Cytology of Hürthle cell neoplasms of thyroid gland.

Hürthle cell neoplasms (HCN) are an uncommon group of tumors of the thyroid gland. Fine needle aspiration cytology (FNAC) is an important diagnostic tool in solitary nodules of the thyroid gland. A 5-year retrospective analysis of all cases diagnosed as HCN on cytology was performed and correlated with the corresponding histopathology wherever available. There were 13 cases diagnosed as HCN out of which 6 cases had subsequent histopathologic examination. Four were adenomas and two were carcinomas. In addition, 3 cases that were adenomas on histopathology were reported on cytology as colloid goiter with cystic degeneration in 2 cases and as follicular adenoma in 1 case. There was extensive cystic degeneration in the former two cases whereas poor cellular preservation led to misdiagnosis in the third case. There were no specific cytomorphological features that distinguished adenoma from carcinoma. FNAC has a high specificity for a diagnosis of HCN, but the sensitivity is not as high because of sampling error.

Collagenous bodies in endometriotic cysts.

A 4-yr retrospective analysis of cases diagnosed as pelvic endometriotic cysts based on clinical, radiological, and cytomorphological features was collected and analysed. Out of 15 cases, only 3 cases showed the presence of endometrial glands/stroma in the aspiration smears. However, 12 of them showed the presence of oval/petal-shaped structures throughout the smear ranging in size from 40 to 70 micro in maximum dimension. These structures stained positive with periodic acid Schiff (PAS) stain. Immunostaining for type IV collagen showed strong positivity, indicating their origin from the basement membrane of the glands. The presence of these "collagenous bodies" in endometriotic cysts appears to be characteristic. However, this needs to be confirmed by prospective studies with a larger number of patients. The mechanism of formation of these collagenous bodies is uncertain.

Leiomyosarcoma of the urinary bladder: a diagnostic challenge in urine cytology.

Most of the available data in the literature describe the cytomorphological features of exfoliated malignant epithelial cells in urine. There are no established diagnostic features that characterize the morphology of exfoliated malignant mesenchymal tumor in urine. Here we highlight the problems in the diagnosis of these groups of tumors. The presence of discohesive atypical cells which lack features of an epithelial nature should make one suspicious of this group of tumors.

Indian file pattern of adenocarcinoma cells in effusions.

OBJECTIVE: To determine the prevalence of the Indian file pattern of adenocarcinoma cells in malignant serous effusions. STUDY DESIGN: Twenty-five malignant and 10 benign effusion samples were selected. Clinical data, including the sites of the primary neoplasms, were noted. The presence or absence of Indian file arrangement of carcinoma cells and other patterns were recorded. RESULTS: Seven of the 25 positive cases showed Indian file arrangement, whereas none of the negative cases did. Their number did not show any correlation with the type and site of the primary neoplasms. In most of the 7 cases other patterns, such as 3-dimensional balls and papillations, were also present. CONCLUSION: Cells in Indian file in serous effusions are strongly suggestive of metastatic carcinoma. They are not specific to any particular site of the primary adenocarcinoma.

Partial duplication of head--a rare congenital anomaly.

Duplication of notochord results in rare congenital anomalies like double headed monsters, with or without trunk/limb duplication, depending upon the extent of notochordal abnormality. Here we describe the morphological abnormalities in a case of partial duplication of cranial structures with fusion of the two. Autopsy findings suggest that the bifurcation of the neural tube took place around 4th to 6th week of gestation. There are only few reports in English literature describing the autopsy findings of such an anomaly, which is termed as Diprosopus triophthalmus in the modern literature.

Basal cell adenoma-an unusual presentation.

Basal cell adenoma is an uncommon epithelial neoplasm of the salivary gland most commonly arising in the parotid glands. We report a case of basal cell adenoma of the minor salivary gland presenting as a slowly progressing, large parapharyngeal mass. Histopathology revealed a well-encapsulated mass with characteristic histomorphology. Immunohistochemistry showed selective positivity for pancytokeratin, S-100, and smooth muscle actin in the tumor which highlighted the participation of myoepithelial cells in histogenesis. In addition, positivity was noted for carcinoembryonic antigen and vimentin. Ultrastructural analysis showed characteristic features including reduplicated basal laminae around the tumor cells, presence of intermediary filaments, and rough endoplasmic reticulum in the cytoplasm. There are no reports of basal cell adenoma presenting as a parapharyngeal mass lesion in the available English literature. This case highlights the rarity of this tumor with regard to its site of origin, possibly from a minor salivary gland.

Giant-cell-rich myxoma of right atrium. An ultrastructural analysis.

Myxoma is the commonest primary tumor of the heart, arising more frequently in the left than the right atrium. Here, we report a case of right atrial myxoma, arising close to the entry of the inferior vena cava, which is rich in multinucleated giant cells. No glandular elements were identified. Ultrastructural analysis of the giant cells was carried out, which revealed these giant cells to be of similar morphology as the mononuclear cells, suggesting their formation by fusion of individual tumor cells. Immunostain for Vimentin and Desmin showed positivity in the giant cells as well as cells with single nucleus, further confirming these observations.

Apoptosis in breast cancer.

OBJECTIVE: To evaluate apoptotic rates on fine needle aspiration (FNA) samples of infiltrating duct carcinoma of the breast and to determine whether cytologic grading improved with consideration of the apoptotic rate in comparison with histologic grading. STUDY DESIGN: We studied 35 women who underwent mastectomy following an FNA diagnosis of infiltrating ductal carcinoma. Concordance between cytologic and histologic grades was calculated. Next, cytologic grades were considered with the apoptotic rates and compared with the histologic grades. RESULTS: An overall concordance of 82.9% was noted between the cytologic and histologic grading systems, with maximum concordance in grade 1 and minimum in grade 3 breast cancers. A highly significant difference in the apoptotic rates, as calculated on cytology, existed between the three histologic grades, indicating a significant increase in apoptosis with rising histologic grade. Applying multiple regression analysis, a significant improvement of cytologic grade with consideration of the apoptotic rate was observed. CONCLUSION: Employing histologic grade as the yardstick, cytology was less sensitive for the purpose of grading breast ductal carcinoma. However, by considering the apoptotic rates, the sensitivity of cytologic grading significantly rose in relation to histologic grade. Larger studies are required to determine whether apoptosis can be incorporated into the existing cytologic grading systems to increase their sensitivity.

Aplastic anaemia following varicella infection with coexistent microfilaremia of Wuchereria bancrofti--a case report.

Filariasis is a common public health problem in various regions of Indian subcontinent. There are many reports describing detection of microfilaria in different organ systems. There are limited number of reports available describing the presence of microfilaria in bone marrow. Here we report a young patient who developed aplastic anaemia following varicella infection. Peripheral blood and bone marrow showed many microfilariae of Wuchereria bancrofti. There are no reports describing this unique combination in the available literature.

Cytological grading, apoptosis, and Bcl-2 protein expression in breast cancer.

A prospective study was conducted on 27 cases of infiltrating duct carcinoma of breast diagnosed by fine-needle aspirate cytology (FNAC), subjected to mastectomy following the FNA diagnosis. Cytological grading, Bcl-2 score, and quantification of apoptotic cell count were done on FNA material. Next, the carcinomas were graded on the corresponding histopathological sections. The overall concordance between cytological and histological gradings was 77.7%, with maximum concordance in Grade I tumors and minimum in Grade II. The mean apoptotic rates were 0.59 +/- 0.722, 2.11 +/- 0.707, and 2.95 +/- 0.854 in Grades I, II, and III, respectively. Similarly Bcl-2 scores were 1.36 +/- 0.82, 0.22 +/- 0.13, and 0.14 +/- 0.116, in Grades I, II, and III lesions, respectively. When the cytological grade was correlated with histological grade alone, and subsequently along with Bcl-2 scores and apoptotic rates, there was a significant improvement from 0.662-0.713 (P value, 0.001).