A cytohistological correlation in salivary gland swelling with special reference to the proposed Milan system.

CONTEXT AND BACKGROUND: Cytological grading of salivary gland lesion, which is a simple, cost-effective, and reproducible method, can be used as a tool for the selection of treatment modality. The proposed Milan classification establishes one guideline for reporting of salivary gland cytology and thus helps in individualized treatment and follow-up. AIMS AND OBJECTIVES: (1) The aims and objectives of this study were to establish the validity and reliability of the Milan classification of cytological grading in salivary gland swelling and (2) to calculate the malignancy risk. MATERIALS AND METHODS: This prospective study was designed in clinically diagnosed salivary gland swelling at the Department of Pathology of a tertiary care referral hospital. Fine-needle aspiration (FNA) was done, and stained smears were examined under light microscope and cytological findings were noted according to the Milan classification. Tissue for the histopathological study was obtained in 119 cases. The previous cytological findings were compared to subsequent histopathology report. RESULTS: : Among 119 FNAs, 2.5% were nondiagnostic and 55.4% were nonneoplastic. While no samples were placed in the atypia of undetermined significance category, benign tumors accounted for 25.2%. About 1.7% was grouped in the salivary gland neoplasm of uncertain malignant potential, 2.5% of cases were categorized as suspicious of malignancy, and 12.6% of cases comprised as malignant tumors. Overall, malignancy risk was observed to be the highest (93.3%) in Category 6 and lowest (3.0%) in nonneoplastic category. CONCLUSIONS: The six-tier diagnostic categories of the Milan classification scheme help in segregating patients with salivary gland lesions into the management categories of follow-up, conservative surgery, and radical surgery with/without chemotherapy.

Amoeboma of colon mimicking colonic carcinoma.

Entamoeba histolytica is a major cause of diarrhea in the developing countries and it can present with a wide range of gastrointestinal symptoms depending on the phase of the infection. We describe a case of 65-year-old male patient presented with abdominal pain and vomiting. On the clinical and radiological examination provisional diagnosis of colonic carcinoma was suspected. After resection of perforated caecal growth, histopathological sections showed numerous trophozoites of E. histolytica in a background of abundant necrosis. This case revealed differentiation between amoeboma and carcinoma is critical.

Analysis of FNAC of cervical lymph nodes: experience over a three-year period.

This study was taken up with the aim to investigate the pattern of cervical lymphadenopathy among patients presenting to IPGME&R, Kolkata, a tertiary care institution in Eastern India to evaluate the diagnostic efficacy of FNAC, and to dissect the diagnostic pitfalls. A total of 509 patients were subjected FNAC of cervical lymph nodes over a three-year period (August 2006-July, 2009). Since in 34 patients, as either the aspirate was inadequate or the opinion equivocal, the remaining 475 cases were analysed. Overall tuberculous lymphadenitis was the most common finding (222/475; 46.7%), while reactive hyperplasia was the commonest presentation (45%) in patients less than 20 years of age. Malignant pathology accounted for 13.7% (65/475) of cervical lymph node enlargement, most of which was due to metastatic squamous cell carcinoma (44/65; 67.7%). Histopathology reports were available for comparison in 220 cases. Twelve cases of tuberculosis were missed in FNAC and were reported as either reactive hyperplasia (n = 9) or acute non-specific lymphadenitis (n = 3). Among the 3 cases of metastatic squamous cell carcinoma that were missed in FNAC, one was reported as tuberculous lymphadenitis (due to granuloma formation) and the other 2 as reactive hyperplasia due to sampling error. FNAC is an excellent first line of investigation and when used with a proper combination of experience and diligence, it can greatly reduce the number of errors.

Fine needle aspiration cytology of supraclavicular lymph nodes: Our experience over a three-year period.

AIMS: This study was taken up with the aim to investigate the pattern of supraclavicular lymphadenopathy among patients presenting to our tertiary care institution, evaluate the diagnostic efficacy of fine needle aspiration cytology (FNAC), and analyze the diagnostic pitfalls. MATERIALS AND METHODS: A total of 215 patients were subjected to FNAC of supraclavicular lymph nodes over a three-year period (August 2006 to July 2009). Since in 18 patients as either the aspirate was inadequate or the opinion was equivocal, we analyzed the remaining 197 cases. RESULTS: Malignant pathology accounted for 79.7% (157/197) of the cases. These were mostly cases of metastatic squamous cell carcinoma (79/197, 40.1%), adenocarcinoma (47/197, 23.9%), small cell carcinoma (12/197, 6.1%) and lymphoma (10/197, 5%). There were 28 (14.2%) cases of tuberculosis. Out of these 197 patients, 92 patients were biopsied. The opinion based on FNAC was erroneous in 6 cases but corroborated with the final histopathology findings in the remaining 86 cases. CONCLUSION: FNAC is an excellent first line of investigation; and when used with a proper combination of experience and diligence, it can greatly reduce the number of errors.

Extranodal non-Hodgkin's lymphoma presenting as an ovarian mass.

An 8-year-old female presented with an abdominal lump. A ultrasonography showed a heterogeneous, mainly solid space-occupying lesion with few cystic components and irregular margin in both adnexae measuring 10.5 x 5.2 x 3.5 cm and 9.2 x 4.8 x 3.0 cm. The tumors were removed by exploratory laparotomy and the histopathological report was primary NHL of the ovary. The uterus and cervix were healthy and there was no tumor extension or omental deposit. The patient was referred for chemotherapy.

Cytodiagnosis of filarial infections from an endemic area.

OBJECTIVE: To throw light on cytologic findings as a possible mode of diagnosis of lymphatic filariasis. STUDY DESIGN: Filariasis has worldwide distribution, but lymphatic filariasis predominantly affects tropical and subtropical regions. Demonstration of microfilaremia, the specific test for diagnosis of lymphatic filariasis, often shows false negative results in endemic areas. The present study, done in an endemic area, showed the presence of microfilariae or adult worms of Wuchereria bancrofti in fine needle aspirates collected from amicrofilariaemic cases. In a few cases the discovery was incidental. A total 4,534 cases undergoing cytologic evaluation were carefully screened for the presence of adult worms or larvae, irrespective of clinical diagnosis. Microfilariae were demonstrated in both clinically suspected cases of filariasis and asymptomatic cases. RESULTS: A total of 1 positive cases were found; in 4 cases the clinical diagnosis was lymphatic filariasis, and 7 cases were asymptomatic. All 11 cases were amicrofilariaemic. CONCLUSION: Various sophisticated investigations are used for diagnosis of lymphatic filariasis without microfilaremia. Fine needle aspiration cytology, being a cheap, simple and easy procedure, may have some role in this field, but further detailed studies are needed before any final claim.

Coexistence of a mature teratoma and mucinous cystadenocarcinoma in the same ovary--a case report.

A case of right sided abdominal lump with pain in a 45 years female was presented. Radiological investigation revealed a multiloculated cystic mass with a few mural nodules arising from right ovary. The tumor was removed by exploratory laparotomy and histopathological examination showed coexistence of dermoid cyst with mucinous cystadenocarcinoma in the same ovary. Left ovary and uterus was healthy and there was no tumor extension or omental deposits. Postoperative period was uneventful.