Cytodiagnosis of Eccrine Porocarcinoma of the Scalp.

Eccrine porocarcinoma is a rare, malignant adnexal tumor of the duct of eccrine sweat gland. Cytology of eccrine porocarcinoma has been described in very few previous literature. Here, we present a case of fine needle aspiration cytology (FNAC) of eccrine porocarcinoma of the scalp, which is subsequently confirmed by histology. Accurate diagnosis of eccrine porocarcinoma by FNAC is very difficult, but determining the malignant nature of the lesion is crucial for curative surgery. FNAC can be a convenient, safe, and effective approach to solve difficult diagnostic dilemma.

Eccrine Porocarcinoma of Scalp: a Rare Case Report.

Eccrine porocarcinoma is a rare malignant adnexal tumor of ductal portion of eccrine sweat gland. It occurs commonly in the lower extremities and rarely in scalp, face, ear, trunk and upper extremities. This survey presents a classic case of eccrine porocarcinoma of scalp in a 58 yr old male patient, presenting as cauliflower like growth over parietal aspect of scalp.

Lymphangioma circumscriptum of the vulva: Report of a rare case.

Lymphangioma circumscriptum (LC) is a form of lymphangioma characterised by benign dilation of lymphatic channels, which affects the skin and subcutaneous tissues. The most common sites of LC are mucosa of mouth, tongue, groin, axilla, trunk and proximal region of extremities. Vulva is a rare site of LC. In this report, we are presenting a case of LC of vulva occurring in a 60-year-old female without any obvious reason. The patient presented with multiple genital wart-like papular lesions in the vulva. Biopsy of lesion reveals LC. She was treated with vulvectomy and showed no sign of recurrence till date.

Role of needle aspiration in diagnosis and management of suppurative bacille calmette-guerin adenitis: an institutional study of 30 cases.

CONTEXT: Regional lymphadenitis is the most common complication of bacille Calmette-Guerin (BCG) vaccination. Most of the BCG lymphadenitis cases are nonsuppurative, but some suppurate and follow abscess formation, rupture, ulceration and cicatrization. Needle aspiration is the rapid, safe and cost-effective method for diagnosis as well as management of suppurative BCG adenitis. AIMS: The aims of the present study were to assess the clinical and cytological spectrum of BCG lymphadenitis and to evaluate the role of needle aspiration in the management of suppurative BCG lymphadenitis. SETTINGS AND DESIGN: We have approached every cases of ipsilateral axillary lymphadenopathy having history of BCG vaccination. We designed to aspirate the suppurative axillary lymph nodes and follow-up of nonsuppurative cases. SUBJECTS AND METHODS: 30 cases of BCG adenitis were studied during a period of 2 years. 12 cases of suppurative lymphadenitis were approached by needle aspiration and cytologically evaluated, and all the cases were followed-up for 12 weeks after diagnosis. Anti-tubercular drugs were not applied, and surgical excision was reserved for nonhealing lesions. STATISTICAL ANALYSIS USED: Data tables. RESULTS: Ipsilateral axillary lymph nodes were commonest site and none had constitutional symptoms. Acid-fast bacilli were detected in 11 (91.67%) cases of suppurative BCG lymphadenitis. On follow-up all nonsuppurative adenitis were resolved spontaneously, and 8 suppurative lymphadenitis cases were resolved after 4 weeks of needle aspiration. Four cases needed repeat aspiration among which 3 resolved in 8 weeks, and one needed surgical excision. CONCLUSIONS: We recommend needle aspiration as a simple, safe, chief and effective modality, which helps in diagnosis as well as in management of suppurative BCG lymphadenitis.

Evaluation of Ultrasound-Guided Fine-Needle Aspiration Cytology of Ovarian Masses with Histopathological Correlation.

BACKGROUND: Preoperative cytodiagnosis of ovarian masses is a difficult process, and sampling of pelvic masses is quite easier after the improvement of imaging techniques. Though histopathology is the gold standard, fine-needle aspiration cytology (FNAC) under ultrasound (US) guidance can be a valuable tool for pre-operative diagnosis of ovarian lesions, especially in the hands of an experienced pathologist. OBJECTIVE: The present study was performed to evaluate the role of US-guided FNAC in pre-operative cytological diagnosis of ovarian masses in comparison with histopathology, and to assess the pitfalls and limitations of cytological interpretation. MATERIALS AND METHODS: This study was conducted over a 2-year period on 70 cases of ovarian masses, which were evaluated by US-guided FNAC. Sensitivity, specificity and diagnostic efficacy were calculated using histopathology as gold standard. RESULTS: On cytological evaluation, non-neoplastic cysts, and benign and malignant ovarian tumours were diagnosed in 8, 18 and 40 cases, respectively. On histopathology, 62 cases were concordant with cytology. Sensitivity and specificity were 95.23 and 95.83%, respectively, in the present study. Diagnostic accuracy was 93.94% in respect to the correct diagnosis. Cytohistological discrepancies and limitations of the study are discussed. CONCLUSION: US-guided FNAC has proved as a quick, economic and safe procedure in diagnosing ovarian masses with brilliant accuracy.

Cytological grading of breast carcinoma on fine needle aspirates and its relation with histological grading.

BACKGROUND: Grading of breast carcinoma on fine needle aspiration cytology (FNAC) is beneficial for selecting patients for neoadjuvant chemotherapy. AIMS: To grade the breast carcinoma on FNAC using Robinson grading system and to assess the concordance of cytological grading (CG) with histological grading (HG) using Elston-Ellis modification of Scarff-Bloom-Richardson grading system. MATERIALS AND METHODS: The study was conducted for 1-year, comprising of 50 female patients attending outpatient departments (OPD) as well as admitted in various surgical wards of a teaching hospital, diagnosed as breast carcinoma. FNAC smears were stained with May-Grunwald-Giemsa and Papanicolaou (Pap) stains and CG was done using Robinson system on Pap stained smears. The results were compared with HG system after resection of tumors. RESULTS: Of 50 cases, 14 (28%) cases were graded as grade I, 24 (48%) grade II, and 12 (24%) grade III by CG, whereas 9 (18%), 28 (56%) and 13 (26%) cases were graded as grade I, II and III by HG. The result showed overall 72% concordance of CG with HG, with grade II and grade III showing highest degree of concordance (83.33%), which is comparable to previous studies. Kappa measurement showed a higher degree of agreement in high-grade tumors compared with low-grade tumors (0.73 in grade III, 0.53 in grade II and 0.39 in grade I). CONCLUSION: Cytological grading is comparable to HG in majority of cases. Because neoadjuvant chemotherapy is becoming increasingly popular as primary treatment modality of breast cancer, CG could be a useful parameter in selecting the mode of therapy and predicting tumor behavior.

Fine needle aspiration cytology of eccrine spiradenoma of back: report of a rare case.

Eccrine spiradenoma is an uncommon benign adnexal tumor. Cytological features of eccrine spiradenoma have been described very rarely in English literature. In the present case, we are describing a case of eccrine spiradenoma of back, which was diagnosed by fine-needle aspiration cytology and subsequently confirmed by histopathology. Its cytology revealed tight multilayered clusters of uniform benign cuboidal epithelial cells along with spindle-shaped myoepithelial cells and occasional lymphocytes.

Cytological diagnosis of epidermal inclusion cyst of breast: A rare benign lesion.

Epidermal inclusion cyst (EIC) is a benign lesion, which occurs due to proliferation and implantation of epidermal elements within a circumscribed space in dermis. They usually occur in the head and neck region, trunk and extremities. EIC occurring in the breast is very rare. In this study, we are presenting a rare case of EIC occurring in the breast; which was diagnosed by fine-needle aspiration cytology (FNAC). Later on, histopathology confirmed the diagnosis. We are presenting this case not only because of its rare site of presentation, but also to highlight the role of FNAC in diagnosing this benign lesion.

Preoperative Diagnosis of Tubular Adenoma of Breast - 10 years of experience.

BACKGROUND: Tubular adenomas are rare benign neoplasms of female breast affecting women, predominantly of child-bearing age group. Definitive diagnosis of this tumor is usually achieved after histopathological study. Clinical, radiological, and even cytological features are often insufficient for accurate diagnosis. AIM: The aim of the present study was planned to analyze clinical and radiological features of histologically confirmed cases of tubular adenoma of breast to find out a clue for accurate preoperative cytological diagnosis. MATERIALS AND METHODS: In our 10-year research program, all histologically confirmed tubular adenoma cases of breast were studied. Clinico-radio-cytological features, if available, were analyzed and tabulated. RESULTS: Thirty-three cases of tubular adenoma of breast were studied. Radiological and cytological assessments are available for 12 and 26 cases, respectively. Tubular adenoma could be diagnosed in only two cases (7.7%) by cytological assessment, but in none by radiological assessment. CONCLUSIONS: Clinico-cyto-radiological assessment could identify the benign nature of the tumors in most cases, but final confirmation was possible only after histopathological study.

Cytodiagnosis of epidermoid cyst of the upper lip: a common lesion in an uncommon site.

Epidermoid cyst and dermoid cysts are developmental pathologies thought to derive from aberrant ectodermal tissue. They are uncommon in the head and neck region. Rarely, they can be found in the oral cavity and buccal mucosa. However, epidermoid cyst is extremely uncommon in the upper lip and is rarely reported. In this study, we report an uncommon case of epidermoid cyst occurring in the upper lip diagnosed by fine-needle aspiration cytology (FNAC). We present this case because of its extremely rare site of presentation and also to highlight the role of FNAC to in the pre-operative diagnosis of this benign lesion.

Endoscopic versus external approach dacryocystorhinostomy: A comparative analysis.

BACKGROUND: Dacryocystorhinostomy (DCR) consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed excreting system. AIM: To compare the result and advantages of both endonasal endoscopic and external DCR regarding the patency rate, patient compliance and complications. STUDY DESIGN: Prospective non-randomized comparative study. MATERIALS AND METHODS: Study was conducted for 16 months duration in a teaching hospital with 50 cases of endoscopic and 30 cases of external DCR with a follow-up of minimum 6 months. Data regarding surgical outcome and complications were analysed and compared using χ(2) test. RESULTS: Total 72 patients were included in the study with six having bilateral involvement, out of which 20 were male and 52 were female. The mean age for endoscopic and external DCR was 33.6 years and 46.0 years, respectively. Right eye (63.8%) was involved more commonly than left eye (36.2%). Epiphora was the commonest presenting symptom (63.7%). Mean duration of surgery was much lengthier in external (mean 119.6 minutes) than endoscopic (mean 49.0 minutes) DCR. Bleeding was the most common immediate postoperative complication seen in 33.3% and 10.0% of external and endoscopic DCR cases, respectively. Primary surgical success rate was 90% and 96.7% for endoscopic and external DCR, respectively (P = 0.046). Among the endoscopic DCR group, four patients underwent revision surgery giving a total successful surgical outcome of 98% at third month of follow-up. However, at 6 month of follow-up, success rate was 92% for endoscopic DCR and 93.3% for external DCR. The difference was not statistically significant (P = 0.609). CONCLUSION: Intranasal endoscopic DCR is a simple, minimally invasive, day care procedure and had comparable result with conventional external DCR.

Teratoid Wilms' tumor in a child: A report of a rare case.

Teratoid Wilms' tumor is an unusual variant of nephroblastoma in which heterologous tissue predominates. We report a case of teratoid Wilms' tumor in a 2-year-old male. Right sided abdominal mass was the presenting complaint. Ultrasonography of the abdomen showed a mass in the right kidney. Histopathological examination revealed blastemal, epithelial, and mesenchymal components along with areas presenting heterologous elements. More than 75% predominance of squamous differentiation with the keratin pearl formation was observed. The patient underwent nephrectomy and was followed post-operatively for 1 year and was normal.

Serum lipid profile in alcoholic cirrhosis: A study in a teaching hospital of north-eastern India.

BACKGROUND: Alcoholic cirrhosis is often associated with impaired lipid metabolism. However, there are only a few studies regarding lipid profile in alcoholic cirrhosis that have been undertaken in India. The aim of the study is to assess the degree of alteration of serum lipid profile in alcoholic cirrhotic patients and also to detect its relationship with the age of the patients and the alcohol consumption pattern. PATIENTS AND METHODS: This cross-sectional study was conducted in a teaching hospital of north-eastern India for 1 year with 100 patients with alcoholic cirrhosis (cases) and 50 healthy individuals (controls) without history of alcohol consumption. A questionnaire of personal characteristics including history of alcoholism was completed for each patient. Serum lipid profile (total, low-density lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol and triglyceride) was recorded for each case and control. t test of significance was applied for statistical analysis. RESULTS: Majority of the cases were in the 41-50 years age group. There was no relationship of cirrhosis with the type of alcoholic beverage, but a definite relationship was observed with the quantity and the duration of alcohol consumption. In patients with cirrhosis, the total serum cholesterol level was decreased. There was a significant decrease in serum HDL and LDL cholesterol compared with the control group ( P < 0.001). However, the serum triglyceride levels were significantly increased in alcoholic cirrhotic patients compared with the control group ( P < 0.001). CONCLUSION: In this study, we found that there was marked alteration of serum lipid profile values in patients with alcoholic cirrhosis compared with normal, non-cirrhotic individuals. Therefore, a search for lipid profile abnormality should be performed in every cirrhotic patient.

Mullerian adenosarcoma of uterus with sarcomatous overgrowth and heterologous component associated with stromal deposit in omentum: a case report and review of the literature.

Background. Mullerian adenosarcoma with sarcomatous overgrowth (MASO) is a very rare variant of uterine sarcomas first described by Clement et al. as early as 1974. The presence of heterologous sarcomatous components is associated with aggressive biological behavior. Case Presentation. This is a case report of a 62-year female (P(2 + 0)) presenting with postmenopausal vaginal bleeding. Her preoperative USG revealed subserosal fibroid with adherent omentum. She underwent abdominal hysterectomy with bilateral oophorectomy. Histopathological diagnosis of resected specimen was Mullerian adenosarcoma with sarcomatous overgrowth and presence of heterologous elements involving body of the uterus. The whole thickness of the myometrium was involved along with the presence of serosal nodules and omental deposits of sarcomatous component. Conclusion. MA is considered as a low-grade malignant tumor, but MASO is a high-grade tumor frequently associated with invasion and metastasis with poor treatment outcome. Because of its rarity, correct identification of these tumors and distinction from other uterine sarcomas are a challenging job and hence its morphological features merits attention.

Cytodiagnosis of pilomatrixoma from an uncommon site with unusual presentation.

Pilomatrixoma or pilomatricoma is an uncommon benign tumor of hair matrix origin, which most commonly occurs in the head and neck region and upper extremities. In this study, we report a case of pilomatrixoma of a 35-year-old female presenting with left-leg swelling with surface ulceration, clinically thought to be malignant. Fine-needle aspiration cytology (FNAC) of the lesion showed clusters of basaloid cells with round to ovoid nuclei, nucleated squamous cells, and anucleated squames and clusters of shadow cells. Acytological diagnosis of pilomatrixoma was made. Subsequent surgical excision and histopathological examination confirmed the diagnosis. This case highlights a rare site of presentation and the role of FNAC in preoperative diagnosis of this benign tumor for proper management.

Cytodiagnosis of filariasis from a swelling of arm.

Cytological demonstration of microfilaria and adult worms often helps in diagnosis of asymptomatic filarial cases. But demonstration of microfilaria in cytological smears from upper extremity lesions is seldom reported. We are presenting a 32-year-old female patient with elongated, small subcutaneous swelling in the medial aspect of right lower arm. Aspirates from the lesion demonstrate microfilaria though there is no eosinophilia or microfilaremia on subsequent examination of blood sample. In endemic areas, filariasis should always be considered as a possible diagnosis during cytological assessment of any swelling.