An 11-year-old castrated male mixed-breed cat presented with a 2-week history of lethargy and anorexia. Abdominal ultrasonography revealed jejunal thickening and adjacent masses. As fine-needle aspiration cytology and PCR for antigen receptor gene rearrangement of the masses suggested small T-cell lymphoma, resection biopsy was performed. Based on histopathology and immunohistochemistry, a diagnosis of small T-cell lymphoma with prominent lymphoid follicle formation and concurrent large B-cell lymphoma was made. Postoperative chemotherapy with chlorambucil and prednisolone was performed. The cat survived for 728 days since initial presentation, with no recurrence of clinical signs or ultrasonographic abnormalities. To the best of our knowledge, this is the first report describing a feline case of intestinal small T-cell lymphoma with prominent lymphoid follicle formation and concurrent intestinal large B-cell lymphoma.

High-grade Spindle Cell Sarcomas (SCS) are rare, aggressive soft-tissue tumours that can be extremely challenging to diagnose, particularly when recurrent or when they morphologically overlap with other spindle-cell neoplasms. This case involves a 76- year-old Indian female who presented with a recurrent right posterolateral thigh swelling six months after surgical excision of a poorly differentiated liposarcoma. The swelling was firm, non tender, and subcutaneous, with no associated systemic symptoms. Primary Fine-Needle Aspiration Cytology (FNAC) revealed polygonal and spindle-shaped cells with hyperchromatic nuclei, mild pleomorphism, and prominent nucleoli, leading to an impression suggestive of malignant melanoma. Ultrasonography (USG) showed a heterogeneous hypoechoic lesion, while Magnetic Resonance Imaging (MRI) demonstrated a 3.5×2.6×1.6 cm subcutaneous mass with mild septal thickening, scarring, and postcontrast enhancement—findings suggestive of recurrent liposarcoma. Intraoperative frozen-section analysis shifted the differential diagnosis to Dermatofibrosarcoma Protuberans (DFSP) versus liposarcoma due to the spindle-cell morphology. Gross examination of the total specimen (measuring 6.5×5×4 cm) revealed a 2.8×1.8×1.5 cm protuberant, greyish-white, firm, lobulated nodular mass arising from the skin. Histopathological evaluation showed a storiform and fascicular pattern of spindle-cell proliferation infiltrating the dermis and subcutis, with pleomorphism and frequent mitoses, confirming a diagnosis of high-grade SCS. This case highlights the limitations of FNAC and frozen-section analysis in the evaluation of recurrent soft-tissue tumours and underscores the importance of integrating histopathology, imaging findings, and prior clinical history for accurate diagnosis.

Abstract Bilateral synchronous tonsillar squamous cell carcinoma is a rare finding, and few cases are described in the medical literature. We present a case of a 67-year-old male with a history of a right neck swelling for 8 months. After imaging and fine needle aspiration cytology (FNAC), a diagnosis of head and neck squamous cell carcinoma (SCC) of unknown origin was reached. As per multidisciplinary meeting (MDT) advice, a conventional open bilateral diagnostic tonsillectomy was performed, and bilateral synchronous tonsillar squamous cell carcinoma was diagnosed. Hospital protocol does not facilitate transoral robotic surgery. The right tonsil tumor staging was T2N1M0, and the left T2N0M0. The patient successfully completed curative concurrent chemoradiotherapy as per MDT recommendation and local treatment protocols. In conclusion, bilateral synchronous tonsillar squamous cell carcinoma is a rare clinical presentation. In similar cases, a bilateral diagnostic tonsillectomy would be the most suitable diagnostic procedure, contrary to the unilateral approach performed in some centers.

Rapid Access Neck Lump clinics are specialised clinics that focus on the evaluation, diagnosis and management of head and neck lumps in a timely manner. Internationally, these dedicated clinics are being utilised to improve outcomes of head and neck cancer patients. To date, there are only a few such clinics in the Australian public health system. The objective of this study was to demonstrate the benefits of a rapid access neck lump clinic, aiming to reduce waiting times for diagnosis and treatment commencement. A multidisciplinary consultant led rapid access neck lump clinic was established including a head and neck surgeon, radiologist, and pathologist. This allowed comprehensive evaluation of the patient with a neck lump in a single visit. Data were collected prospectively for all attendances at this clinic since its inception, over a five-year period from February 2018 to February 2023. The primary outcome was clinic efficiency including referral to assessment interval and time to diagnosis. Secondary outcomes included malignancy rate, diagnostic accuracy of fine needle aspiration cytology, and time to treatment initiation. The review included 437 consecutive patients seen in the clinic. The mean time from referral to first specialist assessment was 16.1 (+/-9.54 days). Ultrasound guided FNA was performed in 61% of patients and yielded a malignancy rate of 38.6%. The median number of days between specialist assessment and discussion at head and neck MDT was 5 days. The mean time between clinic review and treatment commencement was 39.3 days. This is the largest and first dataset of a rapid access neck lump clinic in Australia. The implementation of this clinic has reduced delays to assessment, diagnosis and consequentially treatment planning and treatment for patients with newly diagnosed head and neck cancer.

Thyroiditis is known to induce atypical cytomorphological changes in the thyroid accompanied by increased cancer risk. The current study aims to determine the effect of thyroiditis on the risk of neoplasm (RON), risk of malignancy (ROM), diagnostic concordance and clinico-radiological features associated with discordance in thyroid aspirates. A cohort of histology (thyroidectomy) matched thyroid aspirates were reviewed for medical history of thyroiditis, cytological and histological diagnosis, and clinico-radiological information. Cytology-histology concordance was determined in accordance with the Bethesda system 2023. There were 770 thyroid aspirates with lymphocytic thyroiditis (n = 106), Graves' disease (n = 19), granulomatous thyroiditis (n = 3), IgG4-associated thyroiditis (n = 2), and non-specified autoimmune thyroiditis (n = 2). In the thyroiditis group, the RON/ROM in the Bethesda I to VI categories were 25.0%/21.4% (non-diagnostic/unsatisfactory), 31.3%/25.0% (benign), 45.2%/24.1% (atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS)), 33.3%/0% (follicular neoplasm/suspicious for follicular neoplasm), 100%/100% (suspicious for malignancy), and 100%/100% (malignant), respectively. In the non-thyroiditis group, the RON/ROM were respectively 51.5%/34.9%, 23.3%/8.9%, 44.8%/23.0%, 68.4%/21.1%, 94.8%/87.9%, and 100%/97.7%. The RON for non-diagnostic/unsatisfactory was higher in the non-thyroiditis group (p = 0.009). There were more AUS/FLUS aspirates in the thyroiditis group (47.0% vs. 37.5%, p = 0.042). With AUS/FLUS aspirates considered positive over negative, the concordance rate decreased (59.6% to 51.9%) in the thyroiditis group with a trended towards lower concordance than the non-thyroiditis group (51.9% vs. 61.4%, p = 0.074). Cases with lymphocytic thyroiditis showed a lower concordance rate (p = 0.010), and reciprocally Graves' disease higher (p = 0.031). Other clinico-radiological parameters demonstrated no significant correlations. Decisions arising from AUS/FLUS aspirates in patients with thyroiditis may better err on the conservative side with assumptive negative diagnosis. In managing patients with lymphocytic thyroiditis, the lowered diagnostic accuracy of aspiration cytology should be taken into consideration. Not applicable.

Background: Acromegaly is a rare, chronic, systemic, and progressive disease characterized by an excess secretion of growth hormone (GH) and increased circulating insulin-like growth factor 1 (IGF-1) concentrations, typically due to a macroadenoma in the pituitary gland. Both GH and IGF-1 are implicated in cancer promotion based on experimental and epidemiological data, but research findings remain conflicting and population-based data are scarce. Although there is a high mortality rate among acromegalic patients due to cardiovascular diseases, cancer is the third leading cause of death. Aim: The aim of the present study was to assess the risk of different types of cancer in acromegaly and the impact of changes in disease control and patient outcomes over time. Methods: Patients diagnosed with acromegaly at the Ankara University Ibn-i Sina Hospital Endocrinology and Metabolic Diseases Department between 2015 and 2019 were included in this study. Data including demographic data, history of cancer, size of adenoma (micro or macro), serum IGF-1 and GH levels at the time of diagnosis, serum prostate-specific antigen (PSA), thyroid ultrasonography, and, if needed, thyroid fine needle aspiration cytology (TFAC), colonoscopy, and mammography results were collected from patient records retrospectively. Results: We screened 83 patients, and 78 patients with the compensatory data (female/male: 39/39, 50%/50%) were included. The mean age of patients was 49.4 ± 11.9 years and 41.7 ± 12.1 years at the time of diagnosis. The median duration of follow-up was 72 (12-420) months. Periodic thyroid ultrasonography was performed in 65/78 (83.3%) of the patients, and a colonoscopy and mammography were also conducted in 27/78 (34.6%) and 32/39 (82%) of the patients at least once over the course of the disease, respectively. Cancer was detected in 17/78 (21.7%) of the patients; 11/78 (14.1%) of them had well-differentiated thyroid cancer and 2/39 (5.1%) had breast cancer. Prostate cancer, renal cell carcinoma, pancreatic cancer, malignant chordoma, schwannoma, and colon cancer were detected in one patient each. The increased cancer risk in acromegalic patients did not correlate with age, sex, age at diagnosis, time to diagnosing acromegaly, duration of acromegaly, GH and IGF-1 levels at diagnosis, pituitary adenoma size, or Ki-67 levels. Conclusions: Cancer was detected in 21.7% of the acromegaly patients, 14.1% of whom had well-differentiated thyroid cancer. In this study, we demonstrated that thyroid cancer is the most common malignancy in Turkish acromegalic patients, consistent with the results of previous studies. The increased cancer risk in acromegalic patients did not correlate with age, sex, age at diagnosis, time to diagnosing acromegaly, duration of acromegaly, or GH and IGF-1 levels at diagnosis.

Introduction: Swelling of the thyroid gland is a common presentation of thyroid diseases, both benign and malignant, and some are associated with thyroid dysfunction. Fine needle aspiration cytology, along with ultrasound and assessment of thyroid function status, remains the mainstay of evaluation of thyroid swellings. This study aimed to classify thyroid lesions according to the Bethesda system and to assess their relationship with thyroid hormonal status. Methods: A cross-sectional study was conducted prospectively from April 2023 to April 2024 in a tertiary care center after ethical clearance from the Institutional Review Committee (Reference number: 774). Patients with thyroid lesions were included using convenience sampling, with a sample size of 141. Fine needle aspiration cytology was performed for lesion classification. Data entry and analysis were done using Microsoft Excel and Statistical Package for Social Sciences version 20. Results: Among 141 cases, the most common thyroid lesion diagnosed on fine needle aspiration cytology was benign, comprising 87 (61.70%), with benign follicular nodule accounting for 63 (44.70%) among the benign lesions. Among all, 99 (70.23%) patients presented with euthyroid status, and no statistical correlation between thyroid hormone status and benign versus malignant lesions or Bethesda classification was seen in this study. In total, 120 (85.11%) were female. The age group ranged from 18 to 87 years, and the mean age at presentation was 54.8 years. Conclusions: In this study most thyroid lesions fell into the Bethesda category II. Thus, fine needle aspiration cytology is an important diagnostic tool for thyroid lesions. However, thyroid hormone status and benign versus malignant lesions showed no statistical correlation.

Fine-needle aspiration cytology (FNAC) is the primary screening test for thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) provides six diagnostic categories, each with an implied risk of malignancy (ROM). This study evaluated the performance of thyroid FNAC and the application of TBSRTC categories in a tertiary anatomical pathology service in South Africa. This retrospective laboratory-based audit included all 1703 thyroid FNACs processed between January 2016 and December 2021. Procedural details such as palpation versus ultrasound-guided aspiration were not captured in the laboratory data set. TBSRTC category distribution was assessed, cytology-histology correlation was performed for 315 cases with histology, and ROM was calculated. Diagnostic accuracy metrics, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy, were calculated using dichotomized cytology and histology results. The mean proportion of FNAC reports that included a Bethesda category was 74.9%, and 854 (50.1%) cases were non-diagnostic (Category I). The overall ROM, including category I and category II, was 7.4% if cases of low-risk neoplasms were considered non-malignant. The ROM for Categories I to V was within the published TBSRTC ranges, while the ROM for Category VI was lower (81.8% vs. 86%-100%). The diagnostic accuracy was 54.8%, specificity 41.9%, sensitivity 73.4%, PPV 46.6%, and NPV 69.5%. The rate of non-diagnostic FNACs was higher than published estimates, suggesting the need for provider-training on ultrasound-guided FNAC, with rapid on-site evaluation for specimen adequacy. There is a need to explore the factors that impact FNAC test performance in our setting.

The interpretation of pediatric thyroid lesion represents a challenging diagnostic tool for fineneedle aspiration cytology (FNAC). As for the adult lesions, it represents the first diagnostic tool for correct characterization of these nodules. Recent data from the National Cancer Institute (NCI) have proven that the incidence of thryoid malignancy has been increasing especially in adolescents. These data are mostly linked to an estimated higher prevalence of well-differentiated cancers with 90% diagnosed as papillary thyroid cancer (PTC), with some specific malignant subtypes, such as diffuse sclerosing subtype, are more frequently diagnosed in children, with, not uncommonly, a more aggressive behavior which justifies the increased number of surgical procedures. For this reason, the American thyroid association (ATA) recommended the performance of neck ultrasonography and FNAC in the evaluation of pediatric thyroid nodules. In this regard, the performance of an FNAC has high sensitivity and diagnostic accuracy in pediatric series, sharing the same problematic issues encountered in adult population, mostly in the diagnosis of the indeterminate lesions. Since 2023, the diagnosis of a pediatric lesion was based on the risk of malignancy used for the adulthood. The introduction of the third edition of The Bethesda system for reporting thyroid cytopathology (TBSRCT)introduced a specific adoption of diagnostic categories combined with their personalized ROM and management in pediatric thyroid lesions. We focused on the analysis of the ROM and data from literature hinged on the evaluation of the adoption of the TBSRTC in pediatric thyroid lesions.

Background: Cytological identification of granulomatous inflammation is widely used for the diagnosis of tuberculosis, particularly in extrapulmonary cases. However, cytology alone cannot provide definitive etiological confirmation, and Ziehl–Neelsen staining often shows low sensitivity. Molecular techniques such as tuberculosis polymerase chain reaction (TB PCR) enable rapid and sensitive detection of Mycobacterium tuberculosis and may complement cytological diagnosis. Objective: To evaluate the correlation between cytology-positive granulomatous lesions suggestive of tuberculosis and TB PCR results. Methods: This prospective observational study was conducted in the Department of Pathology & microbiology, Patna Medical College and Hospital, Patna, from August 2024 to December 2025. A total of 135 patients with cytological evidence of granulomatous inflammation on fine-needle aspiration cytology were included. Cytological findings were assessed using May–Grünwald–Giemsa and Ziehl–Neelsen staining. Samples were subsequently subjected to TB PCR for detection of Mycobacterium tuberculosis complex DNA. Cytology findings were correlated with TB PCR results, and statistical analysis was performed to assess diagnostic agreement. Results: TB PCR detected Mycobacterium tuberculosis DNA in a significant proportion of cytology-positive cases. Higher PCR positivity was observed in lesions showing granulomas with necrosis compared to those without necrosis. TB PCR demonstrated additional diagnostic value in cytology-positive but Ziehl–Neelsen–negative cases. A statistically significant correlation was found between cytological features suggestive of tuberculosis and TB PCR positivity. Conclusion: There is a significant correlation between cytology-positive granulomatous lesions and TB PCR results. TB PCR serves as a valuable adjunct to cytology by improving diagnostic confirmation, particularly in smear-negative cases. The combined use of cytology and molecular testing enhances diagnostic accuracy for tuberculosis in high-burden settings. Keywords: Tuberculosis; Granulomatous inflammation; Fine-needle aspiration cytology; TB PCR; Extrapulmonary tuberculosis

Pharyngoesophageal diverticula (PED) are uncommon hypopharyngeal outpouchings that may mimic thyroid nodules because of their close anatomic proximity to the thyroid gland. We describe two cases in which PED presented as thyroid nodules and resulted in atypical cytological findings. The first case was a 56-year-old man, who presented with hoarseness and chronic cough. Ultrasonography showed a heterogeneous hypoechoic nodule, and fine-needle aspiration (FNA) revealed benign squamous cells, food debris, inflammatory cells, and microorganisms, supporting the diagnosis of a PED. The second case was a 61-year-old man with chronic throat discomfort and an incidental neck mass initially suspected to be a benign thyroid nodule. Repeated FNA cytology consistently demonstrated benign squamous cells without thyroid follicular cells or colloid, and imaging correlation suggested a PED. These cases highlight the importance of correlating cytological and imaging findings when assessing presumed thyroid nodules to prevent misdiagnosis and unnecessary thyroid surgeries.

The global incidence of thyroid cancer has risen over recent decades, largely attributed to increased detection of thyroid nodules. This trend has raised concerns regarding overdiagnosis and overtreatment. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) plays a pivotal role in preoperative risk stratification, yet clinical decision-making remains challenging in indeterminate categories (Bethesda III-V), particularly in resource-limited settings where molecular testing is unavailable. To determine the risk of malignancy (ROM) for each TBSRTC category among patients who underwent thyroid surgery over a 10-year period at a tertiary care center in India, and to compare these rates with the 2023 TBSRTC risk estimates. This retrospective study analyzed fine-needle aspiration cytology and histopathology data for all patients who underwent thyroid surgeries conducted between 2014 and 2024. ROM across TBSRTC categories was calculated and compared with established TBSRTC risk estimates. A 100% malignancy rate was observed in TBSRTC VI category, supporting the reliability of surgical decisions in this group. However, significantly higher malignancy rates were found in TBSRTC categories III (58.7%), IV (82.7%), and V (100%) compared to TBSRTC estimates (22%, 30%, and 74%, respectively). TBSRTC III nuclear had a significantly higher malignancy rate (70.0%) than TBSRTC III other (40.57%). Institution specific malignancy data enhances the clinical utility of TBSRTC and improves patient counseling, particularly in settings where molecular diagnostics are not feasible.

To study the clinicopathological spectrum of parasitic infections diagnosed by fine needle aspiration cytology (FNAC) with histopathological and radiological correlation. This was a retrospective study where out of a total of 6213 FNAC of superficial palpable lumps from various sites performed during the study period of 1 year, that is, from July 2022 to July 2023, 97 (1.56%) cases were retrieved out of which 56 cases (0.90%) were diagnosed as definitive parasitic lesions and 41 (0.65%) cases were suspicious of parasitic lesion on cytology which were later correlated with histological and clinical findings. Among 97 patients, 47 were males (48.5%) and 50 were females (51.5%) with the maximum number of cases in the age group of 10-45 years (50%). Overall, the most commonly affected site was the upper extremities 36/97 (37.1%) followed by the lower extremities 26/97 (26.8%) and the abdominal wall 14/97 (14.4%). Cytological findings revealed cysticercosis in 45/97 (46.3%) cases, followed by filaria in 5/97 (5.15%), echinococcus in 6/97 (6.18%), and suspicious parasitic lesions in 41/97 (42.2%) cases. 24 cases had histopathology for confirmation mostly in those suspicious for parasitic lesions. Radiological findings in parasitic lesions to depict specific features were also obtained. FNAC is a rapid, safe, cheap, reliable, and early diagnostic modality to diagnose parasitic infections in developing/endemic nations where parasitic infestation is one of the major health concerns. Careful inspection of swellings, their aspirates, and examination of cytological smears is highly useful for early and definitive diagnosis of the disease leading to proper treatment as well as control of infestations.

Assessment of an innovative synthetic matrix for enhanced cell preservation: evaluating its clinical utility and impact on diagnostic precision in thyroid fine-needle aspiration cytology.

ABSTRACTIntroductionSalivary gland lesions (SGL) are a rare and heterogeneous group of benign and malignant masses. Fine‐needle aspiration cytology (FNAC), guided by the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), offers a minimally invasive method for early differentiation of SGL. The purpose of this study was to evaluate the cost‐effectiveness of FNAC in diagnosing major SGL within the MSRSGC framework.MethodsThree decision tree models were created based on probabilities from real‐world and literature data. Real‐world data was derived from the previously published largest single‐center study evaluating FNAC performance of SGL to date. Costs were determined from German and American fee catalogs. Multiple Monte Carlo simulations were run to assess the cost‐effectiveness of performing FNAC within the MSRSGC framework under different conditions for both health care systems.ResultsUsing decision analysis, FNAC followed by surgery, if indicated, was less costly than upfront surgery. The cost reduction through FNAC was over 30% for all models. Cost reduction per case through FNAC followed by surgery, if indicated, compared to upfront surgery ranged between $5606 and $13,096 in the US model (average costs for upfront surgery: $17,472) and between 2465€ and 5337€ in the German model (average costs for upfront surgery: 8018€). When enhancing the German model with real world data, the cost reduction ranged between 2478€ and 5954€ (average costs for upfront surgery: 7988€).ConclusionIn this model based on MSRSGC estimates and real‐world data, FNAC followed by surgery, if indicated, proved to be a more cost‐efficient approach to diagnosing SGL than upfront surgery. Thus, patients and healthcare systems benefit from high‐output centers that guarantee expert cytopathological diagnosis.

Primary testicular lymphoma is a rarely seen testicular tumor accounting for 19% of all testicular tumors. It is a rare form of extra nodal non-Hodgkin’s lymphoma representing 1% 2% of non-Hodgkin’s lymphoma. The dominant histological subtype is diffuse large B-cell lymphoma (DLBCL). It is the most common testicular malignancy in men aged over 60 years. Patients with primary testicular DLBCL show a continuously high risk of recurrence with no plateau in the survival curves and a tendency to involve other extra-nodal sites, especially the central nervous system and the contralateral testis. Here we present a 60-year-old gentleman from Bangladesh presenting with fever and unilateral testicular mass for 3 months. Fine needle aspiration cytology (FNAC) from testicular mass revealed granulomatous orchitis and he was started anti tubercular medication without improvement. Later orchiectomy was done and Immunohistochemistry showed diffuse large B-cell lymphoma. He was referred to oncology for further management. The Journal of Ad-din Women's Medical College; Vol. 13 (2), July 2025; p 41-46

Hürthle cell carcinoma (HCC) -recently known as oncocytic carcinoma- is a rare type of differentiated thyroid cancer that presents a diagnostic and therapeutic challenge because of its morphological heterogeneity and uncertain biological behavior. This retrospective single-center cohort study included all the patients with HCC who underwent surgical treatment in our center from January 2009 to May 2024. The epidemiological, clinical, and oncological data of the included patients were analyzed. This study included nineteen cases of HCC (9 males and 10 females). The average age at diagnosis was 54.8 ± 12.2 years. Preoperative fine needle aspiration cytology (FNAC) classified 2 tumors as Bethesda I, 7 as Bethesda III, 6 as Bethesda IV, and 4 as Bethesda V. A variety of surgical procedures were used, including hemithyroidectomy in 3 patients and total thyroidectomy in 12 patients. Two patients underwent neck dissection. The median tumor size was 6.7cm. Pathological evaluation identified 9 patients with unifocal lesions and 10 with multifocal lesions. Only one patient showed positive lymph node involvement. The median times to death, distant metastasis, and locoregional recurrence were 4, 13, and 6 years, respectively. For locoregional recurrence, the restricted mean survival time (RMST) at five years was 4.4 years (95% CI 3.9-4.9), 4.6 years (95% CI 4.1-5.0) for distant metastasis, and 4.1 years (95% CI 3.6-4.5) for overall survival. There was a trend towards worse prognosis in females, younger age, and those with primary surgery outside the center. These differences did not achieve statistical significance, at least partly due to the small sample size. Diagnosing HCC remains challenging due to its overlapping features with other thyroid conditions, making fine-needle aspiration cytology less definitive. Surgical treatment remains the preferred therapeutic option. Age, gender, and the volume of the surgical center for the initial procedure can influence patient outcomes, particularly recurrence and survival rates.

Abstract A 27-year-old primigravida at 7 months of gestation presented with multiple itchy red raised lesions, initially on the lower extremities, later progressing to involve the upper extremities. Examination revealed multiple well-defined erythematous papules and nodules with central necrosis over the bilateral upper, lower extremities, and chest. Differential diagnoses of prurigo in pregnancy, papulonecrotic tuberculid, and acquired perforating disorder were considered. Investigations revealed a positive Mantoux test, and fine-needle aspiration cytology of an enlarged cervical lymph node confirmed Koch’s etiology. Dermoscopy showed a central keratotic plug. The patient was started on antitubercular therapy and showed significant improvement within 2 months, with complete resolution after 6 months, leaving only postinflammatory hyperpigmentation and varioliform scarring.

Background: Hepatic mass lesions encompass a wide range of benign and malignant neoplasms. Differentiating primary liver malignancies from metastatic tumors is crucial for patient management. Aims and Objectives: To study the clinicopathological spectrum of hepatic mass lesions with evaluation of the diagnostic role of image-guided fine-needle aspiration cytology (FNAC) and correlation with radiological findings and tumor markers. Materials and Methods: This observational cross-sectional study included 42 patients with hepatic masses at R. G. Kar Medical College and Hospital. Computed tomography-guided FNAC was performed, and smears were evaluated with Leishman and Papanicolaou stains. Tumor markers (alpha-fetoprotein [AFP], carcinoembryonic antigen [CEA], carbohydrate antigen 19-9 [CA 19-9], carbohydrate antigen 125 [CA 125]) and radiological findings were correlated with cytological diagnosis. Results: Of 42 cases, 76.2% were metastatic lesions and 14.2% were hepatocellular carcinoma (HCC). Metastases were more common in patients >60 years. Strong correlations were observed between FNAC and imaging findings (P=0.0038). AFP was positive in all HCC cases; CEA, CA 125, and CA 19-9 showed site-specific elevations in metastatic carcinomas. Conclusion: Image-guided FNAC, combined with radiological findings and tumor markers, is an effective and minimally invasive approach for accurate diagnosis of hepatic mass lesions, particularly in resource-constrained settings.

Tubercular lymphadenitis (TBL) is the most common form of extrapulmonary tuberculosis (EPTB), accounting for 20%-40% of EPTB cases. We present you a case of a 45-year-old male presented with gradually progressive swelling in the lower right side of the jaw for 2 months. At his initial consultation at another center, a diagnosis of carcinoma of the right lower alveolus was suggested. However, the histopathological examination (HPE) performed at the same center revealed a tubercular granulomatous lesion. As the patient's symptoms didn't seem to correlate with this diagnosis, he didn't initiate his treatment there and sought further evaluation at our institution. In course of further investigation, Fine Needle Aspiration Cytology (FNAC) suggested for TBL but Acid-Fast Bacilli (AFB) and Gene Xpert showed negative results for mycobacterium tuberculosis. After 2 months of antitubercular regimen, the patient responded well to drugs with significant reduction in swelling. This case highlights the diagnostic challenge of atypical presentations of TBL in the head and neck region, emphasizing the role of rapid and minimally invasive FNAC for the early diagnosis of TBL even with negative Gene Xpert and AFB stain.