MSRSGC: A prospective study of heterogenous group atypia of undetermined significance

Context: Many standard books, literatures, and internet described the characteristic lineament of each salivary gland lesion. Nevertheless, there are dozens of disarray, confusion, and unmanageable morphological features regarding proper reporting. To fight with these issues, Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was introduced in 2018, but still the third category, Atypia of undetermined significance (AUS), poses difficulties for the pathologists and clinicians for a definite interpretation. Aim: The aim is to analyze the risk of neoplasia (RON) and risk of malignancy (ROM) of Milan's category III (AUS) by subdividing into six groups based on cytolomorphology. Settings and Design: The duration of study was from March 2018 to may 2021 with the focus on ROM and RON of all Milan's categories with especial attention on AUS. Methods and Material: Result of total 329 Fine Needle Aspiration Cytology of salivary glands was categorized according to MSRSGC. On the basis of cytomorphology, further subtyping of AUS and its cytohistopathology correlation was done. The ROM and RON of each subtype was analyzed. Statistical Analysis: All data were calculated by existing formulas. Results: Out of 329 aspirates, 24 (07.29%) cases belong to AUS with availability of histology in 13 (54.17%) cases. RON and ROM was 84.62% and 53.85%, respectively. Cases of lymphocytes with nuclear atypia (L-NA) was the most prevalent (29.17%). The RON were 60.00%, 68.57,% 84.62%, 94.87%, 87.50%, 100%, 100% and the ROM were 20.00%, 11.42%, 53.85%, 05.13%, 43.75%, 83.33% and 100% in each Milan's categories I, II, III, IVa, IVb, V, and VI, respectively. ROM was the highest in cystic fluid with nuclear atypia (C-NA) (100.0%), followed by basaloid cells (75%), L-NA (66.675), and SC (50%), but ROM was zero in NA and oncocytic cells. Conclusions: Subgrouping of AUS helps to dissipate the muddiness and provide more exact and reproducible diagnostic and prognostic tool.

Effectuation to Cognize malignancy risk and accuracy of fine needle aspiration cytology in salivary gland using “Milan System for Reporting Salivary Gland Cytopathology”: A 2 years retrospective study in academic institution

Background: To accost things in a particular disciple, egress related to Fine Needle Aspiration Cytology (FNAC) and to standardize reporting pattern, a framework “Milan System for Reporting Salivary Gland Cytopathology” (MSRSGC) has been sponsored. Aim: Aim of this study was to evaluate the potency of salivary gland FNAC reported under Milan guidelines, to calculate malignancy risk, and to compare the preoperative cytological diagnoses with the postoperative histopathological diagnoses. Settings and Design: This was a retrospective study over a period of 2 years (May 2016 to April 2018), which was classified according to Milan system and correlation with histopathology. Furthermore, the risk of malignancy was calculated for all the diagnostic categories. Materials and Methods: FNAC were analyzed on 105 patients with palpable salivary gland. Results were distributed into six categories. About 76 cases were surgically treated and resected tissues were submitted for histopathological examination. Statistical Analysis: The various diagnostic values of the procedure were calculated using the standard formula. Results: We reviewed 105 salivary gland FNA samples and recorded interpretations according to the proposed standardized six categories. Among them, category IV (neoplastic) had more cases (57.14%). The rates of malignancy in histology were as follows: (1) nondiagnostic, 0.0%; (2) nonneoplastic, 0.0%; (3) atypia of undermined significance, 50.00%; (4a) benign, 02.44%; (4b) uncertain malignant potential, 33.33%; (5) suspicious for malignancy, 100%; and (6) malignancy, 93.33%. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of Milan system came out to be 85.00%, 98.14%, 94.44%, 94.64%, and 94.59%, respectively. Conclusion: The six-tier diagnostic categories of the Milan system helps in triaging patients with salivary gland swelling and thus facilitate individualized management.

MR imaging of primary malignant bone tumors with surgical and histopathological correlation

Background: A bone tumor is a neoplastic growth of tissue in bone. Abnormal growths found in the bone can be either benign (noncancerous) or malignant (cancerous). Aims and objectives: The purpose of this study was to evaluate the role of MRI in cases of primary malignant bone tumors and MRI characteristics of different primary malignant bone tumors, to compare the imaging findings with surgical and gross pathological findings, Staging of tumor on MRI, correlating them with operative and histopathological findings. Materials and methods: This was a prospective study done in Department of Radiodiagnosis of NRIGH comprising of 40 patients 21 male and 19 female who were suspected or proven cases of the malignant bone tumor. Plain radiographs in AP and Lateral views (including the adjacent joint) were taken in all cases. The primary pulse sequences included T1 and T2 WI using spine echo and gradient echo techniques with TR of 600 msec. and TE 30msec. for T1WI and TR of 2740 msec. and TE of 85 msec. for T2 WI . The MR morphology was correlated with surgical and histopathological features. Results: The study “Multiplanar MR Imaging of primary malignant bone tumors with surgical and histopathological correlation” comprised of 40 patients in a two year period starting from august 2010 to September 2012 the age ranged from 8 years to 71 years (mean 40 years). There were 21 males and 19 females. Conclusion: MRI in combination with plain radiography is an excellent modality for evaluation of the musculoskeletal pathologies especially differentiating a malignant from a benign lesion. The multiplanar imaging capabilities place a major role in delineation of tumour extent in to the bone and Karuna V, R Vikash Babu. MR imaging of primary malignant bone tumors with surgical and histopathological correlation. IAIM, 2019; 6(10): 8-21. Page 9 soft tissues with high contrast and resolution with additional information of neurovascular bundle involvement, joint involvement and staging.

Magnetic Resonance Imaging in Focal Liver Lesions with Diffusion Weighted Imaging (DWI) and Pathological Correlation

Background: Magnetic resonance signal intensity of focal liver lesions is affected by numerous pathologic factors. Lesion histologic features, such as cellularity, vascularity, stromal component, and intratumoral necrosis or hemorrhage, strongly affect T1 and T2 relaxation times. Aim and objectives: To assess the lesion characterization potential of MRI by evaluating unenhanced and dynamic gadolinium enhanced sequences, Histopathological correlation of the lesions to explain the major MRI findings and Assessment of the lesions by diffusion weighted imaging and investigating the role of b value in differentiating malignant and benign lesions Materials and methods: The study was done on 42 patients where contrast was given in 38 members. Focal liver lesions were analyzed based on clinical findings, laboratory investigations and MR imaging. Sonographically detected focal lesions were included in the study. Tissue diagnosis (FNAC/ Biopsy), surgery were done in feasible cases. In other cases, where surgery/ tissue diagnosis is not possible, follow up was done (range 3 months - 12 months, average 7.2 months). Results: MRI features of forty two patients with focal liver lesions were studied and morphological features and signal intensities of the masses were described. Contrast study was done in 39 cases. Of the 42 cases, 24 lesions were benign and 18 lesions were malignant. The mean age group ranged from 18 to 74 years with majority between 40 to 60 years. 61% of the lesions were located in right lobe of the liver. Contrast enhancement was done in 39 cases. Contrast enhancement was able to better delineate the cases. Specific pattern of contrast enhancement was typical of certain lesions as Karuna V, R Vikash Babu. Magnetic Resonance Imaging in Focal Liver Lesions with Diffusion Weighted Imaging (DWI) and Pathological Correlation. IAIM, 2019; 6(11): 81-93. Page 82 homogenous early arterial phase enhancement for hepatocellular carcinoma and ring enhancement in arterial phase for metastases. Delayed enhancement was specific for cholangiocarcinoma. Hemangiomas showed peripheral puddling and delayed central enhancement. Diffusion weighted imaging can be used as an additional tool in differentiating benign and malignant focal liver lesions. ADC value using a cut-off of 1.43 X 10 – 3 sec/ mm2 was a useful adjunct for determining benign cystic lesions and hemangiomas from malignant lesions. Conclusion: MRI was able to predict diagnosis in 38 of the 42 tumors. It could suggest the nature of all lesions in benign cysts, hemangiomas, focal nodular hyperplasia and metastases. But it was not possible to achieve a specific diagnosis in two early abscesses, one multifocal hepatocellular carcinoma and one case of regenerative nodules. This accounted for a detection rate of 90%. Thus MR imaging is a powerful tool for the evaluation of focal liver lesions. Pre contrast T1 weighted gradient echo images, T2 weighted images, in phase and out phase imaging, EPI – DWI and gadolinium enhanced T1 weighted images provide accurate characterization of the lesions.

Non specific jejunoileitis--a report of 8 cases.

Nonspecific jejuno-ileitis is a nonocclusive, necrotizing inflammation of the small intestine. We treated 8 patients of jejuno-ileitis in a short span of 8 months. Their mean age was 8.6 years. All had acute pain in abdomen and most had hematochezia. Radiology was helpful only in diagnosis of complications of the disease. Four patients responded to conservative management; the other 4 required surgery--laparotomy and lavage in 2, and multiple laparotomies with resections in 2. One patient died due to chronic malnutrition and metabolic complications. Bowel histology was suggestive of resolving vasculitis in one patient and chronic inflammation in another patient.

Lectin binding patterns in benign and malignant lesions of the breast.

The binding patterns of a panel of eight lectins were studied in twenty eight breast lesions, consisting of ten cases of fibroadenoma, three cases of cystosarcoma phyllodes, five cases of fibrocystic disease and ten cases of infiltrating duct carcinoma by light microscopy. The eight lectins viz. PNA, WGA, RCA, SBA, UEA I, LTA, LCA and Con A were tested on paraffin sections using the Avidin Biotin Peroxidase Complex technique. PNA, RCA and UEA I showed a consistent positivity in benign and malignant lesions. The binding was localised mainly along the apices of mammary ductal epithelial cells in the benign lesions. In contrast, the malignant cells showed a considerable variation in staining patterns like diffuse cytoplasmic, membranous, and vacuolar. No definite correlation was seen between the intensity of binding and the histological grade in infiltrating duct carcinoma except in the case of Con A which was seen to bind more intensely to poorly differentiated tumours. The diagnostic significance of these patterns have been discussed.