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Gratification behavior in a young child: Course and management
Aditya Anand Pandurangi, Swapna Aditya Pandurangi, Sameer Belvi Mangalwedhe, Mahesh Mahadevaiah
January-April 2016, 43(1):48-50
Masturbation (gratification behavior) is rarely seen in young children. It occurs in children between the age of 3 months and 3 years with a second peak incidence at about the adolescent age. A 26-month-old child presented to us with gratification behavior. On evaluation, she did not have any physical illness mimicking gratification behavior. The parents were counseled, and 6 sessions of behavior therapy were carried out. Gratification behavior in young children is not pathological. Waxing and waning of the symptoms may be present.
  23,627 726 1
Fetal polycystic kidney disease: Pathological overview
Sunita B Patil, Madhura D Paricharak, Deepak G Paricharak, SS More
May-August 2013, 40(2):106-108
Polycystic kidney disease is a rare developmental anomaly inherited as autosomal dominant or autosomal recessive. It is characterized by cystic dilatation of the collecting ducts frequently associated with hepatic involvement and progression to renal failure. It is included in the differential diagnosis of cystic diseases of the kidney. We report a case of polycystic kidney disease, in 22 weeks fetus incidentally detected on routine antenatal ultrasonography and confirmed by fetal autopsy. This report elucidates the importance of early diagnosis and intervention in cystic kidney diseases.
  13,958 532 -
Mitomycin C in ophthalmology
Rekha Mudhol, ND Zingade, RS Mudhol
January-April 2012, 39(1):4-6
Introduction to the use of Mitomycin C in ophthalmology was a significant development in the 1960s. Its use and application in ophthalmology has been increasing in recent years, because of its modulatory effects on wound healing. Current applications of this drug in ophthalmology include pterygium surgery, glaucoma surgery, corneal refractive surgery, cicatricial eye disease, conjunctival neoplasia, dacryocystorhinostomy surgeries, squint surgeries, and allergic eye disease. Although it has been used successfully in these conditions, it has also been associated with significant complications. This article reviews the current trends and uses of mitomycin C in the eye and its reported complications.
  11,867 856 -
A randomized controlled trial comparing the efficacy of intralesional 5-fluorouracil versus triamcinolone acetonide in the treatment of keloids
Avinash Prabhu, H Sreekar, Rajesh Powar, VM Uppin
January-April 2012, 39(1):19-25
Background: Effective keloid management is still a distant dream in spite of many recent modalities being tried for the same. Although many treatment protocols have shown efficacy of varying degrees, there are few systematic randomized trials comparing them. Objective: To compare the efficacy of intralesional 5-Fluorouracil versus Triamcinolone acetonide in the treatment of Keloids. Materials and Methods: This randomized controlled trial was conducted on 30 patients with keloids, randomly divided into two groups of 15 each, treated with intralesional 5-fluorouracil (Group A) or triamcinolone acetonide (Group B). The groups were compared for reduction in the size of keloid, pain relief, and the incidence of adverse effects. Statistical analysis was done using the unpaired student t- test and test of proportion. Results: The reduction in the size of the keloid was found to be significantly better in Group B (71.23%) than in Group A (57.48%) with a P value of 0.04. The difference in the reduction of pain, as assessed by the visual analog scale, between Groups A (18%) and B (24%), was found to be insignificant (P value - 0.47). Although the incidence of complications in Group A was three times higher than those in Group B, the difference was not statistically significant (P value - 0.13). Conclusion: Reduction in the size of the keloid, which was the main aim of this study was significantly better in those treated with triamcinolone acetonide than those treated with 5-fluorouracil. The other parameters like reduction of pain and the incidence of adverse effects were comparable in both the groups.
  12,073 635 4
Low grade mucoepidermoid carcinoma of the tongue: An unusual presentation
L Ambika
May-August 2012, 39(2):85-88
Mucoepidermoid carcinoma is the most common malignant salivary gland tumor of epithelial origin. It is an unusual type of tumor and varies in its aggressiveness from a low grade to a high grade rapidly growing tumor. Low-grade mucoepidermoid carcinoma at times misleads the clinician because of its atypical location and innocent appearance. Immunohistochemical studies prove indispensable in identifying such a tumor as routine histopathology may be inconclusive.
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Parameatal cyst of glans penis
Siddalingeshwar I Neeli, Praveen Patne, Suresh Kadli, Siddayya Hiremath
January-April 2012, 39(1):45-46
The parameatal cyst is a very benign condition seen in boys. We report a case of a parameatal urethral cyst in a 12-year-old boy. The cyst was recognized during early childhood, but the boy presented to our clinic at the age of 12 years, when the mass had grown enough to cause spraying of urine and poor cosmesis. A complete surgical excision was performed. Histologically, the cyst wall was lined by a tall columnar epithelium. Good cosmetic results, with no recurrence, were obtained.
  11,075 479 -
Impression techniques for the resorbed mandibular arch: A guide to increased stability
Manish Jain
May-August 2015, 42(2):88-91
All clinicians face the common problems in making complete denture prosthesis for patients exhibiting high degree of bone resorption. Though resorption can be prevented to an extent but sooner or later it comes back to haunt the clinician. The result is a dis-satisfied patient with a loose prosthesis ready for a new one. The real problem lies in the capturing the oral tissues and using them for creating retention and stability in the prosthesis. Though ultimate success also depends on many other factors such as the occlusal scheme used and patient adaptability yet the most important step still remains the impression technique employed. A few impression techniques are suggested for increasing the success rates in such patients.
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Impact of thyroid hormone dysfunction on periodontal disease
Shaila Kothiwale, Vishal Panjwani
January-April 2016, 43(1):34-37
Thyroid hormones play an important role in the regulation of physiologic processes. Thyroid dysfunction is the second most common glandular disorder of the endocrine system and is increasing predominantly among women. Thyroid disease can lead to imbalance in the homeostasis of the body and affect the healing capacity of tissues. However, limited data are available regarding the relationship between thyroid hormone imbalance and periodontal health. This case report presents the influence of thyroid hormone dysfunction and its impact on periodontal disease progression, systemic health of the patient, and the management of periodontal disease. The report emphasizes the need for frequent professional evaluations, patient education, and consistent educational reinforcement by health care providers in patients with hypothyroidism.
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Carcinoid tumors: Challenges and considerations during anesthetic management
Sukhminder Jit Singh Bajwa, Aparajita Panda, Gurpreet Kaur
September-December 2015, 42(3):132-137
Carcinoid tumors are rare, slow-growing neoplasms of neuroendocrine tissues from enterochromaffin or kulchitsky cells, which have the potential to metastasize. The mediators released from these tumors when bypass the hepatic metabolism, can lead to the possible development of carcinoid syndrome. This is a life-threatening complication, which can lead to profound hemodynamic instability, especially in a peri-operative period, when the patient is exposed to various types of noxious stimuli. Off late, use of octreotide, a synthetic analog of somatostatin, has significantly reduced the peri-operative morbidity and mortality. The current review discusses the various anesthetic challenges and considerations during peri-operative management of carcinoid tumors.
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Giant 'giant cell tumor' of pelvis
Nadeem Ali, Abedullah Bhat, Khalid Muzzafar, Suhail Ahmad Bhat
May-August 2012, 39(2):98-99
Giant cell tumor (osteoclastoma) of pelvis is rare entity. Most of these have average size of 9.5cm. We here present a massive osteoclastoma involving pubis and periacetabular region to such an extent that surgical excision could not be done. Our surgical intervention was aimed to correct the associated deformity and improve function by debulking the part of tumor responsible for mechanical symptoms and deformity.
  9,393 461 -
Anencephaly: A pathological study of 41 cases
C Panduranga, Ranjit Kangle, Vijayalaxmi V Suranagi, Ganga S Pilli, Prakash V Patil
May-August 2012, 39(2):81-84
Background : Anencephaly is a lethal neural tube defect which is due to the defective closure of rostral pore of neural tube. In more than 50% of cases it is associated with other systemic anomalies. Hence this study was undertaken to assess pathological parameters associated with anencephaly in particular attention to associated systemic anomalies. Materials and Methods: It is a study on 41 anencephaly fetuses conducted in the Department of Pathology. The period of study is from January 2001 to December 2011. Results: Out of 41 cases, 30 (73%) cases showed presence of systemic anomalies, 48.5% of the cases were observed in primigravida. Most common associated anomaly was spina bifida followed by gastrointestinal anomalies. Conclusion: Pathological examination of the abortus is essential to document the associated anomalies.
  9,014 440 1
A study of the formation and branching pattern of brachial plexus and its variations in adult human cadavers of north Karnataka
Sheetal V Pattanshetti, PS Jevoor, VS Shirol, Daksha Dixit, Shilpa Bhimalli
May-August 2012, 39(2):70-77
Introduction and Objectives: The brachial plexus is highly variable, in its formation and branching pattern thus, knowledge of its anatomical patterns, may be insufficient for the surgeon operating on or around these nerves or for the regional anesthesiologist working in this area. Therefore, the present study was an attempt to study further about variations of brachial plexus encountered during routine dissection classes. Materials and Methods: The present descriptive study was carried out by dissection of 60 upper limbs of 30 cadavers, in the age group of 18 to 85 years, obtained during a study period of 2 years from the Department of Anatomy. The plexus was studied in its entire course commencing from the formation in cervical region, course through root of the neck and axilla, up to the main terminal branches of the upper extremity. During the dissection, variations of brachial plexus pertaining to its formation from the roots, trunks, divisions and cords and the branching pattern were observed and data was collected. Results: Out of the 60 cadaveric upper limbs studied for the anatomical variations of the brachial plexus, 2 limbs (3.33%) were pre-fixed plexuses. Fusion of adjacent trunks was detected in 2 limbs (3.33%). Variations in branches of lateral cord were detected in 8 limbs (13.33%). Among Posterior cord variations 2-thoracodorsal nerves were detected in 2 limbs (3.33%). All the other branches from brachial plexus had been found to have no anatomical variations. Conclusion: In the present study, an attempt has been made to know the possible variations of the brachial plexus. Though the variations mentioned may not alter the normal functioning of the limb of the individual, but knowledge of the variations is of prime importance to be kept in mind, during anaesthetic and surgical procedures.
  8,256 462 -
Knowledge and practices on maternal health care among mothers: A Cross sectional study from rural areas of mid-western development region Nepal
Kapil Gyawali, Damaru P Paneru, Bina Jnawali, Kalpana Jnawali
January-April 2013, 40(1):9-13
Background: Safe motherhood is a priority program in Nepal, aiming to restrain maternal deaths. Meanwhile, knowledge, practices, accessibility, and service quality are considered keys to improve service utilization. This study was conducted to identify knowledge and practices of maternal health care among mothers having < 1-year-old child in the Mid-western Development Region, Nepal. Materials and Methods: A community-based cross-sectional study was conducted during January-April 2011 in rural, Mid-western Development Region, Nepal. Three Village Development Committees (VDC) from Bardiya (plain) and two VDCs from each of the Salyan and Pyuthan (hill) and Jumla (mountain) districts were selected randomly. Hence, there were 81 clusters (1VDC = 9 clusters) and 7-8 participants were selected randomly from each cluster. Data were collected by interview using structured questionnaire and Focus Group Discussion Guideline (18 FGDs), analyzed by SPSS (16.0). CD recorded qualitative data were transcribed and narrated. Percent mean and standard deviation were calculated. Results: Three quarters of the participants had correct knowledge regarding minimum numbers of antenatal visits to be done by a pregnant woman (WHO guideline). Nearly two-fifth participants knew schedule of antenatal care (ANC) visits. Almost 60% had done ≥ 4 ANC visits during last pregnancy. Majority visited Sub Health Post/Health Post/Primary Health Care Centre for ANC Checkup. About 90% had taken Iron and folic acid tablets. About 57% were home deliveries (last childbirth), 40% deliveries were assisted by relatives/husband, and only 32% did postnatal health checkup. Conclusions: There were gaps in the knowledge and practices for health care during pregnancy, childbirth and in the postpartum period. A high rate of home deliveries with the low postnatal service utilization was prevalent. Intensive awareness progam and behavioral change interventions, regular pregnancy monitoring may promote the health service utilization.
  7,681 999 1
Apple peel jejunal atresia: Successful management of a rare case
Santosh B Kurbet, HS Patil, SM Dhaded, MR Bhandankar, RS Mane
January-April 2012, 39(1):29-31
Apple peel jejunal atresia is a rare congenital anomaly. This condition presents at birth as an intestinal obstruction, is diagnosed by X-rays and confirmed by laparatomy. Resection of the dilated proximal intestine and primary anastomosis is the treatment, but has a poor prognosis. We report here a rare form of atresia with apple peel deformity and its successful management.
  8,081 592 -
Nutritional status of adolescent girls residing in rural area: A community-based cross-sectional study
Sulakshana S Baliga, Vijaya A Naik, Maheshwar D Mallapur
January-April 2014, 41(1):22-25
Background: Adolescence is a period of transition between childhood and adulthood. Nutritional requirements during this period increase tremendously compared to preceding years of growth. The nutritional status of adolescent girls, the future mothers, contributes significantly to the nutritional status of the community. The present study was aimed to assess the current nutritional status of the adolescent girls. Materials and Methods: This one-year community-based, cross-sectional study was undertaken at a village Peeranwadi of District Belgaum, Karnataka among 400 adolescent girls of 10 to 19 years. Information on socio-demographic variables was collected by an interview using pre-designed and pre-tested questionnaire. A 24-hour recall method was used to assess nutrient intake. The nutrient intake was calculated using tables of nutritive value of Indian foods. For the comparison of anthropometric data, National Center for Health Statistics and National Health and Nutrition Examination Survey standards were used. Results: The mean age among the study population was 12.9 ± 2.06 years. Majorities (73.5%) of them were Hindus, 98.5% were literate, and 90% were currently studying. Adolescent girls between 10 and 14 years were more stunted (63.82%) as compared to 15 to 19 years (40.84%) (P = 0.0003) and thin (60.79% vs. 39.43%; P = 0.0009). Overall, the mean calorie intake was observed to be 1272.20 ± 133.28 kcal/day, protein intake was 40.99 ± 3.32 gm, and iron intake was 14.42 ± 2.58 mg. Conclusion: Overall, majority of girls were having dietary intake less than 50% of RDA, and almost three fourth of girls were anemic.
  6,980 1,054 2
Rush nail and management of fracture both bone forearm
Soumya Ghosh, Arnad Chowdhury, Arunima Chaudhuri, Soma Datta, Debasis Singha Roy, Abhinay Singh
September-December 2014, 41(3):167-172
Background: The failure of the conventional nailing of both bone of the forearm poses a potential problem of nail migration and rotational instability, despite the best reduction. Objectives: Rush nail is a very handy, low cost easily available implant. In the present study, we have tried to find out its applicability if used in the closed manner under C-arm control without injurying soft tissues and preserving the periosteal vascularity. Materials and Methods: This prospective study was conducted on thirty adult subjects. Skeletally mature subjects with Gustilo type 1 open and closed fractures without the neurovascular deficit were included. Stainless steel rush nails were used for all patients for both radius and ulnar repair. Patients were followed-up for a minimum of 4 months and maximum of 1.5 years. Results: The mean age of study participants was 37.43 years. Mean time of the union was 14.32 weeks. Average operative time was 67.16 min. No intraoperative complication occurred nor was any nailing converted to some other form of fixation, except in three cases radial nail was introduced by open method through anterior Henry's approach. Cast support was maintained for a mean of 7.43 weeks, after that forearm brace was applied for a mean period of 6.26 weeks and continued until radiographic union was seen. Three patients showed non-union of radius mostly distal third. They were treated with open reduction and internal fixation with locking plate and bone grafting. One patient had extensor tendon injury. Two patients have superficial infection which cured with antibiotics. One case had delayed union of radius which required bone grafting. Two patients had gross restrictions of wrist movements and pronation-supination movement. Using Anderson criteria 22 patients had satisfactory results (71.33%), three patients had excellent result. Three patients had non-unions (10%). Implant removal was performed in two cases about 14 months post-operatively and no refracture has been reported until date (after 4 months). Conclusion: Use of rush nail continues to have predictable and good results. Complication rates are lower when compared to plate osteosynthesis and even in locked intramedullary nails although application of above elbow cast after nailing is a downside of this procedure. The rush nail has still a future in repair of forearm fractures considering its low complications rates, cost and acceptable results in a developing country where financial matters are to be considered.
  7,613 420 -
Giant cell tumour of extensor tendon sheath: Preventing recurrence
SS Shirol, Apoorv Jain, Kedareshwar , Geeta Nimbaragi
September-December 2012, 39(3):155-157
Giant Cell Tumour of tendon sheath is relatively rare tumour with an overall incidence of around 1 in 50,000 individuals. Marginal excision of giant cell tumour of the tendon sheath is the treatment of choice. It is also the commonest hand lesion to recur after excision. The incidence of local recurrence is high, ranging from 9-44%. Here we present a case report of a giant cell tumour of extensor tendon sheath in hand which was successfully treated with special emphasis on ways of prevention of recurrence.
  6,736 293 -
Cellulitis and deep venous thrombosis: A rare association
SM Jali, Santosh B Kurbet, Preeti Amarkhed, AS Gogate
January-April 2012, 39(1):26-28
A nine-year-old male child presented to us with a history and clinical examination suggestive of bilateral lower limb cellulitis. Investigations revealed leucocytosis, decreased Protein S levels, and growth of methicillin-resistant Staphylococcus aureas in the blood and pus cultures. A Doppler study revealed bilateral lower limb deep vein thrombosis (DVT). The child underwent fasciotomies under the cover of antibiotics and the DVT was treated with heparin followed by oral anticoagulation. In cases of cellulitis, DVT should be ruled out, as the clinical features of cellulitis may mask those of DVT, leading to missed diagnosis and serious complications.
  6,563 453 -
Prevalence of non-fermenting Gram-negative bacilli and their in vitro susceptibility pattern at a tertiary care teaching hospital
Kirtilaxmi K Benachinmardi, M Padmavathy, J Malini, BV Naveneeth
September-December 2014, 41(3):162-166
Background: Aerobic non-fermenting Gram-negative bacilli (NFGNB) once considered as contaminants now associated with life-threatening infections and emerging as multi drug resistant nosocomial pathogens. Aim: Isolation and identification of NFGNB in all the clinical samples and to determine antibiotic susceptibility pattern of the isolated NFGNB. Materials and Methods: This study has been conducted in the Department of Microbiology at a tertiary care teaching hospital over a period of 2 months from September to October 2013. NFGNB were isolated and identified from clinical specimens by standard procedure and antibiotic sensitivity test was performed. Results: NFGNB isolation rate in the present study was 3.58%. Male to female ratio was 2.125. Pus was the most common specimen (21%) followed by tracheal aspirate (17%). Pseudomonas aeruginosa was the most common isolate (60%) followed by Acinetobacter baumannii (22%) and Acinetobacter lwoffii (12%). P. aeruginosa has shown good sensitivity to amikacin (83.3%), imipenem (80%) and piperacillin-tazobactam (73.3%) whereas A. baumannii showed multidrug resistance. Conclusion: It is necessary to identify NFGNB and to monitor their susceptibility pattern to guide the clinician for better care and management of patients. NFGNB are now emerging as organisms of nosocomial infections. Hence, antibiotic sensitivity testing and infection control measures are needed to prevent the emergence and spread of multi drug resistant NFGNB in health care settings.
  6,082 633 3
Management of spontaneous pneumothorax in a newborn: A rare clinical entity
Hemant Gupta, Smriti Anand, Sukhminder Jit Singh Bajwa
January-April 2014, 41(1):61-62
  6,049 443 -
Diabetes and tuberculosis: A reemerging epidemic
Vinay Mahishale
May-August 2013, 40(2):59-60
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Assessment of the level of stress and coping strategies among patients with coronary artery disease
Madisetty Bhagyalakshmi, Banda Venkata Ramana, Hema Suresh, Jaya Mohan Raj
September-December 2012, 39(3):136-140
Background: Stress evolves out of life events and experiences, stimulates one's thinking process and helps to maintain a basal level of autonomic arousal. Stress and certain behaviors like aggressiveness striving for achievement contribute to the pathogenesis of Coronary Artery Disease (CAD). Presence of psychosocial stressors is associated with increased risk of acute myocardial infarction. Coping processes are usually involved to reduce stress levels. Objectives: The study was conducted to assess the stress level and coping strategies among the CAD patients. Materials and Methods: Non experimental research design was chosen. The patients with CAD admitted for the first time were taken as the samples. A total of 100 patients were selected by non-probability sampling methods. The standardized tool used for the study consisted of stress and coping scale. The questionnaire consisted of 20 questions to assess stress and 20 questions to assess coping. The maximum score indicated increased stress and adequate coping and the minimum score indicated less stress and inadequate coping. Results: In this study 43% of the patients were having moderate stress and 91% of patients showed moderate coping. None had increased stress and only 5% of the patients had adequate coping strategy. Conclusions : This study demonstrated an approach to develop more coping strategies to reduce stress among the CAD patients. Nurses working in the Cardiology Department should engage themselves to address the psychosocial needs of those patients and take measures to plan coping strategies.
  5,490 553 -
Challenging aspects of and solutions to diagnosis, prevention, and management of hypoglycemia in critically ill geriatric patients
Vishal Sehgal, Sukhminder Jit Singh Bajwa, Upinder Khaira, Rinku Sehgal, Anurag Bajaj
September-December 2013, 40(3):128-134
There is a worldwide pandemic of diabetes. Also there is a gradual and steady increase in the elderly population. Often clinicians are faced with managing dysglycemia in the elderly with underlying sepsis and multiple comorbidities. This predisposes the elderly to potentially increased chances of hypoglycemia in inpatient settings. This article reviews the altered renal physiology and its effects in the management of dysglycemia in the elderly population. It also emphasizes the role of renal insufficiency and sepsis as the main etiological factors for hypoglycemia in both diabetics and nondiabetics in the inpatient settings.
  5,585 451 -
Prevalence of extended-spectrum beta-lactamases, AmpC beta-lactamase, and metallo-beta-lactamase producing Pseudomonas aeruginosa and Acinetobacter baumannii in an intensive care unit in a tertiary care hospital
Varun Goel, Sumati A Hogade, SG Karadesai
January-April 2013, 40(1):28-31
Background: Resistance to broad-spectrum beta-lactams, mediated by extended-spectrum beta-lactamases (ESBL), AmpC beta-lactamase, and metallo-beta-lactamase (MBL) enzymes, is an increasing problem worldwide. Aim of the study: This study was undertaken to detect ESBL, AmpC beta-lactamase and metallo-beta-lactamase producing Pseudomonas aeruginosa and Acinetobacter species from the endotracheal aspirates. Materials and Methods: A prospective study was performed over a period of 15 month in a tertiary care hospital. A total of 26 clinical isolates of P.aeruginosa and 40 of Acinetobacter species were tested for the presence of ESBL, AmpC beta-lactamase, and metallo-beta-lactamase enzyme. Detection of ESBL was done by the combined disk diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines, and MBL was detected by imipenem-Ethylenediaminetetraacetic acid (EDTA) combined disk method. Isolates showing reduced susceptibility to cefoxitin (30 μg) disk were considered 'screen positive' for AmpC beta-lactamases and selected for detection of plasmid-mediated AmpC by the AmpC disk test. Results : 42.30% isolates of P.aeruginosa were positive for ESBL while 53.85% were MBL producers. Among 39 isolates of Acinetobacter baumannii, 43.59% were AmpC producers while 48.72% were MBL-producing strains. Conclusion: The study emphasizes the high prevalence of multidrug-resistant P.aeruginosa and A.baumannii producing beta-lactamase enzymes of diverse mechanisms. Thus, proper antibiotic policy and measures to restrict the indiscriminative use of cephalosporins and carbapenems should be taken to minimize the emergence of this multiple beta-lactamase-producing pathogens.
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Cytomorphology of nipple discharge and fine needle aspiration of duct papilloma
HB Bannur, VV Suranagi, R Davanagere, B Hungund, PV Patil
May-August 2012, 39(2):96-97
The primary role of fine needle aspiration (FNA) of the breast is the distinction between benign and malignant lesions; but in many cases, additional information may be obtained. The major breast lesions that yield papillary fragments on FNA are papillary carcinoma, papilloma, fibroadenoma, and invasive ductal carcinoma that have a papillary component. We present cytomorphological features of nipple discharge and FNA of breast lump in a 32-year female.
  5,508 358 -