Role of helicobacter pylori in functional dyspepsia

BACKGROUND: The association of Helicobacter pylori with functional dyspepsia is widely reported, but it remains unclear whether H. pylori infection actually causes symptoms or is just an associated finding. AIMS: This study was conducted to determine the role of H. pylori in causing symptoms of functional dyspepsia and to observe any improvement in symptoms after eradication of H. pylori. SETTING AND DESIGN: This study was conducted in a prospective, randomised double-blind manner at the Surgery Department of our institution. MATERIALS AND METHODS: Eighty patients with functional dyspepsia were randomly distributed into two groups to receive eradication or placebo therapy after taking biopsies for H. pylori. Symptom evaluation was done at baseline, at one and at three months to notice any improvement. STATISTICAL ANALYSIS: Changes in the dyspepsia score were compared using ANOVA test at baseline, one and at three months to compare the improvement in symptoms. RESULTS: Approximately two-thirds of patients with functional dyspepsia are infected with H. pylori. Significant long-term improvement was observed after eradication in H. pylori infected patients. No significant improvement was seen with placebo therapy. CONCLUSION: H. pylori plays a significant role in causing symptoms of functional dyspepsia. Treatment with triple drug regimen brings a significant long-term improvement in the symptoms

Tuberculoid morphology in borderline lepromatous leprosy

The morphologic spectrum of skin lesions in leprosy is characterized by cohesive epithelioid cell granulomas at the tuberculoid pole and by diffuse, macrophage granulomas at the lepromatous pole. Epithelioid cell granulomas indicate strong host resistance; therefore, a search for infective organisms in aspirates with epithelioid cell granulomas is likely to be disappointing. Conversely, macrophage granulomas are associated with poor host immunity to infective organisms1; appropriate stains demonstrate large numbers of infecting organisms. In short, in skin lesions the morphology of the granuloma reflects the bacterial density. The widely accepted Ridley-Jopling (R-J) 5-group classification of leprosy reflects the immunologic status of the patient and allows accurate calibration of the disease. The basis of this classification is a combination of the clinical, bacteriologic, histopathologic and immunologic findings.2 Cytomorphology in fine-needle aspiration cytology can also be used to place the lesions on the R-J scale; in general, the cytomorphology shows a strong correlation between the cell type of the infiltrate and the bacterial index (BI).1 This positive correlation also serves as a self-check to the Ziehl-Neelsen (Z-N) or other acid-fast staining procedure that may be used in the laborator

Fine needle aspiration cytology of primary extraskeletal myxoid chondrosarcoma: A case report

Extraskeletal myxoid chondrosarcoma is a rare soft tissue tumor of the extremities. Since it usually lacks obvious chondroid differentiation on light microscopy, it needs to be distinguished from other myxoid soft tissue sarcomas. CASE REPORT: The diagnosis of extraskeletal myxoid chondrosarcoma was made on fine needle aspiration in a patient with a swelling in the right calf. Cellular myxoid fragments having round to oval cells with grooved nuclei arranged in a cordlike pattern suggested chondroid differentiation. The diagnosis was confirmed by histopathology. CONCLUSION: Fine needle aspiration cytology can be diagnostic of extraskeletal myxoid chondrosarcoma even in the absence of obvious chondroid differentiation

Are all subcutaneous parasitic cysts cysticercosis

We read with interest the letter 'Cysticercosis Diagnosed by Fine Needle Aspiration Cytology' by Agrawal et al.1 The authors stated that 'Cysticercus cellulosae diagnosed by fine needle aspiration is very unusual' and that 'the case is reported because of its unusual presentation and rarity.' A quick review of the literature2-5 suggests the reverse. The cytomorphology of cysticercosis has been described in minute detail, covering the entire range, from viable cysts through necrotic and calcified lesions.2 Agrawal et al1 saw 'classic scolices.' However, each Cysticercus has only 1 scolex.6 Multiple scolices characterize other cestode larvae found in humans, notably the larva (hydatid cyst) of Echinococcus granulosus, which bears more than a passing resemblance to Cysticercus. Both possess a bladder wall: a thin, membranous bladder wall in Cysticercus and a thicker, acellular, lamellated membrane surrounding the germinal layer in a hydated cyst. Protoscolices grow from this germinal layer, differentiating into broods and forming daughter cysts. A hydatid cyst that develops from a single egg may therefore contain thousands of scolices.6 While it is unusual, but not unknown, for hydatid cysts to occur in subcutaneous tissues, this is a common location for cysticercosis. Both cysts may yield clear, watery fluid on aspiration. The findings vary with the stage of evolution. Humans are accidental intermediate hosts of both parasites. Over months, the larva of Cysticercus dies, provoking the characteristic inflammatory response culminating in disintegration of the parasite. The viable cyst and the necrotic and calcified lesion all have distinctive cytomorphologic patterns.2 The most common finding in the clear fluid aspirated from viable cysts are delicate fragments of bladder wall with tiny, parasitic nuclei in a clear, acellular background. Aspirates of necrotic lesions may contain fragments of bladder wall, the invaginated portion, including calcareous corpuscles and detached, single hooklets. The inflammatory background ranges from acute inflammation with prominent eosinophils, through granulomatous inflammation with necrosis, to acellular necrosis without significant residual inflammation. Occasionally an entire scolex can be found in an inflammatory background. Single, detached hooklets and calcareous corpuscles may be the only recognizable remnants in aspirates of calcified cysts. Hydatid cysts live for many years and usually continue to grow unless the contents of the cyst die, presumably due to trauma or therapy, resulting in inflammation and disintegration of the parasite parts; those events are similar to those seen in cysticercosis. To the cytopathologist, the distinction lies in the cytomorphologic details. The scolex of Cysticercus is large, almost 1 mm in diameter. It has a rostellum and 4 suckers. The armed rostellum has 2 rings of alternating large and small hooklets measuring 170 (Figure 1A) and 130 \ub5m, respectively. The scolex is visible to the unaided eye and is easily recognized at scanning magnification (4\ua5) (Figure 1B). Finding an entire scolex in a fine needle aspirate is a rare event and, for reasons that are unclear, occurs in the inflammatory background of a partially necrotic cyst. In contrast, multiple scolices suspended in clear fluid are aspirated from viable hydatid cysts. In stark contrast to the scolex of Cysticercus, individual scolices of Echinococcus are small, albeit each with a rostellum and suckers (Figure 1C). The hooklets measure 22 and 40 \ub5m (Figure 1D). The rostellum can be detailed only at high magnification, as illustrated by Agrawal et al.1 On the basis of the evidence presented by Agrawal et al, their case is Echinococcus, not Cysticercus. The perception that a condition is rare or otherwise is closely linked to our ability to recognize what we see. At our institution we have seen cysticercosis transform from a rare to a fairly common diagnosis ever since we learned to recognize its various cytomorphologic manifestations. Our experience confirms endorsing the aphorism, 'What the mind does not know, the eye does not se

Testicular Fine needle aspiration cytology for the diagnosis of azoospermia and oligospermia

To evaluate qualitative and quantitative cytologic features on testicular fine needle aspiration biopsy in the diagnosis of azoospermia and oligospermia and to correlate cytologic and histologic diagnoses. STUDY DESIGN: In this prospective study, 50 infertile males selected from the infertility clinic of Guru Tegh Bahadur Hospital were studied. Fine needle aspiration cytology (FNAC) smears from both testes of 27 azoospermic and 23 oligospermic patients (sperm count <10 million per milliliter) were stained with May- Gr\ufcnwald-Giemsa and Papanicolaou stain. Differential counting of 500 spermatogenic cells was done, and the number of Sertoli cells per 500 germ cells was determined for calculating the spermatic index and Sertoli cell index, respectively. FNAC and testicular biopsy were performed under local anesthesia as a minor surgical procedure. RESULTS: Six groups were identified on FNAC smears from azoospermic patients: I. normal spermatogenesis (8), II. hypospermatogenesis (2), III. maturation arrest (2), IV. Sertoli cells only (6), V. atrophic pattern (7), and VI. Leydig cell predominance (2). In oligospermic patients two groups were identified: I. those with normal spermatogenesis (4), and II. those with subnormal spermatogenesis (19). Correlation with histopathologic examination was seen in 81.5% azoospermic and 65.2% oligospermic patients. CONCLUSION: Qualitative and quantitative evaluation of testicular FNAC provides useful information on both azoospermic and oligospermic patients. FNAC performed under local anesthesia is an acceptable outpatient procedure that consistently yields sufficient diagnostic material in all patients

Cytology of testicular changes in leprosy

OBJECTIVE: To study the changes in testicular aspirates and semen of patients with leprosy. STUDY DESIGN: A prospective study of 56 patients in the reproductive-age group, with no record of treatment for leprosy. Both Ridley-Jopling and WHO classification systems were used. Skin and/or nerve biopsies were performed for documentation of the diagnosis. Semen analysis and fine needle aspirates of the testes were performed. Smears from the testicular aspirates were stained with May-Gr\ufcnwald-Giemsa and Ziehl-Neelsen stain. RESULTS: Five patients were unable to produce an ejaculate. Abnormal semen analysis and/or testicular aspirates were seen in 24 (42.8%) patients. Eleven had oligospermia and eight azoospermia. Abnormalities in testicular aspirates ranged from hypospermatogenesis (4) through maturation arrest (1) and atrophy (11). Two patients had hydrocoele, and two had associated microfilariae. Three patients with multibacillary leprosy had type 2 reaction. Mycobacterium lepre was demonstrable in testicular aspirates from all patients with multibacillary and in three with paucibacillary leprosy. CONCLUSION: Abnormal semen analysis and/or testicular aspirates occur in a very high percentage of patients with leprosy. While this is expected for multibacillary disease, the high incidence in the paucibacillary form was surprising. With the rapid elimination of leprosy, fertility-related disability might emerge as a major problem in these people

A cytomorphological study of secretions in breast cancer

Background: Secretions are seen in a range of breast cancer that includes invasive ductal carcinoma, mucinous carcinoma and secretory carcinoma. Evaluation of the quantity and location of secretions and the contours of the cell clusters complement cell morphology could improve diagnostic cytopathological criteria. Aim: To identify the range of breast carcinomas with secretions on fine-needle aspiration. Materials and Methods: A retrospective study of 160 patients with breast carcinoma was carried out. The tumors were typed by evaluating the quantity and location of secretions, cellularity and nuclear grade. Results: Secretions were seen in 16 of 160 breast carcinomas. Eleven were invasive ductal carcinoma (IDC), three were mucinous and two were secretory carcinomas. In IDC, minimal intracytoplasmic secretions were seen in 10, nuclear grades of 2 and 3 in 9, cell clusters with irregular margins in 6, and necrosis in 4. All mucinous and secretory carcinomas were nuclear grade 1. Extensive extracellular secretions and cell clusters with rounded contours were seen in mucinous carcinomas. In secretory carcinomas, the secretions were predominantly intracellular; stringy vasculature was a unique feature. Conclusion: Secretions in breast cancer are seen in a range of lesions that include IDC, mucinous, and secretory carcinomas. The quantity and location of secretions in breast cancer offer clues to differentiating these