On-site toluidine blue staining and screening improves efficiency of fine-needle aspiration cytology reporting.

OBJECTIVE: We investigated the role of on-site toluidine blue staining and screening in fine-needle aspiration cytology (FNAC) reporting for patients with thyroid nodules, palpable breast lumps and palpable lymph nodes. STUDY DESIGN: A total of 200 consecutive patients with a palpable lymph node or a lump in the breast or thyroid referred to the outpatient department for FNAC were included in this study. We used toluidine blue to stain FNAC slides for the evaluation of smear adequacy. The toluidine blue-stained slides were compared with the same slides after being decolorised and Papanacolaou (PAP)-stained. RESULTS: Out of 200 cases, 28 (14%) were deemed unsatisfactory on the first attempt as assessed by rapid staining. These included 16 (38%) of 42 thyroid cases, 10 (10.4%) of 96 breast lump cases and 2 (3.2%) of 62 lymph node cases. A repeat FNAC in the same sitting on these 28 patients showed adequate material in 24 (12%) of them. Therefore, for 98%, a decision could be made at the very first visit to plan further management. CONCLUSIONS: We concluded that toluidine blue offers excellent cytological details for the preliminary identification of the lesion and to decide on the adequacy of the material for definitive diagnosis on FNAC slides.

Sputum cytology in suspected cases of carcinoma of lung (Sputum cytology a poor man's bronchoscopy!).

AIMS: To evaluate the role of sputum cytology in the diagnostic work-up of patients with suspected lung cancer SETTINGS AND DESIGN: Spontaneously produced fresh sputum was analyzed in clinically suspected cases of lung cancer. MATERIALS AND METHODS: Spontaneously produced fresh sputum was analyzed in 36 clinically suspected cases of lung cancer. It was carried out using the "fresh pick and smear" method, which employs examination of sputum for blood-tinged, discolored or solid particles and preparation of thin and even smears from these selected portions. STATISTICAL ANALYSIS USED: Average and means. RESULTS: Sensitivity of sputum cytology was 60%, which increased with an increase in the number of samples examined. CONCLUSIONS: Sputum cytology in suspected cases of carcinoma of lung is a useful diagnostic tool. It may be called as a poor man's bronchoscopy.

Sclerosing lobular hyperplasia--cytological similarity to fibroadenoma.

Mammary sclerosing lobular hyperplasia (SLH) is a rare, benign, fibroproliferative tumour-like lesion of adolescent and young women often of African-American heritage. Fine-needle aspiration cytology of mammary SLH shows characteristic features that include an absence of stromal fragments. We report a 45-year-old woman who presented with a gradually enlarging, painless, mobile 4-cm tumour in her left breast. Fine-needle aspiration cytology performed preoperatively was characterized by some fibroadenoma-like features including the presence of stromal fragments and bare nuclei. However branched tubular fragments, typical of fibroadenoma, were not seen. A diagnosis of benign epithelial lesion of the breast was offered, and the possibility of a fibroadenoma was suggested. Excision biopsy histology revealed SLH. The key cytological features of mammary SLH are bland ductal epithelial cell clusters, few scattered fragments of stroma, relatively clean background with a fair number of bare nuclei. However these are not diagnostic as they overlap with those of fibroadenoma and distinction between the two benign entities is of no clinical significance. The definitive diagnosis of SLH requires histopathological evaluation.

Laparoscopic management of large ovarian cysts at a rural hospital.

OBJECTIVE: To assess the feasibility and outcome of laparoscopic surgery for the management of large ovarian cysts at a rural hospital. MATERIALS AND METHODS: Fifteen patients from March 2004 to February 2007, with large ovarian cysts, with diameter >10 cm, were managed laparoscopically. The masses were cystic and were not associated with ascites or enlarged lymph nodes on ultrasound. Serum CA-125 levels were within the normal range (35 U/ml). Preoperative evaluation included history, clinical examination, sonographic images and serum markers. The management of these ovarian cysts included aspiration, cystectomy or salphingo-oophorectomy, depending on the patient's age, obstetric history and desire of future fertility. In large, solid, fixed or irregular adnexal masses, suspicious of malignancy, laparotomy was done. RESULTS: Five patients presented with pain in the abdomen and 10 patients with abdominal distension and discomfort. The average maximum diameter of the ovarian cysts was 16.75 cm (range 10-24 cm). The mean duration of the operation was 80 min. The postoperative hospital stay was from 4 to 6 days. No intraoperative complications occurred and the hospital course of all patients was uncomplicated. In one case, laparoscopy was converted to laparotomy. One patient had minor wound infection at umbilical port site. The patients did not report any complaints during follow up and the clinical examination findings were normal in all, up to 9 months after discharge. CONCLUSION: With proper patient selection, the size of an ovarian cyst is not necessarily a contraindication for laparoscopic surgery.