Objective: We investigated the role of on-site toluidine blue staining and screening in fine-needle aspiration cytology (FNAC) reporting for patients with thyroid nodules, palpable breast lumps and palpable lymph nodes. Study Design: A total of 200 consecutive patients with a palpable lymph node or a lump in the breast or thyroid referred to the outpatient department for FNAC were included in this study. We used toluidine blue to stain FNAC slides for the evaluation of smear adequacy. The toluidine blue-stained slides were compared with the same slides after being decolorised and Papanacolaou (PAP)-stained. Results: Out of 200 cases, 28 (14%) were deemed unsatisfactory on the first attempt as assessed by rapid staining. These included 16 (38%) of 42 thyroid cases, 10 (10.4%) of 96 breast lump cases and 2 (3.2%) of 62 lymph node cases. A repeat FNAC in the same sitting on these 28 patients showed adequate material in 24 (12%) of them. Therefore, for 98%, a decision could be made at the very first visit to plan further management. Conclusions: We concluded that toluidine blue offers excellent cytological details for the preliminary identification of the lesion and to decide on the adequacy of the material for definitive diagnosis on FNAC slides.
Pure ovarian choriocarcinoma is extremely rare and can develop as a germ cell tumor or as a metastasis from uterine or tubal gestational choriocarcinoma or rarely from an ovarian pregnancy. The cytomorphologic findings have been reported previously in different sites. However, this is the first case of pure ovarian choriocarcinoma diagnosed on cytology to the best of our knowledge. The distinction between a gestational and nongestational choriocarcinoma is difficult. A 19-year-old female patient presented with an irregular per-vaginal bleeding and a mass in lower abdomen. Fine needle aspiration cytology smears of the mass were hypocellular and showed large, multinucleated giant cells and malignant mononucleated cells. Background was hemorrhagic. Serum beta hCG level was 3,80,000 mIU/ml. A diagnosis of choriocarcinoma was offered which was later confirmed by histopathology. The diagnosis of choriocarcinoma on fine needle aspiration cytology is based on the presence of large, multinucleated giant cells and malignant mononucleated cells. A high index of suspicion should be maintained and estimation of serum beta hCG plays a key role in supporting the diagnosis.
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