Cytomorphological Analysis of Lymph Node Lesions in HIV-Positive Patients with CD4 Count Correlation: A Cross-Sectional Study.

OBJECTIVES: To study the cytomorphological spectrum of lymph node lesions in HIV-positive patients and correlate the cytological findings with the CD4 count. STUDY DESIGN: This was a cross-sectional study of 23 months' duration which included 110 HIV-positive cases proved according to the guidelines of the National AIDS Control Organisation. Fine-needle aspiration cytology (FNAC) was done on clinically palpable lymph nodes. Special stains and culture were done wherever necessary. CD4 count was done by flow cytometry and subsequently correlated with the cytological findings. RESULTS: Our study included 110 cases, ranging in age from 6 to 70 years, peaking in the 3rd to 4th decade (n = 46). The male-to-female ratio was 1.75:1 and the predominant site was the cervical group of lymph nodes (n = 71). Each lesion was correlated with CD4 count, laboratory and clinical findings, and was further segregated based on WHO and CDC staging. Cytological lesions were tubercular (53.6%), reactive (27.1%), suppurative (6.4%) lymphadenitis, lymphoma (4.5%), cystic lymphoid hyperplasia (2.8%), metastases (1.9%), cryptococcal lymphadenitis (0.9%). The mean CD4 count was 217.4, 434.4, 181.4, 149, 580, 225, and 207 cells/µL, respectively. There was a highly significant correlation of cytological findings with CD4 count (χ2 value = 44.57 and p < 0.001). CONCLUSION: FNAC is a primary, safe, and valuable tool for the identification of opportunistic infections, neoplastic and nonneoplastic lesions, as well as therapeutic modality in certain conditions. Correlation of lesions with CD4 count provides information about immune status, HIV stage and segregating cases, and also aids further evaluation and management.

Sertoliform Endometrioid Tumor of Ovary Presenting as Torsion.

Sertoliform endometrioid carcinoma of the ovary (SEC) is an uncommon variant that bears histologic similarity to sertoli and sertoli-leydig cell tumors. We report an interesting case of SEC in a 55-year-old female with a left ovarian mass with torsion. Histology revealed an SEC, featuring foci of typical endometrioid carcinoma, and areas composed of uniform, small, hollow tubules lined by columnar cells with apical cytoplasm. Tumor cells were strongly immunoreactive for EMA and cytokeratin but negative for inhibin; thus, confirming the diagnosis of SEC ovary. Recognition of this tumor is important as it is a well-differentiated, low-grade malignancy that displays good prognosis when confined to the ovary.

Colorectal malakoplakia in a child presenting as multiple polyposis coli.

Malakoplakia of the gastrointestinal tract is a rare chronic inflammatory disorder, usually affecting the descending colon, sigmoid colon and rectum. It is commonly seen in adults. Only few cases have been reported in children. We report a case of malakoplakia of colon and rectum in a 7-year-old child who presented with multiple polyposis coli.