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Study of Fine Needle Aspiration Cytology and Histopathological Co Original Research Article Study of fine needle aspiration cytology and histopathological co-relation of soft tissue lesions in pediatric patients at tertiary health care institute in western Maharashtra J Juvekar1, S G Surase2*, K A Deshpande3, M S Wadhi4, S V Thavare5 1,4,5Speciality Medical Officer, NMMC, Vashi, Mumbai, Maharashtra, INDIA. 2,3Associate Professor, Department of Pathology, Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai, Maharashtra. Email: [email protected] Abstract Background: The field of soft tissue tumours (STT) is enormously vast, and yet, as cytologically relatively undiscovered. Due to the rarity of primary tumours of soft tissue and a large range of different types of tumours, the diagnosis and classification of STTs become most difficult areas in surgical pathology and absence of recognizable tissue architectural patterns in cytological preparation makes a diagnosis by FNAC even more difficult.1 Objectives: •To study and analyse the spectrum of soft tissue tumours in our tertiary care hospital by FNAC. •To correlate the cytoarchitectural features observed with histopathological parameters. Material and Methods: Present prospective study was conducted in the Pathology Department of GMC and JJ Hospital, Mumbai, Maharashtra, over a period of two years. Study included all the patients in the pediatric age group which were referred to the FNAC outpatient department with soft tissue swelling. The result of FNAC was further correlated with the histopathological diagnosis from paraffin-embedded sections wherever available. Data obtained was analysed for the histopathological correlation and statistical significance. Results: A total of 57 cases were included in the study of which 45 were found to be benign and 12 were malignant on cytology. Cyto-histo correlation was available in 45 cases. The overall sensitivity, specificity and efficiency of FNAC was found to be 90.09 %, 94.1 % and 93.33 % respectively. Conclusion: FNAC has an absolute role in the diagnosis of STT’s in primary lesions, for a timely management. It is a simple, rapid, cost-effective and well-tolerated procedure in well trained and experienced hands. Key words: Cyto-histopathology correlation, FNAC, Sensitivity, Specificity, Soft tissue tumors *Address for Correspondence: Dr.S.G.Surase, Associate Professor, Department of Pathology, Grant Government Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai - 400008, Maharashtra Email: [email protected] Received Date: 21/09/2019 Revised Date: 10/10/2019 Accepted Date: 06/11/2019 DOI: https://doi.org/10.26611/10512210 field of STTs is enormously vast and yet, as cytologically Access this article online relatively undiscovered. The rarity of primary tumours of soft tissue and a large range of different types of tumours, Quick Response Code: Website: the diagnosis and classification of STTs become most www.medpulse.in difficult areas in surgical pathology and absence of recognizable tissue architectural patterns in cytological preparation makes a diagnosis by FNAC even more difficult.1 Soft tissue arises from the non-epithelial extra- Accessed Date: skeleton connective tissue exclusive of the 24 November 2019 reticuloendothelial system, glia and supporting tissue of 2 various parenchymal organs. FNAC as a diagnostic modality for STTs is increasingly being used. Their INTRODUCTION morphologic overlap and biological heterogeneity pose a FNAC is a safe, reliable and cost-effective tool that is significant diagnostic challenge.3 Advantage of FNAC of used in the diagnosis of lesions in various organs. The STT over core needle biopsy is the sampling of material How to cite this article: J Juvekar, S G Surase, K A Deshpande, M S Wadhi, S V Thavare. Study of fine needle aspiration cytology and histopathological co-relation of soft tissue lesions in pediatric patients at tertiary health care institute in western Maharashtra. MedPulse International Journal of Pathology. November 2019; 12(2): 113-119. https://www.medpulse.in/Pathology/ MedPulse International Journal of Pathology, Print ISSN: 2550-7605, Online ISSN: 2636-4697, Volume 12, Issue 2, November 2019 pp 113-119 from different parts of large tumours to diagnose tumour 3. Spindle cell tumours-the predominance of spindle cells heterogenicity. The final diagnosis of STT by FNAC is with fusiform or ovoid nuclei and elongated uni- or based on a combined evaluation of clinical data, patient bipolar cytoplasm. age, site, duration, radiographic and cytological study, 4. Pleomorphic pattern- the cells show marked variation also it requires interaction between pathologist, surgeon in cell and nuclear size and shape. and radiologist.4 The true frequency of soft tissue lesions 5. Myxoid pattern-when the background matrix is the is difficult to estimate, as most of the non-neoplastic and standout component of a tumour and is myxoid i.e. blue benign lesions are not removed. A conservative estimate or blue-violet in MGG and faintly pink in HandE and is that benign tumours outnumber their malignant faintly green in PAP. The cells maybe spindle, round or counterpart tumours by a ratio of about 100:1 in hospital pleomorphic. population and their annual incidence is approximately 6. Round cell pattern- small round to oval, relatively 300 per 1,00,000 population.5,6,7,8 With the above undifferentiated cells, with a variable amount of background, the present study was undertaken to increase cytoplasm. our understanding about STTs, the accuracy of FNAC in 7. Epithelioid cell pattern-rounded or polygonal cells with their diagnosis, its cytoarchitectural features and to distinct cytoplasmic borders, abundant cytoplasm, and compare these findings with histopathological diagnosis. rounded, ovoid or irregular nuclei. Accurate subtyping was done and the nature of the lesion MATERIALS AND METHODS was mentioned. The present study was a prospective study, carried out in The surgical specimens were received for the Department of Pathology, GMC and JJ hospital for a total histopathological confirmation of the diagnosis. period of 2 years. All the patients in the pediatric age Specimens were processed in automated tissue processing group which were referred to the FNAC outpatient unit and staining was performed with routine H and E department with soft tissue swelling were included. staining. The result of FNAC was correlated with the Detailed history was taken and clinical examination of histopathological diagnosis wherever available. Data patient was carried out. Relevant past, family and obtained was analysed for the histopathological treatment history if any was taken. The patient’s relatives correlation and statistical significance. were informed about the procedure and informed consent was obtained from parents/ guardians before subjecting to RESULTS FNAC. FNAC was performed under all aseptic A total of 57 cases were included in the study of which 45 precautions as OPD procedure with the help of 22-24 were found to be benign and 12 were malignant on gauge needle and disposable 5ml/10ml syringes. Smears cytology. A total number of 12 cases were lost because were prepared, fixed in 95% ethyl alcohol and then were histological examination was not available. The age stained with Haematoxylin and Eosin (HandE) or distribution of the STTs as diagnosed by FNAC showed Papanicolaou (PAP) stain. The slides meant for Giemsa benign tumours were more common amongst 5 years to 8 staining were air dried and stained with Giemsa stain. The years, while malignant tumours were relatively evenly interpretation of the slides was done by the distributed among all the age groups.Male patients cytopathologist. outnumbered the female patients in both benign and After assessing for adequacy, the majority of STTs were malignant categories. Cytological categories of total classified into 7 groups - aspirates - Among the various cytomorphological 1. Vascular pattern-showing a predominantly a categories, maximum i.e. 21 cases (36%) were of vascular haemorrhagic background and a paucicellular aspirate tumours, followed by 14 (24%) cases of spindle cell type. showing few spindle cells. (Table 1). 2. Adipocytic pattern-tumours showing a predominance of mature adipocytes. Table1: Cytological categories of total aspirates Sr. No Lesion category No. of cases Percentage 1 Adipocytic tumours 6 10.52% 2 Vascular tumours 21 36.84% 3 Spindle cell tumours 14 24.56% 4 Small round blue cell tumours 9 15.7% 5 Pleomorphic tumours 1 1.75% 6 Myxoid tumours 1 1.75% 7 Miscellaneous 5 8.77% TOTAL 57 100% MedPulse International Journal of Pathology, Print ISSN: 2550-7605, Online ISSN: 2636-4697, Volume 12, Issue 2, November 2019 Page 114 J Juvekar, S G Surase, K A Deshpande, M S Wadhi, S V Thavare The cytological diagnoses included 'terms' like benign vascular lesion-haemangioma, spindle cell lesion-neurogenic, malignant small round cell tumour- highly suggestive of rhabdomyosarcoma, benign adipocytic tumour-lipoma, lipoblastoma, benign spindle cell lesion, spindle cell lesion-probably benign, suggestive of lymphangioma, giant cell tumour (GCT), malignant mesenchymal tumour, pleomorphic cell sarcoma, malignant mesenchymal tumour-highly suggestive of myxoidliposarcoma. On FNAC, 12 cases were labelled as malignant and 45 cases were labelled as benign. (Table 2) Table2: Cytological categories of total aspirates Sr. no Lesion category Cytological diagnosis No. of cases Percentage Lipoma 4 7.0% 1 Adipocytic tumours Lipomatosis 1 1.7% Lipoblastoma 1 1.7% Benign vascular lesion- haemangioma
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