Idiopathic Lipoid Pneumonia: An incidental finding in autopsy specimen

Lipoid pneumonia is a rare form of pneumonia which was initially described to be caused by inhalation or aspiration of fatty substances. Certain autopsy studies have reported the incidence to be 1.0-2.5%. Based on the mode of lipid acquisition, it has been classified into endogenous, exogenous or idiopathic types. Almost 50% of the patients with lipoid pneumonia are asymptomatic, and may be discovered by chance during routine chest imaging. In symptomatic patients, the symptoms are non- specific. However, it can produce inflammatory pneumonitis that can progress to irreversible pulmonary fibrosis as seen in our case. We present a case of a 53-year-old deceased male. A piece of one of his lungs was received after autopsy, which appeared normal grossly. There was no history of any illness before death. Microscopy revealed interstitial fibrosis with collection of foamy macrophages in alveolar spaces and cholesterol crystals surrounded by inflammatory reaction including occasional giant cells. The clinical picture and radiologic changes in cases of lipoid pneumonia can mimic bacterial pneumonia and tuberculosis. The occupational history is of extreme importance and should always be investigated

Comparative analysis of fibreoptic bronchoscope aided cytohistological techniques in diagnosis of benign and malignant lesions of lung

Background: Morbidity and mortality from chronic lung diseases are increasing worldwide. A combination of various cytological and histopathological techniques are required for the high diagnostic accuracy. This study aims to evaluate and compare diagnostic accuracy of fiberoptic bronchoscope aided cytohistological techniques such as BAL (bronchoalveolar lavage), TBNA (Transbronchoscopic needle aspiration) and FB (forceps biopsy) in diseases of lung. Method: A prospective study conducted on 100 patients with symptoms and signs of various respiratory diseases who underwent fibreoptic bronchoscopy. Diagnostic accuracy of various samples alone and in combination were analysed. Results: Sensitivity of BAL-24%, TBNA 64% and FB 66%. Addition of BAL to FB increased the sensitivity to 69%. Addition of BAL to TBNA increased the sensitivity to 70%. Sensitivity of cytological methods (FB and TBNA) 90%. Addition of both BAL and TBNA to FB increased overall senstivity to 93%. FB the most specific amongst the three techniques with specificity of 94% followed by TBNA (59.4%) and BAL (50%). Conclusions: There are variable results regarding diagnostic yields and utilities of various fibre-optic bronchoscope aided cytohistological techniques but there combination adds the yields. Thus a combination of various cytohistological samples should be taken in a patient undergoing fiberoptic bronchoscopic examination to increase the diagnostic yield, to cut short the diagnostic time and early start of treatment

Epidermal inclusion cyst of breast diagnosed on fine needle aspiration cytology: a retrospective study

Background: Epidermal inclusion cyst (EIC) is a rare benign condition of breast. Patient presents with palpable breast lump and needs to be differentiated from other breast lesions. This study included cases of epidermal inclusion cyst of breast (EICB) diagnosed on fine needle aspiration cytology (FNAC) and their correlation with histopathological findings.Methods: Study was conducted in a retrospective manner over a period of 2 years.  8 Patients who presented with breast lump and were cytologically diagnosed as EIC were included in the study. Cytological features were suggestive of EIC or infective EICB. Histopathological confirmation was done. Female: Male ratio in the study was 7:1 with an age range of 35 to 54 years. Radiological investigations favoured benign lesions in 5 cases and tubercular collection in one case.Results: FNAC was performed and May-Grunwald-Giemsa stained smears showed numerous anucleate squames and mature squamous epithelial cells in a clean or inflammatory background. Diagnosis of EICB or infective EICB was made on cytology. Diagnosis was confirmed histologically in 6 cases.Conclusions: Asymptomatic lesions do not require biopsy and treatment. Follow-up is sufficient if typical clinical and radiological findings are there. But in symptomatic cases, excision should be done followed by histopathological confirmation to rule out malignant lesion. Diagnosis should be made on FNA whenever associated with characteristic pultaceous aspirate and cytological findings.

Sebaceous carcinoma of the eyelid diagnosed on fine needle aspiration cytology

Sebaceous carcinoma of the ocular adnexa is a malignant neoplasm which has aggressive local behavior and can metastasize to regional lymph nodes and distant organs. It is a malignant neoplasm known to masquerade as other benign and less malignant lesions, resulting in delay in diagnosis and relatively high morbidity and mortality. Aspiration cytological features of this neoplasm have not been well characterized in the literature. We report a case of this tumor diagnosed on fine needle aspiration. Clinically, a diagnosis of chalazion was made and fine needle aspiration cytology (FNAC) was performed. Cytological diagnosis of a malignant tumor with closest resemblance to sebaceous carcinoma was suggested which was confirmed on histopathology. Eyelid reconstruction was done after histopathological confirmation of tumor-free margins. The article highlights the role of FNAC in early diagnosis and subsequent appropriate surgical management of eyelid sebaceous gland carcinoma to prevent recurrence and metastasis

Accessory spleen within the scrotum

Presence of accessory spleen in scrotal sac is an extremely rare condition. It is attributed to splenogonadal fusion which is a rare congenital anomaly. It can be an incidental finding on ultrasonography and during orchiopexy or inguinal hernioplasty or less frequently can present as a scrotal swelling usually in adult life mimicking as testicular tumor. In view of the rarity of this condition, we present two cases highlighting the clinical characteristics of the condition, with a special focus on the signs and findings which might help prevent unnecessary orchiectomies. Keywords: Ectopic spleen, Orchiectomy, Splenogonadal fusion, Testicular mas