A 35-year-old woman presented with a 2-cm D enlarged right supraclavicular lymph node. Fine needle aspiration cytology smears showed abundant spindle cells with many osteoclast-like giant cells. The case was kept for discussion in the enigma portal.

Objective: To evaluate and compare the diagnostic efficacy of Fine Needle Aspiration Cytology (FNAC), Ziehl–Neelsen (ZN) staining, and Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) in the diagnosis of extrapulmonary tuberculosis (EPTB). Methods: A prospective observational study was conducted on clinically suspected EPTB cases. FNAC smears were examined cytologically, ZN staining was performed for acid-fast bacilli, and CBNAAT was used for molecular detection of Mycobacterium tuberculosis and rifampicin resistance. Results: FNAC showed high sensitivity and rapid diagnostic utility, especially in resource-limited settings. ZN staining demonstrated very high sensitivity and strong rule-out value, but lower specificity. CBNAAT exhibited the highest specificity and reliably identified rifampicin resistance, making it the most effective confirmatory test. Higher EPTB incidence was observed among females. Conclusion: A tiered approach-initial screening with FNAC or ZN staining followed by CBNAAT confirmation—provides accurate, feasible, and cost-effective EPTB diagnosis.

Abstract Background: Argyrophilic nucleolar organizer region (AgNOR) staining is a rapid and cost-effective marker of cellular proliferation, useful in differentiating benign from malignant breast lesions. This study evaluated the mean AgNOR count and the subjective AgNOR pattern assessment (SAPA) score in fine needle aspiration cytology (FNAC) samples of breast neoplasms. Materials and Methods: This prospective study included 100 women with palpable breast lumps who underwent FNAC at a tertiary care teaching hospital over 2 years. Smears were stained with hematoxylin and eosin (H and E) for cytology and silver stain for AgNOR analysis. Mean AgNOR count (mAgNOR) and SAPA score were evaluated in 100 neoplastic cells per case. Histopathology was available for 61 cases for correlation. Data were analyzed using SPSS 20.0; descriptive statistics and Chi-square tests were applied, with P < 0.05 considered statistically significant. Results: Among 100 breast lesions, FNAC classified 53% as benign, 36% as malignant, and 11% as premalignant, with fibroadenoma and ductal carcinoma being the most common benign and malignant lesions, respectively. Histopathological follow-up was available for 61 cases. Mean AgNOR counts rose progressively from benign (3.62 ± 0.91) to premalignant (4.92 ± 1.52) and malignant lesions (6.79 ± 2.11; P < 0.001), paralleling histopathology. SAPA scores similarly distinguished benign (6.92 ± 1.49), premalignant (10.27 ± 1.95), and malignant lesions (12.42 ± 2.43; P < 0.001). FNAC-histopathology concordance was high, with all malignant cases confirmed and 75% of premalignant cases upgraded to malignancy. Conclusion: These findings suggest that both AgNOR count and SAPA score are reliable indicators of proliferative activity and can effectively differentiate malignant from benign breast lesions in FNAC smears.

Introduction: Breast lesions comprise about 34-40% of lesions evaluated by fine-needle aspiration in surgical practice. FineNeedle Aspiration Cytology (FNAC) is increasingly used as a simple and cost-effective method to assess the nature of breast lesions, with high sensitivity and reasonable specificity, which helps in planning further treatment. However, a small percentage of breast lesions cannot be confidently diagnosed as benign or malignant and are termed grey-zone lesions. These include reactive atypia seen in some benign conditions and atypia of malignancy. Aim: To analyse the cytological features of atypical proliferative breast diseases associated with a malignant diagnosis on histopathologic examination. Materials and Methods: This was a cross-sectional study involving FNAC smears of all patients diagnosed as proliferative breast disease with atypia in the Department of Pathology, Government Medical College, Kozhikode, Kerala, India, from January 2018 to June 2021. Clinical and cytological features were studied, and patients were followed-up until June 2022. The lesions were classified histologically into benign and malignant lesions. The cytological features in the FNAC smears were studied. The data were entered into spreadsheets in Microsoft Excel, and the variables were analysed using Statistical Package for the Social Sciences (SPSS) version 16.0 for Windows. The Chi-square test was used to evaluate features significantly associated with a histological diagnosis of malignancy. Results: The study included a total of 162 cases diagnosed as proliferative breast disease with atypia on FNAC. Histopathological follow-up was available for these cases, with 73 benign and 89 malignant. Clinical features that were statistically significant in subjects with malignant histopathological diagnoses included age over 40 years, presence of a hard and fixed breast lump, and nipple changes. Cytological features predictive of a malignant histological diagnosis included clusters with ill-defined borders, loosely cohesive or cribriform clusters, clusters with markedly reduced or absent myoepithelial cells, reduced stromal fragments, numerous singly scattered atypical cells, markedly reduced or absent bipolar bare nuclei in the background, high mitotic rate, and necrosis. The nuclear features that were statistically significant included marked nuclear enlargement, nuclear pleomorphism, irregular nuclear contour, nuclear overlapping, and coarse nuclear chromatin. Conclusion: The diagnosis of malignancy requires a multifaceted approach, including correlation with clinical, radiological, and pathological features. For an unequivocal cytological diagnosis of malignancy, a constellation of cytomorphological features is needed; a single morphological feature cannot reliably distinguish between benign and malignant lesions. Proper knowledge of the various cytomorphological features of malignancy can help predict malignancy even if all classical cytological features are not present. Cytological study can be a useful adjunct in triaging cases where prompt histopathological assessment is mandatory.

This report describes the cytologic features of cholangioblastic intrahepatic cholangiocarcinoma, a distinct subtype of cholangiocarcinoma from a 32-year-old female with a past medical history remarkable for sclerosing mesenteritis who presented with abdominal pain for several days. Abdominal MRI revealed an 8.5 cm central hepatic mass. Fine needle aspiration (FNA) and concurrent biopsy of the liver mass were performed. The FNA smear showed a monotonous population of singly scattered to loosely cohesive epithelioid to focally plasmacytoid tumor cells with round to oval nuclei, a fine chromatin pattern, and scant to moderate cytoplasm. Prominent nucleoli, mitotic figures, and necrosis were not identified. Focally, an acinar/glandular pattern was identified. Based on cytomorphology, an initial impression of low-grade neuroendocrine tumor was favored. The concurrent biopsy showed tumor cells arranged in trabecular, acinar to solid growth patterns. Immunohistochemical stains performed on the concurrent biopsy showed that the tumor cells were diffuse and strongly positive for CAM 5.2, CK7, albumin ISH, inhibin, and focally positive for synaptophysin and CD56. The tumor cells were negative for chromogranin, arginase, glypican-3, CD34, INSM1, GATA3, PAX-8, SF-1, SALL4, HepPar1, and CDX2. The overall findings were consistent with intrahepatic cholangiocarcinoma, cholangioblastic variant. To our knowledge, this case represents the first report of the cytologic features of a cholangioblastic variant of intrahepatic cholangiocarcinoma on FNA.

Abstract Introduction/Objective Primary thyroid lymphoma (PTL) is rare. Most PTLs are non-Hodgkin’s lymphomas, with diffuse large B-cell lymphoma (DLBCL) being the most common type, encompassing approximately 60% to 70% of cases. Fine needle aspiration (FNA) is the initial diagnostic tool to obtain samples of thyroid nodules. It is a minimally invasive procedure and essential for the rapid diagnosis and treatment. In this report, we discuss a primary thyroid lymphoma case diagnosed by FNA. Methods/Case Report A 73-year-old man with past medical history of hypertension and hyperlipidemia presented for neck swelling. A large visible left thyroid firm mass is palpable and measures about 5cm. Ultrasonography revealed markedly asymmetrically enlarged left thyroid lobe which wrapped around trachea and extended substernally resulting in right tracheal deviation. There is no vascularity or microcalcifications. FNA smears revealed diffuse population of highly atypical cells with enlarged nuclei, prominent nucleoli and apoptosis in the background. Colloid is absent. By cytomorphology, it is a malignant neoplasm (Bethesda category VI). Immunostains were performed on the cell block. The tumor cells are positive for CD20 and negative for AE1/AE3, PAX-8, and CD10. Together with cytomorphology. The findings are consistent with lymphoma, favor diffuse large B cell lymphoma (DLBCL). Results NA Conclusion PTL is uncommon and can be confused with other thyroid malignancies like anaplastic thyroid carcinoma. It is important to consider PTL in the differential diagnoses for rapid growing thyroid nodules. FNA plays an important role as the initial diagnostic tool for primary thyroid lymphoma to avoid unnecessary surgery and initiate rapid appropriate treatment. Immunostains on the cell block can help confirm the diagnosis and further classify the subtypes.

Abstract Background Clinical methods for preoperative diagnosis of thyroid nodules using fine needle aspiration (FNA) biopsies, including cytology and genomic sequencing, can be slow, costly, or provide limited diagnostic performance, leading to unnecessary surgeries. As an alternative approach, we developed a method using desorption electrospray ionization mass spectrometry (DESI-MS) imaging and statistical modeling to classify thyroid FNAs, achieving accuracies above 83%. Furthermore, we performed a rigorous analytical validation study evaluating the performance of DESI-MS for classifying thyroid nodules using hundreds of FNAs. Key metrics including predictive accuracy, sample stability, precision, analytical specificity, and analytical sensitivity were methodically investigated. Methods Thyroid tissue sections (127 benign, 111 malignant) and prospectively collected clinical FNA biopsies (111 benign, 59 malignant) were analyzed using a Waters Xevo G2-XS QTof mass spectrometer fitted with a DESI-XS source. Molecular profiles from the thyroid tissue sections and 77 clinical FNAs were used to build classification models using logistic regression with lasso regularization. The model’s predictive performance was evaluated on the remaining 93 clinical FNAs. Analytical performance metrics were evaluated using 641 mock FNA samples prepared in the laboratory and analyzed using our standardized DESI-MS method. Results A classifier for differentiating benign and malignant thyroid samples was built and evaluated on an independent set of clinical FNAs, yielding an overall prediction accuracy of 83.9%, with a sensitivity of 91.4% and specificity of 79.3%. We next evaluated the analytical performance of the classifier. The impact of storage condition on classification was evaluated, with accurate classification achieved for mock FNAs analyzed after being stored up to one day at ambient temperature, one week in the fridge, and two months in the freezer. The method precision, including within run, between run, and between technologist precision, was evaluated using mock FNA smears (n=25/tissue) from 8 different tissues. Mass spectral profiles from replicate FNAs analyzed on different days by different technicians were highly similar, with standard deviations of the average classification probability less than 0.1. To assess analytical specificity of our method and evaluate its ability to distinguish benign and malignant cells in the presence of blood, we prepared mock FNA smears in the lab and mixed with increasing amounts of blood (0%, 20%, 40%, 60%, 80% blood). Accurate classification was achieved with up to 60% blood, with evidence to suggest that our method could be accurate with up to 80% blood. To evaluate the analytical sensitivity of our method and determine how many cell clusters are needed for sample classification, we used data acquired from the clinical FNAs and systematically predicted on an increasing number of pixels from each sample (1, 2, 3, etc.). The model’s performance dropped when using fewer than three pixels for sample classification, indicating that a cutoff of at least three pixels of data, which is the equivalent of 3 clusters of cells, is needed for reliable prediction. Conclusion Here, a DESI-MS method for thyroid FNA classification was developed and analytically validated. With the addition of DESI-MS, unnecessary diagnostic surgeries could be prevented by providing improved preoperative thyroid FNA classification.

IntroductionThyroid nodules can be identified primarily through physical examination and history; however, there is no single test to evaluate a thyroid nodule, especially to assess the risk of malignancy (RoM). Hence, a triple assessment through clinical examination, radiological imaging with Thyroid Imaging Reporting and Data System (TIRADS) scoring, and fine needle aspiration cytology (FNAC) is done. The 2023 Bethesda System of Reporting Thyroid Cytology (TBSRTC) is used for the risk stratification of thyroid lesions by FNAC, which will help in management decisions.Materials and methodsThis is a retrospective cross-sectional study conducted at a tertiary care center in Chennai to compare and correlate 101 thyroid histopathology cases with their corresponding cytology smears over one year. The FNAC smears were categorized into one of the six categories according to TBSRTC. The performance of the thyroid cytology was assessed by calculating parameters such as specificity, sensitivity, and RoMs. The results of the study were then compared with the established RoM in TBSRTC and published literature.ResultsAmong the 101 cases, 65 (64.35%) were benign and 36 (35.64%) were malignant. Papillary thyroid carcinoma (PTC) was the most common type of malignant tumor with 30 cases (83% of malignancies). Out of the six Bethesda categories, Bethesda category II (benign) had the least RoM (18%), but in comparison with the established rates of TBSRTC and other published studies, it was observed to have a higher RoM. Category III (atypia of unknown significance) has 12 cases, of which three were malignant with a RoM of 25%. Category IV (follicular neoplasm) had the most discordance from histopathology and had a higher RoM (50%) than the established TBSRTC rates. The sensitivity of the current study was 68.57%. ConclusionThe current study reveals higher RoMs than published studies. Maximum concordance between histology and cytology can be achieved by avoiding aggressive aspiration techniques, a few amendments to reporting criteria, making them less subjective, and periodic quality assurance procedures to improve the accuracy of diagnosis. Moreover, assistive and adjunct methods like immunocytochemistry and molecular testing can also be used in indeterminate lesions.

Synovial sarcoma (SS) is a highly malignant tumor that occurs mainly in adolescents and young adults and is usually seen in the extremities. However, primary SS arising from the lung is extremely rare, accounting for only 0.5% of cases. A young girl of age 3 years presented with 1 month history of fever associated with shortness of breath and significant weight loss. Computerized tomography and magnetic resonance imaging thorax show a large heterogeneous mass lesion in the left hemithorax from which ultrasonography-guided Tru-cut biopsy was done. Histopathology and immuno histo chemistry (IHC) followed by fine needle aspiration and imprint smear cytology further confirmed the diagnosis. The final diagnosis of primary pulmonary synovial sarcoma was made after ruling out other sites of metastatic involvement by 18 Fluorodeoxyglucose-positron emission tomography imaging. Surgical resection is the treatment of choice, if not possible, palliative chemotherapy can be given. Overall prognosis is very poor. Early diagnosis and intervention can improve outcome of this rare disease entity.

Next Generation Sequencing on Fine Needle Aspirate Smears of Non-Small Cell Lung Cancers: An Institutional Validation Study

Context Salivary gland lesions encompass a multifaceted spectrum of low grade and invasive entities, often presenting diagnostic challenges due to overlapping clinical and radiological features. Minimally invasive cytological technique serves as a minimally invasive, pragmatic financial standpoint for initial evaluation, offering valuable insights into lesion characterization. Aim:To assess the analytical accuracy of cytomorphological evaluation in glandular lesions of oral cavity and correlate cytological findings with histopathological outcomes where available. Study Protocol: A retrospective record based analysis was conducted on cases who had presented with salivary gland swellings over last 1 year (2023-2024) at our centre. FNAC smears were examined for cellularity, architectural patterns, nuclear features, and background elements. Cases with subsequent histopathological examination were included for correlation. Diagnostic accuracy, sensitivity, specificity, and concordance rates were calculated. Results: This cytomorphological study of 120 salivary gland lesions highlights pleomorphic adenoma as the predominant neoplasm, with a notable age distribution skewed toward individuals over 60 years (30%) and those aged 31–45 years (29.2%). Fine-needle aspiration cytology (FNAC) demonstrated robust diagnostic performance, yielding an overall accuracy of 89.2%. For malignant lesions, FNAC showed sensitivity of 85.7%, specificity of 89.9%, PPV of 64.3%, and NPV of 96.7%. In non-malignant cases, sensitivity index was 89.9%, selectivity index 85.7%, PPV 96.7%, and NPV 35.7%. These findings reinforce FNAC’s reliability as a robust tool. Conclusion: Cytomorphological evaluation remains a reliable frontline diagnostic modality for salivary gland lesions, particularly in distinguishing benign from malignant processes. When integrated with clinical and radiological data, FNAC enhances diagnostic precision and guides appropriate management. Histopathological correlation reinforces its role in definitive diagnosis and underscores areas for refinement in cytological interpretation.

Fine needle aspiration cytology (FNAC) is widely accepted as a primary diagnostic tool in evaluating thyroid nodules. The Bethesda system for reporting thyroid cytopathology (TBSRTC) standardizes diagnostic terminology and guides clinical management. A prospective observational study was conducted over 18 months on 100 patients presenting with thyroid swellings. FNAC smears were classified using TBSRTC. Out of 100 cases, 93% were satisfactory. Female predominance (93%) was noted. The majority of cases fell in Bethesda Category II (79%). Malignancy (Category VI) was observed in 5% of cases. Neoplastic lesions constituted 14% of total cases, predominantly follicular neoplasm (35.71%). TBSRTC offers a reproducible and clinically useful system for thyroid lesion reporting. The pattern of thyroid lesions in the Vindhya region closely aligns with national trends, though with regional demographic variations.

Optimizing tissue adequacy for next-generation sequencing in small biopsies and fine-needle aspirations for nonsmall cell lung cancer: a root cause analysis and proposed solutions.

ABSTRACT Background: The Ziehl-Neelsen (ZN) staining technique for demonstrating acid-fast bacilli (AFB) on fine needle aspiration cytology (FNAC) smears is a widely used, easy, and inexpensive method, but it has low sensitivity. Methods for concentration of tubercular bacilli have been proven to increase the detection of AFB on ZN staining in sputum samples. In this study, we aim to compare the detection rates of AFB using the bleach concentration technique and direct cytology smears in lymph node aspirate samples. Aim: To compare the sensitivity of AFB demonstration by ZN staining on direct cytology smear and the bleach concentration technique. Materials and Methods: About 101 consecutive clinically suspected cases of tubercular lymphadenitis sent for FNAC over a six-month period were included in the study. The aspirate was used to prepare both direct cytology smears and bleach concentration method prepared smears. The AFB detection rate after ZN staining on smears prepared by both methods was compared. Statistical Analysis: The data analysis was done using SPSSv29.0 software(IBM,Armonk, New York). The Chi-square test/Fisher’s exact test was used for categorical variables. The P value < 0.05 was considered statistically significant. Results: AFB was demonstrated by ZN staining on direct cytology smears in 48% cases and on modified bleach technique prepared smears in 30%. Thirteen cases missed on direct microscopy were picked on the bleach concentration technique prepared smears, but 31 cases positive on direct microscopy were missed by this method. Conclusion: The bleach concentration technique may be used to supplement the direct cytology prepared smears, but cannot replace them in FNAC aspirates.

Abstract A 27-year-old woman presented to the outpatient dermatology clinic with complaints of nonitchy reddish papules over the trunk and thighs for 2 months. The rash was sudden in onset and rapidly progressive. She also complained of cough with expectoration along with low-grade fever for 6 months. She had experienced a weight loss of 12 kg during this time. General examination revealed bilateral cervical lymphaden­opathy with firm, nontender lymph nodes, the largest lymph node measuring 2 × 2 cm. On cutaneous examination, multiple erythematous to violaceous flat-topped follicular papules arranged in a grouped configuration were observed on the abdomen, lower back, chest and inguinal area. The papules measured 2–3 mm and were associated with minimal scaling. On dermoscopy, pale to whitish monomorphic large dots were observed in the perifollicular regions with central blackish follicular openings or plugs and mild scaling in some areas. A 3.5-mm punch biopsy was obtained from the lesion on the abdomen, which on histopathological examination revealed perifollicular epithelioid cell granulomas along with multinucleated giant cells in the upper dermis. Lymphocytic cuffing was present around the granulomas along with mild perivascular lymphocytic infiltrate in the mid dermis. The epidermis was unremarkable. Ultrasound examination of the cervical region revealed bilaterally enlarged cervical lymph nodes (right > left) at level 1–5, with matting observed in the right cervical area (level 4). Necrotic changes were also visualized. Fine needle aspiration cytology (FNAC) from a right posterior cervical lymph node showed many well-formed epithelioid cell granulomas with polymorphous reactive lymphoid cells in the background. Ziehl–Neelsen stain was positive for acid-fast bacilli from the FNAC smear; however, mycobacterial culture was negative. Mantoux test showed a strong positivity, measuring 25 × 25 mm. High-resolution computed tomography scan of the chest was performed, which showed patchy consolidation with multiple centrilobular nodules and interstitial septal thickening of the right lung along with mediastinal lymphadenopathy. A final diagnosis of lichen scrofulosorum with pulmonary tuberculosis (TB) and cervical TB lymphadenitis was made. The patient was subsequently started on weight-based antitubercular therapy (ATT) comprising isoniazid (225 mg), rifampicin (450 mg), pyrazinamide (1200 mg) and ethambutol (825 mg). There was significant clearance of the cutaneous lesions after 2 months of ATT and the patient continues to be under follow-up. Lichen scrofulosorum is a rare tuberculid that occurs in children and young adults. As it can occur in both pulmonary and extrapulmonary forms of TB, a thorough history, cutaneous and systemic examination, and histopathology, microbiology and imaging are essential for prompt diagnosis and early initiation of ATT.

Background: Kikuchi-Fujimoto disease (KFD) is a frequently febrile, self-limited, subacute necrotizing lymphadenitis. It occurs predominantly in young females and is more common in Asia.Aim: This study aims to characterize the cytomorphological spectrum of KFD through fine-needle aspiration (FNA) findings across multiple centers, highlight under-recognized diagnostic features, and refine cytologic differentials to improve diagnostic accuracy.Materials and methods: The study group comprised a multicenter study experience of 30 cases diagnosed as KFD on cytology or subsequent histology.Results: Cytomorphological features of 30 cases diagnosed as KFD on FNA smears were studied. Out of these 30 cases, spontaneous resolution occurred on 4 to 16 weeks of follow-up in 22 cases; in the remaining eight cases, cytologic diagnosis was confirmed on histology, supplemented by immunohistochemistry.Conclusion: The cytological features of KFD pose diagnostic challenges, on account of its broad cytologic spectrum, though crescentic histiocytes are a constant feature. These cytological features must be interpreted in the appropriate clinical context.

Introduction: Fine Needle Aspiration (FNA) cytology is a well-established essential, basic diagnostic technique for investigating lumps and lesions at various anatomic sites. While performing FNA of the breast lumps a quick or rapid result is desirable to know the nature of the lump and allay the anxiety of the patient. Rapid On-Site Evaluation (ROSE) is useful to evaluate the cytological smears within a few minutes. This study aims to evaluate the utility of Field’s stain in ROSE of breast lesions in arriving at a diagnosis and its comparison to routine MGG (May Grünwald Giemsa) stain. Materials and methods: This prospective observational study was conducted from July 2023 to December 2023 at a tertiary care center. A total of 89 cases with breast lumps were included. Previously diagnosed cases were excluded. All the cases were evaluated by ROSE using Field’s stain for preliminary diagnosis and compared later with MGG stain for final diagnosis. The categorizaƟon of cases was done as per IAC Yokohama System and further management was advised accordingly. Results: After first and repeat aspiration, 62 (69.6%) cases were categorized as benign, 12 (13.4%) cases were found to be malignant whereas 8 (8.9%), 5 (5.6%), 2 (2.24%) cases were included in the suspicious, atypical and insufficient categories respectively. Categorization of the breast lumps by ROSE using Field stain was in complete agreement with the MGG stained smears and the final FNA diagnosis and showed no discrepancy. Conclusion: The use of Field’s stain for ROSE of breast lumps had comparable staining quality to MGG which resulted in accurate correlaƟon between provisional and final cytologic diagnoses with the added advantage of rapid turnaround Ɵme. Field stain was hence found to be reliable, cost effecƟve and Ɵme saving when used for ROSE of breast lumps. Hence the use of this readily available and affordable stain for ROSE of FNA smears, especially of breast lumps, can prove to be highly beneficial for prompt categorization and triaging of patients. KEYWORDS: Rapid on site evaluation, Breast, Field Stain, Prompt Categorization, Triage

Introduction: Micronuclei (MN), markers of chromosomal instability and genetic damage, are emerging as reliable biomarkers in fine needle aspiration cytology (FNAC) of breast lesions. MN scoring aids in distinguishing benign from malignant lesions and may assist in diagnosing borderline cases, improving the accuracy and objectivity of cytological evaluation. This study aims to assess the correlation between MN scoring and epithelial breast lesions and evaluate its utility as a supplementary diagnostic tool in challenging cases. Materials and methods: This prospective study was conducted over one year at Mysore Medical College and Research Institute, involving 208 FNAC smears of breast lesions. Inclusion and exclusion criteria were strictly followed. MN scoring was done using Grocott’s Methenamine Silver stain. Cases were categorized according to the International Academy of Cytology Yokohama System, and malignant cases were graded using Robinson’s criteria. Two independent pathologists scored the slides to ensure good interobserver reliability. Results: Among the 208 cases, 69.7% were benign, predominantly fibroadenomas. MN scores were low in benign lesions (0.3–2.0), increased in atypical and suspicious lesions (3.4 and 5.2), and highest in malignant cases, particularly poorly differentiated tumors (up to 17.4). A positive correlation was observed between MN score and malignancy, with aggressive tumors showing higher genetic instability. Benign lesions were predominantly seen in younger individuals, while the malignant cases showed an upward trend with increasing age. Conclusion: MN scoring correlates strongly with malignancy and provides an objective, reproducible tool in breast cytology, especially valuable in borderline cases such as atypical hyperplasia, enhancing diagnostic confidence in FNAC.

Background: Fine Needle Aspiration Cytology (FNAC) is a very useful technique for morphological diagnosis of any tumors. It is useful in children as the chance of complication is very rare. Moreover, it is rapid, cost effective, and outpatient procedure. No anesthesia is required for this. Diagnosis can be available readily and suitable for giving preoperative chemotherapy. So FNAC plays important role in pediatric kidney tumor where neo adjuvant chemotherapy given before surgery. Guided FNAC is more reliable method than unguided FNAC. Core Needle Biopsy (CNB) is another investigation for preoperative diagnosis. Compared to core needle biopsy, FNAC is more easy to perform and it can be repeated in the same sitting, if necessary. Immunocytochemistry (ICC) can be done on Fine needle aspiration smear or Immunohistochemistry (IHC) can be carried out from the cell block. Aims and Objectives: To find out the profile of kidney tumor, to help the clinicians to give neoadjuvant chemotherapy to the patients, and to evaluate the role of FNAC in pediatric kidney tumors. Materials and Methods: The pediatric patients with clinical and radiological diagnosis of kidney tumors were advised for guided FNAC. After examining the patients CT/ USG guided FNAC was performed and Immunostains were applied on the smears and on cell block. Result: FNAC was done in 96 cases of kidney tumors below 18 year of age over a period of 10 years. The commonest tumor was WILMS’ tumor (86%) with male predominance . Majority patients were below 7 year of age. Mesoblastic Nephroma (5% ), Clear Cell Sarcoma (2% ), Rhabdoid tumor (1% ), Ewing tumor (1%) and one case of Metanephric adenoma were identified. We had 91% accuracy rate. If we use Immunostain the accuracy becomes 96.9%. Conclusion - Fine needle aspiration cytology is a safe and useful, rapid diagnostic tool in case of Pediatric Renal tumors.

Lymphatic filariasis, though often asymptomatic, remains a pervasive parasitic disease in endemic regions worldwide. The incidental identification of microfilariae on fine-needle aspiration cytology (FNAC) smears is rare and their coexistence with thyroid neoplasms is exceedingly uncommon. To our knowledge, very few cases of thyroid malignancy with coexistent microfilarial infestation have been documented. We describe a compelling case of a 68-year-old female who presented with a thyroid nodule and underwent FNAC. Cytological analysis revealed features diagnostic of a Hürthle cell neoplasm, accompanied by the unexpected presence of Wuchereria bancrofti microfilariae. Remarkably, the patient exhibited no clinical signs of filarial infection, and peripheral blood examination showed neither microfilaremia nor eosinophilia. This rare cytological finding underscores the diagnostic breadth of FNAC, not only in the evaluating thyroid pathology but also in revealing occult parasitic infestations. It highlights the necessity of meticulous smear evaluation, especially in patients from endemic regions presenting with chronic nodular lesions. The detection of neoplastic and parasitic elements together illustrates the complex interplay between infectious and neoplastic processes and reaffirms FNAC’s utility in identifying unexpected pathological associations.