Intraoral and Oropharyngeal Lesions: Role of Fine Needle Aspiration Cytology in the Diagnosis.

The oral cavity is affected by a wide range of pathologic lesions, for which a morphologic diagnosis is required for proper management. Fine needle aspiration (FNA) is being increasingly used for preliminary diagnoses of such lesions. This is retrospective analysis of intraoral and oropharyngeal lesions diagnosed with FNAC over a period of 7 years. Out of total 55 cases, a definite diagnosis could be made on cytology in 50 cases (90.9 %). These 50 cases were further included in the study. Thirty cases were reported as non-neoplastic and 20 as neoplastic (11 benign and nine malignant). The diagnoses were made taking into account the background material (blood, mucin) and the predominant cells present (neutrophils, lymphoid cells, macrophages, hemosiderin laden macrophages, squamous cells, basaloid cells, spindle cells, giant cells). Histopathological diagnosis was available in 17 cases and corresponded with FNA diagnosis in 16 cases (94.12 %). No significant complications were seen in patients undergoing these FNAs. It can be concluded that FNA is a simple and rapid diagnostic test that can be useful for preliminary assessment of oral and oropharyngeal lesions.

Diagnosis of filariasis on cytology: a series of 24 cases.

Filariasis has a worldwide distribution, with a special predilection for tropical and subtropical areas. The microfilaria wanders in lymphatics and can be accidentally trapped in the needle during fine-needle aspiration cytology, thus leading to its incidental detection. This is a retrospective study of 24 cases of microfilarial infestation diagnosed on cytology. Accurate recognition and detection of the parasite leads to the institution of specific treatment and prevents chronic manifestations of the disease.

A rare case of ovarian and pelvic filariasis.

Lymphatic filariasis is an important tropic disease associated with significant morbidity. The patients in endemic areas mostly experience problems related to lymphatic obstruction. Physicians practicing in non- endemic areas rarely consider filariasis, especially if it is an uncommon presentation. We present a young woman who posed a significant problem in the diagnosis of ovarian filariasis.

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.

Utility of ultrasound-guided fine-needle aspiration in splenic lesions.

Indications of fine-needle aspiration (FNA) of spleen have increased as more splenic lesions are detected because of advanced imaging techniques. A retrospective analysis of cytological material of 36 patients on whom ultrasound-guided splenic FNA was performed was done. No complications were noted. There were 16 inflammatory lesions, 12 neoplastic and 8 cases were reported as descriptive either because of scant cellularity, blood only, or normal splenic cytology. Inflammatory lesions included nine cases of acute abscess, five cases of tuberculosis, and one case each of leishmaniasis and infarct. Neoplastic lesions included two benign (benign cyst and inflammatory pseudotumor) and 10 malignant lesions. Among malignant lesions, eight were non-Hodgkin lymphoma (NHL), one suspicious of NHL, and one desmoplastic small round cell tumor. FNA proved to be an effective procedure for reaching a microscopic tissue diagnosis and thus a splenectomy could be avoided in cases where it was not required.

Tuberculosis lymphadenitis in a well managed case of sarcoidosis.

Differentiation between tuberculosis (TB) and sarcoidoisis is sometimes extremely difficult. Sequential occurrence of sarcoidosis and TB in the same patient is uncommon. We present the case of a young man, with a proven diagnosis of sarcoidosis who later developed TB after completion of treatment for sarcoidosis. A 32-year-old male patient presented with low-grade fever since two months. Physical examination revealed cervical lymphadenopathy. Initial fine needle aspiration cytology (FNAC) of the cervical lymph node was suggestive of granulomatous inflammation; the chest radiograph was normal. Repeat FNAC from the same lymph node was suggestive of reactive lymphoid hyperplasia. The patient was treated with antibiotics and followed-up. He again presented with persistence of fever and lymphadenopathy and blurring of vision. Ophthalmological examination revealed uveitis, possibly due to a granulomatous cause. His repeat Mantoux test again was non-reactive; serum angiotensin converting enzyme (ACE) levels were raised. This time an excision biopsy of the lymph node was done which revealed discrete, non-caseating, reticulin rich granulomatous inflammation suggestive of sarcoidosis. The patient was treated with oral prednisolone and imporved symptomatically. Subsequently, nearly nine months after completion of corticosteroid treatment, he presented with low-grade, intermittent fever and a lymph node enlargement in the right parotid region. FNAC from this lymph node showed caseating granulomatous inflammation and the stain for acid-fast bacilli was positive. He was treated with Category I DOTS under the Revised National Tuberculosis Control Programme and improved significantly. The present case highlights the need for further research into the aetiology of TB and sarcoidosis.

Intra-thoracic desmoid tumor.

Desmoid tumor is a rare, benign soft tissue tumor having potential for local invasion. It commonly arises in abdominal wall, presenting as a palpable mass. We describe a case of thoracic desmoid tumor in a middle aged male arising from the chest wall. Unlike the usual presentation, two separate non-palpable tumor masses protruded into left thoracic cavity mimicking lung carcinoma. The patient underwent successful complete surgical excision of the tumor. Such tumors, being rare, may pose diagnostic problems if not considered in the initial work up.

Cytologic diagnosis of intravascular papillary endothelial hyperplasia: a report of two cases and review of cytologic literature.

BACKGROUND: Intravascular papillary endothelial hyperplasia (IPEH), previously known as 'Masson's hemangioma', is a reactive endothelial proliferation that occurs most commonly in the vessels of the head, neck, and extremities. The cytologic findings of the lesion are varied and depend on the age of the lesion. CASES: Case 1 is a 61-year-old man who presented with a swelling on the medial aspect of the forearm. The clinical diagnosis was lipoma. Cytologic smears showed spindle cells tagging onto a rich capillary network and smaller round cells arranged around hyaline cores. The cytologic diagnosis was benign vascular tumor. On histolopathogic examination a diagnosis of IPEH was given. Case 2 is a 45-year-old man who presented with swelling on the dorsal aspect of the wrist. The cytologic diagnosis of giant cell tumor was made based on the presence of scattered spindled cells and multinucleate giant cells. The giant cells had various shapes like round or crescent and had 10-25 nuclei. The lesion was excised and a diagnosis of IPEH was rendered. CONCLUSION: These two cases highlight the varied cytomorphology of IPEH making the pinpoint diagnosis of this lesion difficult on cytologic smears.

Inflammatory pseudotumor of the spleen: a rare case diagnosed on FNAC.

Inflammatory pseudotumor (IPT) is a rare space-occupying lesion of unknown etiology that can mimic malignancy on clinic-radiological and pathological examination. We present a case of IPT of the spleen which was clinically suspected to be malignant. This case was initially suggested accurately on fine needle aspiration (FNA) of the mass and subsequently confirmed on histopathology of the resected specimen.

FNA in diagnosis of orbital lesions causing proptosis in adults.

The orbit is affected by a wide range of pathologic lesions, for which a morphologic diagnosis is needed to allow adequate therapy. With increasing use of fine needle aspiration (FNA) in diagnostic pathology, the procedure has been applied for the diagnosis of space occupying lesions of the orbit. We present the cytomorphological diagnosis on orbital FNA in adult patients presenting with proptosis. Records of seven adult patients who had presented with proptosis and had undergone orbital FNA were retrieved and analysed. FNA was performed from the palpable mass in six cases and under ultrasound guidance in one case. No complication during or after FNA was reported in any of the cases. Histopathological diagnosis was available in 5 cases. Out of the 7 cases, 3 were non-neoplastic (2 inflammatory lesions, 1 reactive lymphoid hyperplasia) and 4 were neoplastic (2 primary tumors and 2 secondary involvement). Both the primary tumors were non Hodgkin's lymphoma (NHL) B-cell type. Metastases included one case of uterine sarcomatoid carcinoma and one case of secondary involvement by extension of olfactory neuroblastoma. In all the neoplastic cases, cytological diagnosis corresponded with the histopathological diagnosis. It can be concluded that cause of proptosis among adults are different from those among children and include secondary malignancies. FNA is a simple and important preliminary diagnostic modality in the assessment of adult proptosis prior to any surgical intervention.

Coexistence of leukemic infiltration and extramedullary hematopoeisis in a lymph node: A cytological diagnosis.

Extramedullary hematopoeisis (EMH) occurs when function of the bone marrow is insufficient or destroyed. We report a case of lymph nodal mass in a young patient, diagnosed on fine needle aspiration cytology (FNAC) as infiltration by leukemia along with features of EMH. FNA smears from axillary lymph node revealed lymphoblasts with hand mirror cell and teat cell morphology. Also seen were occasional megakaryocytes and metamyelocytes.

Neutrophil phagocytosis by tumor cells--a cytological study.

Cell cannibalism is defined as the ability of a cell to phagocytose another cell. Malignant tumor cells may develop phagocytic property and demonstrate phagocytosis of own cells or cells of other series like neutrophils and lymphocytes. We report 11 cases in which the tumor cells showed evidence of neutrophil phagocytosis/emperipolesis on FNAC smears. Cases of malignancies diagnosed on FNA over a period of 1 year were retrieved, and smears were examined for neutrophil phagocytosis by tumor cells. These cases were classified according to type and differentiation of malignancy. The cytomorphological features and background inflammation were also studied at both primary and metastatic site. Of 362 malignant cases diagnosed on FNA smears, in 11 cases (3.09%), tumor cells showed neutrophil phagocytosis. The background showed increase in polymorphs in all cases. All the cases were associated with metastasis at presentation and were high-grade tumors cytologically. There were three cases of anaplastic carcinoma, two cases of adenocarcinoma, two cases of carcinoma breast, two cases of anaplastic non-Hodgkins lymphoma, one case each of squamous cell carcinoma and small cell carcinoma from larynx and lung, respectively. Phagocytic activity by tumor cells is uncommon and usually seen in high-grade/poorly differentiated malignancies. It is frequently associated with metastatic disease. On cytology smears, true phagocytosis of neutrophils by tumor cells has to be distinguished from superimposed inflammatory cells from the background. The tumor cells also need to be distinguished from histiocytes displaying phagocytosis.

Cytologic features and differential diagnosis in a case of extraskeletal mesenchymal chondrosarcoma: a case report.

BACKGROUND: Extraskeletal myxoid chondrosarcoma (EMC) is an uncommon tumor. On fine needle aspiration (FNA) it has to be distinguished from other benign and malignant soft tissue lesions. CASE: FNA was done on an 85-year-old man with painful swelling of the forearm. Smears showed fragments comprised of polygonal cells with eccentric nuclei and peripheral fine cytoplasmic vacuoles embedded in a dense, metachromatic matrix. Cell block showed similar cells in a chondromyxoid stroma. The cells were positive for S100 and negative for cytokeratin. CONCLUSION: FNA is a useful tool in the diagnosis of EMC in conjunction with radiology. A preoperative diagnosis can be made due to its distinct cytologic and immunohistochemical features, obviating the need for a biopsy.

Unsuspected multiples myeloma presenting as bilateral pleural effusion - a cytological diagnosis.

BACKGROUND: Multiple Myeloma presenting as a pleural effusion is extremely rare. It is usually a late complication and is associated with a poor prognosis. CASE PRESENTATION: A 40-year-old male presented with dyspnea and fever of six months duration. Clinical diagnosis of pulmonary tuberculosis was considered. X-ray chest showed bilateral pleural effusion. Pleural cytology revealed numerous plasma cells, some of which were binucleated and atypical. Cytological differential diagnosis included: Myelomatous effusion and Non-Hodgkin's Lymphoma deposit (Immunoblastic type). Bone marrow biopsy, serum protein electrophoresis and bone scan confirmed the diagnosis of multiple myeloma (Plasmablastic type). CONCLUSION: Myelomatous pleural effusion as an initial presentation although extremely rare, should always be considered in presence of atypical plasma cells irrespective of age.

Poorly differentiated squamous cell carcinoma coexisting with angiofibroma and spreading as intravascular emboli in its vessels.

We report a case of a 28-year-old male who presented with epistaxis and hyponasal speech. A clinical and radiological diagnosis of nasopharyngeal angiofibroma was made. The patient underwent a modified transpalatal resection of the tumor under general anesthesia. A diagnosis of poorly differentiated carcinoma, possibly squamous, with extensive embolization in the vessels of angiofibroma was made. As the two entities have entirely different management and outcome, it is imperative to distinguish and locate the malignant component.

Vaginal microflora in postmenopausal women on hormone replacement therapy.

To study the spectrum of vaginal microflora in postmenopausal women on hormone replacement therapy (HRT) and to compare the efficacy of Papanicolaou (Pap) smears with other methods for their detection. Eighty postmenopausal women were recruited for the study. These included 40 women who had attained spontaneous and were on HRT (User 1); 20 hysterectomised women on only estrogen therapy (User 2) and 20 controls (Non users). Their clinical data was recorded and specimens were collected for vaginal cultures (for aerobic bacteria and fungi), vaginal pH, Gram stain and Pap stain on cervical-vaginal smears and toluidine blue on wet smears. Vaginal pH was significantly lower in Users as compared to Non users. Lactobacilli and Gardnerella were more frequently isolated from Users while Bacteroides and E. coli were more common in Non users. Cultures were significantly more sensitive than Gram stained direct vaginal smears in detection of aerobic bacteria; however, Candida could be detected on Gram stain alone in all the cases. Frequency of detection of organisms significantly improved by application of Gram stain to the cervico-vaginal smears. However, clinically relevant organisms like Candida, Gardnerella and Mobiluncus could be identified on Pap smears alone in >50% cases. Lactobacilli could be readily identified in Pap smears in 98% cases. Wet mounts could detect cocci more easily as compared to Pap smears. Altered vaginal microbial profile in post menopausal women receiving HRT may cause bacterial and fungal vaginitis. Although culture studies remain the gold standard to detect these microorganisms, Pap and Gram stains and wet smears provide useful supplements and may be used as alternative procedures especially in resource limited settings lacking adequate culture facilities.

Cytohormonal and morphological alterations in cervicovaginal smears of postmenopausal women on hormone replacement therapy.

The objective of the study was to study the cytohormonal and morphological alterations in cervicovaginal smears associated with the use of hormone replacement therapy (HRT) and to assess the utility of vaginal cytology in determining the response to HRT. Ninety postmenopausal women (30 on estrogen-progesterone combination (HRT) for 1 to 24 mo (user 1), 30 on estrogen therapy (ERT) for 1 to 44 mo (user 2), and 30 not on any hormones (nonusers)) were included in the cross-sectional study. Their lateral vaginal wall smears and cervical smears were examined for hormonal and morphological assessments, respectively. The smear pattern showed predominance of parabasal cells in 46.6% of nonusers, while none of the users had >70% parabasal cells. A high percentage (>70%) of intermediate cells was found in 46.6% of users and only in 16.6% of nonusers. A high maturation value (MV) was found in more than 75% of users but in only 16.6% of nonusers. The women with high MV (>50) were significantly less symptomatic than did nonusers. Atrophic changes were present in cervical smears of 14/20 (46.6%) nonusers when compared with 1/60 (1.66%) users. Atypical squamous cells of undetermined significance (ASC-US) were diagnosed in seven users and three nonusers. It persisted on follow-up in four users and one nonuser. Histology revealed one mild dysplasia among users. Lactobacilli were more frequently observed in users. The cytohormonal pattern on vaginal smears correlates well with the response to hormonal therapy and clinical symptoms. Awareness of the morphological alterations associated with the use of replacement hormones would enable the cytologists to reduce the false-positive diagnoses while evaluating postmenopausal smears.

Congenital fibrosarcoma of the upper extremity--a case report and review of literature.

Fibrosarcoma is rare in pediatric age group. Its diagnosis in infants may be difficult clinically and histologically. A twenty-day infant presented with a rapidly growing mass in the right forearm. Histologically a gray white fleshy mass was seen occupying the entire forearm and distal arm. The tumor showed sheets of closely packed spindle cells with minimal pleomorphism. The cells were positive for vimentin, negative jor smooth muscle actin, desmin and S-100. The diagnosis of congenital fibrosarcoma was made. Most cases of infantile fibrosarcomas present in the first year of life and although they have an alarming presentation, in children they have a much better prognosis as compared to adults. Diagnosis can be made on histology with immunohistochemistry.