Role of Fine Needle Aspiration Cytology in Male Breast Lesions.

Fine Needle Aspiration (FNA) is a well-established and widely accepted procedure in the evaluation of breast masses. Fine needle aspiration cytology can be performed as an OPD procedure. It is less traumatic to the patient as compared to surgical biopsy, is cost effective, and can provide rapid results on the same day. Therefore, it can be used as an initial diagnostic procedure for male breast lesions. The aim of our study was to determine the efficacy of Fine-Needle Aspiration Cytology (FNAC) in the diagnosis of male breast lesions and categorization of these lesions as per IAC Categories.METHODSThe present study included 50 cases of male breast lesions presented in the department of the pathology. Fine-Needle Aspiration Cytology (FNAC) was done and slides were stained with MGG and PAP. Findings were analysed by two pathologists independently. Cyto-histological correlation was done in cases wherever possible. Sensitivity and specificity were calculated.RESULTSA total of 50 cases of male breast lesions which had undergone FNAC was analysed in this study. Histopathological examination was available in 10 cases. Gynecomastia C2 (88%) was found to be the most common entity followed by acute on chronic suppurative pathology (4%). There was no false positive or false negative finding. FNAC had a sensitivity and specificity and diagnostic accuracy of 100% for male breast lesions.CONCLUSIONSFNAC is the excellent sensitive and specific diagnostic tool for the assessment of breast lesions in males. Hence, we strongly recommend the use of FNAC as the first-line investigation in the clinical evaluation of male breast lumps.

Sebaceous Cell Carcinoma- Two Rare Case Reports

Bonafide sebaceous carcinoma is extremely rare neoplasm. It may be seen as a component of Muir-Torre syndrome. It should be distinguished from basal cell carcinoma with sebaceous differentiation.

Pigmented Basal Cell Carcinoma of Eyelid: A Case Report

Pigmented basal cell carcinoma is a rare cutaneous variant of BCC with very few cases reported. Exposure to sunlight is the most important environmental risk factor.Pigmented basal cell carcinoma is a very rare variant of basal cell carcinoma that exhibits increased pigmentation.As it is rare, thereby we report here the case of Pigmented basal cell carcinoma on eyelid. Key

Comparative Study of Bone Marrow Aspiration and Bone Marrow Trephine Biopsy in Haematological and Non-Haematological Disorders

Background: This study was conducted in the Department of Pathology, GMC Patiala on 100 patients over period of three years with the objective to study the comparison of the bone marrow aspiration and bone marrow trephine biopsy in haematological and non-haematological disorders in elderly age patients.(Age >50years). Methods: 100 cases with different hematological and non-hematological problems were taken up for the present study with age >50 years. Salah”s bone marrow aspiration needle and Jamshidi’s bone marrow biopsy needle were used to collect the samples. For staining Leishmann’s and H&E stains were used. Results: Majority of the cases were in the age of 50-60. Majority of haematological disorders comprised of anaemia (62%), leukemia(17.7%), multiple myeloma (7.5%), primary myelofibrosis(2.5%), myeloproliferative disorders(2.5%), hypocellular marrow (2.5%), increased eoisinophils and precurcors(1.2%), NHL (1.2%) lymphocytosis(1.2%) and plasmacytosis (1.2%). Both of the 2 cases of non-haematological disorders were of metastatic carcinomatous deposists. Conclusion: The bone marrow aspiration and trephine biopsy were comparative in most of the haematological disorders except in primary and secondary myelofibrosis where biopsy provided clue to the diagnosis. Non-haematological disorders showed the same findings.

Bone Marrow Aspiration Findings in HIV Positive Patients and Correlation with CD4 Count

Background: Bone marrow abnormalities are common in HIV infected individuals and patients with AIDS. Most of the bone marrow abnormalities associated with HIV infection appear to be related directly to the infection or its complications and not to therapeutic intervention. Bone marrow study is an important investigation in HIV infected patients with peripheral hematological abnormalities. The primary objective was to study bone marrow aspiration findings in HIV positive patients and their correlation with CD4 count. Methods: The interventional, crossectional and prospective study was conducted in Department of Pathology, Government Medical College and Rajindra Hospital Patiala on 100 HIV positive patients, during a period of 2 years. Hematological investigations including complete hemogram, peripheral blood film and bone marrow aspiration was done. Absolute CD4 counts were done. Correlation of various bone marrow abnormalities was done with CD4 count. Results: Bone marrow revealed normocellular marrow in majority of cases, followed by hypocellular. Overall prevalence of myelodysplasia was 78%. Dyserythropoiesis was most common dysplastic change (62%) followed by dysmegakaryopoies (36%), dysgranulopoiesis (25%). Reactive plasmacytosis was seen in 44% cases in the range from 6-20%. Increased lymphocytes seen in 9% cases. There was seen significant correlation between myelodysplasia and CD4 count. Conclusion: Bone marrow abnormalities are common in HIV infected individuals and patients with AIDS.So HIV infection should be considered in the differential diagnosis of patients with secondary myelodysplasia or unexplained bone marrow changes.

Clinico-Pathological Correlation of Tubo-Ovarian Lesions

Background: The tubo-ovarian lesions manifest a wide spectrum of clinical, morphological, and histological features. Aims and objectives- To classify the lesions of tubes and ovaries and to correlate the various clinical and histopathological findings with age, chief complaints, and microscopic appearances of lesions. To correlate them radiologically and histopathologically. Methods: The present prospective study was based on the clinico-pathological correlation of various tubo-ovarian lesions in 75 cases over a period of 2 years. The histopathological reports were used to classify the tubo-ovarian lesions and correlate /substantiate the clinical and radiological findings. Results: Out of 75 cases, 51 (68%) ovarian, 18 (24%) tubal, and 6 (8%) cases showed simultaneous involvement of both tube and ovary. Amongst 18 tubal lesions,16 were of ectopic gestation (6 were ruptured) and the rest 2 of salpingitis. Amongst the ovarian lesions,41 cases were of ovarian neoplasms which were categorized as benign and malignant. Serous cystadenoma was the most common benign tumor and serous cystadenocarcinoma was the most malignant tumor. Conclusion: Clinical, radiological and histopathological diagnosis were compared and analysed statistically and the correlation was highly significant. An accurate clinical and radiological examination along with the histopathological examination aids in improving the diagnostic accuracy.

Clinical, Cytological and Histopathological Study of Salivary Gland Lesions

Background: A prospective study was conducted in the Department of Pathology, GMC Patiala for two years on 60 patients with swellings of jaw seeking consultation in Rajindra Hospital, Patiala. Methods: Fine Needle Aspiration Cytology (FNAC) was done on all these patients followed by microscopic examination of the prepared slides and relevant clinical information was collected. The data was compiled and analysed statistically. In lesions where surgery followed FNAC, the comparison was done with histopathology and statistical values were calculated. Results: The results of the study were: non-neoplastic cases were 51.7% and neoplastic cases were 48.3%. Maximum cases were of chronic sialadenitis (30%) followed by pleomorphic adenoma (23.3%). Parotid gland was involved in maximum cases (60%). Biopsies or specimens for histopathological examination were received for 30 cases; maximum cases of which were diagnosed as pleomorphic adenoma on histopathology. Among malignant tumors, mucoepidermoid carcinoma was the most common. Conclusion: On correlating the cytological and histopathological nature of salivary gland lesions, sensitivity of FNAC came out to be 75%, specificity 100% and accuracy was calculated as 93.3%.

Histopathological and Endoscopic Correlation of Gastric Lesions in Endoscopic Gastric Biopsies

ackground: There are a number of lesions that could affect the stomach varying from dyspepsia to highly lethal cancers; that can be chronic and incapacitating or merely an occasional discomfort or asymptomatic. Objective: The study was done to establish a correlation between endoscopic findings and histopathological characteristics of the various pathological gastric lesions. Methods: The study was a prospective study and done on 150 affected patients in 2 years. The endoscopic biopsy was taken from number of points of suspicious lesion for histopathologic diagnosis of the type of gastric lesions. The biopsies were fixed in formalin and adequately processed. The sections were stained with routine Haematoxylin and Eosin stain. Giemsa staining for H.pylori was also done. Results: In this study the most common clinical indications for endoscopic biopsy were pain epigastrium (82.0%) and dyspepsia (67.3%) with mean age of 54.25 and male predominance (1.9:1). The various gastric lesions were chronic gastritis (66.0%), adenocarcinoma (8.0%), no specific diagnosis (8.0%), dysplasia (4.7%), hyperplastic polyp (4.7%), acute on chronic gastritis (3.3%), eosinophilic gastritis (2.0%), acute gastritis (1.3%), intestinal metaplasia (1.3%) and chronic atrophic gastritis (0.7%). Conclusion: H. pylori is most commonly associated with acute on chronic gastritis.

Clinicopathological Study of 100 Cases of Hysterectomies In A Tertiary Care Centre

ackground: A retrospective study of 100 cases of hysterectomies was conducted in Dept. of Pathology, GovernmentMedical College, Patiala. Methods:Clinical and histopathological data were collected and correlation made. Maximum number of patients who underwent hysterectomy were in the age-group of 41-50 years. Results: The median age came out to be 47 yrs. Abnormal uterine bleeding was the most common complaint (82%). Main indication of hysterectomy was fibroid(63%) followed by prolapse (14%) and adenomyosis (12%). Histopathological correlations were made with the clinical findings. On histopathology, leiomyoma was the most common diagnosis followed by atrophic endometrium and adenomyosis. Conclusion: Correlation between clinical and histopathological diagnosis was very good. But still, histopathology remains the mainstay of establishing the confirmatory diagnosis and for histological subtyping of malignancies.

Histopathological Findings in Spleen on Autopsy—A Study of 100 Cases

Background: Autopsies are carried out to establish the identity, cause of death, time of death, and antemortem orpostmortem nature of death. These help in establishing the cause of death and ascertain the disease process which led to death. It provides the opportunity to discover new diseases, to evaluate toxic effects of drugs and therapies. The spleen is the site of direct and indirect toxicity, a target for some carcinogens, and also a site for metastatic neoplasia. Many systemic or generalized diseases have splenic involvement. Methods: The present study was conducted on 100 specimens of spleen on routine autopsies received in the department of pathology, Government Medical College, Patiala, Punjab to find out the frequency of various lesions in spleen on autopsy. All the histological sections were stained in H & E stain, mounted ,examined microscopically & findings were recorded and tabulated. Results: 80 of the 100 autopsies were males, while 20 were females. In 81 (81%) cases, the microscopic findings were congestion, hemorrhage in 8 cases(8%) ,7 cases (7%) had autolytic changes,1 case(1%) had necrosis, granulomatous pathology were seen in 2 cases (2%) and 1 case (1%) had leukemic infiltration. Conclusion: Despite recent advances in diagnostic technology, there is large number of cases of preventable diseases for which the autopsy has remained an important complementary tool for identifying.

A Study of Comprasion of Conventional Cytology with Liquid Based Cytology of Thyroid FNAC – A Study of 100 Cases

Background: Fine Needle Aspiration (FNA) cytology of the thyroid has been increasingly utilized for the investigation of thyroid lesions. FNA of the thyroid gland is considered to be most cost effective and accurate primary diagnostic procedure for thyroid nodules. In the recent years many approaches has been devised to improve the quality of thyroid FNA cytology because the conventional smear (CS) is subject to error in sample collection and slide preparation. The liquid based cytology (LBC) originally developed for the application of gynaecologic cervical smears, has progressively gained for application of both non gynaecologic and fine needle aspiration cytological material. According to the Wilcoxon signed ranked test for thyroid lesions LBC was not useful in goitre and infectious lesions. It gave better results in anaplastic and medullary carcinoma. So conventional smear is more sensitive, specific and accurate than LBC. Methods: in this prospective study, we had 100 cases of thyroid. In each case, two passes were performed. The first pass was for CS and the second pass yielded material for LBC. Both CS and LBC smears were compared for cellularity, background blood and necrotic cell debris, cell architecture, informative background, presence of a monolayer of cells and nuclear and cytoplasmic details and test on an for statistical analysis. Results: Diagnostic accuracy was better in CS compared withLBC smears as CS was most sensitive (93.18%) and accurate (91.75%) method for analysis of thyroid while LBC method is sensitive (89.04%) and accuracy (86.59%).Conclusion: Conventional smear is more sensitive, specific and accurate than LBC because LBC introduce more cytological artifacts to thyroid aspirates.

Aggressive Angiomyxoma of Vagina: A Rare Case Report

Aggressive angiomyxoma is a rare, locally invasive mesenchymal tumor predominantly presenting in women of reproductive age and also having a moderate-to-high risk for local relapse. Hence, it needs to be differentiated from other mesenchymal tumors occurring in this region. We present here a case of a 47 Year old female, with chief complaints of prolapsed uterus since 6 months. During clinical examination, posterior vaginal wall swelling was also identified. Total Abdominal Hysterectomy with Bilateral Salpingoophrectomy was done along with removal of posterior vaginal wall swelling. On histopathology, diagnosis of aggressive angiomyxoma was made. We report this case because of its rarity.

Infiltrating Intramuscular Lipoma: A Rare Case Report

ipomas are the common benign tumors of adipose tissue, but sometimes clinically and grossly they simulate malignancy. Lipomas can also occur in deep soft tissues. One of its rare subtype is Intramuscular lipoma which arise within the skeletal muscle fibers. Most common site is trunk, but can also occur in thigh and head and neck. 20 % recur due to incomplete excision. Histopathology is must for confirmation of the diagnosis. Prognosis of intramuscular lipoma is very good and marginal excision is the treatment of choice. We report a case of a 23 Year old female, who presented in surgery OPD with chief complaint of swelling at upper right side of back since 1 year. She got operated for the same 8 months back but presented with similar complaint at same site after 4 months. Excision of the swelling was done and sent for histopathology. On gross examination skin covered soft tissue piece, grayish brown in color was received. Histopathology revealed Infiltrating intramuscular lipoma. The case was reported because of its rarity.

Adenomatoid Tumor of Epididymis: A Rare Case Report

Adenomatoid tumors are rare benign neoplasms of the paratesticular region, most commonly occurring at the tail of the epididymis. We present a case of adenomatoid tumor in a 65 year old male, known case of prostatic adenocarcinoma, who presented in Urology OPD with painless swelling in testis. Bilateral orchidectomy was done with clinical suspicion of testicular carcinoma. On histopathology, diagnosis of adenomatoid tumor of epididymis was made. Due to its rarity, it is important for the physician and pathologist to be aware of this interesting entity in order to make a correct diagnosis.

Intramuscular Lipoma at Shoulder: A Rare Case Report.

Lipomas are the most common type of soft tissue tumors. Intramuscular lipoma is a rare type of deep-seated lipomas, which arise within the skeletal muscle fibres. It can arise in the background of history of trauma, obesity, chronic irritation, metabolic disorders, etc. Lipomas are usually benign, but sometimes clinically and grossly, they simulate malignancy. Intramuscular lipomas also need separation from muscular dystrophies. Histopathology is must to differentiate. Prognosis of intramuscular lipoma is very good and marginal excision is the treatment of choice. We report a case of 32 years old female, who presented with a painless swelling shoulder since six months. She had history of trauma eight years back. Grossly, the received mass was yellow-tan coloured, well circumscribed swelling of soft tissue along with muscle. Histopathologically, features are consistent with intramuscular lipoma. We report this case because of its rarity.

Squamous Cell carcinoma (Moderately Differentiated) of Conjunctiva – A Rare Case in a Five Year Retrospective Study.

Worldwide squamous cell carcinoma (SCC) of the conjunctiva is a rare malignancy; however, it is reported to be the most common malignant tumour of the ocular surface. Its incidence varies between 0.02 and 3.5/100.000. We report a case of squamous cell carcinoma of conjunctiva presented with triangular pedunculated mass of left eye of 75 years old female. It is diagnosed on FNAC and confirmed on histopathological examination after excision. On analyzing the data of FNA done (19150) and biopsies received (23158) in 5 years in the department of pathology, we found only five cases of eye region came for FNA while 25 biopsies of eye region received and diagnosed rightly. Out of all these cases, this is the only case of squamous cell carcinoma of conjunctiva in this study. Incidence of SCC of conjunctiva in our retrospective study of data of total pathological biopsies received found to be 4.3/100000.

Correlation between Clinical Features, Endoscopic Findings and Histopathological Characteristics in Various Esophageal Lesions-A study of 200 Cases.

Background: The present study analyzed the correlation between clinical features, endoscopic findings and histopathological findings in esophageal lesions. Methods: A sample size of 200 patients was taken in the study conducted in Department of Pathology. Data for patient’s age, gender, clinical features (dysphagia, pain epigastrium, regurgitation, loss of weight, loss of appetite), site of biopsy (upper, middle and lower one third of esophagus), endoscopic appearance (erythema, ulceration, nodular and stricture) were analysed. Results: Frequency of various esophageal lesions both benign and malignant (esophagitis, benign lesions, dysplasia, Barrett’s esophagus, SCC-WD, SCC-MD, adenocarcinoma) was calculated in the study group. Finally, correlations were established between age, gender, above mentioned clinical features, endoscopic findings and final histopathological diagnosis of various esophageal lesions. It was concluded that GERD was the most common esophageal lesion and SCC was the commonest malignancy in our region, being more common in men, in old age group (41-60 years). SCC involved the middle esophagus while GERD, BE and adenocarcinoma involved the lower esophagus more commonly. A statically significant correlation was found between dysphagia, loss of weight and esophageal carcinoma. Conclusion: It was concluded that gastro-esophageal Reflux disease was the most common esophageal lesion and Squamous Cell Carcinoma was histopathologically the commonest esophageal malignancy in our region, being more common in men in the old age group (41-60 yrs).