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A CRITICAL LOOK AT PAP ADEQUECY: ARE OUR CRITERIA SATISFACTORY?CYTOPATHOLOGY, Issue 2006
Liquid based Pap (LBP) specimen adequacy is a highly documented, yet poorly understood cornerstone of our GYN cytology practice. Each day, as cytology professionals, we make adequacy assessments and seldom wonder how the criteria we use were established. Are the criteria appropriate? Are they safe? What is the scientific data that support them? Were they clinically and statistically tested or refined to achieve optimal patient care? In this presentation, we will take a fresh look at what we know about Pap specimen adequacy and challenge some of the core assumptions of our daily practice. LBP tests have a consistent, well-defined surface area for screening, facilitating the quantitative estimates of slide cellularity. This provides an unprecedented opportunity to establish reproducible adequacy standards that can be subjected to scientific scrutiny and rigorous statistical analysis. Capitalizing on this opportunity, the TBS2001 took the landmark step to define specimen adequacy quantitatively, and set the threshold for a satisfactory LBP at greater than 5,000 well visualized squamous epithelial cells. To date, few published studies have attempted to evaluate the validity or receiver operator characteristics for this threshold, define an optimal threshold for clinical utility or assess risks of detection failure in ,satisfactory' but relatively hypocellular Pap specimens. Five years of cumulative adequacy and cellularity data of prospectively collected Pap samples from the author's laboratory will be presented, which will serve as a foundation for a discussion on ,Pap failure'. A relationship between cellularity and detection of HSIL will be presented. Risk levels for Pap failure will be presented for Pap samples of different cellularities. The effect of different cellularity criterion on unsatisfactory Pap rates and Pap failure rates will be demonstrated. Results from this data set raise serious questions as to the safety of current TBS2001 adequacy guidelines and suggest that the risk of Pap failure in specimens with 5,000 to 20 000 squamous cells on the slide is significantly higher than those assumed by the current criteria. TBS2001 designated all LBP to have the same adequacy criterion. Up to this point, it has been assumed that ThinPrep, SurePath, or any other LBP would be sufficiently similar that they should have the same adequacy criteria. Data for squamous cellularity and other performance characteristics of ThinPrep and SurePath from the author's laboratory will be compared. Intriguing data involving the recently approved MonoPrep Pap Test will be reviewed. MonoPrep clinical trial data show the unexpected finding of a strong correlation between abundance of endocervical component and the detection of high-grade lesions, provoking an inquiry of a potential new role for a quantitative assessment of the transition zone component. The current science of LBP adequacy criteria is underdeveloped and does not appear to be founded on statistically valid methods. This condition calls us forward as a body of practitioners and scientists to rigorously explore, clarify and define the fundamental nature of cytology adequacy. As we forge this emerging science, we will improve diagnostic performance, guide the development of future technologies, and better serve the patients who give us their trust. Reference:, Birdsong GG: Pap smear adequacy: Is our understanding satisfactory? Diagn Cytopathol. 2001 Feb; 24(2): 79,81. [source]
Fine needle aspiration of renal cortical lesions in adultsDIAGNOSTIC CYTOPATHOLOGY, Issue 10 2010
Adebowale J. Adeniran M.D.
Abstract The role of fine needle aspiration (FNA) biopsy of renal cortical lesions was controversial in the past because the result of the FNA did not affect clinical management. All renal cortical lesions, except metastasis, were subject to surgical resection. However, with the advances in neoadjuvant targeted therapies, knowledge of the renal cortical tumor histological subtype is critical for tailoring clinical trials and follow-up strategies. At present, there are clinical trials involving the use of novel kinase inhibitors for conventional (clear cell) and papillary renal cell carcinoma. We studied 143 consecutive cases of renal cortical lesions, evaluated after radical or partial nephrectomies over a 2-year period. An air-dried smear and a Thinprep® slide were prepared in all cases. The slides were Diff-Quick and Papanicolaou stained, respectively. The cytology specimens were reviewed and the results were then compared with the histologic diagnosis. Cytology was highly accurate to diagnose conventional RCC, while the accuracy for papillary RCC, chromophobe RCC, and papillary urothelial carcinoma was much lower. Our results indicate that ancillary studies might have an important role in the subclassification of renal cortical neoplasms for targeted treatment. Diagn. Cytopathol. 2010;38:710,715. © 2009 Wiley-Liss, Inc. [source]
Fine-needle aspiration cytology of subcutaneous toxoplasmosis: A case reportDIAGNOSTIC CYTOPATHOLOGY, Issue 10 2010
Xiaowei Chen M.D.
Abstract Toxoplasmosis is a common opportunistic infection in patients with AIDS in whom it typically presents as encephalitis, pneumonia, lymphadenitis, and myocarditis. Skin involvement is very rare and, to our best knowledge, Toxoplasma gondii forming a subcutaneous mass has not been reported. Here, we report the findings of an interesting case of subcutaneous toxoplasmosis with the cytological appearance of an inflammatory fibrovascular lesion in a HIV-positive patient and discuss the differential diagnosis. Diagn. Cytopathol. 2010;38:716,720. © 2009 Wiley-Liss, Inc. [source]
FNA diagnosis of teratoma lung: A case reportDIAGNOSTIC CYTOPATHOLOGY, Issue 10 2010
Farhan Asif Siddiqui M.D.
Abstract A case of teratoma occurring in the lung of a 27-year-old female, diagnosed by fine-needle aspiration cytology and confirmed by histopathology, is being presented here. Occurrence of teratoma at this site is a rare entity. The authors take this opportunity to report such a rare case, and as to the best of our knowledge, not many cases have been reported in literature till date. Diagn. Cytopathol. 2010;38:758,760. © 2010 Wiley-Liss, Inc. [source]
Fine-needle aspiration diagnosis of a metastatic adult sclerosing rhabdomyosarcoma in a lymph nodeDIAGNOSTIC CYTOPATHOLOGY, Issue 10 2010
Richard L. Cantley M.D.
Abstract Adult sclerosing rhabdomyosarcoma (ASRMS) is a rare variant of rhabdomyosarcoma with a characteristic histological appearance of small, round cells in a dense, hyalinized stroma. Although nodal metastases of soft-tissue sarcomas are considered uncommon, up to 5% overall are associated with lymph node metastases. Nonetheless, there is little literature on the cytologic characteristics of metastatic soft-tissue sarcomas in lymph nodes, and to our knowledge, there are no reports of nodal metastasis of ASRMS diagnosed by fine-needle aspiration (FNA) cytology. We report here a 55-year-old woman who presented with a right thigh mass and associated ipsilateral inguinal lymphadenopathy. Biopsy of the mass revealed a uniform population of small, round cells in a dense, sclerotic background. A diagnosis of ASRMS was rendered. Subsequently, the patient underwent FNA of an enlarged inguinal lymph node, which revealed an identical population of small, round cells in a dense, myxoid background. This case highlights the cytologic features of a rare form of rhabdomyosarcoma, and emphasizes the utility of FNA in the assessment of lymphadenopathy in the setting of a soft-tissue sarcoma. Diagn. Cytopathol. 2010;38:761,764. © 2010 Wiley-Liss, Inc. [source]
Epithelioid cell granulomas in urine cytology smears: Same cause, different implicationsDIAGNOSTIC CYTOPATHOLOGY, Issue 10 2010
Sandeep Kumar Arora M.D.
Abstract Tuberculosis of the urinary tract is usually secondary to tuberculosis of the kidney. Multinucleated giant cell histiocytes, often with peripheral nuclei (Langhans' cells), may be identified. Acid-fast bacilli on smear or positive urine cultures confirm the diagnosis. Similar findings can also be seen in patients treated with Bacillus Calmette Guérin (BCG) for transitional cell carcinoma or after bladder surgery. Here, we present two cases showing epithelioid cell granulomas and multinucleated giant cells on urine cytology, and discuss the differentiating features on cytomorphology and their therapeutic implications. Diagn. Cytopathol. 2010;38:765,767. © 2010 Wiley-Liss, Inc. [source]
ThinPrep Pap test of endocervical adenocarcinoma with lymph node metastasis: Report of a case in a 17-year-old woman,DIAGNOSTIC CYTOPATHOLOGY, Issue 9 2010
David G. Wagner M.D.
Abstract Endocervical adenocarcinoma is an uncommon malignancy that is composed of multiple subtypes and accounts for ,15% of all cervical cancers. In this article, we describe the cytomorphology and differential diagnosis of an AJCC clinical stage IIIb, FIGO IB2 endocervical adenocarcinoma in a 17-year-old woman in a ThinPrep Pap test. The patient was a 17-year-old G0P0 white woman with no significant past medical history and no prior history of cervical dysplasia. She presented to her physician with a putrid vaginal discharge. A sample was sent to cytology that was interpreted as atypical endocervical cells, favor neoplasia. A subsequent cervical biopsy was diagnosed as endocervical adenocarcinoma with villoglandular features and ultimately, a hysterectomy with lymph node dissection was performed. The final diagnosis was endocervical adenocarcinoma with metastasis to three pelvic lymph nodes. The cytomorphology of endocervical adenocarcinoma on ThinPrep Pap test is similar to that described for conventionally-processed Pap smears. This difficult diagnosis should be considered on a ThinPrep Pap test, regardless of age when the characteristic cytomorphology is observed. On a cytology sample, it is advisable to state atypical endocervical cells, adenocarcinoma in situ, or endocervical adenocarcinoma without providing a specific subtype even if there is a predominance of features for a particular subtype. Diagn. Cytopathol. 2010;38:633,638. © 2009 Wiley-Liss, Inc. [source]
Intraoperative cytology,Role in bone lesionsDIAGNOSTIC CYTOPATHOLOGY, Issue 9 2010
Khaliqur Rahman M.D.
Abstract In spite of becoming an integral part of surgical pathology, very few reports are available regarding the utility of intraoperative cytology (IOC) exclusively for bone lesions. This study was undertaken in a view to fill this lacuna. Sixty bone lesions were evaluated intraoperatively with the help of cytology smears prepared by touch, scrape, or crush technique. The diagnosis made on cytological preparation was compared with histopathological diagnosis taking the latter as gold standard. Different parameters like reasons for Intraoperative consultation, best technique for preparation of smear, average time taken to render a diagnosis, and finally the accuracy of IOC was evaluated. Common reasons for the intraoperative consultation were to make or confirm a diagnosis for proper surgical intervention and to evaluate the surgical resection margin. Scrape was found to be the best method for cytological smear preparation. Average time taken to render a diagnosis was 20 minutes. Sensitivity, specificity, and overall diagnostic accuracy was 96.7, 96.6, and 96.6%, respectively. Cytology can play a valuable role in the intraoperative diagnosis of bone lesions. The method is simple, cheap, quick, and has no complication. It should be undertaken routinely, as a rapid intraoperative diagnosis will expedite timely and proper management of the patients, along with early post operative treatment and thus avoid the aggravating delays. Diagn. Cytopathol. 2010;38:639,644. © 2009 Wiley-Liss, Inc. [source]
Evaluation of apoptosis in cytologic specimensDIAGNOSTIC CYTOPATHOLOGY, Issue 9 2010
Viktor Shtilbans Ph.D.
Abstract A hallmark of neoplasia is dysregulated apoptosis, programmed cell death. Apoptosis is crucial for normal tissue homeostasis. Dysregulation of apoptotic pathways leads to reduced cytocidal responses to chemotherapeutic drugs or radiation and is a frequent contributor to therapeutic resistance in cancer. The literature pertaining to detection of apoptotic pathway constituents in cytologic specimens is reviewed herein. Virtually all methods for detecting apoptosis, including classic cytomorphologic evaluation, TUNEL assay, immunocytochemistry, and gene sequence analysis, may be applied to cytologic samples as well as tissue. Components of both intrinsic and extrinsic apoptotic pathways have been studied, including many reports examining p53 and bcl-2, as well as studies of caspase inhibitory proteins XIAP and survivin, death receptors and ligands such as Fas, Fas-ligand, and TRAIL. p53 undergoes oncogenic alteration more than any other protein; its immunocytochemical detection almost always connotes loss of its physiologic role as an inducer of apoptosis in response to a damaged genome. Several reports establish cytologic sampling as being as useful as tissue sampling. In one respect cytologic sampling is superior to tissue sampling in particular, by allowing clinicians to repeat sampling of the same tumor before and after administration of therapy; a number of reports use this approach to attempt to predict tumor response by assaying the effect of chemotherapy on the induction of apoptosis. Diagn. Cytopathol. 2010;38:685,697. © 2010 Wiley-Liss, Inc. [source]
Papanicolaou tests associated with cervical mucosal endometriosis: An analysis of cellular features and comparison to endocervical adenocarcinoma in situDIAGNOSTIC CYTOPATHOLOGY, Issue 8 2010
Charles V. Biscotti M.D.
Abstract Endometrium directly sampled from endocervical mucosal endometriosis can mimic endocervical adenocarcinoma in situ (AIS) in Papanicolaou (Pap) tests. We analyzed a series of Pap tests to investigate the cellular features of mucosal endometriosis and to assess the utility of stroma and apoptotic bodies in the differential diagnosis with AIS. Pap test samples from patients known to have endocervical mucosal endometriosis were compared with samples containing AIS. Pap tests from patients with mucosal endometriosis had lesional cells in 13 (62%) cases which includes glandular and stromal cells (10 cases), stroma only (two cases), and glandular cells only (one case). Three (23%) cases had gland-stromal aggregates. Three (23%) cases had mitotic figures and two (15%) had apoptotic bodies. By comparison, only one (8%) AIS case had endometrial-type stroma. Seven (58%) AIS cases had apoptotic bodies and three (25%) had mitotic figures. We conclude that Pap tests from patients with mucosal endometriosis usually (62%) have lesional cells. These lesional cells almost always include stroma, which is useful in the differential diagnosis with AIS. We identified stroma significantly more often in endometriosis cases (92%) than in AIS cases (8%). Pathologists should look for endometrial stroma when considering an interpretation of directly sampled endometrium. In the absence of stroma, AIS should be considered. Diagn. Cytopathol. 2010;38:551,554. 2009 Wiley-Liss, Inc. [source]
Human papillomavirus prevalence and cytopathology correlation in young Ugandan women using a low-cost liquid-based pap preparationDIAGNOSTIC CYTOPATHOLOGY, Issue 8 2010
Janis M. Taube M.D.
Abstract Screening for HPV-driven cervical dysplasia and neoplasia is a significant public health concern in the developing world. The purpose of this study was to use a manual, low-cost liquid-based Pap preparation to determine HPV prevalence in HIV-positive and HIV-negative young women in Kampala, Uganda and to correlate cervical cytopathology with HPV-DNA genotype. About 196 post-partum women aged 18,30 years underwent rapid HIV testing and pelvic examination. Liquid-based cervical cytology samples were processed using a low-cost manual technique. A DNA collection device was used to collect specimens for HPV genotyping. HIV and HPV prevalence was 18 and 64%, respectively. Overall, 49% of women were infected with a high-risk HPV genotype. The most common high-risk HPV genotypes were 16 (8.2%), 33 (7.7%), 35 (6.6%), 45 (5.1%), and 58 (5.1%). The prevalence of HPV 18 was 3.6%. HIV-positive women had an HPV prevalence of 86% compared to 59% in HIV-negative women (P = 0.003). The prevalence of HPV 16/18 did not differ by HIV status. HIV-positive women were infected with a significantly greater number of HPV genotypes compared to HIV-negative women. By multivariate analysis, the main risk factor for HPV infection was coinfection with HIV. HIV-positive women were four times more likely to have abnormal cytology than HIV-negative women (43% vs. 11.6%, P < 0.001). These data highlight that HIV infection is a strong risk factor for HPV infection and resultant abnormal cervical cytology. Notably, the manual low-cost liquid-based Pap preparation is practical in this setting and offers an alternate method for local studies of HPV vaccine efficacy. Diagn. Cytopathol. 2010;38:555,563. 2009 Wiley-Liss, Inc. [source]
Sarcomatoid collecting duct carcinoma of kidney diagnosed with urine and renal pelvic lavage cytologyDIAGNOSTIC CYTOPATHOLOGY, Issue 8 2010
Akihiro Mimura C.T.
Abstract A case of sarcomatoid collecting duct carcinoma (CDC) of kidney is presented, in which the diagnosis was made cytologically with voided urine and renal pelvis lavage. Cytology of hemorrhagic voided urine revealed highly atypical adenocarcinoma cells with reminiscent ductal structure, which suggested CDC as the most likely diagnosis. Computed tomography and magnetic resonance imaging demonstrated a left renal tumor, and selective lavage of left renal pelvis yielded spindle-shaped, highly atypical cells that indicated sarcomatoid carcinoma. The diagnosis of renal cancer with urine cytology is challenging because of small number of tumor cells in the urine, which are often associated with degeneration. As the urinary cytologic findings of sarcomatoid CDC have not been reported, the characteristic cytologic findings of sarcomatoid CDC are described in detail, and the differential diagnoses with diagnostic pitfalls were discussed. Diagn. Cytopathol. 2010;38:603,606. 2009 Wiley-Liss, Inc. [source]
Pulmonary neuroendocrine neoplasms: A review of clinicopathologic and cytologic featuresDIAGNOSTIC CYTOPATHOLOGY, Issue 8 2010
F.I.A.C., Momin T. Siddiqui M.D.
Abstract Neuroendocrine tumors form a distinct group of lung neoplasms sharing characteristic cytohistologic, immunohistochemical, ultrastructural, and molecular features. The objective of this review article is to discuss the diagnostic classifications and the morphologic cytologic,histologic features for the different categories of neuroendocrine tumors of the lung. An accurate characterization of the neuroendocrine tumors of the lung requires knowledge of specific criteria separating the major categories, which is highly essential for determining prognosis and treatment options for these patients. Diagn. Cytopathol. 2010;38:607,617. 2009 Wiley-Liss, Inc. [source]
Nephroblastoma is a success of paediatric oncologic therapy.DIAGNOSTIC CYTOPATHOLOGY, Issue 7 2010
How further can we go?: Results of a cyto-histologic correlation study
Abstract Nephroblastoma is a success of paediatric oncologic therapy, yet, there are still some cases where favourable response to preoperative chemotherapy is not achieved. Fine needle biopsy has the role of diagnostic confirmation and, idyllically of predicting a response to preoperative chemotherapy. To advance in this aim, we retrieved a total of 14 nephroblastomas, (seven male patients and seven female with a mean age of 44.4 months), diagnosed in our department by fine needle biopsy and submitted afterward to chemotherapy and nephrectomy, in the last 10 years. Correlation between cytologic features, (morphology, cell death, and proliferation (Ki-67 labelling index), and post chemotherapy tumour evaluation was done. Cytologic pattern per se was not predictive of histologic tumour classification (P = 0.6061). We did not find any correlation between the percentage of necrosis and apoptosis (P = 0.682) in cytologic smears and histologic regressive changes but when both these two criteria coexisted in cytologic blastemal component of nephroblastomas, this fact seemed to lead to a favourable response of the tumour to chemotherapy. When evaluation of Ki-67 labelling index was done in the blastematous component present in the smears, divergent results were obtained. The small number of cases prevented any firm conclusions. By summing up, our results support the idea that there are probably two types of blastema in nephroblastoma with different "suicide" potential and chemotherapeutic response. Further studies should be performed to stratify the influence of necrosis, apoptosis, and proliferation in chemosensivity of nephroblastomas. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]
Cytologic features and frequency of plasmacytoid dendritic cells in the lymph nodes of patients with histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease)DIAGNOSTIC CYTOPATHOLOGY, Issue 7 2010
I.A.C., Koji Kishimoto C.T., Ph.D.
Abstract Histiocytic necrotizing lymphadenitis (HNL), also known as Kikuchi-Fujimoto disease, is a benign and self-limiting disease. It is histologically characterized by nodal lesions that show the infiltration of histiocytes, lymphoid cells, myeloid dendritic cells (mDCs), and plasmacytoid dendritic cells (pDCs), along with either apoptotic or karyorrhexic nuclear debris. pDCs have been proposed to be lymphoid early-committed immature DCs which are positive for CD123, CD303, CD68, and HLA-DR but negative for fascin, a mature DC marker, as well as CD13 and CD33,which are mDC markers. In the present study, we analyzed the cytomorphologic features and frequency of pDCs in the lymph nodes of HNL patients. Because the cytologic apprearance of pDCs with Papanicolau staining was quite similar to that of large lymphocytes, immunocytochemistry against CD123 was necessary for the distinction of pDCs. Counting the number of CD123-positive pDCs in the HNL lymph nodes revealed that pDCs more frequently infiltrated the lymph nodes in the setting of HNL than in either reactive lymphadenitis or T and B cell lymphoma. In addition, interestingly, the numberof pDCs did not depend on the age of the HNL lesion, thus suggesting that pDCs are excellent indicators for the cytologic diagnosis of HNL. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]
Coexistent atypical polypoid adenomyoma and complex atypical endometrial hyperplasia in the uterusDIAGNOSTIC CYTOPATHOLOGY, Issue 7 2010
Ayako Horita M.D.
Abstract We report a case of atypical polypoid adenomyoma (APA) concomitantly identified with complex atypical endometrial hyperplasia (CAH) in the uterus. Since an initial endometrial smear revealed atypical endometrial cells, a diagnosis of CAH was made. Even though a concomitantly performed uterine cervical smear contained both atypical epithelial and stromal cells, the diagnosis of APA was not initially made because the cytological criteria for APA had not been established. Histologically, we recognized both CAH in the uterine corpus and APA in the lower uterine segment in the hysterectomy material. Retrospectively, the cells in the first cervical smear were interpreted as part of APA because the same types of cells were observed in the intraoperative cytology sample. Although the APA and CAH lesions were interposed by normal endometrium, estrogen was suspected to be the common etiological factor. Reports regarding the cytology of APA are currently scarce. To our knowledge, this is the first report showing cytological presentation of association of APA with CAH in addition to the first cervical smear of APA containing both epithelial and stromal components. Identification of abnormal proliferation of epithelium and stromal cells of smooth muscle origin is useful in the cytological diagnosis of APA. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]
Simultaneous Chlamydia trachomatis and HPV infection in pregnant womenDIAGNOSTIC CYTOPATHOLOGY, Issue 6 2010
Sônia Maria Miranda Pereira B.Sc.
Pregnancy is associated with HPV infection and with Chlamydia trachomatis (CT) infection mostly due to the natural immunosuppression. In addition, pregnancy associated to CT infection can lead to adverse conditions to the woman and fetus, and CT is also believed to be a co-factor in human immunodeficiency virus infection and HPV-induced cervical cancer. The aim of this study was to establish the odds ratios (OR) of CT infection in to HPV-infected pregnant women and vice versa of women stratified by age (<25 years) and marital status. This work is part of a national multicentric transversal study carried out in six Brazilian cities supported by the Ministry of Health of Federal Government of Brazil in 2003. Cervical scrapes of 371 pregnant women were sampled. We performed a hybrid capture-2 technique to diagnose these samples on HPV and CT infection, and the women responded a questionnaire. Significant association was observed between nonstable marital status and hr-HPV infection [OR = 2.61 (1.38,4.97) P = 0.003)], and age <25 years old [OR = 2.26 (1.09,4.71) P = 0.029]. Nonstable marital status was also associated with lr-HPV infection [OR = 2.67 (1.59,4.50) P < 0.001), and age <25 years old [OR = 2.55 (1.51,4.32) P < 0.001). Fifty of the 371 pregnant women were infected with hr-HPV (13.5%) and 111 (30.0%) were infected with lr-HPV. The coinfections of HPV and CT were found in 31 women, that is, 8.36% of the pregnant women (P < 0.001). The high rate of simultaneous CT and HPV infection in pregnant women favors the recommendation to screen pregnant women for both CT and HPV. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]
Correlation between morphology and human telomerase gene amplification in bronchial brushing cells for the diagnosis of lung cancerDIAGNOSTIC CYTOPATHOLOGY, Issue 6 2010
Yi-Bo Fan M.D.
Abstract The aim of this study was to investigate the frequency of amplification of the human telomerase gene (TERC), as measured by fluorescence in situ hybridization (FISH), in routine liquid-based cytological preparations from bronchial brushing specimens, and to assess the associations between TERC amplification, cytological diagnosis, and cytological morphology, in order to obtain further insight into these associations. Bronchial brushings from 102 patients with lung carcinoma (52 squamous-cell carcinomas, 22 adenocarcinomas, 28 small cell lung carcinomas) and 40 patients with nonmalignant disease were used. Amplification of TERC was performed using a commercially available two-color FISH probe, and slides were prepared for the SurePath liquid-based Pap test (LPT) using the same samples. Amplification of TERC was significantly associated with histological diagnoses (P < 0.05). Patients with lung cancer, and especially those with nonsmall cell lung cancer, had significantly higher percentages of cells with amplification of TERC than did patients with nonmalignant disease (P < 0.05). Comparing the FISH and LPT results, there was no significant difference in diagnostic sensitivity between the two methods (P > 0.05). However the difference in diagnostic sensitivity of the two methods for squamous-cell carcinoma was significant (P < 0.01). FISH can be performed on bronchial brushing specimens to detect amplification of TERC. This test may be an adjunct to cytology screening, especially in squamous-cell carcinoma, and may provide an indication of the potential of individual lesions to progress. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]
Angiocentric glioma: A case report and review of the literatureDIAGNOSTIC CYTOPATHOLOGY, Issue 6 2010
Ryan T. Mott M.D.
Abstract Angiocentric glioma (AG) is a rare central nervous system (CNS) neoplasm that was only recently recognized by the World Health Organization (WHO). AG occurs in a broad age range, shows no gender predilection, and arises superficially in the cerebrum, usually resulting in medically intractable seizures. Most cases are cured by surgical excision alone, consistent with a WHO grade I neoplasm. We report a case of an AG in the right frontal lobe of a 57-year-old female, emphasizing the cytologic and immunohistochemical features, including confirmation and comparison with the surgical specimen. To our knowledge, this is the first report detailing the cytology of AG, including demonstration of important diagnostic findings that were only appreciated in the cytologic preparations and not in the smears or the surgical specimen. We also compare and contrast AG to other entities in the differential diagnosis and include a review of the literature. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]
Cytodiagnosis of benign fibrous histiocytoma of rib and diagnostic dilemma: A case reportDIAGNOSTIC CYTOPATHOLOGY, Issue 6 2010
Santosh Kumar Mondal M.D.
Abstract Benign fibrous histiocytoma (BFH) of bone is rare in occurrence, and rib is an unusual site. There are limited case reports of this entity in the literature, and cytodiagnosis of this tumor is not described. A 24-year-old man presented with a firm mass and pain in the right lateral chest wall. Radiological investigations (plain radiograph and computed tomography) revealed a lytic bone lesion involving the 5th rib. Radiologically, giant cell tumor (GCT), BFH, and plasmacytoma were suspected. In fine-needle aspiration cytology (FNAC), admixture of benign stromal cells and scattered osteoclast type giant cells were found in the smears. Differential diagnoses of BFH, GCT (non-epiphyseal type), fibrous dysplasia, and aneurysmal bone cyst were made on cytology. Subsequent histologic examination confirmed the diagnosis of BFH. Cytologic diagnosis of BFH of rib is difficult as this tumor may mimic other giant cell containing tumors of bone in FNAC. The final diagnosis should always be made after correlation with histological, radiological, and clinical features. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]
Comparison of the sensitivity of conventional cytology and the ThinPrep Imaging System for 1,083 biopsy confirmed high-grade squamous lesions,DIAGNOSTIC CYTOPATHOLOGY, Issue 5 2010
C.T. (A.S.C.), C.T. (I.A.C.), J. A. Halford B.App.Sc.
Abstract Liquid-based cytology continues to be utilized as an adjunct to conventional cytology in most Australian laboratories, even though a direct-to-vial ThinPrep protocol has been introduced in many countries with established cervical screening programs. Manual screening of ThinPrep slides has been widely practiced for more than 10 years and the recent introduction of the ThinPrep Imaging System (TPI) has been reported as being more sensitive than the conventional smear (CS) in the identification of high-grade cervical disease. We report our experience with ThinPrep Imaging since its introduction into our routine gynecological cytology service. 87,284 split sample pairs reported using the Imaging System demonstrated a decrease in unsatisfactory reports (3.65% for CS and 0.87% for TPI) and an increase in possible high grade and definite high-grade squamous reports (1.57% for CS and 1.62% for TPI). For 1,083 biopsy confirmed high-grade lesions, the correct diagnosis of high grade or possible high-grade squamous disease was made on the ThinPrep imaged slide in 61.0% (661/1,083) of cases and on the CS in 59.4% (643/1,083). This was not statistically significant. When all abnormalities identified on cytology were considered, including possible low grade and definite low-grade abnormalities, the difference in sensitivity for Thinprep imaged slides of 96.0% (1,040/1,083) and CSs of 91.6% (992/1,083) was statistically significant. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]
Cytopathologist-performed ultrasound-guided fine-needle aspiration of parathyroid lesions,DIAGNOSTIC CYTOPATHOLOGY, Issue 5 2010
David Lieu M.D., M.B.A.
Abstract The gold standard to determine the cause of primary hyperparathyroidism (PHPT) is bilateral neck exploration. As most cases are caused by parathyroid adenoma, there is a movement toward preoperative localization of the abnormal gland by ultrasound and/or Tc99 -sestamibi scan and minimally invasive parathyroidectomy. Nonpalpable thyroid nodules are common and cannot be differentiated from parathyroid lesions by imaging alone. This study examines cytopathologist-performed ultrasound-guided fine-needle aspiration (UG-FNA) in diagnosis of parathyroid lesions. Between January 1, 2007 and December 31, 2008, seven patients with PHPT or other parathyroid lesions with one or more sonographically-visible thyroid masses underwent cytopathologist-performed UG-FNA with immediate cytological evaluation (ICE). One mass was palpable and nine were nonpalpable. Three parathyroid adenomas, two benign colloid nodules, one papillary carcinoma, three parathyroid cysts, and one thyroid cyst were diagnosed. The nodules in three patients with parathyroid adenomas were identified as follicular lesion/neoplasm on ICE. Additional UG-FNA passes were made to obtain tissue for immunohistochemistry stains, which confirmed parathyroid origin. Two of these patients had a separate benign colloid nodule and one had a thyroid cyst diagnosed by UG-FNA. The PHPT patient with papillary carcinoma on UG-FNA had the malignancy confirmed at surgery and a sonographically occult parathyroid adenoma. The three patients with thyroid cysts identified by radiology were suspected of being parathyroid cysts on the basis of real-time sonographic features at the biopsy table. The clear cyst fluid obtained by UG-FNA had markedly elevated PTH. Cytopathologist-performed UG-FNA can distinguish between parathyroid and thyroid nodules in patients with suspected parathyroid lesions. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]
Making the diagnosis with only two levels of nongynecologic cell blocks as opposed to three is more cost effectiveDIAGNOSTIC CYTOPATHOLOGY, Issue 5 2010
Gina Zanchelli-Astran D.O.
Abstract Two hundred forty-three of 246 cases in phase I (98.8%) and 246 of 247 cases in phase II (99.6%) had adequate or the same material present on the level two cell blocks. Sixty-nine cases were malignant (28.1%), 20 were atypical (8.1%), 157 were benign (63.8), and 16 were signed out on the cell block only (6.5%) in phase I. In phase II, 69 (27.9%) cases were malignant, 22 (8.9%) were atypical, 156 (63.2%) were benign, and 18 (7.3%) were signed out based on material present in the cell block. Fifteen cases in phase I (6.1%) and 17 (6.9%) in phase II needed immunohistochemical staining for further evaluation. Twenty-four upper urinary tract (UUT) cases were signed out as malignant (49.0%), 10 were atypical (20.4%), and 15 were benign (30.6%) in phase I. In phase II, 18 (56.3%) UUT were malignant, 8 (25.0%) were atypical, and 6 (18.7%) were benign. In phase I, 13 (26.5%) and in phase II, 18 (56.3%) were graded on the cell block only. On comparing the two phases, there was no significant difference in the amount of diagnostic material present between the level three and level two cell blocks (98.8% and 99.6%, respectively) or the number of cases diagnosed based on the cell block (6.5% and 7.3%, respectively). Cases signed out as malignant, atypical, and benign were similar in both phases. Likewise, the cases that required immunohistochemical staining to aid in the diagnosis between phase one and phase two were similar (6.1% and 6.9%, respectively). respectively). Diagn. Cytopathol. 2010. © 2010 Wiley-Liss, Inc. [source]
Cytological features of cystadenocarcinoma in cyst fluid of the parotid gland: Diagnostic pitfalls and literature reviewDIAGNOSTIC CYTOPATHOLOGY, Issue 5 2010
Akihiko Kawahara C.T., C.M.I.A.C., Ph.D.
Abstract Cystadenocarcinoma is a rare malignant tumor, with an estimated incidence of 2% of malignant salivary gland tumors. Cytological diagnosis of cystadenocarcinoma is important for differential diagnosis between benign lesions and malignant tumors with cystic growth. We report a case of cystadenocarcinoma causing difficulty in cytological diagnosis. A 23-year-old man presented with an asymptomatic mass in the left parotid gland that had been present for 2 years. The mass was elastic hard, measuring 30 × 35 mm in diameter. Preoperative fine-needle aspiration cytology (FNAC) showed a small number of tumor cell clusters in the cystic fluid. The cluster was arranged in a ball-like structure and was cohesive with overlapping. Tumor cells had a small vacuolated, soap-bubble appearance in the cytoplasm. The papillary-cystic variant of acinic cell carcinoma (ACC-PCV) was suggested from these findings on FNAC. Histologically, the tumor was not encapsulated, but formed large cystic spaces against a background of fibrous connective tissue. The tumor cells in the cystic dilated duct showed papillary structures, which were continuous with the lining cuboidal cells. There was neither a definite double-layered arrangement in cystic ducts and solid islands nor histological findings characteristic of the papillary-cystic or follicular pattern of ACC-PCV. As tumor cells with a small vacuolated, soap-bubble appearance of the cytoplasm are common findings of both cystadenocarcinoma and ACC-PCV, they are of little use for differentiation; however, they are so characteristic that the majority of benign salivary gland lesions with cystic structures can be excluded, if enough attention is paid. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]
Immunohistochemical expression of E-cadherin in sclerosing adenosis, ductal carcinoma in situ and invasive ductal carcinoma of the breastDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2010
Gil Facina M.D., Ph.D.
Abstract E-cadherin (EC) is an important glycoprotein cell-adhesion molecule that appears to play a significant role in the progression of breast lesions. The objective of this study was to evaluate EC expression in sclerosing adenosis, ductal carcinoma in situ and invasive ductal carcinoma. Samples of breast lesions from 44 women were used in this study, comprising cases of sclerosing adenosis (n = 11), ductal carcinoma in situ (DCIS) (n = 10) and invasive ductal carcinoma (n = 23). Immunohistochemical evaluation of EC expression was assessed semiquantitatively and considered negative (<10% of cells with stained cytoplasmic membranes), positive+ (10,50% of cells stained) or positive++ (> 50% of cells stained). Fisher's exact test was used to compare the distribution of staining intensity in the lesions (P< 0.05). There was a progressive loss of EC expression from benign to malignant lesions. This difference was statistically significant when sclerosing adenosis was compared with DCIS (P < 0.0002), when sclerosing adenosis was compared with invasive ductal carcinoma (P < 0.008) and when DCIS was compared with invasive ductal carcinoma (P < 0.007). The present findings point to a significant association between reduced EC expression and the progression and aggressivity of breast lesions. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]
Fine-needle aspiration of primary osseous lesions: A cost effectiveness studyDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2010
Lester J. Layfield M.D.
Abstract Fine-needle aspiration (FNA) is not widely used in the work-up of osseous lesions because of concerns regarding its high incidence of nondiagnostic specimens. Although several studies have shown that FNA is less expensive than surgical biopsy, the authors are aware of only one prior study evaluating the cost effectiveness of FNA, which includes the cost of incisional or core needle biopsies necessary to establish a diagnosis when the initial FNA was noncontributory. A computerized search of the pathology records of three medical centers was performed to obtain all FNAs of primary osseous lesions. For each FNA case, all subsequent core needle, incisional or excisional biopsies were recorded as was the result of the definitive operative procedure. The cost of obtaining the definitive diagnosis was calculated for each case including the cost of FNA, imaging guidance utilized, and cost of subsequent surgical biopsy when necessary. The cost of an alternate approach using only surgical biopsy was calculated. The average per patient costs of these two protocols were compared. A total of 165 primary bone tumors underwent FNA. One hundred six of these yielded a definitive cytologic diagnosis. In 59 cases, FNA yielded a result insufficient for definitive therapy necessitating surgical biopsy. FNA investigation of the 165 bone lesions cost 575,932 (average of 3,490 per patient). Surgical biopsy alone would have cost 5,760 per patient. FNA resulted in a cost savings of 2,215 per patient. Diagn. Cytopathol. 2010 © 2009 Wiley-Liss, Inc. [source]
Nipple aspirate fluid and ductoscopy to detect breast cancerDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2010
Edward R. Sauter M.D., Ph.D.
Abstract We prospectively performed cytologic assessment and image analysis (IA) on matched nipple aspirate fluid (NAF) and mammary ductoscopy (MD) specimens to determine (1) the accuracy of these methods in cancer detection and (2) whether the two collection methods provide complementary information. NAF and MD specimens were collected from 84 breasts from 75 women (nine bilateral samples) who underwent breast surgery. Cytologic evaluation was performed on all samples. IA was performed on slides with sufficient epithelial cells. Cytologic evaluation proved more accurate in patients without pathologic spontaneous nipple discharge (PND) than those with PND, mainly because of the potential false positive diagnosis in the latter. While the sensitivity of NAF and MD cytology was low (10% and 14%, respectively), both were 100% specific in cancer detection in the non-PND cohort. Combining NAF and MD cytology information improved sensitivity (24%) without sacrificing specificity. Similar to cytology, IA was more accurate in patients without PND having high specificity (100% for aneuploid IA), but relatively low sensitivity (36%). Combining NAF and MD cytology with aneuploid IA improved the sensitivity (45%) while maintaining high specificity (100%). The best predictive model was positive NAF cytology and/or MD cytology combined with IA aneuploidy, which resulted in 55% sensitivity and 100% specificity in breast cancer detection. Cytologic evaluation and IA of NAF and MD specimens are complementary. The presence of atypical cells arising from an intraductal papilloma in ductoscopic specimens is a potential source of false positive diagnosis in patients with nipple discharge. Diagn. Cytopathol. 2010 © 2009 Wiley-Liss, Inc. [source]
Polymicrobial lung infection in postrenal transplant recipient diagnosed by fine-needle aspiration cytologyDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2010
Rajan Duggal M.D.
Abstract Tuberculous and fungal infections are among the non-neoplastic lesions of the lung, in which fine-needle aspiration cytology (FNAC) has proven to be a useful technique in both immunocompromised and immunocompetent patients. The presence of polymicrobial infection in a renal transplant recipient is documented in the literature, but has rarely been diagnosed on cytology. We report a case of concomitant pulmonary cryptococcosis, aspergillosis, and tuberculosis in a renal transplant recipient diagnosed on FNAC. A 50-year-old renal transplant recipient, asymptomatic for 3 year, presented with intermittent low-grade fever associated with cough, expectoration, and a newly developed cavitatory lesion in the left lung on chest X-ray. Computed tomography-guided FNAC performed on the lung lesion showed fungal profiles with septate hyphae and acute-angled branching consistent with morphology of Aspergillus. In addition, numerous yeast forms of cryptococcus and a few acid-fast mycobacterial tubercle bacilli were seen. Guided FNAC is a useful and reliable technique for the diagnosis of pulmonary infection. One should always keep in mind the possibility of polymicrobial infections especially inimmunocompromised patients. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]
Respiratory cytology: Differential diagnosis and pitfallsDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2010
F.R.C.P.C., Ph.D., Reda S. Saad M.D.
Abstract Pulmonary cytology can be challenging and has its share of diagnostic pitfalls. Reactive atypia can occasionally be alarming, leading to diagnostic pitfall for a false-positive diagnosis of malignancy, even for experienced cytopathologists (Naryshkin and Young, Diagn Cytopathol 1993;9:89,97). In addition, cytologic preparations can show an absence of architectural clues, leading to diagnostic difficulties. Some conditions can cytologically as well as clinically and radiographically mimic malignancies, making these pitfalls even more frequent (Bedrossian et al., Lab Med 1983;14:86,95). A recent report stated that "no laboratory that aims to make definitive diagnoses in pulmonary cytology can be spared from false-positive results"(Policarpio-Nicolas and Wick, Diagn Cytopathol 2008;36:13,19). A false-positive finding could produce unnecessary treatment and morbidity, whereas false-negative diagnosis could result in delayed diagnosis and treatment. This review analyzes and illustrates cellular changes and benign entities that can mimic malignancy in respiratory cytology as well as neoplasms that could lead to a false-negative diagnosis. In addition, some specific challenging and difficult aspects in classification of pulmonary malignancies will be discussed. Guidelines and clues are presented to avoid such pitfalls. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]
The use of p16INK4A immunocytochemistry in "Atypical squamous cells which cannot exclude HSIL" compared with "Atypical squamous cells of undetermined significance" in liquid-based cervical smearsDIAGNOSTIC CYTOPATHOLOGY, Issue 3 2010
Chang Ohk Sung M.D.
Abstract Even though p16INK4a (p16) immunocytochemistry has proven a useful accessory tool verifying the identification of atypical squamous cells of undetermined significance (ASC-US) categorized smears, the procedure still has limitations. To date few studies examining the usefulness of p16 immunocytochemistry in atypical squamous cells which cannot exclude HSIL (ASC-H), compared with ASC-US in liquid-based cervical smears. Therefore, we examined the correlation of p16 immunocytochemical staining with follow-up biopsy results on ASC-H categorized smears and compared the data with those classified as ASC-US on 105 liquid-based cytology samples. We found no statistical significance in the p16 expression of ASC-US smears and the presence of squamous intraepithelial lesions (SIL) in follow-up biopsies (p = 0.546). However, p16 expression did significantly correlate with the presence of SIL (p = 0.002) in ASC-H smears. There was a statistically significant relationship between p16 expression and presence of high grade squamous intraepithelial lesions (HSIL) or more on the follow-up biopsies in both ASC-US (p = 0.012) and ASC-H (p < 0.001) categorized smears. In ASC-US categorized smears, there was no statistical significance between p16 expression and the HR-HPV viral load (p = 0.091). But there was a statistical significance between p16 expression and the HR-HPV viral load (p < 0.001) in ASC-H categorized smears. Our results indicate that p16 immunostaining is a much better useful marker for HR-HPV infection and detection of SIL in ASC-H categorized smears compared to those defined as ASC-US. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]