IP Archives of Cytology and Histopathology Research

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Get Permission Gupta, Gupta, and Bhardwaj: Role of fine needle aspiration cytology in the diagnosis of cutaneous and subcutaneous swellings


Introduction

A wide range of inflammatory as well as neoplastic lesions can present as cutaneous and subcutaneous swellings all over the body. 1, 2 Fine needle aspiration (FNA) is a simple, fast, and inexpensive technique with high sensitivity and specificity in the evaluation of these masses. 3 It can be effectively employed to diagnose nature of lesion, helps to distinguish between neoplastic and reactive process likely to resolve spontaneously or with conservative treatment.4, 5, 6 It helps to diagnose infections presenting as skin nodules. 7 FNAC is of great value in the investigation of suspected skin and subcutaneous metastatic malignancy. 6 The present study was carried out with the aim to assess the cytological spectrum of lesions presenting as skin and subcutaneous swellings.

Materials and Methods

It was an observational study conducted in the Department of Pathology, Govt. Medical College, Jammu w.e.f. 1st January 2022 to 30th June 2022. It included patients presenting with palpable skin and subcutaneous swellings referred from various clinical departments. Detailed history, clinical examination and relevant investigations of all patients were recorded. FNAC was performed using 22 G needle and 20cc syringe after taking written informed consent. Smears were prepared; air dried smears were stained with May-Grunwald-Giemsa (MGG) stain and alcohol fixed smears were stained with Papanicolaou (PAP) stain. Stained smears were examined under light microscope. The cytological features were studied and diagnosis was made. Aspirates showing only peripheral blood or with low cellularity were considered unsatisfactory for evaluation and were excluded from the study.

Results

The present study had 290 patients which included 169 (58%) males and 121 (42%) females with male to female ratio of 1.4:1. The mean age of patients was 36.17 years with age ranging from 6 months to 85 years. The age wise distribution of cases is as shown in Table 1. Maximum cases were in the age group 31-40 years followed by 21-30 years.

Table 1

Age wise distribution of cases

Age (years)

Non-neoplastic

Neoplastic (Benign)

Neoplastic (Malignant)

Total

0-10

11

7

-

18

11-20

23

13

-

36

21-30

24

38

-

62

31-40

21

49

3

73

41-50

17

31

2

50

51-60

10

12

1

23

61-70

5

13

4

22

71-80

-

2

3

5

81-90

-

1

-

1

Total

111

166

13

290

Out of 290 cases, 111 (38.3%) were diagnosed as non-neoplastic and 179 (61.7%) as neoplastic on FNA examination (Table 2). The inflammatory lesions were acute suppurative inflammation (21 cases), tubercular abscess (6 cases) and granulomatous inflammation (1 case). Epidermal inclusion cyst was the most common non- neoplastic lesion (Figure 1). Among neoplastic lesions, 166 cases (57.2%) were benign and 13 cases (4.5%) were malignant. Lipoma was the most common benign neoplastic lesion and was also overall the commonest lesion in our study (137, 47.2%) (Figure 2). Benign appendageal tumors seen were pilomatricoma, chondroid syringioma. Metastatic carcinoma were adenocarcinoma (2 cases) (Figure 3), squamous cell carcinoma (2cases) (Figure 4) and poorly differentiated carcinoma (1case). Of these, adenocarcinoma deposits were seen in abdominal wall, squamous cell carcinoma in chest wall and head, neck region; and poorly differentiated carcinoma deposits were seen in chest wall.

Trunk was involved in 132 cases (45.5%) followed by head and neck (96 cases, 33.1%), upper extremity (42 cases, 14.5%) and lower extremity (20 cases, 6.9%). Trunk was the most common site for benign neoplastic lesions and non neoplastic inflammatory lesions. Head and neck region was the most common site for epidermal inclusion cysts, benign cystic lesions, vascular tumors and benign appendageal tumors.

Table 2

Various lesions diagnosed on FNA

Cytological diagnosis

Number of cases

Percentage (%)

Non-neoplastic

Inflammatory

28

9.6

Benign cystic lesion

11

3.8

Ganglion cyst

05

1.7

Epidermal inclusion cyst

63

21.7

Endometriosis

01

0.3

Hematoma

02

0.7

Gouty tophus

01

0.3

Neoplastic

Benign

Lipoma

137

47.2

Neurofibroma

02

0.7

Benign spindle cell lesion

03

1.0

Benign appendageal tumor

14

4.8

Hemangioma

06

2.1

Giant cell tumor of tendon sheath

04

1.4

Malignant

Metastatic carcinoma

05

1.7

Squamous cell carcinoma

01

0.3

Poorly differentiated carcinoma

01

0.3

Basal cell carcinoma

01

0.3

Malignant melanoma

02

0.7

Malignant spindle cell lesion

02

0.7

Malignant appendageal tumor

01

0.3

Total

290

100.0

Figure 1

Photomicrograph from a case of epidermal inclusion cyst showing numerous anucleated squamous epithelial cells (MGG, 400X)

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/616eeab6-423e-4577-bc72-c0584a51057cimage1.png
Figure 2

Photomicrograph from a case of lipoma showing fragments of mature adipose tissue (MGG, 100X)

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/616eeab6-423e-4577-bc72-c0584a51057cimage2.png
Figure 3

Photomicrograph showing metastatic deposits of adenocarcinoma (MGG 100X)

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/616eeab6-423e-4577-bc72-c0584a51057cimage3.png
Figure 4

Photomicrograph showing metastatic deposits of squamous cell carcinoma (PAP 400X)

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/616eeab6-423e-4577-bc72-c0584a51057cimage4.png

Discussion

A total of 290 cases were cytologically assessed in the present study. There were 169 (58%) males and 121 (42%) females with male to female ratio of 1.4:1. This male preponderance in our study is similar to other studies.5, 7, 8, 9 Maximum cases in our study were in the age group of 21-40 years which is comparable to other studies. 1, 5

Epidermal inclusion cyst was the most common non neoplastic lesion as seen in many studies.1, 5, 7, 8, 9, 10, 11 Inflammatory lesions were the next commonest among non neoplastic lesions, also seen in other studies. 7, 10, 11 Lipoma accounted for maximum cases in our study and is also the commonest benign neoplastic lesion diagnosed in our study. This was also observed in studies by other authors. 1, 5, 7, 8, 9, 10, 11, 12 In our study, next common among benign neoplastic lesions were benign appendageal tumors; similar to few studies. 8, 12 However, in some studies, benign spindle cell lesions were the second common benign neoplastic lesion. 1, 10

Metastatic carcinoma cases were highest among the malignant lesions, comparable to study by Gupta et al. 5 Squamous cell carcinoma cases were overall highest among the malignant lesions. Squamous cell carcinoma was the most common malignant tumor in studies by Dash et al and Bode et al. 8, 9 Skin primary malignancy and metastasis both can present as a nodule. Though most of the cutaneous metastases occur in patients with known primary, they may rarely be the first manifestation of an unknown primary.13, 14 There were 5 cases of metastatic carcinoma in our study. Primary site of origin was known in 3 cases i.e. two from lung and one from gastrointestinal tract.

Trunk was the commonest site of metastasis (chest wall – 2 cases and abdominal wall - 2 cases) followed by head and neck region (1 case). Both chest wall metastasis were from lung. One abdominal wall metastatic deposit was from gastrointestinal tract. Lung and breast cancer commonly metastasize to the chest wall. The abdominal wall is a favored site for the primary from the gastrointestinal tract. 15 This was also observed in our study.

A wide spectrum of skin and subcutaneous lesions have been diagnosed on FNA in our study. Though lesions like spindle cell lesions, appendageal tumors and some malignant lesions further require biopsy for confirmation and categorization, FNA is an effective tool in the initial evaluation of skin and subcutaneous swellings as highlighted by other studies available in the literature.

Conclusion

Fine Needle Aspiration Cytology is a rapid, reliable technique for initial assessment of cutaneous and subcutaneous swellings and thereby guiding further management.

Source of Funding

None.

Conflict of Interest

None.

References

1 

GD Nayak S Raman Cytological spectrum of subcutaneous nodules, a 3 year studyIndian J Pathol Oncol2020734527

2 

S Soni K Mardi Diagnostic utility of fine needle aspiration cytology in the evaluation of neoplastic cutaneous nodular lesions: experience from tertiary care instituteInt J Res Med Sci202081139283310.18203/2320-6012.ijrms20204880

3 

DJ Spitz V Reddy SM Selvaggi L Kluskens L Green P Gattuso Fine needle aspiration of scalp lesionsDiagn Cytopathol2000231358

4 

N Marwah S Rana P Jain S Gupta S Marwah R Sen A Fine Needle Aspiration Study of the Abdominal Cutaneous and Subcutaneous NodulesIranian J Pathol20138297103

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R Gupta R Gupta D Dewan S Mahajan P Singh Fine needle aspiration cytology as a diagnostic tool in nodular skin lesionsInt J Med Sci Public Health201656122932

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SR Orell GF Sterrett SR Orell GF Sterrett Skin and SubcutisOrell & Sterrett’s Fine Needle Aspiration Cytology5th Edn.RELX India Private Limited 201237086

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T Chhadi S Chhadi Study of cytodiagnosis of cutaneous and subcutaneous lesionsGlobal J Res Anal2018710135

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AK Dash S Mohanty M Tripathy S Silal Role of FNAC in the Diagnosis of Skin and Subcutaneous Lesions: A 3 Years Prospective StudyInt J Med Res Prof2019532729

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A Bode R Gadkari Study of cytodiagnosis of cutaneous and subcutaneous lesions: Experience in a Tertiary Care HospitalJ Med Sci Clin Res2017542037782

10 

A Bhowmik MG Mallick Sinha DC Barman Role of Fine Needle Aspiration Cytology in the Diagnosis of Skin and Superficial Soft Tissue Lesions: A Study of 510 CasesTurk J Pathol20153132005

11 

M Jain N Kasliwal G Pachori N Jethani FNAC as reliable preoperative diagnostic test in nodular skin lesionsInt J Med Res Prof201513159

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R Gupta N Sharma S Raman Cytohistological and immunohistochemical correlation of cutaneous neoplastic lesions: Three year retrospective studyIP Arch Cytol Histopathology Res2022713241

13 

S Karki R Pathak U Manandhar S Koirala Metastatic cutaneous and subcutaneous lesions: Analysis of cases diagnosed on fine needle aspiration cytologyJ Pathol Nepal201111374010.3126/jpn.v1i1.4449

14 

N Nair P Chikkannaiah S Venkataramanappa R Shivanna Utility of fine‑needle aspiration cytology in diagnosis of cutaneous and subcutaneous metastasisActa Med Int202181576110.4103/amit.amit_8_21

15 

U Handa R Kundu K Dimri Cutaneous Metastasis: A Study of 138 Cases Diagnosed by Fine-Needle Aspiration CytologyActa Cytol2017611475410.1159/000453252



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Article type

Original Article


Article page

40-43


Authors Details

Chhavi Gupta*, Rajat Gupta, Subhash Bhardwaj


Article History

Received : 27-07-2022

Accepted : 09-08-2022


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