Mayurika S Tyagi

Abstract

Liposarcoma is the most prevalent soft tissue malignant tumour. It mostly arises in the subcutaneous tissue of shoulders, limbs and neck, and retroperitoneal space. Atypical lipomatous tumour (ALT) is a welldifferentiated liposarcoma (WDLPS) and constitutes 40–45% of all liposarcoma cases. They are locally invasive mesenchymal soft tissue tumours. Most of them are large in size. They have heterogeneous histomorphology, molecular and genetic characteristics, and clinical prognosis, making the diagnosis and treatment of difficult for surgeons. A case of 45-year-old woman with a tumour of the right axilla, causing a discreet asymmetry is presented. The tumour was soft and caused no tenderness. The patient reported no previous injury to the region. Fine needle aspiration cytology (FNAC) revealed atypical lipomatous cells suspected of liposarcoma. The patient was operated under general anaesthesia. The postoperative course was uneventful. The final histopathological diagnosis – was atypical lipomatous tumour/well-differentiated liposarcoma (ALT/WDLPS). ALT/WDLPS is a locally invasive tumour with a good prognosis. However delayed treatment is associated with an increase in tumour size, which can affect mobility. Therefore, to avoid possible local recurrence, extensive surgical resection of tumour tissue with wide margins is a desirable treatment for all ALT/WDLPS cases. Besides, for ALT/WDLPS tumours that are difficult to extensively excise, long-term follow-ups are necessary due to the possibility of recurrence. Keywords: Liposarcoma, Atypical lipomatous tumour, Well-differentiated liposarcoma, FNAC, well-differentiated/dedifferentiated, MDM2

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Abstract

Introduction: Fine needle aspiration cytology (FNAC) is widely accepted as the accurate, sensitive, specific and cost-effective procedure in the diagnosis of lymphadenopathy. Tubercular lymphadenitis is one of the most common causes of lymphadenopathy in developing countries like India. Materials and Methods: An observational study was carried out at the pathology department of teaching hospital in Delhi NCR from March 2013 to April 2017. A total of 3392 patients presented in the FNAC OPD of the hospital, out of which 1730 had lymphadenopathies. Smears were stained with Giemsa and categorised into the cytological pattern. Zheil Neelson (ZN) stain was done in all clinically suspicious cases to tuberculosis. Data regarding brief history, site, age, sex, the gross appearance of aspirate and cytomorphologic features were collected and analysed. Results: Out of the 1730 cases of consecutive lymph node aspirations, 17 were excluded from the study due to inadequate material, 979 cases (57.15%) showed features of Tubercular Lymphadenitis followed by Reactive Lymphadenitis, 524 cases (30.58%). Out of the 20 cases which showed HIV positivity 18 showed the presentation of tubercular lymphadenitis. TB was prevalent in all age groups, with the majority of cases affecting people more than 50 years of age. Conclusion: FNAC of lymphadenopathy is of particular importance in view of the high prevalence of tuberculosis in our country, atypical presentation of tuberculosis and because AFB are seen mostly in purulent aspirate smears which do not show granulomas, necrosis or epithelioid cells and which in the absence of Ziehl-Neelsen staining can be dismissed as acute suppurative lymphadenitis. FNAC is a simple, reliable, quick and economical diagnostic tool for peripheral lymph node lesions especially in the quick and simple diagnosis of Tubercular Lymphadenitis. Keywords: Lymph node, Fine needle aspiration cytology FNAC, Tubercular lymphadenitis, Reactive lymphadenitis, Lymphoma.

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