Objective: Phaeohyphomycosis caused by phaeoid fungi is a type of mycosis emerging worldwide whic... more Objective: Phaeohyphomycosis caused by phaeoid fungi is a type of mycosis emerging worldwide which causes a wide variety of clinical manifestations. Study Design: A retrospective analysis of 11 cases diagnosed with fungal inflammation on cytology over a period of 6 years (2013–2018) was done along with culture/histopathologic confirmation. Results: Of the total of 11 cases, 9 cases presented with subcutaneous swellings and 1 case each with brain and lung lesions. The age range was 30–83 years (mean: 53.6); 8 patients were male and 3 were female. Cytologic smears showed fungal profiles with septate tortuous hyphae, as well as swollen and narrow, yeast-like swellings with an irregular breadth of the hyphae in all cases. The fungal profiles were visualized on a Masson-Fontana stain. The background showed inflammatory cells, giant cells, and necrosis in variable proportions. Five cases were diagnosed as phaeohyphomycosis on cytology, whereas 3 cases were misdiagnosed as aspergillus and ...
Context: Abnormal uterine bleeding (AUB) is a common problem for which women seek gynecological c... more Context: Abnormal uterine bleeding (AUB) is a common problem for which women seek gynecological consultation. Endometrial aspiration cytology (EAC) has emerged as a minimally invasive and cost-effective diagnostic procedure for screening the endometrial status of these patients that can aid in diagnosis in high-burden and resource-limited settings. Aims: The study was conducted to evaluate the utility of EAC in women with AUB, and the cytological diagnosis was compared with the histopathology. Materials and Methods: A total of 100 patients presenting with AUB were subjected to EAC using a 4-mm Karman's cannula. Later, they also underwent endometrial dilation and curettage. The cytology smears were evaluated for architectural and cytomorphological features. The cytological diagnoses henceforth made were compared with the histopathological diagnosis to calculate sensitivity, specificity, and diagnostic accuracy of EAC. Results: EAC showed a sample adequacy of 89% viz a viz 90% for histopathology. EAC showed a sensitivity of 87.5% and 100% for diagnosing benign and malignant conditions, respectively. There was a good overall agreement between cytological and histopathological diagnosis (κ = 0.585). Conclusions: EAC is an effective and minimally invasive procedure for the primary investigation of women with AUB.
The management and prognosis of oral squamous cell carcinoma (OSCC) depend on tumor stage and lym... more The management and prognosis of oral squamous cell carcinoma (OSCC) depend on tumor stage and lymph node (LN) metastasis status. Early-stage (T1/T2 N0M0) OSCC comprises a heterogeneous group. We evaluated the role of histological parameters including worst pattern of invasion (WPOI) and tumor budding to determine the risk of LN metastasis in cases of OSCC and to determine the risk of recurrence and death in early-stage OSCC in north Indian patients. All cases of buccal mucosa and tongue SCC which underwent excision over 4 and half years were reviewed for histological parameters including histologic grade, WPOI, tumor budding, lymphovascular emboli (LVE), perineural invasion (PNI), depth of invasion (DOI), host lymphocyte response, and stromal response and compared to LN metastasis. Clinical follow-up of early-stage tumor was obtained and compared. A total of 126 cases of OSCC were included, of which 48 showed LN metastasis. Histological grade, WPOI, tumor budding (≥3/×40 field), LVE...
The aim of this study is to detect breast cancer rate, nodal status, tumor size, and associated r... more The aim of this study is to detect breast cancer rate, nodal status, tumor size, and associated risk factors using clinical breast examination (CBE) and mammography as screening tools in women aged 40-49 years. A total of 500 women were screened in a time period of 2 years, between the ages of 40-49 years for breast cancer. Screening tools used were CBE and mammography. Clinical history and risk factors related to breast cancer were recorded. CBE was performed to detect any breast pathology followed by mammographic screening. Breast Imaging Reporting and Data System (BI-RADS) mammographic density categories were used for reporting breast imaging on mammography. For women with dense breasts or an inconclusive mammography report, ultrasonography was performed to assess the lesion/s. Suspicious lesion was subjected to fine-needle aspiration cytology or an open surgical biopsy for a confirmatory diagnosis. Women with history of breast cancer were excluded from the study. CBE was normal ...
It is challenging for pulmonologists to sample mediastinal lymph nodes or some endobronchial lesi... more It is challenging for pulmonologists to sample mediastinal lymph nodes or some endobronchial lesions because of safety concerns. C-TBNA (conventional transbronchial needle aspiration) is a procedure to sample such sites, but is underutilized. We present a retrospective review of patients subjected to C-TBNA through fibre-optic bronchoscopy over a 10-year period. Year-wise statistics of C-TBNA was reviewed and results were analyzed with regard to sampling sites and type of intraluminal lesions encountered, diagnosis made and their correlation with sampling sites, sex and age. 160 patients underwent successful C-TBNA with 111/160 (69.4%) males and 49/160 (30.6%) females. Non-availability of in-house needles dramatically decreased the number of procedures. 17 (10.6%) patients underwent C-TBNA from intraluminal bulge, 41 (25.6%) from endobronchial growth and 102 (63.8%) from enlarged lymph nodes. Subcarinal lymph node alone was predominantly aspirated in 83/102 (81.4%) lymph node sampled patients. In 100 (62.5%) patients, diagnosis was achieved as follows: 57/100 as tumour, 30/100 as infection and 13/100 as sarcoidosis. Non-small cell lung cancer (NSCLC) and tuberculosis (TB) predominated in tumour and infection groups, respectively. Patients with intraluminal growth or bulge had higher chances of being diagnosed with tumour (p<0.001). Intraluminal bulge and growth predominated in older ages while enlarged lymph nodes predominated in the young (p=0.018). Infection was predominantly diagnosed in younger patients, sarcoidosis in the middle aged, and tumour in older patients (p<0.001). C-TBNA should be used as a diagnostic tool in developing countries like India. It can give confirmatory results in difficult cases with intraluminal growths and submucosal lesions. Cost constraints are of paramount importance, and hence continuous supply of expensive accessories should be ensured.
Background: Cutaneous metastases can occur in a wide variety of internal malignancies and may be ... more Background: Cutaneous metastases can occur in a wide variety of internal malignancies and may be the first sign of a clinically silent visceral cancer. Study Design: A retrospective analysis was made of 138 cases diagnosed with cutaneous and subcutaneous metastasis on fine-needle aspiration cytology (FNAC). Primary tumors of the skin/subcutis were excluded. Results: Of 138 cases, the primary was known in 101 cases and unknown in 37 cases. The age of the patients ranged from 5 to 86 years, and 76 (55.1%) were male and 62 (44.9%) were female. Clinically, the most common lesion was a single nodule (n = 77, 55.8%). The chest wall was the predominant site (n = 53, 38.4%). In males and females, the most common primary sites were the lung (n = 16) and breast (n = 24), respectively. On cytology, the most common diagnosis was metastatic adenocarcinoma (n = 41, 29.7%). Of 37 cases with an unknown primary, FNAC helped to locate the primary site in 17 (45.9%) cases, while in 20 cases it remaine...
Journal of cytology / Indian Academy of Cytologists
Address for correspondence: Dr. Shilpa Goyal, Department of Pathology, Government Medical College... more Address for correspondence: Dr. Shilpa Goyal, Department of Pathology, Government Medical College and Hospital, Sector 32, Chandigarh, Punjab and Haryana, India. E-mail: drshilpag@gmail.com Cilia, the organs of motility, are normally observed in many cell types including those of respiratory system, fallopian tubes, gastrointestinal tract, and inner ear.[1,2] They have also been demonstrated in benign lesions such as intestinal metaplasia of pyloric mucosa, endosalpingiosis, ciliated cysts, and tumors of müllerian origin.[1] Among the ovarian tumors, cilia have been well-documented on cytologic examination in cells of both benign and borderline neoplasms.[3–5] Only a few papers have documented the presence of ciliated tumor cells in ovarian adenocarcinoma.[3,6] We report such a rare case with well-formed cilia on tumor cells giving them a “sea anemone-like” appearance. These ciliated cells are an interesting finding and are a visual treat to the eyes of the cytopathologist as well.
Journal of cytology / Indian Academy of Cytologists
Granular cell tumors (GCTs) are uncommon neoplasms with recently postulated origin from Schwann c... more Granular cell tumors (GCTs) are uncommon neoplasms with recently postulated origin from Schwann cell or neural crest. It can appear in different parts of the body and is most commonly found in the tongue. The cutaneous presentation is not that uncommon. Fine needle aspiration cytology (FNAC) has been suggested to be the diagnostic modality of choice. It will help to differentiate benign tumors from malignant ones and to differentiate GCT from frequent misdiagnoses such as granular histiocytic reaction, xanthogranuloma, rhabdomyoma, oncocyte rich lesions, alveolar soft part sarcoma (ASPS), epithelioid sarcoma, and carcinoma. We report two cases of GCT who presented with subcutaneous swellings in the right thigh and the left lumbar region for 24 months and 18 months, respectively. In the first case, a cytodiagnosis of chronic inflammation showing histiocytes was suggested while GCT was found in the second case. Subsequent histologic examination of the first case and immunocytochemistr...
Small cell osteosarcoma (OS) is a rare histological variant of OS that poses unique diagnostic di... more Small cell osteosarcoma (OS) is a rare histological variant of OS that poses unique diagnostic difficulties. We present a case of a 10-year-old child who underwent fine needle aspiration cytology (FNAC) from a mass in the right thigh. The cytological findings were those of a malignant small round cell tumor, closest to small cell OS. The FNAC findings were confirmed on histopathology.
Carcinoma ex-pleomorphic adenoma (Ca ex-PA) is uncommon; however, its accurate diagnosis is impor... more Carcinoma ex-pleomorphic adenoma (Ca ex-PA) is uncommon; however, its accurate diagnosis is important, as the prognosis is better than other salivary gland malignancies, when it is within the pleomorphic adenoma. Fine needle aspiration cytology may be used for its diagnosis. Smears of five cases of Ca ex-PA diagnosed on fine-needle aspiration (FNA) and confirmed on histopathology were analyzed and diagnostic features were assessed. All cases had history of long-standing masses with recent increase in size. Smears showed high grade carcinoma with differential diagnoses of mucoepidermoid carcinoma, adenocarcinoma NOS and salivary duct carcinoma. Features suggestive of PA origin included chondromyxoid stroma: Benign epithelial cells and scattered plasmacytoid cells. The overall agreement between cytological findings and histopathological diagnosis was 100%. Diagnosis of Ca ex-PA may be possible on FNA by correlation with clinical history and detection of chondromyxoid stroma and benign myo-epithelial cells.
Objective: Phaeohyphomycosis caused by phaeoid fungi is a type of mycosis emerging worldwide whic... more Objective: Phaeohyphomycosis caused by phaeoid fungi is a type of mycosis emerging worldwide which causes a wide variety of clinical manifestations. Study Design: A retrospective analysis of 11 cases diagnosed with fungal inflammation on cytology over a period of 6 years (2013–2018) was done along with culture/histopathologic confirmation. Results: Of the total of 11 cases, 9 cases presented with subcutaneous swellings and 1 case each with brain and lung lesions. The age range was 30–83 years (mean: 53.6); 8 patients were male and 3 were female. Cytologic smears showed fungal profiles with septate tortuous hyphae, as well as swollen and narrow, yeast-like swellings with an irregular breadth of the hyphae in all cases. The fungal profiles were visualized on a Masson-Fontana stain. The background showed inflammatory cells, giant cells, and necrosis in variable proportions. Five cases were diagnosed as phaeohyphomycosis on cytology, whereas 3 cases were misdiagnosed as aspergillus and ...
Context: Abnormal uterine bleeding (AUB) is a common problem for which women seek gynecological c... more Context: Abnormal uterine bleeding (AUB) is a common problem for which women seek gynecological consultation. Endometrial aspiration cytology (EAC) has emerged as a minimally invasive and cost-effective diagnostic procedure for screening the endometrial status of these patients that can aid in diagnosis in high-burden and resource-limited settings. Aims: The study was conducted to evaluate the utility of EAC in women with AUB, and the cytological diagnosis was compared with the histopathology. Materials and Methods: A total of 100 patients presenting with AUB were subjected to EAC using a 4-mm Karman's cannula. Later, they also underwent endometrial dilation and curettage. The cytology smears were evaluated for architectural and cytomorphological features. The cytological diagnoses henceforth made were compared with the histopathological diagnosis to calculate sensitivity, specificity, and diagnostic accuracy of EAC. Results: EAC showed a sample adequacy of 89% viz a viz 90% for histopathology. EAC showed a sensitivity of 87.5% and 100% for diagnosing benign and malignant conditions, respectively. There was a good overall agreement between cytological and histopathological diagnosis (κ = 0.585). Conclusions: EAC is an effective and minimally invasive procedure for the primary investigation of women with AUB.
The management and prognosis of oral squamous cell carcinoma (OSCC) depend on tumor stage and lym... more The management and prognosis of oral squamous cell carcinoma (OSCC) depend on tumor stage and lymph node (LN) metastasis status. Early-stage (T1/T2 N0M0) OSCC comprises a heterogeneous group. We evaluated the role of histological parameters including worst pattern of invasion (WPOI) and tumor budding to determine the risk of LN metastasis in cases of OSCC and to determine the risk of recurrence and death in early-stage OSCC in north Indian patients. All cases of buccal mucosa and tongue SCC which underwent excision over 4 and half years were reviewed for histological parameters including histologic grade, WPOI, tumor budding, lymphovascular emboli (LVE), perineural invasion (PNI), depth of invasion (DOI), host lymphocyte response, and stromal response and compared to LN metastasis. Clinical follow-up of early-stage tumor was obtained and compared. A total of 126 cases of OSCC were included, of which 48 showed LN metastasis. Histological grade, WPOI, tumor budding (≥3/×40 field), LVE...
The aim of this study is to detect breast cancer rate, nodal status, tumor size, and associated r... more The aim of this study is to detect breast cancer rate, nodal status, tumor size, and associated risk factors using clinical breast examination (CBE) and mammography as screening tools in women aged 40-49 years. A total of 500 women were screened in a time period of 2 years, between the ages of 40-49 years for breast cancer. Screening tools used were CBE and mammography. Clinical history and risk factors related to breast cancer were recorded. CBE was performed to detect any breast pathology followed by mammographic screening. Breast Imaging Reporting and Data System (BI-RADS) mammographic density categories were used for reporting breast imaging on mammography. For women with dense breasts or an inconclusive mammography report, ultrasonography was performed to assess the lesion/s. Suspicious lesion was subjected to fine-needle aspiration cytology or an open surgical biopsy for a confirmatory diagnosis. Women with history of breast cancer were excluded from the study. CBE was normal ...
It is challenging for pulmonologists to sample mediastinal lymph nodes or some endobronchial lesi... more It is challenging for pulmonologists to sample mediastinal lymph nodes or some endobronchial lesions because of safety concerns. C-TBNA (conventional transbronchial needle aspiration) is a procedure to sample such sites, but is underutilized. We present a retrospective review of patients subjected to C-TBNA through fibre-optic bronchoscopy over a 10-year period. Year-wise statistics of C-TBNA was reviewed and results were analyzed with regard to sampling sites and type of intraluminal lesions encountered, diagnosis made and their correlation with sampling sites, sex and age. 160 patients underwent successful C-TBNA with 111/160 (69.4%) males and 49/160 (30.6%) females. Non-availability of in-house needles dramatically decreased the number of procedures. 17 (10.6%) patients underwent C-TBNA from intraluminal bulge, 41 (25.6%) from endobronchial growth and 102 (63.8%) from enlarged lymph nodes. Subcarinal lymph node alone was predominantly aspirated in 83/102 (81.4%) lymph node sampled patients. In 100 (62.5%) patients, diagnosis was achieved as follows: 57/100 as tumour, 30/100 as infection and 13/100 as sarcoidosis. Non-small cell lung cancer (NSCLC) and tuberculosis (TB) predominated in tumour and infection groups, respectively. Patients with intraluminal growth or bulge had higher chances of being diagnosed with tumour (p<0.001). Intraluminal bulge and growth predominated in older ages while enlarged lymph nodes predominated in the young (p=0.018). Infection was predominantly diagnosed in younger patients, sarcoidosis in the middle aged, and tumour in older patients (p<0.001). C-TBNA should be used as a diagnostic tool in developing countries like India. It can give confirmatory results in difficult cases with intraluminal growths and submucosal lesions. Cost constraints are of paramount importance, and hence continuous supply of expensive accessories should be ensured.
Background: Cutaneous metastases can occur in a wide variety of internal malignancies and may be ... more Background: Cutaneous metastases can occur in a wide variety of internal malignancies and may be the first sign of a clinically silent visceral cancer. Study Design: A retrospective analysis was made of 138 cases diagnosed with cutaneous and subcutaneous metastasis on fine-needle aspiration cytology (FNAC). Primary tumors of the skin/subcutis were excluded. Results: Of 138 cases, the primary was known in 101 cases and unknown in 37 cases. The age of the patients ranged from 5 to 86 years, and 76 (55.1%) were male and 62 (44.9%) were female. Clinically, the most common lesion was a single nodule (n = 77, 55.8%). The chest wall was the predominant site (n = 53, 38.4%). In males and females, the most common primary sites were the lung (n = 16) and breast (n = 24), respectively. On cytology, the most common diagnosis was metastatic adenocarcinoma (n = 41, 29.7%). Of 37 cases with an unknown primary, FNAC helped to locate the primary site in 17 (45.9%) cases, while in 20 cases it remaine...
Journal of cytology / Indian Academy of Cytologists
Address for correspondence: Dr. Shilpa Goyal, Department of Pathology, Government Medical College... more Address for correspondence: Dr. Shilpa Goyal, Department of Pathology, Government Medical College and Hospital, Sector 32, Chandigarh, Punjab and Haryana, India. E-mail: drshilpag@gmail.com Cilia, the organs of motility, are normally observed in many cell types including those of respiratory system, fallopian tubes, gastrointestinal tract, and inner ear.[1,2] They have also been demonstrated in benign lesions such as intestinal metaplasia of pyloric mucosa, endosalpingiosis, ciliated cysts, and tumors of müllerian origin.[1] Among the ovarian tumors, cilia have been well-documented on cytologic examination in cells of both benign and borderline neoplasms.[3–5] Only a few papers have documented the presence of ciliated tumor cells in ovarian adenocarcinoma.[3,6] We report such a rare case with well-formed cilia on tumor cells giving them a “sea anemone-like” appearance. These ciliated cells are an interesting finding and are a visual treat to the eyes of the cytopathologist as well.
Journal of cytology / Indian Academy of Cytologists
Granular cell tumors (GCTs) are uncommon neoplasms with recently postulated origin from Schwann c... more Granular cell tumors (GCTs) are uncommon neoplasms with recently postulated origin from Schwann cell or neural crest. It can appear in different parts of the body and is most commonly found in the tongue. The cutaneous presentation is not that uncommon. Fine needle aspiration cytology (FNAC) has been suggested to be the diagnostic modality of choice. It will help to differentiate benign tumors from malignant ones and to differentiate GCT from frequent misdiagnoses such as granular histiocytic reaction, xanthogranuloma, rhabdomyoma, oncocyte rich lesions, alveolar soft part sarcoma (ASPS), epithelioid sarcoma, and carcinoma. We report two cases of GCT who presented with subcutaneous swellings in the right thigh and the left lumbar region for 24 months and 18 months, respectively. In the first case, a cytodiagnosis of chronic inflammation showing histiocytes was suggested while GCT was found in the second case. Subsequent histologic examination of the first case and immunocytochemistr...
Small cell osteosarcoma (OS) is a rare histological variant of OS that poses unique diagnostic di... more Small cell osteosarcoma (OS) is a rare histological variant of OS that poses unique diagnostic difficulties. We present a case of a 10-year-old child who underwent fine needle aspiration cytology (FNAC) from a mass in the right thigh. The cytological findings were those of a malignant small round cell tumor, closest to small cell OS. The FNAC findings were confirmed on histopathology.
Carcinoma ex-pleomorphic adenoma (Ca ex-PA) is uncommon; however, its accurate diagnosis is impor... more Carcinoma ex-pleomorphic adenoma (Ca ex-PA) is uncommon; however, its accurate diagnosis is important, as the prognosis is better than other salivary gland malignancies, when it is within the pleomorphic adenoma. Fine needle aspiration cytology may be used for its diagnosis. Smears of five cases of Ca ex-PA diagnosed on fine-needle aspiration (FNA) and confirmed on histopathology were analyzed and diagnostic features were assessed. All cases had history of long-standing masses with recent increase in size. Smears showed high grade carcinoma with differential diagnoses of mucoepidermoid carcinoma, adenocarcinoma NOS and salivary duct carcinoma. Features suggestive of PA origin included chondromyxoid stroma: Benign epithelial cells and scattered plasmacytoid cells. The overall agreement between cytological findings and histopathological diagnosis was 100%. Diagnosis of Ca ex-PA may be possible on FNA by correlation with clinical history and detection of chondromyxoid stroma and benign myo-epithelial cells.
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Papers by Uma Handa