Spectrum of vulvar lesions: patient’s anxiety, clinician’s concern and pathologist’s diagnostic challenge

Background: A wide variety of inflammatory, premalignant and malignant lesions can occur on the vulva. Some of the lesions are limited to the vulva, while some also involve other parts of the body. Although vulvar diseases can cause a significant issue in the patients, they are less commonly discussed than those of cervix, uterus and ovary. Most of the asymptomatic lesions remain un-noticed, and are seen during routine gynecological checkups. Common complaints in symptomatic lesions are lumps, discomfort, itching and pain. Since the symptoms are nonspecific; determining the location of the lesion can assist with the diagnosis. Being a genital part with skin covering on outer aspect and mucosal lining inside, it is associated with various dermatological, nutritional, and hormonal as well as sexually transmitted diseases. The present study thus was conducted to categorize vulvar lesions based on their histological diagnosis and also to study the morphological spectrum of precursor lesions for malignancy.Methods: Present study includes all types of vulvar lesions sent for pathological study in the Department of pathology, at GMC Nagpur over the period of one year.Results: Total 34 lesions were studied including a wide diagnostic range from inflammatory, dermatological to benign, premalignant and malignant. Inflammatory lesions including various infections and LSA (Lichen sclerosus atrophicus) were the most commonly seen lesions along with collection of neoplastic lesions.Conclusions: Proper diagnostic categorization of the lesions is essential for initiating therapy and reducing patient’s anxiety. Morphology of these lesions along with their diagnostic significance is discussed.

Computed Tomography Guided Fine Needle Aspiration Cytology of Lung and Mediastinal Lesions

Introduction: Computed tomography guided fine needleaspiration cytology is a safe and well established technique forthe diagnosis of lung and mediastinal lesions. This study wascarried out in the department of pathology in the tertiary healthcare and teaching institute where radiology department is wellestablished. The aim was to study the cytomorphology of thespectrum of the lung and mediastinal lesions and to correlatethe cytological diagnosis with the radiological diagnosis.Material and methods: Computed tomography guided fineneedle aspiration cytology was done in 90 pateints after takingwritten consent of the patient. Patients were explained thebenefits and risks of the procedure. The results were analysed.Results: A total of 90 patients were included in the study.There were 81 patients of lung lesions and nine patients ofmediastinal lesions. There were 63(70%) males and 27(30%)females. Adequate aspirate was obtained in 77 patientsgiving the adequacy rate of 85.55%. Adenocarcinomawas the most common type of lung malignancy and NonHodgkins Lymphoma was the most common malignancyin the mediastinum. Inflammatory lesions were seen in 13cases. Granulomatous lesions were found in six patients. Oneinteresting case of hydatid with aspergillosis was diagnosedon cytology smears, which on radiology was diagnosed asneoplastic. Pneumothorax was seen in three patients. Nopatient required chest tube insertion.Conclusion: Computed tomography guided fine needleaspiration cytology is a safe and reliable method for thediagnosis of lung and mediastinal lesions. It can help inearly diagnosis and initiation of the treatment avoiding majorsurgical procedures.

Microfilariae in fine needle aspirates: a report of 22 cases.

The objective of the study is to document the value of fine needle aspiration cytology (FNAC) in the diagnosis of filariasis at all possible sites in both exfoliative cytologic material and fine needle aspirates. Both unguided and guided FNACs of all foci were studied over a period of two years between 1999 to 2000. Total 22 cases of filariasis were detected which included subcutaneous swellings(7), breast(3), thyroid(3), lymphnodes(3), effusions(3), cervical scrape(1), eyeball(1), sputum(1) and bronchial washing(1). In none of these cases was filariasis considered a diagnostic possibility. Cytologic smears showed eosinophils in 9 cases, oval ova and embryonated eggs in 2 cases. Microfilariae were associated with other diseases in 13 cases, including 6 cases of malignancy. Significant adherence of inflammatory cells and macrophages to microfilariae was present in 6 of the 22 cases. In endemic areas,filariasis should be considered one of the differential diagnosis of a swelling. Thus demonstration and identification of the parasite in cytologic smears played a significant role in the prompt recognition of the disease and institution of specific treatment, thus obviating the more severe manifestations of lymphatic frilariasis.