Fine Needle Aspiration Research Articles

DIAGNOSTIC EFFICACY OF FNAC IN THYROID LESIONS, CLASSIFIED ACCORDING TO BETHESDA SYSTEM WITH CYTOHISTOLOGICAL CORRELATION

Objective: The objective of the study is to estimate the diagnostic accuracy (DA) of fine needle aspiration cytology (FNAC) in thyroid lesions with cytohistological correlation. Methods: The study was a cross-sectional study which was conducted in the Department of Pathology, Rabindranath Tagore Medical College, M.B.G. Hospital, Udaipur, Rajasthan, from December 2022 to December 2023. A total of 201 thyroid aspirations were performed, and the smears were classified according to The Bethesda system. Cytological and histopathological findings were compared in 132 cases that proceeded to surgery. Sensitivity, specificity, negative predictive value (NPV), positive predictive value, and DA were calculated using standard statistical methods. Results: The distribution of thyroid lesions on cytology was as follows: Non-diagnostic (1%), benign (92%), atypia of unknown significance (1%), follicular neoplasia (3%), suspicious for malignancy (2%), and malignant (1%). The sensitivity, specificity, positive predictive value, NPV, and DA in our study were 78.94%, 100%, 100%, 96%, and 96.9%, respectively. Conclusion: FNAC’s cost-effectiveness, patient-friendly nature, swift results, and high sensitivity, specificity, and accuracy render it a primary diagnostic tool for assessing patients with thyroid swelling preoperatively. The Bethesda system categorizes thyroid lesions cytologically, aiding in their diagnosis and subsequent management. Histopathological correlation facilitates the assessment of DA and ensures quality assurance.

Contrast-Enhanced Ultrasound for Diagnosing Thyroid Nodules With Indeterminate Cytology: A Retrospective Study.

A small number of thyroid nodules cannot be clearly diagnosed using ultrasound-guided fine needle aspiration biopsy. Contrast-enhanced ultrasound (CEUS) has high diagnostic performance for thyroid nodules. We explored the value of CEUS for diagnosing thyroid nodules with indeterminate cytology. Between September 2019 and July 2022, 27,646 patients with thyroid nodule(s) underwent conventional ultrasound (CUS) in our hospital. From these patients, 597 nodules were subjected to CEUS and ultrasound-guided fine needle aspiration biopsy and 116 thyroid nodules with indeterminate cytology diagnose were enrolled in this study. The independent risk factors for predicting malignancy were determined using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were drawn for CUS, CEUS, and CEUS combined with CUS. The area under the curve (AUC) was calculated and compared. Of the 116 thyroid nodules, 40 (34.5%) were benign and 76 (65.5%) were malignant. Univariate analysis showed that the shape, echogenicity, margin, microcalcification, enhancement intensity, enhancement homogeneity, wash in, and wash out were significantly different between benign and malignant thyroid nodules (all p < 0.05). Multivariate logistic regression analysis showed that taller-than-wide, irregular margin, microcalcification, hypo-enhancement, heterogeneity enhancement, synchronous/slower wash in, and synchronous/slower wash out were independent risk factors for malignancy (all p < 0.05). ROC curve analysis showed that the AUC of CUS and CEUS were 0.769 and 0.848, respectively. No significant difference was observed in the AUC between the two modalities (p > 0.05). However, the AUC (0.934) of the CUS combined with CEUS was significantly higher than that of CEUS or CUS alone (both p < 0.05). CEUS is helpful in diagnosing thyroid nodules with indeterminate cytology. CUS combined with CEUS is highly valuable for predicting malignancy.

Neck lumps: Early Detection with Dental Magnetic Resonance Imaging?

Cervical lymphadenopathy can indicate a range of diseases, including infections, inflammation, and neoplastic processes. Accurate diagnosis is crucial for identifying the underlying cause and determining appropriate treatment. Diagnostic procedures include clinical examination, ultrasound, fine needle aspiration, biopsy, and imaging techniques. While conventional imaging methods such as X-ray and computed tomography (CT) have proven useful, they exhibit limitations in sensitivity and specificity, especially for soft tissue structures. Magnetic resonance imaging (MRI) provides superior soft tissue contrast, offering additional critical information for differential diagnosis. This article presents a case study of a 29-year-old male with a cervical mass. Advanced dental MRI protocols, including DESS, SPACE-SPAIR, and SPACE-STIR sequences, have significantly enhanced the imaging capabilities of the den-tomaxillofacial region, enabling the generation of high-resolution images of both hard and soft tissues. Especially, MR OPGs have demonstrated the capacity to identify early signs of potential pathology. These protocols have the potential to enhance early detection, thereby con-tributing to accurate diagnosis and effective treatment planning.

Thyroid cytology in pediatric patients: a single-center study from 2015 to 2023-is there a necessity for distinct treatment approaches for patients with and without autoimmune thyroiditis?

The management of thyroid nodules is guided by the cytological classification provided by The Bethesda System for Reporting Thyroid Cytology. Notably, the biology of thyroid tumors in pediatric patients differs from that in adults, and there is limited research focused on pediatric cases. This study aimed to assess the effectiveness of the Bethesda system in pediatric patients treated at the largest tertiary pediatric thyroid center in Poland between 2015 and 2023. A retrospective analysis was conducted on 566 patients with thyroid nodules, of whom 555 underwent fine-needle aspiration biopsy (FNAB). A total of 217 patients underwent thyroid surgery. Of these, 206 had previously undergone FNAB with cytological evaluation at our center, while 11 patients underwent thyroid surgery due to a RET mutation or the need for an extended procedure. The initial FNAB results showed distribution across Bethesda categories as follows: 7.6% for category I, 54.6% for category II, 20.9% for category III, 4.1% for category IV, 7.6% for category V, and 5.6% for category VI. Among patients who underwent surgery, the distribution of Bethesda categories I through VI was 2.9%, 25.2%, 29.1%, 8.3%, 19.4%, and 15%, respectively. The risk of malignancy (ROM) from the initial FNAB was estimated at 33.3%, 11.5%, 22.2%, 4.8%, 84.4%, and 96.8% for Bethesda categories I through VI, respectively. In patients with autoimmune thyroiditis (AIT), the ROM was higher than in non-AIT patients for Bethesda categories I through IV, while it was lower in category VI. The sensitivity for detecting non-benign neoplasms across Bethesda categories III through VI was approximately 86% in both AIT and non-AIT patients. However, for papillary thyroid carcinoma, sensitivity in Bethesda categories V and VI was 86% in non-AIT patients but decreased to 61.5% in AIT patients. These findings emphasize the importance of considering surgical intervention in pediatric patients with Bethesda III-VI cytology, particularly in those with AIT.

Epidemiological, Clinical, Laboratory, and Radiological Characteristics of Children and Adolescents Diagnosed with Hashimoto's Thyroiditis: A Single-Center Experience.

This study aimed to investigate the epidemiological, clinical, laboratory, and radiological characteristics of children diagnosed with Hashimoto's thyroiditis and to present the experiences of a referral center. This study included 200 pediatric patients diagnosed with Hashimoto's thyroiditis between January 2020 and May 2024 at a single center. The data were extracted and compiled from the participants' medical records, including clinical information, physical examination findings, laboratory test results, and radiological imaging. Mean age of the study population was 11.3 ± 3.2 years at diagnosis, with a female predominance. At the time of clinical presentation, 8.5% of the study participants were 6 years of age or younger. The majority of patients, comprising 39.5% of the cohort, exhibited euthyroid thyroid function. Additionally, 33.5% of the patients were classified as having subclinical hypothyroidism, 22% demonstrated overt hypothyroidism, and 5% presented with hyperthyroidism. Approximately one-third of the study participants were referred for further evaluation due to the identification of abnormal thyroid function test results during routine screening examinations. 48% of the patients had a documented family history of thyroid disease. At diagnosis, 39.5% were prepubertal. The rate of overt hypothyroidism was higher in prepubertal patients compared to pubertal patients (41.8% vs. 9.1%, P < .005). Mean gland volume SDS was 2.61 ± 3.69, and 45.5% had goiter. Thyroid nodular lesions were identified in 5.5% of the study participants. Fine-needle aspiration biopsy was performed on five patients, revealing benign findings in three cases and atypia of undetermined significance in the remaining two cases. Patints with subclinical hypothyroidism who have a baseline TSH level exceeding 8.5 mIU/L at initial presentation and do not receive treatment are likely to progress to overt hypothyroidism during subsequent follow-up. Prepubertal cases were more frequently observed compared to previous reports, and the course of hypothyroidism was more severe in prepubertal patients. These findings suggest a potential shift towards earlier onset of autoimmunity in children. Further studies are warranted to substantiate this observation.

Comparison of Histopathology (Incisional Biopsy) Vs Fine Needle Aspiration Cytology in Diagnosing Tuberculous Cervical Lymphadenopathy

Objectives: To evaluate and compare the sensitivity and specificity between Fine Needle Aspiration Cytology (FNAC) and histopathology of incisional biopsy in diagnosing blood culture positive tuberculous lymphadenopathy (LAD). Methods: : This descriptive study was conducted in the Department of Pathology at Jinnah Teaching Hospital (JTH) Peshawar from January 2021 to August 2022. The study samples included were collected from thepatients at tertiary care Hospitals who were acid fast bacillus(AFB) positive and blood culture positive. The culture and sensitivity and Zn staining was carried out at JTH Peshawar. Seventy subjects with AFB and culture positive with high clinical suspicion of tuberculous LAD were included in the study. After the recruitment of subjects according to the inclusion criteria, subjects underwent FNAC followed by incisional biopsy for histopathology carried out at JTH Peshawar. Subjects’ blood was checked and screened for Hepatitis B and C, TLC, DLC and ESR at Microbiology and Haematology laboratories of JTH Peshawar respectively. The data was then organised and analysed in SPSS software version. 26. Results: Out of the seventy subjects included in the study, 30 were males while 40 were females. Subjects had a mean age of 33.5 years. The sensitivity of FNAC was 89%, however the Specificity came out to be 59%. Conclusion: Our study obviates the use of FNAC as a good screening test however due to the low specificity or in cases where there is a high clinical suspicion of TB, the results need to be confirmed by Incisional biopsy for histopathology. However, further studies are required for not only understanding the medical condition.

Eggshell Calcifications at Thyroid Ultrasound: A Sample-focused Analysis of Cytological Findings and Post-thyroidectomy Pathological Correlates

Eggshell calcifications at thyroid ultrasound are connected to the challenging field of thyroid nodules and/or malignancy from a multidisciplinary perspective. Calcifications may be found in malignant and benign tumors; typically, micro-calcifications are identified in the papillary type of cancer, being equivalent to psammoma bodies in the pathological report. The risk of macro-calcifications, however, is more nuanced; recent data suggest a potential connection with a differentiated malignancy as well. Eggshell calcifications, a distinct type of macro-calcification, are generally considered benign findings, especially uninterrupted forms. Yet, the real incidence is not clear, which is why the topic remains open. In this narrative review, we analyzed eggshell calcifications in relationship with cytological diagnosis upon fine needle aspiration and post-thyroidectomy histological report. A PubMed-based search of the English-language papers using several keywords identified 171 articles. We only included original studies (no timeline restriction). After removing duplicates and applying the inclusion and exclusion criteria, 14 original studies were analyzed. The number of subjects per study varied (N=61 to 2678) so did the number of analyzed nodules per study (a maximum of 2902). Some studies found connections with benign features; others revealed a higher risk of malignancy at fine needle aspiration. Data remain heterogeneous, and oftentimes, studies investigated it only as a secondary endpoint. A high TI-RADS score is important in malignancy prediction, while eggshell calcification might add to the positive predictive value, yet, this trait is difficult to classify as a standalone element. Nevertheless, an interrupted pattern does not exclude thyroid cancer.

Tuberculous parotitis: A case series diagnosed on fine needle aspiration

IntroductionTuberculosis (TB) remains a global health concern with diverse clinical manifestations. Parotid tuberculosis, although rare, presents diagnostic challenges due to its atypical presentation. Cytological examination is pivotal in diagnosing parotid lesions. Case presentationWe present three cases of parotid tuberculosis diagnosed through cytology. A 31-year-old male presented with a painless left parotid swelling. FNAC revealed granulomatous inflammation with AFB positivity. The second case, a 14-year-old female had an enlarging mass in the left parotid. FNAC showed granulomas, confirmed by GeneXpert MTB/RIF assay. The third case, a 39-year-old female presented with a painless swelling in the left parotid. FNAC demonstrated granulomatous inflammation, confirmed by mycobacterial culture. ConclusionCytological examination plays a crucial role in diagnosing parotid tuberculosis. These cases underscore the importance of considering TB in parotid masses. Collaboration among clinicians, radiologists, and cytopathologists is essential for accurate diagnosis and prompt management. Further research is needed to optimize diagnostic algorithms for parotid tuberculosis.

Conventional and Emerging Diagnostic Approaches for Differentiated Thyroid Carcinoma

Differentiated thyroid carcinoma (DTC) is among the most prevalent endocrine cancers. The diagnosis of DTC has witnessed tremendous progress in terms of technological advancement and clinical operational guidelines. DTC diagnostics have evolved significantly over centuries, from early clinical examinations to modern molecular testing and imaging modalities. The diagnosis and management of DTC are currently dependent on the international histological classification and identification of specific genetic abnormalities in tumor tissue, as well as the prognostic implications that can inform treatment decisions. This study goes down the memory lanes of various diagnostic methods for DTCs, highlighting recent advancements in molecular testing and point-of-care (POC) technology. Beginning with conventional methods like fine needle aspiration biopsy (FNAB), fine needle aspiration cytology (FNAC), and ultrasound (US) and moving to contemporary innovative approaches such as POC-thyroglobulin (POC-Tg) and liquid biopsy, this review showcases the current trends in DTC diagnostics. Although considerable progress has been achieved in early malignancy detection, patient stratification, prognosis, and personalized treatment, there is a need to refine the mainstay diagnostic procedures. Finally, future perspectives were provided, and emerging roles of artificial intelligence in DTC diagnostics were explored.

Analysis of Candidate miRNAs' Expression in Pancreatic Cancer.

Pancreatic cancer (PC) is one of the most aggressive types of cancer. Despite advances in molecular diagnostics, PC diagnosis relies on imaging technologies and morphological assessment of fine needle aspirates (FNAs). MicroRNA (miRNA) involvement in PC pathogenesis and potential diagnostics application have been suggested, albeit current supporting evidence is lacking. Here, we investigated the association of selected miRNAs with PC incidence and clinical characteristics. Fold expression of miR-216a-3p, -217-5p, -221-3p, -222-3p, and miR-196a-5p was assessed in 73 PC FNA cell-block sections and 6 healthy pancreas tissues using Taqman advanced miRNA assays. Potential miRNA targets were ascertained using immunocytochemistry. miR-196a-5p was upregulated in PC compared to healthy pancreatic tissue (β = -0.05, 95% CI: -0.065 - (-0.035); p < 0.001). miR-221-3p and miR-222-3p fold expression were strongly correlated (r = 0.897, p < 0.001), whereas miR-196a-5p fold expression correlated with that of miR-221-3p (r = 0.688, p < 0.001) and miR-222-3p (r = 0.489, p < 0.001). Moreover, miR-196a-5p fold expression positively correlated with tumor stage (r = 0.32, p = 0.034). miR-217-5p fold expression inversely correlated with KRAS expression (r = -0.69, p = 0.0027). Our study shows miR-196a-5p has reasonable specificity to PC and thus may have diagnostic and prognostic potential in PC as proposed in the literature. Moreover, KRAS and NFKBIA may be potential targets for miR-217-5p and miR-196a-5p, respectively. Thus, these miRNAs may be involved in tumor progression and may have valuable applications in novel therapeutics or treatment monitoring.

Primary hyperparathyroidism with intrathyroidal location of parathyroid adenoma

Primary hyperparathyroidism is a common endocrine disease with high morbidity and mortality from all causes. The disease can be asymptomatic and for a long time remain undiagnosed, which leads to untimely surgical treatment, increases the risks of development and progression of severe disabling complications and worsens patients prognosis. In clinical practice there are certain difficulties in diagnosing this pathology. One of the urgent problems is the search for the source of parathyroid hormone hyperproduction, especially in case of atypical location of paraаdenoma. The most common atypical locations of altered parathyroid glands are thymus, retroor paraesophageal space, retropharyngeal space, mediastinum and thyroid gland. The frequency of intrathyroidal masses of parathyroid glands, in the thyroid parenchyma or under its capsule, ranges on average from 2 to 3%, but according to some authors can reach 18–22%. With such localization of paraadenomas there is a need for their differential diagnosis, first of all, with nodular formations of the thyroid gland. In addition, the absence of additional laboratory studies parathormone and calcium blood levels does not allow timely suspicion of the disease, and cytologic examination of the material obtained by fine-needle aspiration puncture biopsy does not allow reliable differentiation of the altered parathyroid gland. This article presents a clinical case of a patient with primary hyperparathyroidism with intrathyroidally located parathyroid adenoma, for a long time long identified as a “nodular goiter,” and provides a brief review of the methods that identify an intrathyroidally located parathyroma. Despite the abundance of diagnostic methods in visualization of intrathyroidal parathyroid glands, today the most appropriate seems to be expert ultrasound examination with assessment of the parathyroid hormone level in a washout after fine-needle aspiration, supplemented, if necessary, by scintigraphy and single-photon emission computed tomography combined with computed tomography or multispiral computed tomography.

How important are the cytomorphologic subtypes of the salivary gland neoplasm of uncertain malignant potential (SUMP) category in the Milan system for reporting salivary gland cytology? An institutional experience 2018-2024.

Salivary gland neoplasm of uncertain malignant potential (SUMP) is an important diagnostic category of the Milan System for reporting salivary gland cytology (MSRSGC). Further subcategorization by cytomorphologic subtypes has been recommended to risk-stratify cases. In this study, our institutional experience with the risk of neoplasm (RON) and risk of malignancy (ROM) based on cytomorphologic subcategorization of SUMP is reported. We also report the prevalence of malignancy (POM) at our institution. The pathology database was queried for cases of fine-needle aspiration (FNA) diagnosed as SUMP along with follow-up at our institution from 2018-February 2024. This study was approved by an institutional review board. Of 1159 cases of salivary gland FNA specimens reported as per MSRSGC at our institution, 14.8% (171/1159 cases) were diagnosed as SUMP, with these reports verified by at least 16 cytopathologists. Surgical follow-up was available for 139/171 (81.3%) of these cases, for which the original cytomorphologic subgroups were as follows: 65 (46.8%) basaloid, 48 (34.5%) oncocytic/oncocytoid, 14 (10.1%) myoepithelial, 9 (6.5%) other, 2 (1.4%) clear cell, and 1 (0.7%) mucinous. The POM within SUMP at our institution is within a range of 29.8%-36.7%. When considering all cases, our institutional RON for SUMP was 97.8% (136/139), and the ROM was 36.7% (51/139). Notably, a significant portion of cases (36%, 50/139) underwent review at a daily intradepartmental consensus conference. Analysis revealed that SUMP cases that underwent consensus review had a ROM of 46% (23/50), versus 31.5% (28/89) in independently verified cases (p = .13). Of the cytomorphologic subgroups, basaloid SUMP in particular was more likely to be benign on resection when the case had been independently verified than after consensus review (p = .0082). When considering only the independently verified cases, the ROM for each subgroup was as follows: 38.7% (12/31) in oncocytic/oncocytoid, 20% (9/45) in basaloid, 33.3% (2/6) in myoepithelial, 60% (3/5) in "other", and 100% (1/1) in both mucinous and clear cell (p = .0407). While the RON is high across all cytomorphologic subgroups of SUMP, the ROM does vary across the groups, with basaloid cytomorphology having the lowest ROM. This effect is seen in independently verified cases but not in cases having undergone consensus review.

WITHDRAWN: New thyroid fine needle aspiration biopsy needle. Prospective, randomized, clinical study.

Erhan Aysan, Yeliz Ersoy, Zuhal Gucin, Merve Cengiz, Huseyin Akbulut, Sema Arici, Mahmut Muslumanoglu. New thyroid fine needle aspiration biopsy needle. Prospective, randomized, clinical study, Clinical Endocrinology, 15th July 2014. https://doi.org/10.1111/cen.12554 WITHDRAWAL: The above article, first published online on Wiley Online Library (wileyonlinelibrary.com) on 15th July 2014, has been withdrawn by agreement between the Editors in Chief, Prof Aled Rees and Prof Maralyn Druce and John Wiley and Sons Ltd. The withdrawal has been made because the authors did not respond to requests to finalise the article for publication.

O08 Ultrasonography - Guided fine needle aspiration cytology with rapid on-site evaluation technique for inguinal nodes in penile cancer – A pivotal point in surgical management

O08 Ultrasonography - Guided fine needle aspiration cytology with rapid on-site evaluation technique for inguinal nodes in penile cancer – A pivotal point in surgical management

Predictive genomic and transcriptomic analysis on endoscopic ultrasound-guided fine needle aspiration materials from primary pancreatic adenocarcinoma: a prospective multicentre study

We apply endoscopic ultrasound-guided fine needle aspiration biopsy to cytopathologically diagnose and sample nucleic acids from primary tumours regardless of the disease stage. 397 patients with proven pancreatic adenocarcinoma were included and followed up in a multicentre prospective study. DNA and mRNA were extracted from materials of primary tumours obtained by endoscopic ultrasound-guided fine needle aspiration biopsy and analysed using targeted deep sequencing and RNAseq respectively. The variant allele frequency of the KRAS mutation was used to evaluate the tumour cellularity, ranging from 15 to 20% in all cells, regardless of the tumour stage. The molecular profile of metastatic primary tumours significantly differed from other types of tumours, more frequently having TP53 mutations (p=0.0002), less frequently having RNF43 mutations, and possessing more basal-like mRNA component (p=0.001). Molecular markers associated with improved overall survival were: mutations in homologous recombination deficiency genes in patients who received first-line platinum-based chemotherapy (p=0.025) and wild-type TP53 gene in patients with locally advanced tumours who received radio-chemotherapy (p=0.01). The GemPred transcriptomic profile was associated with a significantly better overall survival in patients with locally advanced or metastatic pancreatic cancer who received a gemcitabine-based first-line treatment (p=0.019). The combination of genomic and transcriptomic analyses of primary pancreatic tumours enables us to distinguish metastatic tumours from other tumour types. Our molecular strategy may assist in predicting overall survival outcomes for platinum or gemcitabine-based chemotherapies, as well as radio-chemotherapy. Institut National Du Cancer (BCB INCa_7294), CHU of Toulouse, Inserm and Ligue Nationale Contre le Cancer (CIT program).

Incidental diagnosis of subcutaneous filariasis with an unusual presentation in a non-endemic area—Need to worry?

ABSTRACT We report an interesting case of Bancroftian filariasis diagnosed on fine needle aspiration cytology in a young female hailing from a non-endemic hilly area of India, who presented with a subcutaneous swelling on the left forearm. This is an unusual extra-lymphatic site to harbor filarial infestation and the cytology smears showed adult worms, eggs, and microfilariae of Wuchereria bancrofti.

P005 Ultrasound (US) with Fine Needle Aspiration Cytology (FNAC) as an adjunct in staging cN0 penile cancer patients: Outcomes of a regional centre in the UK

P005 Ultrasound (US) with Fine Needle Aspiration Cytology (FNAC) as an adjunct in staging cN0 penile cancer patients: Outcomes of a regional centre in the UK

Cytological diagnosis of follicular dendritic cell sarcoma with a unique pattern of D2-40 immunoexpression.

Fine needle aspiration procedure is routinely used for cytological diagnosis of nodal or extra nodal lesions. Follicular dendritic cell sarcoma (FDCS) is a rare mesenchymal neoplasm arising from follicular dendritic cells of lymphoid follicles at nodal and extranodal sites. Multimodal therapies have emerged for FDCS, necessitating its accurate pathologic diagnosis with additional ancillary testing for directing clinical management. By immunohistochemical analysis, FDCS is positive for the complement receptors CD21, CD23, and CD35. In addition, D2-40 is reported to be highly sensitive for FDCS with a strong membranous pattern of expression. In this study, we present the cytological diagnosis of a case of FDCS in retroperitoneal lymph nodes with an emphasis on a unique staining pattern of D2-40 which showed a strong nuclear pattern in tumor cells comparable to the membranous pattern of D2-40 on the control tissue and other surgical cases of FDCS in our comparative study.

Combined modalities for the rapid diagnosis of patients with suspected tuberculous lymphadenitis: A cross-sectional study.

In settings with high burden of extrapulmonary tuberculosis, the use of various diagnostic modalities can result in superior and quick diagnosis leading to prompt initiation of treatment. This study assessed the diagnostic performance of the fine-needle aspiration cytology (FNAC), Ziehl-Neelsen (ZN) stain, fluorescence microscopy (FM) and cartridge-based nucleic acid amplification test (CBNAAT) in patients with suspected tuberculous lymphadenitis (TBLN). This cross-sectional studyodes, who underwent FNAC. The FNAC samples were subjected to cytomorphological examinati involved 255 patients clinically suspected of TBLN with palpable lymph non, ZN stain, FM and CBNAAT. The diagnostic performance of each modality was compared with CBNAAT, and combined performance was determined. The diagnostic performance of CBNAAT was determined by comparing it with composite reference standard. Of 255 patients, 148 (58.04%) showed features of TBLN on FNAC. The presence of epithelioid cell granulomas with caseous necrosis (67.57%) was the predominant cytomorphological pattern. On ZN stain, FM and CBNAAT, 31 (20.95%), 63 (42.57%) and 100 (67.57%) patients were found to be positive for TBLN, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of CBNAAT was 58.59%, 91.83%, 92% and 58.06%, respectively. Finally, the combination of ZN stain, FM and CBNAAT led to the detection of 88.51% patients with TBLN. Combined use of ZN stain, FM and CBNAAT leads to superior and swift diagnosis of patients with clinically suspected TBLN.

Gastric Glomus Tumor Resected by Submucosal Tunneling Endoscopic Resection

ABSTRACT Gastric glomus tumor (GGT) is a rare mesenchymal neoplasm, that is usually asymptomatic. Although benign, malignant transformation has been reported. A 59-year-old man presented with dyspepsia refractory to treatment with proton-pump inhibitor over 6 months. Esophagogastroduodenoscopy revealed a 30 mm subepithelial lesion in the distal gastric antrum, in contact with the pylorus, but biopsies were nonspecific. Upper endoscopic ultrasound revealed a well-defined submucosal echogenic lesion measuring 30 × 20 mm, without muscularis propria involvement. A fine-needle aspiration biopsy showed GGT features. En bloc endoscopic resection was performed using the submucosal tunneling endoscopic resection technique. The histopathological study of the specimen confirmed the diagnosis of a GGT with free margins. The patient remains symptom-free after a 9-month follow-up. We highlight the rare diagnosis of GGT and the possibility of curative en bloc endoscopic resection with submucosal tunneling endoscopic resection.