Prevalence of abnormal Pap smear during pregnancy in a teaching hospital in South India

Background: The prevalence of cancer cervix is very high in our country. Women in our country typically present late when the disease is advanced. Screening during pregnancy gives an opportunity to pick up at pre-invasive/early stage as women come voluntarily seeking health care to hospitals. Abnormal cervical cytology is also associated with increased risk of adverse pregnancy outcome. This study was undertaken to determine the prevalence of abnormal Pap smear among pregnant women.Methods: This cross sectional study was carried out in a teaching institution among pregnant women using conventional cytology (with Ayer’s spatula) reported by Bethesda system after obtaining informed consent. The study was approved by institute ethics committee.Results: Among the 316 women studied the mean (SD) age at marriage was 22 (3) years. The mean period of gestation was 30 weeks. Only one participant (0.3%) reported high risk behaviour. The speculum examination was found to be normal in 99.7% women. There was one abnormal Pap smear report. Specific infection with Candida was reported in 14.6%; in none of these the speculum examination showed a characteristic discharge of candidiasis. Further a significantly higher prevalence of Candida infection was found in rural compared to urban population (Chi square 3.7, p=0.046).Conclusions: The prevalence of abnormal Pap smear is particularly low at 0.3% in our study group. However the prevalence of asymptomatic Candida infection which was missed on speculum exam because of lack of the characteristic discharge was high at 14.6%. Thus the authors recommend routine prenatal microbiological examination to detect candida infection

Fine needle aspiration cytology of warthin-like tumor of the thyroid

Oncocytic change in the thyroid may be encountered in a variety of nonneoplastic and neoplastic lesions. Neoplastic thyroid lesions that display prominent H\ufcrthle cell features include H\ufcrthle cell adenoma, H\ufcrthle cell follicular carcinoma and oncocytic variants of papillary, insular and medullary carcinomas.1 Oncocytic papillary H\ufcrthle cell carcinoma is characterized by complex, branching papillae in which oncocytic cells cover thin, fibrovascular, stromal cores.2 Its incidence is reported to be 1\u9611%, with an age range of 8\u9675 years and a male:female ratio of 5.6:1.0.3,4 The clinical behavior of this tumor varies depending on whether the tumor is encapsulated or widely invasive.4 Based on the common existence of ret/PTC gene rearrangement, recent data suggest a possible pathogenetic link between this tumor and Hashimoto\u92s thyroiditis.1 Warthin-like tumor of the thyroid, or H\ufcrthle cell papillary carcinoma with lymphocytic stroma, is a recent addition to the list of variants of papillary carcinoma and is characterized by cystic change and lymphocytic infiltrate in the cores of neoplastic papillae. The term Warthin-like tumor is derived from the tumor\u92s striking histologic resemblance to papillary cystadenoma lymphomatosum of the salivary gland.1,2,5,6 Generally this tumor has an excellent prognosis.2 As for the cytologic diagnosis, there have been only rare reports of cases diagnosed on fine needle aspiration cytology.6 Below we document another case, describing the cytologic features

Caseous, necrotic material and epithelioid cell granulomas in synovial fluid from a patient with tuberculous infection: A case report

The gross appearance and cytologic findings in synovial fluid in tuberculous infections are similar to those in other types of chronic synovial effusion. Demonstration of acid-fast bacilli (AFB) is required for a definitive diagnosis of tuberculous effusion; it is reported in only 20% of cases. The presence of frank caseous necrotic material and epithelioid cell granulomas in synovial fluid samples is unusual but strongly indicative of tuberculous infection. Case A 28-year-old man, on treatment for pulmonary tuberculosis, presented with a history of right ankle swelling, which was clinically interpreted as nonspecific synovitis. The synovial fluid was yellowish, with fluffy, whitish material. Cytologic smears showed abundant, caseous, necrotic material; a few histiocytic aggregates; and occasional epithelioid cell granulomas. Although stain for AFB was negative, considering the clinical presentation, a diagnosis of tuberculous synovitis could be rendered. Conclusion: Caseous, necrotic material and epithelioid granulomas in synovial fluid are highly unusual but, when present, can be considered definitive evidence of tuberculous effusion, particularly in a known case of pulmonary tuberculosi

Fine needle aspiration cytologic diagnosis of erythema nodosum leprosum: A case report

Erythema nodosum leprosum (ENL), the type 2 lepra reaction occurring in lepromatous or borderline lepromatous leprosy, presents clinically with acute manifestations that compel the patient to seek medical attention. Recognition and timely management of these patients is critical in order to avoid permanent disability. Fine needle aspiration cytology (FNAC) is a simple, effective tool that aids in correct diagnosis and management of ENL. Case A 30-year-old woman presented with history of fever, reddening of the face, and multiple raised, reddish, painful swellings of the bilateral forearms and legs for 7 days. One year previously, she was diagnosed and treated for lepromatous leprosy with type 2 reaction. After a thorough clinical examination a diagnosis of ENL was made. FNA smears from the forearm swellings showed pus-like material with intact and degenerated polymorphonuclear leukocytes and many foamy macrophages with strong granular acid-fast bacillus (AFB) positivity. A cytologic diagnosis of ENL was given, which was confirmed on histopathologic examination of skin biopsy. Conclusion: Cytologic features such as a large number of intact and degenerated neutrophils with foamy macrophages and strong granular AFB positivity, in an appropriate clinical background, allows a confident diagnosis of EN

Fine needle aspiration of follicular variant of papillary thyroid carcinoma presenting with pleural effusion: A case report

Malignant pleural effusion in association with mesothelioma, bronchogenic carcinoma and breast carcinoma is common, although less frequently reported with other malignancies. We report a follicular variant of papillary thyroid carcinoma (FVPTC), diagnosed on fine needle aspiration cytology (FNAC) of thyroid and lymph nodes and subsequently proved to have metastasized to the pleural cavity. Case A 46-year-old man presented with history of breathlessness, thyroid swelling, pleural effusion and bilateral cervical lymphadenopathy. FNAC of the thyroid swelling and the lymph nodes showed features of FVPTC with cervical lymph node metastasis. Pleural fluid examination led to suspicion of pleural involvement by metastatic deposit, confirmed by subsequent pleural biopsy. Conclusion: Thyroid malignancies presenting with pleural effusion are rare. In this case, although pleural fluid cytology suggested involvement of pleura, a definitive diagnosis could be rendered only on pleural biopsy. An ancillary aid, such as immunocytochemistry, could have helped establish pleural involvement on routine pleural fluid cytology alone. This case emphasizes the possible existence of rare cases of FVPTC that may be associated with a dismal prognosis. In our case, initial diagnosis of FVPTC could be made only on correlating FNA features of thyroid aspirate with those of lymph node aspirat

Cytology of urate milk in gouty arthritis: A case report

Synovial fluid (SF) analysis is a useful investigative procedure in the evaluation of various types of arthritides, including gouty arthritis. Rarely, gouty arthritis may present with effusion containing thick, milky white fluid. We report a case of gouty arthritis, describing cytologic features of the urate milk. Case A 42-year-old man presented with pain and swelling of multiple joints of long duration. Approximately 3 mL of milky white SF was obtained for white blood cell (WBC) count, with a clinical diagnosis of septic arthritis. Due to the gross nature of the sample, the WBC count could not be performed; however, cytologic examination of the sample revealed a massive amount of classic, needle-shaped urate crystals on routinely stained May-Gr\ufcnwald-Giemsa smears, favoring a cytologic diagnosis of gouty arthritis. Conclusion: Gouty synovitis occasionally presents with thick, milky white urate-laden synovial effusions, which clinically may be mistaken for septic arthritis. This gross nature of the specimen may interfere with the performance of a WBC count on SF sample

Fine-needle aspiration cytology of granular cell tumor: A report of two cases

Granular cell tumors (GCTs) are uncommon soft tissue tumors, which are difficult to diagnose merely on clinical examination. Being an effective first-line investigation, the fine-needle aspiration cytology (FNAC) plays a significant role in its pre-operative recognition. However, as the tumor is likely to mimic certain other lesions, a cytopathologist needs to be aware of its characteristic cytomorphology. We report two cases of GCT who presented with subcutaneous swellings in the left lower back and the right-sided anterior abdominal wall for 6 and 2 months, respectively. Both the patients had a clinical diagnosis of lipoma/neurofibroma. FNAC was done in both. In the first case a cytodiagnosis of xanthogranuloma was suggested and GCT in the second. Subsequent histologic examination of both showed features of GCT. FNAC would aid in presumptive diagnosis of GCT

Immunohistochemical distinction between mesothelial and adenocarcinoma cells in serous effusions: A combination panel-based approach with a brief review of the literature

Background: The prognostic and therapeutic significance of differentiating adenocarcinoma (AC) from reactive mesothelium (RM) in effusions cannot be overemphasized. To avoid diagnostic errors, ancillary techniques like immunohistochemistry are employed. However, results vary and no universal standard has been accepted so far. Objective: To study the combined diagnostic efficacy of epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), E-cadherin (EC), calretinin (CAL), desmin (DES) and vimentin (VIM) in distinguishing RM from AC cells in serous effusions. Study Design: Unequivocally diagnosed cases of 39 adenocarcinomatous and 38 RM populations were studied using sections from 49 formalin-fixed, paraffin-embedded cell blocks. Materials and Methods: The immunomarkers were applied on cell block sections using the avidin-biotin peroxidase technique. The distribution/intensity of immunostaining in mesothelial and AC cells were graded semiquantitatively. Statistical Analysis Used: Fischer′s exact test was used to calculate the efficacy of individual markers and their combinations. Results: EMA was the best single marker for AC, with 100% sensitivity and 97.37% specificity. For the mesothelial cells, CAL exhibited 100% sensitivity and 92.31% specificity. DES was more specific than CAL but had a poor sensitivity of 55.26%. EC, CEA and VIM had unsatisfactory predictive values precluding their use as individual diagnostic markers. Among the combinations, two panels - EMA+ AND (CAL- OR DES-) for ACs and CAL+ AND (EMA- OR CEA-) for RM had 100% specificities and sensitivities. Conclusions: Most panel studies on fluid cytology are based on the arbitrary use of individual markers with the best statistical values, leading to a less than accurate diagnostic assessment. We believe that statistical parameters calculated in combination provide for a more practical and objective evaluation as well as allowing for meaningful comparative studies