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CytoJournal Quiz Case: CytoJounal quiz case: Fine-needle aspiration of peripancreatic mass clinically mimicking a lymphoma
Adela Cimic, Natasha Rekhtman
CytoJournal 2019, 16:11 (24 May 2019)
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Research Article: Cytologic smears improve accuracy of frozen sections of ovarian tumors in the community practice settings
Adela Cimic, Maria Mironova, Fady Khoury-Collado, Ziyan Salih
CytoJournal 2019, 16:10 (24 May 2019)
Background: The ovaries can be the site for various primary tumors and also the presenting site of metastatic disease. Quick and correct intraoperative diagnosis is crucial for the patient's further management. The aim of this study was to demonstrate the advantages of the combined diagnostic method – ovarian frozen sections in conjunction with cytologic smears. Methods: From June 2016 to June 2017, we prospectively prepared additional two cytologic smears with Diff-Quik stain on ovarian frozen sections comprised of two hematoxylin and eosin sections. For quality assurance purposes, we compared the results of frozen section discrepancies and deferrals with those that of the previous year from June 2015 to June 2016. Results: With the introduction of cytologic smears to ovarian frozen sections, the number of discrepancies and deferrals combined decreased from 13.75% to 7.85%. The most benefit of smears was observed in primary ovarian malignancies. Conclusions: In the setting where all the members of the pathology group render cytologic evaluations routinely, smears play an important complementary role.
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Case Report: Cerebrospinal fluid cytology of choroid plexus tumor: A report of two cases
Manjari Kishore, Prajwala Gupta, Minakshi Bhardwaj
CytoJournal 2019, 16:9 (22 April 2019)
DOI:10.4103/cytojournal.cytojournal_22_18  PMID:31080487
Choroid plexus tumors (CPTs) are relatively uncommon tumors of the central nervous system, constituting approximately 5% of all pediatric brain tumors. Although squash cytology of CPT has been described in literature, shedding of tumor cells into cerebrospinal fluid (CSF) has rarely been described. We report two such cases of atypical choroid plexus papilloma in a 5-month-old male child and a 12-year-old female child, where characteristic cytomorphology of CPT was noted in the CSF.
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Research Article: Subtyping of non-small cell lung cancer by cytology specimens: A proposal for resource-poor hospitals
Betul Celik, Tangul Bulut, Andras Khoor
CytoJournal 2019, 16:8 (22 April 2019)
DOI:10.4103/cytojournal.cytojournal_19_18  PMID:31080486
Aim: Cancer diagnosis and treatment depend on pathology reports but naming a cancer is sometimes impossible without specialized techniques. We aimed to evaluate the sensitivity of cytological sub-classification of non-small cell lung carcinoma, not otherwise specified group (NSCLC-NOS) into Adenocarcinoma (AC) and Squamous cell carcinoma (SqCC) without using immunohistochemistry. Methods: Endobronchial ultrasound guided fine-needle aspiration biopsies and cytology slides diagnosed as NSCLC-NOS between 2004- 2008 were reviewed retrospectively. The final diagnosis was reached by immunohistochemistry (TTF-1, p63) when necessary. Results: One hundred-twenty nine cases were retrieved. The final diagnoses were as follows: SqCC: 30.3%; AC: 65.7%; combined tumor (3 adenosquamous and 1 small cell + SqCC): 4%. Cytological diagnoses rendered were as follow: Definitely SqCC: 10.1%; favor SqCC: 14.1%; definitely AC: 38.4%; favor AC: 35.4%; NSCLC-NOS: 2%. The sensitivity and specificity of cytology were 86.3 and 87.5% for AC diagnosis respectively. Conclusion: Positive and negative predictive value of cytology was 95.3% and it was even 100% for well to moderately differentiated tumors. There was a tendency to sub-classify poorly differentiated SqCC as AC. Papanicolaou stain increased the diagnostic accuracy of SqCC. The combined tumor rate was 4% and after recognizing a tumor component, the second component was missed if the slide examination was terminated prematurely.
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CytoJournal Quiz Case: Anterior neck swelling in a child: Cytological consideration of an uncommon diagnosis
Sonia Raghav, Prajwala Gupta, Arvind Ahuja, Minakshi Bhardwaj
CytoJournal 2019, 16:7 (15 March 2019)
DOI:10.4103/cytojournal.cytojournal_17_18  PMID:31031817
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Methodology Article: Validation of immunohistochemical tests performed on cytology cell block material: Practical application of the College of American Pathologists' guidelines
Swati Satturwar, Renuka Malenie, Ann Sutton, Ding Dai, F Zahra Aly
CytoJournal 2019, 16:6 (15 March 2019)
DOI:10.4103/cytojournal.cytojournal_29_18  PMID:31031816
The advent of fiberoptic endoscopy with biopsy has revolutionized procurement of specimens from deep sites. This has translated into more cytologic specimens whereby the material is limited and best handled by cytology laboratory staff. While the diagnosis of the pathologic process is of utmost importance, there is increasing expectation that the diagnosis be specific and accurate as not to require additional biopsy for initiation of treatment. This expectation has driven demand in immunohistochemical (IHC) and molecular studies conducted specifically on material processed as cytology specimens. The Clinical Laboratory Improvement Amendments of 1988 requires laboratories in the United States of America to verify the performance of patient tests. Due to varying laboratory practices with respect to validation of IHC assays, the College of American Pathologists introduced guidelines for analytic validation of IHC tests. These guidelines address how to perform validation by recommending the number of cases in the validation set, comparator concordance, and when to revalidate. The main thrust of the guidelines is based on formalin-fixed paraffin-embedded tissue with only one expert consensus opinion referring to validation of IHC tests on cytology specimens which delegates to the medical director, the determination of number of positive and negative cases to be tested. This article will outline how an academic center approaches validation of IHC studies performed on cytology cell block specimens using the College of American Pathologists guidelines. A stepwise approach from selection of antibodies to validate followed by building the validation panel and evaluating the stain results for concordance against the gold standard of histology tissue specimen will be described. A rationale for dealing with discordant results and future innovations will conclude the report.
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CytoJournal Quiz Case: Fine-needle aspiration cytology of a thyroid nodule: Challenging morphologic considerations
C Eric Freitag, Lynn Schoenfield, Fadi A Nabhan, Richard T Naturale, Ming Jin
CytoJournal 2019, 16:5 (11 February 2019)
DOI:10.4103/cytojournal.cytojournal_8_18  PMID:30820235
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Review Article: A welcoming guide to social media for cytopathologists: Tips, tricks, and the best practices of social cytopathology
Fikret Dirilenoglu, Binnur Onal
CytoJournal 2019, 16:4 (11 February 2019)
DOI:10.4103/cytojournal.cytojournal_1_18  PMID:30820234
This guide provides an overview of social media (SoMe) use with the recent updates for the “cytopathologists and the ones interested in”. Our aim was to introduce the basic terms and rules, the potential benefits and risks, and some tips and tricks for using SoMe. The two most popular SoMe platforms, Facebook and Twitter, were the focus of this article. Thus far, many pathologists have already proved how efficiently the SoMe services could be utilized; the same applies specifically to the community of cytopathology. In our opinion, the more CPs are involved in SoMe, the more connected, productive, and stronger the community will become.
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CytoJournal Quiz Case: An unusual presentation of carcinoma in gallbladder
Rajesh Kumar, Nalini Gupta, Pranab Dey, Sreedhara B Chaluvashetty, Ujjwal Gorsi
CytoJournal 2019, 16:3 (22 January 2019)
DOI:10.4103/cytojournal.cytojournal_15_18  PMID:30820233
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Commentary: Is it time to standardize fine needle aspiration of gall bladder lesions and what city name it will be stamped with?
Mousa A Al-Abbadi
CytoJournal 2019, 16:2 (22 January 2019)
DOI:10.4103/cytojournal.cytojournal_21_18  PMID:30820232
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Research Article: Fine-needle aspiration cytology of gallbladder with an attempt of cytomorphological classification
Smita Chandra, Harish Chandra, Sushil Kumar Shukla, Shantanu Sahu
CytoJournal 2019, 16:1 (22 January 2019)
DOI:10.4103/cytojournal.cytojournal_5_18  PMID:30820231
Background: Image-guided fine-needle aspiration has emerged as an effective diagnostic tool for precise diagnosis of deep-seated lesions. Although occasional studies have made an attempt to classify the gallbladder carcinoma on cytology, literature lacks the standardized cytological nomenclature system used for it. The present study was conducted to study the role of fine-needle aspiration cytology (FNAC) in diagnosis of gallbladder lesions with an attempt of cytomorphological classification. Methods: The study included cases of image-guided FNAC of the gallbladder over a period of 3½ years. An attempt was made to categorize gallbladder lesions on basis of architectural and cytomorphological features along with analysis of management. Results: The study included 433 cases and lesions were categorized on FNAC into five categories ranging from Category 1 (inadequate), Category 2 (negative for malignancy), Category 3 (atypical cells), Category 4 (highly atypical cells suggestive of malignancy), and Category 5 (positive for malignancy). The most common architectural pattern observed on FNAC of neoplasm was sheets and acini with predominance of columnar cells and adenocarcinoma being the most common malignancy. The histopathological diagnosis was available in 93 cases with cytohistopathological concordance of 94.4% in malignant cases. Conclusions: Image-guided FNAC plays an important role in diagnosis of gallbladder lesions with minimal complications. The cytomorphological classification of gallbladder lesions provides an effective base for accurate diagnosis and management. Category 3 and 4 are the most ambiguous category on FNAC which should be managed by either repeat FNAC or surgery in the light of worrisome radiological features. The vigilant examination of architectural pattern and cytomorphological features of the smears may be helpful in clinching the diagnosis and precisely subtyping malignant tumors along with prognostication of these tumors.
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CytoJournal Quiz Case: Cytology of achylous hematuria: A clue to an underlying uncommon clinical scenario
Manjari Kishore, Vijay Kumar, Manju Kaushal, Apoorva Gomber
CytoJournal 2018, 15:30 (24 December 2018)
DOI:10.4103/cytojournal.cytojournal_11_18  PMID:30662516
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Research Article: Comparison of programmed death-ligand 1 (PD-L1) immunostain for nonsmall cell lung carcinoma between paired cytological and surgical specimens
Huihong Xu, Laura Bratton, Michael Nead, Donna Russell, Zhongren Zhou
CytoJournal 2018, 15:29 (24 December 2018)
DOI:10.4103/cytojournal.cytojournal_2_18  PMID:30662515
Background: programmed death-ligand 1 (PD-L1) is a ligand for the inhibitory programmed cell death protein 1 (PD-L1), which are targeted by several anti-PD-1 and PD-L1 drugs for lung cancer treatment. In clinical practice, many lung cancer cases only have cytology samples available to test PD-L1. Our current study compared the PD-L1 immunohistochemistry (IHC) between paired cytological and surgical samples. Materials and Methods: Formalin-fixed lung cancer tissue microarray and paired cell blocks and surgical specimens from the same patients with a confirmed diagnosis of lung squamous cell carcinoma (SCC, n = 29) and adenocarcinoma (AC, n = 23) were sectioned for PD-L1 IHC. Results: PD-L1 was expressed on tumor cells in 16 of 29 (55%) SCC surgical specimens and 18 of 29 (62%) paired cytologic specimens with 83% matched immunostains. PD-L1 was expressed on tumor cells in 13 of 23 (57%) AC surgical specimens and in 17 of 23 (74%) paired cytologic specimens with 79% matched immunostains. The PD-L1 was expressed on inflammatory cells in 20 of 23 (87%) AC surgical specimens and in 15 of 23 (65%) paired cytologic specimens with 70% matched immunostains. The PD-L1 was expressed on inflammatory cells in 18 of 29 (62%) SCC surgical specimens and in 12 of 29 (41%) paired cytologic specimens with 79% matched immunostains. Conclusions: PD-L1 immunostain in cytology samples matched very well with paired surgical samples in both SCC and AC cases. The cytologic samples present slightly higher sensitivity for PD-L1 immunostain on tumor cells as compared to surgical biopsies.
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Research Article: Cytology of the fallopian tube: A screening model for high-grade serous carcinoma
Maya Dhanani, Aziza Nassar, Mélissa S Charles, Tri Dinh
CytoJournal 2018, 15:28 (12 November 2018)
DOI:10.4103/cytojournal.cytojournal_58_17  PMID:30534183
Ovarian cancer is a heterogeneous disease having the highest gynecologic fatality in the United States with a 5-year survival rate of 46.5%. Poor overall prognosis is mostly attributed to inadequate screening tools, and the majority of diagnoses occur at late stages of the disease. Due to genetic and biological underpinnings, ovarian high-grade serous carcinomas (HGSC) have etiologic evidence in the distal fallopian tube. Fallopian tube screening modalities are aggressively investigated, but few describe cytological characteristics of benign tubal specimens to help in the comparative detection of HGSC precursor cells. Here, we describe fimbrial cytomorphological and nuclear features of tubal specimens (n = 75) from patients clinically indicated for salpingectomy, bilateral or unilateral salpingo-oophorectomy, and hysterectomies for any diagnosis other than ovarian or peritoneal cancer. Fallopian tube histology was used as the diagnostic reference. A total of 75 samples had benign diagnoses. The benign cytological characteristics of fimbrial tubal specimens included ciliated cells in clustered arrangements with mild nuclear membrane irregularity, mild anisonucleosis, round and/or oval nuclei, hyperchromatic chromatin, and mild nuclear membrane irregularity. In contrast, none of the cytology samples had spindle-shaped nuclei, significantly marked anisonucleosis (n = 1), nor had hypochromasia as a characteristic feature. These cytological characteristics could be a potential area of distinction from HGSC precursor cells. Our study establishes cytomorphological characteristics of nonmalignant tubal cells which help underscore the importance of distinguishing malignant HGSC precursors through fimbrial brush sampling in minimally invasive approach.
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Research Article: Increased mast cells in endocervical smears of women with dysmenorrhea
Shunichiro Tsuji, Kiyoshi Tsuji, Hirokuni Otsuka, Takashi Murakami
CytoJournal 2018, 15:27 (12 November 2018)
DOI:10.4103/cytojournal.cytojournal_54_17  PMID:30534182
Background: Mast cells are observed in peritoneal endometriosis which causes dysmenorrhea. However, there is no report about the relationship between endocervical mast cells and dysmenorrhea. The aim of this study is to evaluate the relationship using endocervical smears. Materials and Methods: Between January 2016 and June 2016, patients filled out a questionnaire regarding dysmenorrhea and were classified into the dysmenorrhea or the control group (without dysmenorrhea). Patients underwent endocervical brushing and endocervical smears were obtained. The smears were stained with methylene blue to detect mast cells. The number of mast cells per slide was counted by microscopy and recorded. Results: Eighty-nine patients were enrolled in this study (dysmenorrhea group, 34; control group, 55). The median number of mast cells present in the endocervical one slides was 35 (interquartile range, 17–58) and 2 (interquartile range, 0–6) in the dysmenorrhea and control groups, respectively. There was a significant difference in the number of mast cells between the two groups (P < 0.0001). Conclusion: More mast cells were observed in the endocervical smears of women with dysmenorrhea than in those of women without dysmenorrhea.
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CytoJournal Quiz Case: Cytologic examination of ascitic fluid in a patient with pleural-based mass: A unique presentation of a rare tumor
Priyadarshini Dehuri, Debasis Gochhait, Vidhyalakshmi Rangarajan, Prasath Sathiah, Neelaiah Siddaraju, Ramkumar Govindarajalou
CytoJournal 2018, 15:26 (15 October 2018)
DOI:10.4103/cytojournal.cytojournal_7_18  PMID:30410563
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Letter to the Editor: Endometrial carcinoma with pleural fluid metastasis: A rare phenomenon
Manjari Kishore, Manju Kaushal, Arvind Ahuja
CytoJournal 2018, 15:25 (15 October 2018)
DOI:10.4103/cytojournal.cytojournal_28_18  PMID:30410562
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Research Article: Correlation study of thyroid nodule cytopathology and histopathology at two institutions in Jordan
Niveen Abdullah, Manar Hajeer, Loay Abudalu, Maher Sughayer
CytoJournal 2018, 15:24 (15 October 2018)
DOI:10.4103/cytojournal.cytojournal_53_17  PMID:30410561
Background: Fine-needle aspiration (FNA) plays a fundamental role in determining the appropriate management for patients presenting with thyroid nodules. Aims: The aims of this study are to evaluate thyroid FNA test performance parameters through a cytohistological correlation. Materials and Methods: A retrospective analysis of all thyroid FNAs received over a period of 18 months was carried out. The findings were compared to their subsequent definite diagnoses on surgical specimens as well as to their follow-up repeat FNA results. A total of 499 thyroid FNAs were collected and reviewed against The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The percentage of each diagnostic category was calculated, and the implied risk of malignancy was determined by comparing the cytology results to their definite diagnoses obtained on the resection specimens. Analytical procedures were performed using Microsoft Excel. Results: Out of 499 thyroid FNAs, a benign interpretation was found in 273 patients (54.7%), atypia of undetermined significance in 81 (16.2%), follicular neoplasm in 20 (4%), suspicious for malignancy in 36 (7.2%), malignant in 32 (6.4%) and were nondiagnostic in 57 patients (11.4%). Only 101 patients (20.2%) underwent surgical resection and 47 (9.4%) underwent a follow-up FNA. After cytohistological correlation, FNA test performance, calculated by excluding the inadequate and undetermined categories revealed test sensitivity, specificity, and diagnostic accuracy of 95.6%, 54.8%, and 78.9%, respectively. The positive predictive value was 75.4%, and the negative predictive value was 89.5%. Conclusions: Our results are comparable to those previously published figures. The rate of atypia of undetermined significance/follicular lesion of undetermined significance is higher than what is currently recommended in TBSRTC.
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Case Report: Not all neck mass fine-needle aspirations with squamous cells are squamous cell carcinoma; report of a case of recurrent thyroid carcinoma with papillary and squamous components
Katie Dennis, Maura O'Neil, Anthony Harrington
CytoJournal 2018, 15:23 (21 September 2018)
DOI:10.4103/cytojournal.cytojournal_19_17  PMID:30294355
We report a case of a 65-year-old female who had a total thyroidectomy 12 years ago for papillary thyroid carcinoma (PTC) who presented with a recurrent thyroid bed mass. Fine-needle aspiration biopsy yielded malignant cells, consistent with squamous cell carcinoma (SCCa). Surgical resection was performed, and histologic evaluation of the mass showed mixed PTC and SCCa. The tumor cells were positive for BRAF V600E mutation. Thyroid carcinomas with admixed papillary carcinoma and SCCa are rare and are associated with aggressive behavior, high rates of metastasis, and poor outcomes. Although SCCa presenting as a neck mass is relatively common, clinical history and appropriate workup are essential for accurate diagnosis and determination of origin.
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Research Article: The papanicolaou society of cytopathology guidelines for respiratory cytology: Reproducibility of categories among observers
Lester J Layfield, Magda Esebua, Leslie Dodd, Tamar Giorgadze, Robert L Schmidt
CytoJournal 2018, 15:22 (21 September 2018)
DOI:10.4103/cytojournal.cytojournal_4_18  PMID:30294354
Introduction: The Papanicolaou Society of Cytopathology (PSC) has developed a set of guidelines for reporting respiratory cytology. While the malignancy risk for each category is known, the interobserver reproducibility of these diagnostic categories has not been well described. Methods: Fifty-five cytologic specimens obtained by fine needle aspiration from the pulmonary nodules were independently reviewed by four board-certified cytopathologists and assigned to the diagnostic categories described by the PSC guidelines for respiratory specimens. Statistical analysis for diagnostic accuracy was performed for absolute agreement and chance-corrected agreement (kappa). Differences in frequency of distribution of diagnoses between raters were assessed using the Kruskal–Wallis test. Results: No significant differences in distribution of scores by raters were observed. On average, the absolute agreement was 49.5% and the chance-corrected agreement (kappa) was 20%. 34.5% of interrater comparisons were in full agreement, and total lack of agreement between the four categories was found in 3% of cases. Combining the “suspicious for malignancy” category with the “malignant” category did not significantly alter interrater agreement statistics. Conclusions: The PSC categories showed only fair reproducibility among four cytopathologists. Agreement between raters was at best fair and did not improve significantly when the categories “suspicious for malignancy” and “malignant” were combined. The most common source of disagreement appeared to be between the categories “suspicious” and “malignant.”
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CytoJournal Quiz Case: Lung tumor in a young African American patient with sickle trait: Pieces of a puzzle
Mariam Mir, Michelle Parmley, Kyle Molberg, Stacy Hinson, Joel Thibodeaux, Elena Lucas
CytoJournal 2018, 15:21 (27 August 2018)
DOI:10.4103/cytojournal.cytojournal_57_17  PMID:30197662
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Case Report: Cytological diagnosis of osteoblastoma of the talus: Case report with unusual presentation and diagnostic pitfalls
Smita Chandra, Neeti Puri, Meena Harsh, Anil Kumar Juyal
CytoJournal 2018, 15:20 (27 August 2018)
DOI:10.4103/cytojournal.cytojournal_39_17  PMID:30197661
Osteoblastoma is a rare bone tumor mostly affecting the young adults and commonly involving the spinal cord and long bones. Talus is the uncommon site of presentation, and if involved, then the neck is more commonly involved than the body of talus. The cytological diagnosis of osteoblastoma is limited, and to the best of our knowledge, its fine-needle aspiration (FNA) in the talus has still not been reported in the literature. The present case of osteoblastoma is, therefore, being reported due to the unusual presentation in elderly male in the body of talus and showing extensive involvement on X-ray. The case was initially diagnosed on FNA cytology excluding the possibility of giant-cell tumor and osteosarcoma. The case also highlights the importance of vigilant observation of subtle cytological features of this rare tumor which may be helpful in avoiding diagnostic pitfalls, especially at an uncommon site and with unusual presentation. An early precise diagnosis by cytology may be followed by appropriate treatment and thus avoiding any further complications.
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Research Article: Spectrum of clinicohematological profile and its correlation with average parasite density in visceral leishmaniasis
Vijay Kumar, Poojan Agarwal, Sadhna Marwah, AS Nigam, Awantika Tiwari
CytoJournal 2018, 15:19 (27 August 2018)
DOI:10.4103/cytojournal.cytojournal_38_17  PMID:30197660
Background: Leishmaniasis is the prevalent in tropical and subtropical regions of the world. Demonstration of Leishman-Donovan (LD) bodies in the bone marrow aspirates (BMA) is vital to diagnosis of visceral leishmaniasis (VL). In the present study, we studied the clinicohematological parameters encountered in VL and correlated them with parasite load on BMA. Methods: Retrospective analysis over 3 years was done; clinical details, biochemical profile, complete hemogram with peripheral smear findings, and BMA smears were reviewed and average parasite density (APD) calculated in each case. Multivariate analysis and tests of significance were applied. Results: The study included 28 patients. Splenomegaly showed a positive trend with APD. rK39 antigen detection test was 100% positive in select cases. A strong negative correlation was observed between albumin to globulin ratio and grade of APD. BMA revealed hemophagocytosis (HPS) in 78.57% cases and it had a significant strong correlation with APD (P = 0.014). A significant correlation was also observed between APD and bone marrow plasma cell percentage (P = 0.01). LD bodies were noted in unusual locations such as within myelocytes (14.2%), plasma cells (7.1%), and megakaryocytes (10.7%). Conclusion: HPS and bone marrow plasmacytosis were two statistically significant findings, which showed positive correlation with parasite load. The presence of these two findings should prompt hematopathologists for more focused search of hemoparasites in BMA to arrive at a definitive diagnosis. This will avoid unnecessary workups and improve the prognosis. To the best of our knowledge, a statistical correlation between APD and clinicohematological parameters has never been previously studied.
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Case Report: Cytodiagnosis of extramedullary hematopoiesis in serous effusion: A rare presentation unfolding the underlying etiology
Manjari Kishore, Prajwala Gupta, AK Malhotra, Vijay Kumar, Sanchit Singh, Minakshi Bhardwaj
CytoJournal 2018, 15:18 (13 July 2018)
DOI:10.4103/cytojournal.cytojournal_33_17  PMID:30112016
Extramedullary hematopoiesis (EMH) usually involves reticuloendothelial system. However, it rarely may be present in the serous body effusions. In our case, the fluid cytology of both peritoneal and pleural fluid was diagnostic of the EMH in a patient with an undiagnosed underlying etiology.
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Research Article: Adult exogenous lipoid pneumonia: A rare and underrecognized entity in cytology – A case series
Simon Sung, Henry D Tazelaar, John P Crapanzano, Aziza Nassar, Anjali Saqi
CytoJournal 2018, 15:17 (13 July 2018)
DOI:10.4103/cytojournal.cytojournal_29_17  PMID:30112015
Background: Exogenous lipoid pneumonia (ELP) is a rare benign entity without specific clinical or imaging presentation. Although cytological studies – either bronchoalveolar lavage (BAL) or fine-needle aspiration (FNA) – may be pursued in patients with ELP, a definitive diagnosis is frequently rendered only on histology. The aim of this study is to highlight the cytological features of ELP. Methods: A search of cytopathology (CP) and surgical pathology (SP) diagnoses of ELP was conducted. The corresponding clinical and imaging features were obtained, and the morphology, particularly the presence and size of the intracytoplasmic vacuoles and background, was assessed. Results: Nine cases of ELP were identified, including eight with corresponding CP and SP. A neoplasm was suspected in three based on imaging, but ELP was not in the differential clinically or radiographically in any. Among the cases, six patients had BALs and three FNAs. All of the samples showed multiple large vacuoles within macrophages with at least some equal to or larger than the size of the cell nucleus. Similar vacuoles were noted extracellularly on smears. Conclusions: ELP is typically described in case reports in the clinical or radiological literature. To the best of our knowledge, this represents the largest series of adult ELP in CP. When large vacuoles are present in macrophages in cytology specimens, at least a suspicion of ELP can be suggested to initiate appropriate therapy, identify/remove the inciting agent, and preclude a more invasive procedure.
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CytoJournal Quiz Case: Pleural effusion in a 7-year-old child - with unique cells
Neha Gupta, Kasturi Das
CytoJournal 2018, 15:16 (13 July 2018)
DOI:10.4103/cytojournal.cytojournal_13_17  PMID:30112014
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Research Article: Hematolymphoid neoplasms in effusion cytology
Vidya Monappa, Saritha M Reddy, Ranjini Kudva
CytoJournal 2018, 15:15 (14 June 2018)
DOI:10.4103/cytojournal.cytojournal_48_17  PMID:30034505
Background: Hematolymphoid neoplasms (HLNs) presenting as body cavity effusions are not a common finding. They may be the first manifestation of the disease. A diagnosis on effusion cytology may provide an early breakthrough for effective clinical management. Aims: Study the cytomorphology of HLNs in effusion cytology, determine common types, sites involved and uncover useful cytomorphologic clues to subclassify them. Materials and Methods: Twenty-four biopsy-proven HLN cases with malignant body cavity effusions and 8 cases suspicious for HLN on cytology but negative on biopsy are included in this study. Effusion cytology smears were reviewed for cytomorphological features: cellularity, cell size, nuclear features, accompanying cells, karyorrhexis, and mitoses. Results: Diffuse large B-cell lymphoma (37%) was the most common lymphoma type presenting as effusion followed by peripheral T-cell lymphoma (25%). Pleural effusion (75%) was most frequent presentation followed by peritoneal effusion (20.8%). Pericardial effusion was rare (4.1%). The common cytologic features of HLNs in effusions: high cellularity, lymphoid looking cells with nuclear enlargement, dyscohesive nature, and accompanying small lymphocytes. Mitosis and karyorrhexis were higher in high-grade HLNs when compared to low-grade HLNs. Myelomatous effusion showed plasmacytoid cells. Very large, blastoid looking cells with folded nuclei, high N: C ratio, and prominent nucleoli were seen in leukemic effusion. Conclusion: HLNs have characteristic cytomorphology and an attempt to subclassify them should be made on effusion cytology. Reactive lymphocyte-rich effusions cannot be distinguished from low-grade lymphomas based on cytomorphology alone. Ancillary tests such as immunocytochemistry, flow cytometry, and/or molecular techniques may prove more useful in this regard.
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CytoJournal Quiz Case: Large retroperitoneal soft tissue tumor: A cytopathological diagnosis
Manjari Kishore, Prajwala Gupta, Arvind Ahuja, A S N Rao, Minakshi Bhardwaj
CytoJournal 2018, 15:14 (14 June 2018)
DOI:10.4103/cytojournal.cytojournal_22_17  PMID:30034504
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