Jornal de Citologia e Histologia

Background: The liver is the site of numerous neoplastic and non-neoplastic lesions, with neoplastic lesions accounting for a prominent cause of morbidity and mortality. Being a common site for metastatic tumors, it becomes imperative to differentiate the same from hepatocellular carcinoma, owing to varied management modalities involved. Diagnosis by fine needle aspiration cytology (FNAC),is considered a prominent investigative procedure in this regard. However, it is not without its limitations and disadvantages.

Aim and Objectives: This retrospective research analyzes the cytological features of hepatic masses, with particular reference to pattern assessment, cellular and nuclear details along with background characteristics of note which could define differentiating characteristics of hepatocellular carcinoma from metastatic malignancy. Accompanying clinico-radiological and biochemical parameters that could be helpful in this regard were also studied. An attempt was also made to distinguish the features characteristic to different grades of hepatocellular carcinoma (HCC).

Method: FNAC of 114 hepatic neoplastic lesions received during a two years period in the pathology department of a tertiary care hospital were retrospectively analyzed. Clinico-radiological and biochemical parameters were correlated, and data thus retrieved was analyzed statistically for relevance. Results: Males were predominantly affected both by primary and metastatic malignancy with primary over 60 years of age. Jaundice, history of prior alcohol consumption, pre-existing liver disease, elevated LFT along with AFP levels >400 ng/ml was seen in significant cases of hepatocellular carcinoma. Radiologically, metastasis showed multiple lesions with most cases less than 5cms in diameter with invasion of adjacent structures. Analysis of three characteristic cytological features including presence of cytoplasmic bile, intranuclear inclusions and traversing blood vessel was carried out and it was observed that the highest chance of tumor being HCC was when all three were seen. After analyzing features to differentiate between the different grades of HCC it was observed that as the grades progressed the cells became undifferentiated and similarities increased. Cytohistological correlation was seen in 91.3% of cases of primary and 86.9% of metastatic malignancies.

Conclusion: Close attention to cytological features like cell clusters, intranuclear inclusions, endothelial rimming in conjunction with radiological images and biochemical markers provide valuable pointers in distinguishing between primary HCC and hepatic metastatic carcinomas thus obviating the need of invasive procedures.

The genus Aristolochia gathers plants used in folk medicine, which present in their composition the Aristolochic acids I and II. Among the major toxicological events caused by Aristolochic acids is programmed cell death. Aristolochic acid induced apoptosis occurs in target organs such as the liver, kidney, pancreas, testis, ovary, intestine and lung. Although it is beneficial for the cure of various diseases Aristolochias or Aristolochic acids I and II can also cause necrosis. The objective of this work was to compile information about the effects of Aristolochic acids on the induction of apoptosis. The present work makes an alert when consuming this herb, and derivatives that possess Aristolochic acids.

Oral cancer is one of the most common cancers prevalent in the world. The outcome of the patient’s treatment depends not only on the stage but also on various prognostic parameters. In this review article, prognostic factors which should be included in pathology report have been summarized.

Introduction: Salivary gland shows various pathological conditions ranging from cystic, inflammatory, tumor like and neoplastic lesions. Fine needle aspiration cytology (FNAC) plays an important role in evaluating salivary gland (SG) tumors. Salivary gland tumors are one of the most heterogeneous groups of neoplasms with cytopathological features overlapping among the entities and making it difficult to assign to specific category. Due to these facts, salivary gland cytopathology is one of the most challenging areas of cytology. The lack of a uniform reported guidelines in salivary gland cytopathology leads to inter-observer variability and disagreements. The present study was undertaken to assess the degree of inter-observer reproducibility for diagnostic categorization of salivary gland lesions utilizing MSRSGC among pathologists with varying experience along with its role in providing a framework for reporting salivary gland lesions.

Materials and Methods: In this cross sectional study, total of 44 cases of salivary gland lesions subjected to FNAC over a period of 7 year were studied. The cases were critically reviewed by 2 pathologists and a pathology resident with variable experience in cytopathology using MSRSGC in our institution. Inter-observer variability was assessed by comparing the agreement between two cytopathologists and pathology resident by using Cohen’s kappa statistics (κ score) and interpretation of the results was done using scale of Landis and Koch.

Results: All the salivary gland aspirates were categorized according to MSRSGC.Out of 44 cases, maximum cases 22 (50%) were classified under IVA (BN) followed by 27.27% to 29.5% cases classified under II (NN), 2.27-4.55% of cases under Category IVB (SUMP), 4.55% under category V( SM) and 6.82% cases under category VI ( M). Inter-observer variability (IOV) was calculated for individual category in Milan system using Cohens kappa test, which was found to be in the almost perfect agreement range as per Landis and Koch, for categories II, IVA, V, VI ( κ score 0.89- 1). Kappa score ranged from 0.645 - 1 for category I (ND), which showed substantial to an almost perfect agreement. Whereas, category IVB (SUMP) showed variable results, with substantial agreement (κ score 0.656) to no agreement (κ score 0) between different observers.The overall IOV showed an almost perfect agreement with a kappa score of 0.861(obs1 vs 2) ,0.896 (obs1 vs R), 0.965 (obs 2 vs R). The data was found to be statistically significant (p=< .0001).

Conclusion: MSRSGC is a very efficient system and has the potential to standardize salivary gland FNA diagnoses, providing clear prognostic and management information to clinicians and surgeons. This system can be used with good reproducibility between observers with variable cytopathology experience. Placing lesions in categories using MSRSGC can result in optimal management of discordant cases without using a specific diagnosis. Application of MSRSGC has immense value for standardization of reporting of salivary gland FNAC.Hence we recommend the use of Milan system for reporting salivary gland cytopathology.