BREAST

Anukriti Subhagya, Ariba Zaidi, Anurag Gupta; Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India Introduction: Meningioma is the most common extracerebral intracranial tumour. Rarely, these lesions can occur extracranially and present as a cutaneous lesion. As the incidence is low, this neoplasm can be overlooked during the differential diagnosis of scalp masses. These lesions being easily accessible, FNAC aids in a minimally invasive and a rapid preoperative diagnosis. Objectives: To establish the role of FNAC in early diagnosis of primary cutaneous meningioma To correlate cytological diagnosis with histopathology and radiology. To establish the role of FNAC in early diagnosis of primary cutaneous meningioma To correlate cytological diagnosis with histopathology and radiology. Case Series: All consecutive cases of scalp meningioma presented for FNAC between 2020-2024 at Department of pathology were included. A total of 4 cases were identified. 2 patients were males and 2 were females. The average age of presentation is 53 years. All the cases presented with chief complaint of scalp swelling with an average duration of 3 years and 2 of them had history of trauma. A similar morphology was observed in all cases. Smears are moderately cellular with clusters of atypical cells arranged in syncytial whorls. The cells are polygonal to ovoid with bland ovoid nuclei showing occasional intranuclear inclusions and moderate pale cytoplasm. Occasional psammoma bodies are noted. The diagnosis of FNAC was correlated with radiology and histopathology. 1 patient recovered completely post treatment, 2 patients died and 1 patient was lost to follow-up. Conclusion: FNAC being a simple technique can be helpful to aid in the early diagnosis of such rare neoplasm, distinguishing these from other entities occurring at the same site. An early diagnosis is important for deciding the course of treatment and reducing the risk of avoidable complications due to open biopsy at this vital site.

Akanksha, Gajendra Yadav, Arvind Kumar; Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India Introduction: Epithelial ovarian neoplasms are the most common subtype of ovarian tumours and represent a significant cause of morbidity and mortality in gynaecological malignancies. Accurate histopathological diagnosis is crucial for formulating appropriate management strategies and enhancing patient outcomes. Aim and Objective: This study aims to assess the diagnostic performance of intraoperative imprint cytology in absence of intraoperative frozen section (IFS) in differentiating epithelial ovarian neoplasms in resource limited setting. Methods: A prospective study was done on 55 cases of clinically and radiologically diagnosed ovarian tumor. Imprint smears were made intraoperatively from fresh samples and stained with M.G.G. stain for air dried smears and Papanicoloau stain for alcohol fixed smears. Stained smear was assessed and compared with subsequent histopathology report. Results: In our analysis, imprint cytology identified 58.2% of cases as benign, 21.8% as suspicious, and 20% as malignant while frozen section identified, 58.2% of cases as benign, 12.7% as suspicious, and 29.1% as malignant. On comparing frozen with imprint Out of 32 benign cases in frozen section, 3 (9.37%) cases were reported as suspicious on imprint cytology. Out of 7 borderline cases, 2 cases were reported as benign on imprint cytology (28.57%). Out of 16 malignant cases, 4 (25%) cases reported as suspicious and 1 (6.25%) case as benign on imprint cytology. Conclusion: A comprehensive understanding of cytohistological correlation in ovarian imprint cytology has the potential to obviate the need for cryostat use in intraoperative diagnosis, thereby providing significant advantages in resource-limited settings.

Brij Mohan Kumar Singh, Anuradha C K Rao, Deepak Nayak; Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India Introduction: Despite the success of various methods in imaging techniques and biochemical parameters in evaluating hepatobiliary malignancy, several non-malignant conditions may closely mimic malignancy. Differentiating these benign conditions may be difficult in chronic parenchymal liver disease (CLD) in the presence of a solitary nodule on radiology. Objective: To outline the diagnostic challenges of liver nodules in the background of CLD on FNAC. Case Report: A 74-year-old male was normal until 15 days ago when he started developing fatigue and weight loss (unquantified). There was no history of fever, jaundice, pallor or untoward upper or lower GI symptoms. The biochemical parameters including AFP were within normal range. CT abdomen revealed a lesion in the liver measuring 1.8X1.2X0.7 cm in the background of CLD, suggesting a neoplastic aetiology (LIRADS 5). The lesion underwent a guided FNA. FNAC showed hypercellular broad clusters of atypical hepatocytes with occasional clusters showing endothelial wrapping. The individual cells appear monotonous with granular cytoplasm, and mildly enlarged nuclei in the background of bile ductular proliferation. The possibility of well-differentiating hepatocellular carcinoma (HCC) was suggested, based on cytomorphological features. Further, the patient underwent a guided tru-cut biopsy from the lesion, revealing features of a regenerative nodule in the backdrop of cirrhosis-like features. Discussion and Conclusion: Diagnostic challenge associated with liver cirrhosis includes the distinction of well-differentiated HCC from benign nodules in the liver. A regenerating nodule or a dysplastic nodule is a common finding in CLD, mimicking HCC on FNA. Dysplastic nodules, FNH (focal nodular hyperplasia)-like nodules and hepatic adenoma can undergo morphological changes mimicking malignancy due to fibrosis, inflammation and vascular obliteration in CLD. FNH-like nodules also show endothelial wrapping of the cellular cluster which can be misleading both in radiology and FNA. Finally, the optimum result depends on a cordial conversation between a radiologist and a cytopathologist.

Suramya Jain, Vaishali Walke, Hemlata Panwar, Sumit Raj; Department of Pathology and Lab Medicine, AIIMS, Bhopal, Madhya Pradesh, India Introduction: Ewing sarcoma, a highly malignant bone tumor, typically affects the pelvis and long bones of the lower extremities in children and young adults. Primary involvement of skull bone is rare and accounts for approximately 1% of all Ewing sarcomas that include temporal bone which is most common, followed by frontal and parietal bones. We report a rare case of Ewing sarcoma which presented as a bosselated scalp mass in frontal region in a schoolgirl, with soft tissue extension posing a challenge to pathologist. Objective: To study the cytomorphology and acknowledge the diagnostic difficulties encountered while dealing with common tumors at unusual locations. Utility of comprehensive approach and ancillary tests in solving the diagnostic intricacies as in the present case. Case Report: A 15 year girl presented with rapidly growing scalp mass with complain of headache since 12 months. CT scan revealed a large mass arising from cranial vault with extracranial and intracranial component measuring 14x5x6.2 cm and 8.0x5.3x5.4 cm respectively. Osteosarcoma and Ewing sarcoma were the possibilities. Squash cytology showed discohesive, small groups and singly scattered round cells. They exhibited minimal pleomorphism, scant cytoplasm, enlarged nuclei with fine chromatin and inconspicuous nucleoli. Mitosis was brisk. Areas of necrosis and inflammation were noted. The diagnosis of malignant round cell tumor was considered. Histopathology further confirmed and was supported by immunohistochemistry panel of LCA, CD99 and FLI-1. Bone marrow examination revealed bilateral metastasis. FISH testing revealed t (11;22). The symptoms regressed after surgical resection. Conclusion: Ewing sarcoma, a rare entity, should be included in the diagnostic armamentarium while managing an invasive skull tumor. Early diagnosis with comprehensive approach of radiological, cytomorphological and histopathological examination with ancillary tests ameliorates the prognosis. Multimodal approach including surgery, radiotherapy and chemotherapy protracts patient survival.

Sneha Chauhan 1 , Shalini Bhalla 1 , Ajay Kumar Singh 2 , US Singh 1 ; 1 Department of Pathology, King George’s Medical University, Lucknow, India, 2 Department of Surgical Oncology, King George’s Medical University, Lucknow, India Introduction: Cutaneous metastasis from internal malignancies is rare. Cutaneous metastasis commonly occurs in breast cancer, lung cancer, colorectal cancer, ovarian cancer, and other tumors (1), while cutaneous metastasis of gastric cancer is extremely rare. Case: A 65yr male presented with infraumblical swelling from past 1 -1.5 months. On Fnac smears were cellular displaying clusters , sheets and singly scattered atypical cells. Our patient had a past history of recurrent UTI and urgency for which he was investigated. Biopsyhas features favouring prostatic adenocarcinoma, Gleason Grade 4. The patient complained of significant weight loss of 5 to 10 kgs in a month, multiple episodes of vomiting , with loss of appetite and gastroesophageal reflux, with no relief with PPIs. Endoscopy was performed which showed large ulceroproliferative growth in corpus and extending to involve antrum and pylorus causing luminal narrowing. An endoscopic biopsy from stomach was done which revealed features favouring poorly differentiated carcinoma infiltrating the muscularis mucosae. FNAC donepresently from infraumblical swelling showed metastatic adenocarcinoma, to search for primary, cell block was prepared , immunohistochemistry with EMA, PSA was done, PSA was negative, EMA was positive, therefore a diagnosis of metastatic adenocarcinoma from Carcinoma stomach was made. Discussion: The incidence of cutaneous metastasis from gastric cancer is considered lower than 0.7 %. Gastric cancer (GC) is a highly heterogeneous disease, and the typical sites of metastasis are the liver, lung, bone, and the peritoneum. There is no case of dual malignancy of gastric and prostate carcinoma presenting with a cutaneous metastasis .We report the first case of dual malignancy with cutaneous metastasis. Conclusion: Cutaneous metastasis from gastric cancer usually manifests as an emerged nodule or erysipelas-like skin lesion. FNAC is a rapid and safe technique that can be used as a first line of investigation for confirmation of metastatic lesions of the skin. Critical evaluation of cytomorphological features along with relevant clinical details could help in the localization of an unknown primary site in some cases.

Mona Lisa 1 , Nikhil Kumar 1 , Sanjeet Kumar Singh 1 , Amit Kumar 2 , Tirumala Sripati 2 ; 1 Department of Pathology and Lab Medicine, AIIMS, Deoghar, Jharkhand, India, 2 Mahavir Cancer Sansthan, Patna, Bihar, India Introduction: ALK- positive Anaplastic large cell lymphomas (ALCL) are a group of mature T-cell lymphomas. We present two cases of ALCL with unusual presentation – one with extensive cutaneous involvement and the other with bone marrow and peripheral blood involvement. Case Report: Case 1: An eight-year-old child was brought to the emergency department with fever, breathlessness, and multiple cervical lymphadenopathies. Peripheral blood smear revealed 60% atypical cells having multiple small vacuoles in the cytoplasm. A provisional diagnosis of acute leukemia was made. Bone marrow aspiration also revealed similar atypical cells. Cervical lymph node FNAC was also done. The smears reveled occasionally scattered pleomorphic cells having hyperlobated nuclei, small nucleoli, occasionally having fine cytoplasmic vacuoles, in a background of reactive lymphoid cells. Immunohistochemistry of the marrow biopsy revealed that these cells were CD 30 and ALK1 confirming the diagnosis of ALCL. Case 2: A 28-year-old male presented at an outside facility with cervical lymphadenopathy and was initially diagnosed with a granulomatous lesion. He was given a dose of antituberculosis therapy, after which he developed multiple large nodules on the skin, all over his body. At this stage, he was referred to AIIMS Deoghar. Fine-needle aspiration cytology of the cervical nodes and skin nodules was performed. Both lesions revealed occasional atypical cells with reniform nuclei in a background of reactive lymphoid cells. Occasional granulomas were also noted in the lymph node smears. A skin biopsy was then conducted, which showed diffuse infiltration of intermediate to large, atypical cells in the sub-epidermis. These cells were also found infiltrating the epidermis. Immunohistochemistry confirmed the diagnosis of ALK-positive ALCL. Bone marrow examination was unremarkable. Conclusion: These two cases emphasize the importance of recognizing the atypical clinicopathological presentation of ALCL which is crucial for the proper management of these cases.

Anchi Kumawat, Sudeep Khera, Poonam Abhay Elhence, Aasma Nalwa, Meenakshi Rao, Deepak Vedant, Vikarn Vishwajeet, Divya Aggarwal, Vikrant Verma; Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Background: Peritoneal fluid cytology plays a critical role in the evaluation of various intra-abdominal pathologies. As a minimally invasive diagnostic tool, cytology allows for the examination of cells within the peritoneal cavity, providing valuable insights into the underlying disease processes. However, the accuracy of cytological analysis can vary, making it essential to compare its findings with histopathological examination, which is often considered the gold standard. Aim: This study aims to assess the diagnostic accuracy of peritoneal fluid cytology and its correlation with histopathological results to enhance diagnostic reliability and clinical decision-making. Materials and Methods: This study is a retrospective study of one-year duration. The cases included all the peritoneal fluid samples received in the Department of Pathology & Lab Medicine at AIIMS Jodhpur, from July 2023 to June 2024 and compared with the corresponding histopathological specimens. Results: A total of 988 peritoneal fluid samples were studied, encompassing patients aged 1 to 84 years. The cytology smears were categorized according to the International System for Reporting Serous Fluid Cytopathology (TIS) guidelines as follows: 65 (6.57%) cases were non-diagnostic, 854 (86.4%) cases were negative for malignancy, 14 (1.41%) cases showed atypia of undetermined significance, 7 (0.7%) cases were classified as suspicious for malignancy, and 48 (4.86%) cases were positive for malignancy. Histopathological specimens were obtained for 157 cases, of which 82 (52%) cases demonstrated concordance with the histological diagnosis. Conclusion: This study was conducted to evaluate the efficacy of cytological examination of peritoneal fluid in various pathologies. We found that a definitive diagnosis can be achieved through cytological analysis combined with histopathological findings, ensuring more reliable detection of malignancies and other pathologies.

R Sri Devi, Arvind Kumar, Ashok Singh, Prashant Durgapal, Sanjeev Kishore, Ravi Hari Phulware; Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India Introduction: Granulomatous mastitis (GM) is a rare and challenging condition characterized by inflammation of the breast tissue and can mimic other breast pathologies. Tuberculosis, foreign body reactions, fungal and parasitic infections, and autoimmune diseases can cause GM. Objectives: This case series aims to assess the spectrum of granulomatous mastitis on fine-needle aspiration cytology (FNAC) smears and its histopathological correlation. Case Series: A retrospective analysis was carried out on 30 cases of GM diagnosed through histopathological and cytological examination over 3 years (2022 – 2024). Key features compared included the presence of necrosis, epithelioid histiocytes, epithelioid granulomas, Langhans type of multinucleated giant cells, lymphocytic infiltration, epithelial component, and associated cytological atypia, if any. The most prevalent age group affected is second decade of life 12 cases followed by 10 cases in third decade of life. Ten cases included the right breast, while twenty cases featured lesions on the left. Clinical diagnosis ranges from suggestive of cancer to benign breast abscess. Thirteen instances displayed necrosis, seventeen cases displayed multinucleated Langhans-type giant cells, and fourteen cases displayed epithelioid granulomas. Lymphocytes (76.6%), neutrophils (53.3%), histiocytes (53.3%), and plasma cells (20%) were among the inflammatory cells. Two cases reported as category I –inadequate/unsatisfactory for opinion and one case reported as category III - atypical probably benign. Rest Twenty seven cases show histopathological concurrence. The histological and cytological results showed a strong association, suggesting that granulomatous inflammation was correctly identified. Conclusion: The study reveals that cytopathological and histomorphological evaluations are complementary in diagnosing granulomatous mastitis. The correlation between these diagnostic modalities supports their combined use for accurate diagnosis. FNAC is a reliable and minimally invasive tool to diagnose granulomatous mastitis and rule out clinicoradiological suspicion of malignancy. Careful examination of cytological smears can prevent unnecessary biopsy in granulomatous lesions of breast.

Anju Khairwa, Sonal Sharma, Sowmya Balu; Department of Pathology, University College of Medical Sciences and GTBH, Delhi, India Background: Granulomatous mastitis (GM) is a chronic inflammatory and rare pathology of breast. Clinically and radiologically, it mimics of carcinoma breast. GM mostly reported as tubercular (TB) mastitis, specially from India. Aims and Objective: The Aim of the present study to determine predictive factors of Idiopathic vs Tubercular GM. Methods: Data were retrieved from 2019 to 2023 from departmental archive. Cytomorphology suggested as idiopathic and tubercular granulomatous mastitis, further confirmed with histology, Ziehl-Neelsen (ZN) stain and therapeutic response. Two groups (idiopathic and TB GM) were compared for risk stratification. Results: A total 24 cases of GM included in study on cytomorphology, out them histology correlation available in 17 cases. The age was Mean±SD 29±5.7 years of involved patients. Female: Male ratio was 10.5:1. ZN stain positive in three cases and therapeutic response available 17 cases. Out of 17 cases, 5 cases were responded with ATT and 12 cases were responded with steroids. Cytomorphology revealed only granuloma in one case, granuloma with plasma cells and neutrophils infiltration in 13 cases, granuloma with necrosis and giant cells in 07 cases, and granuloma with giant in 02 cases. 15 cases were idiopathic, and 09 cases grouped in TB GM. Student t test and Chi2 applied to assess predictive factor. Older age group, ZN stain positivity, cytology diagnosis of TB mastitis, cytomorphology of granuloma with necrosis and giant cells and therapeutic response to ATT, significantly (p-value-0.005) predict the TB over Idiopathic GM. On regression analysis cytology diagnosis for TB GM, FNAC pattern for granuloma with necrosis and giant cells, and therapeutic response for ATT were independently predictors (p- value< 0.05) for TB than idiopathic GM. Conclusion: GM of breast have many predictive factors. Cytomorphology can predict the TB and Idiopathic GM easily, rapid and avoid unnecessary surgery, till reports of ancillary technique available.

Savita Agarwal, Sunita K Meena, Pinki Pandey, Alka Yadav; Department of Pathology, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India Introduction: Breast lumps are amongst the commonest swellings subjected to fine needle aspiration cytology. A variety of lesions ranging from inflammatory to neoplastic pathologies are frequently encountered on cytopathological examination. For the reporting of cytopathology smears from various sites such as thyroid, lung, lymph nodes, salivary glands, serous fluids, and breast, diagnostic categorization systems have been introduced that have multiple categories with estimated risk of malignancies (ROM). The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology (IAC YSRB) has been introduced for reporting of breast cytology. The success of these systems is also dependent upon the degree of interobserver agreement for the proposed categories. Like other systems, IAC YSRB also carries variability in interobserver agreement introducing inconsistencies in the interpretation. However, the interobserver agreement has not been widely studied for IAC YSRB. Aim and Objectives: To study the interobserver agreement in the application of IAC YSRB. Materials and Methods: All FNAC breast cases reported between May 2014 and May 2024 were categorized according to IAC YSRB by four cytopathologists blinded to previous cytologic and/ or histopathologic diagnoses of the cases studied. Observed agreement was measured and statistical analysis was carried out. Results: A total of 3321 breast FNAC cases were subjected to categorization by IAC YSRB by four cytopathologists. Overall good interobserver agreement was observed. The majority of diagnoses were concordant. Discordant diagnoses ranged from a single category difference to 3 categories. Agreement varied by diagnostic category which was highest for the benign category and lowest for the suspicious category. The common diagnostic discrepancy was between the diagnoses of atypical or benign categories. Conclusion: Accurate communication between cytopathologists and clinicians is crucial for appropriate treatment based on classification. To link cytological specimens with clinical nd negative in two, with both results matching histopathology findings, demonstrating 100% sensitivity, specificity, positive predictive value, and negative predictive value.

Madhu Kumar, Anjana Shankhwar, Pankaj Gautam; Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India Introduction: Secretory carcinoma (SC) of the breast is a rare variant of breast cancer, comprising less than 0.15% of all invasive breast carcinomas. It is typically slow-growing with an indolent clinical course. The presence of the ETV6-NTRK3 fusion gene is characteristically seen in majority of the cases and is useful in differentiating it from acinic cell carcinoma (ACCA). We report a case of secretory carcinoma in an elderly woman on fine needle aspiration cytology (FNAC). Objectives: To study secretory carcinoma breast and its clinico-radiological and cytohistological correlation. Case Report: A 71-year-old woman presented with a right breast lump, mild pain, and itching for the past year. On FNAC diagnosed as low-grade infiltrating breast carcinoma, possibility of secretory carcinoma breast. Cytosmears are hypercellular, tumor cells arranged in sheets and clusters, individual tumor cells are round to polygonal in shape with granular to vacuolated cytoplasm with secretions. The right modified radical mastectomy specimen, revealed two firm, well-demarcated masses with distance of 1.0 cm, and with pushing borders. Sections revealed malignant neoplasm with microcystic, tubular pattern with low mitotic counts. Out of 17 identified lymph nodes, 5 were infiltrated by similar tumor cells. ER and PR were weakly positive, Her2neu was negative, and S100 immunohistochemical markers were positive. Periodic Acid-Schiff stain-D was also positive in both intracellular & extracellular secretions. In the SC tumor cells have vacuolated cytoplasm with papillary and microcystic pattern, hyaline globule like material and in ACCA, tumor cells have clear cytoplasm. The final diagnosis was secretory carcinoma of the breast with axillary lymph node metastasis. Conclusion: SC is an exceptionally rare neoplasm and it is even rarer to occur in a 71 year old women with aggressive behaviour manifested by nodal metastasis. This case has distinctive histological features with multifocal tumor and mild expression of estrogen and progesterone.

Rohit Singh Jaggi, Sudeep Khera, Vikrant Verma, Poonam Abhay Elhence, V Vikarn, Deepak Vedant, Aasma Nalwa, Meenakshi Rao, Divya Agarwal; Department of Pathology and Lab Medicine, AIIMS, Jodhpur, Rajasthan, India Objective: Granulomatous mastitis (GM) is a rare, chronic inflammatory condition of the breast that can mimic malignancy, posing diagnostic challenges. Fine Needle Aspiration Cytology (FNAC) is a commonly employed diagnostic tool for breast lesions, but its effectiveness in diagnosing GM is variable. This study aims to evaluate the diagnostic utility of FNAC in cases of granulomatous mastitis. Methods: A retrospective analysis was conducted on FNAC cases of breast lesions diagnosed as granulomatous mastitis at our Institute from 2019 to 2024. Clinical, cytological, and histopathological data were reviewed. FNAC results were compared with histopathological findings to determine diagnostic accuracy. Results: A total of 15 cases of granulomatous mastitis were identified over a period of 5 years. Common cytological features included list of cytological features, e.g., epithelioid granuloma, multinucleated giant cells, foamy macrophages, necrotic debris. Histopathological correlation revealed concordance with FNAC findings mostly. Conclusion: FNAC is a useful diagnostic tool for granulomatous mastitis. Accurate diagnosis often requires correlation with histopathological examination and clinical context. Awareness of the cytological features of GM can improve FNAC diagnostic accuracy and guide appropriate management. Further studies are needed to optimize FNAC protocols and enhance diagnostic precision for granulomatous mastitis.

Veeraamarnath P 1 , Deepak Vedant 1 , Poonam Abhay Elhence 1 , Aasma Nalwa 1 , Meenakshi Rao 1 , Sudeep Khera 1 , Vikarn Vishwajeet 1 , Divya Aggarwal 1 , Vikrant Verma 1 , Ram Karan Chaudhary 2 , Jeewan Ram Vishnoi 3 ,Akanksha Solanki 4 , Parmod Kumar 5 ; 1 Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 2 Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 3 Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 4 Department of Radiation Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 5 Department of Medical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Background: Papillary lesions of breast are a wide spectrum of neoplasm which constitutes for less than 5% of benign breast neoplasm and 0.5-2% of all breast malignancies. FNAC (fine-needle aspiration cytology) diagnosis of papillary lesions is difficult, with benign and malignant lesions showing overlapping features. Hence when a papillary lesion is suspected prompt histological evaluation is warranted for accurate diagnosis. Aim/Objectives: This study aimed to compare the cytological and histopathological findings of papillary lesions of breast and assess the accuracy of FNAC in diagnosing Papillary neoplasm of breast. Material and Method: This study is a retrospective study done on all papillary lesions sampled with FNAC and compared with the corresponding histopathological specimens received in the Department of Pathology & Lab Medicine at AIIMS Jodhpur from 01 January 2021 to 31 July 2024. Observation/Result: A total of 16 cases of papillary lesions were included in the study. The ages of the patients ranged from 24 to 67 years. Maximum number of patients were in the 4th decades. Out of 16 cases, 09 cases have histopathological correlation. Out of 09 cases, 03 cases were diagnosed as papillary neoplasm on FNAC which turned out to be benign papillary lesions on histopathology. 06 cases were diagnosed as non-papillary lesions. Conclusion: Fine needle aspiration cytology (FNAC) is a widely utilized procedure for diagnosing breast masses due to its simplicity, cost-effectiveness, high accuracy, speed, and relative lack of discomfort. Hence, it was able to accurately diagnose the benign lesions which was histopathologically confirmed as benign papillary lesions.

E Sharumathi, Vikarn Vishwajeet, Poonam Abhay Elhence, Abhishek Purohit, Sudeep Khera, Meenakshi Rao, Aasma Nalwa, Divya Aggarwal, Deepak Vedant, Vikrant Verma; Department of Pathology and Lab Medicine, AIIMS, Jodhpur, Rajasthan, India Introduction: Fine Needle Aspiration Cytology (FNAC) has emerged as a preferred diagnostic tool for the preoperative evaluation of breast masses, offering high levels of diagnostic accuracy, sensitivity, and specificity. Aim and Objectives: The main aim of this study is to characterize the spectrum of benign breast diseases on FNAC and to correlate the cytological results with histopathological findings, whenever available. Materials and Methods: All cases of benign breast disease diagnosed on FNAC from January 1, 2023, to July 31, 2024, at AIIMS, Jodhpur. The findings were compared with histopathology diagnosis for diagnostic accuracy. Observation and Results: During the study period, a total of 270 patients had reported benign breast disease on cytology. Mean patient age was 30 years (range 17 to 56 years). Of these, fibroadenoma was the most common diagnosis (70.21%), followed by benign phyllodes (12.7%), mastitis (8.51%), fibrocystic disease (6.1%), and proliferative breast disease, unspecified in remaining cases. Histopathological evaluation was performed in 47 cases, and all these cases had benign morphology. None of the cases diagnosed benign on cytology proved to be malignant on histopathology. Conclusion: FNAC is a highly reliable tool in the assessment of breast lump for the differential diagnoses of benign from malignant tumor without any surgical intervention. It has advantage of being highly accurate in expert hands, cost-effective and can be done as an out-patient procedure.

Mona Jamwal, Poonam Sharma, Rajat Gupta, Abhimanyu Sharma; Department of Pathology, AIIMS, Jammu, Jammu and Kashmir, India Introduction: Filariasis is a tropical disease caused by a microscopic thread like parasite (Wuchereria bancrofti) living in the lymphatic system of body causing obstruction of the lymphatic vessels. The disease is prevalent in tropical regions, however in our country it occurs sporadically. The most commonly affected sites are legs but can also occur in arms and genitalia. Extranodal filariasis is rare and breast is an uncommon site for filariasis. Breast filariasis may be misdiagnosed as a breast tumor or cyst. Here we present an unusual clinical site of Filariasis in a patient with clinical complaint of breast lump. Case Description: A 36 year old female presented in Gynaecology OPD with complaint of lump right breast since 2 months. On examination an irregular lump, soft and mobile, measuring 2.5x2 cms in outer lower quadrant was noted. There was no history of lactation, nipple discharge or trauma. Axilla was unremarkable and the overlying skin was normal. The patient was advised routine haematological investigations, ultrasonography and Fine Needle Aspiration Cytology with a provisional diagnosis of Fibrocystic disease. Ultrasound revealed a cystic mass measuring 2x2 cms in lower quadrant at 7 o’ clock position. FNAC of lesion was done which yielded clear fluid. Microscopic examination of smears showed inflammatory cell infiltrate comprising of neutrophils, few lymphocytes and eosinophils. Numerous elongated and coiled microfilaria were also noted. Thus, a cytological impression of Filariasis breast was made. Peripheral blood smear of patient demonstrated presence of microfilaria. Conclusion: Clinicians and pathologists should be aware that filariasis can occur at unusual sites. Such an awareness will avoid missing the diagnosis and provide timely medication for filariasis. A high index of suspicion in FNAC smears, particularly in patient from endemic areas, should be kept in mind so as to avoid surgical measures.

Nishi, Mona Lisa, Nikhil Kumar, Ranwir Kumar Sinha, Prima Shuchita Lakra, Varsha, Niranjan Kumar, Amiy Arnab, Harishkumar Rameshkumar Bohra; Department of Pathology and Lab Medicine, AIIMS, Deoghar, Jharkhand, India Introduction: Breast lesions encompass benign conditions to malignant tumors, breast cancer being the most commonly diagnosed cancer among women worldwide, need early diagnosis.[ 1 ] Fine Needle Aspiration Cytology (FNAC) is an essential, simple, cost-effective, and minimal invasive diagnostic tool for evaluating breast lesions.[ 2 ] The International Academy of Cytology (IAC) introduced the Yokohama System to standardize the reporting of breast FNAC, categorizing specimens into five diagnostic categories: C1 (Insufficient material), C2 (Benign), C3 (Atypical, probably benign), C4 (Suspicious of malignancy), and C5 (Malignant). Objective: To explore the cyto-morphological spectrum of breast lesions and to categorize it according to the IAC Yokohama System at a tertiary care centre in Santhal Pargana, Jharkhand. Materials and Methods: The FNAC slides of 117 female patients undergone FNAC for breast lesions, were reviewed and categorized according to the IAC Yokohama System. Other data including demographic were also re-evaluated. Results: Cytomorphological findings of FNAC of breast lesions had a diverse spectrum, with a notable distribution of 2, 99, 5, 3 and 8 cases across C1, C2, C3, C4 and C5 categories respectively. Conclusion: The IAC Yokohama System is a valuable tool for standardized reporting of breast lesions.

Sachin 1 , Meenakshi Rao 1 , Divya Aggarwal 1 , Aanchal 1 , Rashim Sharma 1 , Jaskaran Singh Gosal 2 , Sarbesh Tiwari 3 ; 1 Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 2 Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 3 Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Introduction: Teratomas are rare germ cell tumors in the Central Nervous System (CNS) with more than one embryonic germ cell layer component and variable size distribution. Pigmented cells can be present in various CNS tumors like pigmented meningioma, primary leptomeningeal melanoma, primary and secondary malignant melanoma, neurocutaneous melanosis, teratomas, etc. In the absence of derivatives of all germ cell layers in the frozen section examination, diagnosis of teratoma can be challenging. We present a case of mixed germ cell tumor of the CNS (with 90% immature teratoma and 10% Yolk sac tumor component) in which pigmented cells were the only component of teratoma seen in the imprint smears, squash smears, and frozen sections. Case Report: A 6-year-old girl presented with complaints of vomiting and headache for a week, with decreased appetite. The biochemical assay revealed an AFP of 546.6 IU/L and hCG of 262.59. CECT showed a solid cystic mass with few punctate calcifications in the suprasellar region, likely craniopharyngioma. CE-MRI showed heterogenous post-contrast enhancement with mass effect and internal hemorrhage, likely pituitary macroadenoma with apoplexy and craniofacial fibrous dysplasia with encasement of the left optic nerve. Imprint smears, squash smears, and frozen sections, all showed the presence of pigmented cells. No definite diagnosis could be given on frozen section examination. However, the final histopathology showed a mixed germ cell tumor, with a 90% immature teratoma component with a 10% yolk sac tumor component. The sections from separately sent tissue labeled as dysplastic bone showed features of fibrous dysplasia. Conclusion: In the appropriate clinico-radiological context, the presence of pigmented cells in a CNS tumor should raise the suspicion of teratoma, along with other differential diagnoses.

Pinki Pandey, Alka Yadav, Roopak Aggarwal, Savita Agarwal, Himanshu Joshi, Mohd Azfar Jamal, Neelshi Pandey; Department of Pathology, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India Introduction: Glial neoplasms called ependymomas make about 4-8% of primary CNS neoplasms. Because of their rarity and variability, there is a great deal of debate over their prognosis and care. Grading is infrequently detailed, despite the fact that intraoperative squash smear cytology is well recorded. Aim: To study cytomorphology of ependymomas using squash smear technique. Objective: To grade ependymomas according to WHO 2007 classification. Materials and Methods: This is a retrospective study, in which all cases of ependymomas diagnosed from 2012 to 2023 were retrieved and their intraoperative squash smears were studied. Observation and Results: Eight (grade I), thirty-two grade II, and thirty-two grade III (anaplastic) ependymomas were found in the histological sections of the 72 ependymomas that were classified according to the WHO 2007 classification. Of the sixty-six smears in which perivascular pseudorosettes were observed, twenty-six showed rosettes. The remaining smears displayed less cohesive cells at the periphery of fragments with unipolar cytoplasmic processes; the background was fibrillary in all except grade I ependymomas. Metachromatic material was found in globi and surrounding vessels in grade I ependymomas. All grade II ependymomas had smears that revealed epethelioid and tadpole cells. The smears of the grade III ependymomas showed cellular pleomorphism, mitoses, microvascular proliferation, intranuclear inclusions, calcification, and necrosis. Conclusion: To identify and grade ependymomas, squash smears are a dependable and economical method; nevertheless, they require a pathologist with competence in CNS pathology.

R Naveen Kumar 1 , Mainak Bhattacharjee 1 , Biswajit Dey 1 , Vandana Raphael 1 , Jaya Mishra 1 , Donboklang Lynser 1 , Yookarin Khonglah 2 , Evarisalin Marbaniang 1 ; 1 Department of Pathology, NEIGRIHMS, Shillong, Meghalaya, India, 2 Department of Radiology, NEIGRIHMS, Shillong, Meghalaya, India Introduction: Atypical teratoid rhabdoid tumors (AT/RT) of the primary central nervous system are extremely rare and aggressive tumors that usually appear in early childhood and infancy. Seldom have reports of it in adults been made. Objectives: To analyze cytology and histology of AT/RT with a cervical lymph node metastasis in adults. Case Report: A 20-year-old male presented with a 1-year history of swelling on the left side of his neck. Fine needle aspiration cytology followed by biopsy, and immunohistochemistry from the left cervical lymph node showed metastatic AT/RT. MRI brain showed a left posterior fossa swelling compressing the pons and cerebellum. Correlating cytomorphology along with immunohistochemistry and radiological features, a diagnosis of metastatic atypical teratoid/rhabdoid tumor from a central nervous system primary was made. Conclusion: The prognosis of AT/RT is extremely dismal if metastasis is discovered at the time of diagnosis, which occurs in 20% of cases. Rarely do CNS tumors metastasize to cervical lymph nodes. We present this rare tumour for unusual age presentation and metastatic location.

Shivangi Nayak 1 , Preeti Agarwal 1 , Manish Shukla 1 , Ram Kumar 1 , Chhitij Srivastava 2 , Ankur Bajaj 2 ; 1 Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India, 2 Department of Neurosurgery, King George’s Medical University, Lucknow, Uttar Pradesh, India Introduction: Central nervous system (CNS) embryonal tumours are rare, poorly differentiated neuroepithelial cancers that primarily affect children and encompass highly aggressive malignancies. The overlapping morphological characteristics of these lesions pose a diagnostic challenge more so in setting of Intraoperative consultation. These are commonly reported as round cell tumours and less is performed for their further typing on cytology. Aim and Objectives: We herewith present detailed squash cytological features of embryonal tumour with multi-layered rosettes (ETMR). Case Report: An eight months old male child presented with complains of excessive cry and irritability. These complaints had sudden onset. The parents also noticed that he had from past 15 days developed deviation of his mouth as well. His prenatal, neonatal history was largely unremarkable. MRI revealed enhancing soft tissue lesion in right cerebellopontine region which was compressing the brainstem and fourth ventricle. The child was undertaken for surgical resection with clinic-radiological diagnosis of medulloblastoma. Intraoperative squash was performed. Two soft tissue pieces were received measuring 0.5x0.8x0.4 cms in dimensions collectively. The tissue was readily squash able. Haematoxylin and eosin stained smears were cellular and displayed largely monomorphic round cells disposed in papillaroid structures. Background displayed necrosis, no fibrillary material was seen. The papillaroid structures exhibited unusual clinging in three-dimensional forms, and upon closer examination, multi-layering was observed. On histology the tumour cells were disposed in sheets with presence of both true and pseudo rosettes displaying cellular multi layering. Individual tumour cells were characteristically round with hyper chromatic nuclei, inconspicuous nucleoli and scant cytoplasm. GFAP, CD99 and vimentin were positive in tumour cells and synaptophysin and EMA were negative. Conclusion: With immunohistochemistry ruling out medulloblastoma and ependymoma the case was diagnosed as EMTR. The present case highlights the cytological features of EMTR and supports that suggestion of EMTR could have been made on squash as well.

Rashim Sharma 1 , Shrilatha 1 , Poonam Abhay Elhence 1 , Aasma Nalwa 1 , Meenakshi Rao 1 , Sudeep Khera 1 , Deepak Vedant 1 , Vikarn Vishwajeet 1 , Divya Aggarwal 1 , Vikrant Verma 1 , Deepak Kumar Jha 2 , Suryanarayanan Bhaskar 2 , Sarbesh Tiwari 3 ; 1 Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 2 Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 3 Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Introduction: Squash smear and imprint cytology is a rapid, simple technique used for diagnosing and screening central nervous system (CNS) lesions. It is valuable in both resource-rich and resource-limited settings. Objective: This ambispective study aimed to compare and correlate the cytomorphology of CNS lesions with their final histopathological diagnosis. The study included cases from January 1, 2023, to July 2024. Case Series: The study evaluated 168 CNS lesions, with patient ages ranging from 9 months to 78 years. There were 87 males and 81 females, including 28 pediatric cases (9 months to 17 years). The lesions were distributed across different CNS regions: 15 in the spinal region, 8 intraventricular, 108 in the cerebral hemispheres, 15 in the cerebellum, pons, or posterior fossa, 11 in the sellar/suprasellar/sphenoid region, and 11 in the cerebellopontine angle. Histopathology (HPE) confirmed 30 meningiomas, of which 28 were identified by squash cytology; 2 cases were anaplastic meningiomas on HPE. Squash smears showing small round blue cell tumors included medulloblastomas, lymphomas, CNS neuroblastomas, Ewings/PNET, and pineocytoma. Schwannomas were diagnosed in 10 cases, but 2 were later confirmed as atypical meningioma and pilocytic astrocytoma (PA). Pleomorphic xanthoastrocytoma (PXA) was misdiagnosed as high-grade gliomas in 4 cases, with 2 being grade 3 on HPE. Other lesions included low-grade astrocytomas, ependymomas, oligodendrogliomas, and metastatic carcinomas. Germ cell tumors (GCT) were difficult to diagnose, requiring additional tests for confirmation. Discussion: The study highlighted the wide variety of CNS lesions diagnosed through squash cytology, with most centered in the cerebral hemispheres. Squash smears provided accurate diagnoses for meningioma and schwannoma, but challenges were faced in grading glial neoplasms and diagnosing GCT. Conclusion: Squash and imprint cytology offer rapid, efficient diagnostic value, requiring minimal tissue. However, it should be seen as a preliminary tool, with limitations acknowledged and mitigated through collaborative efforts among pathologists, neurosurgeons, and radiologists.

Shruti Gupta 1 , Pankaj Kumar 2 , Niraj Kumari 1 , Arvind Kumar 2 , Suyash Singh 2 ; 1 Department of Pathology and Lab Medicine, AIIMS, Raebareli, Uttar Pradesh, India, 2 Department of Neurosurgery, AIIMS, Raebareli, Uttar Pradesh, India Introduction: Intraoperative squash smear cytology is a simple and reliable aid for diagnosis of Central nervous system (CNS) lesions. This cytology tool that exploits the soft nature of various CNS lesions and guides in better patient management. Aim: To assess the utility and accuracy of intraoperative squash smear cytology in central nervous system lesions. Materials and Methods: A total of 60 cases of central nervous system lesions were analysed over a period of 24 months. Intra-operative squash smears were prepared from the fresh tissue sample and stained with Rapid hematoxylin and eosin staining method. The clinical details and radiological findings were noted. The report was conveyed within a turnaround time of 15-20 minutes. The residual tissue was then subjected for routine histopathology. Results: The intra-operative squash cytology diagnosis was correlated with definitive histopathology findings. The results were categorised in four categories: Complete concordance, partial concordance, discordant and deferred. Complete concordance was seen in 56.67 % cases, followed by partial concordance in 26.67 %. Discordance was noted in 12 % cases, while 5 cases were deferred. The overall diagnostic accuracy was 90.9% which included complete and partial concordant cases. There was major discordance in only 3 cases where treatment strategy was affected. Conclusion: Squash cytology is a rapid and economical tool for diagnosis of CNS lesions. A clinico-radiological corelation and awareness of cell morphology and background enables accurate intra-operative diagnosis.

Kriti Roy, Tanvi Jha, Prajwala Gupta; Department of Pathology, ABVIMS and RML Hospital, New Delhi, India Introduction: Ovarian neoplasms are the third leading cause of cancer-related deaths among women in India. Their subtle, nonspecific symptoms often lead to late-stage diagnoses, emphasizing the importance of early detection. Touch imprint cytology, a quick, cost-effective technique, provides valuable preliminary intraoperative information by capturing cell imprints for evaluation, thus assisting in differentiation of benign and malignant lesions. Objective: We report a case of ovarian neoplasm in a 48-year-old woman that was diagnostically challenging on ovarian imprint cytology and histopathology. Case Report: A 48-year-old female presented with intermittent lower abdominal pain, weight loss, and decreased appetite over six months. MRI pelvis revealed solid lesions in the bilateral adnexa with peritoneal deposits, suggestive of a metastatic Krukenberg. No atypical cells were detected in peritoneal fluid cytology. Among the biomarkers, CA 125 was raised. Bilateral salpingo-oophorectomy was performed, followed by total abdominal hysterectomy. Imprint smears were made from the ovarian tissue and they revealed presence of malignant cells. Frozen section analysis of the ovaries also showed malignant features and possibilities of malignant epithelial neoplasm and undifferentiated carcinoma were considered. Post-surgical sections revealed malignancy, prompting application of immunohistochemistry panel on both ovarian and bladder tissues. After thorough sectioning and review, differentiated areas of high grade serous carcinoma of the ovary were identified within a predominantly undifferentiated carcinoma. Conclusion: Touch imprint cytology is an effective diagnostic tool for identifying malignancy intraoperatively. However, at times, determining an epithelial origin may be difficult to diagnose on ovarian touch imprints when the imprints reveal the morphology of an undifferentiated carcinoma.

P Naseeha, Pinki Pandey, Alka Yadav, Roopak Aggarwal, Savita Agarwal; Department of Pathology, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India Introduction: Cervicovaginal infections are a significant public health issue in India, affecting many women. A study conducted by the ICMR found that reproductive tract infections, including cervicovaginal infections, affect around 30% to 40% of reproductive-aged women. The most prevalent organisms are bacterial vaginosis and candidiasis followed by trichomoniasis and high-risk HPV. Infections like chlamydia, gonorrhea, HSV, syphilis, and HIV have relatively lower prevalence rates but still pose significant public health challenges. The Pap smear is a vital, cost-effective tool for early detection of cervical infections and precancerous changes, reducing cancer risk. It’s a simple, quick procedure, ideal for rural settings with limited healthcare access. Aim and Objective: To study the cytomorphological spectrum of cervicovaginal infections and to determine the prevalence of specific infections in liquid-based Pap smears. Case Study: This was a retrospective study conducted over a period of 8.5 years. Out of the total number of 12735 pap smears examined during the 8.5 years, 684 cases were unsatisfactory for reporting and hence were excluded. Out of which, 9158 (76%) reported NILM, remaining 2893 (24%) were diagnosed with epithelial cell abnormalities and cervical cancer. Among the 9158 cases of NILM, 2985 (32.61%) smears were positive for specific pathogenic microorganisms. Out of, 2985 smears examined, 1809 (61%) were BV followed by 955 (32%) of candida infection. Trichomonas contributed to 157 (5.1%) cases, whereas in two cases (0.06%) each of tuberculosis and microfilaria were seen along with that 5(0.1%) case of Actinomyces and 1 (0.01%) case of HSV was seen. Mixed infection by Trichomonas and Gardnerella was seen in 42 (1.41%) cases and Candida and leptothrix contributed to 12 (0.4%) cases. Conclusion: This study will help clinicians by enhancing early detection and management of cervicovaginal infections with Pap smears. Patients will benefit from more accurate identification of abnormalities, personalized treatment, and increased awareness of cervical health, leading to better preventive care and more efficient use of healthcare resources.

K M Mayachi, Puneet Kaur, Uma Handa, Manveen Kaur, Poonam Goyal; Department of Pathology, Government Medical College and Hospital, Chandigarh, India Introduction: Endometriosis is defined as presence of an ectopic, hormonally active endometrium outside the uterus, affecting 1-7% of the women in reproductive age group. It is a relatively common lesion in pelvis and abdominal wall where it can occur following uterine surgeries and is referred as scar endometriosis. As it usually presents as a mass lesion causing a suspicion of neoplasia, fine needle aspiration cytology becomes the preferred diagnostic modality. Objective: To study the cytomorphological spectrum of scar endometriosis on aspiration cytology and its clinical correlation. Case Series: We report the cytomorphological spectrum of scar endometriosis in 5 cases, diagnosed by FNAC over a period of 2 years. The patients’ age ranged from 27 to 38 years, all of which presented with a nodule in the anterior abdominal wall located around the site of previous caesarean section scar. 2 of the cases also showed cyclical pain. The interval between surgery and onset of symptoms ranged from 1.5- 7 years. The cytological findings comprised of epithelial clusters and spindled stromal cells in all the cases. 3 cases showed haemosiderin-laden macrophages also. A diagnosis of scar endometriosis was rendered in all the five cases. Histopathology was done in 2 patients which was in concordance with the cytological reports. Conclusion: FNAC contributes as a safe, effective and reliable tool for the diagnosis of scar endometriosis thereby preventing the need for any surgical procedure. The importance of FNAC lies in excluding other causes of abdominal nodules especially the malignancies.

Suyasha Gautam, Swati Sharma; Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India Introduction: Pap smear examination is known to be the most sensitive test for screening cervical malignancies. Cytological smears are ideal cost effective, screening test for inflammatory, pre-invasive and invasive cervical lesions. They also detect atypical or malignant glandular cells, thus contributing in the preoperative identification of endometrial or endocervical carcinomas. Uterine carcinosarcoma is a highly aggressive neoplasm characterized by its biphasic nature and similar genetic alteration in both high-grade carcinomatous and sarcomatous components. In our case, the cytological examination played a crucial role in its early detection. Case Report: 68-year-old nulliparous female presented with postmenopausal minimal bleeding for 4-5 days. She underwent left ovarian cystectomy 27 years back and had attained menopause 18 years back. Ultrasound showed uterus measuring 7.4x 3.6x 4.1 cm and endometrial thickness 23 mm with heterogeneous echotexture and cysts. Adnexa/ovaries were normal. On per speculum, cervix was healthy. Cervical Pap smear showed atrophic changes along with few large bizarre cells with pleomorphic hyperchromatic nuclei and scant cytoplasm. A diagnosis positive for malignancy, suggestive of poorly differentiated endometrial carcinoma was given. Hysteroscopic polypectomy and endometrial curetting confirmed the diagnosis of endometrial carcinosarcoma. Conclusion: Uterine carcinosarcoma is a relatively rare but aggressive neoplasm. Endometrial cytological features of this tumour have been rarely reported. Pap smear can be an effective and minimally invasive diagnostic tool for its early diagnosis.

G Anju 1 , Meenakshi Rao 1 , Pratibha Singh 2 , V Hemalatha 1 ; 1 Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 2 Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Introduction: Pre-operative diagnosis of ovarian tumors can be challenging due to the limitations of clinic radiological work-up. Intraoperative squash smear cytology is useful for surgical decisions. Adult granulosa cell tumors (AGCTs) are a type of sex-cord stromal tumor; about one-third may present with concurrent endometrial hyperplasia. We report squash smear cytology challenges in a case of biopsy-proven endometrial endometrioid carcinoma (EEC) with suspicion of bilateral ovarian involvement. Objective: The role of cytomorphology in squash smears for diagnosing ovarian malignancies has not been extensively studied. So, squash smear cytology performed during frozen section analysis can be a valuable diagnostic tool. Case Report: A 54-year-old female biopsy-proven case of EEC. Imaging revealed a polypoidal growth in the endometrial and endocervical canal, as well as enlarged bilateral ovaries, suggesting bilateral neoplastic aetiology, likely involvement of bilateral ovaries. The patient underwent resection and was evaluated. The frozen squash and imprint smears from the left ovary revealed papillary fragments. This morphology, along with the presence of sheets of tumor cells, led to an intraoperative diagnosis of epithelial malignancy. The frozen section examination of the right ovarian mass was benign. Histopathological and immunohistochemical examination of the left ovarian mass leads to a diagnosis of an adult granulosa cell tumor. The endometrial tumor is the same as the biopsy diagnosis, and the right ovarian cyst was benign. Conclusion: AGCTs are often associated with endometrial hyperplasia and may rarely progress to low-grade endometrial endometrioid adenocarcinoma. They can be confused with primary or metastatic endometrial stromal sarcomas, endometrial endometrioid, and serous carcinomas. Papillary fragments in squash smears may mimic epithelial malignancies, also noted in brain tumor squash smears.

Nandhitha Ravi 1 , Rimlee Dutta 1 , Shraddhanjali Satapathy 1 , Sachin Khurana 2 , Ruchi Rathore 1 , Sandeep Mathur 1 , V K Iyer 1 ; 1 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India, 2 Department of Medical Oncology (BRAIRCH), All India Institute of Medical Sciences, New Delhi, India Introduction: Recognition of metastatic germ cell tumors (GCTs) in serous effusions have a propensity for misinterpretation owing to its rarity as well as overlapping and altered morphological features in exfoliated cytology specimens. An accurate diagnosis becomes imperative as these tumors respond well to chemotherapy, in contrast to adenocarcinomas. Objective: Herein, we highlight the case of a young female presenting with ascites. Tapping done thrice was reported twice as an adenocarcinoma, on cytomorphological features alone. On ancillary testing however; the patient was revealed to harbor metastatic GCT; thereby elucidating deceptive morphological features of GCTs in effusions. Case Report: A 28-year-old-nulligravida-female presented with diffuse abdominal distension for past 3-weeks. Her AFP-levels were elevated. On imaging, she was found to harbor a right-sided adnexal mass (10x7x6 cm) along with presence of nodules in omentum, peritoneum, lung and gallbladder. Ascitic fluid cytology showed tight-3D-clusters of atypical cells along with singly-dispersed cells. Vague acinar/glandular architecture was exhibited on cell-block.sections, based on which cytomorphological diagnosis of adenocarcinoma was rendered on two occasions. On immunocytochemistry attempted on cell-block from a subsequent tap, these clusters were however immunonegative for both claudin and calretinin, thereby ruling out adenocarcinoma and mesothelioma respectively. SALL4 was diffusely immunopositive. PAX8, WT1, Keratin7, Keratin20, p53 were all immunonegative. Based on above work-up, infiltration by GCT was considered. An omental biopsy performed showed infiltration by tumor cells arranged in glandular pattern. The tumor cells were immunopositive for SALL4, Glypican3, CD117 while negative for OCT3/4. A final diagnosis of Yolk sac tumor was rendered. The patient was started on chemotherapy and later underwent hysterectomy with bilateral-salpingo-oophorectomy, which were histologically found to be free of tumor (chemotherapy-response-score3). The patient was symptom-free on last follow-up. Conclusion: This case highlights the dubious cytomorphological features of GCTs in effusion specimens, while underscoring significance of clinical history, serum-markers levels and ancillary-testing in clinching the correct diagnosis.

Subha Shery, Pallavi Saraf, Manjit Kaur Rana; Department of Pathology and Lab Medicine, AIIMS, Bathinda, Punjab, India Introduction: Hydatid cyst is a zoonotic parasitic disease caused by Echinococcus granulosus. Dogs and foxes are the definitive hosts, while sheep, cattle, and humans serve as intermediate hosts. Humans become infected through the accidental ingestion of parasite eggs from contaminated food or direct contact with infected animals. The parasite’s larval phase develops into cysts in numerous organs of the body, most commonly affecting the liver and lungs, resulting in the production of hydatid cysts. On imaging, hydatid cysts can resemble other benign cystic lesions of the liver, such as biliary cystadenoma and hepatic abscess. Fine needle aspiration proves to be a useful investigation to definitively diagnose hydatid cysts and differentiate it from close mimickers including hepatic cystadenomas. Adverse reactions resulting from spillage of hydatid cyst contents on aspiration though reported are extremely rare. Majority of cases have been recorded from southern and western India with prevalence of around 10-15%. Herein we present a case of 58-year-old male with cystic lesion on liver, diagnosed as hydatid cyst on fine needle aspiration cytology. Objectives: Definitive diagnosis of hydatic cyst on fine needle aspiration cytology based on characteristic features on cytology and differentiate it from other benign cystic lesions. Case Report: A 58-year-old male presented with complaints of pain abdomen. On examination, hepatomegaly was noted. An abdominal ultrasound revealed a liver lesion that was hypoechoic, heterogeneously enhancing, and multiseptated, with differentials of biliary cystadenoma and hydatid cyst. Aspiration of this lesion produced a whitish fluidic material, from which smears were made. Microscopy revealed presence of hooklets along with acellular laminated membrane like structures and granular debris. Conclusion: The inclusion of hydatid cysts in the differential diagnosis of liver diseases is critical, especially in endemic locations. Prompt identification and treatment are essential to prevent fatal consequences such as rupture leading to anaphylaxis.

Patil Sanjana, Hephzibah Rani, P Priyanka, Akanksha Agarwal, U S Dinesh, Ravikala Rao; Department of Pathology, SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India Introduction: Solid Pseudopapillary Epithelial Neoplasm (SPEN) of pancreas is a rare exocrine neoplasm accounting for 1- 3% of all pancreatic tumors. It is most commonly observed in young women (F:M = 10:1) with a median age of 30 years. Very few cases have been reported in men. First described by Virginia Frantz in 1959, this tumor is of unknown etiology with low malignant potential. Case Report: A 14-year-old male presented with repeated episodes of pain abdomen, vomiting and fever for 2-3 months. On examination, the abdomen was mildly tender. Ultrasonography revealed a nodular and a cystic lesion located in the head and body of the pancreas. MRCP (Magnetic resonance cholangiopancreatography) showed a confluent homogenously enhancing solid and non-enhancing cystic lesion in the head and body of pancreas measuring 44 x 43 mm. Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) cytology showed highly cellular smears displaying discohesive tumour cells punctuated by numerous small vessels forming pseudopapillae. Focally these cells are also arranged in pseudorosette pattern. Tumor cells are round to oval with mild anisonucleosis, fine granular chromatin, longitudinal nuclear grooves and moderate eosinophilic cytoplasm. These characteristic cytomorphological features are consistent with SPEN, which was confirmed on biopsy. Conclusion: EUS guided FNAC is a useful minimally invasive diagnostic tool to arrive at an accurate pre-operative diagnosis of SPEN. Although more common in young women, this case highlights the need for pathologists to consider SPEN as a differential diagnosis even in young men presenting with solid-cystic lesion of pancreas.

Jinal Mehta, G V Chaithra, Hemanth Kumar, Aparna Gangoli, A R Sneha Rao, J Padma Priya, Suresh Shenoy, S A Deepa Adiga; Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India Introduction: Solitary fibrous tumours (SFTs) are rare mesenchymal soft tissue tumours. Definite diagnosis can rarely be made on cytology, due to lack of reproducible cytologic features. Objectives: To present a case of SFT metastasized to liver, which was a diagnostic challenge on FNAC. Case Report: A 62-year-old man presented with on-and-off pain abdomen since one week with history of reduced appetite and weight loss. USG abdomen revealed multiple lesions in both lobes of liver suggestive of multifocal hepatocellular carcinoma (HCC)/ metastases. CECT had concordant findings along with triple phase enhancement features which were overlapping with hemangioma and HCC. FNAC of liver lesion showed highly cellular smears with short spindle to round cells arranged in tightly cohesive clusters and forming microbiopsies. Spindle cells appeared to radiate from a central core, forming vasoformative-like structures. These tumour cells had indistinct cell borders with oval to spindle hyperchromatic nuclei, inconspicuous nucleoli and minimal nuclear pleomorphism. Nuclear streaking and focal molding were noted. On the basis of clinical, radiologic and cytologic features, spindle-cell neoplasm was considered. Biopsy revealed tightly packed round to fusiform tumour cells with indistinct cytoplasm arranged around an elaborate vasculature having sinusoidal pattern. Based on these features, a diagnosis of soft tissue neoplasm of intermediate malignancy was given. Subsequently, past history of surgical excision of mass in the auricular region being diagnosed as solitary fibrous tumour based on morphology and immunohistochemistry, to a surprise, came to light. Based on all these features, a final diagnosis of metastatic malignant solitary fibrous tumour was considered. Conclusion: Given the cytologically challenging entity, high cellular yield and tightly cohesive vasoformative aggregates of short spindle cells with minimal atypia may favour cytological diagnosis of malignant SFT in a background of relevant clinical and radiological features.

Surbhi Sharma, Shivani Dogra, Ruchi Khajuria; Department of Pathology, Government Medical College, Jammu, Jammu and Kashmir, India Introduction: Most of the intra-abdominal masses are non-palpable and even if they are palpable the idea of their size and shape and extent of the lesion is not possible, therefore various modalities like fluoroscopy, computerized tomography (CT) and ultrasonography (US) are used as a guide for fine needle aspiration. In majority of cases the diagnosis which is obtained by fine needle aspiration cytology (FNAC) is the substitute for surgical procedures like diagnostic laparotomy. Aim: The present study was conducted to study the cytomorphological features of various intra-abdominal lesions and to determine usefulness of FNAC in their diagnosis. Materials and Methods: This study was conducted on 160 patients with clinically or radiologically diagnosed intra-abdominal masses, referred for FNAC to the Post Graduate department of Pathology at Government Medical College, Jammu. Results: Out of 160 cases, quality of aspirate was satisfactory in 136 (85%) cases and the quality of aspirate was unsatisfactory for evaluation in 24 (15%) cases. 76 (55.88%) cases were females and 60 (44.12%) were males. The youngest patient was 3 years old and the oldest patient was 90 years old. Majority of lesions were located in the liver accounting for 50 (36.76%) cases followed by gall bladder 36 (26.47%) cases. Ovarian lesions comprised 12 (8.82%) cases, retroperitoneum 7 (5.15%) cases, pancreas 6 (4.41%) cases, GIT 5 (3.68%) cases and kidney 2 (1.47%) cases. No organ specific where anatomical site could not be made comprised 18 (13.24%) cases. Majority of lesions 118 (86.77%) were malignant and only 18 (13.23%) were benign. Adenocarcinoma (primary + metastatic) was the commonest cytomorphological finding. Conclusion: The study shows that FNAC is a rapid, convenient and reliable method for early confirmation of diagnosis avoiding an open biopsy in settings with high patient load.

Anshul Burman, Deepa Hans, Subhash Bhardwaj; Department of Pathology, GMC, Jammu, Jammu and Kashmir, India Introduction: Leishmaniasis is a chronic systemic disease that begins with an inconspicuous cutaneous lesion at the site of inoculation by the bite of an infective sandfly. It can eventually lead to hepatosplenomegaly, pancytopenia and elevated total IgG. Approximately 50000 visceral infections occur annually with 90% in the five countries of Sudan, Bangladesh, Brazil, India and Nepal. In advanced cases if it is untreated it can lead to severe cachexia and severe anaemia can lead to heart failure in extreme cases. Objective: To present a cytodiagnostic case report of leishmaniasis in a 43 year old female. Case Report: A 43 year old female patient with a known case of sarcoidosis and suspected metastatic renal cell carcinoma presented with complaints of pyrexia, abdominal discomfort, fatigue, weakness and loss of appetite since one month and was admitted in oncology department GMC Jammu. On routine examination and investigation hepatosplenomegaly and pancytopenia was detected. Materials and Methods: USG CECT FNAC USG CECT FNAC Observations and Results: USG guided FNAC from liver Mass showed adequate cellularity consisting of many benign and reactive hepatocytes along with evidence of extramedullary hematopoiesis in the form of many nucleated RBC and megakaryocytes. Occasional epithelioid cell granuloma and many histiocytic cells containing amastigote form of leishmania. Many Leishmania Donovani (LD) bodies were lying in the background of the smear. Cytomorphological features were of Leishmaniasis. Conclusion: Diagnosing leishmaniasis a comprehensive approach, including imaging studies, biochemical test cytological and histological analysis. early detection essential for patient outcome and appropriate therapeutic treatment.

Pooja K Suresh, Saral Madan, Shikha Jayasheelan; Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India Introduction: Pancreatic cancer is the 12th most common cancer and the 4th leading cause of cancer-related deaths in the world. In India, the incidence rates are lower compared to western countries. Pancreatic cancers are largely asymptomatic in the early stages and by the time symptoms do develop, the disease is locally advanced or metastatic. Hence early diagnosis is imperative. Fine needle aspiration (FNA) is one of the tests which aids in early diagnosis of pancreatic carcinoma. Aim: To assess the cytologic criteria in the diagnosis of pancreatic ductal adenocarcinoma (PDAC). Materials and Methods: A retrospective review of 20 FNA cases of PDAC, which are proven to be malignant on histopathology or clinical follow-up, was done by 2 experienced pathologists. Each case was assessed for the following cytological features: ≥4 malignant clusters, dual population, enlarged nuclei, increased mitoses, necrosis, single cells, nuclear crowding, overlapping, membrane irregularity, anisonucleosis, macronucleoli, and loss of polarity. Results: Patient’s age ranged from 44-88 years (mean age: 60 years). More than 4 malignant clusters were noted in 75% (15/20) cases, Nuclear crowding and overlapping in 90% (18/20) cases, enlarged nuclei and nuclear membrane irregularities in 100% cases, single cells in 80% (16/20) cases, loss of polarity and anisonucleosis in 85% (17/20) cases, macronucleoli in 25% (5/20) cases, necrosis in 30% (6/20) cases, dual population of cells and mitoses in 45% (9/20) cases, while 5 cases showed background mucin. Conclusion: The commonly identified criteria were nuclear crowding, overlapping, enlarged nuclei, nuclear membrane irregularities, loss of polarity and anisonucleosis. Being mindful of the cytological criteria and applying them to every FNA case strengthens the cytological diagnosis of PDAC.

Ridha Zaffar, Ruchi Khajuria; Department of Pathology, GMC, Jammu, Jammu and Kashmir, India Introduction: Umbilical metastasis (Sister Mary Joseph’s nodule), is a rare physical sign encountered in 1−3% of the patients with intra-abdominal and/or pelvic malignancy, with gastric carcinoma being the most common origin in men and ovarian carcinoma in women. However, gall bladder adenocarcinoma metastasized to SMJN is much rarer in women. It suggests advanced distant metastasis and is associated with poor prognosis. Case Report: We hereby report a 40-year-old lady who was referred to Department of Pathology, GMC Jammu, for Fine Needle Aspiration Cytology of circumferential erythematic nodule measuring 2x2cm which was firm, tender, rounded at the umbilical area since 10 days. On GPE, the patient was markedly pale, asthenic, dehydrated and febrile. Giemsa and PAP Stained smears of SMJN showed cytomorphological features of Poorly Differentiated Adenocarcinoma. On evaluation of primary, TRIPLE PHASE CECT abdomen showed neoplastic etiology of Gall Bladder with multiple metastasis in liver, peri-hepatic region, omental and mesenteric fat and multiple enlarged peri-portal mesenteric RIF nodes. Conclusion: SMJN may sometimes be the first and only sign of an internal neoplasm and ominous prognosis, diagnosis has to be confirmed in early stages to improve average survival. CT Scan and FNAC of the tumor are invaluable in the diagnosis of SMNJ and help to exclude primary benign umbilical neoplasm.

Hilda Fernandes; Department of Pathology, Father Muller Medical College, Mangalore, Karnataka, India Background: Ancillary techniques like Cellblock and immunohistochemistry enhance the diagnosis made on FNAC of liver lesions. Objectives: To evaluate the utility of Cellblock and Immunohistochemistry in liver FNAC. Materials and Methods: A prospective study was conducted patients who underwent FNAC of liver during a period of one and a half years.The material was further subjected to Cell block and IHC. Results: Out of total fifty-nine cases, thirty-six were males and twenty-three were females. Six cases had elevated levels of AFP. Twenty-two cases (37.8%) were reported as HCC, 24 cases were reported as metastatic lesions on cytology. On cell block preparation, 15 were reported as metastatic, 21 as HCC, 3 as PDC, 2 as inflammatory. In two cases, cell block revealed adequate material and were diagnosed as HCC. Twenty-five cases (15 HCC, 9 metastatic and 1 PDC) were subjected to an immunohistochemical panel of Hep Par 1, MOC 31. Eleven were positive for MOC 31 with 100% sensitivity, 92.3% specificity with 100% negative predictive value. The analysis of HepPar 1 immunoreactivity showed 14 positive cases with 92.86% sensitivity, 90.91%, specificity and a positive predictive value of 92.86% and negative predictive value of 90.91%. One case which was Non diagnostic on FNAC was diagnosed as HCC on Cell block ,showed Hep Par 1 positivity. Likewise, another case diagnosed as HCC on both Cell block and FNAC showed MOC 31 positivity. Conclusion: SOL of liver are difficult to diagnose with FNAC alone. Cell block and IHC have improved the diagnostic accuracy. Therefore they are found to be an useful adjunct in diagnosing SOL’s of the lover.

Seema Sen, Pradeep Venkatesh, Rohn Chawla, Seema Kashyap, Neiwete Lomi, Bhavna Chawla; Department of Ocular Pathology and Ophthalmology, Dr. R. P. Centre, AIIMS, New Delhi, India Introduction: Aqueous/vitreous cytology is a useful diagnostic modality for small ocular fluid samples in the differential diagnosis of ocular tumours like intraocular lymphomas, Retinoblastoma, melanoma and inflammatory lesions (uveitis/endophthalmitis). Objective: To retrospectively analyse vitreous/aqueous samples received over the past 18 months and to identify cases in which vitreous cytology helped in patient management. Materials and Methods: Cytospin preparations of 67 cases of vitreous/aqueous aspirate were processed by cytospin (Shandon) @1500 RPM x 8 min, stained by MGG and Papanicolaou. IHC/cytochemistry was done whenever necessary. The results were categorized as inflammatory/malignant/benign. Results: Of the 577 cytology samples received, 67 (11.6%) cases were vitreous/aqueous samples. Six cases (8%) diagnosed as inflammatory (endophthalmitis, granulomatous, tubercular or Tococariasis). Malignant cases included choroidal melanomas, retinoblastoma and 5% intraocular lymphomas (4). Malignancy was ruled out in the remaining 30 cases (44.7%) and in 27 (40%) cases material was inadequate for opinion. Conclusion: Vitreous and aqueous cytology are very useful diagnostic tools for the ophthalmologist. They help in planning treatment strategies which may include enucleation for Retinoblasoma and Uveal melanomas or chemotherapy for intraocular lymphomas. For cases diagnosed as inflammatory and benign lesions like uveitis/endophthalmitis, medical treatment is beneficial and unnecessary enucleations/surgeries can be avoided.

Niraimathi Manickam, Balamurugan Madasamy, Arun Kumar Karthikeyan, G Prabakar, Jeyakumari, Balasubramanium; Department of Pathology, JIPMER, Puducherry, India Introduction: Fine needle aspiration cytology (FNAC) is a simple, cost-effective tool with less turnaround time that helps in planning further evaluation and management of patients. Fungal infections are on the rise globally. The most common presentation of the fungal lesions, i.e. subcutaneous swelling, is easily accessible for FNAC. Objectives: (1) To assess the use of on-site evaluation of FNAC material in diagnosing superficial fungal infections. (2) To study the clinical factors and cytomorphological features of fungal infections. Case Series: The Pathology department of JIPMER Karaikal has set up a FNAC Clinic at the Government Hospital, Karaikal, to help with patient management. We have diagnosed 16 cases of fungal infections for the past two years (2022 to 2023) by FNAC. The majority were female, with age ranging from 41 to 64 years. Most of them gave a history of diabetes on treatment. Upper limbs were more commonly infected than the lower limbs. Unusual sites include six forearm swelling, especially near the elbow region in three. After aspirating pus, a rapid onsite evaluation of the unstained slides revealed fungal structures in most cases, which helped us preserve the sample for fungal culture. The common cytological features include a necroinflammatory background with foreign body type of giant cells attached to the fungal structures. The most common fungal morphology includes slender septate hyphae with branching and belongs to the dematacious fungal group. Conclusion: On aspirating pus from any subcutaneous swelling in an elderly female, onsite evaluation helps not only to identify fungal structures but also to preserve the sample for fungal culture. This allows us to avoid using unnecessary stains and further investigations in low-resource settings.

Rakshatha Nayak, Jyoti R Kini, Pooja Suresh, J Padma Priya; Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India Introduction: Cytopathology is essential for diagnosing various conditions through the microscopic examination of cells from gynaecologic and non-gynaecologic samples. The Papanicolaou (Pap) stain has been a fundamental method in cytology, but recent advancements in automation have introduced automated staining systems to improve efficiency and consistency. In resource-constrained settings such as India, where manual processes are still predominant, it is crucial to validate automation to ensure they meet quality standards without compromising diagnostic accuracy. Aim and Objective: This study objective includes: (1) To evaluate the performance of an automated cytology stainer compared to manual staining methods, including the quality of staining. (2) To assess the validation of the automated stainer against standard guidelines. Materials and Methods: This cross-sectional study was conducted for 1 month. It involved 30 gynaecologic and 30 non-gynaecologic samples. Each sample was processed manually and using an automated stainer. The quality of stained slides was assessed by four pathologists based on criteria such as nuclear and cytoplasmic staining quality, staining uniformity, background cleanliness, and image quality. Statistical analysis was done and a p-value < 0.05 will be considered significant. Observation and Results: The study revealed the effectiveness of automated staining over manual methods in terms of staining consistency, clarity, uniformity, background quality, and overall image quality. Percent agreement for both gynaecologic and non-gynaecologic reproducibility of the reference diagnosis was above 95%. The percent agreement for the reproducibility of the consistency of staining quality and cellularity was 100%. Conclusion: The automated slide stainer meets the laboratory requirements for staining both gynaecologic and non-gynaecologic specimens. This technique can be used to validate similar instrumentation in those laboratories that do not have specific validation protocols. Successful validation could lead to enhanced diagnostic accuracy, reduced workload, and improved efficiency in cytology laboratories, ultimately supporting better patient care and optimized laboratory operations.

Vibha Kush, Vikarn Vishwajeet, Meenakshi Rao, Aasma Nalwa, Divya Aggarwal, Vikrant Verma; Department of Pathology and Lab Medicine, AIIMS, Jodhpur, Rajasthan, India Introduction: The incidence of fungal infections has shown a significant rise in the last decade. Cytopathology remains an important minimally invasive technique for diagnosis of infection amenable to direct or guided sampling. Fungal organisms have distinct microscopic characteristics such as whether it is a yeast or a mould (filamentous), size, budding pattern, and the presence or absence of hyphal septation, allow for a relatively accurate classification based solely on morphology. Objective: In this pictorial essay, we present a spectrum of fungal infection diagnosed in a tertiary care center. Case Description: We present the cytopathology features of 11 cases, where diagnosis of fungal infection was established on fine needle aspiration cytology. We present two cases of histoplasmosis, zygomycosis, and eumycetoma, one case of aspergillus and epidermoid cyst with superadded fungal infection, and three cases of undifferentiated filamentous fungal infection. In these cases, suspicion of fungal etiology was suspected based on background necrosis, acute inflammation, giant cells and occasional calcification. Conclusion: FNAC is an easy, reliable, and minimally invasive method to diagnose and categorize the various fungal lesions in the body for early and definitive treatment.

Susmita Debbarma 1 , Sherrin Jacob 1 , V Naren Chandra 2 , Vijay Hadda 2 , Karan Madan 2 , Aruna Nambirajan 1 , Deepali Jain 1 ; 1 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India, 2 Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India Introduction: Rosai-Dorfman disease (RDD) is a histiocytosis characterized by nodal or extra-nodal accumulation of large, histiocytes or macrophages, exhibiting emperipolesis. The typical presentation of the disease is a painless, slow growing lymphadenopathy particularly involving cervical lymph node. Isolated involvement of airway by Rosai Dorfman disease is extremely rare and hence poses a diagnostic challenge. Herein we present a rare incidence of RDD in a 21-year-old female where cytological examination was crucial in identifying the diagnostic emperipolesis. Case Report: A 21-year-old female presented with severe shortness of breath and fainting episodes. Routine clinical examination revealed decreased air entry of the lung with no other systemic abnormalities. CT Chest was suggestive of left whole lung collapse with endobronchial mass in left main bronchus. Video-bronchoscopy revealed a floppy but infiltrative endobronchial mass raising suspicion for an adenoid cystic carcinoma. Initial biopsy from the mass showed bronchial mucosal fragments with dense inflammation with no atypical epithelial cells or malignancy, while stains preformed did not reveal any evidence of any fungal, bacterial colonies, acid fast bacilli, cytomegalovirus or herpes simplex virus. The needle aspiration showed presence of large histiocytes with abundant pale cytoplasm exhibiting prominent neutrophil and plasma cell emperipolesis. Work up for infectious diseases was negative and a repeat biopsy was done. The aspirate and clot core showed similar inflammatory cell infiltrate along with many histiocytes exhibiting emperipolesis. On immunohistochemistry, the histiocytes were immune-positive for CD68, S100, and OCT2 while were negative for CD1a, langerin, BRAFV600E, and Cyclin D1 compatible with an extra-nodal Rosai Dorfman disease. Conclusion: Rosai Dorfman disease is a benign neoplasm which can present as an emergency when it involves tracheobronchial sites and causes air way obstruction. They mimic malignancy in extra-nodal sites and morphology supplemented by immunostains remains gold standard for the diagnosis.

S M Amritha 1 , Sherrin Jacob 1 , Karan Madan 2 , S H Chandrashekhar 3 , Prabhat Singh Malik 4 , Aruna Nambirajan 1 , Deepali Jain 1 ; 1 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India, 2 Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India, 3 Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India, 4 Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India Background: Sclerosing pneumocytomas are rare benign neoplasms currently classified under adenomatous epithelial tumor of lung in the WHO classification of thoracic tumors. They pose considerable diagnostic challenges due to lack of specific clinico-radiological features. Histopathological examination, particularly by intra-operative frozen section examination is central for correct pre-operative diagnosis, to distinguish them from the commoner malignant lung masses that need aggressive management. There is limited knowledge of the cytomorphological features of these rare tumors and they are prone to misdiagnosis as adenocarcinomas, as illustrated in this case. Case Report: A 47-year-old female non-smoker presented with shortness of breast and was detected to have a well defined lung mass on imaging. Patient underwent EBUS guided fine needle aspiration of the lung mass followed by biopsy with clinical suspicion of malignancy. Cytology smears were highly cellular comprising singly lying epithelial cells with abundant foamy cytoplasm with frequent bi- and multi-nucleation. The cells had granular chromatin and prominent nucleoli. A diagnosis of adenocarcinoma was given on the smears based on TTF-1 immunopositivity. Corresponding biopsy showed only features of organizing pneumonia. A repeat sampling was advised in view of cyto-histo discrepancy. Repeat cytology smears showed clusters and sheets of clear cuboidal cells with granular cytoplasm and round nuclei with occasional intranuclear inclusions. Paired biopsy showed few groups of bland appearing clear cells arranged in nests and vague papillae that were immunopositive for TTF-1, ER and Napsin with low proliferative index (<1%) clinching the final diagnosis as sclerosing pneumocytoma. On further work-up, no other masses or metastatic lesions were identified. The patient is currently on radiological surveillance. Conclusion: With increase in minimally invasive pulmonary sampling procedures, awareness of the cytomorphology of rare benign mimickers of adenocarcinomas such as sclerosing pneumocytoma is important. A high index of suspicion and clinico-radiological correlation is mandatory when evaluating lung mass aspirates.

Ridam, S Ahuja, S Zaheer, S Ranga; Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India Introduction: Solitary extramedullary plasmacytoma (SEP) is a rare plasma cell dyscrasia characterised by localised tumors of neoplastic monoclonal plasma cells, either in bone or soft tissue, without systemic involvement or end-organ damage. SEP with minimal marrow involvement shows normal skeletal imaging and lacks systemic symptoms. Objective: This case report aims to highlight the diagnostic challenges and the importance of early and accurate diagnosis of SEP, which is crucial to prevent progression to multiple myeloma. It emphasises the role of multidisciplinary approach in distinguishing SEP from other malignancies and ensuring appropriate management. Case Report: A 70-year-old male presented with hemoptysis and shortness of breath, initially raising concerns for lung cancer. A whole-body FDG PET-CT scan identified a metabolically active soft tissue mass in the left hilar region, causing complete obstruction of the left upper lobe bronchus and encasing the left pulmonary artery and superior pulmonary vein. To further investigate, TBNA/EBUS was performed, revealing a lymphoproliferative disease with possibility of lymphoplasmacytic lymphoma on cytology. Histopathological evaluation suggested the possibility of plasmacytoma, with the majority of cells positive for CD38 and CD138 with lambda restriction. After further investigations including the myeloma panel and bone marrow examination, a final diagnosis of solitary plasmacytoma with minimal marrow involvement was made. Conclusion: Solitary plasmacytoma is a rare condition, with limited clinical trial data due to small patient numbers. This case underscores the importance of detailed histopathological, radiographic and laboratory evaluations in early diagnosis and staging of plasmacytomas. A multidisciplinary approach is essential for accurate diagnosis and to improve prognosis by preventing progression to multiple myeloma.

Pratyush Jaiswal, G V Chaithra, S A Deepa Adiga, Rakshatha Nayak, Sunita Hegde, Sanyo P Dsouza, Sandeep Gopal; Department of Pathology, KMC Hospital, Mangalore, Karnataka, India Introduction: Small cell lung carcinomas (SCLCs) very rarely metastasize to the gastrointestinal tract. Infrequent cases reported till now have been diagnosed on histopathology. This case is first of its kind to be detected on cytology based on the literature reviewed. Objectives: To present a case report of small cell lung carcinoma (SCLC) metastasized to gastric mucosa, diagnosed by gastric crush cytology, biopsy and immunohistochemistry. Case Report: A 72-year-old male chronic smoker presented with decreased appetite, weight loss, melena, cough and hoarseness of voice for one month. UGI endoscopy showed gastric ulcers, following which gastric crush cytology was performed, which showed small-sized tumour cells with minimal cytoplasm, irregular nuclear borders and hyperchromatic coarsely granular chromatin. Few mitotic figures were noted. The background showed streaks of nuclear material. A diagnosis of poorly differentiated neoplasm, favouring small cell carcinoma was rendered. Biopsy had concordant findings. Radiology indicated multiple lesions in liver, left adrenal gland, bilateral kidneys, bone and brain. A 5 cm lesion in the left main bronchus, multiple lung lesions and mediastinal lymph node involvement was also noted. Bronchial brush and bronchoalveolar lavage cytology revealed small-sized tumour cells with scant cytoplasm, in clusters and singles. These cells had irregular nuclear borders and hyperchromatic coarsely granular chromatin. Background showed smeared cells and streaks of nuclear material. Lung biopsy had concordant findings. Immunohistochemistry on both biopsy sections showed positive staining for synaptophysin and chromogranin, with a high Ki-67 proliferation index. A final impression of small cell lung carcinoma was given. Conclusion: Cytology proves to be extremely useful in unveiling a rare diagnosis of metastatic small cell lung carcinoma (SCLC) in gastric mucosa. Though histopathological and immunohistochemical correlation is essential for a definitive diagnosis, cytology provides crucial initial insights and helps to identify the primary tumour site in such cases.

Suhas Dhende, Swati Dighe, Saleem Pathuthara, Trupti Pai, Rajiv Kumar Kaushal; Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India Introduction: Hepatoid adenocarcinoma (HAC) of lung is rare primary malignancy with poor prognosis. Patients may present with or develop effusion as secondary complication. The cytomorphological features of HAC in effusions are not well documented in literature. Aim: To study the incidence and cytomorphology of HAC of lung in effusion. Materials and Methods: 129 histologically proven HAC of lung were identified over a 6-year period (2018-2024). Out of which, 14 had effusion (pleural-13, pericardial-1). Pap and MGG slides were analyzed for cytomorphological details. The cellblock and immunohistochemistry were available in all. Results: Males outnumbered females (13:1) with median age 61 years (34-74). Clinically all presented with cough and breathlessness. Imaging showed predominant involvement of upper lobe (9) followed by lower lobe (4) and no mass in one. Characteristic finding observed was singly scattered polygonal to oval tumor cells with moderate to abundant cytoplasm in all cases and 5 cases revealed groups of tumor cells. Cytoplasm was dense cyanophilic in all; and dense & vacuolated in 7 cases. The nuclei were central with fine chromatin in 9 and showed intra-nuclear inclusion in 7. Tumor cells morphologically resembled non-keratinizing squamous carcinoma in 6, adenocarcinoma in 5 and mesothelioma in 3 cases. Immunohistochemistry on cellblock showed immuno-positivity for HepPar-1 in 12 with TTF1 (cytoplasmic) in 6 cases. Two positive cytology samples were negative on cellblock. Diagnosis of HAC was confirmed in 9 cases on lung biopsy. EGFR mutation done in 5 cases was negative; On NGS, ERBB2 mutation and ALK+ fusion was noted in one each. Eight patients treated with chemotherapy, two referred to palliation and 4 lost to follow-up. Conclusions: HAC is distinct yet under-reported variant of lung adenocarcinoma with cytomorphological features overlapping between squamous carcinoma and mesothelioma. Awareness of cytomorphology and use of cellblock with immunohistochemistry are crucial in clinching the diagnosis.

Y Sunil Kumar, Padma Shetty, B H Giridhar, K Jayaprakash Shetty; Department of Pathology, K S Hegde Medical Academy, Mangalore, Karnataka, India Introduction: The preferred method for diagnosis of mediastinal lesions is endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which avoids more invasive procedures like mediastinoscopy. Its great safety profile and high diagnostic yield make it the procedure of choice. According to Yasufuku et al., EBUS-TBNA has sensitivity of 94.6%, specificity of 100%, and diagnostic accuracy rate of 96.3%. The current study aimed to establish a correlation between histology and EBUS-TBNA of mediastinal lesions. Aim: The aim of this study was to correlate endobronchial ultrasound guided-transbronchial needle aspiration of mediastinal lesions with histopathology. Materials and Methods: Participants in the study are those undergoing EBUS-TBNA for mediastinal lesions at our hospital. EBUS-TBNA was always accompanied by Rapid On-Site Evaluation (ROSE) to confirm the adequacy for reporting. The residual material was processed for cell block. The results of the cytology and cell block were correlated. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EBUS-TBNA were assessed using SPSS 24.0. Results: The mean age of patients was 58.73 ± 12.83 years. Study included Mediastinal lymph node in 21.7%, right lung upper lobe in 21.7%, sub carinal lymph nodes in 15% of the patients followed by left lung and right lung lower lobe (6.7%). EBUS diagnosis was benign in 13 patients (21.7%) and malignant in 47 patients (78.3%). HPE diagnosis was benign in 14 patients (23.3%) and malignant in 46 patients (76.7%). There was one false positive case. Sensitivity was 100.00%, specificity was 92.86% and accuracy was 98.33%. Conclusion: In our study the diagnostic yield of EBUS- TBNA is 100% because of ROSE was done for all cases. Hence it is recommended that all EBUS-TBNA should have ROSE for better yield and helps in appropriately triaging the samples collected for gene expert, cultures, cell blocks and ancillary studies like IHC and molecular studies.

Pallavi Saraf, Manjit Kaur Rana, Ankita Soni, Gargi Kapatia; Department of Pathology and Lab Medicine, AIIMS, Bathinda, Punjab, India Introduction: Cylindroma is a rare, slow-growing benign tumour of the skin adnexa, mostly seen in middle-aged to elderly females. Most common affected site is scalp, other sites involved are neck and extremities. It is usually sporadic and single, although multiple tumours can occur on the scalp as part of a genetic syndrome, and are referred as turban tumours. The literature is sparse regarding the cytomorphological features of this entity. Herein we present a case of cylindroma of scalp diagnosed on fine needle aspiration cytology and confirmed on histopathology. Objective: To identify the salient features of cylindroma on fine needle aspiration cytology. Case Report: A 71-year-old female presented with two swellings on scalp in the frontotemporal region for five years. These swellings were gradually progressive in size and not associated with any other complaints. Both swellings were non-tender, nodular and bosselated in appearance with no ulceration or puckering noted. Fine needle aspiration was done and smears were prepared. The cytology smears were cellular and showed clusters, vague acini and singly scattered basaloid tumor cells having hyperchromatic nucleus, inconspicuous nucleoli and scant cytoplasm. Abundant dark magenta-coloured hyaline membrane like material was seen around these tumor cells and in the background. No nuclear atypia, mitosis or necrosis noted in the smears. A diagnosis of benign adnexal tumour, likely cylindroma was made. Histopathology of excisional biopsy confirmed the diagnosis. Conclusion: Fine needle aspiration cytology is a rapid and easy method to diagnose superficial skin adnexal lesions. Cylindroma can be distinguished from its cytological mimics by carefully interpreting cytology smears, focussing on different patterns and a few other features.

Monica Mishra, Gunvanti Rathod; Department of Pathology, All India Institute of Medical Sciences, Bibinagar, Telangana, India Introduction: Basal cell carcinoma a slow growing, locally aggressive, rarely metastasizing malignant tumor which originates from basal layer of skin. It is common (60-65%) in whites and in Asian it’s around 20-30% of the skin malignancies. Varied Morphology of BCC are nodular, cystic, superficial, pigmented, morphoeaform, (Sclerosing), Keratotic and Fibroepithelioma of Pinkus. FNAC is an important tool in diagnosing cutaneous tumors however reports of an epithelial tumors on cytology is less. Case Report: A 60 year female presented with swelling over left nasal ala which was gradually progressive in size and painful for a period of 3 years. On local examination it was a single irregular swelling measuring 2x2 cm with area of crusting with tenderness. FNAC was done followed by excision and gross specimen received in Pathology department. On gross examination, there was nodular mass measuring 3x2.2x2 cm, skin flap measuring 3x2 cm with white, solid, homogenous cut surface. On Cytology it was reported as an epithelial tumor and on histopathology, final diagnosis was given as Basal cell carcinoma. Discussion: Basal cell carcinoma is common type of skin cancer which generally diagnosed on histopathological examination, however studies have suggested that cytology can be useful for making diagnosis before going for wide local excision. In our case smear was moderately smear and cells were arranged in small clusters, sheets and occasionally in papillaroid arrangement. Individual cells show scant cytoplasm with ill defined cell borders, round to oval nuclei, focal palisading arrangement. No nuclear pleomorphism, mitotic activity, or necrosis. On histopathology a dermal based tumor with cells arranged in nests and islands. Individual cella were basaloid with peripheral palisading noted. On cytology it is always a dilemma to give final diagnosis of Basal cell carcinoma.

Ashish Saraf 1 , Prem Singh 2 , Nikhil Gupta 3 , Jaspreet Singh 4 ; 1 Medical Officer (Pathology), Sub Divisional Hospital, Sultanpur Lodhi, Kapurthala, Punjab, India, 2 Consultant Pathologist, SGL Super Specialty Charitable Hospital, Jalandhar, Punjab, India, 3 Consultant Plastic Surgeon, SGL Super Specialty Charitable Hospital, Jalandhar, Punjab, India, 4 Medical Officer (Orthopaedics), Sub Divisional Hospital, Sultanpur Lodhi, Kapurthala, Punjab, India; Laboratory, Sub Divisional Hospital, Sultanpur Lodhi, Kapurthala, Punjab, India Introduction: Keratoacanthoma (KA) is a low-grade, 1 to 2 cm dome-shaped skin tumor with a centralized keratinous plug. Risk factors are age 50 to 69 years, males gender, fair skin, hair bearing area and sunlight exposure. Keratoacanthoma cannot be confirmed on cytology because architecture cannot be assessed. Objective: Correlation of clinical and cytological features of Keratoacanthoma. Case Report: An 81 year old male patient came with history of swelling over scalp since 3 to 4 months measuring 1.5 cm x 1.1 cm with above mentioned risk factors. X ray skull showed no bony involvement. Gross examination of the FNAC of the scalp swelling shows scanty whitish material. FNAC of the scalp swelling showed clusters and singly scattered mature squamous cells with low N: C ratio, nuclei with occasional nuclear irregularity, partially opened up nuclear chromatin with inconspicuous nucleoli. Diagnosis of Keratinous cyst with a differential of Epidermal inclusion cyst with a very rare possibility of Pilomatrixoma was given. Gross examination in histopathology showed a 3 cm x 2.5 cm x 2.5 cm skin covered tissue with scaly dome shaped mass with keratinous plug. Microscopy showed Keratoacanthoma, Not otherwise specified. Conclusion: Keratoacanthoma can be falsely diagnosed as squamous cell carcinoma. Keratoacanthoma may be suspected on FNAC if clinical correlation is there. One limitation of this case report is PAP stained slides were not made. CD30 positivity in Immunohistochemistry is low in Keratoacanthoma (2.89 %) versus CD 30 positive Lymphoproliferative disorders. In DNA microarray studies, Karatoacanthoma is different from squamous cell carcinoma and normal skin. In FNAC of skin lesions, PAP stained slides should be made. Comparing the cytological findings of Squamous cell carcinoma and Keratoacanthoma, clusters of squamous cells with low N: C ratio goes more in favor of Keratoacanthoma versus at least poorly differentiated squamous cell carcinoma.

Pratikshya S Ray, Soumya S Purohit, Deepika Sahu, Archeeta Pattnaik, Sunil Agarwal, Rashmi Pattnaik, Debi Prasad Mishra; Department of Pathology, Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha, India Introduction: Sebaceous adenomas are uncommon benign adnexal tumors with sebaceous differentiation. They can present as solitary or multiple nodules and are often yellow, tan, skin-coloured, pink papules or nodules less than 1 cm in diameter. Seventy percent are found on the head, with the most common site being nose and cheek area, while 30% are found on the trunk, neck, and legs. Sebaceous adenomas affect both sexes equally and are found more frequently in the elderly with a mean age of 60 years. Objectives: To present the cytological features of a sebaceous neoplasm. Case Report: A 58 years old male presented to General Surgery OPD with a polypoidal lesion over ala of nose measuring 1x1 cm since 4 months. The lesion was non-tender and developed gradually. FNAC was advised which revealed two types of cell population , constituting predominantly groups of mature foamy sebaceous cells with abundant cytoplasm containing fat globules and basaloid cells constituting less than half of the cell population present over a fatty background. Following procedure, the lesion was excised and specimen was sent for histopathological evaluation which was consistent with the cytological diagnosis. Conclusion: Giving importance to the clinical presentation and cytological characteristics of two cell types, Sebaceous Adenoma can be an easily diagnosed case via cytological evaluation.

Ritika Sondhi 1 , Puneet Kaur 1 , Uma Handa 1 , Phiza Aggarwal 1 , GP Thami 2 ; 1 Department of Pathology, Government Medical College and Hospital, Chandigarh, India, 2 Department of Dermatology, Government Medical College and Hospital, Chandigarh, India Introduction: Pilomatricoma or benign calcifying epithelioma of Malherbe is a benign cutaneous adnexal neoplasm with a bimodal age distribution and incidence as low as 1%. It shows differentiation towards matrical cells and the hair cortex. Although easily diagnosed on histopathology, the cytological diagnosis by fine needle aspiration cytology is often problematic. Objective: To describe and characterize the cytomorphologic features of pilomatricoma (PMX) helping in the diagnosis of the lesion on fine needle aspiration cytology (FNAC). Results: A total of 8 cases with their clinical and FNAC findings were analysed over a period of 3 years. The series showed female preponderance, with head and neck being the commonest site. Majority patients presented with a solitary, mobile, firm, papule or nodule, with size ranging from 10 – 30 mm. Cytological findings showed variable component of anucleate squamous cells (ghost cells) in 7 cases, multinucleated giant cells in 7 cases, basaloid cells in 4 cases and calcified material in three cases. A diagnosis of PMX was rendered primarily in all the cases. A differential diagnosis of keratinous cyst in two cases and pseudogout in one case was given. The main reason for this differential diagnosis was predominance of one component over the other. Conclusions: The cytological findings of PMX poses a diagnostic challenge owing to dyssnchrony in expression of varied cellular components. A meticulous examination of smears can be done in achieving accurate diagnosis.

Shrilatha 1 , Meenakshi Rao 1 , Vibhuti 1 , Poonam Abhay Elhence 1 , Taruna Yadav 2 , Kapil Soni 3 ; 1 Department of Pathology and Lab Medicine, AIIMS, Jodhpur, Rajasthan, India, 2 Department of Diagnostic and Interventional Radiology, AIIMS, Jodhpur, Rajasthan, India, 3 Department of Otorhinolaryngology, AIIMS, Jodhpur, Rajasthan, India Introduction: Accessory thyroid is a rare condition of presence of functional thyroid tissue in addition to the one at normal anatomical location. Presence of accessory thyroid in a post total thyroidectomy may lead to clinical and radiological suspicion of malignancy. Objective: To consider accessory thyroid and residual thyroid tissue as a differential diagnosis for neck masses in a post total thyroidectomy patient. Case Report: A 50 years old female, post total thyroidectomy 2 years back, presented with swelling in right side of neck with dysphagia. On USG, a well defined hypoechoic lesion was noted in the subcutaneous plane at previous operated site and also in right tracheo – oesophageal groove. A diagnosis of residual thyroid tissue/ malignancy was made. USG Fine Needle Aspiration Cytology (FNAC) was performed from both of these sites, which showed features of lymphocytic thyroiditis. Conclusion: An early and prompt diagnosis of accessory thyroid is crucial for close follow up of the patient to recognise any inflammatory or neoplastic conditions which can lead to clinical symptoms based on their localisation creating diagnostic difficulties. The incidence of diseases in accessory thyroid gland is same as that of native thyroid gland. FNAC serves as a useful diagnostic technique in diagnosing thyroid pathologies including accessory thyroid, as seen in the current case.

Sindhoora 1 , Meenakshi Rao 1 , Deepak Vedant 1 , Poonam Abhay Elhence 1 , G Anju 1 , Nivedita Sharma 2 , Taruna Yadav 3 ; 1 Department of Pathology and Lab Medicine, AIIMS, Jodhpur, Rajasthan, India, 2 Department of Surgical Oncology, AIIMS, Jodhpur, Rajasthan, India, 3 Department of Diagnostic and Interventional Radiology, AIIMS, Jodhpur, Rajasthan, India Introduction: Riedel’s thyroiditis is an uncommon disorder of thyroid of which IgG4 fibrosing thyroiditis is a rarer entity. It is more common in females. Cytological diagnosis is extremely difficult and may lead to diagnostic pitfalls. Objective: We report a case of a 40- year- female with IgG4 fibrosing thyroiditis (Riedel’s thyroiditis) mimicking medullary thyroid carcinoma in cytology. Case Report: A forty-year-old female presented with midline neck swelling for one month. On imaging, a linear hypo enhancing lesion involving isthmus and both lobes of thyroid with no obvious internal calcification, categorized as TIRADS V, was discovered on imaging, involving the thyroid gland diffusely. Her serum levels showed normal calcium at 9.82 mg/dL, elevated TSH at 4.62 mIU/L, low free T4 at 0.72 ng/dL, normal free T3 and negative anti-TPO. Procalcitonin levels and parathormone were normal at 0.01 ng/mL and 58.9 pg/mL. The patient underwent FNAC from the thyroid which was suspicious for medullary thyroid carcinoma. However, histopathology showed features of IgG4 fibrosing thyroiditis (Riedel’s thyroiditis). Conclusion: Diagnosing Riedel’s thyroiditis presents challenges for pathologists and radiologists, as illustrated in our case where FNAC failed to provide a definitive diagnosis. The definitive diagnosis typically requires histopathological examination from an open biopsy or surgical specimens obtained during decompressive goitre surgery performed for clinical symptoms.

Yambem Pritam Singh, Khuraijam Sucheta Devi, Sushma Khuraijam, Khagokpam Ambala Devi; Department of Pathology, Regional Institute of Medical Sciences, Imphal, Manipur, India Introduction: Thyroid lesions are common in India and predominant in females. It is difficult to distinguish between neoplastic and non-neoplastic thyroid lesions clinically. FNAC is used to evaluate thyroid lesions along with clinical and radiological examination. It is usually preferred after ultrasound examination along with thyroid function test and antibody test. Our aim is to study the cytomorphological spectrum of benign and malignant thyroid lesions according to the age and gender in our region. Materials and Methods: This study was conducted in Regional Institute Of Medical Sciences, Imphal for a duration of one year starting from July 2023 till June 2024. Patients of all age groups and gender were included. Proper history, clinical examination and relevant investigations were noted. Gross appearance of the aspirate was also noted. Squash smears were prepared, fixed with methanol and stained with Giemsa. Reporting was done according to ‘The Bethesda System for Reporting Thyroid Cytopathology’ (TBSRTC). Results: Among 244 cases, maximum cases were females which comprises of 228 (93.4%) cases. Most commonly affected age group in benign thyroid lesion was 41-50 years and in malignant thyroid lesion was 61-70 years. Maximum cases were found in Category II (benign) which comprises of 214 (87.7%) cases. Among benign thyroid lesion cases, most common lesion was colloid nodule which accounted for 112 (45.9%) cases. Malignant thyroid lesion cases comprises of 25 (10.2%) cases. Among malignant thyroid lesion cases, most common lesion was Category IV(Follicular neoplasm or suspicious of follicular neoplasm)which are more common in females and accounted for 8 (3.2%) of all cases.4 cases of suspicious of malignancy were found. 3 cases of confirmed Papillary thyroid carcinoma were found and more common in females. Conclusion: FNAC is a non invasive procedure, cost effective and guides in accurate diagnosis and treatment.

Alka Yadav, Savita Agarwal, Aastha Kapoor, Neelshi Pandey; Department of Pathology, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India Introduction: In recent years, FNA has proven to be rapid cost effective and well tolerated tool in the selection of thyroid nodule patients requiring surgical intervention. Although the cytological features of papillary carcinoma of thyroid are well defined on FNA but none of the single cytological feature is pathognomic for the diagnosis, constellation of cytological features are required. In this study we reviewed 50 histologically proven cases of papillary carcinoma thyroid retrospectively on cytology and specifically clarified details cytologic pitfalls. Aim: To study cytologic pitfalls of histologically proven cases of papillary thyroid carcinoma. Objective: The main objective this study is to study cytological pitfalls of papillary thyroid carcinoma. Materials and Methods: This study is a retrospective study included 50 cases for a period of 2 years from June 2022-June 2024.All the histologically proven malignancies of papillary thyroid carcinoma, there cytopathology were reviewed. The pitfalls were addressed in the present studied in detail. Observation and Results: Out of the various features of papillary thyroid carcinoma the most consistent features in our study was swirling pattern seen in 28 cases followed by papillae formation in 14 cases , chewing gum colloid 4 cases and microfollicular 2 cases. Other findings in rest of the 2 cases were multinucleated giant cells, cyst macrophages. Conclusion: Diagnosis of papillary carcinoma thyroid can be made accurately if architectural features and nuclear features and metaplastic cells are present together in an aspirate

Mona Lisa 1 , Vijayan Varsha 1 , Ranwir Sinha 1 , Amiy Arnav 2 , Sanjeet Kumar Singh 1 ; 1 Department of Pathology and Lab Medicine, AIIMS, Deoghar, Jharkhand, India, 2 Department of Onco-Surgery, AIIMS, Deoghar, Jharkhand, India Introduction: Columnar variant of papillary thyroid cancer is an aggressive form of the disease, characterized by rapid growth, a high likelihood of recurrence, and frequent metastasis. This variant may not present with the characteristic nuclear features of papillary carcinoma, making diagnosis challenging. Anaplastic thyroid carcinoma (ATC) is another highly aggressive and lethal tumor that can arise de novo or through the de-differentiation of papillary or follicular thyroid carcinoma. The osteoclastic variant of ATC is particularly difficult to diagnose, as it may lack the typical nuclear pleomorphism associated with other variants of ATC. Aim and Objectives: We encountered a coexistence of these two variants of thyroid carcinoma in a single patient. Case Report: A 68-year-old female presented with swelling over anterior neck (right>left) for 15 years and sudden increase in size over one months. On examination a soft to firm, non-tender swelling over anterior neck measuring approximately 6 x 7 cm and multiple cervical lymph nodes. CECT revealed a large mass lesion predominantly solid with cystic/necrotic areas with lobulated margins and heterogenous post-contrast enhancement along the lateral aspect of neck on right side. FNA testing revealed many oval to slightly elongated undifferentiated mononuclear cells admixed with multinucleated osteoclast-like giant cells. Also seen were tumor cells in papillary architecture showing nuclear overlapping and overcrowding. Histopathology revealed a mixture of papillary and solid pattern. Individual tumor cells in the papillary areas were columnar with nuclear stratification. In the solid areas there were sheets of mononuclear cells, occasionally having pleomorphic nuclei along with numerous osteoclastic giant cells. Occasional nuclei showed pseudoinclusions, however nuclear clearing and grooving were not prominent. Conclusion: It is crucial to understand and report these less common and morphologically atypical presentations of thyroid tumors, as they impact the clinical management and prognosis of the patient.

Nitika Chawla, Monika B Gathwal, Kulwant Singh, Parveen Kundu, Sunaina Hooda, Swaran Kaur Saluja, Divya Sardana; Department of Pathology, BPS GMC for Women, Sonepat, Haryana, India Introduction: Thyroglossal duct cyst is the most common developmental anomaly of the thyroid gland. Incidence of carcinoma arising in thyroglossal duct cyst is < 1% and is often missed on FNAC of the cysts. Papillary Carcinoma is the most common type of primary tumor (75-80%) in thyroglossal cysts followed by papillary-follicular carcinoma, squamous cell carcinoma and follicular carcinoma. We present two rare cases of papillary carcinoma arising in thyroglossal cyst with normal thyroid gland/ colloid goiter. Case Reports: Case 1: A 38 year old female presented with history of midline neck swelling. FNAC suggested thyroglossal cyst in cyst and colloid goiter in thyroid gland. Excisional biopsy from cyst revealed columnar variant of papillary carcinoma. Case 2: A 37 year old female presented with midline swelling neck moving on deglutition and protrusion of tongue. CECT revealed a cystic lesion measuring 38x20 mm suggesting thyroglossal cyst with enlarged thyroid gland showing colloid nodule. FNAC suggested thyroglossal cyst. Histopathological examination of cyst revealed papillary carcinoma. Conclusion: Primary papillary carcinoma arising in thyroglossal duct carcinoma is extremely rare. Ultrasound examination, FNAC and extensive sampling of thyroglossal cysts should be done to rule out malignancy arising in the cysts. Malignancy should be suspected if the cyst is hard, fixed, irregular or displays sudden expansion with palpable neck lymph nodes and calcification on ultrasonography. Patient follow up every 6 months during the first year and annually thereafter is recommended to detect recurrence.

K Hari Chandana, Vidya Monappa; Department of Pathology, Kasturba Medical College, Manipal, Karnataka, India Introduction: Thyroid lymphomas, though rare, pose significant diagnostic challenges in the Indian context. They account for less than 5% of all thyroid malignancies but require precise cytological assessment for effective management. With an increasing incidence noted in recent years, particularly among elderly women with a history of Hashimoto’s thyroiditis, early detection and accurate diagnosis are paramount. Cytological assessment plays a crucial role in the early identification and differentiation of thyroid lymphomas from other thyroid pathologies while also improving the diagnostic accuracy within the Indian medical community. Case Report: A 74-year-old female presented with a rapidly enlarging thyroid swelling over 15 days. Clinical examination revealed bilateral thyroid enlargement (8x8 cm), hard in consistency and with restricted mobility. Thyroid function tests indicated subclinical hypothyroidism. The Fine needle aspiration cytology (FNAC) smear demonstrated medium to large lymphoid cells with vesicular nuclei, prominent nucleoli, scanty cytoplasm, increased and atypical mitoses, and lymphoglandular bodies and was suggestive of Non-Hodgkin’s lymphoma, categorized under TBSRTC 6. This was in tune with the CT findings which showed a well-defined mass significantly impacting surrounding structures. A trucut biopsy was done followed by Immunohistochemistry tests which confirmed double expressor Diffuse Large B-cell lymphoma (DLBCL), not otherwise specified. IHC were CD10+, BCL-2+, c-Myc+, MUM1+, and p53+, further confirming the diagnosis. Conclusion: Diagnosing Primary thyroid lymphomas, particularly DLBCL can be quiet challenging as they often present with non-specific symptoms. This case demonstrates the critical role played by FNAC in the rapid and accurate diagnosis of thyroid lymphomas, which facilitated immediate intervention. This case adds to the limited literature on thyroid lymphomas and highlights the role of cytology in early and its precise diagnosis and ultimately optimizing patient outcomes in the management of aggressive thyroid malignancies.

Sangeeta Pradhan, Poonam Abhay Elhence, Abhishek Purohit, Aasma Nalwa, Meenakshi Rao, Sudeep Khera, Deepak Vedant, V.Vishwajeet, Divya Aggarwal, VikrantVerma; Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Introduction: Thyroid lesions in children are rare. Their evaluation and triaging by more aggressive diagnostic approach is required to discriminate between benign and malignant lesions. Aim: In the present study, we aimed to assess the prevalence of different thyroid lesions in children with thyroid nodules and ascertain the utility of clinical and fine-needle aspiration cytology (FNAC) findings to discriminate between benign and malignant lesions. Methods: This is an ambispective study between January 2018 and July 2024, where 74 fine-needle aspiration cytology cases of thyroid lesion of paediatric patients were retrieved from hospital information system. The clinical and cytological findings were correlated and analysed. Thyroidectomy specimen of 11 cases was received in our hospital, where sensitivity, specificity and accuracy of the tests was calculated. Results: The age of the patients ranged from 10 days to 18 years, of which 19 were boys and 55 were girl. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was used to categorise the cases into: unsatisfactory, benign, AUS/FLUS Follicular Lesion, Suspicious for malignancy and malignancy. 55 cases presented as thyroid nodules and 19 cases presented as diffuse thyroid swelling. There were 66 (89.18%) satisfactory aspirates and 8 unsatisfactory aspirates (10.81%). Benign lesions, mostly colloid nodule was observed in 50 cases (67.56%), atypia of undetermined significance/ follicular lesion of undetermined significance was seen in 2 cases (2.7%) and follicular neoplasm was reported in 5 cases (6.7%). Suspicious cytology was reported in 4 cases (5.4%) where all cases had a suspicion of Papillary Carcinoma. Papillary Carcinoma was detected on 5 cases (6.75%) where all were females. Conclusion: FNAC is a simple, less-invasive, cost-effective and a good screening technique which can differentiate between benign and malignant thyroid lesions, thereby preventing unnecessary surgical intervention in children.

Krisha Mehta, Sonali Dixit, Shipra Agarwal; Department of Pathology, All India Institute of Medical Sciences, New Delhi, India Introduction: Papillae in the thyroid have been associated with the most common thyroid malignancy, papillary thyroid carcinoma (PTC). However, papillae are no longer considered specific for PTC and are seen in thyroid neoplastic and non-neoplastic lesions, especially follicular adenoma with papillary architecture (FAPA), papillary hyperplasia involving a follicular adenoma, noninvasive encapsulated papillary RAS-like thyroid tumor (NEPRAS) and thyroid follicular nodular disease (FND). Objective: Overdiagnosis of papillary hyperplasia as PTC in thyroid aspirates has a serious impact on patient life. Thus, it is important to diagnose them correctly to avoid under or over treatment. Here, we describe a series of 3 cases which were diagnosed as suspicious for PTC on cytology but on resection revealed FAPA or FND. Case Series: The three patients presented with complain of anterior neck swelling of 4-6 months duration. Fine needle aspiration of thyroid swelling showed papillary fragments, and nuclear overcrowding, overlapping. But intranuclear cytoplasmic inclusion (INCI) and psammoma bodies were absent. Two of these cases were diagnosed as suspicious for PTC (Bethesda category V) and one was diagnosed as PTC (category VI), following which they were subjected to thyroidectomy. Gross examination revealed well-circumscribed solid-cystic tumors filled with colloid along with papillary excrescences. Histopathology of two cases revealed follicular epithelial cells arranged in micro and macro follicles with foci of papillary hyperplasia. Nuclear features of PTC were absent. Thus, a diagnosis of FAPA was made. Third case showed features of FND with variably-sized colloid-filled follicles with numerous pseudopapillae. Conclusion: Papillary structures in a thyroid aspirate do not always equate to papillary thyroid carcinoma. They can be presented in an entire spectrum of thyroid nodules and the key differentiating features between them is the nuclear features. The latter should be looked for so that indolent tumors are not subjected to total thyroidectomy impacting patient’s quality of life.

A STUDY UNRAVELLING THE MYSTERY OF INFARCTED FIBROADENOMA Preeti Diwaker, Priya Suneja, Anurag Gupta, Sonal Sharma; Department of Pathology, UCMS and GTB Hospital, Delhi, India Introduction: Infarction in fibroadenomas is usually encountered in pregnancy, lactation, or secondary to fine needle aspiration. The occurrence of ischemic changes in fibroadenoma without any predisposing condition is uncommon. This entity often poses a diagnostic challenge in cytology being a close morphological mimicker of malignancy. Aim: To study the clinico-cytomorphological spectrum of infarcted fibroadenoma. Materials and Methods: This is a retrospective study and includes a total of 16 cases of infarcted fibroadenomas diagnosed on FNAC over a period of 8 years. Clinical details and slides of these cases were retrieved from cytopathology records and reviewed. Results: The age of the patients ranged from 16 to 24 years and the majority (75%) were unmarried. Most of them presented with complaints of single, firm, non-tender swelling ranging in size from 2-8 cm. Characteristic cytomorphological findings of infarcted fibroadenoma observed were homogeneously opaque sheets of necrotic ductal epithelial cells with atypical nuclear features, maintaining the staghorn architecture, in a necrotic background. Conclusion: Infarction in fibroadenoma is rare and can be misdiagnosed as malignancy on cytology. The knowledge of characteristic cytomorphological features can aid in differentiating infarcted fibroadenoma from malignancy. Thus, FNAC is an efficient and unswerving tool, that can be used for diagnosing infarcted fibroadenoma.

Anurag Gupta, Priya Suneja, Preeti Diwaker, Sonal Sharma; Department of Pathology, UCMS and GTB Hospital, Delhi, India Introduction: Tubercular mastitis is a rare inflammatory breast disease accounting for less than 0.1% of all breast lesions. It is benign but its variable clinical presentation often masquerades as malignancy and poses significant diagnostic challenge. Aim: To study the clinico-cytomorphological features of tubercular mastitis. Materials and Methods: This retrospective study was conducted in the Department of Pathology, UCMS, and GTB Hospital. All consecutively diagnosed cases of inflammatory breast lesions over a period of 9 years, were retrieved from the archives of the cytopathology laboratory. Clinical details of the patients were obtained and slides were reviewed for cytomorphological features. Results: A total of 499 cases were diagnosed as inflammatory breast lesions, which included 97 (19.4 %) cases of tubercular mastitis. Out of 97, 57 cases (58.7%) were below 30 years of age. A solitary, firm to hard lump ranging in size from 1 to 7 cm was found in most of the cases and in 31 cases lump was painful. The majority of aspirates (63.5%) yielded frank pus. Based upon cytomorphological features and Ziehl-Neelsen stain (ZN stain), the cases were categorized as suggestive, consistent, and confirmed cases of tubercular mastitis. A definitive diagnosis of tubercular mastitis (44.3%) was offered in cases that were positive for acid-fast bacilli. Conclusion: This study highlights the importance of FNAC in diagnosing tubercular mastitis in developing countries like India where tuberculosis is still a rampant disease. A definitive cytological diagnosis obviates the need for surgical intervention.

A CASE SERIES ANALYSIS - INTEGRATING CYTOPATHOLOGY WITH MOLECULAR FINDINGS IN BREAST HEMATOLYMPHOID MALIGNANCIES Kranthi Kumar Jandrasupalli 1 , Erna Ahsan 1 , Nilotpal Chowdhury 1 , Mohit Jadli 2 ; 1 Department of Pathology and Lab medicine, AIIMS Rishikesh, Uttarakhand, India, 2 Molecular Research Unit, AIIMS Rishikesh, Uttarakhand, India Introduction: Despite being rare, hematolymphoid malignancies can be difficult to diagnose because of their cytological similarities to other breast tumors. Treatment strategy depends on an accurate diagnosis, which can be improved by combining molecular testing and cytopathological investigation. Next-Generation Sequencing (NGS) has emerged as an effective technique to identify mutations and propose prospective targets for new treatments. It also offers insightful information about the genetic makeup of these cancers. Objective: This study’s main goal was to assess the cytopathological characteristics of hematolymphoid malignancies in breast tumors and compare the results with molecular alterations identified by NGS. Finding certain cytological markers that, when paired with molecular data, which could enhance prognostic information, improve diagnostic accuracy, and reveal mutations that might direct targeted therapy was the goal. Case Series: This study includes 7 cases of hematolymphoid malignancies involving the breast, diagnosed via fine-needle aspiration cytology (FNAC). Cytological features such as cellularity, nuclear atypia, mitotic activity, and background elements were evaluated. NGS was conducted on cytology samples to detect significant genomic mutations. The correlation between cytopathological features and molecular findings revealed that certain mutations, such as those in TP53 and MYD88 genes, were associated with specific cytological patterns, providing valuable diagnostic clues. The study also investigated the presence of translocations and gene rearrangements, further enhancing the diagnostic process and offering potential markers for targeted treatment. Conclusion: The diagnosis of hematolymphoid malignancies in breast lesions can be enhanced by combining NGS genetic testing with cytopathology since it offers vital molecular information that may affect treatment choices. This combined method not only increases the accuracy of the diagnosis but can also find prognostic indicators and mutations that may be targeted by future treatments. The findings underscore the importance of incorporating molecular testing into routine cytopathological practice for the effective diagnosis and treatment of these rare malignancies.

Tanvi Shetty 1 , Brij Mohan Kumar Singh 2 ; 1 Department of Basic Medical Sciences, MAHE, Manipal, Karnataka, India, 2 Department of Pathology, Kasturba Medical College, MAHE, Manipal, Karnataka, India Introduction: Mucin-rich lesions in the breast always pose a diagnostic dilemma on FNAC samples. The cellular morphology of mucinous carcinoma is as bland as seen in other benign conditions such as mucocele or myxoid ground substance in fibroadenoma of breast. However, the possibility of mucinous carcinoma cannot be completely excluded. Objective: To evaluate the cytomorphology of mucin-rich lesions of the breast and its mimics on fine needle aspiration cytology. Case Report: A 69-year-old female presented with a hard lump on the upper inner quadrant of her right breast. No axillary lymph nodes were palpable. A mammogram showed a cystic lesion measuring 2.8 x 2.5 cm, suggesting a BIRADS 3 lesion, likely fibroadenoma. FNAC showed an abundance of mucinous material with bland appearing cells in small clusters and dispersed in small groups. Based on this, the possibility of a benign mucin-rich lesion was suggested and a tru-cut biopsy was requested. During the procedure of biopsy, surgeons reported extracting gel-like materials. Histomorphological diagnosis revealed an invasive breast carcinoma with extensive mucinous differentiation. The malignant cells were immunopositive for estrogen receptor (ER), progesterone receptor (PR) and immunonegative for Her2 neu, IHC with high MIB1 proliferative index. Conclusion: The mucin-rich lesions in breast cytology raise the possibility of benign mimickers such as mucocele or myxoid fibroadenoma. These lesions also warrant differentiating them from mucinous carcinoma or mucinous differentiation in invasive breast carcinoma with overwhelming therapeutic consideration. The cytopathologists should be aware of benign mimickers and whenever in doubt, a biopsy to be considered as the final resort.

Shivani Dogra, Navneet Naz; Department of Pathology, Government Medical College, Jammu, Jammu and Kashmir, India Introduction: Ectopic breast tissue is a developmental anomaly. It is a residual breast tissue that may occur anywhere along the primitive embryonic milk line extending from the axilla to the groin. Axilla is the most common site for the accessory breast tissue. Diagnosing fibroadenoma in accessory breast tissue is challenging due to the lack of clinical suspicion and atypical findings in imaging studies. Moreover it is very rare finding in accessory breast tissue. Objective: To present a case report of fibroadenoma in accessory breast tissue of axilla. Case Report: A 25 year old female presented with right axillary swelling since 2 years. On examination swelling was mobile, firm in consistency with regular margins and measuring approximately 2.5 X 2.5 cm. Both the breast and contralateral axilla was normal. Sonography revealed a nodular hypoechogenic lesion of 2.7 X 2.6 cm with increased vascularity and surrounding capsule. Fine needle aspiration cytology (FNAC) was done and cytologically the diagnosis of fibroadenoma was made. Subsequently excision biopsy was done and sent for HPE. Grossly the tissue piece was well circumscribed, encapsulated with maximum diameter of 2.5cm. Microscopically histomorphological features were consistent with Fibroadenoma. Conclusion: Accessory breast tissue is susceptible to same physiological and pathological disease process including inflammatory, fibrotic, cystic and neoplastic diseases so while evaluating the patient fibroadenoma should be considered as one of the differential diagnosis. Fine needle aspiration cytology (FNAC) is very helpful and reliable procedure to facilitate early diagnosis. Complete clinical examination supplemented with FNAC is the basic tool for management.

Sonal Yadav 1 , Prajwala Gupta 1 , Munish Guleria 2 , Nikhil Gupta 3 ; 1 Department of Pathology, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India, 2 Department of Radiodiagnosis, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India, 3 Department of Surgery, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India Introduction: Breast cancer is a leading cause of mortality and morbidity among women worldwide, particularly in India, where it is the most common malignancy. Axillary lymph node (ALN) status is critical for prognosis and management in breast cancer. Although sentinel lymph node biopsy (SLNB) is commonly used for ALN assessment, it faces practical challenges. Preoperative imaging methods like ultrasonography (USG) combined with fine needle aspiration cytology (FNAC) have shown promise in accurately assessing ALNs, potentially reducing unnecessary surgeries. Objective: This study aimed to evaluate the effectiveness of ultrasound-guided FNAC of ALNs in detecting metastatic deposits in breast carcinoma and its correlation with histopathological findings. Materials and Methods: A cross-sectional study was conducted over one year at a tertiary care centre, including 26 patients with biopsy or FNAC-proven early-stage breast carcinoma. After an initial USG evaluation, USG-guided FNAC was performed on ALNs, and the results were analysed using SPSS version 21.0. Results: Out of the 26 patients, 24 (92.3%) were found positive for malignancy on FNAC. USG identified suspicious lymph nodes in 23 patients, with 88% showing multiple lymph node involvement. Significant findings included 50% of patients with loss of oval shape, 77% with increased cortical thickness, 62% with loss of fatty hilum, 50% with absent vascularity, and 54% with necrosis. FNAC results were positive in 24 patients and negative in two, with both results matching histopathology findings, demonstrating 100% sensitivity, specificity, positive predictive value, and negative predictive value. Conclusion: USG-guided FNAC is a cost-effective, minimally invasive, and highly reliable method for preoperative assessment of ALNs in early-stage breast cancer. Its high diagnostic accuracy supports its integration into routine clinical practice, potentially leading to improved management strategies for these patients.

Priyanka P, Hepzibah Rani, Anita P Javalgi, U S Dinesh; Department of Pathology, SDM medical College and Hospital. Affiliated to Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India Cystic tumors of the pancreas most commonly corresponds to serous microcystic adenoma, intraductal mucinous tumor, mucinous cystic tumor, and solid pseudopapillary tumor and, less commonly to cystic endocrine tumors, cystic metastasis, cystic teratomas, and lymphangiomas. Pancreatic cystic neoplasm could be mistaken for a pancreatic pseudocyst The case reported aimed to redefine the differential diagnosis of a presumed pancreatic pseudocyst, emphasizing the possibility of GIST. This case report also describes E-GIST as an pancreatic mass with DOG1 positivity and CD117 negativity on IHC. We report one such case of a large malignant irresectable stromal tumour, feigning as pancreatic pseudocyst, associated with history of chronic pancreatitis, who was treated palliatively. A 68 years old male came with complaints of pain abdomen since 15 days. He was a K/C/O Acute on chronic pancreatitis. HRUSG showed cystic lesion in the head of pancreas measuring 6.8x6x4 cm abutting the stomach. Guided FNAC showed Features of Pseudocyst of pancreas. Exploratory laparotomy was done. Histopathological examination showed F/S/O Gastrointestinal stomal tumour CD117 negative . IHC for DOG1 was positive . We found only one case report in which GIST ( CD117 Positive ) mimicked pancreatic pseudo cyst in literature review. The study concludes that CD 117 negative E-GIST masquerading as pancreatic pseudocyst is rather unusual. The study emphasises that the differential of GIST should be considered. Radiological, cytological findings and histopathological evaluation are to be used for correct diagnosis and management.

Mansi Sharma 1 , Sudeep Khera 1 , Poonam Abhay Elhence 1 , Aasma Nalwa 1 , Meenakshi Rao 1 , Deepak Vedant 1 , Vikarn Vishwajeet 1 , Divya Aggarwal 1 , Vikrant Verma 1 , Subhash soni 2 ; 1 Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 2 Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Background: FNAC (fine-needle aspiration cytology) is a rapid, cost-effective, and safe diagnostic procedure applicable to various neoplastic and non-neoplastic hepatobiliary and pancreatic lesions. Aim and Objectives: Comparative Analysis of Diagnostic Accuracy between Fine Needle Aspiration Cytology (FNAC) and Histopathology in Hepatobiliary and Pancreatic Lesions. Materials and Methods: This study will be a retrospective study done on all hepatobiliary and pancreatic lesions sampled with FNAC and compared with the corresponding histopathological specimens received in the Department of Pathology & Lab Medicine at AIIMS Jodhpur from 01 January 2022 to 31 June 2024. Observation and Results: A total of 106 cases of hepatobiliary and pancreatic lesions were included in the study. The ages of the patients ranged from 13 to 91 years. Maximum number of patients were in the 6th and 7th decades. Most of the patients were females (53.77%), compared to males (46.22%). Out of 106 cases, 24 cases have histopathological correlation. Out of 24 cases, 15 cases have concordance (15/24 cases: 62.5%) and 09 cases have discordance (09/24: 37.5%) with final histopathological diagnosis. Out of 09 discordant cases 03 cases were falsely diagnosed as non-neoplastic by FNAC (03/09: 33%) and 06 were falsely diagnosed as neoplastic or atypical by FNAC (06/09: 66%). 08 cases were taken from hepatic lesions, 06 cases from gall bladder mass and 10 were from pancreatic mass. The diagnostic accuracy of FNAC for hepatobiliary and pancreatic lesions is calculated as 62.5%. Conclusion: This study demonstrates the effectiveness and utility of hepatobiliary and pancreatic lesion FNAC, with a large proportion of cases yielding definitive diagnoses with good diagnostic accuracy.

Jyoti R Kini, Pratyush Jaiswal, Gayathri Kini, K S Pooja, Cheryl Phillipose, Ranjita Rao; Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India Introduction: Gastrointestinal stromal tumours (GISTs) are rare mesenchymal tumours of the gastrointestinal tract. Concluding on a diagnosis of these tumours on aspirate cytology can be challenging, especially without the use of immunocytochemistry. Objectives: To review the characteristic cytologic features of GIST diagnosed using FNAC, histopathology and immunohistochemistry. Case Report: Four cases of GISTs which had cytologic and histopathologic evaluation and diagnosis confirmed by immunohistochemistry were reviewed, The age range of these patients varied from 46-71 years with three seen in male and one female patient. Two were located in the stomach and two in the right colon. Cytology revealed cellular smears with cohesive irregularly outlined spindle cell clusters with prominent vascular pattern. The tumor cells had elongated to ovoid uniform nuclei and delicate wispy cytoplasm. Histopathology confirmed the cytological diagnosis supported by c-kit and DOG-1 positivity on immunohistochemistry. Conclusion: FNAC proves to be extremely useful in evaluating spindle cell tumors of the gastrointestinal tract and unveiling a rare diagnosis of GIST. Though histopathological and immunohistochemical correlation is essential for a definitive diagnosis, cytology provides crucial initial insights in such cases aiding optimal patient management.

Rakshita Acharya Kotta Lanka 1 , Pragya Verma 1 , Parikshaa Gupta 2 , Nalini Gupta 2 , Radhika Srinivasan 2 , Pankaj Gupta 3 , Shelly Sharma 2 , Usha Dutta 4 , Ritambhra Nada 5 , Anupam Lal 3 ; 1 Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 2 Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 3 Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 4 Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 5 Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India Introduction: Advanced gallbladder carcinoma (AGBC) is an aggressive malignancy with a poor prognosis. The role of immunotherapy has not been much explored as there is a shortage of literature regarding Programmed death ligand 1 (PD-L1) expression in AGBCs. The present study was conducted to assess the expression of PD-L1 in cell blocks prepared from fine-needle aspirates from AGBCs to identify potential candidates who can benefit from immunotherapy. Materials and Methods: This prospective, case-control study was performed on 50 cytologically-diagnosed primary AGBCs. A detailed cytomorphologic assessment was followed by immunocytochemistry(ICC) for PD-L1(SP263 clone) on AGBC cell blocks with at least 100 viable tumor cells. An equal number of age and gender-matched resected chronic cholecystitis specimens were included as controls and assessed for PD-L1 immunoexpression. Results: Of the 50 cases, 5(10%) showed positive immunoexpression for PD-L1 while 45(90%) were negative. Among the controls, none showed any immunoreactivity for PD-L1. On statistical analysis, positive PD-L1 expression was significantly associated with AGBC compared to the controls(P=0.0001). The majority of PD-L1 positive cases were elderly females, having large GB masses with diffuse involvement(n=5), with moderate-marked nuclear pleomorphism(n=5), poorly-differentiated(n=3), and advanced stage(n=5) (P>0.05). Among the cytologic diagnoses, PD-L1 positive immunoexpression was more common in sarcomatoid carcinoma(n=1;100%) and squamous cell carcinomas(n=1/4; 25%) than adenocarcinomas(n=3/39;7.7%). Conclusions: Positive immunoexpression (10%) was significantly associated with AGBC and was more common in higher grade and stage tumors. Ours is the first study to successfully demonstrate the utility of cytologic aspirates in AGBC patients for evaluation of PD-L1 expression.

Chandra Prakash Pandey, Tanvi Jha, Prajwala Gupta; Department of Pathology, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India Introduction: Urinary bladder cancer ranks as the 9th most common cancer globally, with rising incidence and mortality rates. Urine cytology is crucial for early detection, but factors like poor cellularity can hinder its effectiveness. CK 20 immunohistochemistry (IHC), normally expressed only in umbrella cells of healthy urothelium, becomes abnormally expressed in malignancy. Therefore, CK 20 IHC can aid in diagnosing such cases. Objectives: To assess the utility of CK20 IHC in detecting urothelial neoplasms in atypical cases on urine cytology. Case Series: This was a cross-sectional study done over a period of one year at a tertiary health care centre. All cases, which on preliminary urine cytology smear evaluation were diagnosed as “Atypical Urothelial Cells” (AUC) as per the Paris System (TPS) were included, their cell block was made and CK20 IHC was applied. A total of 50 cases were enrolled. CK20 IHC was positive in 41 cases (82.0%) and negative in 9 (19.57%). In 22 cases, diffuse CK20 staining and focal staining was seen in 19. On correlating with histopathology, of these diffusely positive cases, 21 were high-grade urothelial carcinomas. Of the focally positive cases, 17 corresponded to a low-grade carcinoma. While 1 diffuse and 2 focal cases were lost to follow-up. Absence of CK20 correlated with a tumour free biopsy (p<0.001). The accuracy of CK20 in detecting urothelial carcinoma was 100% in terms of sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy. Conclusion: CK20 IHC, thus, may act as a useful adjunct to urine cytology, particularly in detecting cases where cellularity otherwise be a constraint; in AUC category of TPS. Further, the staining intensity may correspond to the grade of the carcinoma and may aid strongly in detecting high grade cases and focal staining may suggest low grade which are often undetected on urine cytology.

Sakshi Mahajan, Rupali Bargotra, Ameet Kaur; Department of Pathology, GMC, Jammu, Jammu and Kashmir, India Introduction: Renal Cell Carcinoma denotes cancer originated from the renal epithelium and accounts for more than 90% of cancers in the kidney. It represents the sixth most frequently diagnosed cancer in men and the 10th in women. Renal Cell Carcinoma is characterised by a lack of early warning signs resulting in a high proportion of patients with metastasis, diverse clinical manifestations and resistance to radiotherapy and chemotherapy. Objective: To present a cytodiagnostic case report of Renal Cell Carcinoma in a 52 year old male. Case Report: A 52-year-old male who presented to the CTVS Department, GMC Jammu with chief complaints of swelling over the left lateral chest wall for 1 month measuring 3 cm x 2.5 cm. On physical examination, the lump was soft, tender, fixed and progressively increased with time. Materials and Methods: USG HRCT FNAC USG HRCT FNAC Observations and Results: USG Chest wall showed well defined, predominantly solid, heterogeneous hypoechoic area measuring 3.3 cm x 2.5cm x 3.2 cm, showing significant vascularity on Colour Doppler causing indentation on pleura, at the visible site of swelling in intercostal plane. USG Abdomen and Pelvis showed Right Renal Mass. HRCT Chest showed multiple lytic lesions involving ribs, manubrium, left humerus, spine with soft tissue component measuring 44 mm x 35 mm, suggestive of metastasis. MGG and Pap stained smears showed cytomorphological features suggestive of metastatic deposits of Adenocarcinoma. In view of USG Abdomen Pelvis and USG Chest and HRCT findings, it points towards the diagnosis of Renal Cell Carcinoma. Conclusion: Diagnosing Renal Cell Carcinoma involves a comprehensive approach, including imaging studies, biochemical tests, cytological and histopathological analysis. Early detection and precise characterization of the tumour are essential for optimising patient outcome and appropriate therapeutic strategies.

Charli Roy 1 , Rimlee Dutta 1 , Akshay Ganeshkumar 2 , Rajeev Sharma 2 , Mehar Chand Sharma 1 ; 1 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India, 2 Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India Introduction: Meningiomas are one of the commonest CNS tumors accounting for 15% of primary brain tumors. Typically benign, they have a good prognosis following gross resection. Malignant meningiomas are rare, with metastasis occurring in only 0.1-0.2% of cases. Extracranial metastasis to cervical lymph nodes is extremely rare and seldom described. Objectives: Herein, we present a case of recurrent meningioma with metastasis to bilateral cervical lymph nodes, diagnosed on cytomorphology of aspirate smears. Case Report: A 50-year-old man, priorly diagnosed 8 years ago, as atypical meningioma of the left frontal convexity on resection, followed by 30 cycles of radiotherapy; presented with seizures, involuntary limb movements, frothing and loss of consciousness. Examination revealed a large exophytic mass (12x10 cm) in bifrontal region with bilateral cervical lymphadenopathy (7.5x7.5 cm and 3x3 cm). Tumor resection was performed along with fine needle aspiration of bilateral cervical lymph nodes. Histopathological examination of the tumor conferred the diagnosis of anaplastic meningioma (WHO Grade 3), recurrent. Bilateral lymph node aspirates were hypocellular however showed loosely cohesive fragments of elongated to spindle cells in a fibrous stroma. The tumor cells exhibited mild nuclear pleomorphism. Significant mitotic activity or necrosis were absent. Cell block yielded scant material. Overall findings were suggestive of metastatic meningioma. The patient expired shortly later due to post-operative complications. Conclusion: Meningiomas usually behaves in a benign manner and have a good prognosis after treatment with tumor resection; with or without adjuvant therapy. Tumor grade is the key predictor of recurrence and metastasis. Malignancy in meningioma is rare and extracranial metastasis to cervical lymph nodes are even rarer. Such cases often pose a diagnostic challenge. Despite their rarity, they should be included in the differential diagnosis of cervical lymphadenopathy, especially in patients with a history of resection. This case highlights the aggressive potential behaviour of meningiomas to spread via lymphatic invasion.

Kalisetty Prashanthi, Vidhya Vikashini Vikashini Balasubramanian, Chayanika Phenang, Debasis Gocchait; Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India Introduction: Extramedullary haematopoiesis (EMH) is a fascinating phenomenon where immature blood cells appear outside the bone marrow. While common in foetal development, its presence in adults often signals underlying pathology, from bone marrow failure to malignancies. This unusual blood production can manifest in various body sites, from lymph nodes to the pancreas, and reflects complex mechanisms like compensatory responses or abnormal cell production in other tissues including lymph node, heart, respiratory tract and kidney. Objective: This case report emphasises on the understanding to EMH offers crucial insights into the underlying pathology, aiding in prompt diagnosis and treatment. Case Report: A 65-year-old female presented with generalized lymphadenopathy and malaise for 4 months. A CT scan revealed asymmetric mucosal thickening in the proximal colon and ileocecal junction, suggesting metastatic colorectal cancer. FNAC of cervical and inguinal lymph nodes showed highly cellular smears with blasts and extramedullary hematopoietic elements, including megakaryocytes and erythroid cells. A bone marrow biopsy indicated near-total marrow replacement. Flow cytometry confirmed T-lymphoblastic leukemia/lymphoma. Additionally, a 30-year-old male was diagnosed with early T-cell precursor lymphoma/leukemia, showing cervical lymphadenopathy. FNAC of his cervical lymph nodes revealed leukemic blasts and extramedullary hematopoietic elements, including erythroid cells and megakaryocytes. Conclusion: Initially in the first case, a fine needle aspiration cytology (FNAC) of the lymph node was performed, revealing blastoid cells with extramedullary hematopoietic elements. This finding was subsequently corroborated by bone marrow being replaced by blasts and flow cytometry, highlighting the crucial role of FNAC in this diagnostic context.

Vidyulata Madhu, Roobashri Murugan, P Janani, Debasis Gochhait, Neelaiah Siddaraju, B H Srinivas; Department of Pathology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Puducherry, India Introduction: Plasmablastic lymphoma (PBL) is a rare, CD20-negative, aggressive lymphoma with a poor prognosis under standard therapies. It features large atypical B cells with plasmablastic or immunoblastic morphology and a terminal B-cell differentiation phenotype. Typically arising from extranodal sites, PBL is classified by the World Health Organization as a CD20-negative, aggressive non-Hodgkin lymphoma (NHL). Diagnosing plasmablastic lymphoma presents significant challenges and requires careful attention to subtle cytological clues. A definitive diagnosis can only be established through additional ancillary testing, including tissue biopsy and immunohistochemistry. Herein, we present a case of cutaneous plasmablastic lymphoma initially identified through cytology smears, with further confirmation achieved via immunohistochemistry on a cell block. Objectives: Accurate diagnosis of plasmablastic lymphoma is crucial due to its diverse presentations. It must be considered alongside common neoplasms, with attention to minor cytologic details for early detection. Early identification enables prompt treatment, significantly improving patient outcomes. Case Report: A 73-year-old man with HIV-negative status, presented with facial pain, ear blockage, and nasal obstruction for 4 weeks. A contrast-enhanced CT revealed a heterogeneously enhancing nasopharyngeal lesion, suggestive of nasopharyngeal carcinoma (cT4N0Mx). One week later, he developed asymptomatic nodules on his left forearm, the largest being 2x2 cm. Fine needle aspiration cytology of these nodules showed dyscohesive clusters of atypical cells with plasmacytoid morphology, negative for cytokeratin. Immunohistochemistry on cell block was positive for CD138 with kappa restriction, confirming plasmablastic lymphoma. A subsequent biopsy of the nasopharyngeal mass was consistent with the cytology findings. Conclusion: In our case, the final diagnosis was swiftly established through cytological examination, supported by ancillary testing such as immunohistochemistry on a cell block. This underscores that histopathological diagnosis is not the only standard if subtle cytologic clues and cell block techniques are utilized. This approach enabled early diagnosis and prompt treatment.

Sudha Sharma 1 , V Anish Chandran 1 , Vinay Kaushik 2 , Rajni Kaushik 1 ; 1 Department of Pathology and Dr. YSPGMC, Nahan, Himachal Pradesh, India, 2 Department of Medicine, Dr. YSPGMC, Nahan, Himachal Pradesh, India Introduction: Tubercular lymphadenitis is a common cause of extrapulmonary tuberculosis in India. Limited literature is available regarding its cytologic spectrum in the Himalayan region of North India. Aim and Objectives: This study aimed to estimate the incidence of tuberculous lymphadenitis in a tertiary medical college in North India over six years, study the demographic profile, cytologic spectrum, and correlate Fine needle aspiration cytology (FNAC) findings with Zeihl Neelsen (ZN) and Cartridge-based nucleic acid amplification test (CBNAAT) positivity. Materials and Methods: A retrospective study was conducted. Lymph node FNACs from 01/01/2018 to 31/12/2023 were studied. Tubercular lymphadenitis was diagnosed if cytology showed caseous necrosis with or without epithelioid cell granuloma and/or ZN positivity, and/or CBNAAT positivity, and/or response to ATT. The pattern of inflammation was recorded: Pattern A: caseous necrosis with epithelioid cell granulomas; Pattern B: Only epithelioid cell granuloma; Pattern C: Only caseous necrosis, and Pattern D: Acute suppuration. Appropriate statistical tools were used. Results: 201 (23.5%) lymph nodes showed features of tuberculosis out of 854 sampled. The age ranged from 5 months to 68 years, the most common age group being 21 to 30. There were 61 males and 140 females. Cervical lymph nodes were the most involved. The most common pattern was Pattern A (75%). Out of 201 cases, 91 (45.3%) showed AFB positivity and 126 (62.3%) showed CBNAAT positivity. Maximum AFB positivity was seen in Pattern A. The difference in CBNAAT positivity was significant between Pattern A and B, Pattern A and C, and Pattern A and D, ( P < 0.05). Conclusion: Tubercular lymphadenitis is common in young females in our region, frequently involving cervical lymph nodes. Most of the cases showed caseous necrosis with granulomas. The pattern of tuberculosis may provide a clue to the diagnosis. CBNAAT increases the diagnostic efficacy of FNAC in diagnosing tuberculosis.

Karthik Dasari, Arshi Khan, Ruquiya Afrose, Sayeedul Hasan Arif, Kafil Akhtar, Mohammed Jaseem Hassan; Department of Pathology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India Introduction: Non-Hodgkin’s Lymphomas (NHL) are a heterogeneous group of lymphoproliferative malignancies, with a greater preference for disseminating to extranodal locations. Over the past decade, there has been an increased prevalence of extranodal involvement in NHL, with sites such as the stomach, spleen, Waldeyer’s ring, Central Nervous System (CNS), lungs, and skin being commonly affected. Objectives: How puzzling can become NHL when it occurs in uncommon sites and how to interpret the diagnosis on cytology. Case Presentation: This case report highlights a rare occurrence of Non-Hodgkin’s Lymphoma (NHL) in a 58-year-old female, characterized by an unusual presentation as a solitary mass on the anterior aspect of the left thigh. Fine needle aspiration cytology (FNAC) of the left thigh lesion show round to oval atypical cells having enlarged, hyperchromatic nuclei with increase N:C ratio, irregular nuclear membrane and scant cytoplasm. Based on these findings, a diagnosis of small round cell tumor, favouring lymphoproliferative disorder was suggested. The histopathological examination of the excised lesion show lining of stratified squamous epithelium. The underlying subcutaneous tissue show well circumscribed nodule comprising of monomorphic population of small to medium sized cells arranged in diffuse sheets. These cells have round to oval nuclei with vesicular to clumped chromatin and scant cytoplasm. On immunohistochemistry, the tumor cells show diffuse and strong membranous positivity for LCA and CD20, while CD3 was negative in tumor cells. Thus a diagnosis of Non-Hodgkin’s Lymphoma, B-cell type was rendered. The patient was subsequently referred to the Radiotherapy department for adjuvant chemotherapy. Conclusion: This case underscores the diverse manifestations of NHL and the importance of a multidisciplinary approach in its diagnosis and subsequent therapeutic interventions.

Sameer Puri 1 , Sunil Kumar Mallick 1 , Shubham Sahni 2 , T Balamurugan 1 , Aruna Nambirajan 1 , Deepali Jain 1 ; 1 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India, 2 Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India Introduction: Inflammatory myofibroblastic tumor (IMT) is a rare intermediate-grade neoplasm composed of myofibroblastic tumor cells admixed with inflammatory infiltrate of plasma cells, lymphocytes, and eosinophils. Although lung is a common site for IMT, pulmonary IMT are rare, accounting for only 0.04–0.7% of all lung masses. They are locally aggressive with frequent local recurrences, but metastases are rare. Herein, we present a rare case of pulmonary IMT that presented with metastatic disease and was misdiagnosed as a high-grade sarcoma on the lymph node aspirate. Case Report: A 29-year-old non-smoker female presented with evening rise in temperature and left lower chest pain for 7 months, shortness of breath for 5 months, abdominal distension for 5 days, and undocumented weight and appetite loss. Examination showed ascites, hepatosplenomegaly and generalized lymphadenopathy. Imaging showed left lower lung consolidation-like mass and multiple omental, mesenteric and adnexal deposits. Fine needle aspirate from right supraclavicular lymph node revealed cohesive clusters of large pleomorphic cells with plump cytoplasm, vesicular nuclei and prominent eosinophilic macronucleoli, prompting diagnosis of metastatic poorly differentiated malignant tumor, possibly high-grade sarcoma. Subsequent lung biopsy showed similar epithelioid to rhabdoid cells with prominent macronucleoli without significant inflammatory infiltrate. Mitoses or necrosis was absent. A panel of immunostains was applied to exclude rhabdoid tumor, GIST, epithelioid sarcoma, dendritic cell sarcoma, carcinoma, germ cell tumor and PEComa. Tumor cells were focally positive for desmin and ALK (diffuse cytoplasmic staining) while negative for CK, SALL4, MUC4, SMA, CD30, CD45, CD3, CD20, SOX10, SMMHC, CD21, CD35, cathepsin K, myogenin, ERG, MPO, DOG1 and ROS1. BRG and INI1 expression was retained. FISH assay confirmed ALK gene rearrangement. Conclusion: Inflammatory infiltrate may not always be prominent and IMT must be included as a differential diagnosis when evaluating epithelioid/spindle cell rich aspirates with prominent nucleoli in young patients with lung masses.

Tanvi Jha 1 , Neha Singh 1 , Prajwala Gupta 2 ; 1 Deparment of Pathology, Dr. Ram Manohar Lohia Hospital, New Delhi, India, 2 Department of Pathology, ABVIMS, New Delhi, India Introduction: Bacillus Calmette-Guérin (BCG) lymphadenitis is a common complication following BCG vaccination. Fine needle aspiration cytology (FNAC) is a practical and cost-effective method for diagnosing and managing this condition. Awareness of BCG lymphadenitis in cytology is crucial to prevent misdiagnosis, as its cytomorphologic features closely resemble those of tuberculosis. Objectives: This study details the clinical presentation and specific cytomorphologic characteristics of 27 children with BCG lymphadenitis. Case Report and Series: The study included 27 patients presenting with isolated left axillary or cervical lymphadenopathy, aged between 1 and 24 months, with a male-to-female ratio of 2.75:1. In all cases, the site of vaccination was left shoulder over the deltoid muscle and the swellings were present on the ipsilateral side of the BCG scar in all the cases. Most children had enlarged left axillary lymph nodes, followed by cervical nodes. None of the children had episode of fever or cough. No history of significant weight loss was identified and all the children were taking feeds properly. Cytomorphological analysis revealed dense acute and chronic inflammatory cells, epithelioid cell granulomas, multinucleated giant cells, histiocytic aggregates, reactive lymphoid cells, lymphohistiocytic clusters, and calcification. A necrotic background was observed in 25 (92.6%) cases, and Ziehl-Neelsen staining for acid-fast bacilli was positive in 17 (62.9%) cases. Conclusions: Clinicians should maintain a high index of suspicion for BCG lymphadenitis in recently vaccinated children. While diagnosis is primarily clinical, cytology and microbiological examination play essential roles in evaluating lymph node swelling. FNAC, in combination with clinical presentation, is valuable for diagnosing BCG lymphadenitis and preventing unnecessary tuberculosis treatment.

Nimishya Joon, Sunil Kumar Mallik, Anant Mohan, Aruna Nambirajan, Deepali Jain; Department of Pathology and Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India Background: Presence of mesothelial inclusions in lymph nodes is an extremely rare occurrence with less than 40 cases reported in literature. Herein, we present a diagnostically challenging case of mesothelial inclusions sampled by aspiration cytology in a young non-smoking male with recurrent chylous effusions and thrombosis. Case Report: A 19-year-old non-smoking male presented with bilateral recurrent chylothorax, chylopericardium and chylous ascites along thrombosis of the superior vena cava, inferior vena cava and subclavian veins. Despite talc pleurodesis, his effusions persisted. However, all effusion cytology examinations were negative for malignancy and showed only reactive mesothelial cells. Imaging revealed generalised lymphadenopathy of cervical, axillary and thoracic lymph nodes with necrotic internal mammary nodes. With clinical differential diagnosis of hematolymphoid malignancy and tuberculosis, patient underwent aspiration of the necrotic internal mammary node. Direct smears prepared were highly cellular with numerous clusters and balls of mesothelial cells in a background of reactive lymphoid tissue. Corresponding clot core also showed similar features. The mesothelial cells were immunopositive for cytokeratin, calretinin, desmin (diffuse) and EMA (focal) while were immunonegative for TTF-1, and claudin-4. P53 showed wild type immunoexpression. BAP1 was retained. Fluorescence in situ hybridisation assay was negative for CDKN2A homozygous deletion. A cytological diagnosis of reactive mesothelial proliferation with possibility of mesothelial inclusions was offered. An inguinal lymph node biopsy subsequently performed confirmed mesothelial inclusions in lymph node. The patient was treated symptomatically and asked to be discharged against medical advice. He is currently lost to follow-up. Conclusion: Mesothelial inclusions are primarily seen in patients with chronic mesothelial irritation wherein there is disruption of mesothelial stomata, allowing dislodged mesothelial cells access to sub-mesothelial lymphatics, leading to presence of the clusters of mesothelial cells in the lymph nodes. Differentiating benign and neoplastic mesothelial cells, especially within a lymph node, require an appropriate panel of immunohistochemical and molecular markers as illustrated in this case.

P Naveen, Madhusmita Sethy, Pavithra Ayyanar, Amit Kumar Adhya, Sarojini Raman, Dillip Kumar Muduly; Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India Introduction: Ovarian tumours remain one of the leading malignancies of the female genital tract, with a high mortality rate. Peritoneal wash cytological analysis is an effective predictor of the involvement of ovarian surface and peritoneal dissemination. The International Federation of Gynaecology and Obstetrics (FIGO) provided staging of ovarian carcinoma, according to which positive peritoneal cytology is observed in stages IC/IIA/IIB or IIC. Aims and Objectives: The study aims to determine the significance of positive peritoneal wash cytology in ovarian tumours and correlate it with cell block and histopathological features. Materials and Methods: Retrospective study including the cases from January 2023 to July 2024. A total of 29 positive pre-resection peritoneal wash sample was obtained from clinically diagnosed ovarian tumour patients. All the cases included underwent bilateral oophorectomy with total abdominal hysterectomy. All the specimens were sent for histopathological analysis. Results: The age-wise distribution of ovarian tumours revealed that, with the exception of one case of high-grade serous ovarian carcinoma in a 38-year-old female patient, the majority of ovarian tumours above the age of 40. Of the 29 cases, all were reported as positive for malignancy in peritoneal wash cytology. In 21 cases, cell block was also performed, and it showed similar cytomorphology. Of these 29 cases, 26 turned out to be malignant (majority of them were high grade serous carcinoma 88%), Benign-2cases, and borderline tumour-1 according to histopathology. In this study, 27 cases are true positive and 2 cases (6.8%) turned out to be false positive. Conclusion: Based on our study findings, we conclude that peritoneal wash cytology is a sensitive indicator of the peritoneal spread of ovarian carcinoma. FIGO, Ovarian carcinoma, Peritoneal wash

Akriti Jindal, Pallavi Saraf, Ankita Soni, Gargi Kapatia, Manjit Kaur Rana; Department of Pathology and Lab Medicine, AIIMS, Bathinda, Punjab, India Introduction: Testicular lymphoma, albeit rare and clinically aggressive, accounts for only 1% of all lymphomas. Diffuse Large B-cell Lymphoma (DLBCL) is the most common type of testicular lymphoma. Metastasis from testicular DLBCL can occur to the contralateral testis, lungs, pleura, brain etc. This report describes a case of primary testicular DLBCL with pleural fluid metastasis. Despite a thorough literature search, no previous case reports of pleural fluid metastasis from primary testicular DLBCL were found. Herein, we present a unique case of 51-year-old male having primary testicular DLBCL associated with metastasis to pleural fluid. Objectives: To demonstrate the efficacy of immunohistochemistry on cell block to confirm the pleural fluid metastasis in a known case of primary testicular lymphoma. Case Report: A 51-year-old male presented with dyspnea and shortness of breath for one month. Contrast enhanced computed tomography (CECT) of chest revealed bilateral pleural effusion. Pleural tap was done and pleural fluid was sent for cytological examination that revealed presence of singly scattered atypical cells. Cell block was also prepared that showed similar atypical cells. After taking detailed history, it was found that the patient had undergone orchiectomy outside one month prior in view of testicular mass. The histopathological blocks of orchiectomy specimen were reviewed which suggested features of Non-Hodgkin Lymphoma. Further, Immunohistochemistry on both the testicular tissue and pleural fluid cell block was performed that showed diffuse strong positivity of atypical cells for CD45, CD20 and MUM1 with a Ki67 index >90%. A final diagnosis of testicular DLBCL, ABC subtype, with pleural fluid metastasis was rendered. Conclusion: Pleural fluid involvement in a proven case of testicular high grade lymphoma is rare and carries a poor prognosis. In such cases, pleural fluid metastasis can be diagnosed by evaluation of cytology smears for morphology and confirmation by immunohistochemical markers on cell block.

Siddharth Garg, Jai Kumar Chaurasia, Deepti Joshi, Vaishali Walke; Department of Pathology and Lab Medicine, AIIMS, Bhopal, Madhya Pradesh, India Introduction: Malignant serous effusion is usually a manifestation of disseminated and advanced stages of malignancy. Sometimes, it can be the first manifestation before the diagnosis of primary malignancy. Metastatic urothelial carcinoma to serous effusions is extremely rare and its cytomorphological features have only been described in rare case reports. The cytomorphological features are challenging and often overlap with reactive mesothelial cells, metastatic adenocarcinomas, mesothelioma, or even squamous cell carcinoma in serous effusions. The accurate diagnosis of this entity requires correlation of clinical history, acquaintance with cytomorphologic features, and application of appropriate immunohistochemical panel on cell blocks. Objectives: To highlight diagnostic challenges and cytomorphological features of metastatic urothelial carcinoma in peritoneal fluid and diagnostic role of cell block with immunocytochemistry. Case Report: A 56-year male presented with history of recurrent haematuria and lower abdominal pain. The peritoneal fluid was submitted for cytological examination. The cellular smears revealed atypical cells in clusters and as single cells with high nuclear-cytoplasmic ratio, irregular nuclear membrane, coarse chromatin, and prominent nucleoli with “window” formation and cytoplasmic vacuolations. Few of the cell clusters showed “cell wrapping”. Cell block prepared confirmed the presence of atypical cells in small clusters with similar morphology. Immunocytochemistry on cell blocks showed membranous positivity for CK7 and CK20 and nuclear positivity with GATA3 and negative for calretinin, WT-1, CDX2, CEA, CK 19 which confirmed the metastasis of urothelial carcinoma. Later, the diagnosis of high-grade urothelial carcinoma was confirmed on resected tumor on histopathology. Conclusion: This case highlights the cytomorphological features of metastatic urothelial carcinoma in peritoneal fluid and also emphasizes the diagnostic role of effusion cytology and cell blocks with immunocytochemistry in diagnosing such rare carcinomas in serous fluid.

Ankita Chaudhari, Chitrawati Gargade, Sujit Gore, Rahul Sakpal, Vijay Dombale; Department of Pathology, BKL Walawalkar Rural Medical College, Ratnagiri, Maharashtra, India Introduction: Pleural effusion develops during the clinical course of non-Hodgkins Lymphoma (NHL) in 16-20% cases. Massive pleural effusion can be the only clinical presentation rarely. In malignancy-related serous effusions, cytology remains the first-line, cost-effective and rapid diagnostic tool. It provides clues to the underlying pathology and with further ancillary investigations accurate diagnosis can be achieved. Case Report: We present a case of 43-year-old immunocompetent, Hepatitis B seronegative female who presented with weight loss , breathlessness and cough of two months duration . Her chest X-ray showed gross left sided pleural effusion. Pleural fluid examination showed marked lymphocytosis with normal fluid adenosine deaminase (ADA) levels and gene expert study was unremarkable. Her complete hemogram reported outside showed polymorphonuclear leucocytosis. There was no organomegaly or generalised lymphadenopathy. Serum LDH was slightly raised. Pleural fluid cytology showed numerous atypical lymphoid cells with blastoid morphology. Hence she has been investigated further. Repeat hemogram showed leucocytosis with 16% blast like cells in peripheral smears. Flow cytometry of pleural fluid and bone marrow aspirate revealed high grade Large B cell Non -Hodgins Lymphoma. Bone marrow biopsy showed infiltration by tumour cells. Fluorescence in situ hybridisation (FISH) detected an IGH rearrangement and MYC rearrangement without associated abnormalities in BCL2 or BCL6. Final diagnosis of high-grade large B cell lymphoma (HGBL)-NOS involving pleura was rendered on account heterologous immunological markers and cytogenetic study. The mystery of whether effusion was due to Primary effusion lymphoma (PEL) or pyothorax associated lymphomas (PAL) or as a complication of systemic lymphoma is resolved by pleural fluid examination with ancillary investigations. Conclusion: Lymphoma should be considered as one of the differential diagnoses while evaluating lymphocyte rich pleural effusion. The final diagnosis can be achieved by meticulous pleural fluid examination and confirmed by fluid flowcytometry.

Divya Nandwana, Aasma Nalwa, Meenakshi Rao, Sudeep Khera, Deepak Vedant; Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Introduction: Hematolymphoid neoplasms (HLNs) in the body cavity effusions (such as pleural, peritoneal, or pericardial effusions) are rare. However, detecting these neoplasms through effusion cytology can be a significant breakthrough for early and effective clinical management. Case Details: We will discuss three compelling cases of Hematolymphoid neoplasms in body cavity effusions. Case 1: A 34-year-male with known case of Non Hodgkin lymphoma on RCHOP regimen since January 2024 presented with bilateral pleural effusion.Pleural fluid examination shows small to intermediate sized cells with scant cytoplasm, cleaved nuclei, irregular nuclear membranes, coarse chromatin and prominent 1-2 nucleoli. Cell block showed sheets and singly scattered atypical lymphoid cells. Immunohistochemistry showed diffuse strong membranous positivity for CD45, CD20, and are negative for CD3, D2-40 was seen in the background mesothelial cells.A diagnosis of B cell Non-Hodgkin lymphoma was given. Case 2: A 15-year-male presented with sudden onset breathlessness since 3 months and developed bilateral pleural effusion. Pleural fluid examination showed singly dispersed atypical lymphoid cells (98%), which include lymphoblasts and large atypical lymphoid cells with increased nuclear cytoplasmic ratio and occasional prominent nucleoli. A diagnosis of Non-Hodgkin lymphoma was given. Case 3: A 28-year-female with complaints of breathlessness 1 year presented with bilateral pleural effusion. Pleural fluid examination showed moderately cellular smears displaying mature lymphocytes, monocytes, & occasional mesothelial cells along with few large atypical lymphoid cells with high N:C ratio,opened up chromatin,prominent nucleoli. A diagnosis of Non-Hodgkin Lymphoma was given. Conclusion: Pleural effusion may be a predominating sign of Non Hodgkin lymphoma and is usually due to direct involvement of the pleura by lymphoma. Pleural effusion if associated with NHL, signifies a widespread disease. Cytological analysis of pleural fluid and other ancillary studies support can help in a quick diagnosis and prognostically significant information for classifying lymphoma and starting treatment.

Epsita Das, Mukul Singh, Priyanka Singh, Sunil Ranga; Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India Introduction: Oral squamous cell carcinoma (OSCC), a global concern is associated with majority of oral cancer-related fatalities. OSCC has propensity for distal spread to lungs, bones, and liver. However, malignant pleural effusions arising from OSCC are exceptionally rare. Objectives: This case report highlights an unusual presentation of distant metastasis of OSCC presenting as a malignant pleural effusion diagnosed primarily on cytology. Case Report: A 61 years male presented with cough, chest pain and shortness of breath for a week with tachypnea and diminished breath sounds. He was diagnosed with SCC, buccal cavity on punch biopsy five months earlier. Local examination revealed an ulceroproliferative lesion in the right buccal cavity. CXR demonstrated bilateral pleural effusion. Pleural fluid aspiration was sent for cytological examination where giemsa, pap smears and cell block were prepared from the cytospin deposits. Giemsa stained smears showed scattered single atypical cells with high N:C ratio, hyperchromatic nuclei, irregular nuclear membranes with moderate cytoplasm amongst reactive mesothelial and inflammatory cells. No three-dimensional clusters, signet ring cells, intercellular ‘windows’ or fiber cells, were seen. Haematoxylin and eosin sections from cell block showed discohesive tumor cells with moderate cytoplasm, pleomorphic nuclei amidst dense inflammation. Immunocytochemistry panel for P63, MUC5AC, Napsin-A and TTF1 was done. Tumor cells were strongly positive for p63 and negative for MUC5AC, Napsin A and TTF-1. Therefore, a diagnosis of a metastatic SCC was made considering the patient’s history, cytomorphological findings and immunocytochemistry. Regrettably, the patient was lost to follow up. Conclusion: Malignant pleural effusions in metastatic OSCC are rare indicating dissemination and is associated with a dismal prognosis. No chemotherapy regimen is found to be effective for patient survival. Hence, it is critical for pathologists to identify such occasional occurrence. In OSCC, malignant pleural effusion can be accurately detected using cytology in conjunction with clinical information, radiology, and immunocytochemistry.

Purnima Shree, R Abhirami Ganesh, Vinay N Gowda, Poonam Abhay Elhence, Abhishek Purohit, Aasma Nalwa, Meenakshi Rao, Sudeep Khera, Deepak Vedant, Vikarn Vishwajeet, Divya Aggarwal, Vikrant Verma, Pratibha Singh, Jeewan Ram Vishnoi; Department of Pathology and Lab Medicine, AIIMS, Jodhpur, Rajasthan, India Introduction: Ascites of malignant etiology appear in only 10% of all ascites cases (1). Non-malignant etiology ascites is most commonly caused by liver and heart diseases. Malignant ascites most frequently present in gynecological, gastrointestinal and breast carcinomas. A combination of malignant ascites and carcinomatosis of the peritoneum is present in 15– 30% of cases (2). Ascites is the most common complaint of patients with ovarian carcinoma. In 54% of patients with peritoneal carcinomatosis, ascites was the first detectable sign of malignancy (3). Objective: The objectives of this study were to examine the percentage of false positive and false negative results in the cytology of ascitic fluid and to determine the validity of peritoneal cytology in relation to the histopathological type of the ovarian tumor. Materials and Methods: This retrospective study included 116 peritoneal cytology fluid cases. The study was conducted from January 2023 to July 2024. Results: 116 fluid samples were examined of which 101 had a diagnosis of malignant ovarian tumour on final histopathology and 15 fluids were associated with a benign ovarian lesion. The sensitivity of peritoneal cytology was 32.3%, specificity 88.9%, positive predictive value was 89.1%, and negative predictive value 17.8%. In 69 of 116 cases (59.48%), the peritoneal cytology did not show malignant cells (false negative), while in 4 of 116 cases, the results were false positive on comparing with histopathology diagnosis. Conclusion: Cytological examination of ascitic fluid is specific but has low sensitivity. In order to increase sensitivity, peritoneal cytology should be combined with cell blocks followed by application of immunohistochemical antibodies and correlation with other serum markers.

Janani Pushparaj, J Thanka; Department of Pathology, SBMCH, Chennai, Tamil Nadu, India Introduction: Bilateral Warthin’s tumour or bilateral papillary cystadenoma lymphomatosum, are relatively rare but can occur. It is the second most common salivary gland neoplasm, arises almost exclusively in the parotid gland. It is a benign tumor occurring more commonly in males and in females, around 5th to 7th decades of life. The risk is increased eightfold in smokers. Most Warthin’s are unifocal, but about 10% are multifocal and 10% are bilateral. Objective: To highlight the cytodiagnosis of unusual presentation of Bilateral Warthin’s tumor. Case Report: A 61 years old male came with complaints of swelling over bilateral cheek for past 2 years and bilateral neck swelling for past 1 year. On examination, a firm swelling measuring 2x2 cm was observed in the right parotid region, while another firm swelling measuring 3x3 cm noted on the left side of the parotid region. An unguided FNAC performed on both sides revealed many clusters of oncocytes in a background of lymphocytes, lymphoid follicular centre cells and granular debris. According to Milan’s system for reporting salivary gland cytology, the findings were categorized as IVA, suggestive of Bilateral Warthin’s tumour. Subsequently, a bilateral superficial parotidectomy was carried out and histopathological examination confirmed the presence of Warthin’s tumour on both sides. Conculsion: We are presenting this rare case of bilateral Warthin’s tumour diagnosed by unguided fine needle aspiration cytology, highlighting the role of cytodiagnosis in salivary gland tumours.

Viral M Bhanvadia, Nirali U Patel, Hansa Goswami; Department of Pathology, B. J. Medical College, Ahmedabad, Gujarat, India Introduction: The diagnostic role of salivary gland fine-needle aspiration (SG-FNA) is well established in the preoperative evaluation of patients with salivary gland lesions. [ 1 ] The latest (second) edition of the Milan System for Reporting Salivary Gland Cytopathology, published in July 2023, includes 6 diagnostic category. Aims and Objective: To investigate the cytomorphological features of salivary gland lesions and reclassify these lesions using the recommended Milan system for reporting of salivary gland cytopathology (MSRSGC). Materials and Methods: The study included 145 cases of fine-needle aspiration cytology (FNAC) of salivary gland lesions over a period of 3 years. The diagnosis of these cases was reclassified into the 6 categories of the MSRSGC & further clinical & histopathological follow up was done, if available. Results: Out of 145 cases 26 cases included in category I, 58 cases included in category II, 4 cases included in category III, 45 cases included in category IV, 3 cases are included in category V where 9 cases are included in category VI. Malignant cases were mostly commonly seen in male patients in age group of 50-70 years, with mucoepidermoid carcinoma being the most common case. Out of 145 cases 30 cases were sent for histopathology examination. Histopathology report found 0 malignant case in category I and category II.One case found carcinoma Ex Pleomorphic adenoma in category III. 2 cases found malignancy in category IV. Conclusion: The MSRSGC is a valuable tool that can help to standardize reporting and stratify cases preoperatively. It is helpful in effectively guiding clinical management of patients with salivary gland lesions.

Sant Prakash Kataria, Soumya Smruti, Sanjay Kumar, Mahak, Usha Rani, Sunita Singh; Department of Pathology, Pt. B D Sharma PGIMS, Rohtak, Haryana, India Introduction: Secretory carcinoma of parotid gland is an uncommon tumor of the salivary gland that is similar to secretory carcinoma of breast in terms of histology, immunohistochemistry, and genetics. It was initially described by Skálová et al in 2010. Mammary Analogue of Secretory Carcinoma (MASC) typically manifests as an asymptomatic mass in the parotid gland and primarily affects men. This tumor is regarded as a low-grade carcinoma with the potential for high-grade transformation. MASC is frequently misdiagnosed as salivary gland acinic cell cancer. Here, we present a case of parotid gland tumor. Objective: To highlight the cytological findings of Secretary Carcinoma of Parotid gland. Case Report: A 21-year-old female patient presented to the OPD with complaints of a swelling of approximately 2 x 1 cm on the left pre-auricular region since one year. Physical examination demonstrated a 2 × 1.0 cm, firm, fixed, and non-tender mass in the left pre-auricular region. USG showed a circumscribed hypoechoic solid lesion measuring 2.1 x 1.3 cm, predominantly seen in left parotid gland. FNA done from the parotid mass showed cytomorphological features suggestive of a malignant lesion. IHC markers were applied on the cell block preparation. The tumor cells were positive for CK-7, S-100 protein, and mammoglobin. Based on the cytological features and immunohistochemical staining, possibility of secretory carcinoma of salivary gland was suggested. Surgical excision and biopsy were advised. Conclusion: No single immunohistochemical marker makes the Secretory Carcinoma diagnosis possible. Differential diagnosis of SC includes acinic cell carcinoma, intraductal carcinoma (low-grade cribriform cystadenocarcinoma), and low-grade mucoepidermoid carcinoma. Positive immunochemical studies for mammoglobin and S100 protein are necessary to confirm the diagnosis of MASC.Treatment of SC depends on the stage of the disease at diagnosis and on the tumor’s histological and molecular characteristics.

Sabari Sinehaa 1 , Chirom Amit Singh 2 , Aanchal Kakkar 1 ; 1 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India, 2 Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India Introduction: Mucoepidermoid carcinoma (MEC) is the most prevalent salivary gland carcinoma. It is a malignant salivary gland neoplasm (SGN) typified by solid-cystic proliferation of mucous, intermediate, and squamoid tumor cells, and MAML2 gene rearrangement. It, however, lacks a diagnostic immunohistochemical profile. Fine needle aspiration cytology (FNAC) diagnosis of classic MEC is straightforward. Conversely, it is challenging to diagnose unusual histological subtypes of MEC on cytology. In the absence of genetic testing, these would be categorized as oncocytic SGN of uncertain malignant potential (SUMP-O) i.e. Milan category IVB, as several other oncocytic SGNs enter the differential diagnosis. Objective: To highlight utility of MAML2 genetic testing on FNAC material. Case Report: This 38-year-old female presented with a left-sided neck swelling for one year. On examination, a 2x2cm non-tender submandibular swelling was noted. Ultrasound-guided aspirate showed cohesive fragments of large polygonal tumor cells with abundant granular cyanophilic cytoplasm, and round vesicular nuclei with prominent nucleoli. An occasional cell showed a cytoplasmic vacuole. However, mucin was not identified in the background. Differential diagnoses considered were acinic cell carcinoma, secretory carcinoma, intraductal carcinoma, oncocytoma and oncocytic MEC (OMEC). p40 on cell block (CB) was negative. Due to strong suspicion of OMEC, CB section was subjected to fluorescence in situ hybridization (FISH) using MAML2 breakapart probe. FISH revealed MAML2 rearrangement, confirming the diagnosis of OMEC, Milan category VI. The patient underwent excision of submandibular gland and selective neck dissection. Microscopy revealed features of OMEC. Conclusion: Although MEC is a common SGN, the oncocytic subtype is rare and often challenging to identify on cytomorphology. Determining the benign or malignant nature of oncocytic neoplasms is crucial to planning surgical management. Ancillary testing helps reduce the number of SUMP cases. In the absence of a diagnostic immunohistochemical marker, MAML2 genetic testing may be performed on CB with excellent results.

Aditi Anand, Charanjeet Ahluwalia, Sunil Ranga; Department of Pathology, VMMC and Safdarjung Hospital, Delhi, India Introduction: Acinic cell carcinoma is a rare primary malignant tumor of the salivary gland, most commonly seen to involve the parotid gland. It is a low grade tumor, however, due to its malignant potential, it can give rise to complications due to invasion into the surrounding structures. Cytomorphological diagnosis of acinic cell carcinoma can be challenging as it has high false negative interpretation rate due to it’s resemblance to normal acinar cells. Objectives: To study cytomorphological features of Acinic cell carcinoma of the parotid gland. Case Report: A 50 year old female presented with a swelling in the left infra-auricular region associated with complaints of difficulty in chewing as well as slurred speech. On examination, a 4 x 3 cm ill-defined, firm ulcerated swelling was observed which had gradually increased in size over 6-7 months. Past history revealed presence of an episode of deviation of lips to one side. On microscopy, smears were hypercellular and showed presence of atypical acinar cells arranged in grape-like clusters as well as sheets in a haemorrhagic background. No ductal or myoepithelial cells or stromal fragments were seen in the smears. A possibility of Acinic cell carcinoma, Milan Category V was suggested. The patient underwent surgical treatment and the diagnosis was confirmed on histopathological studies. Conclusion: FNAC is a minimally invasive procedure and can help in rapid diagnosis and categorization of parotid tumors. Acinic cell carcinoma being a locally aggressive tumor can invade into the the facial nerve leading to facial paralysis. It hence becomes extremely important to make a prompt diagnosis so that timely resection can be carried out. One must consider the possibility of an invasive acinic cell carcinoma when dealing with cases of unexplained facial nerve palsy with FNAC smears from the swelling exhibiting hypercellularity of atypical acinar cells and absence of ductal and myoepithelial cells.

Sanobar Shamim Khan, Ravi H Phulware, Arvind Kumar, Ashok Singh, Prashant Durgapal, Sanjeev Kishore; Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India Introduction: Adenoid cystic carcinoma (ACC) is a rare malignancy of the salivary glands, most commonly involving the major and minor salivary glands. It accounts for 1% of all head and neck tumors and 10% of all salivary gland tumors. The tumor is commonly locally aggressive, typically presents as slow-growing, hard painless swelling, and has a tendency for perineural invasion as well as hematogenous spread to distant organs. The most common site for metastasis is the lung followed by bone and liver. It commonly manifests between the 6th and 7th decade of life with slight female predilection (F:M ratio is 3:2). Case Presentation: A 29-year-old woman presented to the surgery outpatient department with a complaint of swelling on the right side of the neck for three months. The swelling was firm, and tender, and was adhered to the underlying skin measured 5x4 cm on examination. The swelling was not moving with deglutination. There was no lymph node enlargement on palpation. Fine needle palpation showed basaloid tumor cells with prominent hyaline globules. These basaloid tumor cells were arranged in a microcystic, tubular pattern with a sharply defined border confirming the diagnosis of adenoid cystic carcinoma. Subsequently, the histopathology examination confirmed the diagnosis of low-grade ACC. Conclusion: The preoperative diagnosis of ACC has important clinical significance for prognosis and treatment. Integration of the clinical and histopathological data is essential for a correct diagnosis. This will avoid both patient’s distress and unnecessary over-treatment. This case report emphasizes the significance of early diagnosis, thorough treatment planning, and attentive follow-up. It also highlights the infrequent presentation of disease. We believe that diagnosis of ACC improves with the awareness and experience of the cytopathologist. Concluding, the prompt recognition of an ACC is important.

A Mahitha, Swati Sharma; Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India Introduction: Fine Needle Aspiration Cytology (FNAC) is a widely utilized diagnostic tool for evaluating salivary gland lesions, providing preliminary information before surgical intervention. Renowned for its minimal invasiveness, high accuracy and cost-effectiveness, FNAC is an indispensable procedure in the diagnosis of salivary gland tumours. Warthin tumour (WT) is the second most common benign neoplasm of the parotid gland and accounts for approximately 5-20% of all salivary gland neoplasms. It has a higher prevalence in males. This case report emphasizes the role and utility of FNAC in precise diagnosis of Warthin tumour, supported eventually by radiological and histopathologic examination. Case Report: A 63-year-old male presented with a painless, gradually enlarging mass in the right parotid region. On examination, a well circumscribed, partially mobile, nontender, firm mass, measuring approximately 3 x 4 cm. MRI showed solid-cystic enhancing mass lesion epicentered in the right parotid gland, measuring ~ 4.1 x 3.0 x 4.1 cm. Ultrasound guided FNA shows sheets and clusters of ductal epithelial cells, numerous scattered lymphoid cells, few lymphoid tangles in a proteinaceous background. The patient underwent a right superficial parotidectomy with facial nerve preservation. Histopathology confirmed the diagnosis. Post-operative recovery was uneventful. Patient is now on regular follow-up and facial physiotherapy. Conclusion: FNAC has proven to be a highly effective diagnostic tool to distinguish between neoplastic and inflammatory lesions in salivary glands, thereby guiding the surgical management. In this case, precise diagnosis of WT has facilitated timely surgical planning and intervention.

K Hari Krishna, M S Supreetha, T N Suresh; Department of Pathology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India Introduction: Salivary gland tumors present significant diagnostic challenges in cytopathology due to their diverse cytomorphological patterns. Adenoid cystic carcinoma, Acinic cell carcinoma (ACC) and Warthin’s tumor (WT) exemplify these difficulties, often complicating accurate diagnosis through fine needle aspiration (FNA) biopsy. Objective: This study aims to elucidate the diagnostic challenges and considerations in the cytological evaluation of Adenoid cystic carcinoma, Acinic cell carcinoma and Warthin’s tumor, focusing on their distinct features and potential pitfalls. Case Reports: Case-1: FNAC results suggested chronic sialadenitis due to predominant lymphoid cells but later confirmed from Histopathology report (HPR) as Acinic cell carcinoma with acinar differentiation. Based on the component of the tumor that is sampled during FNA, plays an important role in differential diagnosis, since predominantly polymorphous population of lymphoid cells with occasional ductal cells which made us to think differential diagnosis of chronic sialadenitis. Case-2 demonstrated Adenoid cystic carcinoma with cervical lymph node metastasis, emphasizing the importance of recognizing rare local metastatic potential site and the involvement of minor salivary glands. Case-3 was given as chronic sialadenitis with granulomatous reaction on FNAC and on histopathology as Warthin’s tumor. The presence of acini clusters associated with lymphocytes and PMN cells was interpreted as chronic sialadenitis. In cystic salivary gland tumors cellularity of aspirates will be poor, thus insufficient sampling results to false negative results. Conclusion: Accurate diagnosis of salivary gland tumors requires awareness of their diverse presentations and potential for confusion with other conditions. The presence of lymphoid cells and acinar differentiation necessitates careful interpretation. Plays a crucial for effective diagnosis and treatment. Furthermore, an adequate and representative sample is essential for proper cytological evaluation and to reduce errors in diagnosis. Improved diagnostic strategies and a thorough approach to FNAC biopsy can mitigate misdiagnosis and enhance patient management.

Nisha Meshram, Sachin Chaudhari, Shalaka Meshram, Rasika Gadkari; Department of Pathology, AIIMS, Nagpur, Maharashtra, India Introduction: Thyroid lesions are global health problem & with the advancement of imaging technologies, more thyroid nodules are detected in asymptomatic patients, either during routine check-ups or staging for tumors other than the thyroid. These lesions include both non-neoplastic and neoplastic nodules, whereby a correct diagnosis represents an importance for patient management and follow up. Over diagnosis might lead to unnecessary surgeries, causing both morbidity and high health expenditure. On the other hand, underdiagnosis may cause to the exclusion of malignant lesion from follow-up or delayed intervention. Thyroid fine-needle aspiration (FNA) has been established as a first-line triaging tool after the ultrasound examination. TBSRTC proposed three categories for indeterminate cytology: atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), Follicular neoplasm, and suspicious for malignancy (SM) The literature revealed the difficulties in AUS/FLUS and FN/SFN diagnoses that might lead to overdiagnosis and overtreatment. Aim: To evaluate the cytological features in follicular-patterned lesions of the thyroid gland & correlate them with histopathology. Materials and Methods: We reviewed all the fine needle aspiration cytology specimens which were reported as “suspicious for follicular-patterned lesions of thyroid” between years 2023 and 2024 in our hospital and their histological slides. Parameters for cytopathologic assessment were microfollicular arrangement, cellularity, colloid, multilayered rosette formation, monolayered sheets, intact follicles, hyperplastic papillae, nuclear clearing & intranuclear inclusions, nuclear grooves, angulated nuclei, nucleoli, nuclear size, macrophages, flame cells and Hurthle cells. Conclusion: Detailed cytopathologic examination was found to be important in differentiating various follicular patterned lesions. On the other hand, none of the cytopathologic findings were sufficient to distinguish follicular adenoma from follicular carcinoma.

Rohit Kumar Chhaparia, Amrita Ghosh Kar; Department of Pathology, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India Introduction: Filariasis is a major public health problem in India and thyroid is an uncommon site for presence of microfilaria. Most of the reported cases of microfilaria in thyroid gland are mainly associated with benign thyroid condition. Objective: The present case report describes aspiration cytological diagnosis of microfilaria in papillary thyroid carcinoma. Case Report: A 39 years old euthyroid male presented with anterior neck swelling. Physical examination revealed two separate well defined cut in the neck. Both were firm, non tender and move with deglutition. FNAC from right side nodule were hypercellular and showed many papillaroid fragment of follicular cells with enlarged, pale, overlapping nuclei with nuclear grooving, psammoma bodies with few microfilaria of Wuchereria bancrofti . Left side nodule had sheets of benign thyroid follicular cells. On higher magnification, microfilaria had clear Space at the cephalic and caudal ends. Somatic cells appeared as granules extended from head to the tail. The tail tip was free from nuclei. Diagnosis was made as Papillary Carcinoma Thyroid with microfilaria. Conclusion: Filariasis may be detected even in clinically unsuspected individual, so a high index of suspicion and careful screening of smears for microfilaria even in unusual site along with co-existing pathology may help in accurate and prompt diagnosis. FNAC proves to be an easy and reliable tool in its diagnosis.

Renu Singh, Sushma Bharti, Manupriya Sharma, Sudesh Kumar; Department of Pathology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India Introduction: Mucoepidermoid carcinoma (MEC) is the most common malignant neoplasm of the parotid salivary gland in children and young adults. Although certain documented reports of melanocytes in the interlobular ducts of the parotid glands and the labia minor salivary gland exist, but only 5 documented cases of pigmented salivary gland neoplasm exist in the literature. We report a case of pigmented MEC of parotid, initially discovered as metastatic malignant melanoma on Fine needle aspiration (FNA) cytology in an operated case of conjunctival melanoma which was later found to be pigmented MEC on immunohistochemistry. Case Report: A 72-year-old female visits for pain and swelling in preauricular area. On examination, a 1.5x1.5 cm firm, tender and mobile mass was palpated in the parotid region. FNA obtained black aspirate. At the same time, a designated pass was taken for the cell block preparation by the formalin-fixed method. On microscopy, tumour cells were arranged in sheets and clusters and single-cell populations showing marked cellular and nuclear pleomorphism. In addition, abundant extracellular and intracytoplasmic brown-black colour pigment was seen. The background showed numerous mature lymphocytes. The cell block also showed a similar picture. Absence of prominent inclusion-like eosinophilic nucleoli suggested against the melanoma. On re-evaluation patient was found to be an operated case of conjunctival melanoma 10 years back. Special stain and immunohistochemistry (IHC) on cell block were performed and confirming the diagnosis of Mucoepidermoid carcinoma, Pigmented type. Specimen after total parotidectomy revealed well-circumscribed solid dark brown-black 1x1x0.7 cm tumour. On microscopy, similar morphology of tumor cells was seen and diagnosis of pigmented MEC was confirmed on IHC. Conclusion: Pigmented poorly differentiated MEC of parotid gland can pose diagnostic challenge especially in the post-operated case of conjunctival malignant melanoma. Cell block could be useful to resolve the diagnostic dilemma.

A SPINDLE CELL NEOPLASM AT SPHENOID WING BONE ON SQUASH CYTOLOGY – A DIAGNOSTIC DILEMMA Mala Sagar, Madhu Kumar, Sumaira Qayoom, Diparati Mondal, Ankur Bajaj; Department of Pathology and Neurosurgery, King George’s Medical University, Lucknow, Uttar Pradesh, India Introduction: Squash cytology is a rapid, inexpensive and accurate method of diagnosing intracranial lesions. Glial tumors are the most commonly encountered lesions whereas the Non-Glial lesions remain to be less recognized. Objectives: To study the approach of diagnosis of a cranial spindle cell neoplasm on the basis of cytomorphology in corelation with clinical and radiological features. Case Report: A 42 years old female presented with headache and vomiting for 3 months. She also had weakness of all four limbs, altered sensorium and loss of bowel and bladder movements in the last 15 days. On T1 weighted MRI, a well-defined homogenous contrast enhancing right lateral sphenoid wing space occupying lesion was found. The patient was taken up for surgery. Intraoperatively the lesion was found to be pinkish white and highly vascular. The tissue was sent for squash cytology which showed spindle cells arranged in a haphazard pattern. H&E sections of the definite tissue revealed fusiform cells in a patternless pattern against a collagenous stroma. The characteristic staghorn blood vessels were also seen. Immunohistochemistry was applied. Solitary fibrous tumor was rendered as the final diagnosis. Conclusion: Primary intracranial spindle cell neoplasms are rare mesenchymal tumors. Because of the overlapping morphological features of spindle cell tumors, diagnosis relies on ruling out all possible differential diagnoses. Awareness of clinical and radiological findings plays vital role in reaching the definitive diagnosis.

P C M Nagaratnam, Roobashri Murugan, Debasis Gochhait, N Siddaraju; Department of Pathology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India Introduction: Calcium pyrophosphate dihydrate crystal deposition disease is a inflammatory joint disease characterised by presence of these crystals in intraarticular and periarticular tissue. Tumoral pseudogout is one of the rarest entity which resembles metastatic soft tissue or skeletal malignancy. The joint most commonly involved is the knee followed by the wrist. The prevalence of this disease is about 4 to 7 % in adult population and commonly affects people above 60 years. Objectives: The aim of this case report is to illustrate the efficacy of fine needle aspiration in diagnosing pseudogout and to highlight the diagnostic value of FNAC in identifying the crystals in cytology. Case Report: A 36-year female presented with complaints of swelling in the posterior part of neck and occiput for 3 months associated with restriction of cervical movements and intermittent pain. The swelling was a 4 x 4 cm midline swelling in the posterior part of the neck, hard in consistency and immobile in nature. MRI revealed an irregular pedunculated T1/T2 hypointense bony lesion arising from the posterior elements of C1 and C2 vertebra with a possibility of atypical osteochondroma or a chondrosarcoma. Fine needle aspiration revealed blood mixed aspirates which were cellular showing many histiocytes and giant cell reaction admixed with few osteoblasts. The histiocytes and giant cells showed variable sized rectangular shaped crystals. Subsequent cell block processed revealed aggregates of crystals surrounded by granulomatous inflammation and multinucleated giant cells. Conclusion: This case report demonstrates the efficiency of fine needle aspiration in directly visualizing the crystals thereby helping to arrive at an accurate diagnosis. The ease of the procedure combined with its diagnostic potency underscores the FNAC’s potential as a first line approach to joint disorders where pseudogout is a differential diagnosis.

Meghna Walia 1 , Phiza Aggarwal 1 , Ranjeev Bhagat 1 , Uma Handa 1 , Naveen Mittal 2 ; 1 Department of Pathology, Government Medical College and Hospital, Chandigarh, India, 2 Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India Introduction: Pathological fractures of bone occur spontaneously or following minor trauma and are usually attributed to either primary malignant lesions, benign tumours or metastasis. We present an uncommon case with multiple osteolytic lesions and fracture of bilateral shaft femur secondary to severe hyperparathyroidism due to parathyroid lesion diagnosed on FNAC. Objectives: To correlate FNAC, clinicoradiological and biochemical findings in a case of pathological fractures of bilateral femur in a young female. Case Report: A 27-year-old female presented in the orthopaedic OPD with progressively increasing pain in both legs and inability to bear weight. She gave the history of fall while sitting 1 month back. Patient had no history of fever, weight loss and no relevant family history. MRI pelvis was done and revealed expansile space occupying lesion involving mid shaft of both femurs along with pathological displaced fractures. Similar lesions were seen in both iliac bones, bilateral acetabulum, lumbosacral vertebrae and left proximal tibia. She underwent bone biopsy from the fracture site on left side that was composed of giant cells and fibroblasts. Further laboratory investigations showed deflected parameters with markedly elevated PTH levels (1648.6 pg/ml), mildly increased serum calcium and decrease in serum phosphorus. In view of the above findings USG neck was done and showed a hypoechoic lesion measuring 3.1x1.4x1.0 cm posterior to left lobe of thyroid with increased vascularity. USG guided FNA from the lesion showed cytological features suggestive of parathyroid lesion likely adenoma. After careful comprehensive evaluation of all radiological and laboratory findings, the bone biopsy was finally diagnosed as brown tumour of hyperparathyroidism. Conclusion: This case illustrates the role of cytology in the diagnosis of parathyroid lesions. A high index of suspicion of hyperparathyroidism should be kept in young patients presenting with unexplained osteolytic lesions and pathological fractures.

Vibhuti 1 , Aashita Agarwal 1 , Divya Aggarwal 1 , Vikrant Verma 1 , Poonam Abhay Elhence 1 , Meenakshi Rao 1 , Aasma Nalwa 1 , Sudeep Khera 1 , Deepak Vedant 1 , Vikarn Vishwajeet 1 , Dharma Ram Poonia 2 , Bharti Devnani 3 ; 1 Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 2 Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 3 Department of Radiation Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Introduction: Fine needle aspiration cytology (FNAC) is an effective technique for diagnosing soft tissue sarcomas. The current system is FNCLCC to grade the same tumors on histopathology. However, no grading system for these tumors is currently used on cytology smears. We propose a grading system for soft tissue sarcomas on cytology. Aim: To validate a system for grading soft tissue sarcomas on cytology with FNLCC on histopathology as the gold standard. Materials and Methods: Institutional cytopathology database was searched to identify cases of soft tissue sarcomas who underwent pre-operative FNAC. Cases whose final histopathology was available were included in the study. The cytology smears were retrieved and evaluated by a cytopathologist blinded to the final FNCLCC grade. The following parameters were assessed in each case: degree of cell dispersion, degree of nuclear pleomorphism, mitosis, and necrosis. Scores were assigned to each parameter, and a final score (called CytoScore) of 2-9 was calculated. The score was then matched to the final FNCLCC grade to determine the CytoScore corresponding to the final FNCLCC grade. Results: The study included ten cases of sarcomas diagnosed via FNAC. The degree of nuclear dispersion was scored as follows: 1- predominantly cohesive cells; 2- some dispersion/ singly dispersed cells; 3- predominantly singly dispersed cells. The degree of nuclear pleomorphism was graded as 1, 2, and 3- mild, moderate, and severe, respectively. Mitosis was scored 0, 1, or 2- designated as absent, few/ occasional, and easily identifiable, respectively. Necrosis was scored as 0 (absent) and 1 (present). On matching the final score with FNCLCC, CytoScore 2-3 corresponded to FNCLCC grade 1, 4-5 corresponded to grade 2, and 6-9 corresponded to FNCLCC grade 3. Conclusion: We validate a new system (CytoScore) for grading soft tissue sarcomas in cytology with FNLCC as the gold standard. Given the limited sample size, a larger cohort is required for more robust results.

Vidushi Joshi, Pallavi Saraf, Ankita Soni, Manjit Kaur Rana; Department of Pathology and Lab Medicine, AIIMS, Bathinda, Punjab, India Introduction: Extragonadal germ cell tumors (EGGCTs) are rare tumors and can occur as primary tumors or metastasis. It is observed that only 5% of germ cell tumors occurs at an extragonadal site. The most common extragonadal site affected in infants and young children is sacrococcygeal region. Although, diagnosis on cytology alone is challenging, immunohistochemistry on cell block may aid in reaching to a definitive diagnosis. Herein, we present a case of 1-year-old female patient presented with sacrococcygeal region swelling, and was diagnosed as extragonadal germ cell tumor, likely yolk sac tumor on cytology and immunohistochemistry. Objectives: Utility of immunohistochemistry on cell block obtained from fine needle aspiration cytology. Case Report: 1-year-old female patient presented with a large swelling in the sacrococcygeal region and difficulty in passing stools for two months. On examination, the swelling measured 9x8cm and was irregular, tender and firm in consistency. Imaging findings showed presence of heterogeneously enhancing mass, suspicious for malignancy. Laboratory investigations showed raised Alpha-fetoprotein (AFP) levels (>40000 ng/mL). Fine needle aspiration of the swelling was done and smears were made. The smears were cellular and showed presence of tumor cells arranged in papillaroid fragments, clusters, trabeculae and acinar pattern. Cell block sections showed tumor cells arranged in various patterns as described above. Immunohistochemistry on cell block showed strong cytoplasmic positivity for Glypican 3 and strong nuclear positivity for SALL4. CD30 expression was negative. Based on this, a diagnosis of extragonadal germ cell tumor, likely yolk sac tumor was made. Patient was started on cisplatin-based chemotherapy. Conclusion: Extragonadal germ cell tumours can be difficult to diagnose solely on cytomorphology; in such circumstances, cell block and immunohistochemistry can aid in making a definitive diagnosis and improve outcomes by administering chemotherapy to the patient followed by surgical removal.

Molly Mittal, Sakshi, Deepa Rani; Department of Pathology, S. N. Medical College, Agra, Uttar Pradesh, India Introduction: Dermatofibrosarcoma protuberans is a fibrohistiocytic tumor of intermediate malignancy. It is superficial, locally aggressive fibroblastic neoplasm, having a cellular storiform appearance. These neoplasms occur most commonly on the trunk and proximal extremities, followed by the head and neck region. DFSP usually presents in young to middle aged adults, with a slight male predominance. Relative paucity of literature pertaining to cytodiagnosis of this common tumor prompted this study. Objective: To study the cytomorphologic appearance of DFSP and role of fine needle aspiration cytology in diagnosing DFSP. Case Report: A 23-year-old male presented with a lobulated swelling present on the extensor surface of right arm. MRI of the right arm was then performed, which showed a well defined lobulated heterogeneous hyperintense lesion on T2 images centered in the subcutaneous plane anteriorly, appearing hypointense on T1 images, showing mild restricted diffusion and heterogeneous post contrast enhancement. On fine needle aspiration cytology smears were cellular comprising of predominantly of dispersed cell population as well as cellular clusters. Oval to spindle shaped cells having bland chromatin, inconspicuous nucleoli and indistinct cytoplasm. Occasional mitosis maybe seen. With these features diagnosis of dermatofibrosarcoma protuberans was given. Histopathological examination of the lesion shows fibroblastic cells arranged in a storiform pattern, oval to spindle shaped benign looking cells. On immunohistochemistry the cells were diffusely positive for CD34. Conclusion: Based on clinical history, physical findings, imaging data and cytologic observations, a correct diagnosis of DFSP can be made. There are high chances of misdiagnosis due its similarity with other tumors. Therefore there should be improved awareness and understanding of this tumor for early diagnosis and treatment.

Sakshi, Molly Mittal, Deepa Rani; Department of Pathology, S. N. Medical College, Agra, Uttar Pradesh, India Introduction: Fibromatosis, also known as desmoid tumor, are extremely uncommon, nearly 0.03% of all neoplasms and <3% of all soft tissue tumors. These tumors do not metastasize but are locally aggressive and carry a significant risk of recurrence after surgery with clear margins. Fibromatosis can be localized or infiltrative and multicentric and can involve internal tissues and organ such as mesentery, retroperitoneum, breast and almost every organ and region of body. Fibromatosis share many similar clinical and radiographic features with other abdominal wall masses and have varied compositions making the diagnosis difficult with imaging and clinical history alone. Objective: To study the role of fine needle aspiration cytology in diagnosing desmoid fibromatosis. Case Report: A 26-year-old male presented with an abdominal wall swelling. An MRI was done to evaluate the size and spread of the tumor, which showed heterogenous lesion measuring 9x5x4 cm which is isointense to hyperintense on T2, isointense on T1 and it had grown significantly. On fine needle aspiration cytology smears were moderately cellular and showed scattered and aggregated spindle cells, some of them being embedded in dense stromal collagen fragments. The cells were oval to spindle shaped with tapering ends, bipolar nuclei, bland nuclear chromatin. Subsequently, hispopathological examination and immunohistochemistry (beta catenin immunostain) showed nuclear positivity in the majority of cells, supporting the diagnosis of desmoid type fibromatosis. Conclusion: Based on clinical history, physical findings, imaging data and cytologic observations, a correct diagnosis of fibromatosis can be made which can help surgeons to excise the tumor with wide surgical margins to prevent recurrence of tumor. FNAC is fairly reliable for diagnosis based upon which accurate management can be done. However, histopathological examination and immunohistochemistry are gold standard in diagnosing fibromatosis.

Kiran Kumari, Rajnish Kalra, Renuka Verma, Sunita Singh; Department of Pathology, Pt. B. D. Sharma, PGIMS, Rohtak, Haryana, India Introduction: Small round cell tumors are a group of undifferentiated embryonal tumors containing small cells with a large round nucleus and pose a diagnostic challenge. We present here a case of small round cell tumor diagnosed morphologically on FNAC with limited immunocytochemical assessment as poorly differentiated small round cell tumor possibly lymphohematogenous malignancy which on biopsy material and extensive immunohistochemical assessment turned out to be an interesting uncommon entity. Objective: A case report of 19- year- old male with small round cell tumor. Case Report: A 19 years old male presented to the ENT department, PGIMS, Rohtak with left submandibular and posterior triangle of neck swelling. USG showed multiple hypoechoic lymph nodes in bilateral cervical regions largest measuring 25x 20 mm on left side. CEMRI was suggestive of lymphomatous lesion. PET-CT showed hypermetabolic bilateral parapharyngeal, cervical level II, III, left level IB, IV, V and left supraclavicular cervical lymph nodes ? metastasis. FNAC from cervical swelling was suggestive of lymphoproliferative disorder. Histopathological sections revealed features of malignant small round cell tumor. On primary panel possibilities included:- 1) Rhabdomyosarcoma (Embryonal type). 2) Desmoplastic round cell tumor. On exhaustive IHC workup the final diagnosis of Rhabdomyosarcoma was established. Conclusion: Simple light microscopic examination in small round cell tumors many a times may not be sufficient for final diagnosis and histopathological examination with extensive IHC workup is necessary in achieving a definitive diagnosis.

Kritika Lohumi, Veena Gupta, Sunita Singh; Department of Pathology, BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India Introduction: Primary lymph node plasmacytoma is a rare hematologic neoplasm that presents with enlarged cervical lymph nodes without evidence of plasma cell dyscrasia. Accurate and timely diagnosis of cervical plasmacytoma is crucial for appropriate management and treatment which mainly includes radiotherapy and/or surgical excision. Objectives: This study aims to review and analyze the cytological features of cervical plasmacytoma, highlighting the key diagnostic criteria and challenges in cytological evaluation. Case Report: A 55 year old male patient presented in the otorhinolaryngology department with complaint of gradually progressive, non-tender, mobile firm swelling measuring approximately 3x2 cm in the right cervical region since one year. The patient was apparently asymptomatic without any history of fever, weight loss or bone pain. There was no personal history of smoking or tobacco intake. There was no past history for any chronic illness including tuberculosis or exposure to same. No organomegaly reported on ultrasound. Cytological features, including cellular morphology, staining characteristics, and the presence of abnormal plasma cells, were documented and analyzed. Excision biopsy of the lymph node confirmed the diagnosis of plasmacytoma. Cytological examination revealed necrotic non-viable tissue along with lymphocytes, histiocytes, clusters of atypical plasma cells with eccentric nuclei and abundant basophilic cytoplasm and a perinuclear halo. However, distinguishing plasmacytoma from other plasma cell disorders and metastatic lesions can be challenging. Ziehl Neelsen staining with 20% H2SO4 show acid fast globules and granules. However, no acid fast bacilli could be identified. Conclusion: While cytological features can be distinctive, definitive diagnosis is difficult due to overlap with other neoplastic/infective conditions and asymptomatic nature of the disease in the early phase. Histopathological and immunocytochemical techniques enhance diagnostic accuracy and should be employed in conjunction with cytological assessment for definitive diagnosis.

Antriksha Sharma, Akhtar Un Nisa Salaria; Department of Pathology, GMC, Jammu, Jammu and Kashmir, India Introduction: Dermatopathic Lymphadenopathy is a special form of paracortical hyperplasia with increased interdigitating dendritic cells, Langerhans cells and histiocytes/ macrophages typically including melanophages. It is often associated with inflammatory dermatoses such as eczema, psoriasis, pemphigus, atopic dermatitis and neoplastic diseases such as mycosis fungoides. Objective: To present a cytodiagnostic case report of Dermatopathic Lymphadenopathy in a 78 year old male. Case Report: A 78-year-old male who presented with chief complaints of right axillary and bilateral inguinal lymphadenopathy since 4 years along with well defined erythematous to hyperpigmented scaly plaques over scalp, upper and lower limbs, trunk with involvement of palms and soles. Some of the lesions showed ulcerations. Materials and Methods: Aspirates taken from 22G needle are smeared on slides which are fixed by absolute alcohol to be stained with Papanicolau stain and remaining slides are kept dry for other Giemsa and Ziehl Neelsen stains. Observations and Results: Giemsa and Pap stained smears from the enlarged lymph nodes show similar cytomorphological features. Smears are comprising of many pale looking histiocytic cells having conspicuous nuclear folding and oval non folded nuclei depicting prominent grooves lying in a background of predominantly small lymphocytes. Many of the histiocytes are showing intracytoplasmic pigment. Cytomorphological features are suggestive of Dermatopathic Lymphadenopathy. Conclusion: FNA of lymph nodes is an excellent first line investigation to determine the nature of lesion. The diagnosis of Dermatopathic lymphadenopathy was made. However, the differential diagnoses included Mycosis fungoids, Langerhans cell histiocytosis, Hodgkin’s lymphoma, Metastatic melanoma, reactive lymphadenopathy and biopsy was advised for confirmation.

Erna Ahsan, Divya Kumari, Ashok Singh, Sanjeev Kishore, Nilotpal Chowdhury, Shalinee Rao, Prashant Durgapal, Arvind Kumar, Ravi Hari Phulware; Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India Introduction: Lymphadenopathy has significant clinical implications as the underlying pathology may range from infections to neoplasms. The diagnosis of such lesions is greatly aided by fine needle aspiration cytology (FNAC). Aim: To examine the cytomorphological characteristics of various lymph node lesions. Materials and Methods: This retrospective observational study was performed at All India Institute of Medical Sciences, Rishikesh. Eight hundred twenty-eight (828) lymph node FNAs, from January, 2023 to June, 2024, were included in the study. Results: Out of a total of 828 cases, the most frequent cause of lymphadenopathy was found to be reactive lymphoid hyperplasia with 237 cases (28.6%), followed by metastatic lymphadenopathy with 229 cases (27.6%). Granulomatous lymphadenitis was found to be the third most common cause with 96 cases (11.6%). A diagnosis of lymphoproliferative disorder was rendered in 20 cases (2.4%) (Hodgkin lymphoma-3, Non-Hodgkin Lymphoma-17) and of poorly differentiated malignant tumour in 18 cases (2.2%). Acute and chronic non-specific inflammation was seen in 36 cases (4.4%). 44 aspirates (5.3%) showed only necrosis. 2 cases (2%) were diagnostic of cryptococcal lymphadenitis and 1 (1.2%) was consistent with Rosai Dorfman disease. In 129 cases (15.6%), aspirate was inadequate. The most common group of lymph nodes involved in benign pathology was Level 2 (35.6%) with female preponderance (61.3%) and right laterality (49%), seen most commonly in patients of age group 21-30 years (22.8%). The most common group of lymph nodes involved in malignant pathology was Supraclavicular (IVa and Vc) (44.7%) with male preponderance (56%) and left laterality (50.7%), seen most commonly in patients of age group 51-60 years (28%). Conclusion: FNAC is a simple, non-invasive, inexpensive and reliable method which can aid in the early diagnosis of infectious and neoplastic disorders leading to clinical lymphadenopathy.

Purvasha Kardam 1 , Nidhi Verma 1 , Nimisha Dhankar 1 , Ravi Mehar 2 , Sunil Pasricha 3 ; 1 Department of Pathology, Maulana Azad Medical College, New Delhi, India, 2 Department of Otorhinolaryngology, Maulana Azad Medical College, New Delhi, India, 3 Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India Introduction: Mammary analogue secretory carcinoma(MASC) of salivary gland is recently described tumor in 2017 WHO classification of head and neck tumors. It represents less than 0.3% of salivary gland tumors. It shares histological, IHC and genetic similarity to secretory carcinoma of breast. MASC predominantly affects parotid gland(70%) and less frequently submandibular(7%) and other glands. Case Report: 20-year-old male presented with progressively enlarging, painless swelling in right submandibular region for two years. USG revealed solid cystic lesion measuring 4 x 3 x 2 cm in right submandibular gland. USG guided FNAC showed tumor cells in clusters and papillaroid fragments. These cells had round-oval nuclei, fine chromatin, prominent nucleoli with moderate to abundant amphophilic cytoplasm with focal vacuolations in a mucinous and hemorrhagic background. Provisional diagnosis of category 5(Milan’s system) possibly Adenoid cystic carcinoma was given and excision was advised. On histopathology, it was reported as Secretory Carcinoma. Tumor cells were positive for CK7, EMA, S100, mammaglobin and CK5/6(focal positivity) along with special stains-Alcian blue, PAS, mucicarmine. Discussion: MASC is rare low-grade salivary gland tumor. Mean age of presentation is 47yrs. Grossly, it’s solitary and well circumscribed with prominent cystic component. It shows tubular, papillary, microcystic and solid patterns. Tumor cells have round-oval vesicular nuclei, occasional prominent nucleoli with focal nuclear atypia and eosinophilic to vacuolated, bubbly cytoplasm. Intraluminal colloid like secretions are also seen. Common differential diagnosis includes acinic cell carcinoma, mucoepidermoid carcinoma, salivary duct carcinoma and adenocarcinoma. Conclusion: MASC is rare, low-grade tumor with distinctive genetic alterations. Accurate diagnosis relies on recognizing its typical morphology and immunohistochemical profile. Definite diagnosis of MASC by FNA is difficult because of its rarity and morphological overlap with other tumors. Cytopathologist should keep MASC as a differential when presented with characteristic findings on FNA. Histopathology with IHC is mandatory to rule out differentials.

Chittarkaur, Smruti Soumya Panigrahi, Sneh Bhanwala, Nisha Marwah, Sunita Singh; Department of Pathology, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India Introduction: Primitive Neuroectodermal Tumor (PNET) and Ewing Sarcoma (ES) are predominantly neural and nonepithelial in origin.ES is morphologically composed of small round blue cells, are locally aggressive tumors and metastasise especially to bone marrow, brain and lung. It mainly affects children and young adults regardless of gender. ESS is a subgroup of Ewing family arising in soft tissue and shares histomorphological, immunohistochemical and molecular similarity with skeletal ES. Main sites for ESS are chest wall, lower extremities and paravertebral region. Head and Neck have rarely been involved as primary site for ESS. Objective: To present a rare case of ESS of soft palate in a young pregnant female. Case Report: A 19 years old pregnant female with swelling present in parapharyngeal space associated with right eyelid drooping and intraoral soft tissue bulge on right side at junction of soft palate and tonsillar fossa. USG of Face shows a lesion deep to parotid region (? Neoplastic etiology). Plain MRI Brain revealed the presence of right temporal and left frontoparietal meningiomas and a large mass lesion in the masticator space infiltrating into the parapharyngeal fat space. CEMRI of face, orbit and nose revealed a large lobulated heterogenous signal intensity mass lesion noted in the right parapharyngeal space superiorly infiltrating into the masticator space, right middle cranial and inferotemporal fossa, inferiorly extending upto the oropharynx. FNAC of soft tissue intraoral bulge revealed malignant small round cell tumor resembling ES (extraskeletal). The diagnosis was confirmed on cell block and immunohistochemistry. Conclusion: ESS is a rare tumor in oral cavity and it could be misinterpreted as salivary gland tumor or Squamous Cell Carcinoma. The, clinicians should take it into consideration while making differential diagnosis of oral cavity lesions. Being aggressive neoplasms, an early diagnosis and prompt treatment can improve survival.

Varun Garg, Deepshikha, Prajwala Gupta; Department of Pathology, ABVIMS and Dr. RML Hospital, New Delhi, India Introduction: Soft tissue sarcomas are a heterogeneous group of mesenchymal tumors that can occur anywhere in the body. It accounts for only 1% of all adult cancer diagnoses, affecting the extremities in 50%, the trunk and retroperitoneum in 40%, and the head and neck in 10% of cases. These tumors pose a significant diagnostic challenge as a result of their morphologic overlap and biological heterogeneity. Here, we report a case of undifferentiated sarcoma in a 37-year old male with left axillary swelling which was diagnosed on fine needle aspiration cytology (FNAC). Objective: To determine the utility of FNAC in diagnosing and categorization of soft tissue tumors and its correlation with histopathological findings. Case Report: A 37-years-old male presented with a gradually progressive swelling in the left axilla for 4-5 months which was firm to hard in consistency and measured 5x5 cm. The right axilla was clear and no cervical or axillary lymphadenopathy was noted. FNAC was done from left axillary swelling and cell block was made which showed positive staining for vimentin and negative staining for pancytokeratin. Later, the patient also gave the history of being operated for soft tissue sarcoma 2 years back on left upper arm. Hence, in view of previous histopathological findings and immunohistochemistry on cell block, final diagnosis rendered on FNAC was of an undifferentiated sarcoma (recurrence). Conclusion: FNAC is a simple, cost effective, and minimally invasive method useful in early detection of a metastatic or a locally recurrent soft tissue neoplasms.

Afsana Anjum, Vidhu Mahajan, Chhavi Gupta; Department of Pathology, Government Medical College, Kathua, Jammu and Kashmir, India Introduction: Schwannoma can occur anywhere, but it is most common in the head and neck, as well as the extremities, where tumours form from small- to medium-sized nerves. Regardless of their neural origin, the majority of lesions are painless, with the exception of those that are larger or undergoing cystic degeneration. Degenerative changes like haemorrhage, calcification, and fibrosis are common in schwannoma, but cystic changes are uncommon. We report here, the first case of it diagnosed by cytopathology and confirmed by histopathology. Case Description: A 25-year-old female presented to cytopathology section for an axillary mass FNAC. Local examination revealed a 5× 4 cm tender, firm, mobile mass in the right axilla. The mass has been slowly increasing in size and becoming painful. She only complained of a painful, visible swelling and the pain is radiating to the whole arm . Fine needle aspiration from the right axillary mass yielded 30 ml straw colored fluid. The size of the swelling markedly reduced after aspiration and no residual lump was palpated. The smears showed occasional lymphocytes in the proteineceous background and a diagnosis of Benign cystic lesion was made. Thereafter patient was treated accordingly.6 months later the patient again presented to us with the same complaints of swelling, pain in the right axilla. FNA was done that yielded 20 ml of straw colored fluid, this time along with cytology we ask for cell blocks of the fluid. FNAC smears show lymphocytes and few scattered spindle cells. However on Cell block, a provisional diagnosis of Peripheral nerve sheath tumour was made and we ask for the biopsy. On histopathological examination, diagnosis of Schwannoma was confirmed. Conclusion: To conclude, schwannoma with extensive cystic degeneration is a rare differential diagnosis for axillary cystic lesions. Radio-imaging and FNAC features can be indistinguishable, making histopathology the primary method for differentiation.

V Hemalatha 1 , Meenakshi Rao 1 , Deepak Vedant 1 , Taruna Yadav 2 ; 1 Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, 2 Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Introduction: Cytological diagnosis of soft tissue sarcomas is challenging due to the diverse architecture of various subtypes and the variability in appearance within different regions of a single tumor and often requires various ancillary techniques for definite diagnosis. We report two cases of soft tissue sarcomas with suspected recurrence/metastasis in which diagnosis could be reached on cytomorphology alone, without use of ancillary studies. These cases highlight the importance of fine-needle aspiration biopsy (FNAB) in the diagnosis of recurrence/metastasis of soft tissue sarcomas. Objective: To evaluate the efficacy of cytomorphological diagnosis in detecting sarcoma recurrences/ metastasis and demonstrate the reliability of cytomorphology as a primary diagnostic tool, potentially reducing the need for biopsies. Case Report: A 47-year-old male with history of recurrent high-grade synovial sarcoma in the right distal thigh, initially operated on in August 2023, presented with recurrent swelling for 45 days. Imaging revealed a heterogeneously enhancing enlarged lymph node with a cystic component in the right external iliac region, raising concerns about possible metastasis or reactive changes. USG-guided FNA of the right inguinal lymph node showed malignant cells that were morphologically compatible with a diagnosis of synovial sarcoma, and the tumor cells showed similar morphology as in the previous biopsy. An 89-year-old male with a history of myxofibrosarcoma of the scalp, presented with recurrent nodular scalp swelling. FNA performed from the scalp swelling showed cytology morphologically consistent with myxofibrosarcoma. Conclusion: These case reports highlight the critical role of cytomorphological diagnosis in detecting recurrences/metastasis of soft tissue sarcomas. The ability to identify tumor recurrence through FNAB demonstrates its effectiveness as a reliable, minimally invasive diagnostic tool. These findings support the use of cytology as a primary method for monitoring recurrent soft tissue sarcomas, potentially reducing the need for more invasive biopsies while ensuring accurate and timely diagnosis.

Sushmitha Malpe Gopal 1 , Vidya Monappa 2 ; 1 Department of Basic Medical Sciences, MAHE, Manipal, Karnataka, India, 2 Department of Pathology, Kasturba Medical College, MAHE, Manipal, Karnataka, India Introduction: Extramedullary plasmacytoma is a rare plasma cell malignancy with myriad of varying presentations, from being the sole manifestation, to metastatic lesion from an extra medullary plasmacytoma present elsewhere, in the bone as solitary plasmacytoma or part of the disease process of multiple myeloma. Jaw lesions, though not uncommon, rarely present as the first sign in multiple myeloma and involve the mandible more frequently than maxilla. The utility of fine needle aspiration cytology (FNAC) in the diagnosis of plasmacytoma has only been elaborated in few cases to date. Objective: To evaluate the cytomorphology of plasmacytoma in the mandible and its mimics on FNAC. Case Report: A 63-year-old male reported to the outpatient department of our hospital complaining of pain and swelling over the right mandibular region of the face for one month. On FNAC, dyscohesive sheets of plasmacytoid cells and atypical plasma cells suggestive of plasmacytoma noted. On further investigations, diagnosis of multiple myeloma was made based on clinical, laboratory, radiologic and histopathological examination. Bone marrow aspirate and bone marrow biopsy suggested plasma cell neoplasm with 38% atypical forms and occasional plasmablasts and flow cytometry immunophenotyping positive for CD38, CD138 and cLAMBDA. Conclusion: In the present case, plasmacytoma was the presenting complaint and on further work up diagnosis of multiple myeloma was given. Plasmacytoid cells in mandibular lesion on FNAC should raise the suspicion of malignant mimickers like non-Hodgkin lymphoma and benign mimickers like reactive plasmacytosis. Diagnosis of plasmacytoma emphasizes the importance of complete workup to rule out or uncover the underlying myeloma. Thus, rapid & accurate diagnosis of plasmacytoma by FNAC allowed for early initiation of treatment; thus, this case highlights the diagnostic utility of this simple tool as part of the workup of a case and ultimately therapeutic benefit for the patient.

Brijnandan Gupta 1 , Mithlesh Bhargav 1 , Mohd Asif Khan 1 , Meena 1 , Shahnawaz Ahmed Chaudhary 2 ; 1 Department of Pathology, AIIMS, Gorakhpur, Uttar Pradesh, India, 2 Department of General Surgery, AIIMS, Gorakhpur, Uttar Pradesh, India Introduction: Infection with the larval form (cysticercus) of Taenia solium in any tissue or organ is known as cysticercosis. Humans are definite host while pig and human are intermediate host. Cysticercosis symptoms change based on the site affected. Cutaneous or muscular involvement is rare, but if present it presents as a palpable, subcutaneous nodule that may become painful if large enough. Objective: To understand the cytomorphological and histomorphological features of myocysticercosis. Case Report: We reported a 19-year-old female presented to general surgery OPD, AIIMS Gorakhpur, with the complaint of swelling over left upper back measuring 1x0.5cm since 5 years which is gradually increasing in size since past 1 month and associated with mild pain. On examination the swelling was firm, palpable, non-tender nodule. On ultrasonography a well-defined cystic lesion in the intra-muscular plane showing internal hyperechoic scolex and on FNAC the patient was provisionally diagnosed cysticercosis therefore histopathological examination correlation advised. Results and Conclusion: H&E stained sections show few refractile structure with remnants of organism along with dense granulomatous reaction, palisaded granuloma and multinucleated giant cells which are the features of cysticercosis, hence the final diagnosis of myocysticercosis was confirmed. In addition to the CNS, cysticerci can also be located in the subcutaneous tissue, ocular tissue, and skeletal musculature. Subcutaneous cysticercosis accounts for only about 0.9% of all cases of human cysticercosis, hence this reported case would help to understand the cytomorphological and histomorphological feature of myocysticercosis.

S A Deepa Adiga, Daksha D Shetty, Padmapriya Jaiprakash, G V Chaithra; Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India Introduction: Lung cytology reporting is being standardised by the introduction of the new World Health Organization (WHO) reporting system for lung cytopathology which is a 5 tier reporting system. The earlier Papanicolaou Society of Cytopathology (PSC) system for reporting respiratory cytology with six categories is still in use in may centres. Although risk of malignancy for each category is brought to light for these systems, studies on inter observer reliability are not well documented. Aims and Objectives: (a) To assess the diagnostic performances of lung cytology with the WHO Reporting System for Lung Cytopathology and Papanicolaou Society of Cytopathology System in terms of risk of malignancy and (b) To assess the interobserver agreement for each syatem of reporting respiratory cytology. Materials and Methods: Two hundred and thirty-three cases of lung cytology specimens which included sputum, fine needle aspirations, bronchial brushings, washings and lavage were blindly reviewed independently by two experienced cytopathologists and categorized as per WHO system and the Papanicolaou systems of reporting. Further risk of malignancy was estimated and overall interrater reliability was assessed using the Cohen’s Kappa as statistical tool. Observation and Results: There was very good agreement between the raters with a kappa value of 0.822 and interrater agreement of 91% for the WHO system. Similarly very good agreement with a kappa value of 0.825 and agreement of 91% was obtained with the PSC system of reporting. Risk of malignancy correlated with both the systems among all the categories except for the ‘atypical’ category in the PSC system which was 50%. Conclusion: With a very good interobserver agreement between cytopathologists with both the WHO and the PSC systems, lung cytology continues to offer a crucial role in the management of pulmonary lesions. WHO system is more preferably be adopted so as to bring a uniformity in reports both nationally and internationally.

Disha Randive, Rasika Gadkari, Sachin Chaudhari, Shalaka Khade, Akriti Khare; Department of Pathology, AIIMS, Nagpur, Maharashtra, India Introduction: Generalised lymphadenopathy is one of the most frequent presentations seen in the clinic, especially in the Indian scenario. It can be due to inflammatory conditions, infections and neoplasia. Fine Needle Aspiration Cytology (FNAC) is convenient, quick, easy and costeffective diagnostic tool in the investigation of lymphadenopathy. Objective: To diagnose the case using FNAC and ancillary tests. Case Report: A 78-year-old male presented to the medicine clinic with complaints of generalized weakness and easy fatiguability for three months. Complete blood count revealed anemia with thrombocytopenia. Ultrasound examination revealed retroperitoneal, bilateral superficial inguinal and paraaortic lymph nodes, largest measuring 3.2 x 2.5 cm. Prostatomegaly was also noted. Patient was referred to the cytopathology for FNAC from bilateral inguinal lymph nodes. FNAC was performed under ultrasound guidance to correctly locate the lesion. Blood mixed material was obtained, and smears were prepared. Hematoxylin and Eosin, Giemsa and Papanicolaou stains were prepared. On examination, smears were highly cellular and predominantly composed of large round cells which were relatively monomorphic. These cells were dyscohesive with focal loose groups. Focally rounded, ill-defined acini like structures were seen. The nuclei of these cells were two to three times the size of the nuclei of small mature lymphocytes. Few cells showed opened up chromatin and conspicuous nucleoli. Mucin or lymphoglandular bodies were not seen. A differential diagnosis of Non-Hodgkin lymphoma or metastatic carcinoma was given. Next day, bone marrow biopsy was done, which, on examination, showed features of metastatic deposits of prostatic adenocarcinoma. Immunohistochemistry was done on bone marrow biopsy which showed Cytokeratin positivity in lesional cells. Hence, after cytological and hematological correlation, a diagnosis of metastatic prostatic adenocarcinoma was made. Conclusion: Prostate carcinoma should be considered as one of the differential diagnosis in cases of generalized lymphadenopathy in elderly male patients. Lack of lymphoglandular bodies should raise suspicion for metastatic poorly differentiated carcinoma.

Divya Kumari 1 , Erna Ahsan 1 , Saransh Puri 2 , Bhartendu 1 , Arvind Kumar 1 , Ashok Singh 1 , Sanjeev Kishore 1 , Prashant Durgapal 1 , Ravi Hari Phulware 1 ; 1 Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India, 2 Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India Introduction: Hydatid disease is a parasitic infection caused by Echinococcus granulosus . Historically recognized by scholars such as Hippocrates and Galen, this disease remains a significant global health issue. While hydatid cysts most commonly affect the liver and lungs, they can also present in atypical anatomical locations. The prevalence of hydatid cysts in unusual sites is approximately 8-10%, presenting diagnostic challenges. This case series explores the clinical presentation, diagnostic strategies, cytological characteristics, and management of hydatid cysts across a range of anatomical sites. Objectives: The primary objectives of this study are to: Examine the presentation of hydatid cysts in both typical and atypical anatomical sites. Highlight the role of cytology in diagnosing hydatid disease, especially in less common locations. Correlation of clinical, pathological and radiological diagnosis in assessment of hydatid cyst. Examine the presentation of hydatid cysts in both typical and atypical anatomical sites. Highlight the role of cytology in diagnosing hydatid disease, especially in less common locations. Correlation of clinical, pathological and radiological diagnosis in assessment of hydatid cyst. Case Series: We present eight cases of hydatid cysts, ranging in age from 8 to 52 years, identified in diverse anatomical sites with male to female ratio of 3:5. The most common site was liver; five cases, followed by one case in the kidney, neck and paraspinal region each. The clinical and radiological diagnosis varies from benign cystic lesion to malignancy. Eosinophilia was observed in all patients. Cytological evaluation revealed characteristic findings, including hooklets, protoscolices, fragments of laminated membranes, amorphous nuclear debris, foreign body giant cells, which were essential for confirming the diagnosis. Cytological findings correlated with histopathological and serological results, leading to successful surgical management in all cases with favourable postoperative outcomes. Conclusion: Cytology plays a crucial role in diagnosing hydatid cysts, particularly in atypical locations where imaging findings may be inconclusive and clinical diagnosis varies from abscesses to masses. This case series underscores the importance of cytopathology in confirming hydatid disease and highlights its integral role in the diagnosis. In regions where hydatid disease is endemic, meticulously performed FNAC should be considered a key component in evaluating cystic lesions to ensure accurate and timely management of this parasitic infection.