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தொகுதி 7, பிரச்சினை 3 (2021)

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The Bethesda system for reporting thyroid cytopathology and correlation with histopathological diagnosis

Indrakshi Basak, Nandhini Manoli and Kaustav Mukherjee

The Bethesda system is a uniform reporting system for thyroid cytology that facilitates the clarity of communication among cytopathologists, radiologists and
surgeons facilitating cytohistologic correlation for thyroid diseases. The aim of the study was to determine the correlation between the results of thyroid fine needle
aspirations (FNAs) interpreted using the Bethesda system and final histopathological reports for neoplastic and non-neoplastic lesions. A retrospective study was
performed to compare the cytology and histopathology results for patients with thyroid swelling/nodules in JSS Hospital, Mysuru. The final correlation of diagnoses
between the two methods is reported.
Reviewing the thyroid FNAs with the Bethesda system for reporting allows precise cytological diagnosis. It represents standardization and reproducibility in
reporting thyroid cytology. Nature of the disease, experience of cytohistopathologists, and understanding of certain limitations determine its diagnostic utility.

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Evaluation of significance of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of lymphadenopathy

Aarya Unnikrishnan and Nandini N M

Lymphadenopathy is one of the most frequently encountered clinical presentations and the underlying cause may vary from inflammatory conditions to malignant
neoplasm. Fine needle aspiration cytology (FNAC) is a simple, reliable, economical and minimally invasive procedure preferred in diagnosis of lymphadenopathy.
The aim of the study was to evaluate the role of FNAC as a diagnostic tool in lymphadenopathy and correlate the FNAC findings with histopathological diagnosis
in cases possible. A retrospective study of 125 cases of lymphadenopathy that had undergone FNAC was conducted between January 2020 to December 2020
in the department of pathology, JSS Medical College, Mysore. Out of the 125 cases studied, Reactive lymphoid hyperplasia was the most common FNAC finding,
i.e., 60 (48%) followed by Metastatic carcinoma in 28 cases (22.4%), Granulomatous lymphadenitis in 25 (20%), Lymphoproliferative disorder in 5 (4%), Acute
suppurative lesion in 4 (3.2%), HIV lymphadenopathy in 2 (1.6%), and Non-specific lymphadenitis in 1 (0.8%) case.
FNAC is a simple, inexpensive, rapid and reliable diagnostic tool in the investigation of Lymphadenopathy. It helps in differentiating neoplastic from non-neoplastic
conditions and thus providing means for further management.

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Analysis of FNA findings of Salivary gland lesions using Milan System of Reporting salivary gland cytopathology(MSRSGC) in a tertiary care institute in South India

Rohit Kotipalli and Nandini.N.M

Aims and Objectives – The Milan System for reporting Salivary Gland Cytopathology is a internationally accepted reporting system for preoperative diagnosis and
management of salivary gland lesions. The MSRSGC has the following 6 diagnostic categories: 1) Nondiagnostic, 2) Non-neoplastic, 3) Atypia of undetermined
significance, 4) Neoplasm (further divided as benign and salivary gland neoplasm of uncertain malignant potential), 5) Suspicious for malignancy, and 6) malignant.
The aim of the study is to analyse various salivary gland lesions and classify them as per MSRSGC. Correlation with histopathological findings will be done
wherever possible.
Methods - Retrospective study over a period of 2 years (2019 to 2020). The FNA aspirates of salivary gland lesions will be ennumerated and classified according
to MSRSGC. Each case will be reviewed by two pathologists two avoid any inter observer bias.
Results- All the cases studied over 2 years will be studied and subtyped and results will be analysed.
Conclusion- MSRSGC will help classifying both neoplastic and non-neoplastic salivary gland lesions into accurate groups and helps to redefine the grey zone
lesions on cytology. This will help the surgeons to better plan the further management.

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Diagnostic Pathology by use of Manual Liquid based Cytology (MLBC) in LMIC

Nandini N. M

Liquid based cytology (LBC) is a procedure wherein cells are spread in a monolayer with a clean background. It is usually automated, semi-automated and manual
method. Manual liquid based cytology (MLBC) is an indigenous, cost effective method of cytology which we have used in our setup of low middle income group
country (LMIC). Also it helps us to use the residual sample for study of ancillary techniques like cell block (CB), immunocytochemistry, ICC and IHC on MLB and
CB respectively. Molecular tests like HPV can also be performed.
Aim of the study: to study the utility of MLBC in cervical, breast and thyroid lesions. To use ancillary techniques like CB and Molecular techniques like PCR to
improve diagnosis by use of ICC or IHC wherever possible. MLBC was done by using an in house method by use of polymer solution. The systems studied were
pap smear screening for cervical lesions, breast, and thyroid. The study was conducted over a period of 5 years till 2020, covering each aspect of MLBC in step
wise manner. ICC was conducted on both cervix (p16marker) and breast (ER).IHC was done on CB for cervix (p16, ki67) and breast (ER, PR, HER2).
The results for all the three systems showed good results giving a better diagnostic accuracy of non-neoplastic and neoplastic conditions. MLBC is a complimentary
test for routine screening procedure like pap smear screening and FNAC of breast and thyroid. It helps to give a better diagnosis as it helps to remove obscuring
factors like blood and inflammatory cells.

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Treatment of COVID-19 by controlling the activity of the Nuclear Factor-Kappa B and stopping the transcription of the virus within one hour

Mahmoud Saad Mohamed Elkhodary

Heavy infection of the virus leads to overproduction of cytokines. The overproduction of cytokine (cytokines storms) is responsible for the critical cases and deaths
of COVID-19. The nuclear factor kappa-B stimulates the expression of the genes, which are responsible for cytokines storm and RNA transcription. The COVID-19
and all RNA viruses can be controlled by inhibition of nuclear factor kappa-B, which is controlled by inhibition of hydrogen peroxide and inhibitor kappa-B kinase
enzyme.

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The perioperative window presents a long overlooked but important opportunity to prevent relapses in breast and perhaps other cancers

Michael Retsky

My colleagues and I have been studying an unexpected bimodal relapse pattern in breast cancer. This project started in 1993 when data from Italy and UK showed
that 50 to 80% of all relapses in patients treated only with surgery occurred in an early wave of relapses in the first 3 years post-surgery. We proposed a reasonable
explanation. It appears that the surgery to remove a primary tumor causes systemic inflammation for a week. During that time, dormant single malignant cells
and avascular deposits escape from dormancy and appear as relapses within 3 years. The multi-national authors of our reports include medical oncologists,
surgeons, anesthesiologists, physicists, and other scientists from several fields. A potential solution seems to exist based on our analysis. That therapy is the
common inexpensive analgesic ketorolac administered as IV at the time of surgery and perhaps as oral drug for a few days after surgery. We edited a book and
published a number of papers including one recently. Two animal models support our findings. Another paper suggests a way to prevent some late relapses and
a retrospective clinical trial was reported.

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