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Vulvar sarcomas are one of the rarer female genital tract malignancies, characterized by nonspecific signs and symptoms often leading to clinical misdiagnosis which increases the morbidity and mortality. It presents in 5th to 6th decade of life. Undifferentiated pleomorphic sarcomas (UPS) previously known as malignant fibrous histiocytoma (MFH) are the rarest of vulval sarcomas and hence least suspected initially. It is advised to keep vulvar sarcomas as a clinical differential in cases of non specific vulval swellings in order to establish an early accurate diagnosis to expedite its management. We present an unusual and rare case which was clinically misdiagnosed as a benign vulval swelling in a 26 year old married female who presented with painless vulval swelling for 1 year. It was provisionally diagnosed as malignant mesenchymal neoplasm on fine needle aspiration cytology which later was confirmed as UPS on after evaluating a judicious panel of immunohistochemistry markers where a myogenic, vascular and neurogenic origin was ruled out. Patient was treated with wide local excision and adjuvant platinum based chemotherapy which showed good response with no signs of reoccurrence or metastasis in a follow up period of 6 months.

Introduction: Bronchoalveolar Lavage (BAL) is a minimally invasive procedure that allows for the sampling of distal airways and the alveolar environment to diagnose infectious and non infectious respiratory tract diseases. It is a safe and reliable method considered for diagnosis. Aim: To evaluate the concordance of BAL cytology with the histopathology report of biopsied cases concerning cancer diagnosis. Materials and Methods: The study was a cross-sectional observational study conducted in the Department of Respiratory Medicine at King George's Medical University, Lucknow, Uttar Pradesh, India, which is a tertiary care teaching hospital in northern India. Reported BAL cytology cases for one year, from September 2022 to September 2023, were retrieved from records and consecutive histology was followed for cytohistological correlation. The sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV) of BAL cytology were calculated with reference to the identification of malignancy. Histological diagnosis was considered the gold standard and the specificity, sensitivity, positive predictive value and NPV of BAL were calculated. Results: The BAL was performed in 261 cases with a mean age of 56.79 years. The adequacy of BAL cytology was 88.12% (230/261). Of the 261 cases, eight were positive for epithelial malignancies, three were suspicious for malignancies, 219 were reported as negative for malignant cells and 31 cases were deemed inadequate. A biopsy was performed in 56 out of 261 cases (21.45%) and 32 of these cases were found to have epithelial malignancy. A total of 13 cases were reported negative for malignancy, of which 12 were in concordance with BAL results. Three cases were reported as suspicious for malignancy and three were diagnosed as non epithelial malignancies on biopsy, which were deemed inadequate on cytology. Based on the interpretation of the data, the specificity of BAL cytology with respect to histology was 100%, with a PPV of 100%; however, the sensitivity was 14.28% and the NPV was 28.57. Conclusion: The present study results clearly show that BAL cytology is a specific test for malignant diagnosis in lung lesions, in addition to its role in inflammatory conditions. However, due to its low sensitivity, it may not serve as a good screening method. BAL fluid cytology primarily samples the lower respiratory tract, which may not always be affected by malignancy. The low sensitivity may also be attributed to procedural and interpretation limitations. It can serve as a complement to bronchial brushings and histology for the diagnosis of lung cancers. [ABSTRACT FROM AUTHOR]

Interstitial lung diseases (ILDs) are an intriguing group of pulmonary disorders, which still require the study of epidemiological, genetic, pathophysiological, clinical, and radiological parameters. Pulmonary hypertension (PH) is an underreported complication in interstitial lung diseases which is associated with worse outcome. In our study, we have reported the spectrum of ILDs and estimated the prevalence of pulmonary hypertension among these subjects at a tertiary care center. A cross-sectional study was performed in which demographical, clinical, radiological, and histological data of subjects with ILD, attending the Department of Respiratory Medicine in the University was collected from 1st September 2018 to 31st August 2019. Serological tests were done wherever indicated. Standard criteria along with multidisciplinary opinion were needed to arrive at the final diagnosis. All subjects were screened for pulmonary hypertension via 2-D echocardiography. Mean pulmonary artery pressure =20 mmHg was used to define PH. In the defined period, 239 subjects were enrolled (58% females, n=141; mean age 52.38±13.40 years). A tissue diagnosis was obtained in 34% cases. The most common ILD was hypersensitivity pneumonitis (32.2%), followed by autoimmune-ILD (31.4%), idiopathic pulmonary fibrosis (IPF) (15.9%) and sarcoidosis (12.6%), non-IPF idiopathic interstitial pneumonitis (2.1%) and rest 21 (5.9%) subjects were diagnosed as other types of ILD. Pulmonary hypertension was seen in 46.0% of subjects. [ABSTRACT FROM AUTHOR]