty five 25 (7.1%) were malignant. Conclusions: In conclusion; FNAC plays a vital role in managing otorhinolaryngology conditions and gives a way forward for effective treatment to patients and often at times is therapeutic as some patients come with fluid field swelling that get relieved after the procedure.

A 6-year retrospective study of fine needle aspiration cytology pattern of otorhinolaryngological cases of patients referred to national ear care centre Kaduna (2013-2018)

Background: This study was carried out to obtain the retrospective study of FNAC cases referred to NECC; and review occurrences of ortorhinolaryngological swellings and demographic studies of patients for a period of 6 years (2013-2018). Records of FNAC were obtained from the laboratory department’s unit’s register alongside the biodata of patients for demographic studies. Methods: FNAC samples were treated for diagnosis according to the unit’s standard operating procedure for cytology. A total of three hundred and fifty-three 353 cases were reported and tables were then plotted to present the study cases using simple descriptive statistics. Results: Highest age distribution was between thirty to thirty-nine (30-39) years with a total of ninety-five cases 95(26.9%) followed by the range of forty to forty-nine (40-49) years with a value of eighty 80(22.6%). Females had the highest frequency of one hundred and thirty-three 133 (62.3%) compared to their male patient counterpart with a value of two hundred and twenty 220 (37.6%). The site of sample collection had ANS with the highest value of eighty-one 81 (42.4%) compared to other sites. The year 2016 had the highest number of FNAC cases and finally ninety 6 cases 96 (27.2%) of cases were inflammatory, two hundred and thirty-two 232 (65.7%) were benign while twenty five 25 (7.1%) were malignant. Conclusions: In conclusion; FNAC plays a vital role in managing otorhinolaryngology conditions and gives a way forward for effective treatment to patients and often at times is therapeutic as some patients come with fluid field swelling that get relieved after the procedure.

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.