Cytological grading of duct cell carcinoma, NOS of breast and its correlation with histological grading.

Fine needle aspiration cytology is a widely practiced technique in the diagnosis of breast carcinoma and it is the only, diagnostic procedure performed before definitive treatment, at most institutions. While the histological grading of Duct Cell Carcinoma (DCC), NOS is done routinely in many centers worldwide the cytopathological grading of DCC, NOS is not commonly done. Grading of breast carcinoma, while the tumour is still in vivo, would be the most ideal and desirable situation, as it would be helpful in the selection of appropriate therapy for the patient. This study was undertaken with the aim to determine the grade of DCC, NOS by simple cytological scoring system as a method of predicting histological grade. We selected 80 cases of DCC, NOS which were initially diagnosed by Fine Needle Aspiration Cytology (FNAC) with subsequent histological confirmation. For cytological grading Papanicolou's stained smears and for histological grading Haematoxylin and Eosin stained sections were examined under light microscope. For histological grading Scraff Bloom Richardson's grading and for cytological grading Robinson's grading were followed. In both system grading were grade I, grade II and grade III of DCC, NOS. On cytological grading 39 (48.8%) cases were grade-I, 38 (47.5%) cases were grade-II and 3 (3.8%) cases were grade-III. On histological grading 33 (41.3%) cases were grade-I, 39 (48.8%) cases were grade-II and 8 (10%) cases were grade-III. In this study cytological grade correlated with histological grade in 69 (86.3%) cases. For grade-I tumour, sensitivity was 96.96%, efficiency was 94%. For grade-II tumour the sensitivity was 87.18% and efficiency was 77%. For grade-III tumour the sensitivity was 37.50% and efficiency was 23%. The overall accuracy was 96.3%. Significant association between histological and cytological grading of breast carcinoma, NOS was noted. Our observations in this study revealed that grading of duct cell carcinoma, NOS on FNAC material can be a useful in preoperative assessment of DCC, NOS prognosis and can be useful as an alternative to histological grading when neoadjuvant therapy is planned.

A study of histopathological pattern of neuromuscular disorders with clinico-pathologic correlation.

Neuromuscular disorders are frequently seen in our clinical practice, though no certain data are available in this regard. This prospective, observational study which was done as a partial fulfillment of M.Phil (Pathology) degree in BSMMU. The study was undertaken at the Department of Pathology of Bangabandhu Shiekh Mujib Medical University from August 1999 to December 2000 to study the histomorphological pattern of neuromuscular disorders in a selected group of patients attending the neuromedicine, paediatrics and medicine departments of BSMMU. Another purpose of this study was to evaluate the diagnostic utility of muscle biopsy and clinico-pathologic correlation in the diagnosis of neuromuscular disorders. In this study, 55 cases of clinically diagnosed neuromuscular disorders of different kinds were included. Detail clinical history was obtained in all the cases. Clinical diagnosis were made on the basis of history, physical examination, reports of routine and special laboratory tests whenever available. Muscle biopsy was performed in all the cases and histological changes could be identified in 42 cases. In the remaining thirteen undiagnosed cases; eight cases revealed 'essentially normal muscle tissue' and five cases were inadequate for histological evaluation. So, the later two categories were not included for further analysis. Among the histologically diagnosed 42 cases of neuromuscular disorders, basically two different classes of diseases were identified; 1) Dystrophic type of muscular diseases 64.28% and 2) Non dystrophic (acquired) type of neuromuscular diseases such as Inflammatory myopathy 21.82% and Neurogenic muscular atrophy 7.14%. Within the dystrophic group the maximum number of diseases were diagnosed as Duchenne muscular dystrophy 21.49%, Primary myopathy-unclassified 19.04%, Baker muscular dystrophy 4.76% and Limb girdle muscular dystrophy 4.76% etc. Properly executed muscle biopsy is usually the most useful and effective technique for diagnosis of neuromuscular diseases in cases where immunohistochemical, genetic and electron microscopic examination is not possible.