Ne Needle Research Articles

A STUDY ON THYROID NODULES CORRELATION OF TIRADS WITH BETHESDA SYSTEM

Thyroid nodules are very common in clinical practice and the incidence ranges from 4-7% on palpation whereas on ultrasonographic examination the prevalence ranges from 50-60%. Ultrasound has considerably increased the number of cases identied; The USG features of thyroid nodules do not always coincide with the cytological results, leading to discrepancies and confusion in management protocols. This study aims to correlations between USG and cytological ndings in the diagnosis of thyroid nodules. Ultrasonogram of neck done in 100 cases in these 75 of them having thyroid nodules. More common in females. In my study observed a good correlation between ultra sound guided diagnosis made by TIRADS and ne needle aspiration diagnosis by Bethesda classication. By stratifying the thyroid lesions according to TIRADS, FNAC can be performed only on suspicious lesions which can avoid unnecessary aspiration on thyroid lesions & the identication of patients at higher risk of cancer

A CLINICOPATHOLOGICAL STUDY OF 100 CASES OF SALIVARY GLAND LESIONS AT A TERTIARY CARE CENTRE.

Background: Salivary gland shows varied types of pathological lesions ranging from inammatory lesions to neoplasms. We have studied the salivary gland lesions with correlation to clinical and histopathologic features. Objective: Aim of this study was – 1. To study the epidemiology of salivary gland lesions in a tertiary care centre with respect to the age, sex and site distribution. 2. To study the histomorphological aspect of these lesions. 3. To correlate between ne needle aspiration cytology and histopathology of these lesions. Materials and Methods: The present observational study was conducted in the department of pathology in Dr. VPMCH&RC, Nashik. Total 100 cases were studied over a period of two years with particular reference to age, sex, site, cytological details & histological types as per WHO classication. Detailed FNAC & histopathological examination was done in all the cases. Correlation between the cytological & histopathological diagnoses was assessed. A total of 100 cases were studied, comprising of 62 Results: male & 38 female and 16 cases were malignant. The parotid gland was the most commonly involved site (70% of cases). Of the 46 non-neoplastic cases, 38 were of chronic sialadenitis and 8 cases of mucous retention cyst. Among the 38 benign neoplastic lesions, 32 were Pleomorphic adenoma and 6 were Warthin's tumour. Mucoepidermoid carcinoma (8 cases) was the most common malignant neoplastic lesions. Correlated in 95% of instances. Salivary gland lesions, are most Conclusion: nd th commonly seen in 2 to 6 decade of life with more male predominance. Parotid gland is the most common site. Lesions have more frequent occurrences compared to neoplastic lesions, with chronic sialadenitis having highest incidence. Histopathologic examination is fairly accurate in making a diagnosis especially in non-neoplastic & benign neoplasms.

FINE NEEDLE ASPIRATION CYTOLOGY OF SALIVARY GLAND LESIONS: REPORTING BY THE MILAN SYSTEM

Background: In the salivary gland lesions most common presentation is of a swelling or palpable mass of varying duration. In infective lesions, pain is another presenting feature. The most accurate method of diagnosing salivary gland lesions is histopathology, yet the role of ne needle aspiration cytology (FNAC) for the diagnosis of salivary gland masses is well documented and is signicantly accurate. The present study comprise analysis of FNAC of all salivary gland lesions using Milan system of classication. The present retrospective Material and Methods: study involves 234 cases of salivary gland swellings, referred for FNAC to the Department of Pathology, Government Medical College, Jammu for a period of ve years w.e.f November, 2016 to 31 October, 2021. This study includes cytomorphological features of various salivary gland lesions on FNAC and their classication by the Milan system of reporting. It was obs Results: erved that peak incidence of salivary gland tumours was seen in the age group of 31-45 yrs. The majority of benign lesions were seen in the age group 16-30 yrs and the malignant lesions were seen in the age group 46-61yrs. There was female predominance over the male with F:M ratio is 1.46:1. The most frequently involved site was parotid gland (48.7%) followed by submandibular gland (40.6%). 109 cases were diagnosed as non-neoplastic, 98 as benign and 16 cases as malignant. Conclusion: FNAC is an important diagnostic tool to clinch the correct diagnosis of salivary gland tumours Fine needle aspiration cytology was able to distinguish between non-neoplastic and neoplastic lesions and benign and malignant tumours

A CASE REPORT OF MUCOEPIDERMOID CARCINOMA: A RARE PRESENTATION AT SUBMANDIBULAR SALIVARY GLAND

Introduction: Mucoepidermoid Carcinoma (MEC) is the most common malignant salivary gland neoplasm, representing 10 to 15% of all salivary neoplasms. Case Report: Ÿ A rare case of mucoepidermoid carcinoma of the left submandibular gland in a 36-year-old female patient who presented to ENT OPD with a painless mass in the left submandibular region. Ÿ histopathological examination conrmed the diagnosis of low-grade mucoepidermoid carcinoma of the submandibular gland. Ÿ Not all diagnostic features are found on ne needle aspiration, especially in low-grade lesions. Ÿ The diagnosis may be missed or confused with other benign and malignant lesions. Ÿ Treated by total excision of the left submandibular gland and no recurrence seen within 3 months of follow-up.

APPLICATION OF YOKOHAMA SYSTEM FOR BREAST FNAC WITH ASSESSMENT OF RISK OF MALIGNANCY.

ntroduction: This study is based on application of recently proposed International Academy of cytology (IAC) Yokohama system of Breast cytology. The main objective of the study was to categorise the Breast Fi Aim: ne Needle Aspiration Cytology (FNAC) samples according to this new system of reporting and to assess the Risk of malignancy (ROM) for each category as well as the diagnostic yield of the Breast FNAC. Materials and Methods: Total of 191 FNAC cytology smears from July 2021 to June 2022 were obtained. Microscopy was done and classication was done according to newly proposed IAC Yokohama system of reporting. The ROM was obtained. The sensitivity, specicity, Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy of Breast FNAC were calculated accordingly. The Breast FNAB samples were Results: distributed as follows: insufcient material 6.29%, benign 63.87 %, Atypical probably benign 3.14%, suspicious for malignancy 4.71% and malignant 21.98%. Of the 191 FNAC cases, 44 cases had histopathological correlation. The respective ROM for each category was 00% for category 1 (insufcient), 00% for category 2 (benign), 33.3% for category 3 (atypical), 100% for category 4 (suspicious for malignancy) and 100% for category 5 (Malignant). The sensitivity, specicity, positive predictive value, negative predictive value and diagnostic accuracy were respectively 100%, 92.3%, 89.47% 100% and 95.35% when malignant, suspicious of malignancy and atypical categories were considered positive. Categorisation of the Breast FNAC cytology according to IAC Yokohama syste Conclusion: m of reporting helps pathologist in the diagnostic clarity and guides clinician in the appropriate patient management. IAC Yokohama system of reporting breast cytopathology serves as a common language to pathologist and clinician.

A COMPARATIVE STUDY BETWEEN CONVENTIONAL METHOD AND THE BETHESDA SYSTEM FOR REPORTING THYROID CYTOPATHOLOGY

Background- Thyroid swellings are commonly investigated in cytology section and its uniform reporting to convey a decision making diagnosis to clinician is important, hence this study is done to compare conventional and Bathesda system for thyroid cytology reporting. A Prospective study on 100 pati Methodology – ents done who came for thyroid ne needle aspiration cytology. Aspiration done and smears prepared and reporting is done by Bathesda system as well as by conventional system and compared for its accuracy and uniformity. Results: The mean age of presentation of patients in present study is 38.06years. Out of 100 cases, 78 were females and 22 males. The ratio of Non neoplastic and Neoplastic lesion was 2.7:1 by Bethesda system and 3.0:1 by Conventional system. It was observed that, introduction of the new simplied Bethesda thyroid reporting system into six categories logically relates to the prognosis of thyroid diseases and may increase the reproducibility of diagnosis. Each diagnostic category conveys specic risks of malignancy, which offers guidance for patient management. Bethesda system of reporting can effectively determine which patient needed Conclusion: surgery/ follow-up. Bethesda system may be used as national standardized terminology for thyroid FNAC reporting

PAPILLARY THYROID CARCINOMA WITH ADENOID CYSTIC FEATURES: A CYTOPATHOLOGY CASE REPORT

Introduction: Adenoid cystic pattern in papillary thyroid carcinoma is a rare nding. Here w Case description: e present a case of a 62 years old female who came with the complaint of swelling in the midline of the neck since last 7 years. Local examination revealed a rm to hard mass of size approximately 8 x 6 cm in the midline of the neck which moved with deglutition. Another swelling of size 3.5 x 2.5 cm was found in the posterior scalp.MRI neck showed a lobulated mass measuring 7.1 x 6.4 x 8.0 cm in right lobe of thyroid, causing mass effect over adjacent larynx and trachea. MRI brain revealed a well-dened soft tissue mass lesion measuring 3.6 x 3.3 x 3.4 cm in right parietal bone causing lytic destruction of bony calvaria. Ultrasonography of whole abdomen revealed two well dened lesions in liver, suggesting possibility of metastasis/ hemangioma. On ne needle aspiration of neck swelling, cellular smears showing cells arranged in clusters, microfollicles, vague papillary pattern alongwith abundant hyaline globules, nuclear grooving and nuclear inclusions were present, suggestive of papillary thyroid carcinoma with adenoid cystic pattern. FNA of the scalp swelling showed similar features, suggestive of metastatic papillary thyroid carcinoma with adenoid cystic features. Discussion: Though rare, papillary thyroid carcinoma with adenoid cystic features should be differentiated from metastatic adenoid cystic carcinoma of larynx and salivary glands, which at times is challenging.

UNCOMMON SALIVARY GLAND TUMORS: A CASE SERIES

Salivary gland tumors are one of the rare entities having the annual incidence rate of 0.5 to 2 per 100,000 persons[7]. Majority of them are benign, only 20% cases are malignant. They usually present as painless mass in the oral cavity or close to their anatomical location. The main challenge is to differentiate between the benign and the malignant ones. Thus, various imaging modalities are used. Investigations such as ne needle aspiration cytology and MRI scans provide some useful information, but most cases will require tissue diagnosis to come to a denitive conclusion. Hence, biopsy or histopathological study of the surgically excised tissue is the gold standard for diagnosis. Benign tumour and early low-grade malignancies can be adequately treated with surgery alone, while more advanced and high-grade tumour with regional lymph node metastasis will require postoperative radiotherapy[11]. The role of chemotherapy remains largely palliative. In this article, we have presented a series of cases with uncommon tumors involving the various salivary glands.

INVASIVE BREAST CARCINOMA WITH MEDULLARY FEATURES AND HER2/NEU POSITIVITY: A RARE CASE STUDY.

Invasive breast carcinoma with medullary features is a rare variant of invasive ductal carcinoma. It accounts for <5% of invasive breast carcinomas. Despite its aggressive histopathological features, the prognosis is favourable. We are reporting a case in a 60 years female having a mass in the right breast for 8 months. Detailed history, routine investigations, radiological investigation, ne needle aspiration, histopathological examination and immunohistochemistry were performed. The nal diagnosis of the case was given as Invasive Breast Carcinoma with medullary features and Her2/neu positive. TNM staging is T2N0M0. No lymphovascular invasion noted. We are reporting this case for being an uncommon nding.

CORRELATION BETWEEN RADIOLOGICAL AND CYTOLOGICAL AS WELL AS HISTOPATHOLOGICAL FINDINGS OF BREAST LUMP/MASS

Background: Carcinoma of breast is the most common malignancy diagnosed in women worldwide. Pathological diagnosis of the breast lump is established using ne needle aspiration cytology (FNAC), core needle biopsy or surgical biopsy. Ultrasonography (USG) and mammography are the important tools in early detection, prompt treatment and favourable outcome leading to increased survival rate in younger females. FNAC is safe, least invasive and inexpensive. However, it is plagued by high false negative rates and insufciency rates .Correlation of the pathologic result with the imaging ndings after biopsy is found to be useful to validate the biopsy result and to offer subsequent management. To correlateAim: radiological, cytological as well as histopathological nding of breast mass/lump. A total of 74 patients with suspiciousMaterial And Methods breast mass were evaluated with cytology and sonomammography. A correlation was done between cytology, sonomammography and histopathology results individually and combined, taking histopathology as gold standard with ndings recorded as benign, suspicious or malignancy. Suspicious cases were those, which fell in BIRADS IV category. Correlation that was established between FNAC, BIRADSResults: by USG and Mammography there was Near Perfect agreement between these methods, and this agreement was statistically signicant(p = <0.001). A near perfect agreement was also established between BIRADS established by USG and Mammography complementing each other. Conclusions: Through our study it has been well established that the FNAC, Mammography BIRADS and USG BIRADS can very well complement the Biopsy ndings of the breast mass which is considered to be the gold standard.

ASSESSMENT OF DIAGNOSTIC EFFICACY IN LYMPHADENOPATHY BY FINE NEEDLE ASPIRATION CYTOLOGY AND CELL BLOCKS VERSU HISTOPATHOLOGY AT A TERTIARY CARE HOSPITAL

Background- Fine Needle Aspiration cytology (FNAC) is easy to do for diagnosis of lymphadenopathy, but it does not yield sufcient information for precise diagnosis. Cell block (CB) preparation in a way mimics the histopathological sections, thus help in sub classifying various lesions. Methods- This was observational study with evaluation of diagnostic efcacy in lymphadenopathy by ne needle aspiration cytology and cell blocks versus histopathology at a tertiary care hospital from June 2018 to Jan 2020. Results- In this study, (Combined FNAC plus Cell Block) showed concordance with histopathogical diagnosis in 90% cases. For Combined FNAC and Cell Block Sensitivity was 95%, Specicity was 100%, Diagnostic Accuracy was 95%.Conclusion- FNAC as the rst line approach supplemented by Cell Block in selected cases, where the information given by FNAC is in doubt or insufcient to guide clinical management. This strategy is likely to reduce the risk of misdiagnosis and the impact of cytological pitfalls

STUDY OF CYTOLOGICAL GRADING OF DUCTAL CARCINOMA OF BREAST IN THE FINE NEEDLE ASPIRATES AND ITS CORRELATION WITH HISTROGICAL GRADING

Grading of breast carcinoma on ne needle aspiration cytology (FNAC) is benecial for selecting patients for neoadjuvant chemotherapy.To grade the breast carcinoma on FNAC using Robinson grading system and to assess the concordance of cytological grading (CG) with histological grading (HG) using Elston-Ellis modication of Scarff-Bloom-Richardson grading system.The study was conducted for 1-year, comprising of 50 female patients attending outpatient departments (OPD) as well as admitted in various surgical wards of a teaching hospital, diagnosed as breast carcinoma. FNAC smears were stained with May–Grunwald–Giemsa and Papanicolaou (Pap) stains and CG was done using Robinson system on Pap stained smears. The results were compared with HG system after resection of tumors.Of 50 cases, 14 (28%) cases were graded as grade I, 24 (48%) grade II, and 12 (24%) grade III by CG, whereas 9 (18%), 28 (56%) and 13 (26%) cases were graded as grade I, II and III by HG. The result showed overall 72% concordance of CG with HG, with grade II and grade III showing highest degree of concordance (83.33%), which is comparable to previous studies. Kappa measurement showed a higher degree of agreement in high-grade tumors compared with low-grade tumors (0.73 in grade III, 0.53 in grade II and 0.39 in grade I).Cytological grading is comparable to HG in majority of cases. Because neoadjuvant chemotherapy is becoming increasingly popular as primary treatment modality of breast cancer, CG could be a useful parameter in selecting the mode of therapy and predicting tumor behavior.

INTRAPAROTID SCHWANNOMA: A CASE SERIES FROM A TERTIARY CARE CENTRE OF NORTH EAST INDIA

Background: Schwannoma is a benign, encapsulated tumor arising from the Schwann cells of myelinated central, autonomic and peripheral nerves. Schwannomas arising from the facial nerve are rare, mostly intra-temporal, with only 9% extra-temporal lesions, presenting as parotid swellings with non-specic symptoms, making the pre-operative diagnosis difcult and challenging. In this case series, three cases ofMethods: parotid masses that underwent ne needle aspiration cytology during the last two years in the department of Pathology, Gauhati Medical College and Hospital, Guwahati were analyzed with respect to age, sex, site, clinical, radiological and cyto-morphological ndings. Out of theResults: three cases, all diagnosed as Intraparotid Schwannoma based on FNAC, one patient was male and two were females. Two cases involved the right parotid gland and one involved the left parotid gland. Age range of the patients was 10-46 years. All the three cases presented as slow growing, painless parotid masses without symptoms of facial nerve involvement. Radiologically, these cases were diagnosed as pleomorphic adenoma. Conclusion: Few reported cases in literature, non-specic clinical symptoms and difcult radiological diagnosis makes Intraparotid Schwannomas a challenge for the pathologist.

ACCURACY OF ACR-TIRADS IN ROUTINE USG REPORTING

Nodules in the thyroid gland are very common. As per the American Thyroid Association (ATA), thyroid nodules are dened as “discrete lesions within the thyroid gland, radiologically distinct from the surrounding thyroid parenchyma”. The incidence of thyroid cancer has been increasing worldwide in the last few decades (1). Papillary thyroid carcinoma attributes more than other histological subtypes of thyroid carcinoma (2,3). . The malignant nature of the nodule cannot be determined by physical examination and blood tests alone; hence specialized tests such as thyroid ultrasonography and ne needle biopsy are often required (4). To establish the accuracy of ACR-TIRADSObjective: classication system in the diagnosis of thyroid nodules in routine USG reporting and also to evaluate their Doppler characteristics. To conclude the study, the proper stratication of the thyroid nodules onResults & Conclusion: ultrasound-based TIRADS system helps us to determine the probability of a particular nodule being malignant with a certain level of condence and appropriate measures for management of the nodule can be initiated, thus avoiding unnecessary FNA procedures. The addition of Color Doppler further strengthens the probability of a nodule being malignant and thus prompt action can be initiated by the referring clinician/surgeon.

SOLITARY BONE PLASMACYTOMA OF THE LEFT ZYGOMA REGION: A RARE CASE REPORT

Background: Solitary Bone Plasmacytoma (SBP) is a characterized by a mass composed of monoclonal plasma cells in bone without any proof of systemic disease attributing to myeloma. It is a rare form of plasma cells in bone that represents only 5 – 10% of all plasma cell neoplasm. The diagnosis requires solitary bone lesion conrmed by skeletal survey, plasma cell inltration proven by biopsy, normal bone marrow biopsy, and no myeloma-related organ failure. Reporting one rare case of solitary bonePurpose: plasmacytoma of the left zygoma region treated with surgical excision followed by radiotherapy. A 61 years old male came withCase Report: complains of swelling in the left cheek for 2 years. Histopathological examination by ne needle aspiration biopsy of the left zygoma region showed atypical plasmacytoid cell with suspected plasmacytoma which then conrmed by positive CD 138 staining. Clinical Question: What is the management of solitary bone plasmacytoma of the zygoma region? Searching for literature evidence through GoogleReview Method: Scholar. The search obtained 11 journals that met the inclusion and exclusion criteria. There were similarities in clinical symptoms andResult: management with this reported case. In the reported case, the clinical features of SBP are swelling or mass in the zygoma boneDiscussion: spreading to maxillary bone with intermittent mild pain with no ear, nose, or throat complain, and no myeloma related organ dysfunction. The diagnosis was determined by history taking, physical examination, and supporting examination by ne needle aspiration biopsy which was conrmed by the pathology anatomy feature of the post-surgical specimen and CT imaging. Solitary bone plasmacytoma manifestsConclusion: itself as a single osteolytic lesion without plasma cytosis of bone marrow and constitutes approximately 5% of all plasma cell neoplasms. SBP reinforces for the meticulous diagnostic work up. In this case, surgical excision followed radiation is the treatment of choice, as plasma cell neoplasm are highly radiosensitive.

PANCREATIC TUBERCULOSIS: A RARE DIAGNOSIS BY ENDOSCOPIC ULTRASOUND GUIDED FNAC

Introducation: Tuberculosis remains a threat to global public health and is the top infectious cause of death globally. The burden of extrapulmonary tuberculosis (EPTB) is high, ranging from 15-20% of all TB cases in HIV negative patients while in HIV positive people, it account for 40-50% of new TB cases. Abdominal TB cases makes up about 3 % of all EPTB cases in India. In abdominal tuberculosis, Ileocaecal region is most commonly affected; solid organs like kidney, spleen and liver get involved with Tuberculosis much more commonly than the pancreas. Pancreatic tuberculosis is very rare even in regions with high prevalence of tuberculosis. Pancreatic tuberculosis most commonly aficts the region of the head and the uncinate process of the pancreas. It is often misdiagnosed due to low index of suspicion and masquerading of its symptoms as pancreatic malignancy. Case Presentation: A 67 years old male presented to the physician with a history of pain abdomen in umbilical region. Ultrasound whole abdomen demonstrated mildly bulky pancreas with ill dened hypoechoic lesion in the body region. Endoscopic ultrasound-guided ne needle aspiration (EUS-FNA) of the lesion was performed and cytology revealed numerous acid fast bacilli with necrotic material in background of red blood cells. Abdominal computed tomography (CT) scan was done which was suggestive of well- dened non enhancing multiloculated lesions of body of pancreas with evidence of necrotic lymph node in pre and left para-aortic region. Antitubercular treatment was started accordingly. Conclusion: Pancreatic tubercuklosis may present as pancreatic abscess, pancreatitis,or acystic or solid pancreatic mass. The use of EUS-FNA has become essential tool in the evaluation of pancreatic lesion.

CLINICO PATHOLOGICAL STUDY OF TUMOURS OF PAROTID GLAND IN TERTIARY CARE HOSPITAL , PENCHIKALAPADU, KURNOOL

purpose: The objective of the study was to study age and sex pattern in parotid gland tumors, and determine the accuracy of ne needle aspiration cytology in diagnosing parotid gland tumors, and also analyze different modes of surgeries for parotid gland tumors. Detailed study of thirty cases of parotid gland tumors admitted to viswabharathi medical college, penchikalapadu,Design: Kurnool from January -2021 to January 2022, Out of 30 cases , 23 were benign tumors , 19, pleomporphic adenoma , 2 warthin's tumor,Results: 2 basal cell adenoma, while of 19 pleomorphic adenoma , male being 10 as compared to 9 female . The maximum of cases were seen in fourth and sixth decade followed by third and then fth decade. Malignant tumors has male to female ratio of 4:3 with predominance of third and sixth decade. All 23 cases of benign parotid tumors, i.e., 19 pleomorphic adenomas, 2 warthin's tumor and 2 basal cell adenomas were correctly diagnosed by FNAC. Hence the accuracy of FNAC in diagnosing benign parotid tumors in this series was 100%. In malignant tumors, ve of seven cases were correctly diagnosed by FNAC. The accuracy of FNAC in diagnosing malignant parotid tumors is 71.4 %. All pleomorphic adenomas were offered supercial parotidectomy except one where a total parotidectomy with conservation of facial nerve was done due to involvement of deep lobe. Of the other 4 benign tumors, all underwent supercial parotidectomy. In malignant tumors supercial parotidectomy with irradiation was offered in 3 cases, total conservative parotidectomy with irradiation in 1 case , total radical parotidectomy was offered in 3 cases. parotid gland tumors, has a male preponderance in both benign and malignant tumors, with 10:9 and 4:3 respectively. TheConclusion: accuracy of FNAC is 100% in benign tumors as compared to 71.4%. FNAC is a good tool in diagnosing benign parotid gland tumors, but should be cautiously interpreted in malignant tumors.

THE BETHESDA SYSTEM FOR REPORTING THYROID CYTOPATHOLOGY WITH HISTOPATHOLOGIC CORRELATION: A RETROSPECTIVE STUDY AT A TERTIARY CARE HOSPITAL OF LOWER ASSAM

Background: Fine needle aspiration is currently the preferred screening test for guiding the diagnosis and treatment of thyroid nodules as it is quick, assessible, inexpensive, relatively painless with quite accurate diagnosis. The Bethesda system for reporting thyroid cytopathology (TBSRTC) was introduced in 2007 in an attempt to standardize international terminology and to categorize morphological criteria in ne-needle aspirations (FNAs) from patients with thyroid nodules. It introduced 6 diagnostic categories for FNA results and assigns a malignancy risk and recommendations for patient management for each category. To categorize theObjectives: thyroid swelling following The Bethesda system for reporting Thyroid Cytopathology (TBSRTC) and to correlate with nal histopathological reports wherever available. : 99 patients underwent FNAC in our institute from the period of January 2019 to July 2020,Materials and Methods and were categorized according to the Bethesda system for reporting thyroid cytopathology. Results: The 99 cases taken up for FNAC were categorized according to The Bethesda system for reporting Thyroid Cytopathology (TBSRTC) as Non-diagnostic or unsatisfactory at 6.06%, Benign at 81.81%, Atypia of undetermined signicance at 0%, Suspicious for a follicular neoplasm at 4.04%, Suspicious for malignancy at 2.02%, Malignant at 6.06%. The sensitivity, specicity, positive predictive value (PPN), negative predictive value (NPN), and accuracy of FNAC in diagnosing thyroid malignancy were calculated as 66.67%, 100%, 100%, 93.33% and 94.12% respectively. The BethesdaConclusion: system for reporting Thyroid Cytopathology (TBSRTC) helps in standardization of thyroid ne needle aaspiration reporting. This leads to timely and adequate intervention for the patient and also minimizes unnecessary thyroid surgeries

SMALL ROUND CELL TUMORS PRESENTING AS ORBITAL PROPTOSIS IN CHILDREN WITH BONE MARROW INVOLVEMENT: A STUDY OF HAEMATO- MORPHOLOGICAL FEATURE.

Introduction: Childhood proptosis is an interesting clinical presentation of underlying hematological and non-hematological disorders. Malignant proptosis is most commonly caused by retinoblastoma, rhabdomyosarcoma, leukemia/lymphomas and other metastatic tumors such as neuroblastoma. Bone marrow examination is a commonly used diagnostic and staging modality in the evaluation of hematological and non- hematological disorders in pediatric population. Patients with proptosis present with subtle changes in hemogram which point towards metastatic or hematologic etiology and hence a detailed hematologic work-up is mandatory. A descriptive cross-sectional study wasAim/objective: conducted to study the clinical, hematological and pathological data of interesting pediatric malignancies presenting as orbital proptosis with or without bone marrow involvement at the time of diagnosis from July 2020 to June 2021. All cases of orbital proptosis presenting withMethods: cytopenias referred for bone marrow examination were included in the study. Primary diagnosis of was made on histopathology/ne needle aspiration cytology combined with clinico-radiological features. Bone marrow procedure was done from posterior superior iliac spine. The informed consents were taken from the patients in the vernacular language after explaining the procedures. All procedures performed in the current study were approved by Institutional ethical committee. Aspirate smears and biopsy sections were stained by May-Grunwald-Giemsa and Hematoxylin and eosin respectively as per standard protocols. Special stains Myeloperoxidase (MPO), Alcin blue, PAS (perioidic acid and Schiff) and reticulin were performed when required. Samples were also processed for molecular genetics studies in acute leukaemias. The descriptive analysis of the data was done, and the results were presented as mean, frequencies, and percentages. Results: Of total 20 cases presenting as orbital-proptosis, only 11 cases showed bone marrow involvement as acute myeloid leukemia (45%) and as a metastatic site (55%). The most common cause of bilateral orbital proptosis was metastatic malignancies followed by acute myeloid leukaemias. Anaemia and thrombocytopenia were signicantly (p<0.05) associated with marrow inltration. The present analysis showedConclusion: different types of pattern bone marrow inltration had prognostic implications. Pancytopenias/bicytopeinias were most commonly seen in association with solid malignancies. Acute leukaemias presented with leukocytosis along with reduction in red cells and megakaryocytic lineages. Some cases primary diagnosis was initially made from bone marrow examination only. The present study highlights the signicance of bone marrow examination in patients with proptosis wherein subtle changes in hemogram point toward metastatic or hematologic etiology.

SPINDLE CELL SARCOMA: RARE BUT NOT TO BE IGNORED

Spindle cell sarcoma of the lower limb is a rare tumor. It remains a diagnostic as well as a therapeutic challenge to identify and successfully treat a case of spindle cell sarcoma as the tumor can be notorious sometimes. The current study presents a case of spindle cell sarcoma with clinical, imaging and pathological examination. A 20-year-old female presented to the surgery OPD of Rajendra Institute of Medical Sciences, Ranchi suffering from a mass on the posteromedial aspect of her left leg for approximately four years. Imaging examination by leg computed tomography angiogram scan revealed a large thrombosed arterio-venous malformation. The patient underwent wide local excision of the mass. Pre operative ne needle aspiration cytology examination revealed benign spindle cell mass. The swelling was excised under anaesthesia. Post op histopathological examination was done which revealed spindle cell sarcoma