Neoplastic Categories Research Articles

The clinicopathologic significance of psammoma bodies in cytology specimens: A series of 78 cases.

Currently the clinicopathologic significance of psammoma bodies in cytology specimens are not completely understood, including types of cytology specimens and pathologic conditions frequently associated with this unique cytologic feature. In this study, we undertook a retrospective approach to review the specimen types, cytology preparations, patient characteristics, organs or tissues involved and differential diagnoses in cytology specimens with the finding of psammoma bodies. Cytology cases with the finding of psammoma bodies from January 2004 to December 2022 were retrieved from our institution's pathology databases, and their clinicopathological features were reviewed. A total of 78 cytology specimens with the finding of psammoma bodies were recorded in our CoPath system. The mean age at diagnosis was 59 years. The patient group showed female gender predominancy (90%). FNA specimens comprised about 38.5% of total cases. Other common specimen types were body cavity fluids (38.5%), including pleural effusion and peritoneal fluid, and about 20.5% of the cases were pelvic washing performed during gynecologic surgeries. Most cytology cases with psammoma bodies had a malignant diagnosis (69%). About 18% of the cases were in the indeterminate diagnostic categories, with 12% suspicious for malignancy and 6% of the cases with atypical cells. About 5% of cases were placed in the neoplastic category, while 8% of cases were negative for malignancy. About 79% of peritoneal cytology with psammoma bodies were neoplastic and mostly gynecologic tumors. Pleural fluids with psammoma bodies were very likely to be malignant and involved by serous carcinoma (15 of 16 cases, 94%). Papillary thyroid carcinoma was the second most common malignancy in our series, present in about 53% of thyroid cytologies with the finding of psammoma bodies. Our study showed that psammoma bodies in cytology preparations were more often associated with malignancies in our study of 78 cytology specimens (69%). The most sampled location in our study was peritoneal cavity, followed by pleural cavity, thyroid, lymph nodes, neck masses, and omentum. The clinicopathologic value of psammoma bodies in predicting malignancy varies depending on locations and specimen types.

Spectrum of endoscopic gastric subepithelial lesions encountered on EUS-FNA: A single center experience.

Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) is a minimally invasive and reliable non-surgical technique for the diagnosis of gastrointestinal lesions. The present study aimed to evaluate the spectrum of lesions encountered in the gastric subepithelium on EUS-FNA at a tertiary care center. Archival data of all patients undergoing EUS-FNA for gastric submucosal lesions over a period of 5 years was retrieved. Patient demographics, clinical presentation, and EUS findings were recorded along with the FNA results. A total of 78 EUS-FNA samples were analyzed. Material was adequate in 62 cases (79.48%) and inadequate in 16 cases (12.82%) patients due to scant cellularity. Of the adequate samples, 34 (43.5%) were reported as neoplastic while 20 (25.64%) were non-neoplastic, and 8 (10.25%) were reported as suspicious of a neoplasm. In the neoplastic category, the predominant diagnosis was of spindle cell neoplasm comprising gastrointestinal stromal tumor (13), benign neural tumor (03), leiomyoma (02), and spindle cell tumors (03). The latter could not be categorized further due to a lack of IHC material. The next common diagnosis was adenocarcinoma (06) followed by neuroendocrine tumor (02) and poorly differentiated carcinoma (01). The non-neoplastic lesions included non-specific pathology (15), inflammatory lesions (08), and one case each of tuberculosis, pancreatic rest, and Brunner gland hamartoma. Cell blocks for ancillary testing were available in 54 cases (65.23%) and follow-up was available in 42 cases (53.84%). EUS-FNA is a good modality for the diagnosis of gastric submucosal lesions with a high diagnostic yield.

Borderline Mucinous Tumor with Benign Brenner Tumor in an Ovarian mass - A Case Report and Review of Literature

Different groups of neoplastic and non-neoplastic conditions arise from the ovaries and the epithelial tumors such as Mucinous and Brenner tumors are rare neoplastic category. We present a case report of 72 year old postmenopausal woman who presented with progressively worsening abdominal discomfort and distention, diagnosed with huge Borderline Mucinous Tumor associated with Benign Brenner Tumor and also review the reported articles about this rare occurrence. Mucinous neoplasms of the ovary represent 10%–15% of ovarian neoplasms and about 80% of them are benign. Brenner tumors are a relatively rare epithelial neoplasm of the ovary that usually affect postmenopausal women and most of them are benign. Coexistence of Borderline Mucinous tumor with Benign Brenner tumor is a rare mixed epithelial tumor of the ovary. Keywords: Mucinous cystadenoma, Brenner tumor, Ovarian tumor

Clinicopathological Profile of Sinonasal Masses in a Tertiary Care Center in Central India: A Retrospective Study.

Diseases of the nose and paranasal sinuses have a significant impact on the patient's functional and structural aspects. They affect all age groups and both sexes. Due to its proximity to vital structures, diseases of the nose and paranasal sinuses sometimes lead to very grave prognoses. This was a retrospective study done in one of central India's largest tertiary care centers. We studied 227 cases of sinonasal masses in both the non-neoplastic and neoplastic categories. Clinicopathological characteristics of masses were analyzed with the help of clinical and imaging findings and subsequently confirmed by tissue diagnosis. The mean age of presentation was 45.5 years, with a male-to-female ratio of 1.25:1. Most of our patients were from lower-middle socioeconomic groups with educational qualifications below the 10th standard. Nasal obstruction was the most common symptom. A computed tomography scan was the preferred radiological investigation. Sinonasal undifferentiated carcinoma was the most common variant of malignancy, with a total number of six out of 22 (27%). The evaluation of sinonasal masses should be carried out systematically and meticulously. Since the initial presentation of most of the diseases of the nose and paranasal sinuses is the same, a proper clinical, radiological, and tissue diagnosis should be carried out to avoid causing malignant lesions.

Clinical Accuracy Of Dermatologists And Nondermatologists In The Diagnosis Of Dermatological Diseases.

To compare the clinical diagnostic accuracy of dermatologists and non- dermatologists in the diagnosis of dermatological diseases. The descriptive, cross-sectional study was conducted at the Dermatopathology department of a tertiary healthcare hospital in the Punjab province of Pakistan from January 1 to December 31, 2019, and comprised biopsy specimens of patients with diseases of the skin and subcutaneous tissue. The clinical diagnoses of general surgeons, otolaryngologists, dental/maxillofacial surgeons, plastic surgeons and gynaecologists were noted and compared with those of dermatologists in the light of histopathological findings. Data was analysed using SPSS 16. Of the 386 specimens submitted, 113(29.3%) were sent by dermatologists and 273(70.7%) by non-dermatologists. Clinical diagnostic accuracy of dermatologists 92(81.4%) compared to non-dermatologists 137(50.2%) (p<0.005). The dermatologists diagnosed significantly more cases belonging to inflammatory and miscellaneous cutaneous diseases category accurately than non-dermatologists (p<0.005). Similarly, the dermatologists diagnosed significantly more cases of neoplastic disorders accurately than the non-dermatologists (p= 0.018). There was no significant difference in the clinical diagnostic accuracy of dermatologists and non-dermatologists in cases of cystic lesions (p>0.05). In the neoplastic category, no significant difference was found in the clinical accuracy of dermatologists and plastic surgeons (p=0.347). The specialised skills of dermatologists could not be matched by any other group of physicians.

Clinicopathological Spectrum of Vulvar Lesions-A Retrospective Study

Introduction: Vulvar lesions constitute a wide spectrum ranging from non neoplastic inflammatory lesions to malignancies. Some show nodular masses and others remain asymptomatic. This poses challenges to clinicians in differentiating non neoplastic inflammatory dermatoses from benign and malignant lesions. Along with the clinical history and physical examination, a biopsy of the lesion plays an important role in proper diagnosis and treatment. Aim: The aim of the present study was to identify the morphological spectrum of vulvar lesions with clinical and histological findings. Materials and Methods: This was a retrospective observational study conducted in the Konaseema region of India for two years from January 2019 to January 2021. A total of 85 female patients with vulvar lesions were included in the study. Biopsy samples were obtained from all the 85 cases and were formalin-fixed, routinely processed, and paraffin embedded. Haematoxylin and Eosin (H&amp;E) staining was done. Special stains were done wherever necessary. The results were analysed using Microsoft excel. Results: The age of patients ranged from 18 to 88 years. The most common age of patients was in the 4th decade (30 cases amounting for 35.29%). The mean age of the study population was 39.5±15 years. Among the 82 cases, 40 (48.78%) were non neoplastic lesions, and 42 (51.21%) were neoplastic lesions. Among the neoplastic category, 27 (64.2%) were benign lesions and 15 (35.71%) were malignant lesions. The non neoplastic category included five infections (12.5%) and 35 non infectious inflammatory lesions (87.5%). The infections included one case of MC and 4 cases of condyloma acuminatum. The non infectious, and non neoplastic inflammatory lesions included 10 cases of Lichen Sclerosus Atrophicus (LSA), one case of Lipomatoushamartoma, four cases of Lichen planus, six cases of epidermal cysts, 10 cases of Bartholin cysts and four cases of Gartner duct cyst. The benign lesions in the neoplastic category included four cases of Hidradenomapapilliferum, four cases of Aggressive Angiomyxoma (AA), 12 cases of Fibroepithelial Stromal Polyps (FEP), and a case of Leiomyoma. The malignant lesions included 14 cases of squamous cell carcinoma and a case of extramammary Paget’s disease. Conclusion: Vulvar lesions can be due to eclectic causes and pose a diagnostic difficulty both clinically and histopathologically due to their similar presentation. Thorough clinical and pathological examination along with proper clinicopathological correlation is required for accurate diagnosis and treatment.

“Pure” hepatoid tumors of the pancreas harboring CTNNB1 somatic mutations: a new entity among solid pseudopapillary neoplasms

Hepatoid tumors (HTs) represent a rare group of neoplasms that are histologically similar to hepatocellular carcinoma but arise outside the liver. The current World Health Organization classification recognizes the hepatoid morphology of pancreatic tumors only as a possible variant of pancreatic ductal adenocarcinoma (PDAC). Here, we describe two cases of “pure” HT of the pancreas showing common features and characterized by indolent biological behavior. These tumors were roundish nodules with pushing borders, hyaline globules, and pure hepatoid histology; they were diffusely positive for β-catenin and LEF1 on immunohistochemistry. At next-generation sequencing, both neoplasms harbored only one pathogenic somatic mutation that affected the CTNNB1 gene at exon 3 and showed a loss of heterozygosity on chromosomes 18 and 21. By integrating macroscopic and microscopic features, along with their molecular profiles, we advocate that such tumors represent a distinct entity from PDAC and should be considered a new variant of solid pseudopapillary neoplasms. The recognition of this new neoplastic category may have immediate implications not only for tumor taxonomy but also for clinical practice.

Frequency of Thyroid Lesions at Pathology Department of King Edward Medical University Lahore

Background: Thyroid gland is notorious for carrying commonest endocrine pathologies and also for commonest endocrine malignancy. It is the 5th most common cancer in human beings. This makes to carry out current study to get insight of frequency of thyroid lesions at tertiary care level. Methods: This was a descriptive cross-sectional study. The study was done at the Department of Pathology, King Edward Medical University Lahore with the collaboration of four surgical units of Mayo Hospital Lahore from 2010 to 2019. Total 1601 cases were included. Information about age, sex and diagnosis was entered in the pre designed proforma. SPSS version 22 was used for data analysis. Descriptive analysis was done and the results were presented as frequencies, percentages and ratios. The results were then studied against local and international data. Results: This study revealed non neoplastic and neoplastic lesions as 1323 (82.63%) and 278 (17.37%) respectively. Bulk of the lesions 61.6% were between the age bracket of 20-39 years. Mean±SD for age was 34.22±11.42 years. Female to male ratio(F:M) was in favour of females as 9.81:1. Among the non neoplastic lesions, MNG 1151(87%) was a dominant lesion followed by TH 82(6%). LT 29(2.19%) and HT 26(1.96%) were other important lesions. F:M ratio was 10.80:1. Neoplastic lesions were divided into benign 178(64%) and malignant tumors 100(36%). FA was the leading benign neoplasm 164(59%). Rest of the benign tumors shared a minor fraction except HCA 12(4.31%). Among the malignant category, Papillary carcinoma 69(24.82%) dominated over MC 12(4.31%). FC 7(2.51%) and AC 6(2.15%) were other significant findings. F:M ratio in malignancy was 3.16:1 which was significantly lower than 13.83:1 in benign tumors. Conclusion: MNG is the dominant lesion among the non neoplastic lesions while in the neoplastic category FA was leading as benign neoplasm. Papillary carcinoma turned out to be the commonest malignant tumor. Major share of all the lesions were seen between 20-39 years. Keywords: MNG, Papillary carcinoma, Follicular adenoma, neoplastic lesions

Spectrum of Adrenal Lesions on Fine-Needle Aspiration Cytology: A Tertiary Care Centre Experience.

Introduction Fine-needle aspiration cytology (FNAC) is an easy, quick, and specialized technique to distinguish neoplastic from non-neoplastic adrenal lesions, yet limited to tertiary care centers. It helps in analyzing symptomatic, as well as incidental adrenal lesions with high sensitivity and specificity. Aim This study was conducted to determine the cytological spectrum of adrenal lesions in a tertiary care center. Material and Methods This was a retrospective study which included a total of 19 cases of adrenal FNAC received from June 2017 till June 2019 in a north Indian tertiary care university hospital. All the lesions were broadly classified into non-neoplastic and neoplastic categories. The non-neoplastic lesions were divided into infective causes and cystic lesions. Neoplastic lesions were further grouped into benign and malignant lesions. Immunohistochemical findings were retrieved from the hospital records wherever accessible. Results A total of 19 cases were aspirated, of which 16 cases (84.20%) yielded satisfactory material. Six cases (31.57%) showed non-neoplastic pathology of which one was a cystic lesion, three were infective (two histoplasmosis and one tuberculosis), and two showed only benign adrenal cortical cells in a setting of known extra-adrenal primary malignancy. The neoplastic group comprised of 10 cases (52.63%) of which 4 cases showed metastatic carcinomatous deposits from a known extra-adrenal primary malignancy and 6 cases showed primary adrenal neoplasm (one case of myelolipoma, one case of pheochromocytoma, and four cases of adrenal neoplasm) which were then subjected to biopsy and immunohistochemistry. A final diagnosis of pheochromocytoma was made in three cases, adrenocortical carcinoma in one case, and one case was inconclusive because of nonrepresentative biopsy. Conclusion Image-guided fine-needle aspiration cytology of adrenal lesions helps to determine the exact nature of the infection, avoids unnecessary surgery, and helps in targeted management. However, histopathological evaluation with immunohistochemistry remains the diagnostic modality of choice with regard to neoplastic lesions.

A Clinicopathological Study of Developmental and Acquired Causes of Intestinal Obstruction in Paediatric Population- A Retrospective Study

Introduction: Intestinal Obstruction (IO) in the paediatric age group can be due to a variety of developmental and acquired causes which depend on the age at presentation. Histopathological examination of the resected intestine can provide definite evidence of underlying aetiology. Aim: To analyse the spectrum of lesions causing IO and it’s relation with clinicopathological features. Materials and Methods: This was a retrospective study conducted in the Department of Pathology at Seth G.S Medical College and Dr. R. N. Cooper Hospital, Mumbai, Maharashtra, India. Gross and microscopy of 70 surgically resected specimens of patients with IO, received over a period of five years, from January 2009 to December 2013, were studied after getting ethical clearance. Clinical details were retrieved from the records. Lesions were classified as developmental and acquired which were further categorised into infective, neoplastic and miscellaneous categories. Data was analysed using Microsoft excel 2010 and was expressed as frequency and percentage. Results: Out of the 70 cases studied there were 40 males and 30 females. There were 37 cases less than 1 month old, 13 cases between one month to 1 year age and 20 cases between 1 year to 12 years of age. The developmental category comprised of 52/70 cases (74.29%) with 17 cases of Meckel’s diverticulum,16 cases of intestinal atresia, three cases each of mesenteric cysts and duplication cysts, five cases of duodenal webs, four cases of congenital bands, one case each of lymphangiectatic cyst, malrotation, blind ileal loop and meconium ileus. In the acquired category there were three cases of tuberculosis and one case each of fungus and Ascaris infection. In the neoplastic category there were five cases of polyps and one case each of cystic teratoma and Burkitt lymphoma. There were three cases of volvulus, two of perforation and one case of intussusception. Conclusion: The present study highlights the various causes of IO in children from neonatal period up to 12 years of age. With proper gross and microscopic examination it was possible to give confirmed diagnosis which is necessary for further management of the patient.

A Physician-in-the-Loop Approach by Means of Machine Learning for the Diagnosis of Lymphocytosis in the Clinical Laboratory.

The goal of the lymphocytosis diagnosis approach is its classification into benign or neoplastic categories. Nevertheless, a nonnegligible percentage of laboratories fail in that classification. To design and develop a machine learning model by using objective data from the DxH 800 analyzer, including cell population data, leukocyte and absolute lymphoid counts, hemoglobin concentration, and platelet counts, besides age and sex, with classification purposes for lymphocytosis diagnosis. A total of 1565 samples were included from 10 different lymphoid categories grouped into 4 diagnostic categories: normal controls (458), benign causes of lymphocytosis (567), neoplastic lymphocytosis (399), and spurious causes of lymphocytosis (141). The data set was distributed in a 60-20-20 scheme for training, testing, and validation stages. Six machine learning models were built and compared, and the selection of the final model was based on the minimum generalization error and 10-fold cross validation accuracy. The selected neural network classifier rendered a global 10-class classification validation accuracy corresponding to 89.9%, which, considering the aforementioned 4 diagnostic categories, presented a diagnostic impact accuracy corresponding to 95.8%. Finally, a prospective proof of concept was performed with 100 new cases with a global diagnostic accuracy corresponding to 91%. The proposed machine learning model was feasible, with a high benefit-cost ratio, as the results were obtained within the complete blood count with differential. Finally, the diagnostic impact with high accuracies in both model validation and proof of concept encourages exploration of the model for real-world application on a daily basis.

Fine needle aspiration and core needle biopsy of the spleen: A case series illustrating current practices and challenges.

Splenic fine needle aspiration (FNA) and core needle biopsies (CNB) are rare specimen types, potentially avoided due to clinical concern for hemorrhagic complications. The safety and utility of splenic FNA, the role of rapid onsite evaluation (ROSE), as well as the diagnostic utility of CNB versus FNA have not been recently reviewed. A 10-year retrospective review was performed of percutaneous image-guided FNA and CNB of the spleen. Clinical indications, outcomes, ROSE findings, and final diagnoses were reviewed and correlated. Forty-four specimens from 39 patients were identified. The commonest indication for biopsy was a radiographic mass found during assessment for patient complaint (45%, 20/44), evaluation for malignancy (primary or metastatic) (39%, 17/44), and incidentally (16%, 7/44). Malignant diagnoses were rendered in 10 cases, 80% hematolymphoid and 20% nonhematolymphoid. Thirty-one cases were nonneoplastic and identified as infectious/inflammatory processes 39%, cysts 10%, vascular lesions 13%, benign splenic elements 22%, accessory or atrophic spleen 10%, and extramedullary hematopoiesis 6%. The nondiagnostic rate was 7%. Cases with subsequent splenectomy showed 100% specificity and 86% sensitivity. The concordance of ROSE and final interpretation was 90% within the neoplastic category. Finally, the significant complication rate was 6.8% with no bias to occurrence following FNA or CNB. This series affirms the safety and efficacy of splenic FNA and CNB by complication rates comparable to prior studies and high rate of concordance. The diagnostic accuracy may be further improved by ROSE, and CNB in cases reliant on staining and tissue architecture.

Evaluation of peripheral lymphadenopathy by fine needle aspiration cytology: Our experience at a tertiary care center

Peripheral lymphadenopathy is frequently due to a local or systemic benign infectious disease. However, it could be a manifestation of underlying malignancy. Fine needle aspiration cytology (FNAC) acting as a reliable diagnostic tool to find out the cause underlying the lymphadenopathy enables the clinician to plan appropriate management for each patient.The present study was undertaken to assess the utility of FNAC in evaluation of peripheral lymphadenopathy cases in different age groups and sex and to study the cytomorphological patterns in these cases.A retrospective and prospective observational study was conducted in the Department of Pathology, Hind Institute of Medical Sciences over the duration of 2 years. A total of 331 lymph node FNA aspirates were studied. Aspirated material was routinely stained with Haematoxylin &amp; Eosin and Papanicolauo stains. Ziehl Neelsen stain was used wherever required.Most of the patients were in the age group of ≤15 years (117/331). Cervical lymphnodes were the most commonly involved sites (222/331). The largest group of lesions belonged to the non-neoplastic category (227/331). Only 54/331 cases were in the neoplastic category. Amongst the non-neoplastic lesions, granulomatous lymphadenitis comprised the majority (128/277). Amongst the neoplastic lesions, 8 cases showed features of non-Hodgkin’s lymphoma (NHL); where as 3 cases were of Hodgkin’s lymphoma (HL). Non-neoplastic lesions were more common in the younger age group (117/257); where as neoplastic lesions were more common in the older age group (27/54).FNAC is a reliable method of diagnosing the pathology underlying enlarged superficial lymph nodes; thus acting as a triage to distinguish the cases with a suspicion of significant disease. At the same time, it also provides material for ancillary studies especially in lymphoproliferative lesions.

Atypical cells in fine needle aspiration biopsies of pancreas: Causes, work-up, and recommendations for management.

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a sensitive and specific method for diagnosing cancer in solid pancreatic masses. However, some cases receive indeterminate atypical diagnoses, which creates management dilemmas. In the 2014 Papanicolaou Society of Cytopathology (PSC) standardized guidelines for pancreatobiliary cytology, specimens in the "Atypical" category show a spectrum of architectural and/or cellular changes beyond normal or reactive, but, quantitatively or qualitatively, insufficient for classification as neoplastic (benign/other), suspicious or positive for malignancy. Implementation of the PSC system decreased atypical diagnoses, particularly for cystic lesions, and redistributed many cases into benign and neoplastic categories. Because no set cytologic criteria exist for the "Atypical" category there is wide variability in its use, and its frequency ranges from 0%-16% (mean 6%). It consists of a heterogeneous mix of cases that occur because of preanalytic, lesion-specific (low cellularity, necrosis, cystic, reactive and premalignant changes), to pathologist-dependent factors (experience, expertise, training and institutional case volume). Outcomes of atypical diagnoses in solid pancreatic masses range from benign to premalignant and malignant and include reactive atypia in pancreatitis, well differentiated adenocarcinoma, and non-ductal malignancies. The associated risk of malignancy (ROM) ranges from 28%-100%, with an overall intermediate ROM in large-scale studies. Cytopathologists and institutions should monitor and keep their personal and/or laboratory's atypical rates low by judiciously using rapid onsite evaluation, ancillary studies, consensus or expert review, as well as correlation with clinical and radiologic findings. Early repeat EUS-FNA is indicated for unresolved cases.

SWI/SNF-deficient head and neck neoplasms: An overview.

With wide-spread use of next generation sequencing tools in surgical pathology, a variety of neoplasms have been increasingly recognized to be associated with specific recurrent defining genetic abnormalities. This has led to recognition of new genetically defined entities and refinements of preexisting heterogeneous neoplastic categories. Among these, neoplasms associated with inactivating mutations involving different subunits of the SWI/SNF chromatin remodeling complex have received special attention. In the head and neck area, SMARCB1 (INI1) and SMARCA4 (BRG1) are the main two SWI/SNF components responsible for several recently described highly aggressive undifferentiated malignancies with predilection for the soft tissue of the neck (SMARCB1-deficient malignant rhabdoid tumors in children and rare epithelioid sarcoma cases in adults) and the sinonasal tract (SMARCB1-deficient sinonasal carcinoma including a small subset of adenocarcinomas, SMARCA4-deficient sinonasal undifferentiated carcinoma and SMARCA4-deficient sinonasal teratocarcinosarcoma). Molecular studies confirmed paucity of additional genetic abnormalities in these diseases underlining the central role of SWI/SNF deficiency as the primary and frequently sole genetic driver of these lethal diseases. Initiation of clinical trials using drugs that target the SWI/SNF collapse encourages recognition and correct classification of these morphologically frequently overlapping malignancies and underpins the role of SWI/SNF immunohistochemistry as emerging powerful adjunct tool in surgical pathology of the head and neck.

The Pediatric Fluid Cytology: A 2-year experience of a tertiary care pediatric center of North India

Background: Body fluid analysis containing exfoliated cells in effusion may reveal information about neoplastic and non-neoplastic etiology. Most important indication of fluid cytology is to look for malignant cells. CSF examination is another investigation performed routinely in all tertiary care centers in addition to other body fluids examined.&#x0D; Aims and Objective: The aim of the study was to examine the body fluids for cytological examination in diagnosis, prognostic and therapeutic tool for management of pediatric cases.&#x0D; Materials and Methods: Retrospective data analysis of 170 fluid cytology cases taken from departmental data archive of pediatric cases (0-18 years) from Jan 2018-Dec 2019 was tabulated observation was done by 2independent pathologists. The smears were stained with Romanowsky stains and specialized stains of AFB and Rhodamine auramine, MPO, PAS and PAP as per requirement.&#x0D; Results: There were higher number of male (n=99, 58.23%) compared to female (n=71, 41.76%). The commonest fluid cytology received was the CSF (n=150, 88.23%) with 77 samples presenting with significantly high TLC for age (using standard age analysis parameters). The diagnosis was grouped into the Neoplastic and Non neoplastic category. The non-neoplastic category was further divided into infective where most common was viral pleocytosis (n=50, 48 Viral lymphocytic pluecytosis, 1case rubella positive CSF, 1 Primary HLH with viral infection) followed by TB(n=10, 6 pleural, 2 CSF, 2 Peritoneal), bacterial (n=07, microbiology culture was done) and TORCH, Rubella with plasmacytosis (n=01). Another non-neoplastic category was of inherited disease where single case of Griscelli’s syndrome was diagnosed showing hemophagocytosis on CSF examination. Neoplastic Cytology was seen in 07 cases where all the cases were hematolymphoid malignancies.&#x0D; Conclusion: This study concludes that fluid cytology is a useful diagnosis, prognostic, therapeutic tool in diagnosis and management of pediatric cases.

Histopathological Spectrum of Neoplastic and Non Neoplastic Lesions of Urinary Bladder- A Retrospective Study

Introduction: Urinary bladder encompasses a wide variety of lesions, both neoplastic and non neoplastic responsible for significant morbidity and mortality throughout the world. All bladder lesions require biopsy because of their lack of distinctive features. Urinary bladder cancer is the 9th most common cancer worldwide accounting for 6% and 2% of the cancer incidence in men and women, respectively. Aim: To analyse the histopathological spectrum of bladder specimens with neoplastic and non neoplastic lesions, and categorising them according to recent 2016 World Health Organisation (WHO) classification. Materials and Methods: The present study was conducted from January to June 2020 at Subharti Medical College, Meerut, Uttar Pradesh, India. Retrospective data was retrieved from a period of 10 years from January 2010-December 2019. Histopathological analysis of all the urinary bladder biopsies and radical cystectomy/cystoprostectomy specimens received during this period was done on basis of light microscopic examination of Haematoxylin and Eosin (H&amp;E) stained slides. Lesions were categorised into non neoplastic and neoplastic. The neoplastic lesions were classified based on WHO classification 2016 and staging as per 8th edition of American Joint Committee on Cancer (AJCC). Descriptive data analysis was done. Results: Total 252 cases were evaluated. A total of 200 (79%) cases were neoplastic and 52 (21%) cases were diagnosed as non neoplastic with majority of cases being cystitis. Male to female ratio was 7:1. The most common age group was 4th to 7th decade. In neoplastic category, urothelial tumours constituted 194 (97%) cases with Infiltrating Urothelial Carcinoma (IUC) being 118 (60.8%) cases. In non invasive lesions majority 27 (35.6%) cases were Papillary Urothelial Neoplasm of Low Malignant Potential (PUNLMP) followed by urothelial carcinoma in situ and papillary urothelial neoplasm of low grade. Entities other than urothelial tumours encountered in the present study were primary adenocarcinoma, small cell carcinoma, melanosis and metastasis from prostate. TNM staging showed lamina propria invasion (pT1) in 59 (37%) cases, followed by pT2 tumours invading muscle in 56 (35%) cases. Conclusion: Proper knowledge of histologic characteristics of various bladder lesions is of utmost importance as few benign conditions mimic neoplastic and few serve as preneoplastic conditions, misdiagnosis may cause further any unnecessary treatment procedure. With a multidisciplinary approach, early diagnosis and immediate intervention can have a better survival and provide a more comfortable life to the patient.

Impact of ongoing COVID-19 pandemic on cytology: An institutional experience.

BackgroundThe ongoing COVID‐19 pandemic has greatly impacted the health services worldwide, challenging the way modern medicine has been practiced for decades.AimThe present study documents an institutional experience on its impact on cytology services.Materials & MethodsThe cytology samples received during lock down period in India (24 March to 17 May 2020) were analysis and compared to the samples received during the same time frame in year 2019.ResultsThe data revealed an overall 92.6% reduction in cytology samples received. All sample types were reduced with a statically significant reduction in thyroid cytology samples (P‐value: .023). There was relative increase in breast and lymph node samples; however, this relative increase was not statistically significant. The malignancy rate also significantly increased by 34.1% accompanied by decrease in neoplastic category among the samples received during COVID‐19 lockdown period. Breast samples remain the most frequent sample type both in pre‐COVID‐19 and COVID‐19 periods. Majority of fine‐needle aspiration done in these cases, during the lockdown period, were either in cases for recurrence or primary diagnosis.ConclusionPrioritization of samples, proper precautions and triaging of patients before procedure helped in carrying out this procedure safely.

CLINICOHISTOPATHOLOGICAL PROFILE OF NASAL AND SINONASAL LESIONS: A STUDY FROM CENTRAL INDIA

Background: Nasal and sinonasal lesions comprise common as well as rarest rare lesions. This region being a site of histopathologically diverse lesions, interests pathologists.&#x0D; Objectives: The study aimed to find out incidence of nasal and sinonasal lesion with frequency of non-neoplastic, neoplastic lesions, to study spectrum of lesions histopathologically along with correlation of clinical and radiology findings.&#x0D; Material and methods: It was a 2 year retrospective observational study involving 102 cases from January 2012 to December 2013 carried out at Government medical college, Nagpur.&#x0D; Study included all specimens received as nasal and sinonasal lesions. Complete clinical history and radiological findings were correlated with histopathology findings.&#x0D; Results: Nasal and sinonasal lesions are rare having 1.07 % incidence rate. Majority of patients of nonneoplastic and benign neoplastic category belonged to 11-20 age group while malignancies were common in 41-50 age group. We encountered more neoplastic lesions (53.92%) compared to nonneoplastic lesion (46.08%). Male to female ratio was 1.5:1. Sensitivity, specificity and diagnostic accuracy of clinical diagnosis was 94.73%, 97.67 % and 96 % respectively while positive predictive value and negative predictive value was 98.18 % and 93.33 %. p value was 0.317. Discordance in clinic-histopathological diagnosis was in 5.88 %&#x0D; Conclusion: Though there was good correlation between clinicoradiology findings and histopathology, however in 5.88% discordant cases histopathology diagnosis led to significant alteration of treatment plan proving key role of histopathology diagnosis.&#x0D; Keywords: Benign, Central India, Clinicohistopathology, Profile, Malignant, Nasal, Sinonasal.

Role of nuclear morphometry in diagnosis of salivary gland neoplasms.

Fine needle aspiration cytology is an important diagnostic tool in salivary gland cytopathology. However, cytology of salivary gland neoplasms shows diversity with morphological overlap, heterogeneity and subjective variability, posing diagnostic challenge. Nuclear cytomorphometric image analysis turns the subjective criteria into quantitative parameters, which may aid not only in differentiating between benign and malignant tumours but also can aid in categorising challenging cases with morphological overlap. A retrospective analysis of Papanicolaou stained fine needle aspirate smears from 50 patients with salivary gland neoplasms, with available follow-up histopathology, was performed. The aspirates were categorised in to three neoplastic categories of Milan system for reporting salivary gland cytology (MSRSGC) that is benign neoplasm, salivary gland neoplasm with uncertain malignant potential, and malignant. The smears were subjected to cytomorphometric image analysis using Image Pro Software (version 10). Each nucleus was analysed for 13 parameters including aspect ratio, intensity, diameter, perimeter, roundness, area, Feret diameter, circularity, radii, Fournier description and chromatin texture characteristics such as margination, heterogeneity and clumpiness. The data obtained was compared through relevant statistical methods. The comparative morphometric data obtained for parameters using ANOVA, for the three categories showed statistically significant P values (<0.001). The post hoc test (Games-Howel) test also showed significant P values (<.001). Cytomorphometric image analysis is an important tool in diagnosis of salivary gland neoplasms and can improve the diagnostic accuracy for better treatment and improved prognosis. However, more studies with larger sample size may be needed in future for further affirming its role.