POSTER PRESENTATIONS

. 2021 Nov;38(Suppl 1):S27–S125.

POSTER PRESENTATIONS

PMCID: PMC8670425

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-001: FNAC OF BREAST LESIONS WITH SPECIAL REFERENCE TO YOKOHAMA SYSTEM OF REPORTING AND COMPARATIVE STUDY OF CYTOHISTOLOGICAL CORRELATION

Background: Recently the International Academy of Cytology (IAC) proposed a yokohama system of Reporting breast cytopathology. This study is based on the application, categorization of samples according to this classification and cytohistocorrelation wherever available. Cytological grading of FNAC smears was done according to Yokohama Reporting system which was later compared with histological diagnosis.

Material and Methods: The present study is a hospital based study on the routine Materials from the department of Pathology, Government Medical College, Jammu. A total of 174 Cases were prospectively studied over a period of one year from 1st November 2019 to 31st October 2020. All the FNAC received was Reported routinely according to the newly proposed Yokohama system of Reporting breast cytology. Histological samples of the corresponding breast FNAC were considered as the gold standard.

Results: The cytology of 173 Cases were analyzed and categorized into 5 categories from C1 to C5. There were 17 Cases in C1 category, 117 Cases in C2 category, 6 Cases in C3 category, 12 Cases in C4 category and 21 Cases in C5 category. 64 Cases had available histology and cytohistological concordance was seen in 93.75% of Cases.

Conclusion: IAC Yokohama System for Reporting Breast Cytopathology represents a simple system that allows greater diagnostic clarity and, consequently, better communication between pathologists and attending clinicians. IAC Reporting is also linked with management algorithm depending on availability of local medical resources and local practices.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-002: THE UNFOLDING OF A RECURRENCE OF HIGHER GRADE PHYLLODES TUMOUR OF THE BREAST: AN INTERESTING CASE REPORT

Aparna Dutta ¹

Background: Phyllodes tumour constitutes a relatively rare biphasic fibroepithelial neoplasm of breast with an incidence of 2.1 Per 1 million women constituting 1% of breast tumours;of these malignant phyllodes are just in the range of 8 to 20%. This is an instance of a recurrent phyllodes tumour which underwent higher grade malignant transformation within a span of only a year.

Case Report: A 45 year old female Reported to the surgery opd in october 2020 with a mildly tender large right breast lump. Immediate FNAC was carried out and revealed only benign ductal epithelial cells with an intense inflammatory infiltrate and an impression of mastitis was given with a note to repeat the FNAC after a course of antibiotics. The patient however underwent excision few days later,histopathology examination was done and a diagnosis of benign phyllodes was made. Eventually in august 2021 the lady Reported back to the opd with a even larger, bosselated lump in the previously operated right breast itself. This time FNAC slides showed high cellularity with dispersed fragments of highly malignant stromal cells with coarse chromatin in a Background of mitotic figures and rbc's ultimately leading to the diagnosis of a malignant phyllodes Conclusion: Local recurrences in phyllodes occur in around 21% of Cases;recurrences of a higher grade than original tumour constitute 31.5% Of these Cases. Margin clearance at the time of excison appears to be a significant factor in prediction of such recurrences.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-003: AN EVALUATION OF FNAC OF BREAST LESIONS WITH HISTOPATHOLOGICAL CORRELATION AMONG PATIENTS PRESENTING IN A TERTIARY CARE HOSPITAL WITH SPECIAL REFERENCE TO MODIFIED MASOODS SCORING INDEX.

Anindya Addhya ¹, Suchandra Ray ¹

Background: Cytological grading of breast lesion, which is a simple, cost-effective, and reproducible Method, can be used as a tool for the selection of treatment modality. The proposed Modified Masood's scoring index establishes one guideline for Reporting of breast cytology and thus helps in individualized treatment and follow-up. Aims & Objectives: The Aims and Objectives of this study were to (1) establish the validity and reliability of the Modified Masood's scoring index in breast lesions and (2) to calculate the malignancy risk.

Materials & Methods: This prospective & observational study was designed in clinically diagnosed breast lesions at the Department of Pathology of a tertiary care referral hospital. Fine-needle aspiration (FNA) was done, and stained smears were examined under light microscope and cytological findings were noted according to the Modified Masood's scoring index. Tissue for the histopathological study was obtained in 80 Cases. The previous cytological findings were compared to subsequent histopathology Report.

Results: Among 80 FNAs, 46% were Non proliferative breast disease and 7% were Proliferative breast disease without atypia. About 3% was grouped in the Proliferative breast disease with atypia, 44% of Cases were categorized as Carcinoma in situ/ Invasive carcinoma.

Conclusion: The four-tier diagnostic categories of the Modified Masood Scoring System help in segregating patients with breast lesions into the management categories of follow-up, conservative surgery, and radical surgery with/without chemotherapy.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-004: EVALUATION OF BREAST LUMPS USING FINE NEEDLE ASPIRATION CYTOLOGY, CORE NEEDLE BIOPSY AND EXCISIONAL BIOPSY

Monika Pangotra ¹, Surinder K Atri ¹, Rashmi Aithmia ¹

Background: Breast diseases are common affliction of the females. Excisional biopsy was the accepted practice in the past, but current practices utilise radiological imaging in combination with FNAC and CNB, thereby reducing the need for unnecessary surgical excision of benign breast lesions. Therefore this study was undertaken with an intent to evaluate the diagnostic accuracy of CNB and FNAC in the diagnosis of breast lumps.

Methods: The present study was a hospital based study on the routine Materials from the department of Pathology, GMC Jammu. Subjects were prospectively studied over a period of one year. All the FNAC's done and, all Core needle biopsy and their corresponding excisional biopsies received were included in the study and then categorised accordingly.

Results: Out of 306 Cases studied, 264 (86.2%) were females and 42 (13.7%) were males. Maximum number of Cases in females were seen in the age group of 21-30 years and left breast was most commonly involved with 143 Cases. Upper outer quadrant was the most common quadrant involved in females with 74 Cases (28.03%). Our study Reported a kappa score of 69 % (43.6-94.3) indicating a moderate degree of concordance between the two tests i.e. FNAC and CNB.

Conclusion: The findings of our study suggest that FNAC has higher rate of detection of breast lesions, however CNB is able to give definite histology of the lesion which correlated very well with the final histology obtained on excision specimen.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-005: USE OF FINE NEEDLE ASPIRATION IN THE EVALUATION OF PALPABLE BREAST LUMPS

Monika Pangotra ¹, Surinder K Atri ¹, Rashmi Aithmia ¹

Background: Breast carcinoma is the most common malignant tumour and the leading cause of death from cancer in women. FNAC of breast lumps is an important mode of investigation and forms a part of triple test. It is difficult to determine whether a lump is benign or malignant from clinical assessment. FNAC is performed as a pre-operative test to evaluate breast lump. FNAC is cost effective and can prevent unnecessary surgery. This study intended to look the frequencies of different lesions in FNAC of palpable breast lump.

Methods: It is a hospital based prospective study conducted from November 2016 to October 2017 conducted in Department of Pathology, GMC Jammu. FNAC was done in a total of 289 patients who presented with palpable breast lump. We assessed the age of the patient, lesion size, site, type of lesion and axillary lymph node metastasis in Case of malignancies.

Results: Age ranges from 7-88 years with a mean age of 36 years. Most of the patients were in 21-30 years age group (30.6%). Among the lesions 58 Cases (20.06%) fibroadenoma, 30 Cases (10.4%) gynaecomastia, 24 Cases (8.3%) fibroadenomatosis, 19 Cases (6.5%) fibrocystic changes, 13 Cases (4.5%) abscess, 5 Cases (1.7%) granulomatous lesion, 4 Cases (1.3%) chronic mastitis, 29 Cases (10.06%) carcinoma were identified.

Conclusion-FNAC is more suitable in the developing countries, for palpable lesions due to better turnaround time and it is cost effective. Diagnosing a benign entity puts an end to an anticipated surgery in a patient

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-006: RELEVANCE AND IMPACT OF THE INTERNATIONAL ACADEMY OF CYTOLOGY (IAC) YOKOHAMA SYSTEM FOR REPORTING OF BREAST FINE-NEEDLE ASPIRATION CYTOLOGY- AN INSTITUTIONAL EXPERIENCE

Rajashree Khound ¹, Geet Bhuyan ¹

Background: Fine-needle Aspiration Cytology is a simple and effective tool which can be used for giving a presumptive diagnosis thus saving the patient many a times, from undergoing unnecessary operative procedures. It is important to have a standardized system for Reporting breast cytology and the IAC Yokohama System has been recently developed to improve the system of Reporting breast cytology.

Methods: A retrospective study was done in the Department of Pathology, Jorhat Medical College within the three year period from 2019 to 2021. The lesions were categorized as per the IAC Yokohama System followed by correlation of all the available Cases with histopathological findings.

Results: A total of 304 Cases with breast lesions were included, of which 20(6.58%) of the Cases were categorized as inadequate, 180(59.2%) as benign, 42(13.8%) as atypical, 14(4.6%) as suspicious for malignancy and 48(15.8%) as malignant.

Conclusion: Classifying the breast FNAC Cases according to the IAC Yokohama System has provided a systematic way of diagnosing breast cytology. This system emphasizes the need for proper smear making techniques and follow up biopsy thus enhancing the accuracy of the Cases and providing advanced care to the patient.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-007: CYTOHISTOPATHOLOGICAL CORRELATION OF BREAST LESIONS WITH EMPHASIS ON DIAGNOSTIC ACCURACY OF FNAC

G Dyuthi ¹, K Durga ¹, G Bhavana ¹

Background: Palpable breast lump is the most common presenting complaint which poses a diagnostic dilemma to physicians. Fine Needle Aspiration Cytology (FNAC) is one of the first line investigation in diagnosis of palpable breast lesions in resource limited settings and forms a part of triple assessment which includes FNAC, mammography and clinical examination. Histopathological examination is the gold standard for confirmatory diagnosis. The main aim of this study is to categorize breast lesions and correlate cytological findings with histopathological findings thereby evaluating the diagnostic accuracy of FNAC.

Methods : A prospective study was done on 89 patients presenting with breast lump over a period of two years from July 2019 – July 2021 in our department. All aspirations and histopathology slides were stained with H&E. Cytological diagnosis was categorized as inadequate, inflammatory, benign, atypical hyperplasia probably benign, suspicious of malignancy, malignancy and compared with histopathological diagnosis for correlation. Statistical analysis was done.

Results: Out of 89 aspirations, cytohistopathological correlation was obtained in 32 Cases. The sensitivity, specificity, positive predictive value, negative predictive value of FNAC in breast lesions were Reported to be 76.92%, 100%, 100%, 86.36% respectively.

Conclusion: FNAC is a safe, simple and cost effective outpatient procedure with negligible complications. A negative FNAC of breast lesion does not preclude the diagnosis of malignancy, particularly in presence of a clinical suspicion of malignancy and/ or an abnormal mammogram. Histopathological correlation increases the diagnostic accuracy and helps the clinicians for early diagnosis and specific management.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-008: EVALUATION OF EXPANDED MASOOD'S CYTOLOGIC INDEX IN THE CYTOLOGICAL DIAGNOSIS OF BREAST CARCINOMA

R Ratna ¹, Md Khadar Faheem ¹, G Sai Chandana ¹, C Sujatha ¹, BV Sai Prasad ¹, A Venkatalakshmi ¹

Background: Breast cancer is the second most common cancer in the world. FNAC is the most cost-effective, easy, and quick technique for evaluating a lump in the breast. The main aim of the study is to evaluate the Expanded Masood's Cytologic Index of breast carcinoma which helps in targeting the neoadjuvant therapy to appropriate patients.

Methods: The present study is a retrospective study of 2years duration (Aug 19 – Sep 21). A total of 40Cases diagnosed with breast carcinoma on FNAC were included in this study. Data were retrieved and graded according to the Expanded Masood's Cytologic Index.

Results: The incidence of carcinoma was observed between 30 to 70 years of age with a peak in the 4th decade, followed by the 5th decade. By applying the Expanded Masood's Cytologic Index, which includes the evaluation of 6 features each with a score of 1-4 and with a final score ranging from 19-24, FNAC smears of breast carcinoma were classified into 3 grades. The distribution of Cases is as follows: Grade I – 17(42.5%), Grade II – 20(50%), Grade III – 3 (7.5%).

Conclusion: A simple FNAC-based Expanded Masood's Cytologic Index is a reliable and reproducible grading system of breast lesions. It is a useful tool in assisting the cytologist to efficiently grade malignant lesions, prognostification, and prediction of the behaviour of breast carcinoma. Thus, this newly proposed grading system helps clinicians in the formulation of treatment strategies.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-009: BREAST LYMPHOMA: A DIAGNOSTIC CHALLENGE

Damandeep Kaur ¹, Urmi Mukherjee ¹

We Report a Case of Non-Hodgkin Lymphoma, Bilateral Breasts in a 59 year old female. Breast Lymphomas are very rare and comprise less than 1% of malignant breast neoplasms. is an uncommon disease.[1] These constitute only 0.04-0.5% of breast malignancies.[2] Correct Diagnosis hold a important significance as most of the patients do not require surgery for treatment.[3]Misdiagnosis as carcinoma can lead to inappropriate surgeries as well as inappropriate systemic therapy. Here we Report a Case of a Diffuse large B-cell lymphoma, Germ cell type, Bilateral Breast in a 59 year-old female patient

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-010: FIBROADENOMA IN ECTOPIC BREAST TISSUE (AXILLA)

Bhargav Mohan ¹, Aseema Das ¹, Bandita Das ¹

Case Report: Fibroadenoma in Ectopic Breast Tissue (Axilla) Background: Ectopic Breast tissue can occur anywhere along the milk lines from axilla to groin due to persistence of embryonic milk line. Incidence of 0.4 to 6% ectopic breast tissue has been Reported among the female population. We have encountered 2 Cases of Fibroadenoma in ectopic breast tissue in axillary region.

Case Report: A 22 years old female with already diagnosed fibroadenona both breast presented with bilateral axillary swelling referred for Fine Needle Aspiration Cytology with a provisional diagnosis of axillary lymphadenopathy. On local examination swelling of 3x2.5 and 2.5 x2.5 with well defined margins with firm consistency and regular noted on right and left axillary region respectively. Second Case was 36 years old female presented with right axillary swelling of size 2x2 cm, mobile with firm consistency and regular border. After taking consent of both the Cases, FNAC was performed which revealed moderate cellularity with cohesive clusters comprising of both epithelial and myoepithelial cells with few bare bipolar nuclei in a fibromyxoid Background. No lymphoglandular bodies noted. A provisional diagnosis was given as Fibroadenoma in Ectopic Breast tissue in axilla for both the Cases.

Discussions: FNAC is a quick, cost effective procedure tolerated well by most patients. It is reliable to differentiate benign from malignant lesions, giving earlier diagnosis to plan for definitive management. While dealing with swellings in the axilla, a differential of an Ectopic Breast Tissue should always be borne in mind because though rare(6%), it requires prompt diagnosis for further management.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-011: EVALUATION OF UTILITY OF THE IAC YOKOHAMA SYSTEM FOR REPORTING BREAST FINE ASPIRATION CYTOLOGY.

Akankshya S Kashyap ¹, Aseema Das ¹, Bandita Das ¹

Introduction: The new International Academy of Cytology (IAC) Yokohama System for Reporting Breast FNABC, supported by IAC and developed by an International “Breast Group”, was proposed to establish a comprehensive structured approach for performance and Reporting of breast cytology.

Aim: To categorise the breast FNAB samples according to this new system of Reporting and to assess various statistical parameters including Risk of Malignancy.

Materials and Method: Breast FNAB specimens obtained in the Cytology section of the Department of Pathology, AMCH were Reported using the newly proposed IAC Yokohama System. The statistical parameters of Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) as well as Risk of Malignancy (ROM) were calculated using SPSS software. Histopathology was taken as the Gold Standard.

Results and Observation: The distribution of total 178 Cases as per category were Inadequate material 12.76%, Benign 59.67% Atypical 4.94%, Suspicious for Malignancy 4.53% and Malignant 18.1%. When only malignant Cases were considered positive, the Sensitivity was 92.86%, Specificity 98.98%, PPV 97.50%, NPV 97% and Diagnostic Accuracy 97.14. The ROM for Category 1, 2, 3, 4, 5 were 25%, 3%, 27.27%, 90.9% and 97.5% respectively.

Conclusion: This study shows that utilisation of the categories of the Yokohama System for Reporting breast cytopathology is well placed. This classification represents a simple system which allows diagnostic clarity as well as better communication between pathologists and clinicians and ultimately benefit the patients in a major way.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-012: THE IAC YOKOHAMA SYSTEM FOR BREAST CYTOPATHOLOGY WITH ROLE OF ROSE, FNA & CELL BLOCK

Tummidi Santosh ¹, Josephain K ¹, Michael L Anthony ¹, Arundhathi S ¹, Prudhvinath Reddy A ¹

Background: Breast malignancies are one of the emerging leading causes of cancer in India. FNAC using the International academy of cytology (IAC) Yokohama system for breast cytopathology can help treating clinician for further management plan. Implementation of Rapid On-Site Evaluation (ROSE) in cytological analysis can help reducing the inadequacy rate and obtain proper sample for ancillary tests/analysis. Cell block can act as an adjunct to conventional cytopathology services.

Methods: FNAC was done using 23-25gz needles and 10ml syringe. 1% aq. toluidine blue was used for ROSE staining. The slides were air dried and wet fixed for Giemsa and PAP staining respectively. Cell block was prepared suing the cell button technique where ever needed based on ROSE findings. Correlation among ROSE, FNAC and Cell block was done. Histopathological follow up was taken where available.

Result: We analysed 77 Cases of breast lumps under USG guidance and non-guided. The mean age of presentation was 43 years. USG guidance was done in 22% Cases. USG BIRAD staging was available in 97.4% Cases and cell block in 34% Cases. The IAC categories included C1-1.2%, C2-66.2%, C3-8%, C4-5.1%, C5-18.2%. We had 86% correlation between cell block and final histopathological diagnosis. The sensitivity and specificity for the samples was 95% and 100% respectively.

Conclusion: FNAC, ROSE, IAC and Cell block can be considered as the four pillars for Breast cytopathology. When implemented with proper technique under USG guidance they can replace core needle biopsy. Samples can also be further worked up for IHC from the cell block.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-013: MORPHOMETRY IN THE CYTOLOGICAL EVALUATION OF BREAST LESIONS AND ITS DIAGNOSTIC SIGNIFICANCE

Beenish Bano ¹, Sujata Jetley ¹, Shaan Ketrapal ¹, Zeeba S Jairaipuri ¹, Ajay Thakral ¹

Breast is common site for pathological lesions. Fine needle aspiration cytology (FNAC), is initial assessment of patients presenting with palpable breast lumps. It is inexpensive, safe procedure, plays important role in early diagnosis of breast masses. The accuracy rate is Reportedly between 95.8% to 97.87%. The “gray zone” in cytology is estimated to be 8.9% of the Cases. Cytology has its own disadvantages such as inter and intra-observer variability. Nuclear morphometry has helped to decrease the subjective variations and regarded as objective tool to supplement differentiation of benign from malignant lesions in critical Cases. Nuclear structural alterations are the morphologic hallmarks of cancer diagnosis and nuclear morphometry with help of image analysis plays an important role in providing a rapid and reproducible analysis.

Methods: Cytological grading in which cell dissociation, size, uniformity, presence/absence of nucleoli, nuclear margins & nuclear chromatin was assessed and graded into Grade I, II & III. Smears were subjected to computer based cytomorphometry for evaluation of nuclear and cytoplasmic parameters. The values obtained were assessed and correlated with histopathological findings.

Result: Cytomorphometric parameters had significant discriminatory power to predict malignancy and among all the parameters it was the nuclear / cytoplasmic ratio that showed the best discriminatory power to predict malignancy. Significant association was found between the cytomorphometric parameters and histopathological diagnosis.

Conclusion: Cytological examination of FNAC smears on morphology carries a certain degree of interobserver variability and hence supplementing with an objective Methodology like cytomorphometry is a useful adjunct.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-014: A NOVEL AND DISTINCT APPROACH FOR BREAST CYTOLOGY-THE INTERNATIONAL ACADEMY OF CYTOLOGY YOKAHAMA REPORTING SYSTEM

Prajna KS ¹, Ruhisalma Naagar ¹, Server Fathima ¹, Narayana Murthy C ¹, Muktha R Pai ¹

Introduction: With the worldwide increased incidence of breast cancers, fine needle aspiration cytology (FNAC) which is a part of triple testing, plays a vital role in detection of breast malignancy in a suspicious breast lesion.

Aim: 1)To recategorize the Breast FNAC Cases as per the newly proposed IAC Yokohama Reporting system of breast cytology.2)To assess the diagnostic accuracy, sensitivity and specificity of breast FNA and calculate the risk of malignancy (ROM) for each category.

Materials and Methods: This retrospective study included 166 breast FNAC Cases obtained during January 2019- December 2020 in a tertiary care hospital,which were reclassified according to the newly proposed IAC Yokohama Reporting system. Histopathological correlation was done in 113 Cases and ROM for each category was determined. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were evaluated keeping histopathology as the gold standard. IHC was done in malignant Cases.

Results: 166 breast FNAC Cases were reclassified as insufficient material 8.43%, benign 51.81%, atypical 11.45%, suspicious for malignancy 3.61%, and malignant 24.70%. Histopathological correlation was obtained in 113Cases. The respective ROM for each category was 33.33%% for category 1 (insufficient material), 6.56% for category 2 (benign), 31.25% for category 3 (atypical), 100% for category 4 (suspicious for malignancy) and 83.33% for category 5 (malignant). The sensitivity, specificity, PPV, NPV and diagnostic accuracy were 65.79%, 93.33%, 83.33%, 84.34% and 91.84% respectively when malignant Cases were considered as positive tests.

Conclusion: The IAC Yokohama system of Reporting breast cytology provides diagnostic clarity and guides in the appropriate patient management.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-015: UTILITY OF NUCLEAR MORPHOMETRY IN CYTOLOGICAL DIAGNOSIS OF BREAST LESIONS

Swaroop Raj B V ¹, Hemalatha A ¹, P N Sreeramulu ¹

Background: Fine needle cytology is routinely used for diagnosis of breast carcinoma patients. However cytology has its own limitations being subjectivity in interpretation and sampling bias. To overcome this, several cytology grading systems have been proposed with the International Academy of Cytology (IAC) grading being the latest and currently followed grading system. Even this grading system has its own limitations with code 3 and 4 still not providing clear information if the lesion is benign or malignant. Hence nuclear morphometry was used to supplement routine cytology to verify if the objective measurements provided will aid in reducing the code 3 and 4 diagnosis on cytology and aid the clinician in better management of breast carcinoma.

Objectives : To evaluate the role of morphometry with cytology in differentiating between benign and malignant lesions of the breast.

Methods: All Cases with both cytology and histopathology sections between January 2015 to December 2017 received at Department of Pathology were included in the study

Results: A total of Cases 106 Cases were included in the study. The mean age of the patients waith benign breast lesions was 38 years and Malignant lesions was 54 years. The morphometry parameters such as nuclear area, perimeter and area showed significantly greater values in malignant lesions than benign lesions. However parameters such nuclear intensity and nuclear cytoplasmic ratio did not show a significant finding between benign and malignant lesions

Conclusion: Nuclear morphometry is an useful supplement to cytology in differentiating benign from malignant lesions of breast.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-016: APPLICATION OF YOKOHAMA SYSTEM FOR REPORTING BREAST FINE NEEDLE ASPIRATION CYTOLOGY- AN INSTITUTIONAL EXPERIENCE.

Ankita Verma ¹, Gunjan Nain ¹, Meeta Singh ¹, Shyam Lata Jain ¹, Shramana Mandal ¹, Nidhi Verma ¹, C B Singh ¹

Background: Yokohama System was proposed in 2019 to improve the reproducibility and comparability of breast cytology by various cytopathologist.

Materials and Methods: A retroprospective study was done in last two years. It included the Cases in which both cytological and histopathological Results were available. A total of 200 Cases were included and histopathological analysis was done and correlated by two pathologists.

Results: A total of 200 breast Cases were studied on both cytology & histopathology and risk of malignancy(ROM) was calculated for each category as (1)Insufficient material: 5.7%; (2)Benign:1.6%; (3)Atypical:25%; (4)Suspicious:30.7%; (5)Malignant:100%.

Conclusions: Present study highlights the applicability of Yokohama System and also calculates the ROM in every category.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-017: TOUCH IMPRINT CYTOLOGY AS A CHEAP AND EFFICIENT METHOD FOR EVALUATION OF INTRAOPERATIVE SENTINEL LYMPH NODE IN CARCINOMA BREAST.

Priya Yadav ¹, Sufian Zaheer ¹, Chintamani ¹, Sunil Ranga ¹

Objectives: Breast cancer is the most common malignancy among females in the world, with 2.1 million new Cases in 2018. Effective treatment options include surgery, local radiation and systemic chemotherapy. Due to its radical nature, surgery has now been reduced to a minimum by the use of breast conserving procedures and axillary lymph node dissection. Sentinel lymph node biopsy is used to detect the spread of invasive tumor cells from the primary tumor to regional lymph nodes. Intraoperative evaluation of sentinel lymph node status is desirable because patients with positive status can undergo a complete lymph node dissection in the same setting, reducing the need for another operation at a later date

Methods: A sample of 30 patients were taken intraoperatively and touch imprint cytology was performed on SLN and were compared to the histopathological examination Results of the same later.

Results: The sensitivity, specificity and overall accuracy of touch imprint cytology of SLN were found to be 87.5%, 100% and 90% respectively.

Conclusion: Diverse Methods have been used to determine sentinel lymph node status intraoperatively for example frozen section histology, touch imprint cytology, immunohistochemistry and infrared spectroscopy. Imprint cytology is a major breakthrough in the field of rapid diagnosis. Besides the speed and enormous simplicity, it provides excellent cellular details. No special equipment is required and no tissue loss occurs. There is diagnostic difficulty

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-018: SPECTRUM OF BREAST LESIONS--IAC YOKOHAMA SYSTEM

Madhulatha Guntimadugu ¹, Syam Sundar ¹, Pratima ¹

Background: Breast cytology is very useful as it is a component of 'Triple approach' for pre-operative diagnosis of breast lumps. International academy of cytology Yokohama system Aims to establish a standardized approach to breast FNAB cytology Reporting and outlines good practice guidelines covering breast FNAB procedure, indications for FNAB, details of the technique, smear preparation, handling of material, standardized Reporting of FNAB,

Method: All FNAs of breast lesions over a period of 2 years are included in the study. The Cases are grouped according to IAC Yokohama system: Category I (insufficient material), Category II(benign), Category III(atypical, probably benign), Category IV(suspicious, probably insitu or invasive), Category V (MALIGNANT)

Results: Out of 89 breast lesions Reported on FNAC, the category wise is- category I,II,III,IV,V accounting for 01(1.12), 58(65.16), 04(4.49), 02(2.247), 24(26.96) respectively.

Conclusion: FNAC is simple, reliable cost effective first line diagnostic in breast lump Cases. The IAC Yokohama system increases the usefulness of FNAC to clinicians.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-019: DIAGNOSTIC ACCURACY OF FINE NEEDLE ASPIRATION BIOPSY CYTOLOGY IN THE DIAGNOSIS OF BREAST LESIONS AND RECLASSIFICATION AS PER INTERNATIONAL ACADEMY OF CYTOLOGY YOKOHAMA SYSTEM.

Fatma Lubna ¹, Ruquiya Afrose ¹, Sayeedul Hasan Arif ¹, Kafil Akhtar ¹, Aprajita ¹

Background: Fine needle aspiration biopsy cytology (FNAB) is a minimally invasive, cheap and rapid technique which helps in the early diagnosis of breast lumps and also in planning treatment. It also helps in the categorization of a breast lump into benign or malignant.

Methods: It was a retrospective study of all patients who underwent breast fine needle aspiration biopsy cytology conducted in Pathology department, Jawaharlal Nehru Medical College, AMU from January 2020 to June 2021 and were reclassified according to the IAC Yokohama system. The sampling was done in cytology lab. FNAB of breast lumps were done by standard procedure: smears were prepared and stained with H & E, Giemsa and pap for evaluation.

Results: We performed breast FNAB in 100 Cases. Mean age was 45.6 years. There were 4 (4%) male breast cancer patients. 98 (98%) patients had palpable lump with a mean tumor size of 5 cm. The samples were distributed as follows: Insufficient 3%, benign 34%, atypical 3%, suspicious for malignancy 9% and malignant 51%. While calculating statistical values, only malignant Cases were considered positive tests. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 98.04%, 97.96%, 98.04%, 97.96% and 98.01% respectively.

Conclusions: Classification of the breast fine needle aspiration biopsy cytology according to the newly proposed IAC Yokohama system of Reporting helps pathologists in attaining diagnostic clarity and leads to the appropriate patient management by the clinicians. It can serve as a bridge between the pathologists and clinicians in effective categorization of the breast lesions.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-020: PROSPECTIVE EVALUATION OF ACCURACY OF FINE NEEDLE ASPIRATION FOR BREAST LESIONS USING THE INTERNATIONAL ACADEMY OF CYTOLOGY YOKOHAMA SYSTEM FOR REPORTING BREAST CYTOPATHOLOGY

Deepshikha Verma ¹, Sharda Balani ¹, Reeni Malik ¹

Background- Classification of breast lesions into different cytological groups can accurately be done using the International Academy of Cytology (IAC) Yokohama System for Reporting breast cytopathology. Fine needle aspiration of breast lesions has been considered to be primary investigation in detecting breast cancers, especially in low-cost settings. The main objective of this study was to prospectively re-confirm the diagnostic accuracy of breast FNA using the IAC Yokohama system. Additionally, histopathology was done to confirm the accuracy of breast FNA.

Material and Methods- A prospective study was done in a tertiary care centre in central India on patients undergoing core-needle /incisional/excisional biopsy of breast lesions between 1st January 2021 to 30th September,2021. Total 91 breast FNA was Reported using IAC Yokohama system and the most suitable category was allotted in every Case.

Results- Of total 91 patients, new International Academy of Cytology (IAC) Yokohama system for Reporting breast fine-needle aspiration biopsy (FNAB) cytology, which classifies cytologic diagnoses into 5 categories were assigned: C1- insufficient material (5.5%), C2- benign (63.8%), C3- atypical (4.4%), C4- suspicious of malignancy (8.7%), and C5- malignant (17.6%). FNACs were correlated with ancillary tests and histopathological diagnosis to assess the diagnostic accuracy. The complete sensitivity was 92%, specificity 98.6%, positive predictive value 99%, negative predictive value 97.6% and accuracy was 98.04%

Conclusion- The high sensitivity and specificity for each scenario for all tumours and for each examined BIRADS category suggest excellent accuracy for Breast FNA using the IAC Yokohama system.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-021: MORPHOLOGICAL SPECTRUM OF PALPABLE BREAST LESIONS ON FINE NEEDLE ASPIRATION CYTOLOGY AND GRADING OF MALIGNANT LESIONS ACCORDING TO ROBINSON'S GRADING

Nidhi Soni ¹, Mayank Dosi ¹

Background: FNA is cheaper, less invasive procedure, can sample different areas of the lesion in the same sitting and usually fetch good Results the same day. Cytologic categories for Reporting of breast FNB are: Unsatisfactory, benign, atypical, suspicious for malignancy, malignant. Neoadjuvant therapy is now being applied as one of the treatment modalities of breast carcinoma and therefore grading of breast carcinoma is needed for the management. Robinson's grading is used six different cytological parameters to grade the breast carcinoma.

Method: A prospective study in pathology department, Jhalawar medical college, Jhalawar from January 2020 to June 2020. Air dried and wet fixed smears used to stain the slides for Romanowsky group of stain (field) and Papanicolaou stain respectively.

Result: The distribution of various categories from 102 breast lumps was as follows: benign 75 (73.53%), atypical 3 (2.94%), suspicious for malignancy 1 (0.98%), malignant 23 (22.55%), Unsatisfactory 0 (0%). Out of 23 malignant lesions 5 were metastasized to axillary lymph nodes at the time of diagnosis. All malignant lesions were cytologically graded according to Robinson's grading, 4(17.39%) lesions were grade I, 14 (60.87%) were grade II and 5 (21.74%) were grade III.

Conclusion: Breast lump is a common clinical presentation, that can be early diagnosed by FNA. It provides many differential diagnosis including malignancy. Early diagnosis can significantly reduce the morbidity and mortality associated with malignancy. The acceptance of FNA Report reliability both by surgeons and pathologists allows for radical surgery and neoadjuvant therapy on the basis of an FNA diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-022: DETERMINE CYTOLOGICAL, HISTOPATHOLOGICAL AND RADIOLOGICAL CORRELATION OF FEMALE BREAST'S LESIONS IN A TERTIARY CARE CENTER: A RETROSPECTIVE STUDY

Premangshu Ghosh ¹, Ojas Gupta ¹, Neeraj Dhameja ¹, Ashish Verma ¹, Seema Khanna ¹

Background- Breast cancer is one of major cause of cancer related morbidity and mortality globally and also in India. Breast being a readily accessible organ externally is usually subjected to easy identification of lesion by self-examination. Histopathological, cytological and radiological examination aid in arriving proper and detailed diagnosis. The evaluation of association of these findings may herald a new spectrum in breast pathology.

Method- Retrospectively (2018-2021) findings of fine-needle aspiration cytology (FNAC), Histopathology and radiological findings of 10 breast lesions were analyzed.

Result- On FNAC sample examination - 3 patients were Reported as atypical proliferative breast disease. Infiltrating breast carcinoma was diagnosed in 5 Cases and 2 Cases revealed benign breast disease. On histopathological examination (HPE) 2 Cases were diagnosed as DCIS (Ductal carcinoma in-situ), 5 Cases were Reported as Invasive breast cancer, Not otherwise specified (NOS), and rest 3 were Reported as suspicious for malignancy (core needle biopsies), no tumor in post-neoadjuvant therapy specimen and invasive lobular carcinoma, in one Case each respectively. On ultrasonography (USG) of these breast's lesion, score of 4, 5 and 6 were Reported in 4, 4, and 1 Case respectively using Breast imaging Reporting and data system (BIRADS).

Conclusion-Malignant lesions on HPE and FNAC are associated with higher BIRADS score. Our study revealed higher combined accuracy, sensitivity and specificity of HPE, FNAC and USG findings. These are useful tool in terms of cost effectiveness, simplicity and rapidity in categorizing into benign and malignant.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-023: FNAC OF BREAST LESIONS WITH REFERENCE TO INTERNATIONAL ACADEMY OF CYTOLOGY (IAC) REPORTING SYSTEM

Bhavneet Kour ¹, Anu Gupta ¹, Subhash Bhardwaj ¹

Background: International Academy of Cytology (IAC) has established a standardized approach for Reporting Breast FNAC by categorizing the lesions in five tier system (C1 to C5) for diagnostic clarity, ultimately facilitating clinician's understanding and use of FNAB cytology in Breast pathology.

Material and Methods: This is a retrospective study done in the cytology section of the Department of Pathology GMC Jammu.

Results: A total 130 Cases of Breast FNAC's were included in the study with the maximum 111 (85.4%) females and 19 (14.6%) males. Maximum number of Cases were seen in the age group of 31-40 years. CI (Insufficient/ Inadequate) lesions were found in 5 Cases(3.84%), C2 (Benign) in 92 Cases(70.76%), C3 (Atypical) in 8 Cases(6.15%), C4 (Suspicious) in 6 Cases(4.60%) and C5 (Malignant) in 21 Cases(16.15%). Fibroadenoma was the commonest benign lesion found in our study in 44 Cases out of 92 and Ductal Carcinoma was commonest among malignant lesions.

Conclusion: FNAC is an essential component in the preoperative management of breast lesions and the IAC Yokohama system for Reporting Breast FNAB cytology effectively stratifies breast lesions thus providing guidance to both cytopathologists and clinicians leading to better patient care.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-024: AXILLARY LYMPH NODE INVOLVEMENT IN INVASIVE DUCTAL CARCINOMA OF BREAST: CYTOLOGICAL CORRELATION

Anam Imam ¹, Md Wakeel Ahmad ¹, Kumari Seema ¹, Aakash Singh ¹

Introduction: Fine needle aspiration cytology (FNAC) plays an important role in the diagnosis of breast carcinoma. However, its role as aprognostic tool needs to be explored. This can be achieved by studying its correlation with an established prognostic marker suchas axillary nodal metastasis.

Objectives: 1) Age distribution of invasive breast carcinoma as a whole. 2) Grading based on cytological features.

Results: A statistically significant correlation was noted between cytologic grade of tumor and axillary lymph node metastasis. Total 100specimen were taken. most common age group affected was in between 31-40 (24%) followed by 61-70 (21%). For cytological scoring, out of 46 grade 1 Cases, 60.86 were axillary lymph node positive, 32 Cases of grade 2, 62.5% were positive,and grade 3 constitute 22 Cases out of which 59.09% were axillary lymph node positive.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-025: BENIGN BREAST CYST IN A YOUNG MALE DIAGNOSED ON CYTOPATHOLOGY - REPORT OF A RARE CASE

Arushi Gupta ¹, Sabina Khan ¹, Rubeena Mohroo ¹, Shivali Sehgal ¹, Sujata Jetley ¹

Background: Fine Needle Aspiration Cytology (FNAC) is a well-established and widely accepted procedure in the evaluation of breast masses. Male breast lesions are however uncommon, especially on cytology. Here, we Report a rare Case of benign breast cyst diagnosed on FNAC in a 26 year old male without associated gynaecomastia which subsided following aspiration.

Case Report: A 26 year old male presented to Surgery OPD with left breast swelling since 3 months. He had no history of pain, nipple discharge or fever. Patient however was on Anti tubercular treatment for pulmonary tuberculosis. On physical examination, a small diffuse 5-6 mm lump was palpable in left breast. Ultrasound revealed a soft small tissue lesion in superior aspect of left areola with suspicious flow on color flow doppler following which FNAC was advised. Aspiration yielded scanty fluid. On microscopy, smears showed low cellularity comprising of few monolayered sheets and small aggregates of benign ductal epithelial cells admixed with fair number of cystic macrophages in a fluid Background. There was no evidence of malignancy. Thus, cytologic diagnosis of benign breast cyst was rendered.

Conclusion: To the best of our knowledge, this is the first Case Report describing cytology of a benign breast cyst diagnosed in a male as young as 26 year old without associated gynaecomastia. We Report this Case because of rarity of this condition and to create awareness that breast cyst should also be kept in mind when dealing with male breast masses thus avoiding unnecessary surgery especially in a young male.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-026: TO FIND OUT UTILITY OF GRADING BREAST CARCINOMA ON FINE NEEDLE ASPIRATION (FNA) AS PER THE CRITERIA PROPOSED BY ROBINSON AND MOURIQUAND GRADING WITH NOTTINGHAM MODIFICATION OF BLOOM-RICHARDSON HISTOLOGICAL GRADING SYSTEM

Aastha Gupta ¹, Hema Pant ¹, Ankita Yadav ¹, SRMS IMS ¹

Background: Carcinoma of the breast is one of the most frequently occuring malignancy in women. Fine needle aspiration (FNA) cytology is increasingly being used to determine various prognostic parameters in patients with breast carcinoma. Cytological grading should be part of all FNA Reports of breast carcinoma so that preoperative prognostication could be done. This study was undertaken to compare Results of two cytological grading Methods to see which corresponded better to the histological grade.

Methods: The present study was undertaken in the Department of Pathology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly for a period of one year. Breast lumps, diagnosed as infiltrating ductal carcinoma on FNAC and histopathology were assessed with regard to age, laterality, quadrant involved, size of the tumor, presenting symptoms, distribution of Cases according to Robinson, Mouriquand and Nottingham grading. This study was retrospective as well as prospective.

Results: This study included a total of 49 Cases of infiltrating ductal carcinoma of the breast. Robinson's cytological grade II was most common grade in the present study comprising 30 Cases (61.2%). In the present study grade II was observed in maximum number of Cases in Mouriquand's cytological grading constituting 28 Cases (57.1%). The concordance between Robinson's cytological grading and Nottingham modification of Bloom Richardson histological grading was 87.50%.

Conclusion: The present study reveal that it is achievable to grade infiltrating ductal carcinoma of breast on fine needle aspiration and cytological grade correlates with histological Bloom Richardson histological grading.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-027: TUBERCULAR MASTITIS: A RARE ENTITY

Kiran Sharma ¹, Jyotsna Suri ¹, Deepti Gupta ¹

Introduction: Breast tuberculosis is a great masquerader and an uncommon entity. It appears mostly in women of reproductive age group, multiparous, lactating women. Breast tuberculosis is a rare disease with non-specific clinical, radiological, and histological findings. Extra pulmonary breast tuberculosis is a rare clinical entity with an incident ranging from 0.1% in developed countries to about 4% in highly endemic countries like India.

Presentation of Case: We Report a rare Case of cytology of breast tuberculosis. A 29 years old female presented with solitary, ill-defined, unilateral, firm and non mobile swelling situated in the retromammary region of left breast for the past one month. On fine needle aspiration of the breast swelling yielded blood mixed aspirate. Microscopic examination show ill formed granulomas in a Background of granular amorphous necrosis, neutrophils and lymphocytes. Ziehl Neelsen staining for acid fast bacilli is positive. The diagnosis was established as tubercular mastitis. The patient was then treated with antitubercular drugs in pulmonary medicine department.

Conclusion: The significance of breast tuberculosis is due to its rare entity and mistaken identity with breast cancer and pyogenic breast abscess. Fine needle aspiration is the first line screening modality which may lead to proper diagnosis and treatment of the patient.

Keywords: Tuberculous, Mastitis, Antitubercular, Ziehl Neelsen

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-028: STRENGTH AND WEAKNESSES OF APPLICATION OF INTERNATIONAL ACADEMY OF CYTOLOGY YOKOHAMA SYSTEM FOR REPORTING BREAST FINE NEEDLE ASPIRATION CYTOPATHOLOGY: SINGLE INSTITUTIONAL EXPERIENCE

Isha Makker ¹, Preeti Agarwal ¹, Mala Sagar ¹, Madhu Kumar ¹, Shivanjali Raghuvanshi ¹

Background: Multiple International Reporting systems have been developed to establish best practice guidelines and prevent variable jargons used by cytopathologists, IAC Yokohama system is for breast FNAB. This study Aims to assess the strength and weaknesses of its application with respect to conventional Reporting terminologies.

Methods: A retrospective analysis of breast FNAB cytology where slides were retrieved, reanalyzed and categorized as per Yokohama system was performed. The findings were compared to the different forms of Reporting terms used and clinical outcome along with histocytological correlation.

Results: Total 202 breast FNAB were re-assessed and reclassified. Following Results were obtained: 1. Insufficient- 8.91%(n=18); 2. Benign-54.45% (n=110); 3 Atypical- 0.91% (n=1), 4. Suspicious of malignancy 1.48% (n=2), 5. Malignant- 34.15% (n=69). 3.9% (n=8) were Reported as inadequate with a descriptive Report conventionally; following Yokohama criteria this number increased to eighteen. Most variable category was 'Benign' where 52% were named as Fibroadenoma, 24% benign breast disease, 19% descriptive and 5% Benign phyllodes. 94 (85.45%) Cases lacked clear statement regarding 'absence of malignancy'. All the suspicious and atypical Cases turned out to be malignant on further biopsy. Histopathological examination was performed in 54 Cases with significant correlation (p<0.001).

Conclusion: The strength of Yokohama system is that like BI-RADS it gives a simplified, reproducible and uniform Report that leads to a clear understanding both for pathologist and clinicians and thereby guide management with clearer statements. Major weakness is a considerable overlap between the atypical and suspicious categories.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-029: UNDIFFERENTIATED PLEOMORPHIC SARCOMA VERSUS MALIGNANT PHYLLODES: A DIAGNOSTIC CHALLENGE IN A BREAST LUMP

Tohfa Haque ¹, Aishwary Gayatree ¹, Nidhi Priya ¹, Sunayana Misra ¹, Prajwala Gupta ¹, Meenakshi Bhardwaj ¹

Background: Primary breast sarcomas are rare tumors constituting less than 1% of total breast malignancies. Most common age group is fifth and sixth decade. Phyllodes tumors is a specific subset of soft tissue tumor that has both epithelial and stromal component and it is graded as grade 1 to 3, Grade 3 stromal component mimics sarcoma.

Case Report: We Reported a Case of 26 years old female presenting with a left breast mass since 11/2 years. On examination an axillary mass on same side was also detected. On ultra sound, a large lobulated, solid -cystic mass measuring 10.8* 8.5 cm was detected in left breast and a 1.1*1.5 cm axillary lymph node was also detected on the same side. FNAC was done from both breast and lymph node swellings and diagnosis of Malignant phyllodes was given. On trucut biopsy it was Reported as fibroepithelial lesion and possibility of malignant phyllodes cannot be ruled out. Post surgery histopathological evaluation with extensive sectioning and immunohistochemistry, a final diagnosis of Undifferentiated pleomorphic sarcoma was given.

Conclusion: Undifferentiated pleomorphic sarcoma is an extremely rare tumor, specially in a young female. Stomal component of grade 3 phyllodes mimics sarcoma and hence causes a big diagnostic dilemma. Hence, multiple passes in FNAC, tissue processing and immunohistochemistry are needed for correct diagnostic evaluation.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-030: INFILTRATING DUCTAL CARCINOMA BREAST AND NEUROFIBROMATOSIS: A RARE ASSOCIATION

Sonia Hasija ¹, Shilpa Garg ¹, Bhawna Sethi ¹, Puja ¹, Sheetal Gole ¹, Ashok Sangwaiya ¹

Background: Neurofibromatosis type 1 (NF1), also known as Von Recklinghausen's disease, is a rare neuroectodermal disease that mainly affects the skin and the nervous system. Patients with NF1 have a higher risk of developing various types of cancers. Although uncommon, Case Reports describing the association of NF1 and breast cancer are available in the literature. We describe a rare Case of a 26yearold female (with no history of NF1 in the family) presenting with ulcerative carcinoma in the right breast.

Case Report: A 26 years old female presented to the surgical outpatients department with complaints of lump measuring 12x8 cm in the right breast for the last 5months. Multiple, well defined, discrete, soft, sessile nodules in the skin, diffusely scattered throughout the body. Overlying skin of lump showed large area of ulceration measuring 7x6 cm. Fine needle aspiration was performed. On cytology, smears were cellular and showed atypical cells arranged in sheets, clusters and dispersed singly. Cells were pleomorphic having high N:C ratio and multiple nucleoli against a hemorrhagic Background. A diagnosis of infiltrating Carcinoma Breast was made in a patient of Diffuse Neurofiromatosis.

Discussion & Conclusion: Knowledge of the association of NF1 with breast cancer can help in the early diagnosis of breast malignancy by careful clinical breast examination, screening mammography, and further diagnostic evaluation in the Case of a suspicious mass. FNAC is an adjunct in making the diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-031: ATYPICAL MYCOBACTERIA CAUSING GRANULOMATOUS MASTITIS IN A MALE PATIENT: A VERY RARE PRESENTATION

Lalit Mohan Sharma ¹, B K Sinha ¹, PC Prabhakar ¹

Background: Atypical Mycobacteria, also referred to as Nontuberculous mycobacteria (NTM) or mycobacteria other than tuberculosis (MOTT) are a rare cause of mastitis in females, mostly affecting reproductive age group postpartum women, and even rarer cause of gynecomastia in adolescent males, presenting as idiopathic granulomatous mastitis. They are able to infect both immunocompetent and immune-compromised persons mainly Resulting in pulmonary, skin and soft tissue infections. The clinical presentation of mastitis in men is poorly described in the literature & challenges like lack of awareness of the condition, leads to significant diagnostic delay.

Case Report: We Report Case of a 35 year old male farmer, who presented with 18 month history of painful swelling in the left breast, not relieved with medication, with no h/o fever, cough, weight loss, TB contact, trauma and IV drug abuse. Clinical examination was conducted and subsequent FNA revealed thick organised cheesy aspirate, showing ill defined epithelioid cell granulomas, multinucleated giant cells in mixed inflammatory Background, with few sparsely spaced benign breast tissue clusters on Giemsa staining. Modified ZN stain was positive for acid fast bacilli showing clustered arrangement of short and stout bacilli. Aspirate culture showed rapidly growing atypical mycobacteria. Patient was diagnosed for granulomatous mastitis with atypical mycobacteria and started on combination antibiotics.

Conclusion: Due to paucity of well-defined clinical features and rare presentation, tuberculous and non-tuberculous mastitis in men can be difficult to diagnose and high index of suspicion is required to prevent delay in start of treatment.

Keywords: Granulomatous mastitis, Atypical Mycobacteria, NTM, Gynecomastia

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-032: BURKITT LYMPHOMA OF THE BREAST: A RARE CYTOLOGICAL CASE STUDY

Akankshya S ¹, Kashyap ¹, Aseema Das ¹, Bandita Das ¹

Background: Lymphoma of the breast is unusual, accounting for about <0.5% of all malignancies of breast and approximately 2% of all extranodal lymphoma. Eleven percent Cases show bilateral breast involvement.

Case Report: A 26 year female presented to Cytopathology for FNAC of rapidly growing bilateral breast lump with mild fever and jaw pain. Imaging studies were suggestive of malignancy. MGG stained smears from bilateral breasts revealed high cellularity of cells mainly dispersed singly. Individual cells were large with round nuclei, multiple nucleoli and scant cytoplasm interspersed with immunoblasts and abundant mitotic figures. The picture was suggestive of high grade Non Hodgkins lymphoma. Differentials of Diffuse Large B-Cell Lymphoma and Burkitt's were considered. Further ancillary studies revealed positivity for CD45, CD20 and Ki67 100% which clinched a diagnosis of Burkitt's Lymphoma.

Conclusion: The patient was taken to a higher Oncology centre where treatment was started. Burkitt lymphoma, a highly aggressive but potentially curable entity is a rare finding, especially in Breast FNABC and requires timely diagnosis for favourable patient outcome.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-033: DUCTAL CARCINOMA WITH NEUROENDOCRINE DIFFERENTIATION: A CYTOLOGICAL DIAGNOSIS

Anjali Ahalawat ¹, Sanjay Kumar ¹, Nidhi Kaushik ¹, Sant Prakash Kataria ¹, Pooja Dhamija ¹, Sunita Singh ¹

Background: Breast carcinoma with neuroendocrine differentiation, also known as neuroendocrine breast carcinoma includes a heterogeneous group of rare tumors, which account for 2–5% of all invasive breast carcinomas. Neuroendocrine differentiation has been reported in both in situ and infiltrating breast cancers. The prognostic significance of neuroendocrine differentiation in mammary carcinoma is unclear. These tumors are categorized into three groups: well differentiated NEBC (NETs, which included low- and intermediate-grade tumors), poorly differentiated NEBC/small cell carcinoma, and NEBC determined by histochemistry or immunohistochemistry (IHC).

Case Report: A 65 year old female presented in OPD with a firm, non-tender, right breast lump since 1 week associated with red colour nipple discharge, fever and weight loss. General physical examination did not show any other abnormality. On Ultrasonography, a hypoechoic lesion with nodular margins is seen in right breast suggested to be BIRADS III/IV lesion (probably benign or suspicious for malignancy). Fine needle aspiration cytology from breast lesion was performed revealing predominantly singly scattered cells with basophilic cytoplasm containing eosinophilic granules with eccentric nucleus having granular chromatin and inconspicuous nucleoli. Cytological features were suggestive of ductal carcinoma with neuroendocrine differentiation. The diagnosis was further confirmed by IHC using NSE and Chromogranin, both of which showing positivity for neuroendocrine nature of tumor.

Conclusion: Neuroendocrine tumors of the breast are rare tumors which occur predominately in postmenopausal women in the sixth to seventh decade of life. This subtype of ductal carcinoma has distinct cytologic features, rendering preoperative diagnosis possible. Recognition of this entity is important in order to avoid the misdiagnosis of neuroendocrine tumor metastatic to the breast.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-034: CYTOHISTOLOGICAL AS WELL AS RADIOLOGICAL CORRELATION OF CARCINOMA BREAST, A CASE SERIES

Garima Dwivedi ¹, Prof Neeraj Dhameja ¹, Shankneela ¹, Shataskshee Tewari ¹

Background: Breast cancer has become one of the most prevalent malignancy among the female worldwide. In India also it has ranked one cancer among the females with age adjusted rate as high as 25.8 per 100,000 women. The mortality rate is also very high. Besides this young females in our country are at major risk for it. Better health awareness and screening programme can help to identify people at risk, help their early diagnosis and treatment of the same. Cytology and radiology as important role in its screening.

AIM: To study cytohistological correlation of breast disease and to evaluate the outcome.

Material and Methods: we did study of 10 Cases series. We recorded their radiological findings at the time of FNAC (cytology), the same Cases where tracked and their histological findings were noted.

Result: We found the Cases which shows atypia at cytology where frank malignancy at histology, which we further confirmed on IHC. 9 Out of 10 Cases(90%) had radiological suspicion. 8 out of 10(80%) Cases showed atypia/? Malignancy on cytology. All of the Cases where positive for carcinoma breast.

Conclusion: Cytology can be used as the screening test for all breast carcinoma.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-035: CUTANEOUS METASTASIS FROM BREAST CARCINOMA: AN EARLY SIGN OF A PROGRESSIVE DISEASE

Loveleen Kaur ¹, Garima Goel ¹, Deepti Joshi ¹, Manish Gupta ^2,¹

Background: Metastasis is defined as a neoplastic lesion originating from another primary tumour without any contact with it. It signifies widespread systemic involvement and grave prognosis. Breast cancer is the second most common cancer in women, with the highest rate of cutaneous metastasis. Cutaneous metastasis accounts for 30% of all Cases of breast carcinoma. Cutaneous metastasis may Result from the tumor spreading via lymphatic or vascular embolization, direct implant during surgery or skin involvement by contiguity. The identification of cutaneous metastasis can be an early indication of progressive disease and help in appropriate management of the patient.

Case Report: A 55-year-old female presented to the oncology OPD for a routine clinical follow-up. She had been diagnosed with invasive ductal carcinoma involving the left breast two years back. She had been treated with 6 cycles of neo-adjuvant chemotherapy followed by left-sided modified radical mastectomy. Presently on examination, she had multiple papules above the mastectomy scar. A FNAC was performed from the papules, and it showed presence of atypical cells arranged in small clusters and dispersed singly. A diagnosis of cutaneous metastasis from breast carcinoma was rendered. The patient further underwent 4 cycles of chemotherapy and is doing well on follow-up.

Conclusion: To conclude, cutaneous metastasis in an already operated Case of breast carcinoma can have varied clinical presentations and Merits greater awareness. A definite diagnosis of cutaneous metastasis through proper workup is essential as they may be the first sign of progression of the disease.

Keywords: Breast cancer, cytology, cutaneous metastasis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-036: CLEAR CELL NODULAR HIDRADINOMA BREAST MASQUERADING AS CARCINOMA: A RARE CYTOLOGICAL DIAGNOSIS

Manisha Ahuja ¹, Nidhi Verma1 ¹, Reena Tomar1 ¹, Shyam Lata Jain ², IP Singh ³

Introduction: Nodular Hidradenoma is a benign adnexal tumor originating from apocrine glands. The tumor is rare and most common sites of involvement are head, neck and extremities. Although, origin from apocrine gland of breast is rare but has been Reported. The usual age group is 20-50 years with female predominance.

Case HISTORY: A 50/ female presented with lump in her left breast since 3 weeks. No other significant history was present. On examination, a 6 x 4 cm lump was felt in the upper outer quadrant which was non tender, firm to hard in consistency and fixed to skin. The overlying skin showed induration. No lump in opposite breast or axillary lymph nodes were found. FNA from lump was done which yielded yellowish fluidy aspirate. On Cytological examination a diagnosis of benign adnexal lesion was made. It was confirmed by histological correlation which revealed Nodular Hidradenoma.

DISCUSSION: Nodular Hidradenoma is a benign asymptomatic tumor of apocrine gland. It's size usually ranges from 0.5-2cm. Though most commonly found in head and extremities and uncommon sites include eyelids and breast. Lesions in the breast can ulcerated with serous discharge. Common age group is middle age. Cytological smears show cystic and solid pattern. Cystic component shows foam cells and Mucoid Background. Solid component may show eosinophilic to clear polygonal cells. FNAC form this tumor may mimic carcinoma.

Conclusion: Cytological diagnosis of this tumor is rare. It requires early diagnosis for appropriate treatment as it can be mistaken for ductal carcinoma.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-037: A RARE CASE OF INFARCTED BREAST LUMP IN AN ADOLESCENT FEMALE: A CYTOLOGICAL DILEMMA!

Srushti Karmarkar ¹, Nisha Meshram ¹, Milind Bhatkule ¹, Sachin Chaudhari ¹, Rasika Gadkari ¹

Background: Phyllodes tumor constitute a small subset of fibroepithelial neoplasms of breast and are extremely rare in adolescent females. Furthermore, spontaneous infarction of these tumors is highly unusal. Here, we Report a Case of spontaneous infarction in benign phyllodes tumor in an adolescent female, posing diagnostic challenges on fine needle aspiration cytology(FNAC) smears.

Case Report: A 14-year-old female presented with a palpable lump in right breast. The lump had progressively grown over a duration of 5 months and was associated with extreme tenderness. There was no history of any trauma. Ultrasound revealed two hypoechoic circumscribed mass lesions with minimal vascularity and no calcifications, suggestive of fibroadenoma. FNAC revealed highly cellular smears comprising of discohesive population of predominantly spindle cells and few round cells with marked degenerative changes and necrosis. Occasional fragments of benign ductal epithelial cells were also seen on meticulous examination. These features led to the consideration of various spindle cell tumors including, a spindle cell sarcoma as one of the differential diagnosis. However after careful consideration, a final cytology diagnosis of “juvenile fibroadenoma with infarction” was rendered. The histopathological analysis revealed a “benign phyllodes tumor” with extensive areas of stromal infarction and desquamated epithelial cells.

Conclusion: Spontaneous infarction of breast lesion is rare and may not be associated with any known risk factors. An infarcted breast lesion poses a significant diagnostic challenge to the cytopathologist. Knowledge of the cytopathological features of this entity helps in accurate diagnosis and its distinction from malignancy.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-038: CYTOLOGICAL FINDINGS OF DUCTAL CARCINOMA IN-SITU ARISING WITHIN PHYLLODES TUMOR

L Sarat Manohar ¹, Deepti Joshi ¹, Ujjawal Khurana ¹, Tanya Sharma ¹, Swagata Brahmachari ¹

Background: Ductal carcinoma in situ or infiltrating ductal carcinoma arising in a phyllodes tumor is a rare neoplasm of the breast. In this Report a rare phenomenon of malignant alteration of epithelial component of the phyllodes tumour was seen and suggested on cytological smears.

Case Presentation: A 36-year-old female came with complaints of left sided recurrent breast lump for 6 months. Initial fine needle aspirate cytology patient was diagnosed as cellular fibroadenoma(C2) for which the patient underwent lumpectomy and was diagnosed as benign phyllodes tumor on histopathology. After 6 months patient revisited with recurrence of the breast lump. Ultrasonography and MRI showed BIRAD IV lesion in the left breast. FNAC was suggestive of atypical ductal hyperplasia or carcinoma arising in a known Case of phyllodes tumour(C4). Patient underwent mastectomy with clinical suspicion of malignant phyllodes tumor. Microscopy showed fibroepithelial tumor with proliferation of stromal as well as glandular components. The stromal component exhibits foci of stromal overgrowth and show mild to moderate atypia, variable cellularity with areas of myxoid change along with mitotic activity. Few areas showed foci of low to intermediate grade DCIS with cribriform and solid pattern. The histopathology of the specimen was diagnosed as DCIS arising within recurrent phyllodes tumour.

Conclusion: In Conclusion, we present a rare Case of DCIS arising within benign phyllodes tumor, the cytological features that can help in preoperative diagnosis shall be discussed.

Keywords: Atypical ductal hyperplasia, Ductal carcinoma in situ, Fibroadenoma, Phyllodes tumor, Usual ductal hyperplasia.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-039: EVALUATION OF BREAST LESIONS USING IAC YOKOHAMA REPORTING SYSTEM

Manish Jaiswal ¹, Anurag Gupta ¹, Pradyumn Singh ¹, Nuzhat Husain ¹, Tripti Vema ¹, Ashish Singhal ², Akash Agarwal ^2,³, Shamrendra Narayan ³, Neha Singh ¹

Objective: Cytomorphological evaluation of breast lesions as per International academy of cytology Yokohama standardized Reporting system and to evaluate risk of malignancy for each cytology category by cytohistological and triple test correlation.

Materials and Methods: A total of 548 breast FNA specimen were collected from single institution both prospectively and retrospectively. All smears were examined and reclassified according to IAC Yokohama system of Reporting, by three pathologists independently and Cases with disagreement were reviewed by all observers together to reach a consensus. The ROM for each of the five categories was determined along with sensitivity, specificity, Positive and negative predictive value. The diagnostic accuracy of Yokohama system was compared with the original diagnoses. The concordance rates among highly experienced and less experienced pathologists was also determined.

Results: 548 aspirations were categorized as : Cat-1 (Inadequate) – 6.57% Cases, Cat-2 (Benign) – 58.03%, Cat-3 (Atypical) – 2.55%, Cat-4 (Suspicious for malignancy) – 4.56% & Cat- 5 (Malignant) – 28.28%. Histology was available in 228 Cases. Risk of malignancy (ROM) for category 1 is 50%, 8.99% for category 2, 45.45% for category 3, 93.75% for category 4 and 100% for category 5. The sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy of the system was determined to be 92.45%, 100%, 100%, 91.01% and 95.72% respectively.

Conclusion: IAC Yokohama system of Reporting categorize the breast lesions with high degree of diagnostic accuracy and guides the clinicians to take appropriate management decisions accordingly.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-040: AXILLARY COLLAGENOUS SPHERULOSIS: A RARE INCIDENTAL CYTODIAGNOSIS.

Sonam Sharma ¹

Background: Collagenous spherulosis (CS) is a rare benign entity which is usually an incidental microscopic finding in association with a range of benign and malignant breast lesions. The Reported incidence of CS is less than 1% in excisional specimens and only about 0.2% in cytological aspirates. It is characterized by presence of two cell types: epithelial cells and Myoepithelial cells with associated basement membrane like material in the form of hyaline spherules. It is utmost important to differentiate CS from its close morphological mimickers especially adenoid cystic carcinoma so as to avoid a false positive diagnosis and unnecessary therapeutic interventions. Till date, CS presenting as an axillary mass has not been Reported in the world literature.

Case Report: A 48-year-old woman presented with a right axillary swelling of 1.5 cm x 1 cm size since last 2 years. Fine needle aspiration cytology was performed. The smears showed tightly cohesive clusters and a few branching fragments of benign ductal epithelial cells closely intermingled with many spherical, acellular, homogenous hyaline globules surrounded by benign myoepithelial cells. Few bare bipolar nuclei were also noted in the Background. A diagnosis of CS of the right axilla was made. No biopsy or therapy was advised. After 2 years of follow-up, there were no signs of progression.

Conclusion: CS, though an uncommon and innocuous entity, can present as a palpable mass independently or may coexist with accessory breast tissue. Nevertheless, its diagnosis can be clinched on meticulous cytological examination to avoid any misdiagnosis and aggressive treatment.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-041: RIB TUBERCULOSIS UNDER THE SHADOW OF TUBERCULAR MASTITIS: AN ATYPICAL PRESENTATION

Prerna Mahajan ¹, Akanksha Agrawal ¹, Akanksha Agrawal ¹, Somnath Mahapatra ¹, Preeti Diwakerr ¹, Vinod Kumar Arora ¹

Background: Tubercular mastitis is most frequently encountered in pregnant and lactating females. It is rare in males and accounts for only 4% of all Cases of tubercular mastitis. We Report an interesting Case of a young male who had secondary involvement of breast tissue due to tubercular osteomyelitis of the underlying rib.

Case Report: A 18-year-old male presented with complaint of swelling on the right side of chest for 2.5 months. He had no history of trauma or any drug intake. On examination, lesion was firm, non tender, slightly mobile and measured 2 x 1.5 cm. His genitals were also normal. A clinical diagnosis of gynecomastia was made. On fine needle aspiration, yellowish pus like material was aspirated. Smears showed few clusters of histiocytes along with inflammatory cells in a necrotic Background. Ziehl-Neelsen stain for acid fast bacilli was positive. Hence, a diagnosis of tubercular mastitis was rendered. This was further confirmed by PCR. However in view of rarity of tubercular mastitis in males USG was done which revealed an underlying osteomyelitis of the 4th rib with myositis and Mastitis. These findings indicated that the patient had primary bone tuberculosis which secondarily involved the breast.

Conclusion: Tuberculous mastitis in males should be evaluated further due to its rarity. Hence, cytological evaluation alongwith radiological correlation is helpful for accurate diagnosis and efficient management of such Cases.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-042: RARE OCCURRENCE OF SOFT TISSUE CHONDROMA OF BREAST- A CASE REPORT

Karishma Makwane ¹, Reeni Malik ¹

Background: Extra skeletal chondromas are rare neoplasms. This Report describes an exceedingly rare Case of a pure chondroma of the breast in a 80 year old woman, in whom fine needle aspiration cytologic features suggested a cartilaginous neoplasm.

Case Report: A 80-year-old woman presented with a 8x6cm, firm, slightly mobile lump in the lower middle quadrant of the left breast. Clinically, giant fibroadenoma, phyllodes tumor or ductal carcinoma breast were suspected. Mammography showed a high-density-nodule without micro calcification. On ultrasonography, a large ill defined heterogenous lesion of size 8x7cm noted in left breast showing some cystic changes. Fine needle aspiration cytology revealed sheets of chondroblasts against a Background of cartilaginous and Myxoid matrix. So a differential diagnosis of cartilaginous lesion of breast was obtained after which excisional biopsy showed histopathological features of chondroma.

Conclusion: Chondroma of breast shows FNA cytologic features of cartilaginous tumor but difficulties may arise in the diagnosis especially when it occurs at an unusual site such as breast. This Case highlights that the cytopathologist should be aware of the neoplasms of the breast that may show chondroid or chondromyxoid changes to make a correct diagnosis of this neoplasm on a cytologic basis, combined with clinical and radiological findings.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-043: MULTIPLE MYELOMA PRESENTING AS PLASMACYTOMA OF BREAST : AN EXTREMELY UNUSUAL PRESENTATION

Aparna Singh ¹, Charu Agarwal ¹, Mukta Pujani ¹, Varsha Chauhan ¹

Background: Plasmacytomas of breast are an extremely rare entity and can present either as a primary isolated tumor or as an extramedullary manifestation of multiple myeloma. The International Myeloma Working Group recognized three entities of plasmacytoma: solitary plasmacytoma of bone, extramedullary plasmacytoma, and multiple solitary plasmacytomas that are either primary or recurrent.

Case Report: A 59 year old female presented with a hard painless lump in the left breast for two years. She complained of severe back pain with difficulty in walking and sitting upright along with unexplained bouts of fever and generalised weakness for the past six months. She was advised fine needle aspiration cytology of the lump and a CT scan to diagnose the etiology of the back pain. CT scan revealed a lytic lesion in L4 and L5 vertebral bodies. On cytology, a possibility of plasmacytoma was suggested. Serum protein electrophoresis and histopathological examination along with immunohistochemistry was advised to confirm the diagnosis. Immunostaining for CD38, CD138 and CD56 was performed. On the basis of cytology, histopathology and immunohistochemical markers along with the findings of serum protein electrophoresis, a diagnosis of plasmacytoma of breast was made.

Conclusion: Primary breast plasmacytomas are very rare. Only about 45 Cases of breast plasmacytoma have been published since 1928. Both primary and secondary plasmacytomas of breast can present as a breast lump. It is very important to recognize this entity at the earliest so as to initiate therapy and avoid metastasis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-044: CYTOHISTOLOGICAL CORRELATION OF ANGIOMYXOMA BREAST IN A YOUNG MALE

Pournami G ¹, Sandeep R Mathur ¹, VK Iyer ¹, Ruchi Rathore ¹

Case Report: 22 year old male presented with a swelling of size 3*1.5 cm, on right breast nipple and retro-areolar area, with a 1.5 cm sized cystic swelling protruding from right nipple with impending ulceration. The swelling progressively increased in size for a duration of 3 months, and was not associated with pain. The FNAC was suggestive of a myxoid soft tissue neoplasm and excision was advised. Core biopsy also showed the presence of a myxoid soft tissue tumor along with few blood vessels, immunopositive for CD34 and S100 and negative for CK, desmin and myogenin. Wide local excision revealed a tumor of size 6*3.5*2.5cm, histologically diagnosed as angiomyxoma and further confirmed by immunohistochemistry.

Conclusion: Angiomyxoma of male breast is a rare disease. However when encountered with such swellings, a possibility of same must be kept in the list of differential diagnosis. FNAC and cell block technique may be good diagnostic modality for such patients to decide the further course of action.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-045: CYTOMORPHOLOGICAL PATTERNS AND HISTOPATHOLOGICAL CORRELATION OF METASTATIC BREAST CANCER ON FLUID CYTOLOGY

H Subashini ¹, Ruchi Rathore ¹, V Seenu ², SVS Deo ², Venkat Iyer ¹, Deepali Jain ¹, Sandeep Mathur ¹

Introduction: Metastatic breast cancer is challenging for breast specialists. With an unchanging incidence over the last decade,its presence in body cavity fluids not only impart a poor prognosis and shorter survival to the patient but also affects treatment decisions. Invasive breast carcinomas and its various subtypes often have different preferred metastasis sites and distinct histomorphology patterns. While cytomorphological features of metastatic adenocarcinomas are readily recognized on fluid cytology, certain patterns like single cell-mesothelial like pattern may be difficult to diagnosis on fluid cytology. We studied the various cytomorphological patterns of metastatic breast cancers in body cavity fluids including pleural, pericardial, peritoneal, and cerebrospinal fluids (CSF) correlated them with histomorphology on cell block / biopsy of these patients.

Material and Methods: For the purpose of this study, we identified all women with malignant pleural, pericardial, peritoneal, and cerebrospinal fluids (CSF) cytology from department of pathology database. Each effusion was further classified based on primary carcinoma as was determined from the Reports. All metastatic carcinoma Cases originating from breast were identified and their corresponding cytology /histopathology preparations were retrieved from the archives. These were further reviewed by 3 pathologists and cellular features of metastatic breast carcinoma were assessed to determine cell arrangements and nuclear features. These were then correlated with histomorphology on cell block and original biopsy of patient wherever available.

Results: A total of 2134 fluids were evaluated of which 584 were pleural, 642 were peritoneal, 33 pericardial and 875 were CSF. Of these 59 pleural fluids,109 peritoneal,3 pericardial fluids and 106 CSF were positive for malignancy. 10/59 had metastatic breast carcinoma in pleural fluids, 2/109 in peritoneal fluid, 1/3 in pericardial and 1/106 in CSF. while 3 dimensional clusters of tumor cells were the most common pattern in 9/12 Cases,2/12 had single cell mesothelial cell like pattern on pleural and peritoneal fluid. The only Case of CSF with carcinomatous meningitis had few singly scattered large cells on smears. Histopathology of all these Cases however reveled an invasive breast carcinoma no special type of morphology.

Conclusion: Metastasis from an otherwise IBC, NST can occasionally occur in a single cell pattern masquerading as reactive mesothelial cells.A good clinicopathological correlation and the use of ancillary techniques like immunocytochemistry or immunohistochemistry performed on cell blocks are of utmost importance in coming to a correct diagnosis in such Cases.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-046: DIAGNOSTIC ACCURACY OF CENTRAL NERVOUS SYSTEM LESIONS BY SQUASH SMEAR CYTOLOGY AND ITS CLINICO-RADIOLOGICAL AND IMMUNOHISTOCHEMICAL CORRELATION

Madhu Kumar ¹, Jitendra Kumar Vimal ¹, Prof Chhitij Srivastava ¹

Background: Squash smear cytology is universally accepted technique in diagnosing a wide range of central nervous system lesions and is presently employed for both therapeutic and prognostic reasons. The biggest advantage of squash smear cytological diagnosis is rapid intraoperative diagnosis which further helps the neurosurgeon to plan the extent of surgery and modify accordingly.

Aims & Objectives: To study the diagnostic accuracy of squash smears cytology with histopathological and clinic-radiological correlation.

Materials & Methods: Total targeted sample of 100 Cases which includes paediatric and adult central nervous system lesions received along with requisition form will be subjected to squash smear cytology and remaining processes for histopathological examination for final diagnosis. Squash smear cytological diagnosis was correlated with immunohistopathological findings.

Result & Observation: The most common site of CNS lesions was brain 90% followed by spinal cord lesions was 10%. The age of patient ranged from 3 months to 65 years, maximum number of Cases was aged between 21 to 50 years (56%). Most common presenting symptom was headache (70%) followed by nausea and vomiting. Clinical diagnosis provided diagnostic accuracy of 84% with histopathological diagnosis. Radiological investigations provided diagnostic accuracy of 88% with histopathological diagnosis. Cytological diagnostic accuracy of 90% with gold standard histopathological diagnosis.

Conclusion: Squash cytology should be used as a preliminary investigation and should always be confirmed with histopathological examination which is the gold standard. This study shows a very high degree (90%) of cytohistological correlation.

Keywords: Squash smear cytology, Central Nervous System lesions,Histopathology.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-047: MENINGEAL MYELOID SARCOMA DIAGNOSED ON CSF CYTOLOGY

Dipali Deepak Akolekar ¹, Aswini Prabakaran ¹, Aanchal Kakkar ¹, Saranya Gomathy ¹, Arunmozhimaran Elavarasi ¹, Ritu Gupta ¹, Ajay Garg ¹

Introduction: Myeloid sarcoma is a rare presentation of acute myeloid leukemia, seen in 2-14% of Cases, often accompanied by bone marrow involvement. We describe a Case of meningeal myeloid sarcoma in the absence of bone marrow involvement, which presented a diagnostic dilemma.

Case summary: This 24-year-old male presented with complaints of headache and vomiting for 3 years, progressive diminution of vision in both eyes for one year, and complete vision loss for three months. He gave history of a thigh swelling 15 years prior, diagnosed as myeloid sarcoma and treated with radiotherapy. Presently, MRI revealed multifocal hyperintense lesions with leptomeningeal enhancement in bilateral cerebral hemispheres, suspicious for meningeal melanomatosis or metastatic carcinoma. CSF submitted for cytological evaluation with these clinical diagnoses showed singly dispersed tumor cells with abundant cytoplasm and large, irregular nuclei. Immunocytochemistry revealed negativity for SOX10 and cytokeratin, excluding melanomatosis and Metastatic carcinoma. The cells were, however, positive for myeloperoxidase, suggestive of myeloid sarcoma. CSF flow cytometry showed 37.6% abnormal cells that expressed dim CD117, moderate CD33, moderate CD13. Bone marrow aspirate and biopsy did not reveal an increase in blasts; whole body PET-CT did not show any metabolically active lesion elsewhere in the body.

Conclusion: This Case highlights an unusual presentation of a not so unusual disease at an uncommon site. In the absence of relevant clinical history, the diagnosis of myeloid sarcoma on cytology may be difficult. Immunocytochemistry plays an important role in the diagnosis of rare neoplasms that may be encountered in CSF cytology.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-048: DIFFUSE ASTROCYTOMA: COMMON TUMOR WITH UNUSUAL LOCATION

Sanjay Kumar ¹, Vatsala Kishore ¹, Neeraj Singh ¹, Vaishali Kotasthane ¹, D kotasthane ¹

Background: The most common primary brain tumor is the glioma. On the basis of their morphological appearance they are classified as astrocytomas, oligodendrogliomas or ependymomas. Astrocytomas are most common glioma, which express glial fibrillary acidic protein that is routinely used as an aid in classifying a glioma as an astrocytomas. Astrocytomas may occur anywhere in brain, or even in spinal cord, but most commonly found in cerebrum.

Case Report : A 23 years old male presented with fever, headache, loss of appetite and episodes of generalized tonic clonic seizures since 40 days. Patient was in altered state of consciousness with severe weakness and unable to walk. He was operated and during surgery Squash smears were prepared from anterior, posterior and deep region of left side of thalamocapsular region. On microscopy smears showed moderate cellularity and sheets of glial cells on fibrillary Background. Mild nuclear atypia noted. After that similar specimen was received for histopathological examination. Grossly these were greyish white soft tissue fragment. On microscopy similar finding was obtained. Hence a diagnosis of diffuse Astrocytoma NOS.

Conclusion: The unique diffuse infiltrative growth of astrocytomas in the brain parenchyma has important diagnostic, prognostic, and therapeutic implications. Usually astrocytomas are found in cerebrum but in above Case it was located in thalamus. In a clinical setting combination of clinical, radiological, and pathological information is warranted to avoid diagnostic inaccuracy, particularly in Cases where only small biopsy specimens are available for pathological diagnosis. So far, histopathology is the gold standard for typing and grading of astrocytomas and pathologist should use the new WHO criteria to classified such tumor.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-049: INTRAOPERATIVE SQUASH SMEAR CYTOLOGY OF NEUROCYSTICERCUS: A CASE REPORTS

Madhu Kumar ¹, Pratima Verma ¹, Preeti Agarwal ¹, Awdhesh Kumar Yadav ²

Background: Cysticercosis caused by cysticerci larvae of the tapeworm. Taenia solium is the most common worm infection to cause CNS disease. The definitive hosts are humans whereas the intermediate hosts are both pigs and humans. The histopathological features of this parasitic infection are well established, however, the subtle cytological features and their importance in diagnosing of neurocysticercosis, needs more elaboration.

Case Report: A 65 yrs male presented with on & off headache for last 5months duration. He had sudden loss of consciousness for last 4 days back.MR findings are multicystic lesion, hypointense on T1, and hyperintense on T2 with midline shift towords lateral ventricle. Provisional clinical diagnosis was suspected Case of malignancy. Radiological findings are suggestive of pilocytic astrocytoma or tuberculoma. Brain tissue was received for squash smear cytology. Smears prepared and stained with May-Grunwald Giemsa and Hematoxylin and Eosin. On microscopic examination, smears showed parenchymatous fragments of a parasite consisting of loose fibrillary material interspersed with small dark blue nuclei alongwith glial tissue. The cytomorphological diagnosis was neurocysticercosis. Remaining brain tissue was subjected to pathological processing, sectioning, and staining by hematoxylin and eosin. On tissue sections, the cyst wall appears multilayered with an outer cuticular layer which is smooth, hyalinized, frequently thrown into projections. The inner layer parenchyma is loose and reticular, containing mesenchymal cells and calcareous corpuscles. Histopathology confirms the diagnosis of neurocysticercosis.

Conclusion: Squash smear cytology proved to be a successful preoperative tool for the diagnosis of CNS lesions. The possibility of neurocysticercosis should be kept in consideration.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-050: DIAGNOSTIC UTILITY OF CEREBROSPINAL FLUID CYTOLOGY AND FLOW CYTOMETRIC IMMUNOPHENOTYPING IN BURKITT LYMPHOMA

Jesty Pullattu Tom ¹, Parikshaa Gupta ¹, Lekshmon KS ¹, Pulkit Rastogi ¹, Pankaj Malhotra ¹

Background: Central nervous system involvement by lymphomas, although infrequent, is associated with fatal outcomes and carries a poor prognosis. Cytologic examination of the cerebrospinal fluid (CSF) complemented by flow cytometric immunophenotyping (FCI) and/or immunocytochemistry can help establish a prompt diagnosis.

Case Report: A 33-year-old woman presented with two episodes of generalized tonic-clonic seizures and features of lower motor neuron-type right facial nerve palsy. CE-MRI of the brain showed ill-defined hyperintense lesions in the left temporal lobe with associated mass effect. Smooth leptomeningeal thickening was also noted. A cerebrospinal fluid (CSF) sample was collected. The CSF cytospin smears were cellular and showed discretely scattered large atypical lymphoid cells, 3-5 times the size of a mature lymphocyte with a high nucleo-cytoplasmic ratio, large round to irregular nucleus with partly opened-up chromatin, multiple prominent nucleoli, and scanty basophilic cytoplasm with fine vacuolations. FCI showed positivity for CD19, CD20, HLA-DR, CD10, and CD38 with lambda light chain restriction and bright immunoglobulin M expression in these atypical cells. A final diagnosis of infiltration by Burkitt lymphoma was rendered.

Conclusion: This Report describes the characteristic cytomorphologic and flow cytometric immunophenotypic features of Burkitt lymphoma involving the central nervous system. It also reiterates the utility of a minimally-invasive diagnostic procedure like CSF cytology supplemented by immediate flow cytometry to prompt and accurately diagnose such challenging Cases.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-051: CHARACTERISTIC CYTOMORPHOLOGIC FEATURES OF ATYPICAL TERATOID RHABDOID TUMOR IN CEREBROSPINAL FLUID CYTOLOGY IN A TODDLER

Jesty Pullattu Tom ¹, Malvika Shastri ¹, Parikshaa Gupta ¹, Prashant Chhabra ¹, Kim Vaiphei ¹, Madhivanan Karthigeyan ¹, Pragya Verma ¹

Background: Atypical teratoid/rhabdoid tumor (AT/RT) is an extremely rare malignant neoplasm. Cerebrospinal fluid (CSF) involvement at presentation indicates intracranial dissemination and is associated with an aggressive course and worse outcomes. Herein, we present the characteristic cytomorphologic features of AT/RT in the cerebrospinal fluid from a toddler presenting with a posterior fossa space-occupying lesion.

Case Report: A 2-year-old boy presented with recurrent early morning vomiting and medial deviation of the left eye. A magnetic resonance imaging of the brain and spine showed a heterogeneously contrast-enhancing posterior fossa space-occupying lesion measuring 3.4x2.8x3.1 cm with tonsillar herniation and patchy areas of leptomeningeal enhancement in cervical and lumbosacral regions of the spinal cord. The cytologic examination of the CSF showed infiltration by large round atypical cells with large round to irregular eccentrically placed nuclei, prominent nucleoli, and moderate to abundant amount of cytoplasm with many cells showing eosinophilic globular cytoplasmic inclusions. These large, atypical cells resembled the characteristic rhabdoid cells. The small cell component was not conspicuous. Based on these cytomorphologic features, a diagnosis of infiltration by a high-grade malignancy, with a possibility of a malignant rhabdoid tumor, was rendered. A craniotomy and tumor excision was done, and the histopathologic examination confirmed the diagnosis of an atypical teratoid/rhabdoid tumor.

Conclusion: Knowledge of the cytomorphologic features of a posterior fossa AT/RT involving the CSF combined with the characteristic immunocytochemistry can help accurately differentiate these tumors from the more common medulloblastomas and central nervous system primitive neuroectodermal tumors.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-052: CRYPTOCOCCOSIS IN A CHILD WITH CSF RHINORRHOEA: A CYTODIAGNOSIS

Ishu Ghiloria ¹, Meeta Singh ¹, Pallavi Sinha ¹, Tanu Sagar ¹, Ravi Meher ¹, Jyoti Kumar ¹

Background: Cryptococcosis is most commonly caused by Cryptococcus neoformans and is fatal in children. The fungus is known to enter respiratory tract by inhalation and localizes in lungs in immunocompetent host. CSF rhinorrhoea as a predisposing cause of cryptococcal meningitis has been rarely Reported. We hereby describe Cryptococcus species directly spreading to the meninges in 1 year child due to CSF rhinorrhoea and the fungus was detected on Fluid cytology, confirmed on culture.

Case Report: A 1-year male child presented with aqueous nasal discharge for 3 months and fever for 10 days, The patient was not on immunosuppressive therapy and was negative for HIV. The fluid was collected from nasal cavity and sent for cytological examination. The fluid was turbid on gross examination. Two drops of fluid were pipetted in cytofunnel and was centrifuged at 1000xG for 10 minutes. Cytospin slides were air-dried, fixed in acetone for 10 minutes at room temperature and stained with May Grunwald Giemsa. The smears showed numerous spherical structures with halo in a proteinaceous Background. No hyphae or pseudohyphae were found. These structures were identified as yeast forms of Cryptococci, which stained deeply on PAS staining. The findings were confirmed on culture.

Conclusion: CSF rhinorrhoea can lead to ascending infection; the patients require timely diagnosis and Management to avoid life-threatening complications. Fluid cytology serves as a quick tool for diagnosis of such fungal infections.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-053: MORPHOLOGICAL SPECTRUM AND CLINICAL CORRELATION OF CEREBROSPINAL FLUID CYTOLOGY IN A TERTIARY CARE CENTER FROM SEPTEMBER 2020 TO SEPTEMBER 2021: A RETROSPECTIVE STUDY

Ojas Gupta ¹, Amrita G Kar ¹, Neeraj Dhameja ¹, Afreen Siddiqui ¹, Vineeta Gupta ¹

Background: Cytomorphological examination of Cerebrospinal fluid (CSF) is considered as gold standard for leptomeningeal involvement by malignancy.

Methods: CSF samples submitted for cytomorphologic analysis from 1st September, 2020 to 25th September, 2021 were analyzed. Archived cytospin slides' smears were reviewed.

Results: A total of 100 samples from 74 patients (19, 26% adult; 55, 74% children and adolescents) were available for analysis. A total of 25 out of 100 samples (25%) from 13 patients out of 74 patients (18%) had CSF localization diagnosed by positive cytomorphology. Patients with positive/suspicious cytomorphology had more frequent clinical symptomatology (50% vs 27%). Among all the positive/suspicious Cases, maximum Cases were diagnosed as leukemic infiltration of hematological malignancy (samples 21/25, 84%; patients 11/13, 84%), followed by one Case each of Metastatic Retinoblastoma (samples 3/25, 12%; patient 1/13, 8%) and metastatic leptomeningeal malignancy (sample 1/25, 4%; patient 1/13, 8%). B lineage Acute lymphoblastic leukemia/lymphoma (ALL) was predominant among the hematological malignancies (samples 16/21, 76%; patients 8/11, 73%), T lineage ALL was (samples 5/21, 24%; patients 3/11, 27%).

Conclusions: The cytomorphological evaluation of CSF is diagnostically important. The prevalence of CNS involvement from metastatic malignancy is more in pediatric patients with predominance of infiltration by ALL (both B and T lineages). Further evaluation of CSF in these patients are of immense value in risk stratification and management of the disease.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-054: SQUASH CYTOLOGY OF MYXOPAPILLARY EPENDYMOMA- A CASE REPORT

Deepak Vedant ¹, Amit Gupta ¹, Poonam Elhence ¹, Deepak Kumar Jha ¹

Background: The myxoid neoplasms in the sacral area are a diagnostically important group of lesions. Myxopapillary ependymoma is a rare tumor which occurs in the sacrococcygeal region. Its histopathologic features are well-described, however the cytological findings are Reported mainly as Case Reports. Here we present the cytological features of myxopapillary ependymoma diagnosed by intraoperative squash cytology.

Case Report: A 5 year old male child presented with low back pain and weakness in the bilateral lower limbs for the last 2-3 months. The contrast enhanced MRI spine showed moderately enhancing lesion involving ventral thecal space from D8 to L2 with enhancing and thickened filum terminale. Laminectomy was done and a highly vascular intramedullary tumour was sent for intraoperative diagnosis. Squash smear showed a cellular tumor arranged in papillary architecture around vascularized stromal cores in a myxoid Background. The tumor cells were round to oval with minimal cytological atypia. The intraoperative diagnosis of myxopapillary ependymoma was rendered which was confirmed on final histopathological examination.

Conclusion: In CNS tumors, intraoperative cytology is more helpful than frozen sections. Hence, the recognition of the characteristic cytologic features plays an important role in establishing an intraoperative diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-055: SQUASH CYTOLOGY OF CHOROID PLEXUS CARCINOMA WITH HISTOPATHOLOGICAL CORRELATION :A RARE CASE

Shivanjali Raghuvanshi ¹, Prof Ajay Singh ¹, Manisha Raj ¹, Prof BK Ojha ¹

Background: Choroid plexus carcinoma is a rare tumor especially in adults. In the total population, choroid plexus tumor only represents less than 1% of all brain tumors. In adults however, due to its extremely rare occurrence, the diagnosis of choroid plexus carcinoma should be made with caution as it more frequently resembles a metastatic papillary tumor such as from kidney and thyroid. CNS Squash cytology helps neurosurgeons immensely in the management of choroid plexus neoplasms. This Case Report highlights the extremely rare Case of adult choroid plexus carcinoma. The clinical presentation, squash cytology,histopathology, and management are well discussed.

Case Report: 31year male presented with headache since 3 months and a short history of altered sensorium, nausea, and vomiting for 5 days. MRI brain showed a space-occupying lesion in 3rd ventricle extending to right ventricle more abutting the septum pellucidum with Hydrocephalus. Right frontotemporal craniotomy was done. Intraoperative squash cytology showed papillary strands with fibrovascular cores. Lesional cells exhibit relative cellular crowding and cytological atypia. Histopathology revealed solid areas with Blurring of papillary pattern, sheets of malignant pleomorphic cells along with few hemorrhagic and necrotic areas. Malignant cells with round to oval, hyperchromatic nuclei, coarse chromatin and frequent mitotic figures. The Case was diagnosed as Choroid plexus carcinoma.

Conclusion: Cytomorphological and histopathological correlation will aid the neurosurgeons in arriving at the diagnosis of choroid plexus neoplasms and to differentiate them from other papillary neoplasms of that area.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-56: CYTOMORPHOLOGICAL EVALUATION OF ASCITIC FLUID AT A TERTIARY HEALTH CARE CENTRE IN SOUTH- WEST BIHAR: A RETROSPECTIVE STUDY OF 102 CASES

Shipra Jyoti ¹, Md Wakeel Ahmad ¹, Kumari Seema ¹, Aakash ¹

Introduction: The parietal and visceral layers of the peritoneum are separated by a thin layer of peritoneal fluid which is an ultra- filtrate of plasma. The pathological accumulation of excess fluid in the peritoneal cavity, either by an exudative or transudative process is termed as ascites.

Aims & Objectives: 1) To study the cytological features in ascitic fluid. 2) To study the common findings in ascitic fluid. 3) To distinguish between malignant and non- malignant Cases.

Materials & Methods: A retrospective study of 102 ascitic fluid samples was done for cytological evaluation over a period of one year (from July 2020- June 2021). Fluids were processed and slides were prepared for evaluation.

Results: Out of 102 samples examined, 67 (65.68%) were of males while 35 (34.31%) were of females. Most of Cases were due to cirrhosis (38.23%) followed by infectious causes (29.41%), reactive mesothelial hyperplasia (12.74%), malignant (10.78%), miscellaneous (8.82%). Of all the malignant fluids, 7 (63.63%) were of males while 4 (36.36%) were of females. The primary site for malignant effusion were known in 8 out of 11 Cases of which ovary (36.36%) followed by liver and GIT (18.18%) each.

Conclusion: Ascitic fluid cytopathology remains a relevant modality for the prompt evaluation of patients with clinically detectable ascites in our setting. It aids in the diagnosis of an underlying neoplastic or non- neoplastic condition, which may change the prognosis, further management and outcome of patient.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-57: REVISITING SEROUS EFFUSION AS PER INDIAN ACADEMY OF CYTOLOGY SYSTEM AND COMPARING THE OUTCOME.

Bency S ¹, Divya Ail ¹

Background: Serous effusions constitute majority of cytology specimens in clinical laboratory. Pleural and peritoneal effusions form major sample bulk. Accurate and uniform Reporting of these samples play crucial role in patient management. The Indian Academy of Cytologists(IAC) recently introduced guidelines for Reporting serous effusion to ensure uniformity across laboratories. This study was undertaken to recategorize the effusion fluids as per IAC guidelines and to assess feasibility and utility of IAC system in routine practice.

Methods: It is a cross- sectional study carried out on serous effusion fluids from May 2020 to May 2021 in our institute. Slides were reviewed and recategorized as per IAC guidelines- Category1: Unsatisfactory, Category2: Benign, Category3: Atypical cells-NOS, Category4: Atypical cells-suspicious for malignancy, Category 5: Malignant. Old category (benign, suspicious for malignancy, positive for malignancy) was compared with IAC system.

Results: Total of 377 effusion samples were assessed. Majority were ascitic fluid(63%), belonged to 31-60 year age group. Males (70.6%) predominated. Histological follow up was available for 73 Cases. Of old benign category,0.6% Cases were subclassified into category 3 and4, of which 50 % were malignant on follow up. Among the suspicious for malignancy, 18% were reclassified into category 2 and 5 which were histologically benign and positive for malignancy respectively. Among positive for malignancy, 22% were recategorized as cat 4, of which 75% were malignant,4%as cat 3 and 2, which were malignant lesions. IAC showed agreement with the old Reporting system. There was significant correlation between histology and IAC categories(pvalue-0.0).

Conclusion:IAC system is efficient and ensures uniformity of routine serous effusion Reporting.

Keywords: Effusion cytology,IAC system, Category.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-58: APPLICATION OF THE INTERNATIONAL SYSTEM FOR REPORTING SEROUS FLUID CYTOPATHOLOGY 2020 IN A TERTIARY CARE HOSPITAL, BELAGAVI

Savoikar Shalaka Narayan ¹, Vijayalaxmi Dhorigol ¹

Background: Serous fluid effusions are observed in both non-neoplastic as well as neoplastic conditions and provide information to the clinician for prompt diagnosis as well as treatment of diseases. There was no uniformity in Reporting serous fluid cytopathology until the recent establishment of The International System for Reporting Serous Fluid Cytopathology 2020 (ISRSFC). This system provides a systematic format for Reporting serous fluid effusions which bring a uniformity in the Reports.

Methods: The present study is a retrospective study done over a span of 6 months in the year 2021 and includes 115 Cases. Reports on serous fluid effusions comprising of pleural, peritoneal and pericardial fluids were reviewed and were divided into the 5 categories proposed by ISRSFC and the discrepancies were noted.

Results: A total of 115 Cases were studied, 75 males and 40 females. The age ranged from 7 years to 84 years. There were 3 (2.6%) Non-diagnostic(ND), 106 (92%) Negative for malignancy(NFM), 0 (0%) Atypia of Undetermined Significance(AUS), 3 (2.6%) Suspicious for malignancy(SFM) and 3 (2.6%) Malignant(MAL) Cases. 2 Cases got recategorized after using the new system of Reporting. Reactive mesothelial cells were seen in 30 (26%) Cases.

Conclusion: This new system created uniformity in the Reporting system of serous effusion fluids. A systematic format followed by all cytopathologist for serous fluids complete with the advice as proposed by the system will bring about a revolutionary change in Reporting and interpretation of Reports by the clinicians with ease which will lead to faster management of Cases.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-59: COMPARISON OF THE DIAGNOSTIC ACCURACY OF CELL BLOCK WITH CYTOLOGICAL SMEAR IN MALIGNANT EFFUSIONS.

Thumma Deepika Poornima ¹, S B Patil ¹

Introduction: Cytological examination of body fluids is one of the commonly performed investigations. Identifying malignant cells has occasionally posed a diagnostic problem on cytological smears. There are some studies showing that undetermined malignancies on Cytological smears (CS) showed conclusive diagnosis with the aid of Cellblock (CB) preparation.

Objectives: • To assess and compare the accuracy of CB Method in the cytological diagnosis of body fluids in malignant effusion with CS.

Materials and Methods: A total of 90 samples which includes pleural, ascitic, BAL and cyst fluid were examined for CS and CB. Each fluid specimen was divided in two equal parts: one part was subjected to conventional smear technique, while the other part was subjected to 10% buffered formalin cell block technique. Comparative study was done to determine sensitivity and specificity of CB over CS. In 20 Cases histological correlation was done.

Results: Out of these 90 samples, female outnumbered the male patients with age ranging from 6 to 85 years. High cellular was yielded by CB Method rather than CS Method. The Results showed 93.33% sensitivity and 66.67% specificity with 95% of CI by the CB Method. Therefore, utility of the CB in the cytodiagnosis of malignant effusion was highly significant as compared to the CS.

Conclusion: This study suggests that, CB technique along with CS provided significant improvement on the yield for malignancy. Also cell block preparation is simple, rapid and inexpensive technique, in which malignant cells can be reliably detected thus avoiding unnecessary invasive procedure in patient management.

Keywords: Cell block, Conventional smear, effusions, Sensitivity.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-60: MALIGNANT ASCITES IN FEMALE PATIENTS: A COMPARATIVE ANALYSIS OF BREAST, OVARIAN AND HEPATOBILIARY CANCER.

Atiya ¹, Ruquiya Afrose ², Sayeedul Hasan Arif ¹, Kafil Akhtar ², Mohammad Akram ²

Background: Malignant ascites accounts for ≈10% of all Cases of ascites and occurs in association with a variety of neoplasms. Ovarian cancer, the most lethal gynecological malignancy, preferentially metastasizes to the peritoneal cavity. The presence of ascites correlates with the peritoneal spread of ovarian cancer and is associated with poor disease prognosis. As the patients of ovarian carcinoma are largely asymptomatic, ascites is usually noticed after significant disease progression.

Aim: To analyse and compare the clinical and pathological features of ascites secondary to carcinoma ovary, breast and gallbladder.

Materials and Methods: Retrospective study was performed at Department of Pathology and radiotherapy, Jawaharlal Nehru Medical College Aligarh Muslim University Aligarh on 158 Cases of cytologically proven Cases of breast, ovarian and hepatobiliary carcinoma.

Results: Primary malignancy was mostly ovarian 47% followed by gall bladder 24% and others 12% (colorectal, oesophagus, pancreas, hepatocellular and stomach). Breast primary was present in 8% of Cases. Most frequent stage of OC when the malignant ascites was diagnosed was stage 3. The presence of malignant ascites was the first clinical sign of an underlying malignancy in 72% of OC patients, while it was only 7% in BC patients. Frequent aspirations were required in the patients of ovarian carcinoma. Metastatic involvement of other sites were more common in BC than in OC (54% and 15% respectively).

Keywords: Malignant ascites, ovarian cancer, breast cancer, gallbladder cancer, peritonealmetastasis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-61: CELL BLOCK STUDY IN SEROUS BODY CAVITY FLUIDS

Shagufta Chowdhary ¹, Deepti Mahajan ¹

Background: All the effusions are pathological regardless of their cellular content. if a definite diagnosis can be made it may avoid exploratory operation as effusions may contain scanty cellularity which can be missed on routine procedure also a large amount of residual material can be left behind and not evaluated. this residual material can be evaluated in cell block preparation and may help improve diagnosis.

MATERIAL AND Methods: The present study is a prospective study extending over a period of one year from Ist Nov 2019 to 31st Oct 2020 in The Department of Pathology Govt Medical college Jammu. The Cases included all serous body cavity fluid specimen received in cytology section of department. CB were made of all samples and analysed as per point scoring system given by Mair et al.

Results: Cell block of 50 effusion samples were made. Analysed by Mair et al., scoring system and categorised into benign/inflammatory, suspicious and Malignant. Out of 50 Cases 31 were Reported as benign, 07 suspicious and 12 malignant.

Conclusion: CB Method show very good yield, uniform cell distribution, excellent morphology preservation and architectural patterns. It appeared to bridge cytology and histopathology. CB preparation by fixed sediment Method is an easy, simple yet reliable and cost effective Method hence can be incorporated into routine cytology laboratory with limited expertise.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-62: EFFECTIVENESS OF INTERNATIONAL SYSTEM FOR REPORTING SEROUS FLUID CYTOLOGY IN ROUTINE PRACTICE – AN INSTITUTIONAL EXPERIENCE

Ramya Suresh ¹, Amita K ¹, Sanjay M ¹

Background: To standardize the Reporting pattern across various institutions, recently, the International System for Reporting Serous Fluid Cytology (ISRSFC) was introduced. The objective of present study was to classify serous fluids into various categories as per the ISRSFC, derive risk of malignancy for each category and determine diagnostic efficacy of fluid cytology when ISRSFC was applied.

Methodology: Cross-sectional study involving 235 Cases of serous effusion over a duration of two years. All Cases were reclassified as per ISRSFC into five categories. Descriptive statistics was derived. Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) was determined in 74 Cases wherein final diagnosis was confirmed by clinical findings, radiology, or cell block.

Results: Out of total 235 Cases of fluid examined, distribution of Cases in the diagnostic categories were as follows - 11 (4.6%) in Non-Diagnostic (ND), 208 (88.51%) in Negative for Malignancy (NFM), 5 (2.12%) in Atypia of Undetermined Significance (AUS), 2 (0.85%) in Suspicious for Malignancy (SFM) and 9 (3.82%) in Malignant (MAL) category. Out of 208 Cases of NFM, mesothelial cells were seen in only 8 (3.8%) Cases. Risk of malignancy was 0% each in ND and NFM, 40% in AUS, 100% each in SFM and MAL. Sensitivity and specificity of fluid cytology was 100% and 96.6% respectively while PPV and NPV was 81.81% and 100 % respectively.

Conclusion: ISRSFC is easy to apply and has high diagnostic efficacy. Most of serous effusions fall in Negative for Malignancy category. Mesothelial cells are not important for specimen adequacy.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-63: PLEURAL FLUID ANALYSIS IN A TERTIARY CARE HOSPITAL BY USING THE INTERNATIONAL SYSTEM FOR REPORTING SEROUS FLUID CYTOPATHOLOGY

E Dinakar ¹, G Lavanya ¹, BHP Chandra Sekhar ¹, M Srinivasulu ¹, BV Sai Prasad ¹, A Venkatalakshmi ¹

Background: The analysis of the pleural fluid can provide necessary information about the disease process and aetiology. The morphology of the cells can be quite varied and deceptive. The absence of a universal and uniform Reporting system of fluid cytology has led cytopathologists worldwide to use various terminologies. This poses diagnostic and therapeutic challenges for the treating clinicians. In an attempt to standardize the Reporting criteria, a novel system named “The International System for Reporting Serous Fluid Cytopathology (ISRSFC)” was proposed by the International Academy of Cytology (IAC) and the American Society of Cytopathology (ASC). The main aim of the study is the recategorization of pleural fluid samples into the categories recommended by this classification system.

Methods: The present study is a retrospective study of a 2-year duration. The Cases were retrieved from the departmental archives and included all the pleural fluid samples from the patients admitted from July 2019 to June 2021. Recategorization was performed using the ISRSFC classification, and Cases were allocated to one of the five proposed categories.

Results: A total of 146 Cases were studied. The age of patients ranged from 11 to 87 years, and the volume of fluid ranged from 3 to 1000 ml. There were 6 ND (4.10%), 120 NFM (82.19%), 5 AUS (3.42%), 5 SFM (3.42%), and 10 MAL (6.84%) Cases.

Conclusion: This evidence-based and five-tiered system targets the improvement of the communication between the clinicians and cytopathologists, consequently directing them to better patient management and therapeutic strategies.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-64: RISK STRATIFICATION OF PLEURAL FLUID CYTOLOGY BASED ON THE INTERNATIONAL SYSTEM FOR REPORTING SEROUS FLUID CYTOLOGY IN A TERTIARY CARE CENTER.

Sushma Bharti ¹, Aasma Nalwa ¹, Poonam Abhay Elhence ¹, Meenakshi Rao ¹, Jyotsna Naresh Bharti ¹, Sudeep Khera ¹, Deepak Vedant ¹, Vikarn Vishwajeet ¹

Background: The International Academy of Cytology and the American Society of Cytopathology proposed The International System for Reporting Serous Fluid Cytology (TISRSFC) in 2019 to form uniform Reporting terminologies for fluid cytology. This system defines a spectrum of diagnostic categories to be used in daily clinical practice. Fluid cytology is a widely accepted, cost-effective, minimally invasive earliest diagnostic Method for investigation that aids management decisions. The present study Aims to reclassify pleural fluid cytology and calculating the risk of malignancy (ROM) for each diagnostic category.

Material and Methods: It is a retrospective two years observational study comprising 690 pleural fluid specimens. Retrospective reviews were performed, and Cases were reclassified into five categories as per TISRSFC. Immunohistochemistry was applied whenever needed. Cytological diagnosis was correlated with respective histopathology and/or clinical and/or radiological diagnosis. ROM was calculated for all diagnostic categories.

Results: In the present study of 690 Cases, 7.97% were non-diagnostic, 84.1% Cases were negative for malignancy (NFM), 0.87% were AUS, 1.16% were SFM, and 5.94% were malignant. Cell blocks were prepared in 33 (4.8%) Cases and IHC was applied in 7 Cases. The commonest site for pleural fluid metastasis was lungs, accounting for 4.64% (32/690) Cases. Further, ROM was calculated for all diagnostic categories as follows: Non-diagnostic:30.9%, NFM: 12.9%, AUS: 100%, SFM: 100%, and Malignancy: 90.2%.

Conclusion: Cytological examination of pleural fluids is an accurate, prompt, and affordable technique. This standardized ISRSFC Reporting system will maintain uniformity and reproducibility in Reporting, leading to improved clinical decision-making of pleural fluids.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-65: INTERNATIONAL SYSTEM FOR REPORTING SEROUS FLUID CYTOLOGY (ISRSFC): AN EXPERIENCE WITH THE RISK STRATIFICATION OF THE SEROUS FLUID CYTOLOGY.

Chayanika Kala ¹, Lubna Khan1 ¹, Anand Kumar ², Sanjay Kala ³

Background: The newly proposed International system for Reporting serous fluid cytology (ISRSFC) was introduced to promote uniformity in Reporting and to provide guide for diagnosis and Management according to the risk of malignancy (ROM) in different categories.

Material and Methods: Total 2318 Cases of serous fluid were studied retrospectively in a period of 5 year and reclassified as Non Diagnostic (ND), Negative for malignancy (NFM), Atypia of undetermined significance (AUS), suspicious for malignancy (SFM) and malignant (M) categories. Final diagnosis were correlated with radiology, cell block histology and immunohistochemistry of fluid and final excision specimen wherever available.

Results: Total 2318 Cases were evaluated out of which follow up of 472 Cases was available. Distribution of Cases among different categories was as follows: ND 0.17%, NFM 75.75%, AUS 0.51%, SFM 2.46% and M 21.11% and overall ROM Reported were 25%, 17.9%, 66.7%, 75.4% and 96.5% respectively for each category. Overall sensitivity Reported was 58.3%, specificity 1005, positive predictive value 100% and negative predictive value 80.9%.

Conclusion: ISRSFC is a five tiered system which places fluid cytology into well defined categories that limit possibilities of false negative and false positive Cases and thus provides risk stratification for each category which further aids to the better management of Cases.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-66: CYTOMORPHOLOGICAL FEATURES OF SARCOMAS IN EFFUSION CYTOLOGY: A CASE SERIES

Vrushali Raut ¹, Prerna Guleria ¹, P Sengupta ¹, Bhupesh Guleria ¹, Bhushan Asthana ¹

Background: Effusions can occur in upto 15% of malignancies of which Sarcomas account for about 3 - 6%. Definitive diagnosis based on cytology is particularly challenging because Sarcoma cells in fluids can round up and lose their characteristic morphological appearance. In addition, they may show cytoplasmic vacuolations and can form loose aggregates or even tight clusters, mimicking Adenocarcinomas. Immunohistochemistry on cell block preparation and immunocytochemistry on slides help in arriving at a definite diagnosis. We present a series of 5 Cases of different Sarcomas with malignant effusions.

Methods: A 7-year retrospective search using our computer system was performed for Cases diagnosed as Sarcoma on effusion cytology with histopathological confirmation. The clinical presentation, cytologic findings and immunohistochemical stain Results were reviewed.

Results: Of 101 effusion cytology samples Reported as positive for malignant cells, 6 samples from 5 patients were histopathologically confirmed to be Sarcomas. The samples included pleural, pericardial and peritoneal fluids. Cases included one each of Osteosarcoma, Ewing's Sarcoma, Epithelioid Angiosarcoma and two of Synovial Sarcoma. Cytologic features were non-specific easily mimicking other malignancies; especially in absence of known prior malignancy. Cell blocks with immunohistochemistry/ immunocytochemistry were available for 3 Cases which helped in final diagnosis. Two Cases were primarily diagnosed on effusion cytology.

Conclusions: Although Sarcomas are uncommon findings in effusion fluids, they must be kept as a differential diagnosis. This Case series effectively brings to light, the scope and utility of cytological evaluation of effusion fluids. Immunocytochemistry plays an imperative role as an ancillary technique to reach a specific diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-67: ADA LEVELS AND PLEURAL FLUID CYTOLOGY-TOGETHER A POWERFUL GUIDE IN THE DIAGNOSIS OF TUBERCULAR AND MALIGNANT PATHOLOGIES

Saloni Mahajan ¹, Sindhu Sharma ¹, Rashmi Aithmia ¹

Background: In a country like India, where Tuberculous Pleural effusion is a common problem for differential diagnosis from Malignant effusion, ADA levels together with Pleural fluid cytology proved to be a valuable adjunct & a useful parameter.

Aim of the Study: To estimate the value of cut off point of ADA level and Lymphocyte percentage in pleural fluids for evaluation of Tubercular & Malignant pathologies.

Material & Methods: Out & Inpatients coming to the department of Pathology for Pleural fluid cytology along with Reported ADA levels from the department of Biochemistry in the same patient within a period of 1 year were taken as subjects. Pleural fluid specimens were collected, smears were made after centrifugation and Reported. ADA levels of the same patient were also taken (done on a semi auto analyser in biochemistry lab).

Results: Out of 41 patients with pleural effusion 27 Cases were diagnosed as malignant. 27 Cases had pleural fluid Lymphocyte Values between 50-70% excepting 02 Cases where it was >70%. Similarly ADA valves in these 27 Cases were < 38 IU/ L. Out of total 41 patients, 10 Cases were diagnosed as having Tubercular effusion. In all these 10 Cases Pleural fluid lymphocyte Values were > 80% and ADA levels were>38 IU/ L.

Conclusion: Pleural fluid lymphocyte Values > 80% and elevated level of ADA > 38 IU / L had almost 100% sensitivity in diagnosis of Tubercular Pleural effusions and the Pleural fluid lymphocyte Values < 80% along with ADA levels < 38 IU / L should be investigated for Malignant pathology.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-68: INTERNATIONAL SYSTEM FOR REPORTING SEROUS FLUID CYTOPATHOLOGY IN PERITONEAL EFFUSION SAMPLES – AN INSTITUTIONAL EXPERIENCE

Bhagyashree Priyadarshinee ¹, Garima Rakheja ¹, Meeta Singh ¹, Shyam Lata Jain ¹, Shramana Mandal ¹

Background: The present study was done to assess the feasibility of applying the International System for Reporting Serous Fluid Cytopathology(TIS) categories published recently, to peritoneal effusions, studied on gynaecological malignancies.

Materials and Methods: All Cases of peritoneal effusion fluids Reported during one year period were retrieved from the archives. The clinical and histopathological follow-up information was obtained. For convenience, only gynaecological masses were considered. Cases with histopathological follow up were categorised as per the TIS and risk of malignancy(ROM) was calculated.

Results: A total of 255 peritoneal effusion samples were received over a period of one year. Out of which 168(65.8%) Cases were due to gynaecological reasons. The histopathological correlation was available in 42(25%) Cases which were neoplastic tubo-ovarian masses. There were 18 (42.8%) samples in category 1 (non-diagnostic), 21 (50%) in category 2 (benign), 3 (7.14%) in category 5 (malignant) and nil in category 3(atypical of undetermined significance/AUS) and category 4 (suspicious for malignancy). Estimated ROM was 11.7% for category 1, 4.7% for category 2 and 100% for category 5.

Conclusions: The categorization and Reporting format of peritoneal effusion cytology samples as per the TIS is feasible and the ROM was analysed for our institution.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-69: THE SPECTRUM AND CYTOMORPHOLOGICAL FEATURES OF THE COMMON AND UNUSUAL MALIGNANCIES PRESENTING WITH PERITONEAL EFFUSION.

Pradnya Kamble ¹, Rakesh Ajmera ¹, Somesh Nilkanth ¹, Hemant Kokandakar ¹

Background: Ascites is the excess accumulation of fluid in peritoneal cavity also called as peritoneal effusion. Ascites can occur due to various non neoplastic conditions, but when it is caused by neoplastic etiology, it is called malignant ascites. It is a frequent complication of advanced malignancy with significant associated morbidity and mortality. Here we have studied effusion cytology in patients presenting with ascites.

Methods: A total 188 samples of ascitic fluid from 146 patients were studied retrospectively over a period of one year. A total 136 Cases of neoplastic etiology were studied. Cytology slides for second opinion or review were excluded from study. Detailed history, radiological investigations and tumour marker studies were used for confirmation of the diagnoses,

Results: Amongst all the 132 Cases of malignancy, majority of 64 Cases were of ovarian carcinoma in which 16 Cases were positive for malignancy, 21 Cases were Reported as suspicious for malignancy & 27 Cases showed no evidence of malignancy on fluid cytology. 24 Cases were from carcinomas of hepatobiliary system, 21 Cases from gastrointestinal carcinomas & 23 Cases of other malignancies presenting with ascites were evaluated in which 8 Cases had presence of malignant cells & 9 Cases were suspicious of malignancy on fluid cytology.

Conclusion: Identification of malignant cells on cytology always is a challenging task for cytopathologist. Positive and negative Reporting carries huge importance in clinical set up. It should be emphasized that clinical, pathological, and imaging data should be used with the ascitic fluid analysis for correlation & diagnosis of the cause of ascites.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-70: PRIMARY ORIGIN AND CAUSES OF MALIGNANT PLEURAL EFFUSION: A RETROSPECTIVE STUDY CARRIED OUT ON 100 CASES

Aprajita ¹, Ruquiya Afrose ¹, Sayeedul Hasan Arif ¹, Kafil Akhtar ¹, Fatma Lubna ¹

Background: Malignant pleural effusion Results from metastasis from many primary sites. Diagnosis of malignant pleural effusion is important for further proper treatment strategy.

Methods: Retrospective study was carried out in pathology department, Jawaharlal Nehru medical College, Aligarh Muslim University. 467 samples of pleural fluid was received, of which 100 found positive for malignancy were retrospectively studied between November 2019 and August 2021. Analysis was made as to what percentage of various primaries contributed to malignant pleural effusion.

Results: Out of 100 Cases, 69% were male and 31% female. Significant 24% patients were <50 yrs, 17% were >70 yrs and Majority (59%) were between 50-70 yrs. Frequency of primary site irrespective of sex was from lung(48%), followed by breast (15%), genitourinary-tract (12%), Gastro-intestinal-tract(10%),Lymphoproliferative disorders (2%). In 13% primary remained undetermined. Among males, 65.2% Cases were by primary from lung, while gastrointestinal (11.5%), genitourinary (8.6%), lymphoproliferative disorder (2.8%) were other causes. Primary remained undetermined in 11.5% males. Among females most common site was breast (48.3%), followed by genitourinary (19.3%), lung (9.6%), gastrointestinal(6.4%). In 19.3% females primary remained undetermined.

Conclusion: Most common primary causing malignant pleural effusion in males was lungs, in females it was breast. Most common primary irrespective of sex was lungs. Majority of patients found positive for malignancy were males and belonged to age between 50-70 yrs. Significant number of patients belonged to young age group <50 yrs also.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-71: APPLICATION OF INTERNATIONAL SYSTEM FOR REPORTING SEROUS FLUID CYTOLOGY (ISRSFC) IN PERITONEAL EFFUSIONS AND ASSESSMENT OF RISK OF MALIGNANCY.

Ruchita Sachan ¹, Anurag Gupta ¹, Subrat Chandra ¹, Pradyumn Singh ¹, Namrata Punit Awasthi ¹, Nidhi Anand ¹, Nuzhat Husain ¹

Background: Serous effusion cytology is a time and cost effective, minimally invasive, simple and safe procedure that can help in determining the initial diagnosis, origin of the malignancy, stage, and prognosis. The International System for Reporting Serous Fluid Cytology (ISRSFC) provides a standardized uniform framework leading to an evidence-based risk of malignancy (ROM). Here, we present our institutional experience adopting ISRSFC.

Material and Methods: In our institution the ISRSFC was implemented at the beginning of 2020. Our cohort comprised of 416 peritoneal effusion samples which were categorised into 5 categories: Non-diagnostic (ND), negative for malignancy (NFM), atypia of undetermined significance (AUS), suspicious for malignancy (SFM) and malignancy (MAL). The pertinent surgical pathology, radiology and clinical follow-up were also extracted. The data was analysed in SPSS version 21.0.

Results: There were 17 ND (3.1%), 386 NFM (69.5%), 32 AUS (5.8%), 33 SFM (5.9%) and 87 MAL (15.7%) Cases. Ascitic fluid cytology had accuracy of 90%, a sensitivity of 76.2% and a specificity of 96.9%. The ROM ranged from 8.9% in NFM (II) to 97.5% in MAL (V) categories.

Conclusion: The ISRSFC appears to be a useful tool to guide clinical management and provide an indication of possible risk of malignancy. The use of this system has also shown to be highly effective, with a concordantly progressive higher ROM for the assigned diagnostic categories. ISRSFC was successfully adopted by our cytology laboratory and clinicians, with overall diagnostic performance similar to previous studies.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-72: CYTOMORPHOLOGIC EVALUATION OF BODY FLUIDS: A TERTIARY CARE STUDY

Niharika Jain ¹, Anjana Mittal ¹, Manoj Sharma ¹, Nikita Gidwani ¹

Background: Many etiologies lead to development of effusions in serous cavities. Cytological examination of body fluids is easy, rapid and cost effective that helps in characterizing the disease into their varying sub-types. Their presumptive and sometimes, definitive diagnosis plays a very crucial role in staging and prognosis of disease in patients.

Methods: The study was conducted over a period of six months. A total of 500 fluid samples obtained from patients of various departments were thoroughly examined, grossly and microscopically.

Results: A total of 500 fluids were examined. Majority of patients were in the age group of 51-60 years. Most of the fluids belonged to males (61.6%). Out of all the fluids, the most common fluid sample received was CSF (37%) followed by ascitic fluid. On examination, benign Cases were 470 (94%), malignant effusions were 21 (4.2%), and suspicious of malignancy were 9 (1.8%). Majority of population had lymphocytes as predominant cell type (64.8%), followed by neutrophils (19%).

Conclusion: A study of different cytomorphological features of fluid sample helps in establishing the role of cytology as an important diagnostic tool in improving the effectiveness of diagnosis, treatment and prognosis of patients in medical field.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-73: GERM CELL TUMOUR METASTASIS IN EFFUSION CYTOLOGY: A RARE PHENOMENON- CYTODIAGNOSIS OF A SERIES OF 3 CASES

Naadia Nadeem ¹, Debasis Gochhait ¹, Neelaiah Siddaraju ¹

Background: Malignant effusions commonly arise due to carcinomas of the lung, breast, ovarian epithelial tumours, stomach, colon and lymphomas. Germ cell tumours causing malignant effusions are rare and usually signify poor prognosis and widespread disease. Only a few studies in literature have Reported cytology of metastatic germ cell tumours picked up accurately on effusion cytology.

Methods: Retrospective analysis of 3 Cases of metastatic germ cell tumour Reported in effusion cytology in our institution from Jan 2018 till August 2021.

Results: The Cases Reported were metastatic seminoma (40/M), metastatic yolk sac tumour (22/F) and metastatic germ cell tumour with non contributory markers for further characterisation(13/F). Both the females presented with abdominal pain, distension and USG revealed bilateral ovarian masses and ascites. Serum AFP was markedly elevated in the yolk sac tumour Case. The male presented with massive pleural effusion and history of seminoma, diagnosed and operated 3 years prior. Cytomorphologically, seminoma metastasis showed characteristic tumor cells with vacuolated cytoplasm, vesicular nucleus and prominent nucleoli. Yolk sac tumour metastasis showed predominant glandular pattern of tumor cells which were large with moderate cytoplasm and prominent nucleoli and the other Case showed predominantly scattered tumor cells. Cell block preparation and ancillary studies were done wherever available and contributory.

Conclusion: Germ cell tumours causing malignant effusions, albeit rare, can still be picked up accurately on cytology, aided with clinical history, radiological findings, serum tumor markers and ancillary studied performed on cytological smears or cell block, as is evident by this study.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-74: CYTOPATHOLOGICAL STUDY OF PERITONEAL WASHINGS AND ASCITIC FLUID IN GYNAECOLOGICAL MALIGNANCIES WITH HISTOLOGICAL CORRELATION

Shefali Mishra ¹, Sujata kanetkar ¹, Puja Pingale ¹

Background: Gynaecological malignancies are one of the leading cause of morbidity and mortality in women. Analysis of effusion fluid can diagnose or provide clue towards disease and its management. Early detection and prompt management is the key to improve survival rate amongst those affected.

Materials & Methods: This was a cross sectional study consisting of 40 Cases of gynaecological malignancies in which, the cytological examination of peritoneal washings and ascitic fluid was done and the Results were correlated with histopathology findings over a period of 2 years.

Results: Mean age of presentation was 51 years. Commonest presenting symptom was abdominal pain. Amongst 26 samples of peritoneal wash, 14 were positive for malignant cells. Out of 14 samples of ascitic fluid 9 were positive for malignant cells. Out of 40 Cases 35 (87.5%) were ovarian, 4 (10%) endometrial & a single Case was of cervical carcinoma. Out of total 35 Cases of ovarian malignancies, 21 samples were positive for malignant cells & showed capsular invasion, 19/21 of which showed omental metastasis. One Case each of endometrial carcinoma (1/4) and cervical carcinoma (1/1) was positive for malignant cells. Out of 23 positive Cases, 02/23 (8.69%) were in stage II, 19/23(82.62%) in stage III and 2/23(8.69%) in stage IV. Out of 17 negative Cases, 100% were in stage I.

Conclusion: Significant correlation between positive cytopathological findings, staging, tumor grade, capsular invasion and omental metastasis. This can be used as an adjunctive tool in surgical management of ovarian malignancies.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-75: DIAGNOSTIC ACCURACY OF CYTOLOGICAL SMEARS VERSUS CELL BLOCK PREPARATION IN MALIGNANT FLUID ASPIRATES WITH HISTOPATHOLOGICAL CORRELATION

Aditi Rathore ¹, Anjana Arya ¹, Mithila Bisht ¹, Nitesh Mohan ¹, Divya Bajpai ¹

Introduction: Serous effusion cytology is a minimally invasive, readily accessible and affordable diagnostic technique.

Aim & Objective: To study the diagnostic accuracy of both cytological smear and cell block preparation in the malignant fluid aspirates and correlating their Results with histopathological findings.

Material & Methods: About 50 fluid samples were divided into two equal halves, one part was routinely processed for centrifuged cytological smears and other half was subjected to cell block procedure with plasma thromboplastin technique.

Result: In our study, cell blocks showed sensitivity of 91%, specificity of 100%, PPV of 1%, NPV of 0.6% and accuracy of 0.92 whereas conventional smears showed sensitivity of 86.36%, specificity of 100%, PPV of 1%, NPV of 0.5% and accuracy of 0.88.

Conclusion: Cell block is an outstanding complementary technique for improving the cytodiagnosis in effusion studies when applied in conjunction with smears offering more accuracy, diagnostic yield and higher sensitivity.

Keywords: Cytological smears, cell block, serous effusion.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-77: LYMPHORETICULAR MALIGNANCIES IN SEROUS EFFUSIONS: CYTOMORPHOLOGIC, FLOW CYTOMETRIC AND IMMUNOCYTOCHEMICAL ANALYSIS

Parikshaa Gupta ¹, Tushar Pandey ¹, Upasana Gautam ¹, Arvind Rajwanshi ¹, Radhika Srinivasan ¹, Nalini Gupta ¹, Manish Rohilla ¹, Neelam Varma ¹, Pranab Dey ¹

Introduction: Involvement of body fluids by lymphoreticular malignancies (LRM) is rare and often associated with poor prognosis and decreased overall survival. The present study was conducted to analyze the characteristic cytomorphologic, flow cytometric and immunocytochemical features of LRMs in serous effusions.

Methods: This was a three-year retrospective study. A total of 218 effusion samples, Reported as involved by lymphoreticular malignancies, on cytology, were reviewed. All the Cases wherein the cytological diagnosis was confirmed by flow cytometric(FCM) and/or immunocytochemical(ICC) studies were retrieved and studied in detail. FCM and/or ICC were performed in a total of 51/218(23.4%) samples, including 30 pleural (58.8%), 18 peritoneal (35.3%) and 3 pericardial fluid (5.9%) samples.

Results: The cytomorphologic diagnoses included infiltration by non-Hodgkin lymphoma(NHL;n=27), infiltration by LRM(n=19), infiltration by chronic lymphocytic leukemia(CLL;n=2), Hodgkin's lymphoma(HL;n=1) and suggestive of infiltration by LRM(n=2). FCM and/or ICC confirmed the diagnoses as infiltration by T-cell lymphoblastic lymphoma in 18; mature B-cell NHL in 10; Burkitt lymphoma in 7; diffuse large B-cell lymphoma in 4; follicular lymphoma, T- cell NHL and CLL in 2 samples each and hairy cell leukemia, plasmablastic lymphoma and HL in 1 sample each. 94.1% concordance was noted between the initial and final cytologic diagnosis.

Conclusions: Involvement of body fluids and effusions by LRMs, though rare, carries an immense prognostic significance and hence the prompt detection is crucial. Detection of these malignancies by cytologic examination of effusions is challenging yet potentially useful and the least invasive Method available to establish an early diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-78: EVALUATION AND COMPARISION OF CELLULARITY AND OVERALL CELL MORPHOLOGY IN CELL BLOCKS USING SIMPLE SEDIMENTATION METHOD AND AGAR METHOD IN BODY CAVITY EFFUSION FLUIDS

Bijayalaxmi Sahoo ¹, Ponraj ¹

Background: The cell block preparation is a routine cell preservation technique in cytopathology that has gained a major role in diagnosis of cytology samples and in performing ancillary immunohistochemical and molecular studies. Cell block sections offers advantage over conventional cytological smear with respect to cellular architecture and archival storage.

Methods: This prospective study was performed from January 2019 to March 2019 in about 30 Cases of body cavity effusions including pleural, pericardial, ascitic fluid and peritoneal wash. The cellular material from the centrifuged specimens was used for cell block preparation. Two slides were fixed immediately in alcohol for hematoxylin and eosin (H&E) staining and papanicolau (PAP) staining. Samples collected for the cell block were from centrifuged sediment sample.

Results: All 30 Cases (including conventional smear, simple sedimentation cell block, agar cell block) were evaluated and compared for cellularity, cell distribution, and cell morphology including cytoplasm and nucleus and were evaluated semi quantitatively. The scoring for cellularity was done in smears and cell blocks.

Conclusion: In our study, combined use of simple sedimentation and agarose cell block Method improved the cellular yield and Resulted in better preservation of cell morphology of body cavity effusion samples.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-79: DIAGNOSIS OF HYDATID CYST DISEASES: ULTRASOUND GUIDED FINE NEEDLE ASPIRATION CYTOLOGY ABSTRACT

Kiran Sharma ¹, Jyotsna Suri ¹, Swati Arora ¹

Introduction: Hydatidosis is one of the most serious helminthic diseases of human being with worldwide distribution, caused by larval form of the cestode worm of Echinococcus. It may develop in any part of the body. The liver is the most frequently involved organ (75%), followed by the lungs (15%). Humans are infested either by direct contact with definitive host or indirectly by ingestion of eggs due to contaminated water and food resourses.

Presentation of Case: We present a 19 years old female with hydatid disease. The hydatid cyst fluid sent for cytology contain clear 5 ml of fluid. Microscopy of the centifuged deposits of hydatid fluid show few hooklets of Echinococcus granulosus along with red blood cells, lymphocytes and polymorphs in Background.

Conclusion: Fine needle aspiration cytology can be considered as a safe and effective modality for the diagnosis of hydatid cysts pre-operatively with the direct demonstration of hooklets, scolices with rostellum and calcified spherules. Clinicians and pathologist should be aware of the clinical and morphological spectrum of hydatid diseases respectively for immediate diagnosis followed by prompt management.

Keywords: Echinococcus Granulosus, Hydatidosis

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-81: METASTATIC SQUAMOUS CELL CARCINOMA PRESENTING AS BILATERAL PLEURAL EFFUSION: A RARE PRESENTATION

Gajendra Kumar Yadav ¹, Bhoomika Kaushik ¹, Pranoy Paul ¹, Arvind Kumar ¹, Ashok Singh ¹

Background: Oral cavity cancer is one of the leading causes of cancer related deaths in the world including India. Distant metastasis in pleural fluid is a much rarer phenomenon from oral cavity cancers. The route of spread of these tumours is hematogenous. Reported sensitivity and specificity of Computerised tomography(CT) scans in detecting malignancies in Cases of malignant pleural effusions is 36-51% and 88-100% respectively. Hence, in high suspicion of malignancy pleural fluid examination or biopsies are essential.

Case Report: A 54 year old male patient presented with a rapidly growing ulcerative lesion in the right buccal mucosa for a duration of 4 months. The specimen was sent for histopathological examination and diagnosed as moderately differentiated squamous cell carcinoma. Chemotherapy was initiated. Five months later the patient presented with bilateral pleural effusion. Pleural tap was done and a sample was sent to the Cytopathology lab for evaluation. Grossly the pleural fluid was yellowish in colour with turbidity. Cell block and cyto-spin smear was prepared and showed discrete large cells with pleomorphic nucleus, high nucleo-cytoplasmic ratio, coarse chromatin and prominent nucleoli. Immunocytochemistry was done on the cell block and the tumor cell showed nuclear positivity for p40 immuno-stain. The Case was Reported as metastatic Squamous cell carcinoma.

Conclusion: Cytopathology role as a minimally invasive technique in cancer diagnostics needs to be studied more thoroughly. It is helpful to take samples for cell block preparation along with smears as tumour immunomarker studies provide a useful aid when the cytological picture is doubtful.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-82: MUCOCELE OF APPENDIX WITH PSEUDOMYXOMA PERITONEI -A CASE REPORT WITH POORLY UNDERSTOOD CONDITION

Aiswarya Unnithan ¹, Supreetha ¹, ML Harendra Kumar ¹, Hemalatha A ¹

Introduction: Pseudomyxoma peritonei(PMP) is a rare, chronic, relapsing and diagnostically challenging. PMP originates in the appendix and ovaries mainly. Rokitansky first described the morphological entity Appendiceal mucocele which represents 0.3 to 0.7% of appendicular pathology.

Case Report: 62yrs male patient presented with chief complaints of pain abdomen and vomiting since 1week. Past 5yrs back he had underwent appendicular abscess driange on examination all vital organs normal except, on Per abdomen examination showed ascites with sluggish bowel sounds. Clinically made has acute intestinal obstruction secondary to post operative adhesions. Biochemistry revealed inflammatory parameters augmentation. CA19.9 and CEA were also increased. In USG heterogeneous hypoechoic poorly mobile fluid with septations. Ascitic fluid cytology showed abundant mucinous secretion with sparsely cellular showing suspicious cells. Later peritoneal deposites were sent for frozen which showed only acellular myxomatous tissue. Intraoperatively, dense adhesions seen deposits over liver surface, stomach, entire colon, small bowel mesentry, omentum and peritoeum, thus cytoreductive surgery was performed. On histopathology, abundant areas of mucinous secretion and mucinous glands with tall columnar cells having bland nuclei. Identified appendix, showing hyperplasia of mucosal glands with abundant secretions. A week later patient expired.

Conclusion: PMP is a locoregional disease of abdomen characterized by a mucocele that produces a progressive amount of mucinous ascites, which eventually bursts and Malignant cells are scattered in the peritoneal cavity.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-83: MARKED EOSINOPHILIA IN THE CEREBROSPINAL FLUID HOLDS CLUE TO THE DIAGNOSIS OF NEUROCYSTICERCOSIS: REPORT OF AN UNUSUAL CASE

Anchit Goel ¹, Anshu Gupta ¹

Background: Cytologic evaluation of the cellular composition of the CSF forms an integral part of the neurologist's armamentarium. A simple total and differential cell count provides important first information across a spectrum of pathologic conditions involving the central nervous system and its coverings. In our Case it was presence of eosinophils in the CSF which initiated work up and led to the diagnosis of cysticercal meningo-encephalitis.

Case Report: A sample of cerebrospinal fluid of a 28 years male patient who had presented with status epilepticus. Computed tomography had revealed right parieto - occipital gliosis and he was treated with ceftriaxone and sodium valproate. No response had been elicited. CSF showed eosinophilia with total leucocyte count of 240 cells/cumm comprising of 80% eosinophils. Investigation for parasitic etiology was insisted upon following which Magnetic Resonance Imaging (MRI)was done. It revealed diffuse cerebral atrophy with variable sized multiple, few ring enhancing lesion, few non-enhancing and calcified lesions in both cerebral hemispheres suggestive of neurocysticercosis(NCC). Treatment was modified with addition of dexamethasone to which patient responded effectively. Cysticercal meningoencephalitis has been Reported in less than 10% adults patients with NCC in India. Of the two large series of Indian children with NCC, only one Reported meningoencephalitis in 0.3%of the subjects.

Conclusion: A simple but careful cytologic examination of the CSF can play a major role in the evaluation of non responsive patients with status epilepticus. In our Case a very high eosinophila in the CSF led to the diagnosis of NCC and treatment modification.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-84: COMPARATIVE ANALYSIS OF LIQUID BASED CYTOLOGY AND CONVENTIONAL CYTOLOGY IN EFFUSIONS

Sumiti Gupta ¹, Sumiti Gupta ¹, Priyanka Rawat ¹, Reeti Saini ¹, Veena Gupta ¹, Nisha Marwah ¹, Rajnish Kalra ¹, Sunita Singh ¹

Background: The presence of fluid (>10ml) in serous cavities constitutes an effusion. Cytological examination of serous effusions is an important diagnostic modality. During the last decade, LBC emerged as an alternative to conventional cyto-preparatory Methods. Additionally it offered the strong diagnostic aid of the application of ancillary techniques on effusion cytology.

Methods: Present study was conducted in Department of Pathology, Pt. B. D. Sharma, PGIMS, Rohtak. A sample size of 100 effusions (mainly pleural and peritoneal effusions) were taken in the study. The samples were evaluated by both conventional and liquid based cytology and compared for cellularity, morphology, Background, inflammation, architecture and blood cells.

Results: In terms of cellularity, CS and LBC showed no significant statistical difference. LBC was superior to CS in providing clear Background (72% Cases), low blood cell (59% Cases), single layer architecture (81% Cases), moderate inflammatory cells (53% Cases) and good cytomorphology in maximum number of Cases (48%). In CS more blood cells (51% Cases), high inflammatory cells (50% Cases), proteinaceous Background (48% Cases), overlapped architecture (40% Cases), and good cytomorphology (19% Cases) were seen.

Conclusion: From this study, it is concluded that liquid based cytology is of great value for processing of effusion specimens. However, the LBC require familiarity and experience for the accurate interpretation and to avoid diagnostic pitfalls.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-85: FLOW CYTOMETRY OF EFFUSION FLUIDS

Anjali Mittal ¹, Pritika Kushwaha ¹, Meeta Singh ¹, Richa Gupta ¹, Shyama Jain ¹, Sarika Singh ¹

Background: The diagnostic evaluation of lymphoid proliferations in fluid specimens, including serous effusions and cerebrospinal fluids (CSFs), can be challenging to decide whether the lymphocytosis is purely reactive in nature or a presentation of an indolent lymphoma based on microscopy alone. As a Result, immunophenotypic analysis of fluid specimens by Flow Cytometry (FC) has emerged as a useful ancillary study in the diagnosis of lymphomas.

Methods: The study includes serous effusions specimens (pleural fluid and peritoneal fluid) and CSF specimens from four patients. For each Case, the clinical history, volume of material received, and final diagnostic interpretation on cytology smear were noted, and FC was performed. FC Results were classified as positive, that is, diagnostic for a hematopoietic neoplasm, which was further subclassified according to the latest WHO classification.

Results: Out of the total 4 Cases, 2 Cases were of pleural effusion, one Case of peritoneal effusion, and one CSF. FC findings of these Cases were as follows. Both the Cases of pleural effusion turned out to be T-LBL (T-Lymphoblastic Leukaemia). One Case of peritoneal effusion proved to be Burkitt's lymphoma. The CSF sample was positive for acute lymphoblastic leukaemia.

Conclusion: FC offers many advantages in terms of its application in body cavity fluids including immunophenotyping, and it has proven to be very useful both in the setting of known diseases and for new lymphoma/ leukemia diagnoses.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-86: A RARE OCCURRENCE OF LEISEGANG RINGS IN ASCITIC FLUID ASSOCIATED WITH BORDERLINE OVARIAN TUMOR

Akanksha Agrawal ¹, Kaniyappan Nambiyar ¹, Nadeem Tanveer ¹

Introduction: Liesegang rings are acellular, laminated structures which are known in the field of chemistry occurring as an in-vitro phenomenon. They characteristically have central amorphous cores which are surrounded by peripheral concentric layers with radial cross striations. Rarely, they may occur in-vivo in cystic, hemorrhagic, inflammatory, and necrotic tissue processes. There are very few Cases which have Reported these in histopathology. Their identification in cytology has been rarely Reported. To the best of our knowledge, liesegang rings have not been Reported in ascitic fluid in literature. In the present Case we describe liesegang rings in inflammatory ascitic fluid associated with borderline mucinous ovarian tumor.

Case Report: A 28 year old female presented with abdominal pain and distension along with breathlessness since ten days. On CT scan multiloculated mucinous cystic mass was identified in right ovary along with ascitis. Staging laparotomy with right salpingoophorectomy was done. Ascitic fluid was sent for cytology which revealed inflammatory cells along with liesegang rings in a proteinaceous Background. There were no atypical cells seen. The ovarian mass was histopathologically confirmed to be borderline ovarian mucinous tumor.

Conclusion: Liesegang rings can rarely occur in-vivo in body fluids and it is possible to identify them on cytology as well. It is important to know their morphology as they may mimic parasites, psammoma bodies, algae, non-specific calcification or extraneous material and cause a diagnostic dilemma.

Keywords: Liesegang rings, ascitic fluid, cytology, borderline ovarian mucinous tumor

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-87: A STUDY ON APPLICATION OF INTERNATIONAL SYSTEM FOR REPORTING SEROUS FLUID CYTOPATHOLOGY (ISRSFC) ON PLEURAL, PERITONEAL AND PERICARDIAL EFFUSION

Tanvi Aarora ¹, Priti ¹, Kamini SR ¹

Background: Effusion fluid is readily accessible cytopathology sample which helps in differentiating benign and malignant conditions. With the advent of recent International system for Reporting serous fluid cytopathology (ISRSFC), Reporting of pleural, peritoneal and pericardial fluids is expected to be more standardized and accurate. Hereby, we present the application of ISRFC to 165 pleural, peritoneal and pericardial fluid samples and their categorization as per the new Reporting system.

Material and Methods: We studied 165 Cases of pleural, peritoneal and pericardial effusion from January 2019 to present. Patient demographics, clinical history, radiological investigations (if any), nature & amount of sample received and diagnosis was studied and was categorized as per ISRSFC in non diagnostic (ND), Negative for malignancy (NFM), atypia of undetermined significance (AUS), suspicious for malignancy (SFM) and malignant (Mal).

Results: There were 165 subjects with age ranging from 4 days to 85 years (average 32). Of 165 Cases 86 were female & 79 male subjects. Maximum samples were of peritoneal (97) followed by pleural (64) and pericardial fluid (4). As per ISRSFC, most common category Reported was negative for malignancy(80%). 9 Cases were clearly malignant. There were 10 Cases which were Reported as AUS or SFM. These slides were reviewed again to definitely categorise as per new system. 4 Cases fell in AUS category and 6 as SFM.

Conclusions: The ISRSFC is readily applicable system of Reporting fluid cytology. Also, it clearly layouts distinctive features of AUS and SFM categories as ROM is much higher in later.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-88: METASTATIC RHABDOMYOSARCOMA IN PLEURAL FLUID: A CASE REPORT

Sarah John ¹, Debasis Gochhait ¹, Neelaiah Siddaraju ¹

Background: Mesenchymal malignancies presenting with malignant effusions are extremely uncommon, constituting less than 1%, with a major bulk of them being small blue round cell tumors such as rhabdomyosarcoma and Ewing sarcoma detected in children and adolescents. Here, we Report a Case of rhabdomyosarcoma of the prostate in which malignant cells were detected in the pleural fluid.

Case Report: Case: A 17-year-old male presented with a history of breathlessness. Chest X-ray indicated a unilateral pleural effusion. Two years ago, he had presented with grade-III prostatic enlargement along with lower urinary tract symptoms. The core needle biopsy of the prostate had been Reported as embryonal rhabdomyosarcoma of the prostate. Subsequently, the patient had undergone chemotherapy and radiotherapy, followed by a radical prostatectomy. Pleural fluid was sent for cytological evaluation.

Cytological findings: Pleural fluid smears revealed many dyscohesive tumour cells exhibiting moderate nuclear pleomorphism with some of them exhibiting variable amount of dense cyanophilic (Papanicolaou) and basophilic cytoplasm (May-Grunwald-Geimsa). These cytomorphological features with the available clinical details prompted the use of immunocytocytochemistry (ICC) for Myo-D1, which confirmed the involvement of pleural cavity by rhabdomyosarcoma of the prostate.

Conclusions: The present Case highlights the importance of attention to the clinical and certain subtle cytomorphological details in the diagnosis of uncommon sarcomas such as rhabdomyosarcoma metastasizing to serous body fluid cavities. ICC immensely contributes to the precise diagnosis.

Keywords: pleural fluid, rhabdomyosarcoma, prostate, immunocytochemistry.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-89: DIAGNOSITIC CYTOLOGICAL APPROACH FOR INCEPTIVE ANONYMOUS MASSIVE RIGHT SIDED HAEMORRHAGIC PLEURAL EFFUSION

Maryam Fatima ¹

Pleural effusion as a consequence of acute pancreatitis is transient, usually left-sided; straw colored and accounts for 1% of all the Cases. Rarely, it may be right-sided and hemorrhagic causing difficulty in establishing the diagnosis, especially if the chest symptoms are disproportionately more than the abdominal symptoms. We present a Case Report of alcoholic male patients with a history of inadequately treated tuberculosis, diagnosed with right sided pleural effusion and was symptomatic for 1 week during hospital admission. Evaluation of pleural fluid revealed hemorrhagic,inflammatory cell rich exudate,high Adenosine Deaminase (ADA), amylase and lipase levels in serum and pleural fluid. His serum amylase level prompted us to make a clinical diagnosis of pancreatic pleural effusion. Further investigations confirmed the diagnosis of acute pancreatitis. Early pleural fluid amylase along with cytology will certainly avoid a delay in the timely diagnosis

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-90: MALIGNANT MELANOMA EFFUSION CYTOLOGY, SINGLE CELL PATTERN OF INFILTRATION, AN AGGRESSIVE DIAGNOSTIC DILEMMA. IS CELL BLOCK A SAVIOUR?

Salma Ferosh Usman Khan ¹, Sandeep Mathur ¹, Venkateswaran K Iyer ¹

Introduction: Malignant melanoma is an aggressive neoplasm known for multitude of pliable morphology and hence the dilemma, with broad differentials of adenocarcinoma, mesothelioma etc. Secondary metastatic pleural melanoma is rare and usually occurs in pulmonary metastasis. Only 2% of melanoma patients with intrathoracic metastasis develop malignant pleural effusion. Single cell pattern on effusion cytology in such Cases is a diagnostic challenge. We discuss the role of cell block over conventional cytology in a Case of malignant melanoma presenting now with malignant pleural and peritoneal effusion.

Case description: A 28-year-old female presented with adnexal mass and right axillary swelling; core biopsy sent was suggestive of a malignant melanoma. 5 months later she presented with pleural and peritoneal effusion. Peritoneal fluid cytology smears were highly cellular comprising predominantly of single scattered cells. In contrast to typical malignant melanoma effusion, these cells lacked the typical highly pleomorphic cellular features, had scant to moderate amount of cytoplasm and occasional multinucleation. To differentiate them from reactive mesothelial cells was particularly difficult. The cytocentrifuge smears from pleural fluid showed similar morphology. Immunohistochemical studies on cell blocks revealed tumour cells immunopositive for HMB-45 and Melan A.

Conclusion: Patients of malignant melanoma presenting with pleural and peritoneal effusion are uncommon in Indian population. In Cases with ambiguous morphological features like single cell pattern, bland cellular morphology or in amelanotic melanomas, good clinical correlation is a must. Advantage of using cell block over conventional cytology smears for confirming the diagnosis is also highlighted in this Case.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-91: TUBERCULOSIS AND HUMAN PAPILLOMAVIRUS CO-INFECTION DIAGNOSED BY CONVENTIONAL PAP'S SMEAR-A RARE CASE REPORT

Anju Khairwa ¹

Background: Tubercular infection is prevalent in India. It can affect any organ system in the body and can exist without any clinical manifestation. It rarely infects the cervix. Human papillomavirus (HPV) is a common causative agent of genital tract malignancy, especially of cervical cancer. Many factors may predispose to HPV infection.

Case Report: We present a rare case of cervical tuberculosis with co-infection by HPV in the form of a low-grade squamous intraepithelial lesion; both were diagnosed solely by conventional Pap smear. There was no clinical suspicious of tuberculosis infection. HPV infection confirmed by HPV DNA Polymerase chain reaction (PCR) testing and tuberculosis confirmed by ZN (Ziehl-Neelsen) stain.

Conclusion: Hanse, conventional Pap's smears help make a concurrent diagnosis of cervical tuberculosis and HPV infection.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-92: CYTOPATHOLOGICAL PATTERN OF CERVICAL PAP SMEAR.

Nirali Patel ¹, Viral Bhanvadia ¹

Background &Objectives: Cancer of the cervix is an increasing health problem and an important cause of mortality in women worldwide. Papanicolaou smear study is a simple and cost effective screening test for cervical cancer. The objective of the study is to evaluate the use of the Pap smear screening Method for detection of neoplastic and non-neoplastic lesions of cervix.

MethodOLOGY: The retrospective study was carried out at Cytopathology section of Pathology department, B.J. Medical college. • The patients were in the age range 17-70 years, having complaints like vaginal discharge,bleeding per vagina and pain. • Smears were taken by Ayres wooden spatula. Slides were screened and Reported by Cytopathologists according to The Bethesda system,2014.

Result: • Total 187 patients were screened. Most women were in the age range of 30–50 years and Multiparous. • There were 111 (59.35%) abnormal Pap smears, with 68 (36.36%) normal Cases and 8 (4.27%) unsatisfactory or inadequate samples. Total 7 (3.7%) Cases showed epithelial cell abnormalities. Atypical squamous cells of undetermined significance (ASCUS) was the most commonly found (62.5%) epithelial cell abnormality.

Conclusion: • This study emphasized the importance of Pap smears screening for early detection of premalignant and malignant lesions of cervix. • Incidence of invasive cervical malignancy can be prevented if pap screening program is effectively implemented in target population.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-93: UTILITY OF PAP SMEAR AS AN EFFECTIVE TOOL FOR CERVICAL SCREENING CYTOLOGY – OUR INSTITUTIONAL EXPERIENCE

Heer Dabhi ¹, Komal Patel ¹, RN Hathila ¹, Prashant Patel ¹, Archana Patel ¹

Background: Carcinoma cervix is the 2nd most common cancer in females in the world, while it is the leading cause of morbidity and mortality in developing countries like India. It is estimated that in India 1,22,844 new Cases occurs each year due to lack of proper screening facilities or lack of awareness. Cervical cytology by PAP is an effective means of screening as carcinoma cervix is a preventable disease due to long preinvasive stage, early detection and treatment. Objective of our study is to study the frequency of various inflammatory and epithelial abnormalities in a female, to study premalignant and malignant lesions in relation to age, parity, presenting complaint, per speculum examination and histological correlation whenever possible.

Material and Method: This is a retrospective study of 744 cervical smears, screened by conventional PAP smear Method and Reported based on Bethesda system 2014, at our institute over a period of 8 months(January- August,2021).

Result: In this study, age of women ranged from 18 to 87 years, prominent complaints among the participants was abdominal pain. Out of 744 smears, (10.48%) was found to be unsatisfactory, NILM (88.57%), ASCUS (0.53%), LSIL (0.13%), HSIL (0.13%) and Adenocarcinoma (0.13%). 25 PAP smears were followed by histological examination.

Conclusion: Cervical cytology is simple, noninvasive, cost effective and sensitive tool for early detection of premalignant and malignant lesions of cervix and helps the clinician in effective management of these Cases. It should be established as a routine screening procedure to reduce the treatment burden, morbidity and mortality.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-94: A STUDY OF PAP SMEAR EVALUATION AS A TOOL OF DIAGNOSTIC PREFERENCE – AN EVIDENCE-BASED STUDY

R Ratna ¹, G Lavanya ¹, C Sujatha ¹, G Sai Chandana ¹, B V Sai Prasad ¹, A Venkatalakshmi ¹

Background: Cervical cancer is the leading cause of morbidity and mortality in India. Screening with regular Pap smears allows the diagnosis of treatable pre-invasive lesions. The main aim of the study is to evaluate cervical pap smear as a diagnostic tool by classifying according to the Bethesda terminology and histopathological correlation.

Methods: All the Pap smears were retrospectively studied for a period of 6months from March 2021 to August 2021in the department of Pathology of a tertiary care hospital. Detailed clinical history of patients was obtained from the requisition forms received in the cytology section along with pap smears

Results: A total of 312 Pap smears were screened. Most of the screened patients were in the age group of 41-50 years. Out of 312 smears, NILM comprised 74.03%, ASCUS comprised 2.56%, ASC-H comprised 2.56%, LSIL comprised 3.52%, HSIL comprised 9.61%, Atrophic cervical smears comprised 1.6%, squamous cell carcinoma comprised 1.6%. Inadequate smears comprised 1.92%. The cytology-Histopathology correlation was possible in 112 Cases. Sensitivity, specificity, PPV, NPV and diagnostic accuracy was 75.75%, 98.73%, 96.15%, 90.69% and 91.90% respectively.

Conclusion: Pap smear test is a simple, safe, sensitive, and cost-effective modality for screening cervical lesions. The correlation of Pap smear cytology with gold standard histological findings reveals excellent diagnostic parameters, implying the greater efficacy of cervical Pap smears.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-95: CERVICAL CYTOLOGY AND HISTOLOGY CORRELATION AS A QUALITY ASSURANCE EXERCISE IN A TERTIARY CARE SETTING

Shubhangi V Belekar ¹, MM Kamal ¹, D Aishwarya Warke ¹, Rutuja Fuke ¹, Monika Singh ¹, DT Kumbhalkar ¹

Background: Quality assurance is a requirement for cervical cytology Reports which has to be done by regular longitudinal monitoring. Quality standard indicators for cervical cancer screening using Pap smear are adequacy of smear, proportion of HSIL,LSIL and ASC/SIL ratio and cytology-histology correlation (CHC).

Methods: This is a retrospective diagnostic test study. 6000 Pap smears were Reported between 2018-2020. 150 Cases with epithelial abnormalities had histopathology correlation as colposcopic directed punch biopsies(CDB). These included 39 Cases in whom LEEP was done.CHC and other quality indicators were evaluated.

Result: 3% smears were unsatisfactory for evaluation. Cases diagnosed as ASC, AGC,LSIL,HSIL,SCC were1.4%, 0.56%, 0.3%, 0.22%, 0.24% respectively. ASC/SIL ratio was 2.7:1. Sensitivity, specificity, PPV and NPV for Pap smear using CDB Reports was 94.87%, 6.31%, 26.24%, 77.78% respectively. The sensitivity and specificity of Pap smear was found to be more with high grade lesions as compared to low grade lesions. Sensitivity of Pap smear when biopsies were obtained by LEEP was 94.59%.

Conclusion: Quality assurance indicators in our laboratory were within the threshold values. CHC was good whether the biopsy was punch or LEEP. Low specificity in our study could have been improved if HPV testing had been done in patients Reported as ASC-US

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-96: ROLE OF FNAC IN DIAGNOSING MUCINOUS NEOPLASMS OF OVARY

Purnima Shree ¹, Reecha Singh ¹, Anuja Singh ¹, Anju Singh ¹

Background: The spectrum of mucinous tumors of ovary includes entities like mucinous cystadenoma, pseudomyxoma peritonei, mucinous tumors of low malignant potential and invasive mucinous ovarian carcinoma. Only 10- 15% of benign ovarian neoplasms are mucinous cytadenomas, while recent estimations show mucinous ovarian carcinoma (MOC) was believed to constitute only 3% of the ovarian malignancy. Though histopathology remains the gold standard there is no denying the fact that cytology has never been fully exploited as a modality for the diagnosis of ovarian tumours. Image-guided aspiration proves to an efficient Method for the pre-surgical diagnosis and avoiding unnecessary surgery.

Case Report: Here in we Report 3 Cases. 45 yrs female, cytology showed mildly atypical cluster of cells in a mucinous Background, diagnosis of mucin secreting epithelial neoplasm was made. Next, 33 years female and diagnosis of Benign mucinous neoplasm possibly mucinous cystadenoma was made on cytology. Third Case cytology smears of 60 years female showed cells with moderately pleomorphic nuclei in a mucinous Background, a diagnosis of Mucin secreting adenocarcinoma was made.

Conclusion: FNAC proves of great value in classification of ovarian tumors and there by deciding help in the early preoperative choice of therapy and to plan further management.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-97: A RETROSPECTIVE STUDY OF PAPANICOLAOU SMEAR AND CERVICAL BIOPSY CORRELATION IN ABNORMAL CERVICAL CYTOLOGY CASES

Sagar Soman ¹, D K Raman ¹, Jeenu Varghese ¹

Introduction: Cancer cervix is a global health problem and Pap smear is an important screening tool, which has proven to be highly effective in reducing the number of Cases and the mortality from cervical carcinoma. Any abnormality detected in Pap smear has to be confirmed with cervical biopsy, which is the gold standard for diagnosing the lesions of the cervix.

Objectives: To study the prevalence of abnormal cervical cytology Cases detected by Pap smear testing in our setting, to find the distribution of cytologically abnormal Cases and also the concordance and discordance between Pap smear and cervix biopsy in cytologically abnormal Cases to assess the sensitivity of Pap smear in detecting the intraepithelial lesions / malignancy of cervix.

Materials and Methods: A Retrospective descriptive study included all the abnormal cervical cytology Cases and their cervix biopsies, for 1 year from Jan 2019-dec 2019. The cytologically abnormal Cases were listed based on Bethesda system for Reporting cervical cytology (2014) as ASC-US, ASC-H, HSIL, LSIL and a thorough search was made for their cervix biopsy. The histopathological diagnosis of the corresponding cervix biopsies (if done) was also listed and compared for concordance.

Results: There were totally 1700 Cases of Pap smear done during the study period and there were 35 cytologically abnormal Cases. Histopathology Reports of the cervix biopsy were available for 30% (15) Cases. Out of the 15 Cases, 86.6% (13) Cases were concordant.

Conclusion: Our study revealed a good correlation between Pap smear and cervix biopsy.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-98: A HOSPITAL BASED CERVICAL PAP SMEAR STUDY IN DISTRICT PATHANKOT.

Nidhi Gupta ¹, Aman Jyoti ¹

Introduction: Cancer of uterine cervix is a leading cause of mortality and morbidity among women world- wide. In developing countries it is the most common gynecological cancer and one of the leading causes of cancer death among women. The study was conducted to explore various lesions of Uterine cervix, to find out target age group in which screening efforts can be concentrated for early detection as well as reduction of the incidence of cervical cancer, in our set up.

Material & Methods: Patients in the age group 15-70 years with various complaints like vaginal discharge, bleeding per vagina or something coming out per vagina were screened during March,2021 to August, 2021. Total 120 patients were studied. Slides were fixed in 95% ethyl alcohol and stained with Pap stain. Slides were Reported according to The 2014 Bethesda System.

Results: Out of 120 pap smears studied, the Results are divided into inflammatory smear, metaplasia, smears with no remarkable pathology, atrophic smears, infections and other premalignant and malignant lesions. Premalignant lesions were present most commonly in 31-40 year of age group. Malignant lesions were present equally in 31-40 and 51-60 year age group. Infections were present mostly in 41-50 year age group.

Conclusion: Pap smear examination is widely accepted screening Method that is easily available within existing resources to a large section of society, it should begin at 30 years and subsequently followed with HPV-DNA testing at higher centres.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-99: CYTOMORPHOLOGICAL TYPES OF CERVICAL PAPANICOLAOU SMEAR ON ROUTINE CYTOLOGY-AN INSTITUTIONAL EXPERIENCE

Manjit Kaur Rana ¹, Laja Devi Goyal ¹, Amrit Pal Singh Rana ¹

Background: Cervical cytology is a cost effective measure to estimate the hidden disease burden of gynecological abnormalities on routine checkup.

Methods: A prospective analysis on conventional cervical cytology smears was carried out in 387 smears received in the department of pathology. Smears were Reported as per Bethesda System 2014. Findings were correlated with clinical features.

Results: Chief complaints were found to be white discharge per vaginum (WDPV) (20.7%) as most common presentation followed by pain abdomen (12.9%). Per speculum examination showed WDPV 20.7% followed by instrumental bleeding (IB) 10.2%. Cervical smears were Negative for intraepithelial Lesion or Malignancy (38.7%) followed by dense inflammation (27%), categorized as Unsatisfactory for evaluation, specific infections (10.1%), atrophic vaginitis (3.6%), squamous metaplasia in 0.1%, and inflammatory reactive changes in endocervical cells (7.2%) seen associated with IB. Squamous cell abnormalities was seen in 6.0 % (Atypical Squamous Cells of Undetermined Significance (ASC-US) and Atypical squamous cell- cannot rule out HSIL (ASC-H) in 1.5% each Case). Whereas Low grade Squamous Intraepithelial Lesion (LSIL) (2.3%), High grade Squamous Intraepithelial Lesion (HSIL) (0.7%) Squamous Cell Carcinoma (SCC) (0.2%) and recurrence was recorded in 0.7% of the Cases. Atypical Glandular Cells (AGC) was comprised of 5.4% of the total Cases.

Conclusion: Our findings were more or less similar with the Results of studies done, however little rise in the prevalence of AGCs was noticed and also IB was also seen more commonly in reactive lesions.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-100: STUDY OF CERVICAL PAP SMEAR IN A TERTIARY CARE HOSPITAL

Yarlagadda Dharmatej ¹, M Ruth Prasanna ¹

Background: Cervical carcinoma is a common malignancy of women and accounts for 6-29% of all carcinomas in India. Papanicolaou smear remains an effective Method for screening cervical carcinoma. The aim is to study morphological patterns of cervical lesions in pap smears in a tertiary care hospital predominantly catering to rural population.

Methods: This is a 2-year retrospective study conducted in a tertiary care hospital. Cervical smears received in the pathology laboratory were stained with Papanicolaou stain. These smears were examined, morphological findings noted. Clinical findings were recorded from request forms.

Results: A total of 650 cervical pap smears were examined and findings were Reported as per Bethesda system for Reporting cervical cytology. NILM (Negative for intraepithelial lesion or malignancy) Cases account for 90% of Cases and epithelial abnormalities accounted for 6.4% of Cases. Among the non-neoplastic conditions 70% were inflammatory smears, Bacterial vaginosis and Candida infections constituted 11% and 3.6% of Cases respectively. Among the epithelial abnormalities ASCUS, ASC-H, LSIL, HSIL and squamous cell carcinoma accounted for 3.2%, 1.7%, 0.3%, 1.0% and 0.1% of the Cases respectively. Inadequate smears accounted for 2% of the Cases.

Conclusions: The Results indicate that non neoplastic conditions of the cervix were more common among the patients presenting to our hospital. Though incidence of epithelial abnormalities were low these patients were either evaluated further to rule out invasive malignancy or followed-up. Pap smear can be used as a routine screening procedure to lower the incidence of invasive malignancy and thus reducing the morbidity and mortality.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-101: A RARE GYNAEOLOGICAL IMPLICATION WHEN COVID19 JOIN HANDS WITH AN IMMUNOCOMPROMIZED HOST

Priya Jain ¹, Mayank Jain ¹, Mansi Chandna ¹, Ashok Sharma ¹

Coronavirus 2019 is mainly considered a respiratory tract infection which is responsible for severe acute respiratory syndrome. Kidney transplant recipients may be at a uniquely increased risk of serious complications from COVID-19 as compared to the general population because of a chronically immunosuppressed state. various complications arising in these patients include CMV, HSV, EBV infections. This immunosupressed host may present with many complications, but genital manifestations are rare. Our Case is rare as our 30 year old female patient presented with genital herpes as the first complication after recovering from covid infection. The patient presented with painful vulval ulcers involving the anus as well. This patient underwent kidney transplant 1year back and was on regular medication. The diagnosis was made on the basis of cytological as well as histological morphology which was later confirmed by serology. Current literature is sparse on the outcomes and appropriate management of COVID-19 in KTR. tremendous strides have been made in treatment strategies and vaccinations, the impact of these in transplant recipients may be attenuated in the setting of their immunosuppression.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-102: HIGH-GRADE SQUAMOUS INTRAEPITHELIAL LESION (HSIL) IN CERVICAL SMEARS: AN AUDIT OF 12 YEARS FOR REASONS OF UNDERCALLS IN CYTOLOGY

Ruchika Gupta ¹, Shalini Singh ¹, Sanjay Gupta ¹

Background: Conventional cytology is still practiced at many centers in resource-limited countries. The inherent technical limitations coupled with lack of trained pathologists compromises the sensitivity of conventional cytology to detect high-grade squamous intraepithelial (HSIL). This study was aimed at elucidating the diagnostic pitfalls leading to an undercall of HSIL in conventional cervical smears.

Methods: A retrospective review was undertaken for all cervical biopsies Reported as CIN2/3 with their corresponding satisfactory cervical smears over a 12-year period. In these Cases, the cervical biopsy was concurrent or after the cervical smear within a six-month interval. Cases with smear Report of ASC-H/ HSIL were considered as concordant while those with smear Reported as NILM, ASC-US or LSIL were taken to be undercalls on cytology. Such Cases were reviewed by two expert cytopathologists and the reason for the discordance was elucidated.

Results: Among the 175 biopsies of CIN2/3, 36 (20.57%) had a diagnosis of less than ASC-H/ HSIL on the cervical smear. On review, 22 (61.1%) were reclassified as ASC-H/ HSIL. The most frequent reasons for this discordance in the 22 Cases were smears with predominant LSIL morphology and only scattered HSIL cells and the Cases with small HSIL cells in an atrophic Background.

Conclusion: There is a need for cytopathologists to be aware of the confounding morphologic features in conventional cervical smears to avoid an undercall of HSIL and to ensure timely management of a high-grade lesion. Cervical smears need to be thoroughly evaluated to avoid screening and interpretative errors.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-103: CERVICAL CYTOLOGY IN THE DETECTION OF UTERINE CLEAR CELL CARCINOMA: SIGNIFICANT DIAGNOSTIC PREDICTORS FROM A CASE-CONTROL STUDY

Parikshaa Gupta ¹, Nalini Gupta ¹, Pranab Dey ¹, Rashmi Bagga ¹, Vanita Jain ¹, Vanita Suri ¹

Background: Uterine clear cell adenocarcinoma(CCC) is a rare aggressive malignancy with poor prognosis. In cervical samples, the tumor cells from uterine CCC may mimic those seen in endometrial serous carcinoma(ESC), endometrial endometrioid adenocarcinoma(EEA) or endocervical adenocarcinoma(ECA). A precise distinction is important owing to the therapeutic and prognostic differences. The present study was conducted to identify the characteristic morphologic features of uterine CCC in cervical cytology.

Methods: This was a 3-year retrospective Case-control study. Cervical samples of women with histopathologically-proven endometrial and cervical CCC were included as Cases. Controls included cervical samples from histopathologically-proven ESC(n=15), EEA(n=20) and ECA(n=15). 28 cytomorphologic features were evaluated; the strength of association was determined by odds ratio(OR) and Cramer's V. Diagnostic accuracy of statistically significant features was also determined.

Results: Of a total of 72 CCCs of the female genital tract, Reported on histopathology, corresponding cervical samples were available for a total of 14(36.8%) patients, of which, 13(92.8%) were found to be positive for epithelial cell abnormality. On univariate analysis, 3/28 cytomorphologic variables were significant predictors of uterine CCC, viz. presence of dense cytoplasm(OR=88;V=0.72), deep nuclear membrane irregularities(OR=17.5;V=0.55) and coarse chromatin(OR=21.3;V=0.46). The presence of dense cytoplasm had the highest positive predictive value(92%) and specificity(97.8%), whereas coarse chromatin had the highest sensitivity(92.3%) and negative predictive value(96.7%).

Conclusions: The presence of dense cytoplasm and deep nuclear membrane irregularities in the exfoliated tumor cells were the strongest predictors and the presence of coarse chromatin, a moderate predictor of uterine CCC, compared to its close cytologic mimics.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-104: COMPARISON OF LIQUID BASED CYTOLOGY AND CONVENTIONAL PAP IN TERMS OF DIAGNOSTIC CATEGORIES : PRE MALIGNANT LESIONS

Sruthi Pallekonda ¹, Divya Jothi ¹, Lalrinzuali Sailo ¹, Shilpi Agarwal ¹

Background: Cervical cancer is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women, with an estimated 604,000 new Cases and 342,000 deaths worldwide in 2020. It is preceded by squamous intraepithelial lesions which can be detected by PAP smears and hence a comparison between CPS and LBC is warranted.

Methods: Twenty four hundred patients attending Gynaecology OPD with complains of vaginal discharge, vaginal bleeding etc. between November 2016 to November 2019 were included in the study. CPS and LBC using Surepath and stained using Papanicolaou stain. Cytomorphological features were interpreted as per Bethesda system of classification 2014.

Results: AS-CUS was detected in 0.5% (12/2400) CPS and 0.5% (12/2400) LBCs; ASC-H in 0.3% (8/2400) CPS and 0.16% (4/2400) LBCs; LSIL in 0.3% (8/2400) CPS and 0.25% (6/2400) LBCs; HSIL in 1% (22/2400) CPS and 1% (22/2400) LBCs; AGC-NOS in 0.16% (4/24000) CPS and 0.16% (4/2400) LBCs; AGC-N in 0.08% (2/2400) CPS and 0.08% (2/2400) LBCs.

Conclusion: The rate of epithelial cell abnormalities detection was 4.47% on CPS as compared to 3.6% on LBC. There was no statistically significant difference between CPS and LBC in detecting epithelial cell abnormalities. (p=0.98). In the Indian scenario with lower resources availability, CPS is a good alternative to LBC.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-105: COMPARISON OF LIQUID BASED CYTOLOGY(LBC) AND CONVENTIONAL PAP SMEARS (CPS) IN TERMS OF DIAGNOSTIC CATEGORIES : INFECTIONS

Sruthi Pallekonda ¹, Divya Jothi ¹, Lalrinzuali Sailo ¹, Shilpi Agarwal ¹

Background: Vaginal infections continue to be a major health issue in developing countries. The suitability of Papanicolaou Smear for detecting vaginal infections has been under the scanner.(1)

Methods: Twenty four hundred patients attending Gynaecology OPD with complains of vaginal discharge, vaginal bleeding etc. between November 2016 to November 2019 were included in the study. CPS and LBC using Surepath and stained using Papanicolaou stain. Cytomorphological features were interpreted as per Bethesda system of classification 2014.

Results: Organisms were present in 10.7%(216/2400) CPS and 8.9% (200/2400) LBC. Among the 216 CPS, Bacterial Vaginosis(BV), Candida and Trichomonas were detected in 41.7%, 54.6% and 3.7 % respectively. Among the 200 LBC's, BV, Candida and Trichomonas were detected in 49%, 50% and 1 % respectively.

Conclusion: Organisms were detected more often in CPS than LBC but was not statistically significant (p=0.56). The most common organism Reported was candida species followed by BV. Candida was more picked up on CPS whereas BV was more detected in LBC. The difference between the detection rates of Candida (p=0.377), BV(p=0.67), Trichomonas (0.179) in CPS and LBC were not statistically significant. As it is the most cost effective modality of investigation for cervical pathology, the suitability of Papanicolaou Smear for the detection of the common vaginal infections should be determined.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-106: STEROID CELL TUMOR OF THE OVARY-A CYTOLOGICAL DIAGNOSIS WITH HISTOPATHOLOGICAL CORRELATION

Mona Dhillon ¹, Anupama Arya ¹, Bhavna Bansal ¹, Nishu Bhardwaj ¹, Dilip Kumar ¹

Background: Steroid cell tumor(SCT) is a rare sex cord stromal tumor accounting for less than 0.1% of all ovarian neoplasms. It can present at any age with virilization and amenorrhoea being chief complaints in most of the Cases due to androgen excess. Three categories have been described viz. Stromal luteoma,Leydig cell tumor and SCT-Not otherwise specified (NOS) [Most common type].

Case Report: Here we Report a Case of steroid cell tumor in a 23 year old female who presented with irregular menstrual cycles for the past 4 months. An ultrasound pelvis revealed a left ovarian space occupying lesion measuring 6x4 cm- likely a benign cyst. A subsequent Magnetic Resonance Imaging(MRI) revealed a heterogeneously hyperintense lesion involving the broad ligament?Broad ligament fibroid with degeneration ?? Simple cyst rupture. Patient was planned for laparoscopic left ovarian cystectomy. The specimen was sent for frozen section. On cytology imprint smears a diagnosis of SCT was suggested which was later confirmed by histopathological examination and Immunohistochemistry (IHC).

Conclusion: SCT although rare should be kept in differential diagnosis of any ovarian neoplasm in young females. Cytology plays an important role in early diagnosis and Management of such neoplasms.

Keywords: Sex cord stromal tumor, Steroid cell tumor, Ovary

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-107: THE RELEVANCE OF CERVICAL PAPANICOLAOU TEST IN THE DIAGNOSIS OF ENDOMETRIAL CARCINOMA- A CASE REPORT WITH BRIEF REVIEW OF LITERATURE

Swati Sharma ¹, Manna Valiathan ¹

Background: Endometrial carcinoma (EC) is the most common gynecologic malignancy and accounts for 6% of all cancers in women. Similar to cervical cancer, early detection of EC is important for clinical management. However, there is no cost-effective screening tool currently. Few retrospective studies have shown abnormal cytologic findings in 31.9-89.6% of Cases of EC with prior Papanicolaou (Pap) tests.

Case Report: 54 year old female, P2L2 came with pain abdomen and menorrhagia since 2 and 1 month respectively. There was no associated fever/ vomiting/ burning micturition. O/E, cervix was healthy. Per vaginal examination revealed uterus 6 weeks, b/l fornices were non tender and free. No h/o loss of weight/ appetite. Cervical Pap smear showed Atypical glandular cells favoring neoplastic endometrial origin. Endometrial biopsy/ curettage was advised. Radiology showed altered signal intensity lesion of the endometrium involving the body of the uterus s/o EC. Endometrial biopsy showed Endometrioid adenocarcinoma following which total abdominal hysterectomy with bilateral salpingo-oopherectomy along with lymph node dissection was performed. Patient was advised adjuvant radiotherapy 50 Gy/25#/ 5 weeks. Presently patient is receiving treatment.

Conclusion: The value of the Pap test for the detection of endometrial cancer on a large scale is undetermined. However, factors, such as non-endometrioid histology and a higher histological stage are correlated with a higher sensitivity. It is difficult to evaluate whether abnormal Pap usually precedes clinical symptoms of EC to consider it as an effective screening tool. However, the importance of further diagnostic evaluation in patients with atypical endometrial cells in Pap smear, especially with abnormal vaginal bleeding is unquestionable.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-108: DIAGNOSTIC ACCURACY OF FINE NEEDLE ASPIRATION CYTOLOGY IN OVARIAN NEOPLASMS

Mehar Ghuman ¹, Pavneet Kaur Selhi ¹, Ankita Soni ¹, Harpreet Kaur ¹

Introduction: Ovarian cancer is the sixth most common cancer and seventh leading cause of cancer deaths in females with malignant surface epithelial tumours being the commonest histological subtype. The aim is to assess the efficacy of fine needle aspiration cytology (FNAC) in the diagnosis of ovarian neoplasms. Here presented are 21 Cases of ovarian masses in which both FNAC and core needle biopsy (CNB) was done and later IHC was done in 10

Cases Aim: To assess the diagnostic accuracy of aspiration cytology in ovarian neoplasms.

Materials and Methods: Patients with ovarian masses who were subjected to image guided FNAC over a period of 8 months (1st January 2021 to 31st August 2021) at DMCH, Ludhiana were included in the study.

Result: A total of 21 Cases of ovarian neoplasms underwent image guided FNAC during the study period. The age ranged from 15 to 83 years with a median age of 47, 17 Cases were diagnosed as malignant both in cytology and histopathology, and of these 10 Cases were subjected to IHC. Of the remaining, 3 Cases were Reported as malignant neoplasms on cytology and inconclusive on histopathology due to inadequate material. 1 Case was Reported as inconclusive on both cytology and histopathology.

Conclusion: FNAC is fairly useful in diagnosis of ovarian lesions and helps to stratify them in the malignant category with a diagnostic accuracy of 95.2 %. Possibility of multiple passes and rapid onsite evaluation reduces the chances of insufficient cellularity as a hindrance to diagnosis. However, the limitation of immune profiling remains. Hence, FNAC and CNB are complementary procedures and if planned together lead to quick diagnosis and an accurate one.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-109: A COMPARATIVE STUDY OF CELL BLOCK VERSUS BIOPSY FOR TESTING OF PROGRAMMED DEATH LIGAND-1 IN ADENOCARCINOMA LUNG

Saumya Shukla ¹, Rahul Kumar Pandey ¹, Anurag Gupta ¹, Vani Gupta ¹, Suryakant Tripathi ², Nuzhat Husain ¹

Introduction: Immunotherapy currently stands as a novel treatment option specifically in Cases of advanced non small cell lung carcinoma (NSCLC). Expression of programmed death ligand-1 (PD-L1) in tumour cells forms the mainstay for the use of anti-PD-L1 monoclonal antibodies in the treatment of NSCLC.

Aims AND Objectives: The Objectives of the study were to assess utility of cell blocks for testing of PD-L1 in adenocarcinoma lung and to compare the expression of PD-L1 in cell blocks and the corresponding biopsy specimens.

Materials and Methods: The current study was a prospective Case series that included 20 Cases of NSCLC-adenocarcinoma lung. Cases included in the study had biopsies performed from lung masses along with which cell blocks were prepared from fine needle aspiration cytology (FNAC) samples. Testing for PD-L1 was done using the monoclonal PD-L1 antibody, SP-263 clone on the Ventana Benchmark XT system. PD-L1 expression was assessed only in the tumour cells and Cases with >1% expression cytoplasmic or membranous in tumour cells were categorized as positive.

Results: PD-L1 expression was identified in the biopsy samples in 20% Cases (n=4/20) in the tumour cells. In the corresponding cell blocks PD-L1 expression was identified in 15% Cases in the tumour cells (n=3/20). Sensitivity and specificity of cell blocks was 75% and 100% respectively. Positive and negative predictive values were 100% and 94.12% respectively.

Conclusion: PD-L1 testing has both predictive and prognostic implications. PD-L1 testing in cell block samples is a potential alternative specifically in Cases where biopsy tissue is minimal or unavailable.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-110: COMPARISON OF DNA QUANTITY AND QUALITY OF FINE NEEDLE ASPIRATION AND CORE NEEDLE BIOPSY SPECIMEN

Shikha Mudgal ¹, Pranoy Paul ¹, Shalinee Rao ¹, Nilotpal Chowdhury ¹

Background: FNAC smear may serve as a convenient sample for DNA extraction for molecular pathology.

Aim: To examine whether the DNA extracted from Cytology smears may be used as a replacement of DNA extracted from core biopsies.

Method: DNA was extracted from 10 core biopsies and 10 FNAC smears. The DNA was quantify using the fluorimeter, UV- BIS spectrophotometer in all Cases.

Results: The quantity of DNA extracted form FNAC smears were higher that of core biopsy according to fluorometry (mean DNA of Core biopsy = 1.75ng/μl, of FNAC = 4.73ng/μls).

Conclusion: DNA extracted from FNAC slides are comparable to that from core biopsies.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-111: A 2-YEAR AUDIT OF THE CONTRIBUTION OF CYTOLOGY SAMPLES IN LUNG CANCER PREDICTIVE BIOMARKER TESTING IN A TERTIARY CARE CENTRE: ARE WE UTILISING THEM ENOUGH?

Subiyathul Farah Ashraf K M ¹, Aruna Nambirajan ¹, Prabhat Singh Mallik ¹, Anant Mohan ¹, Deepali Jain ¹

Background: Predictive biomarker testing for EGFR/BRAF mutations, ALK/ROS1 rearrangements and PDL1 expression are the minimum mandated tests to be performed in all newly diagnosed non-small cell lung carcinoma patients presenting with advanced disease.

Aim: To audit the success rates of real time predictive biomarker testing for lung cancer on cytology samples

Methods:A retrospective search for all lung cancer predictive biomarker testing was performed in the department of pathology over the last 2 years. EGFR mutations are routinely analysed by PCR-based Methods, ALK and ROS1 rearrangements are analysed by immunochemistry confirmed by fluorescence-in-situ hybridisation wherever indicated, and PDL1 by immunochemistry. The type of preparation (smear, cell block, clot core) and the number of predictive biomarkers successfully performedwere analysed.

Results: Among 508 patient samples that were tested, 85 were cytology specimens (17%) comprising mainly of malignant pleural effusions (45%) followed by EBUS-TBNA aspirates (20%) and clot cores (12%). Testing was performed on the cell block preparations and non-CB preparations in near-equal proportions. EGFR was the commonest biomarker tested (in 83.5% samples) followed by ROS1 (61%), ALK (39%) and PDL1 (2%).

Conclusion: Although nearly 70% of all lung cancer patients undergo cytology sampling, cytology samples are underutilized for biomarker testing in real time. Simultaneous assessment of all matched cytology and histology samples received in a given patient is essential to ensure best utilization of all tumor tissue not only for the minimum mandated tests but also for additional gene panels that are required for clinical trial inclusion.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-112: STUDY OF IMAGE GUIDED FNAC OF LESIONS OF LIVER

Supriya Karmakar ¹, Vijay Bonde ¹, Nanda Patil ¹

Background: Accurate diagnosis of lesions of liver is important to proceed towards the precise management of the patient. A thorough clinical workup and correlation with other ancillary techniques like serum tumor markers is mandatory. Image guided FNAC of lesions of liver helps in rapid diagnosis, it shortens and avoids hospital admission and speeds patients route to appropriate specialist.

Methods: The present study was a two year prospective study of image guided FNAC of lesions of liver over a period of two year done in our department which includes 80 Cases. After taking consent, image guided FNAC of lesion of liver was performed. The smears were prepared and stained with hematoxylin and eosin as well as giemsa stain. Evaluation was done in the light of clinical history and other investigations like tumor markers.

Results: 49 Cases of lesions of liver were diagnosed by FNAC using USG guidance in 44 Cases and CT guidance in 5 Cases. Commonest age group was 5th to 7th decade of life with male predominance. Out of 49 Cases, 27(40.82%) were metastatic malignancies, 20(40.82%) were hepatocellular carcinoma and 2 (2.08%) were non neoplastic lesions. Metastatic adenocarcinoma was the most common metastatic malignancy, primary site being pancreas, colon, ovary, lung, breast and gall bladder in descending order of frequency.

Conclusions: Image guided FNAC of lesions of liver promises a high rate of accuracy of diagnosis particularly in malignant lesions. It provides rapid and valuable morphological information essential for patient management.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-113: SOLID PSEUDOPAPILLARY EPITHELIAL NEOPLASM(SPEN) OF PANCREAS: CELL SPIN TO THE RESCUE

Poonam Yadav ¹, Deep Kumar Raman ¹, Jeenu Varghese ¹

Background: Solid pseudopapillary epithelial neoplasm of pancreas (SPEN) or Frantz tumour is a rare low grade malignant pancreatic tumour accounting for 0.9-2.7% of all exocrine pancreatic neoplasms. It affects adolescent girls and young women (mean age 26) while rarely affecting men.

Methods: This retrospective Case series study of 3 Cases Aims to understand the utility of endoscopic ultrasound guided FNAC cytology in diagnosis of SPEN and the cyto-histopathalogical correlation of these Cases which presented to a tertiary care hospital from 2018-2019.

Results: Between 2018-2019, 03 female patients of age ranging from 11- 15 years presented with symptoms of pain abdomen. While one underwent imaging studies as part of workup for another disease entity. Cytological study from Endoscopic ultrasound guided FNAC revealed poorly cohesive neoplastic cells arranged as slender branching pattern with central fibrovascular core having myxoid stroma within. Diagnosis of SPEN was made on FNAC, cell block with IHC which was later confirmed on biopsy specimens in all 03 Cases.

Conclusion: FNAC being a comparatively less invasive and simpler procedure than biopsy plays a pivotal role in diagnosis of SPEN thereby saving precious time and increasing overall survival rate of patient. Cytological studies have emerged as a powerful Method in timely diagnosis of SPEN Resulting in early surgical resection and complete resolution leading to good prognosis and prevention of local invasion in aggressive Cases.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-114: SPINDLE CELL NEOPLASM OF LIVER

Anju Singh ¹, Reecha Singh ¹, Anuja Singh ¹, Sanjeet Kumar Singh ¹, Kalpana Chandra ¹

Background: Since the first use of percutaneous fine-needle aspiration cytology (FNAC) for liver in 1893 by Ehrlich, FNAC has come a long way in evaluating the various lesions of liver. But rarely do we encounter a spindle-cell lesion in liver on FNAC. The differentials include Hemangiomas, leiomyosarcoma, granulomatous hepatitis, primary angiosarcoma andfibrolamellar hepatocellular. Liver is the most common site for the metastasizing gastrointestinal stromal tumor (GIST), still very few Cases of metastatic GIST diagnosed by FNA have been Reported due to the fact that they exhibit variable morphologic spectrum and cytologic atypia.

Case Report: 57 years male presented with abdominal pain and recent history of weight loss. CT imaging showed multiple heterogeneous enhancing mass and endoscopy reveled stricture in the duodenum. No prior history of gastrointestinal tumor was present. Guided FNA of the liver reveled spindle cells arranged in clusters and singly with moderate pleomorphism. Diagnosis of spindle cell neoplasm was made which on further histological examination and IHC workup turned out to be metastatic GIST.

Conclusion: Even when the initially presentation was of metastasis with no prior history of gastrointestinal tumor FNA proved to be a valuable tool in diagnosing GIST with appropriate clinical and radiological Background, leading to prompt intervention.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-115: PRIMARY HEPATIC LYMPHOMA (PHL) – A CASE REPORT

Quyoom Bashir Khan ¹, Subhash Bhardwaj ¹, Deepti Mahajan ¹, Surbhi Sharma ¹

Background: Primary hepatic lymphoma (PHL) is a rare lymphoproliferative disorder of liver with no evidence of involvement of lymph nodes, spleen, bone marrow or other lymphoid structures. The symptoms are usually non-specific.

Case Report: We describe a sixty year old woman with pain in right hypochondrium and few episodes of vomiting and fever for two months. She had no symptoms of weight loss or anorexia. Physical examinations revealed hepatomegaly without splenomegaly/lymphadenopathy. The laboratory Results were non-specific. Hepatitis and HIV serology were negative. Abdominal USG showed a well-defined hypoechoic lesion in right lobe of liver with compressed adjoining hepatic parenchyma. CECT Scan showed liver mass with homogenous parenchymal density and contrast enhancement on arterial phase. USG guided FNA showed cyto-morphological features that were suggestive of lympho-proliferative disorder – Non Hodgkin's lymphoma. Trucut biopsy of liver showed histomorphological features of malignant small round cell tumor, possibly Small cell neuroendocrine cell carcinoma/Non-hodgkins lymphoma. Further, immuno-histochemistry showed CD20/BCL2 immunoreactive, supporting a diagnosis of Diffuse Large B Cell Non Hodgkin Lymphoma (Non GC type). The patient is being treated with chemotherapy and showing a significant response to it.

Conclusion: Although PHL is a rare disorder, its diagnosis should be considered in any patient at any age who presents with liver mass or infiltration without other known primary tumour or hematological disease. The present Case may help the clinicians to improve their understanding of this disease. To the best of our knowledge this is the first Case of primary hepatic lymphoma Reported from our institute.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-116: IGG4 RELATED DISEASE - AUTOIMMUNE PANCREATITIS TYPE 1 DIAGNOSED ON EUS-FNA: A REPORT OF THREE CASES

Rupali Sharma ¹, Gunjan Mangla ¹, Poojan Aggarwal ¹, Kusum Verma ¹, Anil Arora ²

Background: Autoimmune pancreatitis type 1 is a pancreatic manifestation of IgG4 related disease. It accounts for 2% of chronic pancreatitis Cases. Morphological features and IgG4 IHC are central to its diagnosis. We Report three Cases diagnosed on EUS-FNA.

Case Report: Clinical and imaging findings: Case 1(59 yr female) presented with obstructive jaundice, Case 2(79 yr male) presented with abdominal pain and Case 3(40 yr male) presented with weight loss. EUS showed diffusely enlarged bulky pancreas in all three Cases. Hypoechoic lesion involving lower CBD was also seen in Case1. Serum IgG4 levels were raised in two Cases (>250mg/dl), while were normal in one Case. Cytomorphology and IHC: EUS FNA done from pancreas in all three Cases were cellular and showed moderate lymphoplasmacytic infiltrate (LPI) intermixed with benign pancreatic tissue and few fibrotic fragments. No atypical cells were seen. CBD FNA in Case 1 showed similar infiltrate. IHC done on cell block (in all three Cases) showed IgG4+/IgG+ cells > 40 % and >10 IgG4 positive cells/ HPF in the LPI. Core biopsy done in 2 Cases showed similar findings. The above findings fulfilled the diagnostic criteria for Autoimmune pancreatitis Type 1, IgG4 related disease, with a definitive diagnosis in 2 Cases and a probable diagnosis in one Case.

Conclusion: Diagnosis of Autoimmune pancreatitis Type I is based on constellation of clinical, imaging, serological and morphological findings. It is important to recognize this entity on cytology due to its amatic response to steroids.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-117: FINE NEEDLE ASPIRATION CYTOLOGY OF METASTATIC NEUROENDOCRINE CARCINOMA OF GALL BLADDER: THE DEVIL IS IN THE DETAILS!

Nisha Modi ¹, Rujuta Sanjay Ayachit ¹, Rupesh Prakashrao Gundawar ¹

Background: Neuroendocrine carcinoma of gall bladder (GB-NEC) is a rare entity characterized by lack of early symptoms, advanced stage of presentation and a grave prognosis. There are very few studies in the literature describing its cytomorphology.

Case Report: Herein,we describe a Case of GB-NEC metastasizing to supraclavicular lymph node in a 55-year-old man who came with a history of vague abdominal pain for two months. On physical examination, left supraclavicular node was observed. His hemogram, liver function tests and tumor markers were within normal ranges. Ultrasonography revealed a hyperechoic mass lesion in gallbladder. A subsequent fine needle aspiration cytology from node demonstrated cellular smears of loosely cohesive clusters of pleomorphic neoplastic cells with granular chromatin, scant cytoplasm and prominent nuclear molding. Suggested cytological impression was metastatic poorly differentiated carcinoma with neuroendocrine features. Following which, biopsy showed deposits of small tumor cells with minimal cytoplasm, nuclear moulding, salt-pepper chromatin, frequent mitoses and apoptosis. Immunohistochemically, tumour cells stained positive for Chromogranin, Synaptophysin, p16, while were negative for TTF-1, CK7 and Ki-67 labelling index of >90%. This confirmed the diagnosis of metastatic deposits of small cell neuroendocrine carcinoma. Positron Emission Tomography findings were suggestive of metastatic disease with mass lesion in gall bladder along with metabolically active lymphadenopathy. A diagnosis of GB-NEC with nodal dissemination was made taking into account the clinico-radio-cyto-histological features.

Conclusion:Cytomorphological features of salt-pepper chromatin, if meticulously observed, may be a consistent clue for pickup of neuroendocrine carcinoma even in the setting of metastasis, which could be an adjuct to confirmation by immunostaining.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-118: SOLID PSEUDO PAPILLARY PANCREATIC NEOPLASM - A REPORT OF 4 CASES

Nikita Gidwani ¹, Balaji Baste ¹, Mona Agnihotri ¹, Kanchan Kothari ¹, Leena Naik ¹

Background: Solid pseudo papillary pancreatic neoplasm (SPPN) is a very rare tumor with an overall incidence of 1-2% of all exocrine pancreatic tumors. It typically affects young women, has an uncertain histogenesis and low malignant potential. Most patients present with non specific abdominal symptoms and accurate radiologic diagnosis is made is less than 1/4th of cases.

Method: Four cases of SPPN are Reported herewith. All patients were women, in the age group of 24-38 years, who presented with pain in abdomen of 8 days to 4 months duration.CT scan showed a solid cystic mass in tail and body of pancreas in 2 cases and in the pancreatic head in 2 cases. 2 Cases were suspected to be SPPN on radiology while the other two were suspected to be pseudocysts. Endoscopic ultrasound guided (EUS) guided FNAC was done in all.

Result: Aspirate in 3 cases was cellular and showed cells arranged in papillary fragments with well formed, delicate, myxoid, fibrovascular cores. The cells were uniform, round to oval with vesicular nuclei and scant cytoplasm. Occasional nuclear grooves and many dissociate cells were noted. In one case the tumor was largely necrotic with only an occasional viable papillary fragment. Subsequent histopathology confirmed the diagnosis of SPPN in all cases.

Conclusion: SPPN is a rare exocrine pancreatic neoplasm. Preoperative diagnosis is important as these are vascular tumors and complete surgical resection is generally curative although follow up is recommended. EUS-FNAC thus plays an invaluable role.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-119: PRIMARY HEPATIC LYMPHOMA: REPORT OF A RARE CASE WITH DIAGNOSIS BY FINE NEEDLE ASPIRATION CYTOLOGY

Shruti Shemawat ¹, Shivani Sharma ¹

Background: Primary hepatic lymphoma(PHL) constitutes 0.4% of all extranodal non Hodgkin lymphoma. Because of its rarity, non-specific clinical symptoms and radiological imaging, PHL was often misdiagnosed as some other tumor. Owing to high diagnostic accuracy and low risk of complications, fine needle aspiration cytology (FNAC) has been used as a first line diagnostic modality for primary and metastatic liver neoplasm.

Case Report: A 65 years old immunocompetent patient presented with complaint of pain in right upper quadrant for past 1 month. There was no history of jaundice, vomiting, fatigue or any B-symptoms. Routine laboratory investigations and bone marrow examination were unremarkable. Serum alfa fetoprotein (AFP) level, serum lactate dehydrogenase (LDH) level and liver function test were within normal limits. Radiological investigation indicated presence of a solitary lesion in liver. USG-guided FNAC was conducted from that space occupying lesion. The smears showed dispersed population of monotonous lymphoid cells having high nuclear cytoplasmic ratio. Background was hemorrhagic, consisting of neutrophils and eosinophils. The possibility of Non-Hodgkin lymphoma (NHL) was given. Diagnosis of PHL was established on cytology smear and confirmed by immunohistochemistry on tissue biopsy.

Conclusion: The purpose of this paper is to Report a rare occurrence of primary hepatic lymphoma and to demonstrate the possibility of making this diagnosis by FNAC. The Case has many unique features like negative serology for viruses, no type B symptom and normal AFP and LDH levels. This Case demonstrates that PHL should be considered in the differential diagnosis of space-occupying liver lesions in presence of normal level of AFP.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-120: SQUAMOUS CELL CARCINOMA CERVIX METASTATIC TO PANCREAS- A RARE CASE REPORT

Anju G ¹, Divya Aggarwal ¹, Poonam Elhence ¹, Vaibhav Varshney ², Selvakumar B ³, Deepanksha Datta ⁴

Background: Carcinoma cervix is the second most common malignancy in Indian women, of which 80-90% are squamous cell carcinomas (SCC). Carcinoma of cervix usually exhibits a low incidence of distant metastasis. Apart from locoregional spread, it usually spreads to pelvic and para-aortic nodes. We Report a Case of SCC metastatic to the pancreas.

Case Report: A 52-year-old female presented to the outpatient clinic with complaints of abdominal pain for past 3 months which was dull-aching, gradually increasing in intensity and was non-radiating. CT scan revealed a hypodense lesion involving head & neck of pancreas compressing porto-splenic confluence and proximal superior mesenteric vein. PET scan showed metabolically active mass in proximal pancreas and a single nodule in right middle lobe of lung. EUS-guided FNAC was performed from the lesion which revealed squamous cell carcinoma. On further history taking, she revealed that she had undergone total abdominal hysterectomy 2 years back for SCC cervix and had received chemotherapy and radiotherapy for the same. A final diagnosis of metastatic SCC was rendered.

Conclusion: Most pancreatic tumors are primary and metastatic tumors are rare. We present a rare Case of SCC cervix metastatic to pancreas. A knowledge of such rare entities is important for their timely diagnosis and Management.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-121: COMPREHENSIVE CLINICOPATHOLOGICAL, IMMUNO- CHEMICAL AND MOLECULAR CHARACTERIZATION OF HER2/ERBB2 EXPRESSION IN ADVANCED GALLBLADDER CANCER: A CASE-CONTROL STUDY ON THE CYTOLOGIC ASPIRATES

Pragya Verma ¹, Parikshaa Gupta ¹, Nalini Gupta ¹, Radhika Srinivasan ¹, Pankaj Gupta ¹, Shelly Sharma ¹, Radha Uppal ¹, Usha Dutta ¹, Ritambhra Nada ¹, Anupam Lal ¹

Background: Gallbladder carcinoma (GBC) is the most aggressive malignancy of the biliary tract. To date, no targeted therapies are recommended for the treatment of advanced GBC. The present study was conducted to study the immunochemical expression of HER2/ERBB2 in AGBC in an attempt to identify potential patients that can be benefitted by anti-HER2 targeted therapies.

Methods: This was a prospective, hospital-based, Case-control study, performed on a total of 50 primary advanced gallbladder carcinoma Cases. A similar number of age and gender-matched resected gallbladder specimens Reported on histopathology, as chronic cholecystitis, were included as controls. Detailed cytomorphologic assessment was performed. Immunocytochemistry (ICC) for HER2 was performed on AGBC cell-blocks with at least 100 tumor cells and the control sections. Interpretation was done as per the CAP guidelines for gastric cancer and FISH was performed in equivocal Cases.

Results: Positive HER2 ICC score of 3+ was noted in 10 Cases, 19 Cases showed 2+(equivocal) expression and 21 Cases were negative (1+,0). None of the equivocal Cases demonstrated HER2 amplification on FISH. Among the clinicopathologic parameters, papillary and acinar arrangement of tumor cells were significantly associated with HER2 overexpression. None of the controls showed positive(3+) expression, 23(46%) demonstrated 2+ expression, and 27(54%) were negative. Positive HER2 expression was significantly associated with AGBC as compared to controls(P<0.001).

Conclusions: Ours is the first study to evaluate HER2 amplification in AGBC Cases on cytologic samples. Positive HER2 expression is significantly associated with AGBC and such patients are potential candidates for anti-HER2 targeted therapies.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-122: ANALYSIS OF EFFICACY OF PARIS SYSTEM FOR REPORTING URINARY CYTOLOGY : AN INSTITUTIONAL EXPERIENCE

Sudarshan K ¹, Supreetha MS ¹, Harendra Kumar ¹

Background: Urine cytology acts as a vital tool for detection of urothelial neoplasia. Along with cystoscopy, it establish as a gold standard, in screening and as a surveillance of urothelial carcinoma. Major drawback of urine cytology is due to equivocal or atypical Results, which creates ambiguities in treatment modalities. Since several existing classification systems of urine cytology lacked standard definition, strict criteria, universal acceptance and suffered inter-observer variability, we could like to compare with Paris System for Reporting Urinary Cytology (PSRUC) classification and analyze its sensitivity and specificity in urinary cytology.

Methods: Based on diagnostic criteria of PSRUC 68 urine samples from 28patients with histological follow up data were retrospectively analyzed and diagnosis compared with the original cytological diagnosis.

Results: In total 68Cases, based on the routine urine cytology analysis Method, 40Cases diagnosed as Negative, 10Cases as Atypical urothelial cells and 18Cases as Positive. After reclassification using PSRUC, 6Cases diagnosed as Non –Diagnostic, 30Cases as Negative, 5Cases as Atypical urothelial cells, 5 as Suspicious for High grade urothelial carcinoma, 3Cases Low grade urothelial carcinoma and 19Cases as High grade urothelial carcinoma. After implementing PSRUC criteria, there was significant reduction seen in the ambiguous atypical category from 14.7% to 3% of the Cases. Also observed sensitivity for HGUC diagnosis increased from 36.3% to 48.7% while no change in specificity.

Conclusion: PSRUC plays a vital role in standardization of urine cytology Reports and significantly improves the diagnostic sensitivity for HGUC. Judicious use of urine cytology might aid in early diagnosis of urothelial malignancies.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-124: EXPERIENCE WITH THE PARIS SYSTEM FOR REPORTING URINARY CYTOLOGY IN COMPARISON TO CONVENTIONAL REPORTING: A 5 YEAR RETROSPECTIVE CORRELATIVE STUDY OF URINE CYTOLOGY.

Yusra Jamal ¹, Bushra Siddiqui ¹, Nuzra Fazal ¹, Zohra Naheed Hashmi ¹, Avadh Vihari Lal Sharma ¹

Background: The Paris System for Reporting Urinary Cytology (TPS) is designed to standardize the criteria and terminology used in urinary tract cytology Reporting. The aim of this study was to evaluate the impact of implementing TPS and to correlate and compare it to our current system of Reporting.

Methods: rinary tract cytology specimen slides over a period of 5-year (2017-2021) were reviewed and re-classified according to TPS criteria. Then these were correlated with the previous urine cytology diagnoses and the Results were compared statistically.

Results: Applying TPS in comparison to our previous Reporting system Resulted in fewer Cases in the atypia category with higher specificity, accuracy, and predictive value.

Conclusions: TPS improves the overall performance of urinary tract cytological analysis by standardizing the criteria and terminology Resulting in better and timely patient management.

Keywords: TPS, Urine Cytology, Atypia.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-125: UROTHELIAL CARCINOMA OF THE MID- URETER – A RARE CYTOLOGICAL DIAGNOSIS

Anjnee Sharma ¹, Isheeta S Ahuja ¹, Prajwala Gupta ¹, Minakshi Bhardwaj ¹

Background: Primary ureteral cancer is rare, with a ratio of 1:54 to carcinoma of urinary bladder. Invasive urothelial carcinoma is the most common, being twice more common in males. We present a Case of primary urothelial carcinoma of mid-ureter in a female patient diagnosed using fine needle aspiration cytology.

Case Report: A 56-year old lady presented with complaints of right flank pain since 7 months with history of significant weight loss with no history of hematuria or lithiasis or pyuria.A CECT revealed a thick-walled, peripherally enhancing lobulated mass of size 35x26x22 mm against L5 vertebra with ill-defined margin to the proximal ureter, mid-ureter was not separately visualized in this region. An ultrasound-guided fine needle aspiration was performed from the lesion which revealed atypical urothelial cells with features suggestive of high-grade urothelial carcinoma. Immunohistochemitry was performed on the cell block to confirm the cytological diagnosis.

Conclusions: Urothelial carcinomas of upper urinary tract is relatively rare. Ureteral urothelial carcinoma is even less common than that of renal pelvis. Fine needle aspiration can prove to be an extremely helpful tool in the diagnosis of ureteric malignancy presenting with large mass; especially in Cases where a more invasive diagnostic procedure is not possible

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-126: URINE CYTOPATHOLOGY- A STUDY IN A TERTIARY CARE HOSPITAL

Upasana Kalita ¹, Junu Devi ¹

Introduction: Urothelial carcinoma is a very common malignancy worldwide. Urine cytology helps to detect high-grade urothelial carcinoma (HGUC). The Paris System (TPS) Working Group, has proposed and published a standardized Reporting system that includes specific diagnostic categories and cytomorphologic criteria for the reliable diagnosis of HGUC. The aim of this study is to analyze the urine cytology smears by The Paris System and to assess the frequency of various categories.

Methods and MethodOLOGY: This is a cross sectional study done in a tertiary care hospital. 100 urine samples were received in our department. The data collected were tabulated and categorized according to TPS system: negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells (AUC), low-grade urothelial neoplasm (LGUN), suspicious for high-grade urothelial carcinoma (SHGUC), and high-grade urothelial carcinoma (HGUC).

Results: The male: female ratio was 5.2 : 1. The percentage of various categories as per the TPS are: NHGUC 15%, AUC 23%, LGUN 0%, Suspicious for HGUC 14% and HGUC 15% respectively. The incidence of HGUC was highest in the age group of 71-80 years.

Conclusion: Urine cytology is a valuable, non-invasive and easy procedure suitable for all patients with urinary symptoms for the detection of infectious conditions, pre-malignant conditions and Malignancy specifically HGUC.

KEYWORDS: Urine, Paris System, HGUC

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-127: A CASE OF RETROPERITONEAL MASS PRESENTING AS NEUROBLASTOMA-A RARE CYTOLOGICAL FINDING

Umrah Malik ¹, Fauzia Talat Ekram ¹, Prof Mohammad Jaseem Hasan ¹, Prof Kafil Akhtar ¹

Background: Neuroblastoma is the third most common neurogenic, extracranial solid tumour seen in young children. A multimodal approach is employed with fine needle aspiration cytology as an important modality of diagnosis for this tumour. We present a Case of neuroblastoma diagnosed cytologically in a 10 year old female with abdominal lump and constipation.

Case Report: A 10 year female presented with abdominal distention and constipation since 2 weeks. On examination,a palpable mass was evident.USG abdomen demonstrated a heterogenous mass with internal vascularity features. CT scan abdomen revealed retroperitoneal mass with areas of focal calcification and necrosis. Image guided FNAC revealed small cohesive clusters of small round cells with monomorphic nuclei, fine granular chromatin and scant cytoplasm. Poorly to well formed pseudorosettes,cell processes(neuropil) was also seen. Histological examinational of incisional biopsy revealed sheets of small round blue tumor cells separated by incomplete fibrovascular septae with granular nuclear chromatin and minimal cytoplasm. Few foci with central fibrillary material within the rosettes(Homer Wright)cells were seen. Immunohistochemistry showed cytoplasmic positivity of chromogranin and NSE.

Conclusions: Cytology can help to arrive at a conclusive diagnosis in rare small round cell tumours aided with immunochemistry.

Keywords: Retroperitoneal mass,Neuroblastoma,FNAC.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-128: FINE NEEDLE ASPIRATION CYTOLOGY OF MIXED GERM CELL TUMOR IN THE TRIAGE OF RETROPERITONEAL EXTRAGONADAL MASS: A DEFINITE ROLE

Shruthi ¹, Chatura KR ¹

Background: Pediatric germ cell tumors(GCT) account for approximately 3.5 % of all childhood cancers under the age of 15 years. Up to one-third are extragonadal neoplasms. The diagnosis of Extra-gonadal GCTs is often challenging, and differential diagnosis is particularly wide. Nevertheless, a correct diagnosis is essential for the management of the patient. We present a challenging Case with wide variety of differentials by different modalities in different setups and treatment was purely based on FNA diagnosis of mixed germ cell tumor and patient is on follow up for three months after the course of treatment.

Case Report: A two years old girl presented with abdominal distension since one month associated with fever and lethargy. Various differential diagnosis for the retroperitoneal mass were suggested by radiological investigations with normal gonads. USG-Guided FNAC was performed. Based on cytomorphological features alone, diagnosis of mixed germ cell tumour was made and advised AFP levels for confirmation. Due to Covid scenario, patient was referred to an Oncology centre for management. Elevated levels were revealed on serial estimation of AFP. Following which six cycles of chemotherapy, biopsy and surgical excision was performed of the residual mass. Post treatment AFP levels showed a decline.

Conclusions: A rapid and specific diagnosis of mixed germ cell tumor made by FNAC, may be extremely beneficial and cost effective and aid in preoperative chemotherapy, in addition to surgical resection in the treatment plan.

Keywords: Alpha-fetoprotein, Extragonadal germ cell tumor, Fine needle Aspiration cytology

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-129: APPLICATION OF SYDNEY SYSTEM AND PITFALLS IN THE CYTOLOGICAL REPORTING OF PEDIATRIC LYMPHADENOPATHY

Arti Khatri ¹, Nidhi Mahajan ¹, Somshankar Chowdhury ¹

Background: Peripheral lymphadenopathy is a common presentation for underlying disorders. Experts proposed the Sydney system for performing classification and Reporting of lymph node cytopathology. Also, cytological pitfalls in FNA diagnosis of pediatric lymphadenopathy are largely unaddressed. The study was undertaken to evaluate the applicability of the Sydney system and to analyze the diagnostic pitfalls in the cytological diagnosis of lymph node FNAC.

Methods: In this retrospective study total of 2778 pediatric patients who presented with lymphadenopathy to Chacha Nehru Bal Chikitsalaya (January 2016 to June 2021) were included.

Results: Age ranged from 1 month to 12 years with a male-female ratio of 1.8:1. Anterior cervical lymph nodes were most commonly sampled followed by posterior cervical. Out of 2778 Cases, 2569 (92.47%) Cases were found adequate and categorized according to the Sydney system classification. Overall, n = 209 Cases (7.5%) were categorized as L1-inadequate/non-diagnostic; n = 2490 (96.92%) as benign (L2); n = 18 (0.70%) as atypical (L3); n = 07 (0.27%) as suspicious (L4), and n = 54(2.1%) as malignant (L5). FNAC diagnoses were correlated with available histopathology. Fifteen Cases showed cytohistologic discordant findings. The statistical analysis shows sensitivity and positive predictive values of 88.89% and 98.18%, respectively.

Conclusions: The Introduction of the Sydney system may improve the understanding of Results between the cytopathologists and clinicians. Complete clinical details and consideration of certain points in the cytological examination of smears can minimize diagnostic pitfalls. If the need arises, one should go for a repeat FNAC or biopsy.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-130: ABDOMINAL MASSES IN PEDIATRIC POPULATION: AN ENIGMA TO DATE

Nidhi Mahajan ¹, Arti Khatri ¹, Shafqat Bano ¹, Niyaz Ahmed Khan ¹, Chabbi Rano Gupta ¹

Background: Intraabdominal masses in children pose a diagnostic challenge both radiologically and on cytology. FNAC plays a key role in guiding the management of these potentially treatable Cases by offering a rapid and near accurate diagnosis.

Materials and Methods: All guided and non-guided FNAC of abdominal masses in children <12 years of age were retrieved between Jan 2016 to Dec 2020. Detailed clinical, radiological, cytological and immunocytochemistry features were recorded and analysed. Histopathology correlation (cell block/ specimen) was done, wherever available.

Results: A total of 36 Cases were evaluated in the past four years, of which 35 were adequately cellular (diagnostic yield- 97.1%). Age ranged from 2 months to 12 years, with age distribution as <1 year (4), 1-5 (16) and 5-12 (15). Male preponderance was seen (M: F= 1.6:1). Case distribution was : 27 (77.1%) malignant, 5 (14.2%) benign and 4 (9%) inflammatory Cases. Site involvement was as follows- adrenal> renal> bowel> liver> pancreas. Sensitivity of abdominal FNA was 97.4% and PPV was 100% with a diagnostic accuracy of almost 98%. Cyto-histological discordance was seen in three Cases (namely mixed adrenocortical carcinoma, pancreatic hamartoma and one Case of Wilm's tumor).

Conclusion: Intra-abdominal FNA is a rapid and simple technique for establishing pre-operative diagnosis in children with high accuracy ensuring prompt management, especially in malignant Cases. Majority Cases are malignant small round cell tumors with morphological overlap, however can be subcategorised with the help of ancillary techniques (cell blocks and Immunocytochemistry).

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-131: YOLK SAC TUMOR: PITFALLS IN DIAGNOSIS

Mridul Singh ¹, Aparna Dutta ¹, Vishal Seth ¹

Background: The estimated incidence of yolk sac tumor is 2-3 Cases per year per 1 million. This Case outlines the plethora of diagnostic dilemmas faced by the pathologist in a Case as rare as this especially under the constraints of time due to delayed presentation of the patient to the health care centre.

Case Report: A 4 year old male child presented with an increasing, immobile mass per abdomen since one month. Along with fever and jaundice. Examination findings revealed a mass of size 8cm*5cm in right lumbar region crossing midline with no organomegaly. Clinically teratoma was suspected. USG revealed a SOL in liver parenchyma. CT scan Report- Neuroblastoma probably arising from the body of right adrenal gland along with mass effects, locoregional lymphadenopathy and minimal ascites. FNAC revealed rossettes with dispersed granular chromatin and small inconspicuous nucleoli with few cells showing nuclear molding and vacuolated cytoplasm in a fibrillary matrix. In the absence of ancillary techniques, the possibility of small round blue cell tumor was suggested. On the day of operation markedly elevated Alpha feto-protein levels were revealed and the histopathological Report was consistent with yolk sac tumor. The FNAC slides were again reviewed and we had missed hyaline globules and the fibrillary matrix was mucoid matrix.

Conclusion: FNAC plays an important role in classifying GCTs as seminomatous and non-seminomatous and hence deciding the treatment protocol but it comes with its own set of limitations. Cytological diagnosis should only be done after ruling out all possible differentials including the rare ones.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-132: SACROCOCCYGEAL MALIGNANT TERATOMA IN A 3 YEAR OLD CHILD- A RARE CASE REPORT

Divya PJ ¹, Shwetha JH ¹

Background: Malignant germ cell tumors constitute approximately 3% to 4% of all malignancies in children. sacrococcygeal region is the most frequent extragonadal localization of germ cell tumors in infancy and childhood. Usually treated by gross complete resection, but tends to recur even after complete resection.

Case Report: A 3 year old female child presented with a swelling in the upper gluteal region since 2 months. On examination, a swelling measuring 6X3cm, non tender, non mobile with local rise of temperature present. skin over the swelling is stretched. No other swellings were palpable. FNAC of the swelling was done, which yielded hemorrhagic aspirate. Microscopy showed cellular smear composed of pleomorphic cells arranged in cohesive and dyscohesive clusters with cells having moderate amount of eosinophilic cytoplasm, vesicular nucleus, prominent nucleoli. Few cells showed intracytoplasmic vacuolation and hyperchromatic nucleus. Background showed stromal fragments, myxoid areas and haemorrhage. A diagnosis of Malignant teratoma-Sacrococcygeal region was made. The child underwent surgical excision of the lesion and specimen was sent for histopathological examination. Grossly a globular soft tissue mass measuring 9X6X3cm. On cut section grey brown areas were seen. Microscopy showed an infiltrating tumor with tumor cells arranged in microcystic, reticular, glandular and papillary patterns. These cells are pleomorphic with moderate amount of cytoplasm and vesicular nucleus with prominent nucleoli. Mitosis(0-1/hpf) with atypical forms, schiller duval bodies & focal areas of necrosis seen. A diagnosis of yolk sac tumor was made.

Conclusion: Due to the rarity of presentation of sacrococcygeal malignant teratoma in pediatric age group, this Case Report is presented.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-133: DIAGNOSIS OF LANGERHANS CELL HISTIOCYTOSIS ON FINE NEEDLE ASPIRATION CYTOLOGY: REPORT OF TWO CASES

Deepika Gupta ¹, Aasma Nalwa ¹, Meenakshi Rao ¹

Background: Langerhans cell histiocytosis (LCH) is a rare clonal disorder of unknown etiology affecting predominantly children and young adults. The course of disease ranges from solitary lesion which resolves spontaneously to multisystem life-threatening disorder requiring aggressive therapy. Because of its rarity, diagnosis of LCH is often delayed. We present two Cases of multifocal LCH.

Case Reports: Case 1: 5 year old male child presented with complains of intermittent, unprovoked bleeding from left ear since 1.5 months not associated with pain along with swellings in left supraorbital and left preauricular region. Computed tomography revealed an enhancing soft tissue density lesion with underlying bone erosion in left temporal region with extension upto external auditory canal with similar lesion in right extraconal space of orbit. Case 2: 14 year old male presented with complains of palpable left submandibular and right cervical lymph nodes associated with pain. Smears from both Cases showed similar morphology with cellular smears showing predominantly singly dispersed cells with only focal loose clustering. The cells were round to oval with moderate amounts of cytoplasm, central to eccentric round to oval nucleus with fine, reticular chromatin and 0-1 inconspicuous nucleoli. Many cells showed longitudinal nuclear grooves. Occasional nucleus was indented and mildly lobulated. A few bi and multinucleate cells were noted. Mitotic figures were also seen. Background showed eosinophils, a few neutrophils, plasma cells and histiocytes.

Conclusion: The present Cases highlight the importance of FNAC as a rapid technique which helps in providing accurate diagnosis in appropriate clinical and radiological settings, obviating unnecessary biopsy.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-134: ROLE OF FNAC IN EVALUATION OF PEDIATRIC EXTRATESTICULAR SCROTAL LESIONS

Shafqat Bano ¹, Nidhi Mahajan ¹, Arti Khatri ¹, Niyaz Ahmed Khan ¹

Background: Scrotal masses in children are relatively uncommon and can affect any age from neonate to adolescence. These masses pose a diagnostic difficulty radiographically because of small field of view and lack of tissue charecterization. FNAC is an effective tool in guiding management of these masses as it offers rapid and near accurate diagnosis, alleviating the anxiety of apprehensive patients.

Materials and Methods: All Cases of scrotal swellings with adequate smears between 2016 to 2020 were retrieved and analyzed. Detailed clinical history, examination, radiology and cytology findings were recorded. Histopathological correlation was done wherever available.

Results: A total of 14 Cases were seen of which 3 were inadequate(diagnostic yield-78%). Age ranged from 10 months to 12 years.92%swellings were unilateral. Most common complaint was a mass lesion followed by pain. FNAC was done under sedation in 4 Cases. Radiology was diagnostic in only 5 Cases. Case distribution included non neoplastic(4,2-acute suppurative,2-granulomatous) and neoplastic(7). The latter included 3 Cases of inclusion cyst,1 pilomatrixoma,2 rhabdomyosarcoma and 1 Case of neuroectodermal tumor. Cytohistological correlation was available in 6 Cases and the diagnostic accuracy was 85%.

Conclusion: The scope of FNAC in scrotal masses of children is largely unexplored with scant literature available. Radiological findings may not be very reliable in differentiating benign from malignant ones, which is fairly achieved by FNAC and associated ancillary techniques.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-135: LIVER METASTASIS FROM NASOPHARYNGEAL CARCINOMA DIAGNOSED ON FINE NEEDLE ASPIRATION CYTOLOGY

Ria Mahendru ¹, Aanchal Kakkar ¹, Gargi Das ¹, Adarsh Barwad ¹, Rachna Seth ¹, Venkateswaran K Iyer ¹

Background: Non-keratinizing undifferentiated squamous cell carcinoma is the commonest histological type of nasopharyngeal carcinoma (NPC), with a strong association with Epstein Barr virus. In children, due to the relatively inaccessible primary location, a biopsy may be difficult to obtain or may be non-representative. There are few Reports of cytological diagnosis of NPC at metastatic sites.

Case Report: This 12-year-old boy presented with complaints of a nasal twang, facial swelling, proptosis and abdominal distention for one year. On examination, he had a swelling in the maxillary region, palpable cervical lymph nodes, and massive hepatomegaly. Imaging revealed multiple hypodense liver lesions, necrotic mediastinal and right hilar lymph nodes and Multiple lytic-sclerotic skeletal lesions. A clinical diagnosis of lymphoma was considered. Ultrasound guided fine needle aspirate from the liver lesion showed tumor cells arranged in cohesive clusters in a Background of inflammatory cells. Tumor cells had moderate amount of cytoplasm, ill-defined cytoplasmic borders, and enlarged nuclei with vesicular chromatin and prominent nucleoli. Cell block preparation showed similar cells which, were positive for cytokeratin, and negative for SALL4 and CD30, favoring a metastatic carcinoma. Further immunohistochemistry for EBV-LMP1 was positive, suggesting a primary in the nasopharynx. A subsequent biopsy from metastasis in femur confirmed the diagnosis.

Conclusion: On cytology, the neoplastic cells of NPC can resemble a germ cell tumor or Reed-Sternberg cells of Hodgkin lymphoma. The abundant lymphoid Background can further the diagnostic dilemma, particularly at metastatic sites in previously undiagnosed Cases, necessitating use of ancillary techniques for a definitive cytological diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-136: A STUDY ON CYTOLOGICAL EVALUATION OF SALIVARY GLAND LESIONS BY MILAN SYSTEM

E Dinakar ¹, G Lavanya ¹, Md Khadar Faheem ¹, M Srinivasulu ¹, BV Sai Prasad ¹, A Venkatalakshmi ¹

Background: Salivary gland lesions account for 2-6% of head and neck lesions. FNAC is a cost-effective rapid investigative procedure with good patient compliance. Due to the heterogenicity of the spectrum of lesions, there are a few challenges in its wide use as a diagnostic tool. In 2015 “The Milan system for Reporting salivary gland cytopathology” was introduced to guide diagnosis of the varied cytological spectrum of salivary gland lesions. The main aim of the study is to evaluate the salivary gland lesions by the Milan system.

Methods: The present study is a retrospective study of 3.5years duration (January 2018 to June 2021). Data of salivary gland lesions of all ages on which FNAC was done, is retrieved. Cases were reclassified according to “The Milan system for Reporting salivary gland cytopathology”.

Results: A total of 212 Cases were evaluated cytologically. The parotid gland (84%) is the most common anatomical site and the majority are between 41-50 years with a male preponderance of 54%. Pleomorphic adenoma(36.79%) is the most common benign tumour. The distribution of Cases into different categories are as follows Neoplasm: benign (NB) - 41.03%, Non-neoplastic (NN) - 37.73%, Malignant (M) - 11.79%, Non-diagnostic (ND) - 4.24%, Atypia of undetermined significance (AUS) - 2.83%, Suspicious of malignancy (SM) - 1.41%, Neoplasm: salivary gland neoplasm of uncertain malignant potential (SUMP) - 0.94%.

Conclusions: The Milan system for Reporting salivary gland cytopathology helps in placing lesions into well-defined categories, risk stratification and also further improves treatment & patient care.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-137: ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY IN NECK SWELLING IN TERTIARY CENTRE IN SOUTHWEST BIHAR

Sanjeev Ranjan ¹, Kumari Seema ¹, Aakash ¹

Introduction: differential diagnosis of neck mass is extensive. it ranges from congenital to acquired from inflammatory/infective to neo plastic disease. FNAC has emerged as a sensitive, specific, and cost-effective tool to diagnose Neck Swelling. FNAC is being used as a first line investigation in the diagnosis of neck swelling. Evaluation of a patient with neck mass should always begin with a thorough history, followed by a complete neck examination, Then FNAC of neck swelling.

Aims and Objective: To study the role of Fine Needle Aspiration Cytology (FNAC) in Diagnosis of Neck Swelling.

Material and Methods: Retrospective study including 130 Cases of Neck Swelling in tertiary care hospital studied during october2019-march2021. To categorize the common Etiology of neck Swelling.

Results: In 130 patients of Neck Swelling, 81 were Female and 49 were Males. (a) Patients with Thyroid swelling-60(M-12;F-48;M:F-1:4) (b) Patients with Lymph node swelling-48(M-24;F-24:M:F-1:1) (c) Patients with Salivary gland swelling-22(M-13;F-9;M:F-1.4:1) Out of 60 Cases of Thyroid swelling 73.33 % (44 Cases) were Colloid goitre followed By 32 Cases out of 48 patients of Lymph node swelling were Inflammatory and13.63 % (3Cases) were Sialadenitis in salivary gland.

Conclusions: Most of the neck swelling is Colloid goitre of thyroid followed by Inflammtory lesion then Sialadenitis in salivary gland.

KEYWORDS: FNAC, Colloid goitre, Lymphnode, Salivary gland

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-139: LIQUID BASED CYTOLOGY

Karthik Shunmugavelu ³, B Sekar Vinayaka ¹, Kamraj Penang ², Sathick Manzoor ², Evangeline Cynthia D ³

Oral exfoliative cytology (OEC) is the microscopic examination of exfoliated cells from an epithelial surface. It is a simple, noninvasive, and sensitive staining technique used as an adjuvant for biopsy or in Cases where biopsy is not feasible as well as mass screening. Oral exfoliative cytology (OEC) has been implemented in the diagnosis of pathologic lesions for ages. Liquid-based cytology (LBC) is a new Method of preparing samples for cytological examination. Unlike the conventional 'smear' preparation, it involves making a suspension of cells from the sample and this is used to produce a thin layer of cells on a slide. The sample is collected, normally by a small brush, in the same way as for a conventional smear test, but rather than the smear being transferred directly to a microscope slide, the sample is deposited into a small bottle of preservative liquid. At the laboratory, the liquid is treated to remove other elements such as mucus before a layer of cells is placed on a slide. Liquid-based cytology (LBC) has advantages of fewer unsatisfactory smears, faster and more efficient Method, more accurate interpretation, less obscuring Materials such as blood, mucous, inflammatory cells in smears and the use of residual cell suspension for testing human papillomavirus (HPV) DNA. The aim of our paper is to discuss the liquid based cytology technique and how it differs from the conventional smear preparation.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-140: A STUDY ON ULTRASOUND GUIDED FINE NEEDLE ASPIRATION CYTOLOGY IN HEAD AND NECK LESIONS-A TERTIARY CARE EXPERIENCE

Neha ¹, Geet Bhuyan ¹, Projnan Saikia ¹

Background: FNAC is a well known fundamental diagnostic tool and is of great value in appropriate patient management. FNAC using ultrasound guidance has high accuracy and plays important role in assessing the deep seated and overtly impalpable lesions along with better delineation of palpable masses.

Methods: This retrospective study was done in our department, between 2018 and 2020. The study included 119 Cases of head and neck masses. Each Case was reviewed and correlated with the available histopathological data.

Results: FNAC was performed in various sites in head and neck region : Lymph Nodes (63 Cases), thyroid(27 Cases), salivary Gland (20 Cases), face (3 Cases), scalp, external ear and nasal masses (2 Cases each). Out of these, only 10 Cases sample were unsatisfactory. Cases from lymph node, thyroid and salivary gland which formed the majority of the Cases were further classified according to their respective classification systems viz. Sydney, Bethesda and Milan classification system and we tried to find the accuracy of each of these systems by comparing with the corresponding histopathological data.

Conclusion: Ultrasound Guided FNAC had high sensitivity and specificity in diagnosing deep seated lesions. Assessment of risk of malignancy by application of proposed systems (Sydney,Bethesda and Milan) can provide a uniform system with the ultimate Result of better communication and improved patient care.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-141: A CASE REPORT OF RECURRING ADENOID CYSTIC CARCINOMA

Kaustubhmoni Gogoi ¹, Adity Sharma ¹, Aparna Dutta ¹

Background: Adenoid cystic carcinoma is a slow-growing and unrelenting salivary gland malignancy composed of epithelial and myoepithelial neoplastic cells.

Case Report: A 46 year old male presented to the ENT OPD with a chief complaint of swelling with pain in the left submandibular region for 1½ years. Similar history of swelling and pain in the left submandibular region 2 years back for which he was operated upon and he was diagnosed as a Case of adenoid cystic carcinoma on histopathological examination.

Result: Fine Needle Aspiration Cytology: Smears show high cellularity comprising of basaloid cells arranged in clusters as well as a few cells arranged singly. Individual cells have high N:C ratio which nuclear molding, containing round to oval hyperchromatic nuclei, coarse nuclear chromatin and inconspicuous nucleoli. There is also presence of numerous variably sized hyaline stromal globules and linear branching structures with adherent basaloid cells in the Background of scant chondromyxoid stroma and RBCS. The picture is suggestive of a Category VI lesion: Adenoid Cystic Carcinoma [Milan System]. Histopathology: Show presence of nests of tumour cells along with areas of punched-out spaces filled with basophilic matrix. The tumour cells show scant cytoplasm and typically have small angulated and hyperchromatic nuclei. Picture is consistent with cribiform variant of Adenoid Cystic Carcinoma.

Conclusion: A high chance of locoregional recurrence and distant metastasis is associated with Adenoid Cystic Carcinoma. Hence a combination of adequate radical excision and aggressive radiotherapy is a must to prevent recurrence and for a favorable outcome.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-142: FNAC DIAGNOSIS OF ADENOID CYSTIC CARCINOMA: A CASE REPORT AND ITS DIAGNOSTIC PITFALLS

Monika Terangpi ¹, Aparna Dutta ¹

Background: Adenoid cystic carcinoma is an infrequent slow growing epithelial tumour constituting for around less than 1% of all the oral and maxilla-facial malignancies and almost 10% of all salivary gland tumours. Parotid gland is the second most common site to be involved in head and neck region along with submandibular gland, Palate being the most common site in the oral cavity. Here we discuss a Case of 47 year old lady which was diagnosed as Basal cell adenoma 5 years back now presented with recurrence on same site.

Methods: Fine Needle Aspiration Cytology was approached with 10 ml syringe, 23 gauge needle and the smear was stained with Leishman-Giemsa stain.

Results: The smears were cellular and comprised of clusters of atypical epithelial cells and few cells adherent to moderate amount of hyaline stroma forming globules. Individual cells have scant cytoplasm, with nuclear overlapping and moulding, coarse chromatin, inconspicuous nucleoli. Cytology smears were Reported as suggestive of Adenoid cystic carcinoma. However, we advised biopsy and histopathological study for confirmation.

Conclusion: FNAC is a useful tool in the diagnosis of salivary gland lesions. Preoperative cytology helps in correct diagnosis and also avoids radical surgery in benign and non neoplastic lesions. However, diagnosis of basaloid tumours are always difficult because differential diagnosis include benign and malignant entities.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-143: PLEOMORPHIC ADENOMA ARISING FROM THE ECTOPIC SALIVARY GLAND TISSUE IN THE NECK -A RARE CASE REPORT

Gyanendra Singh ¹, Shalini Bahadur ¹, Shivani Kalhan ¹

Background: Ectopic or heterotopic salivary tissue refers to salivary tissue found in unusual locations. Ectopic salivary gland tissue has been discovered in the middle ear, hypophysis, thyroglossal duct, mandible, and tongue. The presence of ectopic salivary tissue is uncommon, and neoplasms arising from ectopic salivary gland tissue is even rarer. It is extremely rare to find a benign mixed tumour in heterotopic salivary tissue in the upper neck. We Report a Case of pleomorphic adenoma in a 60 years female, arises from ectopic salivary gland in the neck.

Case Report: A 60-year-old female came to the outpatient department with complains of painless lump in the upper midline neck region from last five years. On palpation the lump was pain less, well defined, nodular in appearance and firm in consistency without any enlarged lymph node. USG shows an oval to round shape hypoechoic lesion with regular margin in the midline submental region measuring 16x10 mm in size. Fine-needle aspiration cytology of the lesion shows cellular smears with presence of spindle to oval shaped cells embedded in chondromyxoid substance with presence of oval to plasmacytoid myoepithelial cells in Background.

Conclusion: Although lymphoma, branchial cyst and metastasis are the most prevalent causes of a solitary mass in the neck region and extremely rarely is an ectopic salivary gland tumour. In Case of unusual cytology or a slow-growing mass in the upper neck, it should be kept in the differential diagnosis. Early detection enhances the possibility of complete excision and proper care.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-144: CHALLENGES IN DIAGNOSIS OF NODULAR FASCIITIS IN HEAD AND NECK REGION ON FNA

Shreya Kar ¹, Saloni Naresh Shah ¹, N Geetha ¹, Ashok Parameswaran ¹

Background: Nodular fasciitis is a pseudosarcmatous, self-limiting reactive process composed of fibroblasts and Myofibroblasts. It commonly affects the upper extremity and trunk followed by head and neck region and lower extremity. Fine Needle Aspiration plays a crucial role to establish a diagnosis of Nodular Fasciitis, as it is a self regressive reactive process which can be managed by conservative surgery or just follow up.

Methods: The Cases of Nodular Fasciitis diagnosed by Fine Needle Aspiration Cytology and/or histopathology in head and neck region from January 2016 to August 2021 in Department of Histopathology and Cytology, Apollo Main hospitals, Chennai were retrieved and are described.

Results: 11 Cases of Nodular Fasciitis of head and neck region are described. The age of the patients ranged from 4 to 72years with mean age being 31 years. Incidence in males (6; 54.5%) was slightly more than that in females (5; 45.4%). Most common site of involvement was parotid gland. Fine Needle Aspiration was performed in 6 Cases (54.5%) which was followed by biopsy. Of these, 3 Cases (50%) were diagnosed as Pleomorphic Adenoma and 3 (50%) Cases were highly suspicious of Nodular fasciitis in FNAC which was followed by biopsy for confirmation.

Conclusion: A presurgical diagnosis of Nodular fasciitis in spindle cell lesion in head and neck region by Fine Needle Aspiration Cytology along with clinical and radiological correlation will aid in patient management and unwarranted surgeries can be avoided.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-145: SPECTRUM OF SALIVARY GLAND FNAC AND CATEGORIZATION IN MILAN SYSTEM OF REPORTING : A RETROSPECTIVE STUDY

Asttha Kapoor ¹, Pinki Pandey ¹, Roopak Agarwal ¹, Vineet Chaturvedi ¹, Jasvinder Kumar ¹, Kapil Trivedi ¹, UPUMS Saifai ¹, Etawah ¹

Background: Fine needle aspiration cytology (FNAC) of salivary gland lesions shows high sensitivity and specificity in differentiating a neoplastic from a non-neoplastic lesion. However, its value is limited in diagnosing specific neoplastic entities especially those with well-differentiated morphology. To surmount this, an International group of pathologists have proposed a management-oriented, 6 tiered classification for Reporting salivary gland FNA specimens, “The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC)”. This system helps to standardize the terminology which facilitates communication and optimizes management by providing risk of malignancy (ROM) for each category.

Methods: All Cases of salivary gland FNA with available surgical follow-up, in the period from 2017 to 2020 were retrieved, cytological features were re-evaluated and reclassified as follows Category 1: Non-diagnostic(ND); Category 2: Non-neoplastic(NN); Category 3: Atypia of undetermined significance (AUS);Category 4a: Neoplasm:benign(NB); Category 4b: Neoplasm: salivary gland neoplasm of uncertain malignant potential (SUMP); Category 5:Suspicious for malignancy (SM);Category 6: Malignant(M).

Results: Total 110 Cases were evaluated cytologically,and histological follow-up was available in 59 Cases Distribution of the specimens according to the Milan System was as follows: 7.27% (ND), 33.63% (NN), 4.54% (AUS),30% (NB), 3.63% (SUMP), 4.54% (SM), and 16.36% (M). Overall ROM Reported were 25%,8.3%,20%,4.75%,33.3%,75%,92.8%., respectively for each category. Overall, sensitivity was 82.21%, specificity was 96.32%, positive predictive value 91.71%, and negative predictive value was 90.17%

Conclusion: The Milan System proved to be a useful Method to categorize salivary gland FNAC into well-defined categories and to predict the risk of malignancy in the sample studied.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-146: CYTOMORPHOLOGICAL FEATURES AND ITS CLINOCO-RADIOLOGICAL CORRELATION IN STERNOCLEIDOMASTOID TUMOR OF INFANCY

Subarna Sharma Pinky ¹, Navpreet Kaur ¹, Sufian Zaheer ¹, Sachin Kolte ¹, Sunil Ranga ¹

Background: Sternocleidomastoid tumor of infancy (SCMI) is a rare, benign self-limiting condition which occurs in the perinatal period. The goal of our study is to highlight clinicoradiological and cytopathological findings in these Cases.

Material and Methods: A retrospective study was done at a tertiary level hospital over two years. Thirteen Cases were studied, out of which 11 were clinically suspected Cases of SCMI tumor and 2 Cases were clinically suspected as cervical lymph node tuberculosis which were finally diagnosed as SCMI on FNAC evaluation. Clinical, ultrasonographical, and cytopathological features are highlighted along with follow-up of the Cases.

Results: There was a total of 13 Cases, of which 11 Cases were neonates and 2 Cases more than 1 month of age (2 months and 2.5 months). Male; female ratio was 10:3 and swelling was present more commonly on the right side of the neck. Ultrasonography predominantly showed non-cystic, bulky, and heterogenous echotexture of sternocleidomastoid muscle. Smears were moderately cellular showing mainly singly scattered oval to spindle shaped fibroblasts along with degenerating and regenerating muscle fibers.

Conclusion: FNAC along with adequate clinic-radiological correlation aids in early and reliable diagnosis and can help curtail complications.

Keywords: Sternocleidomastoid tumor, FNAC, Fibromatosis colli

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-147: FNAC AS A TRIAGE TOOL IN THE STUDY OF HEAD & NECK LESIONS IN A TERTIARY CARE HOSPITAL

E Dinakar ¹, G Lavanya ¹, M Bharathisree ¹, M Srinivasulu ¹, BV Sai Prasad ¹, A Venkatalakshmi ¹

Background: Fine needle aspiration cytology (FNAC) is a first-line investigation and minimally invasive diagnostic outdoor procedure for head and neck lesions with high efficacy. FNAC is relevant in head and neck location because of easy accessibility, rapidity. The main aim of the study is to evaluate the wide spectrum of head & neck lesions diagnosed through FNAC and to know its efficacy in diagnosing head and neck lesions.

Methods: The present study is a retrospective study. Out of 1610 FNACs done in the department from January 2019 to December 2019, 554Cases were head & neck lesions. Data was retrieved from the record section of the department and the Results were analyzed accordingly.

Results: Most common site aspirated were Lymph nodes (45.84%) followed by Thyroid (33.93%), skin (6.13%), and salivary glands (5.41%). The most common diagnosis in lymph node FNAC was Non-specific lymphadenitis (48%) followed by granulomatous lymphadenitis (27.2%). Nodular goitre is the most common among thyroid swellings (70.21%) followed by Hashimoto's thyroiditis (24.46%). The majority of salivary gland lesions were benign (46.6%). The most common skin and soft tissue lesions were epidermal inclusion cyst (94%) and lipoma (76.47%) respectively.

Conclusion: FNAC is a simple, quick, cost-effective, and accurate diagnostic procedure. It may help in the triage of neoplastic and non-neoplastic lesions and helps avoid unnecessary surgical intervention.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-148: OLFACTORY NEUROBLASTOMA PRESENTING AS A SUBMANDIBULAR MASS

Monika Bharti ¹, Ruchi Khajuria ¹

A 48 year old male presenting as left submandibular mass was diagnosed as round cell tumour on FNAC. Clinical history of the patient traced and was found that patient had nasal mass which on biopsy, radiology and on immunohistochemistry was diagnosed as olfactory neuroblastoma. It was olfactory neuroblastoma presenting as submandibular mass.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-149: SPECTRUM OF CYTOMORPHOLOGICAL CHANGES IN PLEOMORPHIC ADENOMA AND ITS REFLECTION IN HISTOPATHOLOGY

Sanjay M ¹, Amita K ¹, Rajini T ¹

Background: Although pleomorphic adenoma (PA) is the most common tumour of salivary gland encountered at Fine needle aspiration cytology (FNAC), diverse morphological patterns make this entity challenging for the cytopathologists. The present study was conducted to determine the various morphological patterns seen at cytology and to correlate it with histopathology.

Methodology: Retrospective diagnostic analytical study over a duration of 5 years. FNAC smears of 52 pleomorphic adenoma Cases were reviewed for following parameters: stroma to cell ratio, cellularity, pattern of arrangement, type of cells, metaplasia of various types like sebaceous, oncocyte, squamous, nuclear atypia, mucin, chondromyxoid stroma, hyaline globules, crystals, inflammation and other features like giant cells, basement membrane material, capillaries, macrophages. The same features were evaluated at histopathology.

Results: Out of total 52 Cases, concordant diagnosis was seen in 51 Cases 98.07%, while discordant diagnosis was seen in one Case (1.92%). Cytohistopathologic correlation was noted for stroma to cell ratio, predominant cell type, squamous and oncocyte metaplasia. Hyaline globules (23% versus 0%, p =0.001), presence of giant cells (7.69% versus 1.92%, p=0.01), cystic change (19.23% versus 7.69%, p=0.002) adipocyte (19.23% versus 7.69%, p=0.002) and crystals (3.84% versus 0%, p=0.004) were more frequently seen in smears than at histology.

Conclusion: The cytomorphological variations of PA are well reflected in histopathology. A sound knowledge of these variations is essential for accurate diagnosis at FNAC.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-150: SPECTRUM OF METASTATIC SCALP LESIONS DIAGNOSED ON FNAC – A REPORT OF 15 CASES

Brijdeep Singh ¹, Manveen Kaur ¹, Uma Handa ¹, RPS Punia ¹, Rajeev Sharma ¹

Background: Scalp nodules are commonly encountered in clinical practice and offer an easily accessible site for fine-needle aspiration cytology. Majority of the calvarial lesions present as painless, subcutaneous swellings. Most scalp swellings are benign however a considerable proportion of metastatic deposits are also noted.

Methods: A total of 223 Cases presenting as palpable scalp masses over a duration of 6 years were retrospectively analysed. FNAC was performed using a 22-23 gauge hypodermic needle. Air-dried smears were stained with May-Grunwald-Giemsa and the wet fixed smears with hematoxylin and eosin and/or papanicoloeu stains. The Cases were categorised cytologically, cell block was prepared and immunocytochemistry performed wherever deemed necessary.

Results: Out of the 15 Cases diagnosed as metastatic malignancy, 6 were females and 9 males with age ranging from 19 to 67 years. Most of the patients did not have a previously known primary tumour. 5 Cases (33.3%) had primaries in the head and neck region (thyroid 2; Oral cavity 3), 3 (20%) were hematolymphoid malignancies (2 Non Hodgkin Lymphoma and 1 Plasmacytoma) and 1 Case each of metastatic renal cell carcinoma, leiomyosarcoma, malignant melanoma and adenocarcinoma. The possible site of primary was suggested wherever possible. Non-malignant lesions included keratinous cysts, benign adnexal and mesenchymal tumors, cysticercosis and reactive lymphoid hyperplasia.

Conclusion: FNAC is a prompt, cost effective and easily available diagnostic modality for determining the exact nature of a palpable scalp swelling and aids in establishing the site of occult primary in Cases where the swelling is the first clinical presentation.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-151: CYTOLOGY REPORTING OF SALIVARY GLAND LESIONS USING MILAN SYSTEM OF REPORTING (2018)

Lakshmi Kanth D ¹, DeepaS Masur ¹, Prabhu MH ¹

Introduction: FNAC of salivary is simple, easy, cost effective used to differentiate benign and malignant lesions. Milan system improves the communication between cytopathologists and physicians.

Objectives: To diagnose the salivary gland swellings using fine needle aspirations by Milan system of Reporting.

Materials and Methods: Total 50 Cases of salivary gland lesions were studied from September 2020 to August 2021.

Results: 1. Non-neoplastic – 18., 2. Atypia of undetermined significance – 00., 3. Neoplasm a. Benign – 23. b. Uncertain malignant potential – 02., 4. Suspicious for malignancy – 07., 5. Malignant – 00.

Conclusion: FNAC is a safe, reliable and yet economically effective technique in diagnosing salivary gland lesions. Histopathology is required for confirmation of the diagnosis. FNAC with Milan system can be used effectivity pre-operative investigation in patients with salivary gland lesions. FNAC should be complemented with radiological and clinical correlation.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-152: FINE NEEDLE ASPIRATION CYTOLOGY OF NEOPLASTIC SALIVARY GLAND LESIONS AND INCORPORATION OF MILAN SYSTEM FOR REPORTING SALIVARY GLAND CYTOPATHOLOGY - A 2 YEAR STUDY

Divya PJ ¹, Soumya BM ¹

Background: The mainstay of FNAC in salivary gland tumors is distinguishing between benign from malignant lesions. Milan system for Reporting salivary gland cytopathology (MSRSGC) was introduced to standardize the terminology and Reporting of salivary gland cytology.

Methods: This is a retrospective study done for a period of 2 years from July 2012 to June 2014. Data were collected from Department of pathology, J.J.M.M.C, Davangere and statistical analysis of these Results were carried out. FNAC were retrospectively reviewed and were categorized according to the Milan system.

Results: Among the FNAC done on 101 patients, cytological diagnoses of neoplastic lesions was made in 53 patients which included 38 benign neoplasms(71.70%) in which pleomorphic adenoma in 34 Cases (89.47%) and 1 Case each of basal cell adenoma, warthin's tumour, myoepithelioma and oncocytoma (2.63%) and 15 were malignant neoplasms(28.30%) which included 4 Cases of adenoid cystic carcinoma(26.67%), 3 Cases of acinic cell carcinoma(20%), 2 Cases each of mucoepidermoid carcinoma, polymorphous low grade adenocarcinoma, carcinoma ex pleomorphic adenoma(13.33%), 1 Case each of Non Hodgkin lymphoma and salivary duct carcinoma(6.67%). All the Cases were categorized as per MSRSGC and reclassified. As per MSRSGC, 38 Cases of Benign neoplasms were grouped in Category IV(A) and 15 Cases of malignant neoplasms were grouped under category VI.

Conclusion: FNAC of lesion in salivary glands was approved useful technique for the evaluation of patients having salivary gland masses. MSRSGC helps in planning the management and eventually the surgical plan and hence augment the value of conventional Reporting of salivary gland cytology.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-153: A STUDY OF FNAC ON NON-NEOPLASTIC SALIVARY GLAND LESIONS AND APPLICATION OF MILAN SYSTEM - AN INSITUTIONAL RETROSPECTIVE STUDY

Adicherla Govardhan ¹, Soumya BM ¹

Background: Salivary gland lesions are superficial swellings and seek attention of patient easily. Salivary gland lesions are accounting for 2.0-6.0% of all head and neck neoplasm. The proposed “Milan System For Reporting Salivary Gland Cytopathology” (MSRSGC) Aims to standardize the Reporting terminology. The current study was conducted retrospectively on non-neoplastic salivary gland lesion by conventional FNAC and re-categorized according to MSRSGC.

Methods: This is a retrospective study done for a period of 2 years from July 2012 to June 2014. Data were collected from Department of pathology, JJM medical college, Davangere. FNAC were retrospectively reviewed and were categorized according to the Milan system.

Results: Out of 101 Fine needle aspirates,cytological diagnosis of non neoplastic lesions was made in 48 patients among which 3 Cases each of acute sialadenitis,benign salivary gland inclusion in lymph node (6.25%), 26 Cases were chronic sialadenitis (54.17%), 2 Cases were granulomatous sialadenitis (4.17%), 1 Case each of sialadenitis of autoimmune origin, mucoceole (2.08%) and 12 Cases of lymphoepithelial cyst (12%). All the Cases were categorized as per MSRSGC and reclassified. As per MSRSGC,48 Cases of Non neoplastic lesions were grouped into category II and the concordance rate of conventional FNAC and MSRSGC were equal.

Conclusion: FNAC is being widely used in the preoperative diagnosis of the salivary gland swellings and Management of patients. Role of FNAC, its diagnostic utility are combined with the use of Milan System of Reporting cytopathology in SGLs was found characteristically significant for cytological diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-154: A REVIEW OF FINE NEEDLE ASPIRATION CYTOLOGY AND ITS HISTOMORPHOLOGICAL CORRELATION IN SALIVARY GLAND LESIONS

Sangeeta Lader ¹, Veena Maheshwari ¹

Introduction: Salivary gland tumors accounts for 3-10% of all the head and neck neoplasm and commonly seen in the age group of 40-60 years. Most common benign, malignant, and non-neoplastic lesions are Pleomorphic adenoma followed, Mucoepidermoid carcinoma and Sialadenitis respectively. The objective was to elucidate the cytomorphological features of various salivary gland lesions on FNAC and explore the diagnostic criteria by correlating with histomorphology finding.

Material & Method: This prospective study was done in JNMCH, AMU with a total number of 66 Cases from the month of Sep 2019 to August 2021. The study included the Cases which presented to the OPD with a slow growing painless tumor. FNA was done from the affected salivary gland lesion and stained smears were examined under light microscopy. Paraffin sections were taken from the tissue received in the department of pathology. Diagnosis of tumor like lesions, benign tumors and Malignant tumors was made on fine needle aspiration cytology which was further correlated with the histopathological examination wherever possible.

Result: In our study male predominance was seen in both benign and malignant lesions of salivary gland affecting mainly parotid gland. There was increased incidence of benign lesions compared to its malignant counterpart. The most common benign and malignant tumor was Pleomorphic adenoma and mucoepidermoid carcinoma respectively.

Conclusion: FNAC is highly sensitive and specific technique for diagnosis of most salivary gland swellings. Histological correlation wherever done showed 93.9% diagnostic accuracy. Thus, FNAC can be used as first line investigation for pre-operative diagnosis of salivary gland lesions.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-155: WANDERING THROUGH FNAC – A SPECTRUM OF HEAD AND NECK LESIONS

Shahan Hashmi ¹, BS Sonawane ¹, AR Joshi ¹

Background: Head and Neck lesion are common pathologies which need evaluation by clinical history and examination with the aid of FNAC, USG, CT and excision biopsy. FNAC is a rapid, economical and less invasive Method used for aiding diagnosis in Case of head and neck lesions.

Material and Methods: A retrospective study was conducted at Government Medical College, Aurangabad from January 2020 to June2021 to assess the prevalence and spectrum of palpable head and neck lesions. About 269 patients,173 females and 96 males, ranging from 4 months to 77 years were included in the study.

Results: Out of 269 Cases 133(49.44%) were of lymphnode, 89(33.08%) were of thyroid, 32(11.89%) were of skin and soft tissue swelling and 15(5.57%) were of salivary gland.

Conclusion: FNAC is an inexpensive and minimally invasive first line investigation in approach towards diagnosis of head and neck lesions. In Cases with difficulty in diagnosing, excision biopsy remains gold standard.

Keywords: Head and neck, lymphnode, cryptococal lymphadenitis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-156: APPLICATION OF MILAN SYSTEM IN CYTOLOGICAL REPORTING OF SALIVARY GLAND LESIONS IN A TERTIARY CARE HOSPITAL

S Manasalakshmi ¹, N Mohan Rao ¹, P Dinusha ¹

Background: Fine needle aspiration cytology is a very effective tool in the evaluation of salivary gland lesions. Due to overlapping cytomorphological features of salivary glands, there are diagnostic difficulties in cytologic interpretation. The Milan system in Reporting cytopathology of salivary glands is introduced, which provides a platform for a uniform Reporting system.

Methods: Ours is a retrospective study done over a period of two years. A total of 79 Cases were collected. All the Cases were categorized according to the Milan system and the risk of malignancy for each category was calculated.

Results: Out of 79 Cases 1.3% are non diagnostic, non neoplastic(30.4%),atypia of undetermined significance(5.1%),benign neoplasms(47.8%),salivary gland neoplasm of uncertain malignant potential(1.2%),suspicious for malignancy(1.1%),malignant lesions(14.1%). Out of 79 Cases 52 Cases had follow up. The risk of malignancy are 0% for category II and IVa, 50% for category III and 100% for category IVb , V and VI.

Conclusion: The application of the Milan system in cytological Reporting of salivary gland lesions provides a stage for unified categorization and risk assessment Resulting in effective communication between pathologists and physicians which provides improved patient care. Our study recommends the use of the Milan system for Reporting salivary gland cytology.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-157: ADENOID CYSTIC CARCINOMA OF PALATE: DIAGNOSIS AND PITFALL CASE REPORT

Kumari Sunny ¹, Sanjeet Kumar Singh ¹, Ashish Ranjan Singh ¹, Reccha Singh ¹, Anju Singh ¹, Kalpana Chandra ¹, Bipin Kumar ¹

Background: In the words of Conley and Dingman, Adenoid Cystic Carcinoma (ACC) is described as “one of the most biologically destructive and unpredictable tumors of the head and neck. And rightly so the ACC is an aggressive slow growing biphasic tumor with slight female predilection affecting the major and minor salivary glands accounting for about 5% to 10% of all salivary gland neoplasms and contributing to 2% to 4% of malignant occurrences of the head and neck. The sensitivity and specificity of Fine needle aspiration cytology (FNAC) ranges approximately between 60 and 100% and 90 and 100%, respectively, making it an important tool in diagnosis.

Case Report: Here in we Report a Case of 52 years male presenting with swelling in left side of soft palate which was slowly increasing in size since two and half years. FNAC was done and revealed cellular smear showing metachromatic matrix spheres with sharply defined borders surrounded by basaloid tumor cells. Adenoid cystic carcinoma was given as the provisional diagnosis which was further confirmed on histopathological examination and immunohistochemistry.

Conclusion: Thus role of FNAC in suspected salivary gland lesions is useful in preoperative diagnosis and Management of patients, in spite of its limitations. It is prudent to correlate with clinical and radiological features and follow strict guidelines for diagnosis of salivary gland pathology.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-158: BILATERAL MUCOEPIDERMOID CARCINOMA OF SUBMANDIBULAR GLAND: RARE CASE REPORT

Navpreet Kaur ¹, Sufian Zaheer ¹, Ayushi Agarwal ¹, Sunil Ranga ¹

Background: Mucoepidermoid carcinoma is the most common malignant tumor of the salivary gland especially parotid gland. Its occurrence in submandibular gland is uncommon. However, its synchronous occurrence in both of the submandibular glands is extremely rare.

Case Report: A 65 year old female presented with a painless mass in bilateral submandibular gland with history of loss of weight since 3 months. Fine needle aspiration cytology (FNAC) was done and showed presence of squammous cells, mucin producing cells and intermediate cells and signed out as bilateral mucoepidermoid carcinoma of submandibular gland. Based on cytopathology, surgical excision was done in bilateral submandibular gland and later confirmed as bilateral mucoepidermoid carcinoma of submandibular gland on histopathology. At the 1-year follow-up, there was no recurrence in the submandibular regions and the neck.. A close follow-up is also recommended for the risk of future occurrence of metachronous tumors.

Conclusion: On reviewing the thorough literature and extensive search on Pubmed/Medline it reveals few Cases of bilateral mucoepidermoid carcinoma of parotid gland but no Case on bilateral mucoepidermoid carcinoma of submandibular gland was found. To the best of our knowledge we are presenting this as a first Case in 65-year-old female with bilateral synchronous Mucoepidermoid carcinoma of the submandibular gland diagnosed on fine needle aspiration cytology confirmed on histopathology and finally treated with surgery.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-159: A CYTOLOGICAL DIAGNOSIS OF ACINIC CELL CARCINOMA OF SUBMANDIBULAR GLAND

Hiramoni Haloi ¹, Prajnon Saikia ¹

Introduction: Acinic cell carcinoma is a low grade malignant salivary gland neoplasm that historically represent approximately 2% of all salivary gland tumours. In head and neck region, the parotid gland is the predominant site of origin. Submandibular gland and minor salivary glands are rarely involved. This tumor is more common in women and the peak incidence is in the fifth and sixth decades of life. Rarely, it may arise in ectopic salivary gland tissue. It may be multicentric or bilateral. Previous radiation exposure and familial predisposition are some of the risk factors for Acinic Cell Carcinoma.it has a significant tendency to recur, to produce metastasis and May have an aggressive evolution. Therefore long term follow up is mandatory after treatment.

Case Report: A 40 year old male came to ENT OPD with complaining of swelling in left submandibular region of size 4 cm since 2 years. Size increases gradually since last 1 year. Clinical suspicion, owing in particular to the firm to hard in consistency on palpation, lead to further radiological investigation. Ultrasonography Report shows well demarcated hypoechoic lobular lesion suggestive of malignancy. Subsequent Fine Needle Aspiration cytology Report shows suggestive of Acinic Cell Carcinoma Of submandibular gland. Patient was admitted in ENT ward and surgery was done and specimen was sent to our pathology department of Jorhat Medical College. Histopathology Report shows Acinic Cell Carcinoma of submandibular gland.

Conclusion: Case was presented due to its rarity and rare site of presentation.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-160: FNAC OF SALIVARY GLANDS USING “MILAN SYSTEM FOR REPORTING SALIVARY GLAND CYTOLOGY”:A 3 YEAR RETROSPECTIVE STUDY

Anjali Lakhani ¹, Hema Shantagiri (Bannur) ¹, Kaher's JN ¹

Background: Salivary gland lesions (SGL) represent 3-6 % of all tumors of head and neck region. For adequate management, the exact nature of the lesion has to be revealed. Fine needle aspiration (FNA) poses a negligible risk of complication, allows an individualised treatment plan.

Materials and Methods: FNA was carried out on 50 patients with salivary gland enlargement, from January 2018 through December 2020. Slides stained with PAP and MGG stains were retrieved, reassessed and distributed into six categories using “Milan System for Reporting Salivary Gland Cytopathology” (MSRSGC):

1) Non-Diagnostic 2) Non-Neoplastic 3) Atypia of Undetermined Significance (AUS) 4) Neoplastic (benign & uncertain malignant potential (UMP) 5) Suspicious of Malignancy & 6) Malignancy.

Results: The common age group was between 31-60 years (17 Cases,34%). 26 (52%) aspirates were from parotid glands, 18 (36%) from submandibular glands and 6 (12%) from sublingual glands. According to the Milan system Cases out of 50 Cases: Non- Diagnostic – 6, Non-neoplastic-16, AUS-0, Neoplastic (Benign)-18, Suspicious of Maignancy-04, Malignancy- 06.

Conclusion: Salivary gland neoplasms are more common in the parotid gland. A 3:1 ratio was found between benign and malignant tumors. MSRSGC conveys specific risks of malignancy to the clinicians using Reporting and help them to plan therapeutic approach to the patients.

Keywords: FNA, salivary gland,Milan system

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-161: FINE NEEDLE ASPIRATION CYTOLOGY OF CYSTICERCOSIS: THREE CASE SERIES.

Marisha ¹, Amrita Ghosh Kar ¹, Gagan Kumar Rangari ¹, Shankhanila Muzumdar ¹

Background: Cysticercosis is a systemic parasitic disease caused by larval stage of Taenia solium, pork tapeworm. It is endemic in Southeast Asia, Latin America and South Africa. In India, it is more common in northern parts. The patient most commonly presents with subcutaneous and Muscle involvement in the form of nodular lesions. The other most commonly involved sites include eye, brain, bladder wall, and heart.

Case/Result: We Reported 3 Cases, 1st Case in 42 years old male patient. The patient had single nodular right anterior chest wall swelling for 15 days without any other associated features. The patient was finally diagnosed as a Case of cysticercosis with foreign body granuloma, which was diagnosed on FNAC. 2nd Case in 38 years old female patient. The patient had single nodular left cervical swelling for 1 months without any other associated features, the patient was finally diagnosed as a Case of inflamed cystic lesion consistent with cysticercosis. 3rd Case in 23 years female patient presented with left flank swelling for 18 months with fever on & off since 6 months, the patient was diagnosed as a Case of inflammatory lesion consistent with cysticercosis.

Conclusion: Fine-needle aspiration cytology (FNAC) has emerged as simple, minimally invasive, low-cost, outpatient diagnostic modality for the evaluation of nodules caused by parasites. Cysticercosis can be diagnosed on serology, and radiologically but confirmatory diagnosis is based on cytopathological and histopathological examination of the involved tissue FNAC and biopsy specimen.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-162: A RARE BENIGN TUMOUR OF SKIN MASQUERADING AS MALIGNANCY: PROLIFERATING TRICHILEMMAL TUMOR OF SCALP

Bhoomika Kaushik ¹, Gajendra Kumar Yadav ¹, Shweta Azad ¹, Arvind Kumar ¹, Sanjeev Kishore ¹

Background: Proliferating trichilemmal tumour(PTT), also known as a proliferating trichilemmal cyst. Tumour grossly and microscopically mimics squamous cell carcinoma, hence understanding the cytological and histological features of this tumour is important. Cytology has limitations due to its inability to comment on invasion. Hence histopathology plays a crucial role in diagnosis. As no standard guidelines are present for the treatment of these tumours and recurrence is common which makes its management a challenge. Here we are Reporting a Case of a 65-year-old woman with proliferating trichilemmal tumour on her occipital area.

Case Report: A 65-year-old female with a gradually increasing swelling on her occipital area presented to the Surgical Oncology department, AIIMS Rishikesh. On Physical examination, a non-tender ulcerated nodular mass having a smooth surface and firm consistency, measuring 10x8x7.5cm, was observed. Patient was sent for a FNAC examination. Prepared slides showed numerous nucleated hyperchromatic squamous cells with dyskeratotic cytoplasm, discrete anucleated squamous cells, foreign body type giant cells and keratinous debris. An impression of Suspicious for malignancy was given. Then excisional biopsy measuring 10x7x7cm was sent for histopathological examination shows lobulated tumour with peripheral palisading of small basaloid cells along with areas of ulceration and pushing borders composing variable-sized nest and cyst having outer stratified squamous epithelial lining with trichilemmal type gratification and absent granular layer along with areas of ghost cells, squamous eddies and calcification.

Conclusion: A Pathologist must be acquainted with the limitations of cytomorphology of tumors to avoid overdiagnosis. Hence histopathological findings also demand attention.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-163: FNAC DIAGNOSIS OF LOW GRADE MUCOEPIDERMOID CARCINOMA OF PAROTID GLAND: - A DIAGNOSTIC CHALLENGE YET A PERCEPTIBLY SIGNIFICANT TOOL

Sampada Anwekar Saraf ¹, Sampada Saraf ¹, Bhakti Dangmali ¹, SS Gill ¹

Background: Mucoepidermoid carcinoma is a malignant salivary gland neoplasm with extreme morphologic heterogeneity; hence poses interpretative difficulties for concluding a definitive fine needle aspiration cytology. With this challenge however, the preoperative cytology helps to differentiate diagnosis between benign and malignant lesions and thus the extent of the appropriate surgical modality can be planned and modified accordingly. This Case Report has elucidated the cytological features and confirmed the diagnostic accuracy by comparing with subsequent histopathology.

Case Report: A healthy 33 Y/M presented with complaints of gradually increasing swelling in the Right Parotid region since 1year. MRI suggested a Lobulated hyperintense heterogenous lesion in deep lobe of right parotid. On examination 4x3 cm swelling, hard, fixed, non tender. Oral cavity examination was normal. FNAC was performed with three aspirations and hemorrhagic white granular material was obtained. On microscopy smears were variably cellular with predominantly Intermediate cells in syncytium and small clusters having moderate cytoplasm with few vacuoles. Few oncocytoid and occasional squamoid cells were noted. High N:C ratio with minimal overlapping noted. Background was proteinaceous with few lymphocytes, cell debris and Mucin. A diagnosis of Low grade mucoepidermoid carcinoma was suggested which was confirmed with frozen and histology correlation. Pathological stage was pT2 N0 Mx.

Conclusion: Thus,Careful examination with repeated aspirations in same setting by Fine needle aspiration for mucoepidermoid class of salivary gland tumors is a valuable tool to pre-operatively diagnose/assess lesional tissue, determining the need for an early surgical intervention and planning the appropriate surgical approach.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-164: IMPRESSION CYTOLOGY IN DRY EYES OF RHEUMATOID ARTHRITIS PATIENTS

Surbhi Hemant Patil ¹, Ganga Pilli ¹

Background: Rheumatoid arthritis has manifestations in various organs including ophthalmic involvement and there is a strong association between RA and dry eyes. Dry eye disease is a multifactorial disease of the tears and ocular surface that can Result in ocular discomfort and visual impairment. There are numerous tests to evaluate the ocular status in dry eye disease. However these tests require technical expertise and are not widely available to the practicing ophtholmologist. Among the different tests for diagnosing dry eyes, Impression Cytology is considered a practical and minimally invasive investigation.

Materials and Methods: This study included seventy patients diagnosed to have rheumatoid arthritis as per the American Rheumatism Association guidelines and referred to Ophthalmology department for further evaluation. After eliciting a complete history which included any systemic disease, occupation and drug intake these patients were subjected to various tests like : 1) Schirmer test 2) Rose Bengal test 3) Tear film break up time and 4) Impression cytology.

Results: All clinical tests have limited diagnostic value if performed individually, but impression cytology showed the highest sensitivity.

Conclusion: It is recommended that impression cytology is a fast, non-invasive, easy to perform and economical Method of investigating dry eyes when diagnosis is not clinically obvious or when clinical diagnosis needs substantiation. Also when combined with schirmer test, It increases sensitivity and specificity of diagnosing dry eyes

Keywords: Dry eye, impression cytology, tear break up time

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-165: ORBITAL METASTASIS OF BREAST CARCINOMA- A RARE PRESENTATION

UPAJNA PAL ¹, Senjuti Dasgupta ¹, Nirmal Kumar Bhattacharyya ¹, Parul Jain ¹, Manish Osta ¹

Background: Orbital metastasis from breast carcinoma are rare, but often debilitating. Among orbital tumours, metastatic lesions have a prevalence of 1 to 13%. Interestingly, breast carcinoma is the most common malignancy causing orbital metastasis. Here, we Report a rare Case of proptosis caused by bilateral breast carcinoma metastasizing to orbit.

Case Report: A 55-year-old female patient who presented with left sided proptosis was referred to the Pathology Department for fine needle aspiration cytology (FNAC) from the orbital swelling. CT (computed tomography) guided FNAC from the orbital mass showed cytomorphological features suggestive of metastatic deposits of tumor. Systemic examination revealed bilateral breast lumps. No other lesion was detected on thorough clinical and radiological investigations. Trucut biopsy from the breast lumps showed bilateral invasive carcinoma of breast, NOS (not otherwise specified). The breast carcinoma was triple negative on immunohistochemical examination with ki67 index of 20%. The patient expired within 3 months of diagnosis.

Conclusion: Orbital metastasis are uncommon and FNAC can help as an initial diagnostic tool to suspect breast carcinoma metastasizing to orbit.

Keywords: Fine needle aspiration cytology, Breast carcinoma, Orbital metastasis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-166: A UNIQUE CASE REPORT OF RETINOBLASTOMA METASTASIS IN PAROTID GLAND

Bhoomika Kaushik ¹, Pakesh Baishya ¹

Background: Retinoblastoma is the most common intraocular tumour of childhoodwhich. It may metastasize to other places also as bones, bone marrow, and meninges but very rarely it metastasize to the salivary gland. Till now only 6 Cases are there in the literature Reported as retinoblastoma metastasis to the salivary gland. There is no definitive management present for such types of Cases. Here we are presenting the Case of a 2 yr old girl who presented with left intraocular swelling along with left parotid gland swelling.

Case Report: It is a Case of 2 years-old child who presented to the Radiotherapy Department, AIIMS Rishikesh with left intraocular swelling along with left parotid gland swelling for last 3 months. An excision biopsy of her intraocular tumour was done and sent to the Histopathology Department where it was confirmed as retinoblastoma, after 4 days the patient was sent to the Cytology Department for FNAC of left parotid swelling. Prepared slides shows predominantly inflammatory and degenerated cells with singly scattered and clusters of small to medium-sized cells showing round nucleus, salt and pepper chromatin with scant cytoplasm in a necrotic Background and an impression of small round blue cell tumour suggestive of retinoblastoma was given.

Conclusion: Due to the presence of intraparotid lymph nodes, the parotid gland becomes the major site of tumour metastasis in salivary glands. Due to its rarity and the limited number of data available in literature clinical outcomes and prognosis of these patients are difficult to predict.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-167: CUTANEOUS METASTATIC SQUAMOUS CELL CARCINOMA FROM TONGUE TUMOR: AN UNCOMMON FINDING

Gajendra Kumar Yadav ¹, Bhoomika kaushik ¹, Shruti Agarwal ¹, Arvind Kumar ¹, Gajendra Kumar Yadav ¹, Bhoomika Kaushik ¹, Shruti Agarwal ¹, Arvind Kumar ²

Cutaneous metastatic squamous cell carcinoma from tongue tumor: An uncommon finding

Background: Cutaneous metastasis from the squamous cell carcinoma of tongue is relatively rare. The overall incidence of cutaneous metastasis is 5.3%. The common sites of cutaneous/subcutaneous metastasis are the scalp, abdomen, and chest. In metastasis from an unknown primary, the abdominal wall is the most preferred site. Any rapidly growing single or multiple firm, fixed nodule should raise the suspicion of malignant tumor. Aspiration cytology is of utmost importance in detection of metastatic lesion.

Case Report: A 45 years old male patient, treated Case of squamous cell carcinoma of tongue with pT3N3b staging, presented to ENT OPD with a rapidly growing cutaneous nodules over left side of neck and anterior chest for a duration of 4 months. The nodule was acute in onset, fixed, firm largest measuring 2.0x2.0x1.5 cm of size at the time of presentation. FNAC was done from left side of neck nodule. Smears showed clusters and discrete population of atypical epithelial cells, atypical cells exhibit moderate anisonucleosis, hyperchromatic nuclei, inconspicuous nucleoli and moderate intense eosinophilic cytoplasm. The Case was Reported as cutaneous metastatic squamous cell carcinoma.

Conclusion: Aspiration cytology plays a key role in early detection of common and rare metastatic lesion whether from lymph node or cutaneous site, It is due to it's unparallel simple steps with short duration and cost effectiveness.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-168: MILAN SYSTEM FOR REPORTING SALIVARY GLAND CYTOPATHOLOGY: A TWO YEARS' EXPERIENCE IN A REFERRAL CENTRE OF WESTERN ODISHA

Bijayalaxmi Sahoo ¹, Sunanda nayak ¹, Shailaja prabhala ¹, Gitimadhuri dutta ¹

Background: The Milan system for Reporting salivary gland cytopathology (MSRSGC) represents a stage for a structured, evidence-based International Reporting system for salivary gland fine-needle aspiration (FNA). This system provides a guidance for diagnosis and Management according to the risk of malignancy (ROM) in different categories. The objective of this current paper is to study the various cytomorphological lesions of salivary gland and their cytological categorisation based on the Milan system of Reporting.

Methods: A 2-year study (January 2018 to December 2019) was conducted on FNAC of salivary gland lesions in the Department of Pathology,VSSIMSAR (VEER SURENDRA SAI INSTITUITE OF MEDICAL SCIENCE AND RESEARCH), Burla, Odisha. Based on the classical system,all smears were studied and recategorized into six groups according to the Milan Classification. Histological correlation was carried out in the available Cases.

Results: A total of 103 FNA Cases were examined and 20 different categories were there in the original diagnosis. As per the categorisation based on Milan System there were six categories, maximum Cases were non-neoplastic 34 (33.0 %) followed by benign neoplasms 22 (21.35 %), malignant 14 (13.5 %), non- diagnostic 10 (9.7 %), atypia of undetermined significance 9 (8.7 %), suspicious for malignancy 8 (7.7 %) and neoplasms of uncertain malignant potential 6 (5.8 %). 43 Cases (80.4 %) were found to be concordant out of 54 histopathology correlated Cases.

Conclusion: The Milan system of Reporting salivary gland cytopathology provided an uniform system of Reporting salivary gland cytomorphology that may increase the effectiveness.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-169: SPINDLE CELL LIPOMA OF THE PAROTID GLAND - A RARE ENTITY

Sukanthi Viruthagiri ¹, Ilakkia ¹, Sudha Venkatesh ¹, Geetha Devadas ¹, Bharathi Vidya ¹, Jayanthi< ¹

Background: Spindle cell lipoma is a relatively uncommon benign adipocytic tumor accounting for 1.5% of adipocytic tumors with a low rate of local recurrence. It is frequently located within the subcutis of neck, back, and shoulder. Other rare sites are the face, scalp, nasal cavity, trunk, upper and lower limbs. Spindle cell lipoma arising within the parotid gland is a rare presentation

Case Report: Our patient was a 41 year old male, presenting with painless swelling over the right parotid region for one year. The swelling progressively increased in size. There was no other relevant positive history or comorbidities. On examination, he had a 4*3 centimetre well defined globular swelling in the plane superficial to masseter muscle which was soft to cystic in consistency, smooth surface and restricted mobility. There were no signs of acute inflammation and the skin over the swelling was normal. Imaging studies like high frequency ultrasound gave the possibility of pleomorphic adenoma and MRI face suggested possibility of warthins tumor. FNA was done under strict aseptic precautions which yielded a viscid mucous aspirate and smears were done, fixed and stained. The aspirate smears showed features of spindle cell lipoma. Superficial parotidectomy was done at our institution and the histopathological examination confirmed the diagnosis of spindle cell lipoma.

Conclusion: Spindle cell lipoma is a rare entity and the presentation within the parotid gland is rarer. Given the discordant imaging finding, FNA proved to be a valuable tool in clinching the accurate diagnosis in this Case.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-170: ACINIC CELL CARCINOMA OF PAROTID IN CHILDREN: A CASE REPORT

Kaushal Kumar ¹, Kanika Rastogi ¹, Prajwala Gupta ¹, Minakshi Bhardwaj ¹

Background: Acinic cell carcinoma is usually seen in adults, however it is the second most frequent parotid malignancy in children accounting for 3-4% of all parotid gland tumours. We present two Cases of acinic cell carcinoma in 12 year old and 16 year old which were diagnosed on FNAC.

Case Report: The first Case is of a 12-year-old male child with a well-defined, firm, and non-mobile mass, measuring 2x2 cm in the right parotid region for past 4 years. The second Case is of a 16-year-old male child with a firm mass, measuring 1x1 cm in the left parotid region of 7 months duration. Ultrasonography in both the was suggested of pleomorphic adenoma. FNAC was performed in both the Cases and cytological diagnosis of acinic cell carcinoma was given. Which was confirmed on histological follow up.

Conclusion: Acinic cell carcinoma can be misinterpreted on cytology owing to its benign clinical course and morphological overlap with normal salivary acinar epithelium, other salivary tumors with clear cell component, and oncocytic tumors. An accurate cytological diagnosis in children is crucial to decide the appropriate treatment course.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-171: SCHWANNOMA IN PAROTID REGION: A RARE CASE REPORT

Anuj Pandey ¹, Vatsala Kishore ¹, Neeraj Singh ¹, Vaishali Kotasthane ¹, Dhananjay Kotasthane ¹

Background: Schwannoma is a tumor of schwann cells of 8th cranial nerve. It is usually located in the internal auditory canal and cerebellopontine angle.

Case Report: A 8 year old patient presented with swelling in right parotid region for 2 years.

Conclusion: This Case illustrate the importance of cytological and histological correlation of head and neck swelling and decreases chance of error as FNAC are generally unsuccessful in diagnosis of intraparotid nerve Schwannoma

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-172: NON HODGKIN LYMPHOMA OF TONGUE- A RARE DIAGNOSIS

Surbhi Mahajan ¹, Subhash Bhardwaj ¹, Aishvarya Jandial ¹

Lymphomas consists of a diverse group of solid malignant tumours with a wide variation in clinical, histopathological and molecular features. Head and neck is the second most commonly affected area by NHL after the gastrointestinal tract. Primary non-Hodgkin's lymphoma is the second most common primary malignancy occurring in the oral cavity after squamous cell carcinoma, with the incidence of 3-5%. Of all the lymphomas occurring in head and neck, NHL accounts for 65–90% of the total Cases while those from the extra-nodal sites constitute 20-30%. The oral cavity NHLs arise mainly from the waldeyer's ring and quite less frequently from an extranodal site. The various intraoral sites for lymphomas are the hard palate, vestibule and gingival region. Primary NHL of tongue is a very rare occurrence, which makes its diagnosis even more challenging. The primary NHL of tongue appear as non-tender soft or firm nodules mostly with surface ulcerations which may mimic other oral lesions. We present a Case with a unique presentation of this uncommon malignancy, presenting only with a growth at the base of tongue, without any symptoms or lymph node involvement.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-173: ROSAI DORFMAN DISEASE OF EXTRANODAL SITE: AN UNCOMMON FINDING ON FNAC

Devanshi Brajesh Dubey ¹, Atin Singhai ¹, Suresh Babu ¹

Background: Rosai-Dorfman or Sinus histiocytosis (SH) disease is disease of younger population of unknown aetiology, characterised by excess production and accumulation of histiocytes. It presents with multiple lymphadenopathies. Mostly benign, extranodal spread can occur to parotid gland, temporal bone, skin etc. It can rarely metastasize to other body parts via lymphatic system. differential include pyogenic abscess & lymphoma. Prompt diagnosis on fine needle aspiration cytology (FNAC) itself expedited the management and improves patient's clinical outcome.

Case Report: A 24 years old female presented with tender cystic swelling over left temporoparietal swelling for 8 months previously treated as abscess, without locoregional lymphadenopathy or fever. FNA yielded characteristic findings consistent with diagnosis of Sinus Histiocytosis i.e., presence of predominantly singly scattered as well as multinucleated histiocytes with abundant pale blue cytoplasm containing lipid droplets and vesicular nuclei helped rule out other differentials.

Conclusion: Sinus Histiocytosis rarely presents at extranodal site without locoregional lymphadenopathy as in our Case and mimic other common ailments like abscess. FNAC proves to be a quick and reliable tool in diagnosing the disease thereby reduce exposure to invasive biopsy, thus expediting treatment of the patient.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-174: CYSTIC CHANGE IN PLEOMORPHIC ADENOMA: A RARE FINDING AND A DIAGNOSTIC DILEMMA

Zeeshan Iqbal ¹, Shaan Khetrapal ¹, Sujata Jetley ¹, Zeeba S Jairajpuri ¹, Safia Rana ¹

Background: Pleomorphic adenoma forms the majority of salivary gland neoplasms. Cystic change in pleomorphic adenomas is a diagnostic dilemma and can mimic mucoepidermoid carcinoma, mucocele or carcinoma ex pleomorphic adenoma and squamous cell carcinoma. Hereby we Report this interesting and rare Case of cystic pleomorphic adenoma in a 32-year-old male.

Case Report: A 32-year-old male presented with a swelling on left side of the face, parotid as well as posterior auricular region of 4 months duration. On local examination a 3 x 2 cm firm to hard, fluctuant swelling was seen. It was non tender with normal overlying skin. On ultrasonography, a complex cystic lesion in left parotid region was Reported. On fine needle aspiration cytology the smears showed numerous cystic macrophages against a Background of fluid and squamoid metaplastic cells intermixed with bland epithelial cells and was Reported as a cystic lesion of parotid gland.

Conclusion: On review of literature only a few Cases of Pleomorphic Adenoma with cystic change have been Reported. Cystic change in pleomorphic adenoma is a rare finding. One should be aware of the cytological variations to avoid diagnostic errors. A targeted adequate sampling is suggested to exclude the other cystic lesions in the differential diagnosis of salivary glands. A targeted adequate sampling is suggested to exclude the other cystic lesions in the differential diagnosis. In order to avoid unnecessary aggressive therapy, awareness of this rare benign possibility is essential so that misinterpretation of the pathological findings as malignant are avoided.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-175: SUMP – A TALE OF THREE LESIONS

Padmapriya Jaiprakash ¹, Megha Murali ¹, Swati Sharma ¹, Nikitha Kairanna ¹

Fine needle aspiration from salivary gland lesions is an easy and inexpensive technique to diagnose and sub-classify preoperatively so that appropriate surgery can be planned. With the implementation of the “Milan System for Reporting Salivary Gland Cytopathology” (MSRSGC), this is accomplished well by providing risk of malignancy (ROM) in different categories. Salivary Gland Neoplasm of Uncertain Malignant Potential (SUMP) is used when the smears are diagnostic of a neoplasm but a diagnosis of a specific entity cannot be made and a malignant neoplasm cannot be excluded. Majority of these Cases will include: cellular benign neoplasms, basaloid neoplasms, oncocytic neoplasms, and low grade carcinomas. Here, we describe a Case each showing neoplasm with cellular basaloid cells, oncocytoid cells and vacuolated or clear cells. Case 1: 35 year male with painless swelling in parotid region since 2 months Cytology - Cellular smears with predominantly oncocytic cells with prominent nucleoli. Histopathology - Oncocytic carcinoma. Case 2: 54 year old male with recurrent parotid swelling, previous aspiration Reported as cyst fluid. Cytology - Cellular smears with predominantly oncocytic cells along with few vacuolated cells in a dirty Background. No histopathology.Case 3: 72 year old female with diffuse swelling of face since 6 weeks with pain and difficulty in opening mouth. CT showed mass in palate and maxillary sinus. Cytology - Moderately cellular smear with basaloid cells, forming occasional cribriform pattern Histopathology - Adenoid cystic carcinoma

Conclusions: In cellular smears, it is seen that subtyping SUMP Cases into categories based on cell type demonstrated differential ROMs and better clinical stratification.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-176: PRIMARY SINONASAL MENINGIOMA-A CYTOLOGICAL DIAGNOSIS WITH HISTOPATHOLOGICAL CORRELATION

Anupama Arya ¹, Bhavna Bansal ¹, Sudhir Kulkarni ¹, Dilip Kumar ¹, Poonam Das ¹

Background: Meningioma is a common intracranial tumor.A primary extracranial location involving the head and neck is observed in less than 2% of Cases. Differential diagnosis includes nasal polyp,carcinoma,melanoma,ossifying fibroma and olfactory neuroblastoma.

Case Report: A 68 year old woman presented to the ENT OPD with nasal obstruction. On examination polypoidal mass was seen in the left nasal cavity.A clinical diagnosis of ? Nasal polyp was made.A contrast-enhanced magnetic resonance imaging revealed a well enhancing mass comprising intranasal and ethmoidal masses along with a small anterior cranial fossa (ACF) mass. An endoscopic resection of the masses was done and specimen sent for frozen section. On intraoperative cytology imprint smears a diagnosis of meningioma was suggested and was later confirmed on histopathology.

Conclusion: Primary sinonasal meningioma is a rare tumor and challenge to diagnose,often being confused with a nasal polyp.A cytopathologist should always keep meningioma in the differential diagnosis of nasal masses for appropriate management.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-177: PARATHYROID CYTOPATHOLOGY-PLIGHT OR PERPLEXED?

Nikitha Kairanna ¹, Vidya Monappa ¹, Chethana Babu K Udupa ¹

Background: Parathyroid carcinoma is an extremely rare endocrine malignancy accounting for 0.5 - 5% of all Cases of primary hyperparathyroidism. Fine needle aspiration cytology (FNAC) is not a commonly employed diagnostic modality, especially in the diagnosis of parathyroid tumors. It may lead to misdiagnosis of cytomorphological findings and biological behavior.

Case Report: A 47-year-old female came with c/o bodyache and right loin pain for 1 month. On examination, she had a firm thyroid swelling of size 3x2 cm. She was detected to have nephrolithiasis. The biochemistry revealed hypercalcemia with elevated PTH (4999.0 pg/mL) (N:15-65pg/mL) s/o Primary Hyperparathyroidism. Imaging with Parathyroid Scintigraphy and FNAC showed possibility of parathyroid adenoma. However, paraffin Reporting advised to look for capsular and vascular invasion to r/o parathyroid carcinoma. Parathyroidectomy with right hemithyroidectomy was done and the paraffin sections revealed Parathyroid carcinoma. Post-op the patient had low calcium and phosphate. The possibility of Hungry bone syndrome was considered and patient was transferred to endocrinology. Presently, the patient is on regular follow-up with no fresh complaints.

Conclusion: Pre-operative diagnosis of parathyroid carcinomas remains a diagnostic challenge. FNAC should generally be avoided because on cytology, discerning between malignant and benign parathyroid disease can be challenging. This procedure may also lead to tumor disruption and its seeding through the needle tract, leading to higher chances of recurrence. Clinicians and pathologists should be aware that it is important to consider and correlate clinical history, laboratory findings, radiological, cytological, and histopathological examination in a holistic manner to reach a precise diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-178: INTRAPAROTID SCHWANNOMA: A CASE SERIES FROM A TERTIARY CARE CENTRE OF NORTH EAST INDIA

Asreen Suhana ¹, Junu Devi ¹, Geetanjali Gogoi ¹

Background: Schwannoma is a benign, encapsulated tumor arising from the Schwann cells of myelinated central, autonomic and peripheral nerves. Schwannomas arising from the facial nerve are rare, mostly intra-temporal, with only 9% extra-temporal lesions, presenting as parotid swellings with non-specific symptoms, making the pre-operative diagnosis difficult and challenging. Early diagnosis by FNAC can be helpful in prompt management and thereby preventing facial nerve involvement.

Methods: In this Case series, three Cases of parotid masses that underwent fine needle aspiration cytology during the last two years in the department of Pathology, Gauhati Medical College and Hospital, Guwahati were analyzed with respect to age, sex, site, clinical and radiological findings.

Results: Out of the three Cases, all diagnosed as Intraparotid Schwannoma based on FNAC, one patient was male and two were females. Two Cases involved the right parotid gland and one involved the left parotid gland. Age range of the patients was 10-46 years. All the three Cases presented as slow growing, painless parotid masses without symptoms of facial nerve involvement. Radiologically, these Cases were diagnosed as pleomorphic adenoma. Diagnosis of all the three Cases were confirmed by histopathological examination.

Conclusion: Few Reported Cases in literature, non-specific clinical symptoms and difficult radiological diagnosis makes intraparotid schwannomas a challenge for the pathologist.

KEYWORDS: Schwannoma, parotid mass, Cytology.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-179: CYTOMORPHOLOGICAL FINDINGS IN DIAGNOSIS OF WARTHIN TUMOR

Megha Murali ¹, Nikita Valerina Kairanna ¹, Swati Sharma ¹

Background: Salivary gland tumors account for 2- 6.5% of all head and neck neoplasms. Warthin tumor (WT) is the second most common benign neoplasm of the parotid gland with incidence ranging from 3.5-30% of all salivary gland tumors. It is located almost exclusively in the parotid gland and may occur bilaterally or as multiple lesions. Fine needle aspiration cytology (FNAC) is a simple and non-invasive Method for preoperative diagnosis of the salivary gland tumors, on cytology, WT has a diagnostic triad of oncocytes, lymphoid cells, and a dirty proteinaceous Background. False-positive diagnosis usually include Cases of acinic cell carcinoma and mucoepidermoid carcinoma.

Case Report: 62-year-old male chronic alcoholic and smoker came with the complaints of bilateral hard swelling below the ear for one year. Swellings were insidious in onset, gradually progressive and not associated with the pain, discharge, sudden increase in size or redness. Radiology showed a lobulated heterogeneously enhancing soft tissue density lesion in the left parotid gland s/o neoplastic etiology. FNAC was suggestive of WT following which left superficial parotidectomy was done. Histopathological examination was confirmatory.

Conclusion: Diagnostic accuracy of FNAC for the diagnosis of WT is high and the percentage of missed malignant tumors has been found to be very low. Since malignant transformation of WT is rare with a Reported incidence of 0.3%, a conservative treatment is justified. Hence, precise diagnosis is of paramount importance. Pathologist should not only be aware of typical cytomorphological findings of WT, knowledge about the limitations of cytology is also required.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-180: STERNOCLEIDOMASTOID TUMOR : AN INFANTILE MASS DIAGNOSED ON CYTOLOGY

Shilpa Garg ¹, Shilpa Bairwa ¹, Sonia Hasija ¹, Bhawna Sethi ¹, Ashok Sangwaiya ¹, Puja Sharma ¹

Introduction: Sternocleidomastoid tumor also known as Fibromatosis colli or pseudotumor of infancy or congenital muscular torticollis, is a rare congenital fibroblastic lesion present in approximately 0.4% of the live births. The pathogenesis is still not clear, but birth injury is supposed to play an important role in the pathogenesis.

Case: A 45 days old male infant presented with firm to hard, fixed swelling measuring 2x2 cm on the anterior aspect of right neck since birth. The swelling was progressively increasing in size. On examination restricted movements were noticed on the right side. FNAC showed predominantly spindle cells scattered singly with plump nuclei and eosinophilic cytoplasm in a hemorrhagic Background. Regenerating multinucleated muscle cells were also seen at places. Based on the clinical and cytological examination, a diagnosis of sternocleidomastoid tumor was made.

Conclusion: Sternocleidomastoid tumor has a characteristic clinical history and presentation pertaining to age, sex, birth trauma, location and size of tumor. Differential diagnosis includes branchial cyst, thyroglossal cyst, tuberculous lymphadenitis, cystic hygroma, hemangioma, and malignant tumors such as neuroblastoma, lymphoma, and rhabdomyosarcoma. It is a self-limiting condition and responds to conservative management. Spontaneous regression occurs in weeks to months. FNAC is a rapid, reliable, cheap, and less invasive diagnostic procedure that helps in the diagnosis of sternocleidomastoid tumor and to rule out the above differential diagnosis. Surgical biopsy of the lesion may therefore be avoided.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-181: CARCINOMA OF THE TRACHEA IN A YOUNG MALE– A CYTOLOGICAL DIAGNOSIS WITH HISTOPATHOLOGICAL CORRELATION

Nimisha Dwivedi ¹, Anupama Arya ¹, Anshul Mittal ¹, Dilip Kumar ¹, Urmi Mukherjee ¹

Background: Adenoid Cystic Carcinoma(ACC) is a tumor that arises mainly from salivary glands. Its occurrence is rare in respiratory tract, constitutingabout 0.04- 0.2 % of primary lung tumors. ACC often arises in the trachea and main bronchus. It can occur at any age with a peak incidence of 40-50 years. Most patients present with non specific symptoms including cough, shortness of breath and rarely hemoptysis.

Case Report: A 39 year old male presented to our hospital with the complaints of cough, shortness of breath and occasional hemoptysis for the past one year. A CECT (Contrast enhanced computed tomography) thorax showed a polypoidal hypodense lesion showing mild contrast enhancement in the upper trachea causing significant luminal narrowing. A TBNA (trans bronchial needle aspiration) was done which revealed cytomorphology suggestive of a basaloid cell neoplasm favouring Adenoid Cystic carcinoma. A subsequent biopsy and immunohistochemistry confirmed the diagnosis of a Low grade Adenoid Cystic Carcinoma. Patient underwent a tracheal resection followed by primary anastomosis.

Conclusion: ACC of respiratory tract although rare, should be kept in the differential diagnosis of any intratracheal growth in young patients. Cytology plays a very crucial role in the early diagnosis and appropriate management in these Cases.

Keywords: Adenoid cystic carcinoma, trachea, salivary gland.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-182: STERNOCLEIDOMASTOID TUMOR DIAGNOSED ON CYTOLOGY - A RARE ENTITY

Renu ¹, Parveen Rana Kundu ¹, Kulwant Singh ¹, Sunaina Hooda ¹, Nitika Chawla ¹, Parul ¹, Harman Preet Singh ¹, Preeti Jangra ¹

Background: A sternocleidomastoid tumor is a rare form of fibromatosis in infants which is benign and self-limiting fibroblastic lesion usually presenting with torticollis and a history of birth trauma of infancy. It is the most common cause of mass in the cervical region during infancy and neonatal torticollis. Recognised risk factors are breech delivery, primiparous birth, and instrumental extraction. It is one of the few causes in which Fine Needle Aspiration Cytology (FNAC) is indicated in a neonate to confirm the diagnosis and to differentiate it from other congenital, inflammatory and neoplastic causes. The treatment is conservative.

Case Report: A 31-day-old male child presented with a swelling right side neck. There is history of progressive increase in size of swelling and assisted breech. Feeding and sleeping was normal. On examination : Swelling measuring 2×1.5cm was slightly mobile, soft to firm present on the anterior aspect of right sternocleidomastoid muscle since birth. There was no evidence of other congenital anomalies and family history of similar lesions. Ultrasound neck was done which revealed a hypoechoic round lobulated lesion measuring 2.8cmx2.2cm. FNAC was done and based on the clinical and cytological examination, a diagnosis of fibromatosis colli was made.

Conclusion: Fine needle aspiration cytology(FNAC) is a cheap, rapid, less invasive and fairly accurate diagnostic modality for excluding other causes and detection of this type of infantile lesion. These lesions are usually self-eliminating with few requiring conservative management and rarely surgical intervention. FNAC provides a confirmatory non invasive diagnosis of fibromatosis colli.

Keywords: FNAC, infantile neoplasm, fibromatosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-183: RECURRENCE BY ATYPICAL MENINGIOMA PRESENTING AS SCALP MASS- A CASE REPORT

Swathi C Prabhu ¹, Uma Handa ¹, Phiza Aggarwal ¹, RPS Punia ¹, Vipin Gupta ¹

Background: Atypical meningiomas [WHO]grade II) have a high rate of recurrence and greater mortality compared to WHO grade I tumours. Extra-cranial metastasis is seen in around 0.1% of the Cases. We Report a rare Case of recurrent atypical meningioma of the scalp diagnosed on fine-needle aspiration cytology(FNAC).

Case Report: A 65-year-old female presented to the FNAC clinic with scalp swelling of one-month duration and no other clinical symptom. On eliciting the history, it was revealed that patient had undergone two surgeries in the past which was 7 months and 3 months prior to present complaint. Histopathology Report of these surgeries showed it was a Case of atypical meningioma of the frontal lobe. FNAC from the scalp swelling was done and showed tumour cells arranged as nests and syncytium pattern which exhibited moderate nuclear pleomorphism. Subcutaneous scalp masses with these morphological features can have plethora of differential diagnosis including sarcomas and Metastasis. After careful cytological examination, the final diagnosis of recurrent meningioma was given.

Conclusion: Recurrence of meningiomas to scalp is a rare finding and a high index of suspicion is needed for accurate diagnosis. Cytology plays an important role in early and accurate diagnosis in such Cases.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-184: SALIVARY GLAND NON- HODGKIN LYMPHOMA – A FNAC-FLOWCYTOMETRY STUDY

Rashmi Gautam ¹, Meeta Singh ¹, Gunjan Nain ¹, Varuna Mallya ¹, Pritika Kushwaha ¹, Sarika Singh ¹, Ravi Meher ¹, Maulana Azad ¹

Background: Primary Non-Hodgkin lymphoma (NHL) of the salivary gland accounts for only 5% of Extranodal Non-Hodgkin Lymphoma (E-NHL) and only 1.7% of all salivary gland malignancies. We hereby present 03 Cases diagnosed on FNAC Flowcytometry, confirmed on Histopathology.

Case Reports: We herein Reported three Cases of Non-Hodgkin Lymphoma in salivary glands which were previously diagnosed as Chronic Sialadenitis. Case 1: A 65-yr old female presented with bilateral submandibular swellings since 3 years and Thyroid swelling since one year. FNAC and Flowcytometry bilateral submandibular gland showed features of Diffuse large B cell lymphoma whereas thyroid gland showed features of Malt lymphoma. Case 2: A 65-yr old female presented with bilateral submandibular and parotid swellings since 1 year, in a known Case of Sjogren's Syndrome with previous cytology of Chronic Sialadenitis. FNAC and Flowcytometry bilateral submandibular gland showed features of Low Grade B-cell Non-Hodgkin Lymphoma. Biopsy confirmed as Mantle cell Lymphoma. Case 3: A 59-yr old male with right side Parotid swelling for past 1 year. FNAC- Flowcytometry shows features consistent with Low Grade B-cell Non-Hodgkin Lymphoma. Confirmed on Histopathology.

Conclusion: Salivary gland Lymphoma albeit rare, are amenable to Aspiration. Thus FNAC- Flowcytometry can serve as good adjunct to diagnosis. Patients with known Autoimmune status having Chronic Sialadenitis should be followed up closely.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-186: ORBITAL FINE NEEDLE ASPIRATION CYTOLOGY: AN EFFECTIVE DIAGNOSTIC TOOL FOR ORBITAL MUCORMYCOSIS

Tanvi Jha ¹, Akanksha Agrawal ¹, Preeti Diwaker ¹, Vinod Kumar Arora ¹, Jolly Rohatgi ¹

Background: The incidence of mucormycosis showed a rapid spike after the COVID-19 pandemic in India. Primary orbital mucormycosis is rare and quite challenging to diagnose as the initial changes are mild and nonspecific requiring a high index of suspicion. We present a Case of orbital mucormycosis which was missed on imaging modalities but picked up on cytological evaluation.

Case Report: A 52-year-old diabetic COVID-19 recovered patient presented with sinusitis, peri-orbital swelling and slightly impaired vision in the right eye. CT scan revealed bilateral maxillary and ethmoid sinus opacities but bilateral orbits appeared normal. Nasal crusts and nasal swabs showed broad aseptate hyphae consistent with mucor in KOH preparations. Sinus debridement was done and the patient was put on amphotericin B. However, the patient deteriorated with right-sided progressive visual loss and proptosis. CT scan was reviewed and a mild collection was found in the right orbit prompting an intra-orbital FNAC that yielded thick pus. Smears revealed fungal hyphae consistent with mucor, along with inflammatory exudate, foreign body giant cell reaction and fat necrosis with specs of calcification. A diagnosis of orbital mucormycosis was made and right eye exenteration was then performed as a lifesaving procedure.

Conclusion: FNAC is a rapid and efficient Method for diagnosis of fungal infection and may be applied for confirmation of clinically or radiologically suspected orbital mucormycosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-187: PLEOMORPHIC ADENOMA OF THE CHEEK: A RARE CASE REPORT

Kamini Yadav ¹, Divya ¹, Rahul ¹, Priti Chatterjee ¹, Anup Mohta ¹

Background: Pleomorphic adenoma (PA) is the most common benign tumor, accounting for 40-70% of all the salivary gland tumors. Parotid gland is the most commonly affected site followed by palate, lips, cheeks, gingiva, floor of the mouth and tongue. PA of buccal minor salivary gland is a very rare occurrence both in adults and children.

Case Report: A 40-year-old male, came with the chief complains of small painless swelling over the left side of cheek since 2 months. Swelling was gradual in onset. On extra oral examination, there was mild facial asymmetry. The skin appeared normal and was pinchable with no localized increase in temperature. The mass was round oval in shape, measuring 1.5x1.5 cm in maximum diameter, firm in consistency, non-fluctuant, non-pulsatile and freely movable. Overlying mucosa was of normal in color. FNAC was done. Cytosmears show presence of all the three elements of PA, i.e. 3-dimensional cohesive clusters of ductal cells, Background of singly lying plasmacytoid myoepithelial cells and dense fibrillary brightly metachromatic stroma. The biopsy was planned and complete wide surgical excision was done. Grossly, the lesion was ovoid in shape, encapsulated, grey-white rubbery mass measuring 2.2 × 1.5 × 1.5 cms. On histopathological examinaion, sections showed biphasic population of epithelial and myoepithelial cells.

Conclusion: PA of the cheek is a rare neoplasm. PA should always be considered in the differential diagnosis of cheek masses. Recurrence after surgical excision as well as malignant transformation should be a concern and therefore long-term follow-up is necessary.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-188: PRIMARY NEUROBLASTOMA PRESENTING AS A SUBMANDIBULAR SWELLING IN AN INFANT

Pooja Dhamija ¹, Sanjay ¹, Nidhi ¹, Deepshikha ¹, Sant ¹, Sunita ¹

Background: Neuroblastoma is one of the most common extra-cranial tumors in the pediatric population, but primary presentation as a submandibular mass is quite rare. The tumors are derived from neuro-ectoderm cells and can arise from anywhere along the sympathetic chain. Patients diagnosed under 1 year of age have a much better diagnosis.

Case Report: A 2.5month old male infant presented to the OPD with a complaint of swelling in the left submandibular region for more than 1 month. Ultrasound neck revealed a heterogeneous hypoechoic solid-cystic lesion measuring 3.6*3.3 cm in the left submandibular region. Ultrasound abdomen was normal. CRP, serum ferritin, and serum LDH were raised. FNAC of submandibular mass was performed in the OPD. Smears examined were cellular and revealed atypical cells in loosely cohesive clusters and rosette formation. These tumor cells were small round having a high Nucleocytoplasmic ratio and scant cytoplasm. On IHC, these cells are positive for NSE and CD56, and the diagnosis of neuroblastoma was made. The Bone marrow aspiration and the biopsy are performed. Now the patient is on follow-up.

Conclusion: An initial primary presentation of neuroblastoma as a submandibular mass, in our Case, is rare. The utility of FNAC in early diagnosis and therefore its management is unique. Further workup by radiology and other laboratory investigations assists with staging and treatment of the disease.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-189: PLEOMORPHIC ADENOMA OF TONGUE; AN UNCOMMON LOCATION

Jyoti Dahiya ¹, Sonia Chhabra ¹, Sunita Singh ¹, Meenu Gill ¹, Promil Jain ¹

Background: Pleomorphic adenoma, also known as mixed tumour, is the most common benign neoplasm of major and minor salivary glands. Parotid gland is the primary site for pleomorphic adenoma but involvement of tongue is very rare accounting for 0-2.5% of the Cases. On tongue pleomorphic adenomas are most commonly seen in the posterior, followed by anterior, and rarely in the lateral lingual gland of the tongue.

Case Report: A 41 year old male presented to the head and neck outpatient department with complaint of a growth on left side of the tongue,noticed by him 25 days back. He also had dysphagia and difficulty in talking. He was a chronic smoker but non-alcoholic. Cytological and histological examination revealed pleomorphic adenoma.

Conclusion: The salivary glands may show diverse range of lesions presenting a challenge to the most experienced clinicians and pathologist. Pleomorphic adenoma of tongue is a tumour of rare occurrence. High index of suspicion and an adequate clearance of tumour with cuff of surrounding dispensable normal tissues is key to successful treatment of such tumours.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-190: SALIVARY AMYLASE CRYSTALLOIDS ON FINE NEEDLE ASPIRATION OF PAROTID GLAND

Neha Gahlaut ¹

Background: Crystalline structures have been encountered in various salivary gland lesions including non neoplastic and neoplastic. Different crystalloids that have been described are amylase, oxalate, tyrosine and collagenous.

Case Report: A 54-year-old male presented with swelling in right parotid region since last 4 years with no other associated complaints. On local examination a firm non tender swelling of size 2x 1 cm was noted. Ultrasonograph detected a lesion of size 12.6 mm × 15 mm in the lower zone of the right parotid. The patient underwent fine needle aspiration that revealed many orange colored large rectangular and rhomboid geometrical structures with parallel sides on Papanicolaou stain and appeared pink on H&E stain. The Background showed few scattered neutrophils admixed with debris. No ductal epithelial cells were seen. Final diagnosis was given as amylase crystalloids, possiblity of benign lesion to be considered.

Discussion: It is important to recognize these as specific kinds have characteristic shapes and specific associations that may help in differentiating benign and malignant etiology. Amylase crystalloids are seen in benign conditions only including cystic lesions and sialadenitis. In pleomorphic adenoma, tyrosine rich and collagenous crystalloids are found. Collagenous crystalloids have also been Reported in myoepithelioma. On the other hand, intraluminal crysalline structures are associated with malignant neoplasms. However, histologic examination should always be done to render a definite diagnosis, but sometimes even acellular structures on cytomorphology can point towards a probable etiology, thus avoiding unnecessary surgical intervention.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-191: NASOLABIAL CYST : A RARE CASE REPORT WITH CYTOLOGY AND HISTOLOGY CORRELATION

Riva Choudhary ¹

Background: Nasolabial cysts are rare unilateral lesion of the soft tissue adjoining the anterior maxilla. The patient usually presents with soft tissue swelling amidst the nasal aperture and upper lip, along with obstructive symptoms. It is most commonly seen in middle aged females. There is very limited data on the cytology and histopathological correlation of nasolabial cyst in the literature.

Case Report: A 45-year-old male presented with swelling on left side of nose for 7 months. The swelling was gradually increasing in size and was lying adjacent to the nasal cavity, pushing the lateral nasal wall medially. FNAC yielded light brown coloured fluid, after which the swelling subsided completely, smears showed amorphous acellular granular material, suggesting a benign cyst, for which excision was advised. Biopsy showed a cyst wall lined by ciliated columnar epithelium with focal squamous metaplasia that was consistent with nasolabial cyst.

Conclusion: Due to the reason of overlapping signs, symptoms and location, nasolabial cyst may be confused with a dental or periodontal abscess, odontogenic cyst, choanal polyp. Diagnosis of nasolabial cyst on FNAC remains a challenge with only way of reaching to a diagnosis is by correlating it with history, examination and histopathological correlation. However, given the location and the characteristic cytology findings described in our Case, these findings may help in pointing out the correct diagnosis and further management of the patient accordingly.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-192: MILAN SYSTEM OF REPORTING SALIVARY GLAND CYTOPATHOLOGY: AN EXPERIENCE WITH THE IMPLICATION FOR RISK OF MALIGNANCY

Shipra Singh ¹, Pooja Dwivedi ¹, Akansha Singh ¹, Madhu Kumar ¹

Background: FNAC(Fine needle aspiration cytology) is a well established technique for evaluation of salivary gland neoplasms,but because of heterogenicity and morphological overlap between spectrum of lesions,need for an universally accepted Reporting system was felt. Recently “The Milan system for Reporting salivary gland cytopathology “(MSRSGC) was introduced,providing guide for diagnosis and Management according to the risk of malignancy (ROM) in different categories.

Methods: Total 116 Cases were evaluated and histological follow up was available in 46 Cases. Clinical data, FNAC specimen, histological and clinical follow up of Cases, cytological features were re-evaluated. The distribution of Cases into different categories was as follows: Category 1: Non diagnostic(ND),Category 2: Non neoplastic(NN),Category 3: Atypia of undetermined significance(AUS), Category 4a: Neoplasm; benign(NB), Category 4b: Salivary gland neoplasm of uncertain malignant potential(SUMP),Category 5: Suspicious of malignancy(SM),Category 6:Malignant(M)

Result: Total 116 Cases were evaluated cytologically and histological follow up was available in 46 Cases. The distribution of Cases in different categories was as follows: ND(9),NN(27),AUS(5),NB(44),SUMP(4),SM(5)and M(23) with NB being the largest category. Overall study showed males were affected more than females(73 vs 43),ratio being 1.6:1. Parotid gland was involved in 43.9% of Cases.

Conclusion: MSRSGC is a recently proposed six category scheme,which places salivary gland FNAC into well defined categories that limit the possibilities of false positive and false negative Cases.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-193: TUMOR CONCEALED BENEATH THE FUNGUS: MUCORMYCOSIS COMPLICATING A NEUROENDOCRINE TUMOR

Somnath Mahapatra ¹, Akanksha Agrawal ¹, Preeti Diwaker ¹, Nirupama P Khan ¹, Vinod Kumar Arora ¹

Background: Post-covid mucormycosis has imposed a great challenge to diagnostic medicine. A considerable fraction of mucor infections has been Reported with solid organ malignancies following potent cytotoxic chemotherapy. Herein we describe a Case of untreated sino-nasal neuroendocrine tumor presenting as rhino-cerebro-orbital mucormycosis.

Case Report: A 24-year man presented with features of sinusitis preceded by mildly severe Covid-19 infection. On examination, the patient had bilateral facial swelling, swollen nasal turbinates, bilateral cervical lymphadenopathy and altered sensorium. KOH mount of nasal scrapings was positive for aseptate broad hyphae consistent with mucormycosis. MRI brain was suggestive of skull base osteomyelitis along with soft tissue thickening of the posterior ethmoid and sphenoidal sinuses. FNA smears of cervical lymph node showed confluent necrosis and Marked crushing of cells, suggestive of necrotizing lymphadenitis. Sino-nasal mucosal biopsy showed extensive crushing without any morphologically preserved cells. Later, a cervical lymph node biopsy was done which showed a highly necrotic small round cell tumor with extensive crushing and prominent apoptotic bodies. A battery of immunohistochemical markers including pan-CK, synaptophysin, chromogranin-A, CD99, LCA, vimentin, S-100 was performed. Based on the morphological and immunohistochemical findings, a diagnosis of metastatic neuroendocrine tumor was made. The patient was referred to a dedicated oncology facility but he died after receiving two days of supportive care.

Conclusion: High suspicion for malignancy to be maintained in necrotizing lymphadenitis. Mucormycosis without any overt causes of immunosuppression should be stringently investigated for occult malignancy.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-194: CYTOPATHOLOGICAL CATEGORIZATION OF SALIVARY GLAND LESIONS ACCORDING TO MILAN SYSTEM OF CLASSIFICATION: OUR EXPERIENCE IN A TERTIARY CARE CENTRE OF NORTH-EAST INDIA

Asreen Suhana ¹, Junu Devi ¹, Geetanjali Gogoi ¹

Background: Fine needle aspiration cytology is a widely accepted pre-operative procedure for salivary gland lesions. The aim of this study to evaluate the salivary gland lesions in relation to age, sex, location and the prevalence of non-neoplastic and neoplastic lesions that presented to Gauhati Medical College and Hospital(GMCH), Guwahati.

Materials and Methods: A retrospective study was done over a period of 2 years, from January,2019 to December,2020 and the slides and data of 110 Cases of salivary gland lesions that underwent FNAC in our hospital(GMCH) were reviewed.

Results: Out of a total of 110 cytological smears, 101 smears (91.9%) were adequate and 9 smears (8.1%) were inadequate. Out of 101 adequate smears, 35 (34.6%) were non-neoplastic lesions, 37 (36.6%) were benign and 29 (28.7%) were malignant lesions. Males were more commonly affected (M:F=1.6:1). Parotid gland was most commonly affected in relation to anatomical site. Most common benign lesion was Pleomorphic Adenoma and Mucoepidermoid carcinoma was the most common malignancy.

Conclusion: FNAC is a very reliable, cost-effective, safe and rapid diagnostic tool for categorizing malignant and benign salivary lesions which is complimentary to histopathology. Though histopathological examination remains the gold standard for diagnosis, FNAC remains an useful adjunct for planning patient management.

Keywords: Cytomorphological spectrum, salivary gland lesions

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-195: POLYMORPHOUS LOW GRADE ADENOCARCINOMA OF SALIVARY GLAND: A CASE REPORT WITH CYTOHISTOLOGICAL CORRELATION AND ITS IMMUNOHISTOCHEMICAL STUDY

Himani Rai ¹, Sharda Balani ¹, Reeni Malik ¹

Background: Polymorphous low grade adenocarcinoma of the salivary glands (PLGA) is a low grade neoplasm that predominantly occurs in the minor salivary glands consist of a uniform population of tumour cells that are arranged in variety of architectural pattern (Polymorphous). Experience with FNAC in this tumour is very limited. In this Case Report, we present a Case of Polymorphous low grade Adenocarcinoma with its fine needle aspiration cytology findings and correlation with histopathology & immunohistochemistry.

Case Report: A 33 year male presented with swelling in left submandibular region. Fine needle aspiration cytology was done and later the swelling was excised and sent for histopathological and Immunohistochemical examination. Cytological findings were smears showing sheets,clusters, papillary fragments and singly scattered round to oval tumour cells. The cells have moderate amount of cytoplasm with bland nuclear chromatin and inconspicuous nucleoli. The swelling was excised and on histopathology findings diagnosis made was polymorphous low grade adenocarcinoma. Immunohistochemistry for pancytokeratin, CK7,HMCWK and vimentin was done and findings were in favour of PLGA.

Conclusion: PLGA is a relatively newer type of salivary gland tumour, while common in minor glands, can also arise from the major salivary gland. It is difficult to make a cytological diagnosis of PLGA on its own because its features overlap with those of other salivary gland tumours. However, histopathological correlation and immunohistochemical studies are recommended to confirm PLGA diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-196: PLEOMORPHIC ADENOMA WITH EXTENSIVE SQUAMOUS METAPLASIA WITH KERATIN CYST AND KERATIN PEARL FORMATION : A POTENTIAL DIAGNOSTIC PITFALL IN CYTOLOGY

Aditi Priya ¹, Jai Kumar Chaurasia1 ¹, Ujjawal Khurana ¹, Vaishali Walke ¹, Ashwani Tandon ¹, Deepti Joshi ¹, Vikas Gupta ², Neelkamal Kapoor ¹

Background: Pleomorphic adenoma (PA) is the most common salivary gland (SG) tumor and constitutes approx 80% of all benign SG tumors. Parotid gland is most common site followed by the submandibular and the minor SGs. Focal squamous metaplasia is found in about 20% of PAs. However, extensive squamous metaplasia with formation of extensive keratin-filled cysts and keratin pearl, replacing the conventional morphological features of PA is rare and can be mistaken for malignancy on cytology. We here present such a challenging Case of PA in minor SG with the objective to highlight the diagnostic challenges for overcoming pitfalls.

Case Report: A 37 year female presented with a mass in the oral cavity for last 2 years with complains of difficulty in swallowing and breathing. Patient's CECT revealed heterogeneously enhancing soft tissue mass measuring 7.5 x 7.6 x 5.8 cm, obliterating the oral cavity and replacing the entire soft palate. FNAC revealed abundant population of squamous cells in clusters with evidence of whorl formation and extensive orangophilic keratinisation. Cytomorphological features were suggestive of malignancy favouring squamous cell carcinoma. However, histopathology and immunohistochemistry (IHC) were confirmatory of PA with extensive squamous metaplasia with keratin cyst and keratin pearl formation. IHC was positive for p63, CK7 and vimentin. Ki67 showed only basal expression with normal expression of p16 and p53.

Conclusion: PA with extensive squamous metaplasia is a diagnostic challenge in cytology. Meticulous examination and awareness of its cytomorphological features is important to avoid misdiagnosis of malignancy and unnecessary aggressive treatment.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-197: CYTOMORPHOLOGIC DIAGNOSIS OF A PRIMARY ESOPHAGEAL SCHWANNOMA IN AN ELDERLY WOMAN

Malvika Shastri ¹, Parikshaa Gupta ¹, Surinder Rana ¹, Pranab Dey ¹

Background: Esophageal schwannoma is an extremely rare benign neoplasm. Cytologic diagnosis of esophageal schwannoma has been sporadically Reported in the literature. Herein, we present a Case of esophageal schwannoma in an older woman that could be accurately diagnosed based on endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology accompanied by cell block immunocytochemistry.

Case Report: A 62-year-old female presented with intermittent mild dysphagia for the lasttwo months. On examination, she was well-built, and there was no pallor,icterus,or significant peripheral lymphadenopathy. Upper gastrointestinal endoscopy revealed an extrinsic bulge in the mid-esophagus with normal overlying mucosa. Computerized tomography of the chest revealed a hypodense mass lesion, measuring 5.1x3.1 cm, in the posterior mediastinum. Endoscopic ultrasonography (EUS) revealed a well-defined hypoechoic lesion in the posterior mediastinum. On EUS elastography, the lesion hada predominantly blue color suggestive of a hard lesion. EUS-guided fine needle aspiration(FNA) was performed with a 22G EUS-FNA needle and sample was also collected for cell block preparation.

Conclusion: The present Report describes the cytologic and immunocytochemical features of an esophageal schwannoma. Also, it highlights the diagnostic utility of EUS-FNA as a minimally invasive procedure in accurately diagnosing such rarer and inaccessible lesions.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-198: SEBACEOUS CARCINOMA, A GREAT MASQUERADER

Disha Kakar ¹, Shipra Aggarwal ¹

Introduction: Sebaceous carcinoma is a rare, aggressive malignancy that arises from the meibomian glands, glands of Zeis and sebaceous glands of the caruncle. Clinically, it can mimic a benign condition such as chalazion, chronic blepharconjuctiviyis and keratoconjunctivitis. Fine needle aspiration cytology presents an easy and convenient way to distinguish it from benign and other malignant mimics.

Case Report: We present a Case of 35 years old male who presented with a swelling near right lateral border of eye measuring 2x1cm along with lymphadenopathy in the pre-auricular region. Aspirate from the swelling was moderately cellular with clusters of atypical cells having moderate to abundant vacuolated cytoplasm present in a necrotic and lipidaceous Background. Aspirate from the pre-auricular lymph node showed mainly necrosis along with many cyst macrophages and rare atpical cell clusters consistent with metastasis. The lipidaceous secretions from the tumour can evoke a granulomatous reaction accompanied by neutrophils, plasma cells that can mimic a chalazion and the presence of non granulomatous inflammation often containing neutrophils can suggest blepharoconjunctivitis. Also it can mimic basal cell carcinoma but the latter often has clusters of monomorphic basaloid cells without vacuolation, squamous cell carcinoma but the absence of keratinization and presence of vacuolation would help clinch the diagnosis.

Conclusion: FNAC is a safe, quick and cost effective way to diagnose superficial lid tumors such as sebaceous carcinoma and distinguish it from benign clinical mimics. Early diagnosis by FNAC benefits patients by early surgical intervention and reducing the risk of metastasis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-199: FINE NEEDLE ASPIRATION CYTOLOGY DIAGNOSIS OF OLFACTORY NEUROBLASTOMA METASTATIC TO THE PAROTID GLAND

Diya Roy ¹, Aanchal Kakkar ¹, Kavneet Kaur ¹, Rajeev Kumar ¹, Deepali Jain ¹, Sandeep R Mathur ¹, Venkateswaran K Iyer ¹

Introduction: Olfactory neuroblastoma (ONB) is a rare neuroectodermal tumor of the nasal cavity with a propensity for local recurrence and metastasis. As its primary location is usually not sampled by fine needle aspiration (FNA), there are scarce Reports on its cytology, making its recognition difficult at unusual metastatic sites.

Case Report: This 40-year-old male, a known Case of ONB post-resection and adjuvant chemoradiation, presented a year later with a mass in the left parotid region. FNA showed a malignant small round cell tumor with fine to granular chromatin and inconspicuous nucleoli. Two-cell pattern, fibrillary matrix, crushing of cells, streaking of chromatin and lymphoglandular bodies were absent. On immunocytochemistry, tumor cells showed focal positivity for synaptophysin. A diagnosis of ONB metastatic to parotid gland was made.

Conclusion: Intraparotid and periparotid nodes serve as the first echelon nodes draining several head and neck sites, including the superior nasal cavity. FNA is a cost-effective and reliable diagnostic tool for diagnosis of parotid masses, including metastasis Even in Cases without a known primary, metastatic ONB should be considered in the differential diagnosis of a small round cell tumor in the parotid, and differentiated from primary neuroendocrine carcinoma and lymphoma. Thus, awareness of the possibility of metastasis to parotid and of the cytomorphological features of ONB is necessary among cytopathologists for appropriate workup of small round cell tumors of the parotid gland.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-200: CYTOLOGICAL AND HISTOLOGICAL CORRELATION OF SALIVARY GLAND TUMOURS : A CASE SERIES

Neelanjali Jain ¹, Reeni Malik ¹

Background: Salivary gland lesions comprises about 6% of all head & neck cancers. FNAC plays a crucial role in early detection of salivary gland lesions. However, histopathology of salivary gland lesions is still a confirmatory Method for diagnosis and Management. The aim of this study is to establish the diagnostic accuracy of FNAC in the diagnosis of salivary gland tumours.

Methods: A retrospective study of 17 Cases of salivary gland lesions were done at GMC, Bhopal in one year duration. Out of 17 Cases, 15 Cases underwent final histo-pathological confirmation.

Results: Out of 17 Cases 10 were male and 7 were female. The Majority of tumours were benign neoplastic lesion 8Cases of pleomorphic adenoma, 4 Cases of sialadenitis, 1 Case of warthin tumour and a Case of basal cell adenoma along with 3 Cases of mucoepidermoid carcinoma. Histological diagnosis was inconclusive in 2 Cases. The Sensitivity and specificity of FNAC were found to be 92% & 86% respectively.

Conclusion: We hereby conclude that the aforementioned diagnostic modality is a reliable, safe, convenient, cost-saving, reliable and accurate Method to diagnosis and should be used as a first line investigation in the diagnosis and Management of salivary gland lesions.

Keywords: Salivary gland lesions, cytology, Histology.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-201: CYTOPATHOLOGIST - PATIENT CONSULT”-PERCEPTION OF PATIENTS AND THEIR RELATIVES

Hilda Fernandes ¹, Archana Mitran ¹

Introduction: Pathologists' diagnosis frequently have a life changing impact on patients and their families. In this era of precision medicine and individualized therapy, pathologists have a nondelegable responsibility to re-establish ourselves not just as “doctor's doctor” but as a “patient's doctor.” Pathologist –Patient consultation is not new. Patient Pathology consult programmes have been established in many centres across the world.

Aims and Objectives: To conduct a survey of patients perception regarding pathologist patient consultation service

Materials and Methods: Survey Methodology based on cross sectional study of the population was conducted for the patients/relatives who came for cytopathologist consultation for a period 6 months. Survey Results were analysed using the 'top-box' scoring Method which evaluates the percentage of responses selecting strongly agree to strongly disagree questionnaire.

Results: A total 20 cytopathologist –patient consultations were recorded by the survey. All participants answered score 5(strongly agree) and 4 (agree) for the questions on time given,language used, understanding the disease and recommending this program to others. A score of 3 (neither agree nor disagree) was given by 20% of the responders for the question on repeat session. For a descriptive question on the most memorable part, many of them wrote “reassurance provided”

Conclusion: This type of service will make pathologist more visible as she/he is also a part of the cancer/disease care team which in future will help to establish a Formal Patient –Pathologist consult service in the hospital

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-202: CYTOPATHOLOGY CORRELATION OF BIOPSY SPECIMENS IN UVEITIS FROM A TERTIARY EYE CARE CENTER IN SOUTH INDIA

Jyotirmay Biswas ¹

Cytopathology of the eye can be valuable in providing the diagnosis, confirming a clinical diagnosis and providing clinicopathological correlation. We have analyzed the cytopathology specimens obtained various procedures which includes anterior chamber paracentesis, iris mass aspiration, vitreous tap, diagnostic vitrectomy, fine needle aspiration biopsy of subretinal mass in uveitis. This paper will provide the Results of cytopathology of the eye in various uveitic conditions which include parasitic uveitis (microfilaria), masquerade syndrome (retinoblastoma, leukemia, primary intraocular lymphoma) lens induced uveitis, delayed onset endophthalmitis vitreous amyloidosis. Cytopathologic features with clinical correlation will be presented of the specimens seen between period of 2010 to 2021.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-203: SCROFULODERMA: A RARE CASE REPORT ON CUTANEOUS TUBERCULOSIS

Rishabh Chaudhary ¹, Amir Faiz ¹, Hemant Kumar ¹, Manoj Pandey ¹, Shalini Suman ¹, Bushra Khanam ¹

Tuberculosis is one of the biggest health crises in India accounting for 2.2 million Cases each year. Cutaneous TB manifestations are rare forms of extra-pulmonary TB. Cutaneous tuberculosis accounts for only 0.1-0.9% of total out-patients in dermatology in India, most affected are adolescents belonging to 0-14 years age group. Finding bacilli in a cutaneous tuberculosis (CTB) lesion is a challenge. Here we describe a Case of 15 years old male child who presented with complains of fever, weight loss, loss of appetite, rashes, redness ulcerative lesion, multiple abscesses and discharging sinus over neck for duration of 4 month. On local examination, multiple undermined black colored ulcerative lesions were present with discharging pus sinuses with puckered scar marks over the anterior aspect of the neck. Histopathologically, ulcerated dermal abscess with scattered epithelioid histiocytes with few lymphocytes and Marked Caseative necrosis containing abundant bacilli can be seen. Scrofuloderma diagnosis was made.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-204: EVALUATION OF ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY IN INTRA ABDOMINAL MASS: A HOSPITAL BASED CROSS SECTIONAL STUDY IN A TERTIARY CARE CENTRE.

Surajit Das ¹, Aseema Das ¹, Adity Sharma ¹, Bandita Das ¹

Background: Intra-abdominal mass has always been an enigma in surgical practice. FNAC is a simple way to evaluate the intra abdominal mass before going for surgical interventions. It is cost effective, less invasive and widely accepted procedure with high sensitivity and specificity.

Methods: A cross sectional study was performed in the Department of Pathology, Assam Medical College, Dibrugarh in one year period from 2020, June to 2021, May. Study included the Cases coming for FNAC of intra abdominal mass. USG or CT guided FNAC was done and the slides were stained with May- Grunwald- Giemsa stain and Papanicolaou's stain.

Results: Total 58 Cases were found including Cases of 16 months of age to 75 years of age, with mean age of 49.46 years. Females were more affected than males with a M:F of 1:1.3. The diagnostic yield was 87.9%, out of them 35 (60.34%) Cases were malignant, 8 (14%) Cases were benign, 9 (16%) Cases were inflammatory and 6 (12%) Cases were unsatisfactory for evaluation. The study showed 91.35% sensitivity and 100% specificity with 100% Positive predictive value, 60% negative predictive value and 92.31% of diagnostic accuracy.

Conclusion: Intra abdominal cytology is a safe and economical procedure with high sensitivity, specificity and diagnostic accuracy. However, proper guidelines or a system is needed to make uniformity in Reporting of intra abdominal cytology to guide the both cytologists and clinicians and then better management of the patient.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-205: ADENOCARCINOMA OF THE JEJUNUM – DIAGNOSIS BY FINE NEEDLE ASPIRATION CYTOLOGY AND ROLE OF MISMATCH REPAIR PROTEIN IMMUNOHISTOCHEMISTRY IN A RARE TUMOUR

Tarunpreet Saini ¹, Reetu Kundu ¹, Prof Manish Rohilla ¹, Prof Nalini Gupta ¹, Prof Pranab Dey ¹, Prof Mandeep Kang ¹, Prof Ashim Das ¹, Prof Radhika Srinivasan ¹

Background: Small bowel cancer is a rare malignancy comprising less than 5 % of all gastrointestinal malignancies. Adenocarcinoma of small bowel is most commonly located in the duodenum followed by jejunum and ileum, and has a very low survival rate. It may be associated with Crohn's disease, Celiac disease, Lynch syndrome, familial adenomatous polyposis and Peutz-jegher's syndromes. Clinical presentation is non-specific such as abdominal pain, nausea, vomiting, gastrointestinal bleeding & intestinal obstruction. We present herein a series of 3 Cases of jejunal adenocarcinomas emphasising the role of cytology and immunohistochemistry.

Material and Methods: A retrospective study of FNA of jejunal tumors was done from 2015 to 2021 and 5 Cases identified. Ultrasound guided-FNA was done and routine cytology smears stained with MGG and H&E stains evaluated. Cell block and immunocytochemistry was available in 1 Case only.

Result: All patients were males with ages ranging from 42-60 years. Pain abdomen was the most frequent symptom. Radiologically, they showed mural thickening or mass lesion. All Cases showed features of moderately to poorly differentiated adenocarcinoma on cytology. Cell block immunocytochemistry in 1 Case (with prior carcinoma esophagus) showed focal CK20+ and CK7-. MMR IHC showed loss of expression of MSH6, MSH-2 and of MLH-1 with retained PMS2 expression. Patient was advised to undergo genetic testing for Lynch syndrome.

Conclusion: This series describes jejunal adenocarcinoma, a rare tumour, and provides new insights for screening for Lynch syndrome by mismatch repair protein immunohistochemistry.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-206: EARLY DIAGNOSIS AND PREDICTION OF ANTIFUNGAL THERAPY RESPONSE BY CRUSH SMEAR PREPARATION IN MUCORMYCOSIS

Naba Hasan ¹, Feroz Alam ¹, Bushra Siddiqui ¹, Radhika Arora ¹, Aftab Ahmed ¹

Background: The peak of Covid 19 pandemic was associated with Mucormycosis, a rapidly fatal angio-invasive fungus, requiring rapid diagnosis and treatment. Microbiological culture and DNA based molecular Methods (eg PCR) have been used for diagnosis and therapy monitoring but each has its own limitations. Microscopy is still a gold standard for detection and identification of fungi. Prompt initiation of antifungal drugs together with effective therapy monitoring becomes important for optimal and successful management.

Methods: Pre- treatment biopsy tissue from clinically suspicious mucormycosis patients was received in normal saline and crush/imprint smears were prepared for rapid cytological evaluation. After the initial diagnosis, the patients were managed according to the clinical protocol (surgical/medical therapy or both). Post- therapeutic crush smears from the remaining lesion were also evaluated cytologically.

Results: A total of 53 crush/ imprint smears with suspected mucormycosis were received over a period of three months. On cytology 27 Cases (50.9%) were positive for fungus, 22 Cases (41.5%) were negative, while 4 Cases (7.5%) were suspicious for fungal infection. Post- therapeutic crush/imprint smears from 12 Cases were received for routine follow-up, 7 Cases showed morphologically altered hyphae and 6 Cases showed preferential immune cell localization.

Conclusion: Crush smears are an effective and rapid Method of diagnosing mucormycosis. Our preliminary Results point that fungal and immune cell cyto-morphological pattern can aid in effective and prompt therapy monitoring specially in critically ill patients.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-207: CAN CRUSH CYTOLOGY ALONE BE A RAPID DIAGNOSTIC METHOD FOR MAKING THERAPEUTIC DECISIONS?

Shubhangi Jibhkate ¹, MM Kamal ¹, DT Kumbhalkar ¹

Background: Gold standard for ultimate diagnosis of malignancy is histopathology. However histopathology tissue processing is tedious, time consuming and in a tertiary care centre, it is not possible to provide an early diagnosis of the biopsy specimens due to the large number of samples received in bulk. Cytology in the form of crush can come to the rescue. Crush cytology is simple, easy to perform, cost effective and rapid diagnostic tool for diagnosing lesions specially malignancies where therapeutic decisions can be planned for providing early intervention to the patient.

Objective: To study the efficacy of crush cytology in the pre-operative diagnosis of neoplasms.

Materials Methods: A prospective study carried on patients who had suspected malignancy from January 2020 to August 2021. The crush smears were received in cytology and on the same day biopsy specimens were received in the histopathology section from OT. The cytological diagnosis was correlated with histopathological diagnosis.

Result: Sensitivity and specificity of crush cytology is 69.14% and 78.95%,respectively. The positive predictive value is 93.33% and negative predictive value is 37.50%. Diagnostic accuracy is 71% but weak kappa agreement. On training and removal of discordant Cases sensitivity raised to 98.24% and specificity 100% with diagnostic accuracy of 98.61% concluding almost perfect agreement(Kc=0.96) between crush cytology and histopathology.

Conclusion: Crush cytology was found to be an effective rapid diagnostic tool for preoperative work up of patients with malignancies provided adequate training is ensured in the smear preparation and fixation.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-208: CONUNDRUMS IN FINE NEEDLE ASPIRATION CYTOLOGY: A STUDY OF 15 CASES

Sherrin Jacob ¹, Neeti Nagar ¹, Mukul Singh ¹, Amit Kumar Yadav ¹

Background: Cytopathology as a field of diagnostics is known for its speed, accuracy and cost effectiveness. Its major drawback lies in subjective nature of diagnosis which depends on sample collection technique, smear preparation Methods and interobserver variation. Some of these issues have been addressed by bringing in uniform Reporting systems in each organ. This study Aims to underline the importance of detailed history, use of ancillary techniques and radiological review (Quadruple strategy) in a cytopathological diagnosis.

Method: We studied cytomorphology of 15 Cases which were posing a diagnostic dilemma and worked up with detailed patient history, ancillary techniques and radiological review to narrow down to specific diagnosis based on this quadruple testing.

Result: Quadruple testing paved way for specific diagnosis in atleast 40% of the Cases and these had drastic implication on further treatment guidelines of the patient.

Conclusion: We present this paper to highlight the major routine diagnostic dilemmas in FNA Reporting and the importance of clinicoradiological correlation, patient communication and ancillary techniques in cytopathology diagnostic decision making as cytopathology is usually the first minimally invasive technique the patient undergoes for a diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-210: RETROSPECTIVE STUDY OF IMAGE GUIDED (USG/CT) FINE NEEDLE ASPIRATION CYTOLOGY OF ABDOMINAL OR THORACIC LESION IN RIMS, RANCHI

Md Raihan ¹, Sunil Kumar Mahto ¹

Background: Ultrasonography (USG) and Computed Tomography (CT) scan is a safe and procedure for diagnosis of masses/lesions which are non-palpable and deep seated in the body.

Methods: This is a retrospective study done in Rajendra Institute of Medical Sciences, Ranchi (Jharkhand) for the period of two years, September 2019 to August 2021. Fine needle aspiration cytology (FNAC) under USG / CT guided was performed in total 120 Cases including 108 abdominal- pelvic Cases and 12 thoracic Cases. The smears were made, stained with both Papanicolaou and Giemsa stain and the slides were examined under light microscope.

Results: One hundred and twenty (120) image guided FNAC were performed. Of total 120 Cases, 71 (59.2%) Cases were malignant, 3 (2.5%) benign, 37 (30.8%) inflammatory, 5 (4.2%) inadequate, and 4 (3.3%) suspicious for malignancy. Maximum number of Cases were from liver 42 (35%) followed by intra-abdominal lymph nodes 38 (31.7%), gall bladder 12 (10%), lungs 12 (10%), intestine 9 (7.5%), stomach 3 (2.5%), ovary 2 (1.7%), pancreas 1 (0.8%) and kidney 1 (0.8%).

Conclusions: USG / CT-guided FNA cytology plays an important role in diagnosis of non-palpable abdominal, pelvic and thoracic deep seated lesions. It is safe and outpatient procedure for rapid diagnosis of malignancy.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-211: QUALITY ASSURANCE OF AFB STAINING IN RESPIRATORY EXFOLIATIVE CYTOLOGY SPECIMEN: REVISIT TO DISCORDANT CASES

Swalaha Sadaf Siddique ¹, Sramana Muhopadhyay ¹, Vaishali Walke ¹, Tanya Sharma ¹, Hemlata Panwar ¹, Anand Ku Mourya ¹, Abhishek Goyal ¹

Background: Diagnosis of Mycobacterium tuberculosis (MTB) on exfoliative respiratory sample is major facet of cytology laboratory, making quality audit is important and mandatory exercise.

Materials and Methods: An audit of AFB staining on consecutive 106 respiratory samples and concordance with available Cartridge-based nucleic acid amplification test (CB-NAAT) and cultures was studied. Root cause for discordant Cases was analysed and remedial measures were applied.

Results: Out of total 106 Cases examined, 17 (16%) were discordant with CBNAAT. The maximum discordance (30.7%) in BAL samples followed by sputum (15.8%), bronchial brushings (11.1%) and pleural fluid (7.7%). Out of 17 discordant Cases, 8 (7.5 %) were AFB positive; CBNAAT negative, among this culture is possible in 2 Cases, one was positive for MTB and another for Non tubercular mycobacterium (NTB). AFB in these Cases were in clumps, chains and elongated- beads. To check the quality and exclude the possibility of contamination, distilled water was used in all steps of AFB staining. The bronchoscope were flushed with saline and sample processing for further AFB staining along with changing the lot of stain were the measures taken in the laboratory. Nine Cases were AFB negative and CBNAAT positive; amongst which in two Cases culture was possible. Remaining 07 were reviewed for smear quality thickness, evenness of spread, staining quality, also for staining quality.

Conclusion: The discordance Cases should be addressed appropriately and strict standard operating procedures to be followed with negative and positive controls so as to avoid the false positive and false negative Results.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-212: UNLEASHING THE BEAST FROM BENIGN! – A CASE SERIES

Jayasudha Cheralathan ¹, Teleflo Boopathy ¹, Brihadiswarar ¹, Gowri ¹

Background: Cutaneous lumps are one of the commonest Cases encountered in surgical practice. Spectrum varies from simple epidermal inclusion cyst to malignant neoplasm. Besides the symptomatology and clinical examination, we require radiological and pathological work-up to arrive at the definitive diagnosis. This Case series emphasizes the utility of FNAC, which is quite a simpler procedure, that aids in making the precise diagnosis.

Methods: This series consist of 15 cutaneous lump Cases who were clinically and radiologically diagnosed as “benign” at the outset. Further these patients were subjected to FNAC. The material was smeared and stained with Haematoxylin and Eosin. Results were obtained.

Results: Findings obtained were suggestive of metastatic carcinomatous deposits. Out of 15 Cases, 6 Cases had history of surgery for primary tumor years back: 2 RCC, 1 carcinoma gallbladder, 1 carcinoma breast, 1 malignant melanoma, 1 carcinoma ovary. Remaining 9 Cases underwent further evaluation, in search of occult primary. Investigations revealed the following:2 carcinoma stomach, 2 carcinoma ovary, 1 carcinoma lung, 3 carcinoma oro-pharynx. 1 died before diagnosis.

Conclusion: All these Cases were clinically and radiologically thought as “benign”. Differentials considered were sebaceous cyst, lipoma, abscess,etc. Then, these patients were subjected to FNAC. This was the turning point which clenched the definitive diagnosis thus paved way for appropriate management. Thus this Case series highlights that clinical and radiological investigation alone cannot be taken as criteria for cutaneous lumps, it definitely needs an FNAC as the first-line trust worthy investigation for the right diagnosis and optimal planning and management.

Keywords: FNAC, cutaneous lumps, Metastatic carcinomatous deposits.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-213: DUAL FUNGAL INFECTION: INCIDENTAL CYTOLOGICAL FINDINGS ON CRUSH SMEARS

Sanjeet Kumar Singh ¹, Rakesh Kumar Singh1 ¹, Kalpana Chandra ¹

Background: Covid-19 has caused a devastating pandemic since last two years. 233 million individuals have been infected and 4.7 million have died worldwide. Aspergillosis and candidiasis are the most prevalent Opportunistic invasive fungal infections (OIFIs) in COVID-19 patients. Increased incidence of Mucormycosis was seen in India. Factors such as administration of immunosuppressive agents, corticosteroids, broad-spectrum antibiotics, ICU admission, intubation/mechanical ventilation, and surgery are associated with OIFIs. We Report three post Covid-19 Cases, different age groups with co morbidity, in whom dual fungal infections were seen on cytological examination that were missed on rapid KOH preparation. Culture too showed single infection in one of the Cases. Patients presented with fever, headache, vomiting and diplopia for 2-6 days. MRI brain showed involvement of ethmoid, maxillary and sphenoid sinuses and diffuse exudative process.

Methods: Crush smears were prepared in OT from the debrided tissue. These were examined after staining with Giemsa, PAS and GMS stains. Tissue was also sent for KOH preparation, culture and for histopathological examination.

Results: Crush smears is time saving and also delineates the fungus precisely, avoiding sectioning of the organism. Smears can be stained by different stains, morphology of the fungus is better appreciated and hence it was easy to pick the dual fungal co infection in these patients.

Conclusions: Screening of patients with confirmed COVID-19 for OIFIs could enable early OIFI diagnosis, treatment, and mortality reduction. Further, there is need to improve diagnostic and therapeutic criteria to optimize management procedures so that patients can receive rapid treatment.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-214: FINE NEEDLE ASPIRATION CYTOLOGY DIAGNOSED URIC ACID CRYSTALS PRODUCE BY ASPERGILLUS

Anju Khairwa ¹

Background: Uric acid is a metabolic product of nucleic acid and protein. Uric acid is degraded further into allantoin by urate oxidase and excreted by the kidney in the urine in most mammals. When urate oxidase becomes nonfunction leads hyperuricemia in mammals.

Case Report: Here, we presented a rare Case of cutaneous uric acid crystals produced by fungus with normal serum uric acid level diagnosed by Fine needle aspiration cytology (FNAC). A 61-year-old male presented cutaneous swelling in FNAC OPD, and cytology revealed multiple uric acid crystals along with septate fungal hyphae (morphology of Aspergillus). Morphology of uric acid confirmed in polarized light microscopy and fungal morphology in PAS stain.

Conclusion: FNAC is very useful diagnostic Method for evaluation of fungal derived crystals and delineated their morphology.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-215: NODULAR HIDRADENOMA OF THE SOLE MASQUERADING AS MALIGNANCY- A MYSTERY REVEALED ON FNAC.

Priti Sharma ¹, Chetna Jain ¹, Richa Sharma ¹

Background: Nodular hidradenoma is a benign adnexal neoplasm of apocrine differentiation. Wilson Jones called it a “nosological jungle”. It is commonly encountered on head & neck, trunk with few Cases on extremities. The usual presentation is solitary, slow growing, non tender, firm to hard mass size ranging from 0.5 to 2 cm. Superficial ulceration, blue or red discoloration, serous discharge may arise suspicion of malignancy.

Case Report: A 70 year female patient presented with a slow growing, firm to hard, non tender swelling of 3x3 cm in size on sole of left foot since 7 years. Surface was ulcerated and serous discharge was present. FNAC was requested with provisional diagnosis of basal cell carcinoma. A fairly cellular smear shows many cohesive clusters of epithelial cells at places arranged in basaloid pattern. cells are having round hyperchromatic nuclei with scant cytoplasm. Formation of ducts & hyaline material is discernible. Histopathology reveals a well circumscribed mass arranged in lobules. Cells are having clear to eosinophilic cytoplasm with few cells of squamous differentiation. Ducts & densely hyalinized stroma present. No atypia/ no atypical mitosis is discernible.

Conclusion: FNAC is simple, safe, quick and cost effective tool in differentiating as benign or malignant neoplasm. It helps in early management. Adnexal neoplasms are rarely subjected to FNAC. The diagnosis of hidradenoma was further supported by histopathological evaluation.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-216: CYTOLOGICAL DIAGNOSIS OF MYCOSIS FUNGOIDES : A CASE REPORT

Anu Gupta ¹, Subhash Bhardwaj ¹

Background: Mycosis Fungoides is a clinico pathological type of peripheral T cell lymphoma also known as Granuloma Fungoides or Alibert Bazin syndrome. It typically begins as slowly progressive dermatitis like patches & plaques that may evolve to nodules or tumours, creating diagnostic challenges, requiring careful clinico-pathological correlation.

Case Report: This is a Case of 68 years old male who presented in the cytology section of the Department of Pathology, GMC Jammu, referred from Skin OPD with 10 months history of dermatitis like and ulcerative skin lesions all over the body especially on arms trunk and back. Fine Needle Aspiration Cytology (FNAC) of the ulcerative lesion was done and after staining with May Grunwald Giemsa and Papnicolau stain smears were prepared which showed high cellularity comprising of sheets of medium to large atypical lymphoid cells showing cleaving and clefting at many places, inconspicuous nucleoli, irregular nuclear margins. An occasional cell with cerebriform nuclei was also seen. Peripheral blood film of the patient showed no atypical cells. On the basis of FNAC a diagnosis of cutaneous Non-Hodgkins lymphoma was given and excision biopsy was advised. Histopathology of H&E stained slides showed intadermal monomorphic lymphoid cells similar as was seen in FNAC infiltrating the epidermis. The overall features were consistent with Mycosis Fungoides.

Conclusion: Diagnosis of MF is still challenging because of its confusing clinical presentation. Diagnostic tools like FNAC, histopathology & immuno histochemistry together with clinical features help in early diagnosis and Maximizing periods of remission or stable disease.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-217: CYTOSPIN AS DIAGNOSTIC TOOL FOR DIAGNOSIS OF PRIMARY INTRAOCULAR LYMPHOMA

Rohan Chawala ¹, Neelima Sharma ¹, S Sen ¹, S Kashyap ¹, N Kabir ¹, DK Baitha ¹, K Sartan ¹

Background: Diagnosis of primary intraocular lymphoma (PIOL) is difficult and challenging for both pathologists and clinician. The vitreous sample is of small volume, often admixed with inflammatory cells. Also patients often present as uveitis (masquerade syndrome) leading to delay in diagnosis. CNS involvement is seen in 60% Cases of PIOL. The prognosis is poor with median survival of 3 years with treatment.

Methods: A total of 39 vitreous samples (2018-2020) were received in Ocular Pathology, R.P. Centre. Of these, 24 patients (61.5%) had presented with a clinical suspicion of lymphoma. The samples were processed by cytospin (Thermo Scientific) and slides stained by MGG, PAP and Immunostains (CD-20, CD-3 and CD-68).

Results: Of the 24 vitreous samples, 13 (47.3%) were diagnosed as large B-cell lymphomas. The mean age was 61±14.9 years. There was a slight female preponderance (6/7). Right eye was involved in 7 (53.8%), left in 1 (7.6%) and both eyes in 5 (38.4%). The atypical lymphoid cells were large in size, had irregular nucleus with prominent nucleoli and scant cytoplasm. Few mature lymphocytes and degenerating cells were often seen. The remaining Cases (11) showed scant material or reactive lymphocytes. These patients were kept on close follow up. All the 13 PIOL patients were investigated for CNS lymphoma and treated with intravitreal methotrexate (MTx) for 6 months.

Conclusions: Cytospin is a very useful technique to diagnose PIOL in the hands of an experienced cytopathologist. Increased IL10/IL6 ratios by ELISA and MYD88 specific PCR are useful diagnostic modalities in Cases with diagnostic dilemma.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-218: CYTOLOGICAL DIAGNOSIS OF METASTATIC MELANOMA: A CASE REPORT

Aastha Gupta ¹, Hema Pant ¹

Background: Malignant melanoma is a primary cutaneous malignancy, but is also known to occur in various other locations. Accounting for 3% of all malignancies, it is an aggressive tumor with potential to metastasize anywhere in the body. Melanomas usually first involve the local lymph nodes and organs such as liver, lungs, skin, bones and brain. It has been aptly named the great masquerader. Cytopatology is an important tool in establishing or confirming the diagnosis of malignant melanoma at a metastatic site. Herein we Report a Case in which cytological diagnosis of metastatic melanoma was made prior to clinical and histological diagnosis and the value of cytological examination has been emphasized.

Case Report: A 57 year-old male, presented with complaints of breathlessness, cough with expectoration, anorexia, weakness and swelling in left cervical region. On local examination: Left upper cervical lymph node was enlarged, painless, measuring 3x2 cms. On FNA, blackish material aspirated. Microscopy favors diagnosis of malignant melanoma which was further confirmed by histopathology.

Conclusion: FNAC of palpable lymphadenopathy in patients with malignant melanoma can provide rapid and accurate assessment of lymph node and expedite the management of patients, especially with unknown primary.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-219: TWO RARE ENTITIES DIAGNOSED ON BRONCHOALVEOLAR LAVAGE: DISTINCTIVE CYTOMORPHOLOGY

Snigdha Roy ¹, Pooja Bakshi ¹, Poojan Agarwal ¹, Gunjan Mangla ¹, Samarjit Singh Ghuman ², Amit Dhamija ³

Background: Bronchoalveolar lavage (BAL) is an important non-invasive procedure which retrieves respiratory secretions. It is performed as a diagnostic as well as therapeutic procedure. Two rare and interesting Cases diagnosed on BAL fluid cytology are presented here.

Case Report: Case 1-Clinical features: An 8-year old boy presented with cough, fever and chest pain of 1-month duration. X-ray chest showed fine sandstorm appearance of lungs. CT findings revealed evidence of interlobar septal thickening with associated calcification along the pulmonary interstitium and bilateral pleural margins. BAL Cytology: Smears showed alveolar macrophages, few ciliated columnar epithelial cells, lymphocytes and numerous scattered calcareous concentric lamellated bodies (microliths; positive on von Kossa stain). ZN stain for acid fast bacillus was negative. Diagnosis: Pulmonary Alveolar Microlithiasis (PAM). Case 2-Clinical features: A 31-year old lady presented with shortness of breath of 1-year duration and recent onset type 1 respiratory failure. Chest CT scan showed bilateral crazy paving pattern with interlobar septal thickening. BAL performed on the middle lobe of the right lung yielded milky white fluid. BAL Cytology: Smears showed abundant amorphous acellular material in the form of varying sized globular bodies and fragments along with occasional alveolar macrophages. This material was Periodic Acid Schiff stain positive and diastase resistant. ZN stain for AFB, modified ZN stain for Nocardia and stain for fungus was negative. Diagnosis: Pulmonary Alveolar Proteinosis (PAP).

Conclusions: PAM and PAP are unique and rare diseases with typical radiological and cytological findings, BAL is an important investigation and helps to clinch the diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-220: CUTANEOUS METASTASIS MASQUERADING AS LYMPHANGIOMA CIRCUMSCRIPTUM IN A ZOSTERIFORM PATTERN REVEALED BY TZANCK SMEAR CYTOLOGY

Jalaja Mary George ¹, Preethy Harrison ¹, Sunitha Thomas ¹, Sanju Cyriac ¹, Joejo John ¹

Background: Cutaneous metastasis from visceral malignancies is uncommon and has poor prognosis. The incidence of it is 0.7- 10.4% and constitutes only 2% of all skin malignancies. Endometrial carcinoma with cutaneous metastasis is very rare. Most common clinical presentation of cutaneous metastasis is painless firm papulonodules. One of the rarer clinical presentations mimic dermatomal zoster or lymphangiomatous vesicles. In such confounding Cases, Tzanck smear cytology is a simple, rapid, inexpensive bedside test to aid diagnosis.

Case Report: A 60-year-old female was referred from Oncology to Dermatology clinic with persistent Herpes zoster, on extended Acyclovir. She had a history of serous carcinoma, endometrium, FIGO Stage IV B two years ago and completed protocol chemotherapy. Disease progression was noted after one year. Examination revealed clustered frog spawn appearance of papulovesicular lesions on right thigh, pubis and lower abdomen in a dermatomal spill over zoster-like pattern. Tzanck smear was performed to look for viral cytopathic changes, but showed atypical cells suggestive of malignancy instead. As a clinical differential diagnosis included lymphangioma circumscriptum, skin biopsy was taken, which along with IHC studies, confirmed the diagnosis of cutaneous metastasis from serous carcinoma endometrium. The patient succumbed after 3 months of palliative chemotherapy.

Conclusion: Cutaneous metastasis can rarely present with vesicular lesions mimicking zoster or lymphangioma. A Tzanck smear is a valuable tool in such clinical dilemmas for rapid diagnosis of cutaneous metastasis. It can be used as an adjunct for screening before starting antiviral therapy.

Keywords: Cutaneous metastasis, lymphangioma circumscriptum, zosteriform pattern, Endometrial carcinoma.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-221: MEDULLARY CARCINOMA THYROID WITH UNUSUAL COEXISTENCE OF METASTASIS AND TUBERCULOSIS IN CERVICAL LYMPH NODES

Ankita Yadav ¹, Swasti Jain ¹, Prajwala Gupta ¹, Minakshi Bhardwaj ¹

Background: Medullary carcinoma is a neuroendocrine tumor of parafollicular C cells present in thyroid gland. Though tuberculosis is a common chronic infectious condition in India but the concurrent presence of TB in a metastatic medullary thyroid carcinoma is very rare.

Case Report: We Report a Case of a 38 year old female who presentedwith bilateral cervical lymphadenopathy. USG neck revealed a 6×6mm nodule in the left thyroid lobe, TIRADS 1 category and multiple bilateral cervical lymphadenopathy. Biochemical investigations showed normal thyroid function test. FNAC was performed from bilateral cervical lymph nodes revealing metastasis on right side and tubercular lymphadenitis on left side. Cell block prepared from left cervical lymph node was subjected to IHC showing positivity for synaptophysin and CEA supporting the diagnosis of neuroendocrine tumor. On further workup, S.calcitonin levels were estimated and USG guided FNAC was attempted from small thyroid swelling.

Conclusion: Tuberculosis must always be considered besides metastasis while evaluating an enlarged cervical lymph node and adequate sampling must be done from different lymph nodal swellings to exclude concomitant tubercular pathology. Further metastatic lymph node requires a thorough workup.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-222: NON-HODGKIN LYMPHOMA OF THE EYELID

Surbhi Sharma ¹, Jyotsna Suri ¹, Surbhi mahajan ¹

Background: 1% of all lymphomas and nearly 8% of all the extranodal lymphomas are known to arise in the ocular adnexa. The relative frequencies of the presentation of ocular adnexal lymphomas are 37% in the orbit, 29% in the conjunctiva, 20% in the lacrimal apparatus and 14% in the eyelid. Majority of the eyelid lymphomas are of B-cell origin and the others are of T-cell origin.

Case Report: We present a 70 year old male with left eyelid swelling and dropping for 6 months. No history of trauma was present. Ophthalmological examination revealed the visual acuity of 6/9 in both eyes; the anterior segment and fundi showed normal appearance. A firm diffuse thickening of the left upper eyelid was noted on examination. He underwent cranial computed tomography(CT) scanning which showed that there was no intracranial extension. FNAC of the swelling revealed a diagnosis of malignant small round cell tumour. On incisional biopsy, the diagnosis of non-Hodgkin's lymphoma (NHL) of the left eyelid was made which was later confirmed by leucocyte common antigen (LCA). The patient was then referred to the radiotherapy department for further management.

Conclusion: NHL may present as only diffuse firm thickening of the eyelids. Such Cases can cause delay in the diagnosis and initiating appropriate treatment. Therefore, NHL should be considered in the differential diagnosis of extralymphoid mass lesions present almost at any part of the body.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-223: METASTATIC SEMINOMA WITH AN UNSUAL PRESENTATION OF SUPRACLAVICULAR LEFT NECK SWELLING -A NOTABLE CASE

Pramiti Sarma ¹, Adity Sharma ¹, Aparna Dutta ¹, Bobby Duarah ¹, Luckymoni Duara ¹, Kaustubhmoni Gogoi ¹

Background: Pure seminomas represents approximately 50% of all testicular germ cell tumour in contrary metastatic seminomas with supraclavicular neck swelling is very rare. This is an unusual occurrence of metastasis, primarily presenting with neck swelling that was subsequently diagnosed to be metastatizing from seminoma of the testis.

Case Report: A 45 years old averagely built, man presented to the surgery opd with an irregular swelling in the left supraclavicular region of the neck. Fnac revealed metastatic carcinomatous infiltrations of the neck swelling. On consequent intervention fnac from the testicular mass was taken, that matches the findings of that of the neck swelling.

Conclusion: Metastatic cacinomatous infiltrations in the neck swellings from seminoma of the testis are merely rare. This Case substantiates the need of assesing testicular mass in Cases of enlarged neck swellings.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-224: THE CLINICOPATHOLOGICAL PROFILE OF COVID-19 ASSOCIATED MUCORMYCOSIS IN PATIENTS OF A TERTIARY CARE HOSPITAL IN JAMMU REGION

Surbhi Mahajan ¹, Aishvarya Jandial ¹, Subhash Bhardwaj ¹

Background: With the ongoing serious COVID-19 pandemic in India, mucormycosis, colloquially called as black fungus, has emerged as a serious fungal infection in patients who were earlier infected with COVID 19 virus. Mucormycosis is caused by saprophytic fungi of the order Mucorales. The prevalence of mucormycosis in India is approximately140 per million population which is roughly 80 times more than that in the developed countries. The clinical spectrum of presentations of mucormycosis depends on the anatomic localisation of infection, such as rhino-orbital-cerebral (ROCM), pulmonary, gastrointestinal, cutaneous, renal, and disseminated mucormycosis.

Methods: We, here present a Case series of 20 COVID positive patients, who had later on presented clinically as mucormycosis, along with radiological evidence of the same which was then confirmed on histopathology.

Results: Mucormycosis was more common in male patients with male: female ratio of 4:1. All the 20 Cases had rhino-orbital-cerebral mucormycosis as their clinical presentation. Among the various predisposing factors diabetes mellitus, chronic kidney disease and high dose steroids were the most common contributing factors.

Conclusion: COVID 19 has not only created a havoc for the whole world but it has also set a fertile ground for development of life threatening infection like mucormycosis because of the various predisposing factors involved. Keeping in mind the fatality of this infection the diagnostic study for this opportunistic pathogen should not be ignored in Case the patient is COVID-19 positive and immunosuppressed.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-225: AN UNUSUAL CASE REPORT OF MALIGNANT MELANOMA WITH DISTANT CUTANEOUS METASTASIS AT FIRST PRESENTATION DIAGNOSED BY FNAC

Afrin Siddiqui ¹, Shankhanila Mazumdar ¹, Gagan Kumar Rangari ¹, Neeraj Dhameja ¹, Nandita Chaudhary ¹

Background: Melanoma is an aggressive malignancy and metastasis is not uncommon. Metastasis can occur to different organs with varying frequency. Lymph node and skin metastasis occurs in 42 to 57 % of patients with malignant melanoma but the first clinical manifestation maybe cutaneous metastasis in only 2 – 8% of Cases with melanoma. Fine needle aspiration cytology can play an important role in the diagnosis of such Cases as a relatively non -invasive and rapid alternative.

Case Report: A 60 year old male presented with multiple blackish hyper pigmented swelling on left upper limb and left axilla. First swelling appeared on the left thumb 2 years back following which the thumb was amputated at local hospital, no histopathological record were available. Post amputation there was appearance of multiple similar swellings over the left upper limb and axilla. On microscopy the smears from the swellings were highly cellular and showed predominantly dispersed population and few clusters of atypical cells which were round to polygonal with high nuclear cytoplasmic ratio, eccentric nuclei, conspicuous nucleoli and moderate cytoplasm with pigment in some of the cells. IHC on cell block was positive for PDL1. Hence a diagnosis of malignant melanoma was made.

Conclusion: Any cutaneous lesion showing typical cytological features of melanoma with presence of intracellular pigment should have high level of suspicion for melanoma. Fine needle aspiration cytology can play an important role in rapid diagnosis and early planning of management. IHC on cell block can play an important role for confirmation of diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-226: SECONDARY B CELL LYMPHOMA OF SKIN:CLINICAL AND CYTOLOGICAL ENIGMA

Akshata B ¹, Madhusmita Jena ¹, Niranjan ¹, Rohini ¹

Background: Cutaneous lymphomas may be primary or secondary to nodal/extranodal disease. B cell lymphomas constitute 22.5% of all cutaneous lymphomas. B cell lymphoma of skin is rarer than T cell lymphoma. We present a Case of B cell lymphoma of skin secondary to extracutaneous lymphoma in a 20 year old male which was diagnosed on cytology.

Case History: A 20 year old male presented with multiple itchy nodules over the trunk and fever 15days. Pallor, Icterus and cervical lymphadenopathy were noted. A provisional diagnosis of erythema nodosum of skin was given. Blood investigation showed pancytopenia with positivity for Australian antigen. A mild pleural and pericardial effusion were seen on radiography. FNAC of cervical lymph node was done which showed sheets of monotonous population of large atypical lymphocytes cells with high N:C ratio, round vesicular nuclei, prominent nucleoli and thin rim of cytoplasm. Multiple atypical mitotic figures were seen. A diagnosis of lymphoproliferative disorder was given. Subsequently an aspiration was performed on the skin nodules which showed a similar appearance on cytology favoring a lymphoproliferative lesion. A skin biopsy from cutaneous nodule showed dense collection of immature lymphoid cells infiltrating into subcutaneous fat favoring towards a lymphoma. An IHC on skin biopsy showed CD20 positive and CD 3 negative cells and thus diagnosis of B-cell lymphoma was given.

Conclusion: This Case highlights the significance of aspiration cytology in providing a diagnosis in lesions of skin such as identifying a cutaneous lymphoma.

Keywords : IHC - Immunohistochemistry.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-227: HBH DISEASE -AN UNDER DIAGNOSED ENTITY

Durgeshwari Pandey ¹, Vatsala Kishore ¹, Neeraj Singh ¹, Vaishali Kotasthane ¹, Dhananjay Kotasthane ¹

Background: Thalassemia is the most common single-gene disorder in the world. More than 50% of the population appears to have a clinically silent form of α-thalassemia. With this Case we want to highlight the importance of simple peripheral smear examination and supravital staining on peripheral blood in the diagnosis of Hb H disease.

Case Report: We Report a Case of 61 year old male who was referred to us with a provisional diagnosis of MDS and was found to be alpha thalassemia undiagnosed for 61 years.

Conclusion: All Cases of microcytic hypochromic anemia with adequate iron stores should be suspected for alpha thalassemia. It is also necessary to emphasize early diagnosis of these Cases to facilitate implementation of proper preventive health care measure. Peripheral smear examination and supravital stains is irreplaceable in the diagnosis of these hemoglobinopthies.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-228: CYTOLOGICAL CLUES TO ALTERNARIA ALTERNATA- A CASE REPORT

Shubhra Singhal ¹, Meeta Singh ¹, Pallavi Sinha ¹, Tanu Sagar ¹, Shyama Jain ¹, Lovenish Bains ¹

Background: Alternaria alternata is a dematiaceous fungus. They are opportunistic fungal pathogens affecting mainly immunocompromised hosts. FNAC is an effective tool for primary detection of such organisms.

Case Report: A 27 year male presented with right ankle swelling, gradually increasing in size for 4 months. Swelling was present over the lateral malleolus and was associated with pain. On examination, the swelling was firm, non-tender, not fixed to skin or underlying tissue, overlying skin was normal. FNAC was performed and MGG smears from the lesion consisted mainly of necrosis and inflammatory infiltrate comprising of neutrophils, eosinophils and histiocytes. Many fungal hyphae were seen. They were thin-walled with acute angle branching, also showed septations at regular intervals. Sample was cultured on SDA agar, and fungal growth with greyish-white woolly texture was seen. Lactophenol Blue stain showed chains of brown conidia with rounded base and beaked apex, with transverse and oblique septations. Based on cytology, microscopy and growth characteristics, it was identified as Alternaria alternata.

Conclusion: Diseases caused by dematiaceous fungi are chromoblastomycosis, eumycetoma or phaeohyphomycosis. The colour in dematiaceous fungi is due to presence of melanin which is considered as a virulence factor. Cutaneous alternariosis is characterized by hyphae that are mostly limited to superficial epidermis. Histological features of Alternaria have been described in literature. However, cytological findings have been seldom described. FNAC is an important diagnostic tool for dematiaceous fungi. Isolation by culture is necessary for definitive diagnosis. In this Case, specific morphological features of Alternaria alternata have been described on FNAC.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-229: ISOLATED RENAL CORTICAL CYST:ACCIDENTAL ASPIRATION

Garvita ¹, Meeta Singh ¹, Bhagyashree Priyadarshinee ¹, Sushanto Neogi ¹

Background: Hydatid cyst disease is a parasitic infection caused by Echinococcus Granulosus. It commonly affects lungs and liver. Kidney involvement is seen in 2% of the Cases. The patients may be asymptomatic or present with flank pain, hematuria and hypertension. Radiological investigation are the mainstay of diagnosis. Aspiration of cysts are contraindicated to avoid accidental spillage and anaphylactic reactions. However in rare occasion this may be mistaken as simple renal cyst on ultrasound, which happened in our Case and aspiration was done for malignant cytology. We hereby describe Echinococcus granulosus entering into the kidney of 45year old male and the parasite was detected on fluid cytology.

Case Report: 45year old male presented in OPD with right flank pain and USG guided FNAC was done. USG findings showed complex multiloculated cyst and simple cortical cyst was found in the right kidney. 1 ml of fluid was aspirated from the cyst and was sent for cytological examination. Fluid was clear on gross appearance. Direct and cytospin preparations were made which showed dirty Background containing fragments of laminated wall, debris embedded with hooklets, calcareous bodies and scolex with hooklets morphologically resembling hydatid cyst.

Conclusion: Though FNAC and cytospin show classical finding of hydatid cyst; aspiration is contraindicated. However; the patient was kept under strict follow up and did not develop any anaphylactic reaction.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-230: METASTATIC TESTICULAR LYMPHOMA MASQUERADING AS SEMINOMA ON CYTOLOGY: A RARE CASE REPORT

Shruti Shemawat ¹, DP Soni ¹

Background: Testicular lymphoma is a rare neoplasm which can disseminate to sites like skin,central nervous system, contralateral testis,retroperitoneal nodes,Waldeyer's ring etc in 20% Cases. Review of literature showed very few Reports on peculiar cytologic features of metastatic testicular lymphoma on fine needle aspiration cytology (FNAC). We Report the rare and masquerading cytologic features of a Case of cutaneous metastasis of testicular lymphoma.

Case Report: A 61 year old male presented with cutaneous nodule on anterior abdominal wall and medial side of right thigh for past 15 days. There was preceding history of left radical orchidectomy done 1 month back for left testicular swelling which was diagnosed as testicular lymphoma on histopathology. FNAC was performed for clinical workup for diagnosis of cutaneous nodule suspecting it to be metastatic lymphoma owing to the past history of the patient. However, the cytological findings of skin nodule were more synonymous to seminoma as compared to lymphoma. Biopsy and immunohistochemistry tests were offered to the patient, however, he refused due to his poor economical condition. Despite the contradictory findings on FNAC, the chemotherapy sessions for primary testicular lymphoma were continued which surprisingly Resulted in complete regression of cutaneous nodules without any recurrence.

Conclusion: Although the cytomorphological findings of testicular lymphoma are characteristic, sometimes the presence of discrete malignant cells in lace like vacuolated Background, causes diagnostic confusion with seminoma. Therefore, pathologists must always be looking to differentiate these findings to reach the correct diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-231: ACTINOMYCOSIS: AN UNUSUAL POST COVID MANIFESTATION

Nidhi Kaushik ¹, Sanjay Kumar ¹, Sant Prakash Kataria ¹, Sunita Singh ¹

Background: COVID-19 is an infection caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This infection may be associated with a wide range of bacterial and fungal co-infections. Actinomycosis is an indolent, slowly progressive, suppurative infection caused by gram-positive branching bacteria of the genus Actinomyces. The disease actinomycosis most commonly occurs in these regions: cervicofacial (55%), abdominopelvic (20%), and pulmonothoracic (15%) Cases. Involvement of other parts of the body is uncommon and rare.

Case Report: A 51 year old male was admitted with multiple pus filled lesions over feet and sole including toes. Past history of patient revealed that he was a known Case of diabetes mellitus type 2 and recovered from post covid mucormycosis about two months back. On examination these swellings were tender with sloughed margins and varying in size from 2.0 to 4.0 cm in diameter. Fine needle aspiration was performed from these lesions. Smears were prepared and examined shows numerous long needle shaped crystals in aggregates and scattered singly along with cotton wool like material and inflammation in a necrotic Background. This cotton wool material was found to be positive for Grams stain and GMS. A diagnosis of actinomycosis with secondary changes with crystal deposition was made.

Conclusion: Among COVID-19 patients, recognizing the possible pathogens causing co-infection is important. We are presenting this rare Case of COVID-19 associated with co-infection of mucormycosis followed by actinomycosis. The appropriate antimicrobial agents for treatment is essential to reduce the mortality rate in such patients.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-232: CHONDROID SYRINGOMA:AN UNCOMMON ADNEXAL TUMOR AT AN UNUSUAL SITE

Farhat Fatima ¹, Zeeba S ¹, jairajpuri ¹, Safia Rana ¹, Shaan Khetrapal ¹, Simpy Raj ¹, Sujata Jetley ¹

Background: Chondroid syringoma, is a biphasic benign adnexal tumor with epithelial as well as mesenchymal component. Also known as “Mixed tumor of Skin” due to its resemblance to pleomorphic adenoma or mixed salivary gland tumor. Predominantly seen in middle aged males in the head and neck region.

Case Report: A 19 years old female, presented with a painless nodular swelling on the back. Clinical examination revealed a non tender, firm, 1.5x1.5cm lesion, suspected to be a neurofibroma. Fine needle aspiration cytology (FNAC) yielded a thick mucoid blood mixed aspirate which on microscopy showed cellular smears of biphasic population of monolayered sheets and clusters of benign epithelial cells. Cells were small, round, monomorphic with bland central to slightly eccentric nuclei, moderate amount of cytoplasm. Few had a plasmacytoid appearance. Mesenchymal component was composed of chondromyxoid fibrillary stroma, at places showing entrapped elongated myoepithelial cells along with few cystic macrophages scattered in a hemorrhagic Background.

Conclusion: Chondroid syringoma should be one of the differential diagnosis when a patient presents with a subcutaneous firm nodule keeping aside the age of patient and site of lesion. Awareness of the cytomorphological features aid in giving a correct diagnosis, as it holds a risk of malignancy and hence, recurrence can be prevented by a curative surgical excision.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-233: CYTOLOGICAL DIAGNOSIS OF CUTANEOUS MYELOID SARCOMA-A RARE CASE REPORT

Prabal Kishore Das ¹, Junu Devi ¹

Introduction: Granulocytic sarcoma or myeloid sarcoma also known as chloroma is a rare extramedullary tumour which may occur as a manifestation of acute myeloid leukaemia, myelodysplastic syndrome or blast crisis in chronic myeloproliferative disorder or may precede systemic leukaemia. Granulocytic sarcoma occurs in 2.5-9.1% of patients suffering from AML, but less frequently precedes the development of systemic leukaemia. Most common site includes skin, soft tissue and lymph nodes. Orbit is most commonly involved in paediatric age group.

Case Report: We present a Case of 51 years old female, admitted in department of haematology as known Case of Chronic Myeloid Leukaemia treated with Imatinib. She presented with multiple nodules in nasal cavity, forehead, bilateral arms and whole abdomen. Bone marrow aspiration cytology shows 21% myeloid blast with transformation of the CML to AML.FNAC was done from multiple nodules which showed plenty of myeloid precursors and blast and diagnosis of granulocytic sarcoma was given. BCR-ABL study came out positive and karyotyping for haematological malignancy showed t (5; 12)(q31;24.3). Patient was given chemotherapy, but showed no improvement. She expired 21 days after admission.

Conclusion: Granulocytic sarcoma (GS) is a rare malignant solid tumour with an incidence of 2/1000000 in adults. Diagnosis of GS has been a problem for pathologist because of relatively immature nature of tumour cells and Mostly misdiagnosed as Non Hodgkin's lymphoma. Though diagnosis of GS is considered as an adverse prognostic factor but early confirmation of diagnosis and treatment initiation might improve the prognosis.

Keywords: FNAC, chloroma, granulocytic sarcoma, AML

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-234: CUTANEOUS METASTASIS OF PROSTATIC ACINAR ADENOCARCINOMA: A RARE CASE REPORT

Apurva Arora ¹, Divya Aggarwal ¹, Poonam Elhence ¹, Ram Karan Chaudhary ¹

Background: Prostatic adenocarcinoma is a relatively common malignancy in elderly males. It is associated with good prognosis and rarely undergoes distant metastasis. We present a rare Case of prostatic adenocarcinoma which showed cutaneous metastasis.

Case Report: A 69-year-old male presented to the Out Patient Department of our hospital with an umbilical nodule which he noticed 15 days back. It was gradually progressive in size to become pea-sized. There were no other nodules elsewhere on the body. He had no associated pain or other complaints. Fine needle aspiration cytology was done from the nodule which yielded particulate aspirate. Smears were highly cellular and showed features of a well-differentiated low-grade adenocarcinoma. Microacinar pattern was prominent in the smears, raising the suspicion of prostatic origin. On further history taking, he revealed past history of radical prostatectomy 5 years back. The recent serum PSA level is 540 ng/ml. IHC done on the cell block section showed diffuse nuclear positivity for NKX3.1, confirming prostatic primary. A final diagnosis of cutaneous metastasis of prostatic adenocarcinoma was rendered.

Conclusion: Cutaneous metastasis is a relatively uncommon phenomenon. Prostatic acinar adenocarcinoma rarely undergoes distant metastasis and cutaneous metastasis of this tumor is extremely rare. A knowledge of such rare entities is important for accurate diagnosis and timely management of such Cases.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-235: GIANT CONGENITAL MELANOCYTIC NEVUS WITH MULTIPLE NODULAR LESIONS MIMICKING NEUROFIBROMA

Baby Kakati ¹, Junu Devi ¹

Background: Giant Congenital Melanocytic nevus is a benign neoplasm of nevomelanocytes with incidence <1 in 20000 newborns. It is a variant of congenital nevus, defined as a melanocytic lesion present at birth that will reach a diameter >/=20 cm or that occupies >/= 20% of the body surface area in adulthood. “garment” like presentation, occupying a dermatome has rarer incidence <1:500000. The lesion is important, despite its rarity because it may be associated with severe complications such as malignant melanoma, affect the central nervous system(neurocutaneous melanosis), neurofibroma and have major psychosocial effect on the patient and their family due to its unsightly appearance. Here we present a Case of Giant Congenital Melanocytic Nevus, with nodular lesions mimicking neurofibroma, a rare pathology.

Case presentation: a 17 year old muslim boy, with a sheath like black patch on skin, present since birth, involving lower back, genitals, and groin area, extending to right thigh and leg presented with multiple nodule like swelling over the pigmented area, and scrotal swelling. Also there were satellite lesions over face. FNAC was taken from multiple sites and nodular lesions and was diagnosed cytomorphologically as giant congenital melanocytic nevus, with lesions mimicking neurofibroma. histopathological correlation was done, and the final diagnosis was consistent with cytological diagnosis.

Conlusion.: Diagnosis of the condition has a pivotal role in timely management which can avoid its associated risk of complications(malignant/benign) and psychosocial trauma.

Keywords: Nevus, Congenital, Neurofibroma, Cytology.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-236: VARIABILITY IN CYTOMORPHOLOGICAL FEATURES OF PILOMATRICOMA-A CASE REPORT AND REVIEW OF LITERATURE

Utkarshni ¹, Manjit Kaur Rana ¹, Amanpreet Kaur ¹

Background: Pilomatricoma (PMX) is a benign cutaneous neoplasm which usually presents as dermal nodule on head and neck in children and young adults. This lesion poses a diagnostic dilemma when diagnosed on fine-needle aspiration cytology(FNAC). In this study, we exemplify the cytomorphological features of PMX in a 38 year male with a nodule over arm along with review of literature based on relevant Results of PMC central.

Methods: FNAC was performed using 23G needle and 20 mL syringe. Wet fixed and air dried smears were stained with Pap stain and Giemsa respectively and specimen was sent for histopathological examination Literature was reviewed and we found 13 relevant studies based on Results of PMC central.

Results: Cytological smears examined show atypical pleomorphic cells, ghost cells, basaloid type cells. A total of 13 articles including were found relevant to be discussed for importance of cytomorphological features in diagnosing PMX. Final diagnosis was confirmed histopathologically as PMX in all Cases. Cytologically, out of total 46 Case studies found in our archieves, 23 Cases were correctly Reported as PMX, unequivocal benign diagnosis was made in 15 Cases and 8 Cases were misdiagnosed as malignant.

Conclusion: PMX diagnosis can be made on FNAC if one is able to recognize the typical cytological features of PMX. It also highlights the importance of cytopathologist in considering PMX as differential diagnosis of dermal or subcutaneous nodules in locations other than head and neck and understanding the variability in cellular composition in order to avoid misdiagnosis particularly when Reported as malignant.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-237: FINE NEEDLE ASPIRATION CYTOLOGY OF PAPULO-NODULAR SKIN LESIONS: AN INSTITUTION BASED STUDY

Poonam Sharma ¹

Background: Various skin diseases manifest as papulo-nodular lesions including infectious diseases, benign and malignant neoplasms. Pathological evaluation of papulo-nodular skin lesions is essential for adequate management. Purpose of this study was to evaluate the cytomorphological pattern of papulo-nodular skin lesions on Fine Needle Aspiration Cytology (FNAC)

Material and Methods: This retrospective diagnostic analytical study was carried out in the Department of Pathology. Seventy two patients with clinically diagnosed papulo-nodular skin lesions referred from other departments for FNAC were included. FNAC slides along with records of the patient were retrieved and findings recorded. Histopathological correlation was available in 18 Cases.

Results: Non-neoplastic lesions accounted for majority of Cases in our study. Epidermal inclusion cyst was the commonest non-neoplastic lesion observed in the study. Benign tumours were seen in 11.1% Cases while malignant lesions were seen in 4.2% Cases. Cyto-histological concordance was observed in 17 out of 18 Cases with diagnostic accuracy of 94.4%. Also benign and malignant nature of tumour was correctly established in 100% Cases. However specific subtyping of skin adnexal tumour on FNAC could be done in 50% Cases only.

Conclusions: FNAC is an easy, rapid and relatively painless procedure in the evaluation of papulo-nodular skin lesions with a high diagnostic accuracy.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-238: ROLE OF COMPUTED TOMOGRAPHY GUIDED FNAC IN PULMONARY LESIONS AND ITS CYTOHISTOLOGICAL CORRELATION

Aastha Gupta ¹, Tanu Agrawal ¹, Swarneet Bhamra ¹

Background: CT guided pulmonary biopsy/FNAC is increasingly being used for tissue diagnosis of pulmonary lesions. This procedure allows for safe, fast and reliable diagnosis in patients having pulmonary lesions. It not only distinguishes between benign and malignant lesions but also helps in tumor typing, so that initiation of specific therapy is possible without unnecessary delay.

Methods: CT guided FNA from lung masses were retrospectively reviewed from March 2020 to August 2021 and their findings were correlated histologically and immunohistochemically.

Results: A total of 50 Cases were included in the study. Out of 50 Cases, 37 were male and 13 were female. Age group was 41-90 years with mean age of 51.55 yrs. Out of 50 Cases, definitive cytological diagnosis was obtained in 47 Cases and the rest 3 Cases were inconclusive. Among 47 cytologically diagnosed Cases, 43 (91.5%) were malignant and 4 (8.5%) were benign lesions. Non small cell carcinoma was most common malignancy accounting for 30 (69.7%) Cases (17 were Adenocarcinoma, 10 were squamous cell carcinoma and 3 were non-small cell NOS); followed by metastatic accounting for 8 (18.7%) Cases; followed by small cell carcinoma accounting for 5 (11.6%) Cases respectively. All Cases were concordant with histological and immunohistochemical diagnosis.

Conclusion: CT guided lung FNAC/ Biopsy, if done in expert hands is a safe and reliable procedure with high diagnostic sensitivity for the accurately diagnosis and sub typing of lung cancer leading to less morbidity and mortality.

Keywords: CT Guided, Fine needle aspiration cytology, Pulmonary lesions

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-239: UTILITY OF ENDOBRONCHIAL ULTRASOUND GUIDED TRANS-BRONCHIAL NEEDLE ASPIRATION IN ASSESSMENT OF MEDIASTINAL LYMPH NODES: EXPERIENCE AT A TERTIARY CARE HOSPITAL

Divya Singh ¹, Hema Pant ¹

Background: Endobronchial ultrasound – guided trans- bronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure presently prefered for evaluation of mediastinal lesions. It is safe, cost- effective, utilizes real- time image guidance, and provides high yield specimens. It has also proved to be valuable for the lymph node(N) staging of lung cancer, and for primary diagnosis of unclear mediastinal lesions.

Methods: EBUS-TBNA from mediastinal lymph nodes were retrospectively reviewed from January 2020 to September 2021.

Results: A total of 53 patients underwent EBUS-TBNA procedure. Out of which 3(6%) Cases were non diagnostic, 10(19%) Cases were reactive hyperplasia, 13(25%) Cases were granulomatous lymphadenitis, 27(51%) Cases are positive for malignant cells among which 8(30%) Cases were metastatic small cell carcinoma and 19(70%) Cases were metastatic non small cell carcinoma. Overall sensitivity, specificity and diagnostic accuracy for EBUS-TBNA were 95%, 96.2%,95.6%.

Conclusion: EBUS- TBNA has good diagnostic accuracy and safety profile. It is first line investigation in the diagnosis and in staging of lung cancer patients with mediastinal lymph nodes suspected of malignancy.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-241: ULTRASOUND GUIDED FNAC IN LUNG AND MEDIASTINAL MASSES

D Arunjyothi ¹, G Lavanya ¹, Khadher Fhaheem ¹, BH Poorna Chandra Sekhar ¹, BV Sai Prasad ¹

Background: FNAC is used as a primary modality for evaluation of palpable lumps. It's application is limited in Cases of deep seated lesions like lung & mediastinum. In such Cases FNAC is done under guidance of USG can improve the diagnostic yield to reach diagnosis.

Materials and Methods: The study was done on patients referred to the Department Of Pathology with provisional clinical diagnosis of intrathoracic lesions from Department Of Pulmonology,SVRRGGH, Tirupati from Aug2019- July 2021 comprised of 30 Cases.FNAC under USG guidance is performed after obtaining consent and a thorough physical examination of patient.

Results: In our study out of 30 Cases, lung lesions are 25(83.33%). mediastinal lesions are 5(16.66%). Neoplastic lesions are most common in lung19(76%),among commonest is SCC9(60%). Among mediastinal lesions most common are Benign Spindle Lesions 3(60%)

Conclusion: USG guided FNAC implies use of non ionizing radiation, doesn't require injection of contrast medium & can be easily performed. Thus is the accurate Method for diagnosis of deep seated lesions which are unapproachable by direct FNAC like small lesions in chest, abdomen. The early & accurate diagnosis obtained by USG guided FNAC helps in making early & reliable diagnosis of malignant & benign lesions so that effective management can be done to the patient.

KEYWORDS: FNAC, Lung, Mediastinal Masses, USG Guided FNAC

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-242: THE EFFECTIVENESS OF RAPID ON -SITE EVALUATION DURING ENDOBRONCHIAL ULTRASOUND GUIDED TRANSBRONCHIAL NEEDLE ASPIRATION

Shilpi Dosi ¹, Anushka Khanuja ¹, Ravi Dosi ¹, Amit V Varma ¹

Background: Endobronchial Ultrasound guided Transbronchial Needle Aspiration (EBUS-TBNA) is a technique that utilizes endoluminal ultrasound technology during bronchoscopy to obtain material beyond bronchial wall to get material from both Lung parenchymal and mediastinal lymph nodes. The aim of the present study was to determine the diagnostic utility and accuracy of Rapid on site evaluation (ROSE) cytology of EBUS-TBNA taking paraffin-embedded histology as a gold standard for diagnosis of malignant mediastinal lesions.

Methods: The present study was a prospective study of ROSE cytological and histopathological analysis of material obtained by EBUS-TBNA, including 21 Cases of clinically or radiologically diagnosed Cases with Mediastinal lesions. Results were categorized as Inflammatory, Neoplastic or inconclusive. Concordance between ROSE cytology and histopathological examination was determined.

Results: In the present study, age of patients ranged from 21 years to 75 years with maximum Cases (28.57%) belonging to 51-60 years age group. Male preponderance with a male to female ratio of 3.2:1 was observed. Out of 21 Cases, 16 Cases were malignant, 04 were granulomatous and one Case was inconclusive. The sensitivity, specificity, positive predictive value and negative predictive value of ROSE Cytology were 81.25%, 80%, 92.9% and 57.14% respectively. Concordance rate of 85.7% and discordance rate of 14.3% was observed between ROSE cytological and histopathological Analysis.

Conclusion: We conclude that an overall diagnostic accuracy is high (81%) of ROSE cytology for diagnosis of malignant mediastinal lesions.

Keywords : Endobronchial Ultrasound guided Transbronchial Needle Aspiration(EBUS-TBNA), Rapid on site evaluation (ROSE), Diagnostic accuracy, Concordance rate.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-243: DIAGNOSTIC SURPRISES ON RESPIRATORY FLUID CYTOLOGY

Soni ¹, Hemlata Panwar ¹, Tanya Sharma ¹, Sramana Mukhopadhyay ¹, Jai Kumar Chaurasia ¹, Prof Vaishali Walke ¹, Abhishek Goyal ¹

Background: Helminths infection involve nearly one billion of people globally living in extreme poverty among both Immunocompetent and Immunocomprosmised. Lung pathology induced by helminthes can cause diffuse or focal lung diseases and systemic inflammatory responses or hypersensitivity. Strongyloides and Echinococcus species, both are helminths involving respiratory system and rarely diagnosed in sputum and bronchioalveolar lavage (BAL) fluid. Here, we Report 2 Cases, one each of Pulmonary Strongyloidiasis and Hydatid disease with severe lung involvement diagnosed on respiratory fluid cytology.

Case Reports: Case 1: A 33 year male presented with fever, cough, shortness of breath and weight loss since 1 month. Patient had no eosinophilia. Chest X Ray showed bilateral pleural effusion. Thick mucoid sputum sample was received. Sputum smear showed presence of filariform larvae of Strongyloides. Case 2: A 17 year male presented with cough with haemoptysis since 3 years. CT Scan showed right lower lobe lung mass lesion, suspicious of malignancy. BAL fluid sent for exfoliative cytology. Cytocentrifuged smears revealed many laminated cyst wall like structures and diagnosed as pulmonary hydatid disease.

Conclusion: Diligent search for these parasites, Stronglyloides and Echinococcus should be emphasised in respiratory fluids cytology so as to prevent constellation of complications like cyst wall rupture as conventional diagnostic tests are not sufficiently sensitive and it often gets difficult requesting repeated stool samples. A high index of suspicion and keen observation are required for prompt and accurate diagnosis of parasitic infection in respiratory fluid cytology.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-244: CHALLENGES AND PITFALLS IN BRONCHIAL CYTOLOGY INTERPRETATION IN LUNG CARCINOMA

Mythili R ¹, Prof Sudha Venkatesh ¹

Background: Bronchoscopic guided bronchial wash and brush is a minimal invasive procedure done routinely to diagnose both inflammatory and malignant lesions of the lung. Though this procedure has been done for many years, there are multiple challenges faced by cytopathologist in arriving at diagnosis. This study was retrospective study undertaken to understand the challenges in the Reporting of bronchial cytology by studying the histopathological correlation with cytological findings.

Material and Methods: Databases analysis was performed for all bronchial wash and brush cytology specimens received in the department of pathology, Rajiv Gandhi Government General Hospital chennai from February 2021 to July 2021. Patient details were collected. Slides were reviewed and findings were correlated with bronchoscopic biopsy.

Result: A total 256 samples were received during the study period which included bronchial wash (189),both bronchial wash and brush (65),bronchial brush (2). The cytological samples were Reported by using the IAC guideline. We received biopsy samples for 16 of the above patients. The histopathological diagnosis was compared and correlated with the cytology diagnosis. Out of 16 biopsies 8 Cases were of malignancy among which 6 Cases were in concordance with the cytology diagnosis. One of the discordant Case showed only hemorrhagic material (bronchial wash only). The positive correlation was higher in Cases were both brush and wash cytology samples were examined.

Conclusion: Bronchial wash and brush cytology are used for early diagnosis of lung cancer. Using both techniques simultaneously is more accurate than using a single technique.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-245: CYTOPATHOLOGICAL SPECTRUM OF LUNG MASS

Ayushi Saxena ¹, Vanita Kumar ¹

Background: Image guided FNAC is a well-established Method in the cytolopathological diagnosis of lung lesion.

Aim: Aim of our study is to evaluate the cytopathological spectrum of disease in lung through USG /CT guided FNAC.

Material and Method: 40 Cases were evaluated retrospectively for a period of 3 months in SPMC, Bikaner

Result: Out of 40 Cases, 80% were male. Mean age was 57.55 years. 95% having malignant lesion and 5% have benign. Non small cell carcinoma was the predominant malignant tumor.

Conclusion: Image guided FNAC can diagnose lung lesion fairly accurately leading to less morbidity and mortality and treatment can be started early.

Keywords: USG Guided, CT guided, Fine needle aspiration cytology, Lung mass

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-247: PRIMARY PULMONARY ADENOID CYSTIC CARCINOMA, A RARE ENTITY DIAGNOSED ON EBUS/EUS FNA: A REPORT OF FOUR CASES

Poojan Agarwal ¹, Pooja Bakshi ¹, Gunjan Mangla ¹, Kusum Verma ¹, Amit Dhamija ²

Background: Primary pulmonary Adenoid cystic Carcinoma (AdCC) is an extremely rare neoplasm, postulated to arise from the submucosal glands of the tracheo-bronchial tree and accounts for only 0.04-0.2% of all primary lung tumors. Being an unusual neoplasm, AdCC requires extensive workup to rule out other basaloid tumors of the lung as well as metastatic tumors. In the present study we analyzed cytomorphological features and IHC expression of four such tumors.

Methods: On search of cytopathology archives, four Cases of pulmonary AdCC were found over a six-year period. These Cases were retrieved, patient clinical profile, cyto-morphological features on FNA smears as well as cell blocks were analysed.

Results: Clinical findings: Age ranged from 18 to 40 years. EBUS-TBNA was done from right paratracheal mass (Case1), left para-hilar region mass (Case2), mass in right lower lobe bronchus (Case3) and EUS-FNA from esophageal wall thickening, extending into trachea (Case4). Cytology findings: Smears were cellular and showed tumor composed of small basaloid cells. Three of four Cases showed cells predominantly arranged in solid groups while one Case had prominent cribriform pattern on smears. Hyaline globules/ basement membrane material was abundant in three of four Cases while it was focal in the fourth Case. Differential diagnosis considered were basaloid squamous cell carcinoma, small cell carcinoma and metastatic tumours. On IHC (done on cell blocks), tumor cells express strong CD117. P63/p40 was highlighted in the non-luminal myoepithelial cells. TTF-1 was negative.

Conclusion: Pulmonary AdCC is a rare tumor with distinctive cytomorphology and IHC profile.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-248: TOUCH IMPRINT CYTOLOGY OF GUIDED NEEDLE CORE BIOPSIES IN LUNG USED AS A METHOD OF RAPID ON-SITE EVALUATION: AN INSTITUTIONAL EXPERIENCE

Anurag Gupta ¹, Monjyoti Das ¹, Kiranpreet Mehlotra ¹, Pradyumn Singh ¹, Subrat Chandra ¹

Background & Objectives: Rapid on-site evaluation (ROSE) of touch imprint cytology (TIC) from needle core biopsies (NCB) is used to ensure sample adequacy and immediate diagnosis. We aimed to study the impact of TIC as ROSE of image guided NCB in Lung lesions.

Methods: A total of 57 Cases of lung space-occupying lesions were included in this study. ROSE of TIC was done by two pathologists who gave a categorical diagnosis (benign/malignant/non-diagnostic/inadequate) and exact diagnosis when possible. ROSE diagnoses were compared with corresponding histological NCB diagnoses. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated.

Results: Out of 57 Cases, 46 (81%) were malignant, 01 (1.5%) was diagnosed as benign and 10 (17.5%) as non-diagnostic/inadequate on TIC. 51 (89.5%) TIC Cases had the same diagnosis as on NCB. Sensitivity, Specificity, positive predictive value, negative predictive value and overall accuracy of TIC vis-à-vis CNB could be estimated at 96%, 88.9%, 98%, 66.7% and 95%, respectively. Specific diagnoses could be rendered in 43 (97%) malignant Cases.

Conclusions: In our study high accuracy of TIC proved that it is a useful and valuable tool for ROSE of NCB which can provide accurate preliminary diagnosis on a categorical basis (malignant, benign& inadequate). The main causes of false-negative cytology were scanty cellularity, surrounding or superimposed inflammation and tumour necrosis. High accuracy of TIC in lung malignancies can help in taking a further decisions and triaging specimens for ancillary studies in the era of precision medicine.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-249: CYTOLOGY OF METASTASIS OF LUNG SQUAMOUS CELL CARCINOMA (SCC) TO BRAIN IN A YOUNG MALE – A RARE CASE PRESENTATION.

Chitra Khandare ¹, Nilam More ¹, Kavita Sawant ¹, L P Naik ¹

Background: Lung cancers are the most common and most lethal malignancies worldwide. They most commonly metastasize to lymph nodes and when the disease is in advanced stage, it metastasize to distant organs. The incidence of brain metastasis from non-small cell carcinoma of lung is approximately 5%. However, metastasis from lung SCC to brain is rare. Median age of occurrence of SCC is 67 years.

Case history: A 35 year old man with history of bidi smoking and alcohol abuse, presented with chief complaints of fever, hemoptysis, altered sensorium and weakness in left lower limb. We received his pleural fluid for cytology. Microscopy of fluid showed abundant necrotic material with individual cell necrosis because of which we could suspect the malignancy. After a careful search we got the occasional viable malignant cells. However, the morphology of cells were not clear to type the malignancy, hence impression was given as pleural fluid positive for carcinoma. Because of his clinical presentation, MRI brain was performed which was suggestive of space occupying lesion suspected to be because of ? tuberculoma or ?abscess. His subsequent brain abscess fluid showed malignant keratinizing squamous cells which confirmed that it was a because of metastasis from SCC. His follow up chest CT scan was done which depicted right upper lobe lung mass suggestive of primary malignancy.

Conclusion: 1) Metastasis of SCC from lung to brain is rare presentation in young patients. 2) Cytopathologist should be more vigilant to look for malignant cells in brain abscess fluid showing abundant necrotic material and individual cell necrosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-250: CYTOLOGICAL DIAGNOSIS OF ECHINOCOCCOSIS IN PLEURAL FLUID

Yasmeen Singh ¹, Meenakshi ¹, Arsha BS ¹

Background: Human infection by the larval stage of the tapeworm Echinococcus granulosus can cause life threatening cystic echinococcosis and alveolar echinococcosis. Single organ involvement is seen in most of the Cases. Liver is involved in 50-77% of the patients followed by lung involvement accounting for 18-35% of the Cases. Right lung is involved in 60% of the Cases and Multiple pulmonary cysts are seen in 30% of the Cases. The involvement of pleura usually follows the rupture of a pulmonary or hepatic cyst inside the pleural space causing secondary pleural hydatidosis. We present a Case of echinococcosis in pleural fluid.

Case Report: A 60-year-old female presented with respiratory distress for past few months. Imaging was suggestive of disseminated hydatid cysts with left loculated empyema. 1ml of purulent pleural fluid was received for cytological examination. Smears showed dense inflammatory infiltrate comprising of intact and degenerated neutrophils admixed with few lymphocytes. Hooklets of Echinococcus granulosus were seen in a necrotic Background. A wet mount preparation from the pleural fluid was also evaluated microscopically and it highlighted hooklets of Echinococcus granulosus. A final diagnosis of suppurative inflammation with Echinococcosis was given.

Conclusion: Cytology plays an important role in timely diagnosis of Echinococcosis which is crucial for patient management.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-251: A RARE CASE REPORT OF SIGNET RING ADENOCARC-INOMA-LUNG - CYTOHISTOLOGICAL CORRELATION

Yogendra Narayan Verma ¹, Anand Kumar ¹, Neelima Sachan ¹

Introduction: Primary signet ring adenocarcinoma of lung is a rare variant of pulmonary adenocarcinoma. This entity is most often seen in the gastrointestinal tract, breast, bladder and prostrate. This Case is about a young male which was diagnosed as Case of signet ring adenocarcinoma in cytology which was later on confirmed on histology and immunohistochemistry.

Case Report: A 21 year old male presented with difficulty in breathing and chest pain. On CT scan findings it appeared as mediastinal which was suspected as lymphoma clinically. On guided fna, there were aggregates of signet ring cells which were having eccentrically placed nuclei and abundant cytoplasm. The nuclei showed marked atypia and moderate anisonucleosis. On cytology it was Reported as adenocarcinoma lung -signet ring type. Then the biopsy of the mass was taken which showed infiltration of signet ring shaped cells. This was Reported as signet ring adenocarcimoma. On immunohistochemistry it showed diffuse positivity pancytokeratin (AE1/ AE3), CK7,TTF1, NAPSIN A, BETA CATENIN with focal immunopositivity for CEA which was consistent with primary signet ring adenocarcinoma of lung.

Conclusion: Primary signet ring adenocarcinoma of lung is extremely rare tumors of lung in a young male. Mostly it appears as metastasis from GI tract. So a proper work up with immunohistochemistry is essential for exact diagnosis and typing of lung adenocarcinomas.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-252: CYTOLOGICAL DIAGNOSIS OF METASTATIC OSTEOSARCOMA- A RARE CASE REPORT

Deepsikha Bhanja ¹, Rashim Sharma ¹, Deepak Vedant ¹, Naveen Dutt ¹, Poonam Abhay Elhence ¹

Background: Osteosarcoma is the most common primary malignant tumour of the bone and has aggressive clinical course. Higher tumour grades are associated with higher possibilities of lung, liver and brain metastasis. Almost 80% patients still die of lung metastasis. However performing Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) from lung metastasis, can provide early accurate diagnosis.

Case Report: A 24 year male presented with cough and shortness of breath for one month with a past history of operated Case of osteosarcoma in left tibia. He had received chemotherapy 3 years back. Computerized tomography of thorax revealed left lung mass encasing main bronchus with collapse of left lung. EBUS-TBNA was performed and smears were moderately cellular and showed clusters as well as singly scattered atypical cells. The individual cells had marked nuclear pleomorphism, irregular nuclear membrane, coarse to hyperchromatic nuclei, multiple prominent nucleoli and abundant amounts of cytoplasm. Background showed chronic inflammatory cells and eosinophilic amorphous material resembling lacy osteoid. Morphology favoured metastasis of osteosarcoma. Bronchial wash cytology was also positive for malignant cells. However, biopsy from endobronchial mass showed predominantly necrosis and few atypical cells.

Conclusion: EBUS-TBNA is a very useful minimally invasive technique which provides promising Results for the diagnosis in Case of lung metastasis when lung biopsy have low yield.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-253: CYTOLOGICAL PERSPECTIVE IN A CASE OF DOEGE-POTTER SYNDROME WITH HYPOINSULINEMIC HYPOGLYCEMIA

Ingitha P ¹, Tanya Sharma ¹, Garima Goel ¹, Abhishek Goyal ¹, Alkesh Khurana ¹

Background: Solitary fibrous tumor (SFT) of lung is a rare mesenchymal neoplasm of uncertain histogenesis, unknown molecular features and unpredictable clinical behavior. It is characterized by NAB2-STAT6 fusion. Hypoglycemia accompanying SFT (Doege-Potter syndrome) is seen in about 4 % Cases. We present the cytomorphological features on biopsy imprint smears of a histopathologically confirmed Case of SFT of lung with an uncommon presentation.

Case Presentation: A 76-year-old non-smoker, non-alcoholic and non-diabetic man presented with complains of frequent episodes of hypoglycemia and syncopal attacks (>10 episodes). The patient had no respiratory complaints and no history of weight loss. Examination revealed reduced air entry on left side of chest. X Ray chest showed left sided homogenous opacity. HRCT chest showed a large left sided lung mass. A biopsy was performed. Biopsy imprint smears were cellular and showed tumor cells arranged in clusters and fragments with traversing capillaries displaying monomorphic pump to oval nuclei, fine granular evenly dispersed chromatin, regular nuclear membranes, inconspicuous nucleoli, and moderate amount of wispy cytoplasm. Foci of intercellular hyaline stromal material was noted. A cytodiagnosis of low-grade neoplasm of mesenchymal origin was given. Histopathology revealed a cellular tumor comprising of tightly packed round to fusiform cells, arranged around blood vessels with intervening thick collagen, positive for CD99, vimentin, Bcl2 and negative for EMA, CK7, S100 and SMA.

Conclusion: Familiarity with cytomorphology may play a pivotal role to clinch an early diagnosis of this rare neoplasm of lung particularly in setting of presentation with hypoglycemia.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-254: ROLE OF SPUTUM CYTOLOGY IN THE DIAGNOSIS OF LUNG CANCERS.

Sukhpreet Kaur ¹, Hanni Vasudev Gulwani ¹

Background: Sputum cytology is used for the detection of certain noncancerous lung conditions like pneumonia or inflammatory diseases and also as a screening test for people at risk for developing lung cancer, such as smokers. In this study we aimed to assess the role of sputum cytology for detecting lung cancers.

Methods: A total of 82 sputum samples were analyzed. Cytology findings were correlated with histological diagnosis or clinical outcome. All the Cases were evaluated by same pathologists. The smears were grouped into malignant, benign, suspicious/atypical and unsatisfactory / inadequate.

Results: Out of the total 82 Cases, 68 were adequate sputum samples. There were 47 males and 21 females with age ranging from 30 to 77 years. Seven Cases were with a clinical suspicion of tuberculosis and eight Cases were of lung malignancy. Rest other Cases had history of prolonged cough, COPD or breathlessness. Out of 08 Cases of lung malignancy, seven were male patients and one was female. Three patients were positive for malignant cells on sputum examination (37.5%). Two Cases were of poorly differentiated carcinoma and one was of squamous cell carcinoma. All these Cases were later confirmed by FNA/Biopsy of the tumour site. The first specimen of sputum was diagnostic of cancer in all the three positive Cases (100%). Out of the 07 suspected Cases of tuberculosis, one Case had well defined granulomas and the other showed strong positivity for acid fast bacilli.

Conclusion: In developing countries, sputum cytology can become a useful basic tool in the screening of lung cancers as it is a cost effective and non- invasive procedure, especially in patients in whom invasive procedures are contraindicated and have bronchial based lung mass.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-25: TALE OF TWO MEDIASTINAL GERM CELL TUMORS- AN ENIGMA ON CYTOLOGY

Ramneek Kaur ¹, Harpreet Kaur ¹, Pavneet Kaur ¹, Ruchita Tyagi ¹

Background: Germ cell tumors are the benign or malignant tumors arising from the germ cell layers. They constitute about 15-20% of the primary gonadal tumors. Germ cell tumors can also be seen in extra gonadal locations, most commonly near the midline structures such as the anterior mediastinum accounting for about 15% of the mediastinal tumors. Histologically germ cell tumors can de divided into two subtypes- seminomatous tumors and non seminomatous tumors with teratomas being the most common subtype. Here we present two Cases with mediastinal masses which have been Reported as Germ cell tumors on FNAC and confirmed on Histopathology.

Case Report: Both the Cases are 26 year old males. The first Case presented with breathlessness for 6 months with a large heterogenously enhancing mass measuring 18x14x10 cm in anterior mediastinum on CT scan. Cytology was suggestive of germ cell tumor- Seminoma which was confirmed to be the same on histopathology and IHC. Second Case presented with anterior mediastinal mass and Markedly elevated serum AFP levels. CT chest showed a well defined heterogenously hypodense mass lesion measuring 11x8x6 cm. Cytology showed non seminomatous germ cell tumor, which was proven to be teratoma on histopathology.

Conclusion: Extra gonadal Germ cell tumors involving mediastinum are rare. FNAC allows for prompt diagnosis which is helpful in timely decision regarding the treatment plan for the patients. Hence, germ cell tumors should be considered in differential diagnosis of mediastinal mass especially in young patients.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-256: CYTOHISTOLOGICAL FINDINGS AND DIAGNOSTIC CHALLENGES IN RARE PAEDIATRIC PULMONARY MESENCHYMAL MALIGNANCIES: A TALE OF TWO CASES

Balaji K ¹, Swalaha Sadaf Siddique ¹, Ujjawal Khurana ¹, Garima Goel ¹, Ashwani Tandon ¹, Deepti Joshi ¹, Narendra Chaudhary ², Alkesh Kumar Khurana ³

Background: Primary lung mesenchymal tumors in children are rare and there is only sparse literature describing their cytological features. Herein we Report cytohistological features and ancillary diagnostics of two Pediatric primary lung mesenchymal tumors. Case 1: A 12-year-old male child came with complaints of breathlessness and cough with expectoration since 20 days. Flexible bronchoscopy revealed endobronchial mass in the trachea almost occluding the lumen. The imprint smears made from the bronchoscopic biopsy showed clusters, capillary tagged and scattered moderately pleomorphic spindled tumor cells in a myxoid Background. The possibility of Sarcoma and Spindled Carcinoid Tumor was suggested on cytology. Histopathology followed by extensive immunohistochemistry, helped in confirming the diagnosis of Inflammatory Myofibroblastic tumor (Sarcoma grade). Case 2: A 8-year-old male child presented with complaints of chest pain, fever and cough since 2 months. Imaging showed heterogeneously enhancing large left sided lung mass measuring with scanty pleural effusion. Pleural fluid cytology showed clusters of small round to spindle cells with moderate N:C ratio, vacuolated cytoplasm and scanty myxoid material. Periodic acid Schiff on the cell block showed PAS positive diastase sensitive tumour. The cytological features were suggestive of Mesenchymal tumor of borderline to malignant potential. Histomorphology, IHC and molecular diagnostics was consistent with Spindle cell sarcoma (high grade) with Ewing's sarcoma family of tumors being the likely lineage.

Conclusion: The Reports are being presented for their rarity and to highlight the role of cytology and further comprehensive diagnostic approach in the diagnosis of paediatric pulmonary mesenchymal tumors.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-257: SMALL CELL TRANSFORMATION IN AN EGFR MUTANT LUNG ADENOCARCINOMA WITH TKI RESISTANCE DIAGNOSED ON PLEURAL EFFUSION CYTOLOGY

Divya Mohan ¹, Anju GS ¹, Aruna Nambirajan ¹, Deepali Jain ¹, Prabhat Singh Malik ²

Introduction: EGFR tyrosine kinase inhibitors (TKI) are the standard first line therapy in advanced primary lung adenocarcinoma harbouring EGFR mutations. Despite initial favourable responses, patients invariably develop resistance after median progression-free intervals of 9 to 12 months. In >50% patients, the resistance is attributed to the emergence of T790M mutant clones that can be detected on a liquid biopsy at progression. Small cell transformation (SCT) is a relatively under-recognized cause for TKI resistance observed in 3-10% of patients. These patients usually retain the baseline EGFR mutations, thus always requiring a repeat tissue biopsy for histological diagnosis. The prognosis of SCT is poor with limited information on optimum treatment options. Here, we present a Case of SCT diagnosed on pleural effusion cytology.

Case Report: A 48-year-old man, non smoker, with advanced EGFR mutant adenocarcinoma harbouring baseline exon 19 deletion was treated with first line EGFR TKI (Gefitinib) in combination with Pemetrexed and Carboplatin. After an initial response for 4 months, he developed progressive disease with development of pleural effusion. Effusion cytology shows presence of tumor cells with small cell morphology, immunopositive for TTF-1, INSM-1, synaptophysin and showing loss of RB1 protein. Mutation analysis was positive for exon 19 deletion.

Conclusion: Small cell transformation of EGFR mutant adenocarcinoma is a rare but important mechanism of TKI resistance that can be diagnosed only by a repeat tissue biopsy. Identification of such patients is essential for optimising effective treatment options.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-258: EARLY DIAGNOSIS OF UNCOMMON LUNG DISEASE BY BAL CYTOLOGY

Sachin R Chaudhari ¹, Rasika Gadkari ¹, Nisha Meshram ¹, Milind Bhatkule ¹, Abhijit Chaudhary ¹

Background: Pulmonary alveolar proteinosis (PAP) is uncommon lung disease which can manifest at various age groups. It can be primary or secondary to other causes. Initially it presents as nonspecific respiratory complaints but may lead to respiratory distress if diagnosis is delayed. Bronchio-alveolar lavage (BAL) is performed as diagnostic and therapeutic procedure. BAL Cytology helps in early detection. This Case denotes the importance of cytology in rapid diagnosis of PAP.

Case Report: 3.5 years old male child presented with easy fatiguability since 6 months. He had respiratory distress since last 20 days. He has history of similar episodes the past for which he was treated with supportive medications and had temporary relief. The child was playful and His chest X ray showed bilateral infiltrates suggestive of white out lungs. His bronchoscopy was performed. Differentials considered were Pneumocystis carinii pneumonia and Pulmonary alveolar proteinosis. Broncho-alveolar lavage was sent for cytological studies. Whitish, non-mucoid fluid sample was received in the lab. Smears were pluricellular and showed few respiratory epithelial cells with deposits of homogenous, amorphous material. Inflammation in form few scattered histiocytes was seen. Organisms were not seen. The performing Periodic acid Schiff (PAS) stain material was PAS positive. So Case was labeled as Pulmonary alveolar Proteinosis.

Conclusion: This Case signifies importance of gross examination of fluid before processing it for cytology. Also signifies thorough examination smears help in rapid diagnosis and prevents biopsy. With early intervention the patient was improved.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-259: SPUTUM EOSINOPHILS IN PULMONARY DISEASES

Sankar K ¹, Shalini Mullick ¹, Anil Sharma ¹

Background: Control of dyspnea and prevention of exacerbation are the main Aims in Asthma and COPD management. Blood and/or sputum eosinophilia may help in identifying exacerbator phenotypes and treatment in these patients. Our aim is to have an insight into the occurrence sputum eosinophil among these patients.

Methods: Based on prospective, observational studies at National Institute of Tuberculosis and Respiratory Disease, Delhi, induced sputum with hypertonic saline was used. After centrifugation, thick particles of sputum from supernatant are transferred to the slide and fixed with 95% ethyl alcohol for hematoxylin and eosin (H and E) and PAP stains. Quality of sputum was assessed based on adequate number of cells, pulmonary macrophages and proportion of squamous cells <50%. Eosinophil count was expressed as percentage of total cell count. Eosinophils ≥2 % is taken as cut off value for defining eosinophilia.

Results and Conclusion: Sputum eosinophil count serve as an excellent biomarker of airway inflammation as well as marker of disease severity. As per our Results, sputum eosinophilia can be used for predicting control status of asthma and COPD. It is an easy and noninvasive Method and can be done in multiple visits. Lack of standardization and the inability to obtain sample in all Cases are the drawbacks. So its importance in Asthma and COPD and other respiratory diseases has to be checked in larger studies. Though blood eosinophilia is recommended in COPD patients it has to be taken care among Indian population due to endemicity of helminthic infections.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-260: BRONCHOALVEOLAR LAVAGE CYTOLOGY OF PULMONARY ALVEOLAR PROTEINOSIS: A REPORT OF THREE CASES

Sunil Kumar Mallick ¹, Sudheer Arava ¹, Gopi C Khilnani ², Sushil K Kabra ³

Background: Pulmonary alveolar proteinosis (PAP) is a rare type of restrictive lung disease diagnosed by correlating clinical, radiological and cytological findings. PAP is classified as primary, secondary and congenital PAP. Primary PAP comprises of autoimmune and hereditary PAP. Secondary PAP is caused due to underlying disease conditions such as haematological disorders, immune deficiency syndromes, cancer, chronic infections, and toxic inhalation syndromes. Congenital PAP Results due to impaired surfactant production caused by mutations in surfactant protein, lipid transporter, or mutations affecting lung development. Cytology specimens are important for diagnosis and Management of PAP. It is characterised by progressive filling of alveoli by surfactant related phospholipoproteinaceous material. Bronchoalveolar lavage(BAL) cytology in Cases of PAP shows globules of amorphous proteinaceous material. These material are PAS positive. It also demonstrates free red blood cells and hemosiderin-laden macrophages. BAL is highly sensitive to diagnose PAP along with radiology. It helps in avoiding more invasive diagnostic modality.

Case Reports: The Cases include a 3 and half-year-old male child with non-productive cough and breathlessness for 8-month duration admitted in department of paediatrics, a 45-year-old female with cough and sputum production for a year admitted in pulmonary intensive care unit, and a 40-year-old female. The BAL specimens from these patients were cloudy or milky on gross appearance. The May-Grunwald Giemsa (MGG) and Papanicolaou stain showed paucicellular specimens dominated by amorphous, extracellular material that was PAS-positive. There were few alveolar macrophages. Fungi stain was negative.

Conclusion: Bronchoalveolar lavage cytology is a convenient Method to diagnose patients suspected of PAP.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-261: CYTODIAGNOSIS OF PRIMARY MUCINOUS ADENOCARCINOMA OF LUNG CONFIRMED ON HISTOLOGY WITH IMMUNOHISTOCHEMISTRY AND COEXISTENCE WITH MDR TUBERCULOSIS- CASE REPORT

Yogendra Verma ¹, Awadhesh Kumar ¹, Neelima Sachan ¹

Background: Primary mucinous adenocarcinoma of lung is rare variant of lung adenocarcinoma. Mucinous adenocarcinoma is difficult to diagnose on cytology because of its resemblance to benign bronchial epithelium. This is a rare Case Report of coexistence of mdr tuberculosis and Mucinous adenocarcinoma on cytological examination of guided fna later on confirmed histologically.

Case Report: 49 year female presented with fever, cough and mild chest pain. On bronchoscopy, the bronchoalveolar lavage and fna was taken. The lavage was examined cytologically as well as real time PCR was done for detection of MTB. On cytology it revealed clusters of atypical cells in small acini and papillae with abundant cytoplasm and nuceli with mild nuclear atypia with dense chronic inflammation. On real time PCR it was diagnosed as MDR tubercuosis. On CT scan there was a small mass lesion in the upper loe of right lung. Then bronchoscopic biopsy showed the features of mucinous adenocarcinoma which was confirmed on immunohistochemistry which showed positivity for CK7, TTF1 and napsin A and immunonegative for CDX2 and SATB2.

Conclusion: Mucinous adenocarcinoma of lung share a poorer prognosis among the lung adenocarcinoma. Therefore earlier cytodiagonosis of this variant can be useful for the treatment which can be confirmed on histology and immunohistochemistry.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-262: THYMIC EPITHELIAL TUMOR WITH ROSETTES: A RARE CYTOPATHOLOGICAL DIAGNOSIS

Surabhi Jain ¹, Aruna Nambirajan ¹, Nitesh Rawat ¹, Shipra Agarwal ¹, Ashu Bhalla ², Anant Mohan ³, Deepali Jain ¹

Background: Image guided needle aspiration cytology is rapid,non-invasive and one of the primary diagnostic modalities in evaluation of mediastinal masses. The common neoplastic causes include germ cell tumors,metastatic carcinomas,and lymphomas;thymic epithelial tumors are rare in India with limited cytopathological descriptions. Here,we present a Case of metastatic spindle-cell thymoma and describe the characteristic cytomorphology that aided in final histopathological diagnosis.

Case Report: A 60-year-old male,smoker presented with cough, weight loss and headache for past three months. Radiological investigations revealed a mediastinal mass with lung,brain and liver space-occupying lesions. With a clinical diagnosis of metastatic bronchogenic carcinoma,guided FNAC and biopsy were performed.FNAC showed a cellular tumor with cells in cohesive fragments with acinar-like formations. The tumor cells were small,spindled with ovoid,hyperchromatic nuclei and minimal pleomorphism. No significant lymphocytic sprinkling was noted. The cell block preparation showed similar tumor cells with evident rosette-like formations. With differentials of thymoma,adenocarcinoma,and neuroendocrine tumor;immunocytochemistry for CD5(-),INSM1(-) and TTF1(-) was attempted. The subsequent biopsy showed areas of hyalinization with focus of spindled tumor cells arranged in rosettes,cords,and fascicles with scant cytoplasm,ovoid nuclei lacking pleomorphism or lymphocytic infiltrates raising suspicion for spindle-cell thymomas,basaloid squamous cell carcinoma,and neuroendocrine tumor. Based on cytomorphological correlation,IHC-panel was carefully chosen:Pan-cytokeratin(+), p63(+), PAX8(+), CD117(-), NUT(-), CD20(-), TdT(-) and Ki-67(<2%)clinching the diagnosis of a spindle-cell thymoma (TypeA).

Conclusion: Biphasic population(epithelial and lymphoid cells)with cohesive clusters as characteristic of TypeB/AB thymomas is absent in spindle-cell thymomas and can be misdiagnosed as carcinomas on cytopathology. Attention to absent nuclear atypia,mitotic activity with judicious use of immunostains aided in diagnosis. Though staging and definite subtyping is difficult on FNAC/small biopsy,a diagnosis made with detailed clinico-radiological correlation can mediate early patient management.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-263: CYTOMORPHOLOGICAL SPECTRUM OF LYMPH NODE LESION IN A TERTIARY CARE CENTRE : A STUDY OF 153 CASES

Hafsa Saleem ¹, khatija shameem ¹, M Bhavani ¹

Introduction: lymph nodes are common site of clinical presentation in a wide spectrum of diseases including infections and Malignancies. Fine needle aspiration cytology (FNAC) a simple relatively out patient procedure which can be employed in diagnosis of certain pathological conditions such as reactive lymphadenitis, tuberculous lymphadenitis, metastatic neoplastic lesions, lymphoproliferative condiions.

Aims: To assess overall incidence of various cytological types of lesions in lymph nodes and to study the pattern of occurrence in relation to age and site. To analyse the utility and diagnostic importance of FNAC in lymph node lesions.

Methods: The present study includes total of 153 patients who had presented with lymph node enlargement in department of pathology in our tertiary care centre.

Results: In the study total of 153 patients with lymphadenopathy, most common site was cervical group lymph node (65.3%) with slight female preponderance (58.2%). Cytomorphological study comprised the majority of tuberculous lymphadenitis(32.0%), followed by reactive lymphadenitis including Rosai-Dorfman disease (24.8%), acute suppurative lymphadenitis (15%), metastatic malignancies including Malignant Melanoma(9.8%), granulomatous lymphadenitis(9.1%), chronic non specific lymphadenitis(5.8%), lymphomas(3.2%).

Conclusion: FNAC lymph node employed in cytological study and early detection of inflammatory, reactive and neoplastic conditions. In our present study we diagnosed some of the diseases like Rosai-Dorfman disease and metastatic deposits of malignant melanoma, thereby guiding the patients for early intervention.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-264: IDENTIFYING THE CYTOMORPHOLOGIC PREDICTORS OF ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA: FINDINGS BASED ON COMPREHENSIVE STATISTICAL MODELLING IN A CASE-CONTROL STUDY

Parikshaa Gupta ¹, Nalini Gupta ¹, Amanjit Bal ¹, Pulkit Rastogi ¹, Gaurav Prakash ¹, Pankaj Malhotra ¹, Pranab Dey ¹, Radhika Srinivasan ¹, Ashim Das ¹

Background: Angioimmunoblastic T-cell lymphoma (AITL) is a rare T-cell non-Hodgkin lymphoma, often misdiagnosed as reactive lymphoid hyperplasia on cytology, owing to the heterogenous and polymorphic nature of the aspirate. Additionally, the literature on the cytomorphologic features of AITL is scarce. The present study was conducted to identify the distinctive cytomorphologic features of AITL in lymph node fine needle aspirates (LN-FNA).

Methods: This was a 4-year retrospective Case-control study. Cases included the LN-FNAs from patients with histopathologically confirmed AITL. The controls included LN-FNAs from patients with histopathologically confirmed reactive lymphoid hyperplasia (RLH; n=25). Eleven cytomorphologic features were assessed in all the aspirates; the strength of association was determined by odds ratio, Cramer's V, and multiple correspondence analysis (MCA).

Results: Of a total of 22 Cases of AITL Reported on histopathology, 19 adequate aspirates from 14 patients (63.6%) were available for review. On univariate analysis, 5/11 cytomorphologic variables were found to be significant for AITL; however, on MCA, 3 of these parameters viz. absence of tingible body macrophages (Odds Ratio=0.014; V=0.74), presence of atypical lymphoid cells (Odds Ratio=10.8; V=0.41) and singly scattered epithelioid cells (Odds Ratio=19.3; V=0.31) were found to be the strongest predictors of AITL.

Conclusions: The absence of tingible body macrophages, presence of atypical lymphoid cells, and singly scattered epithelioid cells in polymorphic LN-FNAs are significant cytomorphologic predictors of AITL in comparison to RLH. Knowledge of these diagnostic predictors, supplemented by clinico-radiologic correlation and appropriate ancillary studies, can help diagnose AITL on aspiration cytology.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-265: SINUS HISTIOCYTOSIS (ROSAI-DORFMAN'S DISEASE) WITH MASSIVE LYMPHADENOPATHY WITH NEOPLASTIC PROLIFERATION: TWO CASES

Manish Pradhan ¹, Prof Amrita Ghosh Kar ¹, Gagan Kumar Rangari ¹, Meena ¹

Background: Rosai-Dorfman disease (RDD) or sinus histiocytosis with massive lymphadenopathy is a rare, idiopathic, benign histiocytic proliferation of unknown etiology typically presenting with massive cervical lymphadenopathy with or without systemic involvement. Most commonly seen in children and young adults but it may occur in any age.

Case/Result: We Reported 2 Cases, 1st Case in a 7 year old male child. The child had multiple large cervical and submental lymph nodes for 2 years associated with low-grade fever. The child was finally diagnosed as a Case of sinus histiocytosis with massive lymphadenopathy. The clinical examination and cytomorphological findings were consistent with Rosai-Dorfman disease with massive lymphadenopathy with ongoing neoplastic process. 2nd Case in 9 years old male presented with massive bilateral cervical lymph nodes swelling for 4 months associated fever on & off since 4 months, hepatomegaly 2cm. The patient was finally diagnosed as a Case of Rosai-Dorfmann syndrome (Sinus histiocytosis with massive lymphadenopathy).

Conclusion: It is concluded that FNAC is a rapid, reliable, and useful tool for the diagnosis of sinus histiocytosis with massive lymphadenopathy. This disease etiology is unknown, progresses with a benign prognosis only when an early diagnosis and treatment is made. A delayed diagnosis with generalized lymphadenopathy contributes to a bad outcome.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-266: FNAC OF LEISHMANIA LYMPHADENITIS IN A HIV REACTIVE PATIENT

Bindoo Goria ¹, Subash Bhardwaj ¹, Deepa Hans ¹

Background: Leishmaniasis is an emerging opportunistic coinfection in HIV-positive patients in endemic areas. Diagnosis of the Cases often delayed due to lack of awareness and uncommon presentation. Demonstration of Leishman–Donovan (LD) bodies in lymph node by fine-needle aspiration cytology (FNAC) has rarely been Reported in visceral leishmaniasis.

Case Report: We describe a rare Case of cytology of leishmanial lymphadenitis involving supraclavicular lymph node in a Case of HIV positive.A 46-year-old male patient presented with a history of low-grade on and off fever, weight loss, and anorexia for the past 1 year. General examination revealed mild pallor, splenomegaly, and mild hepatomegaly with discrete enlarged lymph node at the right supraclavicular area. Biochemical parameters were within normal limit except mild elevation of liver enzymes (serum glutamic pyruvic transaminase – 64 IU/L, serum glutamic oxaloacetic transaminase – 52 IU/L, and lactic dehydrogenase – 374 IU/L). Hematological examinations revealed hemoglobin level of 10.2 g% and elevated erythrocyte sedimentation rate (ESR – 66mm/h). On serological screening, he was reactive to HIV I. On FNAC of supraclavicular lymph node, the smears showed polymorphous cell population, comprised reactive lymphoid cells, histiocytes, isolated epithelioid cells, many tingible body macrophages, and macrophages filled with leishmania amastigote form. On subsequent bone marrow examination, the smears revealed high parasitic load of amastigote form of leishmania in bone marrow smears. The diagnosis was established as visceral leishmaniasis with leishmania lymphadenitis with HIV reactive status. He was treated with stibogluconate for 28 days with antiretroviral therapy.

Conclusion: Although leishmaniasis is a rare cause of lymphadenopathy, it should be considered as a differential diagnosis, particularly in endemic region. Visceral leishmaniasis may be a secondary cause of lymphadenopathy and pyrexia of unknown origin in HIV patients. Cytology diagnosis is an excellent tool for the management of leishmanial lymphadenitis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-267: HODGKIN LYMPHOMA- CYTOLOGY HISTOLOGY CORRELATION

Rupali Vardhan ¹, Adarsh Sanikop ¹

Background: Hodgkin lymphoma is mainly divided into 2 distinct groups:Classical Hodgkin lymphoma and Nodular Lymphocyte Predominant. The Classical type includes 4 subtypes: Nodular sclerosis, Mixed Cellularity, Lymphocyte Rich and Lymphocyte depleted. All these subtypes have mononuclear (Hodgkin) and multinucleated (Reed Sternberg cells). Cytological Features: The smears are often scanty due to sclerosis so a careful search is needed to identify them. The smears are dominated by small mature lymphoid cells. The Hodgkin cells have a large nucleus with distinct nucleolus and pale blue cytoplasm. The Reed Sternberg cells usually has a bilobated nucleus with 2 distinct nucleoli. Immunohistochemistry: The tumor cells express CD30 and maybe CD15 positive/negative. They also express PAX5, CD20 and MUM1.

Case Report: A 16 year old boy presented with cervical lymphadenopathy and fever which was on and off.

Conclusion: As there are many mimickers of RS cells so histomorphological correlation and immunohistochemistry is needed to obtain a definitive diagnosis of Hodgkin Lymphoma.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-268: MERKEL CELL CARCINOMA: A DIAGNOSTIC QUANDARY IN SMEARS FROM ATYPICAL SITES

Arkadipta Mukherjee ¹, Rimlee Dutta ¹, Aswini Prabakaran ¹, Aruna Nambirajan ¹, Deepali Jain ¹

Background: Merkel cell carcinoma(MCC) is an uncommon neuroendocrine tumor derived from transformation of homonymous cells in basal layer of epidermis. Owing to its aggressiveness, nodal metastatic lesions often comprises primary presentation and aspiration cytology encompasses one of the initial diagnostic modalities.

Case Report: A 56-year-old male presented with progressive swelling over right side of neck for 4-months, with development of respiratory distress/stridor within last 10-days. Imaging revealed a large(9.5x1.2x1.7 cm) heterogeneously-enhancing-mass which extended inferiorly though thoracic inlet into superior mediastinum and apex of right lung, encasing and compressing the great vessels. Initial work up availing fine-needle-aspiration-cytology yielded cellular smears, comprising of dispersed population of malignant small round cells(MSRC), with scant cytoplasm, round-to-oval nuclei with fine chromatin. A differential of Non Hodgkin lymphoma(NHL) was considered and biopsy evaluation recommended. Trucut biopsy revealed an infiltrative tumor arranged in nests embedded in a vascularised stroma with adjacent areas of extensive necrosis. The tumor cells had scant cytoplasm and displayed nuclear moulding. Pancytokeratin and CK20 exhibited dot-like peri-nuclear immunopositivity. The tumor cells were also immunopositive for synaptophysin and INSM-1 while immunoexpression of Rb and p53 were lost. A final diagnosis of Merkel cell carcinoma was rendered.

Conclusion: De-novo presentation at metastatic sites without an evident primary makes the diagnosis of MCC challenging, more so on cytology. Presence of dispersed population of MSRCs with stippled chromatin, nuclear moulding in the wake of significant mitotic and apoptotic figures, along with high a degree of suspicion aided by appropriate immunolabelling helps in clinching the diagnosis in such scenarios.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-269: CYTOMORPHOLOGICAL STUDY OF TUBERCULOSIS IN TERTIARY CARE HOSPITAL

Crysle Saldanha ¹, Amina Mukhtar ¹

Background & Objectives: In developing countries such as India, tuberculous lymphadenitis continues to be one of the most common causes of lymphadenitis. FNAC plays an important role in diagnosis and prevents unnecessary surgery. The present study aimed to study the cytomorphological patterns of tubercular lymphadenitis among patients presenting with lymphadenopathy in a tertiary care hospital.

Methods: This was a cross-sectional study over a period of three years on archival material. The cytomorphological patterns of tubercular lymphadenitis were correlated with AFB positivity using Chi-square test.

Results: Of the 193 patients diagnosed with tubercular lymphadenitis, cervical group of lymph nodes was commonly affected in 125Cases (64.77%). The cytomorphological pattern B (epithelioid granuloma with necrosis) was commonly noted in 94 Cases (48.7%). On grading the AFB positive smears, grade 1 + was observed in 28.6%, grade 2 + was observed in 47.6% and grade 3+ was observed in 23.8% of Cases. Four Cases were HIV positive, all of which were grade 3 AFB positive.

Conclusions: Tuberculous Lymphadenitis is a common extra pulmonary manifestation of Mycobacterial tuberculosis infections. FNAC is a simple, reliable, cost effective procedure which is well accepted by patients.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-270: PRIMARY NON-HODKIN LYMPHOMA OF THE TONGUE WITH CERVICAL LYMPH NODE INVOLVEMENT; A RARE PRESENTATION MASQUERADING SQUAMOUS CELL CARCINOMA

Priya Jayakumar ¹, Akanksha Bhatia ¹, Prajwala Gupta ¹, Swasti Jain ¹, Devender Singh Chauhan ¹, Minakshi Bhardwaj ¹

Background: Non Hodgkin lymphoma (NHL) of the oral cavity constitutes 2% of all the extranodal NHLs. In the oral cavity, it generally arises from the Waldeyer's ring. We present a Case of primary intraoral NHL, which clinically mimicked squamous cell carcinoma (SCC) as a lesion in the base of the tongue with cervical lymph node involvement.

Case Report: A 60-year-old female presented with swelling in the left cervical region for one month, difficulty swallowing, and a change in voice for 20 days. On examination, 2.5x2.5cm multiple, matted firm lymph nodes were seen in the left upper and lower cervical regions. The oral cavity showed a soft mass in the base of the tongue and left vallecula. Clinically, a diagnosis of SCC with cervical metastasis was considered. Fine-needle aspiration from the left cervical lymph node swelling was highly cellular and a diagnosis of NHL was given. Further, the biopsy from the tongue lesion and immunohistochemistry (IHC) were done and a final diagnosis of diffuse large B cell lymphoma (DLBCL) was given.

Conclusion: Primary NHL of the tongue is a possible clinical mimicker of a commoner intraoral malignancy (SCC), and in such Cases an early diagnosis by FNAC of the metastatic cervical lymph node can prompt histopathological evaluation and further appropriate management.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-271: ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA: DIAGNOSIS OF A RARE DISEASE BY COMBINED CYTOMORPHOLOGIC, IMMUNOCYTOCHEMICAL, AND FLOW CYTOMETRIC ANALYSIS

Sangamitra Rajasekaran ¹, Parikshaa Gupta ¹, Nalini Gupta ¹

Background: Fine needle aspiration cytology (FNAC) is a rapid, minimally-invasive, first-line diagnostic modality for lymph nodal masses. Angioimmunoblastic T-cell lymphoma (AITL) is a rare subtype of CD4 positive peripheral T-cell lymphoma, often misdiagnosed as reactive lymphoid hyperplasia on cytologic examination, owing mainly to the polymorphic nature of the infiltrate and lack of knowledge of the characteristic cytomorphologic features. Furthermore, there is dearth of literature regarding the cytologic features of AITL.

Case: A 54-year-old male, who was a known Case of Hepatitis B virus-related chronic liver disease, presented with generalised lymphadenopathy and skin rash all over the body for the last 5 months. On examination, the skin rash was erythematous, maculo-papular with few nodules of varying sizes. There were multiple enlarged peripheral lymph nodes varying in size from 1-3 cm in diameter. A CECT chest and abdomen showed generalized bulky homogenous lymphadenopathy. FNA was performed from the left cubital and posterior cervical lymph nodes and sample was collected for cell-block preparation and flow cytometric immunophenotyping.

Results: The smears were highly cellular and showed sheets of atypical lymphoid cells with traversing vascular channels in a polymorphic Background composed of immunoblasts, eosinophils, histiocytes, follicular-dendritic cell collections and plasma cells. FCI revealed these atypical lymphocytes to be CD4 positive T-cells. Immunocytochemistry revealed a follicular helper T-cell phenotype of these cells, thereby confirming a diagnosis of AITL.

Conclusion: Knowledge of the distinctive cytomorphologic features with clinico-radiologic correlation can help suggest a cytologic diagnosis of AITL, which can then be confirmed by immunocytochemistry and FCI.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-272: “BURKITT LYMPHOMA” – DIAGNOSING NON HODGKIN'S LYMPHOMA ON CYTOPATHOLOGY IS RARE AND CHALLENGING

Shivangi Mittal ¹, Avinash Mane ¹, SS Kumbhar ¹, Snigdha Vartak ¹, Divya Brahmbhatt ¹

Background: Burkitt lymphoma is a form of Non Hodgkin's lymphoma which is high grade B cell lymphoma. It is a fast growing tumor. It is a rapid proliferating tumor which is associated with EBV infection and other immunocompromised diseases.

Case Report: A 19 year old HIV positive female presented to our surgery department with left sided inguinal swelling which gradually increased since last 1 year. Patient was referred to cytopathology department of our hospital for FNAC. On physical examination, there was a 7 x 4 cm, firm, non tender swelling in left inguinal region. Cytological smears revealed medium to large sized lymphoid cells having round contour, high N:C ratio, coarse irregular chromatin, prominent nucleoli and scant cytoplasm along with tingible body macrophage randomly dispersed throughout the smear, mimicking the 'starry sky' pattern. Based on these cytological findings, diagnosis of Atypical Lymphoid Hyperplasia suggestive of High grade Non Hodgkin's Lymphoma was offered. Also, tru-cut biopsy confirmed the same. Immunohistochemistry Report expressed CD20, CD10 and BCL6 confirming Burkitt Lymphoma.

Conclusion: We are presenting this Case not only for its rarity but to put emphasis on FNAC as a first line diagnostic modality of enlarged lymph nodes.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-273: A STUDY OF SPECTRUM OF LESIONS IN FINE NEEDLE ASPIRATION CYTOLOGY OF CERVICAL LYMPH NODE.

Sarasvati Vaniya ¹, Prashant R Patel ¹, RN Hathila ¹, Archana Patel ¹

Background: Fine needle aspiration cytology of cervical lymph node is first step in evaluation of enlarged lymph node. It is Simple, rapid, minimal invasive, less expensive and basic diagnostic procedure for the definitive and conclusive diagnosis for the immune system which reciprocates in the form of enlarged lymph nodes. Aim of our study is to know the cytological spectrum of lymphadenopathy and understand the burden of disease. Fine needle aspiration cytology is one of most dependant diagnostic tool in Case of cervical lymph node for early diagnosis and detection for better management.

Method: Retrospective observational study conducted in Department of Pathology at Government Medical College, Surat including 175 patients from department of E.N.T. and TB & Chest Disease between January 2021 to August 2021. Cytology smears (Haematoxylin & Eosin, May Grunwald-Giemsa and Papanicolaou stain) were evaluated and Reported.

Result: Out of 175 patients, the Cytopathological diagnosis consisted of 65 (37%) Tuberculous lymphadenitis, 39 (22%) reactive lymphoid hyperplasia, 8 (4.5%) suppurative inflammation, 27 (15%) malignancy, 2 (1.14%) lymphoma.

Conclusion: Tuberculosis is still a commonest cause of cervical lymphadenopathy followed by reactive lymphadenopathy and malignant neoplasm especially metastatic carcinoma. Fine needle aspiration cytology is safe and accurate diagnosis of cervical lymph node which is highly sensitive, specific and reliable diagnostic tool in evaluation of enlarged lymph node.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-274: FINE NEEDLE ASPIRATION DIAGNOSIS OF A METASTATIC RHABDOMYOSARCOMA IN A CERVICAL LYMPH NODE.

Sant Prakash Kataria ¹, Suman ¹, Sanjay Kumar ¹, Rajnish Kalra ¹, Mahak ¹, Sunita Singh ¹

Background: Rhabdomyosarcoma (RMS) is an aggressive malignant soft tissue tumour that arises from primitive striated muscle cells called rhabdomyoblasts. Lymph node metastasis of soft-tissue sarcoma is an infrequent event, with a Reported incidence of 2.6–5%. Incidence of lymph node metastasis is more common in alveolar type compared with the other forms. Fine needle aspiration cytology (FNAC) has been used extensively in the diagnosis of metastatic malignancies. However, metastatic soft tissue sarcomas are often overlooked, primarily due to the low frequency with which they occur.

Case Report: A 14-year-old male child presented with swelling right side of face and orbital area with history of double vision. USG of the swelling showed few hypoechoic lesions largest measuring 15x11 mm in right submandibular region. FNAC revealed hypercellularity with presence of round to plasmacytoid pleomorphic cells with low to high N:C Ratio, fine nuclear chromatin with one to two prominent nucleoli and abundant basophilic cytoplasm. A diagnosis of poorly differentiated malignant neoplasm was made. Cell block prepared show positivity for IHC markers e.g., Desmin, MyoD1,WT1 and Myogenin confirming the diagnosis of Rhabdomyosarcoma.

Conclusions: Fine-needle aspiration (FNA) cytology is a relatively easy way of diagnosing metastatic sarcoma in a lymph node, as the tumour tends to display a pattern of spindle cells or small, round cells, and often there is a history of sarcoma or concurrent biopsy of the primary tumour.

Keywords: Alveolar, Cervical lymph node, Rhabdomyosarcoma

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-275: LYMPH NODE CYTOLOGY RAISING SUSPICION FOR SECONDARY HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS (HLH) IN A CASE OF MENDELIAN SUSCEPTIBILITY TO MYCOBACTERIAL DISEASE (MSMD)

Deepti Soni ¹, Sramana Mukhopadhyay ¹, Hemlata Panwar ¹, Tanya Sharma ¹, Vaishali Walke ¹, Narendra Chaudhary ¹, Mahesh Maheshwari ¹

Background: MSMD is a rare primary immunodeficiency disorder (PID) characterized by increased vulnerability to mycobacterial infection. Chronic mycobacterial infection might overstimulate macrophages through toll-like receptors. HLH is a hyperinflammatory condition where hemophagocytosis either in bone marrow or spleen or lymph node is a characteristic feature. The association of MSMD and secondary HLH, has been only recently recognized. Herein we illustrate role of lymph node cytology in alerting the clinician to possibility of HLH in a Case of MSMD.

Case Report: A 2-year-old boy first presented to pediatric department in 2019 and diagnosed with BCG induced/tubercular lymphadenitis on axillary node FNA. The smears contained singly scattered epithelioid histiocytes, lacked well formed granulomas or Caseous necrosis and showed few acid fast bacilli. He received antitubercular treatment. MSMD was suspected and a molecular study showed homozygous mutation in IFNGR2 (+) at Exon 4 (variant c.540G>A) confirming the disease. At 22 months he presented with generalized lymphadenopathy, massive splenomegaly, bicytopenia and high grade fever. The recent cervical node FNA smears revealed, ill formed granulomas, absence of Caseous necrosis and Many macrophages with engulfed lymphocytes, neutrophils and RBCs. In view of morphological findings of haemophagocytosis and some supporting clinical features a concern for secondary HLH was raised by cytopathologist and further lab investigations recommended.

Conclusion: Since HLH is increasingly being Reported as an infectious complication in PID a high index of suspicion should be maintained to help early identification of this dreaded outcome in MSMD. Nodal cytology may be an effective tool in diagnosing the same.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-276: ROLE OF AUTOFLUORESCENCE TECHNIQUE IN DETECTION OF MYCOBACTERIAL BACILLI ON FINE NEEDLE ASPIRATION CYTOLOGY IN TUBERCULAR LYMPHADENITIS IN COMPARISON TO CONVENTIONAL METHODS

Sanjay Kumar ¹, Nidhi Kaushik ¹, Ritika ¹, Sant Prakash Kataria ¹, Sunita Singh ¹

Background: Lymphadenopathy is the most common presentation of extrapulmonary tuberculosis. Fine needle aspiration cytology has emerged an important diagnostic tool in the evaluation of peripheral adenopathy as a possible non-invasive procedure. Conventional Ziehl-Neelsen Method for acid fast bacilli plays an important role in the diagnosis and Monitoring of treatment in tuberculosis. Fluorescence microscopy using auramine-rhodamine or Papanicolaou staining has been considered superior to ZN staining.

Material And Methods: The study was conducted in tertiary care centre for a period of 2 years. A total number of 75 patients were included in the study. Four smears made from each aspirate: three air dried smears were stained with Giemsa, ZN and AR stains and one wet fixed stained with PAP stain for autofluorescence. Aspirate sent for culture over Lowenstein-Jensen medium was taken as a reference Method.

Results: Seventy five aspirates Reported on cytomorphology as tuberculous lymphadenitis were stained with various Methods. Autofluorescence was of more diagnostic utility for detection of AFB when cytologically only necrosis (64.71%) or granulomatous lymphadenitis (42.11%) was seen. With necrotising granulomatous lymphadenitis Reported Cases, Auramine Rhodamine was positive in maximum Cases (66.7%) and was significant statistically. Overall taking culture as gold standard ZN stain was most specific (100%) and Auramine Rhodamine was most sensitive (82%).

Conclusion: There is a definite advantage of autofluorescence in detecting mycobacteria over Ziehl-Neelsen and auramine rhodamine stain as it is more sensitive as well as an inexpensive technique. Autofluorescence can be an useful adjunct to routine cytology for early diagnosis and effective treatment.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-277: SUPRACLAVICULAR LYMPH NODE A RARE HARBOR TO METASTATIC CA URINARY BLADDER

Chitra Kamlesh Kumar Raval ¹, Pratibha Chandra ¹, A K Das ¹, Tripti Sharma ¹, Amandeep Singh ¹

Background: Urinary bladder cancer is 9th most common cancer world-wide with more predilection for males. The initial presentation in most of the Cases is painless hematuria. Metastasis of urinary bladder tumor is rare and is generally restricted to regional lymph nodes with distant metastasis holding poor prognosis.

Case Report: We present a Case of 60-year old male, a K/C/O operated invasive papillary urothelial carcinoma, high grade with presenting complain of giddiness and few enlarged supra clavicular lymph nodes. PET-CT scan showed multiple FDG avid supraclavicular (10mm), mediastinal (12mm), retroperitoneal (18mm) and pelvic (8mm) lymph nodes. USG guided FNAC was done from one of these lymph nodes which showed pleomorphic tumor cells arranged in cohesive clusters with high N:C ratio, moderate anisonucleosis, round to oval nuclei, dispersed chromatin, 1 – 2 prominent nucleoli and scant basophilic cytoplasm. Occasional tumor giant cells were also seen.

Conclusion: Metastasis at a rare location can be confusing. FNAC plays a crucial role in such Cases because of its sensitivity, low cost and minimal invasive technique. FNAC findings when correlated with age, clinical presentation and radiology are fairly diagnostic.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-278: CERVICAL LYMPH NODE METASTASIS OF OVARIAN DYSGERMINOMA- A CASE REPORT IN A TERTIARY CARE HOSPITAL

Amlan Baruah ¹, Projnan Saikia ¹, Amilee Gogoi ¹

Background: Dysgerminoma, a malignant tumor arising from the germ cells accounts for 2% of ovarian cancers and roughly 50% of malignant ovarian germ cell tumors. It can occur in any age, the average age being 22 years. Dysgerminoma invades pelvic structures locally. Distant metastasis are rare and occur by lymphatic route involving the paraaortic lymph nodes and subsequently the mediastinal lymph nodes. This Case had cervical metastasis which is very rare.

Case Report: A 20-year-old female presented with abdominal distension, mild pain for one month and enlarged right cervical lymph node for 20 days. Biochemical tests revealed elevated Serum LDH Ultrasonography whole abdomen revealed a solid lesion in right ovary with unremarkable left ovary. FNAC of right cervical lymph node was done and patient underwent right salpingoophorectomy. FNAC of right cervical lymph node showed large atypical cells in sheets, cells were uniform medium to large sized having centrally located squared off nucleus with vesicular chromatin and prominent nucleoli. The cells had moderate amount of clear, vacuolated cytoplasm with lymphocytes scattered among the tumor cells. Histopathological examination of right ovary showed tumor cells arranged in nests and lobules separated by fibrous septa infiltrated by lymphocytes. The tumor cells are large, vesicular, having clear cytoplasm with well defined cell boundaries and centrally placed regular nuclei. Based on the above findings a diagnosis of Ovarian Dysgerminoma with Cervical Metastasis was made.

Conclusion: FNAC coupled with radiological and biochemical investigations served as a useful tool to come to a diagnosis of Dysgerminoma of Ovary.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-279: DIAGNOSTIC UTILITY OF FLOW CYTOMETRY IN IDENTIFYING HISTIOCYTIC SARCOMA-A CASE REPORT

Guddanti Dheeraj kumar ¹, Meeta Singh ¹, Sneha Datwani ¹, Pritika Khushwaha ¹, Varuna Mallya ¹, M K Daga ¹, Shyam Lata Jain ¹, Sarika Singh ¹

Introduction: Histiocytic sarcoma is an exceedingly rare and aggressive malignant neoplasm of hematopoietic origin, commonly seen in adults. Diagnosis is difficult owing to lack of specific clinical manifestations with absence of precursor lesions or causative agents. Hence, it primarily relies on histopathological morphology combined with immunohistochemistry, which is time-consuming, Resulting delayed treatment. However, diagnostic utility of flow cytometry is not well-established.

Case Report: A 45-year-old male presented with right axillary lymphadenopathy for one month. FNAC was performed on the axillary lymph node which showed large, atypical lymphoid/histiocyte-like cells. On flow cytometry, these cells were CD64+, CD11c+ and CD45+ suggesting histiocytic sarcoma. Similar morphology was seen on incisional biopsy. On immunohistochemistry, the cells were negative for B- and T-cell markers, PAX5, EMA, CK, ALK, CD1a and expressed CD68, S100 and CD11c. A diagnosis of histiocytic sarcoma was made.

Conclusion: Hence, flow cytometry can be highly effective and powerful tool for early detection of histiocytic sarcoma and can help in prompt treatment, given its aggressive clinical course and low survival interval.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-280: CYTOMORPHOLOGICAL SPECTRUM OF LYMPHO-PROLIFERATIVE DISORDERS IN A SETTING OF IMMUNO-SUPPRESSIVE THERAPY

Roshny J ¹, Vaishali Walke ¹, Sramana Mukhopadhyay ¹, Vaibhav Ingle ¹

Background: Immunomodulatory agent-related Lymphoproliferative Disorders are lymphoid proliferations following administration of drugs in autoimmune and rheumatological diseases. These patients have increased risk of EBV-1 associated lymphoid proliferations due to combined effect of disease and immunomodulatory therapy. Herein we Report two Cases of LPD diagnosed on cytology in a Background of immunosuppressive therapy.

Case Report: Case 1: A 32 year old female, a known rheumatoid arthritis patient who received Methotrexate therapy for six months presented with cervical lymphadenopathy for one month. FNA smears from the nodes were cellular with many small lymphocytes, plasma cells and numerous histiocytes resembling tingible body macrophages with engulfed nuclear debris. The diagnosis of “Reactive Lymphoid Proliferation post Methotrexate therapy” was offered (synonymous with Non Destructive/ Reactive Category of Post Transplant LPD) Case 2: A 28-year-old dermatomyositis patient who received cyclosporine therapy for six months presented with cervical lymphadenopathy for three months. FNA smears from the nodes were cellular and showed a polymorphous population of small and large lymphocytes, immunoblasts, plasma cells and numerous Reed Sternberg (RS) and RS like cells. The diagnosis of “Polymorphic - Lymphoproliferative Disorder in a setting of Immunosuppressive Therapy (Cyclosporine)” with a possibility of Hodgkin Lymphoma was offered which was subsequently confirmed on histopathology.Conclusion: Cytological evaluation of Lymphoproliferative disorders in a setting of immunomodulatory therapy can not only help in early diagnosis but also aid in monitoring and planning further treatment strategies.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-281: PROGRESSIVE DISSEMINATED HISTOPLASMOSIS IN AN IMMUNOCOMPETENT PATIENT: A RARE CASE REPORT

Zoya Hasan ¹, Nidhi Verma ¹, Bhagyashree Priyadarshinee ¹, Rohit Chawla ¹, PK Rathore ¹

Background: Histoplasmosis is a rare fungal disease caused by thermally dimorphic fungi Histoplasma capsulatum. It is caused by Inhalation of microconidia in soil contaminated with birds and bats droppings. Histoplasmosis clinically presents as: Primary cutaneous, Pulmonary and Progressive disseminated histoplasmosis (PDH). PDH is commoner in immunocompromised patients. We Report a Case of PDH in an immunocompetent host. This Case highlights the role of FNAC as quick, easy and less painful diagnostic Method in diagnosis of Histoplasmosis.

Case Report: 48-year female, skin biopsy proven Case of Histoplasmosis presented in emergency with complaints of breathlessness and hoarseness of voice associated with productive cough for two months. On examination, multiple 0.5-1cm, papulo-nodular lesions were noted on face along with bilateral multiple cervical lymph nodes (1-2 cm size). Emergency tracheostomy was done to relieve stridor. CECT showed multiple mediastinal, paraaortic, inguinal, and mesenteric lymph-nodes with foci of necrosis. Bulky left adrenal along with multiple hypodense lesions in liver, splenomegaly and ascites were also noted. FNAC cervical lymph-nodes showed high cellularity. Multiple granulomas with scattered histiocytes and numerous intracellular as well as extracellular yeast forms; 1-2 μm in size, oval, narrow based budding and surrounding halo suggestive of Histoplasma species were noted. PAS stain highlighted the pseudocapsule. On the basis of clinico-radiological and FNAC findings; final diagnosis of PDH with relapse was given.

Conclusion: PDH is a rare presentation in immunocompetent patient which could be due to initial high fungal load. FNAC can be used as simple and rapid diagnostic test for its identification.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-282: SYNCHRONOUS DUAL MALIGNANCY

Arunima Aishwarya ¹, Anuradha Kusum ¹, Mansi Kala ¹

Background: The occurrence of multiple primary malignancies (MPM) is due to common-carcinogen induced multiple cancers in an exposed epithelial surface, called “field-cancerization” or due to microsatellite instability. MPMs are considered synchronous when they present within 6 months of one another.

Case Report: We Report a Case of 60 year male who presented with left supraclavicular swelling, pain abdomen and generalized weakness since 2 months. FNAC of left supraclavicular swelling showed highly atypical cell cluster suggestive of metastatic deposits of poorly differentiated. Total leucocyte counts were markedly elevated. Bone marrow examination revealed a possibility of myeloproliferative neoplasm. Further molecular studies showed positivity for BCR ABL gene mutation, hence a diagnosis of CML was made.

Conclusion: This Case highlights that multiple lesions of different histologic types can occur in different sites which are considered as separate primaries whether occurring simultaneously or at different times. There is always a possibility of occurrence of synchronous dual malignancy which implies patients are at continued risk for new and separate malignancies even after an initial diagnosis is made.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-283: ROLE OF CELL BLOCK IN DIAGNOSING DIFFUSE LARGE B-CELL LYMPHOMA IN INEXCESSIBLE ABDOMINAL LYMPH NODE

Akanksha Raj Khandal ¹, Smita Chandra ¹, Anuradha Kusum ¹

Background: Though fine needle aspiration biopsy is a fast diagnostic procedure with high accuracy but it has a major drawback in availing limited material for adjuvant diagnostic investigations including immunocytochemistry. At times abdominal lymph node are not excessible for biopsy. Therefore Cell-block preparations made from sedimented cells can thus be a useful adjunct to the routine cytological Methods. This study was conducted to compare the diagnostic efficacy parameters of cell-blocks and routine cytological smears of fine needle aspirate in a Case of lymphoma.

Case Report: A 76 year old female patient, housewife by occupation, presented with pain abdomen, abdominal distension, loss of appetite and weight loss since 6 months. Ultrasound and CT scan showed multiple lymphadenopathies and splenomegaly. Bone marrow examination and biopsy revealed hypercellular marrow with no abnormal cell. A high FDG uptake in mesenteric lymph node was seen in PET scan. Biopsy was deferred in view of vascular proximity of nodes therefore an USG guided FNA was done and cell blocks were made which showed mostly monomorphic round cells having scant cytoplasm, nucleus with coarse chromatin, prominent nucleoli and occasional mitotic figures. Hence a diagnosis of lymphoproliferative disorder was made and a lymphoma panel was advised showing positive expression in CD20, CD10 and cMyc whereas CD3, BCL2 and Tdt were negative suggesting a diagnosis of High grade B cell Non Hodgkin's lymphoma - diffuse large B cell type.

Conclusion: Cell blocks can be considered as a reliable and useful adjunct to routine histopathological and cytological techniques for establishing a definitive diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-284: FOAMY HISTIOCYTES AND LEPRA BACILLI IN A LYMPH NODE ASPIRATE: CASE REPORT

Aanchal ¹, Vikarn Vishwajeet ¹, Anil Budania ¹, Poonam Elhence ¹

Background: Fine needle aspiration (FNA) biopsy is a valuable tool in the evaluation of patients with lymphadenopathy for diagnosis of reactive hyperplasia, infections, granulomatous lymphadenopathies, and metastatic diseases. Leprosy is nonfatal, chronic inflammatory disease caused by Mycobacterium leprae, whose clinical manifestations are largely confined to the skin, peripheral nervous system, upper respiratory tract, eyes, and testes. Herein we Report the aspiration cytology of inguinal lymphadenopathy from an elderly patient involved by leprosy.

Case Report: A 78-year-old male presented with high grade fever followed by red raised asymptomatic lesions from 1 month and bilateral inguinal lymphadenopathy. Inguinal swelling is progressively increasing in size and developed yellow debris over it in next few days. Direct FNA from bilateral inguinal lymph nodes yielded blood mixed pus- like aspirate. Smears are cellular and revealed numerous viable and degenerated polymorphs in necrotic Background. Several foamy histiocytes were noted at the edges of necrotic fragments. Occasional multinucleated giant cells are also seen. Fite Faraco stain showed histiocytes filled with clumps of lepra bacilli (Bacillary index: Grade 6 +). Presence of acid fast bacilli are not specific for Mycobacterium leprae infection and can be seen in Cases of atypical mycobacterioses, particularly in immunodeficient patients. However, presence of characteristic skin lesions confirmed the leprosy lymphadenopathy in the present Case.

Conclusion: This Report highlights that FNA biopsy offers an inexpensive and simple test for diagnosing leprosy involvement of lymph nodes. Clinicians practising in endemic areas should consider leprosy in the diagnostic consideration of lymphadenopathy.

Keywords: Leprosy, lymphadenopathy, mycobacterium leprae

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-285: THE THREE MUSKETEERS: A REPORT OF ROSAI-DORFMAN DISEASE, CASTLEMAN DISEASE AND TUBERCULOSIS IN THE SAME PATIENT- A CYTOLOGY REPORT WITH HISTOLOGY CORRELATION.

Naadia Nadeem ¹, Debasis Gochhait ¹, Neelaiah Siddaraju ¹

Background: Benign lymphadenopathies are commonly due to infections, autoimmune disorders and other rarer entities. Among infections, extrapulmonary nodal tuberculosis is common in an endemic country like India. Rare entities like Rosai Dorfman disease(RDD) and Castleman disease(CD) are generally nodal and sometimes extranodal. Although it is common for more than one lymph nodal pathologies to coexist, it is uncommon, as per our literature search, to find these three different benign conditions to co-exist in the same patient.

Case Report: A 25 years old HIV negative male presented with fever, evening rise of temperature, myalgia, breathlessness and generalised lymphadenopathy for 6 months. FNA from axillary and right cervical nodes showed histiocytic proliferation with prominent emperipolesis suggestive of RDD. FNA from left cervical node showed only plasma cells in a reactive lymphoid Background which on subsequent biopsy showed features of plasma cell variant of CD with no histiocytic prominence/emperipolesis. CT lung revealed a cavitatory lesion and bronchoalveolar lavage showed acid fast bacilli present on Ziehl Neelsen stain. Patient was started on ATT but symptoms didn't resolve even after 5 months. Repeat FNA from axillary nodes and repeat cervical node biopsy showed similar picture.

Conclusions: RDD and CD are benign heterogeneous disorders with etiopathogenesis not well known, albeit attributed to certain infections/inflammatory cytokines(IL-6). Tuberculosis is a mycobacterial infection. An underlying immunosuppression can be the cause of this unusual presentation which is important to note since treatment modalities vary. Thus, we present a rare Case Report of three different benign entities in the same patient.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-286: NODULAR LYMPHOCYTE PREDOMINANT HODGKIN'S LYMPHOMA WITH EXTENSIVE EMPERIPOLESIS CYTOLOGICALLY MIMICKING ROSAI-DORFMAN DISEASE: A CASE REPORT

Saurabh Jyoti Goswami ¹, Preeti Diwaker ¹, Vinod Kumar Arora ¹, Vikas Kashyap ¹

Background: Nodular lymphocyte prominent Hodgkin lymphoma (NLPHL) is difficult to diagnose on cytology as popcorn cells (type of Reed Sternberg cells) are not easily identifiable. Its cytological diagnosis becomes even more challenging when emperipolesis is quite prominent in the smears which is otherwise a hallmark feature of Rosai-Dorfman disease (RDD). Herein we present a Case of NLPHL which was diagnosed as RDD on cytology.

Case Report: A 40 year old man presented with cervical lymphadenopathy for 4-6 months. FNAC was done. Smears showed numerous histiocytes with extensive emperipolesis in a reactive lymphoid Background. Possibility of RDD was suggested and excision was advised. Cervical lymph node biopsy revealed predominantly nodular pattern along with partial diffuse effacement of the lymph node architecture. The lesion comprised predominantly of mature small lymphocytes along with abundant histiocytes and some atypical cells. Few atypical cells showed lacunar type of Reed-Sternberg cell morphology, while other cells appeared to be popcorn cells. A panel of immunohistochemical markers including OCT2, CD4, CD15 and CD30 was done. Based on morphology and IHC findings final diagnosis of NLPHL was given.

Conclusion: Lymph node aspirated with extensive emperipolesis should be diagnosed as RDD with caution as focal RDD like areas may be associated with Hodgkin's and non-Hodgkin's lymphomas. So, the accompanying cells should be carefully examined for presence of any atypical cells to reach the correct diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-287: LANGERHANS CELL HISTIOCYTOSIS WITH UNUSUAL PRESENTATION -A DIAGNOSTIC CHALLENGE

Rohit singh ¹, Mala sagar ¹, Madhu Kumar ¹, Preeti Agarwal ¹, Shivanjali Raghuvanshi ¹

Background: Langerhans Cell Histiocytosis is a rare disease of children and young adults.it represents a poorly understood spectrum of disorders which may occur as an isolated lesion or with widespread multisystem involvement. Skin and bones are common sites of involvement. Multiple bilateral and massive lymphadenopathy is an unusual presentation. Patient may require minimum therapy or an advance treatment in the form of multidrug chemotherapy according to the severity of disease. Fine needle aspiration with cell block prepration can aid in early diagnosis of LCH.

Case Report: One year old girl presented with multiple bilateral enlarged cervical lymph node since six months with a clinical suspicion of tuberculosis. FNAC was done. Smear were cellular showing sheets and cluster of cells with large, bland vesicular nuclei with pale abundant eosinophilic cytoplasm in the Background of multinucleated giant cells,plasma cells and lymphocytes. Nuclear indentation and grooves (coffee bean nuclei) were noted in many cells.S100 and CD 68 were positive on cell block. The final diagnosis of Langerhans Cells Histiocytosis was rendered

Conclusion: LCH presenting with cervical lymphadenopathy usually misdiagnosed as tubercular or Rosai Dorfman disease. Recognition of classical morphological features like coffee bean nucleus on aspiration smears along with ease of putting immunohistochemical markers on cell block can help to make a correct diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-288: CRYPTOCOCCAL LYMPHADENITIS- DIAGNOSIS BY FINE NEEDLE ASPIRATION CYTOLOGY

Ankita Garg ¹, Uma Handa ¹, Ranjeev Bhagat ¹, SS Lehl ¹, Purnima Aggarwal ¹

Background: Cryptococcosis is a common mycotic opportunistic infection in HIV affected individuals caused by cryptococcus neoformans. However cryptococcal lymphadenitis is an unusual presentation of infection by the organism which usually involves the lungs and CNS.

Materials and Methods: Three patients, one male aged 41 years and two females of ages 39 years and 14 years respectively, presented in the OPD with complaint of fever. They were found to have lymphadenopathy on systemic examination. Two patients had history of HIV infection. Fine needle aspiration was done from largest assessable lymph node with a 23-gauge needle attached to a 10ml disposable syringe. Air dried May-Grunwald- Giemsa stained smears and wet fixed Haematoxylin and Eosin and Periodic acid-Schiff stained smears were prepared and examined. Ultrasound guidance was used in one Case.

Results: The size of the involved lymph nodes ranged from 0.8-3.6 cm in diameter involving the cervical, axillary and mesenteric group of lymph nodes. Cytosmears examined revealed numerous encapsulated budding yeast forms of cryptococcus neoformans in a Background of reactive lymphoid cells and necrosis. One Case showed a giant cell reaction and increased eosinophils. The organisms were highlighted by PAS stain.

Conclusion: Potentially fatal infections like cryptococcosis can be timely managed by use of fine needle aspiration cytology. Careful examination of smears along with use of ancillary techniques can aid in the diagnosis of infective etiologies at uncommon sites.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-289: VIRCHOW'S NODE: THINK OUT OF GUT.

Nida Shabbir ¹, Sumaira Qayoom ¹, Riddhi Jaiswal ¹, Madhu Kumar ¹, Ajay K Singh ¹, Naseem Akhtar ¹, Kirti Srivastava ¹

Background: Virchow's node described back in 1848 as metastasis to the left supraclavicular lymph node,most commonly from gastric cancer. However,In India the gastric cancer incidence is low as compared to Western countries, this study was taken with the aim to analyze the pattern of supraclavicular lymphadenopathy(SCLAP) evaluated by Fine needle aspiration cytology(FNAC) among patients presenting to our tertiary care institute.

Materials and Methods:A retrospective review of all supraclavicular lymph node aspirations done between March 2019 to August 2021 was performed. The demographic and clinical details were obtained from records in Dept.of pathology and electronically on e-hospital and only descriptive analysis was performed after making data anonymized.

Result: Total of 207 FNAC's of SCLAP were performed.118 (57%) Cases were of left sided, 88 (42.51%) of right sided and one Case was bilateral. The study showed female predilection with 112 (54.10%)Cases & 95 (45.89%)were male. The age ranged from 8-85years. Cytological diagnosis was categorized as Metastatic malignancy in 87 (42%) Cases, Granulomatous lymphadenitis in 45(22%),Reactive lymphadenitis in 11 (5.3%), Abscess in 11 (5.3 %), lymphoma in 8 (4%), hemorrhage in 5 Cases(2.5%) and in 38 (18%) Cases either the aspirates were inadequate or equivocal. Out of 87 Cases of metastasis, the most common type was adenocarcinoma (46%) and commonest primary site was lung (37%). Other sites were breast, Gall bladder,cervix,urinary bladder, gastric, duodenum, testis, liver, bone and buccal mucosa. Primary gut carcinomas constituted only 9% of metastasis in left supraclavicular lymph nodes.

Conclusion: Granulomatous lymphadenitis in supraclavicular lymph node is seen in significant number of Cases and the origin of metastasis is less frequently from GIT and depends on frequency of tumor type in particular geographical area.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-290: AN USUAL CASE REPORT OF ROSAI-DORFMAN DISEASE

Preeti Mathur ¹, Khushboo Dewan ¹, Karsing Patiri ¹, Shyama Jain ¹, Usha Rani ¹, Kusum Gupta ¹, Vivek Sagar ¹, Pravesh Yadav ¹

Background: Rosai Dorfman disease (RDD) is a rare non-malignant histiocytic disorder affecting all age groups; and presents as massive, painless, cervical lymphadenopathy. Extranodal involvement is seen in 28-43% of patients.

Case Report: A 32year woman presented with a gradually increasing swelling in left submandibular region. She also had similar swellings on arm. On clinical examination, submandibular swelling was well defined, measured 2x1.5cm in size, had reddish and ulcerated overlying skin. FNAC from swellings were performed. Air-dried Giemsa stained smears revealed many histiocytes with single to multiple nuclei with fine chromatin, prominent basophilic nucleoli and abundant cytoplasm containing several intact plasma cells and lymphocytes suggestive of 'emperiopolesis'. The cytological diagnosis of 'RDD' was considered, and confirmed on histology and immune-histochemistry (S-100, CD-68 positive). There were no other lesions in the body on radiology. Patient received steroids to which she responded. On follow-up, after six months she developed more skin lesions with systemic involvement.

Conclusion: Rosai Dorfman disease presenting as skin lesions and progressing to systemic involvement within few months of diagnosis is extremely rare. Extranodal involvement is seen in 28-43% of patients. FNAC help in early diagnosis, close follow up of the patient is mandatory as some may develop lymphoma as a long term complication.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-291: EXTRAMEDULLARY BLAST CRISIS INVOLVING CERVICAL LYMPH NODE ON FINE NEEDLE ASPIATION CTOLOGY IN FOLLOW UP CASE OF CHRONIC MYELOID LEUKEMIA

Himadri Shukla ¹, Rashmi Kushwaha ¹

Background: Myeloid Sarcoma is collection of immature cells of granulocytic lineage at an anatomical site other than the bone marrow. It is a rare clinical presentation in Case of chronic myeloid leukemia. It may precede peripheral blood or bone marrow involvement. Because of diverse clinical presentation, differentiation of Myeloid sarcoma from malignant lymphomas (Non Hodgkin's lymphoma or Hodgkin's lymphoma) becomes a diagnostic challenge for a Cytopathologist.

Case Report: A Case is Reported of 60 year old male, who presented with easy fatigability, generalized weakness and nodular mass in neck region. FNAC was done from cervical and axillary lymph node, it shows hypercellular smears comprising of granulocytic precursors along with mature lymphocytes. Precursor cells showed fragile nuclie,vesicular chromatin and evident nucleoli. The Excision biopsy was done, which revealed diffuse areas of fibrosis and areas of primary and secondary follicles. Interfollicular and subcapsular sinuses were dilated and interfolicular spaces were infiltraterd by granulocytic precursors. These cells were positive for MPO and CD34. Immunohistochemistry revealed CD30 positivity in follicles, CD3 psotivity in T-lymphocytes and interfollicular areas and CD34 positivity in Myeloid blast cells.

Conclusion: Uncommon presentation of Chronic myeloid leukemia that was confused with Malignant lymphomas. But with detailed clinical history along with careful morphological evalution for granulocytic cells through various ancillary techniques, the final impression of Extramedullary blast crisis in Case of chronic myeloid leukemia was Reported.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-292: IS TOXOPLASMA A DIFFERENTIAL IN SUPERFICIAL LYMPH NODE ASPIRATES SHOWING GRANULOMATOUS PATHOLOGY?

Gulshan ¹, Riddhi Jaiswal ¹, Shikha Khati ¹, US Singh ¹, Anand Srivastav ¹

Background: Cervical lymph nodes are involved more often than the other lymphatic regions. Based on different geographical areas, the etiology varies. For example, in tropical areas, tuberculosis (TB) is a major benign cause in adults and children. In India some studies have been conducted to assess sero prevalence of toxoplasmosis, another infectious disease of significance

Aim of Study: To investigate and diagnose those Cases that are Reported as 'granulomatous lymphadenitis' on cytology, without being confirmed as tuberculosis

Observations and Results : • Study sample consisted of 49 patients who had granulomatous pathology, out of 100 samples collected • Ziehl- Neelsen : Positive for Acid fast bacilli in 6/49 Cases • ELISA

Results: • Toxoplasma IgM: there were no IgM antibodies detected in any serum sample • Toxoplasma IgG: Positive in 7/49 Cases • Serum samples of patients with granulomatous lymph nodes that were Ziehl- Neelsen negative also showed no raise in IgG and IgM anti toxoplasma antibodies • PCR on the lymph node aspirates did not show any presence of B1 gene of Toxoplasma

Conclusion: • Serologic confirmation in all suspected Cases of this self limited condition, for which no treatment is necessary in cervical lymphadenopathy (especially in children and those who have pets), should be done

• Cytological diagnosis can eliminate the need of hospitalization and surgery

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-293: ANAPLASTIC LYMPHOMA KINASE POSITIVE LARGE B CELL LYMPHOMA: A DIAGNOSTIC DILEMMA

Salma Ferosh Usman Khan ¹, Saumyaranjan Mallick ¹, Deepali Jain ¹, Kavneet Kaur ¹, Raja Parmanik ¹, Atul Sharma ¹, Prashant Ramteke ¹

Introduction: Anaplastic Lymphoma Kinase (ALK) positive Large B Cell Lymphoma (ALK+ LBCL) is an aggressive, rare subset (<1%) of LBCL in the WHO lymphoid neoplasms. Other tumors which also express ALK are ALK-positive ALCL, lung adenocarcinoma, inflammatory myofibroblastic tumor, ALK associated histiocytosis, neuroblastoma and rhabdomyosarcoma. We describe one such Case of ALK positive LBCL in a soft tissue mass with multiple lymphadenopathy.

Case description: A 24-year-old male presented with complaints of pain and swelling over right shoulder, left thigh and inguinal region for 6 months. The patient also had B-symptoms. PET-CT revealed generalized lymphadenopathy. An aspirate from soft tissue mass was sent which showed discohesive sheets of large cells with plasmablastic morphology and had a large round, centrally or eccentrically placed nucleus with prominent nucleolus. Based on cytomorphology we put the IHC panel on cell block for tumors with plasmablastic morphology and the cells were immunopositive for CD138, MUM1 and ALK while are negative for panCK, desmin, myogenin, neuroendocrine markers, LCA, CD3, CD20, CD30 and a diagnosis of ALK+ LBCL was made.

Conclusion: Cytomorphology is very helpful to suspect this entity. So ALK positive LBCL should be considered in the differential diagnosis of neoplasms with plasmablastic morphology, particularly in Cases with immunocompetent young patients, generalized lymphadenopathy, no immunoreactivity to routine B-cell markers, however, expressing markers of plasma cell differentiation. The subtle morphology, rarity and ignorance of this entity can pose a real challenge in rendering an accurate diagnosis of this subtype of LBCL.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-294: FINE NEEDLE ASPIRATION CYTOLOGY: AN EFFECTIVE TOOL IN THE DIAGNOSIS OF METASTATIC LYMPHADENOPATHY IN PERIPHERAL LYMPH NODES

Poonam Sharma ¹

Background: Fine needle aspiration cytology (FNAC) is a simple, safe and rapid investigation in the diagnosis of lymph nodal metastasis. Malignancy in lymph nodes is predominantly metastatic in nature rather than primary. FNAC is particularly useful to differentiate inflammatory lesions and Metastatic deposits, avoids biopsy and aids in clinical staging of the disease. So the study was performed to evaluate the cytomorphological profile of metastatic lymph nodes and to study their site wise distribution pattern.

Material and Methods: This retrospective study was carried out in the Department of Pathology in a tertiary care centre for a period of one year. MGG and PAP stained FNAC slides were reviewed, cytomorphological features studied in detail and Results tabulated.

Results: 78 patients with peripheral metastatic lymphadenopathy formed the material of study. The age of patients ranged from 23 years to 88 years with male to female ratio of 2.25:1. Cervical lymph node (57/78; 73.1%) was the commonest involved group followed by supraclavicular group (12/78, 15.4%) group. Squamous cell carcinoma (44/78; 56.4%) was the commonest metastatic malignancy followed by poorly differentiated carcinoma (13/78, 16.7%) and adenocarcinoma (11/78, 14.1%). Primary site of malignancy was unknown in majority of Cases (56/78, 71.8%).

Conclusions: FNAC is a rapid and cost-effective technique in the evaluation of metastatic peripheral lympahdenopathy. FNAC provides accurate Results with minimal invasion and avoids biopsy, thereby reducing cost and time in making the final diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-295: UNUSUAL INVOLVEMENT OF CERVICAL LYMPH NODE IN A CASE OF MUCORMYCOSIS POST COVID-19

Vedanti Newaskar ¹, Sharda Balani ¹, Reeni Malik ¹

Background: COVID-19 patients may become more susceptible to fungal co-infections. Mucormycosis is an uncommon and often fatal disease which affects lungs, nasal mucosa first.

Case Report: A 43year male presented with complaints of left sided facial heaviness, loss of sensation, left sided facial deviation and blurring of vision since 1 week. Patient is a known Case of DM-II, on medication. He contacted Covid-19 virus 1 month back for which he was advised home isolation and oral steroids for 1 month. O/E in nasal cavity, no blackish curettings noted. No history of epistaxis, oral ulcerations, nasal discharge. USG showed few subcentimetric cervical lymph node noted at neck level II,III on left side. MRI Brain, PNS and Orbit suggestive of Cavernous sinus thrombosis along with possibly left sided mucormycosis. Patient was advised for fine needle aspiration. On gross, there was a single, firm, slightly mobile, non tender swelling of size 3x1cm on left side neck, 3cm below angle of mandible. On microscopy, smear showed polymorphs, lymphocytes, plasma cells, histiocytes and eosinophils. Fair number of foreign body type giant cells and Langhans type of giant cells were also seen. Few foci showed entangled broad ribbon like aseptate and branching hyphae. Overall picture suggestive of Mucormycosis with suppurative granulomatous inflammation.

Discussion: Mucormycosis most commonly affects lungs first and later disseminate to nasal, cerebral and orbital and other regions. It is rare to first isolate fungus in lymph node as in this Case. On further evaluation, patient had cavernous sinus thrombosis which was treated accordingly.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-296: BASALOID SQUAMOUS CELL CARCINOMA: A DIFFICULT DIAGNOSIS IN ASPIRATES FROM METASTATIC LYMPH NODE

Bhawna Sethi ¹, Ashok Sangwaiya ¹, Sapna ¹, Sneha Saini ¹, Snehil ¹, Puja Sharma ¹

Background: Basaloid squamous cell carcinoma is a variant of squamous cell carcinoma which primarily involves upper aerodigestive tract. The cytomorphological diagnosis of this variant is difficult especially in aspirates from metastatic lymph node aspirates.

Case Report: A 69 year male presented with complaints of dysphagia and hoarseness of voice, alongwith left cervical lymph node enlargement. On cytologic examination from lymph node aspirates, the possibility of metastatic deposits from poorly differentiated carcinoma and basaloid squamous cell carcinoma was suggested. CT scan revealed a mass in the left pyriform fossa, and the biopsy proved the diagnosis of basaloid squamous cell carcinoma.

Conclusion: Since it's a high grade variant and its suspicion on aspirates from easily accessible sites may help narrow the search for primary site, a careful examination of cytology should always be done and its suspicion should be addressed.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-297: FINE NEEDLE ASPIRATION CYTOLOGY OF CERVICAL LYMPHADENOPATHY IN A TERTIARY CARE HOSPITAL

Puja Kumari ¹, Kumari Seema ¹

Introduction: Lymphadenopathy is the most common cause of swelling in the neck and commonest presentations in inflammatory and neoplastic disorders. FNAC has been successfully adopted as a routine technique to diagnose the cause of lymphadenopathy in our hospital. FNAC is a simple, quick & inexpensive and equally reliable procedure which can be used as a routine OPD procedure for diagnosis of lymphadenopathy.

Aims: To study the spectrum of cytomorphological features and efficacy of FNAC in cervical lymphadenopathy.

Methods: A retrospective observational and cross sectional study performed on 100 patients in the department of pathology at tertiary care hospital for a period of one year.

Results: Cytomorphological features show reactive lymphadenitis in 2-15age group in 17 Cases, acute suppurative lymphadenitis (2-15 yrs) in 4Cases, granulomatous lymphadenitis (16-26 yrs) in 3Cases, tuberculous lymphadenitis(2-15yrs) in 7Cases. In 100patients, 58 (58%)Cases were males and 42 (42%)Cases were females. Cytological diagnosis in 100Cases of cervical lymphadenopathy, reactive lymphadenitis -55, acute suppurative lymphadenitis- 11, tuberculous lymphadenitis-18, granulomatous lymphadenitis-8, Hodgkin's lymphoma-2, Non Hodgkin lymphoma-2, metastatic ca-1, metastatic SCC-2, metastatic UPSA-1.

Conclusion: Aspiration cytology is a important procedure in establishing the diagnosis of various inflammatory and neoplastic condition of different organs. Although Report of the lesion is still considered due to the lymph node being a highly cellular structure posses a lot of difficulties during its excision, preservation and processing. To summarize the procedure is simple, safe, least traumatizing and acceptable to patient. The study highlights the usefulness of FNAC in early diagnosis in Cases presenting with cervical lymphadenopathy.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-298: FINE NEEDLE ASPIRATION CYTOLOGY OF CERVICAL LYMPHNODES WITH HISTOLOGICAL CORRELATION- STUDY AT A TERTIARY CARE CENTER

Danita G S Edwin ¹, Ganthimathy Sekhar ¹

Background: Cervical lymphadenopathy is a common clinical presentation, frequently attributed to infections like tuberculosis, especially in developing countries like India. However, it could be a manifestation of an underlying malignancy, requiring meticulous investigation. Evaluation by fine needle aspiration cytology (FNAC) or excisional biopsy are the gold standard diagnostic Methods. Our aim was to study the cytomorphological patterns of cervical lymphadenopathies and assess the accuracy of FNAC by histopathological correlation.

Methods: This cross-sectional study was done over a period of 1year (August2020-July2021) on 118patients, who underwent FNAC of cervical lymphnodes in the Department of Pathology. Cytological Reporting was done according to standard guidelines and diagnostic accuracy of FNAC was evaluated by correlating with histopathological findings.

Results: In this study, 57(48.3%) patients were in the age group 11-30yrs, with a slight female preponderance. Of the total Cases, 93(78%) lesions were benign and 22(18%) were malignant. Tuberculous lymphadenitis was the most common benign lesion Reported followed by reactive lymphadenitis. Histopathological correlation was done for 23Cases, of which 17(73%) were concordant with the cytological findings. FNAC was 100% accurate in the diagnosis of malignant lesions.

Conclusion: Simplicity, cost effectiveness, early availability of Results and accuracy makes FNAC a reliable diagnostic tool. Cervical lesions being easily palpable superficial masses, can be readily sampled using FNAC, which eliminates the need of a more invasive procedure like biopsy. FNAC is a reliable diagnostic Method which can be used as a first line investigation in the diagnosis of cervical lymphadenopathies. It is highly accurate in detecting metastatic lymphnode deposits.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-299: CYTOMORPHOLOGICAL STUDY OF LYMPHADENOPATHY IN A TERTIARY CARE CENTRE.

Stanley Samuel ¹, Ankita Raj ¹, Reeta Dhar ¹

Background: Lymph node plays an important role in the immune response. Lymphadenopathy is the most common lesion in any age group. It could be localized or might be an indicator of any underlying inflammatory or neoplastic illness. Our aim is to study the prevalence of lymphadenopathy, epidemiological factors and its underlying etiology along with the cytomorphological analysis of fine needle aspiration of lymph node lesions.

Method: This study was carried out in the Central Clinical Laboratory of our tertiary centre in a period of eight months from January to August 2021. Total 220 patients were sent for FNA of lesions. Out of which FNA of the lymph node was performed in 72 patients during this time period. The procedure was performed after obtaining the clinical history, patient examination and written consent.

Result: Lymph node contributes to 32% of the FNA lesions at our Centre. Cervical lymphadenopathy is the most common site, followed by inguinal. Female preponderance (68%) is seen. Most common age groups involved were in the 2nd and 3rd decade. Majority of patients were diagnosed with tuberculosis followed by other granulomatous inflammatory conditions. Reactive lymphadenitis is seen in 12 % of Cases. Three Cases each of lymphoma, metastasis to lymph nodes were also noted.

Conclusion: FNA is a cheap, reliable, inexpensive, simple procedure that provides early timely intervention, reduces the anxiety and the need for surgery in most patients. However, histopathological correlation or other ancillary tests like flow cytometry, immunocytochemistry or immunohistochemistry, if available, should be done for doubtful Cases.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-300: CORRELATION OF FINE NEEDLE ASPIRATION CYTOLOGY OF LYMPH NODE LESIONS WITH HISTOPATHOLOGY- RETROSPECTIVE STUDY OF 50 CASES

Hemali Vilas Gosavi ¹, B R Sonwane ¹, A R Joshi ¹

Introduction: Lymph nodes are whitish structures, can be easily squeezed by fingers and are present along the course of lymphatic vessels. Lymph nodes may become ill “in sympathy with body”. Lymphadenopathy is one of the commonest presentation in OPD with etiology ranging from inflammatory condition to malignant. Fine needle aspiration cytology was introduced to reduce the number of excisional biopsies of lymph nodes. It is simple, inexpensive, rapid investigative procedure with minimal trauma and low complication. However subsequent histopathological examination of excised biopsy is necessary to correlate cytodiagnosis obtained by FNAC procedure.

Method: 50 patients with lymph node lesions coming to OPD at tertiary health care centre, who are referred to Pathology department for lymph node FNAC and biopsy samples by the clinician, during the period of July 2019 to September 2019.

Results: Total Cases studied- 50, Total cytological and histopathological correlated Cases- 46 Overall cytological and histopathological correlation rate - 92%. Most common site for metastasis- cervical lymph node Majority of Cases were in age group 21 - 30 years. Male to female ratio is 1.08:1

Conclusion: FNAC of lymph node is simple, inexpensive, repetitive, reproducible and less traumatic procedure, which can be easily applied for lymphadenopathy Cases. At times when there is difficulty in diagnosis on cytology, excisional biopsy should be done.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-301: CYTOPATHOLOGICAL EVALUATION OF SPECTRUM OF LYMPH NODE LESIONS - A 3 YEAR RETROSPECTIVE STUDY IN A TERTIARY CARE CENTRE

Jovial Jose ¹, Adarsh Sanikop ¹

Background: Fine needle aspiration cytology (FNAC) is a simple, cost effective and less invasive procedure to assess and diagnose the cause for lymphadenopathy which may range from infectious to various malignancies. Lymph node FNAC being one of the most common procedure encountered in everyday practice, a proper understanding of cytological patterns exhibited by different lymph node lesions is important to give the best diagnosis. The objective of this study is to study and evaluate the patterns of various lymph node lesions on FNAC.

Methods: A retrospective study was done by collecting the slides and Reports of 230 Cases of lymph node FNAC done between July 2018 and June 2021 in our institute and the cytomorphological features were reanalysed and correlated with their etiology.

Results: The age group of patients under study ranged from 5yrs to 76yrs (mean 43 years). Cervical group of lymph nodes were most commonly involved. Out of 230 Cases, 88 Cases were Reported as malignancies followed by 64 Cases as reactive lymphadenitis, 35 Cases as granulomatous lymphadenitis and 27 Cases as suppurative lymphadenitis. 16 Cases were Reported as unsatisfactory for evaluation. Among malignancies, 51 Cases were Reported as metastatic squamous cell carcinoma, 14 Cases as metastatic adenocarcinoma, 10 Cases as metastatic poorly differentiated carcinoma and 13 Cases as lymphoma

Conclusion: FNAC is a simple and rapid tool for early diagnosis of lymph node lesions as it helps to differentiate non-neoplastic and neoplastic conditions and avoid unnecessary lymph node biopsies for the patient for primary diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-302: CYTOLOGICAL FINDINGS ON FNAC IN DRUG DEFAULTERS, IN PATIENTS WITH LYMPH NODE TUBERCULOSIS.

Kavya Varshney ¹, Aarti Kumari ¹, Navpreet Kaur ¹, Sufian Zaheer ¹, Sunil Ranga ¹

Background : Tuberculosis remains a major health problem in the less developed nations and is now a major health problem in developed countries, owing to the emergence of human immunodeficiency virus (HIV) infection and (AIDS). However, despite the availability of effective chemotherapy, patient noncompliance with regimens is the most common reason for therapeutic failures. The aim of this study is to describe the cytological features of drug defaulters on lymph node fine-needle aspiration cytology (FNAC). Due to the common problem of drug defaulters in developing countries like India, we had carried out a study to see the cytological features of drug defaulters on FNAC of the lymph node.

Method: Hundred lymph node tuberculosis Cases, diagnosed based on Mantoux (Mx) test, acid-fast bacilli and/or culture, were followed up for drug compliance by cervical lymph node FNAC.

Result: Fifteen Cases were found to be drug defaulters on detailed and meticulous follow-up. These patients were found to have ill-formed epithelioid cell granuloma with some viable epithelioid cells enmeshed in fibrous tissue elements. Other findings were degenerating epithelioid cells with or without surrounding eosinophilic infiltration and leaching of the degenerating lymphoid and epithelioid cells.

Conclusion: Lymph node FNAC can be used to identify tubercular drug defaulters, which may be time consuming and/or expensive by culture or other ancillary means.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-303: CYTOMORPHOLOGICAL PATTERNS OF TUBERCULAR LYMPHADENITIS ENCOUNTERED IN ROUTINE PRACTICE- AN EXPERIENCE IN A TERTIARY CARE CENTRE

Maheshri Deshpande ¹, Geet Bhuyan ¹

Background: FNAC is an easy, noninvasive, cost effective minor surgical procedure with almost no complications in diagnosing tubercular lymphadenitis which is the most common cause of lymphadenopathy in India.FNAC is the simplest diagnosing tool to study the cytomorphological patterns of tubercular lymphadenitis.

Methods: The Retrospective study was done in our department, between 2018 and 2021. The study included 305 fine needle aspiration smears of lymph node of various sites which are Zn positive. While the other Cases which were not positive on ZN were positive on microbiological analysis. Four patterns of tubercular lymphadenitis were encountered in our study namely : Pattern A- Epithelioid granuloma without necrosis, Pattern B -Epithelioid granuloma with necrosis, Pattern C-Necrosis without epithelioid granuloma with neutrophilic infilterate, Pattern D-With numerous macrophages.

Results: four patterns were observed among 305 Cases are as follows: Pattern A :69 Cases, pattern B: 80 Cases, Pattern C:134 Cases, Pattern D:22 Cases.

Conclusion: FNAC is an useful noninvasive technique for diagnosing and to study the cytomorphological pattern of tubercular lymphadenitis. The sensitivity can further be increased by complementary cytomorphology with acid fast staining.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-304: A COMPARATIVE STUDY OF THE ROLE OF CYTOPATHOLOGY, STAINING FOR ACID FAST BACILLI AND MOLECULAR ANALYSIS USING GENEXPERT MTB/RIF ASSAY IN THE DIAGNOSIS OF TUBERCULAR LYMPHADENOPATHY

Saqib Ahmed ¹, Hena A Ansari ¹, Nazoora Khan ¹, Nazish Fatima ²

Background: Tuberculosis(TB) is a chronic endemic disease with an incidence of 2.69 million Cases in India and 10.0 million globally. The diagnosis of tubercular lymphadenopathy, can be made by FNAC combined with staining for AFB along with newer Methods like GeneXpert assay.

Objectives: To evaluate the role of cytopathology, AFB staining and GeneXpert assay in the rapid diagnosis of tubercular lymphadenopathy along with the usefulness of GeneXpert assay in the diagnosis of indeterminate aspirates.

Materials and Methods: This study was a two-year prospective study conducted from 2018 to 2020.A total of 330 patients presenting with lymphadenopathy and clinical suspicion of a tubercular etiology were included and comparative analysis was done.

Results: Most common age group affected were of adults (20-59 years) comprising of 183 patients(56%) followed by 66 patients (20%)in paediatric age group. 189 were females(57.3%) and 141 were males (42.7%). Cervical group of lymphnodes were most commonly involved (66%). Four major cytomorphological pattern were recognised with epithelioid cell granuloma with necrosis being the most common.69.1% were AFB positive in 201 smears with features favouring tubercular infection (positive cytology) while 72 Cases (55.8%) were AFB positive on Cases with indeterminate cytology. 183 Cases (91.0%) were GeneXpert positive in Cases with positive cytomorphology and 108 Cases (83.7%) positive with indeterminate cytomorphological picture.

Conclusion-FNAC combined with ZN staining and GeneXpert has a much higher diagnostic accuracy, GeneXpert further prevents underdiagnosis and enables rapid and accurate diagnosis in Cases with indeterminate/inconclusive FNAC and ZN staining.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-305: CYTOLOGICAL SUSPICION OF DIFFUSE LARGE B CELL LYMPHOMA MIMICKING HODGKIN'S LYMPHOMA

Dipanjan Sinha ¹, Suhailur Rehman ¹, SH Arif ¹, Kafil Akhtar ¹, Veena Maheshwari Mohammed Jaseem Hasan ¹

Background: Lympadenopathy is a common presentation of a multitude of disease. FNAC is the first line investigation to diagnose the cause. It is an affordable investigation and gives us valuable clues towards the definitive diagnosis often clinching it. The most common differentials in patients with multiple lymph nodes are either metastatic carcinomas or lymphomas.

Case Report: A 60 year old lady presented with generalised lymphadenopathy, fever, malaise and generalised weakness. FNAC from the cervical lymph nodes were done. Good cellularity smears showed lymphohistiocytic clusters with polymorphous lymphoid cell population with few prominent cells having bi nucleate owl eye nucleus with basophilic cytoplasm with surrounding rich chronic inflammatory cells. No granulomas were seen in the smears examined. A probable diagnosis of Hodgkin's lymphoma was made. However according to institution protocol a battery of markers were applied. Pan CK,CD 45, CD 15, CD 30, CD3 and CD 20 were applied. CD 45, CD 20 was positive while CD 3, CD15 & Pan CK was negative. CD 30 showed focal positivity. Based on the morphology and IHC panel, a diagnosis of CD 20 positive Diffuse Large B- Cell Lymphoma was made. Rituximab was started and patient responded well.

Conclusion: Along with careful inspection of the routine FNA smears for lymphadenopathy a basic cocktail of markers must be applied to rule out any high grade lymphomas or metastatic carcinoma for the patient as we see in the above Case.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-306: CARCINOMA URINARY BLADDER PRESENTING AS CERVICAL LYMPH NODE METASTASIS: A CYTOLOGICAL DIAGNOSIS

Shreya Sadhu ¹, Rakshay Kaul ¹

Background: Bladder carcinoma usually metastasizes to regional pelvic lymph nodes, lungs, liver and bones. Metastasis to non-regional lymph nodes especially cervical lymph nodes is an extremely rare presentation, which is associated with poor prognosis and low survival rate.

Case Report: We Report a Case of a 65 year old male patient who presented to the clinician with chief complaints of hematuria, weight loss and swelling right side of neck. We initially received voided urine sample for malignant cytology in our department. Smears were prepared and a diagnosis of High Grade Urothelial Carcinoma (HGUC) was made as per Paris System for Reporting urinary cytology. FNAC from cervical lymph node was done which showed small clusters and dissociated malignant cells with central to eccentric nuclei along with Background lymphocytes and a diagnosis of metastatic TCC was made. CT scan of the abdomen and pelvis was done which showed a heterogeneously enhancing polypoidal mass lesion involving base and right lateral wall of urinary bladder measuring around 5x3x2 cm and a diagnosis of carcinoma urinary bladder was made. Thereafter, the patient underwent transurethral resection of bladder tumour at our centre. On histological examination, a diagnosis of muscle invasive high grade urothelial carcinoma was confirmed.

Conclusion: The importance of urine cytology in diagnosis and follow up of urothelial carcinomas cannot be emphasised enough. Furthermore, cervical lymphadenopathy in a suspected Case of carcinoma urinary bladder should be aggressively evaluated as it can be due to metastasis, albeit rarely.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-307: CYTOPATHOLOGICAL PATTERN OF TUBERCULAR LYMPHADENOPATHY ON FINE NEEDLE ASPIRATION CYTOLOGY (FNAC) IN A TERTIARY CARE HOSPITAL

Manjari ¹, Md Wakeel Ahmed ¹, Kr Seema ¹, Aakash ¹

Background: Fine Needle Aspiration Cytology of lymph nodes is a simple, cost effective procedure. In tuberculous lymphadenitis, it is used for cytological diagnosis, ziehl-Neelsen staining, AFB culture.

Aims: To evaluate the cytopathological pattern of FNAC aspirate of patients presenting with lymphadenopathy with special reference to tuberculous lymphadenopathy.

Materials and Methods: All the patients referred to the cytopathology lab for FNAC of lymph nodes between september 2020 to August 2021 were included. Out of 300 patients presenting with lymphadenopathies, there were 175 Cases of tuberculous lymphadenitis. The cytopathological findings of these 175 Cases were analyzed.

Results: A female preponderance was noted in our study. Cervical lymph nodes were the most common lymph nodes to be involved. Gross examination of aspirate showed maximum Cases of whitish material. Ziehl-Neelsen staining showed overall AFB positivity of 43%. Maximum AFB positivity was seen in Cases having Caseous necrosis with granuloma.

Conclusion: FNAC with ziehl-Neelsen staining should be the 1st line investigation in Cases with lymphadenopathy in a developing country.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-308: CYTOHISTOLOGICAL CORRELATION OF HODGKIN LYMPHOMA

Rasheeda ¹, Uma Handa ¹, RPS Punia ¹, Phiza Aggarwal ¹, Ranjeev Bhagat ¹, Ashwani Kumar Dalal ²

Background: Hodgkin lymphoma (HL) is a hematopoietic neoplasm characterised by the presence of malignant Reed Sternberg (RS) cells in an inflammatory Background. The cytological features of HL have been well established, yet it accounts for most of the false-negative fine-needle aspiration (FNA) of malignant lymphomas. This study Aims to assess the diagnostic reliability of FNA in HL and evaluate the factors contributing to its discordance, taking histopathological diagnosis as the gold standard.

Methods: This was a retrospective study of 5years duration in which histopathological diagnosis of HL was correlated with its prior cytological diagnosis. A total of 44 Cases were Reported as HL on histopathology, out of which 28 Cases (65.9%) had a prior cytological evaluation and were available for review.

Results: The patient's age ranged from 3 to 80 years (median: 44yrs) with a M: F ratio of 3.4: 1. The cervical lymph node was the most common site of aspiration (51.6%). A concordance of 71.4% (20/28) was observed between FNA of HL and its histopathological diagnosis. The remaining 8 Cases had discordant diagnosis, which included reactive lymphadenitis (4), non- Hodgkin lymphoma (3) and malignant small round blue cell tumour (1).

Conclusions: FNA is a rapid first-line diagnostic Method in lymph nodal aspirations. In HL, the reasons for discordance in the cytological diagnosis can be due to the misinterpretation of RS cells, focal involvement of the lymph node and an abundance of reactive inflammatory milieu. Although FNA is a reliable tool for diagnosing HL, a biopsy is required for its confirmation.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-309: FNA VERSUS FNNAC TECHNIQUE AS A CYTODIAGNOSTIC TOOL IN CERVICAL LYMPHNODE SWELLINGS- A COMPARATIVE STUDY

D Arunjyothi ¹, Khader Fhaheem ¹, G Lavanaya ¹, Nagendra Prasad ¹, BV Sai Prasad ¹, AV Lakshmi ¹

Background: FNAC is the first line technique in the diagnosis of LYMPHNODE swellings. It is simple, relatively painless OP procedure & economical. FNNAC- Fine Needle Non Aspiration Cytology was first developed in 1982 & first performed in breast. FNNAC also known as cytopuncture/ Fine Needle Capillary Sampling. Present study is to compare advantages & disadvantages of both FNAC & FNNAC procedures, with the reference to MAIR SCORING SYSTEM.

Materials and Methods: The study was carried out on 180 Cases who presented with palpable cervical lymphnode swellings in Cytology Section in the Department Of Pathology, SVRRGGH, Tirupati from SEP 2020-Aug2021& were subjected to both FNAC & FNNAC procedure after obtaining a detailed history, conducting general & physical examinations. Slides are stained with H&E, correlated with MAIR SCORING SYSTEM.

ResultS: According to MAIR SCORING SYSTEM a cumulative score was obtained for each Case into 3 categories- 1)Cat-1: Unsuitable for Cytological Diagnosis 2)Cat-2: Diagnostically Adequate 3)Cat-3: Diagnostically superior. FNAC procedure obtained Diagnostically Adequate samples compared to FNNAC procedure. FNNAC procedure obtained Diagnostically Superior samples compared to FNAC procedure. Most common lesions in cervical lymphnode swellings are Non neoplastic lesions 120(66.66%), among commonest is Necrotising granulomatous lymphadenitis (41.66%),among neoplastic lesions60(33.33%), most common is SCC DEPOSITS (41.66%). Female to male ratio-1.2:1.

Conclusion: Non neoplastic lesions are more common in cervical lymph nodes. FNAC is essential test to rule out metastatic malignancy, to know the tumor type pre-operatively to decide the line of management. FNNAC Diagnostically Superior than superior than FNAC & in terms of adequacy FNAC is superior than FNNAC.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-310: COMPARATIVE EVALUATION OF GENEXPERT WITH CONVENTIONAL TECHNIQUES IN EVALUATION OF TUBERCULAR LYMPHADENITIS

Poonam Sharma ¹, Deepaka Kumari ¹

Background: Tubercular lymphadenitis must be distinguished from reactive lymphadenitis because it requires anti-tubercular therapy for 6-9 months. So the study was performed to evaluate the cytomorphological features of tubercular lymphadenitis on FNAC and compare the role of Zeihl-Neelsen (ZN) stain, mycobacterial culture and PCR in detection of Mycobacterium tuberculosis (MTB).

Material and Methods: This prospective observational study was carried out in the department of Pathology and microbiology over a period of one year. FNAC was performed in 80 patients with peripheral lymphadenopathy and clinical diagnosis of tuberculosis and 45 patients formed the study material (blood mixed aspirates were excluded due to presence of PCR inhibitors). Aspirated material was divided into 3 parts, one each for cytology, culture and GeneXpert and evaluated for presence of MTB.

Results: Cervical region was the commonest site of involvement (71.1%) followed by submandibular (13.3%) and supraclavicular region (8.9%). Purulent aspirate was seen in 68.89% Cases followed by whitish aspirate (24.44%) and dirty aspirate (6.67%). On cytomorphpological evaluation, features of tuberculous lymphadenitis were seen in 82.2% Cases while suppurative and reactive lymphadenitis were seen in 11.11% and 6.67% Cases respectively. ZN stain was positive in 17.78% Cases whereas geneXpert was positive in 60% Cases and culture in 11.11% Cases. The sensitivity of geneXpert was higher as compared to ZN stain while ZN stain showed greater specificity in our study.

Conclusions: GeneXpert is an effective tool for rapid detection of MTB compared to ZN stain and culture and must be included along with conventional Methods in the evaluation of tubercular lymphadenitis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-318: MARGINAL ZONE LYMPHOMA THYROID

Sanya Bhasin ¹, Anuradha Kusum ¹, Mansi Kala ¹, Sampan Singh Bist ¹

Background: Marginal zone B- cell lymphoma is a major category of thyroid lymphomas. These are most common in elderly females. These usually arise on pre-existing Hashimoto thyroiditis. FNAC is an efficient diagnostic tool for thyroid malignancies.

Case Report: We Report a Case of a young female, age 33 years who presented with anterior neck swelling and weight loss for 2 months. Thyroid function tests were normal. CECT Neck showed a diffuse mass in thyroid gland with retrosternal extension with bilateral cervical lymphadenopathy. FNAC done on the anterior neck swelling showed a round cell malignancy suggestive of a lympho-proliferative disorder associated with auto immune thyroiditis (Bethesda thyroid Reporting system Grade 5). Flow cytometry on the Fine Needle Aspirate revealed CD5 and CD10 negative B lineage NHL with features favouring Marginal zone lymphoma of thyroid.

Discussion: It emphasises the role of Fine Needle Aspirate in flow cytometry and how flow cytometry improves the efficacy of diagnosis made on FNAC.

Conclusion: FNAC along with flow cytometry helps in making early and apt diagnosis. It also prevents the patients from undergoing more invasive procedures like biopsies and lobectomy for diagnosis, which would be time consuming.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-319: FOLLICULAR CARCINOMA OF THYROID PRESENTING WITH SOFT TISSUE METASTASIS: AN UNCOMMON FINE NEEDLE ASPIRATION DIAGNOSIS

Aakhil Nadesan ¹, Sonam K Pruthi ¹, Kamlesh ¹, Namrata Sarin ¹, Sompal Singh ¹

Background: Metastasis from follicular carcinoma of thyroid presenting as subcutaneous swelling

Case Report: A-60-year-old elderly female presented with long standing swelling over the right shoulder. Thyroid was enlarged on examination and along with the routine work-up of patient, serum thyroid function tests,Ultrasonography and Chest X-ray were performed. FNAC was performed from both the swellings i.e., thyroid gland and shoulder, and a provisional diagnosis of metastatic follicular carcinoma of thyroid was made.

Conclusion: A combination of proper history, along with serological markers, and fine needle aspiration cytology findings are necessary to make a provisional diagnosis of thyroid neoplasms. Also, a long term follow up is necessary to knock down the impact of metastasis in previously diagnosed follicular thyroid carcinomas.

Keywords: follicular thyroid carcinoma, metastasis, cytology

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-320: METASTATIC PAPILLARY CARCINOMA THYROID WITH INTRACYTOPLASMIC LUMINA: A DIAGNOSTIC PITFALL IN ASPIRATION CYTOLOGY

Neeta Kumar ¹, Ruchika Gupta ¹, Sanjay Gupta ¹

Background: Papillary carcinoma of the thyroid (PTC) is believed to be a mucin-negative tumor. There have been only rare Reports of mucin, extracellular or intracellular, in Cases of PTC on aspiration cytology.

Case Report: A 68-year-old female presented with a right lateral cervical swelling, six years after undergoing a thyroidectomy, details of which were not available. Aspiration cytology of the swelling showed cohesive clusters, papillaroid fragments as well as dispersed cells. The cells displayed moderate amount of cytoplasm, vesicular nucleus with frequent nuclear grooves and occasional pseudoinclusions. Scattered cells showed a signet ring-like appearance with large intracytoplasmic vacuole, sometimes having a targetoid appearance. Background also showed mucin-like material. A cytological impression of metastatic papillary carcinoma of the thyroid with mucinous metaplasia was rendered.

Conclusion: Mucinous metaplasia is an uncommon occurrence in papillary carcinoma of thyroid and should be considered in the differential diagnosis during cytological evaluation of a metastatic carcinoma in head and neck region.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-321: MELANOTIC VARIANT OF MEDULLARY CARCINOMA OF THYROID- REPORT OF A RARE CASE

Krachi Agarwal ¹, Prof U S Singh ¹, Riddhi Jaiswal ¹

Background: Melanin production in medullary carcinoma thyroid is a very rare entity. Medullary thyroid carcinoma (MTC) is a malignant tumor of thyroid exhibiting C-cell differentiation. They have a confirmed ability for multi-directional differentiation Resulting in subtypes, like mucin producing, melanin producing and MTC with squamous differentiation.

Case Report: A 60-year-old male presented with complaints of cervical swelling for 20 days with incidental thyroid swelling. A fine needle aspiration (FNA) was performed using a 23G needle. FNA smears from cervical swelling were cellular showing atypical cells which were large, plump to oval with abundant brown pigment deposition in the cytoplasm. These cells were pleomorphic with occasional binucleate and multinucleate forms. Smears from the thyroid swelling also revealed the cells of above-described morphology. Provisional Diagnosis: 1. Malignant Melanoma with metastasis to thyroid 2. Anaplastic Carcinoma thyroid with lymph node metastasis 3. Melanocytic MTC with lymph node metastasis. Immunohistochemistry panel for confirmation shows diffuse immunopositivity for Calcitonin, HMB45 and S100 in tumor cells.

Conclusion: Thyroid examination should always be done in cervical swelling Cases to exclude lesions arising from thyroid. Melanocytic differentiation in medullary thyroid carcinoma is extremely uncommon. There is a need to Report greater number of Cases for categorization of this subtype as it appears to be more aggressive. Therefore, an early diagnosis and regular monitoring are key factors that may improve patient prognosis.

References

1.Hirokawa M, et al. Malignant melanoma arising in melanin-producing medullary thyroid carcinoma. International journal of surgery Case Reports. 2016 Dec 31;20:118–22. doi: 10.1016/j.ijscr.2016.01.029. [DOI] [PMC free article] [PubMed] [Google Scholar]
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J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-322: AN UNUSUAL CASE REPORT OF PAPILLARY THYROID CARCINOMA WITH COLUMNAR VARIANT DIAGNOSED BY FNAC

Rahul ¹, Neeraj Dhameja ¹, Late Vikas Kumar(SR) ¹

Background: The columnar and tall cell variant of papillary carcinoma of thyroid are uncommon variant and regarded as more aggressive form as compare to more common classic papillary and follicular sub-types. Cytological diagnosis of these rare variant is as nuclear feature of usual papillary thyroid carcinoma are very often absent.

Case Report: A 30 year male presents with midline nodular swelling size 2.5x2.5 cm since 1 year, progressively increased in size. The aspirate are hyper cellular sampling showing large fragment of cells showing nuclear overlapping with oval enlarged nucleus with fine chromatin and grooving and inclusion are seen. Clusters of cells showing nuclear stratification with nuclear hyperchromasia. Based on these findings diagnosis was malignant neoplastic lesion probably papillary thyroid carcinoma was made with differential diagnosis of medullary carcinoma of thyroid. Subsequent excision was done showing a tumor with papillary architecture with nuclear feature of papillary thyroid carcinoma also identified area showing follicles with marked nuclear stratification and hyperchromatic nuclei was seen.

Conclusion: Nuclear overlapping, oval enlarged nucleus, grooving and nuclear stratification shows feature of papillary carcinoma of thyroid columnar variant. Immunohistochemical staining to rule out other thyroid neoplasms can be done to aid in diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-323: EVALUATION OF THYROID SWELLING BY BETHESDA SYSTEM FOR REPORTING THYROID CYTOPATHOLOGY WITH HISTOPATHOLOGICAL CORRELATION

Umme Salma Farhin ¹, Bandita Das ¹, Aseema Das ¹

Introduction: Thyroid FNAC is the first line diagnostic test for evaluating a thyroid lesion. The Bethesda System has been widely accepted worldwide, as it not only categorize the thyroid lesions but also explains well defined risk of malignancy with further guidance for clinical management.

Aim and Objectives: To evaluate thyroid cytology smears by Bethesda System, to correlate them with histopathological diagnosis & calculate the risk of malignancy.

Materials and Methods: A total of 127 Cases were studied from 1st July 2019 to 30th June 2020 in the department of Pathology, Assam Medical College & Hospital. FNAC was done in all the patients, & 67 patients subsequently underwent surgical resection. Cytological diagnoses were correlated with histopathological Result, & risk of malignancy was calculated.

Results: Majority of the patients were in the age range of 31-40 years,with male to female ratio of 1:4.52. As per FNAC diagnosis, category I (Non-diagnostic) Cases were 3.15%, category II (Benign)- 85.04%, category III (Atypia of undetermined significance)- 2.36%, category IV (Follicular neoplasm/Suspicious for follicular neoplasm)- 3.15%, category V (Suspicious for malignancy)- 1.57% and category VI (Malignant)- 4.72%. Sensitivity, specificity, positive predictive value, negative predictive value & diagnostic accuracy were found to be 80.0%, 100%, 100%, 98.04% and 98.18% respectively. The rates of malignancy of Bethesda categories I, II, III, IV, V, and VI were 0%, 1.92%, 33.33%, 25%, 100%, & 100% respectively.

Conclusion: The study has shown high sensitivity, specificity and diagnostic accuracy, thus recommending the universal use of the Bethesda system in Reporting thyroid cytopathology.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-324: ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY IN EVALUATION OF THYROID LESIONS AT A TERTIARY CARE HOSPITAL

Kirti Moradiya ¹, Rasik N Hathila ¹, Prashant Patel ¹, Archana Patel ¹

Background: Thyroid lesions are one of the significant clinical problems countered in most of patients coming to the tertiary care units. Fine needle aspiration cytology (FNAC) of thyroid is first line diagnostic test for evaluating a thyroid nodule. FNA evaluation by The Bethesda System of Reporting Thyroid Cytopathology (TBSRTC), 2017 of thyroid nodule reduces load of unnecessary surgeries for benign lesion and guides for timely intervention when there is significant risk of malignancy.

Method: A retrospective observational study of 50 patients with thyroid lesions who underwent Fine Needle Aspiration procedure conducted between January 2021 to August 2021 in Department of Pathology at Government Medical College, Surat. Cytology smears (Hematoxylin & Eosin, May GrunwaldGiemsa and Papanicolaou stain) were evaluated and Reported according to The Bethesda System of Reporting Thyroid Cytopathology.

Results: Females 42 (84%) outnumbered Males 08 (16%). 50 Cases were distributed in following categories as per TBSRTC:- Category I (Non-diagnostic or unsatisfactory) – 3 Cases (6%); Category II (Benign) – 39 Cases (78%); Category III (AUS/FLUS) – 4 Cases (8%); Category IV (FN/SFN) – 2 Cases (4%); Category V (SM) – 1 Case (2%); Category VI (Malignant) – 1 Case (2%).

Conclusion: FNAC is easy to perform, cost effective and minimally invasive with few complications. It has high sensitivity in diagnosis of thyroid malignancy and also has high diagnostic accuracy in the evaluation of thyroid disorders.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-325: METASTATIC FOLLICULAR CARCINOMA PRESENTING AS CHEST WALL SWELLING

Lalhmingmawii Renthlei ¹, Nilam More ¹, Kavita Sawant ¹, Leena P Naik ¹

Background: Follicular thyroid carcinoma accounts for 5-10% of all thyroid carcinomas. Risk factors include iodine deficiency, older age, female gender and radiation exposure. It dessiminates hematogenously and metastasizes to lungs, bones, brain, liver and other organs.

Case Report: A sixty-two years old female presented with left chest wall swelling since two years. On examination, it was 3x3cm nodule, firm, non-mobile, non-tender, ill-defined at the level of medial aspect of third and fourth rib away from breast. There were no other palpable nodule in breast, nipple-areolar-complex was normal. Fine needle aspiration cytology (FNAC) was performed from the chest wall lesion, it showed clusters of cells forming follicular pattern, with enlarged round nuclei, coarse chromatin and intrafollicular colloid. Retrospective examination of thyroid revealed no visible or palpable swelling in the anterior neck and was euthyroid. Hence, ultrasound guided FNAC was advised which showed a single small 1.2x1.2cm sized well defined nodule with rim of calcification. FNAC from this thyroid nodule showed clusters and dissociated thyroid follicular cells with microfollicular pattern. Cells had enlarged hyperchromatic nuclei, irregular nuclear membrane, coarse chromatin and colloid within the follicles. Background showed necrotic material which confirmed that this was a Case of follicular carcinoma of thyroid. Follow up biopsy confirmed the diagnosis.

Conclusions: Solitary rib metastasis from follicular carcinoma thyroid as a first presentation is very unusual and hence should be included in differential diagnosis when evaluating the chest wall swelling

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-326: FOLLICULAR CARCINOMA OF THYROID WITH INTRACRANIAL METASTASIS

Kanika Raturi ¹, Aditi Agarwal ¹, Prajwala Gupta ¹, Minakshi Bharadwaj ¹

Background: Follicular carcinoma of thyroid (FCT) constitutes 5% of thyroid carcinoma and usually presents as a solitary mass. Follicular carcinoma disseminates most commonly by hematogenous route to bone, lung and liver. Intracranial metastasis is rarely seen with FCT

Case Report: We Report a Case of 48 year old female who presented with a thyroid swelling along with a swelling in the occipital region on the right side. Swellings were associated with pain and fever. On NCCT head scan, a provisional diagnosis of nerve sheath tumor with intracranial extension or skull base tumor was made. Fine needle aspiration was attempted from both occipital and thyroid swellings and the smears prepared showed features of follicular carcinoma with metastasis to the occipital region. Immunohistochemistry also confirmed the same

Conclusion : Brain metastasis are very rare in differentiated thyroid carcinoma and seen in only 0.9% Cases. FNAC of overlying scalp swelling in such Cases may lead to prompt diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-327: CYTODIAGNOSIS OF SUBACUTE GRANULOMATOUS THYROIDITIS (DE QUERVAIN'S THYROIDITIS):- A REPORT OF FOUR CASES

Apurva Rangari ¹, Mona Agnihotri ¹, Kanchan Kothari ¹, Seth GS ¹

Background: Subacute granulomatous thyroiditis (SGT)/ De Quervain's thyroiditis is a rare self-limiting inflammatory disease, accounting for 3% of all thyroid disorders. Most commonly seen in middle aged women, it shows a characteristic triad of pain in the anterior cervical region, increased ESR and recent history of viral upper respiratory tract infection. The disease usually presents as a diffuse thyroid swelling and rarely as a solitary nodule, simulating a neoplasm. In atypical clinicoradiologic presentations, fine needle aspiration cytology (FNAC) becomes important to render an accurate diagnosis.

Methods: We Report four Cases of SGT, diagnosed on FNAC over a period of 5 years (2016-2021). All patients were females. Mean age was 34 years and they presented with pain in the anterior neck of 15 days to one month duration. Thyroid swelling was grade 0 in two Cases while grade 1 and 2 in the other two. Three Cases were hyperthyroid and one was euthyroid. Ultrasound showed hypoechoic nodules with internal vascularity in 3/4 Cases.

Results: All Cases showed follicular epithelial cells with lymphocytes, numerous multinucleated giant cells (MNGCs) and epithelioid granulomas. Two Cases showed engulfed colloid within MNGCs. Some of these features may also be seen in Hashimotos thyroiditis, granulomatous infections, sarcoidosis, papillary thyroid carcinoma etc. Morphology of the MNGCs is an important feature as the giant cells in SGTare numerous, show mega forms, angulated cytoplasm and phagocytosed colloid. All Cases resolved on follow up.

Conclusion: Familiarity with cytomorphology of SGT and awareness of the clinical setting is essential for making an accurate diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-328: A CYTOMORPHOLOGICAL COMPARISION BETWEEN LIQUID BASED CYTOLOGY AND CONVENTIONAL SMEAR IN FINE NEEDLE ASPIRATION OF BENIGN THYROID LESION

Divya Jyoti ¹, Sruthi pallekonda ¹, Suchita Sharma ¹, Shilpi Agarwal ¹

Background: LBC has achieved great success in gynecologic cytology and generated huge interest for non gynecological sample processing due to various advantages and potential ancillary applications. In present study, we aimed to study the morphological difference of thyroid cytopathology on LBC that might alter diagnostic interpretation.

Methods: Study included 450 patients presenting with palpable thyroid nodule between august 2014 to march 2018. Conventional smear and liquid based cytology(sure path) were prepared for each patient. Cytomorphological assessment was done using Bathesda system for Reporting thyroid cytopathology 2017.

Result: Category 2(Benign) included colloid goitre, Hashimoto's thyroiditis and hyperplastic nodule. Overall 399(88.5%) Cases were given a benign diagnosis by conventional smear which comprised of colloid goitre 300(66.5%) Cases, Hashimoto's thyroiditis 81(18%) Cases and hyperplastic nodule 18(4%) Cases. Overall 367(79.3%) Cases were given benign diagnosis by Liquid based cytology which composed of colloid goitre 261(58%) Cases, Hashimoto's thyroiditis 78(17.3%) Cases, hyperplastic nodule 18(4%) Cases.

Conclusion: Colloid goitre were diagnosed less often on liquid based cytology than conventional smear because of significant reduction in colloid on liquid based cytology slide. Hashimoto's thyroiditis showed slightly lower diagnostic rate by liquid based cytology and hyperplastic nodule can be diagnosed equally on both conventional smear and liquid based cytology.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-329: ISOLATED MEDULLARY THYROID CARCINOMA

Ankit Singh ¹, Vatsala Kishore ¹, Neeraj Singh ¹, Vaishali Kotasthane ¹, Dhananjay Kotasthane ¹

Background: Medullary thyroid carcinoma (MTC) is a rare Neuroendocrine tumor, driven from parafollicular C-cell origin, which occur in two forms sporadic and familial.

Case Report: A 55 year old male presented with complaint of mid-line neck swelling since 2 month gradually progressive in nature

Conclusion: This Case highlight the significance of the rare form of sporadic MTC which can present with a wide array of symptoms while also emphasizing the importance of diagnostic tool, punctuality and treatment measures needed to minimize adverse outcome, ensuring better prognosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-330: LARGE AXILLARY SWELLING UNVEILING EXTENSIVE METASTATIC DISEASE FROM AN OCCULT PRIMARY FOLLICULAR CARCINOMA THYROID– A CYTOLOGIC DIAGNOSIS

Manveen Kaur ¹, Brijdeep Singh ¹, RPS Punia ¹, Sudhir Garg ¹

Background: Follicular thyroid carcinoma (FTC) is the second most common primary thyroid neoplasm which may metastasize to lung, liver, bones, etc. Initial presentation of FTC as large soft tissue metastasis prior to diagnosis of primary tumor is extremely rare.

Case Report: A 50 year old female presented with complaints of pain in left thigh and inability to bear weight. On examination, a 9.5x8.5 cm, firm swelling was noted in right axilla extending upto scapular region. Clinical suspicion was of a metastatic breast neoplasm. FNAC from swelling revealed sheets, clusters and repetitive microfollicular arrangement of round to oval tumor cells with stippled nuclear chromatin and minimal cytoplasm. Focal areas showed scant inspissated material (?colloid). Differential diagnoses of metastatic follicular thyroid carcinoma and small blue round cell tumor were considered. Immunocytochemistry on cell block revealed diffuse strong nuclear positivity for TTF-1 and focal positivity for cytokeratin. Tumor cells were negative for CD99, CD10 and vimentin. So FNA diagnosis of metastatic carcinoma, likely from follicular carcinoma thyroid was rendered. Subsequent radiological examination showed multiple lesions in bilateral lungs, left kidney, sacroiliac joint and scalp. No lesion was found in both breasts. USG neck showed a 3x2cm mass lesion in right lobe of thyroid. Histopathological examination of biopsy from fracture, femur also showed metastatic follicular thyroid carcinoma.

Conclusion: This Case reiterates the utility of FNA as initial diagnostic modality in soft tissue lesions. It is instrumental in guiding further investigations and work up in Cases with extensive metastatic disease from an elusive primary.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-331: COLUMNAR CELL VARIANT OF PAPILLARY THYROID CARCINOMA- A DIAGNOSTIC DILEMMA IN CYTOLOGY

Gayathri Raj ¹, Anjana M ¹, Rari P Mony ¹, Deepthi B ¹, Sindhu Nair P ¹, Jayasree K ¹

Background: The columnar cell variant of papillary thyroid carcinoma (CCVPTC) is a rare, aggressive variant which accounts for 0.15-0.2% of all papillary thyroid carcinomas. Cytological diagnosis of CCVPTC is tricky as it lacks the characteristic nuclear features of classical papillary carcinoma thyroid. This variant with a propensity for early lymph node metastasis and high recurrence rate shows very little response to radioiodine ablation therapy.

Case Report: A 19year old female presented with a small palpable firm mobile subcutaneous swelling measured 1x1cm, on the right side of neck for 6months duration. FNAC showed a cellular smear with columnar cells having scant cytoplasm were arranged in papillaroid clusters and occasional rosettes. The nuclei were ovoid to elongated with granular chromatin and showed significant crowding and pseudo-stratification. They lacked typical features of papillary carcinoma thyroid like nuclear pseudo-inclusions and grooves. A provisional diagnosis was given as poorly differentiated carcinoma with differentials of CCVPTC and medullary carcinoma thyroid. Metastatic carcinoma was also considered in the differential diagnosis. Detailed history revealed a previous total thyroidectomy 1year back and those slides were reviewed. Meanwhile the patient underwent surgical excision of subcutaneous nodule and the specimen received for histopathological examination. The histopathology of excision biopsy and slides for review showed similar cytomorphology as seen in the fine needle aspiration smears and immunohistochemistry confirmed it to be primary columnar cell variant of papillary thyroid carcinoma recurrence.

Conclusion: Here we are presenting this Case to convey the importance of understanding the morphology of CCVPTC in cytology smears to avoid erroneous diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-332: MEDULLARY THYROID CANCER: A CASE SERIES REPORT

Rituparna Dhekial ¹, Junu Devi ¹

Background: Medullary thyroid carcinoma (MTC) is a rare neuro-endocrine tumour arising from C-cells of thyroid gland,having 5% incidence. MTC can be sporadic or familial. Around 20-25% familial MTC Cases may be associated with hereditary syndromes like MEN 2A & 2B. Raised serum calcitonin provides a marker of residual and recurrent disease. Counselling is necessary for familial Cases. The primary management of MTC is surgical. Survival rate is related mainly to the age of patient, stage of disease and completion of the surgical resection. Early diagnosis by FNAC would lead to a markedly improved cure rate.

Methods: Retrospective review of 3 Cases (one familial, two sporadic) who were diagnosed with MTC in the department of Pathology,GMCH,from January 2020 to August 2021. All the patients had preoperative assessment including history taking, clinical examination, tumour marker (calcitonin), thyroid function testing, ultrasonography and Fine Needle Aspiration Cytology (FNAC) using MGG and PAP stains.

Results: The mean age of diagnosis was 36.6 years of age. All the three Cases were females. The diagnosis was established by FNAC. Plasmacytoid cell pattern was observed in two Cases and spindle cell pattern in the third Case with significant amount of amyloid in the Background. The sensitivity of serum calcitonin for the detection of MTC was about 100%. As all the 3 patients had localized tumour, survival is good for all of them.

Conclusion: Cytomorphological evaluation by FNAC is very important for early diagnosis of MTC for proper management and treatment, especially for the familial tumours.

Keywords: MTC,FNAC,MGG & PAP

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-333: UNUSUAL PRESENTATION OF RARE VARIANT OF PAPILLARY THYROID CARCINOMA - A CASE REPORT

Parul ¹, Parveen Rana Kundu ¹, Ruchi Agarwal ¹

Background: Papillary thyroid carcinoma(PTC) is the most common thyroid malignancy. Warthin like variant is a rare variant of PTC. The cytological diagnosis is difficult because of overlap of features of the classical variant and Hashimoto's thyroiditis. The carcinoma resembles the Warthin tumour of the salivary gland. Its unique histopathological features which are lymphocytic infiltration of papillary stalks and nuclear characteristics of papillary carcinoma, make it easily recognisable on histopathological examination. We Report this Case because of its rarity and difference in cytological and histological diagnosis.

Case Report: A 25 yr old female sought medical attention for a one and half year old painless thyroid nodule which was increasing in size. The patient did not have any other significant history and denied any history of thyroid disease in the family. Physical examination revealed a nodule in thyroid, which was moving with deglutination and measured 3×3 cm. Neck ultrasonography revealed TIRADS category V - PTC. Thyroid function test was within normal laboratory range. Fine needle aspiration cytology was performed, which revealed Bethesda category VI - malignancy undifferentiated type thyroid neoplasm. The patient underwent hemithyroidectomy, with cervical lymph node clearance and histomorphological diagnosis of papillary carcinoma with focal warthin like features with metastasis lymph node was made.

Conclusion: Warthin like PTC is an uncommon and relatively unknown variant of PTC and is difficult to diagnose by clinical examination, ultrasound and CT scan. It is frequently associated with Hashimoto's thyroiditis. This variant is regarded as a distinct entity associated with an excellent prognosis.

Keywords: Thyroid carcinoma, warthin variant

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-334: GIANT CELL VARIANT OF MEDULLARY CARCINOMA OF THYROID: THE CYTOLOGICAL APPROACH

Shruti Shemawat ¹, Dharamveer Sihag ¹

Background : Medullary carcinoma of the thyroid (MCT) comprises around 10% of all thyroid tumor. The array of cytomorphological features recognized on fine needle aspiration cytology has been an indispensible tool in the diagnosis of thyroid neoplasms. However, cytology of unusual variants of MTC, including giant cell type has not been well documented

Case Report: A 48 year old female presented with progressively increasing right sided neck swelling for past 1 month, dysphagia and generalized weakness for 10 days. Physical examination revealed swelling to be firm in consistency which moved with deglutition. Enlarged lymph nodes were also identified on both sides of neck. Calcitonin levels were markedly raised. Upon undergoing ultrasonography guided FNAC, the smear showed presence of mixed cell population comprising predominantly of plasmacytoid cells. Spindle shaped cells, polygonal cells, racket shaped cells were also seen. High nucleo-cytoplasmic ratio with salt and pepper chromatin and prominent nucleoli can be appreciated. Cytology smears also showed a profusion of giant cells amidst polygonal and spindle shaped cells typical for giant cell variant of MCT. The diagnosis was confirmed on immunohistochemistry which was positive for calcitonin.

Conclusion : This Report presents a rare variant of medullary (C-cell) carcinoma of the thyroid, referred to as giant cell type which is an important differential for anaplastic carcinoma of thyroid. Our Case highlights the importance of analysis of cytomorphological features in differentiating rare variants from the usual MCT and its mimickers.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-336: RIEDEL'S THYROIDITIS IN AN ELDERLY FEMALE: AN UNCOMMON CYTOLOGICAL DIAGNOSIS.

Anjali Saroha ¹, Ashish C Philip ¹, Priyanka Gogoi ¹, Preeti Diwaker ¹

Background: Riedel Thyroiditis is a type of IgG4-related fibro-inflammatory disorder with an elderly female predisposition. It is usually clinically misdiagnosed as malignancy, due to the sudden diffuse enlargement of thyroid gland along with involvement of the surrounding vital structures. There is paucity of literature regarding the cytomorphological features of this entity due to the frequent inadequate aspirates on account of extensive fibrosis characteristic of this disease.

Case Report: A 60yr old female presented with complaint of a thyroid swelling with a sudden increase in size. On examination, the swelling was diffuse, non tender and hard in consistency. The thyroid function tests were in the normal range. Ultrasonography revealed an ill-defined swelling with infiltration into the surrounding soft tissues. Based on these clinicoradiological findings, possibility of malignancy was considered. Fine-needle aspirate of the swelling demostrated scant to moderate cellularity with follicular cells showing frequent crushing, destruction of the follicular cells and lymphocytes impingement along with fragments of fibrous tissue with bland spindle cells in a hemorrhagic Background with scant colloid. No hurthle cell change, granulomas or epithelioid histiocytes or evidence of malignancy were identified. Based on these cytomorphological and clinico-radiological findings, a diagnosis of Riedel's Thyroiditis was offered.

Conclusion: Cytopathology is an important tool for an early diagnosis of Riedel's Thyroiditis and to rule out malignancy. Hence, it is very essential for the pathologist to be aware of this uncommon benign entity and be familiar with its cytomorphological features to rule out malignancy in an ill-defined thyroid swelling with extrathyroidal extension.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-337: PAPILLARY THYROID CARCINOMA IN A PATIENT TREATED FOR GRAVE'S DISEASE; A CYTOMORPHOLOGICAL CHALLENGE AND DIAGNOSTIC CONUNDRUM.

Praveen BK ¹, Praveen BK ¹, Hemlata Panwar ¹, Jai Kumar Chaurasia ¹, Tanya Sharma ¹, Vikas Gupta ², E Jaya Shankar ¹, Prof Vaishali Walke ¹

Background: Grave's disease (GD) is one of the most common causes of hyperthyroidism. Grave's disease can sometimes pose diagnostic challenges because of overlapping cellular nuclear features with Papillary carcinoma (PTC). This cytomorphological diagnostic challenge further aggravates, if the patient has been treated for GD for long, as the treatment induced changes in form of nuclear atypia becomes more significant. Here, we present a Case of PTC developing on the Background of GD, highlighting the diagnostic challenges for overcoming pitfalls.

Case Report: A 28-year female presented with complaints of anterior neck swelling for 6 months with history of recent weight loss. The patient was a known Case of GD on treatment. Patient's serum thyroid profile was normal. Cytological diagnosis on FNA smears were challenging as it showed mixed cytomorphological features of hyperthyroidism and nuclear features of PTC. Follicular cell with hyperplastic changes with atypia, fire flare cells, hurthle cells with lymphocytes impingement and marked random atypia were suggestive of treatment induced changes in hyperthyroidism. Nuclear features of PTC depicting enlarged nucleus with granular powdery chromatin, intranuclear grooving and occasional intranuclear inclusions were also seen. The final cytological impression suggested was 'Suspicious for papillary thyroid carcinoma' (Bethesda Category V). Histopathology confirmed the diagnosis of conventional papillary carcinoma of thyroid in Background of GD.

Conclusions: Scrupulous evaluation of cellular features and awareness of overlapping cytomorphological features of GD with PTC are of utmost importance for making a correct diagnosis and overcoming pitfalls for better and improved patient care.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-338: AN ARRAY OF THYROID CYTOLOGY CASES-HIGHLIGHTING UTILITY OF THE BETHESDA SYSTEM OF REPORTING

Bhakti Dangmali ¹, Sampada Saraf ¹, Nutan Jumle ¹, (Col) Satyajit Singh Gill ¹

Background: Cytological evaluation of thyroid swellings is a rapid, easy and inexpensive diagnostic procedure which is widely used as a screening tool. It helps in triaging patients into candidates for surgical or conservative management. Due to inter-observer, intra-observer variability and lack of uniformity in Reporting system, led to introduction of The Bethesda System of Reporting for Thyroid Cytology. Palpable thyroid nodules are found in 4-7% of general population and can be approached by Fine Needle aspiration Cytology (FNAC). Standardized Reporting pattern /system for thyroid cytology is need of time due to factors like heterogeneity of lesions, inter-observer and intra-observer variability.

Method: A retrospective study was carried out to study Thyroid cytology Cases in Histopathology-Cytopathology department of a Tertiary health care facility hospital. The study period was that of three months. No inclusion or exclusion criteria was applied. Smears obtained from FNAC procedure were stained with MGG and Pap stains. The Bethesda system of Reporting for Thyroid Cytology (2017) was applied to Report all the Cases.

Results: Total of 26 Cases were Reported over period of three months. Histopathological co-relation was established in applicable Cases. We managed to categorize all the Cases in all six categories of the Reporting system. Maximum Reported Cases were that of Category II.

Conclusion: Categorizing the thyroid cytology Cases in to The Bethesda Reporting system helped in better clinicopathological co-relation and aided in prompt diagnosis as well as triaging patients into surgical and non-surgical modality of treatment.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-339: SPINDLE CELL LESION OF THYROID: A DIAGNOSTIC DILEMMA

Mithilesh ¹, Atin Singhai ¹

Background: Spindle cell lesions of thyroid are uncommonly encountered. These are classified as primary or secondary to metastatic disease. There are many differentials in thyroid lesions having spindle cell population. Distinction among them is very crucial because it dictates therapy and defines prognosis. Here a Case Report of spindle cell lesion of thyroid that created diagnostic dilemma is presented.

Case Report: A Case of 72 years female, with complaints of weight loss, rapid enlargement of thyroid gland and compressive neck symptoms. On examination an asymmetrical smooth swelling, 5x3 cms, was palpated on left lateral side of neck which was firm, nontender and moved with deglutition. Clinically diagnosed as malignant thyroid lesion, was sent for cytology for confirmation. On FNA, Smears were moderately cellular displaying clusters as well as singly scattered predominant population of spindle shaped atypical cells in a Background of inflammatory cells with focal necrosis. These atypical cells show moderate to markedly pleomorphic hyperchromatic nuclei with coarse chromatin, prominent nucleoli, irregular nuclear membrane at places and Moderate amount of cytoplasm giving rise to possibility of malignant spindle cell lesion of thyroid that needed to be confirmed by biopsy differential diagnosis at this stage could be Reidl's thyroiditis,Hashimoto's thyroiditis,Medullary carcinoma, spindle cell variants of anaplastic carcinoma. Biopsy confirmed it as spindle cell varient of anaplastic carcinoma of thyroid.

Conclusion: Spindle cells of thyroid on FNAC are diagnostic dilemma. It can be feature of variety of differential. Biopsy is always advised before labeling it as primary spindle cell neoplasm.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-340: THYROGLOSSAL DUCT CARCINOMA ON FNAC: A CASE REPORT

Neha Gahlaut ¹, SRL Diagnostics ¹

Background: Thyroglossal duct (TGD) cyst is the developmental anomaly as a Result of persistent TGD. It is usually located in the region of hyoid bone. Carcinoma arising in thyroglossal duct cysts is extremely rare, with a Reported incidence of 0.7%–1.0%., papillary thyroid carcinoma being the commonest. Most of the patients present in childhood or young adulthood. Thyroglossal duct carcinoma (TGDC) may be clinically indistinguishable from benign TGD.

Case Report: A 50 year old man presented with midline neck swelling progressively increasing in size from last one year. On examination, a painless, firm, mobile and fluctuant, 2 × 2 cm mass was found. The mass moved vertically with swallowing as well as on tongue protrusion. Thyroid function test was within normal range. USG showed a irregular heterogenous echoic mass with septations in anterior neck with an impression of thyroglossal cyst. USG guided FNAC was done. Smears showed sheets of follicular cells against Background of cyst macrophages and neutrophils admixed with colloid. Few cells showed ovoid nuclei with intranuclear groove and occasional pseudoinclusions. Diagnosis of papillary carcinoma was suggested. Patient underwent Sistrunk operation and biopsy confirmed the cytologic diagnosis.

Discussion: TGDC may be missed due to its rarity. Usually, the diagnosis is only made on histopathological examination after excision. Although there are diagnsotic pitfalls in cystologic diagnosis, for rapidly growing midline neck masses, relevant investigations involving FNAC, CT scan or ultrasound are required to decide the origin before surgical intervention in order to prevent unnecessary thyroidectomy in such Cases.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-341: RARE VARIANTS (ONCOCYTIC AND CYSTIC) OF PAPILLARY THYROID CARCINOMA – A REPORT OF TWO CASES.

A Nivedita ¹, Sudeep Khera ¹, Rashim Sharma ¹, Sangeeta Pradhan ¹, Rashmi Rajora ¹

Background: Papillary thyroid carcinoma (PTC) is the most common malignant neoplasm of thyroid, accounting for approximately 85% of all cancers. Fine needle aspiration cytology (FNAC) diagnosis of PTC accounts for 5% of all thyroid FNAs, with majority conventional PTCs & 94-96% prove to be PTC on histologic followup. The sensitivity & specificity of FNAC were 87.14% and 77.27%, respectively. PTC have many variants with different prognosis & behaviour. We Report 2 Cases of rare variants of PTC on cytology.

Case Report: Case1: A 38-year-old male had slow growing swelling in the left lobe of thyroid for 4 years. Ultrasonography (USG) revealed 2 hypoechoic solid cystic nodules with increased vascularity in the left lobe of thyroid labelled as TIRADS 4. FNAC revealed cellular smears showing thyroid follicular epithelial cells (TFEC) showing histiocytoid appearance with hypervacuolated cytoplasm along with numerous cyst macrophages and classical nuclear features. Final diagnosis was rendered as PTC, cystic variant. Case 2: A 37-year-old hypothyroid female, on thyroxine for 3 years, presented with gradually increasing mildline thyroid swelling. USG showed diffusely enlarged thyroid with increased vascularity, labelled as TIRADS 3. FNAC showed hypercellular smears with TFEC showing extensive hurthle cell change along with classical nuclear features and was diagnosed as PTC, oncocytic variant.

Conclusion: PTC is a malignant tumour with many variants but it is the nuclear features which facilitate diagnosis. Oncocytic variant has a grave prognosis and it is radioiodine resistant. Therefore, early diagnosis and prompt treatment is must and regular follow up is mandated.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-342: EVALUATION OF THE 2017 BETHESDA SYSTEM FOR REPORTING THYROID CYTOPATHOLOGY WITH HISTOLOGICAL FOLLOW UP: AN INSTITUTIONAL PERSPECTIVE

Sayika Hameed ¹, Sabina Khan ¹, Mohd Jaseem Hassan ¹, Musharraf Husain ¹

Background: In 2017, Bethesda System was revised for Reporting thyroid cytopathology. However, very few studies have been done on the utility of recently introduced “The 2017 Bethesda System for Reporting Thyroid Cytopathology” (TBSRTC II) and estimation of risk of malignancy (ROM) in various diagnostic categories.

Material and Methods: This was prospective study done on thyroid lesions over a period of one and half year. The lesions were evaluated cytologically and classified according to TBSRTC II. Histopathological correlation was done, wherever possible. ROM was also calculated for each category.

Results: A total of 190 Cases of thyroid FNACs were included in the study. Using 2017 TBSRTC, the lesions were classified into 6 diagnostic categories with category II showing maximum number of Cases (81%), Histopathological diagnosis was available in 60 Cases. ROM was calculated for each Bethesda category in two ways as per recent TBSRTC II ie. with and without including NIFTP in malignant category. Since category III and V showed one Case each of NIFTP, therefore ROM changed only in these two categories. However there is an overestimation of ROM in category II and III as there are selection biases and not all thyroid nodules underwent surgical resections.

Conclusion: To conclude, the recent 2017 Bethesda system enhances the diagnostic accuracy of FNAC thyroid, facilitate diagnostic correlation with histopathology, enables estimation of risk of malignancy leading to more consistency in management plans. We recommend that each laboratory should calculate its own ROM based on its accumulated cytologic-histologic correlation data.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-343: CYTOMORPHOLOGICAL STUDY OF LYMPHOCYTIC THYROIDITIS AND ITS SEROLOGICAL CORRELATION.

Ankita Raj ¹, Ujwala Maheshwari ¹

Background: Thyroid disorders are universally the most common endocrine disorder. Autoimmune thyroiditis is not an infrequent illness but an under diagnosed state. Most of them are treatable, if detected in their initial stage. FNA is the most reliable tool for diagnosing thyroid lesions. This study was done to correlate cytological grading of Lymphocytic Thyroiditis with thyroid profile and anti TPO levels.

Method: During a period of 1.5 years, 132 patients with midline neck swelling were referred to the central laboratory for cytological evaluation of thyroid lesions. Cytological evidence of Lymphocytic Thyroiditis was seen in 50 Cases. Anti TPO antibodies were done in all along with the thyroid function test. The grading of lymphocytic thyroiditis was further correlated with TSH and anti TPO levels.

Result: Female predominance (90%) was noted. Most common presentation was diffuse goitre (88%). Thyroid function status showed prevalence of hypothyroidism (48%). On cytomorphological analysis Lymphocytic Thyroiditis Grade I (64%) found in most of the patients. A positive correlation was observed between the grading of thyroiditis and Thyroid function test. As the cytological grading increases, the severity of hypothyroidism also increases. Also, Anti-TPO shows positive correlation with lymphocytic thyroiditis.

Conclusion: In all Cases of lymphocytic thyroiditis, anti-TPO is advisable as it is helpful for early diagnosis of an autoimmune process. This study helps in understanding the role of medical management of autoimmune thyroid disease. The present study highlights the importance of thyroid FNAC along with its serological tests in confirming the diagnosis of Lymphocytic Thyroiditis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-344: THYROID PAPILLARY MICROCARCINOMA: A RETROSPECTIVE ANALYSIS OF CLINICO-CYTOLOGICAL FEATURES WITH SPECIAL REFERENCE TO BETHESDA CATEGORY III

Sanchita Paul ¹, Abhijit Kalita ¹

Background: Papillary thyroid microcarcinoma (Pm) is defined as thyroid carcinoma less than 10mm in size. US-guided FNAC help identify such lesions better than blind aspirations. All the cytological features of papillary thyroid carcinoma may not be present in such small lesions, Resulting in most of them put up as Bethesda category III (Cat III) lesions.

Aims and Objectives : To evaluate clinico-cytological features of Pm with special reference to Cat III.

Methods: The study was conducted for a period of 3 years at a tertiary care centre. Cytological diagnoses, clinical data and radiological features of histologically proven Cases of Pm were retrieved and analysed.

Results: 38 Cases of histologicaly proven Pm analysed of which 17 (44.7%) were Reported as Cat III. Out of Cat III Cases, 2 (11.7%) had papillae formation, 3 (17.6%) had nuclear changes, 1 (5.8%) had microcalcification on radiology, 4 (23.5%) presented as single nodule with follicle formation, 3 (17.6%) as lymphocytic thyroiditis with anisonucleocytosis and 4 (23.5%) as colloid nodule. 10 Cases (58.8%) had size < 5mm of which 7 had single foci of tumor. This subset presented as large solitary follicular nodule in 4 Cases and Multinodular goitre (MNG) in 3 Cases. 1 of the Cases had follicular pattern with mild anisonucleosis and another had microcalcification on radiology. In one MNG Case nuclear chromatin clearing was seen. The non-category III Cases with size > 5mm were identifiable in ultrasound guided aspiration.

Conclusion: Cyto-clinico-radiological correlation for better management of Cat III Cases.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-345: PAPILLARY THYROID CARCINOMA-CAMOUFLAGING THE DIVERSITY WITH AN ORPHAN ANNIE EYE.

Rhituparna Das ¹, Priyanka Maity ¹, Moumita Sengupta ¹, Prof Uttara Chatterjee ¹

Background: Papillary thyroid carcinoma (PTC) is an indolent neoplasm which shows the presence of a large number of variants. These variants have different behaviour with a few aggressive and non-aggressive types. Diversity in cytological features ranging from obvious papillae to micro follicles to solid sheets poses difficulty in exact cytological categorisation.

Aim: The aim of this study was to analyze the cytomorphological features of the variants of PTC.

Materials and Methods: This was a retrospective study conducted in the department of Pathology in collaboration with Endocrinology. Twenty one histologically diagnosed Cases of papillary thyroid carcinoma were included. Cytology smears were re-evaluated by two trained pathologists. Both nuclear and extranuclear features were assessed and categorized according to Bethesda System for Reporting of Thyroid cytopathology (BSRTC), 2017.

Results: Total 21 Cases were assessed which included 13 Cases of classic papillary thyroid carcinoma, 5 Cases of follicular variant and one Case of tall cell variant, columnar cell variant and Hurthle cell variant each. Classical variants fell on wide range of BSRTC. Among nuclear features presence of tall cells gave strong diagnostic clue. Mixed bag of extranuclear features were observed.

Conclusion: Reporting the different variants of PTC in FNAC can be challenging due to heterogeneity of its cytological behaviour. Accurate grouping into Bethesda categories is also difficult which poses hindrance in categorical management.

Keywords: Fine needle aspiration, BSRTC, nuclear features, papillary thyroid carcinoma

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-347: CORRELATING THYROID FNAC WITH THYROID FUNCTION TEST: AID IN DIAGNOSIS

Kumar Raktyutpal ¹, Bobby Duarah ¹, Aparna Dutta ¹

Background: Present study has been undertaken with the aim of classifying thyroid cytology based on the Revised Bethesda system for Reporting thyroid cytopathology and correlate them with the Thyroid Function Test (TFT), that helps in estimating the stage of disease and choose the best treatment option that is suitable for the patient.

Methods: This is a prospective study of 95 fine needle aspirations of thyroid nodules and diagnosis were classified according to age and gender, cytological findings and Bethesda categories. All categories were correlated with thyroid function test Results.

Results: In the present study of 95 Cases, there were 10 males (10.52%) and 85 females (89.47%). The mean age was found to be 39.26 years. The adequacy rates in cytology smears of the present study was 98.95%. Maximum Cases were observed in category II (87.37%). The percentage of Cases in category I, III, IV, V and VI were found to be 1.05%, 3.16%, 4.2%, 1.05%, and 3.16% respectively. Thyroid function tests were performed in all Cases. Most of the Cases are euthyroid (52.6%), followed by hypothyroid (28.42%) and hyperthyroid (18.95). All Cases in Category V and VI are euthyroid. Maximum number of altered Thyroid function tests is observed in category II of which 49.39% were euthyroid, 30.12% were hypothyroid, 20.48% were hyperthyroid.

Conclusions: Altered thyroid function tests is usually associated with benign conditions and can help in distinguishing benign conditions with atypical features.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-348: EVALUATION OF THYROID LESIONS BY FINE-NEEDLE ASPIRATION CYTOLOGY ACCORDING TO BATHESDA SYSTEM AND ITS HISTOPATHOLOGICAL CORRELATION IN TERTIARY CARE HOSPITAL

Esha Shah ¹, Kirti Rathod ¹, Yogesh Vastani ¹, Pramukh Swami ¹

Background: Fine needle aspiration cytology is a widely utilized tool for the diagnosis of thyroid lesions with a high grade of sensitivity, specificity and diagnostic accuracy. The Bethesda system is a uniform Reporting system for thyroid cytology that facilitates the clarity of communication among cytopathologists, radiologists, and surgeons. It facilitates cytohistologic correlation for thyroid diseases.

Methods: A total of 175 patients who underwent FNAC-cytological analysis were studied at our institute over 56 months between 1 Janyuary,2017 and 30 August,2021. The Results were correlated with histopathological findings wherever available.

Results: Based on the Bethesda system of classification of thyroid lesions, Out of 175 total samples, 21 were unsatisfactory(Group 1). Out of 154 satisfactory samples; 99 lesions were diagnosed as benign (Group 2), 25 were in category of atypical follicular lesion of atypia undetermined significance (Group 3), 10 were diagnosed as suspicious for follicular neoplasm (Group4), 06 as suspicious for malignancy (Group 5), and 14 Cases were malignant (Group 6). In the present study, cytohistopathological correlation was done in 14 lesions. 8 Cases were in concordance and 6 Cases were proved to be in discordance.

Conclusion: Reviewing the thyroid Fine Needle Aspirations with the Bethesda system for Reporting allowed precise cytological diagnosis. It represents standardization and reproducibility in Reporting thyroid cytology with improved clinical significance and greater predictive value. Nature of the disease, experience of cytopathologist, and understanding of certain limitations determine its diagnostic utility.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-349: A COMPARATIVE STUDY OF FINE NEEDLE ASPIRATION CYTOLOGY, HISTOPATHOLOGY AND RADIOLOGY IN THYROID LESIONS: A CASE SERIES

Shankhanila Mazumdar ¹, Krishna Kumar Singh ¹, Afrin Siddiqui ¹

Background: Thyroid swelling is a common presentation in ENT and head and neck surgery department. Presently FNAC (fine needle aspiration cytology) is an important diagnostic modality for pre operative analysis. It has been recommended by American thyroid association as an initial diagnostic test due to its relatively less invasive nature, cost effectiveness and faster diagnosis. But the pitfall is that there are a number of false negative and false positive diagnoses made on FNAC so histopathological and radiological correlation plays an important role in differentiating neoplastic and non-neoplastic lesions

Methods: A retrospective study was conducted in the department of pathology, IMS, BHU between 2018 to 2020 on 20 patients with thyroid swelling who underwent FNAC and subsequently specimen was submitted for histopathological examination. Out of these 20 patients at least for 15 patients radiology Report was available. A comparative study was done to interpret the FNAC, histopathological and radiological correlation of the thyroid lesions in these patients where histopathology was considered confirmatory.

Results: Out of the Cases considered for this study 80% Cases on FNAC and 73% Cases on radiology correlated correctly with the histopathological findings. Radiologically the sensitivity and specificity of differentiating neoplastic from non-neoplastic lesions were 73% and 80% respectively and that on FNAC were 70% and 90% respectively.

Conclusion: FNAC is a reliable, cost effective, faster and relatively less invasive diagnostic modality for thyroid lesions. Therefore it is considered to be an important pre operative diagnostic modality for thyroid lesions. Radiological correlation with FNAC increases diagnostic accuracy.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-350: FINE NEEDLE ASPIRATION CYTOLOGY:A PREFERRED FIRST LINE SCREENING PROCEDURE FOR THYROID LESIONS

Naghma Anjum ¹, Sunil Arora ¹, Samiksha ¹

Background: Fine needle aspiration cytology of thyroid gland is one of the most common investigation done for thyroid lesions. FNAC is now a first line, easy, simple and minimally invasive screening procedure. The study Aims to categorize the thyroid lesions according to The Bethesda System for Reporting Thyroid Cytopathology(TBSRTC).

Materials: This is a retrospective observational study carried out in the department of Pathology at a tertiary care hospital for a period of three years. All Reported Cases of thyroid lesions on FNAC were reviewed and categorized according to The Bethesda System for Reporting Thyroid Cytopathology(TBSRTC).

Results: Out of 126 patients with thyroid swelling 101 were females in age group 25 – 45 years. Among them colloid goitre was the most common lesion. Of these, 101(80.4%) Cases were benign , 4 Cases(2.6%) were non diagnostic,5(3.8%) Cases were Reported as Atypia of undetermined significance,8 Cases(6.2%) were Reported as follicular neoplasm/suspicious for follicular neoplasm,4 Cases(3.4%) were suspicious for malignancy, 5 Cases (3.6%) were malignant.

Conclusions: FNAC is rapid, safe, and cost effective diagnostic modality in diagnosing thyroid disease with high sensitivity and accuracy. The Bethesda system helps to categorize the thyroid swellings therefore helping in decision making for management.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-351: CYTOLOGIC DIAGNOSIS OF SOLITARY LIVER METASTASIS FROM PAPILLARY THYROID CARCINOMA: CASE REPORT AND REVIEW OF LITERATURE

Neha Gahlaut ¹, SRL Diagnostics ¹

Background: Thyroid cancer represents 2.3% of all new cancer Cases. In 2021, it is estimated that there will be 44,280 new Cases of thyroid cancer and an estimated 2,200 people will die of this disease. Differentiated thyroid carcinoma that includes follicular and papillary carcinoma have indolent course with good survival rate. Hematogenous distant metastasis from papillary thyroid carcinoma (PTC) occurs in less than 10% patients which primarily include lungs and bones. Liver metastasis has been Reported with a frequency of 0.5%. PTC revealed by liver metastasis is rare situation. We Report one such Case of isolated liver mass from a clinically occult PTC.

Case Report: A 67 year old lady presented with complaints of back pain. USG abdomen revealed a single lesion in her liver. The patient underwent endoscopic USG guided fine needle aspiration cytology of liver nodule that revealed cytologic features of papillary thyroid carcinoma, characterized by sheets and clusters of follicular cells with nuclear enlargement, nuclear grooves and intranuclear pseudo-inclusions. USG neck was done which showed a small solid cystic thyroid nodule in right lobe along with multiple tiny cystic cervical lymph nodes.

Conclusion: The present Case exemplifies a very rare presentation of PTC. The liver is a common site for metastasis. Occasionally the primary tumor is not known and the pathologist is expected to help identify the cell of origin. This is of vital importance as frequently therapy is based on tumor type. Cytomorphology of the tumor cells with ancillary studies are helpful in suggesting a specific diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-352: CYTOMORPHOLOGICAL VARIATIONS OF THYROID LESIONS BASED ON BETHESDA SYSTEM – A NOVEL STUDY

R Ratna ¹, G Sai Chandana ¹, C Sujatha ¹, M Bharathi Sree ¹, BV Sai Prasad ¹, A Venkatalakshmi ¹

Background: Thyroid lesions are one of the most common conditions encountered in clinical practice, accounting for 4-5% of the general population. FNAC is the first-line diagnostic test for differentiating various benign and malignant thyroid lesions appropriately. The Bethesda system for Reporting thyroid cytopathology is a significant step to standardize the Reporting of thyroid fine-needle aspiration(FNA).

Methods: The present study is a retrospective study of a 1-year duration from September 2020 to August 2021. The present study includes thyroid lesions of all age groups on which FNAC was performed and Reported according to “The Bethesda System for Reporting Thyroid Cytopathology”.

Results: We have evaluated 153 Cases of thyroid lesions cytologically. The maximum number of Cases were in the age group of 31-50years. Out of 153 Cases, females (136) Cases outnumbered males (17) Cases with an M: F ratio was 1:12.5. The distribution of Cases into different categories are as follows: Unsatisfactory(I) – 5.22%, Benign (II)-86.92%, Atypical follicular lesion of undetermined significance(III) -1.3%, Follicular neoplasm or suspicious of follicular neoplasm(IV)-1.3%, Suspicious of malignancy(V) – 1.3%, Malignant(VI) – 3.9%. Among the benign lesions, Colloid /Nodular goitre is the most common followed by Lymphocytic/Hashimoto thyroiditis.

Conclusion: FNAC is a non-robust, swift, and safe diagnostic test for the evaluation of thyroid lesions with a high degree of accuracy. The Bethesda system for Reporting thyroid cytopathology is very useful as it is systemic and standardized. This system provides better communication between clinicians and cytopathologists for appropriate therapeutic intervention and prognostic evaluation.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-353: THYROID CYTOLOGY? THE BETHESDA SYSTEM OF REPORTING TO THE RESCUE!!

Raghav Kapoor ¹, Adarsh C Sanikop ¹

Introduction: The Bethesda system is a uniform Reporting system for thyroid cytology that facilitates the clarity of communication among pathologists, and surgeons and facilitates cytohistologic correlation for thyroid diseases. An implied risk of malignancy, a preliminary triage, and at times a definitive diagnosis can be offered. Immunocytochemistry can be done on cell blocks. Molecular studies can also be performed.

Objective: This study was carried out to evaluate thyroid lesions by fine-needle aspiration cytology (FNAC) based on Bethesda system of Reporting.

Materials and Methods: A total of 40 patients with clinically palpable thyroid lesions were studied at our institute between july 31, 2020, and December 31, 2020. FNAC was performed on those patients and slides were made, both air dried (MGG stained) and wet fixated (PAP, H&E stained). The slides were screen under light microscope and Results were compared.

Results: Based on the Bethesda system of classification of thyroid lesions, out of total 40 samples : 02 samples were diagnosed as non-diagnostic even after re-aspiration (Category 1). 21 lesions were diagnosed as benign (Category 2). 07 were in category of follicular lesion of undetermined significance (Category 3). 05 were diagnosed as suspicious for follicular neoplasm (Category 4). 03 as suspicious for malignancy (Category 5). 02 Cases as malignant (Category 6). Discussion: FNAC is a widely accepted Method used in the diagnosis of patients with thyroid nodules. The lack of consistency in Reporting FNA was solved in 2007, when TBSRTC was introduced

Conclusions: Reviewing the thyroid FNAs with the Bethesda system for Reporting allowed precise cytological diagnosis. Nature of the disease, experience of pathologist, and understanding of certain limitations determine its diagnostic utility.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-354: THYROID DISORDERS IN NORTH INDIA AND THEIR REPORTING BY BETHESDA SYSTEM - “1 YEAR RETROSPECTIVE STUDY”

Rekha Rani ¹, Ishani Gupta ¹

Background: Thyroid nodules are very common clinical problem and thyroid cancer is becoming more prevalent. Fine needle aspiration cytology (FNAC) has become a well established modality in the diagnosis, staging and follow up of thyroid nodules. FNAC Results are routinely classified using the Bethesda system for Reporting thyroid cytopathology. The Bethesda system for Reporting thyroid cytopathology is a significant step to standardize the thyroid FNA Reporting.

Aims and Objectives: To determine the spectrum of thyroid disorders in North India and to determine the accuracy and reliability of FNAC in our center.

Material and Method: A retrospective study of FNAC thyroid nodules was carried out on 133 patients referred to our Department from July 2021 to August 2020. Slides were retrieved from the archive of the Department and reviewed and then classified as per the Bethesda system for Reporting thyroid cytopathology. Patients of all ages and gender were included in the sudy.

Results: Total 133 FNAC procedures were performed during study period. 86 Cases were females and 47 were males with male to female ratio of 1:1.83. The nodules of 9 patients were classified as Bethesda category-I, 74 patients as Bethesda category-II, 11 patients as Bethesda category-III, 8 patients as Bethesda category-IV, 9 patients as Bethesda category-V and 22 patients as Bethesda category VI respectively. Out of 133 patients only 36 patients were underwent for surgery; among these 36 Cases, 4 were classified as Bethesda category-IV, 9 as Bethesda category-V and 22 as Bethesda category-VI on cytology, which were confirmed as Cases of thyroid malignancy on histopathology Reports.

Conclusion: Our study substantiates greater reproducibility among Pathologists using TBSRTC to arrive at a precise diagnosis with an added advantage of predicting the risk of malignancy which enables the clinician to plan for surgery, extent of surgery or follow up of the patients.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-356: THE BETHESDA SYSTEM OF REPORTING THYROID CYTOLOGY- DIAGNOSTIC ACCURACY AND PITFALLS

Surbhi Kathuria ¹, Shirish Nandedkar ¹, Manju Purohit ¹

Background: The Bethesda system of Reporting thyroid cytology has made the communication between cytopathologist and the referring physician clinically useful. At the same time there are “gray zone” lesions of thyroid cytology where diagnostic accuracy declines leading to discrepancy.

Objectives: To assess the diagnostic accuracy of thyroid fine needle aspiration cytology (FNAC), and critically evaluate the discordance Cases.

Methods: The present study includes 96 consecutive thyroid FNACs with histopathology correlation. Cellularity was assessed by rapid onsite evaluation of the material. USG guided FNAC was done in 28 Cases when the material was inadequate on evaluation. Cytology diagnosis was compared with histology findings and discordant Cases in each Bethesda category were noted and reviewed. Possible causes of failure and diagnostic pitfalls were analyzed.

Results: The cytohistologic correlation was found in 86/96 (90%) Cases with 15% (n=3) false negative and 2.6% (n=2) false positive Cases. Three discordant Cases of Category II were diagnosed as papillary thyroid carcinoma, one discordant Case in Category III was diagnosed as follicular adenoma and one papillary carcinoma in Category VI was diagnosed as colloid goiter on histopathology. In these Cases aspirate from non-representative area might have been the reason for false cytology findings. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of FNAC diagnosis was found to be 85%, 97.3%, 94.7%, 89.4% and 96.1% respectively.

Conclusion: FNAC of thyroid has high diagnostic accuracy. Sampling errors can be avoided by using USG guided FNACs, if possible, for all thyroid lesions. Discrepant Cases falling in category III, are related to interpretation errors.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-357: THYROID CYTOPATHOLOGY - BETHESDA IS THE BEST

Aishwarya MS ¹, Ranjit P Kangle ¹

Background: Thyroid lumps have a prevalence of 4–7% in India; majority being benign. Fine needle aspiration cytology (FNAC) is a cost-effective, basic standard investigation that aids in early diagnosis of thyroid lesions, ultimately impacting the treatment decision. Standardized Bethesda (6 category) system used to Report thyroid cytopathology, stratifies the risk of malignancy with an accuracy rate of 95–98%.

Materials and Methods: A FNAC based prospective study of thyroid swellings was conducted in our institute from January 2017 to August 2021. Patients of all age groups and gender presenting with thyroid swellings were included. FNA was performed using standard procedure and the smears were stained using May Grunwald Giemsa (MGG) and Papanicolaou's (PAP) stains. The cytopathological Reporting was done using the Bethesda System.

Results: Out of total 126 patients included in our study; 12.5% (17 Cases) were diagnosed as Follicular neoplasms, 62.6% (79 Cases) as Colloid Goitre, 7.1% (9 Cases) as Hashimoto's thyroiditis, 13 Cases (10.3%) were Multinodular goitre, 5.5% (7 Cases) were Papillary thyroid carcinoma, 1.4% (1 Case each) of Medullary Carcinoma thyroid and Anaplastic carcinoma. Based on the Bethesda system of classification of thyroid lesions, out of 126 satisfactory samples; 100 lesions (79.3%) were Benign (Group II), Follicular neoplasms constituted 17 Cases (12.5%) (Group IV) and 9 Cases (7.1%) were Malignant (Group VI).

Conclusion: Triaging the patients with thyroid FNAC and precise cytopathological diagnosis using Bethesda system has helped categorization of various thyroid lesions, thus helping to guide further treatment decisions.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-358: EVALUATION OF FNAC THYROID SMEARS USING BETHESDA SYSTEM FOR REPORTING THYROID CYTOPATHOLOGY NOMENCLATURE WITH CLINICOPATHOLOGICAL CORRELATION

Shamim Ahmad Ansari ¹, Reeni Malik ¹, Pramila Jain ¹

Background: The study aimed to interpret thyroid cytology by the Bethesda System for Reporting thyroid cytology (TBSRTC) and to analyze the distribution of lesions under various diagnostic categories and subcategories.

Methodology: This study was conducted as an observational study at tertiary care centre on patients with thyroid lesions. After history taking and detailed local, general and systemic examination, thyroid function tests were conducted. Apart from this, ultrasonography of lesion was done. Patients were subjected to FNAC and after fixation smears were stained with Papanicolaou stain.

Results: About 53% thyroid lesions were hemorrhagic, followed by 17% blood mixed colloid and 4% colorless serous fluid. Sample adequacy was noted in 93.5% Cases in our study. According to Bethesda system of classification, majority of lesions were benign (81.5%) whereas 6.5% lesions were unsatisfactory. Only 6% lesions were categorsied as malignant.

Conclusion: FNAC is widely accepted as the most accurate, sensitive, specific, and cost- effective diagnostic procedure in the preoperative assessment of thyroid nodules. It is the first line of investigation and can differentiate benign nodules from malignant nodules of the thyroid in 95% Cases. Applying a standard Reporting system for thyroid cytology may enhance the communication between pathologists and clinicians, assists them to find out the rate of malignancy in each cytological group, and facilitating a more reliable approach for patient management.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-359: ROLE OF FNAC IN EARLY DETECTION OF ADVANCING ANAPLASTIC THYROID CARCINOMA: A CASE REPORT

Reecha Singh ¹, Anju Singh ¹, Kshiti Atreya ¹, Sanjeet Kumar Singh ¹, Kalpana Chandra ¹

Background: Arising from the undifferentiated thyroid follicular cells, anaplastic carcinoma of thyroid (ATC) accounts for 0.5 – 5% of all thyroid carcinoma. Iodine supplements have played an important role in the decrease in incidence of ATC in recent decades. Commonly affecting females, ATC presents as rapidly enlarging, bulky neck mass and invading adjacent structures causing hoarseness, dysphagia, dyspnea. These are highly aggressive tumours with a 5 year survival rate of 3.6 to 11% and alone accounts for 50% of deaths due to thyroid cancer.

Case Report: A 62 -year-old female presented with recently enlarging diffuse thyoid swelling of 5x4cm size with mild dyspnea. Her CECT imaging showed large multiloculated centrally necrotic and peripherally enhancing midline neck mass arising. Fine needle aspiration cytology (FNAC) done from the swelling revealed a cellular smear comprising of highly malignant oval to spindle shaped cells. The Background was necrotic with few bizarre tumor giant cells.

Conclusion: Despite being a rare entity, the aggressive behavior of ATC necessitates its early detection and prompt induction of therapy, thus making FNAC play a pivotal role in early and accurate diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-360: A CORRELATION OF THYROID CYTOPATHOLOGY BASED ON BETHESDA SYSTEM OF CYTOLOGY REPORTING WITH HISTOPATHOLOGY IN SOLITARY THYROID NODULE CASES

Manoj Pant ¹, Deep Kumar Raman ¹, Jeenu Varghese ¹

Background: Fine needle aspiration cytology (FNAC) is considered a mainstay in the early assessment of Thyroid nodules. It is a simple, cost-effective and minimally invasive procedure, playing an essential role in distinguishing benign from malignant lesions.

Aim: The present study Aims towards finding the accuracy of Bethesda classification and diagnostic efficacy of FNAC by correlating cytological findings with final histopathological diagnosis.

Material and Methods: A retrospective study was conducted on 50 Cases of thyroid cytology Reported by The Bethesda system of Reporting cytopathology(2018), during the period of 2018-2021. Amongst these 30 were benign and 20 were malignant lesions and we compared the efficacy of Bethesda classification with histopathological findings. Bethesda category I- IV is low probability of malignancy. Bethesda IV to VI is high probability of malignancy.

Results: Most lesions were in Bethesda Cat-I to IV 64 % and Cat-V&VI-36%. 84% Cases were found to be concordant with a histopathological diagnosis with 60% benign and 40% malignant lesion. In 16% Cases, discordancy is seen between cytology and histopathological findings with 50% benign and 50% malignant lesions in such Cases. Out of the 4 discordant malignant Cases, 75% are noted in Follicular neoplasm. The sensitivity of the study is 80% and specificity is 86%. Positive predictive value is 80% and negative predictive value is 86%.

Conclusions: Bethesda classification is a criteria-based system that increases the efficacy of diagnosis by FNAC and helps in triaging thyroid lesions before surgery. However Follicular neoplasm thyroid is still a diagnostic challenge in cytopathology.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-361: A RARE CASE OF PAPILLARY THYROID CARCINOMA PRESENTING AS A CYSTIC LESION

Neha Kumari ¹, Reeni Malik ¹

Multinodular goiter(MNG) is a common thyroid disorder characterized by an enlarged thyroid gland with multiple areas of nodularity, these nodules are variably filled with colloid. It is 5-15 times more common in women and prevalance increases with age, 5-10% progressing to hyperthyroidism (toxic MNG). Various studies have showed a 7-17% incidence of malignancy in MNG. We present a Case of 50y old female with complaints of neck swelling since 3months. Patient is also a known Case of ulcerative colitis. Thyroid profile were within normal limits and ultrasonography showed multiple well defined isoechoic lesions in both lobes of thyroid. Cytological diagnosis of colloid goiter with cystic changes was made and a hemithyroidectomy was performed. The specimen sent for histopathological analysis was diagnosed as Diffuse Toxic Multinodular Goiter with focus of Papillary Carcinoma Thyroid. Recent studies have suggested that these microcarcinomas progress to a clinically evident disease if left untreated and can even metastasize to lymph nodes and lungs.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-362: EFFICACY OF BETHESDA SYSTEM FOR REPORTING THYROID CYTOLOGY WITH SPECIAL REFERENCE TO AUS/FLUS CATEGORY: A RETROSPECTIVE STUDY FROM A TERTIARY CARE CENTRE

D Vijaya Chandrika Ravali ¹, Navatha Vangala ¹, Mona Lisa Hui ¹, Pramod Kumar P ¹, Rajashekar Patel ¹

Background: Fine needle aspiration (FNA) cytology is a widely used tool for diagnosis of thyroid lesions with a high degree of sensitivity, specificity and diagnostic accuracy.

Objectives: To estimate the efficacy of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) for Reporting thyroid lesions on cytology. To estimate the risk of malignancy in TBSRTC category III (AUS/FLUS) Cases.

Materials and Methods: This is a four year retrospective study done from 2018 to 2021 at a tertiary care centre. All the Cases of FNAC of thyroid done at the institution during the study period were included and were Reported using TBSRTC, 2017.

Results: The study includes 928 Cases of FNAC of thyroid out of which 239 were USG-guided and the rest were blind FNACs. Of these, 118 Cases have histological correlation which on cytology were diagnosed as Bethesda category I (n=11), II(n=64), III(n=9), IV(n=10), V(n=8) and VI(n=16). Benign lesions were in age range of 20-74 years with a M:F of 1:5. Malignant lesions were in age range of 31-62years with M:F of 1:3.5. Overall accuracy was 85% and was 79% for AUS/FLUS. Risk of malignancy for AUS/FLUS is more for Cases with cytological atypia than in those with architectural atypia and found to be 91%.

Conclusion: TBSRTC categorisation is efficient and accurate for diagnosing thyroid lesions on FNA and helps in estimating risk of malignancy, prognosis and guides in further management.

Keywords: Thyroid, TBSRTC, AUS/FLUS

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-363: CYTOLOGICAL DIAGNOSIS OF AN UNCOMMON ANAPLASTIC (UNDIFFERENTIATED) THYROID CARCINOMA: A CASE REPORT.

Kalyani Ruprao Deshmukh ¹, Priyanka Chandak ¹, Ashish Tayde ¹

Background: Anaplastic/Undifferentiated thyroid carcinoma (ATC) is a relatively uncommon highly malignant tumor originating from the follicular cells of thyroid gland having poor prognosis. It comprises 0.5% to 5% of all thyroid carcinomas1. It typically presents in elderly patients more commonly in females (M:F ratio 1:2) with a mean age of 70 years. It accounts for more than half of the deaths from thyroid cancer, with a mortality rate that is over 90% and a mean survival of 6 months after the diagnosis2.

Case Report: A 60 year old female patient presented with a diffuse midline neck swelling for 4 month, associated with change in voice. On examination, the swelling measured 6 × 6 cm, was fixed, had diffuse margins, hard in consistency. Ultrasonography of local part revealed an ill defined large hypoechoic mass in the right lobe of thyroid measuring 5.5x5.3x5.1 cm with few partially calcified nodules with extension into superior mediastinum raising possibility of malignant mass lesion involving right lobe of thyroid. FNAC from the thyroid swelling revealed a cellular smear comprising of groups, sheets and singly scattered atypical cells having round to oval and marked pleomorphic nuclei, coarse chromatin, prominent nucleoli and moderate to abundant cytoplasm. Patient died within one month after the diagnosis.

Conclusion: Anaplastic carcinoma of thyroid is an uncommon but markedly aggressive tumor. Transformation from pre-existing carcinoma is rare. FNAC plays an important role in making early and accurate diagnosis of ATC and to determine the treatment plan for the patients who suffer with this entity.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-364: ROLE OF FINE NEEDLE ASPIRATION VERSUS NON-ASPIRATION CYTOLOGY IN DIAGNOSIS OF THYROID LESIONS

Bhavneet Kour ¹, Kuldeep Singh ¹

Background: Fine needle aspiration cytology (FNAC) is the first choice for evaluation of thyroid enlargement. Fine needle non-aspiration cytology (FNNAC) avoids aspiration, uses capillary action of the fine needle. The present study Aims to evaluate the Results of FNAC and FNNAC in diagnosis of thyroid lesions.

Materials and Methods: One-year prospective study was conducted on patients with palpable thyroid lesions in the Department of Pathology, GMC Jammu. Both FNAC and FNNAC techniques were performed simultaneously at the same site by the same investigator. Points were allocated to each specimen according to Mair et al. scoring system and categorized as follows: unsuitable for cytodiagnosis (0-2 points), diagnostically adequate (3-6 points) and diagnostically superior (7-10 points).

Results: A total of 140 patients with palpable thyroid lesions were subjected to needle biopsies. Females dominated the study with female to male ratio of 5.36:1. Non-neoplastic lesions were observed in 89.29% and neoplastic in 10.71% Cases. The cumulative score was found significantly more in Case of FNNAC than FNAC (946 vs 784; p<0.0001). For diagnostically superior category, Results of both FNAC and FNNAC were comparable.

Conclusion: FNAC smears produced adequate Results in more Cases. FNNAC was more diagnostically superior. It causes less damage to tissue, less artefacts and allows better perception of lesion. FNNAC is a good technique that should be used alone or in combination with FNAC for better diagnostic yield.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-365: SPINDLE CELL VARIANT OF MEDULLARY CARCINOMA THYROID: A DIGNOSTIC DELIMA

Kshiti Atreya ¹, Anju Singh ¹, Reecha Singh ¹, Kalpan Chandra ¹, Bipin Kumar ¹

Background: Arising from the C cells of thyroid, Medullary Carcinoma (MCT) accounts for 5–10% of all thyroid malignancies. Currently 14 variants of MCT are recognized by WHO of which spindle cell variant is the rarest. More so owing to the various mimickers like fibroblastic tumor, benign or low-grade soft tissue tumors, spindle cell melanoma, trabecular adenoma and nodular fascitis variant of papillary carcinoma, anaplastic carcinoma or even the fibroblasts from supporting stroma or granulation tissue in a nodular or colloid goiter may baffle the cytopathologist. Fine needle aspiration cytology (FNAC) is widely used as an initial and crucial investigation to select those patients who require excision of the lesion for histopathological confirmation.

Case Report: Here in we Report 29 years female presenting with 2x2 cm left side thyroid swelling since 2 months. FNAC yielded a cellular smear dispersed and clustered spindle cells with pale nuclei and indistinct attenuated cytoplasm and stippled chromatin. A provisional diagnosis of Spindle cell variant of MCT was given which on further workup turned out to be consistent with the cytological findings.

Conclusion: In majority of MCT one can arrive at the correct diagnosis on FNAC but it becomes increasing difficult in rare variant-like pure spindle cell variety of MCT should be always be confirmed by histopathologic examination and other supporting investigations.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-366: LYMPHOCYTIC THYROIDITIS: A CORRELATION BETWEEN CYTOLOGICAL GRADING AND THYROID FUNCTION TESTS

Bhavneet Kour ¹, Ishani Gupta ¹, Roopali Jandial ¹, Subhash Bhardwaj ¹

Background: Chronic lymphocytic thyroiditis also known as Hashimoto's thyroiditis or autoimmune thyroiditis, is the second most common thyroid lesion diagnosed on FNAC after goiter. It can be graded on cytomorphology. The present study Aims to correlate Fine Needle Aspiration(FNA) cytologic findings with Thyroid function tests in lymphocytic thyroiditis.

Materials and Methods: This is a retrospective study conducted in the Department of Pathology, GMC Jammu over a period of one year. 65 Cases of chronic lymphocytic thyroiditis were diagnosed on cytology which were included in the study for which biochemical parameters were available. Cytological grading of thyroiditis was done on smears.

Results: Out of 65 Cases, most of the patients were females [61 Cases (94%)] with male to female ratio of 1:15. Most common age group was ≤ 40 years (52 Cases, 80%). Grade I lymphocytic thyroiditis was observed in 17 Cases(26%), Grade II in 28 Cases(43.07%) and Grade III in 20 Cases(31%) Cases. Anti-TPO and TSH values were increased in 95% of Cases with grade 3 lymphoid infiltrate, 92.8% of Cases with grade 2, and 94.1% of Cases with grade 1.

Conclusion: The diagnosis of Hashimoto Thyroiditis should be based on a multidisciplinary approach wherein clinical, radiological, biochemical, cytological, and radionuclide parameters are taken into consideration. However, demonstration of lymphocytic infiltration on cytologic smears still remains the gold standard.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-367: FOLLICULOMEDULLARY CARCINOMA OF THYROID- A CASE REPORT WITH UNUSUAL CYTOLOGY

Binjul Juneja ¹, Neelam Sood ¹, Deen Dayal ¹

Background: Thyroid gland tumors originate from follicular cells like papillary carcinoma and follicular carcinoma or from parafollicular cells which are progenitor of medullary carcinoma. A new rare variant known as mixed medullary-follicular carcinoma of the thyroid is an uncommon malignant epithelial tumor with metastatic behaviour which is difficult to recognize on fine needle aspiration cytology. Hence, histopathological examination is required.

Case Report: A 64 year female presented with left sided nodular neck swelling since 1 year. Swelling was firm, non tender and moving with deglutition. On USG, left lobe of thyroid showed well defined hypoechoic space occupying lesion of size 16x14mm with calcific foci. Conventional smears prepared from fine needle aspiration revealed moderate cellularity with small clusters and discrete neoplastic cells having moderate anisonucleosis, hyperchromasia and moderate vacuolated cytoplasm. No follicular/papillary/trabecular arrangement and colloid was identified in the Background. Total thyroidectomy with left modified radical neck dissection was done. Histopathology and immunohistochemistry panel including calcitonin and thyroglobulin confirmed the diagnosis of mixed medullary-follicular carcinoma of thyroid with metastasis to lymph nodes and surrounding tissue- paratracheal cartilage.

Conclusion: A patient with a mixed medullary-follicular thyroid carcinoma is Reported showing coexistence of endocrine (follicular) and neuroendocrine C- cell differentiated lineages in a thyroid.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-368: GIGANTIC OSTEOCHONDROMA IN ELDERLY FEMALE- A RARE CARE REPORT

Ankita Raj ¹, Ujwala Maheshwari ¹, Richa Shinglot ¹

Background: Osteochondroma or exostosis is the most common primary cartilaginous neoplasm mostly present in the 1st two decades of life. Commonly involved sites are around the knees and Metaphysis of long bones. They are often asymptomatic and are discovered incidentally. Growth often stops after skeletal maturity and regresses spontaneously. Osteochondroma, although benign, has a very small risk of malignant transformation into chondrosarcoma. However, rapid growth, associated pain or mobility restriction Cases, surgery is the treatment of choice.

Case Report: A 35 years female presented with painless, bosselated, firm to hard swelling measuring 12x10 cm on the medial aspect of right foot for 10 years leading to movement restriction. No relevant family or past history of trauma or surgery. MRI showed a large exophytic mass with a thick cartilaginous cap. FNAC was performed which showed chondrocytes, scattered osteoblasts, chondroblast, focal calcification and fibromyxoid Background. A diagnosis of osteochondroma was made by radio-cytological correlation. Further, the excised tumor was sent for histopathological confirmation. Massive painless neglected growth in a elderly female makes this Case unusual.

Conclusion: FNAC is a reliable, accurate and useful Method in diagnosis of bone tumors, with clinical data and its ease of use, rapidity, and accuracy is helpful in making therapeutic decisions. Radio Pathological correlation is specific. Most osteochondromas are benign and are managed conservatively. Surgery is the mainstay line of treatment for relief of pain, deformity correction and improving range of motion. Hence, follow up must be advised and such lesions should not be overlooked.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-369: A CYTOLOGICAL CASE OF ADAMANTINOMA OF TIBIA - A RARE CASE REPORT

Biswajit Bora ¹, Projnan Saikia ¹, Amilee Gogoi ¹, Hiramoni Haloi ¹

Background : Adamantinoma is a rare slow-growing neoplasm of long bones, with more than 90% located in the diaphysis of tibia and in the fibula or forearm bones. Patients with long bone lesions are usually between 20 to 30 years of age. Men are commoly affected. The clinical sign of adamantinoma is the insidious onset of pain and swelling, sometimes developing over many years. The radiological finding is a multicystic (soap-bubble) osteolytic lesion with surrounding sclerosis, and expansion with cortical thinning.

Case Report: A 27yr old girl came with chief complaint of Pain over right leg since 8 months which was mild dull aching and Swelling over right leg since 8 months which was thumb size increased gradually. Radiological finding shows of right tibia shows diaphyseal single multiloculated lytic lesion with sclerosis involving the medullary cavity.

Cytological findings : MGG stained shows moderately cellular smear arranged in sheets and singly. The biphasic population comprised of predominantly of epithelioid cells having oval nuclei with bland chromatin pattern and prominent nucleoli and other population having spindle cells with clear cytoplasm and elongated nuclei. Above cytomorphological pictures are suggestive of Adamantinoma. Histopathological examination : H&E from the section shows biphasic cell population of epithelial and osteofibrous components arranged in nests form with basaloid pallisading nuclei in a fibrocollagenous stroma. The above morphology shows features of Adamantinoma. Immunohistochemistry shows Vimentin positive.

Conclusions : Case was presented due to its rarity.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-370: CYTOMORPHOLOGICAL SPECTRUM OF VARIOUS LIPOSARCOMAS: AN EXPERIENCE AT A TERTIARY CANCER REFERRAL CENTER, INDIA

Bharat Rekhi ¹, Sampada Ghate ¹, Radhika Agrawal ¹

Background and Objectives: There are few studies on the cytomorphological spectrum of various liposarcomas from our country. Conventional cytologic smears and corresponding histopathologic sections were studied in 17 Cases, including pleomorphic liposarcoma(PLPS)(n=6), myxoid liposarcoma(MLS)(n=7), atypical lipomatous tumor/well-differentiated liposarcoma(ALT/WDLPS)(2) and de-differentiated liposarcoma(DDLPS)(n=2).

Results: The indication for FNAC in Cases of PLPS was for primary diagnosis(n=3), recurrence(2), metastasis(1); myxoid liposarcoma(MLS) was for primary(n=3), recurrence(n=1), metastasis (n=3); in ALT/WDLPS was primary (n=2) and in DDLPS was for a primary diagnosis(n=1) and recurrence(n=1). Among Cases, where FNAC was performed for a primary diagnosis(n=9), pleomorphic sarcoma was offered in 2/3 and malignant tumor in 1/3 PLPSs. A single MLS was correctly diagnosed on FNAC, while another Case was diagnosed as suspicious for malignancy, and another as sarcoma. Both ALTs/WDLPSs were correctly diagnosed on FNAC. A single DDLPS was diagnosed as “suspicious for malignancy”. Radiologically(n=2), in a single Case, each of ALT/WDLPS and DDLPS, primary cytological diagnosis, was diagnosed as a liposarcoma. On review, lipoblasts were identified in 2/6 PLPSs, 3/7 MLSs, and in both ALTs/WDLPSs. There were two false-positive Cases, misdiagnosed as recurrences. Overall diagnostic concordance for malignancy (including suspicious) between FNAC and the histopathologic diagnosis was in 17/19 Cases(89.4%). MDM2 immunostain was positive in ALT/WDLPS and DDLPS.

Conclusions: Liposarcomas can be fairly diagnosed on cytology, including primary, recurrent and metastatic lesions. Careful examination of lipoblasts is helpful in the identification of PLPS that is mostly diagnosed as pleomorphic sarcoma. Correlation of morphologic features with radiological imaging, and MDM2 immunostaining is helpful in diagnosing ALT/WDLPS and DDLPS on FNAC.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-371: AN UNUSUAL CASE OF OSTEOSARCOMA WITH COEXISTING MICROFILARIAL INFESTATION- AN INCIDENTAL FINDING.

Fauzia Talat Ekram ¹, Umrah Malik ¹, Prof MD Jaseem Hassan ¹, Prof Kafil Akhtar ¹

Background: Osteosarcoma is the most common type of malignant bone cancer. Detection of microfilaria is infrequently Reported during cytological evaluation of various lesions. Microfilariae in cytological smears of few benign and malignant neoplasms have also been Reported. Though it is a chance finding, cytology can be an effective tool for detection of asymptomatic filariasis which is helpful in disease eradication. Here we present a rare Case of presence of microfilariae in a smear from fine-needle aspiration of knee swelling in a Case of osteosarcoma.

Case Report: A 17 years old male experienced mild pain in the left knee after playing football. The pain was progressive in nature, intermittent and worsened at night. Within a week the pain was accompanied by marked swelling and loss of considerable motion of the knee joint. On examination, the left knee was enlarged diffusely, firm, and non-tender. No regional lymph nodes was palpable. Cytology smear showed cohesive clusters and singly scattered round cells with abundant reddish granular cytoplasm with eccentric nuclei. The nuclei showed moderate to marked nuclear enlargement, pleomorphism with coarse chromatin and inconspicuous to prominent nucleoli. Multinucleated giant cells were seen at places. Background showed multiple microfilarial parasites admixed with eosinophils, polymorphs and necrotic debris. Radiographs shows an ill-defined lesion in the metaphysis of bone, with focal osteoblastic and osteolytic areas with periosteal reaction.

Conclusion: This Case highlights the significance of apt cytological visualization so as not to miss infective pathology with associated malignant lesion.

Keywords: Cytology, Osteosarcoma, Microfilaria

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-372: A CYTOMORPHOLOGICAL STUDY OF PERIARTICULAR AND ARTICULAR LESIONS.

Aditi Jadhav ¹, Kalpana A Deshpande ¹, Snehal Chavhan ¹, Shweta Watane ¹, Sanjay Bijwe ¹

Background: The articular and periarticular pathology is mainly dependent on imaging techniques. Aspiration cytology, is often used as a preliminary diagnostic approach to these lesions, and in many Cases it yields adequate material to establish the final diagnosis. These include lesions of the joint, joint space and periarticular soft tissues, that have the propensity to produce mass lesions. Fine needle aspiration cytology, thus provides rapid and reliable diagnosis at a considerably low cost. It can provide valuable information on the morphology of individual cells and the architecture of cell clusters. This study, therefore, entails the diagnosis of articular and periarticular lesions by FNAC.

Method: The present study is a cross sectional study of a period of six months at the cytology section, in department of pathology at a tertiary care centre. A total of 39 Cases were evaluated during this period from different articular and periarticular lesions.

Results: The study comprised of 39 Cases. Male to female ratio(M:F) was 1.8:1. Maximum Cases were found in the second to fourth decade of life. Of the 39 Cases, 13 (33%)were diagnosed as lipoma, ganglion cysts- 10 (25%) Cases, benign cystic lesions- 4 (10%) Cases, gouty arthropathy- 4 (10%)Cases, Giant cell tumor- 2 (5%)Cases, keratinous cyst- 2 (5%)Cases, suppurative lesions -2 (5%)Cases, acute on chronic synovitis- 1 (2.5%) Case, granulomatous lesions- 1(2.5%) Case and spindle cell lesions- 1 (2.5%)Case.

Conclusion: FNAC being a rapid, cost effective, minimally invasive, outpatient procedure, is of great diagnostic utility for articular and periarticular lesions.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-373: PATTERN BASED APPROACH- A BETTER NAVIGATOR FOR CYTODIAGNOSIS OF SOFT TISSUE TUMORS

Deepak Gupta ¹, T Chhadi ¹, P Bhadarge ¹, J Sathe ¹, B Kowe ¹

Background: Fine needle aspiration cytology (FNAC) forms one of the first diagnostic tools in the evaluation of tumours. Its role in diagnosing soft tissue tumours (STT) has been fairly documented, as well as debated. Soft tissue tumours encompass a diverse group of tumours showing a wide range of cytomorphologies that can be broadly grouped as lipomatous, myxoid, spindled, pleomorphic, round cell, and epithelioid. This pattern-based classification enables the formation of appropriate differentials. Present study was aimed at evaluating its scope in diagnosing 30 Cases of soft tissue tumours (STT).

Methods: All patients presented with soft tissue masses were included in the study after due informed consent and followed with FNAC as per standard guidelines. HE,PAP,MGG stains were performed. Smears were categorised into 6 patterns according to cytomorphology. Histopathological correlation was done wherever available. And IHC was performed wherever feasible.

Results: Most of the Cases were found to be in the category of lipomatous differentiation. Rest of the Cases were placed in the category of spindle cell pattern, myxoid pattern, epithelioid pattern and round cell pattern. Special attention was given to false positive Cases to increase cyto-histopathological correlation rate.

Conclusion: FNAC is fairly specific and sensitive in soft tissue tumour (STT) diagnoses for primary, recurrent and metastatic lesions. The cytological types, especially round cell and pleomorphic sarcomas, can be quickly identified. Clinicopathological correlation with immunohistochemistry as an adjunct, are valuable in exact sub typing.

Keywords: FNAC, Pattern based approach, soft tissue tumours (STT)

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-374: AN UNCOMMON CASE REPORT OF FIBROUS DYSPLASIA PRESENTING PRIMARILY AT 5TH DECADE, REPORTED AS GIANT CELL LESION ON FNAC.

Durgeshwari Pandey ¹, Vatsala Kishore ¹, Neeraj Singh ¹, Vaishali Kotasthane ¹, Dhananjay Kotasthane ¹

Background: Fibrous dysplasia (FD) is a rare bone disorder. Bone affected by this disorder is replaced by abnormal scar-like (fibrous) connective tissue. This abnormal fibrous tissue weakens the bone, making it abnormally fragile and prone to fracture. The affected bone may become misshapen (dysplastic). The long bones of the legs, the bones of the face and skull, and the ribs are most often affected. FD is usually diagnosed in children or young adults, but mild Cases may go undiagnosed until adulthood.

Case Report: A 56year old female had a history of trauma and pathologically displaced fracture in right proximal femur, in MRI accidentally found to have expansile lytic lesions at proximal 1/3rd of right femur, right acetabulum and right inferior pubic ramus. A USG guided FNAC was done which revealed a Giant Cell Lesion which was later found to be Fibrous Dysplasia on histopathology.

Conclusion: Osteolytic lesions showing cytological features of giant cell lesions may have a suspicion for Giant cell tumor. Fine needle aspiration cytology may play an important role in rapid diagnosis and early management. Histopathological correlation is required for confirmation of the diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-375: LIPOFIBROMATOSIS : CYTOLOGY – HISTOPATHOLOGICAL CORRELATION OF 6 CASES OF A UNCOMMON ENTITY

Somshankar Chowdhury ¹, Nidhi Mahajan ¹, Arti Khatri ¹

Background: Lipofibromatosis is a rare pediatric soft tissue tumor. There is a paucity of its cytological description in literature as its a recently recognized entity. Therefore, with this, we Report six Cases with their cytological features and cyto-histological correlation.

Methods: Six Cases of lipofibromatosis were diagnosed on fine-needle aspiration cytology at our institute and later confirmed on histopathological examination. Patient age, sex, tumor site and size, cytological and histological findings, management, and recurrence data were recorded.

Results: Four out of the six patients were one year or younger at presentation. Males were slightly more in number (4 out of 6). The sites (gluteal region, upper back, thigh) and size were variable (largest measuring 17 cm while the majority were 4 to 6 cm in the most significant dimension). FNAC showed a similar picture in all the Cases, comprising adipose tissue fragments along with bland spindle cell proliferation. No mitoses or atypia were noted. Skeletal muscle fragments were seen. All six tumors were managed by wide local excision, and histopathology confirmed the cytological diagnosis of lipofibromatosis. 3 out of the 6 Cases have been followed up, and no recurrence has been Reported as yet.

Conclusion: Lipofibromatosis is associated with high recurrence rates of about 72%. No metastasis, however, has been Reported so far. We present this series as cytological features of this tumor are infrequent in literature. However, a pre-operative cytological diagnosis is essential for managing these Cases as complete surgical excision with a wide margin ensures low recurrence.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-376: CYTOLOGY OF A RARE NOTOCHORDAL MALIGNANT LESION : CHORDOMA.

Nishant Mitra ¹, Seema Awasthi ¹, Shyamoli Dutta ¹, Rajneesh Kumar ¹

Background and Objectives: Chordoma is a rare malignant tumor arises from the notochordal remnants. Chordoma occurs usually in both ends of neural axis. Most common location of Chordoma are sacral and spheno-occipital region. It represents 2-4 % of all malignant bone tumors. Most commonly seen in middle or elderly aged patients with male predominance. Median survival in 7 years. Cranial Cases has worse prognosis whereas 40% of non cranial tumors metastasize to lung and lymph nodes.

Methods: A 31 year old male presented with painful deep seated mass in presacral region of right pelvis since 3 years along with complaint of tingling and numbness over right limb. On MRI of right pelvic region shows features of schwannoma.

Result: On cytological examination smears show abundant chondrites-myxoid substance with embedded tumor cells. These tumor cells have abundant pale cytoplasm with vacuolation in few, pleomorphic hyperchromatic nuclei and inconspicuous nucleoli.

Conclusion: FNAC of Mass in pre sacral region of right pelvis shows : CHORDOMA

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-377: ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY IN THE DIAGNOSIS OF METASTATIC BONE TUMORS

Mohammad Jaseem Hassan ¹, SH Arif ¹, Kafil Akhtar ¹, Roobina Khan ¹, Mahboob Hasan ¹, S Shamshad Ahmad ¹

Background: FNAC is useful and convenient Method for diagnosis of musculo-skeletal tumors as it is simple, rapid, safe, cost effective and non-traumatic procedure and it also permits surgical or radiation therapy without lapse of time. To a large extent, many of the primary as well as metastatic bone tumors are accessible to FNAC. A concerted multidisciplinary approach including clinical, radiological and cytological examination can certainly overcome the problem in early diagnosis of metastatic bone tumors.

Method: This prospective study was done over a period of one and half years. All Cases of bone tumors were aspirated after clinical and radiological correlation. Histological correlation was done, wherever possible.

Results: A total of 15 Cases of metastatic bone tumors were included in our study with M:F ratio of 4:1. The average age of presentation was 51.5 years with maximum Cases (8 Cases) detected in 40-60 years of age group. Femur was the most commonly involved bone (4 Cases), followed by humerus (3 Cases), vertebra (2 Cases), sternum and pelvic bone (1 Case each). Multiple bones were involved in 4 Cases. Primary Cases were detected in 13 Cases. Lung was the most common primary site (6 Cases, 3 Cases each of SCC and Adenocarcinoma), followed by GIT Adenocarcinoma (3 Cases), Kidney (2 Cases, RCC), Breast (1 Case of IDC) and Thyroid (1 Case of Papillary thyroid carcinoma.)

Conclusion: FNAC can no more be regarded as screening procedure as it can play a pivotal role in the treatment decision making of metastatic bone tumors.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-378: FNAC DIAGNOSIS OF SPOROTRICHOSIS PRESENTING AS A MASS LESION -A CASE REPORT OF AN UNUSUAL PRESENTATION

Jalli Pravallika ¹, Amita K ¹

Background: Sporotrichosis also called as Schenk's disease or Rose gardener's disease is caused by the fungus Sporothrix Schenckii. The infection usually involves the skin and subcutaneous tissue and occurs from inoculation of the fungus from plants and soil through the skin. Plethora of fungal and parasitic infections including tumor like lesions and rarely squamous cell carcinoma mimics sporotrichosis clinically. Herein we Report this Case to highlight the importance of FNAC in the diagnosis of sporotrichosis.

Case Report: A 65-year-old immunocompetent male presented with a soft tissue mass over the dorsum of the right ring finger. FNAC was done using standard technique. Smears showed predominantly suppurative inflammation, foreign body giant cells, granulomas and fungal yeast form and hyphae morphologically consistent with Sporotrichosis. The biopsy, PAS stain and culture corroborated the diagnosis.

Conclusion: FNAC is an early diagnostic tool which is easy, less painful, cost effective and with a shorter turnaround time than biopsy or culture in making precise diagnosis of sporotrichosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-379: RETROPRITONEAL PLEOMORPHIC LIPOSARCOMA DIAGNOSED ON FNAC: A CASE REPORT

Monika Bhagat ¹, Rajat Gupta ¹, Deepti Mahajan ¹

Background; Retroperitoneal sarcoma is relatively uncommon, constituting only 10-15% of all soft tissue sarcomas. The most common histologic types of Retroperitoneal sarcoma are Liposarcoma and Leiomyosarcoma. Retroperitoneal sarcoma is classified based on the amount of lipid inside the cells, the mucoid lipid and the degree of cell differentiation. It is classified into well differentiated, myxoid, round cell, pleomorphic and dedifferentiated types and the commonest is the pleomorphic type. Pleomorphic liposarcoma represents one of the rarest variants of liposarcoma. It has a poor prognosis and unlike other variants of liposarcoma, lacks a molecular or genetic signature.Case Report; We Report a 52 years old female patient presenting with lump abdomen and pain, diagnosed of large Retroperitoneal mass on Contrast-enhanced computed tomography of the abdomen and subsequently on Ultrasound guided FNAC as High grade Pleomorphic Liposarcoma. Conclusion; The present Case emphasizes the role of FNAC and cell block in the diagnosis of Pleomorphic Liposarcoma as it is minimally invasive and leads to early diagnosis and early commencement of treatment.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-380: PRIMARY CUTANEOUS LEIOMYOSARCOMA OF SCROTUM METASTASIZING TO INGUINAL LYMPH NODE – A RARE CASE REPORT

Gyanendra Singh ¹, Shalini Bahadur ¹, Shivani Kalhan ¹

Background: Primary cutaneous leiomyosarcoma comprises of 0.04% of all neoplasms and 5-10% of all soft tissue sarcomas and has an incidence rate of 0.2/100,000/year. It arises in the dermis from the malignant transformation of arrector pili muscle. Superficial leiomyosarcoma can occur at any age and anywhere in the body but proximal extremity, face and trunk are the commonest site. Regional lymph node metastasis in primary cutaneous leiomyosarcoma is extremely rare. We Report a Case of primary cutaneous leiomyosarcoma of scrotum in a 48 years male, metastasising to the inguinal lymph node.

Case Report: A 48 years old male presented with swelling in the right scrotum for the last 2 years which was mildly tender, with smooth, bosselated outer surface and firm consistency on palpation, grossly measuring 9.5x7x4 cm. Scrotal leiomyosarcoma was confirmed on histopathology supported by immunohistochemistry. Multiple lymph nodes were found in right inguinal region largest measuring 1.2x1 cm. Fine needle aspiration cytology was done from the inguinal lymph node. Clusters of spindle shaped cells with oval to elongated pleomorphic nuclei, inconspicuous nucleoli and moderate amount of cytoplasm, on a Background of reactive population of lymphoid cells was visualised. A high index of suspicion for metastatic deposits from scrotal leiomyosarcoma was considered and excisional biopsy advised.

Conclusion: Regional lymph node metastasis in patients with soft tissue sarcomas is an infrequent event occurring in 2.6 - 5% of all patients. Intratumoural lymphatics are found in soft tissue sarcomas that have a high proclivity for metastasizing to lymph nodes like epithelioid sarcoma. The reduced rate of lymph node metastasis in leiomyosarcomas could be due to the fact that these tumours have less Intratumoural lymphatics.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-381: DESMOID FIBROMATOSIS: DIAGNOSIS OF A RARE LESION BY FINE NEEDLE ASPIRATION CYTOLOGY AND CELL BLOCK IMMUNOCYTOCHEMNISTRY

Anjali Gupta ¹, Neha Bhardwaj ¹, Radhika Srinivasan ¹

Background: Desmoid fibromatosis (DF) is a locally aggressive fibroblastic tumor with a high incidence of local recurrence but no metastatic potential and hence allows its categorization as borderline fibroblastic tumors. It occurs commonly in the abdominal wall and has a propensity to develop following pregnancy, previous trauma or surgery.

Case Report: A 24-year-old puerperal female presented with abdominal pain and suprapubic mass following caesarean section which was rapidly increasing in size. On examination, the mass was large, firm to hard, fixed, non-tender, measuring 8 x 7 cm in the suprapubic region. On ultrasound, the mass was located in the suprapubic region separate from the bowel loops pushing the bladder posteriorly. She was referred with a clinical and cytological diagnosis of epithelioid sarcoma from another centre. Repeat FNAC was performed by palpation guidance for smears and cell block preparation. Smears were cellular and showed abundant fibrocollagenous pale pink matrix material admixed with bland spindle shaped fibroblasts and plump epithelioid myofibroblasts. No mitosis or necrosis was identified. Cell block section showed similar features. On immunocytochemistry, the tumor cells were positive for vimentin, beta catenin cytoplasmic positivity, and negative for desmin and CD34. A diagnosis of desmoid fibromatosis was made.

Conclusion: Desmoid fibromatosis can mimic malignancy clinically, radiologically and even on cytology. Proper interpretation of cytomorphology aided by immunocytochemistry on cell blocks with clinical and imaging correlation is important for an accurate diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-382: CLIVAL CHORDOMA- A CASE REPORT

N Durgadevi ¹, R Padmavathi ¹, J Bharathi Vidhya Jayanthi ¹

Background: Chordomas are uncommon malignant tumors that accounts for 1-5% of all primary bone tumors. Chordoma is most frequent in fifth and sixth decades. Clival Chordoma represent the second commonest site of Chordoma, the first being sacrococcygeal region.

Case Report: A 13year old boy came with complaints of headache on and off for one year, bilateral nasal obstruction for 6 months.MRI Brain showed a well defined,multilobulated T1 hypodense T2 hyperdense Solid mass over roof and posterior wall of Nasopharynx and Focal erosion of Clivus - Suggestive of Clival Chordoma. Peroperatively, fluid aspirated from the mass received for cytological examination showed Moderately cellular smear with clusters and singly scattered polyhedral cells with vesicular nuclei with moderate to abundant cytoplasm and also seen are large cells with vacuolated cytoplasm ?Physaliferous cells with Background showing myxoid matrix- Features suggestive of Chordoma. The mass from clivus received for Histopathological examination also showed features of Chordoma.

Conclusion: Chordomas can also present in young age and as in this Case at short time duration also (usually the duration of symptoms before diagnosis will be over 5 years). The characteristic cytological features of Chordoma- (The physaliferous cells and Myxoid matrix) can be studied from the fluid aspiration cytology too. The differentials are Benign notochordal cell tumor and Ecchordosis physaliphora.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-383: EPITHELIOID SARCOMA – A CAMOUFLAGE TUMOR IN PATHOLOGY

Syed Saad Salman ¹, Anju GS ¹, Adarsh Barwad ¹, Sameer Rastogi ¹

Background: Epithelioid sarcomas are rare soft tissue sarcomas (representing less than 1%) with a predilection for distal extremity of young adult males. It can mimic a variety of benign and malignant lesions including malignant melanoma, synovial sarcoma, squamous cell carcinoma, adenocarcinoma, and granulomatous inflammation. Considering the rarity, odd biologic behavior and diagnostic perplexity, here in, we Report a Case of Epithelioid Sarcoma.

Case Report: 22 years old antenatal female with history of right flank lump excision at an outside centre, presented at 27 weeks with scar site recurrence and right inguinal lymphadenopathy. Fine needle aspiration from the lesion and lymph node were done. Cytopatholgical examination of both showed singly dispersed large oval cells with dense cytoplasm and eccentric nuclei with conspicuous nucleoli. The tumor cells were immunopositive for Cytokeratin and showed loss of INI1 immunoexpression, based on which a diagnosis of Epithelioid sarcoma was rendered. Simultaneous review of histopathology slides of lump excision showed similar tumor cells in a Background of desmoplastic stroma and patchy lymphocytic infiltrate. Immunohistochemistry for EMA was positive, while that of S100 was negative and INI-1 immunoexpression was lost, confirming cytology diagnosis of Epithelioid sarcoma.

Conclusion: Epithelioid sarcomas are rare soft tissue tumors occurring in young adult population with a known propensity for local recurrence and distant metastasis. Since it can mimic commonly occuring benign granulomatous conditions, a misdiagnosis and Mismanagement is likely. Early diagnosis by histopathological/cytopathological examination with adjunct immunohistochemistry offers a prompt diagnosis for an early treatment and prevention of local recurrence and distant metastasis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-384: INTRAMUSCULAR HYDATID CYST OF THIGH DIAGNOSED BY FINE NEEDLE ASPIRATION CYTOLOGY – A CASE REPORT

Rajini T ¹, Amita K ¹

Background: Hydatid cyst, caused by echinococcus granulosa, occurs rarely in musculoskeletal region. Most of the time, clinically and radiologically it is diagnosed as a soft tissue tumor, benign or malignant. There are few Case Reports of hydatid cyst presenting as intramuscular thigh mass, which has been diagnosed at FNAC. Accurate preoperative diagnosis is essential in view of a specific therapeutic options for this disease. Here in we Report a Case of hydatid cyst occurring in an unusual location (thigh) diagnosed at FNAC.

Case Report: A 56-year-old male patient presented with gradually increasing swelling of the left thigh since 25 yrs. On examination, there was firm non-tender 25 × 20 cm swelling on the posterior aspect of left thigh extending from gluteal region to 5 cm above knee joint. An ultrasound diagnosis of soft tissue tumor was made. FNAC was done and smears showed granulomas along with multiple, hyaline, acellular membrane like fragments, few showing vague laminations. A diagnosis of hydatid cyst was made at FNAC which was corroborated at histopathology.

Conclusion: Intramuscular Hydatid cyst of the thigh is a very rare manifestation. Possibility of hydatid cyst should be considered while aspirating any soft tissue mass lesion, especially when fluid is obtained and microsopy shows acellular hyaline membrane like material, even when fewer laminations are noted.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-385: EXTRANODAL ROSAI- DORFMAN DISEASE: A RARE SOFT TISSUE NEOPLASM

Renuka Verma ¹, Niti Dalal ¹, Sunita Singh ¹

Background: Rosai-Dorfman disease (RDD) was first described by Rosai and Dorfman in 1969 and is referred to as sinus histiocytosis with massive lymphadenopathy. It is a rare, idiopathic, benign and self-limiting histiocytic proliferative disorder. The etiology is still unknown; however, genetic, infectious and inflammatory theories have been postulated. Classically, nodal type presents as massive painless cervical lymphadenopathy; however, 40% of the patients have extranodal involvement, with skin being the most frequently affected site. Isolated subcutaneous lesions in the absence of lymphadenopathy are extremely rare, Reported in only 3% of Cases and the most common locations are the trunk and proximal extremities.

Case Report: A 40 years old male presented in surgery OPD, with gradually progressive, painless swelling over left shoulder since 6 months. On examination, no lymphadenopathy was noted. On ultrasonography, a diagnosis of lipoma was made. Cytological examination revealed large number of giant cells admixed with lymphoid cells, cystic macrophages and plasma cells in a Background of hemorrhage and amorphous material. Features of emperipolesis were evident in the smears as lymphocytes and plasma cells were phagocytosed by histiocytes. Cytologically, a diagnosis of Extranodal Rosai-Dorfman disease was made after correlating with the clinical and CT scan findings of the patient.

Conclusion: Diagnosis of extranodal RDD is often complex because of overlap with many neoplastic and inflammatory conditions. For Definite diagnosis of cutaneous RDD, correlation of the histopathologic findings, immunohistochemical studies, clinical presentations, and imaging findings are necessary.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-386: NOT ALL BLACK FUNGUS IS MUCOR IN COVID ERA: A CHALLENGING CASE OF MEDICOPSIS ROMEROI

Nithye Parvathy ¹, Neha Bhardwaj ¹, Harsimran Kaur ², Sanjeev Handa ³, Radhika Srinivasan ¹

Background: Subcutaneous phaeohyphomycosis is an uncommon fungal infection of the dermis and subcutaneous tissues. This large heterogenous group of dematiaceous fungi are known for causing invasive manifestations especially in immunocompromised setting. Fine needle aspiration and culture sensitivity are the most sensitive technique for the diagnosis of the causative organism.

Case Report: A 59-year-old female who is a known Case of poorly controlled diabetes presented with history of serosanguinous discharge from recurrent subcutaneous swelling over the right hand for 10 months. She suffered from COVID-19 infection following which the size and discharging sinuses were increased. On examination, the swelling was firm, nontender with multiple discharging points however no granules were identified. Ultrasound revealed lobulated heteroechoic lesion in subcutaneous plane with prominent vessels coursing through the lesion. The fine needle aspiration cytology smears showed extracellular, branching septate hyphal forms and bullous ends with melanin pigment in its wall. Numerous pigmented rounded yeast forms were also seen. Masson Fontana further highlighted these fungal profiles and confirmed the diagnosis of phaeohyphomycosis. Further fungal culture grew dematiaceous moulds and Molecular tests revealed Medicopsis romeroi species.

Conclusion: The increasing prevalence of invasive fungal infections have taken a toll in the COVID era. If there is disseminated infection, these are associated with high mortality and poor outcome even with adequate antifungal therapy. Fine needle aspiration cytology enables a rapid diagnosis and emergent treatment of phaeohyphomycosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-387: CALVARIAL TUBERCULOSIS: AN UNUSUAL CYTOLOGICAL CASE REPORT

Shital Mahure ¹, Nilam More ¹, Kavita Sawant ¹, L P Naik ¹, Kanchan Hire ¹

Background: The global prevalence of TB was 1.7 billion in the year 2019 with India bearing the maximum burden of disease. 15 – 25% of TB Cases present with extrapulmonary manifestations; tuberculous lymphadenitis being the most common presentation occurring in 35% of these Cases. Calvarial TB is rare with a prevalence of 0.01% of all mycobacterial infections. The most common presentation of calvarial TB is multiple punched out lesions of skull. Rarely there are studies Reported in literature with diagnostic cytological analysis of calvarial TB presenting unusually with a soft cystic swelling of scalp.

Case Report: A 22 year old young healthy male with no features or history of contact with tuberculosis, presented with chief complaints of a 5x5 cm well defined, immobile, soft cystic swelling, gradually increased to present size, painful only while sleeping due to pressure effects since 6 months. FNAC yielded yellow thick fluid. PAP and Giemsa stained smears showed presence of epithelioid cell granulomas, thick walled blood vessels, lymphocytes and histiocytes against a Background of abundant necrosis. There was no evidence of atypia/ fungus/ anucleate squames. MRI showed presence of a lytic lesion in the occipital bone with intra and extracranial extension of the lesion. Microbiological evaluation confirmed presence of AFB on Ziehl Neelson staining and with Gene expert positivity for mycobacterium Tuberculosis.

Conclusions: Most of the soft cystic lesions of scalp are trichilemmal cysts and sebaceous cysts, however a rare Case like calvarial tuberculosis also presents in a similar manner.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-388: BENIGN SMOOTH MUSCLE VERSUS NEURAL TUMOR OF FOOT IN AN ELDERLY MALE: A CASE WITH CYTO-HISTOLOGIC CORRELATION

Pallavi Saraf ¹, Meenakshi Rao ¹, Sudeep Khera ¹

Background: Leiomyomas are benign tumors of smooth muscle origin, most commonly occurring in uterus and gastrointestinal tract with extremities being a rare location. They pose a diagnostic challenge to pathologists on Fine Needle Aspiration Cytology (FNAC). We present a Case of a 60-year-old male with nodule over plantar aspect on foot, which mimicked a benign tumor of neural origin on fine needle aspiration cytology.

Case Report: A 60-year-old male presented with swelling on plantar aspect for six months, which was gradually increasing in size. Physical examination revealed a nodule of 2.5cm x 2.0cm which was firm and slightly tender. FNAC of the nodule was done, which revealed a cellular tumor comprised of spindle cells scattered singly and in clusters. The cells had elongated nuclei with pointed ends, inconspicuous nucleoli and moderate cytoplasm embedded in eosinophilic fibrillary stroma. Based on these findings, diagnosis of benign spindle cell lesion of neural origin was made. Subsequently, the lesion was excised. Grossly, the lesion was well encapsulated with a pearly white and whorled cut surface. On microscopy, it was consistent with leiomyoma with extensive stromal calcification with no cellular atypia. On Immunohistochemistry, tumor cells were positive for SMA and negative for S-100, further confirming the diagnosis of benign smooth muscle tumor.

Conclusions: Herein, we concluded that on FNAC leiomyomas can closely mimc benign tumors of neural origin. Therefore histopathology and immunohistochemistry remains the mainstay of diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-389: PLEOMORPHIC DERMAL SARCOMA WITH MYXOID CHANGE MASQUERADING AS ANCIENT SCHWANNOMA ON CYTOLOGY: A CASE REPORT

Garima Singh ¹, Urvashi Sharma ¹, Akhil Nadesan ¹, Rupinder Kalra ¹, Sompal Singh ¹, Namrata Sarin ¹, Aarzoo Jahan ¹

Background: Pleomorphic dermal sarcoma is a rare low grade malignant cutaneous tumour of uncertain differentiation. This tumour mostly presents in elderly patients on sun exposed regions.

Case Report: A 19-year-old male patient presented for fine needle aspiration for a recurrent lump at upper back region. The lesion was 4x3.5 cm, soft and mobile on clinical examination. Cytosmears show fair amount of pink fibrillary material with cells having large, highly pleomorphic nucleus. On Giemsa smears no nucleolus was visible. No mitotic figure seen. A cytology report suggestive of ancient schwannoma was given. However, in view of recurrent nature of the lesion, a complete excision with safe margin was advised on cytology Report. Histopathological examination of the excised mass showed features of 'pleomorphic dermal sarcoma' with myxoid change. Following this a review of cytology slides along with histopathology slides was done. The reason for pink stromal material on cytosmears was extensive myxoid change of the lesion. Another important finding missing on cytosmears was mitotic figures which were seen focally on histopathology slides.

Conclusion: In the hindsight we conclude that in such lesions, the presence of pink stroma material with absence of nuclear features/ mitosis on cytosmears, reporting should be done with utmost caution keeping these differential diagnosis in mind

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-390: FINE NEEDLE ASPIRATION CYTOLOGY OF INCLUSION BODY FIBROMATOSIS: REPORT OF A RARE CASE

Rucha Kanhe ¹, Balaji Baste ¹, Mona Agnihotri ¹, Pragati Sathe ¹, Kanchan Kothari ¹

Background: Inclusion body fibromatosis(IBF) or infantile digital fibromatosis(IDF) is a rare fibroblastic- myofibroblastic lesion occurring in infants, with a predilection for the extremities. This tumor has a remarkable tendency of recurrence as well as spontaneous regression. The pathognomonic feature is the presence of paranuclear inclusions within the tumor cells. Only a handful of articles in literature describe the cytologic findings in IBF.

Case Report: A two and a half year old female child presented with swelling on the dorsum of right little toe since five months. The swelling was well defined, round, firm, non tender and measured 1cm x 1cm in size. Clinical differential diagnoses were keloid and pyogenic granuloma. The patient had been operated for a similar swelling at the same site, one and a half year ago, which had been Reported as inclusion body fibromatosis on histopathology. Fine needle aspiration cytology (FNAC) was performed on the present swelling and smears showed dispersed spindle cells with distinct paranuclear inclusions prompting the diagnosis of recurrent inclusion body fibromatosis. The patient is being followed up clinically and surgery is not planned.

Conclusion: The presence of paranuclear inclusions is the key diagnostic feature of IBF and can be well seen on cytology smears as well. The possibility of spontaneous regression makes accurate diagnosis of this lesion important as a wait and watch policy may be adopted and surgical intervention can be avoided or deferred in these young children. Cytology thus can be an important tool in the diagnosis of IBF.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-391: SYNOVIAL SARCOMA OF PELVIS CLINICALLY MASQUERADING AS AN OVARIAN MALIGNANCY: A RARE CASE REPORT

Abhishek Malik ¹, Deepika Gupta ¹, Aasma Nalwa ¹, Amit Goyal ¹, Deepak Vedant ¹

Background : Synovial sarcoma (SS) is a soft tissue sarcoma with specific clinicopathological and genetic features. It can occur anywhere in the body, the commonest site is extremities near the large joints. Though precise morphological diagnosis and grading of sarcomas by FNA is more problematic than biopsy, however, biphasic synovial sarcomas have been successfully diagnosed on aspiration.

Case Report: A 32-year-female presented with complaints of abdominal distension for one month and was evaluated in another hospital and diagnosed as adenocarcinoma of the ovary on (USG)-guided FNAC for which she had received three cycles of chemotherapy. CECT of the abdomen revealed a well-circumscribed heterogeneous solid cystic mass, measuring 13.9x10x9.1 cm in the left adnexal region compressing the adjacent structures. We received one Hematoxylin & Eosin stained USG-guided FNAC slide for review that showed a cellular smear displaying loosely cohesive clusters as well as numerous scattered bland-looking spindle cells with occasional acinar-like structures at places. A final diagnosis of biphasic synovial sarcoma was suggested Subsequently, the patient underwent pan-hysterectomy with mass excision and omentectomy. diagnosis of biphasic synovial sarcoma was established on morphological and immunohistochemical findings.

Conclusion: Primary pelvic synovial sarcoma is a rare entity and recent data which advocates the importance of adjuvant chemotherapy makes it imperative to keep it in the differential diagnosis of high-grade intra-abdominal masses and FNA can be useful in preoperative diagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-392: CYTODIAGNOSIS OF CLEAR CELL SARCOMA OF SOFT TISSUE

Ritu ¹, Renuka Verma ¹, Ritesh ¹, Archana Yadav ¹, Pooja Rathee ¹

Background: Clear cell sarcoma is a rare malignant neoplasm of soft tissue. It is most commonly seen in young adults in third to fourth decade. Maximum Cases occur in distal extremities followed by thigh, trunk and rarely in head and neck. This neoplasm has high recurrence rate and metastasises to lung and lymph nodes. Microscopically, it is composed of mainly epithelioid and spindle cells with clear to eosinophilic cytoplasm separated by fibrocollagenous stroma. Here, we Report an unusual Case of clear cell sarcoma arising in the neck region.

Case Report: A 30 year old female presented with right supraclavicular swelling since past 3 months. Fine needle aspiration cytology smears prepared from swelling revealed high cellularity with degenerative changes. Smears were comprised of atypical cells mainly dispersed singly and in loose cohesive groups admixed with lymphoid cells and plasma cells. Background of amorphous granular debris and few RBCs was also noted. The atypical cells have high N:C ratio with round to oval pleomorphic hyperchromatic central to eccentrically placed nucleus, conspicuous nucleoli and moderate to abundant amount off cytoplasm which is vacuolated at places. Cytological features were suggestive of malignant mesenchymal neoplasm. Excision was done and received for histopathological examination. Final diagnosis of clear cell sarcoma was made on microscopy and immunohistochemistry (Positive markers were S-100,Vimentin,HMB-45)

Conclusion: Clear cell sarcoma is a rare soft tissue sarcoma. Key diagnostic cytological features of Clear cell sarcoma include monomorphic epithelioid cell population, mostly singly scattered with prominent nucleoli and granular to vacuolated cytoplasm,occasional racquet cells in tigroid Background. However, for confirmation biopsy followed by immunohistochemistry is mandatory.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-393: PROXIMAL TYPE EPITHELIOID SARCOMA PRESENTING AS A PERINEAL SWELLING: A DIAGNOSTIC DILEMMA

Amandeep Singh ¹, Divya Shelly ¹, Amit Kumar Das ¹, Tripti Sharma ¹, Chitra Raval ¹

Background: Epithelioid sarcoma (ES) is a rare, aggressive soft-tissue neoplasm, accounting for around 1% of all soft tissue sarcomas. Two types of epithelioid sarcoma have been described- distal/classic and proximal type with later having lower incidence than the former.

Case Report: Here, we present a Case of perineal swelling in a 24- year old male who was misdiagnosed as av malformation in an outside center and managed for the same for the same for 6 months. He presented to our center with persistence of the symptoms and inguinal lymphadenopathy. CT angiogram at our center was suggestive of subcutaneous perineal infective granuloma. FNAC from the mass revealed dispersed and cohesive clusters of large, epithelioid cells with binucleation, multinucleation and macro nucleoli. Differential diagnosis of melanoma, poorly differentiated carcinoma epithelioid sarcoma was offered. Excision biopsy of the mass confirmed the diagnosis of proximal type epithelioid sarcoma with immunohistochemical findings of CK, CD34, EMA positivity and loss of INI1.

Conclusion: Epithelioid sarcoma is a rare neoplasm with potential for local recurrence as well as metastasis. FNAC, in conjunction with age, gender and clinical presentation can be fairly suggestive of epithelioid sarcoma. Subsequent, histopathology and immunohistochemistry can be used to confirm the diagnosis. FNAC, a low cost and minimal invasive technique can play a crucial role in ruling out benign lesions especially in Indian set up and avoid unnecessary delay in the diagnosis and Management.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-394: NODULAR FASCIITIS ON CHEST WALL IN A TEENAGER

Fallguni Arora ¹, Jenna Bhattacharya ¹, Priti Chatterjee ¹

Background: Benign fibroblastic lesions of the chest wall are rare and even rarer in childhood. Of particular interest is Nodular fasciitis which is a benign proliferation of myofibroblasts that is mistaken for a soft tissue sarcoma leading to misdiagnosis.

Case Report: We present a 13-year-old male who came with a swelling on the right anterior chest wall, clinically suspicious of gynecomastia. On physical examination, the tumor was well-defined and not fixed to the chest wall. FNAC, revealed clusters of benign spindle cells with bipolar cytoplasmic projection, mild anisonucleosis, mixed inflammatory cells in a myxoid stroma. Overall features were suggestive of benign reparative lesion possibly nodular fasciitis which on trucut biopsy showed similar morphology.

Conclusion: Chest wall tumors rarely occur in children and account for only 1.8% of the solid tumors. Nodular fasciitis is a benign lesion which can mimic malignant soft tissue sarcomas from a clinical and path-ologic point of view and hence physicians should consider it during the evaluation of chest wall tumors in childhood for an accurate diagnosis and proper intervention.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-395: GIANT CELL TUMOUR OF SMALL BONE OF HAND: A CASE REPORT

Debolina Nag ¹, Junu Devi ¹, Geetanjali Gogoi ¹

Background: Giant cell tumour (GCT) is a locally aggressive benign neoplasm, primarily involving the epiphysis of long bones. Giant cell tumour in the bones of hand and feet is a rare phenomenon and accounts for about 1.7-5% of all GCT.

Case Report: We present a Case of a 35 years old male who presented with swelling and pain over the dorsal aspect of right hand for the past 6 months. There was no history of trauma. X-Ray of the hand showed an osteolytic lesion in the right 5th metacarpal. FNAC was performed and slides were stained with May Grunwald-Giemsa (MGG) Stain. On microscopic examination, dual cell population was seen consisting of uniform looking mononuclear spindle cells and osteoclastic type multinucleated giant cells. The Case was Reported as Giant Cell Tumour of the right 5th metacarpal and confirmed on histopathological examination.

Conclusion: Despite being rare, Giant cell tumours of bone can present at unusual sites such as small bones of hands and feet and, hence, should be considered as a differential diagnosis in Case of tumours of hand and feet showing presence of giant cells.

Keywords: Giant cell tumour, Metacarpal, FNAC

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-396: CD56 IN CUTANEOUS PLASMACYTOMA – AN FNAC – FLOWCYTOMETRY STUDY

M Bharanidharan ¹, Rabish Kumar ¹, Meeta Singh ¹, Nidhi Verma ¹, Sarika Singh ¹, Rajdeep Singh ¹, Sandeep Garg ¹

Background: Plasmacytoma is a solitary lesion of clonal plasma cells that are cytologically, immunophenotypically and genetically like plasma cell myeloma. Extramedullary plasmacytoma is a monoclonal plasma cell neoplasm at sites other than bone marrow without any bony lesions. CD56 belongs to the immunoglobin superfamily but is expressed in 65-80% of patients with multiple myeloma carries a good prognosis. Lack of CD56 expression is observed in extramedullary plasmacytoma and marks aggressive behaviour. FNAC- flowcytometry is a easy and effective Method of utilizing a large panel of markers for diagnosis of plasmacytoma and predicting outcome

Case Report: We present three Cases of cutaneous plasmacytoma with special focus on CD56 expression. FNAC was performed, aspirated material was used to make smears, fixed in methanol, and stained with MGG stain. Slides were scanned by two cytopathologists and FCM performed on aspirated material. Complete hematological and serological workup was available in all Cases for correlation. Cases were diagnosed as plasmacytoma on FNAC smears, flow cytometry was performed, all three Case strongly expressed CD 38, CD 138, CD 81, dimly expressed CD 19 and CD28 and these cells were negative for CD 56, CD 117, CD 27, CD 200. Kappa restriction was seen in two Cases, while third Case showed lambda restriction.

Conclusion: Flow cytometry prove to be valuable ancillary technique in the diagnosis of plasmacytosis where a large panel of markers must be applied saving lot of time thus helping in the quick accurate diagnosis of plasmacytoma. All three Cases in present study were negative for CD56.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-397: EWING'S SARCOMA OF ULNA : A RARE PRESENTATION IN A CHILD

Deepshikha ¹, Sanjay ¹, Nidhi ¹, Pooja ¹, Sant ¹, Sunita ¹

Background: Ewing's sarcoma is the second most common primary malignant bone tumor of childhood and adolescence that mainly involves diaphysis of long bones and flat bones of pelvis. Involvement of ulna is extremely rare and seen in only <1% of all diagnosed Cases of Ewing's sarcoma. This tumor is highly aggressive and metastasizes frequently.

Case Report: Patient presented to OPD with complaint of painful swelling near wrist joint for last three months which was gradually increasing in size. X Ray and USG done revealed mixed lytic and sclerotic lesion involving distal metaphysis and diaphysis of ulna. MRI showed hypointense lesion on T1W and hyperintense on T2W and heterogenous enhancement on contrast enhanced MR. Fine needle aspiration cytology from the swelling was performed. Smears showed malignant round cells with high nucleocytoplasmic ratio having scanty cytoplasm which were at places vacuolated with round to oval nucleus showing micronuclei in some of these cells. There was also sparse population of small round cells with negligible cytoplasm and hyperchromatic nucleus. There were several rosette like structures seen. On immunocytochemistry these cells showed membranous positivity for CD99 and were also positive for special stain Periodic Acid Schiff (PAS). Cytological diagnosis of Ewing's sarcoma was offered.

Conclusion: Fine needle aspiration cytology can prove an extremely valuable and accurate diagnostic tool in early diagnosis of such bony lesions as the most important prognostic factor for Ewing's sarcoma is metastasis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-398: CYTOLOGICAL DIAGNOSIS OF GOUTY TOPHI: REPORT OF FOUR CASES

Niketa Sharma ¹, Uma Handa ¹, Phiza Aggarwal ¹, Sudhir Garg ¹

Background: Gout is a metabolic disorder of uric acid characterised by hyperuricemia and monosodium urate deposition in joint spaces and viscera. Fine needle aspiration cytology (FNAC) is a diagnostic modality in differentiating gouty arthritis from other periarticular lesions and the atypical presentation of gouty arthritis.

Case Report: Four male patients varying in age from 41-66 years were evaluated for periarticular swelling by FNAC. Two patients presented with swelling at the first metatarsal joint, one had lateral malleolus swelling. One patient had multiple swellings on both the hands and right foot, alongwith granular discharging sinuses, and in concordance with the presentation, the clinical suspicion of Mycetoma was made. Two of them had renal involvement and were on medications. FNA from the lesions yielded thick white cheesy/calcified aspirate. Microscopic examination revealed numerous clumps and singly scattered, needle-shaped crystals which were birefringent under a polarising microscope unlike rhomboid blunt-ended crystals in pseudogout. All the Cases had minimal inflammatory cell infiltrate in the background.

Conclusion: The unusual presentation of gout can pose a difficulty in diagnosis and disguise the true nature of the lesion. The presence of chalky aspirate and needle shaped crystals should prompt the cytopathologist to examine under a polarising microscope to avoid a diagnostic trap.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-399: CYTOLOGICAL DIAGNOSIS OF CHONDRO LIPOMA- A RARE CASE REPORT

Tummidi Santosh ¹, Nagiredla Puneeta ¹, Manoj Kumar Patro ¹

Background: Chondrolipoma is a rare benign mesenchymal tumor, comprising of adipose and cartilaginous tissue. They can be seen in almost any part of the body but are commoner in the connective tissue of skeletal muscle, breast, pharynx, and nasopharynx.

Case Report: We Report a Case of 56-year female patient who presented with swelling in left ring finger. FNAC was done using 23gz needle followed by routine Geimsa and Papanicolaou staining. Cytosmears were showing mature adipocytic tissue fragments along with bluish matrix material. There were few chondrocytes with eccentric nuclei and lacunae. The Background was clear to fatty in nature. A diagnosis of chondrolipoma was given with advice for excision of the lesion.

Conclusion: Cartilaginous metaplasia is an infrequent occurrence, seen in large and long-standing lipoma. However, in hands the it's not the Case due to early removal of lesion in view of restricted mobility. Surgical excision is the treatment of choice.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-400: PILOMATRICOMA OF ARM DIAGNOSED BY FINE NEEDLE ASPIRATION CYTOLOGY-A CASE REPORT

Danita G S Edwin ¹, Jaya Ganesh ¹

Background: Pilomatricoma (PMX) is a benign skin appendage tumor, originating from the hair matrix which usually occurs on the face or upper extremities. Though they can appear at any age, it is commonly seen in children and females. They typically present as superficial, firm, solitary, slow-growing, painless mass in the dermis. The overlying skin can be normal or exhibit a bluish-red discoloration or ulceration. Despite presenting as defined swellings, they continue to be frequently misdiagnosed and are not usually considered in differential diagnoses in clinical settings or cytological Reporting.

Case Report: A 39 -year-old female presented with a slow-growing, non-tender swelling in the right arm for 6 months, the overlying skin showed a hypertrophic scar as a Result of the earlier native treatments she had undergone. Clinically, it was diagnosed as lipoma and patient was sent for fine needle aspiration cytology (FNAC). A precise diagnosis of pilomatricoma on cytological examination was made based on the clusters and sheets of basaloid cells accompanied by numerous multinucleated cells and the characteristic ghost cells, which was subsequently confirmed by histopathology.

Conclusion: Cytological features of PMX are variable but still characteristic and allow a conclusive diagnosis when the smears are keenly examined bearing in mind the diagnostic traps that can mislead a cytopathologist in differentiating various morphological patterns of pilomatricoma, especially in smears where basaloid cells predominate and ghost cells are not easily identified. Thus, FNAC serves as a valuable tool in diagnosis of such uncommon skin adnexal tumors.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-401: AN INTERESTING CYTOHISTOPATHOLOGICAL CORRELATION OF TELANGIECTATIC OSTEOSARCOMA-A CASE REPORT

Bensy Stephen ¹, DK Raman ¹, Jeenu Varghese ¹

Background: Telangiectatic osteosarcoma is a rare variant of osteosarcoma and hence its occurrence presentation and prognosis are poorly understood.

Case Report: A 38-year-old male presented with complains of swelling in anteriomedial aspect of right arm period of 1 month. An ultrasound examination revealed large intermuscular heterogeneous collection in anteriomedial aspect of right arm measuring 6.6x4.5x9.5cm with a few fluid levels and areas of soft calcification suggesting a differential diagnosis of telangiectatic osteosarcoma vs vascular soft tissue sarcoma radiographically. FNAC done revealed a cellular swelling with poorly cohesive tumour cells arranged in clusters and dispersed singly. Few osteoblasts like cells, few large bizarre tumour cells, few osteoclastic giant cells and few atypical mitotic figures are seen as well. Further a tru cut biopsy and IHE studies done revealed a lesion of similar cytological features as in FNAC with a nested and diffuse architectural pattern.IHC panel showed ki 67 score of 60-70%, vimentin positive while it was negative for EMA, LCA, Desmin, SMA, CD34, S100 and Melan A.

Conclusion: Telangiectatic osteosarcoma of soft tissue is rare subtype of extra osseous osteosarcoma and is characterized by production of neoplastic osseous tissue without attachment to the underlying bone or periosteum. It generally affects adults older than 50yrs of age. Although histopathologic morphology seen in excision biopsy forms the gold standard of diagnosis, it is rarely seen that the same cytomorphological features of the tumor cells and intervening stroma could effectively point to a diagnosis of extra osseous telangiectatic osteoscarcoma even on FNAC

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-402: CYTO-HISTOLOICAL PEARLS IN TENOSYNOVIAL GIANT CELL TUMOR: AN INTERESTING CASE REPORT

Pooja Awasthi Mahajan ¹, Ila Singh ¹, Vaishali Kotasthane ¹, Usha ¹

Background: Tenosynovial giant cell tumor (TGCT) are relatively rare, benign tumor, arising in synovial lining of joints, tendon sheaths, or bursae. The majority of Cases are of unknown etiology, but possible etiological factors include trauma, inflammation and neoplastic trigger. Tenosynovial giant cell tumor is the term used in the latest WHO(2013) classification. They can occur at any age but mostly present in the 3rd to 5th decades and have a slight female predilection.

Case Report: Here we present a Case of a 58year old male, who had a history of trauma and surgery in the index finger around 10 years back, presented with a painless swelling in the left index finger measuring 1.5 x 1.5 cm. FNAC was done showing moderately cellular smear with mononuclear cells and Many scattered multinucleated osteoclast like giant cells suggestive of a giant cell lesion, which was later on found to be Tenosynovial Giant Cell Tumor on histopathology.

Conclusion: Tenosynovial giant cell tumor should be kept in differential diagnosis of any lesion in the finger showing giant cells lesion in cytology. Fine needle aspiration cytology can play an important role in rapid diagnosis and early planning of management.

Keywords: Giant Cell Tumor, tendon sheath, cytology

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-403: MYXOID LIPOSARCOMA DIAGNOSED ON FINE NEEDLE ASPIRATION CYTOLOGY: A RARE CASE REPORT WITH HISTOPATHOLOGICAL CORRELATION

Anju Dhali ¹, Priti Chatterjee ¹, Smita Singh ¹, Anup Mohta ¹

Background: Myxoid liposarcoma accounts for 15-20 % of liposarcoma and represents about 5% of all soft tissue sarcomas in children and adolescent with peak incidence in fourth and fifth decade of life. It typically occurs as a large painless mass within the soft tissue of lower limbs. Approximately 68-74 % of liposarcoma occurs in the lower extremities, most frequently found in thigh and rarely found in foot (1.3%-2.7%) or leg (6.7 %-13.5%). There is very limited data on the on cytomorphology of myxoid liposarcomas in the literature.

Case Report: A 20-year-old male presented with complaint of swelling on the medial aspect of left leg since 1.5 years. It was painless and progressively increasing in size. He had no history of trauma. Physical examination revealed soft tissue swelling measuring 3x3 cm in the medial aspect of left leg, not associated with pain and soft to firm in consistency. FNAC smear were cellular and showed spindle to ovoid cells with mild nuclear atypia embedded in myxoid matrix. Occassional lipoblasts and thin walled capillaries traversing the cellular fragments were seen. Occasional binucleate and multinucleate cells were present The diagnosis of myxoid liposarcoma was suggested and an excision of lesion was advised. Histopathological findings were consistent with myxoid liposarcoma.

Conclusion: This Case is being presented to highlight that myxoid liposarcoma demonstrates characteristic albeit cytomorphological features and can help to differentiate morphologically with other mimickers on FNA material.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-404: INFANTILE TUMORAL CALCINOSIS: CYTOLOGICAL DIAGNOSIS OF A RARE CASE

Sarada Prasad Sahoo ¹, Priti Chatterjee ¹, Vibhu Mendiratta ¹

Introduction: Infantile tumoral calcinosis is a rare disease characterized by painless and asymptomatic mass around joints due to the deposition of calcium phosphate in periarticular tissue. The deposits are usually around large joints; but rarely can be found around small joints of hand and feet. Cytomorphological features in conjunction with clinal presentation has rarely been described in the literature.

Case Report: We present the Case of 4-year-old male with one year history of insidious nonprogressive, nontender swelling at the sacral region. On physical examination Similar swellings were present at occipital region, Bilateral ankle joints, Elbows. The swellings were nodular, nontender, well defined and soft cystic in consistency measuring 4.5x3.5cm. Clinically a diagnosis of Juvenile Hyaline fibromatosis was made. Plane radiography demonstrated a dense lobulated cluster of calcific nodules near ankle joint and sacral soft tissue. On fine needle aspiration from swelling shows refractile, nonbirefringent basophilic calcific debris along with many histiocytes in the back ground. Von kossa stain for calcium was positive. No hyaline material, myxoid matrix or spindle cell component was seen. A diagnosis of Infantile tumoral calcinosis was made and serological investigation for Serum calcium, phosphate, vitamin D, and parathyroid hormone levels are advised. On follow up, Serum calcium comes to be normal. Excision biopsy for histopathological confirmation was advised, on follow up skin biopsy showed features of Calcinosis cutis.

Conclusion: This Case is being presented to highlight the cytomorphological features which aid in diagnosis of Infantile tumoral calcinosis and help in distinguishing it from its close mimickers.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-405: RAPID ON-SITE EVALUATION (ROSE) OF BIOPSY CORE IMPRINT SMEARS IN DIAGNOSTIC WORK-UP OF BONE LESIONS: BEST OF BOTH WORLDS

Kranthi Kumar ¹, Prashant Joshi ¹, Ashok Singh ¹, Mohit ¹, Dhingra ¹, Pankaj Kandwal ¹, Udit Chauhan ¹

Background: FNAC is an effective procedure but has a high rate of inadequacy as a standalone modality in bone tumours, biopsies have a long turn-around time. we evaluate utility of biopsy core imprint smears in workup of bone lesions.

Methods: Tissue core biopsies of patients at AIIMS Rishikesh, under orthopaedic management, were used on-site, to prepare imprint smears stained with Toludine Blue. Parameters assessed: Cellularity, Adequacy, Nature of lesion (Inadequate, Benign, Indeterminate, Malignant) & Specific diagnosis. Clinico-radiological correlation was done on-site. Triage recommendations made (Culture, FISH & PCR). Biopsy cores used for imprint smears were processed in separately to assess for tissue handling artefacts and correlation.

Results: ROSE done on 67 Cases (duration: 12.09.20 to 25.09.21). 44, 17 & 2 Cases, categorised as benign, malignant & inadequate respectively, 4 Cases yet to be Reported. There was 100% concordance in the imprint cellularity, cell types and deemed adequate with the FFPE tissue. There was a 100% concurrence for the Reported 64 Cases in the broad diagnostic category among ROSE Imprint and FFPE. In 90% of Cases (58/64) specific diagnoses could be made on imprint smears which concurred with FFPE diagnosis, rest 4 Cases a probable diagnosis was given. Triage (TB-PCR) given for 17 Cases and in 1 Case imprint smears were used for FISH. Biopsy cores used for imprints did not show any significant artefacts.

Conclusion: ROSE is a simple and reliable technique for determining specimen adequacy, diagnosis and importantly for immediate triage recommendations. It has potential to markedly reduce rebiopsy rates and sampling for ancillary testing.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-406: FUNGAL ORGANISM MIMICKING SOFT TISSUE LESION: ROLE OF RAPID STAIN, SPECIAL STAIN & CELL BLOCK

Josephain K ¹, Michael L Anthony ¹, Tummidi Santosh ¹, Arundhathi S ¹, Pavithra B ¹, Naresh Kumar P ¹

Background: FNAC is a basic diagnostic Method used for investigation of superficial and deep-seated lesions. Rapid On-Site Evaluation (ROSE) in cytological analysis can help in rapid diagnosis, obtain proper sample for further tests/analysis and cell block preparation further aid in confirmation of diagnosis.

Case Report: We Report a Case of 44-year-old male, presenting with swelling in right arm since last 34 years. FNA with ROSE was done using 1% aq. toluidine blue was helpful in identifying the pathology (fungal lesion) in the patient with further confirmation by cell block, periodic acid schiff & Gomori methenamine silver stain.

Conclusion: Role of FNA was significant in the above Case, special stains and cell block provided added advantage to the FNA procedure. The differential diagnosis of fungal etiology should be considered in subcutaneous soft tissue lesions. There has been major leap in diagnostic cytopathology with the advent of molecular testing, however FNAC morphology still has its charm.

Keywords: Cytology, Rapid on-site, Cell block, Fungal, Gomori methenamine silver, Polariser, Subcutaneous, Soft tissue.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-407: RECURRENCE OF EXTRASKELETAL MYXOID CHONDROSARCOMA : AN UNUSUAL PRESENTATION ON CYTOLOGY

Pooja Shinde ¹, T Chhadi ¹, J Sathe ¹, P Bhadarge ¹, R Patil ¹, B Kowe ¹

Background: Extraskeletal myxoid chondrosarcoma (EMC) is a rare low-grade malignant mesenchymal neoplasm of uncertain differentiation characterized by abundant myxoid matrix located in the soft tissue. EMC is rare, accounting for less than 3% of soft tissue tumors.

Case Report: A 33 years old male came to opd with complaints of right arm swelling for last 5 years, associated with pain since 3-4 months. Patient gave history of similar swelling at the same site 8 years ago for which wide local excision was done. On examination, swelling of size 5 x 4 cm, fixed, hard, tender with previous excision scar. The Case was investigated thoroughly. FNA was performed which showed cells arranged in groups, clusters, acini, dispersed singly and attached to and embedded in myxoid stroma. Individual cells were uniform round having moderate eosinophilic cytoplasm, at places showing dense eosinophilia, nuclei were rounded or ovoid with vesicular chromatin, prominent 1-2 nucleoli and mild anisokaryosis. A diagnosis of a myxoid sarcoma favouring an extraskeletal myxoid chondrosarcoma was given on cytology and also confirmed histopathologically.

Conclusion: Although extraskeletal myxoid chondrosarcoma is a rare entity, presence of myxoid stroma on cytology smears should raise the suspicion of myxoid chondrosarcoma as a differential diagnosis. This Case also demonstrates the recurrence of the lesion despite local excision.

Keywords: Myxoid, Extraskeletal myxoid chondrosarcoma, Recurrence.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-408: DERMATOFIBROSARCOMA PROTUBERANS / NEURO-FIBROMA: A DIAGNOSTIC DILEMMA

Bhawna ¹, Ashok Sangwaiya ¹, Sonia Hasija ¹, Sheetal Gole ¹, Puja Sharma ¹

Background: Dermatofibrosarcoma protuberans (DFSP) is a superficial, intermediate grade, locally aggressive fibroblastic neoplasm, characterised histomorphologically by diffuse infiltration of dermis and subcutis. It has a predilection for trunk and proximal extremities of young to middle aged adults. At molecular level, it is characterised by COL1A1-PDGFB fusion product. The cytomorphological features overlap with other spindle cell neoplasm and may pose a great difficulty in diagnosis.

Case Report: A 29 year old male presented with a nodular thigh mass for 7-8 months, measuring 5.5x5x3cms. On fine needle aspiration, smears were cellular and comprised bland oval to spindle cells entrapped within stromal fragments. The nuclear aytpia or mitosis was not evident. Very occasional cell revealed nuclear buckling. The diagnosis of benign mesenchymal lesion with a possibility of neurofibroma was given. The histomorphology and immunohistochemistry revealed the diagnosis of Dermatofibrosarcoma protuberans. The lump recurred after 9 months with focal fibrosarcomatous areas.

Conclusions : Aspirates from DFSP may mimic benign spindle cell neoplasms, including neurofibroma, though the aspirates are more cellular and monomorphic in DFSP. Though nuclear buckling with waviness is a feature of neural tumors, it can occasionally be observed in DFSP. Due to higher chance of recurrence, a rare transformation to fibrosarcoma, and wide excision (~3cm) for management, it should be kept in consideration in specific clinical scenario (superficial, nodular/plaque-like cutaneous/dermal lesion involving the proximal extremities). The clinical and cytological suspicion mandates the needed histopathological examination and ancillary techniques for proper grading, characterisation, and management.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-409: RARE PRESENTATION OF METASTATIC LUNG CARCINOMA MIMICKING SARCOMA

Souvik Saha ¹, Deepak Vedant ¹, Anju G ¹, Suman Choudhary ¹

Background: Lung carcinoma commonly metastasizes to liver, adrenal gland, brain and bone. However, soft tissue metastasis is rare with a Reported rate of only 2.3%. The most common metastatic sites are the paraspinal and psoas muscle. These patients have significantly poorer prognosis. We Report a Case of lung carcinoma, where the patient had initially presented with a thigh mass.

Case Report: A 65 year old male presented with swelling on the anterolateral aspect of upper thigh. The swelling was 9x6cm, firm and fixed to underlying muscle. There was no inguinal lymphadenopathy. A clinical diagnosis of soft tissue sarcoma. The FNA cytology smears were markedly cellular and showed cohesive clusters and isolated tumor cells. The tumor cells were epithelioid, had coarse chromatin, prominent nucleoli and moderate amount of cytoplasm. Several binucleated and multinucleated cells and brisk mitosis were observed. Cell block showed sheets of epithelioid tumor cells in fibrinohemorrhagic Background. Based on morphology and site of tumor, a provisional diagnosis of sarcoma was considered. However, Immunocytochemistry showed the tumor cells were reactive for CK. A possibility of metastatic carcinoma was suggested. Further workup revealed a Hilar mass in the right lung and a diagnosis of lung carcinoma was made.

Conclusion: Our Case Reports a very rare presentation of lung carcinoma, mimicking a sarcoma. Cytology eventually led to the diagnosis of lung malignancy. Although rare, it must be kept in mind that carcinomas can metastasize to soft tissue and that all soft tissue mass is not a sarcoma.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-410: CYTOLOGY TO THE RESCUE': CYTOMORPHOLOGIC DIAGNOSIS OF A CLEAR CELL SARCOMA OF SOFT TISSUE WITH ABERRANT CD38 AND CD138 POSITIVITY

Amarjot Kaur ¹, Parikshaa Gupta ¹, Nalini Gupta ¹, Amanjit Bal ¹, Gaurav Prakash ¹

Introduction: Clear cell sarcoma of soft tissue (CCS-ST) is a rare high grade, soft tissue sarcoma. Establishing a cytodiagnosis is challenging owing to multiple morphologic mimics.

Case: A 36-year-old male presented with fever and gradually progressive back and neck swellings for the last 3 months. On examination, there was a firm to hard soft tissue mass measuring 10x7 cm over left scapular region with ipsilateral supraclavicular lymphadenopathy. Hematologic investigations were within normal limits. PET–CT was suggestive of a lymphomatous disease. Percutaneous FNAC was done followed by a core needle biopsy. FNA smears were cellular with sheets of discretely scattered round to epithelioid tumor cells and loose clusters with traversing capillary channels in a vacuolated Background. The tumor cells were mildly pleomorphic with round eccentric nuclei, fine chromatin, prominent nucleoli and moderate amount of finely vacuolated cytoplasm. On immunocytochemistry, tumor cells showed strong positivity for vimentin, HMB-45, S-100, and were negative for EMA and MUM-1. INI-1 was retained. A final cytologic diagnosis of CCS-ST was rendered. The core biopsy, also showed similar features; however, on IHC, the tumor cells showed diffuse positivity for CD38 and CD138, hovering a possibility of a plasma cell neoplasm (PCN). Subsequently, in view of the cytologic diagnosis, HMB-45 and Melan-A were done and showed positivity in the tumor cells, which were negative for chromogranin, MUM-1, kappa, and Lambda ISH, confirming the diagnosis of CCS-ST and excluding PCN.

Conclusions: Knowledge of the characteristic cytomorphological and immunocytochemical features of this entity is important to establish an accurate cytodiagnosis.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-411: UTILITY OF COTTON BLOCK METHOD FOR FNA REPORTING OF SUPERFICIAL LESIONS

Aarzoo Jahan ¹, Peeyush Kishor ¹, Akhil Nadesan ¹, Namrata Sarin ¹, Sompal Singh ¹

Background: Cell block preparation usually needs a base to hold cytology material. The cotton block method though described long back, is not being used widely due to paucity of objective studies on its utility.

Methods: A total of 30 cell blocks were made using cotton as a base (cotton block method). The cellular yeild, preservation of cytological details were studied. Where ever required immunohistochemistry was done on slides prepared from cotton block and its quality assessed.

Results: Technically there was difficulty faced by microtomist as material was mostly in the front face of cotton block which required minimal trimming. The cellular yield was moderate and there was satisfactory antigen preservation for immunohistochemistry.

Conclusion: Cotton block method is easy to implement even in a low-resource setting. It gives satisfactory results for immunohistochemistry.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-412: CYTOHISTOPATHOLOGICAL CORRELATION OF CERVICAL PAP SMEARS: A HOSPITAL-BASED STUDY

Anju Khairwa ¹

Background: The cervical carcinoma most common in Indian women. The rural women predominantly affected. The most common etiological factor HPV (human papillomavirus). Aim of present study to assess the diagnostic accuracy, sensitivity, specificity, and different pattern of cervical Pap smears test by comparing histological findings.

Materials and Methods: The index study is a prospective study and the data collected at pathology department from May 2017 to December 2019 as per hospital ethical protocol. Cervical Pap smears received in pathology department underwent for Pap staining.

Results: Total 884 cases Pap smears were included in study as satisfactory. Age of enrolled women 46.4±9.7 years. The 800 cervical Pap reported as NILM (negative for intraepithelial lesion) and 84 Pap smears reported as abnormal, which included. ASC-US (atypical squamous cell-undetermined significance) in 64 (7.1%) patients, LSIL (low grad squamous intraepithelial) in 09 (1.01%) patients, ASC-H (high grad squamous intraepithelial lesion cannot be rule out) in 05 (0.56%), HSIL (high grad squamous intraepithelial lesion) in 03 (0.33%), AGC-NOS (Atypical glandular cell-not specific otherwise) in 02 (0.22%) and squamous cell carcinoma in 01(0.11%) cases. The cyto-histological correlation found in 56 cases that were chronic cervicitis 41.07%, chronic cervicitis with squamous metaplasia 26.75%, cervical polyp 5.35%, CIN-1 1.78%carcinoma in situ 16.07%, squamous cell carcinoma (keratinizing) 7.14%, squamous cell carcinoma (non-keratinizing) 1.78%. Cyto-histological correlation of 56 cases revealed sensitivity (83.33%), specificity (94.73%), PPV (88.23%), NPV (92.3%) and accuracy (91.07%).

Conclusion: Cervical Pap test is cost effective, almost equally sensitive, and accurate to histology for screening cervical lesion.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-413: CYTOMORPHOLOGICAL EVALUATION OF PAP SMEAR IN HIV POSITIVE PATIENTS IN A TERTIARY CARE HOSPITAL

Upasana Kalita ¹, Junu Devi ¹

Introduction: HIV positive patients are more likely to have abnormal PAP smear findings as compared to HIV negative patients. The abnormal smear findings are also usually associated with human papilloma virus infection, the incidence of which increases as immune function declines. The aim of this study is to analyse PAP smear abnormalities in HIV positive patients categorised as per the Bethesda System of Reporting Cervical Cytology and to correlate with CD4 cell counts.

Methods and Methodology: This was a prospective study done in a tertiary care hospital. A total of 100 cervical smears was obtained from HIV positive patients and stained with Papanicolaou stain. The data collected were tabulated and analysed and then categorised as per the Bethesda System and correlated with the immune status of the patients, CD4 counts.

Results: NILM was the most common finding (79%) which is subdivided into non-inflammatory, non specific and specific inflammatory smears. The percentage of ASCUS, HSIL, LSIL were 14%, 2% and 3% respectively. The highest incidence of intraepithelial lesion in HIV positive patients was in the age group of 31-50 years which was statistically significant, p<0.01. The most common PAP smear finding in patients with CD4 counts >500cells/mm3 was inflammatory smear (48%) which was statistically highly significant, p<0.0001.

Conclusion: Routine PAP smear examination is advocated in HIV positive patients as it helps in early detection of precancerous lesions. Thus early diagnosis and intervention helps in prevention of malignancy and mortality.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-414: A COMPARATIVE ANALYSIS OF DIAGNOSTIC UTILITY OF LIQUID BASED CYTOLOGY AND CONVENTIONAL CYTOPREPATORY SMEARS IN SEROUS FLUIDS

Sana Firdaus ¹, Roobina Khan ¹, Shagufta Qadri ¹, Veena Maheshwari ¹, Md Jaseem Hasan ¹

Background-The use of liquid based cytology (LBC) dates back as early as 1970s and has already gained wide acceptance in cervical cytology. The shift towards LBC follows the fact that using a liquid media provides better preservation of cells and residual material can be used for ancillary tests. LBC has slowly entered non gynecological cytology as well. The present study focuses on the advantages and limitations of LBC over conventional method in serous effusions.

Methods: Eighty (80) samples of effusions of which 30 peritoneal and 50 pleural were collected from May 2019 to July 2021. These samples were then processed by both conventional cytoprepatory technique and by Sure Path liquid based cytology method. The results from both methods were compared on basis of cellularity, background, cytomorphology and staining quality. Results- LBC showed cleaner background in 94%of smears as compared to only 56% in conventional smears. Staining quality was almost comparable by both methods. High cellularity smears were more common in conventional cytology as compared with LBC, whereas moderate cellularity was more with LBC than conventional. No significant difference was seen in low cellularity smears between the two methods. Cytomorphology was better appreciated in LBC as compared to conventional smears.

Conclusion: LBC provides a much cleaner background in contrast to conventional smears. As cytomorphology is better in LBC, it can be more helpful where the suspicion index of malignancy is high. However conventional smear has better cellularity and is more cost effective and so more readily used in routine laboratory.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-415: THE USEFULNESS OF ULTRASOUND AND COMPUTED TOMOGRAPHY GUIDED FINE NEEDLE ASPIRATION CYTOLOGY IN DIAGNOSING INTRA-ABDOMINAL AND INTRA-THORACIC LESIONS: AN INSTITUTIONAL EXPERIENCE

Geet Bhuyan ¹, Projnan Saikia ¹

Background: Ultrasonography and computed tomography guided fine needle aspiration cytology is an invaluable diagnostic tool in diagnosing intra-abdominal and intrathoracic mass lesions. It has a high accuracy and is helpful in studying lesions located in deep anatomical locations.

Methods: This retrospective study was done in our department between 2018 and 2021. The study included 58 abdominal and 40 thoracic masses. The cytological diagnosis was correlated with clinical and radiological data to arrive at a final diagnosis. Histopathological correlation was done in a few cases.

Results: Fine needle aspiration cytology was performed in various anatomic sites. Among the abdominal cases, aspiration was attempted from liver (19 cases), pancreas (8 cases), lymph nodes (25 cases), ovary (3) and gall bladder (3). Thoracic aspirations were done from the lung (34 cases) and mediastinal lymph nodes (6 cases). The most common malignancy encountered in the abdomen was hepatocellular carcinoma (8 cases) and adenocarcinoma, lung among the lung aspirations.

Conclusion: Ultrasonography and computed tomography guided fine needle aspiration cytology had a high sensitivity and specificity in diagnosing deep seated lesions.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-416: EXTRACTION OF BETA VULGARIS : CAN IT BE ALTERNATIVE TO HAEMOXYLIN AND EOSIN STAINING FOR STUDYING CYTOMORPHOLOGICAL FEATURES

Supreetha MS ¹, Hemalatha A ¹, Harendra Kumar ML ¹

Introduction: Haematoxylin and Eosin staining is a most commonly used stain in cytology, histology, histopathology and histochemistry. There are various drawbacks in obtaining this dye along with economical factors. Hence there is necessary to develop environment safe, non toxic and cost effective natural dye. The beet root (Beta vulgaris) plant, has proven medicinal properties but very little known about its colorant features.

Aim: To compare the results and assess the quality of Routine Hematoxylin and Eosin stain with nature dye extract of Beetroot.

Material and methods: Beetroot dye stain was standardized using buccal mucosa smears. 90slides comprising lymph node histopathology, cytology cases of thyroid, breast, lymph node and fluid cytology were stained used both dyes. Stained smears were given quality scores and analyzed.

Results: Extraction and preparation time of this new dye was about 20 -30mins. Duration of beetroot dye staining was 2-3 hrs. Overall staining and cell morphology showed statistical significance with routine H&E stain for Cytology and Exfoliative cytology cases. Histopathology sections did not take up the stain and showed no statistical significance. Nuclear and chromatin details along with background staining features improved with slight modification in preparation of dye.

Conclusion: Natural dye extraction from beetroot is cost effective and could be used as an alternative to haematoxylin and eosin dye for studying cytomorphological features with few alteration in preparation of stain so that it can be used in a resource limited areas.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-417: USE OF FORMALIN-ALCOHOL METHOD OF CELL BLOCK PREPARATION IN EXAMINATION OF BODY FLUIDS - AN ORIGINAL STUDY

Amrita Neelakantan ¹, Mr Sarthak Goriwale ¹, Rakesh Patkar ¹, Shilpa Mishra ¹, Mr Sunil Bhojane ¹, Mr Deeptesh Salvi ¹

Background : Cell block preparation (paraffin embedding of fluid sediments), is a widely practiced technique. It maintains intact architecture of the tissue and reduces diagnostic errors. Numerous techniques have been followed over the years, but need for an optimal technique for routine use in laboratory still persists. We propose an alternate technique which will not only enable clear visualization of the architectural patterns with maximum preservation of cell morphology, but is also cost effective and easy to perform.

Methods: We prepared the cell blocks of 20 body fluid samples received in our laboratory. Only fluids with adequate cellularity were included in the study. Each fluid was subjected to two methods, Plasma-Thrombin Method and Formalin-Alcohol Method. The pellets were processed, stained with routine Haematoxylin-Eosin stain, and additional stains when required, and microscopy was carried out.

Results: Slides prepared from cell block were examined for type of pathology- inflammatory, benign or malignant, cellular architecture, nucleo-cytoplasmic details and artifacts. We observed that these features were comparable in both the methods. However formalin-alcohol method proved superior in terms of cost effectiveness, ease of performance and simplicity of method, as reagents needed were readily available in the laboratory.

Conclusion: Formalin-Alcohol technique of cell block preparation has proven to be a useful and resourceful method on a routine basis, due to its optimal cellular morphological appearance, cost effectiveness and ease of preparation in the laboratory.

Keywords: Formal-Alcohol method, Cost effectiveness, Cellular Morphology

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-418: EFFICIENT AND RAPID DIAGNOSIS OF RHINO-ORBITAL CEREBRAL MUCORMYCOSIS ON CYTOSPIN PREPARATIONS

Akanksha Agrawal ¹, Preeti Diwaker ¹, Priyanka Gogoi ¹, Vinod Kumar Arora ¹

Introduction: Rhino-orbital cerebral mucormycosis (ROCM) infection's surge was seen during declining phase of the second wave of COVID-19 pandemic. Being the commonest form of infection it rapidly evolves to become life-threatening; thus requiring quick diagnosis & treatment. KOH-mount preparations aid in early diagnosis, however sometimes diagnosis is elusive. Biopsy and culture are gold-standards but are time consuming. Hence, we planned to evaluate the utility of cytology smears prepared by double-concentration method for early diagnosis.

Methodology: This prospective study was done in the Cytopathology section from May-July 2021. Samples (Nasal crusts/ scrapings, orbital tissue aspirates and drained pus) from 47cases of suspected ROCM sent for cytology formed the sample universe. Double-concentration method was used to prepare the final cytospin smears from all samples, however an additional step of crushing was used for nasal crust/scrapings prior to concentration. Smears were stained with MGG and PAP stain for evaluation of mucormycosis and PAS stain was used for its confirmation.

Results: Eleven out of 47cases showed pauciseptate broad fungal hyphae consistent with mucormycosis; of which 2 were inconclusive on KOH. Apart from detection of mucor hyphae, tissue reactions in the form of acute-inflammatory exudate, foreign-body giant-cell reaction, and varying degrees of fat necrosis were also seen.

Conclusion: Double-concentration method can be used as a fast effective method for detection of mucormycosis on cytology especially in cases of doubt where cross confirmation is required. It is a rapid and efficient method for identifying fungal hyphae and studying the type of tissue reactions associated with ROCM.

Keywords: Mucormycosis, ROCM, Cytospin, Centrifugation, Double-Concentration.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-419: INTRA-OPERATIVE DIAGNOSIS OF CRANIO-SPINAL MYXOID TUMORS BY SQUASH CYTOLOGY: MORPHOLOGICAL CLUES WITH DIFFERENTIAL DIAGNOSIS

Kailash Kumar ¹, Vaishali Walke ¹, Jai Kumar Chaurasia ¹, Hemlata Panwar ¹, Sramana Mukhopadhayay ¹, Adesh Shrivastav ¹

Background: Intraoperative squash cytology is an important diagnostic tool for early and rapid diagnosis of cranio-spinal tumors. The cyto-diagnosis of tumors with predominant myxoid pattern is many times challenging because of overlapping morphological features, obscuring abundant myxoid stroma, variable cellularity and failure to recognize subtle conventional cytological features. Here, we present three cases of cranio-spinal tumors with dominant myxoid pattern diagnosed on intraoperative squash cytology and later confirmed on histopathology.

Case Reports: First case is of 23 years old male with radiological (MRI) evidence L2-L4 intradural enhancing tumor. Intraoperative squash smears on rapid Hematoxylin & Eosin staining revealed tumor cells embedded in myxoid matrix and focally arranged in papillary structures and also forming rosettes. A cytological diagnosis of myxopapillary ependymoma was suggested. A differential diagnosis of chordoma, spinal schwannoma, meningioma were also considered based on location and cytological features. The other two cases were of radiologically evident destructive clival mass in a 52 year female and 54 year male who presented with headache and blurring of vision. Spheno-occiptal synchondrosis was seen in one case. Intraoperative cytology in both these cases revealed cells with abundant pale cytoplasm with focal vacuolations against a myxoid background, suggestive of chordoma. The differential diagnosis considered were myxoid chondrosarcoma, myxopapillary ependymoma and echordosis physalyphora.

Conclusion: Intraoperative diagnosis of myxoid cranio-spinal tumors is challenging. However, acquaintance with their cytomorphological features not only aid in reaching correct diagnosis at an early stage but also helps in further treatment planning.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-420: CAN CRUSH CYTOLOGY OF TISSUES OTHER THAN CENTRAL NERVOUS SYSTEM BE A RAPID DIAGNOSTIC METHOD FOR GUIDING THERAPEUTIC DECISIONS?

Sharada Bholay ¹, Shubhangi Jibhakate ¹, MM Kamal ¹, DT Kumbhalkar ¹

Background: Crush or squash cytology smears are routinely done for tissues of central nervous system and gastrointestinal tract lesions. Similar smears from tissues of malignancies of the aerodigestive tract are also being sent by our clinicians for a rapid diagnosis to guide them in therapeutic decisions.

Objective: To study the efficacy of crush cytology in the pre-operative diagnosis of malignancies.

Material and Method: A prospective diagnostic test study done on 100 patients who had suspected malignancies mostly of aerodigestive tract. Crush smears for cytology were prepared by surgeons from biopsy specimens and the residual tissue was fixed in formalin for histopathology. Initial 30 cases in the pilot study were analysed for causes of cyto-histo discordance. Training was imparted to clinicians regarding preparation and fixation of cytology smears. Agreement analysis was done for the diagnostic performance of cytology smears and tissue sections.

Result: Of the 100 cases studied 82 were from aerodigestive tract. Overall the sensitivity and specificity of crush cytology was 69.14%and78.95%, respectively. But when the 30 cases of the pilot study were excluded, smears in the post training phase, showed that the sensitivity raised upto 98.24% and specificity to 100%. Similarly, the diagnostic accuracy raised from 71%to98.61%. The overall agreement analysis between crush cytology and histopathology was almost perfect with cohen-kappa value of 0.96.

Conclusion:Crush cytology smears from solid tissue biopsies can provide a rapid and accurate diagnosis for planning preoperative workup of patients with malignancies. However, training of surgeons in smear preparation is a prerequisite to optimize use of hospital resources.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-421: ROLE OF TRANSRECTAL FINE NEEDLE ASPIRATION AS A DIAGNOSTIC MODALITY IN PROSTATIC LESIONS

Ankita Parashar ¹, Fauzia Talat ¹, Rachel Tirkey ¹, Umrah Malik ¹, Fatima Lubna ¹, Zohra Hashmi ¹, Kafil Akhtar ¹

Background: Transrectal fine needle aspiration cytology is feasible, reliable and highly sensitive diagnostic tool for the diagnosis of prostatic diseases. This study was performed to evaluate the sensitivity, specificity and positive productive value of transrectal fine needle aspiration cytology as compared to needle biopsy histology.

Methods: Transrectal FNAC was performed in 69 patients, in clinically diagnosed cases of prostate diseases with histo-morphological correlation.

Results: The youngest patient was 32 years old and the oldest was 81 years of age, with the mean age of 57.16 years. Clinically most of the patients presented with features of prostatism. Satisfactory smears could be obtained in 93.9% cases on first aspiration. Out of the clinically diagnosed 69 cases of prostatic diseases, 51(69.4%) cases were diagnosed as benign and 18(28.6%) cases as malignant. The diagnostic accuracy for malignant disease was 88.1% and for benign lesions was 83.4%, with a positive predictive value of 100.0% for malignancy of the prostate. False positivity was seen in 2.1% and false negativity in 11.2% cases.

Conclusions: Transrectal FNAC is an accurate, sensitive, highly specific procedure with a high positive predictive value without any complication.

Keywords: FNAC, Franzen technique, Prostatic Lesions, Transrectal

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-422: THE DIAGNOSTIC SIGNIFICANCE OF FNAC AND CORE NEEDLE BIOPSY OF BREAST LUMP

Madhu Singh ¹

Background: Breast disease form a significant proportion of cases in developed in countries. It is essential to differentiate benign and malignant disease before definitive treatment. Breast cancer mostly found in women presenting with breastlump on average 1 in 8 women will develop breastcancer are 55 older most of the rest are b/w 35 to 54 yrs of age. BRCA1, BRCA2 are responsible for breastcancer in families.

Aim and Objective: The comparative study b/w FNAC & needle biopsy. core needle biopsy is better alternative for diagnosing breast cancer. There are 60 cases age b/w 35-55yrs presenting with breast lump.

Material and Methods: FNAC-there is no special preparation firstly we palpate lump & use 22–24-gauge needle with disposable syringe takes a sample make smear stained by giemsa and H&E staining. CNB: injected 2 % xylocaine in lump area after 8-10 minute18 gauge core biopsy needle insert & take a tissue kept in 10% formalin solution do the H/P study

Result: 60 cases studied the sensitivity of FNAC, CNB is 84% vs 89%, PPV 66% vs 100%, Diagnostic accuracy 79% vs 100%.INFLAMMATORY 44 FIBROADENOMA 12 MALIGNANCY 02 INADEQUATE 02

Conclusion: FNAC is high accurate method for breast lesion, but Core needle biopsy detected more breast carcinomas as compared to fineneedle. Core needle biopsy was able to correctly categorize inadequate lesions into definitely benign & malignant categories. We suggest that core needle biopsy should be preferred over fine needle aspiration cytology for the diagnosis of palpable breast lumps.

J Cytol. 2021 Nov;38(Suppl 1):S27–S125.

PP-423: A CASE OF METAPLASTIC CARCINOMA BREAST.

Background: Metaplastic carcinoma breast encompasses a group of neoplasms characterised by differentiation of neoplastic epithelium into into squamous and/or mesenchymal looking components. Its prognosis is poor with high rate of distant metastasis and recurrence. It is an uncommon neoplasm accounting for about 1% of breast cancers. Metaplasia in mammary ductal epithelium includes squamous, neuroendocrine, apocrine, pseudosarcomatous and rarely pigmented melanocytic differentiation. Breast tumours with these kinds of metaplasia excluding apocrine and neuroendocrine metaplasia. Cytological evaluation helps in early diagnosis, treatment and hence better survival.

Case Report: 41y/F presented with a single, firm, mobile non tender swelling of size 2.5x1.5cm in upper outer quadrant of right breast since 3 months. An FNAC of the lesion was done and reported as ?Metaplastic carcinoma breast.

Conclusion: Morphological evaluation of different cell components in the smear and poorly differentiated elements indicated towards making the diagnosis. The patient was further followed up with an excision biopsy and the results were in support of the cytological diagnosis. The patient was further managed.

[ref1] 1.Hirokawa M, et al. Malignant melanoma arising in melanin-producing medullary thyroid carcinoma. International journal of surgery Case Reports. 2016 Dec 31;20:118–22. doi: 10.1016/j.ijscr.2016.01.029. [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref2] 2.Hugo GD, et al. In: Comprehensive Cytopathology. 4thed. Bibbo M, editor. Philadelphia, PA: Elsevier Saunders; 2015. pp. 536–7. [Google Scholar]

PERMALINK

POSTER PRESENTATIONS

PP-001: FNAC OF BREAST LESIONS WITH SPECIAL REFERENCE TO YOKOHAMA SYSTEM OF REPORTING AND COMPARATIVE STUDY OF CYTOHISTOLOGICAL CORRELATION

Rashmi Aithmia

Sindhu Sharma

PP-002: THE UNFOLDING OF A RECURRENCE OF HIGHER GRADE PHYLLODES TUMOUR OF THE BREAST: AN INTERESTING CASE REPORT

Aparna Dutta

PP-003: AN EVALUATION OF FNAC OF BREAST LESIONS WITH HISTOPATHOLOGICAL CORRELATION AMONG PATIENTS PRESENTING IN A TERTIARY CARE HOSPITAL WITH SPECIAL REFERENCE TO MODIFIED MASOODS SCORING INDEX.

Anindya Addhya

Suchandra Ray

PP-004: EVALUATION OF BREAST LUMPS USING FINE NEEDLE ASPIRATION CYTOLOGY, CORE NEEDLE BIOPSY AND EXCISIONAL BIOPSY

Monika Pangotra

Surinder K Atri

Rashmi Aithmia

PP-005: USE OF FINE NEEDLE ASPIRATION IN THE EVALUATION OF PALPABLE BREAST LUMPS

Monika Pangotra

Surinder K Atri

Rashmi Aithmia

PP-006: RELEVANCE AND IMPACT OF THE INTERNATIONAL ACADEMY OF CYTOLOGY (IAC) YOKOHAMA SYSTEM FOR REPORTING OF BREAST FINE-NEEDLE ASPIRATION CYTOLOGY- AN INSTITUTIONAL EXPERIENCE

Rajashree Khound

Geet Bhuyan

PP-007: CYTOHISTOPATHOLOGICAL CORRELATION OF BREAST LESIONS WITH EMPHASIS ON DIAGNOSTIC ACCURACY OF FNAC

G Dyuthi

K Durga

G Bhavana

PP-008: EVALUATION OF EXPANDED MASOOD'S CYTOLOGIC INDEX IN THE CYTOLOGICAL DIAGNOSIS OF BREAST CARCINOMA

R Ratna

Md Khadar Faheem

G Sai Chandana

C Sujatha

BV Sai Prasad

A Venkatalakshmi

PP-009: BREAST LYMPHOMA: A DIAGNOSTIC CHALLENGE

Damandeep Kaur

Urmi Mukherjee

PP-010: FIBROADENOMA IN ECTOPIC BREAST TISSUE (AXILLA)

Bhargav Mohan

Aseema Das

Bandita Das

PP-011: EVALUATION OF UTILITY OF THE IAC YOKOHAMA SYSTEM FOR REPORTING BREAST FINE ASPIRATION CYTOLOGY.

Akankshya S Kashyap

Aseema Das

Bandita Das

PP-012: THE IAC YOKOHAMA SYSTEM FOR BREAST CYTOPATHOLOGY WITH ROLE OF ROSE, FNA & CELL BLOCK

Tummidi Santosh

Josephain K

Michael L Anthony

Arundhathi S

Prudhvinath Reddy A

PP-013: MORPHOMETRY IN THE CYTOLOGICAL EVALUATION OF BREAST LESIONS AND ITS DIAGNOSTIC SIGNIFICANCE

Beenish Bano

Sujata Jetley

Shaan Ketrapal

Zeeba S Jairaipuri

Ajay Thakral

PP-014: A NOVEL AND DISTINCT APPROACH FOR BREAST CYTOLOGY-THE INTERNATIONAL ACADEMY OF CYTOLOGY YOKAHAMA REPORTING SYSTEM

Prajna KS

Ruhisalma Naagar

Server Fathima

Narayana Murthy C

Muktha R Pai

PP-015: UTILITY OF NUCLEAR MORPHOMETRY IN CYTOLOGICAL DIAGNOSIS OF BREAST LESIONS

Swaroop Raj B V

Hemalatha A

P N Sreeramulu

PP-016: APPLICATION OF YOKOHAMA SYSTEM FOR REPORTING BREAST FINE NEEDLE ASPIRATION CYTOLOGY- AN INSTITUTIONAL EXPERIENCE.

Ankita Verma

Gunjan Nain

Meeta Singh

Shyam Lata Jain

Shramana Mandal

Nidhi Verma

C B Singh

PP-017: TOUCH IMPRINT CYTOLOGY AS A CHEAP AND EFFICIENT METHOD FOR EVALUATION OF INTRAOPERATIVE SENTINEL LYMPH NODE IN CARCINOMA BREAST.

Priya Yadav

Sufian Zaheer

Chintamani

Sunil Ranga

PP-018: SPECTRUM OF BREAST LESIONS--IAC YOKOHAMA SYSTEM

Madhulatha Guntimadugu