Fine Needle Aspiration Smears Research Articles

Efficacy of modified cell block cytology compared to fine needle aspiration cytology for diagnostic oral cytopathology

ABSTRACT Cell blocks and fine needle aspirations can be used for cytopathological diagnosis. Conventional fine needle aspiration smears provide limited material for diagnosis. The cell block technique provides more tissue, which improves diagnostic accuracy. We compared a modified cell block cytology to fine needle aspiration for providing optimal preservation of histochemical and immunocytochemical properties. We used 30 fine needle aspirates from oral lesions in two groups: group 1, fine needle aspiration cytology; group 2, cell block cytology. Smears of fine needle aspirates were stained with Papanicolaou. For the modified cell block technique, aspirated material was centrifuged to create a cell pellet, which then was fixed with Nathan alcohol formalin substitute. After routine histopathological processing, cell pellets were embedded in paraffin, then sectioned and stained with hematoxylin and eosin. Sections were compared to Papanicolaou stained smears of fine needle samples. Cellular morphology and staining quality of modified cell block samples were superior to fine needle aspiration cytology; both methods exhibited distinct nuclear morphology. Modified cell blocks provide excellent cytopathologic features compared to fine needle aspiration cytology.

Removal of Air-Drying Artifact of Papanicolaou Stained Smears with Normal Saline and Fresh Frozen Plasma

Background Papanicolaou stained (Pap) smears in fine needle aspiration cytology play an important role for studying chromatin details of the cells and also ensures its optimal resemblance with the cell nuclei on histological sections. The conventional Pap Stained smears are ethanol fixed before drying. But delay in fixation due to any reason results in drying artifacts in the stained smears making it an inept smear for further examination. Aims & objectives: To study the role of rehydration fluid for removal of air drying artifact. Material and methods: Fifty fine needle aspiration smears from different organs with drying artifact in Pap Stained smears were included in the study. The smears were destained, rehydrated with rehydrating fluid for two hours and were restained with Pap stain after fixation with 95 % alcohol. Results : Smears treated with this solution showed reversal of the air drying artifact with better nuclear details and background material staining. Conclusion: Rehydration of destained Pap smears with rehydrating fluid followed by restaining results in optimal staining of the nuclear and background details preventing the material loss and making the smears appropriate for staining.

Preoperative detection of malignancy in fine-needle aspiration cytology (FNAC) smears with indeterminate cytology (Bethesda III, IV) by a combined molecular classifier

AimsAnalysis of molecular markers in addition to cytological analysis of fine-needle aspiration (FNA) samples is a promising way to improve the preoperative diagnosis of thyroid nodules. Previously, we have developed...

Clinicopathological Study of Mucinous Carcinoma of Breast with Emphasis on Cytological Features: A Study at Tertiary Care Teaching Hospital of South India.

Introduction Mucinous carcinoma (MC) is a rare form of breast cancer. It accounts for 1 to 7% of the cases and characterized by the presence of extracellular mucin (ECM). Depending on the amount of mucin, it is classified into pure mucinous carcinoma (> 90%, PMC) and mixed mucinous carcinoma (MMC; < 90%). In comparison to most common subtypes, MC is having better prognosis. There exist clinicopathological differences among PMC and MMC and also MC and IDC-NOS. Materials and Methods MCs diagnosed between January 2012 and December 2017 were included. Fine needle aspiration cytology smears were screened for cellularity, ECM, nuclear pleomorphism, signet ring cells (SRC), mucinophages, and myxovascular fragments (MVF). Histopathology slides were screened to confirm the diagnosis. Immunohistochemistry slides were graded as per the standard protocol. Statistical analyses were performed by SPSS software. Results In the present study, MC constituted 3.3%. The mean age of the patients was 50.9 years. ECM, mucinophages, and SRC were the key diagnostic cytological features. The PMC and MMC were clinicopathologically distinct with respect to gross findings and lymph node status. MMCs were highly proliferative. The mean duration of follow-up was 24.5 months. Complications were more common in MMC than PMC. Lymph node involvement is the key prognostic factor and it is independent of other prognostic factors like age, size, and hormonal receptor status. Conclusion PMC are rare subtype of breast cancer. The diagnostic cytological features are ECM, MVF, and SRC. MMC and PMC are clinicopathologically and genetically distinct.

Cytorich fixative system- A new modality in haemorrhagic fine needle aspiration smears

The CytoRich Red fixative system for red blood cell lysis in liquid based cytology technique is quite effective in hemorrhagic cervical PAP smears. However, its role in fine needle aspiration cytology needs to be explored. (1). Highlight the role of CytoRich Red fluid as fixative media. (2). To compare CytoRich Red fixed smear with conventional smear. (3). To compare CytoRich Red fixed smear with liquid based cytology (LBC) smear. Thirty hemorrhagic smears from breast (16 ) , thyroid (08), lymph node (04) and soft tissue (02) lesions were included in the study. The fine needle aspirate was divided into two parts. First part was used for conventional smears and CytoRich Red treated smears. An unstained smear was stored in cold acetone for immunocytochemistry, which was applied on relevant cases. The second part was used for Liquid-Based cytology (LBC). All smears were compared for cytomorphological features and background material. The smears were classified into 3 groups based on the percentage of hemorrhage that is &amp;#60;25%, 25-50% and &amp;#62;50%. Statistical analysis was done by SPSS version 24. A p value of ≤0.05 was considered as significant. Red blood cells were significantly reduced without hindering staining with a statistically significant difference between background haemorrhage in conventional smears and CytoRich Red treated smears (p value &amp;#60;0.001). However, this difference was not significant between the Cytorich Red fixed smears and LBC. The Diagnostic utility of CytoRich Red treated smears was more than that of LBC alone (p value &amp;#60; 0.05). Also, there was no significant loss of desired material on CytoRich Red fixed smears. Cytorich red fixative system can be used in case of hemorrhagic fine needle aspiration slide which provides a clear background without compromising the cellularity of the smears.

Non-malignant fibroblastic/myofibroblastic tumors in pediatric age group: Clues and pitfalls to the cytological diagnosis.

Fibroblastic/myofibroblastic tumors constitute 12% of all pediatric soft tissue tumors with the majority of them belonging to the benign and intermediate prognostic categories. They are often misdiagnosed owing to their variable clinical presentation and unusual microscopic features. The diagnosis, specially cytological diagnosis of benign and intermediate categories is difficult due to paucity of cellular component and increased amount of extracellular matrix as compared to malignant ones. We hereby discuss the Fine needle aspiration cytology (FNAC) findings of non-malignant fibroblastic/myofibroblastic lesion in the pediatric age group encountered at our institute. All the benign and intermediate fibroblastic/myofibroblastic/fibroadipocytic lesions (age 0-12years) diagnosed on FNAC over a period of 3½years (Jan 2016- July 2019), with availability of corresponding histopathology were included in the study. A total of seven pediatric benign and intermediate fibroblastic/myofibroblastic lesions with histopathological confirmation were identified which included Infantile digital fibromatosis (IDF) (n=2), Lipofibromatosis (n=1), Fibrous hamartoma of infancy (FHI) (n=1), Fibromatosis colli (FC) (n=2) and myofibroma/myofibromatosis (n=1). FNAC smears were mainly paucicellular with presence of benign spindle shaped cells in a collagenous stroma common to almost all the cases. A few additional findings such as degenerated skeletal muscle fibres, muscle giant cells and mature adipose tissue were also present in some cases. Fibroblastic/myofibroblastic tumors although uncommon, form an important category that must be considered in the differential diagnosis of pediatric soft tissue tumors. FNAC cytology features when assessed in a proper clinical setting (specially the age and site of presentation) are helpful in suggesting probable preoperative diagnosis in these lesions.

CYTOLOGICAL CHARACTERISTICS OF POSTOPERATIVE METASTASES OF PAPILLARY THYROID CANCER DURING THE DEVELOPMENT OF SECONDARY RADIOIODINE REFRACTORINESS

Radioiodine refractoriness is the main problem in the diagnosis and treatment of papillary thyroid carcinoma. The aim of the study was to investigate the cytological and immunocytochemical changes of thyrocytes in fine-needle aspiration smears of thyroid papillary cancer metastases in the course of the development of secondary radioiodine resistance. A total of 70 postoperative metastases of thyroid papillary cancer (secondary radioiodine refractory metastases, previously responsive to radioiodine, that eventually loses the ability to radioiodine accumulation, radioiodine-avid metastases, primary radioiodine-refractory metastases), immunohistochemical staining of thyroid peroxidase, thyroglobulin, cytokeratin 17 and cytological analysis were performed. Revealing the presence of specific cellular phenotypes and structures in punctuates, a low percentage of thyroid peroxidase and thyroglobulin-positive thyrocytes allows the development of the method of cytological prediction of the radioiodine therapy effectiveness.

Diagnostic capability of fine-needle aspiration cytology in assessment of intraosseous lesions of the jaws: A systematic review.

To systematically review (SR) and critically appraise studies that investigated the diagnostic capability of fine-needle aspiration cytology (FNAC) in the assessment of intraosseous lesions of the jaws. Six main electronic databases and three gray literature databases were searched aiming diagnostic studies, which were selected in a two-phase process. Risk of bias (RoB) of included studies was assessed using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies. A total of eight articles were included, of which six evaluated the FNAC smear technique exclusively, one assessed both smear and cell-block techniques, while one investigated only the cell-block technique. With regard to the FNAC smear technique, from 134 benign lesions investigated, concordance with the histopathological diagnosis was achieved in 64.17% of cases. In addition, considering the 32 malignant lesions assessed through this technique, concordance with histopathology was achieved in all cases. Regarding the cell-block technique, only benign lesions (n = 40) were evaluated in the included studies, in which the concordance rate with histopathology was of 77.5%. The overall RoB judgment was "at risk of bias" for seven included studies mostly due to lack of information or reportedly absence of blinding of evaluator. Within the limitations of this SR, FNAC presented modest to satisfactory diagnostic capability for the assessment of intraosseous jaw lesions, showing concordance rates higher than 64% for the smear and 77% for the cell-block technique. Also, considerably high concordance rates were found for the assessment of malignant lesions regarding FNAC smear technique.

Solid variant of papillary thyroid carcinoma: an under-recognized entity.

Solid variant of papillary thyroid carcinoma (SVPTC) is a rare morphological variant of papillary thyroid carcinoma (PTC). SVPTC is histologically characterized by predominant solid, trabecular and insular nests of tumor cells while cytological features of PTC such as nuclear grooves and nuclear inclusions are preserved. In fine needle aspiration cytology smears, tumor cells of SVPTC may be presented in cohesive, syncytial or trabecular clusters accompanied by some discohesiveness in the absence of necrosis. Although SVPTC and poorly differentiated thyroid carcinoma (PDTC) share similar histological findings of solid nests, SVPTC can be differentiated from PDTC in the lack of tumor necrosis, severe nuclear atypia, and a higher mitotic index. Immunohistochemical expression of CK19 and HBME-1, common markers of PTC, is decreased in solid nests of SVPTC. In pediatric patients exposed to radiation after the Chernobyl nuclear accident, there was a higher prevalence of SVPTC with RET/PTC3 type rearrangement. BRAF mutations are also reported in a small number of adult patients with SVPTC without any prior radiation exposure. Patients with SVPTC may have a slightly higher incidence of metastasis and recurrence of the tumor compared to conventional PTC, although overall survival rate is comparable. In this article, the current knowledge of SVPTC will be reviewed and discussed with an emphasis on the histopathological feature.

Indigenous Technique as an Effective Liquid-Based Cytology Tool for Multiple Single-Layered Cell Preparations.

Aims and Objectives:The aim of this work was to study the application of Modified Millipore technique (MMT) as a liquid-based tool to have multiple monolayer cellular smears for the routine cytology and Immunocytochemistry.Materials and Methods:In this study, we included 32 effusion fluid samples and 30 fine-needle aspiration cytology (FNAC) samples. From each of the samples, at first routine conventional smear was prepared. The residual samples were processed by MMT to make multiple smear preparation. Both the conventional and MMT of the monolayer cells were evaluated. The various cytomorphological features including the cellularity, background information, nuclear morphology, and cytoplasmic preservation were compared in these two techniques.Result:There were a total of 15 cases of fluid samples and 27 cases of FNAC. Statistical analysis of Mann–Whitney U test showed that the monolayer preparation by MMT and liquid-based cytology of fluid and FNAC smears are of same quality (P > 0.01).Conclusion:Monolayer preparation by MMT is cheap and effective. This technique can be used in routine laboratory for multiple monolayer cell preparations.

Fine-needle aspiration cytology-induced infarction of thyroid nodule hampers diagnosis

Fine-needle aspiration cytology (FNAC) is a useful procedure for the investigation of thyroid swellings. It is a safe and minimally invasive procedure but is accompanied by its own set of complications. Infarction of the parent tissue post-FNAC has been reported in the lymph node, salivary gland, and breast but is a rare phenomenon in the thyroid. We present a case of a 34-year-old female with a solitary thyroid nodule. FNAC smears were hypercellular and showed numerous Hurthle cells suggesting a possibility of Hurthle cell neoplasm. Hemithyroidectomy performed 1 month thereafter showed extensive necrosis and hemorrhage with only few atypical follicular epithelial cells and Hurthle cells at the periphery. The near-total infarction and paucity of viable cells made it extremely difficult to make a histopathological diagnosis. The case highlights the need for extensive sampling and thorough examination of the periphery for any viable foci on histopathology along with cytologic-histologic correlation in such cases.

Appreciation of Pattern in Diagnosis of Lung Adenocarcinoma from Cytology Specimen: Our Experience with Fine Needle Aspiration Cytology and Cell Block in a Resource Constraint Setup.

Background and Aims:Advent of personalised treatment needs correct diagnosis of lung adenocarcinoma with its molecular subtyping. Minimal use of special stain or immunohistochemistry (IHC) in small specimens save material for molecular testing. Various histologic patterns in adenocarcinoma (ADC) subtypes have different prognostic implications and current recommendation is to describe these patterns in small specimens. Aim of this study was to diagnose adenocarcinoma from cytology specimens depending on adenocarcinoma pattern on fine needle aspiration smears and cell blocks. We also studied the additional role of cell blocks as a platform for special stain and IHC.Materials and Methods:Conventional smears and cell block (CB) preparation were examined from transthoracic CT guided FNA samples of suspicious lung malignancy cases. Clear defining architectural pattern and cytomorphological features in favour of adenocarcinoma were evaluated and mucin stain and IHC were used as and when required.Results:A total of 86 cases were included in this study, of which 83 cases were diagnosed as adenocarcinoma, 52 (62.5%) showed clear cut evidence of adenocarcinoma from smears and CBs. CB morphology alone aided the diagnosis in 12. Various ADC patterns in combination or alone were appreciated in these 64 cases. Sixteen needed mucin stain and 3 needed IHC for diagnosis. Forty one were ADC with solid pattern of which 39 showed high nuclear grade.Conclusion:Adequately cellular FNA smears and corresponding cell blocks of optimal quality can aid effectively in diagnosing adenocarcinoma and appreciating its pattern. Therefore, it would minimize the need for special stain and/or IHC with preservation of more material for molecular testing.

To study the differentials of suppurative lymphadenitis by FNAC and their evaluation by Z.N. staining, CB-NAAT, fluorescent microscopy, fungal and bacterial cultures

Introduction: Suppurative lymphadenitis is most commonly unilateral in presentation. It is caused due to transportation of invading microorganisms (initially penetrating from mucosa or skin of the head or neck most commonly) to afferent lymph nodes. The most common bacterial causes of suppurative lymphadenitis are Staphylococcus aureus and Streptococcus pyogenes, accounting for between 40% and 89% of cases.AIM: To study the cytomorphological features in fine needle aspiration smears from patients suspected of having suppurative lymphadenitis and to study the differentials of suppurative lymphadenitis by FNAC and their evaluation by Z.N. staining, CB-NAAT, fluorescent microscopy, fungal and bacterial cultures so as to know the exact cause of suppurative lymphadenitis.Material and Methods: The present study was conducted in 50 patients of clinically suspected cases of suppurative lymphadenitis. Fine needle aspirations were performed and smears from the aspirates were processed for routine cytology (H&E, MGG) N, the conventional ZN method, fluorescent method, CBNAAT, bacterial and fungal culture for evaluation.Results: Z.N. positivity was seen in 34.14% while with fluorescent stain positivity was increased up to 60.97% and was increased up to 78.05% with CB-NAAT. Fluorescent stain positivity was seen in 60.97% while with CB-NAAT positivity was increased to 78.05%. Out of 9 cases of with bacterial etiology, only 5 cases were positive on bacterial culture. 3 cases showed MRSA and two cases showed Streptococcus pyogenes. No case of fungal lymphadenitis was identified in our study as all the cases were negative on PAS staining and fungal culture. Conclusion: Though cytomorphological appearance and Z.N. staining are commonly used in developing countries as they are economical and convenient alternative to open biopsy of lymph nodes but fluorescent method proves to be more sensitive technique than the Z.N. CB-NAAT proves to be more sensitive than both Z.N. and fluorescent staining for those patients which show cytomorphological appearance of TB. Patients with high risk of tuberculosis in whom AFB smear examination is usually negative are most likely to be benefited from CB-NAAT. Hence for the differentials of suppurative lymphadenitis cytomorphological examination along with various other ancillary techniques (methods) has more diagnostic value.

Fine-Needle Cytological Characteristics of Carcinoma Breast with Medullary or Medullary-like Features Masquerading as Dendritic Reticulum Cell Sarcoma: An Attempt to Explore the Reasons for Erroneous Cytologic Interpretation.

Background:Infiltration of tumors by dendritic reticulum cells (DRC) reflects the host immune defense mechanism. We observed three breast carcinomas cases with dense tumor-infiltrating DRC and lymphocytes in fine-needle aspiration (FNA) smears, leading to cytodiagnosis or differential diagnosis of dendritic reticulum cell sarcoma (DRCS). An attempt was made to find out the reason behind such an erroneous interpretation.Materials and Methods:Between 2009 and 2014, two cases were diagnosed as DRCS of the female breast by FNA cytology and in one case possibility of DRCS was considered along with medullary breast carcinoma (MBC). We compare and contrast the cytomorphological features of these three cases with those of nine cytologically diagnosed MBC.Results:Cases diagnosed as DRCS or MBC showed singly dispersed tumor cells, nuclear pleomorphism, bare nuclei, prominent nucleoli, and presence of lymphocytes. There was no significant difference between the two groups for discohesive clusters, syncytial clusters, plasma cells, neutrophils, foamy histiocytes, and necrosis. However, there was significant difference for presence of cohesive clusters (0% DRCS and 100% MBC, P = 0.00485), severe degree (+++) of pleomorphism (100% DRCS vs. 11.1% MBC, P = 0.01818), +++ DRC (P = 0.04697), and DRC with ++ to +++ enlarged nuclei (P = 0.03333), and pleomorphic nuclei (P = 0.00833). Two of the three cytologically diagnosed DRCS cases proved to be MBC or MBC-like and one as invasive ductal carcinoma. Six of nine cytologically diagnosed MBC cases with histology proved to be invasive breast carcinomas.Conclusion:Criteria for cytodiagnosis MBC need a fresh look. Cases with numerous dendritic cells possibly represent MBC.

Comparison of Five Cytochemical Stains used for Fine Needle Aspiration Cytology of Breast and Lymph Node Lesions: A Comparative Study

Introduction: Fine Needle Aspiration Cytology (FNAC) is an established diagnostic tool aiming at an early diagnosis of mass lesions which in turn aids in planning further management of the patients. The need for minimal turnaround time with good quality of cell morphology has encouraged the development of different staining techniques. Quality Index (QI) of cytochemical stains is evaluated with a scoring system based on morphological features. Aim: To find rapid staining methods which were economical without compromising on the quality of FNAC smears. QI of five stains namely Papanicolaou stain (Pap), Haematoxylin and Eosin (H&amp;E), May Grunwald Giemsa (MGG), Modified Ultrafast Papanicolaou (MUFP) and Rapid Economic Acetic acid Pap stain (REAP) were studied and compared. Materials and Methods: This was a prospective study conducted in the Department of Pathology, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India, from August 2011 to July 2013. FNAC of 80 mass lesions including 44 of breast lesions and 36 lymph nodes were included in this study. A minimum of five smears were made in each case and stained with Pap, H&amp;E, MGG, MUFP and REAP. The QI of stain was assessed by the scores given for background of the smear, overall staining, and preservation of cell morphology, nuclear characteristics, cytoplasmic details and air drying artifacts. Statistical analysis of the data was done using chi-square test and Statistical Package for the Social Sciences (SPSS) version 15.0. Results: Pap stain showed maximum QI score followed by H&amp;E, REAP, MGG and MUFP in case of breast lesions. In cases of lymph node highest QI was again with Pap followed by H&amp;E, REAP, MUFP and MGG. Good cytomorphology with lesser expenditure and turnaround time was obtained by REAP and MUFP stains. Conclusion: Pap stain is still the best for cell morphology whereas MUFP and REAP are good, economical and with lesser turnaround time and can be used in routine cytopathology.

Cell Block Preparation for Fine Needle Aspiration Cytology of Thyroid; Cost Effective Method in a Resource Poor Setting

Over the past thirty years thyroid tumor incidence has triplicated and it is currently 7% of a given population. However, interestingly the thyroid cancer incidence is quite low and is approximately 5-10% of the thyroid tumor patients. Expeditious diagnosis of the thyroid nodules at the pre surgery stage is important to determine the tumor prognosis. A Widely used diagnostic approach is the direct observation of the fine needle aspiration specimens. However, using only this method many reported cases of unnecessary surgeries and re-operative incidents due to false diagnosis at the preoperative stage have been observed. Poor cellularity, loss of tissue architecture, poor cytomorphologic features in fine needle aspiration smears leads to incorrect diagnosis. Cell block technique is a better diagnostic approach at the pre-operative stage to overcome the pitfalls in direct smears as it concentrates the cells and preserve tissue architecture. Further, multiple sections with same cellularity can be prepared from a single cell block allowing the use for more advanced techniques like immunohistochemistry and molecular diagnosis. Cell block technique strengthen the diagnosis of tumors by fine needle aspiration specimens. Combined use of cell block technique with fine needle aspiration can reach to a sensitivity of about 95-100% suggesting that every FNAC specimen should be subjected to cell block preparation whenever possible.

Cytopathological and immunohistochemical assessment of mammary tumors in male dogs

Three male dogs affected with mammary tumors brought for treatment were aged 7 to 10 years. Tumor was noted at right caudal thoracic in one dog and left caudal thoracic region in two dogs. The mean haemato-biochemical parameters revealed no alterations except leucocytosis associated neutrophilia and elevated blood urea nitrogen and creatinine. The serum sex hormones estradiol and progesterone were increased, whereas, testosterone values were unaltered. Grossly, cut surface of the tumor mass from one dog revealed greyish white, blood tinged and cauliflower like growth. Fine needle aspiration smears revealed neoplastic cells mixed with inflammatory cells. Histopathologically the tumor mass revealed extensive proliferation of dense fibrous tissue, area of chondroid differentiation and transformation of fibroblast into cartilage. Proliferating neoplastic cells showed degeneration, necrosis and infiltration of inflammatory cells. Immunohistochemical analysis of tumor tissues revealed triple negative phenotype for estrogen and progesterone receptors and Human Epidermal Growth Factor-2, but positive reaction for cytokeratin. Clinico-pathological investigations and immunohistochemical features were consistent in diagnosis of mammary tumors in male dogs.

Cytomorphology of hepatoblastoma with histological correlation and role of SALL4 immunocytochemistry in its diagnosis, subtyping, and prognostication.

Hepatoblastoma (HB) is the most common malignant pediatric liver tumor, and cytology material is often the only tissue available for evaluation before definitive therapy. Subcategorization of HB based on cytomorphological features thus carries an important role in its prognostication. Spalt-like transcription factor 4 (SALL4), a marker of embryonic stem cells that is also found in the fetal liver, is reactivated in certain liver tumors. Limited studies have evaluated its role in HB. This study was aimed at evaluating the cytomorphological features of HB and assessing the utility of SALL4 immunocytochemistry (ICC) in its subtyping and prognostication. Pretherapy fine-needle aspiration smears from patients diagnosed with HB over a period of 9years were retrieved. Aspirates were subclassified on the basis of the cytomorphology and were correlated with the histology wherever it was available. ICC for SALL4 was performed in 33 cases, and nuclear staining was considered positive. A total of 53 HB cases were included with 30 available postchemotherapy resection specimens. All the patients were diagnosed asepithelial HB on cytology, and the cases were subclassified as pure fetal (9 of 53), pure embryonal (2 of 53), or combined epithelial HB (42 of 53). There was good concordance between cytology and histology for subtyping. SALL4 immunostaining displayed strong and diffuse nuclear positivity in the embryonal component whilefocal and weak to negative staining in fetal cells. Fine-needle aspiration cytology serves as a rapid and effective tool for a correct diagnosis of HB before the implementation of chemotherapy, and SALL4 may serve as a useful diagnostic and prognostic marker.

Artificial neural network model to distinguish pleomorphic adenoma from adenoid cystic carcinoma on fine needle aspiration cytology.

To differentiate pleomorphic adenoma (PA) and adenoid cystic carcinoma (ACC) on fine needle aspiration cytology (FNAC) is often challenging to cytologists. In the present study, we tried to make an artificial neural network (ANN) model from the FNAC smears to differentiate PA from ACC. The detailed cytomorphological features were analysed on the FNAC of histopathology proven cases of PA (n = 35) and ACC (n = 33) and enumerated semi-quantitatively by two independent observers. These data were used to make an ANN model to distinguish PA from ACC on FNAC material. We used neuro-intelligence software to build the ANN model. The network architecture was 10-2-1. The heuristic search engine was applied to have this model. We used backpropagation neural network to teach ANN. At least 500 iterations were done to train the model. The efficacy of this ANN model was assessed with the help of the confusion matrix and receiver operating characteristic curve. The data were separated automatically by the software as a training set (n = 48), validation set (n = 10) and test set (n = 10). The ANN model was able to differentiate every case (10/10) of PA and ACC in the final test set. The area under the receiver operating characteristic curve was 1. The currently built ANN model is competent to identify PA and ACC cases on FNAC. Additional parameters and new cases can be incorporated into this open-ended ANN model to make it more robust.

Cytomorphology of Chondroid Syringoma: Analysis of 20 Cases and Review of Literature

Background: Chondroid syringomas [CS] are interesting skin adnexal tumours. They have a remarkable pleomorphic-adenoma like morphology in the skin. Though the histopathology of the tumour has been described in detail in literature, cytomorphological studies are restricted to case reports and small case series. For diagnosing a CS on cytology, the index of suspicion must be high, clinical evaluation must be thorough and knowledge of variant existing morphologies is essential. Aim: This study was done with the aim of studying the common and variant cytological features of chondroid syringomas. Methods: This was a retrospective study conducted over a four-year period (2014-17) in the Department of Pathology, VMMC and Safdarjung hospital. Fine needle aspirate smears and biopsy slides were studied. Morphological details were independently reviewed in detail by two pathologists (Dr MS and Dr MA). Result and Conclusion: The conventional biphasic cell morphology of CS was seen in nearly 50% cases. Rest of the cases showed predominance of one or more variant features in few areas and thus CS was only one of the differential diagnosis in these cases. Nevertheless, FNA proved to be fast, inexpensive and a reliable method for diagnosis of chondroid syringoma. The study will be relevant and helpful in the day to day cytological reporting of CS.