A 63-year-old woman presented with a 4-week history of vulval bleeding. On examination, an 8 mm fleshy irregular vascular lesion was present on the vulva in the periclitoreal area. This vulval lesion was treated by surgical excision. Histological analysis showed irregular pieces of skin partly covered by hyperplastic squamous epithelium. There were areas of fistulous-like endophytic proliferations lined by hyperplastic squamous epithelial cells. The intervening stroma showed granulation tissue with severe active chronic inflammation. At least five hair follicle shafts surrounded by foreign body type giant cells were also identified within the inflamed area. There was no evidence of dysplasia or malignancy. This chronically inflamed fistulous tract together with hair shafts within the wall of the tract were diagnostic of a pilonidal sinus of the vulva. This case report summarises the importance of diagnosing pilonidal sinus at an unusual location.

Involvement of the bilateral submandibular glands and thyroid by the same lymphoma simultaneously has been reported in the literature. However, two different types of lymphomas presenting simultaneously at different sites have never been reported. This case report highlights this rare occurrence. A 65‐year‐old female, a known case of Hashimoto’s thyroiditis with raised anti‐TPO antibodies, presented with thyroid swelling for 1 year and bilateral submandibular swelling for 3 years. FNAC and flow cytometry showed features of mucosa‐associated lymphoid tissue lymphoma in the thyroid gland, whereas the bilateral submandibular glands showed features of diffuse large B cell lymphoma. Histopathology and immunohistochemistry from the submandibular swelling led to similar diagnoses as the flow cytometry.

Histiocytic sarcoma (HS) is a malignant neoplasm of hematopoietic origin. It is an exceedingly rare and aggressive malignancy commonly seen in adults. Diagnosis is difficult owing to lack of specific clinical manifestations with the absence of precursor lesions or causative agents. Hence, it primarily relies on histopathological morphology combined with immunohistochemistry, which is time‐consuming, hence resulting in delayed treatment. However, diagnostic utility of flow cytometry is not well established in this. We report a case of a 45‐year‐old man who presented with right axillary lymphadenopathy for 1 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, and CD1a and expressed CD68, S100, and CD11c. A diagnosis of histiocytic sarcoma was made. Hence, flow cytometry can be a highly effective and powerful tool for the early detection of HS and can help in prompt treatment, given its aggressive clinical course and low survival interval.

No abstract

Introduction: Protocol for immunocytochemical (ICC) staining in May-Grünwald Giemsa (MGG)–stained smears has been difficult to establish. It is the need of the hour to be able to use prestained slides for ICC in specific cases to deliver timely diagnoses and reduce inconvenience to patients. Aims and Objectives: To evaluate and compare the use of MGG-stained smears for the purpose of ICC, after de-staining and saline rehydration to that of routine standard ICC. Materials and Methods: A prospective study was conducted on 40 FNAC samples: 25 cases of breast disease and 15 cases of reactive lymphoid hyperplasia known to express pancytokeratin and leukocyte common antigen (LCA)/CD45, respectively. Air-dried smears of each case were stained by standard MGG stain and after the report was dispatched, one smear was selected and sent for ICC. The smears were analyzed to determine the overall result and grade each smear semi-quantitatively with respect to staining-intensity, stain-localization, staining-uniformity, counter-staining, and background-staining. Observations and Results: The proposed protocol was inferior to conventional ICC in all the parameters, more pronounced in pancytokeratin than LCA/CD45. Only 8% of air-dried smears stained for pancytokeratin showed optimal stain intensity (as opposed to 44% of wet-fixed smears), whereas only 14.3% of air-dried smears were optimally stained for LCA (as opposed to 85.7% of wet-fixed smears). Conclusion: The proposed protocol of de-stained Giemsa smears as an alternative to conventional technique for ICC was unsuccessful in giving satisfactory results.