Fine Needle Aspiration Cytology Report Research Articles

A Prospective Study to Evaluate the Reliability of Thyroid Imaging Reporting and Data System in Differentiation between Benign and Malignant Thyroid Lesions.

Objectives:To evaluate diagnostic reliability of the daily use of thyroid imaging reporting and data system (TIRADS) classification proposed by Kwak et al., in differentiating between a benign and a malignant thyroid lesion, to calculate inter-observer variability in the interpretation of each of the TIRADS ultrasound features and to evaluate role of TIRADS system in reducing unnecessary biopsies of benign lesions.Materials and Methods:Three hundred and sixty-five patients with clinically suspected thyroid lesions during the period from November 1, 2011, to August 31, 2015, were prospectively scanned on gray-scale and Doppler imaging by six radiologists separately. We used GE VOLUSON 730 PRO machine (GE healthcare, Milwaukee, USA) equipped with a 7.5–12 MHz high-frequency linear array transducer with color and power Doppler capability. We evaluated five sonological features: Internal composition, echogenicity, margins, presence and type of calcification, and shape of the lesion. Based on the TIRADS proposed by Kwak et al., we determined categories of the thyroid lesions. The diagnostic performance of TIRADS classification system was evaluated by comparison with the fine-needle aspiration cytology (FNAC) reports which were subsequently obtained after taking informed consent from the patients. All follicular neoplasms on FNAC were further followed up with excision biopsy and histology. The cytopathological report was used as the standard final diagnosis for comparison. The P value and odds ratio were determined to quantify how strongly the presence or absence of a particular ultrasound feature was associated with benignity or malignancy in the study population. The risk of malignancy was stratified for each TIRADS category-based on the total number of benign and malignant lesions in that category. Cervical lymph nodes were also evaluated for their size, loss of the central, echogenic hilum, presence of irregular and indistinct margin, microcalcification, and necrotic changes. Cohen's Kappa coefficient was determined separately for each of the five TIRADS malignant features to study the inter-observer agreement. Furthermore, the percentage of benign cases that were accurately determined by TIRADS which could have avoided unnecessary FNAC was determined.Results:The risk of malignancy in TIRADS categories 1 and 2 was found to be 0%, 0.64% in category 3, 4.76% in category 4A, 66.67% in category 4B, 83.33% in category 4C, and 100% in category 5. Out of the five suspicious sonological features, irregular margins showed the highest positive predictive value (95.45%) for malignancy followed by taller than wide shape (92.86%), microcalcifications (66.67%), marked hypoechogenicity (54.55%), and solid composition (48.15%). The specificity of three sonological features (completely cystic structure, hyperechogenicity, and macrocalcification) in classifying a nodule as benign was 100%. Loss of central echogenic hilum, presence of an irregular and indistinct margin, microcalcification and necrosis were found to have sensitivity of 100%, 63.63%, 27.27%, and 9.09%, respectively and specificity of 95.7%, 98.5%, 100%, and 100%, respectively for cervical lymph node to be malignant. The Kappa value for taller than wide shape, microcalcification, marked hypoechogenicity, solid composition, and irregular margins was 1.0 (95% confidence interval [CI]: 1–1), 1.0 (95% CI: 1–1), 0.90 (95% CI: 0.82–1), 0.88 (95% CI: 0.77–0.92), and 0.82 (95% CI: 0.64–1), respectively. The estimated decrease in unnecessary FNACs was found to be 43.83–86.30%.Conclusions:TIRADS proposed by Kwak et al., combined with evaluation for sonological features of malignant lymph nodes is a valuable, safe, widely available, and easily reproducible imaging tool to stratify the risk of a thyroid lesion and helps in precluding unnecessary FNACs in a significant number of patients. TIRADS features convincingly show comparable results in the interpretation of TIRADS features more so, in the hands of radiologists experienced in thyroid imaging.

Comparison of pre operative fine needle aspiration cytology diagnosis and histopathological diagnosis of salivary gland tumours

Objective: FNAC is a useful method for evaluating suspicious salivary gland lesions due to its low cost, minimum morbidity, rapid turnaround time, high specificity, and sensitivity. The present study was undertaken to diagnose salivary gland tumors based on the cytomorphology and to correlate with histopathology wherever available and to review the histologic and cytomorphological features in discordant cases and evaluate the possible reasons of misinterpretation. Methods: The study was both prospective and retrospective. All the cases of salivary gland tumors that had fine needle aspiration cytology reports were taken from records of Nizam’s Institute of Medical Sciences. This study was done between January 2000 to May 2008. Results: A total of 135 cases of salivary gland neoplasms were identified during 8 1/2 period of our study. 1. Histologic correlation was available for 36 cases 2. There is a concordance between cytology and histopathology in 31/36 cases (86.1%). In three cases (8.3%) diagnostic possibilities were given. 94.1% of pleomorphic adenoma cases had concordance (16/17). 3. The number of discordant cases were 5/36 (13.9%) and the discordance was due to scant cellularity and rarity of the lesions. Majority of the cases 4(80%) it was underdiagnosis and in one case (20%) it was over diagnosis. Conclusion: FNAC is a highly reliable technique for pre-operative diagnosis of salivary gland tumors in the hands of experienced pathologists. However, there still remain few cases that may be inaccurately diagnosed on cytology due to overlapping features and in these cases histopathology is the only modality for final diagnosis.

Cytologic patterns of lymph node diseases in Hawassa University Referral Hospital, Southern Ethiopia

Background: Lymphadenopathy is becoming common pathological prblem in most part of the world. There is a wide variation in the pattern of disease in different ethinic groups and in various countries. The knowledge of the pattern of these diseases in a given geographical region is essential for making a confident diagnosis of suspecting a disease. Objective: The aim of this study was to assess the cytological patterns of lymph node diseases in patient attended Hawassa University referral hospital.Methods: A five years retrospective study was conducted on fine needle aspiration cytology report of patient referred to pathology laboratory of Hawassa University referral hospital from September, 2009 to September, 2014.Results: A total of 1,067 lymph nodes were aspirated in the study period. Cervical lymphadenophathy was the most frequent (48.82%) followed by submandibular (22.77%) lymph nodes. The second decade was the most affected age group while age group above 60 was less frequent. Tuberculosis lymphadenitis was highest (48.82%), chronic non-specific lymphadenitis (20.33%), reactive (16.21%), pyogenic abscess (5.99%) and the rest were malignant. Conclusion: Lymphadenopathy can be associated with a wide range of disorders however; tuberculosis lymphadenitis is the most common cause of enlarged lymph node in the study area.

Diagnosis of Salivary Gland Lesions By Fine Needle Aspiration Cytology and Its Histopathological Correlation in A Tertiary Care Center of Southern India.

Salivary glands may enlarge either due to inflammation or neoplastic conditions and the diagnosis is possible by fine needle aspiration cytology (FNAC). The present study was undertaken to determine utility of FNAC in the diagnosis of salivary gland lesions. In this retrospective study, a total of 186 FNACs of salivary gland lesions were retrieved and evaluated. Of these, 146 cases had follow-up histopathological diagnosis. FNAC diagnoses were compared to histopathological diagnoses. The parotid glands were more commonly involved than others. Among the various diagnostic categories used in FNAC reports, Non neoplastic category was seen in 24 (16.4%), benign category in 86 (58.9%) and malignant category in 30 (20.6%) and unsatisfactory category in 6 (4.1%) of 146 cases. The overall sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FNAC in the diagnosis of salivary gland lesions were 86.6%, 94.6%, 93.6%, 88.3%, and 94.6% respectively. The present study concluded that FNAC in the diagnosis of salivary gland lesions is highly sensitive, specific and accurate method. Hence, FNAC is a useful, quick and reliable diagnostic tool. It also appears to be a safe, cost effective and minimally invasive procedure, which provides information for management of salivary gland lesions.

Differentiated thyroid cancer patients with a previous indeterminate (Thy 3) cytology have a better prognosis than those with suspicious or malignant FNAC reports.

The prognosis of differentiated thyroid cancers (DTC) read at cytology as indeterminate and classified as Thy 3 according to the British Thyroid Association has recently been suggested to be good. To obtain robust information about this potential novelty, in this study we retrospectively reviewed DTC with a prior fine-needle aspiration cytology (FNAC) of Thy 3, Thy 4 or Thy 5 presently followed up at two institutes. Patients with no FNAC before surgery were excluded and a series of 284 DTC was enrolled in the study. Of these, 53 had Thy 3, 108 Thy 4, and 123 had Thy 5 prior to surgery. At histology, 280 (98.6 %) papillary and 4 follicular (1.4 %) cancers were found. Overall, the less aggressive cancer forms were prevalent in all three groups. The lower TNM stages (I and II) were more frequent in the Thy 3 group (96.2 %) than in the other cases (76.6 %) (p < 0.001). Neck lymph node metastasis at diagnosis was found in 3.8 % of Thy 3, 18.5 % of Thy 4, and 26 % of Thy 5 cases. At follow-up, a 16.2 % recurrence rate was recorded, ranging from 1.9 % in Thy 3 group to 19.5 % for Thy 4 and Thy 5 (p < 0.001). According to the Kaplan-Meier curve, Thy 3 was thus a favorable prognostic factor compared with Thy 4 and Thy 5 (OR = 0.079, p < 0.001, 95 %CI 0.01-0.59). At multivariate analysis, Thy 3 was an independent predictor of good prognosis (OR = 0.06, p = 0.03, 95 %CI 0.01-0.80). In conclusion, DTC with a preoperative Thy 3 cytology have a better prognosis than those with Thy 4 and Thy 5 due to less aggressive tumor types and lower TNM stage at diagnosis.

Breast filariasis – A fine needle aspiration cytology report

Abstract Filariasis is a major health problem in tropical countries. The disease is endemic in large areas of India. Lymphatic filariasis in human is commonly caused by Wuchereria bancrofti and Brugia malayi . Extranodal filariasis is a rare entity and the breast is an uncommon site for filariasis. We report a case of female who presented with lump in the left breast. Fine needle aspiration cytology of lump revealed numerous adult filarial worms.

The role of fine needle aspiration cytology in the diagnosis of orbital lesions

Context: Fine needle aspiration cytology (FNAC) in orbital lesions has gained importance over the last 3 decades, especially with the advent of imaging studies. Aims: The study was undertaken to evaluate the role of FNAC as a diagnostic tool in patients presenting with orbital mass lesions. Subjects and Methods: Patients of different age groups presenting with orbital lesions were studied over a period of 2 years. The 38 patients selected for this study were evaluated clinically by thorough general and ophthalmological examination, and then were investigated with computed tomography (CT) scanning (both axial and coronal planes). Each patient included in this study was then subjected to FNAC under direct vision or under ultrasonography or CT guidance with a sterile 22 gauge needle without anesthesia. Results: The age of the patients varied from 2 to 72 years. On cytology, four cases were diagnosed as nonneoplastic and the remaining 34 (89.48%) as neoplastic lesions. In the neoplastic group, benign tumors (20; 58.8%) outnumbered malignant (14; 41.2%). The distribution of malignant lesions was more heterogeneous with a predominance of lymphoma involving the orbit. Surgical biopsy was done in 27 cases. Surgical biopsy report correlated with the FNAC report in 23 out of 27 cases. The sensitivity was 86.6%, specificity 100%, and positive predictive value 100%. Conclusion: FNAC is a useful, safe and cost-effective method of diagnosing orbital pathology. Image guidance is helpful especially in deeply situated nonpalpable lesions.

Denovo malignant fibrous histiocytoma of breast: Report of a case and review of literature

Sarcomas are rare histological types of malignancy found in the breast. While angiosarcoma is the most common type of sarcoma found here, malignant fibrous histiocytoma (MFH) arising de novo is one of the rare varieties. We recently cared for a middle aged lady with a locally advanced fungating growth in her right breast. The patient underwent right modified radical mastectomy (MRM) as her fine needle aspiration cytology report was suggestive of malignancy. The histopathological report revealed the tumour to be MFH. The patient had an uneventful postoperative recovery and is subjected to adjuvant radiotherapy.

Cervical lymphadenopathy with special reference to fine needle aspiration cytology corroborated with histological examination: A cross sectional study

Introduction: Cervical lymphadenoparthy is a common presentation of many diseases, though it is mostly tubercular in origin in developing countries. This cross sectional study was done to corroborate fine needle aspiration cytology (FNAC) findings with histopathological examinations (HPE) in cervical lymphadenopathy. Materials and methods: 120 patients of both sexes attending the FNAC unit of Nilratan Sircar Medical College and Hospital, Kolkata were enrolled in this study. They were evaluated by thorough clinical examination followed by routine investigations, FNAC and histopathological examination (HPE). Results: There was maximum corroboration of FNAC and HPE reports in tubercular lymphadenitis (76 v/s 76) and Hodgkin’s disease (2 v/s 2) followed by metastatic carcinoma (20 v/s 16) and non specific lymphadenitis (14 v/s 5) respectively. Overall correlation was 88.4% (excluding 8 cases where FNAC results were inconclusive due to unsatisfactory smear). The sensitivity, specificity, positive predictive value and negative predictive value of FNAC to diagnose tubercular lymphadenopathies were 86.36%. 100.0%, 100.0% and 72.73% respectively. In case of metastatic CA, these were 100.0%, 96.15%, 80.0% and 100.0% respectively. Conclusion: FNAC is simple, safe, quick, cheap, acceptable yet accurate method of establishing the etiology in cases of cervical lymphadenopathy.

Hürthle cell presence alters the distribution and outcome of categories in the Bethesda system for reporting thyroid cytopathology

We aimed to determine whether the presence of Hürthle cells altered the distribution of categories in the Bethesda system for reporting thyroid cytopathology, or the expected neoplastic and malignant outcome. Fine needle aspiration (FNA) cytology reports of Hürthle cells in a 2-year period were evaluated. The distribution of Bethesda system categories and the outcome at partial or complete thyroidectomy were compared for FNAs with and without Hürthle cells. Of 895 adequate FNAs with Hürthle cells, 764 (85.4%) were classified as benign, 86 (9.6%) as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 32 (3.6%) as follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 12 (1.3%) as suspicious for malignancy (SFM) and one (0.1%) as malignant. Of 10359 adequate FNAs without Hürthle cells, 9707 (93.7%) were classified as benign, 412 (4.0%) as AUS/FLUS, 77 (0.7%) as FN/SFN, 93 (0.9%) as SFM and 70 (0.7%) as malignant. The distribution of categories in FNAs with and without Hürthle cells was significantly different (P<0.001) as a result of a decrease in benign and an increase in AUS/FLUS and FN/SFN categories. Among 128 patients with and 582 without Hürthle cells undergoing surgery, the overall neoplastic and malignancy rates were higher in the former than in the latter group (27.3% versus 14.9%, P<0.001; 21.1% versus 11.7%, P=0.003; respectively). Although neoplastic and malignant rates were higher in the group with than without Hürthle cells in all categories, the differences were only significant for a neoplastic outcome of benign cytology (15.1% versus 6.0%, P=0.0013) and a malignant outcome of FN/SFN cytology (63.6% versus 21.9%, P=0.0108). We found that the rates of AUS/FLUS and FN/SFN categories in the Bethesda system were higher when Hürthle cells were present. After surgery, neoplastic and malignant outcomes were significantly higher in the Hürthle cell group.

Fine‐Needle Aspiration Cytology versus Direct Laryngoscopic Biopsy in Suspicious Laryngo‐Hypopharyngeal Masses

Objectives: Evaluate the feasibility and performance of ultrasound-guided fine needle aspiration cytology (FNAC) of suspicious laryngo-hypopharyngeal masses. Methods: Cross-sectional study (2012-2013). After routine clinical and radiological evaluation, patients with advanced laryngo-hypopharyngeal masses were included in the study. Early lesions and vascular masses were excluded. In all patients, ultrasound guided FNACs were performed with a free-hand technique by a single radiologist and direct laryngoscopic biopsies were done on the subsequent day. Results: A total of 10 patients met the criteria for the study. Nine patients were primary cases and one was recurrent. There were 8 males and 2 females in the age group of 40-73 years. Ultrasound guided FNAC reported squamous cell carcinoma in 8 patients, atypical cells in one patient and the remaining one had inadequate specimen. There was no complication following the procedure. In direct laryngoscopic biopsies 8 patients were positive for squamous cell carcinoma and two were negative. Ultrasound guided FNACs in these two negative cases were positive for squamous cell carcinoma. One case was a recurrent tumor and in the other, direct laryngoscopic biopsies were done twice. Both the patients were inoperable due to advanced disease and palliative treatments were planned based on FNAC reports. Conclusions: Although biopsy under direct laryngoscopy remains the gold standard technique, ultrasound guided FNAC can be used to diagnose advanced laryngo hypopharyngeal lesions. It is simple, safe, cost effective, and done as an out-patient procedure. It seems to be more beneficial in deep seated submucosal tumors.

Punção Aspirativa Por Agulha Fina De Lesões Da Cabeça E Pescoço Dirigida Por Ultrassonografia: Experiência De 15 Anos Em Uma Instituição

To evaluate the diagnostic potential of the fine needle aspiration biopsy tecnique on head and neck lesions with ultrasound guidance. Retrospective study based upon ultrasound guided fine needle aspiration cytology reports bettween july/1995 and july/2011. Cytologic findings were categorized in organ origin, neoplastic or non-neoplastic, their sub-categories, and non conclusive or indeterminate samples. There was also a evalution of possible local or sistemic complications of the procedures. The study reveals the main diagnosis among cervical nodes sent to be elucidated, with histopathologic correlation, as possible, when the initial situation required further investigative ou therapeutic procedure. Considers also some comments about the tecnique and specially the practice of a four handed work crew uniting radiologist and pathologist. Fine needle aspiration tecnique ultrasound guided is a highly safe and a highly efficacious method to diagnose head and neck lesions.

Fine-Needle Aspiration in the Diagnosis of Thyroid Diseases: An Appraisal in Our Institution

Objective and Aims. In the last two decades, fine-needle aspiration cytology (FNAC) of thyroid has been introduced as the most reliable and cost-effective method for diagnosing of clinically important thyroid disorders. The aim of our study was to determine the accuracy and reliability of FNAC in our center. Materials and Methods. Thyroid fine-needle aspiration cytology (FNAC) of 1639 patients from October 2007 to September 2011 was evaluated in our center. Only patients which had a solitary or multiple thyroid nodules were selected for FNA. The FNAC results are classified as benign, malignant, suspicious, and unsatisfactory. From above patients, 192 (11.7%) cases underwent surgery, and histopathologic examination was performed. By comparing the FNAC reports with the corresponding histopathologic results, the accuracy of thyroid FNAC was determined. Results. According to FNAC diagnostic criteria, there were 1054 (64.3%) benign cases, 128 (7.8%) malignant, 306 (18.66%) suspicious and 151 (9.2%) inadequate for diagnosis. In 192 cases, which underwent surgery, FNAC reports were compared with histopathologic results and statistical indices were calculated. The sensitivity, specificity, and accuracy were 91.6%, 100%, and 97%, respectively. These findings strongly support that FNAC as a useful technic for preoperative diagnosis of thyroid lesions. Conclusion. This technique is easy to perform, cost effective, minimally invasive with few complications. FNAC has high sensitivity in diagnosis of thyroid malignancy and also has high diagnostic accuracy in the evaluation of thyroid disorders.

150. Indeterminate FNAC in thyroid nodules – How certain do we want to be?

Background: it is estimated that a palpable thyroid nodule, which has a prevalence of 5%, is a follicular neoplasm in 15-20% of cases. All patients with a solitary thyroid nodule should have fine-needle aspiration cytology (FNAC) as the initial screening test but, unlikely, up to 30% patients with nodular thyroid disease will receive a FNAC report diagnostic for follicular lesion, or suspicious. Thence, most patients with follicular lesions will require surgical management.

Clinicopathologic study of parapharyngeal tumors

Background:Parapharyngeal space (PPS) tumors are rare. Three main groups are identified, namely those of salivary origin, neurogenic tumors and paragangliomas. Early pathological classification of PPS tumors is important for pin point diagnosis and timely management.Aims:The PPS is a complex anatomical potential space and poses high risk of per and postoperative complication. This study was done to perform optimum preoperative evaluation by clinicoradiologic correlation and guided fine needle aspiration cytology (FNAC) which is essential to minimize intraoperative risk.Materials and Methods:Guided FNAC was carried out to diagnose parapharyngeal tumors in 48 patients from January 2008 to January 2010. The inflammatory lesions were excluded in the present study. Correlation with histopathology was done in all the cases.Results:The mean age for all the patients was 38.2 years. There were 23 male and 25 female subjects. Seventy nine percent of the lesions were benign with pleomorphic salivary adenoma being the commonest, while only 20.8% of the lesions were malignant. All the patients presented with neck swelling. No complication was encountered in the present study.Conclusion:FNAC can replace incisional biopsy which may be hazardous in this area. Immediate treatment can be planned based on the FNAC report.

Parapharyngeal Space Tumors: Our Experience In A Tertiary Hospital In Andhra Pradesh, India

Introduction Parapharyngeal space tumors are rare, accounting for 0.5 % of all head and neck tumors; 80% of them are benign. According to the site of tissue origin, parapharyngeal space tumors are mainly grouped into four varieties i.e., salivary tumors, neurogenic tumors, lymphoid masses and paragangliomas. Material and methods Our study period was 5 years. During this time, 13 patients were operated for parapharyngeal space tumors. The age ranged from 14-70 years with the mean age being 42 years. Male-to-female ratio was 1.16:1. All patients presented with neck mass. Clinical diagnosis was uncertain in cases of neural origin. Routine investigations and fine-needle aspiration cytology were done for all cases. Imaging studies were done when the fine-needle aspiration cytology report was inconclusive. Results Out of 13 cases operated, 5 were salivary neoplasms, 3 neurogenic tumors and 5 lymph node masses. Out of the 5 salivary neoplasms, 2 were reported as pleomorphic adenomas, 1 was a duct cell carcinoma and 1 a schwannoma. Four cases were arising from the parotid gland; one case was reported as plexiform neurofibroma which was arising from the submandibular salivary gland. Out of 3 neurogenic tumors, 2 were reported as neurofibromas and the remaining one was a ganglioneuroma arising from the vagus nerve. Out of 5 lymph node masses, 2 were metastatic masses from papillary carcinoma and 1 was a metastatic mass from medullary carcinoma of the thyroid gland. The remaining 2 were metastatic masses from squamous cell carcinoma. Four cases presented with occult primary while the medullary carcinoma of the thyroid presented with a small nodule in the right lobe.Fine-needle aspiration cytology was diagnostic in pleomorphic adenomas and secondary lymph node masses. It was inconclusive in diagnosing neurogenic tumors. Computerized tomography was done in complicated cases when fine-needle aspiration cytology was inconclusive. It helped in locating the site and extension of the tumor and in delineating its plane. Ultrasonography proved helpful in locating the tumor in the thyroid gland. Conclusion Parapharyngeal space tumors are rare accounting for only 0.5% of all head and neck tumors. There are difficulties in clinical assessment as they are deep seated. Fine-needle aspiration cytology has limited value in neural tumors. Radiological evaluation is essential to minimize the intraoperative risk. Excision biopsy is advisable in view of the complex anatomy of the space. It is diagnostic and curative.

Validity of fine needle aspiration cytology in the diagnosis of thyroid diseases

Introduction : Fine needle aspiration cytology (FNAC) is regarded as an important first line investigation for evaluation of thyroid swellings. It has a diagnostic accuracy of over 90% in terms of specificity, sensitivity and predictive values. Objective : The aim of this study was to determine the validity (specificity, sensitivity positive/negative predictive values) of FNAC in the diagnosis of thyroid diseases. Methods : FNAC reports and histopathology reports of patients with thyroid diseases, who have undergone surgery, were retrospectively retrieved from data banks in the Department of Pathology, University of Sri Jayewardenepura, from August 2004 to August 2006. In addition a prospective study in patients with thyroid diseases who came to this unit for FNAC from June to September 2006 was carried out. In all the cases the histological diagnosis was compared with the cytological diagnosis and the results were documented and analyzed by using standard statistical methods. Results : FNAC has an acceptable validity in the diagnosis of thyroid diseases with high specificity (86.74%), sensitivity (84.05%), positive predictive value (84.05%) and negative predictive value (86.74%). Keywords: thyroid cytology; specificity; sensitivity; positive and negative predictive values. DOI: 10.4038/jdp.v5i1.2956 Journal of Diagnostic Pathology 2006/07; 5: 19-29

Prediction of lack of response to neoadjuvant chemotherapy in rare breast tumour histology with Tc-99m sestamibi scintimammography

The authors report a case of a 47-year-old female with a malignant lump in the right breast and ipsilateral axillary nodal involvement. She was pathologically misinterpreted as a case of ductal cell carcinoma with papillary component on fine needle aspiration cytology (FNAC) pre-operatively. On lines of the FNAC report, the patient underwent scintimammography (SMM) for prediction of treatment response based on washout pattern. The SMM revealed rapid washout of radiotracer predictive of poor responder. Despite unfavourable result seen with SMM, the patient received 4 cycles of neo-adjuvant chemotherapy (NACT). However, there was no clinical response after chemotherapy. The post-surgical histopathology revealed the actual histology to be pleomorphic liposarcoma. This case highlights that SMM has the ability to predict non-responsiveness of unusual tumour histology to standard NACT.

Infected Thyroglossal Duct Cyst Involving Submandibular Region: A Case Report

Thyroglossal duct cyst presents most frequently in the midline of the neck, either at or just below the level of the hyoid bone. They generally manifest as painless neck swelling, and they move on protrusion of tongue and during swallowing. A case of thyroglossal cyst was reported in the left submandibular region in a 14-year-old girl, above the level of hyoid bone; ultrasound examination favored a cystic lesion which moved in a vertical fashion on swallowing whereas fine needle aspiration cytology report was suggestive of simple cystic lesion of thyroglossal cyst. No lymphoid or malignant cells were present. The cyst was excised completely by surgical procedure under general anesthesia. Histopathological analysis revealed thyroglossal cyst showing columnar and flattened epithelium of cyst with focal aggregate of chronic inflammatory cells supported by fibrocollagenous cyst wall. The clinical, ultrasound, and histopathological findings suggested that the lesion was an infected thyroglossal cyst. There was no evidence of recurrence 6 months after surgery.

Fine needle aspiration cytology of pilomatrixoma

Aim:To delineate and characterize the cytomorphologic features of pilomatrixoma (PMX) helpful in correct diagnosis of the lesion on fine needle aspiration cytology (FNAC).Materials and Methods:Archival records of clinical findings, FNAC and histopathological reports of PMX cases were analyzed. Aspirate findings in 14 cases of PMX were correlated with detailed clinical data and subsequent histopathology on excisional biopsy. Different morphological findings were graded semiquantitatively from 0 to 3+.Results:The series showed female preponderance, with head and neck being the commonest site. Majority patients had a single tumor with mean size of 1.6 cm. Out of 14 biopsy proven cases of PMX, cytology findings revealed PMX in 7 cases on the basis of ghost cells, groups of basaloid cells, squamous cells in combination with multinucleated giant cells and calcium deposits in a background of debris. The main reasons for erroneous diagnosis were predominance of one component over the others and non-representative aspirated material.Conclusions:The cytological features of PMX are characteristic and allow a conclusive diagnosis provided the smears are examined keenly bearing in mind the diagnostic traps that can mislead a cytopathologist.