Ultrasound evaluation of cervical lymphadenopathy: Can it reduce the need of histopathology/cytopathology?

Background

The differentiation between the causes of cervical lymphadenopathy is of paramount importance as these have different modalities of treatment with varying prognosis. The aim of this study was to evaluate the efficacy of B Mode and colour Doppler ultrasound (CDUS) to differentiate between benign and metastatic lymph nodes.

Methods

100 patients of clinically palpable lymph nodes were evaluated with B Mode and CDUS. B Mode assessment included short-long (S:L) axis ratio, hilum, nodal border, echogenicity, intranodal necrosis and ancillary features. CDUS assessment included distribution of vascularity, resistive index (RI) and pulsatility index (PI). Statistical analysis was carried out with histopathological or cytological diagnosis as gold standard.

Results

B-Mode US correctly diagnosed 22/25 (88%) of the reactive lymph nodes giving it a sensitivity of 88% and specificity of 97.3%. Colour Doppler US diagnosed 23/25 (92%) reactive lymph nodes with a sensitivity of 92% and specificity of 97.3%. B-Mode underdiagnosed one case each of granulomatous disease and metastasis as reactive node while CDUS missed out two cases of granulomatous disease as reactive lymph node.

Conclusion

Individual parameters of B Mode when used alone were not found to be very effective in differentiating benign and malignant lymph nodes. However features of B-Mode combined together as well as color Doppler ultrasound, help in the detection of reactive lymph nodes and can be used as a diagnostic tool with good accuracy. However, they cannot be used as a diagnostic method for metastatic or tubercular nodes and cytopathology/histopathology remains the gold standard in such situations.

Correlation of microvessel parameters in invasive ductal carcinoma of the breast and fibroadenomas: a morphometric study

Modifications of microvascular configuration are essential features encountered during the progression of breast tumors. Our objectives were to correlate morphometrically evaluated microvessel parameters (microvessel density [MVD], microvessel caliber [VC], microvessel cross-sectional area [VCSA], percentage of total VCSA [%TVCSA], and total microvessel boundary density [TVBD]) with histologic grades of invasive ductal carcinoma (IDC) of the breast and benign breast lesions. Sixty cases of IDC presented with modified radical mastectomy, and 20 benign breast fibroadenomas were evaluated for various microvessel parameters, using CD34-immunostained histologic sections by computerized image morphometry. Samples were divided into 4 histologic groups: benign, grade 1, grade 2, and grade 3; mean with SD and range was evaluated for each group. Histologic grades showed a strong positive correlation with %TVCSA (ρ=0.773) and TVBD (ρ=0.811) and a moderate positive correlation with MVD (ρ=0.607), VC (ρ=0.609), and VCSA (ρ=0.616) when analyzed for all samples of the 4 groups. Except MVD, all parameters including age was the lowest (P<.001) for the benign group. Among the IDCs, differences of mean VC and VCSA were not significant; MVD, %TVCSA, and TVBD were the lowest in grade 1 and the highest in grade 3. Upper cutoff value of benign lesions for MVD was 155mm^-2; VC, 9.94μm; VCSA, 94.42 μm²; %TVCSA, 1.33; and TVBD, 4.37mm^-1. Total microvessel boundary density included the information of microvessel concentration and size showed the best correlation with grades. Microvessel density showed a positive correlation with grades in the IDCs, but for the differentiation of benign from malignant, VC, VCSA, %TVCSA, and TVBD showed excellent area under the receiver operating characteristic curve (area under the curve > 0.990), unlike MVD (area under the curve = 0.797).

Solitary Extramedullary Plasmacytoma of the Maxillary Sinus, Progressing to Smoldering Multiple Myeloma with Multifocal Skeletal Involvement, which Resolved Completely Following Chemotherapy Alone

Plasmacytoma is an uncommon malignant tumor originating either from plasma cells located in the bone marrow also known as the solitary bone plasmacytoma, or from plasma cells located outside the bone, for e.g. in mucosal surfaces, referred to as the extramedullary plasmacytoma also called the solitary extramedullary plasmacytoma. Both, solitary as well as extramedullary bone plasmacytomas may, particularly in later stages, be accompanied by other osteolytic bone lesions (multifocal bone involvement) and features such as anemia, hypercalcemia, or renal impairment attributable to and indicative of progression to multiple myeloma. These three distinct disorders together comprise the plasma cell neoplasms and essentially represent a continuum of related disease processes. Extramedullary and solitary bone plasmacytomas of the head and neck region are extremely uncommon, and amongst them plasmacytoma of the maxilla is extremely rare. Such a case is being reported here for its rarity. Also, it was associated with multifocal skeletal involvement, making a correct categorization difficult as well as imperative in order to institute the correct treatment. Radiotherapy is considered to be the treatment of choice of plasmacytoma, with adjuvant chemotherapy for multi focal involvement. Surgery is usually limited to biopsy and excision of any residual disease following radiotherapy. The case presented responded extremely well to chemotherapy alone, with a complete resolution of the maxillary tumor, obviating the need for radiotherapy.

Anti-neutrophil cytoplasmic antibody negative crescentic paucimmune glomerulonephritis in a case of scleroderma with systemic lupus erythematosus overlap

Renal Involvement in scleroderma is a known problem and the manifestations are well described. Renal involvement in systemic lupus erythematosus (SLE) is also well known. However, in scleroderma and SLE overlap syndrome, the renal findings may vary being a combination of features of immune complex mediated glomerulonephritis as well as thrombotic microangiopathy. We report a case in which the renal manifestation in such a situation was of a focal necrotising pauci-immune glomerulonephritis with crescents, anti-neutrophil cytoplasmic antibody negative. To the best of our knowledge, such manifestations have not been described before. Renal dysfunction in a normotensive setting in such a case should direct one towards evaluation for other causes and should prompt a kidney biopsy. This would be valuable in delineating the pathological process in the kidney and would help in guiding therapy.

Comparison of aspiration vs non-aspiration techniques in fine-needle cytology of thyroid lesions

Aim:

To compare the efficacy of fine-needle non-aspiration cytology (FNNAC) with that of fine-needle aspiration cytology (FNAC) of thyroid lesions.

Materials and Methods:

FNAC and FNNAC techniques were studied in 50 cases of thyroid lesions. All the needle-sampling procedures were done by a single operator. The samples were assessed cytologically and evaluated using five parameters, that is, background blood or clot, amount of cellular material, degree of cellular degeneration, and degree of cellular trauma and retention of appropriate architecture.

Statistical Analysis:

Wilcoxon signed rank test was performed using SPSS14 software. Differences between all the individual parameters as observed in FNAC and FNNAC smears were insignificant.

Results and Conclusion:

After evaluation of FNAC and FNNAC on the basis of these scores, greater numbers of diagnostically superior samples were obtained by FNNAC; however, by FNAC more number of diagnostically adequate smears were observed. The numbers of unsuitable smears were also more by FNNAC technique.

Fine needle aspiration cytology of amyloid goiter. A report of four cases

BACKGROUND

Amyloid goiter is a very rare clinical entity. It can be confused easily with a neoplastic goiter both clinically and cytologically.

CASES

In four cases of amyloid goiter the diagnosis was established preoperatively by fine needle aspiration cytology. Abundant violet to pink amorphous material with staining characteristics of amyloid was obtained in all cases. This material was morphologically distinct from colloid. Abdominal fat aspiration was done in all four cases. Two of the four abdominal fat aspirates were positive for amyloid.

CONCLUSION

Attention to the morphology of cells accompanying amyloid allows exclusion of medullary thyroid carcinoma, thereby avoiding unnecessary surgery. Moreover, aspirates from the abdominal pad of fat and the thyroid and salivary glands, when enlarged, are useful in the workup of suspected amyloidosis, especially since it is a safe, easily performed procedure.

Bilateral intraabdominal ganglioneuroblastoma in an adult

Ganglioneuroblastoma is an unusual tumour in an adult. We present a case of bilateral intraabdominal ganglioneuroblastoma in an adult patient. The two tumours had different morphological features and origins. The appearances on ultrasound, CT and MRI are discussed. To the best of our knowledge, this is the first case of bilateral ganglioneuroblastoma reported in an adult patient with ultrasound, CT and MRI findings.

Fine-needle aspiration cytology of sacrococcygeal chordoma

The fine-needle aspiration cytology (FNAC) of four cases of chordoma that were diagnosed preoperatively is presented. One of the cases showed anaplastic components along with the classical features of chordoma; this is probably the second case diagnosed with these features on FNAC. The cytologic features of classical chordoma include conspicuous extracellular matrix in the background. Polygonal cells, dissociated and in small groups, were identified in all cases. Physaliphorous cells were also prominently found in these cases. In addition, the case with anaplastic features showed very bizarre cells with profound multinucleation and the presence of intranuclear cytoplasmic inclusions. The diagnosis of chordoma was possible because of a high index of suspicion on clinical grounds and the use of special staining for confirmation.

Role of fine-needle aspiration cytology in childhood malignancies

During the last 4 yr, fine-needle aspiration cytology (FNAC) has been employed in 1,474 patients in 0-15-yr age group at our institute. Of these, 245 patients were found to have malignant disease, including primitive neuroectodermal tumors, hepatoblastoma, nephroblastoma, sarcoma, and epithelial malignancies. Four metastases from medulloblastoma and two each from astrocytoma and meningioma were confirmed without open biopsy. FNAC interpretation was easy when cytologic findings were correlated with relevant clinical and radiologic data.