Search

We report a case of primary umbilical endometriosis a rare clinical entity, with an incidence of 0.5–1% of all the patients of endometriosis. 1 Endometriosis as such is a common gynecological condition and pelvis being the most common site of the disease. Extra pelvic site is less common and even more difficult to diagnose due to the extreme variability in presentation. Extra genital endometriosis is less common but has been described almost in every area of female body including bowel, bladder, lungs, brain, umbilicus and surgical scars. A 35 years old multi para presented to surgical OPD with complains of swelling at Umbilicus for past 3 months. FNAC was advised on OPD basis which to our surprise revealed an adenocarcinoma. Excision Biopsy with Umbliectomy was done which confirmed endometriosis of umbilicus.

Follicular dendritic cell sarcoma (FDCS) is a rare malignant tumor that could arise in both nodal and extranodal sites, with only nine previously reported cases demonstrating cytologic features. In this report, we describe a case of FDCS in a 60-year-old female who presented with neck mass. Fine-needle aspiration cytology and subsequent core biopsy were suggestive of metastatic carcinoma. The cytologic features were epithelioid-to-spindle cell morphology, vesicular nuclei, prominent nucleoli, intranuclear inclusions, and occasional binucleated and multinucleated forms. However, absence of cytokeratin expression was against the diagnosis of metastatic carcinoma. The definitive diagnosis was reached by the demonstration of CD21 and CD23 expression. The pathologist should be aware of this rare malignant tumor, especially its cytologic features in aspirated material. The differential diagnosis in the above case was metastatic carcinoma, melanoma, and malignant granular cell tumor. The demonstration of expression of one or more dendritic cell marker is the clue for the diagnosis, which could be applied on cytological preparations with sufficient material.

Granulomas are a rare finding on Papanicolaou (Pap) smear which if encountered are usually attributed to tuberculosis, especially in an endemic country like India. Here, we report an interesting case of a 40-year-old female presenting with blood-stained discharge and chronic pelvic pain for 8 years. She was advised Pap smear which showed granulomatous inflammation suggestive of tuberculosis. The patient was worked up for tuberculosis which was noncontributory. Dilatation and curettage was done which revealed multiple small bones and bony chips in the endometrial cavity. Following the removal of bones, the patient showed considerable symptomatic improvement. Repeat Pap smear did not reveal any evidence of granuloma. Even after extensive search of literature, we did not come across any such case report in which intrauterine retention of fetal bones evoked a granulomatous response in cervical smears though the presence of uterine granulomas in response to foreign body has been well documented.

Context: Efficacy of immunocytochemistry (ICC) in determining molecular biomarkers like estrogen receptor (ER), progesterone receptors (PRs), and human epidermal growth factor receptor-2 (HER2). Aims: To evaluate biomarkers using ICC in breast cancer as per American Society of Clinical Oncology/College of American Pathology (ASCO/CAP) guidelines. Settings and Design: The study was conducted over a period of 2 years from September 2012 to August 2014 and is the first such study in eastern India. Materials and Methods: Fine needle aspiration cytology (FNAC) was done for suspected cases of breast cancers and slides were prepared using ThinPrep (TP) technology of liquid-based cytology (LBC) for ICC and corresponding biopsy specimens were processed as formalin fixed paraffin embedded (FFPE) sections for comparison. Both the LBC slides and tissue sections were subjected to immunostaining for ER, PR, and HER2. ICC was evaluated by Allred Scoring and IHC by Quick Scoring. Statistical Analysis Used: Statistical analysis done by Wilconxon Signed rank test on the SPSS program, Chicago, Illinois, USA. The results of ICC and IHC were compared by evaluation of sensitivity, specificity, kappa-value (k-value), positive predictive value (PPV), and negative predictive value (NPV). Results: The comparison of ICC with immunohistochemistry (IHC), ER, and PR showed very good correspondence rate, sensitivity, specificity, NPV, PPV, and agreement with k-value; whereas for HER2 the results were only good. Conclusion: ICC using LBC can be a useful tool in assessing biomarkers in advanced cases of breast cancer where surgery is not possible or cases where ASCO/CAP guidelines for management are not followed.

Background: Conventional Papanicolaou (Pap) stain has undergone many modifications; of these, ultrafast Pap stain is the most popular as it shortens the turnaround time of reporting. Application of modified ultrafast Pap (MUFP) stain in the evaluation of fine needle aspiration (FNA) samples and body fluids are scanty. Aim: To evaluate the utility of MUFP stain in various FNA samples and body fluids and compare the findings with those of conventional Pap stain. Materials and Methods: In this cross-sectional study, two wet-fixed and two airdried smears from each sample [301 samples (255 FNA samples and 46 body fluids)] were prepared and stained by the conventional Pap and MUFP stains, respectively. Concordant and discordant rate was calculated. Quality index (QI) of MUFP stain was assessed by background, overall staining, cell morphology, and nuclear characteristics. MUFP-stained smears were also categorized into excellent, good, and fair. Results: The concordance rate for MUFP stain was 100%. QI of MUFP stain for breast, thyroid, lymph node, soft tissue, salivary gland, and body fluids was 0.9, 0.93, 0.95, 1, 0.94, and 1, respectively. Excellent quality of stain was noted in 53.2% and good in 24.6% of the cases allowing easy diagnosis. In 22.2% of fair cases, diagnosis was possible with some difficulties. Conclusion: Our study concluded that MUFP stain could be considered as a rapid and reliable diagnostic tool and can be applied on a regular basis in FNA samples and body fluids to offer immediate diagnosis. However, caution should be taken while reporting certain MUFP-stained smears to avoid over/under diagnosis.

Objective: Multiple sclerosis is a multifactorial, autoimmune, chronic inflammatory demyelinating disease of the central nervous system. Recent studies do not give possibility to estimate the contribution of neurodegenerative changes in neurological deficit of individual patient, to predict the disease development and the effectiveness of therapy. The goal of our research was to investigate methylprednisolone and citicoline co-administration effect to the processes of energy providing of the mitochondria of the cerebral cortex neurons in experimental allergic encephalomyelitis. Materials and Methods: Experiments were carried out on rats of both sexes weighing 150-180 g. Experimental allergic encephalomyelitis was induced by a single subcutaneous inoculation of encephalitogenic mixture in complete Freund's adjuvant. As material we used brains. We studied markers of mitochondrial dysfunction and content of adenine nucleotides, lactate, malate, isocitrate, aspartate, pyruvate. We also studied the state of neurons, their area, RNA-content and proportion of apoptotic cells. Results: Formation of experimental allergic encephalomyelitis (EAE) led to permanent disturbance of energy metabolism of brain. The administrations of methylprednisolone did not have a significant effect. Co-administration of methylprednisolone and citicoline exerted significant influence on some parameters of mitochondrial dysfunction and brain energy metabolism. We also found neuronal damage of sensorimotor cortex of experimental animals and to the neuroapoptosis activation. Administration of methylprednisolone resulted in direct neuroprotective effect. Conclusion: Combination of citicoline and methylprednisolone limit activity of unproductive anaerobic glycolysis and increases aerobic ATP synthesis reaction. Thus the combination of citicoline and methylprednisolone does not affect the activity of malate aspartatic shunt in EAE conditions.

Objective: The objective of this study is to delineate the clinical and laboratory profile of infectious mononucleosis due to Epstein-Barr virus (EBV) infection in children admitted to tertiary care teaching hospitals. Materials and Methods: Retrospective observational multicentric analysis of clinical and laboratory features of children between 1 month to 12 years with a diagnosis of infectious mononucleosis due to EBV infection confirmed by positive serology over a 12-month period after seeking approval from the Institutional Ethics Committee. Results: Out of 66 children screened, 53 were included in final analysis. The majority were aged between 5 and 8 years with male: female ratio of 1.2:1. Most presentations were during the monsoon months. The common clinical features were fever (100%), splenomegaly (86.7%), and cervical lymphadenopathy (73.5%) in contrast to the classical triad of fever, sore throat, and generalized lymphadenopathy described in the literature. There were no age differences in clinical findings except for generalized and cervical lymphadenopathy and hepatomegaly which were commoner in 9–12 years age band. Although the incidence of common findings matched with previously published studies, there were some notable differences. While frequencies of upper eyelid edema, epitrochlear lymphadenopathy, and splenomegaly were more, those of rash and sore throat were less. Lymphocytosis and presence of atypical lymphocytes were relatively less common in our series. All children recovered. Conclusions: This multicentric study on profiling childhood infectious mononucleosis, possibly first of its kind from Eastern India, has documented clinical and laboratory features associated with this condition. These data can serve as a reference for future studies.

Primary sarcomas of the urinary bladder or prostate are extremely rare entities. The rarity and lack of awareness makes it difficult for the cytologists to detect the spindle cell lesions in urine for malignant cytology. The literature available for the detection of urinary tract sarcomas is little. Here, we report the urine cytology findings of two interesting cases of urinary bladder and prostatic leiomyosarcoma.

Background: In developing countries, cervical cancer is the most common cancer cause of death among women. Aim: This study was undertaken to evaluate the cervical cytology smears in postmenopausal and elderly age group women, and also to assess the usefulness of cytological screening in elderly women. Materials and Methods: In this prospective study, a total of 600 Papanicolaou smears were evaluated and categorized according to Bethesda system for reporting cervical cytology 2014. Of these, 420 smears were obtained from postmenopausal women aged over 45-65 years and 180 were from elderly women aged over 65 years. Results: Overall, the prevalence of epithelial cell abnormality was 5.5%. Epithelial cell abnormalities found in elderly women were 10.5% and in postmenopausal women were 3.3%. Reactive cellular changes associated with inflammation were observed in 72.3% of postmenopausal women and 28.3% of the elderly female; whereas, atrophic changes were noted 61.1% in elderly female and 24.2% in postmenopausal women. Both these findings revealed statistically significant differences ( P Conclusion: The present study showed that postmenopausal and elderly female from rural areas and low socio-economic groups significantly suffered from precancerous lesions of the cervix; even though, the rate seems to be low. Hence, our study concluded that postmenopausal and elderly female should undergo cervical cancer screening to avoid morbidity and mortality.

Cytological examination of serous effusions helps in staging, prognostication and management of patients with malignancy. The method has disadvantage of lower sensitivity in differentiating reactive atypical mesothelial cells from malignant cells.The aim of this study is to compare the cytological features of pleural and peritoneal exudative fluids by conventional smear (CS) method and cell block (CB) method and also to assess the utility of a combined approach for cytodiagnosis of these effusions.One hundred and fifty-three pleural and peritoneal exudative fluid samples were subjected to evaluation by both CS and CB methods over a period of 2 years. Cellularity, architecture patterns, morphological features and yield for malignancy were compared, using the two methods. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for diagnosing malignancy were calculated by both methods, using histology as a gold standard.CB method provided higher cellularity, better architectural patterns and additional yield for malignancy as compared to CS method (P0.005). Sensitivity, specificity, PPV, NPV, and accuracy by CS method were 69.2%, 95%, 56.25%, 97.08% and 92.8%, while by CB method were 92.30%, 99.2%, 92.30%, 99.28% and 98.6%.The present study shows that it is advisable to routinely make CBs before discarding specimens that are suspicious for malignancy by smear examination.

Background: Conventional cytology (CC) is a well-established and effective methodology for the evaluation of pediatric tumors. Liquid-based cytology (LBC) is a better technique of smear preparation and is at present the standard protocol in cervical cytology samples. Aims: In the present study, we analyzed both smear preparatory techniques in fine-needle aspiration (FNA) samples from solid pediatric neoplasms in terms of adequacy and efficacy with objectives to study the changes in background and morphology of tumor cells in LBC smears. Materials and Methods: This was a prospective observational study conducted in a tertiary care teaching hospital, which included 52 pediatric patients with clinical diagnosis of malignancy and an assessable lump. Both conventional aspiration cytology and LBC smears were prepared as per standard protocols (SurePath BDTM) from FNA samples of cases and examined. Results and Conclusion: On comparing the diagnostic efficacy of cytology smears prepared by both techniques, LBC alone was diagnostic in 80.8% of the cases and conventional smear (CS) alone was diagnostic in 71.2% of the cases (agreement was 83.7%, P = 0.3). Cellular morphology was better preserved in LBC and interpretation was easier. There was a lower inadequacy rate in LBC and none of the samples was inadequate due to poor morphology in LBC smears (P = 0.0003). LBC showed an overall 40% improvement in inadequate cases by CS. LBC has been recommended as a complement to CC in nongynecological samples. Improved morphology and lower inadequacy rate make LBC a finer technique compared to CS in pediatric tumors as well.