Cytopathology of Intraoral Salivary Gland Tumours and Tumour-Like Lesions: Diagnostic Challenges and Pitfalls

Fine needle aspiration cytology is an important diagnostic tool in cytopathology. There are many challenges and pitfalls encountered in intraoral salivary gland cytopathology as tumours of these glands show morphological diversity and overlapping features. There are often variable solid-cystic components, metaplastic or necrotic changes, fibrosis, hyalinisation and haemorrhage accounting for heterogeneity of these tumours. The tumour profile of intraoral salivary gland is quite different from the major salivary glands and needs special attention. A low-grade malignant tumour may sometimes mimic a benign neoplasm or a non-neoplastic lesion resulting in a false negative diagnosis. Moreover, misinterpretation and failure to recognize subtle morphological and architectural patterns of cells also pose diagnostic challenges. In this chapter, we intend to highlight the key cytopathological features of intraoral salivary gland tumours and tumour-like lesions with emphasis to overcome diagnostic challenges and pitfalls to avoid misdiagnosis which will aid in planning further management and treatment

Usefulness of Fine Needle Aspiration Cytology in Diagnosis of Neck Masses

Abstracts: Background: Fine needle aspiration cytology (FNAC) is a well established, simple, quick, inexpensive and minimally invasive diagnostic technique. Neck region of human body is relatively small area but houses a fairly large number of organs with a variety of lesions and consequently require from conservative to aggressive management protocols. Aims and objectives: To assess sensitivity and specificity or diagnostic value of FNAC of neck masses keeping histopathology as gold standard. Materials and Methods: Surgical biopsies or excisions from neck masses were received in fifty nine cases in which prior FNAC was done. The findings of histopathological study were correlated with the diagnosis given on FNAC. Further the sensitivity and specificity were calculated. Results: Twenty eight aspirates were from lymph nodes, fourteen were from thyroid gland, thirteen were of salivary gland origin and four were others. Out of the Fifty nine cases the diagnosis of forty four (74.57%) was corroborated by histopathology. In fifteen (25.42%) cases the histopathological diagnosis was dissimilar to that of FNAC. The overall sensitivity of FNAC in the diagnosis of neck masses was calculated to be 83.01% and specificity was 78.94%. Sensitivity was highest (82.14%) for neck lymph nodes and lowest for thyroid masses (64.28%). Specificity was the highest for other neck masses (100%) and the lowest for neck nodes (71.2%). Conclusion: FNAC of neck masses is an effective diagnostic tool but its sensitivity and specificity of diagnosis in different organs should be kept in mind while creating a management protocol for the patient. [ Kapoor N NJIRM 2011; 2(4) : [26][27][28

Central neurocytoma in the vermis of the cerebellum

In neuropathology, anatomic landmarks and topographic relationships bear particularly on issues of differential diagnosis. A case of central neurocytoma of the vermis of the cerebellum is being reported in this article. A 45-year-old male with features of hydrocephalous and a posterior fossa space-occupying lesion was diagnosed as having central neurocytoma upon a microscopy of Hematoxylene and Eosin stained sections. The diagnosis was confirmed by a positive immunohistochemical reaction for Neuron Specific Enolase (NSE) and Synaptophysin. This case report is being made to emphasize that a high index of suspicion is required even for reporting neuropathology where the site does not match the conventional location of the lesion seen and also to emphasize the importance of immunohistochemistry in proving such unusually located lesion

Cytomorphological variables of hepatic malignancies in fine needle aspiration smears with special reference to grading of hepatocellular carcinoma

Background: The evaluation and management of discrete hepatic masses is a clinical problem. Ultrasound guided fine needle aspiration cytology (FNAC) is a rapid, accurate and safe diagnostic procedure that can be used in various neoplastic and non-neoplastic diseases of the liver. Aim: To evaluate the cytomorphological features of hepatocellular carcinoma. Materials and Methods: Ultrasound-guided fine needle aspiration was performed on 52 patients clinically suspected of having hepatic lesion. Results: Malignancy was detected in 50 cases. The primary malignancies consisted of 15 cases of hepatocellular carcinoma (HCC), 4 cases of cholangiocarcinoma and 2 of hepatoblastoma. There were 29 metastatic lesions, which included 26 cases of adenocarcinoma, 2 cases of squamous cell carcinoma and 1 of lymphoma. The key diagnostic features for HCC were trabecular arrangement, polygonal cells with eosinophilic and granular cytoplasm, hyperchromatic nuclei with macronucleoli. Atypical naked hepatocytic nuclei and malignant cells separated by sinusoidal capillaries were also commonly seen. The sensitivity and specificity of FNA for malignancies was found to be 96% and 100% respectively, yielding a positive predictive value of 100% and negative predictive value of 50%. Conclusions: There was a very good correlation of cytological criteria and histopathological diagnosis in hepatocellular carcinoma of various grades as well as in differentiating primary from metastatic tumors. It is recommended that image directed FNAC should be the primary diagnostic modality for assessing potential malignancy in any patient with a localized hepatic mass

The UICC/WHO-CCCE cancer education project:An Indian experience

BACKGROUND: Although India has a long history of providing excellent allopathic medical education, the knowledge about oncology is scattered all over the curriculum, losing focus, impact, and usefulness. METHOD: The World Health Organization Collaborating Center for Cancer Education at the University Medical Center, Groningen in the Netherlands designed a course for Gandhi Medical College Bhopal, which stressed on problem-based teaching of oncology. The idea of the course was to provide multidisciplinary cancer knowledge. It was aimed at cancer care in general practice by creating interaction between patients, students, and teachers, thus making the emphasis and focus of teaching student and patient centered rather then teacher centered. The aim was to assess the feasibility of problem-based teaching of oncology and its effectiveness in medical education in an Indian setting. RESULTS: The undergraduate medical students gave a positive response to this method of teaching, which according to them made various cancers not just a topic to be studied for examination but a problem for the community. We found a perceptible positive change in their knowledge and attitude toward cancer as a manageable and treatable entity. CONCLUSION: Providing cancer education in a problem-based manner is possible in a non-western country once it is adjusted to local needs

Bilaterally enlarged parotids and sicca symptoms as a presentation of sarcoidosis: Pivotal role of aspiration cytology in diagnosis

Sarcoidosis is a chronic multisystem inflammatory disease of unknown etiology characterized by widespread noncaseating granulomas in various organs. The diagnosis of sarcoidosis is based on cytological, clinicolaboratory, and radiological findings, and requires careful exclusion of other granulomatous diseases especially tuberculosis. Involvement of parotid glands is uncommon. Presentation of sarcoidosis with sicca symptoms that include dryness of eyes and mouth is an even rarer phenomenon. We present a case of multisystemic sarcoidosis presenting with dryness of eyes and mouth along with bilateral enlargement of parotid glands. Fine-needle aspiration cytology (FNAC) smears showed epithelioid cell granulomas and multinucleate giant cells. Stain for acid-fast bacilli was negative. Careful cytological examination revealed crystalline structures inside the giant cells, which prompted us to evaluate the patient for sarcoidosis. This case report highlights the cytological features that can be useful in clinching the diagnosis of sarcoidosis in conjunction with clinicoradiological and laboratory findings in a clinically unusual case

Clinico-histological correlation in Hansen's disease: Three-year experience at a newly established tertiary care center in central India

Background: Hansen's disease is a chronic infectious disease caused by Mycobacterium leprae. It is characterized by a wide range of clinical and histological manifestations. Ridley–Jopling criteria are widely used for classifying leprosy. The demonstration of acid-fast bacilli on slit-skin smear examination and in skin biopsy aids in its diagnosis. Aim: The aim of the present study was to perform clinico-histological correlation of skin lesions in all patients with a clinical suspicion of Hansen's disease. Materials and Methods: The study included skin biopsies of all suspected cases of Hansen's disease received over a period of 3 years. Hematoxylin and eosin and Fite-Faraco stained sections of all cases were examined. Corresponding slit-skin smears, if available, were also reviewed. Results: During the study, a total of 116 cases were clinically diagnosed as Hansen's disease. Clinico-histological correlation was obtained in 62.9% of the cases (73/116). The most common histological subtype of Hansen's disease was borderline tuberculoid (TT) (40/116). Seven cases were diagnosed as lepromatous leprosy, five as TT, four as histoid, one as indeterminate, and three cases diagnosed as erythema nodosum leprosum. Fite-Faraco stain was positive in 33/73 cases. Out of 116 cases, slit-skin smears were available for 43 cases and were positive in 23 cases. Conclusion: Correlation between clinical, bacteriological, and morphological features is required for accurate classification of Hansen's disease. Clinical detection and morphological diagnosis of early lesions remain challenging, and the histological findings should always be interpreted in correlation with clinical findings