Archana Shivamurthy

Abstract

Introduction: Endometriosis is an important gynecologic disorder with multifactorial causes, primarily affecting women during their reproductive years. Pathologically, it is the result of functional endometrium located outside the uterus which may vary from microscopic endometriotic implants to large cysts. Endometriotic cysts and infertility is a well-known association. Some patients are asymptomatic while others present with disabling pelvic pain, infertility, or adnexal masses. Cyst aspiration, fenestration and ablation of cyst wall are commonly performed surgical procedures. Excision of the cyst wall is an accepted surgical treatment owing to the low recurrence rates. Materials and Methods: A total of 35 patients who underwent ovarian cystectomy for endometriotic cysts between January 2019 and December 2020 were retrospectively identified. The clinical findings, gross and histopathological features were noted in each case. Microscopically, the presence or absence of ovarian tissue adjacent to the cyst wall was evaluated. If ovarian tissue was present, the morphologic characteristics were graded on a semi-quantitative scale of 0-4 as described by Muzii et al. Results: The age group of patients ranged between 22-28yrs. Right side cysts accounted for the majority, however 6 cases had bilateral endometriotic cysts. Majority of patients presented with primary infertility (46.2%). The maximum weight recorded for these cysts was 35gm, size ranging between 4.5 to 18cm and median thickness of the cyst wall being 0.7cm. 68% of the cysts showed a lining epithelium, few showing atypia and oncocytic change. Fibrosis and hemosiderin laden macrophages were present in more than 70% of cases and endometrial glands and stroma in more than 50%. Inflammation when present was predominantly lymphocytic. On evaluation of the ovarian tissue, 42.8% of cases showed no follicles and the rest showing grades ranging from 1 to 4, with grade 1 accounting for majority. Conclusion: The present study further emphasizes endometriosis to be an important cause of primary infertility which needs to be recognized and treated appropriately. Recognition of these cysts on histopathological examination can be challenging at times when endometrial stroma is scant and in cases of tubo-ovarian masses where these lesions could mimic malignancy. The excision of endometriotic cyst wall may cause loss of functional ovarian tissue in patients with primary infertility and thus could effect the response to ovarian stimulation, ocyte recovery, implantation and fertilization rates in these patients. Keywords: Endometriosis, Cysts, Infertility, Ovary.

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Abstract

Primary ovarian neoplasms constitute a heterogenous group of benign and malignant tumors of epithelial, sex cord–stromal, mesenchymal and germ cell origin. Secondary tumors constitute a minority. The management of benign and malignant ovarian neoplasms varies and it is here that imprint cytology plays a crucial role in diagnosis. It provides a rapid intraoperative diagnosis which will decide further treatment course for the patient. Imprint cytology of ovarian neoplasms is simple, inexpensive, challenging and provides a rapid diagnosis with excellent cellular details. The aim of the present study is to determine the role of imprint cytology in the diagnosis of ovarian neoplasms. A retrospective study was conducted in the department of pathology. A total of 53 cases were included in the study. In 48 cases, the imprint cytology findings correlated with the histopathological diagnosis. 5 cases did not correlate. Epithelial ovarian tumors accounted for the majority, (85%) followed by germ cell tumors (9.4%) and sex cord stromal tumors (5.6%). The sensitivity and specificity were 93.75% and 100% respectively. Thus imprint cytology is an effective cytological method in the diagnosis of ovarian neoplasms. Knowledge of specific cytological features for each tumor type helps in accurate diagnosis which in turn is valuable in immediate appropriate treatment and management of patients with benign or malignant neoplasms. Keywords: Imprint, Cytology, Ovary, Tumors.

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Abstract

Introduction: Mucinous (colloid) carcinoma (MC) of the breast is relatively rare and accounts for 1-6% of all breast cancers. Traditionally, pure mucinous tumors and mixed infiltrating ductal carcinomas with a mucinous component have been described. Pure mucinous carcinoma of the breast has a favorable prognosis than the mixed variety noted in several studies. The common age of presentation is the postmenopausal group. Cytological diagnosis of these tumors is challenging. Materials and Methods: A retrospective study was conducted at our institute. 22 cases consisting of both mixed and pure mucinous carcinomas diagnosed by cytology and verified on histopathology between January 2007 and November 2015 were included in the study. All cytology and histopathology slides were reviewed. Results & Discussion: A total of 22 cases were evaluated. The age ranged from 34-78years. The left breast was involved in 12 cases and the right breast in 10cases. 19 cases were diagnosed as mucinous carcinoma on cytology. However 12 of these cases were reported as pure mucinous carcinoma on biopsy. All these cases displayed abundant mucin, small nuclei and/or regular nuclear outlines on cytology. 7 cases turned out to be mixed tumors on histopathology. Sparse mucin, large nuclei, irregular nuclear outlines or the presence of nucleoli were found in mixed mucinous carcinomas but not in pure tumors. Three cases were diagnosed as infiltrating ductal carcinoma (IDC) on cytology. One of these patients had 2 nodules, diagnosed on histopathological examination as IDC and mucinous carcinoma. Out of the other two cases, 1 case was diagnosed as cellular variant of mucinous carcinoma and another case as mixed carcinoma on biopsy. Cellular variant of mucinous carcinoma can mimic low grade ductal carcinoma on cytology. A thorough examination of the slides for mucinous material and few thin capillary fragments provide a valuable diagnostic clue. Conclusion: The distinction between pure and mixed mucinous carcinoma is important, because patients with the former type have a much favorable prognosis, with a low propensity for lymph node and distant metastasis. Cytopathological identification of patients with pure mucinous carcinomas may be performed only in a limited number of cases. The various differential diagnosis should always be kept in mind while dealing with lesions associated with mucin. However the age of presentation, clinical features and radiological findings can help to further categorize the various mucinous lesions. Keywords: Carcinoma,Breast, Cytology.

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