Abstract

Background: Tuberculosis is still a global health problem. Most common presentation of extrapulmonary tuberculosis is tuberculous lymphadenitis. In our setting, keeping huge burden of tuberculosis in mind, clinicians have to depend on pathological diagnosis of enlarged lymph nodes, i.e., cytomorphology with acid-fast staining in diagnosing these cases so that diagnosis and management of such cases can be initiated quickly. Fine needle aspiration cytology (FNAC) of lymph nodes has been a simple, rapid and cost-effective procedure for diagnosis of various causes of lymphadenopathies. Objective: To determine the diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of tuberculous lymphadenitis patients in Bangladesh. Materials and Methods: This cross-sectional study was done on 317 subjects in Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with icddr,b. After clinical examination, fine needle aspiration (FNA) was done. The FNA materials were processed for Papanicoulaou staining (PAP stain), Ziehl-Neelsen staining and culture for the diagnosis of tuberculosis. Sensitivity, specificity, positive and negative predictive values of FNAC were determined where culture was taken as the gold standard. Results: Initially 351 clinically suspected tuberculous lymphadenitis patients were enrolled, but 34 cases were excluded due to diagnosis of malignancy. Among them 123 were male and 194 were female. Mean age was 27.91±13.16 years. Among the subjects 95.9% presented with cervical lymphadenopathy, others presented with lymphadenopathy of axillary or other groups of lymph nodes. The results of cytomorphological diagnosis of TB were in 58.36% cases, and culture was positive in 23.3% cases. Sensitivity, specificity, positive predictive value and negative predictive value of cytomorphological diagnosis were 79.7%, 48.1%, 31.9% and 88.6% respectively. Conclusions: FNAC is an effective diagnostic method for tuberculous lymphadenitis. It can diagnose granulomatous inflammation as well as reactive and other disease conditions including malignancies, thereby providing more information about the patient’s disease status. J Enam Med Col 2019; 9(1): 30-33

We determined the sensitivity, specificity, positive and negative predictive values of physical examination and fine needle aspiration cytology (FNAC) for diagnosis of tumor’s, considering histopathology as standard that included fifty suspected tumor patients. Following the completion of interview for clinical history and physical examination, FNAC and histopathology were performed. Lump was present in 44% cases, weight loss was observed in 42% cases as complaint signs and pain occurred at the site of tumor in 44% cases. Physical examination indicated that 36% cases were malignant and 64% were benign tumors. Histopathological diagnosis of the tumor confirmed that 46% cases were malignant and 54% were benign. Thus, physical examination was sensitive in 52.11%, specific in 77.78%, accurate in 76% and the negative and positive predictive values were 34.37% and 66.57%, respectively. However, FNAC showed 72% neoplasm and 28% non-neoplasm, while histopathology revealed 86% neoplasm and 14% non neoplasm among the patients. So, the sensitivity, specificity, accuracy, false positive and false negative results , positive and negative predictive values of FNAC were 62.50%, 88.46%, 76%, 16.67%, 28.12%, 83.33% and 71.88%, respectively. Particularly in 28% non-neoplasm’s, FNAC showed equal accuracy and sensitivity and that was 50%. In correlation with 27 benign cases and 23 malignant tumors from histopathology, FNAC showed accuracy of 92.60% and 43.48%, respectively. Though FNAC is less sensitive than histopathology in making unequivocal diagnosis of cancer but insignificantly different from histopathology in interpreting atypical or malignant cases of tumors.

Radiological examination, endoscopy, cytology, biopsy and detection of p21 oncogens and others have resulted in the identification of early cases of gastric carcinoma. Among these, endoscopic biopsy is an important tool to detect gastric carcinoma. But some times, it can not give information due to inadequate and improper sampling. On the other hand,modern diagnostic tools of detecting gastric carcinoma as like detection of p21 oncogens and others are not available in our country. So, In conjunction with imprint cytology, it is possible to reach an accurate diagnosis.

A 25 years old male attended the skin & VD outpatient department of Khulna Medical College Hospital on 16th June, 2013 with complaints of multiple asymptomatic small rounded firm, cystic nodules that are adherent to the overlying skin of scortum. The microscopic examination of the cystic nodules showed the features of steatocystoma multiplex. This disorder, although it is asymptomatic, is a cosmetic threat to the patient. Only a few cases of the patients with an autosomal dominant mutation, who had keratin 17; have been reported. We are reporting here a case of steatocystoma multiplex of scortum in a 25 years old male along with review of literature.J Bangladesh Coll Phys Surg 2015; 33(4): 218-221