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Background: Most modern haematology analysers have a dedicated body fluid mode for cell counts of body fluids. Many analysers also count the number of high fluorescence cells (HF cells). HF cells have a large nuclear size and emit high fluorescence when stained with fluorescent dyes. Due to their large nuclear size, Malignant cells are counted as HF cells. Aims and Objectives: We aim to determine the diagnostic utility of HF cells in predicting the presence of malignant cells in serous effusions. Materials and Methods: HF cell counts were done on 209 serous fluid samples using the body fluid mode of Mindray BC-6800 plus haematology analyser. Papanicilaou-stained smears of all samples were examined for the presence of malignant cells by a panel of cytopathologists. ROC curve analysis was done to determine the sensitivity and specificity of HF cells in malignant effusions. Results: Out of 209 samples, malignant cells were found by microscopy in 97 cases (46.4%). The absolute number and percentage of HF cells were significantly higher (P < 0.001) in malignant effusions (HF# = 24.9 cells/ul, HF% = 10.4%) when compared to non-malignant samples (HF# = 4.95 cells/ul, HF% = 5.76%). ROC curve analysis determined an optimal cut-off of ≥30 HF cells/ul (sensitivity = 73.91, specificity = 55.66%) for the prediction of malignant cells. Conclusion: HF cells in serous effusions can be a helpful tool to aid the pathologist, but it is not an ideal screening test due to its low sensitivity (67.74%) and negative likelihood ratio (0.5) at a cut-off of ≥30 HF cells/ul. However, due to high specificity of 83.18% at a cut-off of ≥72 HF cells/ul, a meticulous search for malignant cells should be done on microscopy.
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Background: Chronic myeloid leukemia (CML) is relatively rare in pediatric and adolescent age groups. The purpose of this study was to evaluate the clinical, hematopathological, and biochemical parameters of CML in pediatric and adolescent age groups, along with an assessment of the treatment response with first-line tyrosine kinase inhibitors (TKI) and its correlation with the prognostic scoring systems of adults. Materials and Methods: A retrospective study of 44 Breakpoint Cluster Region-Abelson leukemia virus (BCR-ABL1)-positive pediatric and adolescent CML cases registered at our hospital was done. The clinical and laboratory parameters were evaluated using hospital software. The treatment response was monitored and scoring was performed using mathematical calculations. Results: The mean age was 11.6 (±4.7) years. The median hemoglobin was 8.4 g/dL and 63.6% of the cases showed white blood cell (WBC) counts >250,000/µL. The average follow-up was 21 months. A total of 97.7 and 78.1% cases achieved complete hematological response (CHR) and molecular response, respectively, during the treatment course. The maximum number of patients had low Sokal and European treatment and Outcomes Study (EUTOS) scores. Seventy-five per cent of the cases achieved CHR at 3 months, while 73.6 and 78.6% CML-Chronic phase (CP) cases with low Sokal and EUTOS scores achieved CHR at 3 months, respectively. Conclusion: This study revealed that the CML cases in pediatric and adolescent age groups are normally present with higher WBC counts at the time of diagnosis. The association of the prognostic scoring system with treatment response was statistically insignificant. However, a larger cohort study is needed to determine the treatment response of TKI in children and adolescent CML and its correlation with the prognostic scoring systems.
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Leucemia Mielógena Crónica BCR-ABL Positiva , Adulto , Humanos , Niño , Adolescente , Estudios de Seguimiento , Estudios Retrospectivos , Pronóstico , Leucemia Mielógena Crónica BCR-ABL Positiva/diagnóstico , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Leucemia Mielógena Crónica BCR-ABL Positiva/patología , Resultado del Tratamiento , India/epidemiologíaRESUMEN
Biren ParikhIntroduction Hormonal status and HER2 expression are valuable biomarkers and dictate the management of the patients diagnosed with invasive breast cancer (IBC). It is crucial to identify the patients who truly respond to anti-HER2 targeted therapy. Updated 2018 American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines has recommended certain modifications in HER2 interpretation by fluorescence in situ hybridization (FISH) with concomitant immunohistochemistry (IHC). Objectives We aimed to evaluate HER2 FISH interpretation in IBC with equivocal IHC results as per 2018 ASCO/CAP recommendations and compare FISH results with hormonal receptor status. Materials and Methods FISH results of 502 cases of IBC with equivocal IHC report between January 2016 to January 2022 were reviewed retrospectively. FISH results were categorized according to ASCO/CAP guidelines 2018 into five respective groups. Results FISH testing in IHC equivocal cases showed 219 (43.6%) cases were classic amplified (positive) belonged to group 1, 217(43.2%) cases were classic nonamplified (negative) fell into group 5, 39 (7.8%) and 02 (0.4%) patients were in group 2 (negative) and group 3 (positive), and 25 (5.0%) cases were in group 4 (negative). About 52.1 and 49.3% of cases with estrogen receptor and progesterone receptor positivity were reported as HER2 positive. Among 502 cases, 25 equivocal cases according to the 2013 guidelines were redefined as HER2 negative and 02 (0.4%) cases reported positive were classified negative as per updated 2018 guidelines. Conclusion Revised 2018 guidelines is helpful in accurate identification of HER2 status and in avoiding targeted therapy in unwarranted cases. Updated 2018 guidelines has removed equivocal HER2-FISH category that has eliminated management dilemma in these cases. Only long-term clinical follow-up will establish the validity of the updated guidelines.
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BACKGROUND: Plasma cell leukemia (PCL) is a rare aggressive variant of multiple myeloma (MM) characterized by a fulminant course and poor prognosis. Flow cytometry (FCM) is very useful in the diagnosis of the plasma cell leukemia. Herein, we present 10 cases of PCL. MATERIALS AND METHODS: We retrospectively studied immunophenotypic profile of 10 cases of PCL from Jan 2009 to Dec 2013 using 5 parameters, 6 color flow cytometric analysis. We also studied their clinical presentation and other laboratory findings. RESULTS: Common clinical features at presentation were weakness, bone pain, anemia, thrombocytopenia and osteolytic lesions. Plasma cell population were identified by strong expression of CD38 and co-expression of CD38 and CD138. CD56 was expressed in 20% cases. CD19 and CD117 were negative in all cases. CONCLUSIONS: Immunophenotyping is highly useful to differentiate PCL from other chronic lymphoproliferative disorders with plasmacytoid morphology as well as from non-neoplastic reactive plasma cells. Co-expression of CD38 and CD138 is a best combination to identify the plasma cells by using FCM.
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Biomarcadores de Tumor/análisis , Leucemia de Células Plasmáticas/diagnóstico , Citometría de Flujo , Estudios de Seguimiento , Humanos , Inmunofenotipificación , Leucemia de Células Plasmáticas/inmunología , Pronóstico , Estudios RetrospectivosRESUMEN
Testicular sarcomas constitute only 1-2% of all testicular tumors and are mostly associated with germ cell tumor. Primary intratesticular rhabdomyosarcoma is rare and only 14 cases have been reported in the literature till date. It should be differentiated from germ cell tumor with sarcomatous component, other intratesticular spindle-cell sarcomas and paratesticular rhabdomyosarcoma. Accurate diagnosis and early treatment is essential as it is an aggressive tumor with high metastatic potential and poor prognosis. Orchidectomy is the treatment of choice. Chemo-radiotherapy is recommended in case of recurrence and metastasis.
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BACKGROUND: Fine Needle Aspiration Cytology (FNAC) is a simple, minimally invasive, cost effective, outpatient based and a rapid diagnostic method for breast lesions. The aim of the present study was to correlate cytological findings with histopathological findings and to determine the accuracy of FNAC in the diagnosis of breast lesions. MATERIAL AND METHODS: A total of 222 breast aspirates were studied. Histo-cytopathological correlations were obtained in 91 cases. All the aspirates were stained with Haematoxylin and Eosin (H andE) stain. RESULTS: Among 222 patients, 217 were females and 5 were males. Benign breast lesions were found in 144 cases (64.87%); among which fibroadenoma (30.18%) was the commonest lesion which was observed. Malignancy was observed in 69 cases (31.08%); among them, ductal carcinoma was the predominant lesion (29.28%) which was seen. Histopathological confirmations were obtained in 90 cases out of 91 cases in which histo-cytopathological corrections were possible. All 45 malignant aspirates were confirmed by histopathology. Benign reports were confirmed in 45 out of 46 cases by doing histological examinations; except one case which was diagnosed as malignant by studying its histopathology. Sensitivity and specificity of FNAC in breast lesions were reported to be 97.82% and 100% respectively, with 100% positive predictive value and 97.85% negative predictive value. Diagnostic accuracy of FNAC in the present study was found to be 98.90%. CONCLUSION: It is important to remember that a negative FNAC of a breast lesion does not preclude the diagnosis of a carcinoma, particularly in presence of a clinical suspicion of malignancy and/or an abnormal mammogram.
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BACKGROUND: Mediastinal tumors are an uncommon abnormalities found in clinical practice. Anterior mediastinum is the common site and tissue diagnoses of anterior mediastinal masses (AMMs) are very important for correct therapeutic decision. OBJECTIVE: We evaluate the different malignant AMMs in various age groups and the sensitivity of fine needle aspiration cytology (FNAC) and core needle biopsy (CNB). Cytology smears are reviewed with particular emphasis on pitfalls in the cytological diagnosis. MATERIALS AND METHODS: This was a prospective study of 50 patients who were consulted for AMMs and underwent FNAC and CNB under guidance of ultrasound or computed tomography (CT) scan from 2006 to 2011. Cytology smears and histological sections were evaluated in all patients. RESULTS: Among 50 cases, 36 were male and 14 were female. Most AMMs (52%) were identified in the fifth and sixth decades of life. Metastatic carcinoma and nonHodgkin's lymphoma are the common AMMs. Adequate tissue material was obtained in 49 of 50 cases by CNB. Of these 49 patients, 35 (71.42%) cases were diagnosed correctly by FNAC, whereas 14 (28.57%) cases were not diagnosed definitely by FNAC. The sensitivity of CNB for AMMs was 97.95%, significantly higher than FNAC (71.42%) (P < 0.05). CNB had statistically significant higher diagnostic rate than FNAC in the noncarcinoma group (100% versus 62.96%) (P < 0.05). There is no significant difference of CNB and FNAC in carcinoma group (P > 0.05). Diagnostic rate of FNAC was higher for carcinomatous lesions (81.81%) than for noncarcinomatous lesions (62.96%). CONCLUSION: Ultrasound or CT scan-guided CNB in combination with FNAC are safe, minimally invasive, and cost-effective procedure, which can provide a precise diagnosis in the AMMs, and may obviate the need for invasive surgical approach. FNAC usually suffice for carcinomatous lesions but CNB should be performed whenever the diagnosis of carcinoma is equivocal or noncarcinoma lesions are suspected.
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Localized gingival enlargement is often associated with systemic medications, abscess formation, trauma, or reactive lesions. Very few reports are available reporting enlargement of gingiva due to metastasis of adenocarcinoma of the esophagus. A case of localized gingival growth affecting right maxillary and mandibular gingiva was reported in a 60-year-old male patient in which excisional biopsy of the lesion was done. Histopathological examination showed metastatic signet ring cell adenocarcinoma, which on further examination showed lower one-third of esophagus as the primary site of metastasis.
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Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/diagnóstico , Condrogénesis , Hamartoma/complicaciones , Hamartoma/diagnóstico , Metaplasia/patología , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Desmina/análisis , Femenino , Hamartoma/patología , Hamartoma/cirugía , Histocitoquímica , Humanos , Inmunohistoquímica , Mamografía , Microscopía , Persona de Mediana Edad , Receptores de Estrógenos/análisis , Receptores de Progesterona/análisisRESUMEN
Cutaneous and subcutaneous metastases from internal malignancies are rare and indicate a dismal outcome for the patient. This study is designed to analyze cases of cutaneous and subcutaneous metastases from a known or unknown primary and evaluate usefulness of fine needle aspiration cytology as a diagnostic modality. The present study is a retrospective analysis of 83 patients who were diagnosed with metastatic skin deposits on fine needle aspiration cytology. Seventy-four patients were previously diagnosed cases of malignancy and nine patients had metastatic deposits simultaneously with the primary tumor. The commonest malignancies showing cutaneous metastases were from breast, colon and rectum, lung, ovary, and thyroid. The differential diagnoses are from primary cutaneous tumors. FNAC provides a rapid diagnosis and should be used as a preferred first line diagnostic modality in such patients. In our study, FNAC yielded a sensitivity and specificity of 100% as a microscopic method for confirmation.
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Adenocarcinoma/secundario , Carcinoma de Células Escamosas/secundario , Neoplasias Cutáneas/secundario , Adenocarcinoma/diagnóstico , Adenocarcinoma/patología , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/patología , Adenocarcinoma Mucinoso/secundario , Adolescente , Adulto , Anciano , Biopsia con Aguja Fina , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patología , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , Adulto JovenRESUMEN
Granulosa cell tumor (GCT) with synchronous mature teratoma is extremely rare and only eight cases are documented in the literature. GCT is low-grade malignancy and need a close follow up for recurrences which may be late. We report a case of GCT and mature teratoma occurring synchronously in the same ovary in a perimenopausal woman.
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Tumor de Células de la Granulosa/complicaciones , Tumor de Células de la Granulosa/diagnóstico , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/patología , Teratoma/complicaciones , Teratoma/diagnóstico , Femenino , Tumor de Células de la Granulosa/patología , Histocitoquímica/métodos , Humanos , Inmunohistoquímica/métodos , Inhibinas/análisis , Persona de Mediana Edad , Ovario/patología , Teratoma/patologíaRESUMEN
Teratoid Wilms' tumor with raised serum alpha-fetoprotein level is an unusual type of tumor. We, here, describe a twelve month old boy presenting with lumbar mass. Clinical features, radiological findings, gross examination, and histomorphological features are studied, and various differential diagnoses like Wilms' tumor with heterologous elements, intrarenal teratoma and metastatic germ cell tumor are taken into consideration.
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Neoplasias Renales/patología , Teratoma/patología , Tumor de Wilms/patología , Diagnóstico Diferencial , Humanos , Lactante , Neoplasias Renales/sangre , Neoplasias Renales/diagnóstico , Masculino , Proteínas/metabolismo , Teratoma/sangre , Teratoma/diagnóstico , Tumor de Wilms/sangre , Tumor de Wilms/diagnóstico , alfa-FetoproteínasRESUMEN
The aim of this study was to assess the usefulness and accuracy of cytologic smears by making crush preparation as a diagnostic method, in central nervous system tumors. 278 patients with central nervous system tumors were investigated. In 98 cases, material was obtained intraoperatively during craniotomy and in 180 cases stereotactic biopsies were done. In all the cases crush preparations were made, and cytologic diagnosis was correlated with final histologic diagnosis. 244 out of 278 patients showed correlation with histopathological diagnosis. So, in present study diagnostic accuracy was 87.76%. In 18 cases no definite diagnosis was made due to inadequate material. Majority of the patients were in age group 31 to 40 years (72 cases). The youngest patient was three years old and the eldest was 87 years old. The most common tumor in intracranial cavity was astrocytoma (56.68%), followed by meningioma (6.88%), medulloblastoma (5.66%) and ependymoma (5.56%). The most common tumor in intraspinal cavity was ependymoma (38.46%), followed by meningioma (23.07%) and schwannoma (23.07%). In conclusion, crush preparation is an effective, simple, rapid, relatively safe and reliable technique for the diagnosis of central nervous system tumors. Diagnostic accuracy of cytology with final histopathological report is established with accuracy rate of 87.76%.
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Astrocitoma , Neoplasias del Sistema Nervioso Central/diagnóstico , Citodiagnóstico , Ependimoma , Meduloblastoma , Meningioma , Neurilemoma , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Astrocitoma/diagnóstico , Astrocitoma/patología , Neoplasias del Sistema Nervioso Central/patología , Niño , Preescolar , Técnicas Citológicas/métodos , Ependimoma/diagnóstico , Ependimoma/patología , Femenino , Humanos , Masculino , Meduloblastoma/diagnóstico , Meduloblastoma/patología , Meningioma/diagnóstico , Meningioma/patología , Persona de Mediana Edad , Neurilemoma/diagnóstico , Neurilemoma/patología , Reproducibilidad de los ResultadosRESUMEN
A case of primary chondrosarcoma of the left lung in 50 year-old man is presented. The tumor was diagnosed as primary chondrosarcoma of the lung after exclusion of any primary lesion elsewhere. Histologically, tumor consisted of predominantly chondromatous lesion. Immunohistochemistry showed that tumor cells positive for S-100 protein and vimentin, and negative for epithelial markers. On the basis of clinical, histological and immunohistochemical studies, the tumor was diagnosed as a primary chondrosarcoma of the lung.
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Condrosarcoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Biomarcadores de Tumor/metabolismo , Condrosarcoma/patología , Femenino , Humanos , Inmunohistoquímica , Pulmón/patología , Neoplasias Pulmonares/patología , Masculino , Proteínas S100/metabolismo , Vimentina/metabolismoRESUMEN
The authors describe a case of primary mucinous carcinoma of urachus in 65 years old male. Patient presented with hematuria with suprapubic mass. The patient underwent total cystectomy with en bloc excision of the tumor mass and umbilicus. Histological examination showed features of mucinous carcinoma of urachus. A clinicopathological study and brief review of literature is presented.
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Adenocarcinoma Mucinoso/patología , Uraco , Neoplasias de la Vejiga Urinaria/patología , Vejiga Urinaria/patología , Adenocarcinoma Mucinoso/cirugía , Anciano , Cistectomía , Humanos , Masculino , Tomografía Computarizada por Rayos X , Neoplasias de la Vejiga Urinaria/cirugíaRESUMEN
Adult granulosa cell tumor (GCT) of the ovary is the most common malignancy amongst the sex cord stromal tumors. Clinical stage, age, tumor size, residual disease and several histologic factors have been reported to be of prognostic significance. There were 839 ovarian malignancies at our institute during the period from 1998 to 2002. Out of 54 granulosa cell tumors, 40 cases were evaluable which includes 37 cases of adult GCT and 3 cases of juvenile GCT. They were studied retrospectively. Majority of patients presented with abdominal symptoms and FIGO stage I. All patients were treated surgically and 62.1% of adult GCTs were given post-operative chemotherapy. Clinical stage, presence of residual disease and tumor volume were the most important prognostic factors. Age of patient, menstrual status, post-operative chemotherapy, mitosis or histological patterns were of little significance in our study.
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Tumor de Células de la Granulosa/patología , Neoplasias Ováricas/patología , Adulto , Anciano , Femenino , Tumor de Células de la Granulosa/mortalidad , Tumor de Células de la Granulosa/terapia , Humanos , India/epidemiología , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/terapia , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
Hepatoblastoma (HBL) is the most common primary malignant hepatic tumor in children. The aim of the present study is to describe cytological findings of HBL, to subclassify it, and to discuss differential diagnoses. Twenty cases were taken from records of Cytopathology department, Gujarat Cancer and Research Institute, Ahmedabad. The aspiration smears were stained with Papanicolaou stain andlor Giemsa stain. Cytological and architectural criteria were applied to aspiration smears. Fifteen cases (75%) of HBL were diagnosed in the patients below the age of two years. The commonest presentation was found to be lump in abdomen. On the basis of cytoarchitectural features, HBL was classified in two groups undifferentiated and differentiated. Morphologically, the tumor cells were commonly arranged in acinar pattern, papillary pattern, or in sheets. FNA cytology alone had some limitations in the diagnosis of HBL. Hence, cytoarchitecture in combination with clinicalfeatures, imaging techniques and serum a-fetoprotein levels were helpful for specific diagnosis of HBL and to rule out various others differential diagnosis of small round cell tumor. The cytological differential diagnosis between differentiated HBL and Hepatocellular carcinoma (HCC) was found to be very difficult.