Biomedical subjects
Publications and source records attributed to S Bhambhani.
A 60-year-old female presented with a growing tumor of her left upper eyelid of 6 mo duration. The fine-needle aspiration cytology (FNAC) report was consistent with the clinical diagnosis of meibomian gland carcinoma, which was subsequently confirmed by histopathologic examination of tumor tissue. Exenteration was performed following a course of radiotherapy. There was no sign of recurrence after a follow-up period of 6 mo.
OBJECTIVE: To evaluate the role of cytomorphologic features in the diagnosis and differential diagnosis of small round cell tumor (SRCT) of the abdomen and thorax. STUDY DESIGN: During a period of six years (1985-1990), ultrasound/ computed tomography-guided fine needle aspiration cytology was performed on thoracic and abdominal/ pelvic masses in 899 cases. Slides were not available for review in 28 cases. Review of smears by one of the investigators (D.K.D.) in the remaining cases, which included 239 with intrathoracic and 632 with intraabdominal/pelvic masses, yielded 380 (43.6%) cases of malignancy. Of these, 71 (18.7%) cases were small round cell tumors. In 59 cases of SRCT the smears were found suitable for detailed assessment of cytomorphologic features. RESULTS: The 59 cases of small round cell tumors included 5 cases of neuroblastoma, 7 of hepatoblastoma, 4 of nephroblastoma, 1 of pulmonary blastoma, 2 of Ewing's sarcoma, 23 of non-Hodgkin's lymphoma (NHL), 15 of small cell anaplastic carcinoma (SCAC), 1 NHL/SCAC and 1 small round cell tumor (not otherwise specified). The frequencies of rosettes (60%) and filamentous/fibrillar matrix (100%) in neuroblastoma; acinar formation in hepatoblastoma (100%) and SCAC (93.3%); tubule formation in nephroblastoma (100%); lipid vacuoles (69.6%), exclusive noncohesive cells (95.7%) and lymphoglandular bodies (87%) in NHL; and nuclear molding (100%) and paranuclear blue inclusions (60%) in SCAC were significantly higher as compared to the rest of the SRCTs (P < .01 to < .0001). CONCLUSION: The various cytomorphologic features, alone or in conjunction with other cytologic features, and clinical/imaging findings are very useful in the diagnosis of specific types of SRCT.
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Recent reports have indicated the usefulness of nuclear grooves (clefts or notches) as an additional criterion for the diagnosis of papillary thyroid carcinoma in fine needle aspirates; most of these studies were carried out on alcohol-fixed material stained with the Papanicolaou stain or with hematoxylin and eosin, which yield good nuclear details. In the present study air-dried thyroid aspirates stained with the widely used May-Grünwald-Giemsa stain were evaluated. Nuclear grooves were observed in 88% of the May-Grünwald-Giemsa-stained aspirates from papillary thyroid carcinoma, usually in substantial numbers. A few grooved nuclei were seen in a small percentage of the other thyroid aspirates studied. These results show that nuclear grooves can also be used as a possible marker of papillary carcinoma of the thyroid in May-Grünwald-Giemsa-stained aspirates.
Both fine needle aspiration (FNA) and conventional scraping were used to obtain cytodiagnostic samples from ulcers and sinuses of the skin (18 cases) and tongue (3 cases). These included 14 cases of tuberculosis, 5 squamous-cell carcinomas and 2 cases of nonspecific infection. The FNA smears contained characteristic tuberculous granulomas or epithelioid cells in 10 of the 14 tuberculosis cases and ample diagnostic material in 4 of the 5 carcinoma cases; in contrast the scraping smears predominantly contained necrotic material on which a diagnosis was not possible. Of the 19 cases of tuberculosis and malignancy, 12 were diagnosed only by FNA, 6 were diagnosed by both methods and the FNA sample was negative while the scrape was positive in 1 case. Hence, the diagnosis was made in 18 of 19 by FNA cytology, but in only 7 of 19 cases by scraping cytology, strongly indicating the diagnostic superiority of the former in diagnosing many lesions of the body surface.
Fine needle aspiration (FNA) was performed on small lumps in three female patients in the reproductive age group. One lump in the axilla and one on the chest wall were clinically suspected of being a lipoma or an angioma while another axillary lump was thought to be an enlarged lymph node. Cytologically, the aspirates revealed the presence of ectopic breast tissue. These cases show yet another instance in which FNA cytology can make the diagnosis of lumps of unknown origin, avoiding the need for open biopsy.
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Explore the source record for details and available documents.
Forty-five patients with oral or pharyngeal swellings were subjected to fine needle aspiration cytology (FNAC) of the mucosal surface over eight years. The age of the patients ranged from 2 to 85 years. The male:female ratio was 25:20. The common sites of involvement were palate (16 cases), cheek (9), pharynx (7) and tonsillar/peritonsillar area (6). Tongue, maxilla, alveolus and lips were less frequently involved. FNAC played an important role in differentiating inflammatory from neoplastic lesions and also benign from malignant neoplasms. Fifteen cases were cytologically diagnosed as benign neoplasms and included pleomorphic adenoma (11 cases), schwannoma (2), odontogenic tumor (1) and benign neoplasm not otherwise specified (1). Sixteen cases were diagnosed as malignancies. There were seven cases of malignant salivary gland tumors and 6 of squamous cell carcinoma. Two cases were high grade non-Hodgkin's lymphomas, and one was malignant odontogenic tumor. Of the 11 inflammatory or reactive lesions, 4 were found to be harboring Actinomyces. The rate of inadequate sampling was 6.7%. Histopathology reports on excised tissue were available for 10 cases only. Seven of nine cases with adequate cytology (77.88%) showed complete agreement with histology.
The study includes 61 cases which were subjected to ultrasound (US) guided fine needle aspiration cytology (FNAC) to find out the utility of this technique in the diagnosis of pancreatic lesions. Age of the patients ranged from 23 to 85 years with a median of 50 years. Male to female ratio was 36:25. One or more clinical diagnoses were offered in 16 and in 9 of these, the disease was related to pancreas. Subsequent to US, the lesions were localized to pancreas in 57 and the nature of pathology in the pancreatic lesion could be diagnosed in 31. By FNAC, 31 cases (50.8%) were diagnosed to have pancreatic malignancy which included adenocarcinoma (23 cases), papillary cystic tumour (1), muco-epidermoid carcinoma (1), acinic cell carcinoma (1), islet cell tumor (1), and non Hodgkin lymphoma (4). FNAC of liver in 2 cases and retroperitoneal lymph node in a case of pancreatic adenocarcinoma revealed metastasis. During follow up, 1 case of non Hodgkin's lymphoma showed CSF involvement. Three cases (4.9%) were suspected to have epithelial malignancy of which one was confirmed as an adenocarcinoma following surgery and histology. Four (6.6%) were benign lesions which included nonspecific inflammation (2 cases), tuberculous pancreatitis (1) and pseudopancreatic cyst (1). The remaining 23 cases (37.7%) had normal or inadequate cytology. Of these, FNAC of liver showed metastasis in 2 cases and one case each were diagnosed as adenocarcinoma and pseudopancreatic cyst respectively following surgery. None of the patients had any complication following FNAC. We recommend US guided FNAC to be routinely used for diagnosis of pancreatic lesion.
Ultrasound or CT-guided fine needle aspiration was performed on 212 patients with space occupying lesions of the liver during a period of 5 years (1986-1990) to study the utility of fine needle aspiration (FNAC) in the diagnosis of hepatic malignancies. The initial FNAC diagnosis was malignancy in 91 cases. However, following review of the smears by one of the investigators (DKD) 93 (43.9%) cases were found to be malignant. Age of the patients with malignancy ranged from 20 days to 85 years. Male to female ratio was 57:36. The clinical diagnosis was malignancy in 58% which improved to 72% following imaging whereas nonspecific diagnosis was reduced from 34% to 20%. The primary malignancies consisted of 21 cases of hepatocellular carcinoma (HCC) and 7 hepatoblastomas. There were 61 metastatic lesions which included 43 adenocarcinomas, 6 small cell anaplastic carcinomas, 3 leiomyosarcomas, 2 cases each of malignant melanoma, paraganglioma and germ cell tumour, and one case each of squamous cell carcinoma, neuroendocrine tumour and undifferentiated carcinoma/soft tissue sarcoma. In two cases decision between HCC and secondaries was not possible. There were also two cases of non-Hodgkin's lymphoma. Thirty six percent of primary malignancies and 58% of secondaries were correctly diagnosed or suggested as one of the possibilities by combined clinical examination and imaging prior to FNAC. Thus, US/ CT guided FNAC played an important role in diagnosis and classification of malignancies of liver.