Use of medicinal plants by health professionals in Mexico

Publication date: 23 February 2017
Source:Journal of Ethnopharmacology, Volume 198
Author(s): Angel Josabad Alonso-Castro, Fabiola Domínguez, Juan José Maldonado-Miranda, Luis Jesús Castillo-Pérez, Candy Carranza-Álvarez, Eloy Solano, Mario Alberto Isiordia-Espinoza, María del Carmen Juárez-Vázquez, Juan Ramón Zapata-Morales, Marco Antonio Argueta-Fuertes, Alan Joel Ruiz-Padilla, César Rogelio Solorio-Alvarado, Joceline Estefanía Rangel-Velázquez, Rolffy Ortiz-Andrade, Ignacio González-Sánchez, Gustavo Cruz-Jiménez, Luis Manuel Orozco-Castellanos
Ethnopharmacological relevanceThe use of medicinal plants in Mexico has been documented since pre-Hispanic times. Nevertheless, the level of use of medicinal plants by health professionals in Mexico remains to be explored.Aim of the studyTo evaluate the use, acceptance and prescription of medicinal plants by health professionals in 9 of the states of Mexico.Materials and methodsDirect and indirect interviews, regarding the use and acceptance of medicinal plants, with health professionals (n=1614), including nurses, physicians, pharmacists, and odontologists from nine states in Mexico were performed from January 2015 to July 2016. The interviews were analyzed with the factor the informant consensus (FIC).ResultsThe information obtained indicated that 46% of those interviewed feel patients should not use medicinal plants as an alternative therapy. Moreover, 54% of health professionals, and 49% of the physicians have used medicinal plants as an alternative therapy for several diseases. Twenty eight percent of health professionals, and 26% of the physicians, have recommended or prescribed medicinal plants to their patients, whereas 73% of health professionals were in agreement with receiving academic information regarding the use and prescription of medicinal plants. A total of 77 plant species used for medicinal purposes, belonging to 40 botanical families were reported by the interviewed. The results of the FIC showed that the categories of diseases of the digestive system (FIC=0.901) and diseases of the respiratory system (FIC=0.898) had the greatest agreement.ConclusionsThis study shows that medicinal plants are used for primary health care in Mexico by health professionals.

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Activity of Pericampylus glaucus and periglaucine A in vitro against nasopharangeal carcinoma and anti-inflammatory activity.

Publication date: 23 February 2017
Source:Journal of Ethnopharmacology, Volume 198
Author(s): Fiona Natalia Shipton, Teng-Jin Khoo, Md Shahadat Hossan, Christophe Wiart
Ethnopharmacological relevancePericampylus glaucus is a climbing plant found across Asia and used in traditional medicine to treat a number of conditions including splenomegaly, fever, cough, laryngitis, pulmonary disease, asthma, headache, hair loss, snake bite, boar bite, factures, boils, tumours, tetanus, rheumatic pain, itches and eclampsia.Aim of the studyTo test extracts of P. glaucus in a number of bioassays and determine the legitimacy of its traditional use.Materials and methodsThe stems, leaves, roots and fruits of P. glaucus were collected and extracted sequentially with hexane, chloroform and ethanol, respectively. The anti-inflammatory activity was assessed by testing the ability of the extracts to inhibit heat induced protein denaturation, stabilise human red blood cells under hypotonic stress and by testing the inhibitory activity of the extracts against cyclooxygenases 1 and 2. Cytotoxicity was tested using the human lung epithelial cell line MRC-5 and nasopharangeal carcinoma cell line HK1 in the MTT assay.ResultsMany of the samples showed an ability to prevent heat induced protein denaturation, as well as prevent lysis of red blood cells. Most of the extracts demonstrated inhibitory activity towards both of the COX enzymes. The ethanol extracts tended to demonstrate greater toxicity than other extracts, with some of the other extracts significantly enhancing growth and metabolism of the cells.ConclusionThe benefit of P. glaucus for the treatment of diseases related to inflammation and cancer was supported by the in vitro assays adopted in this study.

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Genetic toxicity of Epimedium koreanum Nakai

Publication date: 23 February 2017
Source:Journal of Ethnopharmacology, Volume 198
Author(s): Youn-Hwan Hwang, Hey Jin Yang, Nam-Hui Yim, Jin Yeul Ma
Ethnopharmacological relevanceIn Eastern Asia, E. koreanum Nakai (EKN) has traditionally been used as an aphrodisiac herbal medicine. However, there was no available information for its genotoxicity. This study was conducted to evaluate the genotoxic potentials of EKN.Materials and methodsThe phytochemicals of EKN were identified using liquid chromatography/tandem mass spectrometry (LC/MS/MS). Three standard battery of genotoxicity assay for bacterial reverse mutation, mammalian chromosomal aberration and in vivo micronuclei formation was employed.ResultsThe LC/MS/MS analysis revealed four hydroxybenzoic acids, three lignans, and ten flavonoid glycosides in EKN. The bacterial reverse mutation assay revealed no mutagenic effects of EKN. Moreover, EKN did not show any clastogenic effects in the in vivo and in vitro assays.ConclusionEKN water extract was shown to be a non-genotoxic herbal medicine under the conditions tested in this study.

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Protective Effects of Petroleum Ether Extracts of Herpetospermum caudigerum against α-naphthylisothiocyanate-Induced Acute Cholestasis of Rats

Publication date: Available online 6 January 2017
Source:Journal of Ethnopharmacology
Author(s): Wen-rui Cao, Jing-qiu Ge, Xin Xie, Meng-lin Fan, Xu-dong Fan, Hong Wang, Zhao-yue Dong, Zhi-hua Liao, Xiao-zhong Lan, Min Chen
Ethnopharmacological relevanceThe ripe seeds of Herpetospermum caudigerum have been used in Tibetan folk medicine for treatment of bile or liver diseases including jaundice, hepatitis, intumescences or inflammation. Previously reports suggested that the seed oil and some lignans from H. caudigerum exhibited protective effects against carbon tetrachloride (CCl4)-induced hepatic damage in rats, which may be related to their free radical scavenging effect. However, the protective effect of H. caudigerum against cholestasis is still not revealed. The aim of the present study was to investigate the pharmacological effect and the chemical constituents of the petroleum ether extract (PEE) derived from H. caudigerum against α-naphthylisothiocyanate (ANIT)-induced acute cholestasis in rats.Materials and MethodsMale cholestatic Sprague-Dawley (SD) rats induced by ANIT (60mg/kg) were orally administered with PEE (350, 700 and 1400mg/kg). Levels of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-Glutamyl transpeptidase (γ-GTP), total bilirubin (TBIL), direct bilirubin (DBIL) and total bile acid (TBA), as well as bile flow, and histopathological assay were evaluated. Hepatic malondialdehyde (MDA), myeloperoxidase (MPO), superoxide dismutase (SOD), glutathione S-transferase (GST), and nitric monoxide (NO) in liver were measured to explore the possible protective mechanisms. Phytochemical analysis of PEE was performed by gas chromatography-mass spectrometer (GC-MS).ResultsPEE have exhibited significant and dose-dependent protective effect on ANIT-induced liver injury by reduce the increases in serum levels of ALT, AST, ALP, γ-GTP, TBIL, DBIL and TBA, restore the bile flow in cholestatic rats, and reduce the severity of the pathological tissue damage induced by ANIT. Hepatic MDA, MPO and NO contents in liver tissue were reduced, while SOD and GST activities were elevated in liver tissue. 49 compounds were detected and 39 of them were identified by GC-MS analysis, in which long-chain fatty acids were the main constituents.ConclusionsPEE exhibited a dose-dependently protective effect on ANIT-induced liver injury in cholestatic rats with the potential mechanism of attenuated oxidative stress in the liver tissue, and the possible active compounds were long-chain fatty acids.

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Endometriosis mimicking glandular atypia in a cervical cytology

Paula A Rodriguez-Urreg, Isabel C Dulcey-Hormiga, Luis E Barrera-Herrera, David A Suarez-Zamora, Mauricio A Palau-Lazaro, Catalina Buritica-Cifuentes

Journal of Cytology 2017 34(1):61-63

Endometriosis involving the uterine cervix is a rare condition that can lead to diagnostic errors in the interpretation of Pap smear. We report the case of a 41-year-old patient in whom the initial Pap smear revealed three-dimensional clusters of glandular cells with elongated nuclei, occasional mitosis, and atypia, which was interpreted as atypical glandular cells, not otherwise specified (NOS). The patient was taken to colposcopy and endocervical biopsy. Colposcopy was normal and the biopsy presented glands with elongated nuclei and surrounded by endometrial stroma admixed with normal endocervical glands. Immunohistochemical studies were reactive for CD10 in the stromal cells and vimentin in endometrioid glands. The findings were consistent with cervical endometriosis. Endometriosis in the cervix is an uncommon pathology that mimics malignancy and may be interpreted as atypical or glandular neoplasia in the cytology.

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Evaluation of thyroid nodules classified as Bethesda category III on FNAC

Shiwani Garg, Leena P Naik, Kanchan S Kothari, Gwendolyn C Fernandes, Mona A Agnihotri, Jagruti C Gokhale

Journal of Cytology 2017 34(1):5-9

Background: The Bethesda (BSRTC) category III has been ascribed a malignancy rate of 5-15%, however, the probability of malignancy remains variable. Aim: To evaluate category III with respect to its rate and risk of malignancy and substratify it. Settings and Design: Atypia of undetermined significance/Follicular lesion of undetermined significance (AUS/FLUS) percentage, cytohistological correlation, and risk of malignancy were analyzed and substratification was done. Material and Methods: Category III cases over a 2-year period were analyzed retrospectively. Statistical Analysis: Two-tailed Fisher exact test, with a level of significance set at 0.05, was performed for data analysis. Results: Of 1169 thyroid fine needle aspirations (FNAs), 76 (6.5%) were category III. A total of 48 patients had follow up; 24 patients underwent surgery, 12 repeat FNA, and 12 were clinically followed. Repeat FNA cytology was unsatisfactory in 8.3%, benign in 66.7%, AUS in 8.3%, and follicular neoplasm in 16.7%. Of the 24 operated, 8 (33.3%) were malignant (follicular variants of papillary thyroid carcinoma), 5 (20.8%) were follicular adenomas, and 11 (45.8%) were non-neoplastic. Among all AUS/FLUS nodules with follow-up, malignancy was confirmed in 16.7% (8/48) whereas with nodules triaged to surgery only, the malignancy rate was 33.3% (8/24). Substratification into categories of "cannot exclude PTC" and "favor benign" helped detect malignancy better, as 85.7% cases in the first subcategory (P < 0.001) and none (P < 0.02) in the last proved malignant. Conclusion: Though the rate of Category III in our study is in accordance to BSRTC, the risk of malignancy in AUS/FLUS nodules is higher. Substratification of AUS/FLUS may help better patient management.

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Sialosis: Cytomorphological significance in the diagnosis of an uncommon entity

Sunil Vitthalrao Jagtap, Shakuntala S Aramani, Avinash Mane, Vijay Bonde

Journal of Cytology 2017 34(1):51-52

A diffuse, chronic, usually bilateral, noninflammatory, nonneoplastic enlargement of major salivary glands is termed as Sialosis or Sialadenosis. It is an extremely uncommon cause for enlargement of the parotid gland. We hereby present a case of a 45-year-old female patient having a swelling at the left preauricular region. The swelling was gradually increasing in size since 6 months. On clinical examination, the swelling was 3 cm × 3 cm, mobile, and nontender. On ultrasonography, it was suggestive of benign parotid lesion or  parotitis with cervical lymphadenopathy. On fine needle aspiration cytology, it was suggestive of sialadenosis. This is an extremely rare salivary gland lesion with specific cellular features. It is very important to distinguish sialadenosis from other causes of enlargement of the parotid gland as treatment modality differs.

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Study of nuclear morphometry on cytology specimens of benign and malignant breast lesions: A study of 122 cases

Anamika Kashyap, Manjula Jain, Shailaja Shukla, Manoj Andley

Journal of Cytology 2017 34(1):10-15

Background: Breast cancer has emerged as a leading site of cancer among women in India. Fine needle aspiration cytology (FNAC) has been routinely applied in assessment of breast lesions. Cytological evaluation in breast lesions is subjective with a "gray zone" of 6.9-20%. Quantitative evaluation of nuclear size, shape, texture, and density parameters by morphometry can be of diagnostic help in breast tumor. Aims: To apply nuclear morphometry on cytological breast aspirates and assess its role in differentiating between benign and malignant breast lesions with derivation of suitable cut-off values between the two groups. Settings and Designs: The present study was a descriptive cross-sectional hospital-based study of nuclear morphometric parameters of benign and malignant cases. Materials and Methods: The study included 50 benign breast disease (BBD), 8 atypical ductal hyperplasia (ADH), and 64 carcinoma cases. Image analysis was performed on Papanicolaou-stained FNAC slides by Nikon Imaging Software (NIS)-Elements Advanced Research software (Version 4.00). Nuclear morphometric parameters analyzed included 5 nuclear size, 2 shape, 4 texture, and 2 density parameters. Results: Nuclear morphometry could differentiate between benign and malignant aspirates with a gradually increasing nuclear size parameters from BBD to ADH to carcinoma. Cut-off values of 31.93 μm2, 6.325 μm, 5.865 μm, 7.855 μm, and 21.55 μm for mean nuclear area, equivalent diameter, minimum feret, maximum ferret, and perimeter, respectively, were derived between benign and malignant cases, which could correctly classify 7 out of 8 ADH cases. Conclusion: Nuclear morphometry is a highly objective tool that could be used to supplement FNAC in differentiating benign from malignant lesions, with an important role in cases with diagnostic dilemma.

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Role of morphometry in the cytological differentiation of benign and malignant thyroid lesions

Pallavi Khatri, Monisha Choudhury, Manjula Jain, Shaji Thomas

Journal of Cytology 2017 34(1):1-4

Context: Thyroid nodules represent a common problem, with an estimated prevalence of 4-7%. Although fine needle aspiration cytology (FNAC) has been accepted as a first line diagnostic test, the rate of false negative reports of malignancy is still high. Nuclear morphometry is the measurement of nuclear parameters by image analysis. Image analysis can merge the advantages of morphologic interpretation with those of quantitative data. Aims: To evaluate the nuclear morphometric parameters in fine needle aspirates of thyroid lesions and to study its role in differentiating benign from malignant thyroid lesions. Material and Methods: The study included 19 benign and 16 malignant thyroid lesions. Image analysis was performed on Giemsa-stained FNAC slides by Nikon NIS-Elements Advanced Research software (Version 4.00). Nuclear morphometric parameters analyzed included nuclear size, shape, texture, and density parameters. Statistical Analysis: Normally distributed continuous variables were compared using the unpaired t-test for two groups and analysis of variance was used for three or more groups. Tukey or Tamhane's T2 multiple comparison test was used to assess the differences between the individual groups. Categorical variables were analyzed using the chi square test. Results and Conclusion: Five out of the six nuclear size parameters as well as all the texture and density parameters studied were significant in distinguishing between benign and malignant thyroid lesions (P < 0.05). Cut-off values were derived to differentiate between benign and malignant cases.

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Vaginal Infections of Albanian women Infected with HPV and their impact in intraepithelial cervical lesions evidenced by Pap test

Elsa S Kone, Avenir D Balili, Piro D Paparisto, Xheladin R Ceka, Elizana D Petrela

Journal of Cytology 2017 34(1):16-21

Background: Cervical cytology is the best single method for large screening of the population in identifying precancerous lesions of the uterine cervix. Aim: To estimate the frequency of human papillomavirus (HPV) positivity in a group of Albanian women, the prevalence of vaginal coinfections, and the relationship of coinfections with HPV, as well as their role in metaplasia or cervical intraepithelial lesions (CIN). Materials and Methods: In this retrospective study, 2075 vaginal smears were examined. The Papanicolaou stain was used for all slides. The New Bethesda System 2001 was used for the interpretations of the smears. Data analysis was completed using the Statistical Package for the Social Sciences version 19.0. Results: Prevalence of HPV positivity was 43.9% with an average age of 35.48 ± 9.27 years. Candida coinfection resulted in 57.8% of HPV positive women with a significant relationship between them. Gardnerella coinfection resulted in 36 (23%), mixed flora in 34 (8%), and Trichomonas vaginalis in 50% of HPV positive woman. Among the women with positive HPV, 19% had CIN, 8% had metaplasia, and 1% had metaplasia and CIN; 9% of the women with HPV had CIN1 and one of the coinfections. Conclusions: There is a strong relationship between CIN1 and HPV positivity as well as between CIN1 and coinfections. HPV infection is a major factor contributing to metaplasia, and bacterial coinfections in HPV positive women have a statistically significant impact in the development of metaplasia.

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A rare case of signet ring cell lymphoma: Diagnosis aided by immunofluorescent staining

Charusheela R Gore, NK Panicker, Harsh Kumar, Archana Buch, SS Chandanwale

Journal of Cytology 2017 34(1):56-58

Signet ring cell lymphomas are the proliferations of malignant lymphoid cells containing cytoplasmic vacuoles or globules which displace the nuclei, imparting it a signet ring appearance. This rare tumor is a variant of non-Hodgkin lymphoma. Signet ring appearance is due to cytoplasmic accumulation of immunoglobulin or vacuoles derived from multivesicular bodies. These cells, particularly with cytoplasmic vacuoles, may be mistaken for adenocarcinoma cells. We are presenting one such case where immunofluorescence helped us to demonstrate the immunoglobulins on fine needle aspiration smears. This is an innovative technique and has not been reported earlier. Our aim of presenting this case is to review the awareness of this rare lymphoma among pathologists to give due consideration for avoiding inappropriate investigations and treatment.

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Cytopathology practice in Kumasi: A 2-year retrospective audit

Babatunde M Duduyemi, Osei Owusu-Afriyie, Kwabena O Danquah, Derick NA Osakunor

Journal of Cytology 2017 34(1):22-26

Aim: Surgical pathology service is generally unavailable in most developing countries and comes with challenges. Cytopathology is a reliable, inexpensive adjunct to surgical histopathology. We present a retrospective review of the various cytopathology cases received at the department. Materials and Methods: A retrospective review of 836 cytopathology cases from January 2010 to December 2011 at the Department of Pathology of our hospital was conducted. All cytopathology reports and records from the department were retrieved and analyzed using the Statistical Package for the Social Sciences version 16 for windows. Results: A total of 836 (mean age 38.18 ± 22.18) cases were reviewed, at an average of approximately 418 cases performed a year (5.7% of the total workload). More than half (58.0%) of the cases received had no clinical diagnosis indicated on request forms. Seventy-seven percent (77%) of the cases were diagnosed as either definite or nondefinite. The breast was the most aspirated specimen site (20.2%). Benign cases formed 45.0% of all the cases and 29.0% were malignant. There were more benign than malignant cases with respect to all sites aspirated except the breast (18.3%), lymph nodes (35.0%), and soft tissues (11.7%) where the reverse occurred. Conclusion: Patronage of cytopathology in Kumasi is increasing and serves as a quick, cheap, and effective alternate means for diagnosis. Improving and expanding on the current practice will ensure that pathologists in practice sustain and improve diagnostic cytopathology and provide material for training young pathologists.

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Filarial abscess: Aspiration of adult gravid female worm from submandibular region, an unusual presentation

Ruquiya Afrose, Mohammad Feroz Alam, Syed Shamshad Ahmad, Mohammed Naim

Journal of Cytology 2017 34(1):66-68

Microfilaria is a major public health problem in tropical and subtropical countries and is an endemic problem in India. Wuchereria bancrofti is the most common filarial infection. In some cases, microfilariae and adult filarial worm have been incidentally detected in fine-needle aspirates of various lesions; detection of microfilaria from subcutaneous site or from abscess site is even rarer. We here report an unusual case of Bancroftian microfilariasis in a 68-year-old female coming from endemic area presenting with right submandibular abscess. Our aim is to highlight the chances of finding microfilaria and adult worm in cytology of an unsuspected case at an unusual site.

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Cytomorphometric analysis and morphological assessment of oral exfoliated cells in type 2 diabetes mellitus and healthy individuals: A comparative study

Khushboo Sahay, Shweta Rehani, Priyanka Kardam, Madhumani Kumra, Rashi Sharma, Nisha Singh

Journal of Cytology 2017 34(1):27-33

Context: Oral exfoliative cytology is a simple, nonaggressive technique that is well accepted by patients. Therefore, it is an attractive option, which aids in the diagnosis and observation of epithelial atypias associated with oral mucosal diseases. Aims: The aim of this study was to evaluate and compare the quantitative and qualitative alterations in exfoliative smears from type 2 diabetics and healthy individuals. Patients and Methods: The study includes 30 type 2 diabetics and 30 healthy persons of both sexes. PAP and hematoxylin and eosin (H and E) stained smears were prepared from buccal mucosa (BM), tongue (T), floor of the mouth (FOM), and palate (P). Under a light microscope, 50 clearly defined unfolded epithelial cells were quantitatively evaluated for cellular area (CA), nuclear area (NA), and cellular-to-nuclear area ratio (CA:NA) and assessed for morphological features. Statistical Analysis: Collected data was manually entered into the Statistical Package for the Social Sciences version 13.5 for analysis. Student's t-test was used at 95% confidence interval. Results: Quantitative assessment of the overall mean CA was less, mean NA was more, and mean CA:NA was less in diabetics than that in healthy persons at all the four sites. Diabetic oral cells showed qualiative cytoplasmic and nuclear alterations: cytoplasmic vacuoles, karyorrhexis, karyolysis, pyknosis, peri-nuclear halo, binucleation, nuclear vacuoles, inflammation, and microbial colonies. Conclusion: Oral cytology from type 2 diabetics is associated with detectable cytomorphological changes with alteration in size of the cell and nucleus, which is site specific, indicating epithelial cell degeneration in cytoplasm and nucleus.

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Cytological diagnosis of xanthogranulomatous appendicitis

Rajni Kaushik, Anchana Gulati, Deepak Vedant, Vijay Kaushal

Journal of Cytology 2017 34(1):48-50

Xanthogranulomatous reaction can occur in any organ but the most common sites are kidney and gallbladder. Xanthogranulomatous appendicitis (XA) is a rare clinical entity. There are a few case reports of XA diagnosed on histopathology but none on cytology. Here we report a case of a 47-year-old lady who presented with acute abdomen and was found to have a mass lesion in the right iliac fossa. She was diagnosed with XA intraoperatively on imprint cytology that was subsequently confirmed on histopathological examination. Due to the rarity of XA itself and the use of imprint cytology for intraoperative diagnosis the case is being presented.

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Immunocytoexpression profile of ProExC in smears interpreted as ASC-US, ASC-H, and cervical intraepithelial lesion

Zeynep Tosuner, İlknur Türkmen, Sema Arıcı, Cavide Sönmez, Seval Turna, Öykü Onaran

Journal of Cytology 2017 34(1):34-38

Aims: We aimed to investigate the immunocytoexpression profiles of a novel assay ProEx C for topoisomerase II alpha (TOP2A) and minichromosome maintenance protein 2 (MCM2) in abnormal interpreted smears. Settings and Design: Screening programs with Papanicolaou smear and high risk group human papilloma virus testing have yielded a dramatic reduction of cervical cancer incidence. However, both of these tests have limited specificity for the detection of clinically significant cervical high grade lesions. ProEx C for topoisomerase II alpha (TOP2A) and minichromosome maintenance protein 2 (MCM2) has been considered to have tight association with high grade intraepithelial lesions. Materials and Methods: A total number of 54 SurePath cervical cytology specimens of patients previously interpreted as atypical squamous cells-undetermined significance (ASC-US), atypical squamous cells-cannot exclude high grade squamous intraepithelial lesion (ASC-H), low grade squamous intraepithelial lesion (LSIL), and high grade squamous intraepithelial lesion (HSIL) were included in our study. Results and Conclusions: ProEx C was positive in 14 of HSILs (100%), 3 of 19 LSILs (16%), 2 of 4 ASC-Hs, and none of ASC-USs (0%). The ProEx C test showed very intense nuclear staining in all cytologically abnormal cells. Further studies are indicated to evaluate the diagnostic role of ProEx C.

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Myofibromatosis: Utility of fine needle aspiration cytology in the diagnosis of an underreported entity

Sandhya V Poflee, Anjali N Bode, Sneha Chavarkar, Pradeep S Umap

Journal of Cytology 2017 34(1):53-55

Myofibromatosis (MFS) was recognized as a distinct form of childhood fibromatosis. Infantile myofibromatosis (IMF) is now identified as a solitary or multicentric tumor that predominantly occurs in neonates and infants. The adult counterpart of IMF, though of rare occurrence, is identified and is known as MFS. Morphological diagnosis of MFS is made by histopathological examination of the biopsy or surgically excised mass and confirmed on the basis of specific immunoprofile. We report a case of multicentric MFS occurring in an adolescent in whom diagnosis was suggested on the basis of fine needle aspiration cytology (FNAC) that avoided surgical excision of multiple nodules. The diagnosis was later confirmed on histopathological study and contributory immunohistochemical markers. Details of the clinical features and cytological diagnosis of the case are provided to diminish the paucity of available literature on FNAC diagnosis of the rare disease.

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Cytopathologic features of an unusual case of multiple eccrine spiradenomas misdiagnosed as a malignant round cell tumor

Bharat Rekhi, Archi Agarwal

Journal of Cytology 2017 34(1):39-42

A 28-year-old lady presented with multiple swellings in her left shoulder, associated with intermittent pain since last one and a half years. Radiologic imaging revealed multiple, well-defined, subcutaneous lesions in her left supraclavicular region. Fine needle aspiration cytology (FNAC) smears were initially reported as Ewing sarcoma, elsewhere. On review, the smears showed cohesive clusters of round-to-oval cells with scant cytoplasm, which were focally arranged in an acinar-rosetting pattern around hyaline "droplets/bodies," along with few scattered lymphocytes against a background of red blood cells. The diagnosis considered was adnexal tumor. Subsequent biopsy from the multiple lesions confirmed the diagnosis of eccrine spiradenoma. By immunohistochemistry, tumor cells were positive for CK7, epithelial membrane antigen (focally), S100 protein, and tyrosine-protein kinase Kit(C-KIT) /Cluster of differentiation (CD117). This case underscores the value of FNAC in skin adnexal tumors and constitutes as the first case report of multiple eccrine spiradenomas, initially misdiagnosed as Ewing sarcoma. Literature review of similar reported cases with treatment implications are presented.

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Frontal bone metastasis from an occult follicular thyroid carcinoma: Diagnosed by FNAC

Rajnish Kalra, Richa Pawar, Sonia Hasija, Abha Chandna, Manoj Sankla, Chanchal Malhotra

Journal of Cytology 2017 34(1):59-61

Metastatic deposits in skull bones from follicular thyroid carcinoma is rare, and metastatic disease in skull being the presenting symptom without obvious thyroid lesion (occult primary) is even rarer. A 60-year-old female patient presented with a mass in the frontal region of the skull. Fine needle aspiration cytology was done which revealed an adenocarcinoma with repeated follicular pattern, reminiscent of follicular neoplasm of thyroid, which on immunocytochemistry revealed positivity for thyroglobulin. Patient was investigated further for primary thyroid malignancy, and imaging revealed a nodule in the left lobe of thyroid. Neuroimaging showed osteolytic lesion involving the cranium.

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Coexistence of microfilaria with metastatic adenocarcinomatous deposit from breast in axillary lymph node cytology: A rare association

Nibedita Sahoo, Arpita Saha, Pritinanda Mishra

Journal of Cytology 2017 34(1):43-45

Filariasis is a global social health problem of tropical and sub tropical countries like India. W.bancrofti accounts for 95% of cases of lymphatic filariasis. Microfilaria in cytosmears are a rare finding. We report a case of 55 year old female presented with right axillary swelling with ipsilateral breast lump. Cytosmears from the lymph node aspirate showed metastatic adenocarcinomatous deposits and a bunch of microfilariae surrounding the tumor cells and the aspirate from the breast shows ductal carcinoma. We report an additional case of a rare association of microfilaria co-existing with carcinomatous deposit in the lymph node.

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