Fine needle aspiration cytology diagnosis of cutaneous leishmaniasis in a 6-month-old child: a case report.

BACKGROUND: Skin biopsy and scrape smear examination are the two most commonly employed investigatory techniques in the diagnosis of cutaneous leishmaniasis. Although cases Leishmania lymphadenitis are reliably diagnosed with fine needle aspiration (FNA) cytology, it has not attained popularity in the diagnosis of cutaneous leishmaniasis, and only a few reports are available. CASE: A 6-month-old Kuwaiti child presented with a skin lesion on her left forearm of five months' duration. Both scrape smears and FNA were performed from the lesion. FNA cytology smears showed a rich population of inflammatory cells predominating in lymphocytes and histiocytes and epithelioid cell granulomas. The amastigote forms of Leishmania were noted on the smears. The scrape smears were nondiagnostic. CONCLUSION: FNA cytology can be reliably used in the diagnosis of cutaneous leishmaniasis, especially in dry lesions, where scrape smears are likely to be nondiagnostic.     

Value of image-guided needle aspiration cytology in the assessment of pelvic and retroperitoneal masses. A study of 112 cases

OBJECTIVE: To evaluate the diagnostic value of the noninvasive method of image-guided needle aspiration cytology (NAC) in the assessment of radiologically detected pelvic and retroperitoneal space-occupying lesions (excluding the pancreas, kidney and adrenal). STUDY DESIGN: NAC was performed under computed tomographic or ultrasound guidance on 112 patients suspected of having a pelvic or retroperitoneal mass. Cytologic examination was performed on site after staining smears with the Papanicolaou method. In addition, air-dried smears, fixed smears, filter preparations from needle washings and cell blocks were studied. The NAC diagnosis was supported by examining cell blocks; further support was obtained with a tissue biopsy in some cases. Additionally, pertinent immunoperoxidase and/or histochemical studies were done. RESULTS: Eighteen cases were diagnosed as inflammatory lesions, 17 cases consisted of normal cellular elements, and 12 cases showed scanty material and were considered unsatisfactory/inadequate for a diagnosis. Five cases were suspicious for malignancy, and in 39 cases metastatic tumors were diagnosed from a previously known primary. Thirteen cases were diagnosed as lymphoma, and in 8 cases a diagnosis of soft tissue sarcoma was made. There were no false positive diagnoses of malignancy. Cell block preparations and immunohistochemistry were helpful with tumor typing, although lymphoma subtyping and soft tissue tumor typing generally required open biopsy. CONCLUSION: NAC, as the first-line investigation, is not only useful in the diagnosis of space-occupying lesions of the pelvic and retroperitoneal region but can also help in choosing appropriate management. The technique is most useful in diagnosing metastases but is also helpful in excluding malignancy in some cases and in suggesting diagnoses of lymphomas and soft tissue tumors.     

Diagnostic value of needle aspiration cytology in the assessment of palpable axillary lymph nodes. A study of 336 cases

OBJECTIVE: To evaluate the diagnostic value of needle aspiration cytology (NAC) in the assessment of palpable axillary lymph nodes and determine whether ancillary procedures can be useful in enhancing the diagnosis. STUDY DESIGN: The material was analyzed in 336 cases with enlarged axillary lymph nodes in which NAC were performed by the conventional method. In all cases cytologic examination was done on site after staining the smears with the Papanicolaou method. In addition, air-dried smears, fixed smears, filter preparations from needle washings and cell blocks were studied. The NAC diagnosis was supported by examining cell blocks, which showed the reliability of histologic architecture; further support was obtained with tissue biopsy and/or comparison with the primary tumor in some of the cases. RESULTS: Twelve cases were diagnosed as inflammatory lesions, and 64 were unsatisfactory due to scanty/acellular samples (despite 2-3 repeat samplings). However, in 6 of these, malignant tumors were later found on a biopsy done due to persistent and continued enlargement of an axillary lymph node or nodes. One hundred twenty-two cases were regarded as negative (normal cellular elements, n = 52; reactive elements, n = 70), and 4 cases were suspicious for malignancy. In 124 cases a variety of metastatic tumors were diagnosed (breast, n = 63; melanoma, n = 22; others, n = 39), and in 10 cases a diagnosis of lymphoma was made. CONCLUSION: NAC of palpable axillary lymph nodes as a first-line of investigation is a cost-effective procedure and is not only useful in the diagnosis of various lesions but can also help in deciding on management. Also, histologic architecture from cell blocks can be correlated with cytology, and such material can be used for histochemical and immunomarker studies.     

Cutaneous relapse in Hodgkin's disease: a case report

BACKGROUND: Skin involvement in Hodgkin's disease is rare, can be seen in advanced stages of the disease and indicates a poor prognosis. CASE: A young male presented with multiple nodular lesions on the chest wall and matted cervical lymph nodes. Aspiration smears from skin lesions showed atypical mononuclear cells with a prominent nucleolus, many lymphocytes and plasma cells. Smears from the lymph nodes showed classical Reed-Sternberg cells in a polymorphous background. The cytologic diagnosis of Hodgkin's lymphoma was entertained and later confirmed on skin biopsy. Past history revealed that the patient had been diagnosed with Hodgkin's disease and treated for it 2 years earlier, but had been lost to follow-up during treatment. CONCLUSION: Cutaneous Hodgkin's disease should always be considered in smears from skin lesions showing atypical mononuclear cells in a polymorphous background, even in the absence of a definitive clinical diagnosis at the time of presentation.     

The diagnostic value of fine needle aspiration cytology (FNAC) in the assessment of palpable supraclavicular lymph nodes: a study of 218 cases

The aim of this study was to evaluate the diagnostic value of fine needle aspiration cytology (FNAC) in the assessment of palpable supraclavicular lymph nodes. The material was analysed in 218 cases with enlarged supraclavicular lymph nodes in which FNAC was performed by the conventional method. In all cases cytological examination was performed on-site after staining the smears by the Papanicolaou method. In addition, air-dried smears, fixed smears, filter preparations from needle washings and cell blocks were studied. The FNAC diagnosis was supported by examining cell blocks which added the reliability of histological architecture; further support was obtained by tissue biopsy and/or comparison with the primary tumour in some of the cases. Eleven cases were diagnosed as inflammatory lesions and 41 cases were unsatisfactory because of scanty/acellular samples (despite two to three repeat samplings). However, in five of these, malignant tumours were later found on biopsy, which was done for persistent enlargement of the supraclavicular lymph node(s). Fifty-three cases were diagnosed as negative for malignancy (normal cellular elements, n=15; reactive elements, n=38) and 12 cases were suspicious of malignancy. In 11 cases a diagnosis of lymphoma was made on histology and in 90 cases metastatic tumours were diagnosed. The overall sensitivity was 92.7%, specificity 98.5%, positive predictive value 97.3% and the negative predictive value was 94.8%. Based on our study we feel that FNAC of palpable supraclavicular lymph nodes as a first line of investigation is a cost-effective procedure and is not only useful in the diagnosis of various lesions but can also help in deciding on appropriate management. Furthermore, the histological architecture from cell blocks can be correlated with cytology, and such material can be used for appropriate histochemical and immunomarker studies, which can be useful in enhancing the diagnosis.     

Fine needle aspiration cytology and flow cytometry immunophenotyping of non‐Hodgkin lymphoma: can we do better?

P. Zeppa, E. Vigliar, I. Cozzolino, G. Troncone, M. Picardi, A. De Renzo, F. Grimaldi, F. Pane, A. Vetrani and L. Palombini
Fine needle aspiration cytology and flow cytometry immunophenotyping of non‐Hodgkin lymphoma: can we do better? Objective: To evaluate the diagnostic efficiency of fine needle aspiration cytology/flow cytometry (FNAC/FC) in the diagnosis and classification of non‐Hodgkin lymphoma (NHL) in a series of 446 cases and to compare the results with those of previous experiences to evaluate whether there had been an improvement in FNAC/FC diagnostic accuracy. Methods: FNAC/FC was used to analyse 446 cases of benign reactive hyperplasia (BRH), NHL and NHL relapse (rNHL) in 362 lymph nodes and 84 extranodal lesions. When a diagnosis of NHL was reached, a classification was attempted combining FC data and cytological features. Sensitivity, specificity and positive and negative predictive values (PPV and NPV) of FNAC/FC in the diagnosis and classification of NHL were calculated and compared with those available in the literature. Results: FNAC/FC provided a diagnosis of NHL and rNHL in 245 cases and of BRH in 188 cases. In nine cases, the diagnosis was ‘suggestive of NHL’ (sNHL) and in four cases was inadequate. Histology and clinical follow‐up confirmed 102 cases of NHL and detected one false positive. In 18 cases of BRH diagnosed by FNAC/FC, histological examination revealed 14 BRH and four NHL (false negatives). All nine cases diagnosed as sNHL were confirmed by histology. Including sNHL cases as false negatives, statistical analysis showed 94.9% sensitivity, 99.4% specificity, 99.6% PPV and 93.4% NPV in the diagnosis of NHL. A specific subtype was diagnosed in 125 cases and confirmed in 67 of 70 cases that had histological biopsies. Statistical analysis did not demonstrate significant improvements between the present series and previous studies either in diagnosis or in classification of NHL. Conclusions: FNAC/FC is a fundamental tool in the diagnosis and classification of NHL but the exiguity of diagnostic material and other technical and clinical limitations will probably continue to limit further improvement of the technique.     

Sediment cytology in bone biopsies

The cytologic examination of smears prepared from the sediment of biopsy specimen fixatives ("sediment cytology") was used to study 70 bone lesions biopsied with a suspicion of malignancy. The smears were adequately cellular in most cases and showed good morphologic preservation; some contained fragments of tissue. Cytology was able to identify the smears from the 47 malignant lesions as malignant, but was not always able to identify the histologic type. While the osteoclastomas, Ewing's sarcomas and metastatic carcinomas were accurately diagnosed, the osteogenic sarcomas could only be identified as sarcomas and the scanty smears from chondrosarcomas only permitted a diagnosis of malignancy. The latter was also true for soft tissue lesions and lymphoma involving the bones. The 12 benign lesions yielded less cellular specimens and were more difficult to cytologically diagnose. The 11 inflammatory lesions were identified as nonmalignant. While this simple technique of sediment cytology can provide an early diagnosis for bone lesions, the final diagnosis requires the histopathologic study of the actual biopsy specimen.     

Fine needle aspiration cytology of primary lymphoid lesions of the orbit: report of four cases

BACKGROUND: The role offine needle aspiration cytology (FNAC) in diagnosis and differentiation of primary orbital lymphoid lesions is debatable, and little literature exists on cytodiagnosis of orbital lymphoid lesions. CASES: Four patients with orbital lesions underwent routine FNAC. In 3 cases, histopathologic examination was performed with immunohistochemistry (IHC). Cytologic features and diag- noses were correlated with histopathologic diagnoses. Two were cytologically diagnosed with low-grade non-Hodgkin lymphoma (NHL) and 2 with pseudolymphoma and inflammatory pseudotumor, respectively. Of the 2 cases of histologically diagnosed NHL, 1 had concordant diagnosis and the other had a jalse negative diagnosis of pseudolymphoma; both showed significant increase in mast cells, with neoplastie lymphoid cells exhibiting a higher N:C ratio and coarser chromatin texture. The case cytologically interpreted as suspicious for NHL was identified as a psetedolymphoma on histology (false positive). The case of inflammatory pseudotumor, in which hiopiy was not peiformned, responded well to corticosteroids, strengthening the cytologic diagnosis. CONCLUSION: FNAC diagnosis and differentiation of benign vs. malignant primacy orbital lymphoid lesions is often difficult. Careful cytologic interpretation with respect to certain subtle cytologic details is needed in minimizing false positive or false negative diagnoses. In difficult situations, IHC using suitable immunomarkers proves highly useful.     

流式细胞术检测外周血淋巴细胞诊断淋巴瘤的应用研究

目的:探讨流式细胞术(FCM)检测外周血淋巴细胞在淋巴瘤诊断中的应用价值。方法:通过筛选2011年8月至2017年8月期间初诊的皮肤淋巴瘤病例25例,淋巴节良性病变6例,采用FCM检测外周血淋巴细胞表面抗原分子,通过与病理切片HE染色和免疫组化法(金标准)比较,分析两种检测方法之间的差异。结果:在31例检测病例中,FCM检测结果与金标准检测结果一致性较高(Kappa=0.61):26例检查结果相同,5例检查结果不一致;检测19例T淋巴细胞淋巴瘤,FCM检测结果与金标准检测结果一致性也较高(Kappa=0.57):检测14例初诊为T细胞淋巴瘤病例,FCM检测T淋巴瘤细胞的表面抗原标志CD3分子为阳性,与组织学结果相符,另有5例T细胞淋巴瘤病例HE染色和免疫组化诊断明确,而FCM未能检出。检测6例B细胞淋巴瘤病例,6例淋巴瘤病例FCM检测结果都为阳性,FCM检测B淋巴瘤细胞的表面抗原标志CD19分子为阳性,与金标准检测结果符合率为100%。6例淋巴节良性病变病例FCM检测结果与金标准检测结果一致。结论:通过FCM检测外周血可以检测出部分皮肤淋巴瘤,FCM在皮肤淋巴瘤诊断和分型中有一定的临床价值,是检测皮肤淋巴瘤的有效的辅助方法。     

Fine needle aspiration cytology diagnosis of a cutaneous granular cell tumor in a 7-year-old child. A case report

BACKGROUND: Granular cell tumors are neoplasms of uncertain histogenesis, although a neural origin is favored. Most reports on the cytologic features of granular cell tumors have been on lesions from the breast or respiratory tract. However, there are only a few reports on fine needle aspiration (FNA) cytologic diagnosis of cutaneous or soft tissue granular cell tumors. CASE: A 7-year-old girl presented with a skin lesion on her right forearm of one year's duration. The FNA smears showed sheets and clusters of oval to polygonal cells with an abundant amount of granular cytoplasm. Many single, scattered cells with similar morphology were seen in the background. Immunostaining for S-100 protein showed granular cytoplasmic positivity. The tumor was diagnosed as a benign granular cell tumor. The histopathology report on the excised lesion confirmed the FNA diagnosis. CONCLUSION: The cytopathologic features of granular cell tumors presenting as skin lesions are distinctive enough to allow a correct diagnosis on FNA cytology.     

Open or closed nuclear membrane? A question to help distinguish malignant lymphoma from carcinoma and sarcoma

OBJECTIVE: To describe a cytomorphologic criterion that may help improve diagnostic safety in morphologic differentiation of non-Hodgkin's lymphoma (NHL) from carcinoma or sarcoma and investigate the significance of this cytomorphologic phenomenon. STUDY DESIGN: Eighty-two smears of NHL, carcinoma and sarcoma smears were examined. Forty-five smears were from patients with carcinoma and 35 from patients with NHL. The remaining 2 smears were from patients with sarcoma. RESULTS: In 40 of 46 smears of carcinoma or sarcoma the nuclear membrane was assessed as "open" by the observer. In 6 smears the membrane was assessed as "closed. " In 30 of 35 smears with histologically confirmed NHL, the membrane was estimated as being closed. In the remaining 5 smears it was assessed as open. The sensitivity of evaluating the parameter as open or closed membrane was 87% and the specificity was 86%. The negative predictive value was 89%, and the positive predictive value was 83%. CONCLUSION: We suggest that the presence of an open or closed nuclear membrane may be helpful in differentiation of malignant lymphoma from carcinoma or sarcoma and may help improve diagnostic safety in daily practice.     

FNAC of malignant lymphoma in an area with a high incidence of T-cell lymphoma. Correlation of accuracy of cytologic diagnosis with histologic subtype and immunophenotype

OBJECTIVE: To analyze the usefulness of fine needle aspiration cytology on malignant lymphoma in an area with a high incidence of T-cell lymphoma and to correlate the accuracy of cytologic diagnosis with histologic subtype and immunophenotype. STUDY DESIGN: We retrospectively studied the usefulness of fine needle aspiration cytology in the diagnosis of 49 cases of nodal and extranodal non-Hodgkin's lymphoma (NHL) and seven cases of Hodgkin's disease in a total of 56 patients in whom subsequent excisional biopsy revealed lymphoid malignancy. Slides showing the results of cytologic investigation were reviewed together with the information on which histologic diagnosis was based. On the basis of pathologic variables, such as prognostic groups based on the Working Formulation, so-called grade, cell size based on the modified Rappaport classification, and--in cases of NHL--immunophenotype, the accuracy of original and reviewed cytologic diagnoses was compared. RESULTS: Of the 49 cases of NHL, 8 (16.3%) were inadequate for cytologic diagnosis, and malignant lymphoma was diagnosed or suspected in 36 (73.5%), excluding inadequate specimens; the diagnostic accuracy for NHL was 87.8%. In high grade cases, malignant lymphoma was more easily diagnosed or suspected than in those that were low or intermediate grade. The rate of inadequate cases was highest in the "mixed small and large cell" category, and cases that were "false negative" were either composed entirely of small cells or contained a small cell component. Cytologic diagnosis or suspicion of malignant lymphoma was easily obtained in the "large cell" category, followed by mixed small and large cell and "small cell." Aspirates from non-B-cell type were more frequently acellular than those of B-cell type; with regard to diagnostic accuracy, however, there was no noticeable difference between the two immunophenotypes. CONCLUSION: In many cases in the mixed small and large cell category or where the immunophenotype was non-B, the aspirate was inadequate, and no definitive diagnosis was possible. Many of our cases of T-cell lymphoma were mixed small and large cell, and in Korea, where the incidence of extranodal and T-cell lymphoma is high, the usefulness of FNAC for the initial diagnosis of malignant lymphoma is limited. For a definitive diagnosis, biopsy is required.     

Role of fine needle aspiration cytology in nodular sclerosis variant of Hodgkin's lymphoma

OBJECTIVE: To assess the efficacy of fine needle aspiration cytology (FNAC) in the diagnosis of nodular sclerosis variant of Hodgkin's lymphoma (NSHL) and to analyze cytologic features that could help in subtyping a case of Hodgkin's lymphoma into this variant. STUDY DESIGN: FNAC smears of 18 histopathologically proven cases of NSHL were analyzed for a variety of features. RESULTS: On initial cytologic assessment, 14 of 18 cases were diagnosed as Hodgkin's lymphoma. No further subtyping was performed. In this retrospective analysis it was possible to revise the diagnosis in the remaining 4 cases. Of the various cytologic features analyzed, presence of numerous lacunar-type cells along with fibroblasts and collagenous material were useful pointers toward a diagnosis of nodular sclerosis variant. Fibroblasts were seen in 83.33%, collagenous material in 27.77% and numerous lacunar cells in 77.77%. CONCLUSION: Subtyping of NSHL based on cytologic features alone has been a matter of debate for a long time. Of the various subtypes, nodular sclerosis poses the greatest diagnostic difficulty. Though certain cytologic features may help in suggesting a diagnosis of nodular sclerosis variant, the primary role of fine needle aspiration is to diagnose a case of Hodgkin's lymphoma as such and advise histopathologic examination for further categorization.     

Investigation and analysis of a human orf outbreak among people living on the same farm

Human orf is a viral zoonotic infection caused by Parapoxvirus. The skin lesions of human orf can be misdiagnosed as cutaneous anthrax leading to overtreatment and also fear. This study was conducted to analyze an outbreak which led to deaths among kids and lambs in the same flock, and skin lesions in some persons who were living on the same farm that were initially diagnosed as cutaneous anthrax by a practitioner. Eight patients with skin lesions and eleven persons who had no skin lesion were considered as patients and control groups, respectively. The cultures obtained from the lesions of all patients were negative for Bacillus anthracis. The diagnosis of skin lesions was done by clinical findings, histopathological examination and PCR as human orf. To be under 20 years of age, direct contact with the animals, and contact with flayed skin of sick animals were the risk factors for human orf (Odds Ratio 7.5; 95% Confidence Interval 1.02-54.54, OR 12.25; 95% CI:1.3-100.9, OR 16.67; 95% CI:1.65-148.20, respectively). Orf should be kept in mind in the differential diagnosis of skin lesions resembling anthrax. For control and prevention of orf, transmission routes should be known; good hand hygiene and other personal protective measures have to be implemented.     

Papillary breast lesions diagnosed on cytology. Profile of 65 cases

OBJECTIVE: To analyze the cytologic features of nipple discharge and fine needle aspiration (FNA) cytologic smears from breast lesions reported as showing papillary features and to correlate them with histopathologic features. STUDY DESIGN: The study group consisted of FNA smears and/or nipple discharge smears from 65 breast lesions diagnosed on cytology as duct papilloma, papillary lesion, fibrocystic condition, fibroadenoma, papillary neoplasm or papillary carcinoma. Cytomorphologic features assessed included cellularity, cell pattern (clusters, papillary, 3-dimensionality, etc.) and cell characteristics (monomorphism, pleomorphism, apocrine change, plasmacytoid features). Histological material was available for review and cytohistologic correlation in all cases. RESULTS: Forty-six specimens were FNA smears, and 16 were nipple discharge smears; in 3 cases FNA and nipple discharge cytologic smears were available for review. Cytologic study could predict the presence of a papillary pattern in all neoplasms with pure or focal papillary differentiation. There was an overlap in cytomorphologic features between papillary and nonpapillary benign lesions as well as between benign and malignant papillary neoplasms. Frank blood in the aspirate, cell dissociation and atypia, however, were more frequent in the last. CONCLUSION: Overlap of cytologic features in nonneoplastic and neoplastic benign papillary lesions and between benign and malignant papillary neoplasms necessitates histologic evaluation in all cases diagnosed as papillary on cytology. Since 49.2% of lesions showing papillary features on cytology prove to be malignant, all cases reported as papillary on cytology should be excised urgently for histologic assessment.     

Fine needle aspiration cytology of primary non-Hodgkin's lymphoma of the tongue. A case report.

BACKGROUND: Fine needle aspiration cytology (FNAC) of extranodal non-Hodgkin's lymphoma of the tongue has rarely been described. CASE: A 47-year-old male was referred to the cytology laboratory for FNAC of a 3-cm-diameter swelling on the dorsum of the tongue, with a primary clinical diagnosis of soft tissue tumor. FNAC smears showed discrete, monomorphic, round to oval cells with scanty, deep blue cytoplasm. The nuclear margin was regular, with occasional prominent nucleoli and fine nuclear chromatin. The background showed many lymphoglandular bodies. The cells were strongly positive for leukocyte common antigen. A cytologic diagnosis of high grade non-Hodgkin's (NHL) was offered and subsequently confirmed by histopathology. CONCLUSION: Primary NHL of the tongue is relatively rare. As there are no characteristic clinical features of extranodal NHL of the tongue, FNAC may be useful for rapid diagnosis and management of such cases.     

Computerized morphometric study on fine needle aspirates of cellular follicular lesions of the thyroid

OBJECTIVE: To investigate the value of computerized nuclear morphometry in the differential diagnosis of cellular follicular lesions of the thyroid cytologically diagnosed on fine needle aspiration (FNA) smears. STUDY DESIGN: Sixty cases of FNA thyroid smears were cytologically diagnosed and classified as follows: 30 cases of follicular carcinoma, 20 cases of cellular hyperplastic nodules and 10 cases of follicular adenoma. Using an image analysis system, two morphometric variables, nuclear area and major axis length of the nucleus, were measured for each case. RESULTS: For both nuclear morphometric variables, statistical differences were found between carcinomas and hyperplastic nodules as well as between carcinomas and adenomas. No statistical differences were found between the nuclear variables in either hyperplastic nodules or adenomas. CONCLUSION: The results confirm the aim of our study, to establish nuclear morphometry by computerized image analysis as an additional tool in the differential diagnosis of thyroid follicular lesions cytologically diagnosed on FNA smears.     

Cytology of leukemic lymphadenopathy

OBJECTIVE: To describe the cytomorphologic features of leukemic cells in lymph node aspiration material. STUDY DESIGN: We studied lymph node fine needle aspiration (FNA) smears of 36 leukemic patients. In 23 cases the lymphadenopathy was noticed simultaneously with marrow leukemia, and in the other 13 cases the lymphadenopathy was noticed during a relapse. Special stains, such as periodic acid Schiff, Sudan Black-B, Oil Red-O and nonspecific esterase, were used in special cases. RESULTS: Thirty-three cases were diagnosed as lymphoma, 1 as extramedullary hematopoiesis and 2 as leukemic involvement. CONCLUSION: Leukemic lymphadenopathy can be misdiagnosed as lymphoma on FNA smears. The clinical findings, previous history, hematologic studies and immunocytochemical studies are essential to the differentiation of leukemic smears from lymphoma. However, in some cases the leukemic infiltration can be diagnosed with certainty, provided that the smears show the characteristic findings, such as Auer rods and neoplastic promyelocytes with azurophilic granules.     

Pleural effusions in non-Hodgkin's lymphoma. A cytomorphologic, cytochemical and immunologic study

Review of the records of 243 cases of cytologically diagnosed non-Hodgkin's lymphomas (NHL) revealed pleural effusions in 21 (8.6%). Cytologic examination of pleural fluid was done in 17 cases, of which 16 were reported as positive. Cytologic examination was supplemented with cytochemical staining (acid phosphatase, alpha naphthyl acetate esterase and periodic-acid-Schiff reactions) and E-rosetting studies in 12 cases. Of the 16 positive cases, 11 were malignant lymphomas consisting of convoluted lymphocytes. Acute lymphatic leukemia of the prothymocytic type (T-ALL) and chronic lymphocytic leukemia of the T-cell type (T-CLL) comprised one case each, and there were three cases of follicular center cell lymphomas, two of the cleaved-cell type and one of the Burkitt-type. Comparison of the cytomorphology of the tumor cells in the pleural effusion with those in fine needle aspiration smears from the solid tumors in 14 cases showed an identical appearance in 13 cases; in one, the Burkitt-type lymphoma, the cells were larger and more pleomorphic in the pleural effusion. This study indicates that the cytologic diagnosis and categorization of NHL of the convoluted-cell type is greatly enhanced by the study of neoplastic lymphocytes in a pleural effusion.     

Smear morphology of cryptococcosis presenting as a subcutaneous swelling in healthy adults: a report of three cases

OBJECTIVE: To highlight the various morphological smear pattern in cases of subcutaneous Cryptococcus infection in healthy adults. METHOD: Cryptococcus is an opportunist fungus and primary infection is acquired through respiratory tract. Dissemination by blood stream results in systemic infection. Ten to 15% of systemic infection present as cutaneous lesions. Between December 2002 and April 2004 three healthy adults presented to us consecutively with subcutaneous swelling. RESULTS: We diagnosed these cases on FNAC as Cryptococcus. In all the three patients there was no history of local penetrating injury and any signs or symptoms of systemic disease. They were two male and one female, immuno competent and were negative for HIV 1 & 2 tested by ELISA. The sites were right abdominal flank, occipital and left anterior upper thigh. Aspirated materials were oily fibro fatty tissue and necrotic purulent materials. Cryptococcus numbers varied in all the smears so also their size and capsule thickness. Background smear morphology and tissue reaction were also different. It could be gelatinous, granulomatous, and cellulitic response or mixed responses and this can be picked up on cytological smears. Cultures were confirmatory in all the three cases. These lesions were resolved with antifungal treatment. CONCLUSION: Our brief article highlights the morphological spectrum on FNAC smears and diagnostic problems faced in these uncommon circumstances where the aspirates were purulent and the yeasts were small, few and thin walled. In the acute inflammatory smear with occasional giant cells and/or granulomas special stains like PAS or Mucicarmine are necessary to look for budding yeast of Cryptococcus with thin neck.