ABSTRACT
INTRODUCTION: The most common malignant tumour among women is breast carcinoma. Early lesions of the breast including carcinoma are potentially curable if treated properly in the era of breast conservative therapy. For this purpose different diagnostic strategies are in practice. Intra operative Imprint Cytology (IC) and Frozen Section (FS) have a role in spite of the intense recognition of aspiration cytology in the following settings: inconclusive cytological/core biopsy findings; for evaluation of lumpectomy margins and intra operative nodal status. Both IC and FS are dependable intra operative diagnostic consultation modalities and provide accurate results in minutes thereby making appropriate therapeutic decision. AIM: To study the IC and FS features of breast lesions with correlation of final Histopathologic (HP) diagnosis and to determine its diagnostic accuracy. MATERIALS AND METHODS: This was a descriptive cross-sectional study conducted in the Department of Pathology, JSS Medical College, JSS University, Mysuru over a period of two years (October 2011-September 2013). A total of 62 cases of surgically resected breast specimens were evaluated for features of IC, FS and correlation with HP diagnosis. After describing gross features, representative tissue fragment was taken, three imprint smears were made and same tissue fragment was subjected to FS and later for routine HP processing. Slides prepared by IC, FS were interpreted and later correlated with HP diagnosis. Statistical analysis was done with SPSS for windows (version 16.0) by applying appropriate tests. RESULTS: Out of 62 cases, 33(53.23%) were malignant and 29(46.77%) were benign. Sensitivity, specificity and accuracy of IC were 100%, 96.43% and 98.36% and for FS were 100%, 96.55% and 98.39% respectively. p-value for both were <0.001 indicating significant correlation with HP study. CONCLUSION: IC is a simple, accurate, rapid and cost effective diagnostic tool intra operatively where services for FS are not available. It preserves crisp cellular and nuclear detail. FS tissue architecture strongly approximates permanent HP sections but is frequently hampered by freezing artifact. But FS is able to differentiate carcinoma in situ and infiltrative lesions from benign breast lesions. Thus, IC and FS together offer a more reliable diagnosis; hence, it is always useful to prepare both the slides intra operatively. HP study still remains the gold standard in final diagnosis of any breast lesion. In surgical pathology, the correlation of intra operative IC and FS diagnosis with the final HP diagnosis form an essential part of quality assurance activity.
ABSTRACT
INTRODUCTION: The Surface Epithelial Ovarian Carcinoma (SEOC) at the moment of diagnosis, the disease is extended beyond the structures of the pelvis. Ki-67 is one of the prognostic marker which determines the growth fraction of a tumour and its over expression is associated with malignancy, tumour aggression, reserved prognosis and metastasis. AIM: To evaluate the proliferative activity using Ki-67 immuno-staining in SEOC and to correlate with histological subtype, grade, Federation of Gynecology and Obstetrics (FIGO) stage, CA125 levels for diagnostic and prognostic purpose. MATERIALS AND METHODS: The study was conducted in JSS Medical College and Hospital, JSS University, Mysuru. It was a descriptive cross-sectional study involving 40 cases of SEOC over a period of two years. The proliferation expression related to Ki-67 antigen was evaluated by immunohistochemical monoclonal MIB-1 antibody. In each case, the Ki-67 labeling index (Ki-67 LI) was articulated as percentage of positively stained cells using high power objective of the microscope (x400). RESULTS: Among the 40 carcinomas, 26 were serous, five mucinous, four each of clear cell and undifferentiated and one transitional cell carcinoma. A total of 75% were high grade tumours. High Ki-67 LI was associated with high grade tumours (69.9%), high grade serous tumours (65.34%) and advanced FIGO staging (70.6%) with the p-value of <0.001. CA 125 levels did not have a significant correlation with Ki-67 LI. CONCLUSION: Ki-67 is an exceptionally a cost effective marker to determine the growth fraction of a tumour cell population. In SEOC histological grade and FIGO stage when combined with Ki-67 LI in histopathology report would help in diagnostic differentiation of subtypes, prognostication, deciding the need for adjuvant chemotherapy and in predicting survival analysis.
ABSTRACT
INTRODUCTION: Skin is one of the frequent site of disease in human body. Fine Needle Aspiration Cytology (FNAC) is a safe diagnostic method in these cases. FNAC has some limitation, particularly related to representativity of samples, exact typing of skin adnexal tumours and classifying the nature of metastatic cutaneous nodules. Thus, FNAC alone may not give a confirmative diagnosis regarding few skin lesions. Hence, histopathological study has been the standard technique for the diagnosis of skin lesions. AIM: To study the FNAC findings in various papulonodular lesions and to correlate them with histopathological findings wherever possible. MATERIALS AND METHODS: In the present study, 50 cases of clinically diagnosed papulonodular lesions were evaluated by FNAC and correlated with histopathology wherever possible. RESULTS: There was 100% correlation in cases of epidermal cyst, leprosy, tuberculosis, actinomycosis, acute and chronic inflammatory lesions and 67% accuracy was seen in adnexal tumours. Aspiration cytology along with radiological studies proved very useful in classifying the nature of metastatic cutaneous nodules and suggesting the possible site of unknown primary. Sensitivity of FNAC for epidermal cyst and inflammatory lesions was 100%. In case of adnexal tumours, sensitivity and specificity was 67% and 50% respectively. CONCLUSION: FNAC is a rapid, efficient, cost effective, relatively painless procedure and produces a speedy result with high diagnostic accuracy. It has high rates of sensitivity and specificity in diagnosing papulonodular lesions of skin and hence, is a valuable tool in the diagnosis and management of patients with papulonodular skin lesions.
ABSTRACT
Congenital infiltrating lipomatosis of the face is a rare lesion that comprises a subgroup of lipomatous tumor-like lesions of infancy and childhood. It is characterized by (1) no encapsulation, (2) diffuse infiltration of mature adipose tissue over normal muscle fiber and surrounding structures of face, (3) osseous hyperplasia of subjacent bone, and (4) a high recurrence rate. We report a case of a nine-month-old infant who presented with swelling over right face since birth. Early diagnosis of this lesion provides better surgical approach to control the infiltrative nature of its growth with recurrence and aesthetic appearance.
ABSTRACT
Fibrous dysplasia is a noninherited bone disease in which abnormal differentiation of osteoblasts leads to replacement of normal marrow and cancellous bone by immature bone with fibrous stroma. Monostotic fibrous dysplasia accounts for 28% in the ribs. It is often asymptomatic and incidentally detected on radiographs. As with many bone abnormalities, it can be superimposed by the formation of aneurysmal bone cysts. We report a case of a 70-year-old lady who presented with swelling on the chest wall of 20-ear duration and sudden increase in size for 8 months. Radiologically, X-ray and CT scan showed an expansible lesion of the medullary cavity with a ground-glass centre and thinning of cortex of the 5th rib. The resected lesion was a firm, well-defined solid, grey-white expansile mass replacing the medullary cavity. Histopathologically, benign fibrous spindle areas with disorganized irregular bony trabeculae were seen. Hemorrhagic spaces lined by osteoclast-like multinucleated giant cells were also noted. The diagnosis was fibrous dysplasia with aneurysmal bone cyst changes. Although fibrous dysplasia with aneurysmal bone cyst is rare, it should be taken into account in differential diagnosis of the rapidly growing solitary rib lesion.
