Introduction: Telecytology is the practice of cytology at a distance. The images captured by a camera are sent to the cytopathologist at a different location who views the images and reaches a diagnosis. Recently, smartphone-assisted telepathology has been evaluated for different subspecialities of pathology including cytology for second opinion. Materials and Methods: For the purpose of the study, a total of 151 cases of fine needle aspiration and 10 cases of urine cytology reported by a single pathologist were retrieved from the records. The images of all the cases were captured by a trained pathologist using the primary camera of a smartphone from the ocular of a binocular microscope. The images were sent by WhatsApp to the same pathologist who had made the conventional microscopy diagnosis. The images were viewed on the smartphone screen by the pathologist who replied with the diagnosis after analysing all the images with or without digital zoom. Results: A total of 154 cases out of 161 were correctly diagnosed on smartphone-assisted tele-pathology (overall intraobserver concordance of 95.6%). For head and neck swellings, the concordance was 65/70 (92.9%), for breast lesions, it was 23/24 (95.8%), and for miscellaneous swellings, it was 57/57 (100%). For urine cytology, the concordance rate was 9/10 (90%). Conclusion: Though the results of this study are encouraging, further improvement in the smartphone camera resolution and internet connectivity would enhance the utility of smartphone-assisted telecytopathology.

A 62-year-old man was admitted to the hospital with complaints of right scrotal swelling and pain for eight months. On physical examination of the patient, cardiovascular system, respiratory system, per abdomen was normal. Blood pressure was 135/80 mm Hg, pulse rate was 84 per minute and respiratory rate was 16 per minute. Patient had no history of hypertension, diabetes mellitus or any other disease. There were no hyperpigmented macules on lips, gynaecomastia, impotence, anaemia, lymphadenopathy or any other tumour except for a right sided testicular swelling. Swelling was hard, non tender and fixed to the scrotal skin and measured 8x3x2cm. Swelling showed no translucency and there was no hydrocele. Left side testis was normal. Clinical diagnosis was testicular tumour possibly malignant.Ultrasound revealed a right testicular mass with internal vascularity and calcification . Left side testis, bilateral kidneys, prostate and urinary bladder were normal on ultrasonography. Ultrasonogram did not show intrabdominal lymphadenopathy. Lab investigations showed haemoglobin 14.1 gm/dl, TLC 7800 per cu.mm, platelets 160000 per cu.mm, random blood sugar 105 mg/dl, serum sodium was 142 mEq/L, potassium was 3.9 mEq/L. Serum lactate dehydrogenase was 200 U/L (normal 115-221 U/L), serum alpha feto protein was 3.4 ng/ml (Normal 0-8.5 ng/ml) and serum beta HCG was 1.1 mIU/ml (normal <5 mIU/ ml). Serum testosterone, serum prostate specific antigen levels and serum estrogen levels were within normal limits. High inguinal orchiectomy specimen of right testis measuring 8x3x2 cm and skin attached to upper pole of testis was received. The tumour measured 6x3x1.5cm. The cut section was yellowish with fleshy areas. Numerous areas of calcification were also seen [ Sertoli cell tumours of testes are classified into sertoli cell tumour NOS (not otherwise specified), sclerosing variant and large cell calcifying variant. So far, 90 cases of the large cell calcifying variant have been reported in literature. We describe a rare case of inhibin negative locally invasive large cell calcifying sertoli cell tumour of testis. A 62-year-old man presented with complaints of pain and swelling in right scrotum for 8 months. Ultrasound revealed a right testicular mass with internal vascularity and calcification. Gross examination of right inguinal orchiectomy specimen showed firm to hard mass with yellow areas and calcification seen on cut section. Microscopy revealed a tumour in the testis infiltrating the epididymis and rete testis and reaching up to the skin. Tumour cells were arranged in the form of solid nests, tubules and cords with neutrophilic stromal infiltrate and calcification. Tumour cells had abundant clear to eosinophilic cytoplasm, round nucleus with vesicular chromatin and conspicuous nucleoli. On immunohistochemistry, tumour cells were positive for pan cytokeratin, Epithelial Membrane Antigen (EMA), S-100 protein, desmin, vimentin, neuron specific enolase, and chromogranin. However, it was negative for inhibin alpha, OCT4, CD10, CD99, ...

Introduction Traditional telepathology techniques like whole slide imaging require expensive equipment and are currently out of reach of the developing countries. However, the improvements in smartphone camera resolution and availability of faster internet have made smartphone‐assisted telepathology possible. Methods A total of 186 cases pertaining to gynecologic pathology reported by single consultant (NT) were retrieved from the records of the histopathology department. A trained histopathologist then photographed representative areas of each case by using the smartphone camera. After a wash off period of 6 months, the images along with the clinical details were sent by Whatsapp Messenger to the same reporting pathologist. The reporting pathologist replied with the diagnosis of each case by using Whatsapp. Results The smartphone diagnosis was concordant in 179/186 (96.2%) cases. The intraobserver concordance rates varied with the organ involved – it was highest for endometrial and myometrial pathology (123/126, 97.6%) lowest for ovarian lesions (08/10, 80%). For cervical pathology, it was 97.2% (35/36) and for fallopian tube pathology it was 92.9% (13/14). Conclusion Although the initial results of this pilot study are encouraging, there is a long way to go before smartphone‐assisted telepathology can be put to routine use for the second opinion. More experience of the pathologists with this technique and faster internet and better smartphone cameras will further improve the concordance of smartphone‐assisted telepathology diagnosis with conventional microscopy diagnosis.

Context:In the context of competency-based medical education being advocated worldwide, fine needle aspiration biopsy (FNAB) is considered as an entrustable professional activity (EPA). There is no information regarding how much time and training are required to achieve a “competent level” for performing and documenting FNAB in the Indian context.Aim:To determine the time taken by an average postgraduate pathology trainee to become competent in performing FNAB with respect to history taking, clinical examination, and fine needle aspirate adequacy.Settings and Design:A descriptive, retrospective, chart-based audit was conducted in the Department of Pathology.Materials and Methods:FNAB chart records documented during 3 years of postgraduate training by a cohort of 13 postgraduate (PG) resident trainees admitted in 2010 were included in the study. Adequacy rates and criteria for adequacy were defined for the purpose of the study.Statistical Analysis:Data was entered in MS Excel and analyzed using the Statistical Package for the Social Sciences version 20.0. The adequacy rates are presented as percentages and time taken to achieve adequacy rates as median values.Results:A total of 3272 charts were audited. Median time taken to achieve 85% adequacy rate for history taking, for clinical examination by the first and the second criteria, and for FNAB were 1 month, 1 month and 3.5 months, and 1 month, respectively.Conclusions:Although the mean time taken to achieve 85% adequacy rates for FNAB was 1 month, there was wide variation in the time durations between the residents to achieve this level.