Biomedical subjects
Publications and source records attributed to G Jayaram.
A case of papillary cystic neoplasm of the pancreas diagnosed by fine needle aspiration cytology is presented surgical removal of the pancreatic tumour and histological study confirmed the cytologic diagnosis. A brief review of the literature and emphasis on cytological and histological features are discussed.
Twenty-five patients with solitary cold thyroid nodules (SCN) were studied by fine needle aspiration (FNA) cytology, radionuclide perfusion scanning (RPS) and pentavalent technetium dimercaptosuccinic acid (99m Tc DMSA) scanning, with an aim to distinguish neoplastic from non-neoplastic nodules. All the patients were operated upon and the nodules were subjected to histopathological examination. 13 of the 25 nodules (52%) were malignant (7 papillary carcinomas, 3 medullary thyroid carcinomas and 1 each of follicular carcinoma, insular carcinoma and clinically anaplastic thyroid tumour). The specificity of DMSA scanning and FNA cytology were 100% and that of RPS 60%. The sensitivity of RPS and DMSA scanning were 80% and 20% and that of FNA cytology (using a broad definition of test-positivity), 100%. Additionally, FNA cytology could morphologically type the majority of neoplasms.
Fine needle aspiration (FNA) cytology was performed on 62 primary and 22 metastatic bone tumours. Histological correlation was available in all 62 primary bone tumours, which included 7 benign and 53 malignant tumours. The most common of the malignant tumours were Ewing's sarcoma, followed by giant cell tumour, osteosarcoma and chondrosarcoma. The benign tumours included 4 enchondromas, 1 chondromyxoid fibroma and 2 osteochondromas. The overall cytodiagnostic accuracy in primary malignant bone tumours was 86.9%, the specificity was 100% and cytological categorization of tumours was possible in the majority of cases. This eliminated the need for bioptic confirmation. Our results indicate that FNA cytology is a valuable diagnostic tool in bone tumours.
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Two hundred-seventy-five azoospermic males were subjected to fine-needle aspiration (FNA) cytologic study of testis with the aim of determining the cause of azoospermia; 534 aspirates from these patients were classified as follows: normal spermatogenesis (162), hypospermatogenesis (mild, moderate, or severe, 226), absence of spermatogenesis (130), maturation arrest (36), Sertoli-cell-only syndrome (14), and Leydig-cell hyperplasia (3). The morphology of cells was excellent in the cytologic preparations and various spermatogenic cells and Sertoli cells were easily recognized. Leydig cells were uncommonly seen, except in cases of Leydig-cell hyperplasia. Degenerative changes, possibly due to obstruction, were seen in 104 cases. The procedure was well tolerated by the patients. We conclude that FNA cytology is a useful investigative modality in the evaluation of azoospermic males.
Crystalline structures measuring < 800 microns in length, were found in smears of a fine-needle aspirate of a cystic lesion in a parotid salivary gland. Numerous neutrophil leukocytes were also present, intimately mixed with the crystalloids. The lesion was re-aspirated and the cyst completely evacuated, with no recurrence after a 6-month follow up.
Of 2,012 fine-needle aspirations (FNA) performed by us between 1984 and 1988, we present a detailed cytomorphologic analysis of 95 cases that were diagnosed as neoplastic on histology and/or cytology and those that received an equivocal cytodiagnosis. Discussed are eight tumors, which include three classic and five variant forms of Hürthle cell carcinoma. The latter showed a papillary tumor populated wholly by Hürthle cells, which we have morphologically designated as papillary Hürthle cell carcinoma. All three Hürthle cell carcinomas (PHC) were diagnosed on FNA as papillary Hürthle cell neoplasms (PHN). One was a false negative cytodiagnosis.
56 patients with prostatic enlargement were subjected to transrectal fine needle aspiration (FNA) of prostate. The cytologic diagnosis was correlated with histology in 55 cases. Benign prostatic hyperplasia (BPH) was diagnosed in 44 cases. In 18 of these, there was associated chronic prostatitis in three cases acute prostatitis and in two cases granulomatous prostatitis. One case of tuberculous prostatitis and 11 cases of prostatic carcinoma could also be diagnosed on cytologic basis. There was only one false negative and no false positive cytodiagnosis was made.
Seventy-eight symptomatic females without palpable breast lumps were subjected to bilateral four quadrant fine needle aspiration cytology. Cytological evidence of an epithelial proliferative lesion was seen in 44 of these cases. Based on the cytological evidence of proliferation, the site for open biopsy was determined. Histopathological study of the breast biopsies in these patients showed proliferative disease without atypia (PDWA) in 40 cases, atypical ductal hyperplasia (ADH) in two, atypical lobular hyperplasia (ALH) in one and ADH with ALH in one case. Cytology was thus useful in establishing the presence of proliferative activity, commenting on the extent of proliferation, and thereby roughly mapping out the area of the breast most suitable for biopsy. On cytological grounds, it was not possible to distinguish the atypical hyperplastic lesions from the proliferative diseases without atypia.
Forty-eight patients with breast carcinoma were subjected to four quadrant fine needle aspiration (FNA) cytology examination of the ipsilateral and contralateral breast in an attempt to detect any accompanying benign proliferative lesion. Mastectomy of ipsilateral and open biopsy of contralateral breast provided material for histopathological study. Cytological evidence of epithelial proliferation was found in 8 (16.6%) cases which included atypical lobular hyperplasia (ALH), lobular neoplasia in-situ (LNIS), atypical ductal hyperplasia (ADH), and proliferative disease without atypia (PDWA). In lobular proliferative lesions, cytological smears showed configurations of cells that resembled filled up or expanded lobular units. The cytology was not distinctive enough to distinguish the sub-types of lobular proliferations. Likewise, the presence of ductal alterations could be suggested by cytological study but the distinction of proliferative disease without atypia (PDWA) from atypical ductal hyperplasia (ADH) was not possible on a cytological basis.
Fine needle aspiration cytology is today one of the first line investigations for palpable and deep seated masses. Non aspiration fine needle cytology is another recently described cytologic technique. The thyroid gland is one of the common head and neck structures to be subjected to cytologic sampling. Cytology has proved to be a highly sensitive and specific investigative modality in solitary cold thyroid nodules on the basis of which the therapeutic protocol is decided. By providing an accurate morphologic diagnosis in most of the neoplastic lesions, cytology enables pre-operative planning of the extent of surgery. It is also an excellent method for the diagnosis and monitoring of patients harboring inflammatory or autoimmune thyroid lesions.
A stepwise logistic regression analysis was performed in 27 cases of papillary carcinoma thyroid (PC), 20 follicular neoplasms (FN), 30 cases of Grave's disease (GD), and 40 cases of colloid adenomatous goitre (CAG). The three most important variables in predicting PC were papillary clusters, dense cytoplasm, and intranuclear cytoplasmic inclusions, whereas the predictors of FN were high cellularity combined with a prominent acinar pattern. A few cases of GD and CAG showed a cytologic overlap with PC and FN, respectively. Regression analysis established high cellularity, fire flare appearance, and epitheloid granulomas as reliable predictors of GD, whereas abundant colloid with or without foam cells and follicles associated with colloid (FAC) were important variables in CAG.
Of 2,012 fine-needle aspirations (FNA) of the thyroid performed by the authors between the years 1984 and 1988, a detailed cytomorphologic analysis of 95 cases diagnosed as neoplastic on histology and/or cytology and those that received an equivocal cytodiagnosis is presented. Discussed are papillary carcinomas (28 correctly diagnosed on FNA and two false positives). In most of the cases of papillary carcinoma, the cytologic features were characteristic enough to enable accurate tumor typing. Follicular cells with dense cytoplasm, well defined cell margins, and presence of papillary clusters were the most consistent features observed. Intranuclear cytoplasmic inclusions, though characteristic, were found in only 66.6% of cases. In cystic papillary carcinomas (seven cases) study of the cyst wall as well as the cyst contents enabled an accurate cytodiagnosis. Two cases of multinodular goiter with papillary hyperplasia could not be distinguished with certainty from papillary carcinoma on cytologic grounds.
From 2,012 fine-needle aspirations (FNA), performed by us between the years 1984 and 1988, we present a detailed cytomorphologic analysis of 95 cases that were diagnosed as neoplastic on histology and/or cytology and those that received an equivocal cytodiagnosis. Discussed are 37 lesions that have been diagnosed on cytology and/or histopathology as follicular neoplasms. In this group, there were 22 cases of histologically proven follicular carcinoma and 11 follicular adenomas. Three cases of multinodular goiter and one case of Hashimoto's thyroiditis with marked follicular hyperplasia have also been included because they received either a neoplastic or an equivocal cytodiagnosis. Of 22 follicular carcinomas, 12 were diagnosed on FNA as follicular neoplasms, eight as follicular carcinoma, one was a false-negative benign cytodiagnosis, and one was equivocal. Of 11 follicular adenomas, seven were diagnosed as follicular neoplasms and four were cytologically equivocal. Three cases of multinodular goiter and one Hashimoto's thyroiditis had been diagnosed on FNA as either follicular neoplasm or equivocal.
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The rare presentation of a follicular thyroid carcinoma mimicking the clinical and radionuclide features of subacute thyroiditis is described. Granulomatous thyroiditis was initially suspected on the clinical basis of acute onset of a hard, tender right lobe thyroid enlargement with associated systemic symptoms, modest elevation of thyroid hormone levels and suppressed thyroid RAIU. Fine needle aspiration cytology specimens were unsatisfactory for characterization. Three weeks later the thyroid RAIU was normal. The thyroid enlargement persisted, now being clearly visualized as a hypofunctional nodule on scintiscan. Repeat fine needle aspiration cytology was suggestive of acinar proliferation with hyperfunction. Ultrasonography revealed a solid nodule with a peripheral sonolucent halo. Radionuclide angiography showed intense arterial flow of Tc-99m pertechnetate through the right lobe thyroid enlargement suggestive of malignant thyroid pathology. Surgical excision and histopathological examination revealed a follicular carcinoma involving the right lobe. The possibility of carcinomatous involvement should be considered in those patients where initially tender thyroid nodularity persists longer than expected for a benign inflammatory disease, careful follow-up and relevant investigations being necessary to confirm the diagnosis.
An 80-yr-old female with a grade I diffuse goiter was diagnosed on fine-needle aspiration cytology as having Hashimoto's thyroiditis. Two years later, she developed a hard nodular growth in the right lobe of the thyroid, which was subjected to fine-needle aspiration and diagnosed as a non-Hodgkin's lymphoma. Immunocytology demonstrated the monoclonal B cell nature of the lesion. The patient underwent total thyroidectomy and is alive and free of the disease 27 mo after surgery.
The cytological appearance of breast lesions has been well-studied. However, skin lesions occurring as breast nodules have less often been studied by fine-needle aspiration. In addition. skin tumors occurring over the breast may be clinically mistaken for breast carcinoma owing to their fixity to the skin. This article presents one such case and describes its cytologic appearance.