Coats' disease - disease of the eye rarely encountered by pathologists.

Coats' Disease is an idiopathic condition of the eye affecting young children although it can be seen in adults. Most patients present early in life with unilateral decreased vision, strabismus or leukocoria. The most important differential diagnosis is unilateral retinoblastoma. In this study we report a case of coat's disease in an young girl, and evaluate histopathological and clinical findings.

Adult filarial worm from the breast aspirate of a young man.

Microfilariae and adult filarial worm have been incidentally detected in fine needle aspirates of various lesions in clinically unsuspected cases. Here we report a male patient who presented with a tender breast nodule and single enlarged lymph node. Fine Needle Aspiration (FNA) yielded 1 ml of yellow coloured fluid and single thread like worm measuring 6 × 0.2 cm. A diagnosis of breast abscess with a worm morphologically consistent with filariasis was offered. A follow up visit after 2 months showed regression of the breast lesion and the lymph node. Filariasis of the breast is an uncommon condition and can cause a diagnostic dilemma at times. FNA cytology appears to be a more convenient and effective diagnostic tool in patients with mass lesions. Demonstration and identification of the parasite in smears helps in avoiding surgical excision and early institution of prompt therapy especially in young patients.

Fine needle aspiration cytology of male breast lesions - a retrospective study over a six year period.

BACKGROUND: Fine needle aspiration cytology (FNAC) has a well-established role in the management of palpable breast lumps. However breast masses in males are rarely aspirated and hence there is limited cytopathologic experience. The aim of our study was to determine the efficacy of FNAC in the diagnosis of male breast lesions and also we attempted to describe the cytomorphological features of some of these lesions. MATERIALS AND METHODS: Data on male breast FNAC done between 2008 to 2013 were retrieved from the records of the cytopathology laboratory. FNAC diagnosis were categorized as benign, malignant, suspicious for malignancy and inadequate or unsatisfactory. Cytohistologic correlation was done with data from histopathology records. Sensitivity, specificity and diagnostic accuracy were calculated using standard statistical methods. RESULTS: Forty out of 1098 patients undergoing breast FNAC were males. Histopathology was available in 8 (20%) out of 40 cases. There were no false positive or false negative diagnoses. FNAC had a sensitivity, specificity and diagnostic accuracy of 100% for male breast lesions. CONCLUSION: FNAC is a very accurate tool for the diagnosis of male breast lesions. It is highly sensitive and specific with good cytohistologic correlation. To reduce the high rate of surgical biopsies of benign male breast masses, we conclude that FNAC should be performed as a standard procedure in the clinical evaluation of male breast lesions.

Role of FNAC in the Preoperative Diagnosis of Salivary Gland Lesions.

BACKGROUND: The characteristic cytologic features of the common salivary gland lesions have been well-delineated in literature. However, there also exist cytologic pitfalls and overlapping features that make an accurate diagnosis difficult in few cases. The present study was designed to compare the cytologic findings of salivary gland lesions with the histologic diagnoses, in order to assess the sensitivity, specificity and diagnostic accuracy of FNAC, with an emphasis on discordant cases. MATERIALS AND METHODS: Patients with suspected salivary gland enlargements, who were referred for FNAC, were included in this study, which was done over a 3 year period in a medical college hospital. FNAC was performed by using the standard procedure. Smears were stained by using Papanicolaou's and MGG stains. Cytologic diagnosis was compared with histopathologic diagnosis wherever it was available. RESULTS: Eighty eight patients with salivary gland swellings were included in the study. The ages of the patients ranged from 15 to 82 years, with the M:F ratio being 1.6:1. Out of 88 cases, 68 had swellings in parotid gland, 19 had them in submandibular gland and one had them in hard palate. Pleomorphic adenoma was the commonest neoplasm which was seen in our study. Mucoepidermoid carcinoma (MEC) was the only malignant lesion seen in our study. One each of Warthin's tumour (WT) and MEC were overdiagnosed and underdiagnosed respectively, the reason being squamous metaplasia in WT and subtle nature of malignant cells in low-grade MEC. CONCLUSION: WT and MEC can pose problems in cytologicdiagnosis. Sampling errors and interpretational errors can lead todiscordant diagnoses.

Tuberculous salpingitis: a case report.

Tuberculosis (TB) of the genital tract commonly occurs secondary to a primary lesion. The mode of spread is via the lymphatics, the haematogenous route or less commonly by a peritoneal spread. The fallopian tubes are the first targets, followed by the pelvic organs. Isolated cases of TB which occur in a unilateral fallopian tube are rare, particularly with it as a primary site. The aim of this study was to report a rare case of TB of the left fallopian tube in a post menopausal lady with no positive history, clinical or laboratory finding to suggest it to be a secondary focus. As the pre-operative diagnosis was that of a right ovarian neoplasm, the patient underwent staging laparotomy. TB of the left fallopian tube was diagnosed, as there were numerous typical granulomata throughout the fallopian tube.

Sporadic Multifocal Malignant Peripheral Nerve Sheath Tumor-A Rare Presentation: Multifocal MPNST.

Malignant peripheral nerve sheath tumors(MPNST) are uncommon neoplasms with an incidence of 0.001% in general population. Multifocality is a rare manifestation of MPNST . A case of a 65 year old patient who presented with multiple swellings involving the neck, extremity and back without associated neurofibromatosis is reported for its rarity of presentation.. Diagnosis was made by FNAC and confirmed by peroperative findings and histopathology.

Male breast cancer-review of literature on a rare microscopic variant (oncocytic carcinoma).

Breast cancer is uncommon in males. Approximately 85 % of male mammary carcinomas are of the infiltrating duct type. One of the uncommon subtypes is oncocytic carcinoma (OC). Oncocytic tumors may occur in several different anatomical sites such as meninges, choroid plexus, soft tissue, and gastrointestinal tract; they tend to affect more frequently the endocrine and glandular epithelia such as salivary gland and renal tubules that have high metabolic activity. At present, OC is a morphological entity, and there is no practical reason for including OC into everyday reports, since any significant clinical features are found. However, more cases of OC of the breast have to be studied in view of the fact that oncocytic tumors of colon, thyroid, and meninges seem to be resistant to radiation therapy, a finding that might be taken into consideration when planning the treatment in breast carcinomas.

A Comparative Study on Fine Needle Aspiration Cytology versus Fine Needle Capillary Cytology in Thyroid Nodules.

OBJECTIVES: Fine needle aspiration cytology (FNAC/FNA) is the primary investigation for thyroid nodules. Fine needle capillary cytology (FNCC/FNC) is an alternative technique not commonly used, though it is easy to perform. Both the techniques have their own advantages and disadvantages. This study aims to compare these two cytological techniques for better specimen and cytological diagnosis. METHODS: This prospective study was conducted on 50 patients attending the FR Muller Medical College Hospital from May 2006 to April 2008. The patients with thyroid nodules (diagnosed by palpation) were subjected to both the cytological techniques; FNA and FNC. The specimen and results were compared and then correlated with the final histopathological findings wherever surgical specimens were available (38 cases). RESULTS: The mean age of the patients was 39.16 with a female predominance. The majority of cases were diagnosed to have nodular goiters. The FNC technique yielded 88% diagnostic superiority and adequate specimens compared to 94% by FNA. Sensitivity was 50% for FNC and 100% for FNA while specificity was 100% for both techniques; accuracy score was 97.4% for FNC and 100% for FNA in predicting malignancy. While sensitivity was 75% for FNC and 100% for FNA; specificity was 100% for both techniques, and accuracy score was 97.4% for FNC and 100% for FNA in the prediction of neoplasia. CONCLUSION: The results indicated that there was no significant difference between the two techniques; if done in tandem can give better and accurate cytological diagnosis. In highly cellular lesions, in which abundant material was obtained, FNC was more likely to be diagnostically superior, but FNA can diagnose most of the lesions. In less cellular lesions, FNA is more likely to be diagnostically superior to FNC.

Primary umbilical endometriosis - Diagnosis by fine needle aspiration.

Primary (spontaneous) umbilical endometriosis is very rare with an estimated incidence of 0.5-1% of all patients with endometrial ectopia. Endometriosis is a common gynecological condition, the pelvis being the most common site of the disease. Extrapelvic site is less common and even more difficult to diagnose due to the extreme variability in presentation. A 38-year-old woman presented with a blackish nodule over the umbilicus of 3 years duration. Fine needle aspiration cytology of the lesion showed cells in clusters and sheets with background of scant stromal fragment, hemosiderin laden macrophages and RBCs, leading to a suggestion of umbilical endometriosis. Histopathological examination of the excised lesion confirmed the same.

Fine needle aspiration cytology of benign fibrous histiocytoma of bone: a case report.

UNLABELLED: BACKGROUND; Benign fibrous histiocytoma (BFH) of bone is a very rare tumor, and almost all reported cases were diagnosed after surgical resection by histologic examination. We report a case in which cytologic features of BFH of bone were established preoperatively by fine needle aspiration (FNA). To the best of our knowledge, FNA findings of BFH of bone have not been previously reported. CASE: A 30-year-old man presented with pain in the right knee of 3 days' duration. Radiographs of the distal femur showed a lytic lesion. FNA biopsy followed by cytologic examination revealed highly cellular smears with spindle-shaped cells arranged in sheets, papillary fronds and storiform pattern. These cells had a moderate amount of cytoplasm and round to elongated nuclei with inconspicuous nucleoli. Multinucleate giant cells were occasionally seen. A cytologic diagnosis of Giant cell tumor of bone with a BFH component was rendered. Histology revealed a pure BFH of bone. CONCLUSION: The current case reveals the cytomorphologic features of BFH of bone. Cytology may permit the preoperative recognition of the lesion, allowing a more sound therapeutic approach.

Prevalence of transfusion transmitted infections in voluntary and replacement donors.

The aim of the study was to find out the prevalence of transfusion transmitted infections (TTI) in voluntary and replacement donors. A total of 9599 donors were analysed for the prevalence of TTI over a period of 2 years.Of these 61.2% were voluntary donors and 38.8% were replacement donors. Prevalence of TTI in total donors was 0.6%. Prevalence of hepatitis B was highest (0.34%) followed by syphilis (0.11%), HIV&HCV (0.06%) and malaria (0.01%). Prevalence was more in male replacement donors. Extensive donor selection and screening procedures will help in improving the blood safety.

Ameboma of the colon with amebic liver abscess mimicking metastatic colon cancer.

Amebic colitis is common in developing countries, with its variable and non-specific symptoms. Amebomas occur rarely, resulting from the formation of annular granulation tissue, usually in the cecum and in the ascending colon. This report describes the case of a 59-year-old male who presented with abdominal pain. Radiological examination depicted concentric thickening of the cecal wall with mass formation and a cystic lesion in the liver. The endoscopy performed showed a growth in the ascending colon. Biopsy revealed extensive necrosis and inflammatory cells. The patient was referred to this hospital for surgical treatment with a provisional diagnosis of carcinoma of the colon. Peroperatively, a cecal mass was identified. However, suspected secondaries were not seen on the surface of the liver. Histological examination of the right hemicolectomy specimen revealed cecal and ascending colon amebomas. Trophozoites of Entamoeba histolytica were better recognized after periodic acid-Schiff staining. Treatment with Metronidazole for 2 weeks followed by diloxanide furoate for an additional 2 weeks was administered. The liver lesion resolved completely after 8 weeks. Colonic ameboma accompanied by amebic liver abscess may be misdiagnosed as metastatic colon cancer. A high index of suspicion is essential for diagnosis when dealing with colonic masses and liver lesions, especially in the tropics.

Cytodiagnosis of actinomycetoma.

Mycetoma is a late clinical manifestation of a subcutaneous infection produced by bacteria (actinomycetoma) or fungi (eumycetoma). The distinction between eumycetoma and actinomycetoma in Fine Needle Aspiration Cytology (FNAC) is as accurate as histopathology. A 55 year old man presented with a slow growing swelling on the plantar aspect of the right foot which was present for the last 10 years. A clinical diagnosis of soft tissue tumor was made and FNAC was advised. Smears revealed mixed inflammatory infiltrate and foreign body type of giant cells along with clumps of fibrillar organisms. Gram stain done later demonstrated gram positive thin branching filaments. A diagnosis of actinomycetoma was rendered. Histopathology of the excised specimen confirmed the cytologic diagnosis of actinomycetoma. Mycetoma can be accurately diagnosed by FNAC, which is a simple, inexpensive technique for rapid diagnosis.

Pure lipoma of the uterus: a rare case report.

Pure fatty tumors of the uterus are exceedingly rare. The more common lipomatous tumor is lipoleiomyoma with varying amounts of two components. Most are post-operative chance findings following hysterectomy for leiomyoma. Computed Tomography and Magnetic Resonance Imaging can assist in pre-operative diagnosis. A 60 year old post-menopausal woman presented with a mass per abdomen. Ultrasound revealed fibroid uterus with lipomatous areas. The hysterectomy specimen showed a pure intramural lipoma of the uterus. As clinical symptoms and signs of uterine lipoma are indistinguishable from uterine leiomyoma, various imaging techniques can aid in pre-operative diagnosis. The diagnosis of pure lipoma of the uterus should only be made when any smooth muscle if present is confined to the periphery of the tumor.