Role of image guided fine needle aspiration cytology in the diagnosis of intra-abdominal and intra-thoracic lesions

Background: Intrathoracic and intra-abdominal tumors at inaccessible sites pose difficulty in diagnosis. Ultrasonography and computed tomography guided fine needle aspiration cytology has an important role in the diagnosis and distinguishing them as benign and malignant lesions. Image guided FNA has proved to be safe, quick, reliable and cost-effective method for obtaining tissue for cytopathological examination. The objective was to describe the pattern of intra-abdominal and intra thoracic masses on FNAC.Methods: This cross-sectional study was done in the postgraduate Department of pathology Government, Medical college Jammu i.e. 1st September 2017 to 30th September,2018 for a period of one year under image guided FNAC. Air dried and wet fixed smears were stained with may Grunwald Giemsa (MGG) and Papinacolau (PAP) stains respectively. Acid fast bacilli stain was done on additional smears in case of suspected tubercular lesions.Results: A total of 60 patients were subjected to ultrasonography and CT guided intra-abdominal and intra thoracic FNACs in a period of one year. FNAC was performed from various anatomical sites of which intra-abdominal lesions were 40 (liver:21 cases, gallbladder:8 cases, ovary: 3 cases, lymph nodes 3 cases, pancreas: 2 cases, omentum 2 cases, GIT 1 case).  Intrathoracic lesions were twenty (20); out of which lung cases were eighteen (18) and two (2) were mediastinal aspirations.Conclusions: Percutaneous fine needle aspiration cytology under image guidance well described the pattern of deep-seated lesions

Surgical and audiological outcome of canal wall down mastoidectomy in Sub Himalayan region: our experience

Background: Pre-operative and post-operative hearing status and status of mastoid cavity were compared in patients undergoing canal wall down mastoidectomy (CWDM) with tympanoplasty.Methods: Forty-three patients who underwent surgery and completed their follow up post-surgery were included in the study. Nineteen patients underwent CWDM with type III tympanoplasty with PORP, 7 patients underwent CWDM with type III tympanoplasty without PORP and 17 patients underwent CWDM with type IV tympanoplasty with TORP.Results: Among enrolled patients, 21 patients were females and 22 patients were male. Right ear (29) was commonly involved than left ear (14). Hearing loss was predominant symptom followed by recurrent ear discharge and other symptoms. Patients underwent three types of surgeries, type III tympanoplasty with PORP (19/43), type III tympanoplasty without PORP (7/43) and type IV tympanoplasty with TORP (17/43) by using Teflon prosthesis.Conclusions: Thirty seven percent (16/43) of patients had hearing threshold 60dB hearing threshold, all belonging to group C. Anatomical results were assessed by examining the mastoid cavity showing 95%, 72%, 70% patients in group A, B and C had well epithelialized cavity

A case of Dentigerous Cyst in Association of Impacted Mandibular Canine

Dentigerous cyst being the second most common odontogenic cyst which constitutes around 20-24% of all the odontogenic cysts involving the jaws. Usually, these cysts remain asymptomatic and rarely cause enlargement and displacement of associated tooth. It develops by an accumulation of fluid between reduced enamel epithelium and the tooth crown of an unerupted tooth. This case report presents conservative treatment modality for 17-year-old female patient, diagnosed with a dentigerous cyst in association of impacted mandibular canine. The patient was treated with a minimal invasive approach, enucleation followed by marsupialization under local anesthesia, preserving all the teeth in occlusion

A PILOT STUDY FOR EVALUATION OF ROLE OF B-MODE ULTRASOUND AND STRAIN ELASTOGRAPHY IN DIFFERENTIATING BENIGN AND MALIGNANT BREAST MASSES

Background: Early detection of malignant lesions is critical key stone for the successful management of breast cancer. Conventional B-mode ultrasound although could not replace the histopathology which is still gold standard, plays an important role in the diagnostic pathways by using the Breast Imaging Reporting and Data System (BIRADS) lexicon (standardized by American College of Radiology [ACR]). Although characterization of solid breast masses by sonography has improved greatly since the early 1990s, specificity remains low and a large number of biopsies result in benign diagnosis. Strain elastography and strain ratio (SR) are recent techniques which may help in increasing the specificity of ultrasound. Methods: The present study was a pilot study aimed to establish a correlation between B-mode ultrasound and strain elastography in differentiating benign and malignant breast masses and to compare the results of B- mode ultrasound and Strain Elastography with fine-needle aspiration cytology/ biopsy findings. It was a prospective study conducted in the Department of Radio-diagnosis of Rajindra Hospital, Patiala. A total of 40 patients who presented with the complaint of palpable breast lump were evaluated with B-Mode Ultrasonography (USG) and Strain elastography (using elastography score [ES] and SR). Results: The study group (40 patients with breast lumps) comprised 38 (95%) female patients and 2 (5%) male patients. Among the group 29 were benign and 11 were malignant. Fibroadenoma followed by fibrocystic disease was the most common benign pathologies and invasive ductal carcinoma followed by Ductal Carcinoma in situ was the most common malignant pathologies. Sensitivity, specificity, and diagnostic accuracy of B-Mode USG in diagnosing palpable breast lump are 72.7%, 86.2%, and 82.5%, respectively, while that of strain elastography in diagnosing palpable breast lump are 81.8%, 93.10%, and 90.0%, respectively. Using strain ratio (SR) only the sensitivity, specificity, and diagnostic accuracy was found to be 93.1%, 100%, and 95% better than B-Mode USG and shear elastography alone separately and combined. The mean SR for a benign mass is 2.00±0.97 and for a malignant mass is 5.40±1.55. Conclusion: Ultrasound elastography (using ES) has a higher sensitivity, specificity and diagnostic accuracy in differentiating benign and malignant breast masses then B mode USG (using BIRADS). Using SR alone has shown better sensitivity, specificity, and diagnostic accuracy but its standalone or in combination diagnostic application has to be followed up with further studies

Cyto-histopathological correlation in palpable breast lesions

Background: Breast lesions are one of the most commonly encountered lesions in women which require prompt pathological confirmation by fine needle aspiration cytology (FNAC) and histopathological examination.Methods: We conducted a prospective study from January 2015 to December 2015. A total 98 cases included presenting with palpable breast lump in which 80 cases were also subjected to surgical biopsy or mastectomy.Results: Out of 98 cases, 34.7% benign cases, 59.2% malignant cases, and 6.1% non-neoplastic case were diagnosed cytologically in which 7 (7.1%) cases of mastitis, 2 cases (2%) of granulomatous mastitis, 22 cases (22.4%) of fibroadenoma, 11 cases (11.2%) of benign breast disease or fibrocystic disease, 10 (10.2%) cases of dyskaryotic changes , 45 cases (45.9%) carcinoma. Mean age was 46.4±14.2 years. Majority of cases 29(29.6%) belonged to 41-50 years age group. Majority of the masses were situated in the left breast (57.2%) in the upper outer quadrant (40.8%). In addition to breast lump, pain in 22 cases, bloody discharge in 5 cases, ulceration in 8 cases and nipple retraction in 11 cases were present. Histology was available for 80 cases in which 5 (6.3%) cases of non-neoplastic, 27 cases (33.7%) benign and 48 cases (60%) of malignant histology. FNAC proved to be 91.25 % sensitivity in the diagnosis of all breast lesions in our study.Conclusions: So we concluded that breast lesions are easily accessible to FNAC, which is an easy, cost effective and less time-consuming procedure. FNAC is used to diagnose both benign and malignant lesions.

Histopathological Spectrum of various gastroduodenal lesions in North India and prevalence of Helicobacter pylori infection in these lesions: a prospective study

Background: Gastroduodenal diseases are perhaps the commonest diseases in adult population worldwide. Helicobacter pylori (H. pylori) represent one of the most common gastroduodenal infections and have been established as the etiologic factor in the development of various gastroduodenal diseases. Spectrum of H. pylori associated gastroduodenal diseases have not been systematically investigated in North India. So this study was carried out to determine the spectrum of gastroduodenal lesions on upper Gastro-Intestinal (GI) endoscopic biopsies and to determine the prevalence of H. pylori in gastric mucosa in these lesions.Methods: Gastroduodenal mucosal biopsies of 100 patients from November 2012 to October 2013 in a tertiary care centre in north India were evaluated by routine histopathological methods and the presence of H. pylori in gastric mucosa in these lesions was determined.  Results: An age range of 17 years to 80 years was observed with maximum cases in the 4th decade and a male to female ratio of 1.86:1. The most frequently observed lesions were chronic gastritis followed by duodenitis, duodenal ulcer and gastric carcinoma. 5% cases showed unremarkable mucosa. H. pylori positivity was seen in 47% cases. 80% cases of duodenal ulcer, 68.75% cases of duodenitis, 50.56% cases of chronic gastritis, 50% cases of gastric ulcer & 40% cases of gastric carcinoma were positive for H. pylori infection.Conclusion: Endoscopic gastroduodenal biopsies help to detect benign and malignant gastroduodenal diseases and to rule out H. pylori infection. Chronic gastritis was the most common gastroduodenal lesion followed by duodenitis, duodenal ulcer and gastric carcinoma. Duodenal ulcer, duodenitis, chronic gastritis and gastric ulcer showed strong positivity for H. pylori highlighting the role of this microorganism in the pathogenesis of these diseases.

Comparative evaluation of FESS and septoplasty with FESS in cases of DNS with chronic maxillary sinusitis

Background: Present study compares basic FESS and septoplasty with FESS alone in DNS with maxillary sinusitis.Methods: Sixty patients of DNS with chronic maxillary sinusitis were divided into two groups alternatively. After pre-operative symptoms score and computerized tomography (CT scan), twenty patients underwent FESS with septoplasty (group A) and other 20 underwent FESS alone (group B) under local anaesthesia and topical 4% lignocaine with 1:1000 adrenaline. At 6 weeks, post-operative symptom score and CT scan findings were documented and compared statistically by using unpaired student t-test.Results: Ninety six percent of patients in group A and 87.6% in group B have shown complete improvement in facial pain/pressure. Ninety three percent of patients in group A and 83.3% in group B have shown complete improvement in headache. Ninety percent patients in group A and 63.3% in group B has shown complete improvement in nasal obstruction. Seventy six percent of patients in group A and 63.3% of patients in group B have shown complete improvement in nasal discharge. Eighty six percent and 63.3% of patients in group A and group B respectively were satisfied from the surgery. Ninety three percent of patients in group A and 70% in group B were found to have normal maxillary sinus mucosa on HRCT nose and PNS after 6 weeks following surgical treatment. Hundred percent patients in group A and 96.7% of patients in group B were found to have normal OMC on HRCT nose and PNS 6 weeks after surgery.Conclusions: It was observed that FESS with septoplasty is effective for the treatment of chronic rhinosinusitis with deviated nasal septum on VAS as well as radiologically (the Lund and Mackay staging system: radiologic staging) than FESS alone