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Context There is a wide gap between supply and demand in relation to healthy corneal grafts. Specific contraindications like infection and malignancy lead to non-usage of many grafts, despite the fact that deeming graft unhealthyness for these two contraindications is debatable. Aims This study was conceptualized to assess if corneas donated from the deceased with septicaemia or malignancy can be deemed fit for implantation. Settings and design Retrospective histopathological and microbiological analysis of cadaveric donor corneas. Methods A total of 76 donor corneas from 38 patients rejected for corneal transplantation in view of patient having septicaemia or malignancy were analysed for pathological and microbiological workup, to look for dissemination of disease within corneal tissue. Pathology workup included gross and microscopic histopathological evaluation of tissue. Microbiology workup included Grams stain and KOH with calcofluor mount, culture in blood agar, chocolate agar, Sabourauds dextrose agar and Mc Conkeys broth. Results A total of 46 donor corneas of 23 septicaemia patients when evaluated showed presence of culture positive infection in 18 patients (78.2%). Histopathological examination done for 30 donor corneas from 15 cancer patients did not reveal presence of tumour cells in the specimen. Corneas of two of cancer patients having septicaemia revealed growth on cultures. Conclusions Corneal tissues harvested from septicaemia donors showed significantly higher incidence of corneal contamination, confirming their unsuitability for usage. However, there was no incidence of tumour transmission in corneal tissues of the patients with malignancies, suggesting that they can be considered for ophthalmic purpose. [ABSTRACT FROM AUTHOR]

The article talks about the diagnosis on cytological examination of the primary intravitreal hydatid cyst that is caused by Echinococcus granulosus. These human cysts may occur in almost any organ or tissue but are usually found in the lung or liver. A case report of a 35-year-old man with an intra-ocular cyst that was admitted at the Government Medical College Hospital in Chandigarh, India is discussed.

Objectives: To evaluate the results of fine needle aspiration cytology (FNAC) in the diagnosis and management of thyroid lesions. Materials and Methods: A review was conducted of FNAC of diffuse or nodular thyroid lesions performed on 434 patients over a period of three years. The cytological results were correlated with clinical features, biochemical investigations, and subsequent histopathological examination and management of the patients. Results: The most frequently encountered lesion was the colloid goiter in 250 (57.60%) cases followed by thyroiditis in 119 (27.41%) cases, ten (2.30%) adenomatous goiters and two (0.004%) thyroglossal cysts. In the neoplastic group, 14 (1.38%) cases were reported as follicular/Hurthle cell neoplasms and 17 (3.91%) as malignant tumors. When compared with the clinical diagnosis, FNAC proved to be an improvement on the diagnosis of thyroiditis and malignancy when compared with that of goiter. FNA revealed a sensitivity of 97%, a specificity of 100%, a positive predictive value of 96% and a negative predictive value of 100%. Conclusions: FNAC is a minimally invasive, highly accurate and cost-effective procedure for the assessment of patients with thyroid lesions. It also helps in differentiating lesions that require surgery from those that can be managed otherwise.

A 58-year-old-man presented with painful rapidly progressive bilateral proptosis with restricted ocular movements of 15 days duration. There was history of significant weight loss in the recent past. Computed tomography scan of the head and orbit revealed bilateral multiple, well-defined, round, soft tissue masses, isointense with muscles in intraconal and extraconal space. Fine needle aspiration cytology and incision biopsy from the lesion, urine for Bence-Jones proteins and immunofixation clinched the diagnosis of multiple myeloma. Skeletal survey did not reveal any bony involvement. The diagnosis of multiple myeloma should be kept in mind in cases of bilateral proptosis. Bony involvement is not universal in cases of orbital myeloma. Early diagnosis can be established with extensive biochemical and histopathological investigations and timely treatment is life saving for these patients.

Acne agminata or lupus miliaris disseminatus faciei is a chronic granulomatous inflammatory disorder-affecting adults of both sexes which terminates spontaneously with scarring. Histopathologically, the papules show granulomas consisting of epithelioif cells, Gaint cells, with or without caseation necrosis along with periappendigeal lymphomononuclear cell infiltrate in the dermis. The exact aetiopathogenesis of this condition is still unknown. We report 3 cases of this uncommon dermatoses recently seen by us.

Rosai Dorfman Destombes disease, also known as sinus histiocytosis with massive lymphadenopathy, is a rare non-neoplastic idiopathic disorder characterised by histiocytic proliferation with evidence of emperipolesis. They present with a varied spectrum of clinical manifestations and cytomorphological features, posing diagnostic challenges and therapeutic dilemmas., (© 2024 John Wiley & Sons Ltd.)

Objectives: To determine the efficacy of quantitative shear wave elastography in differentiating benign and malignant axillary lymph nodes (ALN)., Methods: Exactly 127 lymph nodes from 127 patients with clinically palpable axillary swelling were examined by both B-mode sonography and elastography from November 2022 to March 2024. Gray-scale sonograms were evaluated based on: the short-axis diameter, shape, hilum, maximum cortical thickness, and border of the ALN. Shear wave elastography determined the mean elasticity modulus (E-mean) and elasticity ratio (E-ratio). Fine needle aspiration cytology or histopathological examination was kept as the gold standard and diagnostic performance shear wave elastography was compared., Results: The data showed that out of 127 lymph nodes, 77 (60.6%) were benign and 50 (39.4%) were malignant based on pathological results. The E-mean for malignant lymph nodes (mean, 73.15 kPa) was higher than that for benign lymph nodes (mean, 21.47 kPa; P < .001). The area under the receiver operating characteristic curve for E-ratio in predicting malignant and benign lymph nodes was 0.897 (95% CI: 0.839-0.955). The E-ratio for malignant lymph nodes was also higher (mean, 10.2) than for benign nodes (mean, 2.95; P < .001). The area under the receiver operating characteristic curve for E-ratio in predicting malignant and benign lymph nodes was 0.816 (95% CI: 0.733-0.899)., Conclusion: Our results showed a significant association between tissue elasticity and pathological correlation., (© 2025 American Institute of Ultrasound in Medicine.)

Background: Hodgkin lymphoma (HL) is a hematopoietic neoplasm characterized by malignant Reed-Sternberg (RS) cells in an inflammatory background. Although the cytological features of HL are well elucidated in literature, yet many postulated factors cause its misdiagnosis. This study aims to assess the diagnostic reliability of fine needle aspiration cytology (FNAC) in HL and evaluate the factors contributing to a false-negative and false-positive diagnosis, taking histopathology as the gold standard., Methods: This was a retrospective study in which 47 cases of HL diagnosed on histopathology were compared with their prior cytological diagnosis., Results: The patient's age ranged from 3 to 80 years (median: 36 years) with a M:F ratio of 2.9:1. Lymph node aspirations were performed from multiple anatomical sites, out of which the cervical was the most common (57.8%). FNAC was inconclusive in two cases due to unsatisfactory smears. The false-negative diagnosis of reactive lymphadenitis was given in four cases, and false-positive in four cases, which included three cases of non-HL, and one case of malignant small round blue cell tumor. The overall diagnostic accuracy of FNAC in the diagnosis of HL was 82.2%., Conclusions: The cytological diagnosis of HL can be challenging when classic RS cells are absent. Contributing factors for a false-negative diagnosis include obscuring reactive inflammatory cells, fibrosis of the involved lymph nodes, partial involvement of the lymph node, and misinterpretation. A thorough clinical examination with evaluation of FNAC smears from multiple areas, and ancillary tests help improve the diagnostic accuracy of cytological diagnosis., (© 2024 Wiley Periodicals LLC.)

Abstract: The abuse of illicit drugs causes a myriad of systemic complications. Intravenous (IV) injection of such drugs poses various additional threats, primarily due to the use of excipient materials in them. Pulmonary artery embolism with foreign material and granulomatosis may be encountered in the lungs on histopathological examination in such cases. In this study, we aimed to analyze the histopathological findings in lungs in postmortem specimens with suspected IV drug abuse. This was a retrospective study of 5 years in which 15 cases of known or suspected history of drug abuse were assessed. The clinical details were compiled, and the hematoxylin and eosin (H and E)-stained microscopic slides were retrieved from the archives for reviewing the histopathological features in lungs submitted for postmortem analysis. All the cases were male, aged 21 to 36 years (median: 27 years). Gross examination revealed edematous lungs in four cases (26.6%). On microscopic examination of the lungs, all the cases (100%) showed the presence of basophilic irregular structures to rod-like pale crystalline refractile material, which was accompanied by a granulomatous reaction in the lumen of the pulmonary arteries. Four of these cases (26.6%) showed birefringence on polarizing microscopy. The use of illicit drugs is becoming widespread, especially among young individuals. IV drug abuse increases the rate of morbidity and mortality by affecting primarily the pulmonary vasculature, particularly pulmonary arteries. An acquaintance with the various patterns of pulmonary involvement in IV drug abuse is essential to arrive at an accurate pathological diagnosis and provide a possible cause of death in such cases., (Copyright © 2024 Indian Journal of Pathology and Microbiology.)

Aim: To evaluate thyroid nodules with sonoelastography and magnetic resonance imaging (MRI)., Materials and Methods: The study included 28 patients with 40 thyroid nodules. Clearance was obtained from the institute's ethical clearance committee. Patients with pure cystic nodules or nodules with eggshell calcification, diffuse thyroid pathology (such as Graves' disease, Hashimoto's thyroiditis, De Quervain thyroiditis, and Riedel's thyroiditis), inaccessible nodules via fine needle aspiration cytology (FNAC), or patients with a history of thyroid gland surgery were excluded from the study. Strain elastography was performed on a Phillips iU22 machine, producing qualitative color-coded strain maps (graded using the Rago 5-point system) and semiquantitative strain ratios. MRI was performed on a Phillips ACHIEVA 1.5T magnet with a head and neck coil., Results: Rago scores statistically correlated ( χ 2 = 18.052, p < 0.001) with malignant nodules, and using the receiver operating characteristic (ROC) curve, the area under the ROC curve (AUROC) for the mean strain ratio predicting malignant outcomes was 0.88 [95% confidence interval (CI): 0.767-0.992], which was also statistically significant ( p < 0.001). A cutoff of mean strain ratio ≥2.48 predicted malignant outcomes with 100% specificity. T2 signal intensity ratio (SIR) and apparent diffusion coefficient (ADC) values were not statistically significant in predicting malignant outcomes. Kinetic curves were statistically significant for Rago scores ( χ 2 = 11.356, p = 0.045); however, no significant difference was found in predicting malignant outcomes., Conclusion and Clinical Significance: We concluded that sonoelastography, along with grayscale ultrasound, is a useful noninvasive technique for predicting histological outcomes. However, MRI should largely be reserved as a problem-solving tool rather than a standalone imaging modality. The kinetic curves show some degree of overlap between histologically distinct diseases, and thus large-scale multicenter trials are needed for further standardization., (© Journal of the Association of Physicians of India 2024.)

Background: Malignancy in pleural effusion is an indication of poor prognosis. The distinction between malignant cells and reactive mesothelial cells in effusion cytology is sometimes difficult and requires ancillary techniques. Evaluation of morphological indicators of chromosomal instability (CI) like micronuclei (MN), chromatin bridging (CB), nuclear budding (NB), and multipolar mitosis (MM) on routine cytology smears is a promising tool to distinguish malignant from benign ascitic fluids. However, it has been scarcely evaluated in pleural effusions. The present study was conducted to evaluate the diagnostic value of these markers in differentiating between malignant and benign pleural fluids., Methods: It is a cross sectional study in which a total of 72 pleural fluid samples over a period of 2 years received in the cytology department of the hospital were evaluated. The cytological analysis was done by two independent cytopathologists and interpreted as either malignant or benign. Four morphological markers of CI were counted in the May-Grünwald Giemsa (MGG) stained smears of all the cases and the score was compared with the conventional cyto-morphological diagnosis., Results: Out of 72 cases, there were 42 malignant and 30 benign effusions on cytological examination. The mean score of micronuclei count, nuclear budding, chromatin bridging and multipolar mitosis in malignant effusions were 7.26 ± 2.74, 9.55 ± 5.53, 1.83 ± 1.17, and 2.21 ± 1.62 respectively that was significantly higher than the benign effusions (1 ± 0.71, 1.1 ± 0.86, 0.38 ± 0.50, and 0.15 ± 0.37 respectively) (p < .05). On Receiver operating characteristic (ROC) curve analysis, a cut-off of 5 for the MN count had a sensitivity of 88% and specificity of 100% in detecting malignant pleural effusion [Area under curve (AUC) 95.8%, p < .001]., Conclusion: Evaluation of morphological indicators of CI on routine MGG stained smears is a simple and cost-effective method to differentiate between benign and malignant pleural fluids., (© 2023 Wiley Periodicals LLC.)

Purpose: Brachytherapy is the gold-standard treatment for choroidal melanoma. This study evaluated iodine-125 brachytherapy by using Ocuprosta seeds with indigenous non-collimated plaques in Asian patients., Methods: Retrospective single-center study in a tertiary care hospital of 12 eyes with choroidal melanoma in 12 Asian patients who underwent brachytherapy with Ocuprosta seeds fixed on non-collimated plaques and had a follow-up of at least 32 months (mean: 42.4 ± 9.5 months; median: 40 months). Radiotherapy was planned after developing the digital 3D model of the tumor within the eye by using radiological images and clinical pictures. Ocuprosta iodine-125 seeds were used on indigenous non-collimated gold plaques to deliver the radiation for precalculated time. "Successful outcome" was taken as a decrease in the volume of the tumor, and "unsuccessful outcome" was defined as no change in the tumor volume or increase in the tumor volume at 24 months after brachytherapy., Results: The mean decrease in tumor volume was 21% (914.5 ± 912.2 mm3 to 495.7 ± 633.6 mm3) after brachytherapy, which correlated with the baseline volume of the tumor. Ten eyes (83.3%) showed a reduction in tumor volume, whereas two eyes showed an increase in the volume of the tumor after brachytherapy. One of the cases with a reduction in tumor size developed neovascular glaucoma. Enucleation was done in three eyes. A globe salvage rate of 75% and tumor regression rate of 83% were seen in the present study using Ocuprosta seeds., Conclusions: Iodine-125 brachytherapy with uncollimated indigenous gold plaques is an effective treatment modality for choroidal melanomas in Asian patients., (Copyright © 2023 Copyright: © 2023 Indian Journal of Ophthalmology.)

Background: Although nucleation kinetic data is quite important for the concept of supersaturation behavior, its part in rationalizing the crystallization inhibitor has not been well understood., Objective: This study aimed to investigate the nucleation kinetic profile of Dextromethorphan HBr (as an ideal drug, BCS-II) by measuring liquid-liquid phase segregation, nucleation induction time, and Metastable Zone width., Methods: Surfeit action was examined by a superfluity assay of the drug. The concentration was scrutinized by light scattering techniques (UV spectrum (novel method) and Fluorometer (CL 53))., Results: The drug induction time was 20 min without polymer and 90 and 110 min with polymers, such as HPMC K15M and Xanthan Gum, respectively. Therefore, the order of the polymer's ability to inhibit nucleation was Xanthan Gum > HPMC K15M in the medium (7.4 pH). Similarly, the drug induction time was 30 min without polymer and 20, 110, and 90 min with polymers, such as Sodium CMC, HPMC K15M, and Xanthan Gum, respectively. Therefore, the order of the polymer's ability to inhibit nucleation was HPMC K15M > Xanthan Gum > Sodium CMC in SIFsp (6.8 pH), which synchronizes the polymer's potentiality to interdict the drug precipitation., Conclusion: The HPMC K15M and xanthan Gum showed the best crystallization inhibitor effect for the maintenance of superfluity conditions till the drug absorption time. The xanthan gum is based on the "glider" concept, and this shows the novelty of this preliminary research. The screening methodology used for rationalizing the best polymers used in the superfluity formulations development successfully., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Vocal cord nodule is a common reactive transformation of the laryngeal mucosa encountered routinely. Although benign, rare instances of stromal atypia have been demonstrated, which can often be confused with other spindle cell lesions. There is a dearth of literature explaining this peculiar transformation. Hence, the diagnosis of these lesions can be put-forth only after histopathological evaluation and appropriate immunohistochemical analysis. Herein, we report a case of a 55-year-old male who presented with vocal cord nodule with stromal atypia., Competing Interests: Conflict of InterestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background : Malignancy of the breast is one of the most common cancers among females worldwide. Magnetic resonance mammography (MRM) is a valuable complement to conventional methods for the early diagnosis of disease, thereby providing patients with a better prognosis. The number of unnecessary biopsies and repeated excisions in cases of indeterminate breast lesions detected on conventional imaging is high. Aims : The purpose of this study was to evaluate the role of MRM in the evaluation of indeterminate breast lesions [Breast Imaging Reporting and Data System (BIRADS) 3/4] found in conventional mammography and ultrasonography (USG), taking the histopathological examination (HPE) as the gold standard. Materials and methods : A total of 38 patients with conventional radiological imaging diagnosis of indeterminate breast lesions (BIRADS 3/4) were included in this study and evaluated using contrast-enhanced MRM according to the MR-BIRADS lexicon (5th edition). Morphological characteristics of lesions were evaluated to determine the probability of malignancy. Histopathology was kept as the gold standard for comparing all the statistical parameters. Results : There were a total of 40 lesions, 35 masses, and five nonmass enhancement (NME) available for evaluation out of the 38 patients. The sensitivity of margins to detect malignancy approached 100%; however, it had a slightly lower specificity of 66.67%. Magnetic resonance imaging (MRI) showed good diagnostic performance with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 85, 90, 89.47, 85.71, and 87.50%, respectively. Conclusion : The MRI has been shown to be useful as a problem-solving tool in breast cancer screening, clarifying indeterminate findings and avoiding unnecessary short follow-ups and percutaneous biopsies. How to cite this article : Mishra E, Kaur N, Kaur R, et al. Role of Magnetic Resonance Mammography in the Evaluation of Indeterminate Breast Lesions. J Assoc Physicians India 2023;71(11):76-84., (© Journal of the Association of Physicians of India 2023.)

Background: Skin malignancies are the most common form of malignant disease in the western world, predominantly affecting older age groups. The majority of skin cancers are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma, which account for more than 95% of total skin malignancies. However, in India, these constitute only 1-2% of all cancers. There is an increase in incidence in India over 10 years of period. There is scarcity of data on the clinico-pathological profile of these tumours from this geographical region., Materials and Methods: This was a retrospective study conducted in a tertiary care teaching hospital in which archival records and histopathology sections of all patients of skin carcinomas diagnosed over a period of 5 years (January 2016 to December 2020) were analysed. The clinical parameters and histopathological features of the cases were analysed and correlated for any possible association., Results: Out of the 230 skin malignancies studied, SCC constituted the most common type ( n = 148), followed by BCC ( n = 70) and malignant melanoma ( n = 12). The tumour commonly presented in the 6 th decade of life with slightly higher male preponderance (M: F =1.6:1). Sun-exposed areas were the most common sites, and the common presentations included non-healing ulcer, fungating/cauliflower/polypoidal growth, and hyperpigmented or nodular plaque. In SCC, previous history of diabetes and burns was noted in 10% and 3.4% of the patients, respectively., Conclusion: SCC is likely the most common histological type of skin malignancies in India. The clinico-pathological profile of skin malignancies of patients depends on multiple factors, notably the skin colour and the geographical location., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Dermatology.)

Context: The conventional smears (CS) and Liquid based cytology (LBC) are important tools to detect carcinoma cervix and its precursor lesions., Aims: The present study was done to compare the cytomorphological features of cervical lesions using both techniques and compare with the histopathological diagnosis., Settings and Design: This was a prospective observational study over a period of 1.5 years at a tertiary care hospital., Methods and Material: A total of 969 women in the age group of 21-65 years presenting with either routine screening or complaints of vaginal bleeding, discharge, or pelvic pain were enrolled for the study. Both the CS and LBC smears were analyzed and compared with the corresponding histopathology diagnosis. The data was analyzed using Statistical Package for the Social Sciences (SPSS) software and P values <0.05 were considered significant., Results: There were 8.57% unsatisfactory smears in CS as compared to 0.5% in LBC smears. Liquid-based cytology was superior to conventional preparations in terms of smear adequacy, lesser hemorrhagic and inflammatory background, and presence of more endocervical cells. Liquid-based cytology showed a better yield in detecting all the types of epithelial cell lesions with a concordance rate of 73.9% between the two techniques. On histopathology correlation of these lesions, LBC had a higher sensitivity (96.67%) and diagnostic accuracy (99.08%) as compared to CS (73.33% and 92.66%, respectively)., Conclusions: Liquid-based cytology is superior to conventional cytology for the detection of epithelial cell lesions. Reduction in the unsatisfactory smears, a cleaner background, and better representation of the sample are more significantly appreciated on LBC in contrast to CS., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Cytology.)

Magnetic resonance imaging (MRI) of breasts using diffusion-weighted imaging and dynamic contrast enhancement is now well-established imaging for the evaluation and characterization of suspicious breast lesions, where it has become a problem-solving tool. Breast lesions are characterized according to their morphological features and enhancement characteristics. Breast MRI is helpful in the evaluation of breast lesions in patients with dense breasts and women with breast implants and to differentiate scars and recurrence. However, this technique has its own limitations, a few of which are elucidated in the present case report., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mishra et al.)

Background: Cytomorphological distinction between hepatocellular carcinoma and metastatic tumors to the liver may be difficult, especially when these have poor differentiation. The present study was done to assess the diagnostic utility of hepatocyte paraffin-1 (HepPar-1), CD10, and CD34 in differentiating hepatocellular carcinoma from metastatic carcinoma., Materials and Methods: Ultrasound-guided fine-needle aspiration was performed on 50 patients with space-occupying lesions of liver suspicious for malignancy on clinical/radiologic findings. The cytological assessment was done on smears stained with May-Grünwald-Giemsa and hematoxylin and eosin. Cell blocks were prepared, and immunostaining for HepPar-1, CD10, and CD34 was done., Results: In these 50 patients, hepatocellular carcinoma was diagnosed in 7 and metastatic tumors in 43 cases. The sensitivity of smears in diagnosing hepatocellular carcinoma was 100% and the specificity was 95.3%, while the sensitivity and specificity of cell block were 100%. A canalicular pattern of CD10 immunoreactivity had a 100% positive predictive value for diagnosing hepatocellular carcinoma. CD10 had a sensitivity of 57.1% and 41.9% in identification of HCC and metastatic tumors, respectively. For the diagnosis of hepatocellular carcinoma, the sensitivity of CD34 was 85.7% and the specificity of sinusoidal pattern of immunoreactivity was 100%. The sensitivity and specificity of granular cytoplasmic staining pattern of HepPar-1 were 100% in hepatocellular carcinoma., Conclusions: The staining patterns of HepPar-1, CD10, and CD34 are highly specific in distinguishing hepatocellular carcinoma from metastasis. These three immunomarkers should be included in the immunocytochemical panel for differentiating hepatocellular carcinoma from metastatic carcinoma to the liver., Competing Interests: None

Introduction: Fine-needle aspiration cytology (FNAC) forms one of the first-line investigations in the evaluation of tumors in modern era. Its role in diagnosing soft tissue tumors (STT) has been well established. However, the morphological overlap and biological heterogeneity of STT pose a morphological diagnostic challenge., Aims: To evaluate the scope of FNAC in diagnosis and categorization of STT and to correlate the cytological features with histological findings wherever available, and to analyze the reasons for discordance, if any., Materials and Methods: All FNAs of cytologically diagnosed STT during 5-year period were retrospectively analyzed. FNAC smears stained using May-Grünwald Giemsa, Pap- and hematoxylin and eosin, were evaluated and interpreted inconjunction with clinical details. Cellblock and immunocytochemistry (ICC) was done, wherever required to render the final diagnosis., Results: Of the total 15,844 FNAC done in 5 years, 1319 (8.3%) cases were diagnosed as STT. Benign tumors comprised the majority (94.2%), whereas 5.8% were diagnosed to be malignant. These were further grouped according to the cytomorphological features into adipocytic (82.2%), benign spindle cell lesions (10.8%), vascular (1.4%), spindle cell sarcoma/sarcoma NOS (2.2%), myxoid (0.3%), round cell tumors (0.9%), metastatic tumors (1.9%), and others (0.3%). The cytological findings were corelated with histopathological findings, which were available in 316 cases. The specificity and sensitivity calculated for detecting malignancy was 99.2% and 95.4%, respectively. The overall diagnostic accuracy for diagnosing malignancy was 98.7%. Among the group of non-adipocytic tumors, the sensitivity, specificity, PPV, NPV calculated for diagnosing a malignant tumor (irrespective of exact sub-categorization) is 95.2%, 100%, 100%, and 96.4%, respectively. The overall diagnostic accuracy in non-adipocytic tumors is 97.92%., Conclusion: FNAC is a simple, cost effective, and minimally invasive method in diagnosing STT with good sensitivity and specificity. It is of utility not only in primary lesions, but also for metastatic tumors, and for the documentation of locally recurrent soft tissue neoplasms., (© 2022 Wiley Periodicals LLC.)

Tumours developing after a protracted period of time in burn scars are a notable complication with carcinomas forming a major share. The occurrence of burn scar sarcomas is scarce with dermatofibrosarcoma protuberans (DFSP) being an uncommon entity having only three prior reported cases. The authors report a case of a 32-year-old male patient with a 5 year prior history of thermal burn who presented with an expanding painless swelling for 2 years in the right flank region, diagnosed as DFSP on fine needle aspiration cytology and subsequently confirmed on histopathology., (© 2021 John Wiley & Sons Ltd.)

Objective: Morphological indicators of chromosomal instability (CI), including multipolar mitoses, chromatin bridges (CB), strings, nuclear buds (NB), micronuclei (MN), and deoxyribonucleic acid (DNA) ploidy analysis help in prognostication of breast carcinoma. The present study was done to evaluate CI in breast carcinoma and correlate with DNA ploidy and tumor grade., Study Design: Fifty cases of carcinoma breast diagnosed by fine-needle aspiration cytology were included. Robinson's grading method was used on smears to grade breast carcinoma. To assess the morphological features of CI, the best May-Grünwald Giemsa stained smear was chosen. At least 1,000 epithelial cells on oil immersion magnification (×100 objective) were counted. DNA ploidy on the aspirates was done by flow cytometry., Results: All the patients were female, diagnosed as infiltrating ductal carcinoma on cytology. Eight tumors were grade I, 32 were grade II, and 10 were grade III. MN was seen in 48 cases, NB in 45, and CB in 12 cases. Mean MN, NB, and CB scores in aneuploid (24) cases were 9.96 ± 8.42, 5.29 ± 4.71, and 1.08 ± 1.84 while 6.19 ± 6.67, 1.92 ± 1.79, and 0.11 ± 0.33 were seen in diploid (26) cases. Statistically significant positive correlation was observed between CI and DNA ploidy., Conclusions: Morphological evaluation of CI by light microscopy on routinely stained breast aspirates is feasible, although a meticulous search is required. Cytomorphological features of CI and ploidy have a positive correlation with increasing tumor grade., (© 2022 S. Karger AG, Basel.)

Most cases of retinoblastoma are diagnosed before the age of 5 years. The cases in older age groups can have variable presentations leading to misdiagnosis and management challenges. We report a case of retinoblastoma in an 8-year-old female who was primarily referred as a case of sympathetic ophthalmia due to a co-incidental misleading history of penetrating eye injury to other eye 3 weeks prior. The patient complained of decreased vision in the left eye after 3 weeks of repair of the corneo-scleral laceration in the right eye. Visual acuity in the right and left eye was 3/60 and light perception respectively. The anterior segment examination showed moderate sized keratic precipitates, intense inflammatory cellular reaction with large fluffy cells, hypopyon and dense vitreous exudates. Ultrasonography showed abundant hyperechoic contents within the vitreous cavity in the left globe. The retino-choroid was thickened. The possibility of endophthalmitis and sympathetic ophthalmia was considered. Diagnostic vitrectomy was planned. Intraoperatively, after clearing the exudates, a yellowish white mass lesion was seen superiorly. Post- operatively contrast-enhanced MRI scan confirmed the presence of an enhancing mass lesion in the globe consistent with the diagnosis of intraocular retinoblastoma. Enucleation of left globe was done after chemotherapy. Thus, a high risk of suspicion has to be kept for this malignant tumour in children with unexplained visual loss.

Intraoperative pathologic consultation plays an essential role in therapeutic decision making, possibly avoiding under or overtreatment of the patient. Common indications for intraoperative consultation include obtaining a diagnosis in an unknown pathology, ruling out malignancy, confirming a provisional diagnosis, and assessing margin status. Fifty patients undergoing surgery for soft tissue tumors or tumor-like lesions were included in the present prospective study to evaluate the role of intraoperative pathologic consultation by imprint and scrape cytology. Careful and quick gross examination of the specimen was performed, followed by processing for imprint and scrape smears. The prepared smears were evaluated by three pathologists and the cytological diagnosis compared subsequently with final histopathological diagnosis. Intraoperative consultation was primarily requested to make or confirm preoperative diagnosis. In 44.0% cases, no previous tissue/cytological diagnosis was available. In 56.0% cases, previous pathological diagnosis was available, but the reports were inconclusive or were reported from outside our institute. The diagnostic yield of imprint smears was 24% (5 malignant, 6 benign, and 1 inconclusive), and scrape smears was 100% (10 malignant, 38 benign, and 2 inconclusive). Paraffin-embedded sections yielded diagnosis in 100% cases (11 malignant, 38 benign, and 1 nonneoplastic). Imprint smears alone were not of much help in intraoperative diagnosis. Scrape smears were found to be superior to imprint smears in terms of diagnostic yield and accuracy. Combined imprint and scrape smear cytology did not provide any advantage in intraoperative provisional tissue diagnosis in soft tissue tumors., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Rupali Gautam et al.)

Background: The use of fine-needle aspiration (FNA) as a primary tool in the diagnosis of breast carcinoma provides opportunity for early proliferative characterization of the tumor. This study was undertaken to assess DNA ploidy and S-phase (SPF) fraction by flow cytometry in fine needle aspirates of patients with breast cancer., Method: Fifty patients of breast cancer diagnosed on fine needle aspiration cytology (FNAC) and who subsequently underwent either mastectomy or lumpectomy were included. Material obtained by FNAC was subjected to DNA ploidy and SPF analysis. Immunohistochemical estimation of Ki-67 was done on histopathology sections. The proliferation markers (SPF and Ki-67) were compared with each other and with the histopathologic parameters., Results: On DNA flow cytometry, 27 (54%) cases were aneuploid and 23 (46%) cases were diploid. The median SPF was 12.43% and 4.03% in aneuploid and diploid tumors respectively. Median Ki-67 among aneuploid tumors was 28.6% compared to 8.7% among diploid tumors. Aneuploid tumors were significantly associated with higher values of SPF and Ki-67, with Kappa 0.437 and agreement of 72%. Diploid tumors showed lower values of SPF and Ki-67, with Kappa 0.455 and agreement of 72.7%. Correlation among SPF and Ki-67 was highly significant with Kappa value 0.446, P value of .002 and agreement of 72.3%., Conclusion: DNA ploidy and proliferative activity by flow cytometric SPF estimation on fine needle aspirates from breast cancer can provide valuable prognostic and predictive information at the time of diagnosis in patients with breast cancer. This might help in selection of appropriate treatment modality., (© 2021 Wiley Periodicals LLC.)

Background: Circulating tumor cells (CTCs) are cells present in the blood stream that are antigenically or genetically similar to a specific tumor type and are markers of tumor diagnosis, prognosis, residual disease and metastasis. The ever-increasing burden of breast cancer globally warrants the incorporation of this all-inclusive marker in the diagnostic repertoire using the simplest of techniques., Aims: To identify CTCs in peripheral blood by cell block (CB) technique in cases of breast cancer diagnosed on fine-needle aspiration (FNA) or core needle biopsy (CNB) and to correlate their presence with nodal metastasis., Material and Methods: This study was conducted in the Department of Pathology, at a tertiary care hospital. Peripheral blood samples from a total of 30 cases of primary breast carcinoma diagnosed on FNA or CNB without prior neoadjuvant chemotherapy were analyzed using the CB technique., Results: The age ranged between 29-74 years with the most common presenting complaint being a palpable, single, unilateral breast lump. CTCs were detected in 2 (6.7%) cases with a <5 cell cluster with both the cases being grade I breast carcinomas and also displaying nodal metastasis., Competing Interests: None

Background: Human papilloma virus (HPV) testing can be useful in work-up of patients presenting with cervical node metastasis, suspected to be of head and neck origin as HPV positive tumors show better response to therapy. The current study was planned to detect HPV in aspirates from metastatic cervical nodes using p16 immunocytochemistry in head and neck squamous cell carcinoma (HNSCC). Further correlation of HPV status between node metastasis and primary tumor was done., Methods: The prospective study included 50 patients diagnosed as metastatic SCC in cervical nodes on fine needle aspiration with either known head and neck primary or primary detected post cytodiagnosis. Immunostaining for p16 was carried out on both smears and tissue sections., Results: Forty-three patients were male and seven were female. Age of the patients ranged from 35 to 80 years. Primary sites of HNSCC were oropharynx (25), oral cavity (14), and larynx (11). Immunocytochemistry for p16 on smears showed positivity in 28 cases. Immunohistochemistry for p16 in primary tumors was positive in 34. There was substantial agreement between p16 immunocytochemistry and immunohistochemistry (Kappa value: 0.823). The sensitivity of p16 immunocytochemistry for the detection of HPV in metastatic HNSCC was 82.4% while the specificity was 100%. The positive and negative predictive values were 100% and 72.7%, respectively., Conclusions: P16 immunocytochemistry in HNSCC metastatic to cervical node mirrors the HPV status of the corresponding primary tumor. Hence in tumors of unknown origin presenting as cervical node metastasis, p16 immunocytochemistry can be employed for localization of the primary., (© 2021 Wiley Periodicals LLC.)