Letters to Editor
FNAC in the diagnosis of two rare lung infections in this case, prompting an early and sucessful treatment.
2.
3.
Nalini Gupta, Sangeeta Verma, Pinaki Dutta1, Diveyesh Mahajan2, Naveen Kalra2 Departments of Cytology and Gynecological Pathology, Endocrinology, and 2Radiodiagnosis, Postgraduate Institute of
1
Medical Education and Research, Chandigarh, India Address for correspondence: Dr. Nalini Gupta, Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, India. E-mail: [email protected]
5.
Access this article online Quick Response Code Website: www.jcytol.org
References 1.
4.
Paksoy N, Ozer D, Tuneli IÖ. Diagnosis of pulmonary hydatid disease presenting with solid nodule and mimicking malignancy by fine needle aspiration cytology. Cytojournal 2012;9:13. Gupta N, Arora J, Nijhawan R, Aggarwal R, Lal A. Aspergillosis with pulmonary echinococcosis. Cytojournal 2006;3:7. Duggal R, Rajwanshi A, Gupta N, Lal A, Singhal M. Polymicrobial lung infection in postrenal transplant recipient diagnosed by fine-needle aspiration cytology. Diagn Cytopathol 2010;38:294-6. Sodhani P, Gupta S. Pulmonary echinococcosis complicated with actinomycotic abscess: A rare fine needle aspiration diagnosis. Acta Cytol 2006;50:359-60.
Kilinç O, Döskaya M, Sakar A, Yorgancioğlu A, Halilçolar H, Caner A, et al. Three atypical pulmonary hydatidosis lesions mimicking bronchial cancer from Turkey. New Microbiol 2009;32:229-33.
DOI: 10.4103/0970-9371.117637
Donovanosis: An incidental finding on Pap test Sir, Pap test has been an effective way to screen women for squamous dysplasia and carcinoma of the uterine cervix. Although the Pap test is primarily used for detecting cellular and epithelial abnormalities, certain infections are detected on the Pap test too e.g., donovanosis, tuberculosis, coccidioidomycosis, schistosomiasis, teniasis, molluscum contagiosum.[1] These rare entities pose challenges due to the infrequent occurrence of these entities in the daily practice of cytology. These conditions may also give rise to diagnostic pitfalls to be aware of in Pap tests. We are reporting an incidental finding of Calymmatobacterium granulomatis/ Donovan bodies on Pap test. A 27-year-old married woman presented with chief complaint of recurrent seropurulent vaginal discharge. She was treated with anti-fungals repeatedly but got only symptomatic relief for some time. Her spouse was also counseled and treated. A complete history and examination was sought in the Indian Council of Medical Research (ICMR) clinic Mandi, Himachal Pradesh. There was a history of seropurulent discharge and itchy ulcerations on the vulva for past one year. There was no promiscuous sexual behavior. Both partners were non reactive for human immunodeficiency virus and Veneral Diseases Research Laboratory test. A Pap test was taken. Pap smears were satisfactory and negative for intraepithelial lesion/malignancy. In addition, smears showed acute inflammatory cell infiltrate
with numerous macrophages. The macrophages contained numerous safety pin shaped structures with polar thickening (donovan bodies) and a halo around them [Figure 1]. Pap smears was reported positive for Calymmatobacterium granulomatis/ Donovanosis. It was an incidental finding in a patient who was given erroneous treatment for an intractable infection in an on-going cancer control project in Himachal Pradesh. Donovanosis is another name for granuloma inguinale. It is a bacterial sexually transmitted disease (STD) caused by a gram negative, intracellular, non-motile, non-sporing cocco-bacillus
Figure 1: Macrophages show numerous safety pin shaped structures with polar thickening of chromatin (donovan bodies) and a halo around them (circle) (Pap, ×100)
Journal of Cytology / July 2013 / Volume 30 / Issue 3
217
Letters to Editor
Calymmatobacterium granulomatis also known as Donovan body. Pathogenicity is limited to humans only,[2] and is seen more frequently in Africa and Asia.[3] Incubation period ranges from 1 to 12 weeks. It begins as a painless papule on the genitalia, which ulcerates slowly.[2] In early stages donovanosis is difficult to differentiate from chancroid.[4] The chancroid ulcers are painful whereas those of donovanosis are painless. In later stages, it is difficult to differentiate from lymphogranuloma venereum (LGV) and anogenital cutaneous amebiasis.[4] LGV is also a STD caused by Chlamydia trachomatis characterized by painless ulcer and lymphadenopathy (buboes). Anogenital amebiasis is diagnoses by identifying ameba from the ulcers. Microscopically, Donovan body appears as rounded 1-2 µm in diameter, within thin-walled intracytoplasmic vacuoles inside mononuclear cells. They show bipolar condensation of chromatin, giving a closed ‘safety pin’ appearance in stained smears. Neutrophilic infiltrate without giant cells is often seen. Reactive epithelial cells are usually scant and marked reparative change may be found in case of ulceration. The differential diagnosis includes follicular cervicitis, granulation tissue, and other granulomatous diseases, including malakoplakia.[5] In follicular cervicitis, lymphoid cell infiltrate is seen instead of neutrophils along with tingible-body macrophages with cellular debris. In malakoplakia, cytoplasmic inclusions called Michaelis-Gutmann bodies are more dense, laminated and round, compared to Donovan bodies. Ancillary studies that may be helpful include special stains (e.g. Romanowsky and Warthin-Starry stains) to highlight Donovan bodies. In such granulomatous cases it is also important to perform acid-fast stains for mycobacteria and fungal stains (e.g. Gomori methenamine silver).
presence should prompt screening for other STDs. Therefore, knowledge of the cytomorphology of unusual entities and their diagnostic pitfalls is important.
Shailja Puri Wahal, Deepak Tuli1 Senior Resident, Department of Pathology, Indira Gandhi Medical College, Shimla, 1Pathologist, Task Force Project for Cancer Control through Multi-organ approach, Himachal Pradesh, India Address for correspondence: Dr. Shailja Puri Wahal, Senior Resident, Department of Pathology, Indira Gandhi Medical College, Shimla 171001, Himachal Pradesh, India Email: [email protected]
References 1.
2.
3. 4.
5.
Khalbuss WE, Michelow P, Benedict C, Monaco SE, Pantanowitz L. Cytomorphology of unusual infectious entities in the Pap test. Cytojournal 2012:9-15. Ananthanarayan R, Panikar CK. Miscellaneous bacteria-Granuloma inguinale. Textbook of microbiology 6th ed. Hyderabad: Orient Longman; 2000: p. 373-4. Chandra M. Cervical smear with intracellular organisms from a case of granuloma venereum (donovanosis). Acta Cytol 1991:35:143-5. Ballard RC. Klebsiella granulomatis (Donovanosis, Granuloma Inguinale). In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. 7th ed. Philadelphia: Elsevier Churchill Livingstone; 2009. Ramdial PK, Sing Y, Chotey NA, Bagratee JS. Concomitant malacoplakia and granuloma inguinale of the cervix in acquired immune deficiency syndrome. Int J Gynecol Pathol 2008:27:282-7.
Access this article online Quick Response Code Website:
In conclusion rare entities may be encountered on Pap test. Finding and accurately diagnosing these entities is important, even if their presence does not always signify infection, but rather contamination from vulvar or genital lesions or fecal material. Some of them are sexually transmitted, and their
www.jcytol.org
DOI: 10.4103/0970-9371.117638
Aspiration cytology in the preoperative diagnosis of granular cell tumor of thyroid region in an 11-years-old female child Sir, Granular cell tumor (GCT) is a rare tumor and even rarer in children. They are neoplasms of uncertain histogenesis but neural origin is favored.[1-3] Here, we present a case of GCT in an 11-years-old female child who presented with well circumscribed, non tender, firm swelling of size 4 cm × 4 cm × 2 cm in the right thyroid region which was not moving with 218
deglutination or protrusion of tongue. The swelling was present for 2 years. Ultrasonography (USG) confirmed a well encapsulated subcutaneous oval mass anterior and superior to right lobe of thyroid. Fine needle aspiration cytology (FNAC) slides stained with geimsa stain revealed polyhedral cells in syncitial clusters and in isolation with granular background. The cells showed central to eccentric round to oval nuclei, granular nuclear chromatin,
Journal of Cytology / July 2013 / Volume 30 / Issue 3
Copyright of Journal of Cytology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
FNAC in the diagnosis of two rare lung infections in this case, prompting an early and sucessful treatment.
2.
3.
Nalini Gupta, Sangeeta Verma, Pinaki Dutta1, Diveyesh Mahajan2, Naveen Kalra2 Departments of Cytology and Gynecological Pathology, Endocrinology, and 2Radiodiagnosis, Postgraduate Institute of
1
Medical Education and Research, Chandigarh, India Address for correspondence: Dr. Nalini Gupta, Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, India. E-mail: [email protected]
5.
Access this article online Quick Response Code Website: www.jcytol.org
References 1.
4.
Paksoy N, Ozer D, Tuneli IÖ. Diagnosis of pulmonary hydatid disease presenting with solid nodule and mimicking malignancy by fine needle aspiration cytology. Cytojournal 2012;9:13. Gupta N, Arora J, Nijhawan R, Aggarwal R, Lal A. Aspergillosis with pulmonary echinococcosis. Cytojournal 2006;3:7. Duggal R, Rajwanshi A, Gupta N, Lal A, Singhal M. Polymicrobial lung infection in postrenal transplant recipient diagnosed by fine-needle aspiration cytology. Diagn Cytopathol 2010;38:294-6. Sodhani P, Gupta S. Pulmonary echinococcosis complicated with actinomycotic abscess: A rare fine needle aspiration diagnosis. Acta Cytol 2006;50:359-60.
Kilinç O, Döskaya M, Sakar A, Yorgancioğlu A, Halilçolar H, Caner A, et al. Three atypical pulmonary hydatidosis lesions mimicking bronchial cancer from Turkey. New Microbiol 2009;32:229-33.
DOI: 10.4103/0970-9371.117637
Donovanosis: An incidental finding on Pap test Sir, Pap test has been an effective way to screen women for squamous dysplasia and carcinoma of the uterine cervix. Although the Pap test is primarily used for detecting cellular and epithelial abnormalities, certain infections are detected on the Pap test too e.g., donovanosis, tuberculosis, coccidioidomycosis, schistosomiasis, teniasis, molluscum contagiosum.[1] These rare entities pose challenges due to the infrequent occurrence of these entities in the daily practice of cytology. These conditions may also give rise to diagnostic pitfalls to be aware of in Pap tests. We are reporting an incidental finding of Calymmatobacterium granulomatis/ Donovan bodies on Pap test. A 27-year-old married woman presented with chief complaint of recurrent seropurulent vaginal discharge. She was treated with anti-fungals repeatedly but got only symptomatic relief for some time. Her spouse was also counseled and treated. A complete history and examination was sought in the Indian Council of Medical Research (ICMR) clinic Mandi, Himachal Pradesh. There was a history of seropurulent discharge and itchy ulcerations on the vulva for past one year. There was no promiscuous sexual behavior. Both partners were non reactive for human immunodeficiency virus and Veneral Diseases Research Laboratory test. A Pap test was taken. Pap smears were satisfactory and negative for intraepithelial lesion/malignancy. In addition, smears showed acute inflammatory cell infiltrate
with numerous macrophages. The macrophages contained numerous safety pin shaped structures with polar thickening (donovan bodies) and a halo around them [Figure 1]. Pap smears was reported positive for Calymmatobacterium granulomatis/ Donovanosis. It was an incidental finding in a patient who was given erroneous treatment for an intractable infection in an on-going cancer control project in Himachal Pradesh. Donovanosis is another name for granuloma inguinale. It is a bacterial sexually transmitted disease (STD) caused by a gram negative, intracellular, non-motile, non-sporing cocco-bacillus
Figure 1: Macrophages show numerous safety pin shaped structures with polar thickening of chromatin (donovan bodies) and a halo around them (circle) (Pap, ×100)
Journal of Cytology / July 2013 / Volume 30 / Issue 3
217
Letters to Editor
Calymmatobacterium granulomatis also known as Donovan body. Pathogenicity is limited to humans only,[2] and is seen more frequently in Africa and Asia.[3] Incubation period ranges from 1 to 12 weeks. It begins as a painless papule on the genitalia, which ulcerates slowly.[2] In early stages donovanosis is difficult to differentiate from chancroid.[4] The chancroid ulcers are painful whereas those of donovanosis are painless. In later stages, it is difficult to differentiate from lymphogranuloma venereum (LGV) and anogenital cutaneous amebiasis.[4] LGV is also a STD caused by Chlamydia trachomatis characterized by painless ulcer and lymphadenopathy (buboes). Anogenital amebiasis is diagnoses by identifying ameba from the ulcers. Microscopically, Donovan body appears as rounded 1-2 µm in diameter, within thin-walled intracytoplasmic vacuoles inside mononuclear cells. They show bipolar condensation of chromatin, giving a closed ‘safety pin’ appearance in stained smears. Neutrophilic infiltrate without giant cells is often seen. Reactive epithelial cells are usually scant and marked reparative change may be found in case of ulceration. The differential diagnosis includes follicular cervicitis, granulation tissue, and other granulomatous diseases, including malakoplakia.[5] In follicular cervicitis, lymphoid cell infiltrate is seen instead of neutrophils along with tingible-body macrophages with cellular debris. In malakoplakia, cytoplasmic inclusions called Michaelis-Gutmann bodies are more dense, laminated and round, compared to Donovan bodies. Ancillary studies that may be helpful include special stains (e.g. Romanowsky and Warthin-Starry stains) to highlight Donovan bodies. In such granulomatous cases it is also important to perform acid-fast stains for mycobacteria and fungal stains (e.g. Gomori methenamine silver).
presence should prompt screening for other STDs. Therefore, knowledge of the cytomorphology of unusual entities and their diagnostic pitfalls is important.
Shailja Puri Wahal, Deepak Tuli1 Senior Resident, Department of Pathology, Indira Gandhi Medical College, Shimla, 1Pathologist, Task Force Project for Cancer Control through Multi-organ approach, Himachal Pradesh, India Address for correspondence: Dr. Shailja Puri Wahal, Senior Resident, Department of Pathology, Indira Gandhi Medical College, Shimla 171001, Himachal Pradesh, India Email: [email protected]
References 1.
2.
3. 4.
5.
Khalbuss WE, Michelow P, Benedict C, Monaco SE, Pantanowitz L. Cytomorphology of unusual infectious entities in the Pap test. Cytojournal 2012:9-15. Ananthanarayan R, Panikar CK. Miscellaneous bacteria-Granuloma inguinale. Textbook of microbiology 6th ed. Hyderabad: Orient Longman; 2000: p. 373-4. Chandra M. Cervical smear with intracellular organisms from a case of granuloma venereum (donovanosis). Acta Cytol 1991:35:143-5. Ballard RC. Klebsiella granulomatis (Donovanosis, Granuloma Inguinale). In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. 7th ed. Philadelphia: Elsevier Churchill Livingstone; 2009. Ramdial PK, Sing Y, Chotey NA, Bagratee JS. Concomitant malacoplakia and granuloma inguinale of the cervix in acquired immune deficiency syndrome. Int J Gynecol Pathol 2008:27:282-7.
Access this article online Quick Response Code Website:
In conclusion rare entities may be encountered on Pap test. Finding and accurately diagnosing these entities is important, even if their presence does not always signify infection, but rather contamination from vulvar or genital lesions or fecal material. Some of them are sexually transmitted, and their
www.jcytol.org
DOI: 10.4103/0970-9371.117638
Aspiration cytology in the preoperative diagnosis of granular cell tumor of thyroid region in an 11-years-old female child Sir, Granular cell tumor (GCT) is a rare tumor and even rarer in children. They are neoplasms of uncertain histogenesis but neural origin is favored.[1-3] Here, we present a case of GCT in an 11-years-old female child who presented with well circumscribed, non tender, firm swelling of size 4 cm × 4 cm × 2 cm in the right thyroid region which was not moving with 218
deglutination or protrusion of tongue. The swelling was present for 2 years. Ultrasonography (USG) confirmed a well encapsulated subcutaneous oval mass anterior and superior to right lobe of thyroid. Fine needle aspiration cytology (FNAC) slides stained with geimsa stain revealed polyhedral cells in syncitial clusters and in isolation with granular background. The cells showed central to eccentric round to oval nuclei, granular nuclear chromatin,
Journal of Cytology / July 2013 / Volume 30 / Issue 3
Copyright of Journal of Cytology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
