Background:Mediastinal lymphadenopathy (ML) presents a diagnostic challenge. The technique to sample the lymph nodes has evolved from conventional “blind” transbronchial needle aspiration (TBNA) to the present day endobronchial ultrasound (EBUS)-guided procedure that improves the accuracy of sampling.Objective:This study was undertaken to evaluate the utility of “rapid on-site evaluation” (ROSE) in EBUS-guided TBNA (EBUS-TBNA) for the diagnosis of ML.Patients and Methods:This prospective study included 80 patients who underwent EBUS-TBNA for computed tomography/positron emission tomography (CT/PET) diagnosed ML over a 4-month period at a single tertiary care center. All 80 of these patients underwent histopathological evaluation (HPE) in addition to cytology. Three out of these 80 (3.7%) patients were excluded in view of inadequate material on EBUS-TBNA. After the sampling of nodes was done, the slides were stained with rapid hematoxylin and eosin (H&E) and then on-site evaluation was done. The tissue derived was also processed for HPE in all cases.Results:ROSE revealed granuloma in 27 patients and malignancy in 14 patients, and the remaining patients showed nonspecific inflammation. Concomitant histopathology revealed granuloma in 34 patients and malignancy in 14 patients. Considering HPE as gold standard, the overall sensitivity and specificity of EBUS-TBNA for diagnosis were 85.4% and 89.6%, respectively. For malignancy alone, the sensitivity and specificity were 100% and 98.4%, respectively.Conclusion:This novel approach is safe, has good diagnostic yield, and has an excellent potential in assisting safe and accurate diagnostic interventional bronchoscope.

Histiocytic sarcoma is derived from histiocytes and is among the rarest of the tumors affecting the lymphoid tissue. We report a case of a histiocytic sarcoma arising from the lymph node in a 35-year-old male who came for a fine needle aspiration cytology and a subsequent biopsy was conducted and the tissue subjected to hematoxylin and eosin and immunohistochemistry staining.

Congenital mesoblastic nephroma is a stromal neoplasm of infancy. It has been referred to as mesenchymal, cystic or leiomyomatous hamartoma. These tumors are centered around the hilus of the kidney. Mesoblastic nephromas need to be distinguished from other pediatric renal neoplasms as these lesions are treated by complete surgical excision without chemotherapy unless gross residual tumor remains. Here, we describe the gross and microscopic features of mesoblastic nephroma in a twenty-day old infant.

Introduction. Omental cysts are a part of cystic lymphangiomas and are benign proliferations of ectopic lymphatics without a communication with the normal lymphatic system. They commonly involve the neck in the pediatric population and are uncommon at other sites and occur rarely in adults. Case Presentation. A 42-year-old female with complaints of vague lower abdominal pain for 8 months presented with a soft, nontender swelling of size 22×18 cm in the hypogastrium and umbilical region. Computerized tomography (CT) of the abdomen showed a peripherally enhancing hypodense cystic lesion of size 19×14×12 cm perhaps arising from the mesentery. The cyst had spontaneously reduced in size by about 70% over the next 4 months. During surgery, the cyst of size 10×9×8 cm was present in the greater omentum. Excision was done, and histopathology was suggestive of cystic lymphangioma. Discussion. Cystic lymphangiomas have an incidence of 1/20000 at infancy and 1/100000 to 1/250000 of hospital admissions in adults, and the female-to-male ratio is 2 : 1. In adults, they are found in the age group between 40 and 70 years. Spontaneous regression of omental cysts is very rare and presumably from increased pressure in cysts overcoming incomplete obstructions or by establishment of alternative routes of drainage. Conclusion. As the disease is essentially benign and if there are no significant pressure symptoms, the cysts of short duration can be watched further for regression. Long-standing, symptomatic cysts, nonregression, and diagnostic uncertainty will warrant surgery to confirm the diagnosis and relieve the symptoms.