Diagnostic utility of fine needle aspiration cytology in the evaluation of neoplastic cutaneous nodular lesions: experience from tertiary care institute

Background: Cutaneous nodules can result from neoplastic and non-neoplastic causes. The present study conducted with the aim to find out sensitivity, specificity and diagnostic accuracy of cytology in neoplastic cutaneous nodules.Methods: This prospective study was conducted for a period of one year from August 2017 to August 2018. Nodular skin lesions diagnosed clinically as neoplastic were assessed by Fine needle aspiration cytology (FNAC) and correlated with histopathology. The sensitivity, specificity and accuracy of FNAC were determined using histopathology as a gold standard.Results: 82 cases with nodular skin lesions were subjected to cytological examination and biopsy. Aspiration was inadequate in 03 cases. For diagnosing neoplastic lesions, FNAC had a sensitivity of 98.7%, specificity of 94.6% and diagnostic accuracy of 97.4%.Conclusion: FNAC is safe, rapid, cost effective, highly sensitive and specific for the diagnosis of neoplastic nodular skin lesions with high diagnostic accuracy

Histopathological study of placentae in intrauterine growth retardation pregnancies in a tertiary care hospital and correlation with fetal birth weight

Background: Intra uterine Growth Retardation is the most significant factor of perinatal mortality. The aim of this study was to assess the histopathological changes in the placenta in association with IUGR and correlation with fetal birth weight.Materials and Methods: A total of 100 placentae were included. Twenty five normal placentae and 75 placentae were from IUGR pregnancies were included.Results: Intervillous fibrin deposition (64%), increased  syncytial knotting (64%), stromal fibrosis (65%), cytotrophoblastic hyperplasia (44%) and  basement membrane thickening (40%) were seen along with hypovascular villi and infraction were present in 32% and 28% respectively. These changes were seen less in the control group (p&lt;0.001). Statistically significant association between the birth weight and microscopic changes (chi square=19.543, degree of freedom=4, p&lt;0.005) was observed.Conclusion: Severity of IUGR is related to the microscopic change in the placenta. The number and severity of microscopic changes in IUGR placentas increased with decreasing fetal birth weight.</p

The Bethesda system for reporting thyroid cytology: a prospective study in a tertiary care institute along with review of literature

Background: The Bethesda system for reporting thyroid cytology (TSBRTC) was devised by the National Cancer Institute (NCI) to obtain uniformity, reproducibility and a defined management protocol while dealing with thyroid lesions. This study was undertaken with the aim to see the benefits of adopting TBSRTC in the diagnosis of thyroid FNAC, and identify the malignancy risk of each category.Methods: This cross-sectional study was conducted in Indira Gandhi Medical College, Shimla, Himachal Pradesh from June 2016 to July 2017 on 181 thyroid FNACs which were reported according to the Bethesda system for reporting thyroid cytopathology (TBSRTC) under six categories: (I) non-diagnostic/unsatisfactory (II) benign (III) atypia of undetermined significance/follicular lesion of undetermined significance (IV) follicular neoplasm/suspicious for follicular neoplasm (specify if Hurthle cell (oncocytic) type (V) suspicious for malignancy (VI) malignant. Histopathological diagnosis was available for 65 cases where thyroidectomy was performed. Malignancy risk was calculated for each category. Sensitivity, specificity, positive and negative predictive values for TBSRCT were also calculated. All the data was analyzed in SPSS software version 22.0 (IBM, USA).Results: Benign lesions constituted the major bulk. After the use of TBSRTC, there was increased ability to look for follicular neoplasms, improvement in making definitive diagnosis of the cases, an improvement in diagnostic accuracy, and we were in line with the implied risk outlined by TBSRTC in most of the cases.Conclusions: Application of TBSRTC results in uniformity in reporting among pathologists and better interdisciplinary communication and patient management

Cyto-histological correlation in diagnosis of gastrointestinal lesions- a prospective study in a tertiary care institute

Background: Gastrointestinal tract is involved by a large number of inflammatory, infectious and neoplastic diseases. There is a worldwide rising incidence of GIT lesions especially neoplasms.Methods: This study was planned to correlate endoscopic and colonoscopic brush cytology with histopathology of gastrointestinal lesions and to determine the spectrum of gastrointestinal lesions in patients subjected to endoscopic brushings and biopsy.Results: Sensitivity of upper GI brush cytology was 95.15% and specificity 90.41%. Sensitivity of colonoscopic brush cytology was 100% and specificity 86.79%. The accuracy of brush cytology came out to be 92.45% in upper GIT and 92.22% in lower GIT.Conclusions: Brush cytology is a non-invasive and cost-effective method to retrieve epithelial cells from a much larger surface area of the mucosa, thus allowing thorough sampling and increasing the diagnostic yield

Cyto-histological correlation of salivary gland lesions- a prospective study in a tertiary care institute

Background: Fine needle aspiration cytology (FNAC) has an essential proven role in diagnosing most of the common and benign salivary gland lesions. However, limited cellularity and morphological heterogeneity of the lesion can pose diagnostic challenges. The present study was conducted in a tertiary care centre over a period of one year with an objective to study the cyto-morphological features of salivary gland lesions and correlate cytological findings with histopathology.Methods: The study was carried out over a period of one year from January 2014 to December 2014. FNA specimens obtained from 78 patients were analyzed. Of these, only 51 patients underwent biopsy or surgery and their specimens were subjected to histopathological examination. Validation of cytological diagnosis was done on the basis of histopathological diagnosis.Results: A total 78 patients with salivary gland lesions were subjected to FNAC. Non neoplastic lesions constituted 19 cases (25%) and benign lesions constituted 46 cases (80.70%).  Malignant lesions constituted 11 cases (19.30%). Two cases were inconclusive due to inadequate aspirated material. Overall sensitivity, specificity and diagnostic accuracy were 95.98%, 99.20% and 98.09% respectively.Conclusions: FNAC continues to be an accurate diagnostic technique in the hands of an experienced cytopathologist. It is a highly sensitive and specific technique for rapid diagnosis of most of the salivary gland swellings

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Papillary thyroid carcinoma with nodular fasciitis-like stroma: A rare variant with distinctive morphology

Papillary thyroid carcinoma (PTC) is a common malignancy with multiple variants, some of which are rarely encountered in routine surgical pathology practice. PTC with exuberant nodular fasciitis-like stroma or PTC with fibromatosis-like stroma is one such variant. This tumor is characterized by an abundant stromal component with an intervening epithelial component with the typical morphologic features of PTC. We describe gross and histopathological features of this rare variant of papillary carcinoma in a 38-year-old female and review the literature. We also discuss the importance of a thorough search for epithelial components within any fibroproliferative lesion of the thyroid and address the diagnostic difficulties created by the tumor's extensive stromal component. Given the rarity of this condition, the experience gained from the present case is a useful addition to the current knowledge on disease prognostication and management

Multiple scrotal epidermal cysts: A rare case report

Multiple epidermal cysts over the scrotum is a rare condition and requires excision if infected or cosmetically unacceptable. Grossly enlarged or infected cysts require total excision of the scrotal wall followed by the coverage of bare testes. We are reporting a case of multiple epidermal cysts on the scrotum. Total excision of scrotal wall followed by the fascio cutaneous flap coverage was done in this case