IntrOductIOnBreast lumps are common in women of all ages. A thorough examination of breast is very important to rule out Breast cancer since it is the most common cancer in women. WHO estimates, more than half a million deaths worldwide are due to Breast cancer [1]. Recently, Breast cancer has overtaken cervical cancer in India with the incidence rate being 26 per 100,000 women population and mortality rate of 13 per 100,000 women population [2]. With the advent of triple testing for breast malignancies, FNAB has become an integral part of the evaluation of breast lesions. Triple testing includes breast clinical examination, mammography and/or ultrasonography, and cytology {FNAB/Core needle biopsy (CNB)} [3].FNAB is a simple, relatively painless, inexpensive OPD procedure with speedy results. One of the major goals of Breast FNAB is to differentiate benign from malignant lesions. Differentiation is not possible in all cases due to significant overlap of the cytomorphologic features of both benign and malignant breast lesions [4]. To address these cytomorphologic grey zone uncertainties and to bring a degree of uniformity to the reporting system, in 1996 the National Cancer Institute (NCI) proposed five diagnostic categories [5]. Since then use of FNAC in the evaluation of breast lesions has changed substantially over the period of 20 years, mainly due to changes in screening programs and available treatments and recent preference for CNB.In 2016, the International Academy of Cytology (IAC) established a "Breast Group" which included pathologists, radiologists, surgeons, and oncologists mainly to produce comprehensive and standardised guidelines for breast FNAB cytology reporting. The IAC Yokohama System for Reporting Breast Cytopathology incorporates the indications for breast FNAB cytology, FNAB technique, smear making and material handling, a reproducible standardised reporting system, the use of ancillary diagnostic and prognostic tests, and correlation with clinical work-up algorithms. Ultimately, this will facilitate clinician's understanding and use of FNAB cytology in breast pathology [6].In the Yokohama System for Reporting Breast Cytopathology, the "Breast Group" has proposed a five-category classification: category 1insufficient material; category 2-benign; category 3-atypical, probably benign; category 4-suspicious for malignancy, probably in situ or invasive carcinoma; and category 5-malignant [6]. In the present study, the newly proposed IAC Yokohama system of breast FNAB cytology was applied to breast FNAB cytology cases from the Pathology Department and ROM of each category and the diagnostic yield of this technique calculated. This categorisation of the Breast FNAB cytology according to IAC Yokohama system of reporting helps pathologist in the diagnostic clarity and guides clinician in the appropriate patient management, hence the need for this study. The main objectives of the study were to categorise the Breast FNAB samples according to this new system of reporting and to assess the ROM for each...
BACKGROUND Urine cytology when combined with cystoscopy remains a gold standard in screening and surveillance of urothelial carcinoma. Paris system for reporting urine cytology (PSRUC) gives seven well defined diagnostic criteria. We aimed to analyse utility of urine cytology in patients with urogenital symptoms, compare existing institutional system (EIS) with PSRUC and assess the performance of both reporting systems in predicting subsequent high-grade urothelial carcinoma on histopathology. METHODS A five year retrospective study included a total of 146 urine samples from 74 patients. Each case was assigned a category according to both EIS and PSRUC system. After cyto-histological correlation, sensitivity, specificity and diagnostic accuracy of urine cytology in detecting malignancy using PSRUC and EIS were determined. Performance of urine cytology in predicting subsequent high grade urothelial carcinoma (HGUC) was assessed for both reporting systems. RESULTS PSRUC resulted in reduction in number of cases assigned to atypical category (10.5 % vs. 3.4 %) and increase in low grade carcinomas assigned to NGUC category (66 % vs. 100 %). Positive predictive value (PPV) for predicting subsequent high grade urothelial carcinoma for HGUC and SHGUC category remained the same (100 %). Sensitivity (66.67 % vs. 55.5 %), specificity (100 % vs. 85.71 %) and diagnostic accuracy (81 % vs. 68.75 %) was improved with application of PSRUC when compared to EIS. Two cases of genitourinary tuberculosis were diagnosed. CONCLUSIONS PSRUC improves predictive accuracy of subsequent high-grade urothelial carcinoma on histopathology and it ensures uniformity in reporting. Judicious use of urine cytology might aid in early diagnosis of infectious conditions like tuberculosis. KEYWORDS PSRUC, Urine Cytology, High Grade Urothelial Carcinoma
Type 2 lepra reaction or erythema nodosum leprosum (ENL) is an immune complex syndrome that occurs mostly in lepromatous leprosy and sometimes in borderline lepromatous leprosy patients. We present an untreated case of lepromatous leprosy, who presented with type 2 lepra reaction and livedo reticularis. Livedo reticularis, though seen in lucio phenomenon, is not a part of type 2 lepra reaction. The case is being reported for its rarity.
Leukemia cutis is an infiltration of the skin by myeloid or lymphoid neoplastic leukocytes resulting in clinically identifiable cutaneous lesions. It may follow, precede, or occur concomitantly with the diagnosis of systemic leukemia. A 55-year-old female patient was a known case of acute myeloid leukemia (AML) and was on palliative chemotherapy. She presented to the Department of Dermatology with sudden-onset nodules over the chest and abdomen which were multiple, nontender and firm in consistency. Histopathological examination from the nodule over the abdomen suggested leukemic infiltration of the skin and repeat hemogram showed reappearance of blast cells in the peripheral smear, consistent with a diagnosis of leukemia cutis with relapsed AML. The case has been reported for its rarity and poor prognosis associated with its presentation.
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