Abstract

Objective: The aim of present study was the role of Ultrasound Guided FNAC of right hypocondrium lump and its comparative study with histopathlogical findings.

Material and Method: A total of 50 patients of different age groups of both sexes with presentation of right hypocondrium lump were referred from surgical and gynecological OPD for FNAC in our department were included in study. After thorough clinical history, all the patients were subjected to proper clinical examination. Prior to F.N.A.C. all the relevant routine investigation (CBC, ESR, LFT, KFT, BT, CT. Blood Sugar, Viral Markers) were performed and written consent were taken. After preparation of patient FNAC was done by 10 ml syringe with 22 gauze needle in the presence of radiologist by Ultrasound Machine, Aspirated Materials were placed on grease free slide and fix. The entire fixed smear were stained by Giemsa and papanicolaou stain and examined under oil immersion microscope. After surgical removal of lump, histopathological examination was done and they were correlated with FNAC findings regarding accuracy of FNAC.

Results: Fine needle aspiration cytology was done in 50 patients from the palpable Right hypochondrium lump. The age distribution was up to 10 years in 2% of cases, 11- 20 years in 2% of cases, 21-30 years  in 8% of cases , 31-40 years 22% of cases, 41-50 years in 38% of cases , 51 - 60 years in 16% of cases  and 61 and above in 12% of cases. Out of 50 patients there are 28 (56%) male and 22 (44%) female. The commonest organ from where lump was aspirated is Liver followed by Gall bladder, kidney and stomach. The sex-ratio related with organ from where F.N.A.C. was done particularly in Liver and G.B. pathology related with liver in male 75% and in female 25% whereas pathology related with G.B. in male 17.6% and in female it was 82.4%. The consistency of lump was soft in 5 cases (10%), firm in 12 (24%) cases and Hard in 33 (66%) of cases. Out of 50 patients mild tenderness was present in 7 cases (14%), Moderate in 34 (78%) cases, Severe in 6 cases (12%) and only 3 cases (6%) was non-tender lump. The sufficient material for Smear was obtained on Aspiration cytology of 88% of cases, Scanty with lesser number of cells in 4% cases and unsatisfactory in 8% of cases. Out of this cytological diagnosis Malignant lesion was found in 60% of cases, Benign in 16%, Infective or in inflammatory in 16% of cases and 8% was undiagnosed. 68% of the Right hypochondrial lump were malignant and 32% were either Benign and inflammatory as found on histopathological examination. In the malignant Group 36 cases (68%) diagnosed by histopathology where as 30 cases (60%) were diagnosed cytological as malignant. The distribution of Malignant case by cytologically and histologically was, From Carcinoma Liver (secondary) 12 cases out of 18 malignant and 6 primary cases by both, same diagnosis carcinoma G.B. 8 cases out of 12 diagnosed cytologically and 12 cases by histologically diagnosed as malignant. Renal cell carcinoma 2 cases cytologically and histologically both found malignant. Lymphoma and Carcinoma stomach 1 and 1 cases found cytologically and histologically, malignant in distribution respectively. In liver out of 18 cases malignant diagnosed by cytologically 12 cases was secondary and 6 cases was Primary. The distribution of Benign lesion diagnosed by cytologically and histologically was as from ,liver 3 benign and 3 infective or Inflammatory and from G.B. 5 benign lesion and 4 cases which consider under miscellaneous group were infective or inflammatory and 1 cases from L. N. consider as infective or inflammatory. So total 32% (16 cases) consider as benign out of 50 cases. The diagnostic accuracy of cytological Aspiration was 92% out of 60% malignant and 32% benign or infective and inflammatory lesion. The complication related with F.N.A.C. included as pain and discomfort in 09 cases (18%) and post aspiration bleeding in 03 cases (06%). There was no sepsis, peritonitis and injury to other visceral structure reported in follow up cases.

Conclusion: FNAC is simple, low cost, safety, painless and for the initial investigative and diagnosis of both superficial and deep lesion. The clinical value of F.N.A.C. is not limited to Neoplasitc condition but also valuable in the diagnosis of inflammatory, Infectious and degenerative conditions. It is also useful in the diagnosis and monitoring of graft rejection in transplantation surgery.

Keywords: FNAC, Right hypochondrium Lump, Histopathology, Geimsa Stain, Liver, Neoplastic.