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Introduction  Fine-needle aspiration cytology (FNAC) has become widely used as a first-line diagnostic tool in the evaluation of cervical lymphadenopathies (LADs). However, there are conflicting reports regarding its accuracy in differentiating between malignant and benign pathologies. In this study, we aim to determine the reliability of FNAC in distinguishing between benign and malignant pathologies causing cervical LAD. Methods This is a cross-sectional study reviewing the electronic medical records of all patients who underwent both FNAC and excisional biopsy of cervical LADs between January 2016 and December 2023 at a tertiary care center in the Kingdom of Bahrain. A comparison was conducted between the cytopathological results obtained by FNAC and the histopathological results obtained by excisional biopsy to determine the diagnostic accuracy of FNAC. Results In the study period, 83 patient records were reviewed and included in the data analysis. Fine-needle aspiration cytology yielded a sensitivity of 89.3%, a specificity of 55.6%, a positive predictive value (PPV) of 72.4%, a negative predictive value (NPV) of 80.0%, and an overall accuracy of 74.7% in diagnosing cervical LADs. Conclusion Despite FNAC being accessible, convenient, and cost-effective, it has certain limitations that can restrict its accuracy in diagnosing lymphomas. We recommend further studies to research these limitations and the possible tools, such as ancillary testing, that may be useful in overcoming them.

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BACKGROUND: Thyroid nodules are a common clinical challenge, with a significant proportion being cancerous. Fine-needle aspiration cytology (FNAC) is widely used for diagnosis but has limitations. Ultrasound has emerged as a promising tool for distinguishing between benign and malignant nodules. This study aims to compare the diagnostic accuracy of ultrasonography (USG) and FNAC in diagnosing malignant thyroid swelling using postoperative histopathological examinations as the gold standard. METHOD: A diagnostic accuracy study was conducted over 1.5 years at Rajendra Institute of Medical Sciences, Ranchi, India. A total of 132 patients with thyroid swellings were included. Patients underwent USG and FNAC, and 99 patients subsequently underwent surgery and histopathological examination. Statistical analysis was performed to evaluate the performance of USG and FNAC, including sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: The study encompassed 132 patients, predominantly 94 (71.21%) females. Most patients, i.e., 76 out of 132 (57.58%), were aged 30-50 years, with an average age of presentation at 41 years. Socioeconomic status revealed 120 (90.9%) belonging to Classes II and III. USG and FNAC exhibited sensitivities of 77.4% and 90.3%, specificities of 94.1% and 98.5%, and accuracies of 88.9% and 96.0%, respectively. FNAC demonstrated superior diagnostic performance metrics compared to USG, with higher PPV and NPV, indicating its stronger ability to correctly identify true-positive cases. Ultrasound features and FNAC findings showed significant associations with biopsy results, reaffirming their utility in diagnosing thyroid nodules. CONCLUSION: FNAC emerged as a highly accurate diagnostic tool for distinguishing between benign and malignant thyroid nodules, outperforming USG. Understanding demographic and clinical characteristics can aid in the timely diagnosis and management of thyroid disorders. Further research is warranted to enhance diagnostic algorithms and optimize patient care in resource-constrained settings.

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Introduction In females, carcinoma of the breast is a common malignancy. Disease management can be challenging for the treating clinician if the condition is presented in a locally advanced stage. Clinical presentation of a disease in a defined area provides a comprehensive map to target the at-risk population efficiently and select the appropriate intervention accordingly. In this retrospective study, we analyzed different factors that can affect breast carcinoma outcomes by assessing patients for a specific period of one year. Methods This is a retrospective study of carcinoma of breast patients and was conducted between 2017 and 2018. Results We reported a 25.83% incidence of breast cancer during the study period. A painful breast lump was present in 54.2% of patients, axillary nodes were present in 50% of patients, ulcers were present in 10% of patients, and nipple discharge was present in 8.5% of patients. According to the side and quadrant of involvement, the right side was the most common site of involvement in 55.7% of patients, and the upper outer quadrant was the most common quadrant involved in 61.4% of patients. The most familiar stage of the presentation was stage II, presented in 45.7% of patients. The most common histology was infiltrating ductal carcinoma, presented in 85.7% of patients. Conclusions This retrospective cohort study shows that carcinoma of the breast is a predominant malignancy among middle-aged females in developing countries such as India. This predominance is due to unawareness regarding disease symptoms and the fear of diagnosed malignancy during the investigation of symptoms. Early detection by screening and intervention at an early stage is the core of treatment success in this malignant disease. However, it is still challenging to apply screening as a tool to pick up early malignant disease in developing countries like India.

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Thyroid abscess is a rare occurrence and is characterized by an accumulation of pus within the thyroid gland. It most commonly forms as a sequela of acute suppurative thyroiditis, and it presents as a painful swelling of the anterior neck with fever. Patients may also develop referred ear pain and compressive symptoms such as difficulty breathing and swallowing as the abscess enlarges. On examination, the swelling is often associated with erythema, local rise of temperature, and tenderness. Laboratory investigations may reveal leukocytosis, elevated acute phase reactants, and an abnormal thyroid function test. Despite advancements in diagnostic modalities and treatment approaches, literature on thyroid abscesses remains limited. We present a unique case of a long-standing thyroid abscess resulting from chronic suppuration which did not exhibit any of the mentioned expected findings seen in other cases. This patient was euthyroid, and laboratory investigations showed no significant abnormality. It was successfully treated with total thyroidectomy and appropriate antibiotics.

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Objectives: This study aimed to investigate ultrasound (US) features of thyroid nodules categorized as nondiagnostic (ND) and atypia of undetermined significance (AUS) according to the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and their potential implications for clinical management. Materials and Methods: A retrospective study was conducted on patients who underwent thyroid nodules FNAC between 2019 and 2023. Nodules falling into the ND and AUS categories were analyzed for US features, nodule size, composition, echogenicity, shape, margin, echogenic foci, the distribution of the American College of Radiology's Thyroid Imaging Reporting and Data System (ACR TI-RADS) categories, and other parameters. The study included a total of 1,199 patients and 1,252 nodules (ND: 1110; AUS: 142). Results: No significant differences in age, gender, nodule features, echogenicity, shape, margin, echogenic foci, TI-RADS scores, localization, number of nodules, or thyroid parenchymal disease presence were found between the ND and AUS categories (p > 0.05). Also, no statistically significant difference in nodule size (<10 mm vs. ≥10 mm) existed between the ND and AUS categories (p = 0.475). Both showed predominantly solid composition and hyperechoic/isoechoic echogenicity. High proportions of TI-RADS 4 nodules were observed in both groups, with 727 (65.5%) in ND and 95 (66.9%) in AUS. Conclusion: This study found no statistically significant differences in US characteristics between the ND and AUS categories, indicating potential similarities in their radiological appearances. Also, no significant difference in nodule size (<10 mm and ≥10 mm) was observed between these categories. Clinical management should consider further investigations, including repeat FNAC, due to the diagnostic challenges and malignancy risk in both categories.

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Skeletal tuberculosis is a rare form of extrapulmonary tuberculosis. Due to non-specific clinical features, these cases are often diagnosed very late, ultimately affecting treatment outcomes. The present case is a very rare case of tuberculosis of the iliac bone and acetabulum with iliopsoas, obturator internus, and obturator externus abscesses in an Indian female. She reported pain in her right hip and a limp. It was a difficult diagnosis, especially due to the rare involvement of bones and muscles in the absence of any lesions in the lungs. Nevertheless, the diagnosis was achieved by a detailed radiometric and laboratory workup. She was initiated on antituberculous treatment per her weight for 12 months.

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Introduction Accurate cytological assessment is pivotal for managing thyroid lesions and various global reporting systems are in use, such as the globally acclaimed The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), alongside other reporting systems namely, the Japanese Reporting System for Thyroid Aspiration Cytology (JRSTAC), Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC), the UK Royal College of Pathologists System for Reporting Thyroid Cytopathology (UK RCPath), the Royal College of Pathologists of Australasia and Australian Society of Cytology Classification System (RCPA/ASC). Notably, variations exist among these systems which are influenced by country-specific statistics. Given the lack of large-scale data in India and the difference in prevalence of diagnostic entities compared to the western population, this study aimed to identify reporting systems suitable for the Indian population focusing on distinguishing neoplastic from non-neoplastic lesions. Materials and methods A cross-sectional analysis of 40 thyroid cytology cases with histopathological correlation was conducted. Pathologists independently assessed cytology slides using JRSTAC, ICCRTC, RCPA/ASC, UK RCPath and TBSRTC. Five performance indicators, sensitivity, specificity, positive predictive value (PPV) of neoplastic conditions, negative predictive value (NPV) of non-neoplastic conditions, diagnostic accuracy and two quality indicators, percentage of Atypia of undetermined significance (AUS) and AUS/Malignant ratio were analyzed and compared. Results Among 40 cases, 22 cases were neoplastic (16 papillary thyroid carcinoma, six follicular adenoma) and 18 non-neoplastic (14 multinodular goiter, four lymphocytic thyroiditis). Specific patterns emerged in cases labeled "Non-diagnostic", prompted questions about categorizing inadequately cellular cases as "benign" in light of the presence of specific findings. All reporting systems showed 100% specificity in detecting non-neoplastic and neoplastic conditions in Category 1 and Category 6 respectively. Performance and quality indicators varied among reporting systems with TBSRTC (PPV of neoplastic cases 85.71%, NPV of non-neoplastic cases 70.58%, specificity 85.7%, sensitivity 70.58%, diagnostic accuracy 60%, AUS percentage 22.5% and AUS/Malignant ratio 3%) and RCPA/ASC (PPV of neoplastic cases 76.47%, NPV of non-neoplastic cases 70.58%, specificity 75%, sensitivity 72.2%, diagnostic accuracy 62.5%, AUS percentage 15% and AUS/Malignant ratio 3%) showing better results. Conclusion Among the five thyroid cytology reporting systems studied, TBSRTC and RCPA/ASC showed better overall performance results and quality indicators were close to benchmark. Better performance by TBSRTC 2023 could be due to the detailed criterion mentioned per category with subcategorization of AUS and suspicious for malignancy by features of cytological and architectural atypia. Similarly, RCPA/ASC has subcategorized AUS with defined criteria and certain background features were included as an isolated criterion for the suspicious for malignancy category. These defined criteria outlined in TBSRTC and RCPA/ASC played a crucial role in minimizing and reclassifying cases from the indeterminate categories (AUS and suspicious for malignancy) into well-defined categories with established management protocols.

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BACKGROUND: The thyroid gland is responsible for various functions, but it is susceptible to pathologies. The gold standard for preliminarily diagnosing thyroid abnormalities is fine-needle aspiration cytology (FNAC), although it has some limitations; thus, postoperative histopathological examination confirms the diagnosis. The aim of the present study was to compare preoperative FNAC results with postoperative histopathological examination. METHODS: This study is a retrospective study based on FNAC and postoperative histopathology examination, which were compared and analyzed. RESULTS: This study included 344 patients between 18 and 86 years old (mean age: 53.06 ± 13.89), comprising 274 females and 70 males (mean ages 52.72 ± 13.86 and 54.39 ± 14.05, respectively) with a 3.9:1 female-to-male ratio. Statistical significance between the FNAC and histopathology results was observed (p = 0.0000), and 86 (25.00%) patients were found to have been diagnosed incorrectly based on FNAC. The sensitivity of FNAC was 92.31%, and its specificity was 82.08%, with positive and negative predictive values of 68.57% and 96.08%, respectively. CONCLUSIONS: Due to many factors, FNAC may lead to over- or under-diagnosis, increasing the chances of complications associated with the selected treatment. However, we do not have any other more accurate tools; therefore, FNAC should still remain as the gold standard of preliminary examination.

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Squamous cell carcinoma (SCC) in salivary glands is rare, often posing diagnostic challenges. This case report presents a 75-year-old male with progressively increasing swelling and pain in the right submandibular gland, eventually diagnosed as moderately differentiated SCC. The diagnostic journey involved fine needle aspiration cytology, imaging studies, and histopathological examination. The patient underwent surgical intervention, including submandibular gland excision and selective neck dissection, which successfully achieved local control. Subsequent postoperative follow-up indicated a favorable outcome, with no significant complaints. This report contributes insights into the multidisciplinary diagnostic approach and underscores the importance of imaging modalities in managing salivary gland SCC. This rare case emphasizes the need for ongoing research to refine management strategies for salivary gland SCC. By presenting a comprehensive diagnostic and therapeutic approach, this report contributes to the limited literature on this malignancy, emphasizing its rarity and the necessity for continued exploration of long-term outcomes. In conclusion, our case provides valuable insights into the medical knowledge surrounding SCC in salivary glands, warranting attention and further investigation.

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Amelanotic primary signet ring cell melanoma is a rare variant of cutaneous malignant melanoma. The diagnosis of amelanotic primary signet ring cell melanoma is rarely made based on cytological examinations. Most of the cases reported in the routine practice involve metastatic lesions of known cutaneous amelanotic primary signet ring cell melanoma. The diagnosis of amelanotic primary signet ring cell melanoma on fine needle aspiration cytology (FNAC) is scarce. We present one such extremely rare diagnosis of amelanotic primary signet ring cell melanoma at the unusual site of the axilla, which was established on FNAC. We also discuss its histological differential diagnosis and confirmative immunohistochemistry (IHC).

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Human cysticercosis can affect any tissue or organ in the body and may be asymptomatic or manifest clinical signs and symptoms depending on the area of the body where cysticerci are found. However, at the same time, the involvement of the breast by cysticercosis is an extremely rare phenomenon, with very few case reports published before. In this report, we present the case of a 26-year-old married woman who came with a history of painless swelling in the left breast.

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INTRODUCTION:  Salivary gland tumors are known to have a heterogeneous profile with variable clinical presentation and a wide variety of histological subgroups of prognostic significance. Immunocytochemical markers that aid in the diagnosis and characterization of the cell type of origin are critical for this heterogeneous group of malignancies. AIMS AND OBJECTIVES: To study the application of The 'Milan System' for Reporting Salivary Gland Cytology and the diagnostic utility of a panel of immunocytochemical markers in the diagnosis of salivary gland neoplasms and their cytohistological correlation for their risk stratification. MATERIALS AND METHODS: This was a prospective study carried out in which a total of 60 patients were enrolled in the study. Fine-needle aspiration cytology (FNAC) smears and cell blocks were prepared with standard techniques and staining procedures. Immunocytochemistry (ICC) was performed on cell block sections by immunoperoxidase procedure. Immunocytochemical (ICC) stains were used for the differentiation of the lesions in cell blocks. Histopathology was also studied if the patient underwent excision of salivary gland lesions. DISCUSSION AND RESULTS: Almost 60 cases were studied under FNAC and cell block evaluation, as well as ICC, among those five (8.33%) samples were inadequate, eight (13.3%) were non-neoplastic, 27 (45%) were benign, one (1.7%) was neoplasm with uncertain malignancy potential, one (1.7%) was suspected of malignancy, and 19 (31.7%) were malignant. The histopathological diagnosis was confirmed in 47 cases. Of these, 24 (51.1%) were benign and 23 (48.9%) were malignant. The malignancy rate for Milan Categories I, II, III, IVa, IVb, V, and VI was 0%, 0%, 100%, 24%, 50%, 80%, and 84.6%, respectively. The study showed that malignancy risk stratification could be further improved by using cell block with immunocytochemistry as a complementary diagnostic modality. CONCLUSIONS: The present study was carried out to assess the usefulness of the Milan system to report salivary gland cytology results. Thus, the findings of the present study show that the Milan system is helpful in stratifying the risk of malignancy in salivary gland tumors.

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Background: Renal transplantation is the treatment of choice in patients with end-stage renal disease. However, allograft recipients are at a higher risk of infection due to immunosuppressive therapies. This study aimed to analyze the utility of fine needle aspiration cytology (FNAC) lung in the etiological diagnosis of pulmonary infections in renal allograft recipients with respiratory failure. Materials and Methods: This is a retrospective study done in post-renal transplant patients presenting with pulmonary infections and respiratory failure in the past 7 years, in whom image-guided lung FNAC was done for diagnosis. Results: A total of 35 renal allograft recipients presenting with respiratory failure and having focal or diffuse pulmonary opacities (lesions) on radiological imaging were subjected to lung FNAC. The mean age of the patients was 41.1 ± 11.8 years (range 19-72), with the majority being males (n = 28, 80%); six (17.1%) of them were on invasive ventilation. The diagnostic yield of FNAC in our cohort was 77.1% (27 out of 35). Microorganisms were isolated in 21 cases (60%), with Nocardia being the most common (nine cases, 25.7%), Mycobacterial tuberculosis identified in six patients (17.1%), Aspergillus in three (8.6%), and one (2.9%) each had atypical Mycobacterium, zygomycetes, and Cryptococcus. FNAC suggested viral cytopathic effect in five patients, and cytomegalovirus (CMV) quantitative polymerase chain reaction test was found positive in four of these. One case was diagnosed as adenocarcinoma lung. Conclusion: Lung FNAC is a useful for establishing the etiological diagnosis of pulmonary lesions in renal transplant patients with respiratory failure.

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Germ cell tumors usually occur in the gonads. Extragonadal germ cell tumors (EGCTs) are uncommon, and the head and neck region is a rare primary location. In this region, endodermal sinus tumors are relatively uncommon; they are typically recorded alongside teratomas and infrequently by themselves. When an endodermal sinus tumor arises in the neck, it can present with unique clinical and radiographic features and can be challenging to diagnose and manage. We report the peculiar case of a 25-year-old young adult who was suffering from a painful left-sided neck swelling for a year. Fine needle aspiration cytology (FNAC) of neck mass was performed and the cytomorphological features were suggestive of germ cell tumor. After the diagnosis, the patient received chemotherapy and was posted for wide local excision of the tumor. On microscopic examination, the tumor mass showed histopathological features suggestive of an endodermal sinus tumor.

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Background Lymphadenopathy is a frequently encountered presentation in the clinical practice. Cervical lymphadenopathy implies that the cervical nodal tissue measures more than 1 cm in diameter. It requires prompt and accurate diagnosis to begin an appropriate treatment plan. Fine-needle aspiration cytology (FNAC) is considered an initial diagnostic method due to its simplicity, minimal invasiveness, quick availability of results, and low risk of complications. This study aimed to evaluate the diagnostic value of FNAC by comparing the cytological and histological diagnoses of patients with cervical lymph node enlargement at Aseer Central Hospital, Southern Region, Saudi Arabia. Methodology This observational, retrospective, record review study was conducted at the Otorhinolaryngology Head and Neck Surgery Department in Aseer Central Hospital, Abha, Saudi Arabia. Using a data collection sheet, the data of 102 patients were collected from electronic records and reviewed retrospectively. The study included patients who underwent cervical lymph node excision biopsy between 2020 and 2023 due to enlargement of the cervical lymph node. The cytological diagnoses were compared with the histopathological diagnoses of the same enlarged cervical lymph nodes. Results The most common FNAC findings were lymphomas and reactive lymph nodes (26.2% and 19.7%, respectively). The positive predictive value of FNAC was 100% and the negative predictive value was 86.7%. Overall, the diagnostic accuracy was 95.3%. Conclusions FNAC is a safe diagnostic method with minimal invasiveness and complications. This study showed that FNAC and tru-cut biopsy have good diagnostic value in examining patients with cervical lymphadenopathy regardless of their limitations and drawbacks. They have good sensitivity, specificity, positive and negative predictive values, and accuracy.

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In underdeveloped countries, Mycobacterium tuberculosis infection is common and typically manifests as pulmonary tuberculosis. Nevertheless, reports of tuberculous extrapulmonary involvement are also documented. Tuberculous breast abscess is a rare presentation, especially in immunocompetent hosts. Herein, a case of primary tuberculous breast abscess is presented. The patient came with complaints of pain in her right breast and a discharging sinus. A thorough diagnostic workup resulted in the establishment of a diagnosis with the detection of Mycobacterium tuberculosis on smear microscopy of pus, a cartridge-based nucleic acid amplification test, a line probe assay, and culture. Ultimately, she was put on anti-tubercular treatment.

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Accessory breast is an extremely rare condition that develops in 0.4%-6% of females. It is primarily found in the axilla and is frequently misdiagnosed. It is usually bilateral and manifests during pregnancy or lactation as an asymptomatic tumor. The diagnosis of ectopic breast tissue is crucial because it is capable of undergoing the same pathological changes as normal breast tissue, including mastitis, fibrocystic changes of the breast tissue, and, in extreme cases, even malignancy. We present the case of a 40-year-old female who presented with swelling in the left upper arm for the past eight years, which was associated with pain. Initially, accessory breast was kept as the clinical diagnosis. However, further imaging and histological analysis revealed it to be a giant lipoma of the upper arm.

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In this unique cytology case of a 64-year-old diabetic male who presented with left-sided facial swelling between the ala and lateral canthus of the left eye, conventional fine-needle aspiration cytology (FNAC) was done. FNAC of the swelling showed desquamated epithelial cells from the nasolacrimal duct and abundant proteinaceous material admixed with fungal organisms like that of budding yeast forms, morphologically resembling Candida on May-Grunwald-Giemsa stain. Special stain with periodic acid-Schiff revealed positivity for budding yeast forms. In this case report, we discuss the causes and clinical effects of nasolacrimal duct obstruction, cytological diagnostic features, and microscopic recognition of fungal organisms on routine staining as well as on special fungal stains.

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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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Tuberculosis is widespread in developing countries, which usually presents as pulmonary tuberculosis. However, cases of extrapulmonary tuberculosis at sites other than the lungs are also reported. The present case is a rare variety of extrapulmonary tuberculosis presenting as a primary tubercular breast abscess in an Indian female with no pulmonary involvement and no history of tuberculosis. A detailed clinical workup led to the final diagnosis, and she was put on anti-tuberculous treatment per the national guidelines.