Histopathological study of salivary gland tumors.

CONTEXT: The salivary glands are the site of origin of a wide variety of neoplasms and are also relatively uncommon. The histopathology of these tumors is said to be the most complex and diverse of any organ in the body. The incidence of salivary gland tumors (SGTs) is claimed to be influenced by geographical and racial factors. Histopathological diagnosis plays a major role in the diagnosis of these neoplasms, with very few contribution using special stains, immunohistochemistry and cytogenetic studies. AIMS: Aimed at understanding the epidemiological pattern of these tumors and to compare our findings with reports done elsewhere. SETTINGS AND DESIGN: This is a retrospective study done at Pathology Department a Postgraduate Teaching Hospital, Tertiary Care Centre in Bagalkot, Karnataka, India. All the cases of SGTs, which had been recorded in a 3-year period from 2009 to 2012, were enrolled in the study. SUBJECTS AND METHODS: Clinical data were recorded and analyzed with respect to gender, age, site and histopathologic type. RESULTS: Data of 59 cases of SGTs were recorded, of which 43 (69.16%) cases were classified as benign tumors and 16 (22.39%) cases as malignant tumors. Male to female ratio (M/F) and the mean age of patients were 1:1.8 and 43 years, respectively. Pleomorphic adenoma (60.71%) and adenoid cystic carcinoma (14.94%) were the most common benign and malignant neoplasms. CONCLUSIONS: Although the SGTs encountered were similar in most of their characteristics to those reported in India and other countries, some differences such as relative frequency, age and gender prevalence were discovered.

Multiple nerve abscesses on cutaneous radial nerve--a case of pure neural leprosy.

Leprosy is a unique infectious disease due to varied spectrum of clinical signs it exhibits. Pure neural leprosy (PNL) is an unusual form of leprosy and accounts for 4-8% of all leprosy cases. It can manifest as a simple tingling sensation to complex and tragic motor paralysis. Here we report a case of PNL involving isolated cutaneous radial nerve as multiple abscesses along the course of the nerve. To the best of our knowledge, this is rarest presentation of pure neural leprosy.

On-site toluidine blue staining and screening improves efficiency of fine-needle aspiration cytology reporting.

OBJECTIVE: We investigated the role of on-site toluidine blue staining and screening in fine-needle aspiration cytology (FNAC) reporting for patients with thyroid nodules, palpable breast lumps and palpable lymph nodes. STUDY DESIGN: A total of 200 consecutive patients with a palpable lymph node or a lump in the breast or thyroid referred to the outpatient department for FNAC were included in this study. We used toluidine blue to stain FNAC slides for the evaluation of smear adequacy. The toluidine blue-stained slides were compared with the same slides after being decolorised and Papanacolaou (PAP)-stained. RESULTS: Out of 200 cases, 28 (14%) were deemed unsatisfactory on the first attempt as assessed by rapid staining. These included 16 (38%) of 42 thyroid cases, 10 (10.4%) of 96 breast lump cases and 2 (3.2%) of 62 lymph node cases. A repeat FNAC in the same sitting on these 28 patients showed adequate material in 24 (12%) of them. Therefore, for 98%, a decision could be made at the very first visit to plan further management. CONCLUSIONS: We concluded that toluidine blue offers excellent cytological details for the preliminary identification of the lesion and to decide on the adequacy of the material for definitive diagnosis on FNAC slides.

Sputum cytology in suspected cases of carcinoma of lung (Sputum cytology a poor man's bronchoscopy!).

AIMS: To evaluate the role of sputum cytology in the diagnostic work-up of patients with suspected lung cancer SETTINGS AND DESIGN: Spontaneously produced fresh sputum was analyzed in clinically suspected cases of lung cancer. MATERIALS AND METHODS: Spontaneously produced fresh sputum was analyzed in 36 clinically suspected cases of lung cancer. It was carried out using the "fresh pick and smear" method, which employs examination of sputum for blood-tinged, discolored or solid particles and preparation of thin and even smears from these selected portions. STATISTICAL ANALYSIS USED: Average and means. RESULTS: Sensitivity of sputum cytology was 60%, which increased with an increase in the number of samples examined. CONCLUSIONS: Sputum cytology in suspected cases of carcinoma of lung is a useful diagnostic tool. It may be called as a poor man's bronchoscopy.

Sclerosing lobular hyperplasia--cytological similarity to fibroadenoma.

Mammary sclerosing lobular hyperplasia (SLH) is a rare, benign, fibroproliferative tumour-like lesion of adolescent and young women often of African-American heritage. Fine-needle aspiration cytology of mammary SLH shows characteristic features that include an absence of stromal fragments. We report a 45-year-old woman who presented with a gradually enlarging, painless, mobile 4-cm tumour in her left breast. Fine-needle aspiration cytology performed preoperatively was characterized by some fibroadenoma-like features including the presence of stromal fragments and bare nuclei. However branched tubular fragments, typical of fibroadenoma, were not seen. A diagnosis of benign epithelial lesion of the breast was offered, and the possibility of a fibroadenoma was suggested. Excision biopsy histology revealed SLH. The key cytological features of mammary SLH are bland ductal epithelial cell clusters, few scattered fragments of stroma, relatively clean background with a fair number of bare nuclei. However these are not diagnostic as they overlap with those of fibroadenoma and distinction between the two benign entities is of no clinical significance. The definitive diagnosis of SLH requires histopathological evaluation.

Pure choriocarcinoma of ovary diagnosed by fine needle aspiration cytology.

Pure ovarian choriocarcinoma is extremely rare and can develop as a germ cell tumor or as a metastasis from uterine or tubal gestational choriocarcinoma or rarely from an ovarian pregnancy. The cytomorphologic findings have been reported previously in different sites. However, this is the first case of pure ovarian choriocarcinoma diagnosed on cytology to the best of our knowledge. The distinction between a gestational and nongestational choriocarcinoma is difficult. A 19-year-old female patient presented with an irregular per-vaginal bleeding and a mass in lower abdomen. Fine needle aspiration cytology smears of the mass were hypocellular and showed large, multinucleated giant cells and malignant mononucleated cells. Background was hemorrhagic. Serum beta hCG level was 3,80,000 mIU/ml. A diagnosis of choriocarcinoma was offered which was later confirmed by histopathology. The diagnosis of choriocarcinoma on fine needle aspiration cytology is based on the presence of large, multinucleated giant cells and malignant mononucleated cells. A high index of suspicion should be maintained and estimation of serum beta hCG plays a key role in supporting the diagnosis.

Diagnosis of metastatic carcinoid in mesenteric lymph node by fine needle aspiration cytology.

Although carcinoid tumor is a relatively common neoplasm in surgical pathology, fine needle aspiration cytology (FNAC) as a method of primary diagnosis has only been reported a few times. We report the case of a 55-year-old male patient who presented with colicky pain in the abdomen and a vague mass in the right lumbar region. Ultrasonographic study showed an enlarged mesenteric lymph node. Ultrasonography-guided FNAC revealed cellular smears with neuroendocrine cellular arrangement and morphology. The cytomorphologic characteristics of carcinoid tumors are distinctive enough for diagnosis. A diagnosis of metastatic carcinoid was given. 5-hydroxyindolacetic acid in 24-hour urine turned out to be high. Histopathology and immunohistochemistry studies also confirmed the diagnosis. Thus, FNAC can be a useful and safe tool in the diagnosis of carcinoid tumors.

Primary malignant melanoma of left buccal mucosa with metastasis in thyroid: a case report.

Primary oral malignant melanomas are rare with an incidence of .2 to 8% of all melanomas. Less than 1% of them arise on buccal mucosa. Grossly they arise as a black macule with irregular borders & are commonly of mucosal lentiginous type. They appear at a higher stage and are aggressive with a 5 yr survival rate of 10-25%. 39% of metastasis in thyroid occur from skin (melanomas) and melanomas produce a thyroid mass while the original source remains occult. We report a case of oral malignant melanoma of left buccal mucosa for its rarity and its spread to cervical lymph nodes and thyroid.

Infantile fibromatosis (desmoid type)--a case report.

Infantile fibromatosis represents the childhood counter part of musculoaponeurotic fibromatosis & arises as a solitary mass in skeletal muscle, adjacent fascia, aponeurosis or periosteum. The lesion is extremely rare. Microscopically it exists in two forms diffuse (mesenchymal) & desmoid. The less common desmoid form rarely occurs in infancy. Immunophenotype shows vimentin positivity with variable positivity with muscle markers. The differential diagnosis of this type is infantile fibrosarcoma. The tumor may locally recur if inadequately excised. We report a case of infantile fibromatosis of desmoid type occurring in 10 months male child for its extreme rarity.