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Cyto-morphological and clinical approach to infections presenting with discharging sinuses mimicking malignancy
Soundarya Ravi1, Norton Stephen1, Jinkala Sreerekha1
1Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Introduction:
Discharging sinuses is a form of chronic unhealed infection that can present at any site due to a variety of infectious organisms. These discharging sinuses may be associated with mass lesions and lymphadenopathy to mimic some neoplastic processes. Identifying these infections with accuracy and promptness is essential, as the treatment regimens are specific. Fine-needle aspiration (FNA) of these lesions, along with appropriate cytochemical stains, aids in the rapid and precise diagnosis of these infections and excludes neoplasms at these sites. Also, material for culture and other studies can be obtained by FNA.
Material And Methods:
This retrospective study was conducted in the Department of pathology from 2018 to 2020. A total of 179 patients with similar clinical presentation and confirmed infection on cytology were identified. On the evaluation of the requisition forms, 32 (18%) patients were identified with discharging sinus associated along with swelling.
Results:
The five infections (32 cases) that were identified, included 18 cases of tuberculosis (56.25%) followed by 9 cases of actinomycosis (28.12%), 3 cases of pheohypomycosis (9.37%), and one case each of Nocardia (3.12%) and eumycetoma (3.12%) which presented as swelling with discharging sinus. Special stains were performed in all cases for confirmation. Histopathological/Microbiological correlation was done whenever available.
Conclusion:
Infections presenting as swelling with discharging sinuses mimicking malignancy can be diagnosed on FNAC with good accuracy.
Insights
Fine-needle aspiration (FNA) accurately diagnoses chronic infections presenting as discharging sinuses, even when mimicking cancer. This rapid diagnostic method aids in prompt treatment by identifying various infectious organisms.
Area of Science:
- Pathology
- Infectious Diseases
- Cytopathology
Background:
- Discharging sinuses are chronic infections that can mimic neoplastic processes.
- Accurate and prompt diagnosis is crucial for specific treatment regimens.
- Fine-needle aspiration (FNA) aids in rapid diagnosis and exclusion of neoplasms.
Purpose of the Study:
- To evaluate the accuracy of FNA in diagnosing infections presenting as discharging sinuses.
- To identify common infectious organisms causing discharging sinuses.
- To differentiate infectious causes from neoplastic lesions.
Main Methods:
- Retrospective study of 179 patients from 2018-2020.
- Analysis of 32 cases with discharging sinus and swelling.
- Cytochemical stains and histopathological/microbiological correlation performed.
Main Results:
- Tuberculosis (56.25%) was the most common infection, followed by actinomycosis (28.12%).
- Other identified infections included pheohypomycosis, Nocardia, and eumycetoma.
- FNA successfully diagnosed these infections, differentiating them from malignancy.
Conclusions:
- FNA is a highly accurate method for diagnosing infections presenting as swelling with discharging sinuses.
- This technique is valuable in distinguishing infectious etiologies from malignancy.
- Prompt diagnosis via FNA facilitates appropriate patient management.
