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Biomedical subjects

K Kapila

Publications and source records attributed to K Kapila.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

Phyllodes tumor of the breast. A cytohistologic study of 80 cases.

OBJECTIVE: To study the cytologic features of phyllodes tumor (PT) of the breast and determine the accuracy of their subclassification in fine needle aspirates. STUDY DESIGN: Eighty cases of histologically diagnosed PT between 1982 and 1997 with a previous fine needle aspiration (FNA) were evaluated. The FNA smears of each case were reviewed without knowledge of the initial cytologic diagnosis and subclassified into benign, borderline or malignant PT. RESULTS: Benign PTs were characterized by a dimorphic mixture of stromal and epithelial cells. The stromal fragments showed mild to moderate cellularity with absent to minimal pleomorphism and no mitosis. There were occasional, if any, single stromal cells. Borderline PTs had stromal fragments with moderately cellular stroma exhibiting moderate pleomorphism. Two additional features were the presence of single stromal cells and an occasional mitosis in the stromal fragments/single cells. Aspirates from malignant PT were very cellular, with a high stromal/epithelial ratio and marked stromal cellularity. The stromal cells were highly pleomorphic, with frequent mitosis and atypical single stromal cells in the background. Fifty-seven of the 80 histologically documented cases (71.3%) were diagnosed as PT on FNA (40 benign, 10 borderline and 7 malignant). In 81% (46 of 57 PTs), good cytohistologic correlation (32 benign, 8 borderline and 6 malignant) was observed. In another eight cases, one grade differentiation between cytologic and histologic grade was observed. Six of the nine malignant PTs on histology were correctly subclassified on cytology. There were one false positive and two false negative cases. CONCLUSION: Cytologic diagnosis and grading of PT on FNA is possible. Special care should be undertaken in interpreting phyllodes fragments, cellularity of stroma, pleomorphism and mitosis. Single stromal cells are also important morphologic criteria for subclassification. Multiple-site aspiration is advisable to avoid diagnostic errors.

Adolescent↗
PubMedDate not supplied

Fine needle aspiration cytology in the management of male breast masses. Nineteen years of experience.

OBJECTIVE: To determine the utility and accuracy of fine needle aspiration cytology (FNAC) as well as its sensitivity, specificity and predictive value in the diagnosis of male breast masses. STUDY DESIGN: Data on male breast FNAC done between 1978 and 1997 were retrieved from the records of the cytopathology laboratory. FNAC diagnoses were categorized as positive, negative, inconclusive or unsatisfactory. Cytohistologic correlation was done with data from histopathology records. Sensitivity, specificity, diagnostic accuracy and predictive values of FNAC were calculated using standard statistical methods. RESULTS: Five hundred seven of 13,175 patients undergoing breast FNAC were males. Of them, 393/507 had satisfactory aspirates. Of these, 70 were positive (13.8%), 295 were negative (58%), and 29 were inconclusive (5.7%). A total of 114 FNACs (22.5%) were unsatisfactory. Histopathology was available in 97/507 cases. There were no false positive or false negative diagnoses. FNAC had a sensitivity, specificity and diagnostic accuracy of 100% for male breast lesions. CONCLUSION: This large study shows that FNAC is a very accurate tool for diagnosis of male breast lesions. It is highly sensitive and specific, with good cytohistologic correlation. FNAC should therefore be an integral part of the primary assessment of breast lumps in males.

Biopsy, Needle↗
PubMedDate not supplied

Fine needle aspiration cytology of dermatopathic lymphadenitis.

OBJECTIVE: To delineate and describe the cytomorphologic features of dermatopathic lymphadenitis on fine needle aspirated material. STUDY DESIGN: Thirteen cases of previously diagnosed dermatopathic lymphadenitis (DLN) and 10 cases of reactive lymphadenitis (RLN) (5 each of sinus histiocytosis and follicular hyperplasia) were reexamined by two independent observers. The cytologic features were semiquantitated (0-3+). Histology was available in two cases. RESULTS: A variable amount of melanin pigment was seen in all 13 cases of DLN and in only 3 cases of RLN. DLN had large histiocytic collections with blood vessels at the center (12/13). The histiocytic cells had an elongated nucleus (13/13) with nuclear grooves (13/13) and pseudonucleoli (11/13). Many of these nuclei had a convoluted and crumpled appearance (11/13). On immunocytochemistry these cells were S-100 positive (six cases) and CD68 negative (one case). In contrast, in RLN with sinus histiocytosis, the histiocytes were polygonal and had rounded nuclei. Spindle-shaped histiocytes were rare, while pseudonucleoli and nuclear grooves were absent. Sinus histiocytes were CD68 positive and S-100 negative on histologic sections. Tingible body macrophages were rare (2/13) in DLN and prominent (8/10) in RLN. Mitoses were seen in DLN (6/13) and RLN (9/10). CONCLUSION: The morphologic features found to be helpful in the diagnosis of DLN on fine needle aspiration cytology are melanin-laden macrophages with variable pigment; large, histiocytic clusters with blood vessels at the center; characteristic histiocytes, with elongated vesicular nuclei, nuclear grooves, crumpled and convoluted nuclei and pseudonucleoli; and absence of or very few tingible body macrophages. Positivity on immunostaining for S-100 and negativity for CD68 aid in the diagnosis.

Biopsy, Needle↗
PubMedDate not supplied

Follicular neoplasms of the thyroid. Decision tree approach using morphologic and morphometric parameters.

OBJECTIVE: Fine needle aspiration of the thyroid is limited in differentiating hyperplastic nodular goiters from true follicular neoplasms and in separating follicular adenomas from follicular carcinomas. The present study was done to evaluate if a panel of morphologic and morphometric parameters of the thyroid and ploidy status, either alone or in combination, would help differentiate hyperplastic nodular goiters from follicular adenomas and carcinomas. STUDY DESIGN: Fine needle aspiration smears of 75 cases classified as follicular neoplasms of the thyroid were studied for morphologic (cellularity, colloid and cellular patterns) and morphometric parameters (nuclear diameters and nucleoli). RESULTS: Of the large number of parameters utilized in this study, only two of the cellular patterns (honeycomb and single dispersed) and the average maximum nuclear diameter showed trends in differentiating these lesions. CONCLUSION: Based on these patterns and nuclear diameter (9 microns), we developed a decision tree classification that separated the benign from malignant lesions (follicular carcinomas) with a sensitivity and specificity of 92.8% and 57.4%, respectively.

Adenocarcinoma, Follicular↗
PubMedDate not supplied

Atypical lipoma as a potential pitfall in the cytodiagnosis of subcutaneous tumors. A report of two cases.

BACKGROUND: If well-differentiated liposarcomas of lipomalike type occur in the subcutis, they behave as benign neoplasms. For these tumors the term atypical lipoma was introduced in 1975. Fine needle aspiration (FNA) findings in these tumors may raise a false impression of malignancy. CASES: Females aged 34 and 48 years presented with well-defined subcutaneous nodules in the left supraclavicular region and on top of the head, respectively. FNA showed fragments of mature fat tissue and numerous dispersed, large, hyperchromatic, often bizarre nuclei. Lipoma with atypical cells was diagnosed cytologically in one case and atypical lipoma in the other. Histologically both cases were evaluated as atypical lipoma. CONCLUSION: A correct cytologic diagnosis of atypical lipoma can be established if cytomorphologic features are coupled with clinical data.

Adipocytes↗
PubMedDate not supplied

Diagnosis of parasites in fine needle breast aspirates.

OBJECTIVE: To document the value of fine needle aspiration cytology (FNAC) in the diagnosis of parasites in breast aspirates. STUDY DESIGN: Review of 8,364 breast aspirates studied over 15 years (1978-1992) for parasitic infections. RESULTS: Eight cases of cysticercosis and nine of filariasis were detected among 4,714 benign breast aspirates. Diagnosis of cysticercosis was based on identification of parts of the parasite in aspirates (seven cases) and excisional biopsy (one case). Among the cases of filariasis in breast aspirates, gravid adult females of Wuchereria bancrofti were seen in three cases and microfilarial larvae in four. In the remaining two cases, an intense, eosinophilic infiltrate was seen in breast aspirates, while microfilariae were identified in aspirates from draining axillary lymph nodes. CONCLUSION: In rare cases, parasitic infections present as breast lumps and can be easily diagnosed by FNAC.

Adolescent↗
PubMedDate not supplied

Extramedullary involvement in acute lymphoblastic leukemia and its relation to therapy.

Extramedullary involvement (EMI) of various body sites was studied by doing CSF cytology anu FNAC of testes and lymph nodes in 82 children with acute lymphoblastic leukemia (ALL). Forty-five patients had received no therapy (group I) and 37 had been diagnosed and treated earlier and were now in remission (36) or relapse (group II). EMI was documented in 48.9% and 32.4% of patients of group I and II respectively. EMI was seen more frequently in patients with FAB-L 2 subtype (66.6%) as compared to FAB-L1 subtype (34.6%) in group I. Lymph nodes and testes were commonly involved in group I and II patients respectively. Successful remission after complete chemotherapy was achieved in 82.5% of group I patients. However, successful remission rates were 95.2% in patients without any evidence of EMI versus 68.4% in those with EMI. These differences were also observed when response to therapy was analysed separately for patients with FAB-L1 and FAB-L2 subtypes.

Adolescent↗
PubMedDate not supplied

Fine needle aspiration cytology of mucoepidermoid carcinoma. A diagnostic problem.

The cytomorphologic findings in fine needle aspirates from 18 cases of histologically confirmed primary mucoepidermoid carcinoma of the salivary gland were reviewed and correlated with the findings on the tissue sections. An accurate diagnosis of these tumors in fine needle aspirates was possible when all three components (i.e., epidermoid cells, intermediate cells and mucus-producing cells) were identified. The pitfalls in the cytologic diagnosis of this tumor are discussed.

Biopsy, Needle↗
PubMedDate not supplied

Pulmonary blastoma.

Pulmonary blastoma is a rare tumour of the lung. We report three cases of this tumour. In all three cases, a possibility of blastoma was considered on aspiration cytology of the tumours. The relevant literature including its pathogenesis is reviewed.

Adolescent↗
PubMedDate not supplied

Value of demonstration of cytokeratin and leukocyte common antigen in poorly differentiated malignant tumors in fine needle aspirates.

Immunoperoxidase staining for cytokeratin and leukocyte common antigen (LCA) was applied to aspirated material from 21 well-differentiated malignant tumors ("control cases," which could be cytologically categorized) and 32 poorly differentiated malignant tumors ("study cases," whose tumor type was not clearly evident from study of the aspirate). Fifteen (48%) of the 32 poorly differentiated malignant tumors were classified as carcinomas (12 cases) or lymphomas (3 cases) by positive staining for cytokeratin or LCA, respectively. Good cytohistopathologic correlation was observed in all 7 control cases and in 11 cases of the study cases for which histologic specimens were available. The addition of staining for desmin helped in categorizing one undifferentiated tumor as a rhabdomyosarcoma. Immunostaining for vimentin was not found to be valuable in the categorization of these tumors.

Adenocarcinoma↗