Comparison of Conventional PAP smear and Manual Liquid Based Cytology with P16 marker in screening for cervical cancer in Indian tertiary healthcare setups in Mysuru

In India, there are 20.2 per 100000 new cases of Cervical Cancer diagnosed and 11.1 per 100000 deaths annually accounting for more than one fifths of global cervical cancer deaths. [1] Thus, due to an absence of a national immunization program to cover human papillomavirus (HPV) vaccination and lack of accessible cervical cancer screening, the disease is characterized by late detection, lack of access to affordable and quality health care, and high mortality rates. [2] Papanicolaou Smear Test was a novel invention by Dr George Papanicolaou in the year 1927 which gained maximum popularity in 1950 as a screening test for Cervical Cancer. Liquid based cytological technique has been recently developed and has gained popularity because in preliminary studies the use of such techniques was associated with a reduction in incidence of inadequate cervical smears. [3, 4] Manual Liquid Based Cytology (MLBC) is a technique that enables cells to be suspended in a monolayer and thus improves detection of precursor lesions and improvement of specimen adequacy. MLBC has been reported to improve the effectiveness of cervical cancer screening in a population by increasing the detection of histologically confirmed neoplastic and preneoplastic disease while simultaneously decreasing over diagnosis of benign processes. [1] Liquid-based cytology (LBC), although claimed to provide clearer background and better preservation of nuclear and cytoplasmic details, have yet to be proven to have better sensitivity and specificity for identification of high-grade cervical intraepithelial lesions compared to the conventional smears.[5] P16 expression, which can be detected immunohistochemically, is directly related to the presence of HPV [8]. Thus, this protein can be used as a biomarker that can add significant diagnostic precision in the assessment of CIN lesions [7, 9]. Add about ancillary technique like use of immunomarker p16 on mlbc. The aim of this study is establishing that MLBC with p16 immunomarker is very effective in screening for cervical cancer as it overcomes the major setbacks like inadequate sampling, drying artefacts and obscuring blood which are seen in conventional PAP smear technique

Cytology of secondary hemophagocytic lymphohistiocytosis masquerading as lymphoma in a nonimmunocompromised adult

Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal immune disorder which is uncommon in a nonimmunocompromised adult. A 27-year-old female who presented with fever, hematuria, generalized lymphadenopathy was clinically suspected to have lymphoma was subjected to fine needle aspiration of cervical lymph nodes. Cytology of lymph node had numerous histiocytes with phagocytosed lymphocytes, red blood cells and nuclear debris. A diagnosis of secondary HLH was made based on cytological findings, clinical manifestations, and laboratory results. She was treated with steroids and recovered completely. A high degree of clinical suspicion coupled with comprehensive cytology with fine needle aspiration cytology is fruitful in the diagnosis of HLH, a potentially fatal disease and help in the delineation of therapeutic regimen