Background: To standardize the reporting pattern across various institutions, recently the international system for reporting serous fluid cytology (ISRSFC) was introduced. The objective of the present study was to classify serous fluids into various categories as per the ISRSFC, derive the risk of malignancy for each category and determine the diagnostic efficacy of fluid cytology when ISRSFC was applied. Methodology: Cross-sectional study involving 235 cases of serous effusion over a duration of two years. All the cases were reclassified as per ISRSFC into five categories. Descriptive statistics was derived. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was determined in 74 cases wherein final diagnosis was confirmed by clinical findings, radiology, or cell block. Results: Out of total 235 cases of fluid examined, distribution of cases in the diagnostic categories were as follows, 11 (4.6%) in nondiagnostic (ND), 208 (88.51%) in negative for malignancy (NFM), 5 (2.12%) in atypia of undetermined significance (AUS), 2 (0.85%) in suspicious for malignancy (SFM) and 9(3.82%) in malignant (MAL)category. Out of 208 cases of NFM, mesothelial cells were seen in only 8 (3.8%) cases. The risk of malignancy was 0% each in ND and NFM, 40% in AUS, 100% each in SFM and MAL. Sensitivity and specificity of fluid cytology was 100% and 96.6% respectively while PPV and NPV was 81.81% and 100 % respectively. Conclusion: ISRSFC is easy to apply and has high diagnostic efficacy. Most of the serous effusions fall in negative for malignancy category. Mesothelial cells are not important for specimen adequacy.

Background: Fine needle aspiration cytology (FNAC) is very useful for the pre-operative diagnosis of breast cancer. The efficacy of FNAC to determine the prognosis in breast carcinomas has to be explored. Aims: The present study is designed to determine the prognostic role of FNAC by correlation of the cytological features of Invasive Ductal carcinoma of Breast (IDC) with the axillary lymph nodal metastasis, which is a known prognostic marker. Materials and Methods: A total of 68 cases of IDC of breast diagnosed on FNAC with subsequent modified radical mastectomy in our hospital were included in the study group. Both FNAC and histopathology slides were retrieved for all the cases. The FNAC smears were assigned cytological grades according to Robinson's grading system. The histopathological sections of axillary lymph nodes were assessed for metastasis. Correlation was done between cytological grade and lymph nodal metastasis. Results: Cytological grading of IDC and axillary lymph nodal metastasis showed a statistically significant correlation (P <0.05). Individual features like nuclear size, cell uniformity, nucleoli and nuclear margin showed positive correlation with axillary lymph node metastasis (P < 0.05). Conclusion: Positive correlation is observed between Robinson's cytological grading of IDC on FNAC with axillary lymph nodal metastasis, hence cytological grading on FNAC can be used as a prognostic tool. Possibility of axillary lymph nodal metastasis in cases with high cytological grade of IDC on FNAC must be considered by the treating oncologist for the adequate patient management.

Background: Functional lymphatics at the peritumoral site is mainly responsible for lymphovascular invasion (LVI) in breast cancer. Marginal adipose tissue invasion (ATI) leads to larger area of contact between peritumoral lymphatics and may increase chances of LVI. Objectives: To investigate whether ATI of cancer cells at the tumour margin influenced lymph node status and prognosis in patients with invasive ductal carcinoma of the breast. Materials and methods: Cross sectional study involving 33 cases of invasive ductal carcinoma diagnosed over a duration of three years. Clinicopathologic prognostic parameters in 33 cases with marginal ATI was were compared 10 patients without ATI. The value of the combination of ATI and peritumoral lymphatic vessel invasion (LVI) was also assessed. Chi square was applied to assess the statistical significance at p<0.05. Results: The frequency of axillary lymph node metastases was 63.63.7% in patients with ATI (21/33) and 0% in patients without ATI (0/10) with a p value of < .001. The frequency of peritumoral lymphovascular invasion was 88.88% in patients with ATI (24/27) and 11.1% in patients without ATI (3/27) with a p value of < 0.01. ATI was an independent factor influencing nodal metastasis. Conclusion: ATI of cancer cells at the tumour margin is one of the biologic indicators of tumour aggressiveness in invasive breast cancer. This study indicate that ATI+ cases were associated with adverse outcomes in addition to the converse. ATI should be incorporated in a standard surgical pathology report of infiltrating ductal carcinoma of the breast as ATI and peritumoral LVI will be useful in the framing therapeutic strategies and in assessment of prognosis.

Background:The term noninvasive follicular tumor with papillary-like nuclear features (NIFTP) was introduced as a surrogate for noninvasive encapsulated follicular variant of papillary thyroid carcinoma with a defined set of histopathologic criteria. There are very few studies depicting the cytological cues for the diagnosis of NIFTP. The objective of the study was to determine the spectrum of cytological features in fine needle aspiration cytology (FNAC) smears of cases histopathologically diagnosed as NIFTP. Methods:This was a retrospective cross-sectional study conducted over a duration of four years between January 2017 and December 2020. All surgically resected cases (n-21), who met the diagnostic criteria of NIFTP on histopathology and who underwent preoperative FNAC were included and reviewed in the study. Results:Out of a total of 21 cases, at FNAC, diagnosis of benign, suspicious for malignancy, follicular variant of papillary thyroid carcinoma, and classic papillary thyroid carcinoma (PTC) was rendered in 14 (66.6%), 2 (9.5%), 2 (9.5%), and 3 (14.28%), respectively. Scanty cellularity was noted in 12 (57.1%) cases. Papillae, sheets, and microfollicles were seen in 1 (4.7%), 10 (47.6%), and 13 (61.9%) cases, respectively. Nucleomegaly, nuclear membrane irregularities, nuclear crowding, and overlapping were seen in 7 (33.3%), 9 (42.8%), and 9 (42.8%), respectively. Nucleoli, nuclear grooving, and inclusions were seen in 3 (14.2%) 10 (47.6%), and 5 (23.8%) cases, respectively. Conclusion:At FNAC, NIFTP can be found in every category of The Bethesda System for Reporting Thyroid cytopathology (TBSRTC). Nuclear membrane irregularities, nuclear grooving, mild nuclear crowding, and overlapping were noted in a modest number of cases. However, the absence or rare occurrence of features such as papillae, inclusions, nucleoli, and metaplastic cytoplasm may help prevent an overdiagnosis of malignancy.

Purpose: Breast fine needle aspiration cytology (FNAC) has a long history of providing accurate, rapid and cost-effective diagnosis of palpable breast lesions. Recently, International Academy of Cytology (IAC) at Yokohama proposed a new reporting system for breast cytology, in order to bring uniformity across the globe. Any new classification system needs to be validated for its practical applicability. Objectives: This study was conducted to categorize the breast lesions as per this classification and further determine the diagnostic efficacy and risk of malignancy in each category. Material and Methods: This was a cross sectional observational analytical study. All the cases presenting to cytology OPD from January 2020 up to December 2022, (N=296) with breast lesions for FNAC were included in the study. All the cases were divided into five categories as per the newly proposed IAC Yokohama reporting system. The risk of malignancy for each category was determined and diagnostic efficacy was evaluated. Results: The sample were distributed as follows: insufficient material 4.39%, benign 66.21%, atypical 10.47%, suspicious for malignancy 1.35% and malignancy 17.56%. Histopathology was obtained in 88 cases, out of which 82 (93.18%) showed concordant diagnosis. The sensitivity and specificity were 85.71% and 98.11% respectively. Risk of malignancy (ROM) in each category was as follows-benign (0.01%), atypia (71.4%), suspicious (100%) and malignancy (96.66%) respectively. Conclusion: The high efficacy of FNAC obtained in the present study, when IAC Yokohama reporting system was applied, confirms the usefulness of this scheme in reporting breast lesions. A risk-based stratification is essential in the present era to guide and alert the clinician about the subsequent management plan and the ROM.

Background: Hypertension is a major health issue in India and it has led to increasing incidences of target organ damage including hypertensive retinopathy (HR). Many factors like platelet activation show influence in levels of HR. Mean platelet volume (MPV) being an indicator of platelet activation can help in predicting the severity of HR. The present study was planned to find a correlation of levels of MPV with the severity of HR. Methodology: Data of 100 cases of hypertensive retinopathy aged 31 to 80 years diagnosed by direct and indirect ophthalmoscopic examination in the outpatient department of ophthalmology was recorded and reviewed. Complete clinical and demographic data (age, gender, weight, body mass index and socioeconomic status) was noted. Mean platelet volume was obtained from fully automated haematology analyser Horiba medical Yumizen H550. Results: The mean age (years ± standard deviation) of cases with grade 1 HR was 59.448±11.642, grade 2 HR was 56.166±10.0377 and grade 3 HR was 58±19.37. The mean value of MPV in the study population for grade 1 HR was 8.55±0.576, for grade 2 HR was 9.17±0.8224, for grade 3 was 9.6±1.5594. The comparison between grades of HR and levels of MPV was done by one way analysis of variance. Conclusion: We established a significant relationship between mean platelet volume and severity grades of hypertensive retinopathy. MPV a cheap and easily available biomarker can be used for predicting severity in hypertensive retinopathy.

Background: The spread of COVID-19 infection paved way to many admissions into hospitals worldwide exhausting the healthcare systems. A simple test for immediate stratification of risk in patients with infection by COVID 19 virus is important. Aim in this study was to know the prognostic value of neutrophil to lymphocyte ratio (NLR) in determination of the severity of infection in COVID-19 infected patients. Methods: This study was conducted in a tertiary care institute, Mandya. Clearance from Institutional Ethical committee was taken. Data from 108 COVID-19 infected hospitalized patients between April 2021 and June 2021 were collected retrospectively from hospital records. Patients in the study were grouped into two groups as Intensive Care Unit (ICU) and Ward (Non ICU) patients, based on admission into ICU. The patient’s demographic characteristics, comorbidities, clinical manifestations, medications used and investigations done initially during admission were noted from the hospital files for both groups. Chi-square test/ Fisher's exact test was used for comparison of categorical outcomes. Statistical significance was noted if P value < 0.05. Results: Of 108 patients, 25 patients (23.15%) had ICU admission. Patients aged >55years had more ICU admission (44%) than non-ICU admissions (22.89%). In patients <55years non-ICU admissions were more (77.11%) compared to ICU admissions (56%). Leukocytosis, neutrophilia, lymphopenia, high CRP values were seen more in patients in ICU than in ward and is significant statistically (p <0.05). High NLR values were seen in patients in ICU than in ward. Chi-square test is significant (p < 0.05). Conclusion: Increased NLR predicts the severity of infection in patients infected with COVID-19 virus, who will require admission into ICUs. It can be used as a biomarker which can aid in identifying severe COVID 19 infection.

Introduction. Hydatid cyst, caused by Echinococcus granulosa, occurs rarely in the musculoskeletal region. Most of the time, clinically and radiologically it is diagnosed as a soft tissue tumor, benign or malignant. There are a few case reports of hydatid cyst presenting as an intramuscular thigh mass, which has been diagnosed at fine needle aspiration cytology (FNAC). Accurate preoperative diagnosis is essential in view of specific therapeutic options for this disease. Here we report a case of hydatid cyst occurring in an unusual location (thigh) and masquerading as a soft tissue tumour, diagnosed at FNAC. Case Report. 56-year-old male patient presented with gradually increasing swelling of the left thigh since 3 years. On examination, there was a firm non-tender 25 x 20 cm swelling on the posterior aspect of left thigh extending from the gluteal region to five cm above the knee joint. An ultrasound diagnosis of a soft tissue tumor was made. At FNAC, fluid was aspirated and smears showed granulomas along with multiple hyaline acellular membrane-like fragments, few showing vague laminations. A diagnosis of hydatid cyst was made at FNAC which was corroborated at histopathology. Conclusion. Intramuscular hydatid cyst of the thigh is a very rare manifestation. The possibility of hydatid cyst should be considered while aspirating any soft tissue mass lesion, especially when fluid is obtained and microscopy shows acellular hyaline membrane-like material, even when fewer laminations are noted.

Introduction: Fine needle aspiration cytology (FNAC) is a valuable diagnostic tool in evaluation of mass lesions. One of the major limitations of FNAC is the need for repeat aspiration which imposes workload on the laboratory and stress on the patient as well as on the aspirator. There are only few studies which have focused on the issue of repeat aspiration especially the factors associated with repeat FNAC. Aim: Present study was conducted with the aim to determine the factors associated with repeat FNAC. Materials and Methods: This was a retrospective, analytical laboratory audit of 350 repeat FNAC over a duration of two years. Age, sex, site of FNAC, reasons for repeat and outcome of repeats were recorded. Reason for repeat and final outcome of repeat FNAC were considered as outcome measures. Results: Repeat FNAC accounted to 20.94% (350/1671) of all FNAC performed. Maximum number of repeat FNAC were from thyroid 96/351 (27.4%) followed by soft tissue 86 (24.6%) and breast 81(23.1%). The outcome of repeat FNAC were diagnostic in 279 (79.7%), non-diagnostic 47 (13.4%) and loss of patient follow-up in 24 (6.9%) cases. Reasons for repeat were inadequate aspirates in 223 (63.7%), nonrepresentative material in 118 (33.7%) and suspicious cells to be repeated in 9 (2.6%). Logistic regression analysis revealed that organ of FNAC, month of FNAC and reason for repeat FNAC were independent variables linked with outcome of FNAC. Conclusion: FNAC as an investigative modality has immense diagnostic utility and this potential is fettered by inadequate aspirates and descriptive reporting in certain cases. The tricky cases were often encountered in thyroid, soft tissue and breast lesions. Regular audit of repeat FNACs gives us an insight into conditions where a diligent and meticulous approach is required. Keywords: Fine needle aspiration, Cytology cytology in low resource setting.

Orbital aspergillosis masquerading as lymphoma diagnosed by cytology – A case report - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/2394-6792.2019.0027, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Primary follicular lymphoma (PFL) of gastrointestinal tract (GIT) is rare and account for 1%-3% of non-Hodgkin lymphoma. Within the small intestine, the PFL is more common in jejunum than in the ileum. Due to low prevalence of the disease, the clinical manifestations are not well known, and diagnosis is usually delayed leading to complications. We herein report a case of PFL of GIT who presented with intestinal obstruction and unique gross morphology. Diagnosis was made by morphology and supported by immunohistochemistry.

Objective: The main objective of this study was to assess the lipid profile in prehypertensives and compare it with that of normal subjects and to study the co relation of blood pressure with lipid profile. Methods: We conducted a cross sectional study on 50 prehypertensives and 50 normotensive subjects. Blood pressures were recorded and serum lipid profiles were measured and compared using student t test. Correlation between blood pressure and serum lipid profile was done. Results: The study results showed significant increase in total cholesterol, LDL, VLDL, Triglyserides in prehypertensives compared to normaltensives. While decrease in HDL value was seen in prehypertensives compared to normaltensives. And there was a significant correlation between blood pressure and lipid profile. Conclusion: Lipid profile is altered in prehypertensives compared to normal. So analysis of lipid profile in pre hypertensive individuals will serve as a useful tool for monitoring adverse cardiovascular outcomes. Key words: Lipid profile, Hypertension, Prehypertension

Objective: The aim of this study is to investigate, primarily, the effectiveness of the application of pattern-based analysis in the diagnosis of salivary gland (SG) lesions. Secondarily, an attempt was made to study the cytomorphology of the various lesions in detail and discuss the pitfalls and solutions involved in the challenging conditions at cytology. Materials and Methods: This was a prospective, cross-sectional study. All SG lesions over 2 years were subjected to fine-needle aspiration cytology with patients' prior informed consent. The lesions were classified based on the predominant pattern, and a provisional diagnosis was made. The secondary pattern and other features, such as background, were then taken note of, and a combined cytological diagnosis was rendered. The entire spectrum of lesions was divided into 6 morphological categories. Results: We had a total of 72 SG lesions. The most commonly affected gland was the parotid gland in 79.16% (57/72) of the cases. Surgery was performed in 26 cases (36.11%). A concordant diagnosis was obtained in 22 cases. The sensitivity, specificity and diagnostic accuracy by the pattern-based approach was 75, 100 and 88.46%, respectively. There were no false-positive cases, but 2 false-negative cases were recorded. Conclusion: The precise cytological preoperative diagnosis of SG lesions is important for the management of patients. The pattern-based approach can be used routinely in the cytological diagnosis of SG lesions.

Objective: To determine the efficacy of Nucleated Red blood cell count in the Early diagnosis of neonatal sepsis. Material and Methods: Cross sectional diagnostic study conducted over a period of 1 year from Oct 2013 to Sept 2014, which included 60 neonates with clinical suspicious of sepsis at birth and within 72 hours or had maternal history of infection. The cord blood was collected immediately after delivery for NRBCs count under peripheral smear. Statistical analysis was performed and Sensitivity, specificity, positive predictive value and negative predictive value was calculated. Result: NRBCs count was higher in all sepsis cases. Sensitivity of NRBc for detecting proven sepsis was 35%, its specificity 53.48%, its positive predictive value was 23.07% and its negative predictive value was 67.64%. Conclusion: It is a simple and cost effective test in early diagnosis of early neonatal sepsis. It will help the clinicians in early diagnosis and treatment whenever applicable, thereby reducing the neonatal morbidity and mortality. Keywords: Nucleated red blood cells, Early onset neonatal sepsis, Blood culture, Hematological parameters.

Benign Triton tumours are exceedingly rare tumours occurring predominantly in young children. Fewer than 20 cases have been reported in literature. The tumours develop as masses in various large nerve trunks, the most common of them being the brachial and the sciatic. They are very rarely encountered in the head and neck region. Neurological symptoms may manifest due to their strategic locations. Various case studies in literature support their benign nature. Early diagnosis and complete excision avoids deformities and other associated complications. We present one such rare case of benign triton tumour of the head and neck region in a 10 year old female child who presented with a diffuse nodular swelling in the upper lip involving the philtrum and extending upto the left ala of the nose along with a brief review of literature.

Primary mucinous eccrine adenocarcinoma, a rare malignant neoplasm of the skin adnexa usually occurs in the head and neck region. The most common sites for its occurrence are the eyelid, the peri-orbital region and the scalp. We report the rare occurrence of primary mucinous eccrine adenocarcinoma of the inguinal region which has been reported in only 1% of cases according to literature search. Since the differentiation from metastatic mucinous carcinomas is difficult, a careful search for primary in the breast, gastrointestinal tract and prostate is mandatory.This case report highlights the importance of precise diagnosis and accurate histological typing of mucinous carcinomas with an emphasis on their role in appropriate patient management along with a brief review of literature.