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Hoshi M, Jikuzono T, Suzuki S, Ishibashi O, Kawamoto Y, Kure S, Kawamoto M, Ohashi R, Sugitani I. Use of Ultrasonographic Shear Wave Measurements to Diagnose Thyroid Metastasis from Breast Carcinoma. J NIPPON MED SCH 2023; 90:398-403. [PMID: 35644558 DOI: 10.1272/jnms.jnms.2023_90-501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A metastatic thyroid tumor (MTT) arising from breast carcinoma (BC) is rare and sometimes difficult to diagnose. We present a case of MTT from BC; we suspected anaplastic thyroid carcinoma at initial presentation. The patient was a 58-year-old female with a hard nodule in the right anterior neck and a history of breast cancer. Computed tomography indicated tumors on both thyroid lobes, and ultrasonography (US) with shear wave measurement (SWM) showed malignant features. We performed fine needle aspiration cytology (FNAC), the results of which led us to strongly suspect MTT from BC. The surgically resected specimen was evaluated histopathologically, including by immunohistochemistry (IHC), and the diagnosis was confirmed. In addition to FNAC and IHC, SWM is useful to diagnose MTT from BC.
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Affiliation(s)
- Masae Hoshi
- Department of Endocrine Surgery, Kanaji Thyroid Hospital
| | | | | | - Osamu Ishibashi
- Department of Endocrine Surgery, Nippon Medical School
- Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University
| | - Yoko Kawamoto
- Department of Integrated Diagnostic Pathology, Nippon Medical School
| | - Shoko Kure
- Department of Integrated Diagnostic Pathology, Nippon Medical School
| | - Masashi Kawamoto
- Department of Diagnostic Pathology, Shonan Fujisawa Tokushukai Hospital
| | - Ryuji Ohashi
- Department of Integrated Diagnostic Pathology, Nippon Medical School
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School
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Lee J, Ha HJ, Kim DY, Koh JS, Kim EJ. Analysis of Under-Diagnosed Malignancy during Fine Needle Aspiration Cytology of Lymphadenopathies. Int J Mol Sci 2023; 24:12394. [PMID: 37569769 PMCID: PMC10418811 DOI: 10.3390/ijms241512394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
Fine needle aspiration cytology (FNAC) is a useful tool in the evaluation of lymphadenopathy. It is a safe and minimally invasive procedure that provides preoperative details for subsequent treatment. It can also diagnose the majority of malignant tumors. However, there are some instances where the diagnosis of tumors remains obscure. To address this, we re-analyzed the misinterpreted patients' samples using mRNA sequencing technology and then identified the characteristics of non-Hodgkin's lymphoma that tend to be under-diagnosed. To decipher the involved genes and pathways, we used bioinformatic and biological analysis approaches, identifying the response to oxygen species, inositol phosphate metabolic processes, and peroxisome and PPAR pathways as possibly being involved with this type of tumor. Notably, these analyses identified FOS, ENDOG, and PRKAR2B as hub genes. cBioPortal, a multidimensional cancer genomics database, also confirmed that these genes were associated with lymphoma patients. These results thus point to candidate genes that could be used as biomarkers to minimize the false-negative rate of FNAC diagnosis. We are currently pursuing the development of a gene chip to improve the diagnosis of lymphadenopathy patients with the ultimate goal of improving their prognosis.
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Affiliation(s)
- Jeeyong Lee
- Division of Radiation Biomedical Research, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea; (J.L.); (D.Y.K.)
| | - Hwa Jeong Ha
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea; (H.J.H.); (J.S.K.)
- Convergence Institute of Biomedical Engineering and Biomaterials, Seoul National University of Science and Technology, Seoul 01811, Republic of Korea
| | - Da Yeon Kim
- Division of Radiation Biomedical Research, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea; (J.L.); (D.Y.K.)
- Department of Radiological and Medico-Oncological Sciences, University of Science and Technology, Daejeon 34113, Republic of Korea
| | - Jae Soo Koh
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea; (H.J.H.); (J.S.K.)
| | - Eun Ju Kim
- Division of Radiation Biomedical Research, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea; (J.L.); (D.Y.K.)
- Department of Radiological and Medico-Oncological Sciences, University of Science and Technology, Daejeon 34113, Republic of Korea
- Institute for Molecular Bioscience, The University of Queensland, Carmody Rd., St Lucia, Brisbane, QLD 4072, Australia
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Siddiqui YS, Abbas M, Muhammad J, Sherwani MKA, Khan MJ, Yadav A. Challenges in management of benign bone tumours complicated by pathological fracture in paediatric population. Int J Burns Trauma 2021; 11:207-219. [PMID: 34336387 PMCID: PMC8310879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Optimum treatment of pathological fractures following benign bone tumours in paediatric population is controversial. The usual difficulties encountered while dealing such cases is to establish a correct pre-operative diagnosis and to choose between conservative vs operative management. The aim of the work is to highlight the difficult aspects of diagnosis and management of pathological fractures following benign bone tumours in paediatric population. METHODS All paediatric patients (<18 years) with pathological fractures following benign bone tumours were included. Pathological fractures due to infection, metabolic bone diseases and malignant bone tumours were excluded. Initial pre-operative diagnosis was based on clinico-radiological characteristics of the tumour and FNAC/needle biopsy, while final diagnosis was confirmed with post-operative histology. Primary outcome measure was determination of any disparity between pre-operative diagnosis and final post-operative histological diagnosis and the need of a separate open biopsy procedure for establishing the exact nature of lesion. Secondary outcome measures were determination of complications following surgery, functional grade and any recurrence at latest follow-up at 3 years. RESULTS Out of 13 patients enrolled for the study, twelve patients met the inclusion criteria. Female to male quotient was 3:1, with average age of 12.17 years. We were able to make correct pre-operative diagnosis in 10 patients (83.3%) with systematic clinico-radiological analysis and carefully performed FNAC/needle biopsy. Disparity between pre-operative and final post-operative diagnosis was seen in two patients. In one of these two patients, initial pre-operative diagnosis was fibrous dysplasia, which turned out to be ossifying fibroma on final post-operative biopsy. While the other patient required an open biopsy to establish the nature of underlying pathology, as the pre-op histological evaluation revealed equivocal nature of bone lesion. Secondary outcome measures showed superficial infection in one, coxa vara in one, limb length discrepancy in 2 and fibular graft donor site morbidity in two. None of the patient had developed recurrence. All patients had complete healing of the fracture and lesion. CONCLUSION A thorough clinico-radiological analysis and carefully performed FNAC/needle biopsy can establish a correct pre-operative diagnosis in majority of patients with benign bone tumours complicated by pathological fracture. This approach will avoid preventable delay in the definitive treatment of such patients, and also preclude the need of a separate operation prior to definitive management. In sight of the findings of our study along with existing literature we propose for definitive treatment in straight-forward cases and pre-treatment biopsy in cases with inconclusive FNAC/needle biopsy results and lesions with suspicion of malignancy. Proper diagnostic evaluation and differentiation of benign pathological fractures from malignant counterparts followed by extended curettage or excision of lesion and biological reconstruction with or without osteosynthesis represents a feasible approach for managing such fractures.
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Affiliation(s)
- Yasir Salam Siddiqui
- Department of Orthopaedic Surgery, J. N. Medical College, Faculty of Medicine, A.M.U. Aligarh, India
| | - Mazhar Abbas
- Department of Orthopaedic Surgery, J. N. Medical College, Faculty of Medicine, A.M.U. Aligarh, India
| | - Julfiqar Muhammad
- Department of Orthopaedic Surgery, J. N. Medical College, Faculty of Medicine, A.M.U. Aligarh, India
| | - Mohd Khalid A Sherwani
- Department of Orthopaedic Surgery, J. N. Medical College, Faculty of Medicine, A.M.U. Aligarh, India
| | - Mohammad Jesan Khan
- Department of Orthopaedic Surgery, J. N. Medical College, Faculty of Medicine, A.M.U. Aligarh, India
| | - Akash Yadav
- Department of Orthopaedic Surgery, J. N. Medical College, Faculty of Medicine, A.M.U. Aligarh, India
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Capezzone M, Cantara S, Di Santo A, Sagnella A, Pilli T, Brilli L, Ciuoli C, Maino F, Forleo R, Cartocci A, Castagna MG. The Combination of Sonographic Features and the Seven-Gene Panel May be Useful in the Management of Thyroid Nodules With Indeterminate Cytology. Front Endocrinol (Lausanne) 2021; 12:613727. [PMID: 33716969 PMCID: PMC7943869 DOI: 10.3389/fendo.2021.613727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/14/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction The management of patients with indeterminate thyroid nodules, which account for 10-25% of thyroid fine needle aspiration biopsies (FNABs), is still very challenging. Aim To verify the utility of the seven-gene panel in combination with ultrasound features in the clinical management of indeterminate thyroid nodules. Results The study group included 188 indeterminate thyroid nodules, divided into TIR3A (56.4%) and TIR3B (43.6%). A significant correlation between US categories and both cytological and molecular results was observed. In detail, TIR3B cytology was more frequent in EU-TIRADS 4 and 5 nodules (54.7 and 50%, respectively) than in EU-TIRADS 2 and 3 nodules (31%, p = 0.04). Similarly, the rate of a nodule with a mutation increased with the increase of US risk class (6.0% in EU-TIRADS 2 and 3, 9.3% in EUTIRADS-4 and 27.8% in EUTIRAD-5, p = 0.01). Among thyroid nodules submitted to surgery, final histology was benign in 61.4% nodules, while malignancy was diagnosed in 38.6% nodules. Using US score as tool for decision-making in TIR3A subgroup, we correctly classified 64.5% of thyroid nodules. The second tool (seven-gene panel test) was used in the subgroup of US high-risk nodules. By multiple tests with a series approach (US in all cases and US plus seven-gene panel in US high risk nodules) 84% of cases were correctly classified. In TIR3B nodules, using only seven-gene panel as tool for decision making, we correctly classified 61.9% of indeterminate nodules. By multiple tests with series approach (seven-gene panel in all cases and seven-gene panel plus US score in non-mutated nodules) only a slight improvement of thyroid nodule classification (66.6%) was observed. Conclusions US score seems able to correctly discriminate between TIR3A nodules in which a conservative approach may be used, and those in which additional test, such as molecular test, may be indicated. On the contrary, in TIR3B nodules both US risk stratification and seven-gene panel seem to be of little use, because the risk of thyroid cancer remains high regardless of US score and mutational status.
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Affiliation(s)
- Marco Capezzone
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Silvia Cantara
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | | | - Alfonso Sagnella
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Tania Pilli
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Lucia Brilli
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Cristina Ciuoli
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Fabio Maino
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Raffaella Forleo
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | | | - Maria Grazia Castagna
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
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Budhwar A, Kataria SP, Kumar S, Singh G, Kaushik N, Sen R. Fine needle aspiration cytology of cervical lymph nodes: Comparison of liquid based cytology (SurePath) and conventional preparation. Diagn Cytopathol 2020; 49:18-24. [PMID: 32841545 DOI: 10.1002/dc.24589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 07/03/2020] [Accepted: 08/03/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Fine needle aspiration cytology (FNAC) is the first diagnostic step in patient with cervical lymphadenopathy because of its simplicity, safety and early availability of the results. Liquid-based cytology (LBC) is an alternative processing method which is used for both gynecological and nongynecological samples. Literature reviewed show few studies comparing LBC with conventional preparation (CP). AIM The present study was undertaken to evaluate the efficacy of LBC and comparison of LBC and CP in cervical lymphadenopathy. MATERIALS AND METHODS In this prospective study, a total of 75 cases of FNAC with cervical lymphadenopathy were included. The first pass was used for CP followed by LBC with the use of SurePath (SP) technique. Both the smears were compared for cellularity, background containing blood, cell debris, lymphoglandular bodies, stromal fragments, cytoarchitectural pattern, etc., by semiquantitative scoring system. RESULTS There was no statistical difference in the cellularity, cell architecture, and monolayer cells (P > .05). On the basis of background containing blood, cell debris, lympho-glandular bodies, stromal fragments (P < .001), nuclear, and cytoplasmic details (P < .05), LBC was found to be superior to CP. CONCLUSION LBC is a relatively simple technique and superior to CP in respect of better nuclear and cytoplasmic details with loss of background blood and debris. It has a diagnostic accuracy equivalent to that of CP. However, use of both LBC and CP can result in better diagnostic accuracy.
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Affiliation(s)
- Archana Budhwar
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sant Prakash Kataria
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sanjay Kumar
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Gajender Singh
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Nidhi Kaushik
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Rajeev Sen
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Croonenborghs TM, Van Hevele J, Scheerlinck J, Nout E, Schoenaers J, Politis C. A multicentre retrospective clinico-histopathological review of 250 patients after parotidectomy. Int J Oral Maxillofac Surg 2020; 49:149-56. [PMID: 31375455 DOI: 10.1016/j.ijom.2019.03.963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/07/2019] [Accepted: 03/17/2019] [Indexed: 01/09/2023]
Abstract
A clinicopathological review of parotid tumours treated surgically in two oral and maxillofacial surgery departments was conducted. The performance of fine needle aspiration cytology (FNAC) was also assessed. This retrospective study included 250 consecutive patients treated surgically for parotid gland-related tumours. Benign tumours (n=211, 84.4%) were more prevalent than malignancies (n=39, 15.6%). A predominance of pleomorphic adenoma (48.8%) was identified, and epithelial-myoepithelial carcinoma (3.6%) was the most common malignant tumour. Overall, the sensitivity and specificity of FNAC were 64% and 99%, respectively. Subgrouping resulted in sensitivity and specificity of 50% and 100% for clinically assisted FNAC versus, 72% and 99% for ultrasound guidance. Surgically, 31.6% underwent complete superficial parotidectomy and 28.4% underwent extracapsular dissection. Overall, facial nerve palsy was the most prevalent postoperative complication, affecting 29.2% (70/240); loss of function was transient in 21.2% (51/240) and permanent in 7.9% (19/240). Extracapsular dissection and superficial parotidectomy with facial nerve preservation were the treatments of choice when a benign tumour was suspected. Facial nerve palsy was quite frequent; treatment options however are scarce. Preoperative diagnostic workup using imaging and ultrasound-guided FNAC was essential in identifying malignancy so that surgical planning could be adapted.
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Mennella S, Paparo F, Revelli M, Baccini P, Secondini L, Barbagallo S, Friedman D, Garlaschi A. Magnetic resonance imaging of breast cancer: does the time interval between biopsy and MRI influence MRI-pathology discordance in lesion sizing? Acta Radiol 2017; 58:800-808. [PMID: 27784760 DOI: 10.1177/0284185116674498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Breast magnetic resonance imaging (MRI) is more accurate than ultrasound and mammography in estimating local extension of both invasive breast cancer and ductal carcinoma in situ (DCIS) and it is part of a breast cancer patient's preoperative management. Purpose To verify if time interval between breast biopsy and preoperative MRI, lesion margins, and biopsy technique can influence tumor sizing on MRI. Material and Methods By a database search, we retrospectively identified all women with a newly diagnosed, biopsy-proven, primary breast cancer who underwent MRI before surgery. The time interval between biopsy and MRI, the type of biopsy procedure, and various pathological features of tumors were collected. We defined the concordance between MRI and pathology measurements as a difference of <5 mm in lesion sizing. Results One hundred and sixty-six women (mean age, 51.4 ± 10.4 years) were included. The time interval between biopsy and MRI showed only a weak correlation with the absolute MRI-pathology difference (r = 0.236). Stratifying the whole cohort of patients using a cutoff value of 30 days, we found that the MRI-pathology discordance was significantly higher in patients with a biopsy-MRI time interval >30 days ( P < 0.05). By means of multivariate analysis, we found that DCIS subtype and the presence of poorly defined margins on MRI are the only two factors independently and strongly associated with MRI-pathology discordance in lesion sizing. Conclusion Size, histology, and margins of tumors may affect the accuracy of MRI measurements. The type of biopsy procedure and the time interval between biopsy and preoperative MRI are not independently associated to MRI-pathology discordance.
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Affiliation(s)
| | - Francesco Paparo
- Radiology Unit, Department of Diagnostic Imaging, E.O. Ospedali Galliera, Genoa, Italy
| | - Matteo Revelli
- Radiology Unit, Diagnostic Imaging Department, “San Bartolomeo” Hospital, Sarzana, Italy
| | - Paola Baccini
- Pathology Unit, Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | | | | | - Daniele Friedman
- Breast Surgery, IRCCS “A.O.U. San Martino-IST” Genoa, Genoa, Italy
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Cantara S, Marzocchi C, Pilli T, Cardinale S, Forleo R, Castagna MG, Pacini F. Molecular Signature of Indeterminate Thyroid Lesions: Current Methods to Improve Fine Needle Aspiration Cytology (FNAC) Diagnosis. Int J Mol Sci 2017; 18:ijms18040775. [PMID: 28383480 PMCID: PMC5412359 DOI: 10.3390/ijms18040775] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 03/29/2017] [Accepted: 04/03/2017] [Indexed: 02/05/2023] Open
Abstract
Fine needle aspiration cytology (FNAC) represents the gold standard for determining the nature of thyroid nodules. It is a reliable method with good sensitivity and specificity. However, indeterminate lesions remain a diagnostic challenge and researchers have contributed molecular markers to search for in cytological material to refine FNAC diagnosis and avoid unnecessary surgeries. Nowadays, several "home-made" methods as well as commercial tests are available to investigate the molecular signature of an aspirate. Moreover, other markers (i.e., microRNA, and circulating tumor cells) have been proposed to discriminate benign from malignant thyroid lesions. Here, we review the literature and provide data from our laboratory on mutational analysis of FNAC material and circulating microRNA expression obtained in the last 6 years.
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Affiliation(s)
- Silvia Cantara
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy.
| | - Carlotta Marzocchi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy.
| | - Tania Pilli
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy.
| | - Sandro Cardinale
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy.
| | - Raffaella Forleo
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy.
| | - Maria Grazia Castagna
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy.
| | - Furio Pacini
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy.
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Abstract
Anaplastic large cell lymphoma (ALCL) is a T-cell lymphoma, accounting for <5% of non-Hodgkin's lymphoma. Cutaneous involvement can be primary or secondary arising in systemic ALCL. The diagnostic feature in both is the presence of pleomorphic, CD30 positive hallmark cells. We present a case of ALCL in a 19-year-old male presenting as an ulcerated scalp swelling. Clinical impression was actinomycosis or scrofuloderma. Cytology smears showed large dispersed pleomorphic cells with hyperlobated nuclei and multinucleated giant cells. The differentials considered were ALCL, rhabdomyosarcoma, and poorly differentiated carcinoma. Immunocytochemistry (ICC) showed positivity for leukocyte common antigen (LCA) and CD30 while negativity for desmin, favoring ALCL. Computed tomography (CT) showed a lytic paravertebral lesion. Subsequently, both paraspinal and scalp lesions were biopsied and immunochemistry confirmed the diagnosis of ALCL. Thus, cutaneous involvement in ALCL can resemble inflammatory and other neoplastic lesions clinically and cytologically. Hence, a high index of suspicion and ICC can aid in the correct diagnosis on fine needle aspiration cytology (FNAC).
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Affiliation(s)
- Mona A Agnihotri
- Department of Pathology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Kanchan S Kothari
- Department of Pathology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Leena P Naik
- Department of Pathology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Sharada Patil
- Department of Pathology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
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Abstract
Myofibromatosis (MFS) was recognized as a distinct form of childhood fibromatosis. Infantile myofibromatosis (IMF) is now identified as a solitary or multicentric tumor that predominantly occurs in neonates and infants. The adult counterpart of IMF, though of rare occurrence, is identified and is known as MFS. Morphological diagnosis of MFS is made by histopathological examination of the biopsy or surgically excised mass and confirmed on the basis of specific immunoprofile. We report a case of multicentric MFS occurring in an adolescent in whom diagnosis was suggested on the basis of fine needle aspiration cytology (FNAC) that avoided surgical excision of multiple nodules. The diagnosis was later confirmed on histopathological study and contributory immunohistochemical markers. Details of the clinical features and cytological diagnosis of the case are provided to diminish the paucity of available literature on FNAC diagnosis of the rare disease.
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Affiliation(s)
- Sandhya V Poflee
- Department of Pathology, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Anjali N Bode
- Department of Pathology, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Sneha Chavarkar
- Department of Pathology, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Pradeep S Umap
- Department of Pathology, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
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Arul P, Masilamani S, Akshatha C. Fine needle aspiration cytology of atypical (C3) and suspicious (C4) categories in the breast and its histopathologic correlation. J Cytol 2016; 33:76-9. [PMID: 27279682 PMCID: PMC4881409 DOI: 10.4103/0970-9371.182522] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 1996, National Cancer Institute (NCI) proposed five categories for the diagnosis of breast cytology in order to bring a degree of uniformity to the diagnostic reporting. Of these, categories 3 and 4 were sparsely studied. AIMS The present study was undertaken for the evaluation of the fine needle aspiration cytology (FNAC) categories of C3 and C4 in the breast lump and its histopathological correlation. MATERIALS AND METHODS In the retrospective study, a total number of 728 FNACs were categorized according to the NCI; of these, 28 cases of category C3 and 65 cases of category C4 were compared with histopathological diagnoses. RESULTS On histopathological examination of category C3, 18 (64.3%) cases showed benign lesions and 10 (35.7%) cases showed malignancy and among the C4 category, benign lesions found in nine (13.8%) and malignancy found in 56 (86.2%) cases. There was a significant statistical difference between the number of benign and malignant diagnoses for cytological categories of C3 (64.3%) and C4 (86.2%) (P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of C4 category in the diagnoses of malignancy were 84.8%, 66.7%, 86.2%, and 64.3%, respectively. CONCLUSION FNAC of the breasts is a simple, cost-effective, accurate, quick, and relatively less painful procedure, and it continues to play an integral part in the management of breast lesions. Our study concluded that there was a statistically significant difference between the number of benign and malignant diagnoses for categories of C3 and C4.
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Affiliation(s)
- P Arul
- Department of Pathology, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
| | - Suresh Masilamani
- Department of Pathology, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
| | - C Akshatha
- Department of Pathology, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
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12
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Krishnappa A, Shobha SN, Shankar SV, Aradhya S. Fine needle aspiration cytology of chondroblastoma: A report of two cases with brief review of pitfalls. J Cytol 2016; 33:40-2. [PMID: 27011442 PMCID: PMC4782403 DOI: 10.4103/0970-9371.175514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chondroblastoma is a rare, giant cell-rich, benign neoplasm of bone. Since the past few decades fine needle aspiration cytology (FNAC) has gained momentum in preoperative diagnosis of bone lesions. At cytology, other giant cell-rich tumors and tumorlike lesions such as aneurysmal bone cyst (ABC), giant cell tumor, and chondromyxoid fibroma fall under the differential diagnosis of chondroblastoma. Due to the difference in the treatment protocol and prognosis, preoperative diagnosis is mandatory. We describe the cytomorphology in two cases of chondroblastoma diagnosed at FNAC and confirmed by histopathology. At cytology, the presence of giant cells, chondroid matrix, mononuclear cells with nuclear indentation, and grooving along with glassy, vacuolated cytoplasm are characteristic of chondroblastoma. In addition to this, the presence of chicken wire calcification is a useful clue to the accurate diagnosis of chondroblastoma at FNAC.
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Affiliation(s)
- Amita Krishnappa
- Department of Pathology, Adichunchanagiri Institute of Medical Sciences, Bengaluru, Karnataka, India
| | - S N Shobha
- Department of Pathology, Adichunchanagiri Institute of Medical Sciences, Bengaluru, Karnataka, India
| | - S Vijay Shankar
- Department of Pathology, Adichunchanagiri Institute of Medical Sciences, Bengaluru, Karnataka, India
| | - Sushma Aradhya
- Department of Pathology, Adichunchanagiri Institute of Medical Sciences, Bengaluru, Karnataka, India
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Joshi P, Agarwal S, Singh G, Xess I, Bhowmik D. "A fine needle aspiration cytology in time saves nine" - cutaneous phaeohyphomycosis caused by Exophiala jeanselmei in a renal transplant patient: Diagnosis by fine needle aspiration cytology. J Cytol 2016; 33:55-7. [PMID: 27011447 PMCID: PMC4782408 DOI: 10.4103/0970-9371.175529] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Infections by dematiaceous fungi are an emerging group of infectious diseases worldwide with a variety of clinical presentations. Though generally localized, they can disseminate in immunocompromised settings, therefore, early diagnosis and prompt therapy can prevent significant morbidity and mortality in these patients. Fungi of genus Exophiala are common causative organisms; however, Exophiala jeanselmei (E. jeanselmei) has not yet been reported from environmental sources in India. We present here the case of a renal transplant recipient who presented with an innocuous lesion on the foot, diagnosed on fine needle aspiration cytology (FNAC) as phaeohyphomycosis, and promptly treated with excision and antifungal therapy. To the best of our knowledge, this is the first case report from India of E. jeanselmei causing phaeohyphomycosis in a transplant recipient and highlights the role a cytopathologist can play in the timely management of such cases.
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Affiliation(s)
- Prashant Joshi
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Geetika Singh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipankar Bhowmik
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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14
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Sherpa M, Lamichaney R, Roy AD. Kimura's disease: A diagnostic challenge experienced with cytology of postauricular swelling with histopathological relevance. J Cytol 2016; 33:232-235. [PMID: 28028342 PMCID: PMC5156990 DOI: 10.4103/0970-9371.190453] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Kimura's disease is a rare, chronic inflammatory disorder of unknown cause. It is endemic in Asia, affecting more number of males than females, with a ratio of 3:1. The typical clinical manifestations include a triad of painless unilateral cervical lymphadenopathy or subcutaneous masses predominantly in the head and neck region, blood and tissue eosinophilia, and an elevated serum immunoglobulin E (IgE) levels. Variable conditions both benign and malignant may mimic Kimura's disease both clinically and on fine needle aspirates. The confirmatory diagnosis is established only by histopathological examination. We report a case of Kimura's disease in a patient who underwent multiple investigations in view of her past history and family history of pulmonary Koch's. Fine needle aspiration cytology (FNAC) was performed thrice with consistently similar result of reactive lymphadenitis with numerous histiocytes and eosinophilia. The final diagnosis of Kimura's disease could finally be established only on histopathological examination.
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Affiliation(s)
- Mingma Sherpa
- Department of Pathology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
| | - Rachna Lamichaney
- Department of Pathology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
| | - Asitava Deb Roy
- Department of Pathology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
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15
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Jain MF, Khandekar SL, Mahadani JW, Raut WK. Report of a case of primary breast lymphoma highlighting the importance of fine needle aspiration cytology as an initial diagnostic tool. J Cytol 2015; 32:127-9. [PMID: 26229252 PMCID: PMC4520046 DOI: 10.4103/0970-9371.160570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Primary non-Hodgkin lymphoma of breast is a rare pathology, representing 0.5% of malignant breast tumors. We report a case of 52 year old female presenting with a large painful mass in left breast with ipsilateral axillary lymph node diagnosed on fine needle aspiration cytology as non-Hodgkin's lymphoma. Breast lymphoma should be differentiated from other breast malignancies because of the differences in their treatment modalities. When breast lymphoma presents as a lump with axillary node, it clinically mimics breast carcinoma. Ultrasonogram and mammogram shows no characteristic features that can distinguish it from other breast malignancy. In such cases, FNAC becomes an important diagnostic tool that can differentiate PBL from other breast malignancy and avoid unnecessary surgery.
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Affiliation(s)
- Millu F Jain
- Department of Pathology, Shri Vasantrao Naik Government Medical College and Hospital, Yavatmal, Maharashtra, India
| | - Sanjay L Khandekar
- Department of Pathology, Shri Vasantrao Naik Government Medical College and Hospital, Yavatmal, Maharashtra, India
| | - Jayawant W Mahadani
- Department of Pathology, Shri Vasantrao Naik Government Medical College and Hospital, Yavatmal, Maharashtra, India
| | - Waman K Raut
- Department of Pathology, Shri Vasantrao Naik Government Medical College and Hospital, Yavatmal, Maharashtra, India
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16
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Tamgadge S, Avinash T, Bhalerao S, Rajhans S. Juvenile psammomatoid ossifying fibroma with aneurysmal bone cyst in the posterior mandible. Ecancermedicalscience 2014; 8:471. [PMID: 25374619 PMCID: PMC4203472 DOI: 10.3332/ecancer.2014.471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Indexed: 12/22/2022] Open
Abstract
Aneurysmal bone cysts (ABCs) are a rare benign lesion seen as locally destructive, rapidly expansile, and mostly affecting the long bones and vertebrae. The association of ABCs with juvenile psammomatoid ossifying fibroma (PsJOF) is predominantly seen in the extragnathic region, and it is extremely rare with only a few cases reported so far in the mandible. Here, we report one such case of a hybrid lesion in a seven-year-old boy, who presented with a solitary swelling of the left mandible showing partial obliteration of buccal vestibular sulcus, which shows juvenile psammomatoid ossifying fibroma as a pre-exsiting lesion, transforming into an ABC. Such hybrid lesions are usually misdiagnosed and have been sparsely reported in the dental literature.
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Affiliation(s)
- Sandhya Tamgadge
- Prof & PG Guide Dept of Oral & Maxillofacial Pathology and Microbiology Padmashree, Dr D Y Patil Dental College & Hospital, Sector 7, Nerul, Navi Mumbai, Maharashtra 400706, India
| | - Tamgadge Avinash
- Prof & HOD Dept of Oral & Maxillofacial Pathology and Microbiology Padmashree, Dr D Y Patil Dental College & Hospital, Sector 7, Nerul, Navi Mumbai, Maharashtra 400706, India
| | - Sudhir Bhalerao
- Prof & PG Guide Dept of Oral & Maxillofacial Pathology and Microbiology Padmashree, Dr D Y Patil Dental College & Hospital, Sector 7, Nerul, Navi Mumbai, Maharashtra 400706, India
| | - Sonali Rajhans
- PG Student Department of Oral & Maxillofacial Pathology and Microbiology Padmashree, Dr D Y Patil Dental College & Hospital, Sector 7, Nerul, Navi Mumbai, Maharashtra 400706, India
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17
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Bhat V, Shariff S, Reddy RAN. Extramedullary plasmacytoma of thyroid - a mimicker of medullary carcinoma at fine needle aspiration cytology: A case report. J Cytol 2014; 31:53-6. [PMID: 25190987 PMCID: PMC4150345 DOI: 10.4103/0970-9371.130710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A rare case of extra medullary plasmacytoma (EMP) of thyroid gland in a 60 year old male, occurring against a background of Hashimoto's thyroiditis is reported. The fine needle aspiration cytology (FNAC) initially done as an outpatient procedure, showed atypical epithelial cells on a background of amyloid. Considering these findings we gave a diagnosis of medullary carcinoma. Histology of the total thyroidectomy specimen showed an extensive infiltration of neoplastic plasma cells against a background of Hashimoto's thyroiditis, with a bizarre Hurthle cell change. Immunohistochemistry on the histology sections confirmed the diagnosis of solitary plasmacytoma of thyroid against a background of Hashimoto's thyroiditis.
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Affiliation(s)
- Vidya Bhat
- Department of Pathology, MVJ Medical College and Research Hospital, Bangalore, Karnataka, India
| | - Shameem Shariff
- Department of Pathology, MVJ Medical College and Research Hospital, Bangalore, Karnataka, India
| | - Roopa A Narayana Reddy
- Department of Pathology, MVJ Medical College and Research Hospital, Bangalore, Karnataka, India
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18
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Singh A, Butuc R, Lopez R. Metastatic papillary thyroid carcinoma with absence of tumor focus in thyroid gland. Am J Case Rep 2013; 14:73-5. [PMID: 23569568 PMCID: PMC3619041 DOI: 10.12659/ajcr.883834] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 02/08/2013] [Indexed: 11/21/2022]
Abstract
Background: Papillary thyroid carcinoma presenting as isolated cervical lymphadenopathy with clinically and histologically normal thyroid gland is rarely reported. Case Report: We report a case of 31 years old female who presented with a left cervical mass and clinically normal thyroid gland. After inconclusive FANC, excision biopsy of her cervical lymph nodes revealed metastatic papillary thyroid carcinoma. The patient subsequently underwent total thyroidectomy with bilateral lymph node dissection. Interestingly pathological examination showed no primary carcinoma in the gland. Postoperative radioactive iodine scan revealed no other metastasis. Conclusions: Total thyroidectomy is the next best step despite clinically and radiologically normal appearing thyroid gland once cervical lymph nodes are proven to be metastatic in nature followed by a RAI therapy to treat occult foci of PTC.
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Affiliation(s)
- Anil Singh
- Department of Medicine, Queens Hospital Center, Jamaica, NY, U.S.A
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19
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Gangopadhyay M, De A, Chakrabarti I, Ray S, Giri A, Das R. Idiopathic granulomatous mastitis-utility of fine needle aspiration cytology (FNAC) in preventing unnecessary surgery. J Turk Ger Gynecol Assoc 2010; 11:127-30. [PMID: 24591917 DOI: 10.5152/jtgga.2010.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 08/12/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Granulomatous mastitis is a benign disorder which closely mimics malignancy clinico-radiologically. A simple and cost effective modality like fine needle aspiration cytology (FNAC) can help in prompt diagnosis and avoid unnecessary surgery. MATERIAL AND METHODS A retrospective study where data were collected for granulomatous lesions of the breast diagnosed by histopathology in a five year period and review of FNAC slides. Cases positive for Mycobacterium tuberculosis either on ZN stain or Polymerase chain reaction (PCR) and fungus were excluded. A total of 8 cases were included in our study for analysis. RESULTS All the cases showed the presence of granuloma composed of epithelioid histiocytes against a background of giant cells, polymorphs with absence of necrosis. CONCLUSION Cytological diagnosis of granulomatous mastitis is difficult as it overlaps with other etiologies like tuberculosis which is prevalent in this part of the world. However, with the use of ancillary techniques like PCR and negative microbiological investigations, a definitive diagnosis can be made.
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Affiliation(s)
- Mimi Gangopadhyay
- Department of Pathology, North Bengal Medical College & Hospital, Sushrutanagar, Darjeeling, India
| | - Anuradha De
- Department of Pathology, North Bengal Medical College & Hospital, Sushrutanagar, Darjeeling, India
| | - Indranil Chakrabarti
- Department of Pathology, North Bengal Medical College & Hospital, Sushrutanagar, Darjeeling, India
| | - Sailesh Ray
- Department of Gyneclogy & Obstetrics, North Bengal Medical College & Hospital, Sushrutanagar, Darjeeling, India
| | - Amita Giri
- Department of Pathology, North Bengal Medical College & Hospital, Sushrutanagar, Darjeeling, India
| | - Rinki Das
- Department of Surgery, North Bengal Medical College & Hospital, Sushrutanagar, Darjeeling, India
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Abstract
Somatostatinomas are rare pancreatic endocrine neoplasms (PEN). We present a case of a PEN in a 63-year-old lady having diabetes mellitus, cholelithiasis, steatorrhea, weight loss, indigestion, nausea and fatigue. Ultrasonography revealed a large calcified mass occupying the liver, pancreas and emboli in the splenic vein. Fine needle aspiration cytology (FNAC) of the metastatic mass in the liver showed features of neuroendocrine tumor. Correlating the clinical picture, computed tomography and cytological findings, a diagnosis of pancreatic somatostatinoma was suggested. Serum somatostatin levels and biopsy findings confirmed the same. The patient was put on chemotherapeutic agents and octreotide and is doing well after two years of follow-up. We discuss the FNAC findings of pancreatic endocrine tumors and its differentiating features from hepatoma and other small round cell tumors.
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Affiliation(s)
- Us Dinesh
- Department of Pathology, SDMCMSH, Dharwad, Karnataka, India
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21
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Abstract
BACKGROUND Reporting templates are increasingly common in all fields of pathology. In this paper, we present an assessment of the impact of a thyroid fine needle aspiration cytology (FNAC) template on diagnostic classification and cytohistologic concordance. MATERIALS AND METHODS A thyroid FNAC reporting template was developed and introduced at a university teaching hospital. We examined FNAC reports for a five-month period before introduction of the template and compared these to the five month period after the template introduction. We recorded diagnostic categorization as well as cytohistologic correlation. RESULTS A total of 168 cases were identified in the five month period prior to the introduction of the reporting template and 172 cases in the five month period after the introduction of the reporting template. The template appeared to improve the diagnostic precision of benign conditions without altering the proportion of cases classified as unsatisfactory, benign or abnormal. There was no significant difference in the rate of cytohistologic concordance before and after the template introduction. CONCLUSIONS The introduction of a reporting template for thyroid FNAC improved diagnostic precision of benign conditions and did not alter the general diagnostic classification or cytohistologic concordance.
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Affiliation(s)
- Laurette Geldenhuys
- Dalhousie University and Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, 5788 University Avenue, Halifax, Nova Scotia, Canada B3H 1V8, Canada
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