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Cytological Diagnosis (cytological + diagnosis)

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Preparation of thyroid FNA material for routine cytology and BRAF testing: A validation study

DIAGNOSTIC CYTOPATHOLOGY, Issue 3 2010
Giancarlo Troncone M.D., Ph.D.
Abstract V600E BRAF mutation is emerging as an independent marker of papillary thyroid carcinoma aggressive behavior. Papillary thyroid carcinomas harboring this mutation should be extensively resected. However, this requires an unquestionable cytological diagnosis of malignancy. Thus, cytological specimens should be properly handled to provide both morphological and molecular information. Here, we assessed whether our method of preparation of fine-needle aspiration material is suitable for both tests. A series of 128, routinely performed, fine-needle aspirations was analyzed. Each nodule was punctured three times. A representative Diff-Quik smear prepared from the first two passages was evaluated onsite. When microscopy was diagnostic (n = 44), the third needle pass was dedicated to harvest material for BRAF testing; in the remaining cases (n = 84), additional direct smears for cytology were prepared and the remaining material in the needle plus the needle rinsing was collected for BRAF testing. Cellularity was adequate in 126/128 (98%) cases. Cytological diagnoses were inadequate (2%), benign (85%), follicular lesion of undetermined significance (5%), follicular neoplasms (2%), suspicious for malignancy (2%), and malignant (4%). Higher average of extracted DNA concentration was observed in the dedicated pass group (25.9 vs 7.95 ng/,l). However, the rate of successful exon 15 BRAF amplification was similar with (43/44; 97.7%) or without (79/84; 94%) the dedicated pass. Thus, our protocol is suitable for both tests. Whenever necessary BRAF testing may also be performed on the residual samples of thyroid nodules, without interfering with routine cytology. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source]

Fine-needle aspiration cytology in the follow-up of Hodgkin lymphoma

DIAGNOSTIC CYTOPATHOLOGY, Issue 7 2008
Pio Zeppa M.D.
Abstract Hodgkin lymphoma (HL) is characterized by long survival and risk of relapse and second neoplasm. The aim of this study is to evaluate the possibility of improving the accuracy of fine-needle cytology (FNC) in HL follow-up using Power Doppler ultrasound (US) assistance and immediate microscopic evaluation (ICE). The study was performed in two consecutive groups of 200 FNC in HL patients. In the first group FNC of palpable lymph-nodes or extra lymph-nodal masses were performed without US assistance except for impalpable and/or deep located masses (nonassisted group); In the second group, all the FNC were performed under Power Doppler US assistance with ICE and immediately repeated in inadequate cases (assisted group). Cytological diagnoses were controlled by histology (61) or clinical follow-up (69); sensitivity and specificity were calculated in the two groups and to evaluate the effect of Power Doppler alone, adequate cases were compared with the total number of FNC in each of the two groups. FNC identified 90 negative cases, 3 false negatives, 70 HL relapse, 16 inadequate and 14 suspicious; second neoplasia were diagnosed in 12 cases and all histologically confirmed. Sensitivity and specificity were 64 and 84% in the nonassisted group and 86 and 94% in the assisted group and there were significant differences between the number of adequate cases v.s. the total number of FNC in each of the two groups. Sensitivity and specificity in assisted FNC are higher than in nonassisted ones. The main advantage of assisted FNC in the follow-up of HL is to produce accurate diagnoses avoiding invasive biopsies. Diagn. Cytopathol. 2008;36:467,472. © 2008 Wiley-Liss, Inc. [source]

Exfoliative sputum cytology of cancers metastatic to the lung,

DIAGNOSTIC CYTOPATHOLOGY, Issue 3 2005
Tehmina Z. Ali M.D.
Abstract Although largely replaced by fine-needle aspiration (FNA) and bronchoscopy, cytological examination of sputum for exfoliated malignant cells still is considered a valuable initial diagnostic test in patients presenting with a lung mass. Thirty-five cases of secondary/metastatic tumors involving the lung and diagnosed on sputum were retrospectively reviewed from our cytopathology files for a period of 22 yr (1980,2001). Clinical history and the relevant histopathological material were examined and correlated with the cytological findings. In all cases, a history of malignancy was known. Cytological diagnoses included colonic adenocarcinoma (7 cases); non-Hodgkin's lymphoma (NHL; 5 cases); malignant melanoma (MM; 5 cases); breast carcinoma (5 cases); Hodgkin's lymphoma (HL; 3 cases); pancreatic adenocarcinoma (2 cases); prostatic adenocarcinoma (2 cases); and 1 case each of urothelial carcinoma, endometrial carcinoma, renal cell carcinoma, hepatic small-cell carcinoma, squamous-cell carcinoma (cervix), and leiomyosarcoma (LMS). Cellular preservation was optimal in all cases. The smear background was relatively clean in 25 (71%) cases and predominantly inflamed and/or necrotic in 10 (29%) cases. In non-lymphoid tumors (27 cases), isolated single malignant cells were seen in 7 (26%) cases (all cases of MM and prostatic adenocarcinoma), whereas 20 (74%) cases displayed fragments with intact tumor architecture. Overall, only 10/35 (29%) cases showed noticeable tumor-cell necrosis. In one case (LMS), cell block sections were used for immunoperoxidase (IPOX) studies with positive staining for desmin and actin. Exfoliation of cancer cells in sputum from secondary tumors in the lung is a rare phenomenon in current-day practice, with metastatic colonic adenocarcinoma seen most commonly. Intact tumor architecture was observed in exfoliated cells in 75% of the cases. Diagn. Cytopathol. 2005;33:147,151. © 2005 Wiley-Liss, Inc. [source]

Diagnostic value of pyrosequencing for the BRAFV600E mutation in ultrasound-guided fine-needle aspiration biopsy samples of thyroid incidentalomas

CLINICAL ENDOCRINOLOGY, Issue 1 2009
Young Suk Jo
Summary Context, Dideoxy sequencing is the most commonly used method for detecting the BRAFV600E mutation in thyroid cancer and melanoma. However, this gold standard method often makes less definite results in detecting the BRAFV600E mutation when there are relatively low amounts of the mutant template in biopsy specimens, which are invariably contaminated with normal tissues. Pyrosequencing, which measures the incorporation of each of the four nucleotides at each template position and indicates the amounts of mutant template present, may be more useful in such situations. Objective, To investigate the diagnostic efficiency of pyrosequencing for the mutant BRAF allele in ultrasound (US)-guided fine needle aspiration biopsies (FNABs) of thyroid incidentalomas. Design, setting and subjects, A total of 101 thyroid incidentaloma cases were included prospectively. Cytological diagnoses of the FNAB samples were made according to the American Thyroid Association (ATA) guidelines, 2006. The presence of the BRAFV600E mutation was investigated by pyrosequencing and dideoxy sequencing. Results, On the basis of cytological analysis, the thyroid incidentalomas were classified into benign (n = 43), malignant (n = 30), indeterminate or suspicious neoplasm (n = 24), and nondiagnostic (n = 4) categories. Pyrosequencing detected the BRAFV600E mutation in 30 cases: 22 malignant cases, 7 indeterminate cases, and 1 nondiagnostic case. Dideoxy sequencing also detected the BRAFV600E mutation in 28 of the same cases but failed to clearly distinguish the mutant allele from the wild-type allele in one indeterminate case and one nondiagnostic case. Histopathological analysis ascertained that all BRAFV600E -positive cases were papillary thyroid carcinomas. Conclusions, Pyrosequencing may be suitable for detecting the BRAFV600E mutation in thyroid incidentaloma and may be superior to dideoxy sequencing when low amounts of the mutant template are present in the biopsy. [source]

Cytological diagnosis of basal cell carcinoma and actinic keratosis, using Papanicolaou and May,Grünwald,Giemsa stained cutaneous tissue smear

CYTOPATHOLOGY, Issue 5 2008
E. Christensen
Objective:, Cytology may become the diagnostic method of choice with the advent of new non-invasive treatments for non-melanoma skin cancer, as the sampling technique for cytology entails little tissue disfiguration. The aim of this study was to compare and evaluate the diagnostic performance of scrape cytology using two different cytological staining techniques, and to evaluate additional touch imprint cytology, with that of histopathology of basal cell carcinoma (BCC) and actinic keratosis (AK). Methods:, We investigated 50 BCC and 28 AK histologically verified lesions, from 41 and 25 patients, respectively. Two separate skin scrape samples and one touch imprint sample were taken from each lesion. The smears were stained with Papanicolaou (Pap) or May,Grünwald,Giemsa (MGG) stains. All cytological specimens were examined in random order by pathologists without knowledge of the histology. Cytodiagnostic results were compared with the histopathological report. Results:, Scrape cytodiagnosis agreed with histopathology in 48 (Pap) and 47 (MGG) of the 50 BCC cases, and in 26 of 28 (Pap) and 21 of 26 (MGG) AK cases, yielding sensitivities of 96%, 94%, 93% and 81%, respectively. No significant difference in sensitivity between the two staining methods was found but a trend towards higher Pap sensitivity for AK was noted (P = 0.10). Touch imprint cytology confirmed histopathology in 38 of the 77 cases of BCC and AK. Conclusion:, Cytological diagnosis with either Pap or MGG stain for BCC and AK is reliable, and differentiates well between BCC and AK. Imprint cytology proved to be non-diagnostic in half of the examined cases. [source]

Cytological features of cystadenocarcinoma in cyst fluid of the parotid gland: Diagnostic pitfalls and literature review

DIAGNOSTIC 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]

The BSCC Code of Practice , exfoliative cytopathology (excluding gynaecological cytopathology)

CYTOPATHOLOGY, Issue 4 2009
A. Chandra
Exfoliative cytopathology (often referred to as non-gynaecological cytology) is an important part of the workload of all diagnostic pathology departments. It clearly has a role in the diagnosis of neoplastic disease but its role in establishing non-neoplastic diagnoses should also be recognised. Ancillary tests may be required to establish a definitive diagnosis. Clinical and scientific teamwork is essential to establish an effective cytology service and staffing levels should be sufficient to support preparation, prescreening, on-site adequacy assessment and reporting of samples as appropriate. Routine clinical audit and histology/cytology correlation should be in place as quality control of a cytology service. Cytology staff should be involved in multidisciplinary meetings and appropriate professional networks. Laboratories should have an effective quality management system conforming to the requirements of a recognised accreditation scheme such as Clinical Pathology Accreditation (UK) Ltd. Consultant pathologists should sign out the majority of exfoliative cytology cases. Where specimens are reported by experienced biomedical scientists (BMS), referred to as cytotechnologists outside the UK, this must only be when adequate training has been given and be defined in agreed written local protocols. An educational basis for formalising the role of the BMS in exfoliative cytopathology is provided by the Diploma of Expert Practice in Non-gynaecological Cytology offered by the Institute of Biomedical Science (IBMS). The reliability of cytological diagnoses is dependent on the quality of the specimen provided and the quality of the preparations produced. The laboratory should provide feedback and written guidance on specimen procurement. Specimen processing should be by appropriately trained, competent staff with appropriate quality control. Microscopic examination of preparations by BMS should be encouraged wherever possible. Specific guidance is provided on the clinical role, specimen procurement, preparation and suitable staining techniques for urine, sputum, semen, serous cavity effusion, cerebrospinal fluid, synovial fluid, cyst aspirates, endoscopic specimens, and skin and mucosal scrapes. [source]

Cytomorphological study of soft tissue neoplasms: role of fluorescent immunocytochemistry in diagnosis

CYTOPATHOLOGY, Issue 5 2005
B. Rekhi
Objectives:, Exact categorization of soft tissue tumours (STTs) on smears requires application of various ancillary techniques. This study was aimed at evaluating the role of fluorescent immunocytochemistry (FICC) in cyto-diagnosis of 30 STT cases. Methods:, Thirty cases of soft tissue tumours were included in the present study. All cases were subjected to routine Giemsa and Papanicolaou stain. Extra smears were made and kept for fluorescent immunostaining. A panel of cytoskeletal antibodies, tagged with FITC (Fluorescein isothyocynate), was employed in all these cases. Fluorescent immunostained smears were examined under Zeiss Confocal Laser scanning microscope, using double immunofluorescence (red-green). Finally, all cases were subjected to biopsy and again immunoperoxidase staining. Results:, Among the 30 cases in the present study, unaided cytological diagnoses ranged from ,spindle cell' tumour in four (13.3%) cases, benign and malignant spindle cell tumour in 17 (56.6%) cases, to malignant mesenchymal tumour in nine (30%) cases. FICC helped in further correct categorization of 25/30 (83.3%) cases viz. leiomyoma (three), benign neurogenic tumour (six), schwannoma (one), dermatofibrosarcoma protuberans (three), synovial sarcoma (two), rhabdomyosarcoma (two), malignant fibrous histiocytoma (five) and malignant peripheral nerve sheath tumour (three). Aggressive fibromatosis was found to be a missed diagnosis in two cases. Overall concordance between cyto-diagnosis with FICC, and histopathology results was 83.3% (P < 0.05). Conclusion:, Fluorescent immunocytochemistry is a significant ancillary technique for making a rapid and specific diagnosis of STT, as required for their timely management. Incorporation of a wide panel of antibody markers with clinico-cytological correlation is recommended in forming an exact diagnosis in these cases. [source]

ThinPrep Pap tests in patients with endometrial cancer: A histo-cytological correlation

DIAGNOSTIC CYTOPATHOLOGY, Issue 7 2007
Jianhong Zhou M.D.
Abstract The aim of this retrospective study was to correlate cytological diagnoses of endometrial cancers in ThinPrep Pap tests with the histological diagnoses. ThinPrep specimens from 67 patients within 12 mo of the histological diagnosis of endometrial cancer were studied. Of this study sample, 89.6% had abnormal Pap tests. Abnormal Pap tests occurred in 96.8, 68.4, and 100% of patients with grades 1, 2, or 3 endometrial cancers, respectively. Of patients with endocervical involvement, 88.9% had positive or suspicious Pap tests, compared with 41.1% without endocervical involvement (LR = 7.85, P < 0.01). Of patients with ,50% myometrial invasion, 78.9% had positive or suspicious Pap tests, compared with 34.8% with less than 50% invasion (LR = 10.97, P < 0.01). Positive or suspicious Pap tests were found in 59.5 and 32.1% of those with tumors ,3 cm or <3cm, respectively (LR = 4.85, P < 0.05). Diagn. Cytopathol. 2007;35:448,453. © 2007 Wiley-Liss, Inc. [source]

Anal cytology: Is there a role for reflex HPV DNA testing?

DIAGNOSTIC CYTOPATHOLOGY, Issue 3 2005
A.E. Walts M.D.
Abstract There is an increased incidence of anal squamous carcinoma and its precursor lesions (anal intraepithelial neoplasia [AIN]) among persons who engage in anal-receptive sex. Analogous to cervical cancer screening, anal Papanicplaou (Pap) smears currently are used to screen these high-risk populations. Human papilloma virus (HPV) has been implicated in anal carcinoma pathogenesis and this study was performed to assess the potential role of HPV DNA testing as an adjunct to anal cytology. We correlated cytological diagnoses and HPV DNA (Digene Hybrid Capture [HC II] assay) in anal specimens collected in SurePath liquid medium from 118 patients; 54.8% of cases diagnosed as atypical squamous cells of undetermined significance (ASC-US) and 87.8% diagnosed as low-grade squamous intraepithelial lesion (LSIL) or above tested positive for high- risk HPV DNA (B+). High-grade SIL (HSIL) was present in 31 of the 51 patients with follow-up. Although a cytological diagnosis of ASC-US or above was a reliable indicator for AIN, cytology frequently did not accurately predict the grade of SIL in subsequent biopsy. Our findings suggest that reflex HPV DNA testing would be helpful in triaging patients diagnosed with ASC-US. However, patients diagnosed with LSIL or above should go directly to ansocopic biopsy. Diagn. Cytopathol. 2005;33:152,156. © 2005 Wiley-Liss, Inc. [source]

O-10 Endometrial cells in cervical smears: cytological features associated with clinically significant endometrial pathology

CYTOPATHOLOGY, Issue 2007
R. N. Tiam
Introduction:, To establish the significance of cytological features which could predict clinically significant endometrial pathology, and therefore guide reporting practice in cervical samples. Methods:, A retrospective review of SurePath liquid-based cytology (LBC) cervical samples between 2002 and 2006, obtained at screening and colposcopy. These smears contained normal endometrial cells present at inappropriate times of the menstrual cycle, endometrial cells with atypia (borderline change) and with features suspicious / diagnostic of endometrial carcinoma (glandular neoplasia). False negative and false positive cases detected on subsequent histology were also included. The control group comprised negative samples and a few abnormal smears. All smears were randomly assigned and blinded to menopausal status, age, use of oral contraceptive pill and hormone replacement therapy and presence of intrauterine device. Each smear was reviewed for 16 cytologic criteria and a cytological diagnosis was given for each. Results:, A total of 219 smears were available for review; 137 were negative, out of which 85 contained normal endometrial cells, 41 contained endometrial cells with atypia, 10 contained endometrial cells with features suggestive of adenocarcinoma and 31 contained endometrial cells with features diagnostic of adenocarcinoma. The feature most associated with benign endometrial cells is top hat with central cell condensation. In contrast, the features associated with malignant endometrial cells are smooth nuclear membrane, pale chromatin, small nucleoli and scalloped borders. Discussion:, The criteria identified in this study do not definitively define a neoplastic process, but appear to be helpful in individual cases. This study emphasises that endometrial changes should be always interpreted with the relevant clinical information, which would otherwise lead to overdiagnosis in premenopausal women. [source]

Intraoperative cytology of clear cell carcinoma of the ovary

CYTOPATHOLOGY, Issue 6 2006
D. Vrdoljak-Mozeti
Objective:, To describe the cytomorphology of clear cell carcinoma (CCC) of the ovary in intraoperative samples of peritoneal fluid, imprint and scraping samples of the tumour tissue. Study design:, Fourteen histologically confirmed cases, stained by standard cytological procedures, were analysed by light microscopy. Results:, In 33.3% of peritoneal fluid samples and 92.9% of imprint and scraping cytological samples, besides variable clear cell cellular morphology, one or both distinct cytological characteristics were observed: eosinophilic, hyaline, extracellular, globular substance with or without formation of a ,raspberry' body and an eosinophilic, intracytoplasmic inclusions. These structures were clearly seen only in samples stained by May-Grünwald,Giemsa. Conclusion:, Using cytological analysis of imprint and scraping samples of ovarian tumours it is possible to make a precise intraoperative cytological diagnosis in most cases of CCC of the ovary. [source]

Mesothelioma Symposium 11.30,12.30 Tuesday 16 September 2003

CYTOPATHOLOGY, Issue 2003
Darrel Whitaker Dr
The diagnosis of malignant mesothelioma on the cytology of serous effusions is a two-phase process. First is to determine that the effusion is malignant based on morphological features such as a highly cellular fluid with many large three dimensional cell aggregates, and/or the recognition of minor malignant criteria including prominent cell engulfment, uniformly present very prominent nucleoli, or the finding of very large (giant) cells. In cell block sections, strong positive staining with EMA often with cell membrane accentuation provides compelling support for a cytological diagnosis of malignancy. Second is to recognize that the malignant cells have a mesothelial phenotype and do not represent metastatic malignancy (usually adenocarcinoma). Criteria in support of mesothelioma include the lack of a ,two cell' population, that is one native (mesothelial) and one foreign (metastatic), cells with abundant dense staining cytoplasm, the presence of ,windows' where mesothelioma cells lie in close apposition and intracytoplasmic glycogen presenting either as small peripheral vacuoles on MGG stained smears or large yellow refractile crescents on Papanicolaou stained smears. In addition, mesothliomas often possess connective tissue stromal cores occurring as either well-formed collagen within papillary aggregates or lying free as pink (MGG) or light green (Pap) amorphous material in the background of the smear or in loose association with mesothelioma cells. Finally small orange staining squamous-like cells can occasionally be identified and sometimes this may be a very prominent finding and has resulted in the false impression of a squamous cell carcinoma. Almost certainly these cells represent apoptotic tumour cells. The connective tissue mucin hyaluronic acid may be found as a net-like pattern in the smear background or as large hard-edged magenta-stained vacuoles on MGG-stained smears. Cell block sections provide architectural information and it is usually possible to separate mesothelioma aggregates with their cuboidal cells, central nuclei and abundant dense cytoplasm arranged in solid, papillary or hollow clusters from those of adenocarcinoma with less dense, often foamy cytoplasm, often composed of columnar cells with elongated nuclei. Aggregate form in adenocarcinoma can be variable but true acini are a rare finding. These cell block sections provide an ideal medium for histochemistry (PAS with and without diastase digestion) and immunocytochemistry. By using a panel of antibodies (Calretinin and CK 5/6, BerEp4, CEA, B72.3) it is almost always possible to distinguish mesothelioma from metastatic adenocarcinoma. Calretinin and CK 5/6 positive staining and absent staining with BerEp4, CEA and B72.3 is considered diagnostic of mesothelioma. [source]

Fine needle aspiration cytology in non-neoplastic non-toxic recurrent nodular goitre

CYTOPATHOLOGY, Issue 4 2003
ska-Klencka
The aim of the study was to examine whether evaluation of anisokaryosis is helpful in the cytological diagnosis of focal lesions in non-toxic recurrent goitre (NRG) after thyroidectomy for non-malignant goitre. Karyometric analysis was performed in routine cytological smears obtained from 80 females: 40 with focal lesions in non-toxic primary goitre (NPG) and 40 with NRG (postoperative histopathological examination revealed nodular goitre in both groups in all cases). We found that the level of anisokaryosis was significantly (P < 0.005) higher in NRG than in NPG. There were no significant differences between the two lesions, in cellular composition or thyroid follicular cell arrangement. Thus, isolated anisokaryosis, a feature of malignancy in patients without a prior thyroidectomy, has limited diagnostic value in recurrent goitre. [source]

Stereotactic biopsy and cytological diagnosis of solid and cystic intracranial lesions

CYTOPATHOLOGY, Issue 3 2003
L. M. Collaço
Cytological smears from 115 consecutive cases of stereotactic biopsies of intracranial lesions were reviewed. Ninety-five lesions were solid and 20 cystic. Material from 90 solid and 13 cystic lesions was sent both for cytological and histological examination. In 66 of the solid lesions, the cytological diagnosis was confirmed by histology (five were benign lesions and 61 malignant tumours: 56 primary brain tumours, three metastases and two lymphomas). In 24 cases with discrepant cytology and histology, the histology was inconclusive or insufficient in 14 cases, while cytology established the diagnosis of astrocytoma grade II (seven cases), metastases (two cases), gliosis (one case) and benign (four cases). Necrosis of tumour type was observed cytologically in six patients representing glioblastoma (two cases), anaplastic astrocytoma (one case), lymphoma (one case) and normal brain (two cases) histologically. Three cases reported cytologically as benign were primary brain tumour (two cases) and gliosis (one case). One smear of a glioblastoma was insufficient for cytological diagnosis. Cystic lesions were cytologically benign in 17 cases and malignant in three cases. Histology from the cyst wall confirmed the malignant diagnosis in three cases and showed tumour in six more cases, a benign process (two cases), changes induced by radiotherapy for arteriovenous malformation (one case) and insufficient material (one case). In conclusion, cytology from solid brain lesion allows an accurate diagnosis and subtyping of tumours in a majority of cases, and can thus be used to choose type of therapy. In cystic brain tumours, however, examination of the cystic fluid, is often inconclusive and a biopsy from the cyst wall should be performed if there is clinical or radiological suspicion of tumour. [source]

The use of cytospin monolayer technique in the cytological diagnosis of vulval and anal disease

CYTOPATHOLOGY, Issue 5 2001
T. S. Levine
The use of cytospin monolayer technique in the cytological diagnosis of vulval and anal disease This pilot study investigated the use of the non-invasive cytospin monolayer technique in the diagnosis and screening of neoplastic and non-neoplastic vulval disease. Twenty-three patients (age range 34,86 years) attending a vulval disease clinic had brush cytology performed. The samples were prepared with a cytospin monolayer technique and the slides Papanicolaou-stained. Subsequent cytological interpretation and diagnosis were performed without knowledge of the clinical history and correlated with follow-up biopsy histopathology from each patient. Twenty-eight cytospin samples were analysed in total, of which 11 (39%) contained dyskaryotic cells which were assessed and a predicted VIN/AIN grade given. Ten of 11 samples (91%) reported as dyskaryotic had VIN/AIN on biopsy histology. One of 11 samples (9%) was reported as containing occasional squamous cells with borderline nuclear features and, although the corresponding biopsy did not show VIN, basal atypia was reported. One patient had features suggesting invasive carcinoma on cytology which was verified on subsequent biopsy. The 15 cases in which no dyskaryotic cells were identified did not show VIN or AIN on subsequent histology. Two cases were acellular and considered inadequate for cytological interpretation. The cytospin monolayer technique allows the diagnosis of neoplastic from non-neoplastic vulval disease. It is a quick, inexpensive and non-invasive method that may have a role in diagnosis, screening and surveillance of patients. [source]

Significance of high-risk human papillomavirus detection by polymerase chain reaction in primary cervical cancer screening

CYTOPATHOLOGY, Issue 2 2001
Y. L. Oh
Significance of high-risk human papillomavirus detection by polymerase chain reaction in primary cervical cancer screening The purposes of this study were to evaluate the incidence of high-risk human papillomavirus (HPV) infection by polymerase chain reaction (PCR) and to assess its diagnostic usefulness in primary cervical screening. PCR testing for HPV type 16, 18, 31 and 33 was performed on 1305 specimens obtained during routine cervical cancer screening. We analysed the concurrent cervical smears and biopsy, and correlated them with the HPV infection status. We also evaluated histologically-proven cases with ASCUS smears according to HPV infection. HPV DNA was identified in eight (0.7%) of 1144 cytologically normal patients; nine (10.5%) of 86 ASCUS; seven (25.0%) of 28 LSIL; 26 (78.8%) of 33 HSIL; and in all of three squamous cell carcinomas (SCC). HPV positivity was significantly associated with cytohistological diagnosis for HSIL of more. In addition, HPV-positive ASCUS cases were found to be associated with histological abnormality rather than HPV-negative. The results indicate that high-risk HPV testing by PCR could be a useful adjunct tool for Pap smear in primary cervical screening. The combination of Pap smear and high-risk HPV testing by PCR might reduce unnecessary colposcopy-guided biopsy of women with cytological diagnosis of ASCUS. [source]

Langerhans cell histiocytosis in lymph nodes , cytomorphological diagnosis and pitfalls

CYTOPATHOLOGY, Issue 6 2000
S. Kakkar
Background Langerhans cell histiocytosis (LCH) is a rare disorder of unknown aetiology that may present as a multisystem or unisystem disease. The Lymph nodes can be involved as part of disseminated disease, as a metastatic site draining a focus of LCH or may be a unisystem involvement. Paucity of literature on the cytomorphology of LCH in lymph nodes led us to undertake this study. Materials and methods Nine cases with a confirmed histological diagnosis of LCH and a prior lymph node aspirate were retrieved over a 12 year period (1988,1999). Five more cases were reviewed where the cytological diagnosis of LCH was rendered on a background of clinical and radiological findings. Papanicolaou and May Grunwald,Giemsa-stained smears were examined. S-100 protein staining was available in four cases. Results and conclusions Nine cases had multisystem involvement, while in five cases only lymph nodes were involved. There were eleven males and three females; age ranged from five months to 27 years. The cytological diagnosis of LCH had been rendered in six, suspected in four and missed in four. Of the latter, two were reclassified as LCH on review, one as reactive lymphadenitis and in one a necrotising lesion was suspected. The pathognomonic ,LCH cell' was identified in 12 of 14 cases along with varying numbers of eosinophils, polymorphs and lymphocytes. Giant cells were seen in only six cases. In conclusion lymph node involvement by LCH can be identified on aspirates. However, LCH must be differentiated from dermatopathic lymphadenitis, sinus histiocytosis with massive lymphadenopathy and Hodgkin's disease. [source]

Coexistent atypical polypoid adenomyoma and complex atypical endometrial hyperplasia in the uterus

DIAGNOSTIC 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]

Correlation between morphology and human telomerase gene amplification in bronchial brushing cells for the diagnosis of lung cancer

DIAGNOSTIC 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]

Cytological features of cystadenocarcinoma in cyst fluid of the parotid gland: Diagnostic pitfalls and literature review

Preparation of thyroid FNA material for routine cytology and BRAF testing: A validation study

,-Methylacyl-CoA racemase (AMACR) in fine-needle aspiration specimens of prostate lesions

DIAGNOSTIC CYTOPATHOLOGY, Issue 11 2009
Gordana Kai, M.D.
Abstract The elevated expression of P504S gene and its product ,-methylacyl-CoA racemase (AMACR) can serve as a molecular marker for prostate cancer. The goal of this study is to investigate P504S/AMACR expression in fine-needle aspiration smears and correlate it with cytological diagnosis. Immunocytochemistry was performed in 35 patients with morphological diagnosis of prostate carcinoma (n = 16), atypia (n = 15), and benign hyperplasia (n = 4). Among 16 malignant cases there were two low-grade, eight intermediate, and six high-grade prostate carcinomas. Cytoplasmic positivity is analyzed qualitatively as predominantly diffuse or focal and quantitatively as <5%, 5,50%, and >50% of cells. Benign cases showed no P504S/AMACR expression. Positive staining was recorded in 75% of malignant cases, but in the majority of them it was weak and focal or diffuse and in a small amount of cells. The most intensive staining was seen in low-grade carcinomas and some atypical cases. This observation indicates a correlation between P504S/AMACR expression and differentiation of cells. P504S/AMACR staining might be of great value in cytodiagnosis of prostate lesions as well as an example of the characterization of cells at the molecular level using fresh tissue obtained by fine-needle aspiration. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source]

Usefulness of lavage cytology during endoscopic transpapillary catheterization into the gallbladder in the cytological diagnosis of gallbladder disease

DIAGNOSTIC CYTOPATHOLOGY, Issue 6 2009
Ph.D., Yoshiki Naito M.D.
Abstract Many studies have reported methods of cell collection involving percutaneous transhepatic cholangiodrainage (PTCD) and fine-needle aspiration cytology for the diagnosis of gallbladder disease. However, few studies have described the use of a transpapillary approach, i.e., endoscopic transpapillary catheterization into the gallbladder (ETCG). In this study, we analyzed cells collected by ETCG to evaluate its usefulness in the cytological diagnosis of gallbladder disease. The subjects were 19 patients who had undergone ETCG for the diagnosis of gallbladder disease. Of these patients, 11 and 8 had gallbladder cancer and benign gallbladder disease, respectively. We also evaluated the diagnostic accuracy of PTCD cytology performed in 15 patients with gallbladder cancer. Specimens were cytologically diagnosed as normal or benign, indeterminate, suspected malignancy, malignant, and inadequate in 47% (9/19), 11% (2/19), 0% (0/19), 37% (7/19), and 5% (1/19) of patients, respectively. Specimens were diagnosed as malignant, indeterminate, normal or benign, and inadequate in 7, 2, 1, and 1, respectively, of the 11 patients diagnosed with gallbladder cancer. The sensitivity and specificity of ETCG cytology were 78 and 100%, respectively, whereas the diagnostic accuracy of PTCD cytology was 20% (3/15). None of the patients developed complications of ETCG. Despite its technical difficulty, ETCG for bile cytology allows the collection of adequate cell numbers from patients with benign disease or gallbladder cancer and facilitates a cytological diagnosis, making it a useful method for collecting cells. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source]

Intrapancreatic schwannoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration cytology

DIAGNOSTIC CYTOPATHOLOGY, Issue 2 2009
Shaoying Li M.D.
Abstract Schwannoma is a tumor of neuro-ectodermal origin, usually occuring in the head and neck and extremities. A retroperitoneal, and particularly intra-pancreatic presentation is very rare, and poses a clinical and diagnostic challenge. We report a case of a male patient who underwent an Endoscopic Ultrasound-guided Fine Needle Aspiration (EUS-FNA) biopsy of a hypoechoic, intra-pancreatic mass. The onsite cytological evaluation was consistent with a spindle cell neoplasm. Further evaluation, aided by immunohistochemical stains, defined the mass as a Schwannoma. The patient then underwent a pancreaticoduodenectomy and the histopathological diagnosis of the surgical specimen confirmed the cytological diagnosis. To our knowledge, this is the first report of intra-pancreatic Schwannoma diagnosed preoperatively by EUS-FNA cytology. Diagn. Cytopathol. 2009. © 2008 Wiley-Liss, Inc. [source]

Simultaneous cytological diagnosis of herpes simplex virus infection and primary lung cancer: Report of two cases

DIAGNOSTIC CYTOPATHOLOGY, Issue 11 2008
Nicoletta Maounis M.D., Ph.D.
Abstract Herpes simplex is an uncommon cause of lower respiratory tract infection that requires prompt diagnosis and treatment to prevent late complications. We report two cases with simultaneous herpes simplex virus infection of the lower respiratory tract and lung carcinoma. Cytology of bronchial brushing and washing fluids and postbronchoscopic sputum established the diagnosis, which was further corroborated by real-time polymerase chain reaction. Diagn. Cytopathol. 2008;36:818,822. © 2008 Wiley-Liss, Inc. [source]

HBME-1 and CK19 are highly discriminatory in the cytological diagnosis of papillary thyroid carcinoma

DIAGNOSTIC CYTOPATHOLOGY, Issue 8 2008
FRCPA, Min-En Nga MRCPath
Abstract The cytologic diagnosis of papillary thyroid carcinoma is straightforward in most instances. However, there are some mimics including goitrous nodules and Hurthle cell neoplasms. Many studies have shown the combination of HBME-1 and CK19 expression to be useful in reaching a correct histologic diagnosis on tissue sections. We aim to assess the value of these markers in the setting of cell blocks prepared from needle aspiration specimens. We performed immunohistochemical staining of HBME-1 and CK19 on cell block material from 22 thyroid nodules that also had follow-up histology. Both CK19 and HBME-1 were strongly positive in all nine cases of papillary thyroid carcinoma, the latter showing distinct luminal accentuation. In the non-papillary carcinomas, none showed positivity for both HBME-1 and CK19. Two of six Hurthle cell neoplasms were positive for CK19, however all were negative for HBME-1. One of nine goitrous nodules was strongly positive for HBME-1 with luminal/membranous staining, but this were negative for CK19. The sensitivity, specificity and positive predictive value of HBME-1 in distinguishing between papillary thyroid carcinoma and goitrous nodules/Hurthle cell neoplasms were found to be 100%, 92.9% and 0.9, respectively; and that of HBME-1 and CK19 combination was 100%, 100% and 1. We thus conclude that the combination of positive HBME-1 (luminal/membranous) and CK 19 (cytoplasmic) staining on cell blocks of thyroid cytologic specimens is highly discriminatory in the diagnostic workup for papillary thyroid carcinoma. Diagn. Cytopathol. 2008; 36: 550,556. © 2008 Wiley-Liss, Inc. [source]

ThinPrep are superior to conventional smears in the cytological diagnosis of subfertile men by testicular fine-needle aspiration

DIAGNOSTIC CYTOPATHOLOGY, Issue 1 2008
Grigoris Grimbizis M.D., Ph.D.
Abstract The aim of this study was the comparison of liquid-based cytology (ThinPrep, TS) to conventional smears (CS) in the investigation of subfertile men with testicular fine-needle aspiration (FNA). Between January and December 2004, testicular FNA biopsies were performed in 30 subfertile men. Both TS and CS were diagnosed according to Meng classification. Features specifically recorded in each smear included sample adequacy, tissue cells preservation, contamination with red blood cells, quality of smear background, ease of cell recognition, and the cytological diagnosis. There was agreement in the cytological diagnosis between TS and CS (P = 0.88) and sample adequacy (P = 0.73). TS was superior to CS regarding cell preservation, presence of red blood cells or tissue artifacts, quality of the smear background, and cell recognition (P < 0.0001). In testicular FNA cytology, TS appear to be superior to CS in respect to cell preservation, absence of red blood cells, background quality, and cell recognition. These advantages, however, are not translated in improved cytological diagnosis. Diagn. Cytopathol. 2008;36:1,7. © 2007 Wiley-Liss, Inc. [source]

Granular cell tumor of the neurohypophysis: Report of a case with intraoperative cytologic diagnosis

DIAGNOSTIC CYTOPATHOLOGY, Issue 1 2008
Maria Luisa C. Policarpio-Nicolas M.D.
Abstract Cytological techniques including touch and smear preparations are very useful diagnostic modality in the evaluation of central nervous system (CNS) lesions and, in many instances, may be effectively used as the sole modality of tissue preparation for intraoperative consultation. Cytologic preparations offer many advantages over frozen sections for CNS specimens. These include selective examination of multiple areas from small biopsy specimens, superior preservation and details of cellular morphology, fewer artifacts, faster results, and improved cost-effectiveness. We describe the cytologic diagnosis of a granular cell tumor (GCT) of the neurohypophysis in a 33-year-old male who presented with headache and blurred vision. CT scan revealed an enlarged sella with a 2.15 × 2.0 cm pituitary lesion. Transsphenoidal resection of the mass was performed and submitted for intraoperative consultation. Smears and touch preparations were made on a portion of the mass that showed uniform polygonal cells with round to ovoid nuclei and abundant eosinophilic granular cytoplasm. An intraoperative cytological diagnosis of "favor GCT" was rendered. The histologic sections of the remaining material confirmed the diagnosis. Although GCT of the neurohypophysis is very rare, a specific intraoperative cytological diagnosis is possible. We report the clinical, cytological, and pathological findings of a GCT affecting the neurohypophysis. Diagn. Cytopathol. 2008;36:58,63. © 2007 Wiley,Liss, Inc. [source]

Fine-needle aspiration cytology of basal cell adenoma of the parotid gland: Characteristic cytological features and diagnostic pitfalls

DIAGNOSTIC CYTOPATHOLOGY, Issue 2 2007
Akihiko Kawahara C.T., Ph.D. C.M.I.A.C.
Abstract We retrospectively studied the cytological features of aspiration cytology in 12 cases of basal cell adenoma (BCA) and 5 cases mistakenly diagnosed as BCA. On macroscopic findings, the 12 cases of BCA included 7 cases of solid type and 5 cases of cystic type. The characteristic cytological features of solid type BCA were three-dimensional clusters in 71%, sharp-angle small clusters in 86%, basement membrane- like material in 71%, and cell crush in 86%. In contrast, 3 of the 5 cystic type BCA cases showed inadequate cellular components or no basaloid tumor cells, and the cytological diagnosis of BCA could not be determined. In the 5 cases misdiagnosed as BCA, there were 2 cases of pleomorphic adenoma, 2 cases of benign lymphoepithelial cyst, and 1 case of basal cell adenocarcinoma. Accurate differential cytological diagnosis of BCA is relatively easy to determine the solid type BCA, but is more difficult for cystic type BCA. Diagn. Cytopathol. 2007;35:85,90. © 2007 Wiley-Liss, Inc. [source]