Granulomatous epididymo-orchitis: diagnosis by fine needle aspiration.

Tuberculosis is the leading cause of chronic granulomatous epididymo-orchitis in the Asian population. A retrospective analysis of 40 patients diagnosed with granulomatous or tubercular epididymo-orchitis on fine-needle aspiration (FNA) was carried out. May Grünwald giemsa, haematoxylin and eosin and Ziehl Neelsen stained smears were evaluated. Of 40 patients studied, aspiration smears showed epithelioid cell granulomas with caseation in 17, granulomas alone in 19 and caseation only in four. Acid fast bacilli were seen in 15. Cytologic diagnoses rendered were tubercular epididymo-orchitis in 15, granulomatous inflammation suggestive of tuberculosis in six and granulomatous inflammation in 19. FNA may readily diagnose tubercular epididymo-orchitis and may avoid unnecessary orchidectomy in a good number of patients.

An innocent giant.

A cutaneous horn (cornu cutaneum) is a protrusion from the skin composed of a cornified material. It may be associated with a benign, premalignant, or malignant lesion at the base, masking numerous dermatoses. In a 24-year-old female, a giant cutaneous horn arising from a seborrheic keratosis located on the leg is presented. This case has been reported to emphasize that a giant cutaneous horn may also occur in young patients, even in photoprotected areas, and are not always associated with malignancy.

Fine needle aspiration cytology: a useful technique for diagnosis of invasive fungal rhinosinusitis.

Mycotic infections are on the rise globally. Patients with invasive fungal infection of the paranasal sinuses often present with destructive mass lesions and mimic malignancy clinically and radiologically. To assess the utility of Fine needle aspiration cytology for early diagnosis of invasive fungal rhinosinusitis. Fine needle aspiration cytology was performed from the maxillary/ethmoid sinus in patients with a destructive mass lesion in the maxilla. Differential diagnoses were malignancy and fungal rhinosinusitis. In eight cases fungi were detected on initial examination whereas in a single case that was initially reported as giant cell lesion, hyphae could be identified within giant cells, on review. Smears showed inflammatory cells with variable numbers of eosinophils with neutrophils and histiocytes. Foreign body giant cells were seen in all cases. The fungi conformed to morphology of aspergillus in seven cases (77.78%); in two cases (22.22%), typing could not be done. Periodic acid Schiff and Grocott stains highlighted the fungi in all the cases. Fine needle aspiration is a simple technique that can be useful for diagnosis of fungal rhinosinusitis and to exclude malignancy. Search for fungus may be more aggressive in smears with many foreign body giant cells and inflammatory cells and in cases with a high clinical suspicion. Differentiation between aspergillus and mucor can be made with help of special stains. Aspergillus is the commonest agent isolated. Preoperative cytological diagnosis obviates the need for biopsy, saves time and helps to plan proper treatment.