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Publisher: Medknow Publishers   (Total: 355 journals)

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Showing 1 - 200 of 355 Journals sorted alphabetically
Advanced Arab Academy of Audio-Vestibulogy J.     Open Access  
Advances in Human Biology     Open Access   (Followers: 1)
African J. for Infertility and Assisted Conception     Open Access  
African J. of Business Ethics     Open Access   (Followers: 7)
African J. of Medical and Health Sciences     Open Access   (Followers: 1)
African J. of Paediatric Surgery     Open Access   (Followers: 7, SJR: 0.269, h-index: 10)
African J. of Trauma     Open Access  
Ain-Shams J. of Anaesthesiology     Open Access   (Followers: 3)
Al-Azhar Assiut Medical J.     Open Access  
Al-Basar Intl. J. of Ophthalmology     Open Access   (Followers: 1)
Ancient Science of Life     Open Access   (Followers: 6)
Anesthesia : Essays and Researches     Open Access   (Followers: 7)
Annals of African Medicine     Open Access   (Followers: 1, SJR: 0.331, h-index: 15)
Annals of Bioanthropology     Open Access   (Followers: 3)
Annals of Cardiac Anaesthesia     Open Access   (Followers: 12, SJR: 0.408, h-index: 15)
Annals of Indian Academy of Neurology     Open Access   (Followers: 3, SJR: 0.308, h-index: 14)
Annals of Maxillofacial Surgery     Open Access   (Followers: 6)
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Pediatric Cardiology     Open Access   (Followers: 7, SJR: 0.441, h-index: 10)
Annals of Saudi Medicine     Open Access   (SJR: 0.24, h-index: 29)
Annals of Thoracic Medicine     Open Access   (Followers: 4, SJR: 0.388, h-index: 19)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15, SJR: 0.148, h-index: 5)
APOS Trends in Orthodontics     Open Access   (Followers: 1)
Arab J. of Interventional Radiology     Open Access  
Archives of Intl. Surgery     Open Access   (Followers: 9)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Archives of Pharmacy Practice     Open Access   (Followers: 5)
Asia Pacific J. of Clinical Trials : Nervous System Diseases     Open Access  
Asia-Pacific J. of Oncology Nursing     Open Access   (Followers: 3)
Asian J. of Andrology     Open Access   (Followers: 1, SJR: 0.879, h-index: 49)
Asian J. of Neurosurgery     Open Access   (Followers: 2)
Asian J. of Oncology     Open Access   (Followers: 1)
Asian J. of Transfusion Science     Open Access   (Followers: 2, SJR: 0.362, h-index: 10)
Astrocyte     Open Access  
Avicenna J. of Medicine     Open Access   (Followers: 1)
AYU : An international quarterly journal of research in Ayurveda     Open Access   (Followers: 6)
Benha Medical J.     Open Access  
BLDE University J. of Health Sciences     Open Access  
Brain Circulation     Open Access  
Bulletin of Faculty of Physical Therapy     Open Access   (Followers: 1)
Cancer Translational Medicine     Open Access   (Followers: 1)
CHRISMED J. of Health and Research     Open Access  
Clinical Dermatology Review     Open Access   (Followers: 1)
Clinical Trials in Degenerative Diseases     Open Access  
Clinical Trials in Orthopedic Disorders     Open Access  
Community Acquired Infection     Open Access  
Conservation and Society     Open Access   (Followers: 11, SJR: 0.82, h-index: 12)
Contemporary Clinical Dentistry     Open Access   (Followers: 4)
Current Medical Issues     Open Access   (Followers: 1)
CytoJ.     Open Access   (Followers: 2, SJR: 0.339, h-index: 19)
Delta J. of Ophthalmology     Open Access  
Dental Hypotheses     Open Access   (Followers: 3, SJR: 0.131, h-index: 4)
Dental Research J.     Open Access   (Followers: 9)
Dentistry and Medical Research     Open Access  
Digital Medicine     Open Access  
Drug Development and Therapeutics     Open Access  
Education for Health     Open Access   (Followers: 4, SJR: 0.205, h-index: 22)
Egyptian J. of Bronchology     Open Access  
Egyptian J. of Cardiothoracic Anesthesia     Open Access  
Egyptian J. of Cataract and Refractive Surgery     Open Access   (Followers: 1)
Egyptian J. of Dermatology and Venerology     Open Access   (Followers: 1)
Egyptian J. of Haematology     Open Access  
Egyptian J. of Internal Medicine     Open Access  
Egyptian J. of Neurology, Psychiatry and Neurosurgery     Open Access   (Followers: 1, SJR: 0.121, h-index: 3)
Egyptian J. of Obesity, Diabetes and Endocrinology     Open Access  
Egyptian J. of Otolaryngology     Open Access  
Egyptian J. of Psychiatry     Open Access   (Followers: 2)
Egyptian J. of Surgery     Open Access   (Followers: 1)
Egyptian Orthopaedic J.     Open Access  
Egyptian Pharmaceutical J.     Open Access  
Egyptian Retina J.     Open Access  
Egyptian Rheumatology and Rehabilitation     Open Access  
Endodontology     Open Access  
Endoscopic Ultrasound     Open Access   (SJR: 0.473, h-index: 8)
Environmental Disease     Open Access  
European J. of Dentistry     Open Access   (Followers: 2, SJR: 0.496, h-index: 11)
European J. of General Dentistry     Open Access   (Followers: 1)
European J. of Prosthodontics     Open Access   (Followers: 2)
European J. of Psychology and Educational Studies     Open Access   (Followers: 7)
Fertility Science and Research     Open Access  
Formosan J. of Surgery     Open Access   (SJR: 0.107, h-index: 5)
Genome Integrity     Open Access   (Followers: 4, SJR: 1.227, h-index: 12)
Global J. of Transfusion Medicine     Open Access   (Followers: 1)
Heart India     Open Access   (Followers: 1)
Heart Views     Open Access   (Followers: 2)
Hepatitis B Annual     Open Access   (Followers: 3)
IJS Short Reports     Open Access  
Indian Anaesthetists Forum     Open Access  
Indian Dermatology Online J.     Open Access   (Followers: 3)
Indian J. of Allergy, Asthma and Immunology     Open Access   (Followers: 1)
Indian J. of Anaesthesia     Open Access   (Followers: 8, SJR: 0.302, h-index: 13)
Indian J. of Burns     Open Access   (Followers: 1)
Indian J. of Cancer     Open Access   (SJR: 0.318, h-index: 26)
Indian J. of Cerebral Palsy     Open Access   (Followers: 1)
Indian J. of Community Medicine     Open Access   (Followers: 2, SJR: 0.618, h-index: 16)
Indian J. of Critical Care Medicine     Open Access   (Followers: 2, SJR: 0.307, h-index: 16)
Indian J. of Dental Research     Open Access   (Followers: 4, SJR: 0.243, h-index: 24)
Indian J. of Dental Sciences     Open Access  
Indian J. of Dentistry     Open Access   (Followers: 1)
Indian J. of Dermatology     Open Access   (Followers: 2, SJR: 0.448, h-index: 16)
Indian J. of Dermatology, Venereology and Leprology     Open Access   (Followers: 3, SJR: 0.563, h-index: 29)
Indian J. of Dermatopathology and Diagnostic Dermatology     Open Access  
Indian J. of Drugs in Dermatology     Open Access   (Followers: 1)
Indian J. of Endocrinology and Metabolism     Open Access   (Followers: 4)
Indian J. of Health Sciences     Open Access   (Followers: 2)
Indian J. of Medical and Paediatric Oncology     Open Access   (SJR: 0.292, h-index: 9)
Indian J. of Medical Microbiology     Open Access   (Followers: 1, SJR: 0.53, h-index: 34)
Indian J. of Medical Research     Open Access   (Followers: 4, SJR: 0.716, h-index: 60)
Indian J. of Medical Sciences     Open Access   (Followers: 2, SJR: 0.207, h-index: 31)
Indian J. of Multidisciplinary Dentistry     Open Access   (Followers: 1)
Indian J. of Nephrology     Open Access   (Followers: 1, SJR: 0.233, h-index: 12)
Indian J. of Nuclear Medicine     Open Access   (Followers: 2, SJR: 0.213, h-index: 5)
Indian J. of Occupational and Environmental Medicine     Open Access   (Followers: 4, SJR: 0.203, h-index: 13)
Indian J. of Ophthalmology     Open Access   (Followers: 4, SJR: 0.536, h-index: 34)
Indian J. of Oral Health and Research     Open Access  
Indian J. of Oral Sciences     Open Access   (Followers: 1)
Indian J. of Orthopaedics     Open Access   (Followers: 9, SJR: 0.393, h-index: 15)
Indian J. of Otology     Open Access   (Followers: 1, SJR: 0.218, h-index: 5)
Indian J. of Paediatric Dermatology     Open Access   (Followers: 2)
Indian J. of Pain     Open Access   (Followers: 1)
Indian J. of Palliative Care     Open Access   (Followers: 5, SJR: 0.35, h-index: 12)
Indian J. of Pathology and Microbiology     Open Access   (Followers: 1, SJR: 0.285, h-index: 22)
Indian J. of Pharmacology     Open Access   (SJR: 0.347, h-index: 44)
Indian J. of Plastic Surgery     Open Access   (Followers: 12, SJR: 0.303, h-index: 13)
Indian J. of Psychiatry     Open Access   (Followers: 3, SJR: 0.496, h-index: 15)
Indian J. of Psychological Medicine     Open Access   (Followers: 1, SJR: 0.344, h-index: 9)
Indian J. of Public Health     Open Access   (Followers: 1, SJR: 0.444, h-index: 17)
Indian J. of Radiology and Imaging     Open Access   (Followers: 4, SJR: 0.253, h-index: 14)
Indian J. of Research in Homoeopathy     Open Access  
Indian J. of Rheumatology     Open Access   (SJR: 0.169, h-index: 7)
Indian J. of Sexually Transmitted Diseases and AIDS     Open Access   (Followers: 2, SJR: 0.313, h-index: 9)
Indian J. of Social Psychiatry     Open Access   (Followers: 2)
Indian J. of Urology     Open Access   (Followers: 3, SJR: 0.366, h-index: 16)
Indian J. of Vascular and Endovascular Surgery     Open Access   (Followers: 2)
Industrial Psychiatry J.     Open Access   (Followers: 2)
Intl. J. of Academic Medicine     Open Access  
Intl. J. of Advanced Medical and Health Research     Open Access  
Intl. J. of Applied and Basic Medical Research     Open Access  
Intl. J. of Clinical and Experimental Physiology     Open Access   (Followers: 1)
Intl. J. of Critical Illness and Injury Science     Open Access   (Followers: 1)
Intl. J. of Educational and Psychological Researches     Open Access   (Followers: 3)
Intl. J. of Environmental Health Engineering     Open Access   (Followers: 1)
Intl. J. of Forensic Odontology     Open Access   (Followers: 1)
Intl. J. of Green Pharmacy     Open Access   (Followers: 4, SJR: 0.229, h-index: 13)
Intl. J. of Health & Allied Sciences     Open Access   (Followers: 2)
Intl. J. of Health System and Disaster Management     Open Access   (Followers: 2)
Intl. J. of Heart Rhythm     Open Access  
Intl. J. of Medicine and Public Health     Open Access   (Followers: 7)
Intl. J. of Mycobacteriology     Open Access   (SJR: 0.239, h-index: 4)
Intl. J. of Noncommunicable Diseases     Open Access  
Intl. J. of Nutrition, Pharmacology, Neurological Diseases     Open Access   (Followers: 4)
Intl. J. of Oral Health Sciences     Open Access   (Followers: 1)
Intl. J. of Orthodontic Rehabilitation     Open Access  
Intl. J. of Pedodontic Rehabilitation     Open Access  
Intl. J. of Pharmaceutical Investigation     Open Access   (Followers: 1)
Intl. J. of Preventive Medicine     Open Access   (Followers: 1, SJR: 0.523, h-index: 15)
Intl. J. of Shoulder Surgery     Open Access   (Followers: 7, SJR: 0.611, h-index: 9)
Intl. J. of Trichology     Open Access   (SJR: 0.37, h-index: 10)
Intl. J. of Yoga     Open Access   (Followers: 15)
Intl. J. of Yoga : Philosophy, Psychology and Parapsychology     Open Access   (Followers: 6)
Iranian J. of Nursing and Midwifery Research     Open Access   (Followers: 2)
Iraqi J. of Hematology     Open Access  
J. of Academy of Medical Sciences     Open Access  
J. of Advanced Pharmaceutical Technology & Research     Open Access   (Followers: 4, SJR: 0.427, h-index: 15)
J. of Anaesthesiology Clinical Pharmacology     Open Access   (Followers: 8, SJR: 0.416, h-index: 14)
J. of Applied Hematology     Open Access  
J. of Association of Chest Physicians     Open Access   (Followers: 2)
J. of Basic and Clinical Reproductive Sciences     Open Access   (Followers: 1)
J. of Cancer Research and Therapeutics     Open Access   (Followers: 4, SJR: 0.359, h-index: 21)
J. of Carcinogenesis     Open Access   (Followers: 1, SJR: 1.152, h-index: 26)
J. of Cardiothoracic Trauma     Open Access  
J. of Cardiovascular Disease Research     Open Access   (Followers: 3, SJR: 0.351, h-index: 13)
J. of Cardiovascular Echography     Open Access   (SJR: 0.134, h-index: 2)
J. of Cleft Lip Palate and Craniofacial Anomalies     Open Access   (Followers: 2)
J. of Clinical and Preventive Cardiology     Open Access   (Followers: 1)
J. of Clinical Imaging Science     Open Access   (Followers: 1, SJR: 0.277, h-index: 8)
J. of Clinical Neonatology     Open Access   (Followers: 1)
J. of Clinical Ophthalmology and Research     Open Access   (Followers: 1)
J. of Clinical Sciences     Open Access  
J. of Conservative Dentistry     Open Access   (Followers: 4, SJR: 0.532, h-index: 10)
J. of Craniovertebral Junction and Spine     Open Access   (Followers: 4, SJR: 0.199, h-index: 9)
J. of Current Medical Research and Practice     Open Access  
J. of Current Research in Scientific Medicine     Open Access  
J. of Cutaneous and Aesthetic Surgery     Open Access   (Followers: 1)
J. of Cytology     Open Access   (Followers: 1, SJR: 0.274, h-index: 9)
J. of Dental and Allied Sciences     Open Access   (Followers: 1)
J. of Dental Implants     Open Access   (Followers: 7)
J. of Dental Lasers     Open Access   (Followers: 2)
J. of Dental Research and Review     Open Access   (Followers: 1)
J. of Digestive Endoscopy     Open Access   (Followers: 3)
J. of Dr. NTR University of Health Sciences     Open Access  
J. of Earth, Environment and Health Sciences     Open Access   (Followers: 1)
J. of Education and Ethics in Dentistry     Open Access   (Followers: 5)
J. of Education and Health Promotion     Open Access   (Followers: 5)
J. of Emergencies, Trauma and Shock     Open Access   (Followers: 9, SJR: 0.353, h-index: 14)
J. of Engineering and Technology     Open Access   (Followers: 6)
J. of Experimental and Clinical Anatomy     Open Access   (Followers: 2)
J. of Family and Community Medicine     Open Access   (Followers: 1)
J. of Family Medicine and Primary Care     Open Access   (Followers: 8)

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Journal Cover CytoJournal
  [SJR: 0.339]   [H-I: 19]   [2 followers]  Follow
    
  This is an Open Access Journal Open Access journal
   ISSN (Print) 1742-6413 - ISSN (Online) 1742-6413
   Published by Medknow Publishers Homepage  [355 journals]
  • Evaluation of polymerase chain reaction in space-occupying lesions of
           liver reported as granulomatous inflammation/tuberculosis on fine-needle
           aspiration cytology

    • Authors: Kusum Sharma, Nalini Gupta, Kapil Goyal, Ajay Kumar Duseja, Aman Sharma, Arvind Rajwanshi
      Pages: 1 - 1
      Abstract: Kusum Sharma, Nalini Gupta, Kapil Goyal, Ajay Kumar Duseja, Aman Sharma, Arvind Rajwanshi
      CytoJournal 2017 14(1):1-1
      Background: Tubercular involvement of the liver is uncommon, but is a serious consideration in differential diagnosis of granulomatous conditions, especially in endemic regions like India. Objective: To assess the role of polymerase chain reaction (PCR) done on archival cytological material in diagnosing tuberculosis (TB) in cases reported as granulomatous inflammation/TB in liver lesions. Materials and Methods: This was a retrospective study including a total of 17 cases of liver space-occupying lesions (SOLs) reported as granulomatous inflammation (n = 12) and TB (n = 5). The smears were retrieved from the archives of the department and were reviewed for the cytomorphologic features. Air-dried smears stained with May–Grünwald–Giemsa (MGG) stain were assessed for the representative material in the form of epithelioid granulomas and giant cells. One/two MGG smears from each case were destained and the material was used for performing PCR for Mycobacterium tuberculosis by amplification of 123 bp fragment of the IS6110 insertion element. Results: The age of the patients ranged from 3 to 61 years. There were 12 females and 5 males. The patients presented with solitary/multiple liver SOLs. DNA could be extracted from 10/17 cases from archival MGG smears. PCR positivity was noted in 8/10 cases (including four acid-fast bacilli smear-positive cases), confirming a diagnosis of TB. Conclusion: Cytomorphology alone may not be sufficient for differentiating various granulomatous lesions reported in liver SOLs. DNA can be extracted from the archival cytological MGG-stained smears. PCR should be carried out if Ziehl–Neelsen staining is negative in granulomatous lesions, especially when material has not been submitted for culture.
      Citation: CytoJournal 2017 14(1):1-1
      PubDate: Fri,20 Jan 2017
      DOI: 10.4103/1742-6413.198815
      Issue No: Vol. 14, No. 1 (2017)
       
  • Primary orbital mantle cell lymphoma: Flow cytometric immunophenotyping as
           an adjunct to fine-needle aspiration cytology for diagnosis

    • Authors: Sangeeta Verma, Nalini Gupta, Satyawati Mohindra, Manupdesh Singh Sachdeva, Arvind Rajwanshi
      Pages: 2 - 2
      Abstract: Sangeeta Verma, Nalini Gupta, Satyawati Mohindra, Manupdesh Singh Sachdeva, Arvind Rajwanshi
      CytoJournal 2017 14(1):2-2

      Citation: CytoJournal 2017 14(1):2-2
      PubDate: Fri,20 Jan 2017
      DOI: 10.4103/1742-6413.198816
      Issue No: Vol. 14, No. 1 (2017)
       
  • Thyroid fine-needle aspiration of an immunocompromised patient:
           Cytomorphological clues

    • Authors: Longwen Chen, Nirvikar Dahiya, Matthew A Zarka
      Pages: 3 - 3
      Abstract: Longwen Chen, Nirvikar Dahiya, Matthew A Zarka
      CytoJournal 2017 14(1):3-3

      Citation: CytoJournal 2017 14(1):3-3
      PubDate: Fri,24 Feb 2017
      DOI: 10.4103/1742-6413.200934
      Issue No: Vol. 14, No. 1 (2017)
       
  • Detection of BRAF mutation in the cytocentrifugation supernatant fluid
           from fine-needle aspiration of thyroid lesions may enhance the diagnostic
           yield

    • Authors: Ashley E Brown, Khin Sandar Lim, George Corpus, Martha T Hustek, Tien Anh N Tran, Chung-Che Chang
      Pages: 4 - 4
      Abstract: Ashley E Brown, Khin Sandar Lim, George Corpus, Martha T Hustek, Tien Anh N Tran, Chung-Che Chang
      CytoJournal 2017 14(1):4-4
      Objective: BRAF mutations using cellular DNA from fine-needle aspiration (FNA) specimens are commonly used to support the diagnosis of papillary thyroid carcinoma (PTC). The goal of this study was to preliminarily evaluate the diagnostic utility of detecting BRAF mutations in the routinely discarded FNA specimen supernatant fluid. Materials and Methods: Seventy-eight FNAs of thyroid lesions were evaluated for BRAF mutations using both cellular and supernatant DNA. BRAF mutation data were correlated with cytology and surgical pathology. Results: Of the 78 samples evaluated, 68 (87%) had amplifiable DNA in the supernatant with 2 (3%) positive for BRAF mutations. These two samples showed no mutations in the cellular counterpart. Among the 11 samples showing morphologic findings (FNA/surgical pathology) suspicious/diagnostic of PTC, 6 (55%) samples (one supernatant and five cellulars) were positive for BRAF mutations. This suggests that testing supernatant DNA in FNA specimens may increase the diagnostic yield by 1/11 (9%) in this setting. Conclusions: The vast majority of routinely discarded FNA supernatants contain amplifiable DNA. In addition, profiling the mutations of BRAF and other genes using supernatant DNA may provide valuable diagnostic information to assist the diagnosis of PTC in patients with clinical/morphologic findings suspicious for malignancies and cellular DNA showing no mutations.
      Citation: CytoJournal 2017 14(1):4-4
      PubDate: Fri,24 Feb 2017
      DOI: 10.4103/1742-6413.200935
      Issue No: Vol. 14, No. 1 (2017)
       
  • KRAS detection on archival cytological smears by the novel fully automated
           polymerase chain reaction-based Idylla mutation test

    • Authors: Caterina De Luca, Elena Vigliar, Melania d'Anna, Pasquale Pisapia, Claudio Bellevicine, Umberto Malapelle, Giancarlo Troncone
      Pages: 5 - 5
      Abstract: Caterina De Luca, Elena Vigliar, Melania d'Anna, Pasquale Pisapia, Claudio Bellevicine, Umberto Malapelle, Giancarlo Troncone
      CytoJournal 2017 14(1):5-5
      Background: Molecular techniques are relevant to modern cytopathology, but their implementation is difficult without molecular expertise and infrastructure. The assessment of KRAS mutational status on cytological preparations may be useful either to refine uncertain diagnoses on pancreatic aspirates or to yield predictive information to plan targeted treatment of metastatic colorectal cancer (mCRC). The novel test Idylla™ enables fully automated KRAS genotyping in approximately 2 h, even in less experienced hands. Materials and Methods: This study aims to validate this methodology to detect KRAS mutations on archival cytological preparations of pancreatic cancer (n = 9) and mCRC (n = 9) by comparing the Idylla™ performance to that of standard real-time polymerase chain reaction. Results: The same 11 mutations (n = 4: p.G12D; n = 2: p.G12V; n = 2: p.A59E/G/T; n = 1: p.G12R; n = 1: p.G13D; n = 1: p.Q61H) were detected by both techniques. Conclusion: Even in less experienced laboratories, a cytopathologist may easily integrate morphological diagnostic report with accurate KRAS mutation detection, which is relevant for diagnostic and treatment decisions.
      Citation: CytoJournal 2017 14(1):5-5
      PubDate: Fri,24 Feb 2017
      DOI: 10.4103/1742-6413.200936
      Issue No: Vol. 14, No. 1 (2017)
       
  • Falling under the umbrella cells: A single institutional experience and
           literature review of urothelial carcinoma presenting as a primary
           pancreatic mass on endoscopic ultrasound-guided fine-needle aspiration

    • Authors: Michael Chambers, Konrad Krall, Shantel Hébert-Magee
      Pages: 6 - 6
      Abstract: Michael Chambers, Konrad Krall, Shantel Hébert-Magee
      CytoJournal 2017 14(1):6-6
      Metastases to the pancreas are much less common than primary pancreatic lesions, and there are few reports in the literature of metastatic urothelial carcinoma (UC) found in the pancreas. We report two cases of metastatic UC mimicking a primary pancreatic lesion. Two female patients, aged 48 and 83 years, presented with isolated pancreatic lesions causing obstructive jaundice suspicious for pancreatic adenocarcinoma and underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with rapid on-site evaluation (ROSE). On cytopathology, the lesions were found to be UC, confirmed with immunohistochemical (IHC) staining. UC rarely metastasizes to the pancreas, and diagnosis through EUS-FNA can be challenging. However, the utilization of ROSE, dedicated cell block passes, and IHC have proved to be effective in obtaining this unusual pancreatic diagnosis by EUS-FNA.
      Citation: CytoJournal 2017 14(1):6-6
      PubDate: Mon,20 Mar 2017
      DOI: 10.4103/1742-6413.202601
      Issue No: Vol. 14, No. 1 (2017)
       
  • Next-generation sequencing of non-small cell lung cancer using a
           customized, targeted sequencing panel: Emphasis on small biopsy and
           cytology

    • Authors: David M DiBardino, David W Rawson, Anjali Saqi, Jonas J Heymann, Carlos A Pagan, William A Bulman
      Pages: 7 - 7
      Abstract: David M DiBardino, David W Rawson, Anjali Saqi, Jonas J Heymann, Carlos A Pagan, William A Bulman
      CytoJournal 2017 14(1):7-7
      Background: Next-generation sequencing (NGS) with a multi-gene panel is now available for patients with lung adenocarcinoma, but the performance characteristics and clinical utility of this testing are not well-described. We present the results of an extended 467 gene panel in a series of advanced, highly selected nonsmall cell lung cancer (NSCLC) patients using a range of specimens, including predominantly small biopsy and cytology specimens. Materials and Methods: A retrospective review of 22 NSCLC biopsies sent for NGS using an extended gene panel from January 2014 to July 2015. The customized NGS panel sequences 467 cancer-associated genes with exonic and intronic sequences obtained from purified tumor DNA. Genomic alterations, patient characteristics, and success of testing were determined. Results: The majority of samples tested were metastatic lung adenocarcinoma on final pathology. Of the 22 specimens tested, 5 (22.7%) were surgical resections and 17 (77.3%) were small biopsy and cytology specimens. Twenty-one (95%) of the specimens were adequate for full sequencing and yielded a total of 204 genomic alterations (average 8.9 per tumor), of which 17 (average 0.81 per tumor) were actionable and/or clinically relevant. Genomic alterations were found most commonly in the TP53, EGFR, EPHB1, MLL3, APC, SETD2, KRAS, DNMT3A, RB1, CDKN2A, ARID1A, EP300, KDM6B, RAD50, STK11, and BRCA2 genes. Conclusions: NGS using a comprehensive gene panel was performed successfully in 95% of all NSCLC cases in this series, including 94% small biopsy and cytology specimens and 100% surgical resections. This custom assay was performed on a range of tumor specimens and demonstrates that small specimens are able to provide a similar depth of information as larger ones. As many patients present at an advanced stage and only small specimens are obtained, the information these provide has the potential for guiding treatment in highly selected patients with advanced lung adenocarcinoma.
      Citation: CytoJournal 2017 14(1):7-7
      PubDate: Mon,20 Mar 2017
      DOI: 10.4103/1742-6413.202602
      Issue No: Vol. 14, No. 1 (2017)
       
  • Ultrasound-guided fine-needle aspiration of hyperenhancing lesion
           suspicious for pancreatic neuroendocrine tumor in the tail of
           pancreas-potential pitfalls

    • Authors: Kinda Hayek, Tatyana Kalinicheva, Vinod B Shidham
      Pages: 8 - 8
      Abstract: Kinda Hayek, Tatyana Kalinicheva, Vinod B Shidham
      CytoJournal 2017 14(1):8-8

      Citation: CytoJournal 2017 14(1):8-8
      PubDate: Fri,28 Apr 2017
      DOI: 10.4103/1742-6413.205311
      Issue No: Vol. 14, No. 1 (2017)
       
  • Indian visceral leishmaniasis with extensive lymphadenopathy – An
           unusual presentation: A case report with literature review

    • Authors: Poojan Agarwal, Vijay Kumar, Manju Kaushal, Manju Kumari, Arvind Chaudhary
      Pages: 9 - 9
      Abstract: Poojan Agarwal, Vijay Kumar, Manju Kaushal, Manju Kumari, Arvind Chaudhary
      CytoJournal 2017 14(1):9-9
      Visceral leishmaniasis (VL), also known as kala-azar, is a life-threatening systemic disease caused by the obligate intracellular protozoan, Leishmania, and transmitted to humans by the female phlebotomine sand fly (Phlebotomus argentipes). The disease is fatal, if left untreated. We report a case of a patient clinically suspected of disseminated tuberculosis, but fine needle aspiration cytology of cervical and axillary lymph nodes yielded a diagnosis of leishmaniasis. Diagnosis of VL was challenging as the disease closely mimicked tuberculosis in the setting of extensive lymphadenopathy including conglomerate of mesenteric lymph nodes, on and off fever, and granulomatous lymphadenitis on aspiration. Bone marrow examination was further performed. A detailed workup revealed patient to be severely immunocompromised and newly diagnosed human immunodeficiency virus (HIV) positive. Worldwide, India has the largest number of VL cases, accounting for 40%–50% of world's disease burden and the second largest HIV-infected population, accounting for approximately 10% of the global disease burden. HIV increases the risk of developing VL by 100–2320 times in endemic areas and concurrently VL promotes the clinical progression of HIV disease. Co-infection with HIV alters the body's immune response to leishmaniasis thus leading to unusual presentations. This case highlights the diagnostic problem in the aforesaid setting. Moreover, co-infection with HIV in VL can be a potential source of drug resistance. An early diagnosis and intensified treatment is the key to patient management.
      Citation: CytoJournal 2017 14(1):9-9
      PubDate: Fri,28 Apr 2017
      DOI: 10.4103/1742-6413.205312
      Issue No: Vol. 14, No. 1 (2017)
       
  • Cytomorphologic features distinguishing Bethesda category IV thyroid
           lesions from parathyroid

    • Authors: Simon Sung, Anjali Saqi, Elizabeth M Margolskee, John P Crapanzano
      Pages: 10 - 10
      Abstract: Simon Sung, Anjali Saqi, Elizabeth M Margolskee, John P Crapanzano
      CytoJournal 2017 14(1):10-10
      Background: Thyroid follicular cells share similar cytomorphological features with parathyroid. Without a clinical suspicion, the distinction between a thyroid neoplasm and an intrathyroidal parathyroid can be challenging. The aim of this study was to assess the distinguishing cytomorphological features of parathyroid (including intrathyroidal) and Bethesda category IV (Beth-IV) thyroid follicular lesions, which carry a 15%–30% risk of malignancy and are often followed up with surgical resection. Methods: A search was performed to identify “parathyroid” diagnoses in parathyroid/thyroid-designated fine-needle aspirations (FNAs) and Beth-IV thyroid FNAs (follicular and Hurthle cell), all with diagnostic confirmation through surgical pathology, immunocytochemical stains, Afirma® analysis, and/or clinical correlation. Unique cytomorphologic features were scored (0-3) or noted as present versus absent. Statistical analysis was performed using R 3.3.1 software. Results: We identified five FNA cases with clinical suspicion of parathyroid neoplasm, hyperthyroidism, or thyroid lesion that had an eventual final diagnosis of the parathyroid lesion (all female; age 20–69 years) and 12 Beth-IV diagnoses (11 female, 1 male; age 13–64 years). The following cytomorphologic features are useful distinguishing features (P value): overall pattern (0.001), single cells (0.001), cell size compared to red blood cell (0.01), nuclear irregularity (0.001), presence of nucleoli (0.001), nuclear-to-cytoplasmic ratio (0.007), and nuclear chromatin quality (0.028). Conclusions: There are cytomorphologic features that distinguish Beth-IV thyroid lesions and (intrathyroidal) parathyroid. These features can aid in rendering correct diagnoses and appropriate management.
      Citation: CytoJournal 2017 14(1):10-10
      PubDate: Fri,28 Apr 2017
      DOI: 10.4103/1742-6413.205313
      Issue No: Vol. 14, No. 1 (2017)
       
  • An elderly man with a solitary liver lesion

    • Authors: Lisa Barton, Lichao Zhao, Jessica N Doty, Thomas Stasko, Rachel Conrad
      Pages: 11 - 11
      Abstract: Lisa Barton, Lichao Zhao, Jessica N Doty, Thomas Stasko, Rachel Conrad
      CytoJournal 2017 14(1):11-11

      Citation: CytoJournal 2017 14(1):11-11
      PubDate: Fri,26 May 2017
      DOI: 10.4103/1742-6413.207138
      Issue No: Vol. 14, No. 1 (2017)
       
  • Cytological features of adenocarcinoma admixed with small cell
           neuroendocrine carcinoma of the uterine cervix

    • Authors: Naoshi Shimojo, Yoshifumi S Hirokawa, Kazuki Kanayama, Misao Yoneda, Ryotaro Hashizume, Akinobu Hayashi, Katsunori Uchida, Hiroshi Imai, Yuji Kozuka, Taizo Shiraishi
      Pages: 12 - 12
      Abstract: Naoshi Shimojo, Yoshifumi S Hirokawa, Kazuki Kanayama, Misao Yoneda, Ryotaro Hashizume, Akinobu Hayashi, Katsunori Uchida, Hiroshi Imai, Yuji Kozuka, Taizo Shiraishi
      CytoJournal 2017 14(1):12-12
      Adenocarcinoma admixed with neuroendocrine carcinoma of the uterine cervix is a rare malignancy with a poor prognosis, and few reports have described the cytological features of this carcinoma. To characterize the cytological features of this malignancy in cervical smears, we report a case of a 52-year-old Japanese woman with cervical adenocarcinoma admixed with small cell neuroendocrine carcinoma (SCNEC). Cytologically, there were two types of cells with different sizes. The smaller cells formed clusters, which showed a partially Indian file pattern, a high nuclear/cytoplasmic ratio, and hyperchromatic nuclei. In contrast, the larger cells showed cytological features of adenocarcinoma, indicating a glandular-like pattern. Histological examination of biopsy specimens revealed that the tumors were composed of almost equal areas of SCNEC and adenocarcinoma. Neuroendocrine differentiation was confirmed by immunohistochemistry for synaptophysin and CD56. Thus, when adenocarcinoma cells are detected in smears, attempts to search for SCNEC cells should be made by combined cytological and histological analyses in order to reach an accurate diagnosis of the carcinoma in the uterine cervix.
      Citation: CytoJournal 2017 14(1):12-12
      PubDate: Fri,26 May 2017
      DOI: 10.4103/1742-6413.207139
      Issue No: Vol. 14, No. 1 (2017)
       
  • “Low-grade squamous intraepithelial lesion, cannot exclude
           high-grade:” TBS says “Don't Use It!” should I
           really stop it?

    • Authors: Jeanine M Chiaffarano, Melissa Alexander, Robert Rogers, Fang Zhou, Joan Cangiarella, Melissa Yee-Chang, Paul Elgert, Aylin Simsir
      Pages: 13 - 13
      Abstract: Jeanine M Chiaffarano, Melissa Alexander, Robert Rogers, Fang Zhou, Joan Cangiarella, Melissa Yee-Chang, Paul Elgert, Aylin Simsir
      CytoJournal 2017 14(1):13-13
      Background: The Bethesda System uses a two-tiered approach in the diagnosis of cervical squamous intraepithelial lesions (SILs). Occasionally, Papanicolaou (Pap) tests with evident low-grade SIL (LSIL) also have some features suggestive but not diagnostic of high-grade SIL (HSIL). This study reviews our experience with “Low-grade Squamous Intraepithelial Lesion, Cannot Exclude High-grade” (LSIL-H) and discusses the best approach to report such Paps if the LSIL-H interpretation is abandoned. Methods: Abnormal Paps were identified between January and December 2014 that had surgical follow-up within 6 months. Their biopsy outcomes were compared. Statistical analysis was performed using Pearson's Chi-square and McNemar tests in SPSS software version 23. Statistical significance was defined as P ≤ 0.05. Results: There were a total of 1049 abnormal Paps with follow-up. High-grade dysplasia/carcinoma (HGD+) was found in 8% of LSIL, 30% of LSIL-H, 52% of atypical squamous cells (ASCs), cannot rule out HSIL (ASC-H), and 77% of HSIL Paps. The detection rate of HGD+ for LSIL-H was between that of LSIL (Pearson's Chi-square test, P = 0.000) and ASC-H (P = 0.04). If LSIL-H cases are reported as ASC-H, the rate of HGD+ for the ASC-H category would decrease from 51.5% to 37.4% (McNemar test, P = 0.000). Alternatively, if LSIL-H cases are downgraded to LSIL, the rate of HGD+ for the LSIL category would rise from 7.7% to 10.4% (McNemar test, P = 0.000). Nearly 86.7% of LSIL-H cases were positive for high-risk HPV (HR-HPV) in comparison to 77.5% of LSILs, 100% of ASC-Hs, and 75% of HSILs. The sample size for HR-HPV and LSIL-H was too small for meaningful statistical analysis. Conclusions: “LSIL-H” category detects more HGD+ than LSIL, and fewer than ASC-H and HSIL. If LSIL-H is eliminated, Paps with this finding are best reported as ASC-H to ensure that women with potential HGD+ undergo colposcopy in a timely manner. Reporting LSIL-H as LSIL may delay colposcopy since management of LSIL Paps depends on multiple factors (age, HPV status, etc.).
      Citation: CytoJournal 2017 14(1):13-13
      PubDate: Fri,26 May 2017
      DOI: 10.4103/cytojournal.cytojournal_48_16
      Issue No: Vol. 14, No. 1 (2017)
       
  • Myoepithelioma of soft tissue in the gluteal region: Diagnostic pitfall in
           cytology

    • Authors: Viral M Bhanvadia, Neeru M Agarwal, Alpesh D Chavda, Bharat V Bhetariya
      Pages: 14 - 14
      Abstract: Viral M Bhanvadia, Neeru M Agarwal, Alpesh D Chavda, Bharat V Bhetariya
      CytoJournal 2017 14(1):14-14

      Citation: CytoJournal 2017 14(1):14-14
      PubDate: Tue,20 Jun 2017
      DOI: 10.4103/cytojournal.cytojournal_45_16
      Issue No: Vol. 14, No. 1 (2017)
       
  • Metastatic prostatic stromal sarcoma: A challenging diagnosis on
           fine-needle aspiration with broad differential diagnosis

    • Authors: Muhammad Siddique Khurram, Ghassan Tranesh, Ramen Sakhi, Ameer Hamza, Warda Ibrar, Roohi Bano
      Pages: 15 - 15
      Abstract: Muhammad Siddique Khurram, Ghassan Tranesh, Ramen Sakhi, Ameer Hamza, Warda Ibrar, Roohi Bano
      CytoJournal 2017 14(1):15-15
      Prostatic stromal sarcomas (PSS) are rare solid organ mesenchymal sarcomas. PSS may pose difficult diagnostic challenges on fine needle aspiration biopsy. We report a 48-year-old man diagnosed with metastatic high grade prostatic stromal sarcoma by a CT-scan guided fine needle aspiration (FNA) biopsy of a right lower lung lobe nodule. We reviewed the literature on the epidemiologic, cyto-histological, and immunophenotypic findings and discussed the differential diagnosis for this rare entity.
      Citation: CytoJournal 2017 14(1):15-15
      PubDate: Tue,20 Jun 2017
      DOI: 10.4103/cytojournal.cytojournal_46_16
      Issue No: Vol. 14, No. 1 (2017)
       
  • Metastatic neoplasms to the thyroid diagnosed by fine-needle
           aspiration/core needle biopsy: Clinicopathologic and cytomorphologic
           correlation

    • Authors: Mobeen Rahman, Ashley Rae Okada, Kevin Guan, Pamela Tauchi-Nishi
      Pages: 16 - 16
      Abstract: Mobeen Rahman, Ashley Rae Okada, Kevin Guan, Pamela Tauchi-Nishi
      CytoJournal 2017 14(1):16-16
      Background: Although thyroid fine-needle aspiration (FNA) and core needle biopsy (CNB) are commonly utilized modalities in the evaluation of thyroid nodules, metastatic tumors to the thyroid are only rarely encountered. We aspired to determine the incidence and primary origin of metastases to the thyroid at our institution and to examine their clinicopathologic and cytomorphologic features. Materials and Methods: A search of our database was undertaken to review all thyroid FNA and/or CNB examined between January 2004 and December 2013. Results: During our 10 year study period, 7497 patients underwent 13,182 FNA and/or CNB. Four hundred sixty one (6%) patients were diagnosed with neoplasms. Only five (1.1%) were found to have metastatic tumors to the thyroid involving three females and two males. Two were diagnosed by FNA, one by CNB, and two by both FNA and CNB, with rapid on-site evaluation (ROSE) employed in all cases. The primary malignancies in the five cases were pulmonary and nasopharyngeal squamous cell carcinomas, renal cell carcinoma, pancreatic adenocarcinoma, and olfactory neuroblastoma. The cytomorphologic features of these metastases to the thyroid aided in their distinction from primary thyroid carcinoma. Two of these metastases, a renal cell carcinoma and pancreatic adenocarcinoma, were the first clinical manifestations of cancer. Conclusion: Metastases to the thyroid diagnosed by FNA and/or CNB are exceedingly rare in our institution, comprising only 0.04% of total FNA/CNB and only 1.1% of all thyroid neoplasms. We report the first known case of metastatic olfactory neuroblastoma to the thyroid diagnosed by aspiration cytology. In addition, an occult primary may present as a thyroid mass on FNA or CNB as occurred with two of our cases. FNA/CNB proved to be highly effective in the diagnosis of metastases to the thyroid, with ROSE proving valuable in assuring specimen adequacy. Thyroid FNA and CNB demonstrated great utility in the setting of metastatic disease, obviating the need for more invasive procedures.
      Citation: CytoJournal 2017 14(1):16-16
      PubDate: Tue,20 Jun 2017
      DOI: 10.4103/cytojournal.cytojournal_50_16
      Issue No: Vol. 14, No. 1 (2017)
       
  • Interobserver reproducibility of the Paris system for reporting urinary
           cytology

    • Authors: Theresa Long, Lester J Layfield, Magda Esebua, Shellaine R Frazier, D Tamar Giorgadze, Robert L Schmidt
      Pages: 17 - 17
      Abstract: Theresa Long, Lester J Layfield, Magda Esebua, Shellaine R Frazier, D Tamar Giorgadze, Robert L Schmidt
      CytoJournal 2017 14(1):17-17
      Background: The Paris System for Reporting Urinary Cytology represents a significant improvement in classification of urinary specimens. The system acknowledges the difficulty in cytologically diagnosing low-grade urothelial carcinomas and has developed categories to deal with this issue. The system uses six categories: unsatisfactory, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells, suspicious for high-grade urothelial carcinoma, high-grade urothelial carcinoma, other malignancies and a seventh subcategory (low-grade urothelial neoplasm). Methods: Three hundred and fifty-seven urine specimens were independently reviewed by four cytopathologists unaware of the previous diagnoses. Each cytopathologist rendered a diagnosis according to the Paris System categories. Agreement was assessed using absolute agreement and weighted chance-corrected agreement (kappa). Disagreements were classified as low impact and high impact based on the potential impact of a misclassification on clinical management. Results: The average absolute agreement was 65% with an average expected agreement of 44%. The average chance-corrected agreement (kappa) was 0.32. Nine hundred and ninety-nine of 1902 comparisons between rater pairs were in agreement, but 12% of comparisons differed by two or more categories for the category NHGUC. Approximately 15% of the disagreements were classified as high clinical impact. Conclusions: Our findings indicated that the scheme recommended by the Paris System shows adequate precision for the category NHGUC, but the other categories demonstrated unacceptable interobserver variability. This low level of diagnostic precision may negatively impact the applicability of the Paris System for widespread clinical application.
      Citation: CytoJournal 2017 14(1):17-17
      PubDate: Mon,24 Jul 2017
      DOI: 10.4103/cytojournal.cytojournal_12_17
      Issue No: Vol. 14, No. 1 (2017)
       
  • A diagnostically difficult case of a cellular pleural fluid: Morphology,
           immunohistochemistry, and fluorescence in situ hybridization study

    • Authors: Minhua Wang, Shabnam Samankan, Amarpreet Bhalla, N Paul Ohori, Nora K Frisch
      Pages: 18 - 18
      Abstract: Minhua Wang, Shabnam Samankan, Amarpreet Bhalla, N Paul Ohori, Nora K Frisch
      CytoJournal 2017 14(1):18-18

      Citation: CytoJournal 2017 14(1):18-18
      PubDate: Mon,24 Jul 2017
      DOI: 10.4103/cytojournal.cytojournal_54_16
      Issue No: Vol. 14, No. 1 (2017)
       
  • Metastatic urachal carcinoma in bronchial brush cytology

    • Authors: Fatima Zahra Aly, Abeer Z Tabbarah, Lysandra Voltaggio
      Pages: 1 - 1
      Abstract: Fatima Zahra Aly, Abeer Z Tabbarah, Lysandra Voltaggio
      CytoJournal 2013 10(1):1-1
      Urachal carcinoma is rare comprising less than 1% of all bladder carcinomas. Metastases of urachal carcinoma have been reported to meninges, brain, ovary, lung, and maxilla. Cytologic features of metastatic urachal carcinoma have not been previously reported. We present a case of metastatic urachal adenocarcinoma in bronchial brushings and review the use of immunohistochemistry in its diagnosis. A 47-year-old female was seen initially in 2007 with adenocarcinoma of the bladder dome for which she underwent partial cystectomy. She presented in 2011 with a left lung mass and mediastinal adenopathy. Bronchoscopy showed an endobronchial lesion from which brushings were obtained. These showed numerous groups of columnar cells with medium sized nuclei and abundant cytoplasm. The cells were positive for CK20 and CDX2 and negative for CK7. The cytomorphological findings were similar to those in the previous resection specimen and concurrent biopsy. This is the first case report of bronchial brushings containing metastatic urachal carcinoma. No specific immunohistochemical profile is available for its diagnosis. The consideration of a second primary was a distinct possibility in this case due to the lapse of time from primary resection, absence of local disease, and lack of regional metastases.
      Citation: CytoJournal 2013 10(1):1-1
      PubDate: Thu,31 Jan 2013
      DOI: 10.4103/1742-6413.106684
      Issue No: Vol. 10, No. 1 (2013)
       
  • Oncocytic follicular nodules of the thyroid with or without chronic
           lymphocytic thyroiditis: An institutional experience

    • Authors: Sule Canberk, A Carruth Griffin, Abha Goyal, He Wang, Kathleen Montone, Virginia LiVolsi, Zubair Baloch
      Pages: 2 - 2
      Abstract: Sule Canberk, A Carruth Griffin, Abha Goyal, He Wang, Kathleen Montone, Virginia LiVolsi, Zubair Baloch
      CytoJournal 2013 10(1):2-2
      Background : Oncocytic follicular (OF) cells can be a prominent component of fine needle aspiration (FNA) specimens from neoplasms (adenomas and carcinomas) and nodules arising in multinodular goiter and chronic lymphocytic thyroiditis (CLT). Because OF cells can be present in non-neoplastic and neoplastic thyroid lesions it can be challenging to differentiate between these two in FNA specimens. The aims of this study were to determine the risk of malignancy in cases diagnosed as either oncocytic follicular neoplasm (OFN) or hyperplastic/adenomatoid nodule with OF on FNA and to identify clinicopathologic features that may help in predicting malignancy in such cases, especially the presence or absence of CLT. Design : We retrospectively searched the computerized laboratory information system at our institution between 1998 and 2009 for thyroid US guided FNA specimens in which the term "oncocytic/oncocytes" was mentioned in the final cytopathologic diagnosis. A total of 340 cases were selected for this study. The following data points were collected: Patient demographics, site of thyroid biopsy, size of lesion, FNA diagnosis, histopathologic follow-up and presence of CLT. Surgical pathology follow-up (SPFU) was available in 269 (79%) cases. Results : Two hundred and sixty patients were females and 80 males (average age 53 years). The lesion size was
      Citation: CytoJournal 2013 10(1):2-2
      PubDate: Thu,31 Jan 2013
      DOI: 10.4103/1742-6413.106686
      Issue No: Vol. 10, No. 1 (2013)
       
  • Constructing a modern cytology laboratory: A toolkit for planning and
           design

    • Authors: Janie Roberson, Allison Wrenn, John Poole, Andrew Jaeger, Isam A Eltoum
      Pages: 3 - 3
      Abstract: Janie Roberson, Allison Wrenn, John Poole, Andrew Jaeger, Isam A Eltoum
      CytoJournal 2013 10(1):3-3
      Introduction: Constructing or renovating a laboratory can be both challenging and rewarding. UAB Cytology (UAB CY) recently undertook a project to relocate from a building constructed in 1928 to new space. UAB CY is part of an academic center that provides service to a large set of patients, support training of one cytotechnology program and one cytopathology fellowship training program and involve actively in research and scholarly activity. Our objectives were to provide a safe, aesthetically pleasing space and gain efficiencies through lean processes. Methods: The phases of any laboratory design project are Planning, Schematic Design (SD), Design Development (DD), Construction Documents (CD) and Construction. Lab personnel are most critical in the Planning phase. During this time stakeholders, relationships, budget, square footage and equipment were identified. Equipment lists, including what would be relocated, purchased new and projected for future growth ensure that utilities were matched to expected need. A chemical inventory was prepared and adequate storage space was planned. Regulatory and safety requirements were discussed. Tours and high level process flow diagrams helped architects and engineers understand the laboratory daily work. Future needs were addressed through a questionnaire which identified potential areas of growth and technological change. Throughout the project, decisions were driven by data from the planning phase. During the SD phase, objective information from the first phase was used by architects and planners to create a general floor plan. This was the basis of a series of meetings to brainstorm and suggest modifications. DD brings more detail to the plans with engineering, casework, equipment specifics, finishes. Design changes should be completed at this phase. The next phase, CD took the project from the lab purview into purely technical mode. Construction documents were used by the contractor for the bidding process and ultimately the Construction phase. Results: The project fitted out a total of 9,000 square feet; 4,000 laboratory and 5,000 office/support. Lab space includes areas for Prep, CT screening, sign out and Imaging. Adjacent space houses faculty offices and conferencing facilities. Transportation time was reduced (waste removal) by a Pneumatic Tube System, specimen drop window to Prep Lab and a pass thru window to the screening area. Open screening and prep areas allow visual management control. Efficiencies were gained by ergonomically placing CT Manual and Imaging microscopes and computers in close proximity, also facilitating a paperless workflow for additional savings. Logistically, closer proximity to Surgical Pathology maximized the natural synergies between the areas. Conclusions: Lab construction should be a systematic process based on sound principles for safety, high quality testing, and finance. Our detailed planning and design process can be a model for others undertaking similar projects
      Citation: CytoJournal 2013 10(1):3-3
      PubDate: Thu,28 Feb 2013
      DOI: 10.4103/1742-6413.107983
      Issue No: Vol. 10, No. 1 (2013)
       
  • Micropapillary urothelial carcinoma: Cytologic features in a retrospective
           series of urine specimens

    • Authors: Jonas John Heymann, Anjali Saqi, Andrew Thomas Turk, John Crapanzano
      Pages: 4 - 4
      Abstract: Jonas John Heymann, Anjali Saqi, Andrew Thomas Turk, John Crapanzano
      CytoJournal 2013 10(1):4-4
      Background : The micropapillary variant of urothelial carcinoma (uPC) is a rare variant of urothelial carcinoma that carries a poor prognosis. Definitive surgery may represent optimal management of low stage tumors. Urine cytology is indispensable in the screening and follow-up of urinary tract cancer. However, cytopathological criteria for diagnosis of uPC and its differentiation from conventional urothelial carcinoma (CUC) are not well-defined. Materials and Methods : Twenty-five cases of histologically confirmed micropapillary uPC from 21 patients were compared to 25 cases of histologically confirmed high-grade CUC. Results : In uPC cases, cell clusters were identified in 13 of 25 specimens from 10 patients. Six of the 13 specimens containing cell clusters corresponded to surgical pathology specimens in which micropapillary carcinoma accounted for at least 50% of total carcinoma. In contrast, only 1 of the 12 urine specimens devoid of cell clusters corresponded to surgical specimens in which micropapillary carcinoma accounted for at least 50% of total carcinoma. Cytomorphologic features of urinary specimens from patients with histologically confirmed micropapillary carcinoma were generally similar to those from patients with high-grade CUC, making it difficult to distinguish these entities in exfoliative urine specimens. Conclusions and Summary : Further investigation of the core cytopathological characteristics of uPC is warranted to refine its diagnostic criteria by exfoliative urine cytology.
      Citation: CytoJournal 2013 10(1):4-4
      PubDate: Thu,28 Feb 2013
      DOI: 10.4103/1742-6413.107986
      Issue No: Vol. 10, No. 1 (2013)
       
  • Fine needle aspiration cytology in diagnosis of salivary gland lesions: A
           study with histologic comparison

    • Authors: Ritu Jain, Ruchika Gupta, Madhur Kudesia, Sompal Singh
      Pages: 5 - 5
      Abstract: Ritu Jain, Ruchika Gupta, Madhur Kudesia, Sompal Singh
      CytoJournal 2013 10(1):5-5
      Objectives: Fine needle aspiration cytology (FNAC) has been employed in pre-operative diagnosis of salivary gland lesions for many years. Various studies in the existing literature have shown a wide range of sensitivity and diagnostic accuracy of cytologic diagnosis. This study was aimed at evaluating salivary gland FNAC for sensitivity, specificity and diagnostic accuracy at a tertiary care center. Materials and Methods: This study included 80 patients who underwent pre-operative FNAC followed by surgical procedure and histologic examination. The histologic diagnosis was considered as the gold standard. FNAC diagnosis was compared with the final histologic impression and concordance assessed. Sensitivity, specificity and diagnostic accuracy of FNAC for malignant lesions were calculated. Results: Of the 80 cases, majority (67.5%) involved the parotid gland. Eight cases (10%) were non-neoplastic lesions, comprised of sialadenitis, retention cyst and sialadenosis. Of a total of 72 neoplasms, 58 were benign and 14 were malignant salivary gland tumors. A cyto-histologic concordance of benign diagnosis was achieved in 85.7% of cases and for malignant lesions in 92.8% of the malignant tumors. FNAC showed a sensitivity of 92.8%, specificity of 93.9%, a positive predictive value of 81.2% and negative predictive value of 98.4% for malignant salivary gland tumors. There was one false-negative diagnosis and four false-positive cases diagnosed on FNAC. Conclusion: FNAC continues to be a reliable diagnostic technique in hands of an experienced cytopathologist. The sensitivity of diagnosis of malignant lesions is high, though the rate of tumor type-specific characterization is lower, due to variable cytomorphology. In difficult cases, histologic examination may be employed for accurate diagnosis.
      Citation: CytoJournal 2013 10(1):5-5
      PubDate: Mon,25 Mar 2013
      DOI: 10.4103/1742-6413.109547
      Issue No: Vol. 10, No. 1 (2013)
       
  • Effect of Thin Prep® imaging system on laboratory rate and relative
           sensitivity of atypical squamous cells, high-grade squamous
           intraepithelial lesion not excluded and high-grade squamous
           intraepithelial lesion interpretations

    • Authors: Brooke R Koltz, Donna K Russell, Naiji Lu, Thomas A Bonfiglio, Sharlin Varghese
      Pages: 6 - 6
      Abstract: Brooke R Koltz, Donna K Russell, Naiji Lu, Thomas A Bonfiglio, Sharlin Varghese
      CytoJournal 2013 10(1):6-6
      Introduction: Automated screening of Thin Prep ® Papanicolaou Tests has become increasingly common in clinical practice. Increased productivity has initiated laboratory use of the Thin Prep ® Imaging System (TIS). Increased sensitivity is a potential additional benefit of TIS. Published studies have shown an increase in discovery of dysplastic cells. This study evaluates the effect of TIS on the incidence of atypical squamous cells high-grade squamous intraepithelial lesion not excluded (ASC-H) and high-grade squamous intraepithelial lesion (HGSIL) results on Thin Prep ® Pap Tests by comparing TIS-assisted and manual screening findings and the diagnoses on subsequent follow-up in a screening population over a 1-year time period. Materials and Methods: A compilation of all ASC-H and HGSIL cases was prepared by conducting a computerized search over a 1-year period (7/06-6/07). The accumulated cases include Thin Prep Pap tests that were both TIS and manually screened. Follow-up results of cytologic and histologic cervical specimens were obtained for a time period extending to 2010. Interpretation utilizing TIS was in place 10 months prior to the study's initiation. Results: During the study period 70,522 Pap tests were performed in our laboratory. One third (33%) of Pap tests were screened with assistance of TIS. Manual screening was performed on 47,380 Pap tests of which 153 (0.32%) were interpreted as ASC-H and 164 (0.35%) were interpreted as HGSIL. During the same time period automated screening (TIS) was performed on 23,111 Pap tests. Interpretation of 62 (0.27%) cases provided an ASC-H result, while 71 (0.31%) were HGSIL. Follow-up cervical dysplasia by colposcopic biopsy and cone biopsy was distributed proportionally between TIS and manual screening for both ASC-H and HGSIL categories. Cervical intraepithelial neoplasia (CIN II/III) was identified on follow-up biopsy of 41% TIS cases and 45% manually screened cases for ASC-H. In the HGSIL subset 71% of TIS cases and 69% manually screened cases showed CIN II/III on follow-up. TIS was 26% less sensitive relative to manual screening for ASC-H cases and 3% less sensitive for HGSIL. Conclusion: The similar rate of detection using TIS with an equal percentage of histologic correlation for ASC-H and HGSIL lesions on follow-up histology suggests patients screened by the TIS method are being sent for appropriate follow-up surveillance and treatment. A high-grade or possible high-grade lesion is as likely to be detected by TIS as by a manual screen. The similarities in relative sensitivity and specificity in a direct comparison between manual and TIS screening methodologies indicate that TIS compared to manual screening does not affect detection in patients with high-grade cervical lesions.
      Citation: CytoJournal 2013 10(1):6-6
      PubDate: Sat,30 Mar 2013
      DOI: 10.4103/1742-6413.109720
      Issue No: Vol. 10, No. 1 (2013)
       
  • Abdominopelvic washings: A comprehensive review

    • Authors: Erika F Rodriguez, Sara E Monaco, Walid Khalbuss, R Marshall Austin, Liron Pantanowtiz
      Pages: 7 - 7
      Abstract: Erika F Rodriguez, Sara E Monaco, Walid Khalbuss, R Marshall Austin, Liron Pantanowtiz
      CytoJournal 2013 10(1):7-7
      Intraperitoneal spread may occur with gynecological epithelial neoplasms, as well as with non-gynecological malignancies, which may result in serosal involvement with or without concomitant effusion. Therefore, washings in patients with abdominopelvic tumors represent important specimens for cytologic examination. They are primarily utilized for staging ovarian cancers, although their role has decreased in staging of endometrial and cervical carcinoma. Abdominopelvic washings can be positive in a variety of pathologic conditions, including benign conditions, borderline neoplastic tumors, locally invasive tumors, or distant metastases. In a subset of cases, washings can be diagnostically challenging due to the presence of co-existing benign cells (e.g., mesothelial hyperplasia, endosalpingiosis, or endometriosis), lesions in which there is only minimal atypia (e.g., serous borderline tumors) or scant atypical cells, and the rarity of specific tumor types (e.g., mesothelioma). Ancillary studies including immunocytochemistry and fluorescence in situ hybridization may be required in difficult cases to resolve the diagnosis. This article provides a comprehensive and contemporary review of abdominopelvic washings in the evaluation of gynecologic and non-gynecologic tumors, including primary peritoneal and mesothelial entities.
      Citation: CytoJournal 2013 10(1):7-7
      PubDate: Wed,24 Apr 2013
      DOI: 10.4103/1742-6413.111080
      Issue No: Vol. 10, No. 1 (2013)
       
  • Cytomorphology of Boerhaave's syndrome: A critical value in
           cytology

    • Authors: Walid E Khalbuss, Shveta Hooda, Manon Auger
      Pages: 8 - 8
      Abstract: Walid E Khalbuss, Shveta Hooda, Manon Auger
      CytoJournal 2013 10(1):8-8
      Spontaneous esophageal perforation into the pleural cavity (Boerhaave's syndrome) is a rare life-threatening condition, which requires early diagnosis and urgent management. The diagnosis of such critical condition in many cases is delayed because of atypical clinical presentation, resulting in increased morbidity and mortality. Cytological examination of pleural fluid can provide early, fast and accurate diagnosis of such critical condition and help in better and early management of this disease. We describe a case of an 81-year-old female with esophageal perforation who presented with a left sided pleural effusion. The correct diagnosis was established in this case by observing gastrointestinal-like fluid characteristics of the thoracic drainage upon cytological and chemical analyses and the rupture was confirmed by esophagography. The cytological examination of pleural fluid revealed benign reactive squamous cells, fungal organisms, bacterial colonies, and vegetable material consistent with a ruptured esophagus. Cytological examination of pleural fluid is a rapid and accurate technique that can help in establishing the diagnosis of this challenging entity and guide initiation proper management of this unusual entity.
      Citation: CytoJournal 2013 10(1):8-8
      PubDate: Tue,30 Apr 2013
      DOI: 10.4103/1742-6413.111811
      Issue No: Vol. 10, No. 1 (2013)
       
  • Metastatic colorectal adenocarcinoma in cervicovaginal cytology specimens
           confirmed by immunocytochemical stains on liquid base specimens: Two study
           cases with review of the literature

    • Authors: Muhammad Zulfiqar, Susan Liu, Dongping Shi, Shashi Madan, Suzanne Jacques, Laquita King, Vinod Shidham, Tamar Giorgadze
      Pages: 9 - 9
      Abstract: Muhammad Zulfiqar, Susan Liu, Dongping Shi, Shashi Madan, Suzanne Jacques, Laquita King, Vinod Shidham, Tamar Giorgadze
      CytoJournal 2013 10(1):9-9
      Only a few cases of adenocarcinoma (ACA) metastatic to the female lower genital tract diagnosed on cervicovaginal Pap smear have been reported during the past several decades. Both conventional and liquid based cytology (LBC) have limited sensitivity and specificity in diagnosing metastatic disease and immunocytochemical (ICC) staining may be needed for confirming the diagnosis. We present two cases of metastatic colorectal ACA diagnosed on cervicovaginal ThinPrep (TP) Pap smears, with one confirmed by ICC staining method. Recognition of extra-uterine malignancy in the cervicovaginal cytology specimen is critical for the disease diagnosis, prognosis, and the treatment. ICC staining performed on the residual LBC specimen is an important methodology to confirm the diagnosis.
      Citation: CytoJournal 2013 10(1):9-9
      PubDate: Mon,20 May 2013
      DOI: 10.4103/1742-6413.112297
      Issue No: Vol. 10, No. 1 (2013)
       
  • Performance of endoscopic ultrasound-guided fine needle aspiration in
           diagnosing pancreatic neuroendocrine tumors

    • Authors: Jane Bernstein, Berrin Ustun, Ahmed Alomari, Fang Bao, Harry R Aslanian, Uzma Siddiqui, David Chhieng, Guoping Cai
      Pages: 10 - 10
      Abstract: Jane Bernstein, Berrin Ustun, Ahmed Alomari, Fang Bao, Harry R Aslanian, Uzma Siddiqui, David Chhieng, Guoping Cai
      CytoJournal 2013 10(1):10-10
      Background: Pancreatic neuroendocrine tumors (PNETs) are rare tumors of the pancreas, which are increasingly diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). In this retrospective study, we assessed the performance of EUS-FNA in diagnosing PNETs. Materials and Methods: We identified 48 cases of surgically resected PNETs in which pre-operative EUS-FNA was performed. The clinical features, cytological diagnoses, and surgical follow-up were retrospectively reviewed. The diagnostic performance of EUS-FNA was analyzed as compared to the diagnosis in the follow-up. The cases with discrepancies between cytological diagnosis and surgical follow-up were analyzed and diagnostic pitfalls in discrepant cases were discussed. Results: The patients were 20 male and 28 female with ages ranging from 15 years to 81 years (mean 57 years). The tumors were solid and cystic in 41 and 7 cases, respectively, with sizes ranging from 0.5 cm to 11 cm (mean 2.7 cm). Based on cytomorphologic features and adjunct immunocytochemistry results, when performed, 38 patients (79%) were diagnosed with PNET, while a diagnosis of "suspicious for PNET" or a diagnosis of "neoplasm with differential diagnosis including PNET" was rendered in the 3 patients (6%). One case was diagnosed as mucinous cystic neoplasm (2%). The remaining 6 patients (13%) had non-diagnostic, negative or atypical diagnosis. Conclusions: Our data demonstrated that EUS-FNA has a relatively high sensitivity for diagnosing PNETs. Lack of additional materials for immunocytochemical studies could lead to a less definite diagnosis. Non-diagnostic or false negative FNA diagnosis can be seen in a limited number of cases, especially in those small sized tumors.
      Citation: CytoJournal 2013 10(1):10-10
      PubDate: Wed,29 May 2013
      DOI: 10.4103/1742-6413.112648
      Issue No: Vol. 10, No. 1 (2013)
       
  • Cytodiagnosis of gouty tophus

    • Authors: Vaishali Walke, Sushma Ramraje, Vinod Jadhao
      Pages: 11 - 11
      Abstract: Vaishali Walke, Sushma Ramraje, Vinod Jadhao
      CytoJournal 2013 10(1):11-11

      Citation: CytoJournal 2013 10(1):11-11
      PubDate: Wed,29 May 2013
      DOI: 10.4103/1742-6413.112649
      Issue No: Vol. 10, No. 1 (2013)
       
  • Gallbladder carcinoma: An attempt of WHO histological classification on
           fine needle aspiration material

    • Authors: Rajni Yadav, Deepali Jain, Sandeep R Mathur, Atul Sharma, Venkateswaran K Iyer
      Pages: 12 - 12
      Abstract: Rajni Yadav, Deepali Jain, Sandeep R Mathur, Atul Sharma, Venkateswaran K Iyer
      CytoJournal 2013 10(1):12-12
      Background: Carcinoma of the gallbladder (CaGB) is common in India and its prognosis depends primarily on the extent of the disease and histological type. We aim to study the role of guided fine needle aspiration cytology (FNAC) for diagnosis of CaGB and to evaluate the feasibility of applying world health organization (WHO) classification on fine needle aspiration (FNA) material to predict the outcome of the tumor. Materials and Methods: Retrospective cytomorphologic analysis was performed in all cases of CaGB diagnosed by ultrasound (US) guided FNAC over a period of 2 years. A specific subtype was assigned according to WHO classification based on characteristic cytologic features. These included papillary or acinar arrangement, intra and extracellular mucin, keratin, rosettes and columnar, signet ring, atypical squamous, small, clear, spindle and giant cells. Correlation with histopathology was performed when available. Results: A total of 541 aspirations with clinical or radiological suspicion of primary CaGB were studied. Of these, 54 aspirates were unsatisfactory. Fifty cases were negative for malignancy. Remaining 437 aspirates were positive for carcinoma. Histopathologic diagnosis was available in 32 cases. Adenocarcinoma was the most frequent diagnosis in 86.7% of cases. Mucinous, signet ring, adenosquamous, squamous, small cell, mixed adenoneuroendocrine and undifferentiated carcinoma including spindle and giant cell subtypes were diagnosed identifying specific features on FNAC. Correlation with histopathology was present in all, but one case giving rise to sensitivity of 96.8%. No post-FNA complications were recorded. Conclusions: US guided FNAC is a safe and effective method to diagnose CaGB. Although, rare, clinically and prognostically significant variants described in WHO classification can be detected on cytology.
      Citation: CytoJournal 2013 10(1):12-12
      PubDate: Tue,18 Jun 2013
      DOI: 10.4103/1742-6413.113627
      Issue No: Vol. 10, No. 1 (2013)
       
  • Cytopathology of neoplastic meningitis: A series of 66 cases from a
           tertiary care center

    • Authors: Gurdeep Singh, Sandeep R Mathur, VK Iyer, Deepali Jain
      Pages: 13 - 13
      Abstract: Gurdeep Singh, Sandeep R Mathur, VK Iyer, Deepali Jain
      CytoJournal 2013 10(1):13-13
      Background: Neoplastic meningitis (NM) is a condition characterized by leptomeningeal involvement by metastatic carcinoma. Detection of exfoliated malignant cells in cerebrospinal fluid (CSF) due to meningeal metastasis is frequently associated with diverse neurologic presentations. Materials and Methods: In this retrospective study of all cases of NM diagnosed in CSF samples over a 20-year period at a tertiary care referral center, the cytomorphologic features were reviewed. Results: Sixty six cases of NM were identified of which 36 already had an established diagnosis of malignancy while in 30 patients, there was no previously known tumor. The most common known primary in the former group was breast followed by ovary. Single cell pattern, cellular cannibalism, moderate cytoplasm and rounded nuclei were seen in breast and lung tumors. Papillary architecture and cytoplasmic vacuolation were seen in the ovarian primaries. Melanin pigment was seen in malignant melanoma. Conclusion: CSF cytology is an important tool for diagnosis of NM. Cytomorphologic features helped in diagnosis and for prediction of the primary site. Correct identification of this condition is important as it has therapeutic and prognostic implications.
      Citation: CytoJournal 2013 10(1):13-13
      PubDate: Sat,29 Jun 2013
      DOI: 10.4103/1742-6413.114212
      Issue No: Vol. 10, No. 1 (2013)
       
  • High risk human papillomavirus type 16 and 18 infection in the cervical
           lesions of women with epithelial cell abnormality in Pap smear: A
           cytohistomorphologic association in Bangladeshi women

    • Authors: Urmila Banik, M Shahab Uddin Ahamad, Pradip Bhattacharjee, Arun Kumar Adhikary, Zillur Rahman
      Pages: 14 - 14
      Abstract: Urmila Banik, M Shahab Uddin Ahamad, Pradip Bhattacharjee, Arun Kumar Adhikary, Zillur Rahman
      CytoJournal 2013 10(1):14-14
      Background: The aim of this study was to find out the extent of high-risk human papillomavirus (hrHPV) type 16/18 infection in the cervical tissue of women with epithelial cell abnormality in Pap smear and to establish an association between hrHPV type 16/18 infection and cytohistomorphology. Materials and Methods: A cross-sectional descriptive study was carried out in 1699 patients who went through Pap smear examination. Prevalence of epithelial cell abnormality was calculated. Forty eight of these women underwent routine histopathology and 47 were evaluated for human papillomavirus (HPV) type 16/18 by polymerase chain reaction assay. Results: Total 139 women revealed epithelial cell abnormality. Histopathology showed simple inflammation to malignancy. HPV type 16/18 infection was detected in 40.42% (19/47) of the patients. Individually type 16 and 18 were positive in 7 (14.9%) cases each and dual infection with type 16 and 18 were seen in 5 (10.6%) cases. While cervical intraepithelial neoplasia grade 1 (CIN 1) and < CIN 1 lesions showed 18.75% (3 out of 16) and 35% (7 out of 20) positivity respectively, ≥CIN 2 lesions revealed positivity of 81.82% (9 out of 11). Eighty percent HPV 16/18 positivity was seen in women of < 30 years of age. Conclusion: The findings of this study will contribute to HPV 16/18 knowledge in Bangladesh that will be useful in assessing the success of current vaccines with limited type spectra and augmenting cervical cancer screening strategies.
      Citation: CytoJournal 2013 10(1):14-14
      PubDate: Tue,16 Jul 2013
      DOI: 10.4103/1742-6413.115088
      Issue No: Vol. 10, No. 1 (2013)
       
  • Indications for renal fine needle aspiration biopsy in the era of modern
           imaging modalities

    • Authors: Ema A Dragoescu, Lina Liu
      Pages: 15 - 15
      Abstract: Ema A Dragoescu, Lina Liu
      CytoJournal 2013 10(1):15-15
      Background: Renal fine needle aspiration biopsy (FNAB) has become an uncommon procedure in the era of renal helical computed tomography (CT), which has high diagnostic accuracy in the characterization of renal cortical lesions. This study investigates the current indications for renal FNAB. Having knowledge of the specific clinico-radiologic scenario that led to the FNAB, cytopathologists are better equipped to expand or narrow down their differential diagnosis. Materials and Methods: All renal FNABs performed during a 6 year interval were retrieved. Indication for the procedure was determined from the clinical notes and radiology reports. Results: Forty six renal FNABs were retrieved from 43 patients (14 females and 29 males with a mean age of 52 years [range, 4-81 years]). Twenty one cases (45.6%) were performed under CT-guidance and 25 cases (54.4%) under US-guidance. There were four distinct indications for renal FNAB: (1) solid renal masses with atypical radiological features or poorly characterized on imaging studies due to lack of intravenous contrast or body habitus (30.2%); (2) confirmation of radiologically suspected renal cell carcinoma in inoperable patients (advanced stage disease or poor surgical candidate status) (27.9%); (3) kidney mass in a patient with a prior history of other malignancy (27.9%); and (4) miscellaneous (drainage of abscess, indeterminate cystic lesion, urothelial carcinoma) (14.0%). 36 patients (83.7%) received a specific diagnosis based on renal FNAB cytology. Conclusions: Currently, renal fine needle aspiration remains a useful diagnostic tool in selected clinico-radiologic scenarios.
      Citation: CytoJournal 2013 10(1):15-15
      PubDate: Tue,16 Jul 2013
      DOI: 10.4103/1742-6413.115093
      Issue No: Vol. 10, No. 1 (2013)
       
  • Macrofollicular variant of papillary carcinoma, a potential diagnostic
           pitfall: A report of two cases including a review of literature

    • Authors: Maria Luisa C Policarpio-Nicolas, Deepika Sirohi
      Pages: 16 - 16
      Abstract: Maria Luisa C Policarpio-Nicolas, Deepika Sirohi
      CytoJournal 2013 10(1):16-16
      Macrofollicular variant of papillary thyroid carcinoma (MFVPTC) is one of the rarest histologic types of papillary carcinoma. This tumor may mimic an adenomatoid/colloid nodule or follicular neoplasm (macrofollicular type) both on histology and cytology. There are very few articles describing the cytologic features of MFVPTC. We report the cytologic findings of two surgically confirmed MFVPTC. The first case showed abundant thin colloid with moderate amount of follicular cells arranged in a honeycombed and syncytial pattern. Some but not all the follicular cells showed enlarged round to ovoid nuclei, overlapping nuclei, few nuclear grooves and rare intranuclear inclusions. The second case showed abundant thin colloid and predominantly benign appearing follicular cells with few overlapping nuclei, enlarged round to ovoid nuclei and rare nuclear grooves. No intranuclear inclusions were identified. A review of the literature was done and the cytologic findings of MFVPTC including our two cases were tabulated. The cytologic findings showed moderate to abundant thin with focally thick colloid in 75% of cases and sheet like arrangement of follicular cells in 76%. Although nuclear features such as chromatin clearing, overlapping and grooves were present in majority of cases, the quantity varied from rare to focal. Small to prominent nucleoli were present in all of the evaluable cases. Intranuclear inclusions were seen only in 45% of patients. Hence, the cytologic features of macrofollicular variant of papillary carcinoma though present can be subtle and intranuclear inclusions may not be present always.
      Citation: CytoJournal 2013 10(1):16-16
      PubDate: Fri,30 Aug 2013
      DOI: 10.4103/1742-6413.117352
      Issue No: Vol. 10, No. 1 (2013)
       
  • Cytomorphology of unusual primary tumors in the Pap test

    • Authors: Walid E Khalbuss, Liron Pantanowitz, Sara E Monaco
      Pages: 17 - 17
      Abstract: Walid E Khalbuss, Liron Pantanowitz, Sara E Monaco
      CytoJournal 2013 10(1):17-17
      Rare entities in the Pap test, which include neoplastic and non-neoplastic conditions, pose challenges due to the infrequent occurrence of many of these entities in the daily practice of cytology. Furthermore, these conditions give rise to important diagnostic pitfalls to be aware of in the Pap test. For example, cases with adenoma malignum (AM) have been called benign. Recognition of these conditions can help correctly interpret Pap tests as abnormal and thereby ensure that patients get appropriately diagnosed. In this paper, we illustrate and discuss selected uncommon primary neoplastic lesions of the cervix and the vagina that may be seen in Pap test, with a focus on cytomorphology, differential diagnosis and the role of possible ancillary studies. These cases include high-grade squamous intraepithelial lesion cells with small cell morphology; small cell carcinoma; large neuroendocrine carcinoma; glassy cell carcinoma; AM; malignant mixed Müllerian tumor; clear cell carcinoma and primary malignant melanoma. Recognition of these rare variants/neoplasms is important so that involved Pap tests are not diagnosed as benign and that patients with these conditions get additional follow-up.
      Citation: CytoJournal 2013 10(1):17-17
      PubDate: Fri,30 Aug 2013
      DOI: 10.4103/1742-6413.117356
      Issue No: Vol. 10, No. 1 (2013)
       
  • Announcement of first time Cytojournal impact factor for 2012 coincides
           with Cytojournal decade celebration (2004-2013)

    • Authors: Vinod B Shidham, Richard M DeMay
      Pages: 18 - 18
      Abstract: Vinod B Shidham, Richard M DeMay
      CytoJournal 2013 10(1):18-18

      Citation: CytoJournal 2013 10(1):18-18
      PubDate: Fri,30 Aug 2013
      DOI: 10.4103/1742-6413.117359
      Issue No: Vol. 10, No. 1 (2013)
       
  • Can cytomorphology of granulomas distinguish sarcoidosis from
           tuberculosis? Retrospective study of endobronchial ultrasound guided
           transbronchial needle aspirate of 49 granulomatous lymph nodes

    • Authors: Gagandeep Kaur, Amit Dhamija, Jolsana Augustine, Pooja Bakshi, Kusum Verma
      Pages: 19 - 19
      Abstract: Gagandeep Kaur, Amit Dhamija, Jolsana Augustine, Pooja Bakshi, Kusum Verma
      CytoJournal 2013 10(1):19-19
      Background: The differential diagnosis of tuberculosis (TB) and sarcoidosis on fine needle aspiration material is very challenging in tubercular endemic regions. We carried out a pilot study to explore cytomorphologic features of granulomas which could help in differentiation between sarcoidosis and TB. Final diagnoses in these patients were based on clinical, microbiologic and follow-up studies. Materials and Methods: Endobronchial ultrasound guided transbronchial needle aspiration smears of 49 consecutive patients with a final cytologic diagnosis of granulomatous lymphadenitis were reviewed. Based on cytologic features two cytologic categories were enunciated and the results were correlated with microbiologic studies and/follow-up of minimum of 6 months. Results: The cytologic categories did not correlate with the final clinical outcome of patients. Conclusions: Different patterns of granulomas observed in cytology smears do not help distinguish TB from sarcoidosis. The novel non-invasive techniques of mediastinal sampling though help in confirming granulomatous pathology, distinction between these entities and treatment decisions still depend upon correlating cytologic, microbiologic, clinical and radiological data in a large number of cases in tubercular endemic regions.
      Citation: CytoJournal 2013 10(1):19-19
      PubDate: Fri,27 Sep 2013
      DOI: 10.4103/1742-6413.119008
      Issue No: Vol. 10, No. 1 (2013)
       
  • Bone marrow elements in cerebrospinal fluid: Review of literature with a
           case study

    • Authors: Anitha Ann Thomas, Felicia Tze Yee Goh
      Pages: 20 - 20
      Abstract: Anitha Ann Thomas, Felicia Tze Yee Goh
      CytoJournal 2013 10(1):20-20
      Presence of bone marrow elements in cerebrospinal fluid is rare. Journal publications on this topic are few and majority of them were written over a decade ago mostly as case reports in young children or the elderly. The increased cellularity and presence of myeloid precursors can be a pitfall and may be misdiagnosed as leukemia or lymphoma or central nervous system infection, when the specimen is actually not representative. With the intention to create awareness of potential pitfalls and avoid erroneous diagnoses, as well as adding on to the current photo archive of bone marrow elements in CSF, we present a recent case of bone marrow contaminants in the CSF of a 16-year-old girl.
      Citation: CytoJournal 2013 10(1):20-20
      PubDate: Fri,27 Sep 2013
      DOI: 10.4103/1742-6413.119009
      Issue No: Vol. 10, No. 1 (2013)
       
  • Adequacy of fine-needle aspiration specimens for human papillomavirus
           infection molecular testing in head and neck squamous cell carcinoma

    • Authors: Ricardo R Lastra, Michelle R Pramick, Megan O Nakashima, Gregory S Weinstein, Kathleen T Montone, Virginia A LiVolsi, Zubair W Baloch
      Pages: 21 - 21
      Abstract: Ricardo R Lastra, Michelle R Pramick, Megan O Nakashima, Gregory S Weinstein, Kathleen T Montone, Virginia A LiVolsi, Zubair W Baloch
      CytoJournal 2013 10(1):21-21
      Background: Head and neck squamous cell carcinoma is often associated with human papillomavirus (HPV) infection. Positive HPV status has been associated with increased response to treatment and improved prognosis in terms of recurrence-free and overall survival. In certain instances, diagnosis is performed through fine-needle aspiration of lymph nodes with metastatic carcinoma, often demonstrating extensive tumor necrosis. We evaluated the effect of tumor necrosis on deoxyribonucleic acid (DNA) adequacy for HPV molecular testing. Materials and Methods: Retrospective review of the pathology files at our institution identified cases of squamous cell carcinoma (SCC) diagnosed by fine-needle aspiration (FNA) on which HPV DNA molecular testing was performed. The cases were classified according to percent tumor necrosis into three categories (70% necrosis) and the percentage of cases with adequate HPV DNA for molecular testing in each of the categories was compared. When available, p16 immunohistochemistry performed on the cases was compared with HPV status by molecular testing. Results: A total of 70 cases from 67 patients were included in the study. Adequate DNA for molecular HPV testing was obtained from samples of 47 cases (67%) while samples from 23 cases (33%) were inadequate for molecular testing. Of the adequate samples, 36 (77%) were positive and 11 (23%) were negative for high-risk HPV. Adequate DNA for testing was obtained in 22 out of 33 cases showing no necrosis (67%), 10 out of 16 cases showing partial necrosis (63%) and in 13 out of 17 cases showing extensive necrosis (76%). Conclusion: Our study found that HPV molecular testing is not influenced by percent tumor necrosis or method by which FNA was performed. We believe that a portion of the FNA specimen obtained from head and neck lesions diagnosed as SCC during the rapid on-site evaluation should be sent for HPV DNA testing, independent of the amount of tumor necrosis, thus guaranteeing availability of specimen for HPV testing.
      Citation: CytoJournal 2013 10(1):21-21
      PubDate: Tue,29 Oct 2013
      DOI: 10.4103/1742-6413.120789
      Issue No: Vol. 10, No. 1 (2013)
       
  • Screening and dotting virtual slides: A new challenge for
           cytotechnologists

    • Authors: Walid E Khalbuss, Jackie Cuda, Ioan C Cucoranu
      Pages: 22 - 22
      Abstract: Walid E Khalbuss, Jackie Cuda, Ioan C Cucoranu
      CytoJournal 2013 10(1):22-22
      Digital images are increasingly being used in cytopathology. Whole-slide imaging (WSI) is a digital imaging modality that uses computerized technology to scan and convert entire cytology glass slides into digital images that can be viewed on a digital display using the image viewer software. Digital image acquisition of cytology glass slides has improved significantly over the years due to the use of liquid-based preparations and advances in WSI scanning technology such as automatic multipoint pre-scan focus technology or z-stack scanning technology. Screening cytotechnologists are responsible for every cell that is present on an imaged slide. One of the challenges users have to overcome is to establish a technique to review systematically the entire imaged slide and to dot selected abnormal or significant findings. The scope of this article is to review the current user interface technology available for virtual slide navigation when screening digital slides in cytology. WSI scanner vendors provide tools, built into the image viewer software that allow for a more systematic navigation of the virtual slides, such as auto-panning, keyboard-controlled slide navigation and track map. Annotation tools can improve communication between the screener and the final reviewer or can be used for education. The tracking functionality allows recording of the WSI navigation process and provides a mechanism for confirmation of slide coverage by the screening cytotechnologist as well as a useful tool for quality assurance. As the WSI technology matures, additional features and tools to support navigation of a cytology virtual slide are anticipated.
      Citation: CytoJournal 2013 10(1):22-22
      PubDate: Wed,30 Oct 2013
      DOI: 10.4103/1742-6413.120790
      Issue No: Vol. 10, No. 1 (2013)
       
  • Protein extraction from methanol fixed paraffin embedded tissue blocks: A
           new possibility using cell blocks

    • Authors: Theresa J Kokkat, Diane McGarvey, Miral S Patel, Andrew D Tieniber, Virginia A LiVolsi, Zubair W Baloch
      Pages: 23 - 23
      Abstract: Theresa J Kokkat, Diane McGarvey, Miral S Patel, Andrew D Tieniber, Virginia A LiVolsi, Zubair W Baloch
      CytoJournal 2013 10(1):23-23
      Background: Methanol fixed and paraffin embedded (MFPE) cellblocks are an essential cytology preparation. However, MFPE cellblocks often contain limited material and their relatively small size has caused them to be overlooked in biomarker discovery. Advances in the field of molecular biotechnology have made it possible to extract proteins from formalin fixed and paraffin embedded (FFPE) tissue blocks. In contrast, there are no established methods for extracting proteins from MFPE cellblocks. We investigated commonly available CHAPS (3-[(3-cholamidopropyl) dimethylammonio]-1-propanesulfonate) buffer, as well as two commercially available Qiagen ® kits and compared their effectiveness on MFPE tissue for protein yields. Materials and Methods: MFPE blocks were made by Cellient™ automated system using human tissue specimens from normal and malignant specimens collected in ThinPrep™ Vials. Protein was extracted from Cellient-methanol fixed and paraffin embedded blocks with CHAPS buffer method as well as FFPE and Mammalian Qiagen ® kits. Results: Comparison of protein yields demonstrated the effectiveness of various protein extraction methods on MFPE cellblocks. Conclusion: In the current era of minimally invasive techniques to obtain minimal amount of tissue for diagnostic and prognostic purposes, the use of commercial and lab made buffer on low weight MFPE scrapings obtained by Cellient ® processor opens new possibilities for protein biomarker research.
      Citation: CytoJournal 2013 10(1):23-23
      PubDate: Thu,28 Nov 2013
      DOI: 10.4103/1742-6413.122299
      Issue No: Vol. 10, No. 1 (2013)
       
  • Pre-analytic steps for molecular testing on thyroid fine-needle
           aspirations: The goal of good results

    • Authors: Esther Diana Rossi, Fernando Schmitt
      Pages: 24 - 24
      Abstract: Esther Diana Rossi, Fernando Schmitt
      CytoJournal 2013 10(1):24-24
      Fine-needle aspiration cytology (FNAC) represents a valid alternative to biopsy in a variety of clinical settings mainly based on its simplicity and less invasive clinical approach. In some cases, morphology evaluation alone is not sufficient to manage the patients, so that the application of ancillary techniques can contribute to diagnosis, prognosis and prediction of tumor behavior. These techniques include polymerase chain reaction (PCR), fluorescence in situ hybridization (FISH), in situ PCR, direct Sequencing, microarrays and proteomic methodologies. Although several recent experiences underline the superior value of deoxyribonucleic acid (DNA) quality mainly for advanced genomic high throughput platforms, very scant literature studied the role of the pre-analytical or analytical phases. Despite the high specificity of molecular techniques as a support for diagnosis, there is a need for an increased standardization of pre-analytical/analytical steps such as providing appropriate clinical history, proper collection of laboratory specimens and proper preparation of samples, adequate fixative/reagent concentrations and technical equipments. All these requirements are crucial according to the results from 42 American laboratories, which reported 0.33% of significant molecular errors with 60% of them in the pre-analytical phase. The most common error is to forget that cytological preparation requires specific molecular variables, which are different from histological specimens. Cytological samples offer the advantage of a well preserved DNA, readily extractable and reasonably stable (from 6 months to 5 years) avoiding pitfalls due to formalin-fixation. Freshly prepared, unstained direct, alcohol-fixed papanicolaou, air-dried diff-quick smears are all suitable for DNA extraction and preservation. In the specific field of thyroid FNAC, molecular analysis has been supported by the growing evidence that papillary thyroid carcinoma (PTC), the most common thyroid cancer, frequently is a diploid lesion and can display non-overlapping mutations of the v-Raf murine sarcoma viral oncogene homolog B1 (BRAF) in 46% to 70%, cases, ret proto-oncogene (RET) in 3 to 85% and Rat Sarcoma oncogene (RAS) in 0-21% cases. Recently, several cytological papers demonstrated that the combination of morphology and molecular analysis can increase the diagnostic accuracy allowing more precise prediction of malignancy regardless of the diagnostic categories. In conclusion, the correct use of the pre-analytical-analytical steps might lead to optimal results on cytology and empower the prognostic value of molecular techniques as strong indicators of cancer for their high specificity and positive predictive value.
      Citation: CytoJournal 2013 10(1):24-24
      PubDate: Thu,28 Nov 2013
      DOI: 10.4103/1742-6413.122300
      Issue No: Vol. 10, No. 1 (2013)
       
  • Evaluation of a triple combination of cytokeratin 20, p53 and CD44 for
           improving detection of urothelial carcinoma in urine cytology specimens

    • Authors: Brent Arville, Emily O'Rourke, Fai Chung, Mahul Amin, Shikha Bose
      Pages: 25 - 25
      Abstract: Brent Arville, Emily O'Rourke, Fai Chung, Mahul Amin, Shikha Bose
      CytoJournal 2013 10(1):25-25
      Background: Atypical urine cytology results trigger cystoscopy or molecular tests, both of which are costly, complex and difficult to perform tests. Several immunostains are being investigated to improve cancer detection; however, cytology material is limited and restricts the use of multiple immunostains. This study was designed to determine the utility of a cocktail of three stains, cytokeratin (CK20), p53 and CD44 in urine cytology samples for improving the detection of urothelial carcinoma. Materials and Methods: Urine cytology specimens with cell blocks containing adequate cytologic material between 2005 and 2010 and subsequent follow-up biopsy and/or Urovysion test (102 cases including 29 negative, 56 atypical and 17 malignant) were included in the study and evaluated with the triple stain. Results were first validated on the positive and negative cases and then applied to the atypical cases to determine the utility in the diagnosis of urothelial carcinoma. Results: Based on the validation and published literature, two distinct immunoprofiles were defined - malignant, characterized by at least five CK20 and/or p53 positive atypical cells and reactive, all other staining patterns. The malignant immunoprofile showed 88% sensitivity, 78% specificity, 74% positive predictive value (PPV) and 90% negative predictive value (NPV) for detecting urothelial carcinoma. These values improved to 95% sensitivity and 96% NPV when low-grade urothelial carcinoma cases were excluded. Summary: Our results indicate that the triple stain is an inexpensive, easy to perform test most useful for differentiating high-grade urothelial carcinoma from its mimics. Inclusion of CD44 in the cocktail did not provide additional value and is best excluded.
      Citation: CytoJournal 2013 10(1):25-25
      PubDate: Fri,27 Dec 2013
      DOI: 10.4103/1742-6413.123784
      Issue No: Vol. 10, No. 1 (2013)
       
  • Clear cell variant of solid pseudopapillary neoplasm of pancreas diagnosed
           by fine needle aspiration: A case report and review of the literature

    • Authors: Sule Canberk, Bilge Baskir Elcin, Atay Uludokumaci, Nesrin Uygun, Fatih Gulsen
      Pages: 26 - 26
      Abstract: Sule Canberk, Bilge Baskir Elcin, Atay Uludokumaci, Nesrin Uygun, Fatih Gulsen
      CytoJournal 2013 10(1):26-26
      Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor of uncertain malignant potential, predominantly affecting young adult females. We report a case of clear cell variant of SPN, which was diagnosed by fine needle aspiration biopsy. The aspirate was highly cellular and exhibited delicate branching papillary structures with central capillaries covered with several layers of plasmacytoid tumor cells. Acinar and rosette-like formations, as well as single neoplastic cells were also observed. An unusual cytologic feature was the presence of large, clear cytoplasmic vacuoles. The diagnosis of SPN was confirmed by characteristic immunocytochemical staining pattern including nuclear staining for β-catenin, cytoplasmic staining for vimentin and lack of reactivity for cytokeratin.
      Citation: CytoJournal 2013 10(1):26-26
      PubDate: Fri,27 Dec 2013
      DOI: 10.4103/1742-6413.123785
      Issue No: Vol. 10, No. 1 (2013)
       
  • How to write an article: Preparing a publishable manuscript!

    • Authors: Vinod B Shidham, Martha B Pitman, Richard M DeMay
      Pages: 1 - 1
      Abstract: Vinod B Shidham, Martha B Pitman, Richard M DeMay
      CytoJournal 2012 9(1):1-1
      Most of the scientific work presented as abstracts (platforms and posters) at various conferences have the potential to be published as articles in peer-reviewed journals. This DIY (Do It Yourself) article on how to achieve that goal is an extension of the symposium presented at the 36 th European Congress of Cytology, Istanbul, Turkey (presentation available on net at http://alturl.com/q6bfp). The criteria for manuscript authorship should be based on the ICMJE (International Committee of Medical Journal Editors) Uniform Requirements for Manuscripts. The next step is to choose the appropriate journal to submit the manuscript and review the 'Instructions to the authors' for that journal. Although initially it may appear to be an insurmountable task, diligent organizational discipline with a little patience and perseverance with input from mentors should lead to the preparation of a nearly perfect publishable manuscript even by a novice. Ultimately, the published article is an excellent track record of academic productivity with contribution to the general public good by encouraging the exchange of experience and innovation. It is a highly rewarding conduit to the personal success and growth leading to the collective achievement of continued scientific progress. Recent emergences of journals and publishers offering the platform and opportunity to publish under an open access charter provides the opportunity for authors to protect their copyright from being lost to conventional publishers. Publishing your work on this open platform is the most rewarding mission and is the recommended option in the current modern era. [This open access article can be linked (copy-paste link from HTML version of this article) or reproduced FREELY if original reference details are prominently identifiable].
      Citation: CytoJournal 2012 9(1):1-1
      PubDate: Tue,31 Jan 2012
      DOI: 10.4103/1742-6413.92545
      Issue No: Vol. 9, No. 1 (2012)
       
  • Comparing endobronchial ultrasound-guided fine needle aspiration specimens
           with and without rapid on-site evaluation

    • Authors: Sara E Monaco, Liron Pantanowitz, Walid E Khalbuss
      Pages: 2 - 2
      Abstract: Sara E Monaco, Liron Pantanowitz, Walid E Khalbuss
      CytoJournal 2012 9(1):2-2

      Citation: CytoJournal 2012 9(1):2-2
      PubDate: Tue,31 Jan 2012
      DOI: 10.4103/1742-6413.92414
      Issue No: Vol. 9, No. 1 (2012)
       
  • Authors' Reply

    • Authors: Adrienne Carruth Griffin, Lauren Ende Schwartz, Zubair Baloch
      Pages: 3 - 3
      Abstract: Adrienne Carruth Griffin, Lauren Ende Schwartz, Zubair Baloch
      CytoJournal 2012 9(1):3-3

      Citation: CytoJournal 2012 9(1):3-3
      PubDate: Tue,31 Jan 2012
      DOI: 10.4103/1742-6413.92416
      Issue No: Vol. 9, No. 1 (2012)
       
  • Comparative evaluation of the modified Scarff-Bloom-Richardson grading
           system on breast carcinoma aspirates and histopathology

    • Authors: Cherry Bansal, US Singh, Sanjeev Misra, Kiran Lata Sharma, Vandana Tiwari, AN Srivastava
      Pages: 4 - 4
      Abstract: Cherry Bansal, US Singh, Sanjeev Misra, Kiran Lata Sharma, Vandana Tiwari, AN Srivastava
      CytoJournal 2012 9(1):4-4
      Background: Fine needle aspiration (FNA) is a quick noninvasive procedure to assess in vivo tumor grade. The Scarff-Bloom-Richardson (SBR) grade on histological sections is a well established tool to guide selection of adjuvant systemic therapy. Grade evaluation is possible on cytology smears to avoid and minimize the morbidity associated with overtreatment of lower grade tumors. Aim : The aim was to test the hypothesis whether breast FNA from peripheral portion of the lesion is representative of Scarff-Bloom-Richardson grade and score on histopathology compared to FNA from central portion. Materials and Methods : Fine-needle aspirates and subsequent tumor tissue specimens of 45 women with ductal carcinoma (not otherwise specified) were studied. FNAs were performed under ultrasound guidance from central as well as peripheral (1/3) portion of the lesion for each case avoiding areas of necrosis/calcification. The SBR grading and score were compared on alcohol fixed aspirates and tissue sections for each case. Results : Comparative analysis of SBR grade on aspirates from peripheral portion and histopathology by the Pearson chi-square test (χ2 =78.00) showed that it was statistically significant (P
      Citation: CytoJournal 2012 9(1):4-4
      PubDate: Tue,31 Jan 2012
      DOI: 10.4103/1742-6413.92550
      Issue No: Vol. 9, No. 1 (2012)
       
  • Two smalls in one: Coincident small cell carcinoma and small lymphocytic
           lymphoma in a lymph node diagnosed by fine-needle aspiration biopsy

    • Authors: Alaa Afify, Shweta Das, Chen Mingyi
      Pages: 5 - 5
      Abstract: Alaa Afify, Shweta Das, Chen Mingyi
      CytoJournal 2012 9(1):5-5
      Background: Fine needle aspiration (FNA) is a quick, minimally invasive procedure for evaluation of breast tumors. The Scarff-Bloom-Richardson (SBR) grade on histological sections is a well-established tool to guide selection of adjuvant systemic therapy. Grade evaluation is possible on cytology smears to avoid and minimize the morbidity associated with overtreatment of lower grade tumors. Aim : The aim was to test the hypothesis whether breast FNA from the peripheral portion of the lesion is representative of Scarff-Bloom-Richardson grade on histopathology as compared to FNA from the central portion. Materials and Methods : Fine-needle aspirates and subsequent tissue specimens from 45 women with ductal carcinoma (not otherwise specified) were studied. FNAs were performed under ultrasound guidance from the central as well as the peripheral third of the lesion for each case avoiding areas of necrosis/calcification. The SBR grading was compared on alcohol fixed aspirates and tissue sections for each case. Results : Comparative analysis of SBR grade on aspirates from the peripheral portion and histopathology by the Pearson chi-square test (χ2 =78.00) showed that it was statistically significant (P
      Citation: CytoJournal 2012 9(1):5-5
      PubDate: Sat,25 Feb 2012
      DOI: 10.4103/1742-6413.93280
      Issue No: Vol. 9, No. 1 (2012)
       
  • Fine-needle aspiration cytology of eccrine hidrocystoma

    • Authors: Shelly Sehgal, Reena Agarwal, Sompal Singh, Prashant Goyal
      Pages: 6 - 6
      Abstract: Shelly Sehgal, Reena Agarwal, Sompal Singh, Prashant Goyal
      CytoJournal 2012 9(1):6-6

      Citation: CytoJournal 2012 9(1):6-6
      PubDate: Sat,25 Feb 2012
      DOI: 10.4103/1742-6413.93283
      Issue No: Vol. 9, No. 1 (2012)
       
  • The Bethesda System thyroid diagnostic categories in the African-American
           population in conjunction with surgical pathology follow-up

    • Authors: Pamela Anne Archuletta, Raja Gidwani, Mujtaba Husain, Teresa Johnson, Vinod Shidham, Opada Alzohaili, Sudeshna Bandyopadhyay, Jining Feng, Dongping Shi, Lili Geng, Paul Tranchida, Tamar Giorgadze
      Pages: 7 - 7
      Abstract: Pamela Anne Archuletta, Raja Gidwani, Mujtaba Husain, Teresa Johnson, Vinod Shidham, Opada Alzohaili, Sudeshna Bandyopadhyay, Jining Feng, Dongping Shi, Lili Geng, Paul Tranchida, Tamar Giorgadze
      CytoJournal 2012 9(1):7-7
      Background: It has been reported that African - Americans (AA) have a higher prevalence of overall malignancy compared to Caucasians, in the United States, yet the incidence of thyroid malignancy is half. The aim of this study is to assess the rate of malignant versus benign thyroid disease in AA from an urban-based hospital with an academic setting. Our study analyzed the AA population with respect to fine needle aspiration (FNA) of thyroid lesions, in correlation with final surgical pathology. This is the first study of its kind to our knowledge. Design: We retrospectively reviewed thyroid FNA cytology between January 2005 and February 2011. Consecutive FNA specimens with corresponding follow-up surgical pathology were included. The patients were categorized as African- American (AA) and Non-African-American (NAA), which included Caucasians (C), Hispanics (H), and Others (O). The FNA results were classified using the latest edition of The Bethesda System for Reporting Thyroid Cytopathology (TBS-Thy) and the follow-up surgical pathology was used for the final categorization. Results: We studied 258 cases: 144 AA (56%) and 114 NAA [43 C (17%), 3 H (1%), and 68 O (28%)]. The average age for AA was 51 years (range 20 - 88) and for NAA was 53 years (range 25 - 86). There were more females than males in the AA versus the NAA group (85 vs. 75%). The incidence of thyroid lesions in the FNA specimens was similar between these two populations. The distribution of benign versus malignant diagnosis on follow-up surgical pathology was examined across TBS-Thy class. Conclusion: Our data suggest that distribution of benign versus malignant lesions in the thyroid FNA of AA versus NAA, with follow-up surgical pathology, is comparable for TBS-Thy classes, non-diagnostic (I), benign (II), suspicious for malignancy (V), and malignant (VI) in AA versus NAA.
      Citation: CytoJournal 2012 9(1):7-7
      PubDate: Sat,24 Mar 2012
      DOI: 10.4103/1742-6413.94274
      Issue No: Vol. 9, No. 1 (2012)
       
  • Establishing a protocol for immunocytochemical staining and chromogenic in
           

    • Authors: Elsa Beraki, Thale Kristin Olsen, Torill Sauer
      Pages: 8 - 8
      Abstract: Elsa Beraki, Thale Kristin Olsen, Torill Sauer
      CytoJournal 2012 9(1):8-8
      Background: Protocols for immunocytochemical staining (ICC) and in situ hybridization (ISH) of air-dried Diff-Quick or May-Grünwald Giemsa (MGG)-stained smears have been difficult to establish. An increasing need to be able to use prestained slides for ICC and ISH in specific cases led to this study, aiming at finding a robust protocol for both methods. Materials and Methods: The material consisted of MGG- and Diff-Quick-stained smears. After diagnosis, one to two diagnostic smears were stored in the department. Any additional smear(s) containing diagnostic material were used for this study. The majority were fine needle aspirates (FNAC) from the breast, comprising materials from fibroadenomas, fibrocystic disease, and carcinomas. A few were metastatic lesions (carcinomas and malignant melanomas). There were 64 prestained smears. Ten smears were Diff-Quick stained, and 54 were MGG stained. The antibodies used for testing ICC were Ki-67, ER, and PgR, CK MNF116 (pancytokeratin) and E-cadherin. HER-2 Dual SISH was used to test ISH. Citrate, TRS, and TE buffers at pH6 and pH9 were tested, as well as, different heating times, microwave powers and antibody concentrations. The ICC was done on the Dako Autostainer (Dako®, Glostrup, Denmark), and HER-2 Dual SISH was done on the Ventana XT-machine (Ventana / Roche® , Strasbourg, France). Results: Optimal results were obtained with the TE buffer at pH 9, for both ICC and ISH. Antibody concentrations generally had to be higher than in the immunohistochemistry (IHC). The optimal microwave heat treatment included an initial high power boiling followed by low power boiling. No post fixation was necessary for ICC, whereas, 20 minutes post fixation in formalin (4%) was necessary for ISH. Conclusions: Microwave heat treatment, with initial boiling at high power followed by boiling at low power and TE buffer at pH 9 were the key steps in the procedure. Antibody concentrations has to be adapted for each ICC marker. Post fixation in formalin is necessary for ISH.
      Citation: CytoJournal 2012 9(1):8-8
      PubDate: Thu,29 Mar 2012
      DOI: 10.4103/1742-6413.94518
      Issue No: Vol. 9, No. 1 (2012)
       
  • Cytological diagnosis of metastatic alveolar rhabdomyosarcoma in the
           ascitic fluid: Report of a case highlighting the diagnostic difficulties

    • Authors: Andrew C Nelson, Charanjeet Singh, Stefan E Pambuccian
      Pages: 9 - 9
      Abstract: Andrew C Nelson, Charanjeet Singh, Stefan E Pambuccian
      CytoJournal 2012 9(1):9-9
      Alveolar rhabdomyosarcoma is an uncommon tumor affecting adolescents and young adults that is only rarely encountered in body fluid cytology. We report the cytological features of metastatic alveolar rhabdomyosarcoma in the ascitic fluid of a 17-year-old female patient, who had presented with abdominal distention, 21 months after being diagnosed with perirectal alveolar rhabdomyosarcoma. The rare single neoplastic cells that were admixed with abundant reactive mesothelial cells were initially misinterpreted as reactive mesothelial cells. However, their neoplastic nature was established after a careful review of their cytological features and the performance of immunoperoxidase stains. Compared to the reactive mesothelial cells that were present in the sample, the malignant cells were smaller, with less ample and more homogenous cytoplasm. They had slightly larger, more hyperchromatic, and more frequently eccentric nuclei, with larger nucleoli. This case highlights the potential pitfall of the misinterpretation of metastatic alveolar rhabdomyosarcoma cells for reactive mesothelial cells. Awareness of this potential diagnostic problem and recognition of the cytomorphological features of this neoplasm in the body fluids allows the identification of malignant cells, even when they are rare and intimately associated with mesothelial cells.
      Citation: CytoJournal 2012 9(1):9-9
      PubDate: Sat,31 Mar 2012
      DOI: 10.4103/1742-6413.94569
      Issue No: Vol. 9, No. 1 (2012)
       
  • Dual color multiplex TTF-1 + Napsin A and p63 + CK5 immunostaining for
           subcategorizing of poorly differentiated pulmonary non-small carcinomas
           into adenocarcinoma and squamous cell carcinoma in fine needle aspiration
           specimens

    • Authors: Seema Sethi, Lili Geng, Vinod B Shidham, Pamela Archuletta, Sudeshna Bandyophadhyay, Jining Feng, Shashi Madan, Dongping Shi, Paul Tranchida, Tamar Giorgadze
      Pages: 10 - 10
      Abstract: Seema Sethi, Lili Geng, Vinod B Shidham, Pamela Archuletta, Sudeshna Bandyophadhyay, Jining Feng, Shashi Madan, Dongping Shi, Paul Tranchida, Tamar Giorgadze
      CytoJournal 2012 9(1):10-10
      Background: The distinction of lung adenocarcinoma (ADC) from squamous cell carcinoma (SCC) has important therapeutic implications. Napsin A is a recently developed marker, which has shown high specificity for lung tissue in the surgical pathology specimens. In this study, we have evaluated whether the use of a panel of novel multiplex cocktails of TTF-1 + Napsin A and p63 + CK5 for dual color immunostaining will improve the diagnostic accuracy of lung adenocarcinoma and squamous cell carcinoma in fine needle aspiration (FNA) specimens, usually with relatively scant microfragments of diagnostic material. Materials and Methods: Formalin-fixed, paraffin-embedded, adequately cellular FNA cell blocks with a confirmed diagnosis of either ADC (n = 22), SCC (n = 20) or poorly differentiated carcinoma (PDC; n = 7), from a total of 49 consecutive cases, were studied. All these cases had subsequently confirmed diagnosis in biopsies or resection specimens. The sections were immunostained with two color methods of TTF-1 + Napsin A and p63 + CK5 multiplex cocktails. The presence of one or more unequivocal individual tumor cells with convincing brown nuclear TTF-1 and red cytoplasmic Napsin A staining, and cells with brown nuclear p63 and membranous / cytoplasmic CK5 staining were interpreted as 'positive'. Results: All 20 FNA cell blocks from SCC cases were positive for dual stain p63 + CK5 and negative for dual stain TTF-1 + Napsin A. The sensitivity and specificity of the dual immunoexpressions of p63 + CK5 for SCC of lung FNAs were both 100%. All 22 ADC cases were positive with dual stain of TTF-1 + Napsin A and negative for dual stain of p63 + CK5. On follow-up of the surgical pathology specimens, 22 cases were confirmed as ADC. The sensitivity of the dual immunoexpression of TTF-1 + Napsin A for ADC of lung FNAs was 100% and the specificity was also 100%. Of the seven PDC cases, five cases that were positive for dual stain p63 + CK5 and negative for dual stain TTF-1 + Napsin A could be categorized as SCC. Two of the seven (2 / 7) PDC cases were positive for dual stain TTF-1 + Napsin A and negative for dual stain p63 + CK5, consistent with ADC. Conclusions: Simultaneous coordinate or individual immunostaining for Napsin A / TTF-1 in ADC and p63 / CK5 in SCC demonstrated high sensitivity and specificity. The panel with multiplex Napsin A / TTF-1 and p63 / CK5 dual color immunostains could specifically subcategorize PDC into ADC and SCC in lung FNA specimens. Multiplex dual color Napsin A / TTF-1 and p63 / CK5 immunostaining is especially recommended for evaluation of FNA specimens with relatively scant cellularity.
      Citation: CytoJournal 2012 9(1):10-10
      PubDate: Sat,31 Mar 2012
      DOI: 10.4103/1742-6413.94570
      Issue No: Vol. 9, No. 1 (2012)
       
  • A case of clear cell adenocarcinoma arising from the urethral
           diverticulum: Utility of urinary cytology and immunohistochemistry

    • Authors: Shin-ichi Nakatsuka, Isao Taguchi, Tadasuke Nagatomo, Michiaki Yamane, Kenji Sugio, Ryuichi Yoshino, Kazuko Oku, Teruaki Nagano, Hayato Kimura, Kazuya Nakajo, Gaku Kawabata
      Pages: 11 - 11
      Abstract: Shin-ichi Nakatsuka, Isao Taguchi, Tadasuke Nagatomo, Michiaki Yamane, Kenji Sugio, Ryuichi Yoshino, Kazuko Oku, Teruaki Nagano, Hayato Kimura, Kazuya Nakajo, Gaku Kawabata
      CytoJournal 2012 9(1):11-11
      Carcinomas rarely arise from the urethral diverticulum. In this report, we present a case of clear cell adenocarcinoma arising from the urethral diverticulum. A 42-year-old woman complained of bloody discharge and lower back pain. Imaging studies showed a tumor involving the region surrounding the urethra and cystourethroscopy showed papillary and villous tumors in the urethral diverticula. Cytology of the urine sediment showed papillary or spherical clusters of atypical cells, some of which had clear abundant cytoplasm and formed mirror ball-like clusters, suggesting adenocarcinoma. Although histological diagnosis was indeterminate by biopsy and transurethral resection (TUR) because of absence of stromal invasion, surgically resected specimen via cysturethrectomy revealed that the tumor was clear cell carcinoma. Urinary cytological findings and immunohistochemical analysis for CD15, Ki-67, and p53 might be useful for accurate diagnosis of clear cell adenocarcinoma that arises from the urethral diverticulum when sufficient materials are not available by biopsy and TUR.
      Citation: CytoJournal 2012 9(1):11-11
      PubDate: Mon,30 Apr 2012
      DOI: 10.4103/1742-6413.95528
      Issue No: Vol. 9, No. 1 (2012)
       
  • Virtual microscopy in cytotechnology education: Application of knowledge
           from virtual to glass

    • Authors: Amber D Donnelly, Maheswari S Mukherjee, Elizabeth R Lyden, Stanley J Radio
      Pages: 12 - 12
      Abstract: Amber D Donnelly, Maheswari S Mukherjee, Elizabeth R Lyden, Stanley J Radio
      CytoJournal 2012 9(1):12-12
      Background: Virtual microscopy (VM) is a technology in which the glass slides are converted into digital images. The main objective of this study is to determine if cellular morphology, learned through virtual microscopy, can be applied to glass slide screening. Materials and Methods: A total of 142 glass slides (61 teaching and 81 practice) of breast, thyroid, and lymph node fine needle aspiration body sites were scanned with a single focal plane (at 40X) using iScanCoreo Au (Ventana, Tuscan, AZ, USA, formerly known as BioImagene, California, USA). Six students including one distant student used these digital images to learn cellular morphology and conduct daily screening. Subsequently, all the students were tested on 10 glass slides using light microscopy (LM). At the end of the study, the students were asked to respond to an online survey on their virtual microscopy experience. The glass slide screening test scores of the participating students who were taught through VM and tested on glass slides (VMLM group) were compared with the last three classes of students who were taught through LM and tested on glass slides (LMLM group). Results: A non-parametric statistical analysis indicated no difference (P = 0.20) in the glass screening test scores between VMLM (median = 93.5) and LMLM groups (median = 87). The survey indicated that the annotated teaching slides and access to the VM, off campus, were well appreciated by the students. Conclusions: Although the students preferred LM, they were able to apply the cytological criteria learned through VM to glass slide screening. Overall, VM was considered a great teaching tool.
      Citation: CytoJournal 2012 9(1):12-12
      PubDate: Mon,30 Apr 2012
      DOI: 10.4103/1742-6413.95827
      Issue No: Vol. 9, No. 1 (2012)
       
  • Diagnosis of pulmonary hydatid disease presenting with solid nodule and
           mimicking malignancy by fine needle aspiration cytology

    • Authors: Nadir Paksoy, Düriye Özer, Irem Özöver Tuneli
      Pages: 13 - 13
      Abstract: Nadir Paksoy, Düriye Özer, Irem Özöver Tuneli
      CytoJournal 2012 9(1):13-13

      Citation: CytoJournal 2012 9(1):13-13
      PubDate: Sat,5 May 2012
      DOI: 10.4103/1742-6413.95832
      Issue No: Vol. 9, No. 1 (2012)
       
  • Endoscopic ultrasound and endobronchial ultrasound-guided fine-needle
           aspiration of deep-seated lymphadenopathy: Analysis of 1338 cases

    • Authors: Amberly L Nunez, Nirag C Jhala, Andrew J Carroll, Fady M Mikhail, Vishnu V. B. Reddy, Rena R Xian, Darshana N Jhala
      Pages: 14 - 14
      Abstract: Amberly L Nunez, Nirag C Jhala, Andrew J Carroll, Fady M Mikhail, Vishnu V. B. Reddy, Rena R Xian, Darshana N Jhala
      CytoJournal 2012 9(1):14-14
      Background: We retrospectively studied 1338 samples of lymph nodes obtained by endoscopic and endobronchial ultrasound-guided fine needle aspiration biopsy (EUS and EBUS-FNAB) with an objective of characterizing the utility of this diagnostic modality in the assessment of deep-seated lymphadenopathy. The secondary aims were to establish the utility in the diagnosis of lymphoma and to determine the number of passes required to obtain adequate cellularity for flow cytometric analysis. Materials and Methods: On-site assessment was performed by a cytopathologist using Diff-Quik (American Scientific Products, McGraw Park, IL) stain. In addition, Papanicolaou and immunohistochemical stains were performed and additional samples were sent for flow cytometric analyses (n = 145). The final cytologic diagnosis was correlated with surgical pathology diagnosis and/or clinical follow-up. In select cases, fluorescence in situ hybridization analysis with specific probes was performed on Diff-Quik smears. Results: Both morphology as well as ancillary studies (flow cytometry or immunohistochemical stain and/or fluorescence in situ hybridization) show that EUS and EBUS-FNA are effective techniques to detect and stage intrathoracic and intra-abdominal tumors. Operating characteristics show that these are highly sensitive (89%) and specific (100%) techniques for the diagnosis of lymphoma. At least two passes provided an average of 5.66 million cells (range, 0.12-62.32 million) for lymphoma cases. Conclusions: EUS and EBUS-FNA are powerful modalities to stage malignancies and at least two passes can provide adequate cells for flow cytometric analysis. We also demonstrate that fluorescence in situ hybridization analysis can be performed on Diff-Quik-stained and mounted smears.
      Citation: CytoJournal 2012 9(1):14-14
      PubDate: Sat,5 May 2012
      DOI: 10.4103/1742-6413.95845
      Issue No: Vol. 9, No. 1 (2012)
       
  • Cytomorphology of unusual infectious entities in the Pap test

    • Authors: Walid E Khalbuss, Pam Michelow, Cynthia Benedict, Sara E Monaco, Liron Pantanowitz
      Pages: 15 - 15
      Abstract: Walid E Khalbuss, Pam Michelow, Cynthia Benedict, Sara E Monaco, Liron Pantanowitz
      CytoJournal 2012 9(1):15-15
      Rare entities in the Pap test, including neoplastic and non-neoplastic conditions, pose challenges due to their infrequent occurrence in the daily practice of cytology. Furthermore, these conditions give rise to important diagnostic pitfalls. Infections such as tuberculosis cervicitis may be erroneously diagnosed as carcinoma, whereas others, such as schistosomiasis, are associated with squamous cell carcinoma. These cases include granuloma inguinale (donovanosis), tuberculosis, coccidioidomycosis, schistosomiasis, taeniasis, and molluscum contagiosum diagnosed in Pap tests. Granuloma inguinale shows histiocytes that contain intracytoplasmic bacteria (Donovan bodies). Tuberculosis is characterized by necrotizing granulomatous inflammation with Langhans-multinucleated giant cells. Coccidioidomycosis may show large intact or ruptured fungal spherules associated with endospores. Schistosoma haematobium is diagnosed by finding characteristic ova with a terminal spine. Molluscum contagiosum is characterized by the appearance of squamous cells with molluscum bodies. This article reviews the cytomorphology of selected rare infections and focuses on their cytomorphology, differential diagnosis, and role of ancillary diagnostic studies.
      Citation: CytoJournal 2012 9(1):15-15
      PubDate: Fri,29 Jun 2012
      DOI: 10.4103/1742-6413.97763
      Issue No: Vol. 9, No. 1 (2012)
       
  • An unusual case of Primary Effusion Lymphoma with aberrant T-cell
           phenotype in a HIV-negative, HBV -positive, cirrhotic patient, and review
           of the literature

    • Authors: Charitini Nepka, Dimitrios Kanakis, Maria Samara, Andreas Kapsoritakis, Spyridon Potamianos, Maria Karantana, Georgios Koukoulis
      Pages: 16 - 16
      Abstract: Charitini Nepka, Dimitrios Kanakis, Maria Samara, Andreas Kapsoritakis, Spyridon Potamianos, Maria Karantana, Georgios Koukoulis
      CytoJournal 2012 9(1):16-16
      Primary effusion lymphoma (PEL) is an unusual, human herpes virus-8 (HHV-8)−associated type of lymphoma, presenting as lymphomatous effusion in body cavities, without a detectable tumor mass. It primarily affects human immunodeficiency virus (HIV)-infected patients, but has also been described in other immunocompromised individuals. Although PEL is a B-cell lymphoma, the neoplastic cells are usually of the 'null' phenotype by immunocytochemistry. This report describes a case of PEL with T-cell phenotype in a HIV-negative patient and reviews all the relevant cases published until now. Our patient suffered from cirrhosis associated with Hepatitis Β virus (HΒV) infection and presented with a large ascitic effusion, in the absence of peripheral lymphadenopathy or solid mass within either the abdomen or the thorax. Paracentesis disclosed large lymphoma cells with anaplastic features consisting of moderate cytoplasm and single or occasionally multiple irregular nuclei with single or multiple prominent nucleoli. Immunocytochemically, these cells were negative for both CD3 and CD20, but showed a positive reaction for T-cell markers CD43 and CD45RO (VCHL-1). Furthermore, the neoplastic cells revealed strong positivity for EMA and CD30, but they lacked expression of ALK-1, TIA-1, and Perforin. The immune status for both HHV-8 and Epstein-Barr virus (EBV) was evaluated and showed positive immunostaining only for the former. The combination of the immunohistochemistry results with the existence of a clonal rearrangement in the immunoglobulin heavy chain gene (identified by PCR), were compatible with the diagnosis of PEL. The presence of T-cell markers was consistent with the diagnosis of PEL with an aberrant T-cell phenotype.
      Citation: CytoJournal 2012 9(1):16-16
      PubDate: Fri,29 Jun 2012
      DOI: 10.4103/1742-6413.97766
      Issue No: Vol. 9, No. 1 (2012)
       
  • Ossifying fibromyxoid tumor - Diagnostic challenge for a cytopathologist

    • Authors: Prashant Goyal, Shelly Sehgal, Reena Agarwal, Sompal Singh, Ruchika Gupta, Awanindra Kumar
      Pages: 17 - 17
      Abstract: Prashant Goyal, Shelly Sehgal, Reena Agarwal, Sompal Singh, Ruchika Gupta, Awanindra Kumar
      CytoJournal 2012 9(1):17-17

      Citation: CytoJournal 2012 9(1):17-17
      PubDate: Sat,28 Jul 2012
      DOI: 10.4103/1742-6413.99169
      Issue No: Vol. 9, No. 1 (2012)
       
  • Parakeratotic-like cells in effusions - A clue to diagnosis of malignant
           mesothelioma

    • Authors: Ling Gao, Ward Reeves, Richard M DeMay
      Pages: 18 - 18
      Abstract: Ling Gao, Ward Reeves, Richard M DeMay
      CytoJournal 2012 9(1):18-18
      Background : Malignant mesothelioma (MM) is an aggressive neoplasm with a poor prognosis. Its incidence has been increasing worldwide. Cytological examination of an effusion is often the first opportunity to diagnose MM. However, the cytological diagnosis of MM can be difficult. We have noticed that parakeratotic-like cells, with orange cytoplasm and pyknotic nuclei, are present in many cases of mesothelioma on Papanicolaou-stained cytology slides. Although this cytological finding has been described previously, to our knowledge, there has been no systematic study of this finding. Our study is to determine whether the presence of small parakeratotic / orangeophilic cells (PK-like cells) is specific for the cytodiagnosis of mesothelioma. Materials and Methods: A total of 90 body fluid cases were selected from our archived specimens in the Cytology Section at the University of Chicago Hospital accessioned between January 2000 to November 2011. They included 30 cases of mesothelioma, 30 cases of adenocarcinoma, and 30 cases of reactive mesothelial cells. Results: PK-like cells were present in 83% of the mesothelioma cases, 13% of the adenocarcinoma cases, and 7% of the reactive cases. Our data showed that the presence of PK-like cells has a specificity of 90%, sensitivity of 83%, positive predictive value of 81%, and negative predictive value of 84% for the diagnosis of malignant mesothelioma in body cavity fluids. Conclusion: The presence of PK-like cells in the effusion specimen, especially in pleural effusions, is a highly specific and moderately sensitive cytological feature for diagnosis of mesothelioma.
      Citation: CytoJournal 2012 9(1):18-18
      PubDate: Sat,28 Jul 2012
      DOI: 10.4103/1742-6413.99170
      Issue No: Vol. 9, No. 1 (2012)
       
  • Prevalence of human papilloma virus in cytological abnormalities:
           Association of risk factors and cytomorphological findings

    • Authors: Christo D Izaaks, Ernest J Truter, Sehaam Khan
      Pages: 19 - 19
      Abstract: Christo D Izaaks, Ernest J Truter, Sehaam Khan
      CytoJournal 2012 9(1):19-19
      Background: Previous studies demonstrated the etiological role of human papilloma virus (HPV) in cervical carcinogenesis. Assessing the distribution of HPV may elucidate these observations. Materials and Methods: In total, we examined 3839 specimens, of which 187 abnormally classified cervical smears were immunostained using the p16 INK4A assay. DNA was extracted from 182 specimens, and polymerase chain reaction (PCR) was performed. Participants' socio-demographics, sexual and reproductive history, HIV status, contraceptive use, and Pap smear history were recorded. Results: Subject ages, number of sexual partners, and age at first sexual encounter ranged from 15 to 49 years, from 1 to 37 partners, and from 13 to 34 years, respectively. P16 immunoreactivity was detected in 60.4% of cases. The distribution of epithelial lesions and P16 overexpression (bracketed) was: 28 (5) atypical squamous cells of undetermined significance (ASC-US), 96 (50) lower grade squamous intraepithelial lesion (LSIL), 9 (7) atypical squamous cells-cannot exclude HSIL (ASC-H), and 54 (51) higher grade squamous intraepithelial lesion (HSIL). Ninety-four percent of HSIL expressed P16. Fifty-two percent of LSIL expressed P16. P16 expression declined from 61% (25-34 year age group) to 5% (45-49 year age group) for different age groups. HPV-DNA by PCR was detected in 94.5% of P16-positive samples. Type-specific PCR (HPV 16 and 18) was found in 12.2% and 14.5% of abnormal lesions, respectively. Younger age at first sexual encounter and HIV infection predominated in HPV type(s) 16 and/or 18 positive subjects. Conclusion: This study reinforced the value of the p16 INK4A surrogate marker in identifying women with progressive cervical disease.
      Citation: CytoJournal 2012 9(1):19-19
      PubDate: Sat,25 Aug 2012
      DOI: 10.4103/1742-6413.100123
      Issue No: Vol. 9, No. 1 (2012)
       
  • Adult rhabdomyoma: A challenging diagnosis on cytology

    • Authors: Abberly Lott Limbach, Abha Goyal
      Pages: 20 - 20
      Abstract: Abberly Lott Limbach, Abha Goyal
      CytoJournal 2012 9(1):20-20

      Citation: CytoJournal 2012 9(1):20-20
      PubDate: Sat,25 Aug 2012
      DOI: 10.4103/1742-6413.100124
      Issue No: Vol. 9, No. 1 (2012)
       
  • Metastatic hepatocellular carcinoma presenting as gynecomastia in male: A
           diagnostic dilema in fine needle aspiration cytology

    • Authors: Jitendra G Nasit, Birwa Shah, Manoj Shah
      Pages: 21 - 21
      Abstract: Jitendra G Nasit, Birwa Shah, Manoj Shah
      CytoJournal 2012 9(1):21-21

      Citation: CytoJournal 2012 9(1):21-21
      PubDate: Tue,23 Oct 2012
      DOI: 10.4103/1742-6413.102863
      Issue No: Vol. 9, No. 1 (2012)
       
  • Cytomorphology of giant cell tumor of bone in pleural fluid

    • Authors: Rajni Yadav, Sameer Bakhshi, Sandeep R Mathur, TVSVGK Tilak, Geetika Singh, Venkateswaran K Iyer, Suvendu Purkait, Prashant Durgapal
      Pages: 22 - 22
      Abstract: Rajni Yadav, Sameer Bakhshi, Sandeep R Mathur, TVSVGK Tilak, Geetika Singh, Venkateswaran K Iyer, Suvendu Purkait, Prashant Durgapal
      CytoJournal 2012 9(1):22-22

      Citation: CytoJournal 2012 9(1):22-22
      PubDate: Tue,23 Oct 2012
      DOI: 10.4103/1742-6413.102864
      Issue No: Vol. 9, No. 1 (2012)
       
  • Drug eluting beads on cytology smears

    • Authors: Niti Manglik, Palam Annamalai, Ranjana S Nawgiri
      Pages: 23 - 23
      Abstract: Niti Manglik, Palam Annamalai, Ranjana S Nawgiri
      CytoJournal 2012 9(1):23-23

      Citation: CytoJournal 2012 9(1):23-23
      PubDate: Tue,23 Oct 2012
      DOI: 10.4103/1742-6413.102866
      Issue No: Vol. 9, No. 1 (2012)
       
  • Endoscopic ultrasound-guided fine needle aspiration of the celiac
           ganglion: A diagnostic pitfall

    • Authors: Di Xia, Kidada N Gilbert-Lewis, Manoop S Bhutani, Ranjana S Nawgiri
      Pages: 24 - 24
      Abstract: Di Xia, Kidada N Gilbert-Lewis, Manoop S Bhutani, Ranjana S Nawgiri
      CytoJournal 2012 9(1):24-24
      Endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) is now widely used as a primary tool in the evaluation of lymphadenopathy in both the mediastinum and abdomen. A sympathetic ganglion may be mistaken for an enlarged lymph node on endoscopic ultrasound and are rarely sampled as such. A 51-year-old female presented with a history of weight loss, vomiting for several months, and right upper quadrant discomfort. Computed tomography (CT) and magnetic resonance imaging (MRI) scans showed a dilated common bile duct (CBD) with a possible periampullary mass, paraaortic, and pericelial lymph nodes suspicious for metastatic disease. Endosonography revealed a 17 mm oval hypoechoic structure with distinct margins in the para-aortic, celiac axis region suggestive of an enlarged lymph node. An EUS-FNA was done. Cytology revealed ganglion cells with large oval epithelial-like cells with round nuclei and prominent nucleoli consistent with a benign sympathetic ganglion. It is crucial for the cytopathologist to be aware of the fact that the endoscopist might have sampled a celiac ganglion instead of a celiac lymph node and be able to distinguish the cytological features of a benign sympathetic ganglion from a malignant process.
      Citation: CytoJournal 2012 9(1):24-24
      PubDate: Wed,31 Oct 2012
      DOI: 10.4103/1742-6413.103025
      Issue No: Vol. 9, No. 1 (2012)
       
  • Fine needle aspiration-induced vascular proliferation of the thyroid: A
           report of two cases

    • Authors: Sushma N Ramraje, TJ Kambale
      Pages: 25 - 25
      Abstract: Sushma N Ramraje, TJ Kambale
      CytoJournal 2012 9(1):25-25

      Citation: CytoJournal 2012 9(1):25-25
      PubDate: Thu,27 Dec 2012
      DOI: 10.4103/1742-6413.105118
      Issue No: Vol. 9, No. 1 (2012)
       
  • Paraganglioma with unusual presentation in parotid gland: A diagnostic
           dilemma in fine needle aspiration

    • Authors: Anagh A Vora, Chi K Lai, Jian Yu Rao, Sophia K Apple, Neda A Moatamed
      Pages: 26 - 26
      Abstract: Anagh A Vora, Chi K Lai, Jian Yu Rao, Sophia K Apple, Neda A Moatamed
      CytoJournal 2012 9(1):26-26
      Paragangliomas (PGLs) are uncommon tumors. Although PGLs are known to occur in the head and neck region, especially the carotid body, middle ear, and larynx, involvement of the parotid glands has not been reported. In this article, we report the fine needle aspiration features of tumor in an unusual location, presenting as a parotid gland mass, submitted to pathology for initial diagnosis. The clinical presentation, cytomorphology, and the immunohistochemical features for the diagnosis are described. To our knowledge, this is the first case of paraganglioma of the parotid gland reported in the literature.
      Citation: CytoJournal 2012 9(1):26-26
      PubDate: Thu,27 Dec 2012
      DOI: 10.4103/1742-6413.105119
      Issue No: Vol. 9, No. 1 (2012)
       
  • p16 INK4a immunocytochemistry on cell blocks as an adjunct to cervical
           cytology: Potential reflex testing on specially prepared cell blocks from
           residual liquid-based cytology specimens

    • Authors: Vinod B Shidham, Ravi Mehrotra, George Varsegi, Krista L D'Amore, Bryan Hunt, Raj Narayan
      Pages: 1 - 1
      Abstract: Vinod B Shidham, Ravi Mehrotra, George Varsegi, Krista L D'Amore, Bryan Hunt, Raj Narayan
      CytoJournal 2011 8(1):1-1
      Background: p16 INK4a (p16) is a well-recognized surrogate molecular marker for human papilloma virus (HPV) related squamous dysplasia. Our hypothesis is that the invasive interventions and related morbidities could be avoided by objective stratification of positive cytologic interpretations by p16 immunostaining of cell block sections of cytology specimens. Materials and Methods: Nuclear immunoreactivity for p16 was evaluated in cell block sections in 133 adequate cases [20 negative for intraepithelial lesion or malignancy, 28 high-grade squamous intraepithelial lesion (HSIL), 50 low-grade squamous intraepithelial lesion (LSIL), 21 atypical squamous cells, cannot exclude HSIL (ASC-H), and 14 atypical squamous cells of undetermined significance (ASCUS)] and analyzed with cervical biopsy results. Results: (a) HSIL cytology (28): 21 (75%) were p16 positive (11 biopsies available - 92% were positive for cervical intraepithelial neoplasia (CIN) 1 and above) and 7 (25%) were p16 negative (3 biopsies available - all showed only HPV with small atypical parakeratotic cells). (b) LSIL cytology (50): 13 (26%) cases were p16 positive (12 biopsies available - all were CIN1 or above) and 37 (74%) were p16 negative (12 biopsies available - all negative for dysplasia. However, 9 (75%) of these biopsies showed HPV). (c) ASC-H cytology (21): 14 (67%) were p16 positive (6 biopsies available - 5 showed CIN 3/Carcinoma in situ/Ca and 1 showed CIN 1 with possibility of under-sampling. Cytomorphologic re-review favored HSIL) and 7 (33%) were p16 negative (5 biopsies available - 3 negative for dysplasia. Remaining 2 cases - 1 positive for CIN 3 and 1 showed CIN 1 with scant ASC-H cells on cytomorphologic re-review with possibility under-sampling in cytology specimen). (d) ASCUS cytology (14): All (100%) were p16 negative on cell block sections of cervical cytology specimen. HPV testing performed in last 6 months in 7 cases was positive in 3 (43%) cases. Conclusion: p16 immunostaining on cell block sections of cervical cytology specimens showed distinct correlation patterns with biopsy results. Reflex p16 immunostaining of cell blocks based on the algorithmic approach to be evaluated by a multiinstitutional comprehensive prospective study is proposed.
      Citation: CytoJournal 2011 8(1):1-1
      PubDate: Mon,31 Jan 2011
      DOI: 10.4103/1742-6413.76379
      Issue No: Vol. 8, No. 1 (2011)
       
  • Diagnosis of metastatic fibrolamellar hepatocellular carcinoma by
           endoscopic ultrasound-guided fine needle aspiration

    • Authors: Amanda Crowe, Carrie S Knight, Darshana Jhala, Steve J Bynon, Nirag C Jhala
      Pages: 2 - 2
      Abstract: Amanda Crowe, Carrie S Knight, Darshana Jhala, Steve J Bynon, Nirag C Jhala
      CytoJournal 2011 8(1):2-2
      The fibrolamellar variant of hepatocellular carcinoma (FL-HCC) is distinguished from other hepatocellular carcinomas (HCC) by its unique clinical and pathologic features. Cytological features for this tumor on fine needle aspiration (FNA) of primary tumors have been described earlier. We present here a unique case of metastatic FL-HCC diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of mediastinal adenopathy. A 32-year-old woman with a history of oral contraceptive use presented with nausea and severe abdominal pain but no ascites or stigmata of cirrhosis. She had a past history of resection of a liver lesion. Serial computed tomography scans revealed mediastinal lymphadenopathy and the patient was referred for endoscopic ultrasound (EUS). A transesophageal EUS-FNA was performed and tissue was collected for cytological evaluation by an on-site pathologist with no knowledge of prior history. Based on morphology correlated with prior history received later, a final diagnosis of metastatic FL-HCC in the retrocardiac lymph node was rendered on the EUS-FNA samples. There are very few reports in the literature where a diagnosis of FL-HCC is rendered at unusual sites. This case highlights that EUS-FNA is a relatively non-invasive, rapid, accurate and effective modality in obtaining tissue from otherwise hard-to-reach areas. It also suggests that metastasis of FL-HCC can be observed in mediastinal nodes and that diagnosis based on cytological features can be rendered even when the tumor is identified at unusual locations.
      Citation: CytoJournal 2011 8(1):2-2
      PubDate: Mon,31 Jan 2011
      DOI: 10.4103/1742-6413.76495
      Issue No: Vol. 8, No. 1 (2011)
       
  • Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman Disease):
           

    • Authors: Yuquan Shi, Adrienne Carruth Griffin, Paul JL Zhang, James N Palmer, Prabodh Gupta
      Pages: 3 - 3
      Abstract: Yuquan Shi, Adrienne Carruth Griffin, Paul JL Zhang, James N Palmer, Prabodh Gupta
      CytoJournal 2011 8(1):3-3
      Rosai-Dorfman disease (RDD), a rare, benign, self-limiting histiocytic proliferative disorder, can be encountered in both nodal and extranodal locations, and fine needle aspiration (FNA), a simple, accurate and economic tool, has been widely used for the diagnosis of superficial and deep-seated lesions. Familiarity with the cytomorphologic features of RDD is important as prognosis and treatment are quite different from other benign or malignant diseases for which it may clinically masquerade. Although large numbers of RDD cases have been reported, review of the literature has revealed 49 reported cases of RDD diagnosed by FNA. Here, we report a case of RDD with nasal and sinus involvement. The patient was seen at our institution, carrying a diagnosis of inflammatory pseudotumor rendered by an outside institution, based on material obtained by nasal and sinus surgical biopsies. Cervical lymph node FNA performed at our institution revealed typical features of RDD. The case, as well as a brief review of the literature and 49 RDD cases with FNA cytology, will be discussed.
      Citation: CytoJournal 2011 8(1):3-3
      PubDate: Sat,12 Feb 2011
      DOI: 10.4103/1742-6413.76731
      Issue No: Vol. 8, No. 1 (2011)
       
  • Microfilariae coexisting with a follicular lesion in thyroid aspirate
           smears in an uncommon case of a retrosternal thyroid mass, clinically
           presenting as malignancy

    • Authors: Bharat Rekhi, SV Kane
      Pages: 4 - 4
      Abstract: Bharat Rekhi, SV Kane
      CytoJournal 2011 8(1):4-4

      Citation: CytoJournal 2011 8(1):4-4
      PubDate: Sat,12 Feb 2011
      DOI: 10.4103/1742-6413.76732
      Issue No: Vol. 8, No. 1 (2011)
       
  • Cytologic features of microcystic adnexal carcinoma

    • Authors: Sasis Sirikanjanapong, Andrew W Seymour, Bijal Amin
      Pages: 5 - 5
      Abstract: Sasis Sirikanjanapong, Andrew W Seymour, Bijal Amin
      CytoJournal 2011 8(1):5-5
      Microcystic adnexal carcinoma (MAC) is an uncommon skin neoplasm with a predilection location around the lips. It is characterized by cords and nests of neoplastic cells forming ductular or glandular structures that are embedded in dense collagenous stroma. An eighty-seven year old Caucasian female patient presented with a painless, slowly enlarging mass measuring 3.3 x 2.7 x 1.0 cm on the lower lip for approximately 6 months. The patient underwent 2 fine needle aspiration biopsies (FNAs). Smears made from both FNAs demonstrated similar features including low cellular smears, three dimensional cell clusters forming a glandular structure, round to oval cells with high N:C ratio, occasional cytoplasmic lumens, without distinct hyperchromasia, focal inconspicuous nucleoli, smooth regular nuclear membranes, abundant naked nuclei, occasional squamoid cells and focal acellular stromal fragments in the background. The cytologic differential diagnosis included skin adnexal carcinoma and low grade mucoepidermoid carcinoma arising in the minor salivary gland. The mass was subsequently excised. The diagnosis of microcystic adnexal carcinoma was made. We report cytologic features of MAC and also suggest that MAC can possibly be diagnosed by FNA with the appropriate clinical vignette and immunohistochemical profile..
      Citation: CytoJournal 2011 8(1):5-5
      PubDate: Thu,3 Mar 2011
      DOI: 10.4103/1742-6413.77285
      Issue No: Vol. 8, No. 1 (2011)
       
  • Solitary Tracheobronchial Papilloma: Cytomorphology and ancillary studies
           with histologic correlation

    • Authors: Tee U Lang, Walid E Khalbuss, Sara E Monaco, Liron Pantanowitz
      Pages: 6 - 6
      Abstract: Tee U Lang, Walid E Khalbuss, Sara E Monaco, Liron Pantanowitz
      CytoJournal 2011 8(1):6-6
      Solitary tracheobronchial papilloma (STBP) is a rare benign tumor that primarily involves the tracheobronchial tree. Human papilloma virus (HPV) infection is associated with dysplasia and a high risk of carcinoma in these lesions. The cytomorphology of STBP is not well established in the literature. Our aim is to characterize the cytomorphologic features of STBP, with histologic correlation in a series of 6 patients - 4 males and 2 females - with a mean age of 67 years (range, 53-88 years). There were 5 biopsy-proven squamous papillomas and 1 glandular papilloma. On surgical biopsy, squamous papillomas exhibited cytological atypia (4 graded mild and 1 graded moderate with focal severe dysplasia), surface erosion, and inflammation. Cytology specimens available for review included a combination of 4 fine-needle aspirations (FNAs), 2 bronchoalveolar lavages and 2 (of 3) bronchial brushings. Cytologic findings associated with squamous papillomas included atypical squamous cells and rare squamous cell resembling koilocyte in 1 bronchial brushing. Sheets of squamous cells were identified in another specimen. Several cases had a prominent background of acute inflammation, and candida was present in 1 specimen. HPV in-situ hybridization was positive in 1 case and negative in 2 cases. A p16 immunocytochemical stain performed on 1 cell block was negative. In conclusion, although STBP is a rare neoplasm, these cases may be encountered in respiratory cytology samples. FNA of papillomas yields fewer lesional cells compared to exfoliative samples. These lesions may be mistaken in cytology specimens for squamous cell carcinoma, squamous-lined cavitary lesions, an infectious (fungal) process, reactive squamous metaplasia, or oral contamination.
      Citation: CytoJournal 2011 8(1):6-6
      PubDate: Thu,3 Mar 2011
      DOI: 10.4103/1742-6413.77286
      Issue No: Vol. 8, No. 1 (2011)
       
  • Endoscopic ultrasound-guided fine-needle aspiration of metastases to the
           pancreas: A study of 25 cases

    • Authors: Christopher M Gilbert, Sara E Monaco, Scott T Cooper, Walid E Khalbuss
      Pages: 7 - 7
      Abstract: Christopher M Gilbert, Sara E Monaco, Scott T Cooper, Walid E Khalbuss
      CytoJournal 2011 8(1):7-7
      Background: Metastases to the pancreas are an uncommon cause of pancreatic masses seen on endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA). The purpose of this study is to retrospectively review the cytomorphology, clinical findings, and results of ancillary studies in a large series of these unusual cases. Materials and Methods: We searched our institution's pathology database for EUS-guided FNAs of the pancreas that were diagnostic of metastatic tumor over a 5-year period. The final cytologic diagnosis, results of ancillary studies, corresponding histological material, and clinical follow-up data were reviewed in these cases. Results: A total of 1172 pancreatic EUS-guided FNAs were identified, of which 25 cases (2.1%) had a confirmed diagnosis of a pancreatic metastasis. This included 12 (48%) cases of renal cell carcinoma, 3 (12%) melanomas, 3 (12%) small cell carcinomas, and 7 (28%) other malignancies. In these metastatic tumors involving the pancreas, 20 (80%) of the lesions were solitary. Four (16%) cases had no prior history of malignancy. The average time to diagnosis of pancreatic metastasis was 5.3 years. Immunohistochemistry and special stains were performed in 22 (88%) and 9 (36%) cases, respectively. Conclusions: Our data shows that although metastases to the pancreas are rare, they can present as a solitary mass many years after the primary malignancy is diagnosed and can even be the first manifestation of an extrapancreatic primary in a small number of cases. It is important to consider the possibility of a metastatic lesion in the pancreas because this may require a different management than a primary pancreatic tumor.
      Citation: CytoJournal 2011 8(1):7-7
      PubDate: Thu,21 Apr 2011
      DOI: 10.4103/1742-6413.79779
      Issue No: Vol. 8, No. 1 (2011)
       
  • Pattern of epithelial cell abnormality in Pap smear: A clinicopathological
           and demographic correlation

    • Authors: Urmila Banik, Pradip Bhattacharjee, Shahab Uddin Ahamad, Zillur Rahman
      Pages: 8 - 8
      Abstract: Urmila Banik, Pradip Bhattacharjee, Shahab Uddin Ahamad, Zillur Rahman
      CytoJournal 2011 8(1):8-8
      Background: In the low resource settings of a developing country, a conventional Papanicolaou (Pap) test is the mainstay screening system for cervical cancer. In order to counsel women and to organize a public health system for cervical cancer screening by Pap smear examination, it is imperative to know the pattern of premalignant and malignant lesions. This study was undertaken to find out the prevalence of an abnormal Pap smear, in a tertiary hospital of a developing country, and to carry out a clinicopathological and demographical analysis for establishing the pattern of epithelial cell abnormality in a Pap smear. Materials and Methods: A cross-sectional descriptive study was carried out in a total of 1699 patients who underwent Pap smear examination. The prevalence of epithelial cell abnormality in the Pap smear was calculated in proportions / percentages. Specimen adequacy and reporting was assessed according to the revised Bethesda system. Results: Among the total of 1699 patients who had their Pap smear done, 139 (8.18%) revealed epithelial cell abnormality. Altogether 26 smears revealed high-grade lesions and malignancy, most of which were found to be in women belonging to the 30 - 39 and ≥ 45 age group. A total of 75 (53.96%) women were in the 20 - 44 age group and 64 (46.04%) were in the ≥ 45 age group. A bimodal age distribution was detected in the epithelial cell abnormality, with the bulk being diagnosed in patients aged 45 or above. Overall one-third of the patients with an abnormal Pap smear result showed healthy cervix in per vaginal examination. Conclusions: A raised prevalence of epithelial cell abnormality reflects the lack of awareness about cervical cancer screening. Women aged 45 or above harbor the bulk of premalignant and malignant lesions in the Pap smear, signifying that these women are among the under users of cytological screening.
      Citation: CytoJournal 2011 8(1):8-8
      PubDate: Sat,7 May 2011
      DOI: 10.4103/1742-6413.80527
      Issue No: Vol. 8, No. 1 (2011)
       
  • Teenage cervical screening in a high risk American population

    • Authors: Songlin Zhang, Jaiyeola Thomas, Joel Thibodeaux, Ami Bhalodia, Fleurette Abreo
      Pages: 9 - 9
      Abstract: Songlin Zhang, Jaiyeola Thomas, Joel Thibodeaux, Ami Bhalodia, Fleurette Abreo
      CytoJournal 2011 8(1):9-9
      Background: The new 2009 ACOG guideline for cervical cytology screening changed the starting age to 21 years regardless of the age of onset of sexual intercourse. However, many recent studies have shown a dramatic increase in the incidence of cervical epithelial abnormalities among adolescents within the past two decades. Materials and Methods: For this study, the reports of 156,342 cervical cytology were available of which 12,226 (7.8%) were from teenagers. A total of 192 teenagers with high grade intraepithelial lesion (HSIL) cervical cytology were identified. The ages ranged from 13 to 19 years with a mean of 17.7 years and a median of 18 years. Among them, 31.3% were pregnant, 12.0% were postpartum, and 13.5% were on oral contraceptive. Ninety-eight had prior cervical cytology. Results: The teenagers had statistically significant higher detection rates of overall abnormal cervical cytology (23.6% vs. 6.6%, P = 0), with 15.4% vs. 3.2% (P = 0) of low grade intraepithelial lesion (LSIL) and 1.8% vs. 1.0% (P = 2.56 Χ 10 -13 ) of HSIL compared to women ≥20 years. The teenage group had the highest abnormal cytology among all age groups. The LSIL/HSIL ratio was 8.5:1 for teenagers and 3.1:1 for women ≥20 years. A total of 131 teenagers had cervical biopsies within 12 months of the HSIL cytology, with diagnoses of 39 CIN 3, 1 VAIN 3, 15 CIN 2, 62 CIN 1, and 14 had a negative histology (CIN 0). Only in 19 of these 39 women, the CIN 2/3 lesion proved to be persistent. Conclusion: We conclude that cytology screening of high risk teenagers is effective in detecting CIN 2/3 lesions. Moreover, treatment and careful follow-up can be realized.
      Citation: CytoJournal 2011 8(1):9-9
      PubDate: Tue,31 May 2011
      DOI: 10.4103/1742-6413.81773
      Issue No: Vol. 8, No. 1 (2011)
       
  • Endobronchial ultrasound-guided transbronchial needle aspiration biopsy is
           useful evaluating mediastinal lymphadenopathy in a cancer center

    • Authors: Laila Khazai, Uma R Kundu, Betsy Jacob, Shobha Patel, Nour Sneige, George A Eapen, Rodolfo C Morice, Nancy P Caraway
      Pages: 10 - 10
      Abstract: Laila Khazai, Uma R Kundu, Betsy Jacob, Shobha Patel, Nour Sneige, George A Eapen, Rodolfo C Morice, Nancy P Caraway
      CytoJournal 2011 8(1):10-10
      Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy is used to stage mediastinal lymph nodes in cancer patients to optimize treatment strategies. In this retrospective study, the authors determined the utility of EBUS-TBNA biopsy in the evaluation of mediastinal lymphadenopathy at a high-volume cancer center. Materials and Methods: The pathology database was searched for all patients who had undergone EBUS-TBNA biopsy of mediastinal lymph nodes over a one-year period. Cytologic diagnoses were correlated with clinical histories, subsequent resection, and clinical follow-up data. Results: Of 928 lymph node samples, 226 (24%) were diagnosed as malignant, 4 (0.4%) were suspicious for malignancy, 9 (1%) were atypical, 640 (69%) were benign, and 47 (5%) were insufficient for evaluation. In 89 (9.6%) cases, the patients had surgical resection. There was one false positive, in which the primary tumor contained infiltrating lymphocytes, had been sampled. There were five false-negative cases, which resulted from sampling errors, including two with micrometastases. The sensitivity, specificity, and positive and negative predictive value rates for EBUS-TBNA biopsy in the evaluation of mediastinal lymph nodes were 68.7% and 98.6% and 91.6% and 93.5%, respectively on a per lymph node basis. The overall clinical sensitivity, specificity, and positive and negative predictive value rates after one year clinical/radiological and histologic follow-up were 97%, 99.3%, 96.7% and 99.4%, respectively. Conclusions: EBUS-TBNA biopsy is a sensitive and specific method for evaluating mediastinal lymphadenopathy in patients with lung and other primary tumors.
      Citation: CytoJournal 2011 8(1):10-10
      PubDate: Tue,31 May 2011
      DOI: 10.4103/1742-6413.82022
      Issue No: Vol. 8, No. 1 (2011)
       
  • Detection of amyloid in abdominal fat pad aspirates in early amyloidosis:
           Role of electron microscopy and Congo red stained cell block sections

    • Authors: Sumana Devata, Parameswaran Hari, Natalia Markelova, Rongshan Li, Richard Komorowski, Vinod B Shidham
      Pages: 11 - 11
      Abstract: Sumana Devata, Parameswaran Hari, Natalia Markelova, Rongshan Li, Richard Komorowski, Vinod B Shidham
      CytoJournal 2011 8(1):11-11
      Background: Fine-needle aspiration biopsy (FNA) of the abdominal fat pad is a minimally invasive procedure to demonstrate tissue deposits of amyloid. However, protocols to evaluate amyloid in fat pad aspirates are not standardized, especially for detecting scant amyloid in early disease. Materials and Methods: We studied abdominal fat pad aspirates from 33 randomly selected patients in whom subsequent tissue biopsy, autopsy, and/or medical history for confirmation of amyloidosis (AL) were also available. All these cases were suspected to have early AL, but had negative results on abdominal fat pad aspirates evaluated by polarizing microscopy of Congo Red stained sections (CRPM). The results with CRPM between four reviewers were compared in 12 cases for studying inter observer reproducibility. 24 cases were also evaluated by ultrastructural study with electron microscopy (EM). Results: Nine of thirty-three (27%) cases reported negative by polarizing microscopy had amyloidosis. Reanalysis of 12 mixed positive-negative cases, showed considerable inter-observer variability with frequent lack of agreement between four observers by CRPM alone (Cohen's Kappa index of 0.1, 95% CI -0.1 to 0.36). EM showed amyloid in the walls of small blood vessels in fibroadipose tissue in four out of nine cases (44%) with amyloidosis. Conclusion: In addition to poor inter-observer reproducibility, CRPM alone in cases with scant amyloid led to frequent false negative results (9 out of 9, 100%). For improved detection of AL, routine ultrastructural evaluation with EM of fat pad aspirates by evaluating at least 15 small blood vessels in the aspirated fibroadipose tissue is recommended. Given the high false negative rate for CRPM alone in early disease, routine reflex evaluation with EM is highly recommended to avert the invasive option of biopsying various organs in cases with high clinical suspicion for AL.
      Citation: CytoJournal 2011 8(1):11-11
      PubDate: Thu,23 Jun 2011
      DOI: 10.4103/1742-6413.82278
      Issue No: Vol. 8, No. 1 (2011)
       
  • A review of the utilization of fine needle aspiration in clinical practice
           and research in Nigeria

    • Authors: Sani Abubakar Malami, Ochicha Ochicha
      Pages: 12 - 12
      Abstract: Sani Abubakar Malami, Ochicha Ochicha
      CytoJournal 2011 8(1):12-12
      Background: Research and publications are critical to advancements in the quality of healthcare delivery. This article attempts to highlight the prospects and challenges of fine needle aspiration (FNA) cytology as a tool for research in Nigeria. Materials and Methods: Data available in local and international bibliographic databases for the period 1986-2005 (20 years) were collated and analyzed. Results: The theme of Nigerian FNA-focused studies correlated with the recognized disease patterns in the country which are tuberculous lymphadenitis, breast tumors and Burkitt's lymphoma. The accuracy of FNA in these situations was high and comparable to the experience in developed countries. It was found that the total number of articles published during two contiguous periods (1986-1995 and 1996-2005) had increased from 5 to 18. Also, in majority of cases, the articles were not published in specialized pathology journals. Conclusions: The utilization of FNA is apparently lagging in Nigeria. Given its potential in resource-constrained settings, we are of the opinion that it should be used more often in clinical and translational research.
      Citation: CytoJournal 2011 8(1):12-12
      PubDate: Thu,23 Jun 2011
      DOI: 10.4103/1742-6413.82277
      Issue No: Vol. 8, No. 1 (2011)
       
  • A review of uncommon cytopathologic diagnoses of pleural effusions from a
           chest diseases center in Turkey

    • Authors: Ebru Cakir, Funda Demirag, Mehtap Aydin, Yurdanur Erdogan
      Pages: 13 - 13
      Abstract: Ebru Cakir, Funda Demirag, Mehtap Aydin, Yurdanur Erdogan
      CytoJournal 2011 8(1):13-13
      Background : After pneumonia, cancer involving the pleura is the leading cause of exudative pleural effusion. Cytologic examination of pleural effusions is an important initial step in management of malignant effusions. The aim of this study is to evaluate the spectrum of uncommon malignant pleural effusions in a chest disease center in Turkey. Materials and Methods : A retrospective study of samples of pleural effusions submitted to Ataturk Chest Diseases and Chest Surgery Education and Research Hospital Department of Pathology between March 2005 and November 2008 was performed. Results : Out of a total of 4684 samples reviewed 364 (7.8%) were positive for cancer cells. Of the malignant pleural effusions 295 (81%) were classified as adenocarcinoma or carcinoma not otherwise specified (NOS). Pleural effusion specimens revealing a diagnosis other than adenocarcinoma/carcinoma NOS were: 32 (8.8%) malignant mesotheliomas, 14 (3.8%) small cell carcinomas, 13 (3.5%) hematolymphoid malignancies and 10 (2.7%) squamous cell carcinoma. Hematolymphoid malignancies included non- Hodgkin lymphoma (diffuse B large cell lymphoma, mantle cell lymphoma), multiple myeloma, chronic myeloid leukemia, and acute myeloid leukemia. Conclusions: Despite that adenocarcinoma is the most common cause of malignant pleural effusions, there is a significant number of hematological and non-hematological uncommon causes of such effusions. Cytopathologists and clinicians must keep in mind these uncommon entities in routine practice for an accurate diagnosis.
      Citation: CytoJournal 2011 8(1):13-13
      PubDate: Tue,19 Jul 2011
      DOI: 10.4103/1742-6413.83026
      Issue No: Vol. 8, No. 1 (2011)
       
  • Utility of a limited panel of calretinin and Ber-EP4 immunocytochemistry
           on cytospin preparation of serous effusions: A cost-effective measure in
           resource-limited settings

    • Authors: Raman Arora, Shipra Agarwal, Sandeep R Mathur, Kusum Verma, Venkateswaran K Iyer, Manju Aron
      Pages: 14 - 14
      Abstract: Raman Arora, Shipra Agarwal, Sandeep R Mathur, Kusum Verma, Venkateswaran K Iyer, Manju Aron
      CytoJournal 2011 8(1):14-14
      Background: Differentiation between reactive, but morphologically atypical, mesothelial cells and adenocarcinoma in effusions can be problematic. Elaborate immunohistochemical panels have been devised. Techniques like DNA analysis, flow/image cytometry, and K-ras mutation analysis are research oriented and difficult to perform in routine, especially in resource-poor centers. We evaluated the efficacy of a limited two-antibody panel comprising calretinin and Ber-EP4 on cytospin and cell block preparations, in 100 effusion samples. Materials and Methods: Fifty cases of reactive mesothelial hyperplasia and 50 cases of adenocarcinoma diagnosed by cytomorphology in ascitic/pleural fluid specimens over a 2-year period were assessed. The diagnoses were confirmed by clinical/histopathologic correlation. Cytospin smears were made in all. Cell blocks were prepared, wherever adequate fluid was available. Immunocytochemistry (ICC) for calretinin and Ber-EP4 was performed. Results: Forty-five of the reactive effusion cases (90%) were calretinin reactive and Ber-EP4 negative. Among the adenocarcinoma cases, 49 (98%) were calretinin negative but Ber-EP4 positive. Thus, both calretinin and Ber-EP4 had a high sensitivity (90% and 98%, respectively), as well as a high specificity (100% and 86%, respectively). In the 21 reactive mesothelial cases, whose cell blocks were made, results were comparable to those on cytospin. However, of the 19 adenocarcinoma cases in which cell blocks were prepared, all were Ber-EP4 immunopositive except for three, which were positive on cytospin, implying false-negative results on cell blocks. Conclusions: A limited panel of two monoclonal antibodies, calretinin and Ber-EP4, may be useful in cytology, as a "primary antibody panel", for accurate diagnosis and patient management. Additionally, ICC can be performed easily on cytospin preparations, which gave results comparable to cell blocks in our study.
      Citation: CytoJournal 2011 8(1):14-14
      PubDate: Thu,28 Jul 2011
      DOI: 10.4103/1742-6413.83233
      Issue No: Vol. 8, No. 1 (2011)
       
  • Salivary duct carcinoma with striking neutrophil-tumor cell cannibalism

    • Authors: Payam Arya, Walid E Khalbuss, Sara E Monaco, Liron Pantanowitz
      Pages: 15 - 15
      Abstract: Payam Arya, Walid E Khalbuss, Sara E Monaco, Liron Pantanowitz
      CytoJournal 2011 8(1):15-15
      Cannibalism of neutrophils by tumor cells has previously been reported in certain carcinomas, lymphoma and melanoma. Tumor cannibalism is believed to serve as a tumor-immune escape mechanism, associated with high-grade aggressive cancers with a significantly increased metastatic potential. This interesting phenomenon has not been previously documented in association with salivary gland tumors. We report, for the first time, striking neutrophil-tumor cell cannibalism associated with a high grade, aggressive and metastatic salivary duct carcinoma of the parotid gland highlighted within cytological and surgical excision pathology specimens.
      Citation: CytoJournal 2011 8(1):15-15
      PubDate: Wed,24 Aug 2011
      DOI: 10.4103/1742-6413.84222
      Issue No: Vol. 8, No. 1 (2011)
       
  • Abstracts for the 59th Annual Scientific Meeting (November 2011) by
           American Society of Cytopathology (ASC) at Baltimore, MD, USA

    • Pages: 16 - 16
      Abstract:
      CytoJournal 2011 8(1):16-16
      These are peer-reviewed poster-platform submissions finalized by the Scientific Program Committee. A total of 153 abstracts (14 Platforms [PP1 through PP14] & 139 Posters [1 through 139]) were selected from 161 submissions to be considered for presentation during November 4 - 8, 2011, at the Hilton Baltimore Hotel, to pathologists, cytopathologists, cytotechnologists, residents, fellows, students, and other members of cytopathology-related medical and scientific fields.
      Citation: CytoJournal 2011 8(1):16-16
      PubDate: Fri,16 Sep 2011
      DOI: 10.4103/1742-6413.84993
      Issue No: Vol. 8, No. 1 (2011)
       
  • Cyto-morphological features of extramedullary acute megakaryoblastic
           leukemia on fine needle aspiration and cerebrospinal fluid cytology: A
           case report

    • Authors: Sanjeev Chitragar, Shipra Agarwal, Venkateswaran K Iyer, Sandeep R Mathur, Asis K Karak, Taher Chharchhodawala, Atul Sharma, Sameer Bakhshi
      Pages: 17 - 17
      Abstract: Sanjeev Chitragar, Shipra Agarwal, Venkateswaran K Iyer, Sandeep R Mathur, Asis K Karak, Taher Chharchhodawala, Atul Sharma, Sameer Bakhshi
      CytoJournal 2011 8(1):17-17
      Extramedullary deposits may be the presenting feature of acute myeloid leukemia. An early and accurate diagnosis on cytology will aid in correct patient management. This is especially true for patients with acute megakaryoblastic leukemia (AML M7), where bone marrow aspiration may yield only a dry tap. While cytomorphological features of myeloid sarcoma of other types are well recognized due to its rarity, there are only two case reports discussing the morphological details of megakaryoblastic differentiation on aspiration cytology. We present the case of a 25-year-old patient with extramedullary involvement of lymph node and cerebrospinal fluid by AML M7, describing in detail, the morphological features on aspiration as well as exfoliative cytology.
      Citation: CytoJournal 2011 8(1):17-17
      PubDate: Tue,27 Sep 2011
      DOI: 10.4103/1742-6413.85496
      Issue No: Vol. 8, No. 1 (2011)
       
  • The cytomorphologic spectrum of small-cell carcinoma and large-cell
           neuroendocrine carcinoma in body cavity effusions: A study of 68 cases

    • Authors: Walid E Khalbuss, Huaitao Yang, Qian Lian, Abdelmonem Elhosseiny, Liron Pantanowitz, Sara E Monaco
      Pages: 18 - 18
      Abstract: Walid E Khalbuss, Huaitao Yang, Qian Lian, Abdelmonem Elhosseiny, Liron Pantanowitz, Sara E Monaco
      CytoJournal 2011 8(1):18-18
      Background: Small-cell carcinoma (SCC) and large-cell neuroendocrine carcinoma (LCNEC) are uncommon in serous body cavity effusions. The purpose of this study is to examine the cytomorphological spectrum of SCC and LCNEC in body cavity serous fluids. Materials and Methods: We have 68 cases from 53 patients who had metastatic SCC or LCNEC diagnoses. All cytology slides and the available clinical data, histological follow-up, and ancillary studies were reviewed. Results: A total of 68 cases (60 pleural, 5 peritoneal, and 3 pericardial effusions) from 53 patients with an average age of 73 years (age range 43-92 years) were reported as diagnostic or suspicious of SCC (52 cases) or LCNEC (16 cases). The primary site was lung in 56 cases, pancreas in 6 cases, and 2 cases each from cervix, colon, and the head and neck region. Of the 68 cases, 48 cases had no history of malignancy of the same type. Ancillary studies were used in 46 cases (68%) including flow cytometric studies in 5 cases. There were three predominant cytomorphological patterns observed including small-cell clusters with prominent nuclear molding (33 cases, 49%), large-cell clusters mimicking non-small-cell carcinoma (18 cases, 26%), and single-cell pattern mimicking lymphoma (17 cases, 25%). Significant apoptosis was seen in 22 cases (33%) and marked tumor cell cannibalism was seen in 11 cases (16%). Nucleoli were prominent in 16 cases (24%). The most frequent neuroendocrine markers performed were synaptophysin and chromogranin. Conclusions: The most common cytomorphologic patterns seen in body cavity effusions of SCC and LCNEC were small-cell clusters with nuclear molding. However, in 51% of the cases either a predominant single-cell pattern mimicking lymphoma or large-cell clusters mimicking non-small carcinoma were noted. In our experience, effusions were the first manifestation of disease in the majority of patients diagnosed with neuroendocrine carcinoma. Therefore, familiarity with the cytomorphological spectrum of neuroendocrine carcinomas in fluid cytology may help in rapidly establishing an accurate diagnosis and in directing appropriate management.
      Citation: CytoJournal 2011 8(1):18-18
      PubDate: Sat,29 Oct 2011
      DOI: 10.4103/1742-6413.86816
      Issue No: Vol. 8, No. 1 (2011)
       
  • Malignancy rate in nondominant nodules in patients with multinodular
           goiter: Experience with 1,606 cases evaluated by ultrasound-guided fine
           needle aspiration cytology

    • Authors: Nadir Paksoy, Kadri Yazal, Selin Çorak
      Pages: 19 - 19
      Abstract: Nadir Paksoy, Kadri Yazal, Selin Çorak
      CytoJournal 2011 8(1):19-19
      Background: Conventional medical sources recommend the use of fine needle aspiration cytology (FNAC) for single thyroid nodules and the dominant nodule in multinodular goiter (MNG). The purpose of the present study was to analyze the utility of FNAC for multiple thyroid nodules in patients with MNG and to determine the rate of malignancy in teh nondominant nodules. Materials and Methods : Our private practice performed ultrasound-guided FNAC on 1,606 patients between February 2001 and February 1, 2010. In the MNG cases, samples were taken from the dominant nodule and from trhee suspicious / nonsuspicious nodules larger than 1 cm on ultrasound. Ninety-four cases were diagnosed as 'suspiciously malignant'(SUS) or 'malignant' (POS) based on FNAC. Results: The rate of an SUS / POS diagnosis was 5.7% in the dominant nodules; 2.3% of the nondominant nodules had a SUS / POS diagnosis in FNAC (p = 0.0003). Follow-up revealed malignancy in 15 (35.7%) nondominant nodules and in 27 (64.2%) dominant nodules, with 42 MNG cases undergoing surgery. X test showed a 'p-level of 0.0003' between the percentages of SUS / POS diagnosis in dominanat and nondominanat nodules. It was less than the significance level of 0.05. Therefore, the result was regarded to be statistically significant. Conclusions: Nondominant nodules could harbor malignancy. The risk of malignancy in nondominant nodules in MNG should not be underestimated. We have shown that the dominant nodule in patients with MNG was in fact about 2.5 times more likely to be malignant than a nondominant nodule. The use of FNAC for nondominant nodules could enhance the likelihood of detecting malignancy in an MNG.
      Citation: CytoJournal 2011 8(1):19-19
      PubDate: Mon,31 Oct 2011
      DOI: 10.4103/1742-6413.86970
      Issue No: Vol. 8, No. 1 (2011)
       
  • Utility of on-site evaluation of endobronchial ultrasound-guided
           transbronchial needle aspiration specimens

    • Authors: Adrienne Carruth Griffin, Lauren Ende Schwartz, Zubair W Baloch
      Pages: 20 - 20
      Abstract: Adrienne Carruth Griffin, Lauren Ende Schwartz, Zubair W Baloch
      CytoJournal 2011 8(1):20-20
      Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an integral tool in the diagnosis and staging of malignant tumors of the lung. Rapid on-site evaluation (ROSE) of fine needle aspiration (FNA) samples has been advocated for as a guide for assessing the accuracy and adequacy of biopsy samples. Although ROSE has proven useful for numerous sites and procedures, few studies have specifically investigated its utility in the assessment of EBUS-TBNA specimens. The intention of this study was to explore the utility of ROSE for EBUS-TBNA specimens. Materials and Methods: The pathology files at our institution were searched for all EBUS-TBNA cases performed between January 2010 and June 2010. The data points included number of sites sampled per patient, location of site(s) sampled, on-site evaluation performed, preliminary on-site diagnosis rendered, final cytologic diagnosis, surgical pathology follow-up, cell blocks, and ancillary studies performed. Results: A total of 294 EBUS-TBNA specimens were reviewed and included in the study; 264 of 294 (90%) were lymph nodes and 30 of 294 (10%) were lung mass lesions. ROSE was performed for 140 of 294 (48%) specimens. The on-site and final diagnoses were concordant in 104 (74%) and discordant in 36 (26%) cases. Diagnostic specimens were obtained in 132 of 140 (94%) cases with on-site evaluation and 138 of 154 (90%) without on-site evaluation. The final cytologic diagnosis was malignant in 60 of 132 (45%) cases with ROSE and 46 of 138 (33%) cases without ROSE, and the final diagnosis was benign in 57 of 132 (47%) with ROSE and 82 of 138 (59%) without ROSE. A cell block was obtained in 129 of 140 (92%) cases with ROSE and 136 of 154 (88%) cases without ROSE. Conclusions : The data demonstrate no remarkable difference in diagnostic yield, the number of sites sampled per patient, or clinical decision making between specimens collected via EBUS-TBNA with or without ROSE. As a result, this study challenges the notion that ROSE is beneficial for the evaluation of EBUS-TBNA specimens.
      Citation: CytoJournal 2011 8(1):20-20
      PubDate: Mon,21 Nov 2011
      DOI: 10.4103/1742-6413.90081
      Issue No: Vol. 8, No. 1 (2011)
       
  • Cytological analysis of small branch-duct intraductal papillary mucinous
           neoplasms provides a more accurate risk assessment of malignancy than
           symptoms

    • Authors: Jill Ono, Kurt A Yaeger, Muriel Genevay, Mari Mino-Kenudson, William R Brugge, Martha B Pitman
      Pages: 21 - 21
      Abstract: Jill Ono, Kurt A Yaeger, Muriel Genevay, Mari Mino-Kenudson, William R Brugge, Martha B Pitman
      CytoJournal 2011 8(1):21-21
      Objectives: The Sendai guidelines for management of patients with clinically suspected intraductal papillary mucinous neoplasms (IPMN) recommend resection of cysts > 30 mm, a dilated main pancreatic duct (MPD) > 6 mm, a mural nodule (MN), symptoms or positive cytology. Although sensitive, asymptomatic cysts, nonspecific symptoms, and a high threshold for positive cytology limit the specificity of the guidelines. We have assessed the value of cytology relative to symptom for predicting malignancy in IPMNs without high-risk imaging features. Materials and Methods: We retrospectively reviewed the clinical, radiological, and cytological data of 31 small branch-duct IPMNs without a MN. The cytological presence of high-grade atypical epithelial cells (HGA) was considered true positive, with a corresponding histology of high-grade dysplasia or invasive carcinoma. The performance of cytology versus symptoms was evaluated by calculating the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy. Results: The sensitivity (0.80), specificity (0.85), and accuracy (0.84) of HGA were higher than the corresponding performance characteristics of symptoms (0.60, 0.45, and 0.48, respectively). The NPV of no HGA on cytology was > 95%. Conclusions: Cytology is a better predictor of malignancy than symptoms, for the conservative management of small branch-duct IPMNs. Cytology contributes to a highly accurate triple negative test for malignancy in small IPMN: No dilated MPD, MN or HGA.
      Citation: CytoJournal 2011 8(1):21-21
      PubDate: Mon,21 Nov 2011
      DOI: 10.4103/1742-6413.90084
      Issue No: Vol. 8, No. 1 (2011)
       
  • Cytomorphology of Erdheim-Chester disease presenting as a retroperitoneal
           soft tissue lesion

    • Authors: Bibianna Purgina, Ronald Jaffe, Sara E Monaco, Walid E Khalbuss, H Scott Beasley, John A Dunn, Liron Pantanowitz
      Pages: 22 - 22
      Abstract: Bibianna Purgina, Ronald Jaffe, Sara E Monaco, Walid E Khalbuss, H Scott Beasley, John A Dunn, Liron Pantanowitz
      CytoJournal 2011 8(1):22-22
      Erdheim-Chester disease (ECD) is a rare, multisystem disorder of macrophages. Patients manifest with histiocytic infiltrates that lead to xanthogranulomatous lesions in multiple organ systems. The cytologic features of this disorder are not well characterized. As a result, the cytologic diagnosis of ECD can be very challenging. The aim of this report is to describe the cytomorphology of ECD in a patient presenting with a retroperitoneal soft tissue lesion. A 54-year-old woman with proptosis and diabetes insipidus was found on imaging studies to have multiple intracranial lesions, sclerosis of both femurs and a retroperitoneal soft tissue mass. Fine needle aspiration (FNA) and a concomitant core biopsy of this abnormal retroperitoneal soft tissue revealed foamy, epithelioid and multinucleated histiocytes associated with fibrosis. The histiocytes were immunoreactive for CD68, CD163, Factor XIIIa and fascin, and negative for S100, confirming the diagnosis of ECD. ECD requires a morphologic diagnosis that fits with the appropriate clinical context. This case describes the cytomorphologic features of ECD and highlights the role of cytology in helping reach a diagnosis of this rare disorder.
      Citation: CytoJournal 2011 8(1):22-22
      PubDate: Tue,27 Dec 2011
      DOI: 10.4103/1742-6413.91242
      Issue No: Vol. 8, No. 1 (2011)
       
  • Thank you reviewers - CytoJournal 2011

    • Authors: Vinod B Shidham, Richard M DeMay, Martha B Pitman
      Pages: 23 - 23
      Abstract: Vinod B Shidham, Richard M DeMay, Martha B Pitman
      CytoJournal 2011 8(1):23-23
      CytoJournal, with its continued contribution of scientific cytopathology literature to the public domain under open access (OA) charter, thanks its dedicated peer reviewers for devoting significant efforts, time, and resources during 2011. The abstracts of poster-platform submissions to the 59 th Annual Scientific Meeting (November 2011) of the American Society of Cytopathology (ASC) in Baltimore, MD, USA, were peer reviewed by the ASC Scientific Program Committee.
      Citation: CytoJournal 2011 8(1):23-23
      PubDate: Tue,27 Dec 2011
      DOI: 10.4103/1742-6413.91243
      Issue No: Vol. 8, No. 1 (2011)
       
  • Testicular touch preparation cytology in the evaluation of male
           infertility

    • Authors: Isil Z Yildiz-Aktas, Sara E Monaco, Walid E Khalbuss, Anil V Parwani, Thomas M Jaffe, Liron Pantanowitz
      Pages: 24 - 24
      Abstract: Isil Z Yildiz-Aktas, Sara E Monaco, Walid E Khalbuss, Anil V Parwani, Thomas M Jaffe, Liron Pantanowitz
      CytoJournal 2011 8(1):24-24
      Background: Male infertility is traditionally evaluated by tissue core biopsies of the testes. Touch preparations (TP) of these biopsies have been infrequently used. The aim of this study is to report our experience with using testicular biopsy TP for the evaluation of male infertility. Materials and Methods: A retrospective search was performed for cases of testes biopsies with concurrent TP. These cases were evaluated for clinical information, specimen adequacy, and cytological-histological correlation. Results: A total of 39 cases were identified from men with a mean age of 34 years (range 23 to 50 years). TP slides were satisfactory for evaluation in 31 (89%) cases, and less than optimal in four due to low cellularity, obscuring blood or air drying artifact. Cytopathology showed concordance with the biopsy in almost all cases. In one discordant case where the biopsies showed no active spermatogenesis, a rare sperm were identified on the TP. Conclusions: TP of the testis is a helpful adjunct to biopsy because of its ability to clearly evaluate all stages of spermatogenesis. These data demonstrate that TP cytopathology of the testes in our experience has an excellent correlation with both normal testicular biopsies and those showing pathological spermatogenesis, and in rare cases may provide added benefit in evaluating the presence of spermatogenesis for male infertility. Albeit uncommon, cytopathologists may be required to identify and evaluate spermatogenic elements in cytology specimens being submitted from men with infertility.
      Citation: CytoJournal 2011 8(1):24-24
      PubDate: Tue,27 Dec 2011
      DOI: 10.4103/1742-6413.91244
      Issue No: Vol. 8, No. 1 (2011)
       
  • Two-color immunocytochemistry for evaluation of effusion fluids for
           metastatic adenocarcinoma

    • Authors: Vinod B Shidham, George Varsegi, Krista D'Amore
      Pages: 1 - 1
      Abstract: Vinod B Shidham, George Varsegi, Krista D'Amore
      CytoJournal 2010 7(1):1-1
      Background: The evaluation of serous fluids by conventional one color immunocytochemistry is complex and challenging. Design: We selected and studied 37 serous fluid cytology specimens (23 pleural, 13 peritoneal, 1 pericardial), collected over a 4-year period. They were unequivocally positive for metastatic adenocarcinoma based on clinical correlation, cytomorphology, and one color immunocytochemistry on cell block sections. 3 µm serial sections of cell blocks were immunostained by a two chromogen method (peroxidase with brown chromogen followed by alkaline phosphatase with red chromogen). Combinations evaluated were: A- vimentin followed by cytokeratin (CK) 7; B- calretinin followed by BerEP4, C- calretinin followed by CK 20. Additionally, difficulty of interpretation was evaluated on a scale of 1(easy) to 5 (difficult). Cases demonstrating decreased or complete loss of immunoreactivity with alkaline phosphatase red chromogen system were also evaluated with routine one color immunostaining by alkaline phosphatase and peroxidase individually. The pretreatments for antigen retrieval and antibody dilutions were identical to those used for conventional one color immunostaining with respective immunomarker. Result: Combination 'A' showed correlation with the immunoreactivity pattern observed with one color immunostaining. However, the immunoreactivity of the second immunomarker was compromised in combinations B and C. In the latter group, the sections immunostained with one color alkaline phosphatase indicator system also showed weak immunoreactivity or complete loss of immunoreactivity for the corresponding second immunomarker. However, the peroxidase system showed proper immunoreactivity for those immunomarkers. Average difficulty of interpretation for the two color method was 1.06 (range- 1 to 2) as compared to 2.95 (range: 1 to 5) with the one color method. This difference was statistically significant (two-tailed P
      Citation: CytoJournal 2010 7(1):1-1
      PubDate: Wed,10 Feb 2010
      DOI: 10.4103/1742-6413.59887
      Issue No: Vol. 7, No. 1 (2010)
       
  • A Shandon PapSpin liquid-based gynecological test: A split-sample and
           direct-to-vial test with histology follow-up study

    • Authors: J Rimiene, J Petronyte, Z Gudleviciene, Giedre Smailyte, Ingrida Krasauskaite, A Laurinavicius
      Pages: 2 - 2
      Abstract: J Rimiene, J Petronyte, Z Gudleviciene, Giedre Smailyte, Ingrida Krasauskaite, A Laurinavicius
      CytoJournal 2010 7(1):2-2
      Background: Studies for liquid-based Papanicolaou (Pap) tests reveal that liquid-based cytology (LBC) is a safe and effective alternative to the conventional Pap smear. Although there is research on ThinPrep and SurePath systems, information is lacking to evaluate the efficiency and effectiveness of systems based on cytocentrifugation. This study is designed to determine the sensitivity and specificity of the Shandon PapSpin (ThermoShandon, Pittsburgh, Pennsylvania, USA) liquid-based gynecological system. We used split-sample and direct-to-vial study design. Materials and Methods: 2,945 women referred to prophylactic check-up were enrolled in this study. Split sample design was used in 1,500 women and residual cervical cytology specimen from all these cases was placed in fluid for PapSpin preparation after performing conventional smear. The direct-to-vial study was carried out in another cohort of 1,445 women in whom the entire cervical material was investigated using only the PapSpin technique. Follow up histological diagnoses for 141 women were obtained from both study arms following 189 abnormal cytology cases. 80 LBC cases from the split sample group and 61 LBC cases in the direct-to-vial group were correlated with the histology results. The sensitivity and secificity of the conventional smear and PapSpin tests in both study arms were compared. Results: In the split sample group, conventional smears showed a higher proportion of ASC-US (atypical cells undetermined significance): 31 (2.1%) vs 10 (0.7%) in PapSpin (P = 0.001). A higher proportion of unsatisfactory samples was found in the conventional smear group: 25 (1.7%) vs 6 (0.4%) cases (P = 0.001). In the split sample group, the sensitivity of the conventional and PapSpin tests was 68.7% vs 78.1%, and the specificity 93.8% vs 91.8%, respectively. In the direct to vial group PapSpin sensitivity was 75.9% and specificity 96.5%. The differences in sensitivity and specificity were not significant. The positive predictive values for the conventional and PapSpin methods were not different in the split sample group: 88.0% vs 86.2% and 95.7% in the direct-to-vial group. Also, no differences were found for negative predictive value (82.1, 86.8% and 80.0% respectively). Conclusions: PapSpin showed good qualitative results in both study arms, even after the material splitting in the first study arm, and is a good alternative to the conventional Pap smear. Additionally, the PapSpin method offers several advantages such as the opportunity to prepare duplicate slides, option for HPV DNA testing and cell block preparations from residual material. Microscopic evaluation of thinner cell preparations is less time consuming than the conventional Pap smears.
      Citation: CytoJournal 2010 7(1):2-2
      PubDate: Sat,20 Mar 2010
      DOI: 10.4103/1742-6413.61200
      Issue No: Vol. 7, No. 1 (2010)
       
  • Integrating a FISH imaging system into the cytology laboratory

    • Authors: G Denice Smith, Matt Riding, Kim Oswald, Joel S Bentz
      Pages: 3 - 3
      Abstract: G Denice Smith, Matt Riding, Kim Oswald, Joel S Bentz
      CytoJournal 2010 7(1):3-3
      We have implemented an interactive imaging system for the interpretation of UroVysion fluorescence in situ hybridization (FISH) to improve throughput, productivity, quality control and diagnostic accuracy. We describe the Duet imaging system, our experiences with implementation, and outline the financial investment, space requirements, information technology needs, validation, and training of cytotechnologists needed to integrate such a system into a cytology laboratory. Before purchasing the imaging system, we evaluated and validated the instrument at our facility. Implementation required slide preparation changes, IT modifications, development of training programs, and revision of job descriptions for cytotechnologists. A darkened room was built to house the automated scanning station and microscope, as well as two imaging stations. IT changes included generation of storage for archival images on the LAN, addition of external hard drives for back-up, and changes to cable connections for communication between remote locations. Training programs for cytotechnologists, and pathologists/fellows/residents were developed, and cytotechnologists were integrated into multiple steps of the process. The imaging system has resulted in increased productivity for pathologists, concomitant with an expanded role of cytotechnologists in multiple critical steps, including FISH, scan setup, reclassification, and initial interpretation.
      Citation: CytoJournal 2010 7(1):3-3
      PubDate: Tue,6 Apr 2010
      DOI: 10.4103/1742-6413.62258
      Issue No: Vol. 7, No. 1 (2010)
       
  • Cytomorphologic consideration in malignant ascites with renal cell
           carcinoma: A report of two cases

    • Authors: Ruchika Gupta, Sandeep R Mathur, Venkateswaran K Iyer, Sudheer A Kumar, Amlesh Seth
      Pages: 4 - 4
      Abstract: Ruchika Gupta, Sandeep R Mathur, Venkateswaran K Iyer, Sudheer A Kumar, Amlesh Seth
      CytoJournal 2010 7(1):4-4
      Effusions, especially peritoneal, are seen in less than 2% of patients with renal cell carcinoma (RCC). Since the tumor cells in RCC are bland and nondescript, the involvement of serous effusions is difficult to diagnose. An accurate recognition of malignant effusion and differentiation from reactive mesothelial cells is imperative. A 55-year-old male presented with gradually progressive ascites. Cytospin preparations from ascitic fluid showed reactive mesothelial cells admixed with few smooth-contoured clusters of cells with moderate cytoplasm, vesicular nuclei with prominent nucleolus. He had undergone nephrectomy for papillary RCC two years earlier. Another 36-year-old man underwent left nephrectomy for suspected RCC. Intra-operative ascitic fluid was sent for cytologic examination and showed numerous reactive mesothelial cells along with few clusters of cells with scant to moderate amount of cytoplasm, vesicular nucleus and a small nucleolus. Considering the histomorphology of the primary renal tumor in both cases, a cytologic diagnosis of malignant peritoneal effusion, morphologically compatible with RCC was rendered. RCC, due to its bland cytologic features, is easily overlooked in effusions. In a known patient, the cytopathologist must be extra vigilant to pick up the few cell clusters present in the fluid preparations and differentiate them from reactive mesothelial cells. A close inspection of the cytologic features and comparison with the histopathology of the primary tumor helps in making an accurate diagnosis.
      Citation: CytoJournal 2010 7(1):4-4
      PubDate: Tue,6 Apr 2010
      DOI: 10.4103/1742-6413.62256
      Issue No: Vol. 7, No. 1 (2010)
       
  • Fine needle aspiration biopsy diagnosis of dedifferentiated liposarcoma:
           Cytomorphology and MDM2 amplification by FISH

    • Authors: Hatem Q Al-Maghraby, Walid E Khalbuss, Uma N.M Rao, Kathleen Cieply, Sanja Dacic, Sara E Monaco
      Pages: 5 - 5
      Abstract: Hatem Q Al-Maghraby, Walid E Khalbuss, Uma N.M Rao, Kathleen Cieply, Sanja Dacic, Sara E Monaco
      CytoJournal 2010 7(1):5-5
      Lipomatous mesenchymal tumors constitute the most common type of soft tissue tumors. Well-differentiated liposarcoma (WDLS) can undergo dedifferentiation to a nonlipogenic sarcoma of variable histologic grade. In the recent literature, amplification of the murine double minute 2 (MDM2) oncogene, which has a role in cell cycle control, has been successful in distinguishing WDLS from benign lesions. We present a case of dedifferentiated liposarcoma diagnosed by fine-needle aspiration (FNA), using cytomorphology and ancillary studies (immunocytochemistry and fluorescent in-situ hybridization). An 85-year old female presented to our institution with a firm soft tissue mass of the right buttock. The FNA showed atypical spindle cells, osteoclast-like giant cells and extracellular dense matrix material. The cell block showed cellular groups of highly atypical spindle cells with osteoid and adipose tissue. Fluorescence in situ hybridization (FISH) studies performed on the cell block demonstrated amplification of the MDM2 gene. In addition, the findings were morphologically compatible with the previously resected retroperitoneal dedifferentiated liposarcoma with areas of osteosarcoma. This rare case illustrates the usefulness of FNA and ancillary studies in the diagnosis and subclassification of soft tissue tumors. To the best of our knowledge, this is the first report of MDM2 FISH positivity in a liposarcoma diagnosed by FNA.
      Citation: CytoJournal 2010 7(1):5-5
      PubDate: Tue,6 Apr 2010
      DOI: 10.4103/1742-6413.62257
      Issue No: Vol. 7, No. 1 (2010)
       
  • Progression from on-site to point-of-care fine needle aspiration service:
           Opportunities and challenges

    • Authors: Prabodh K Gupta
      Pages: 6 - 6
      Abstract: Prabodh K Gupta
      CytoJournal 2010 7(1):6-6
      Background: Standard-of-care requires the availability of an efficient, economical and accurate on-site fine needle aspiration (FNA) service. Presence of a trained individual during the procedure ensures an improved patient care. Appropriate selection of the equipment, interaction with the clinicians and compliance with the various regulations during the procedure is essential. This is often done by an on-site FNA service. Organization and implementation of such a system in a large academic center is challenging. Method: we reviewed the ambulatory care needs in the new Perelman Center for Advanced Medicine (PeCAM). Multiple (9) FNA sites have been established keeping in view the patient's convenience, clinic demands, various regulatory requirements and laboratory staff. Each location has dedicated FNA station with microscopes and supplies. In addition, state- ofthe -art technologies including a mobile FNA cart (Penn-A- Cart), remote specimen evaluation (TeleCyP) have been incorporated. Results: The new set up is extremely efficient and much valued by the patients and the clinicians. It has improved patient care. Conclusion: With necessary investments and resources a point-of-care FNA service has been created which has improved patient care. This, albeit with certain modifications may serve as a model for FNA service.
      Citation: CytoJournal 2010 7(1):6-6
      PubDate: Wed,12 May 2010
      DOI: 10.4103/1742-6413.63195
      Issue No: Vol. 7, No. 1 (2010)
       
  • Clinical history of HIV infection may be misleading in cytopathology

    • Authors: Liron Pantanowitz, Michael Kuperman, Robert A Goulart
      Pages: 7 - 7
      Abstract: Liron Pantanowitz, Michael Kuperman, Robert A Goulart
      CytoJournal 2010 7(1):7-7
      Human immunodeficiency virus (HIV)-infected patients are at an increased risk for developing opportunistic infections, reactive conditions and neoplasms. As a result, a broad range of conditions are frequently included in the differential diagnosis of HIV-related lesions. The clinical history of HIV infection may, however, be misleading in some cases. Illustrative cases are presented in which knowledge of a patient's HIV status proved to be misleading and increased the degree of complexity of the cytologic evaluation. Case 1 involved the fine needle aspiration (FNA) of a painful 3 cm unilateral neck mass in a 38-year-old female with generalized lymphadenopathy. Her aspirate revealed a spindle cell proliferation devoid of mycobacteria that was immunoreactive for S-100 and macrophage markers (KP-1, PGM1). Multiple noncontributory repeat procedures were performed until a final excision revealed a schwannoma. Case 2 was a CT-guided FNA of a positron emission tomography positive lung mass in a 53-year-old man. The acellular aspirate in this case contained structures resembling fungal spore forms that were negative for mucicarmine and GMS stains, as well as cryptococcal antigen immunocytochemistry. A Von Kossa stain confirmed that these pseudo-fungal structures were calcified debris. Follow up revealed multiple calcified lung and hilar node based granulomata. Case 3 involved the cytologic evaluation of pleural fluid from a 47-year-old man with Kaposi sarcoma and recurrent chylous pleural effusions. Large atypical cells identified in his effusion were concerning for primary effusion lymphoma. Subsequent pleural biopsy revealed extramedullary hematopoiesis, documenting these atypical cells as megakaryocytes. These cases demonstrate that knowledge of a patient's HIV status can be misleading in the evaluation of cytology specimens, with potential for misdiagnosis and/or multiple procedures. To avoid this pitfall in the setting of HIV infection, common entities unrelated to HIV infection and artifacts should always be included in the differential diagnosis.
      Citation: CytoJournal 2010 7(1):7-7
      PubDate: Sat,12 Jun 2010
      DOI: 10.4103/1742-6413.64375
      Issue No: Vol. 7, No. 1 (2010)
       
  • Atypical squamous cells, cannot exclude high grade squamous
           intraepithelial (ASC-H) in HIV-positive women

    • Authors: Pam Michelow, Ingrid Hartman, Doreen Schulze, Stella Lamla-Hillie, Sophie Williams, Simon Levin, Cynthia Firnhaber
      Pages: 8 - 8
      Abstract: Pam Michelow, Ingrid Hartman, Doreen Schulze, Stella Lamla-Hillie, Sophie Williams, Simon Levin, Cynthia Firnhaber
      CytoJournal 2010 7(1):8-8
      Objective: South Africa has very high rates of both HIV infection and cervical pathology. The management of ASC-H is colposcopy and directed biopsy, but with so many women diagnosed with HSIL and a dearth of colposcopy centres in South Africa, women with cytologic diagnosis of ASC-H may not be prioritized for colposcopy. The aim of this study was to determine if HIV-positive women with a cytologic diagnosis of ASC-H should undergo immediate colposcopy or whether colposcopy can be delayed, within the context of an underfunded health care setting with so many competing health needs. Materials and Methods: A computer database search was performed from the archives of an NGO-administered clinic that offers comprehensive HIV care. All women with a cytologic diagnosis of ASC-H on cervical smears from September 2005 until August 2009 were identified. Histologic follow up was sought in all patients. Results: A total of 2111 cervical smears were performed and 41 diagnosed as ASC-H (1.94%). No histologic follow up data was available in 15 cases. Follow up histologic results were as follows: three negative (11.5%), five koilocytosis and/ or CIN1 (19.2%), ten CIN2 (38.5%) and eight CIN3 (30.8%). There were no cases of invasive carcinoma on follow up. Conclusion: The current appropriate management of HIV-positive women in low-resource settings with a diagnosis of ASC-H on cervical smear is colposcopy, despite the costs involved. In the future and if cost-effective in developing nations, use of novel markers may help select which HIV-positive women can be managed conservatively and which ones referred for more active treatment. More research in this regard is warranted.
      Citation: CytoJournal 2010 7(1):8-8
      PubDate: Sat,12 Jun 2010
      DOI: 10.4103/1742-6413.64376
      Issue No: Vol. 7, No. 1 (2010)
       
  • Diagnostic difficulties and pitfalls in rapid on-site evaluation of
           endobronchial ultrasound guided fine needle aspiration

    • Authors: Sara E Monaco, Matthew J Schuchert, Walid E Khalbuss
      Pages: 9 - 9
      Abstract: Sara E Monaco, Matthew J Schuchert, Walid E Khalbuss
      CytoJournal 2010 7(1):9-9
      Background: One of the novel techniques utilizing fine needle aspiration (FNA) in the diagnosis of mediastinal and lung lesions is the endobronchial ultrasound (EBUS)-guided FNA. In this study, we describe five cases which had a discrepancy between on-site evaluation and final diagnosis, or a diagnostic dilemma when rendering the preliminary diagnosis, in order to illustrate some of the diagnostic difficulties and pitfalls that can occur in EBUS FNA. Methods: A total of five EBUS FNA cases from five patients were identified in our records with a discrepancy between the rapid on-site evaluation (ROSE) and final diagnosis, or that addressed a diagnostic dilemma. All of the cases had histological confirmation or follow-up. The cytomorphology in the direct smears, cell block, and immunohistochemical stains were reviewed, along with the clinical history and other available information. Results: Two cases were identified with a nondefinitive diagnosis at ROSE that were later diagnosed as malignant (metastatic signet-ring cell adenocarcinoma and metastatic renal cell carcinoma (RCC)) on the final cytological diagnosis. Three additional cases were identified with a ROSE and final diagnosis of malignant (large cell neuroendocrine carcinoma (LCNEC) and two squamous cell carcinomas), but raised important diagnostic dilemmas. These cases highlight the importance of recognizing discohesive malignant cells and bland neoplasms on EBUS FNA, which may lead to a negative or a nondefinitive preliminary diagnosis. Neuroendocrine tumors can also be difficult due to the wide range of entities in the differential diagnosis, including benign lymphocytes, lymphomas, small and nonsmall cell carcinomas, and the lack of immunohistochemical stains at the time of ROSE. Finally, the background material in EBUS FNAs may be misleading and unrelated to the cells of interest. Conclusions: This study illustrates the cytomorphology of five EBUS FNA cases that address some of the diagnostic challenges witnessed while examining these specimens during ROSE. Many of the difficulties faced can be attributed to the baseline cellularity of the aspirates, the bronchial contamination, the difficulty identifying neoplasms with bland cytology, the wide spectrum of diseases that can occur in the mediastinum with overlapping cytomorphologic features, the mismatch between the background material and the cell populations present, and the overall unfamiliarity with these types of specimens.
      Citation: CytoJournal 2010 7(1):9-9
      PubDate: Mon,14 Jun 2010
      DOI: 10.4103/1742-6413.64385
      Issue No: Vol. 7, No. 1 (2010)
       
  • Fine-needle aspiration cytology of extra mammary metastatic lesions in the
           breast: A retrospective study of 36 cases diagnosed during 18 years

    • Authors: Torill Sauer
      Pages: 10 - 10
      Abstract: Torill Sauer
      CytoJournal 2010 7(1):10-10
      Background: Metastatic tumors in the breast require treatment according to origin and type of tumor. It is important to recognize these lesions in fine-needle aspiration cytology (FNAC) in order to avoid unnecessary mastectomy or non-relevant chemotherapy. The aim of this study was to evaluate the cytological features of metastatic tumors and possible criteria that could alert us as to the possibility of a metastasis from an extra mammary malignancy. Methods: The material included 36 confirmed or suspected metastases in the breast registered in the pathology files at Oslo University Hospital, Ulleval, during 1990-2007. There were a total of 6,325 cases of malignant breast FNAC, representing 30 men and 6,295 women. Smears were evaluated for the amount of material, presence or absence of myoepithelial cells, microcalcifications, mitoses and necrotic material. All carcinomas were graded. Results: There were seven men (7/30 = 23.3%) and 29 women (29/6,295 = 0.46%). The primary tumor was known in 22 cases (22/36 = 61.1%). No other primary tumor was known and metastatic lesion was not initially suspected in 14 cases (14/36 = 38.9%). The most common origin was lung (15/36 = 41.7%). In five cases (5/36 = 13.9%), the origin remained uncertain. Conclusions: Metastases from extra mammary sites are (relatively) common in males (23.3%). In women, metastatic lesions are rare (0.46%). A large proportion of them (88%) are high-grade adenocarcinomas and poorly differentiated carcinomas that may resemble grade 3 ductal carcinomas. Unusual clinical and/or radiological presentation in combination with high-grade malignant cells should alert us to consider the possibility of a metastasis.
      Citation: CytoJournal 2010 7(1):10-10
      PubDate: Fri,2 Jul 2010
      DOI: 10.4103/1742-6413.65056
      Issue No: Vol. 7, No. 1 (2010)
       
  • APTIMA assay on SurePath liquid-based cervical samples compared to
           endocervical swab samples facilitated by a real time database

    • Authors: Samer N. Khader, Kathie Schlesinger, Josh Grossman, Richard I Henry, Mark Suhrland, Amy S Fox
      Pages: 11 - 11
      Abstract: Samer N. Khader, Kathie Schlesinger, Josh Grossman, Richard I Henry, Mark Suhrland, Amy S Fox
      CytoJournal 2010 7(1):11-11
      Background: Liquid-based cytology (LBC) cervical samples are increasingly being used to test for pathogens, including: HPV, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) using nucleic acid amplification tests. Several reports have shown the accuracy of such testing on ThinPrep (TP) LBC samples. Fewer studies have evaluated SurePath (SP) LBC samples, which utilize a different specimen preservative. This study was undertaken to assess the performance of the Aptima Combo 2 Assay (AC2) for CT and GC on SP versus endocervical swab samples in our laboratory. Materials and Methods: The live pathology database of Montefiore Medical Center was searched for patients with AC2 endocervical swab specimens and SP Paps taken the same day. SP samples from CT- and/or GC-positive endocervical swab patients and randomly selected negative patients were studied. In each case, 1.5 ml of the residual SP vial sample, which was in SP preservative and stored at room temperature, was transferred within seven days of collection to APTIMA specimen transfer tubes without any sample or patient identifiers. Blind testing with the AC2 assay was performed on the Tigris DTS System (Gen-probe, San Diego, CA). Finalized SP results were compared with the previously reported endocervical swab results for the entire group and separately for patients 25 years and younger and patients over 25 years. Results: SP specimens from 300 patients were tested. This included 181 swab CT-positive, 12 swab GC-positive, 7 CT and GC positive and 100 randomly selected swab CT and GC negative patients. Using the endocervical swab results as the patient's infection status, AC2 assay of the SP samples showed: CT sensitivity 89.3%, CT specificity 100.0%; GC sensitivity and specificity 100.0%. CT sensitivity for patients 25 years or younger was 93.1%, versus 80.7% for patients over 25 years, a statistically significant difference (P = 0.02). Conclusions: Our results show that AC2 assay of 1.5 ml SP samples transferred to APTIMA specimen transfer medium within seven days is sufficiently sensitive and specific to be used to screen for CT and GC. CT sensitivity may be somewhat reduced in samples from patients over 25 years. SP specimens retained in the original SP fixative for longer time intervals also may have decreased sensitivity, due to deterioration of RNA, but this was not assessed in this study. The ability to tap the live pathology database is a valuable tool that can useful to conduct clinical studies without a costly prospective clinical trial.
      Citation: CytoJournal 2010 7(1):11-11
      PubDate: Fri,2 Jul 2010
      DOI: 10.4103/1742-6413.65057
      Issue No: Vol. 7, No. 1 (2010)
       
  • Fine needle aspiration diagnosis of Rosai-Dorfman Disease in an osteolytic
           lesion of bone

    • Authors: Shaoying Li, Zhijie Yan, Nirag Jhala, Darshana Jhala
      Pages: 12 - 12
      Abstract: Shaoying Li, Zhijie Yan, Nirag Jhala, Darshana Jhala
      CytoJournal 2010 7(1):12-12
      Sinus histiocytosis with massive lymphadenopathy (SHML) or Rosai-Dorfman disease (RDD) is an uncommon but well-defined benign self-limited clinicopathological entity. It mainly involves lymph nodes. Extranodal involvement is seen in up to 43% of cases, with the most common location in the head and neck region. Primary RDD occurring in the bone is rare with only twelve cases reported in the literature to date, all diagnosed on histology except one by fine needle aspiration (FNA) cytology. We report a case of RDD diagnosed by FNA cytology in a 28 year-old female presented as an osteolytic lesion of superior pubic ramus where the differential diagnosis included a sarcoma and lymphoma. Based on the cytologic findings, a diagnosis of a RDD was considered during the rapid FNA on site with no clinical history provided. The diagnosis of RDD was further confirmed by immunohistochemical stains and histology diagnosis. Our findings show that even in the absence of a clinical history, FNA is a less invasive and a very reliable tool for the diagnosis of SHML (RDD).
      Citation: CytoJournal 2010 7(1):12-12
      PubDate: Fri,2 Jul 2010
      DOI: 10.4103/1742-6413.65058
      Issue No: Vol. 7, No. 1 (2010)
       
  • Case study documenting the diagnosis of idiopathic CD4+ Lymphocytopenia in
           a patient with atypical fungal infection (disseminated blastomycosis) by
           FNA of adrenal mass

    • Authors: Richard H Siderits, Osman Ouattara, Alan Marcus, Hong Guang Gao, Hong Bing Deng, Janusz Godyn
      Pages: 13 - 13
      Abstract: Richard H Siderits, Osman Ouattara, Alan Marcus, Hong Guang Gao, Hong Bing Deng, Janusz Godyn
      CytoJournal 2010 7(1):13-13
      Idiopathic CD4+ lymphocytopenia, described in 1992 by the Centers for Disease Control, is characterized by persistent CD4+ lymphocytopenia (less than 300 cells per micro-liter) in nonimmunosuppressed, HIV negative individuals, who present with atypical infections. This rare though likely undiagnosed entity is associated with chronic disseminated forms of either fungal or bacterial infections in otherwise healthy adults. We report a case of a 59-year-old male with ring-enhancing brain lesions, bilateral adrenal masses, lung and vocal cord nodules, where the diagnosis of exclusion was metastatic malignancy. Fine needle aspiration (FNA) of the adrenal mass and a subsequent vocal cord biopsy confirmed chronic widely disseminated blastomycosis. Flow cytometric evaluation of peripheral blood documented persistent selective CD4+ lymphocytopenia with T8 (suppressor) T-Lymphocyte count within normal range. We believe that idiopathic CD4+ lymphocytopenia is an important etiologic factor to be considered for patients who present with mass lesions and are diagnosed by FNA with atypical fungal infections. We relate the diagnostic criteria for idiopathic CD4+ lymphocytopenia and the importance of providing on-site triage for FNA samples for fungal studies and correlation for flow cytometry.
      Citation: CytoJournal 2010 7(1):13-13
      PubDate: Thu,5 Aug 2010
      DOI: 10.4103/1742-6413.67106
      Issue No: Vol. 7, No. 1 (2010)
       
  • Pituitary carcinoma diagnosed on fine needle aspiration: Report of a case
           and review of pathogenesis

    • Authors: Tatiana V Yakoushina, Ehud Lavi, RS Hoda
      Pages: 14 - 14
      Abstract: Tatiana V Yakoushina, Ehud Lavi, RS Hoda
      CytoJournal 2010 7(1):14-14
      Pituitary carcinoma (PC) is a very rare entity (0.2% of all pituitary tumors), with only about 140 cases reported in English literature. There are no reliable histological, immunohistochemical or ultrastructural features distinguishing pituitary adenoma (PA) from PC. By definition, a diagnosis of PC is made after a patient with PA develops non-contiguous central nervous system (CNS) or systemic metastases. To date, only three cases of PC have been reportedly diagnosed on fine needle aspiration (FNA). Two of the reported cases were diagnosed on FNA of the cervical lymph nodes and one on FNA of the vertebral bone lesion. Herein, we present a case of PC, diagnosed on FNA of the liver lesion. In this case, we describe cytologic features of PC and compare them to histologic features of the tumor in the pituitary. Clinical behavior of tumor, pathogenesis of metastasis and immunochemical and prognostic markers will also be described.
      Citation: CytoJournal 2010 7(1):14-14
      PubDate: Thu,5 Aug 2010
      DOI: 10.4103/1742-6413.67108
      Issue No: Vol. 7, No. 1 (2010)
       
  • Evaluation of atypical squamous cells on conventional cytology smears: An
           experience from a screening program practiced in limited resource settings
           

    • Authors: Bharat Rekhi, Dulhan Ajit, Santhosh K Joseph, Sonali Gawas, Kedar K Deodhar
      Pages: 15 - 15
      Abstract: Bharat Rekhi, Dulhan Ajit, Santhosh K Joseph, Sonali Gawas, Kedar K Deodhar
      CytoJournal 2010 7(1):15-15
      Background: The Bethesda system (TBS) 2001 has subdivided the category of atypical squamous cells (ASC) into: ASC-US (undetermined significance) and ASC-H (cannot exclude high-grade squamous intraepithelial lesion (HSIL)). The present study is an analysis of ASC-US and ASC-H cases diagnosed in a screening program practiced in limited resource settings. Methods: During the period January 2005 to December 2008, a total of 9190 smears were received, of which 568 were unsatisfactory. Cases initially diagnosed as ASC-US (n=74) and ASC-H (n=29) on conventional cytology smears were reviewed. Biopsy and human papilloma virus (HPV) results were available in limited cases. Results: On review, diagnosis of ASC-US was retained in 49 (66.2%) of the 74 initially diagnosed ASC-US cases. Remaining 12 cases were re-labeled as negative for intraepithelial lesion or malignancy (NILM), nine as low-grade squamous intraepithelial lesion (LSIL), three as ASC-H and one case as squamous carcinoma (SCC). Similarly, on review, diagnosis of ASC-H cases was retained in 17 of the 29 initially diagnosed ASC-H cases. Seven cases were re-labeled as NILM, three as HSIL and one case each as ASC-US and SCC. Overall, 8622 cases (96.6%) were diagnosed as NILM, 72 (0.83%) as LSIL, 121 (1.40%) as HSIL, 23 (0.26%) as SCC, 50 (0.57%) as ASC-US cases, 20 (0.23%) as ASC-H, five (0.05%) as atypical glandular cells (AGC) and two cases as adenocarcinomas. Out of 50 ASC-US cases, biopsy in 23 cases showed presence of CIN 1 in 16 cases (69.5%) and CIN 2 in one case (4.34%), while the remaining six cases were negative for CIN/malignancy. The remaining 20 cases with unavailable biopsy results were HPV-positive. Out of 20 ASC-H cases, biopsy in 15 revealed CIN 2 and above in 11 cases (73.3%). Three cases (20%) revealed CIN 1. Conclusions: Critical review is helpful in further reducing the number of ASC cases. The percentage of cases with CIN 2 and above is higher with ASC-H cases. The reason for relative increase in HSILs in the present study included referral bias in the screening program.
      Citation: CytoJournal 2010 7(1):15-15
      PubDate: Thu,5 Aug 2010
      DOI: 10.4103/1742-6413.67110
      Issue No: Vol. 7, No. 1 (2010)
       
  • Colposcopic evaluation of cervix with persistent inflammatory Pap smear: A
           prospective analytical study

    • Authors: Papa Dasari, S Rajathi, Surendra V Kumar
      Pages: 16 - 16
      Abstract: Papa Dasari, S Rajathi, Surendra V Kumar
      CytoJournal 2010 7(1):16-16
      Background: Inflammatory Pap smear is the most common report received by a gynecologist. The cervical screening algorithm for benign cellular changes on the Pap smear recommends treatment of infection if indicated and a repeat Pap smear in 4 to 6 months time. If the inflammatory changes still persist, subject the patient to colposcopy. However, in practice, this is not followed, especially in developing countries like ours where proper screening protocols are not available. Hence, a good number of patients in the premalignant stage are being missed. This study was undertaken to evaluate patients with persistent inflammatory Pap smears without atypia using colposcopy. Methods: A prospective analytical study of 150 gynecologial patients with persistent inflammatory Pap smear between 2006 and 2008 in an out-patient setting. All of them were subjected to colposcopy and biopsy from the abnormal areas. The incidence of cervical intraepithelial neoplasia (CIN)/invasive carcinoma was calculated by proportions/percentages. Results: The incidence of invasive carcinoma was
      Citation: CytoJournal 2010 7(1):16-16
      PubDate: Thu,5 Aug 2010
      DOI: 10.4103/1742-6413.67112
      Issue No: Vol. 7, No. 1 (2010)
       
  • Pleomorphic adenoma: A diagnostic pitfall in the diagnosis of salivary
           gland lesions on FNAC: Case reports with review of the literature

    • Authors: Renuka Gahine, Vijaya Sudarshan, Nighat Hussain, Chandani Krishnani
      Pages: 17 - 17
      Abstract: Renuka Gahine, Vijaya Sudarshan, Nighat Hussain, Chandani Krishnani
      CytoJournal 2010 7(1):17-17
      Fine needle aspiration cytology (FNAC) is commonly being used with increasing frequency for the pre-operative evaluation of salivary gland lesions. However, it has areas of considerable interpretational difficulties. The most frequent problems involve variations in the expected cytology of pleomorphic adenoma (PA). Salivary gland FNACs performed at Pt. JNM Medical College, Raipur, Chhattisgarh, during July 2006 to June 2007 were reviewed, and we report four cases of interesting diagnostic dilemma. As PA is the most common salivary gland neoplasm, it should always be considered and ruled out as the first differential in the diagnosis of salivary gland FNACs. In order to avoid diagnostic pitfalls, we emphasize a diagnostic approach based on the mandatory presence of all three elements of PA, i.e. 3-dimensional cohesive clusters of ductal cells, background of singly lying plasmacytoid myoepithelial cells and dense fibrillary brightly metachromatic stroma with partially obscured entrapped myoepithelial cells. To document the same, we advocate liberal use of repeat aspirations with multiple sampling performed from different parts of the tumor. Some differential diagnostic problems, e.g. carcinoma ex PA, may still however remain insolvable by cytologic means.
      Citation: CytoJournal 2010 7(1):17-17
      PubDate: Fri,17 Sep 2010
      DOI: 10.4103/1742-6413.70406
      Issue No: Vol. 7, No. 1 (2010)
       
  • Fine needle aspiration biopsy of an osteoclast-rich undifferentiated
           

    • Authors: Chetna N Purohit, Marilyn M Bui, Ardeshir Hakam
      Pages: 18 - 18
      Abstract: Chetna N Purohit, Marilyn M Bui, Ardeshir Hakam
      CytoJournal 2010 7(1):18-18
      Osteoclast-rich undifferentiated carcinoma of urinary bladder (ORUCUB) is a very rare and an unusual variant of high-grade urothelial carcinoma. Here, we report an extraordinary case of metastatic ORUCUB, diagnosed by fine needle aspiration (FNA) biopsy, in a 74-year-old Hispanic male who presented with a palpable, tender left groin mass and a known previous history of high-grade carcinoma of urinary bladder and prostatic cancer. To the best of our knowledge, diagnosis of ORUCUB by FNA is the first case report in FNA cytology to be published to date. A review of the literature is emphasized on the cytological, histological and immunohistochemical features and differential diagnoses of giant cell tumor.
      Citation: CytoJournal 2010 7(1):18-18
      PubDate: Fri,17 Sep 2010
      DOI: 10.4103/1742-6413.70407
      Issue No: Vol. 7, No. 1 (2010)
       
  • Eosinophilic ascites due to severe eosinophilic ileitis

    • Authors: Namrata Setia, Peter Ghobrial, Liron Pantanowitz
      Pages: 19 - 19
      Abstract: Namrata Setia, Peter Ghobrial, Liron Pantanowitz
      CytoJournal 2010 7(1):19-19
      Background: There is a broad etiology for effusion eosinophilia that includes allergic, reactive, infectious, immune, neoplastic, and idiopathic causes. We report and describe the cytomorphologic findings of a rare case of eosinophilic ascites due to severe eosinophilic ileitis. Case Presentation: A 17-year-old male manifested acutely with eosinophilic ascites due to severe biopsy-proven subserosal eosinophilic ileitis. Isolated peritoneal fluid submitted for cytologic evaluation revealed that 65% eosinophils were present in a bloody background. The patient responded to corticosteroids, with complete resolution of his ascites. Conclusion: Eosinophilic gastroenteritis with subserosal involvement should be added to the list of causes for eosinophils in peritoneal fluid. The finding of eosinophilic ascites, with appropriate clinical and laboratory findings, may warrant the need to perform laparoscopic intestinal biopsies to confirm the diagnosis.
      Citation: CytoJournal 2010 7(1):19-19
      PubDate: Fri,17 Sep 2010
      DOI: 10.4103/1742-6413.70408
      Issue No: Vol. 7, No. 1 (2010)
       
  • The spectrum of coincident entities with small lymphocytic
           lymphoma/chronic lymphocytic leukemia (SLL/CLL) diagnosed by cytology

    • Authors: Hannah A Kastenbaum, Walid E Khalbuss, Raymond E Felgar, Ronald Stoller, Sara E Monaco
      Pages: 20 - 20
      Abstract: Hannah A Kastenbaum, Walid E Khalbuss, Raymond E Felgar, Ronald Stoller, Sara E Monaco
      CytoJournal 2010 7(1):20-20
      Background: The cytologic diagnosis of Small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) often relies on finding a small lymphoid population with the characteristic immunoprofile by ancillary testing. There are only a few reports of other processes identified with SLL/CLL. The aim of this study was to review the fine needle aspiration (FNA) and touch prep (TP) diagnoses of SLL/CLL in order to identify any coincident entities. Materials and Methods: We retrospectively reviewed all FNA and TP cytology cases between January 2005 and May 2009 with a diagnosis of SLL/CLL to determine the presence of any coincident process. Results: We identified 29 cases, including 23 FNAs and six TPs, from 23 patients. Ancillary studies were utilized in 97% of the cases, including flow cytometry (FC, 79%), immunohistochemistry (IHC, 55%), fluorescent in situ hybridization studies (24%) and special stains (7%). Coincident entities were identified in nine cases (31%) and included seven (28%) neoplastic entities (Hodgkin lymphoma [HL], adenocarcinoma, squamous cell carcinoma, seminoma) and two (7%) non-neoplastic entities (infection and immunoglobulin containing cells). Six cases (21%) suspicious for large cell transformation were also identified. Conclusion: In our review of SLL/CLL, coincident entities were present in 31% of the cases and included a spectrum of non-neoplastic and neoplastic processes. FC was the most frequently utilized ancillary test, but IHC provided important information by excluding a mantle cell lymphoma or confirming a coincident process. Thus, cytomorphologic evaluation in these patients is important due to the high risk of a coincident process that may not be apparent by FC alone and may require clinical management.
      Citation: CytoJournal 2010 7(1):20-20
      PubDate: Mon,11 Oct 2010
      DOI: 10.4103/1742-6413.70968
      Issue No: Vol. 7, No. 1 (2010)
       
  • Determination of HER-2 status on FNAC material from breast carcinomas
           using in situ hybridization with dual chromogen visualization with silver
           enhancement (dual SISH)

    • Authors: Elsa Beraki, Torill Sauer
      Pages: 21 - 21
      Abstract: Elsa Beraki, Torill Sauer
      CytoJournal 2010 7(1):21-21
      During the last years, HER-2 status kits and protocols for chromogen visualization of hybridization signals have come on the market. The first generation using chromogen visualization used single color probes. The second generation, now emerging on the market, uses dual chromogen visualization. The aim of this study has been to test a new dual color chromogen kit (Ventana INFORM HER2 Dual Colour ISH Roche ® ) and compare the results with our in-house method(s). The material consisted primarily of cytological material from invasive breast carcinomas in 49 women. Dual SISH was done on all 49 cytological and histological specimens. The histological specimens were treated according to the manufacturer's recommendations. The procedure was modified in several steps in order to adapt it to the cytological material. Hybridization failed in two cytological specimens. Dual SISH showed concordant results on cytological and histological material as to amplified/not amplified. The included cases had the same HER-2 expression in the invasive and the in situ components on histology. Four IDC showed HER-2 amplification (8.5%). Polysomy was found in two cases. All dual SISH results except for one concurred with the results of the in-house method(s) (1/47=2.1%). The dual SISH is suitable for cytological examination of HER-2 status. The protocol must be optimized for cytological material.
      Citation: CytoJournal 2010 7(1):21-21
      PubDate: Mon,11 Oct 2010
      DOI: 10.4103/1742-6413.70968
      Issue No: Vol. 7, No. 1 (2010)
       
  • Adequate reimbursement is crucial to support cost-effective rapid on-site
           cytopathology evaluations

    • Authors: Mousa A Al-Abbadi, Leonard I Bloom, Lisa A Fatheree, Lori A Haack, Gerald Minkowitz, David C Wilbur, Marshall R Austin
      Pages: 22 - 22
      Abstract: Mousa A Al-Abbadi, Leonard I Bloom, Lisa A Fatheree, Lori A Haack, Gerald Minkowitz, David C Wilbur, Marshall R Austin
      CytoJournal 2010 7(1):22-22

      Citation: CytoJournal 2010 7(1):22-22
      PubDate: Mon,18 Oct 2010
      DOI: 10.4103/1742-6413.71740
      Issue No: Vol. 7, No. 1 (2010)
       
  • Compensation crisis related to the onsite adequacy evaluation during FNA
           procedures-Urgent proactive input from cytopathology community is critical
           to establish appropriate reimbursement for CPT code 88172 (or its new
           counterpart if introduced in the future)

    • Authors: Inderpreet Dhillon, Martha B Pitman, Richard M DeMay, Pamela Archuletta, Vinod B Shidham
      Pages: 23 - 23
      Abstract: Inderpreet Dhillon, Martha B Pitman, Richard M DeMay, Pamela Archuletta, Vinod B Shidham
      CytoJournal 2010 7(1):23-23
      The confusion centered around appropriate use of the CPT billing code 88172 is addressed in the commentary from the Economic and Government Affairs Committee of the American Society of Cytopathology (ASC) who have written a timely commentary in this issue of Cytojournal, "Adequate Reimbursement is Crucial to Support Cost-Effective Rapid Onsite Cytopathology Evaluations". Currently, lack of standardized use within and between pathology departments is stirring unhealthy practices of denying reimbursements for this critical and legitimate cytopathology service. This editorial discusses the important concerns raised in this commentary and recommends immediate corrective action. (See also Al-Abbadi MA, et al. Adequate reimbursement is crucial to support cost-effective rapid on-site cytopathology evaluations. CytoJournal 2010;7:22)
      Citation: CytoJournal 2010 7(1):23-23
      PubDate: Mon,18 Oct 2010
      DOI: 10.4103/1742-6413.71741
      Issue No: Vol. 7, No. 1 (2010)
       
  • Liquid based material from fine needle aspirates from breast carcinomas
           offers the possibility of long-time storage without significant loss of
           immunoreactivity of estrogen and progesterone receptors

    • Authors: Torill Sauer, Kristin Ebeltoft, Mette Kristin Pedersen, Rolf Kåresen
      Pages: 24 - 24
      Abstract: Torill Sauer, Kristin Ebeltoft, Mette Kristin Pedersen, Rolf Kåresen
      CytoJournal 2010 7(1):24-24
      Background: Estrogen receptor (ER) status and progesterone receptor (PgR) status are strong prognostic and predictive markers in breast carcinomas. Steroid receptors are fragile and optimal handling of both cytological and histological material, including fixation, is crucial. Liquid based material offers the possibility to prepare a number of slides from one lesion and is increasingly being used for immunocytochemistry. It also offers the possibility to prepare several smears and to store these at different temperatures as well as storing residual material in the liquid. Materials and Methods: The samples consisted of fine needle aspirate material from 53 breast carcinomas. Direct smears and liquid based preparations were used in parallel for immunocytochemical detection of ER and PgR receptor status. Slides from liquid suspensions were stored at -20°C and -74°C for 3 and 6 months, respectively. Direct smears were fixed primarily in 4% formalin. Liquid based specimens were post-fixed in 4% formalin. All specimens were subjected to microwave-stimulated epitope retrieval. Antibody concentrations were ER 1:150 and PgR 1:200 for both preparation methods. The immunostaining program was identical for both the methods. Results : Liquid based specimens had a statistically non-significant higher percentage of positive cases compared to direct smears. Specimens prepared from liquid suspensions and stored at -20°C and -74°C for 3 and 6 months, respectively, showed a virtually unchanged ER and PgR reactivity (P = 0.002). Conclusions : Liquid suspensions and liquid based slide preparations seem to offer an optimal pre-fixation and preservation of ER/PgR in breast carcinoma cells. Post-fixation with 4% formalin followed by microwave-stimulated epitope retrieval before immunostaining is recommended. Long-time storage of liquid based specimens at -20°C or -74°C for at least 6 months without significant loss of immunoreactivity is feasible. They may be used as internal positive and negative controls.
      Citation: CytoJournal 2010 7(1):24-24
      PubDate: Fri,31 Dec 2010
      DOI: 10.4103/1742-6413.75665
      Issue No: Vol. 7, No. 1 (2010)
       
  • Cytomorphology of cervicovaginal melanoma: ThinPrep versus conventional
           Papanicolaou tests

    • Authors: Namrata Setia, Robert A Goulart, Gladywn Leiman, Christopher N Otis, Rukmini Modem, Liron Pantanowtiz
      Pages: 25 - 25
      Abstract: Namrata Setia, Robert A Goulart, Gladywn Leiman, Christopher N Otis, Rukmini Modem, Liron Pantanowtiz
      CytoJournal 2010 7(1):25-25
      Background: Primary cervicovaginal melanoma is a rare malignancy associated with a high risk of recurrence. Prior studies discussing the cytomorphology of cervicovaginal melanoma have been based primarily on review of conventional Papanicolaou (Pap) smears. The aim of this study was to evaluate cervicovaginal melanomas identified in liquid-based Pap tests, in comparison with features seen on conventional Pap smear preparation. Materials and Methods: Cases of cervicovaginal melanoma identified on Pap tests with concurrent or subsequent histopathologic confirmation were collected from the Baystate Medical Center cytopathology files and personal archives of the authors over a total period of 34 years. All cytopathology (n = 6) and the available histology slides (n = 5) were reviewed. Cases were analyzed regarding clinical, histopathologic and cytomorphological findings. Results: A total of six cases with invasive cervicovaginal melanoma diagnosed on Pap tests were identified. Most patients were postmenopausal with contact bleeding, correlating with surface ulceration (identified in biopsy/excision material in 5/5 cases). Most cases had deeply invasive tumors (5/5: modified Breslow's thickness > 5 mm and Chung's level of invasion IV/V). Pap tests included four ThinPrep and two conventional smears. Overall, ThinPrep Pap tests exhibited a higher ratio of tumor cells to background squamous cells. While all Pap tests were bloodstained, tumor diathesis was prominent only within conventional smears. Melanoma cells were present both as clusters and scattered single cells in each Pap test type. Both the preparations contained epithelioid tumor cells, whereas spindled tumor cells were seen in only two ThinPrep cases. Prominent nucleoli and binucleation of tumor cells were seen in both the preparations. Melanin pigment was identified in only ThinPrep (3/4) cases and nuclear pseudo-inclusions in one conventional Pap smear. Cell blocks were made in three ThinPrep cases and immunocytochemistry (S-100, HMB45, Melan-A) performed on additional vial material (one ThinPrep slide and one cell block) was immunoreactive in melanoma cells. Conclusion: Primary cervicovaginal melanoma, a rare malignancy seen predominantly in postmenopausal women, may be successfully diagnosed in either ThinPrep Pap tests or conventional Pap smears. While ThinPrep Pap tests did not demonstrate morphological advantage over conventional smears, liquid-based cytology specimens did provide additional material for cellblock preparation and immunocytochemical evaluation in a subset of cases.
      Citation: CytoJournal 2010 7(1):25-25
      PubDate: Fri,31 Dec 2010
      DOI: 10.4103/1742-6413.75666
      Issue No: Vol. 7, No. 1 (2010)
       
  • Thank you CytoJournal reviewers and authors - 2008 through 2010

    • Authors: Vinod B Shidham
      Pages: 26 - 26
      Abstract: Vinod B Shidham
      CytoJournal 2010 7(1):26-26

      Citation: CytoJournal 2010 7(1):26-26
      PubDate: Fri,31 Dec 2010
      DOI: 10.4103/1742-6413.75668
      Issue No: Vol. 7, No. 1 (2010)
       
  • Diagnosis and typing of systemic amyloidosis: The role of abdominal fat
           pad fine needle aspiration biopsy

    • Authors: Ruba A Halloush, Elena Lavrovskaya, Dina R Mody, Donna Lager, Luan Truong
      Pages: 24 - 24
      Abstract: Ruba A Halloush, Elena Lavrovskaya, Dina R Mody, Donna Lager, Luan Truong
      CytoJournal 2009 6(1):24-24
      Introduction: Systemic amyloidosis (SA) has a broad nonspecific clinical presentation. Its diagnosis depends on identifying amyloid in tissues. Abdominal fat pad fine needle aspiration (FPFNA) has been suggested as a sensitive and specific test for diagnosing SA. Materials and Methods: Thirty-nine FPFNA from 38 patients (16 women and 20 men, age range 40-88 years) during a 15-year period were reviewed. Smears and cell blocks were stained with Congo red (CR). A panel of antibodies (serum amyloid protein, serum amyloid A, albumin, transthyretin, kappa light chain and lambda light chain) was used on six cell blocks from five patients. The FNA findings were correlated with clinical and histological follow-up. Results: FPFNAs were positive, confirmed by CR in 5/39 (13%), suspicious in 1/39 (3%), negative in 28/39 (72%), and insufficient for diagnosis in 5/39 (13%) of cases. In all the positive cases, SA was confirmed within 2-16 weeks. Among the 28 negative cases, SA was diagnosed in 21, the rest were lost to follow-up. Among the insufficient cases, SA was diagnosed in four and one was lost to follow-up. Specificity was 100%, whereas sensitivity was 19%. SA typing using cell block sections was successful in three, un-interpretable in one, and negative in two cases. Conclusion: FPFNA for SA is not as good as previously reported. This may be due to different practice setting, level of experience, diagnostic technique, or absence of abdominal soft tissue involvement. A negative result of FPFNA does not exclude SA. Immune phenotyping of amyloid is possible on cell block.
      Citation: CytoJournal 2009 6(1):24-24
      PubDate: Fri,15 Jan 2010
      DOI: 10.4103/1742-6413.58950
      Issue No: Vol. 6, No. 1 (2010)
       
  • Hepatic epithelioid hemangioendothelioma: A diagnostic pitfall in
           aspiration cytology

    • Authors: Ruchika Gupta, Sandeep R Mathur, S Datta Gupta, Prashant Durgapal, Venkateswaran K Iyer, Chandan Jyoti Das, Shalimar, Subrat K Acharya
      Pages: 25 - 25
      Abstract: Ruchika Gupta, Sandeep R Mathur, S Datta Gupta, Prashant Durgapal, Venkateswaran K Iyer, Chandan Jyoti Das, Shalimar , Subrat K Acharya
      CytoJournal 2009 6(1):25-25
      Hepatic epithelioid hemangioendothelioma (EH) is a rare vascular neoplasm. An accurate radiologic diagnosis is usually difficult due to the presence of multiple nodules, simulating metastatic carcinoma. Though histologic features of this tumor are well described, cytologic reports of hepatic EH are very few in the available literature. We describe a case of a young healthy adult male who was found to have multiple hepatic masses on radiologic investigations. A guided fine needle aspiration demonstrated a poorly differentiated neoplasm. The diagnosis was made on core biopsy assisted by immunohistochemistry, which showed characteristic features of EH. He is doing well 14 months after diagnosis, without surgical excision or chemotherapy. An accurate diagnosis of hepatic EH on aspiration cytology requires an adequate specimen and awareness of its cytologic features, including discohesive atypical cells with intracytoplasmic lumina and intranuclear inclusions. Since this tumor is usually unresectable but has a favorable prognosis as compared to hepatocellular carcinoma, a correct diagnosis is essential for appropriate management and prognostication.
      Citation: CytoJournal 2009 6(1):25-25
      PubDate: Fri,15 Jan 2010
      DOI: 10.4103/1742-6413.58951
      Issue No: Vol. 6, No. 1 (2010)
       
  • FNA of misclassified primary malignant neoplasms of the thyroid: Impact on
           clinical management

    • Authors: Sejal S Shah, William C Faquin, Roberto Izquierdo, Kamal K Khurana
      Pages: 1 - 1
      Abstract: Sejal S Shah, William C Faquin, Roberto Izquierdo, Kamal K Khurana
      CytoJournal 2009 6(1):1-1
      Background: Fine needle aspiration (FNA) cytology is a popular, reliable and cost effective technique for the diagnosis of thyroid lesions. The aim of our study was to review cases of misclassified primary malignant neoplasms of the thyroid by FNA, and assess the causes of cytologic misdiagnosis and their impact on clinical management. Methods: Clinical data, FNA smears and follow-up surgical specimens of cases diagnosed with primary thyroid carcinoma were reviewed. Results: Of the 365 cases with a malignant diagnosis by FNA over a period of 11 years, nine (2.4 %) were identified with discrepant histologic diagnosis with regard to the type of primary thyroid malignancy. In addition, four cases were added from the consultation files of the Massachusetts General Hospital. Areas of difficulty contributing to misclassification included overlapping cytologic features (n = 6), rarity of tumors (n = 3), and sampling limitations (n = 4). Of the 13 cases, 12 underwent total or near total thyroidectomy and one patient had concurrent surgical biopsy. Measurement of serum calcitonin levels in one case, with an initial cytologic diagnosis of medullary carcinoma, prevented unnecessary lymph node dissection. Misclassification of medullary carcinoma as papillary carcinoma precluded lymph node dissection in one case. Further management decisions were based on the final histologic diagnosis and did not require additional surgery. Two cases of undifferentiated (anaplastic) thyroid carcinoma were misdiagnosed as papillary thyroid carcinoma. Both patients received total thyroidectomies, which may not otherwise have been performed. Conclusions: A small subset of primary malignant neoplasms of the thyroid may be misclassified with regard to the type of malignancy on FNA. The majority of primary malignant neoplasms diagnosed on FNA require thyroidectomy. However, initial cytologic misclassification of medullary carcinoma or undifferentiated carcinoma as other malignant neoplasms or vice versa may have an impact on clinical management.
      Citation: CytoJournal 2009 6(1):1-1
      PubDate: Tue,20 Jan 2009
      DOI: 10.4103/1742-6413.45191
      Issue No: Vol. 6, No. 1 (2009)
       
  • Comparison of the efficacy of the cervex brush and the extended-tip wooden
           spatula with conventional cytology: A longitudinal study

    • Authors: Caroline J Whitaker, Elaine C Stamp, William Young, Lesley A Greenwood
      Pages: 2 - 2
      Abstract: Caroline J Whitaker, Elaine C Stamp, William Young, Lesley A Greenwood
      CytoJournal 2009 6(1):2-2
      Background: Within the United Kingdom, the change from conventional to liquid based cytology (LBC) has brought with it the universal introduction of broom style samplers, as represented by the Cervex sampler. The aim of this study was to assess whether or not there were benefits associated with a change from wooden spatulae to broom style samplers for those countries where conversion to LBC might not be readily available or is not fully supported. Methods: A longitudinal study was designed to compare the performance of Cervex brushes and extended-tip wooden spatulae as sampling devices for conventionally prepared cervical smears. General Practices serving the population of Hull and East Yorkshire (UK) were provided with Cervex brushes for a period of nine months to routinely collect cervical smears. The results of 66,931 cervical smear tests were compared between those practices that were using extended-tip wooden spatulae before the trial and then returned to their use afterwards, and those who were previously using Cervex samplers and continued to use them throughout. Analyses comparing both specimen inadequacy, as recorded on the standard cervical screening request form (HMR101), and also the presence of identified transformation zone (TZ) elements in smears, both indicated significant advantages associated with the Cervex brush. Results: Inadequate smears decreased from 5.96% with extended-tip spatulae to 4.77% with Cervex brushes (p
      Citation: CytoJournal 2009 6(1):2-2
      PubDate: Tue,20 Jan 2009
      DOI: 10.4103/1742-6413.45192
      Issue No: Vol. 6, No. 1 (2009)
       
  • Hemosiderin laden macrophages and hemosiderin within follicular cells
           distinguish benign follicular lesions from follicular neoplasms

    • Authors: Reema Jaffar, Sambit K Mohanty, Ashraf Khan, Andrew H Fischer
      Pages: 3 - 3
      Abstract: Reema Jaffar, Sambit K Mohanty, Ashraf Khan, Andrew H Fischer
      CytoJournal 2009 6(1):3-3
      Background: Published criteria to distinguish benign colloid nodules from follicular neoplasms emphasize only three interdependent features: size of follicles, amount of colloid, and cellularity. There is a need for the validation of other independent criteria. Methods: This study quantified the significance of cystic change, defined as presence of macrophages, and the presence of hemosiderin in either the macrophages or follicular cells. The cohort consisted of 165 patients with fine needle aspiration (FNA) and histologic follow-up of either goiter (101), follicular adenoma (47), or follicular carcinoma (17). Papillary thyroid carcinomas and Hürthle cell neoplasms were excluded from the cohort, because these categories are known to show cystic change and hemosiderin. FNAs were reviewed blindly with the most cellular slide scored for the presence of macrophages and/or hemosiderin. Results: Hemosiderin within macrophages were seen in 67% (68 of 101) of the goiters and only 6% (four of 64) of follicular neoplasms ( P
      Citation: CytoJournal 2009 6(1):3-3
      PubDate: Tue,20 Jan 2009
      DOI: 10.4103/1742-6413.45193
      Issue No: Vol. 6, No. 1 (2009)
       
  • Collection of the BD SurePath Pap Test with a broom device plus
           endocervical brush improves disease detection when compared to the broom
           device alone or the spatula plus endocervical brush combination

    • Authors: Sharon Davis-Devine, Sarah J Day, Amy Anderson, Ashley French, Darcy Madison-Henness, Naomi Mohar, Danielle Tansy, Adarsh Hiremath, Jeffrey A Douglas, Gregory G Freund
      Pages: 4 - 4
      Abstract: Sharon Davis-Devine, Sarah J Day, Amy Anderson, Ashley French, Darcy Madison-Henness, Naomi Mohar, Danielle Tansy, Adarsh Hiremath, Jeffrey A Douglas, Gregory G Freund
      CytoJournal 2009 6(1):4-4
      Objective: Here we examine the diagnostic utility of the US Food And Drug Administration (FDA) approved Spatula + endocervical brush combination for the BD SurePath Pap Test (SPPT) and compare it to SPPT collection with the broom alone or to an off-label combination of broom + EC brush. This question is important due to lingering concerns over the value of EC detection to a satisfactory Pap test. Methods: 20,125 SPPT vials were examined for the collection devices contained. The SPPT collection device combinations allowed were: Rovers Cervex-Brush (broom, FDA approved), Medscand Pap Perfect Spatula + Medscand CytoBrush Plus GT (spatula + GT brush, FDA approved) or Rovers Cervex-Brush + Surgipath C-E Brush (broom + CE brush, off label). Results: Examination of SPPT vials revealed 11,130 collected with the broom, 4,687 collected with the spatula + GT brush and 2,921 collected with the broom + CE brush. Absence of an endocervical/transformation zone was seen in 22.86% of broom cases, 13.10% of spatula + GT brush cases (p= 0.00005 vs broom) and 10.17% of broom + CE brush cases (p= 0.00005 vs broom, p= 0.00005 vs spatula + GT brush). Importantly, LSIL detection was: broom 2.99%; spatula + GT brush 2.45% (p= 0.053 vs broom); broom + CE brush 4.18% (p= 0.034 vs broom, p= 0.0001 vs spatula + GT brush). Conclusion: When broom + brush combination is compared to broom alone or to spatula + GT brush, the broom + CE brush combination better sampled the endocervical/transformation zone and increased LSIL detection.
      Citation: CytoJournal 2009 6(1):4-4
      PubDate: Thu,12 Feb 2009
      DOI: 10.4103/1742-6413.45495
      Issue No: Vol. 6, No. 1 (2009)
       
  • Pleomorphic adenoma with squamous and appendageal metaplasia mimicking
           mucoepidermoid carcinoma on cytology

    • Authors: Meenakshi Batrani, Manju Kaushal, AK Sen, Rajbala Yadav, NK Chaturvedi
      Pages: 5 - 5
      Abstract: Meenakshi Batrani, Manju Kaushal, AK Sen, Rajbala Yadav, NK Chaturvedi
      CytoJournal 2009 6(1):5-5
      Background: Histological diversity is the hallmark of pleomorphic adenoma, the most common salivary gland tumor. It may cause difficulty in cytological interpretation, due to limited and selective sampling. Case presentation: A 16-year-old female patient presented with right cheek swelling. Fine needle aspiration cytology showed squamous cells, basaloid cells, and foamy cells, along with extracellular keratin and foreign body giant cells. Characteristic metachromatic fibrillary chondromyxoid stroma, which is usually seen in pleomorphic adenoma, was not seen in the aspirate. A diagnosis of mucoepidermoid carcinoma was given on cytology. Subsequent resection revealed an encapsulated pleomorphic adenoma, with extensive squamous metaplasia and appendageal differentiation on histology. Conclusion: This case illustrates that pleomorphic adenoma with squamous metaplasia presents a potential for misinterpretation as mucoepidermoid carcinoma on cytology. We discuss the various pitfalls and the features that are helpful in distinguishing these two lesions.
      Citation: CytoJournal 2009 6(1):5-5
      PubDate: Thu,12 Feb 2009
      DOI: 10.4103/1742-6413.45496
      Issue No: Vol. 6, No. 1 (2009)
       
  • The impact of digital imaging in the field of cytopathology

    • Authors: Liron Pantanowitz, Maryanne Hornish, Robert A Goulart
      Pages: 6 - 6
      Abstract: Liron Pantanowitz, Maryanne Hornish, Robert A Goulart
      CytoJournal 2009 6(1):6-6
      With the introduction of digital imaging, pathology is undergoing a digital transformation. In the field of cytology, digital images are being used for telecytology, automated screening of Pap test slides, training and education (e.g. online digital atlases), and proficiency testing. To date, there has been no systematic review on the impact of digital imaging on the practice of cytopathology. This article critically addresses the emerging role of computer-assisted screening and the application of digital imaging to the field of cytology, including telecytology, virtual microscopy, and the impact of online cytology resources. The role of novel diagnostic techniques like image cytometry is also reviewed.
      Citation: CytoJournal 2009 6(1):6-6
      PubDate: Fri,6 Mar 2009
      DOI: 10.4103/1742-6413.48606
      Issue No: Vol. 6, No. 1 (2009)
       
  • Cytologic features of metanephric adenoma of the kidney

    • Authors: Jose A Jimenez-Heffernan, Eva Tejerina, Pilar Gonzalez-Peramato, Blanca Vicandi, Ana Lopez-Garcia
      Pages: 7 - 7
      Abstract: Jose A Jimenez-Heffernan, Eva Tejerina, Pilar Gonzalez-Peramato, Blanca Vicandi, Ana Lopez-Garcia
      CytoJournal 2009 6(1):7-7

      Citation: CytoJournal 2009 6(1):7-7
      PubDate: Sat,4 Apr 2009
      DOI: 10.4103/1742-6413.49164
      Issue No: Vol. 6, No. 1 (2009)
       
  • Assessment of oral cytological changes associated with exposure to
           chemotherapy and/or radiotherapy

    • Authors: Hussain G Ahmed, Dalia AI Elemirri
      Pages: 8 - 8
      Abstract: Hussain G Ahmed, Dalia AI Elemirri
      CytoJournal 2009 6(1):8-8
      Background: Death from cancer is high in Sudan, with low survival rates, as most of the patients present with advanced disease. Most patients receive high and repeated doses of radiotherapy or chemotherapy. The aim of this study was to investigate the feasibility of using cytological evaluation to detect oral epithelial atypia amongst these patients. As a part of the continuous development in cancer therapy, this case control study was conducted in Khartoum, Sudan. Methods: Papanicolaou stained oral mucosal cells were obtained from 100 cancer patients receiving radiotherapy and/or chemotherapy (ascertained as cases), 50 cancer patients not exposed to either therapy (control 1), and 50 apparently healthy individuals (control 2). Statistical analysis: The data was analyzed by using a computer SPSS program, to obtain the Chi-square test. Results: Without prior knowledge of the subjects' group, oral epithelial atypia was detected in 7% of the cases. Inconclusive features of cytological atypia were observed in 13% of the cases. Atypia was not observed in both the control groups. Inflammatory infiltrate and viral cytopathic effects were identified in 32% and 8% of the cases respectively. Conclusion: Cytological atypia, viral infections, and inflammatory infiltrates were detected after exposure to radiotherapy and/or chemotherapy.
      Citation: CytoJournal 2009 6(1):8-8
      PubDate: Sat,16 May 2009
      DOI: 10.4103/1742-6413.51332
      Issue No: Vol. 6, No. 1 (2009)
       
  • Inadequate fine needle aspiration biopsy samples: Pathologists versus
           other specialists

    • Authors: GS Gomez-Macias, R Garza-Guajardo, J Segura-Luna, O Barboza-Quintana
      Pages: 9 - 9
      Abstract: GS Gomez-Macias, R Garza-Guajardo, J Segura-Luna, O Barboza-Quintana
      CytoJournal 2009 6(1):9-9
      Background: Fine needle aspiration biopsy (FNAB) is a simple, sensitive, quick and inexpensive method in which operator experience is essential for obtaining the best results. Methods: A descriptive study in which the aspiration biopsy cases of the Pathology and Cytopathology Service of the University Hospital of the UANL (2003-2005) were analyzed. These were divided into three study groups: Group 1, FNAB performed by a pathologist; Group 2, FNAB performed by specialists who are not pathologists, Group 3, FNAB guided by an imaging study with immediate evaluation by a pathologist. The samples were classified as adequate and inadequate for diagnosis, the organ, the size and characteristics of the lesions were taken into consideration. Results: A total of 1905 FNAB were included. In Group 1: 1347 were performed of which 1242 (92.2%) were adequate and 105 (7.7%) were inadequate. Of the 237 from Group 2, 178 were adequate (75.1%) and 59 inadequate (24.8%); in Group 3 there were 321 of which 283 (88.1%) were adequate and 38 (11.8%) inadequate. A statistically significant difference was found between FNAB performed by Group 1 (p< 0.001) and the other groups. A multivariate analysis was done where the organ punctured, the study groups, the size and characteristics of the lesion by study group were compared, finding that the most important variable was the person who performed the procedure. Conclusion: The experience and training of the person performing the aspiration biopsy, as well as immediate evaluation of the material when it is guided, substantially reduces the number of inadequate samples, improving the sensitivity of the method as well as reducing the need for open biopsies to reach a diagnosis.
      Citation: CytoJournal 2009 6(1):9-9
      PubDate: Thu,18 Jun 2009
      DOI: 10.4103/1742-6413.52831
      Issue No: Vol. 6, No. 1 (2009)
       
  • Penile metastasis of urothelial carcinoma diagnosed by fine-needle
           aspiration

    • Authors: Gilda da Cunha Santos, Marcia Lanzoni de Alvarenga, Vinicius Freitas Borlot, Michel Antonio Kiyota Moutinho, Marcello Fabiano de Franco
      Pages: 10 - 10
      Abstract: Gilda da Cunha Santos, Marcia Lanzoni de Alvarenga, Vinicius Freitas Borlot, Michel Antonio Kiyota Moutinho, Marcello Fabiano de Franco
      CytoJournal 2009 6(1):10-10
      Penile neoplasms are rare and can be primary or represent metastasis or local recurrence. The most common primary cancer of the penis is squamous cell carcinoma, accounting for 95% of all cancers. In spite of the rich vascularity of the organ, penile metastases are uncommon. Cutaneous metastasis of urothelial carcinoma (UC) is extremely rare and generally accepted as the late manifestation of a systemic spread. By 1998, approximately 500 cases of penile metastasis had been reported worldwide. However, only few case reports and series of fine-needle aspiration cytology (FNAC) of penile tumors have been documented. We report a case of penile metastasis from UC diagnosed by FNAC and describe the cytomorphological findings with an emphasis on cercariform cells. Although not commonly used, FNA of penile nodules can be effective in diagnosing recurrence or metastasis and avoiding surgical procedures, thus being an excellent initial procedure in the diagnostic approach.
      Citation: CytoJournal 2009 6(1):10-10
      PubDate: Thu,18 Jun 2009
      DOI: 10.4103/1742-6413.52832
      Issue No: Vol. 6, No. 1 (2009)
       
  • Assessment of quality of data provided on Pap test requisitions:
           Implications for quality of care and patient safety

    • Authors: Sonya Naryshkin, Brenda L Schultz
      Pages: 11 - 11
      Abstract: Sonya Naryshkin, Brenda L Schultz
      CytoJournal 2009 6(1):11-11
      Background: The reliability of patient history and clinical information on Pap test requisitions has been questioned but not previously objectively determined. The effect of incomplete/inaccurate information on quality of patient care has not been previously quantified. Our objectives were (1) to find out how clinicians and their assistants viewed the requisition slip, and whether they understood the reasons for supplying the information requested, (2) to measure the completeness and accuracy of information on the requisition slips, and (3) to determine whether the clinical information and patient history provided on Pap test requisitions could be relied upon to accurately assign a Pap test to the laboratory's "high-risk rescreen" pool. Methods: Clinicians and their assistants were surveyed. A total of 899 consecutive Pap test requisition slips were reviewed. Patient history and clinical information from the slips were compared to data from our laboratory information system and/or electronic patient medical records. Results: Most survey respondents felt that proper completion of requisitions was important, but only 17% of clinicians and less staff realized that negative high-risk Pap tests underwent a quality assurance rescreen. Clinicians and/or staff recorded the last menstrual period, specimen source, and clinical information on the requisition slips 96%, 97%, and 88% of the time, respectively. Of 695 Pap tests with applicable computerized records, 172 (25%) qualified for high-risk rescreen based upon information provided on the requisition slip alone. An additional 52 Pap tests (7%), or 23% of the total high-risk Pap tests were discovered to be of high risk only after review of the electronic records. Conclusions: Clinicians and staff were receptive to discussions concerning the completion of requisition slips, but laboratory expectations could be better communicated. Requisition slips were properly completed with a high frequency, but the check boxes did not elicit all the information expected, so revision was necessary. The high accuracy of the completion of requisition slips permitted 77% of high-risk Pap tests to be identified via the requisition slip alone. Our findings challenge the conventional anecdotal impressions of "notoriously unreliable" information on Pap test requisition slips, but our experience may not be applicable to other settings.
      Citation: CytoJournal 2009 6(1):11-11
      PubDate: Sat,11 Jul 2009
      DOI: 10.4103/1742-6413.53360
      Issue No: Vol. 6, No. 1 (2009)
       
  • Test group biases and ethical concerns mar New England Journal of Medicine
           articles promoting HPV screening for cervical cancer in rural India

    • Authors: R Marshall Austin, Chengquan Zhao
      Pages: 12 - 12
      Abstract: R Marshall Austin, Chengquan Zhao
      CytoJournal 2009 6(1):12-12

      Citation: CytoJournal 2009 6(1):12-12
      PubDate: Thu,16 Jul 2009
      Issue No: Vol. 6, No. 1 (2009)
       
  • Comparison of the modified fluorescent method and conventional
           Ziehl-Neelsen method in the detection of acidfast bacilli in lymphnode
           aspirates

    • Authors: Vamseedhar Annam, Mohan H Kulkarni, Rekha B Puranik
      Pages: 13 - 13
      Abstract: Vamseedhar Annam, Mohan H Kulkarni, Rekha B Puranik
      CytoJournal 2009 6(1):13-13
      Objectives: The objectives were to correlate the modified fluorescent method with the conventional Ziehl-Neelsen (ZN) method for the detection of acid-fast bacilli (AFB) and, also to study the efficacy and advantages of using the auramine-rhodamine stain on lymph node aspirates under fluorescent microscopy. Methods: In 108 consecutive patients with a clinical suspicion of tuberculosis (TB) presenting with lymphadenopathy, fine needle aspirations were performed. Smears from the aspirates were processed for routine cytology, the conventional ZN method, and the modified fluorescent method. The significance of the modified fluorescent method over the conventional ZN method was analyzed using the chi-square test. Results: Out of 108 aspirates, 102 were studied and remaining 6 were excluded from the study due to diagnosis of malignancy in 4.04% (4/6) and inadequate aspiration in 2.02% (2/6). Among the 102 aspirates, 44.11% (45/102) were positive for AFB on the conventional ZN method, 58.9% (60/102) were indicative of TB on cytology, while the smear positive increased to 81.37% (83/102) on the modified fluorescent method. Conclusions: Fluorescent microscopy has the advantage of speed and ease of screening, and reduces observer fatigue. The modified fluorescent method was found to be more advantageous than routine cytology and conventional ZN method, particularly in paucibacillary cases. The bacillary positivity rates were higher in the modified fluorescent method than in the ZN method. Hence, the modified fluorescent method can be an adjuvant when used with routine cytology for the identification of AFB.
      Citation: CytoJournal 2009 6(1):13-13
      PubDate: Sat,18 Jul 2009
      DOI: 10.4103/1742-6413.53887
      Issue No: Vol. 6, No. 1 (2009)
       
  • The status of cervical cytology in Swaziland, Southern Africa: A
           descriptive study

    • Authors: Sylvain Okonda, Colleen Wright, Pam Michelow
      Pages: 14 - 14
      Abstract: Sylvain Okonda, Colleen Wright, Pam Michelow
      CytoJournal 2009 6(1):14-14
      Background: Cancer of the cervix is the most common cancer in women in Swaziland where most women never undergo cervical screening. The extremely high prevalence of HIV/AIDS in Swaziland complicates the management of preinvasive and invasive cervical cancer. The purpose of this study was to assess the current status of cervical cytology in Swaziland, its strengths and limitations. Methods: The study is a retrospective review of 12,188 conventional cervical smears received by the Central Public Health Laboratory in Swaziland from June 2004 to May 2006. Results: Review of results showed very high rates of cytologic abnormalities with 43.2% of smears screened reported as abnormal. The percentages of abnormalities were as follows: atypical squamous cells of undermined significance (ASC-US), 19.8%; atypical squamous cells, cannot exclude HSILs (ASC-H), 8.8%; low-grade squamous intraepithelial lesions (LSIL), 9.0%; high-grade squamous intraepithelial lesions (HSIL), 4.6%; squamous cell carcinomas, 0.5%; atypical endocervical cells, 0.6%; and atypical endometrial cells, 0.4%. Just over 5% of smears were inadequate. The highest rates of HSILs and invasive squamous carcinoma occurred in women aged 50-59 years. Conclusions: This study underscores the need to reduce the incidence of cervical cancer and its precursor lesions in Swaziland women. Based on studies of human papillomavirus (HPV) types in other Southern African countries, current HPV vaccines would reduce the incidence and mortality from cervical cancer in the future, but cervical screening would still be required, both for women already infected with the HPV and for HPV subtypes not covered by current vaccines. The most cost-effective combination of screening modalities such as visual inspection, HPV DNA testing, and cytology should be investigated. Cervical cancer reduction needs to be managed within the greater framework of the HIV/AIDS epidemic.
      Citation: CytoJournal 2009 6(1):14-14
      PubDate: Thu,6 Aug 2009
      DOI: 10.4103/1742-6413.54916
      Issue No: Vol. 6, No. 1 (2009)
       
  • Does the ThinPrep Imaging System increase the detection of high-risk
           HPV-positive ASC-US and AGUS? The Women and Infants Hospital experience
           with over 200,000 cervical cytology cases

    • Authors: M Ruhul Quddus, Theresa Neves, Mary E Reilly, Margaret M Steinhoff, C James Sung
      Pages: 15 - 15
      Abstract: M Ruhul Quddus, Theresa Neves, Mary E Reilly, Margaret M Steinhoff, C James Sung
      CytoJournal 2009 6(1):15-15
      Background: Published reports have demonstrated that introduction of the ThinPrep Imaging System (Imager) to the cytology screening services has increased the detection rate of high-grade squamous intraepithelial lesions (HSILs). In accordance with recent clinical treatment guidelines, patients with atypical squamous or glandular cells of undetermined significance (ASC-US or AGUS) are often tested for high-risk HPV infection using the Hybrid Capture HPV DNA test. We took the opportunity to investigate whether the Imager had resulted in any significant differences in our diagnostic categories, as well as whether the Imager increased the detection of high-risk HPV-DNA-positive (HRHPV+) ASC-US or AGUS. Materials and Methods: Cytology cases with the diagnosis of ASC-US and AGUS were retrieved from the archival files of our institution during periods of 11 months prior to and 11 months after the introduction of the Imager. The total number of cases in each category was correlated with results of reflex high-risk HPV DNA testing when the latter were available. All AGUS diagnoses were correlated with subsequent biopsy follow-up. Statistical analyses were performed using the chi-Square test with Yate's Correction and Fisher's Exact test. Results: A total of 108,371 and 104,555 of ThinPrep ® Pap Test (TPPT) cases were reviewed during 11 months pre- and post-imager introduction. The ASC-US rate was 5.4% in the pre-Imager and 5.3% in the post-Imager period. The HPV reflex test was 38% and 34% positive respectively in the pre- and post-Imager period ( P >0.124). Similarly, 0.14% and 0.12% AGUS were found in the pre- and post-Imager period. The positive HPV reflex test was 14% versus 23% ( P = 0.1690). The abnormal biopsy follow-up rate in the AGUS category was increased from 20.9% in the pre-Imager period to 31% in the post-Imager period ( P = 0.1471). The ASCUS/SIL ratios were 1.9 and 1.6 respectively. Conclusions: The ASC-US and AGUS rates did not change statistically before and after the introduction of the Imager in our cytology laboratory. Although use of the Imager did not increase detection of HPV+ ASC-US, it did appear to increase the detection rate of HPV+ AGUS and subsequent abnormal biopsy follow-up rates in all categories. However, the increase in the detection rate did not reach the point of statistical significance
      Citation: CytoJournal 2009 6(1):15-15
      PubDate: Thu,6 Aug 2009
      DOI: 10.4103/1742-6413.54917
      Issue No: Vol. 6, No. 1 (2009)
       
  • Routine review of ascites fluid from patients with cirrhosis or
           

    • Authors: Michael J Thrall, Ellen J Giampoli
      Pages: 16 - 16
      Abstract: Michael J Thrall, Ellen J Giampoli
      CytoJournal 2009 6(1):16-16
      Background: Patients with cirrhosis develop ascites for physiologic reasons that are unrelated to malignant progression. However, physicians performing paracentesis in these patients, often send fluid to the cytology laboratory, sometimes specifically looking for hepatocellular carcinoma (HCC). We have investigated the diagnostic yield of these specimens. Materials and Methods: A computerized pathology database search for all ascites fluid cases submitted to the cytology laboratory at a major liver transplant center between November 2004 and April 2008 was performed. Clinical history was obtained for each case. Patients with cirrhosis, with or without HCC, were included in the study. Cytologic diagnoses were compiled and follow-up information was obtained for cases with non-negative findings. Results: A total of 167 specimens from 133 patients ranging from 29 to 85 years of age (mean 56 years) were submitted over the said time period. The causes of cirrhosis included: alcohol - 44; Hepatitis C - 30; Hepatitis B - 6; non-alcoholic steatohepatitis - 7; cryptogenic - 18; other single causes - 6; and multifactorial (alcohol and hepatitis viruses) - 22. Hepatocellular carcinoma (HCC) was present or strongly suspected in 17 patients and had been previously resected in two others. The status of fifteen patients was post liver transplant, with recurrent liver failure. Human immunodeficiency virus was present in seven patients and eight patients had a history of non hepatic malignancies. Among the specimens, 162 were negative, two had atypical lymphocytes worked up for lymphoma, and three had atypical epithelioid cells; none was positive for HCC. Immunohistochemistry demonstrated a mesothelial origin for the atypical epithelioid cells in two cases; in the third case, the patient died shortly after the specimen was collected, with no radiological evidence of HCC. Conclusion: Ascites fluid cytology specimens in patients with cirrhosis, even those known or suspected to have HCC, are almost always negative. Atypical cells seen in such specimens should be treated with skepticism since the likelihood that they represent peritoneal spread of HCC is low.
      Citation: CytoJournal 2009 6(1):16-16
      PubDate: Fri,7 Aug 2009
      DOI: 10.4103/1742-6413.54919
      Issue No: Vol. 6, No. 1 (2009)
       
  • Market survey predictions on the future of US Pap testing

    • Authors: R Marshall Austin, Barbara Benstein, Joel Bentz, Sandra Bigner, Gregory G Freund, Gregory La Rocco, Ibrahim Ramzy, Lynnette Savaloja, Vinod B Shidham
      Pages: 17 - 17
      Abstract: R Marshall Austin, Barbara Benstein, Joel Bentz, Sandra Bigner, Gregory G Freund, Gregory La Rocco, Ibrahim Ramzy, Lynnette Savaloja, Vinod B Shidham
      CytoJournal 2009 6(1):17-17

      Citation: CytoJournal 2009 6(1):17-17
      PubDate: Fri,18 Sep 2009
      DOI: 10.4103/1742-6413.55885
      Issue No: Vol. 6, No. 1 (2009)
       
  • Differential expression of galectin-3, CK19, HBME1, and Ret oncoprotein in
           the diagnosis of thyroid neoplasms by fine needle aspiration biopsy

    • Authors: Husain A Saleh, Jining Feng, Farah Tabassum, Opada Al-Zohaili, Muji Husain, Tamara Giorgadze
      Pages: 18 - 18
      Abstract: Husain A Saleh, Jining Feng, Farah Tabassum, Opada Al-Zohaili, Muji Husain, Tamara Giorgadze
      CytoJournal 2009 6(1):18-18
      Background: Fine needle aspiration biopsy (FNAB) is a common and excellent procedure for the evaluation of thyroid lesions that require surgical resection. At times, the FNAB diagnosis can be difficult, particularly of follicular-patterned lesions. Previous studies have shown that some immunohistochemical (IHC) markers may be helpful in establishing more accurate diagnosis. In this study, our goal was to evaluate four of the recently investigated markers in differentiating benign from malignant thyroid nodules on FNABs. Materials and Methods: We performed IHC staining of galectin-3, Ret oncoprotein (Ret), HBME-1, and cytokeratin 19 (CK19), on cell block sections of thyroid FNAB cases that had corresponding surgical resections. They included 44 benign lesions (37 hyperplastic or cellular nodules, HN; and 7 follicular adenomas, FA) and 27 malignant tumors (6 follicular carcinoma, FC; 19 classic papillary carcinoma, PTC; and 2 follicular variant of papillary carcinoma, FVPC). The stains were done according to the standard avidin-biotin-peroxidase method. Results: Statistical analysis showed that immunoexpression was significantly higher in the malignant group for all four markers. The sensitivity for positive expression for all benign lesions versus malignant tumors was as follows: 10/44 (22.7%) versus 25/27 (92.6%) for galectin-3; 14/44 (31.8%) versus 23/27 (85%) for Ret; 12/44 (27.3%) versus 24/27 (88.8%) for HBME-1; and 13/44 (29.5%) versus 23/27 (85%) for CK19. The sensitivity and specificity was highest for galectin-3 (92.6% and 77.3%, respectively) followed by HMBE-1 (88.9% and 72.7%, respectively). When combining the markers' expressions, the panel of galectin-3 + HBME-1 showed the highest sensitivity and specificity (90.7% and 75%, respectively), but this was, however, lower than galectin-3 alone (92.3% and 77.3%, respectively). Conclusion: We conclude that galectin-3 is the best single marker in differentiating benign from malignant thyroid lesions with the highest sensitivity and specificity. The galectin-3 + HBME-1 was the best combination for distinguishing benign from malignant lesions. Because they were the best two independent and combined markers, we recommend the use of the galectin-3 + HBME-1 panel to enhance the diagnostic accuracy of follicular-patterned thyroid lesions on FNABs.
      Citation: CytoJournal 2009 6(1):18-18
      PubDate: Fri,18 Sep 2009
      DOI: 10.4103/1742-6413.55894
      Issue No: Vol. 6, No. 1 (2009)
       
  • Surrogate indicators of sensitivity in gynecologic cytology: Can they be
           used to improve the measurement of sensitivity in the laboratory?

    • Authors: Andrew A Renshaw, Fadi Brimo, Manon Auger
      Pages: 19 - 19
      Abstract: Andrew A Renshaw, Fadi Brimo, Manon Auger
      CytoJournal 2009 6(1):19-19
      Background: Measuring the sensitivity of screening in gynecologic cytology in real life is problematic. However, other quality measures may correlate with sensitivity, including the atypical squamous cells (ASC)/squamous intraepithelial lesion (SIL) ratio. Whether these other measures can function as "surrogate indicators" for sensitivity and improve the assessment of sensitivity in the laboratory is not known. Materials and Methods: We compared multiple quality measures with true screening sensitivity in a variety of situations. Results: The abnormal rate, ASC rate, and ASC/SIL ratio were all highly correlated (r = .83 or greater) with sensitivity when the overall laboratory sensitivity was low (85%) but became less correlated (.64 or less) or uncorrelated when the screening sensitivity was higher (88% or 95%, respectively). Sensitivity was more highly correlated with the abnormal rate than the ASC/SIL ratio at low screening sensitivity. While thresholds could be set that were highly sensitive and specific for suboptimal screening, these thresholds were often less than one standard deviation away from the mean. Conclusion: The correlation of the abnormal rate and the ASC/SIL ratio with sensitivity depends on overall sensitivity. Standards to define minimum screening sensitivity can be defined, but these standards are relatively narrow. These features may limit the utility of these quality measures as surrogates for sensitivity.
      Citation: CytoJournal 2009 6(1):19-19
      PubDate: Fri,9 Oct 2009
      DOI: 10.4103/1742-6413.56359
      Issue No: Vol. 6, No. 1 (2009)
       
  • Broom versus broom-and-brush: A comparison of surepath® liquid-based
           papanicolaou test (LBPT) collection devices

    • Authors: Min Yi Ngae, Clinton D Crowder, Klint Kjeldahl, Roberto Gamez, Samantha Paulson, Daniel M McKeon, Priti Goyal, Stefan E Pambuccian
      Pages: 20 - 20
      Abstract: Min Yi Ngae, Clinton D Crowder, Klint Kjeldahl, Roberto Gamez, Samantha Paulson, Daniel M McKeon, Priti Goyal, Stefan E Pambuccian
      CytoJournal 2009 6(1):20-20

      Citation: CytoJournal 2009 6(1):20-20
      PubDate: Fri,9 Oct 2009
      DOI: 10.4103/1742-6413.56360
      Issue No: Vol. 6, No. 1 (2009)
       
  • Primary effusion lymphoma involving three body cavities

    • Authors: Fadi Brimo, Gizelle Popradi, Rene P Michel, Manon Auger
      Pages: 21 - 21
      Abstract: Fadi Brimo, Gizelle Popradi, Rene P Michel, Manon Auger
      CytoJournal 2009 6(1):21-21
      Primary effusion lymphoma (PEL) is a human herpes virus-8 (HHV8)-associated large-cell non-Hodgkin lymphoma localized in body cavities and presenting as pleural, peritoneal, or pericardial lymphomatous effusions. It typically affects immunocompromised patients and usually involves only one body site. We describe herein a case of PEL affecting three body cavity sites in an immunocompetent patient. A 69-year-old HIV-negative man presented with upper gastrointestinal bleeding and ascites. An examination of the fluid by cytology showed large atypical lymphocytes with abundant basophilic cytoplasm, either central or eccentric nuclei having irregular outlines, and multiple prominent nucleoli. The neoplastic cells showed positive staining for CD45, CD3, HHV8 latent nuclear antigen (LNA), and Epstein-Barr virus-encoded RNA. A diagnosis of PEL was rendered. Despite chemotherapy and valganciclovir, the disease progressed to involve the pleural and pericardial cavities and the patient died 5 months following the initial diagnosis. Although PEL is a B-cell lymphoma, it is usually of null phenotype by immunohistochemistry, and can rarely aberrantly express T-cell markers, as seen in the current case. The key to the diagnosis of PEL rests on identifying HHV8 in the neoplastic cells. Therefore, restricting the term of PEL only to those cases that are HHV8 positive is important in order to differentiate PEL from other lymphomas that can present as serous effusions and that carry, in general, a more favorable prognosis than PEL
      Citation: CytoJournal 2009 6(1):21-21
      PubDate: Fri,9 Oct 2009
      DOI: 10.4103/1742-6413.56361
      Issue No: Vol. 6, No. 1 (2009)
       
  • Ciliated foregut cyst of the pancreas: Preoperative diagnosis using
           endoscopic ultrasound guided fine needle aspiration cytology-A case report
           with a review of the literature

    • Authors: Kulwinder S Dua, Aravind S Vijayapal, Janis Kengis, Vinod B Shidham
      Pages: 22 - 22
      Abstract: Kulwinder S Dua, Aravind S Vijayapal, Janis Kengis, Vinod B Shidham
      CytoJournal 2009 6(1):22-22
      A 51-year-old male presented with a 4-month history of abdominal pain, decreased appetite, and postprandial bloating. A CT scan showed a solitary, 5.3 Χ 4.4 cm, cystic lesion in the body/tail of the pancreas. Endoscopic retrograde cholangiopancreatography did not show communication between the pancreatic duct and the cystic lesion. Endoscopic ultrasound (EUS) examination revealed a 6.9 Χ 2.4 cm cystic lesion in the body/tail region of the pancreas without septae or solid components. The pancreatic parenchyma, pancreatic duct, and common bile duct were unremarkable. EUS-guided fine needle aspiration (EUS-FNA) was performed using a 22-gauge EchotipTM needle. Only a few drops of viscous fluid could be aspirated. Papanicolaou-stained direct smears and SurePath (Autocyte) preparations were evaluated. The direct smears were hypocellular; however, the concentration method producing liquid-based cytology preparation showed detached ciliary tufts (degenerated debris with ciliated cellular fragments of cell tops without nuclei) and occasional intact ciliated cells consistent with a ciliated foregut cyst. Although benign, the cyst was resected to alleviate the symptoms. The surgical pathology confirmed the benign preoperative interpretation of the ciliated foregut cyst. To the best of our knowledge, this is the first case of pancreatic ciliated foregut cyst reported to be diagnosed preoperatively by EUS-FNA. For a proper preoperative cytologic diagnosis, the needle rinses should be processed adequately. Otherwise, these hypocellular specimens with mucin may be misinterpreted as mucinous cystic lesions.
      Citation: CytoJournal 2009 6(1):22-22
      PubDate: Fri,9 Oct 2009
      DOI: 10.4103/1742-6413.56362
      Issue No: Vol. 6, No. 1 (2009)
       
  • Reply to: Austin et al. CytoJournal 2009;6:12 (Unfounded claims mar
           scientific critique)

    • Authors: Jose Jeronimo, Mark A Barone, Silvana Luciani, Ricky Lu, Jacqueline Sherris, Julie Torod, Vivien Tsu
      Pages: 23 - 23
      Abstract: Jose Jeronimo, Mark A Barone, Silvana Luciani, Ricky Lu, Jacqueline Sherris, Julie Torod, Vivien Tsu
      CytoJournal 2009 6(1):23-23

      Citation: CytoJournal 2009 6(1):23-23
      PubDate: Tue,17 Nov 2009
      DOI: 10.4103/1742-6413.57780
      Issue No: Vol. 6, No. 1 (2009)
       
  • Utility of Thyroglobulin measurement in fine-needle aspiration biopsy
           specimens of lymph nodes in the diagnosis of recurrent thyroid carcinoma

    • Authors: Zubair W Baloch, Julieta E Barroeta, Janet Walsh, Prabodh K Gupta, Virginia A Livolsi, Jill E Langer, Susan J Mandel
      Pages: 1 - 1
      Abstract: Zubair W Baloch, Julieta E Barroeta, Janet Walsh, Prabodh K Gupta, Virginia A Livolsi, Jill E Langer, Susan J Mandel
      CytoJournal 2008 5(1):1-1
      IntroductionThe most common site for the metastasis of papillary carcinoma of the thyroid (PTC) is regional lymph nodes. Ultrasound (US) imaging may identify abnormal appearing lymph nodes, suspicious for PTC recurrence. Although fine needle aspiration biopsy (FNAB) of abnormal lymph nodes is often diagnostic of recurrence, small or cystic lymph nodes may be non-diagnostic due to lack of tumor cells. The measurement of thyroglobulin (TG) levels in FNAB specimens from lymph nodes suspicious for recurrent PTC can serve as an adjunct to the cytologic diagnosis.Materials and methods115 abnormal appearing lymph nodes were aspirated under ultrasound guidance in 89 patients with history of thyroid carcinoma. In addition to obtaining material for cytologic interpretation, an additional aspirate was obtained by FNAB and rinsed in 1 ml of normal saline for TG level measurements.ResultsThe cytologic diagnoses included: 35 (30%) reactive lymph node, no tumor seen (NTS), 39 (34%) PTC, 23 (20%) inadequate for evaluation due to lack of lymphoid or epithelial cells (NDX) 15 (13%) atypical/suspicious for PTC, and 3 (3%) other (e.g. paraganglioma, poorly differentiated carcinoma and carcinoma not otherwise specified). TG levels were markedly elevated (median 312 ng/ml; normal < 10 ng/ml) in 28 (72%) cases of PTC lymph node recurrence identified on cytology. TG measurements were also elevated in 5 lymph nodes classified as NTS and 4 NDX on cytology which resulted in 5 and 3 carcinoma diagnoses respectively on histological follow-up. Of the 9 atypical/suspicious cases with elevated TG levels all resulted in carcinoma diagnoses on follow-up.ConclusionThe measurement of TG in FNAB specimens from lymph node in patients with history of PTC is useful in detecting recurrent disease, especially in cases when the specimen is known to be or likely to be inadequate for cytologic evaluation.
      Citation: CytoJournal 2008 5(1):1-1
      PubDate: Thu,31 Jan 2008
      DOI: 10.1186/1742-6413-5-1
      Issue No: Vol. 5, No. 1 (2008)
       
  • Cytological and molecular diagnosis of solid variant of papillary thyroid
           carcinoma: A case report

    • Authors: Giancarlo Troncone, Maria Russo, Umberto Malapelle, Marina Accardo, Angelo Ferraro, Immacolata Cozzolino, Lucio Palombini
      Pages: 2 - 2
      Abstract: Giancarlo Troncone, Maria Russo, Umberto Malapelle, Marina Accardo, Angelo Ferraro, Immacolata Cozzolino, Lucio Palombini
      CytoJournal 2008 5(1):2-2
      Papillary thyroid carcinoma (PTC) composed by predominant solid areas is diagnosed as a distinct variant on histological samples. Here we present a case of PTC recognized preoperatively by fine needle cytology as a solid variant. This diagnosis was made by combining cytology with the detection of the BRAFVK600-1E mutation, the molecular hallmark of the solid variant of PTC. Histological and molecular evaluation of the surgical specimen confirmed this pre-operative diagnosis. Thus combining cytology to BRAF molecular analysis is useful to refine the cytological diagnosis of this variant also on FNC specimens.
      Citation: CytoJournal 2008 5(1):2-2
      PubDate: Wed,19 Mar 2008
      DOI: 10.1186/1742-6413-5-2
      Issue No: Vol. 5, No. 1 (2008)
       
  • Comparison of Thin-Prep and cell block preparation for the evaluation of
           Thyroid epithelial lesions on fine needle aspiration biopsy

    • Authors: Husain A Saleh, Jamal Hammoud, Richard Zakaria, Aurang Zeb Khan
      Pages: 3 - 3
      Abstract: Husain A Saleh, Jamal Hammoud, Richard Zakaria, Aurang Zeb Khan
      CytoJournal 2008 5(1):3-3
      Background: The objective of this study was to compare the utility of Thin-Prep (TP) cytologic preparation with that of Cell Block (CB) preparation in the diagnosis of thyroid lesions, mainly follicular epithelial lesions, by fine needle aspiration biopsy (FNAB). Feasibility of using the TP slides for immunocytochemical stains is also discussed.Methods: A total of 126 consecutive cases of thyroid FNAB with TP slides and 128 consecutive cases of thyroid FNAB with CB slides were reviewed blindly by two cytopathologists. The presence of colloid, follicular cells, macrophages and lymphocytes/plasma cells were recorded and scored 0-4 on each case based on TP or CB slide review. The cytologic diagnoses were grouped as follows: cyst, colloid nodule, colloid nodule with cystic change, chronic thyroiditis, atypical/neoplastic and non-diagnostic.Results: The TP slides had higher diagnostic rate than CB slides. The diagnostic yield was 68% of the TP slides whereas only 24% of the CB slides were diagnostic. Also, only 4 atypical/neoplastic lesions were diagnosed on the TP slides and the corresponding direct smears, while 5 cases of atypical/neoplastic lesions were diagnosed on the smears but could not be diagnosed on the corresponding CB slides. Additionally, the TP slides revealed cytologic features that were not observed on the direct traditional smears of the same case.Conclusion: In thyroid FNAB cases, TP slide preparation is superior to CB slide preparation and is more likely to have greater cellularity for diagnosis and detect atypical/neoplastic thyroid lesions, particularly those of follicular cell origin. Furthermore, TP slides appear to detect helpful diagnostic cytologic features and should be considered complementary to, rather than replacing, direct smears.
      Citation: CytoJournal 2008 5(1):3-3
      PubDate: Tue,25 Mar 2008
      DOI: 10.1186/1742-6413-5-3
      Issue No: Vol. 5, No. 1 (2008)
       
  • Fine needle aspiration biopsy of intraoral and oropharyngeal mass lesions

    • Authors: Husain A Saleh, Lewis Clayman, Haitham Masri
      Pages: 4 - 4
      Abstract: Husain A Saleh, Lewis Clayman, Haitham Masri
      CytoJournal 2008 5(1):4-4
      Background: Fine needle aspiration (FNA) biopsy has been rarely used in oral and oropharyngeal lesions. The goal of this study was to assess the value and accuracy of FNA biopsy in the diagnosis of oral and oropharyngeal lesions particularly in regards to discriminating benign from malignant tumors.Methods: Sixteen cases of FNA biopsies obtained of various intraoral and oropharyngeal masses or lesions performed at our institution during the eight-year period from 1998 to 2006 were retrospectively reviewed. The aspiration cytologic diagnoses were correlated with the histologic examination of the corresponding resected lesions.Results: Sixteen cases of intraoral lesions evaluated by FNA biopsies during the period of 1998-2006 were reviewed. The sites of involvement were: lip [1], maxillary sinus [3], pharynx/oropharynx [5], floor of mouth [4], buccal mucosa [2] and peritonsillar area [1]. Patients' age ranged from 30 to 87 with an average of 54 years. Male to female ratio was 1:3. Cytologically, 7 cases were diagnosed as suspicious/malignant, and 9 cases as benign (including 6 benign neoplasm, 1 atypical, and 2 reactive or "descriptive"). Fifteen cases had corresponding surgical resection for histologic examination, of these, 9 cases were interpreted as malignant, and 6 as benign. There were no false positive diagnoses of malignancy on FNA. Two cases were interpreted as benign or atypical cytologically, but were found to be malignant on histologic examination.Conclusion: FNA biopsy of intraoral and oropharyngeal masses is a valuable procedure for the initial evaluation of various lesions. It provides helpful information about these lesions and avoids hasty or unnecessary surgical biopsy. It is a rapid and relatively noninvasive procedure. Furthermore, aspiration biopsy is an important tool in the diagnosis and management of these lesions, both neoplastic and non-neoplastic, and can be sometimes complemented by ancillary studies for more accurate interpretation. However, its sensitivity in the diagnosis of malignancy is lower than that of histologic samples. This is probably due to the superficial nature and small size of these lesions, the limited space for maneuvering the needle and difficulty in immobilizing the lesion to obtain adequate samples, rather than to interpretation or inherent limitations of the technique itself.
      Citation: CytoJournal 2008 5(1):4-4
      PubDate: Fri,28 Mar 2008
      DOI: 10.1186/1742-6413-5-4
      Issue No: Vol. 5, No. 1 (2008)
       
  • A 5-year-old girl with a congenital ganglioneuroma diagnosed by fine
           needle aspiration biopsy : A case report

    • Authors: Marco A Ponce-Camacho, Ricardo Diaz de Leon-Medina, Ivet Miranda-Maldonado, Raquel Garza-Guajardo, Jorge Hernandez-Salazar, Oralia Barboza-Quintana
      Pages: 5 - 5
      Abstract: Marco A Ponce-Camacho, Ricardo Diaz de Leon-Medina, Ivet Miranda-Maldonado, Raquel Garza-Guajardo, Jorge Hernandez-Salazar, Oralia Barboza-Quintana
      CytoJournal 2008 5(1):5-5
      Introduction: Ganglioneuroma is a rare, benign, neuroblastic tumor arising mainly from the central or peripheral autonomic nervous system, especially the sympathetic system. The most affected anatomical sites are the posterior mediastinum, retroperitoneum, adrenal gland and head and neck soft tissue. In the current literature, reports of ganglioneuroma diagnosed by fine-needle aspiration and its cytological appearance are scarce. Case Presentation: A 5-year-old girl presented with a mass in the cervical region since birth. Laboratory routine tests were within normal limits, ultrasonography demonstrated a solid and well-circumscribed lesion in the soft tissues of the cervical region. Fine needle aspiration biopsy was carried out, and the obtained smears showed a mixture of mature ganglion cells and groups of spindle cells suggestive of schwann cell origin. A diagnosis of ganglioneuroma was suggested. Core biopsy and surgical resection confirmed this diagnosis. Conclusion: Congenital ganglioneuroma of the cervical region is an uncommon soft tissue benign neoplasm of neuroblastic origin, and it should be considered in the differential diagnosis of head and neck pediatric soft tissue tumors. Fine needle aspiration biopsy technique is a reliable method that can be used with confidence when dealing with pediatric soft tissue tumors.
      Citation: CytoJournal 2008 5(1):5-5
      PubDate: Sun,30 Mar 2008
      DOI: 10.1186/1742-6413-5-5
      Issue No: Vol. 5, No. 1 (2008)
       
  • The National Cancer Institute Thyroid fine needle aspiration state of the
           science conference : A summation

    • Authors: Zubair W Baloch, Edmund S Cibas, Douglas P Clark, Lester J Layfield, Britt-Marie Ljung, Martha Bishop Pitman, Andrea Abati
      Pages: 6 - 6
      Abstract: Zubair W Baloch, Edmund S Cibas, Douglas P Clark, Lester J Layfield, Britt-Marie Ljung, Martha Bishop Pitman, Andrea Abati
      CytoJournal 2008 5(1):6-6

      Citation: CytoJournal 2008 5(1):6-6
      PubDate: Mon,7 Apr 2008
      DOI: 10.1186/1742-6413-5-6
      Issue No: Vol. 5, No. 1 (2008)
       
  • Prevalence and significance of psammoma bodies in cervicovaginal smears in
           a cervical cancer screening program with emphasis on a case of primary
           bilateral ovarian psammocarcinoma

    • Authors: Teresa Pusiol, Anna M Parolari, Irene Piscioli, Luca Morelli, Franca Del Nonno, Stefano Licci
      Pages: 7 - 7
      Abstract: Teresa Pusiol, Anna M Parolari, Irene Piscioli, Luca Morelli, Franca Del Nonno, Stefano Licci
      CytoJournal 2008 5(1):7-7
      Background: The purpose of our study was to determine the prevalence and significance of psammoma bodies (PBs) in the cervicovaginal smears of the screening population of Trento district (Italy), with the description of the cytological presentation of an asymptomatic bilateral ovarian psammocarcinoma. Methods: From 1993 to 2006, women with PBs detected on consecutively screened cervical smears were identified from the computerized pathology database of Rovereto Hospital. The follow-up period was set from the time of cytological diagnosis to May 31 st , 2007. Clinical information was obtained from retrospective review of women's medical records. The source of PBs was identified with adequate diagnostic procedures. Results: PBs were found in six of the 201,231 Papanicolaou screening smears (0.0029%). Benign conditions (intrauterine device, inclusion ovarian cysts and ovarian cystoadenofibroma with PBs) were found in four patients. In two cases, PBs were associated with malignant cells; a bilateral ovarian malignancy was diagnosed in both cases, a serous adenocarcinoma and a psammocarcinoma. Conclusion: PBs in the cervicovaginal smears are a rare finding, associated more often with benign conditions than with malignancies. Moreover, to our knowledge, our case of primary ovarian psammocarcinoma is the first report in which the presence of malignant cells and PBs in the cervicovaginal and endometrial smears represents the first manifestation of disease.
      Citation: CytoJournal 2008 5(1):7-7
      PubDate: Wed,16 Apr 2008
      DOI: 10.1186/1742-6413-5-7
      Issue No: Vol. 5, No. 1 (2008)
       
  • Calcium pyrophosphate dihydrate deposition disease (CPPD)/Pseudogout of
           the temporomandibular joint - FNA findings and microanalysis.

    • Authors: Asghar H Naqvi, Jerrold L Abraham, Robert M Kellman, Kamal K Khurana
      Pages: 8 - 8
      Abstract: Asghar H Naqvi, Jerrold L Abraham, Robert M Kellman, Kamal K Khurana
      CytoJournal 2008 5(1):8-8
      We report a case of a Calcium pyrophosphate dihydrate deposition disease (CPPD) presenting as a mass in the parotid and temporomandibular joint (TMJ) that simulated a parotid tumor. A 35 year-old man presented with pain in the left ear area. A CT Scan of the area showed a large, calcified mass surrounding the left condylar head, and extending into the infratemporal fossa. FNA of the mass showed birefringent crystals, most of which were rhomboid with occasional ones being needle shaped, embedded in an amorphous pink substance. Scanning electron microscopy (SEM) with energy dispersive x-ray spectroscopy (EDS) of these crystals showed peaks corresponding to calcium and phosphorus. SEM/EDS is a rapid method of diagnosing calcium pyrophosphate dihydrate deposition disease (CPPD) and an alternative to more commonly used method of special staining of cell block sections coupled with polarizing microscopy.
      Citation: CytoJournal 2008 5(1):8-8
      PubDate: Mon,21 Apr 2008
      DOI: 10.1186/1742-6413-5-8
      Issue No: Vol. 5, No. 1 (2008)
       
  • Myoepithelial Cells : Any role in aspiration cytology smears of breast
           tumors?

    • Authors: Sanjib Kumar Pattari, Pranab Dey, Subhash K Gupta, Kusum Joshi
      Pages: 9 - 9
      Abstract: Sanjib Kumar Pattari, Pranab Dey, Subhash K Gupta, Kusum Joshi
      CytoJournal 2008 5(1):9-9
      Aims and Objective: To study the role of myoepithelial (ME) cells in distinguishing benign, proliferative breast diseases (PBD) and frank malignant breast lesions. Materials and methods: In this study, histology proven 71 cases of fine needle aspiration cytology (FNAC) of palpable breast lesions were selected. There were 30 invasive carcinomas (24 infiltrating duct carcinoma and 6 infiltrating lobular carcinoma), 25 cases of benign lesion (21 fibroadenomas and 4 fibrocystic lesions) and 11 proliferative breast diseases (other than carcinoma in situ) and five cases of carcinoma in situ. The number of ME cells were estimated in respect to 1000 ductal cells. In every case at least 20 high power fields (x 40) were studied. Quantitative estimation of ME cell was correlated with the final diagnosis. Corresponding histopathology cases were also evaluated for diagnostic confirmation along with the pattern of distribution of ME cells. The ME cells were also quantitated on histopathology sections on smooth muscle actin (SMA) immunostained sections. Results: The mean number of ME cells per 1000 ductal cells on cytology smears was 5.1 ± 5.5, 30.8 ± 25, 28.3 ± 20.2, and 38.4 ± 38.8 in malignant, carcinoma in situ, PBD and benign breast lesions respectively. The non parametric Mann Whitney test showed significant difference in number of the ME cells between benign and malignant groups (p < .000), PBD and malignant groups (p < .000) and carcinoma in situ and malignant group (p < .001). However, it was insignificant between benign and PBD group, and PBD and carcinoma in situ (p > .01). In SMA stained histopathology sections, ME cell in benign, PBD, carcinoma in situ and malignant cases were 741.12 ± 248, 238 ± 172, 121.6 ± 115 and 15.6 ± 25.1 respectively. Statistical analysis showed significantly different number of ME cell between benign versus PBD group, carcinoma in situ and malignant group. It was also significant between PBD versus malignant, and carcinoma in situ versus malignant (p < .001, Mann Whitney test). However number of ME cell was not significant between PBD versus carcinoma in situ. Conclusion: The number of ME cell in breast lesions may be helpful in distinguishing PBD versus invasive malignant tumors on FNAC smears. However it is not helpful to distinguish benign lesions versus PBD.
      Citation: CytoJournal 2008 5(1):9-9
      PubDate: Mon,21 Apr 2008
      DOI: 10.1186/1742-6413-5-9
      Issue No: Vol. 5, No. 1 (2008)
       
  • Use of the ThinPrep(R) Imaging System does not alter the frequency of
           interpreting Papanicolaou tests as atypical squamous cells of undetermined
           significance

    • Authors: Michael J Thrall, Donna K Russell, Thomas A Bonfiglio, Rana S Hoda
      Pages: 10 - 10
      Abstract: Michael J Thrall, Donna K Russell, Thomas A Bonfiglio, Rana S Hoda
      CytoJournal 2008 5(1):10-10
      Background: Automated screening of Papanicolaou tests (Pap tests) improves the productivity of cytopathology laboratories. The ThinPrep ® Imaging System (TIS) has been widely adopted primarily for this reason for use on ThinPrep ® Pap tests (TPPT). However, TIS may also influence the interpretation of Pap tests, leading to changes in the frequency of various interpretive categories. The effect of the TIS on rates of TPPT interpretation as atypical squamous cells of undetermined significance (ASC-US) is of concern because any shift in the frequency of ASC-US will alter the sensitivity and specificity of the Pap test. We have sought to determine whether automated screening of TPPT has altered ASC-US rates in our institution when compared with manual screening (MS) of TPPT. Methods: A computerized search for all ASC-US with reflex Human Papillomavirus (HPV) testing over a one-year-period (7/1/06 to 6/30/07) was conducted. Cases included both TPPT screened utilizing TIS and screened manually. HPV test results for both groups were recorded. Pertinent follow-up cervical cytology and histology results were retrieved for the period extending to 11/30/07. Automated screening was in clinical use for 10 months prior to the start of the study. Results: Automated screening was performed on 23,103 TPPT, of which 977 (4.23%) were interpreted as ASC-US. Over the same period, MS was performed on 45,789 TPPT, of which 1924 (4.20%) were interpreted as ASC-US. Reflex HPV testing was positive for high risk (HR) types in 47.4% of the TIS cases and 50.2% of MS cases. Follow-up cervical dysplasia found by colposcopy was also distributed proportionally between the two groups. Cervical intraepithelial neoplasia (CIN) was found on follow-up biopsy of 20.1% of the TIS cases (5.2% CIN 2/3) and 21.2% of MS cases (5.1% CIN 2/3). None of these differences were statistically significant. Conclusion: Use of the ThinPrep ® Imaging System did not appreciably change ASC-US rates or follow-up reflex HPV test results in our laboratory. This demonstrates that the benefits of automated screening may be obtained without increasing the rate of referral to colposcopy for ASC-US follow-up.
      Citation: CytoJournal 2008 5(1):10-10
      PubDate: Thu,24 Apr 2008
      DOI: 10.1186/1742-6413-5-10
      Issue No: Vol. 5, No. 1 (2008)
       
  • Transabdominal Fine-Needle Aspiration Biopsy: A Colour Atlas and Monograph
           

    • Authors: Prabodh K Gupta
      Pages: 11 - 11
      Abstract: Prabodh K Gupta
      CytoJournal 2008 5(1):11-11

      Citation: CytoJournal 2008 5(1):11-11
      PubDate: Fri,25 Apr 2008
      DOI: 10.1186/1742-6413-5-11
      Issue No: Vol. 5, No. 1 (2008)
       
  • Entamoeba gingivalis pulmonary abscess - Diagnosed by fine needle
           aspiration

    • Authors: Bo Jian, Ana S Kolansky, Zubair W Baloach, Prabodh K Gupta
      Pages: 12 - 12
      Abstract: Bo Jian, Ana S Kolansky, Zubair W Baloach, Prabodh K Gupta
      CytoJournal 2008 5(1):12-12
      Entamoeba gingivalis ( E. gingivalis ) is a parasitic protozoa of the oral cavity, most often found in gingival tissues around the teeth associated with poor oral hygiene. Here, we report a case of E. gingivalis in a pulmonary CT guided fine needle aspiration material, from a 60-year-old man with newly found lung mass. On site Diff-Quik ® smear examination revealed the presence of marked acute inflammation, colonies of actinomyces, and a number of 'large macrophages-like organisms'. Upon examination of the additional material, organisms morphologically consistent with E. gingivalis were identified. Pulmonary mass resolved after six weeks of treatment with antibiotics (Clindamycin followed by Penicillin). Proper recognition and distinction between E. gingivalis and other species of Entamoeba is important for the management of patients.
      Citation: CytoJournal 2008 5(1):12-12
      PubDate: Tue,30 Sep 2008
      DOI: 10.4103/1742-6413.43179
      Issue No: Vol. 5, No. 1 (2008)
       
  • Review of thyroid cytopathology: An Atlas and text

    • Authors: Melina Flanagan, Prabodh Gupta
      Pages: 13 - 13
      Abstract: Melina Flanagan, Prabodh Gupta
      CytoJournal 2008 5(1):13-13

      Citation: CytoJournal 2008 5(1):13-13
      PubDate: Fri,3 Oct 2008
      Issue No: Vol. 5, No. 1 (2008)
       
  • Nodular fasciitis of the external ear masquerading as pleomorphic adenoma:
           A potential diagnostic pitfall in fine needle aspiration cytology

    • Authors: Deepali Jain, Nita Khurana, Shyama Jain
      Pages: 14 - 14
      Abstract: Deepali Jain, Nita Khurana, Shyama Jain
      CytoJournal 2008 5(1):14-14
      Background: Nodular fasciitis (NF) is a benign myofibroblastic proliferation in soft tissue. The most common sites are extremities, followed by the trunk and head and neck region. It is infrequently seen in the post-auricular region of pinna. Case presentation: We present here an interesting case of a young male who had a swelling in the post-auricular region; on cytology, it was diagnosed as pleomorphic adenoma; however, biopsy revealed characteristic morphology of NF. Conclusion: The case highlights the potential pitfall of cytology in diagnosing NF, especially because of unusual site and morphologic overlap.
      Citation: CytoJournal 2008 5(1):14-14
      PubDate: Wed,26 Nov 2008
      DOI: 10.4103/1742-6413.44242
      Issue No: Vol. 5, No. 1 (2008)
       
  • CytoJournal's move to the new platform: More on financial model to
           the support open-access charter in cytopathology, publication quality
           indicators, and other issues

    • Authors: Vinod B Shidham, Martha B Pitman, Richard M DeMay, Barbara F Atkinson
      Pages: 15 - 15
      Abstract: Vinod B Shidham, Martha B Pitman, Richard M DeMay, Barbara F Atkinson
      CytoJournal 2008 5(1):15-15

      Citation: CytoJournal 2008 5(1):15-15
      PubDate: Tue,16 Dec 2008
      DOI: 10.4103/1742-6413.44572
      Issue No: Vol. 5, No. 1 (2008)
       
  • Informatics applied to cytology

    • Authors: Liron Pantanowitz, Maryanne Hornish, Robert A Goulart
      Pages: 16 - 16
      Abstract: Liron Pantanowitz, Maryanne Hornish, Robert A Goulart
      CytoJournal 2008 5(1):16-16
      Automation and emerging information technologies are being adopted by cytology laboratories to augment Pap test screening and improve diagnostic accuracy. As a result, informatics, the application of computers and information systems to information management, has become essential for the successful operation of the cytopathology laboratory. This review describes how laboratory information management systems can be used to achieve an automated and seamless workflow process. The utilization of software, electronic databases and spreadsheets to perform necessary quality control measures are discussed, as well as a Lean production system and Six Sigma approach, to reduce errors in the cytopathology laboratory.
      Citation: CytoJournal 2008 5(1):16-16
      PubDate: Mon,29 Dec 2008
      DOI: 10.4103/1742-6413.44773
      Issue No: Vol. 5, No. 1 (2008)
       
  • Time for evidence-based cytology

    • Authors: Pranab Dey
      Pages: 1 - 1
      Abstract: Pranab Dey
      CytoJournal 2007 4(1):1-1
      Evidence-based medicine (EBM) is a fashionable and an extremely hot topic for clinicians, patients and the health service planners. Evidence-based cytology (EBC) is an offshoot of EBM. The EBC is concerned with generating a reproducible, high quality and clinically relevant test result in the field of cytology. This is a rapidly evolving area with high practical importance. EBC is based entirely on research data. The various professional bodies on cytology design and recommend guidelines on the basis of evidences. Once the guideline is implemented and practiced then the experiences of the practicing cytopathologists may be used as a feed back to alter the existing guideline. The various facets of EBC are sampling and specimen adequacy, morphological identification and computer based expert system, integrated reporting, identification of the controversial areas and high quality researches for evidences. It is the duty of the individuals and institutions to practice EBC for better diagnosis and management of the patients. In this present paper, the various aspects of EBC have been discussed.
      Citation: CytoJournal 2007 4(1):1-1
      PubDate: Mon,8 Jan 2007
      DOI: 10.1186/1742-6413-4-1
      Issue No: Vol. 4, No. 1 (2007)
       
  • Evaluation and significance of hyperchromatic crowded groups (HCG) in
           liquid-based paps

    • Authors: Mamatha Chivukula, R Marshall Austin, Vinod B Shidham
      Pages: 2 - 2
      Abstract: Mamatha Chivukula, R Marshall Austin, Vinod B Shidham
      CytoJournal 2007 4(1):2-2
      Objective: Hyperchromatic crowded groups (HCG), a term first introduced into the cytology literature by DeMay in 1995, are commonly observed in Pap tests and may rarely be associated with serious but difficult to interpret lesions. In this study, we specifically defined HCG as dark crowded cell groups with more than 15 cells which can be identified at 10x screening magnification. Methods: We evaluated consecutive liquid-based (Surepath) Pap tests from 601 women (age 17-74 years, mean age 29.4 yrs) and observed HCG in 477 cases. In all 477 HCG cases, Pap tests were found to be satisfactory and to contain an endocervical sample. HCG were easily detectible at 10x screening magnification (size up to 400 um, mean 239.5 um) and ranged from 1 to 50 (mean 19.5) per Pap slide. Results: HCG predominantly represented 3-Dimensional groups of endocervical cells with some nuclear overlap (379/477 - 79%), reactive endocervical cells with relatively prominent nucleoli and some nuclear crowding (29/477 - 6%), clusters of inflammatory cells (25/477 - 5.2%), parabasal cells (22/477 - 4.6%), endometrial cells (1/477 - 0.2%). Epithelial cell abnormalities (ECA) were present in only 21 of 477 cases (4.6%). 18 of 21 women with HCG-associated ECA were less than 40 years old; only 3 were =/> 40 years. HCG-associated final abnormal Pap test interpretations were as follows: ASCUS (6/21 - 28%), LSIL (12/21 - 57%), ASC-H (2/21 - 9.5%), and HSIL/CIN2-3 (3/21 - 14%). The association of HCG with ECA was statistically significant (p = 0.0174. chi-square test). In patients with ECA, biopsy results were available in 10 cases, and 4 cases of biopsy-proven CIN2/3 were detected. Among these four cases, HCG in the Pap tests, in retrospect represented the lesional high grade cells in three cases (one HSIL case and two ASC-H cases). Interestingly, none of the 124 cases without HCG were found to have an epithelial cell abnormality. Conclusion :We conclude: a. HCG are observed in a high proportion of cervical smears. b . In the vast majority of cases, HCG are benign. c. ECA were only observed in cases with HCG. This observation is consistent with the hypothesis that the presence of HCG in Pap tests most often represents adequate sampling of the transformation zone, thus increasing the chances of detecting an epithelial cell abnormality. d. Only a few cases with HCG were associated with a serious ECA, but careful scrutiny of all HCG appears warranted to avoid the potential diagnostic pitfall of a significant false negative interpretation.
      Citation: CytoJournal 2007 4(1):2-2
      PubDate: Mon,22 Jan 2007
      DOI: 10.1186/1742-6413-4-2
      Issue No: Vol. 4, No. 1 (2007)
       
  • Cytologic findings in malignant myoepithelioma: a case report and review
           of the literature

    • Authors: Torill Sauer
      Pages: 3 - 3
      Abstract: Torill Sauer
      CytoJournal 2007 4(1):3-3
      Background: Myoepithelioma of the breast is a rare tumor and the cytologic features have only been described in one previous report. Case presentation: The present case comprises a 70 year old woman with a mammographic equivocal and ultrasonographic suspicious lesion. The aspirates were cellular and consisted mainly of single spindle or polymorphic, polygonal cells. The nuclei were generally large, ranging from 2 - > 5 x RBC. Most nuclei had a distinct medium-sized nucleolus. The nuclear outlines were irregular with buds and folds. The chromatin was granular. In the background there was abundant granular metachromatic ground substance and some metachromatic stromal fragments. A few mitotic figures were found. The cytologic diagnosis was suspicious for malignancy and a metaplastic carcinoma where only the non-epithelial component had been aspirated, or a non-epithelial lesion, was suggested.Macroscopically the tumor was round, seemingly well circumscribed, firm and with a white cut surface. The lesion consisted of spindled and polygonal cells with distinct pleomorphism. There were 6-9 mitoses per high power field (HPF). The tumor infiltrated in the surrounding fatty tissue. On immunohistochemistry, tumor cells were positive for smooth muscle actin, keratin MNF 116 and vimentin. Desmin and S-100 were negative.Ultrastructurally, there were abundant tonofilaments, including globular filamentous bodies and granulated endocytoplasmic reticulum with many dilated cisterns. The histologic diagnosis was malignant myoepithelioma. Conclusion: The case mirrors completely the WHO definition and the previous cytological and histological descriptions of malignant myoepitheliomas in the literature which describe a spindle cell population with unequivocal nuclear atypia, metachromatic background substance and mitoses.
      Citation: CytoJournal 2007 4(1):3-3
      PubDate: Thu,25 Jan 2007
      DOI: 10.1186/1742-6413-4-3
      Issue No: Vol. 4, No. 1 (2007)
       
  • Thank you reviewers- CytoJournal 2007

    • Authors: Vinod B Shidham, Barbara F Atkinson
      Pages: 4 - 4
      Abstract: Vinod B Shidham, Barbara F Atkinson
      CytoJournal 2007 4(1):4-4
      Significant efforts, time, and resources are devoted for peer-reviewing numerous CytoJournal manuscripts. The Editorial Board of CytoJournal shares a significant proportion of this activity. Additional peers are requested to join periodically as 'academic editors' and reviewers to review CytoJournal manuscripts. We thank all the reviewers and academic editors for their time and efforts for completing the peer-review of CytoJournal manuscripts during 2006. The continued success of this important academic exercise depends on their continued enthusiasm to support with their highest standards. We also thank all the contributing authors for selecting CytoJournal and supporting open access initiative, which allows retention of the copyrights to their corresponding academic accomplishments.
      Citation: CytoJournal 2007 4(1):4-4
      PubDate: Tue,30 Jan 2007
      DOI: 10.1186/1742-6413-4-4
      Issue No: Vol. 4, No. 1 (2007)
       
  • Solitary metastatic cancer to the thyroid: A report of five cases with
           fine-needle aspiration cytology

    • Authors: Mark W Lee, Yuri K Batoroev, Alexandre N Odashiro, Gia-Khanh Nguyen
      Pages: 5 - 5
      Abstract: Mark W Lee, Yuri K Batoroev, Alexandre N Odashiro, Gia-Khanh Nguyen
      CytoJournal 2007 4(1):5-5
      Three men and 2 women with ages ranging from 37 to 70 years, clinically and histologically confirmed solitary, palpable metastatic cancers to the thyroid (SMCT) and preoperative cytologic investigation of their thyroid lesions by fine-needle aspiration (FNA), were reviewed. Four patients were known to have a solid cancer treated by radical surgery 1 to 4 years prior [1 bronchogenic squamous cell carcinoma, 1 parotid adenoid cystic carcinoma, 1 renal cell carcinoma (RCC) and 1 cutaneous melanoma], and 1 patient had no past history of cancer. Direct smears prepared from the patients' thyroid FNAs were fixed in 95% ethanol and stained with the Papanicolaou method. In 3 cases, immunostaining of the aspirated tumor cells with thyroglobulin antibody was performed, and in 1 case an aspiration smear was stained with commercial HMB-45 antibody. A correct cytodiagnosis of metastatic cancer to the thyroid was made in all 5 cases. In 1 patient the thyroid FNA revealed a metastatic RCC that led to the discovery of a clinically occult RCC. All 5 patients died of metastatic disease 27 to 40 months after surgical resection of their SMCTs.
      Citation: CytoJournal 2007 4(1):5-5
      PubDate: Tue,30 Jan 2007
      DOI: 10.1186/1742-6413-4-5
      Issue No: Vol. 4, No. 1 (2007)
       
  • Introduction of the Thin Prep Imaging Systemâ„¢ (TIS): Experience in a
           high volume academic practice

    • Authors: Mamatha Chivukula, Reda S Saad, Esther Elishaev, Susan White, Nancy Mauser, David J Dabbs
      Pages: 6 - 6
      Abstract: Mamatha Chivukula, Reda S Saad, Esther Elishaev, Susan White, Nancy Mauser, David J Dabbs
      CytoJournal 2007 4(1):6-6
      Objective: Since the introduction of the liquid-based ThinPrep testing in 1996, most cytology laboratories across the country have adopted the liquid-based cytology (LBC) for Pap test screening. Subsequent to wide-spread adoption of the ThinPrep Pap test, the ThinPrep Imaging System (TIS) Cytyc Corp, Marlborough, MA was introduced to improve the accuracy and efficiency of screening interpretation. We report our initial experience with the TIS at Magee Women's Hospital. We introduced the TIS in December 2004. Methods: The imager assisted Pap test results over the first 12 months (December 2004 to December 2005) of implementation were reviewed and analyzed. Our implementation protocol included each cytotechnologist manually prescreening 200 negative slides to gain experience with the imager slides and serve as a quality check for the TIS. We re-screened 3400 slides (200 slides each for 17 cytotechnologists) manually which were initially determined to be negative using the TIS. 104,457 Pap tests were imaged on the TIS. 95,899 manually screened Pap tests, 12 months prior to the introduction of the TIS (December 2003-November 2004) are taken as the historic control group for our study. Results :The mean ASC-US rate employing the automated imager was 8.70% [9088/104,457]. The mean LSIL detection rate was 4.22% [4409/104,457]. The imager did not miss any detectible high-grade lesions during these months, with a HSIL (+) detection rate of 0.68% in comparison to 0.60% by manual screening confirmed by follow-up biopsies. The difference is statistically significant with a p value of 0.022 . The definition of false negative rate for purposes of this study is calculated as the number of false negative cases identified out of number of negatives re-screened. The TIS false negative rate was estimated at 0.012% [4/3400]. Conclusion :The overall performance of the TIS in our lab appears to be highly satisfactory in terms of improving sensitivity in screening cervical precursor lesions. The increased accuracy of detection of HSIL indicates a positive impact of the TIS in our laboratory.
      Citation: CytoJournal 2007 4(1):6-6
      PubDate: Thu,8 Feb 2007
      DOI: 10.1186/1742-6413-4-6
      Issue No: Vol. 4, No. 1 (2007)
       
  • Should LSIL with ASC-H (LSIL-H) in cervical smears be an independent
           category? A study on SurePathâ„¢ specimens with review of literature

    • Authors: Vinod B Shidham, Nidhi Kumar, Raj Narayan, Gregory L Brotzman
      Pages: 7 - 7
      Abstract: Vinod B Shidham, Nidhi Kumar, Raj Narayan, Gregory L Brotzman
      CytoJournal 2007 4(1):7-7
      Background: Cervical smears exhibiting unequivocal features of 'low grade squamous intraepithelial lesion' (LSIL) are occasionally also admixed with some cells suspicious for, but not diagnostic of, 'high grade squamous intraepithelial lesion' (HSIL). Only a few studies, mostly reported as abstracts, have evaluated this concurrence. In this study, we evaluate the current evidence that favors a distinct category for "LSIL, cannot exclude HSIL" (LSIL-H), and suggest a management algorithm based on combinations of current ASCCP guidelines for related interpretations. Methods: We studied SurePath™ preparations of cervical specimens from various institutions during one year period. Cytohisto correlation was performed in cases with cervical biopsies submitted to our institution. The status of HPV DNA testing was also noted in some LSIL-H cases with biopsy results. Results: Out of 77,979 cases 1,970 interpreted as LSIL (1,523), LSIL-H (146), 'atypical squamous cells, cannot exclude HSIL' (ASC-H) (109), and HSIL (192) were selected. Concurrent biopsy results were available in 40% (Total 792 cases: 557 LSIL, 88 LSIL-H, 38 ASCH, and 109 HSIL). Biopsy results were grouped into A . negative for dysplasia (ND), B . low grade (HPV, CIN1, CIN1 with HPV), and C . high grade (CIN 2 and above).The positive predictive values for various biopsy results in relation to initial cytopathologic interpretation were: a . LSIL: (557 cases): ND 32% (179), low grade- 58% (323), high grade- 10% (55); b . LSIL-H: (88 cases): ND 24% (21), low grade- 43% (38), high grade- 33% (29); c . ASCH: (38 cases): ND 32% (12), low grade- 37% (14), high grade- 31% (12); d . HSIL (109 cases): ND 5% (6), low grade 26% (28), high grade 69% (75). The patterns of cervical biopsy results in cases reported as LSIL-H were compared with that observed in cases with LSIL, ASC-H, and HSIL.94% (32 of 34) of LSIL-H were positive for high risk (HR) HPV, 1 was negative for HR HPV but positive for low risk (LR), and 1 LSIL-H was negative for HR and LR both. Conclusion: LSIL-H overlapped with LSIL and ASC-H, but was distinct from HSIL. A management algorithm comparable to ASC-H and HSIL appears to be appropriate in LSIL-H cases.
      Citation: CytoJournal 2007 4(1):7-7
      PubDate: Tue,20 Mar 2007
      DOI: 10.1186/1742-6413-4-7
      Issue No: Vol. 4, No. 1 (2007)
       
  • Book Review on "Modern Uterine Cytopathology: Moving to the Molecular
           Smear" by Alexander Meisels MD and Carol Morin, MSc, PhD

    • Authors: Barbara Mahoney
      Pages: 8 - 8
      Abstract: Barbara Mahoney
      CytoJournal 2007 4(1):8-8

      Citation: CytoJournal 2007 4(1):8-8
      PubDate: Fri,13 Apr 2007
      DOI: 10.1186/1742-6413-4-8
      Issue No: Vol. 4, No. 1 (2007)
       
  • Should fine needle aspiration biopsy be the first pathological
           investigation in the diagnosis of a bone lesion? An algorithmic approach
           with review of literature

    • Authors: Ravi Mehrotra, Mamta Singh, Premala A Singh, Rahul Mannan, Vinod K Ojha, Pradumyn Singh
      Pages: 9 - 9
      Abstract: Ravi Mehrotra, Mamta Singh, Premala A Singh, Rahul Mannan, Vinod K Ojha, Pradumyn Singh
      CytoJournal 2007 4(1):9-9
      Background: Fine needle aspiration biopsy (FNAB) is gaining increasing popularity in the diagnosis of musculoskeletal lesions; and in many patients, a definitive diagnosis can be rendered from aspiration smears alone. Its applicability in bone pathology, however, has been controversial due to a high percentage of inadequate smears, difficulty in evaluation of tissue architecture and nonspecific results in the diagnosis of primary bone lesions. In this study, the value of aspiration as the first pathological investigation in the diagnosis of a bone lesion was evaluated. Methods: 91 cases of clinically suspected cases of bone lesions were aspirated over a period of two years. Direct or cytospin smears were fixed in 95% alcohol and stained by Hematoxylin and Eosin or air-dried and later fixed in methanol for May Grŭnwald Giemsa staining. Results: Of the 91 patients who were subjected to FNAB, 81 were considered satisfactory and 10.9 % (10) were inadequate\inconclusive for diagnosis. Cyto-histological concordance was obtained in 78.5 % (51/65) patients. Positive and negative predictive values were 87.5% and 97.2 % respectively. Sensitivity as a preliminary diagnostic technique was 93.3%, whereas specificity was 94.5 %. Overall, diagnostic accuracy was 94.2 %. Metastatic lesions were detected with 100% accuracy. Two cases were reported as false positive and one case as false negative. Conclusion: Cytology provides valuable information to the clinician to make an informed decision regarding appropriate therapy. We conclude that time-consuming and costly investigations may be reduced by choosing FNAB as the initial pathological diagnostic method for skeletal lesions of unknown origin. The choice of radiological examinations, laboratory tests and surgical biopsies can be determined after the FNAB diagnosis.
      Citation: CytoJournal 2007 4(1):9-9
      PubDate: Tue,17 Apr 2007
      DOI: 10.1186/1742-6413-4-9
      Issue No: Vol. 4, No. 1 (2007)
       
  • Lymphocytic Thyroiditis - is cytological grading significant? A
           correlation of grades with clinical, biochemical, ultrasonographic and
           radionuclide parameters

    • Authors: Alka Bhatia, Arvind Rajwanshi, Radharaman J Dash, Bhagwant R Mittal, Akshay K Saxena
      Pages: 10 - 10
      Abstract: Alka Bhatia, Arvind Rajwanshi, Radharaman J Dash, Bhagwant R Mittal, Akshay K Saxena
      CytoJournal 2007 4(1):10-10
      Background: Clinical, biochemical, ultrasonographic, radionuclide and cytomorphological observations in Lymphocytic thyroiditis (LT), to define the cytological grading criteria on smears and correlation of grades with above parameters. Methods: This prospective study was conducted on 76 patients attending the Fine needle aspiration cytology clinic of a tertiary care institute in North India. The various parameters like patients' clinical presentation, thyroid antimicrosomal antibodies, hormonal profiles, radionuclide thyroid scan and thyroid ultrasound were studied. Fine needle aspiration of thyroid gland and grading of thyroiditis was done on smears. The grades were correlated with above parameters and the correlation indices were evaluated statistically. Results: Most of the patients were females (70, 92.11%) who presented with a diffuse goiter (68, 89.47%). Hypothyroid features (56, 73.68%) and elevated TSH (75, 98.68%) were common, but radioiodide uptake was low or normal in majority of patients. Thyroid antimicrosomal antibody was elevated in 46/70 (65.71%) patients. Cytomorphology in fine needle aspirates was diagnostic of lymphocytic thyroiditis in 75 (98.68%) patients. Most of them had grade I/II disease by cytology. No correlation was observed between grades of cytomorphology and clinical, biochemical, ultrasonographic and radionuclide parameters. Conclusion: Despite the availability of several tests for diagnosis of LT, FNAC remains the gold standard. The grades of thyroiditis at cytology however do not correlate with clinical, biochemical, radionuclide and ultrasonographic parameters.
      Citation: CytoJournal 2007 4(1):10-10
      PubDate: Mon,30 Apr 2007
      DOI: 10.1186/1742-6413-4-10
      Issue No: Vol. 4, No. 1 (2007)
       
  • Sequential use of bronchial aspirates, biopsies and washings in the
           preoperative management of lung cancers

    • Authors: Eric Piaton, Djamal Djelid, Bernard Duvert, Marielle Perrichon, Bernard Saugier
      Pages: 11 - 11
      Abstract: Eric Piaton, Djamal Djelid, Bernard Duvert, Marielle Perrichon, Bernard Saugier
      CytoJournal 2007 4(1):11-11
      Background: The combination of cytology and biopsies improves the recognition and typing of small cell (SCLC) versus non small cell (NSCLC) lung cancers in the fiberoptic bronchoscopy assessment of centrally located tumours. Methods: We studied whether bronchial aspirates performed before biopsies (BA) and washings performed after biopsies (BW) could increase the diagnostic yield of fiberoptic bronchoscopy. A series of 334 consecutive samples taken in patients with suspicious fiberoptic bronchoscopy findings was studied. Two hundred primary tumours were included in the study. The actual diagnosis was based on surgical tissue specimen analysis and/or imaging techniques. The typing used was that of the 1999 WHO/IASLC classification. Results: The diagnosis of malignancy and tumour typing were analyzed according to the sequential (combined) or single use of tests. Malignancy was assessed by cytology in 144/164 (87.8%) positive biopsy cases and in 174/200 tumour cases (87.0%). BA before biopsies allowed 84.0% of cancers to be diagnosed, whereas BW after biopsies allowed 79.0% of cancers to be found (p = ns). However, combining biopsies with BW allowed 94.0% of cancers to be diagnosed, whereas 82.0% were diagnosed by biopsies alone (p < 0.001). The highest diagnostic yield was obtained with the combination of BA, biopsies and BW, with 97.0% sensitivity. Exact concordance in typing was obtained in 83.8% of cases. The six surgically resected cases (3.0%) with negative cytology and biopsy results included four squamous cell carcinomas with necrotizing or fibrous surface and two adenocarcinomas, pT1 stage. Conclusion: Fiberoptic bronchoscopy may reach a yield of close to 100% in the diagnosis and typing of centrally located, primary lung cancers by combining bronchial aspirates, biopsies and washings.
      Citation: CytoJournal 2007 4(1):11-11
      PubDate: Mon,4 Jun 2007
      DOI: 10.1186/1742-6413-4-11
      Issue No: Vol. 4, No. 1 (2007)
       
  • The Best in CytoJournal: 2006

    • Authors: Michael B Cohen
      Pages: 12 - 12
      Abstract: Michael B Cohen
      CytoJournal 2007 4(1):12-12
      This year CytoJournal celebrates the second full year of publication with its Best of CytoJournal: 2006. Like last year, it recognizes the work of the authors in thyroid FNAB. And, importantly, this years award, which was handed out at USCAP, was endowed by a gift from the Pathikonda family.
      Citation: CytoJournal 2007 4(1):12-12
      PubDate: Mon,11 Jun 2007
      DOI: 10.1186/1742-6413-4-12
      Issue No: Vol. 4, No. 1 (2007)
       
  • Immunohistochemical expression of SMAD4, CK19, and CA19-9 in fine needle
           aspiration samples of pancreatic adenocarcinoma: Utility and potential
           role

    • Authors: Mauricio Zapata, Cynthia Cohen, Momin T Siddiqui
      Pages: 13 - 13
      Abstract: Mauricio Zapata, Cynthia Cohen, Momin T Siddiqui
      CytoJournal 2007 4(1):13-13
      Background: Pancreatic adenocarcinoma comprises 85% of all cases of pancreatic malignancies. From a diagnostic standpoint, these tumors are readily diagnosed by fine needle aspiration, with an accuracy of greater than 90%; however it is often difficult to ascertain whether these are primary or metastatic in nature. This study was undertaken to see the usefulness of CK19, CA19-9 and a newly described marker, SMAD4 in confirming the pancreatic origin of these tumors. Briefly, SMAD4 (DPC4) is a tumor-suppressor gene located on chromosome 18q which has been shown to mediate the downstream effects of TGF-β superfamily signaling, resulting in growth inhibition. The loss of SMAD4, which as been reported to occur in 55% of pancreatic ductal adenocarcinomas may lead to up regulation of cell cycle proteins and hence increase cellular proliferation. In addition, SMAD4 has been suggested to possibly have prognostic potential, with the presence of SMAD4, indicating shorter survival after resection. Design: Clinical data was reviewed to identify patients with proven, primary pancreatic adenocarcinoma. A total of 25 patients with diagnostic material from fine needle aspiration cell blocks, were retrieved from our files at Emory University Hospital. In addition cell blocks from clinically diagnosed non-pancreatic adenocarcinomas were also selected as controls for this study (10 cases of colonic adenocarcinoma, 10 cases of pulmonary adenocarcinoma, 10 cases of breast ductal carcinoma and 10 cases of ovarian mucinous adenocarcinoma). Formalin fixed, paraffin-embedded sections from these were stained with SMAD4, CK19, and CA19-9, using pressure cooker antigen retrieval, labeled polymer HRP (DAKO), and the DAKO autostainer. Results: Immunohistochemical staining was reviewed based on intensity (negative, low-positive, and high-positive) and percentage of cells. In primary pancreatic ductal adenocarcinoma, CK 19 showed diffuse cytoplasmic positivity in 23 of 25 cases, CA 19-9 showed apical cytoplasmic staining in all 25 cases, and SMAD4 showed nuclear staining in 20 of 25 cases. In the control group comprising of non-pancreatic adenocarcinoma SMAD4 was negative (100%) in all 10 cases of colonic and pulmonary adenocarcinoma. However 1 of 10 cases (10%) of breast and ovarian adenocarcinoma did show low positivity nuclear staining. However the expression of CA19-9 and CK19 was more variable in these different non-pancreatic malignancies. Conclusion :Pancreatic adenocarcinoma showed positive immunohistochemical staining for SMAD4 in 80%, CK19 in 100% and CA19-9 in 100% of the selected cases. These markers, when used as a panel, may confirm the diagnosis of pancreatic adenocarcinoma in fine needle aspiration samples, and help in differentiating from metastatic adenocarcinoma. This may help in determination of appropriate surgical and chemotherapeutic options.
      Citation: CytoJournal 2007 4(1):13-13
      PubDate: Fri,22 Jun 2007
      DOI: 10.1186/1742-6413-4-13
      Issue No: Vol. 4, No. 1 (2007)
       
  • Nevoid melanoma of the vagina: Report of one case diagnosed on thin layer
           cytological preparations

    • Authors: Franco Fulciniti, Paolo Antonio Ascierto, Ester Simeone, Patrizia Bove, Simona Losito, Serena Russo, Maria Stella Gallo, Stefano Greggi
      Pages: 14 - 14
      Abstract: Franco Fulciniti, Paolo Antonio Ascierto, Ester Simeone, Patrizia Bove, Simona Losito, Serena Russo, Maria Stella Gallo, Stefano Greggi
      CytoJournal 2007 4(1):14-14
      Background:Primary melanoma of the vagina is an extremely rare neoplasm with approximately 250 reported cases in the world literature [1-4]. In its amelanotic variant this lesion may raise several differential diagnostic problems in cytological specimens [5]. In this setting, the usage of thin layer cytopathological techniques (Liquid Based Preparations = LBP) may enhance the diagnostic sensitivity by permitting immunocytochemical study without having to repeat the sampling procedure.The aim of this paper is to describe the cytomorphological presentation of primary vaginal melanoma on LBP since it has not previously been reported up to now, to our knowledge.Case presentation: a 79-y-o female complaining of vulvar itching and yellowish vaginal discharge underwent a complete gynaecological evaluation during which a LBP cytological sample was taken from a suspicious whitish mass protruding into the vaginal lumen. A cytopathological diagnosis of amelanotic melanoma was rendered. The mass was radically excised and the patient was treated with α-Interferon.Conclusion: amelanotic melanoma may be successfully diagnosed on LBP cytological preparations. Thin layer preparations may enhance the diagnostic cytomorphological clues to its diagnosis and may permit an adequate immunocytochemical characterization of the neoplasm
      Citation: CytoJournal 2007 4(1):14-14
      PubDate: Tue,3 Jul 2007
      DOI: 10.1186/1742-6413-4-14
      Issue No: Vol. 4, No. 1 (2007)
       
  • Clear cell sarcoma of the soft parts arising in the rectus abdominis in a
           child - aspiration cytology of a rare case

    • Authors: Paari Murugan, Debdatta Basu, Surendra Kumar, Sadasivan Jagadish
      Pages: 15 - 15
      Abstract: Paari Murugan, Debdatta Basu, Surendra Kumar, Sadasivan Jagadish
      CytoJournal 2007 4(1):15-15
      Background: Clear cell sarcoma of soft parts is most commonly found associated with the tendons and aponeuroses of distal extremities in young adults with a peak incidence in the third decade. Location in the abdominal wall and in a child is very rare.Case presentation: A nine-year-old female child presented with a swelling in the anterior abdominal wall in the suprapubic region. Fine needle aspiration revealed predominantly discrete cells with loose clustering at places. The cytoplasm was abundant, finely granular, and eosinophilic with some cells exhibiting clear vacuolated zones. No pigment was seen. The nuclei were rounded and eccentrically placed with a striking single eosinophilic macro nucleolus present in all the cells. Taking into consideration, the history, age of the patient, location of the tumor and absence of melanin pigment, a diagnosis of soft tissue sarcoma was made, the differential including Clear cell sarcoma. This was subsequently confirmed on histopathological examination and immunohistochemistryConclusion: The atypical presentation of the case made the cytological diagnosis rather challenging. Clear cell sarcoma should be considered when cytology of a soft-tissue tumor shows uncharacteristically high cellularity and relatively uniform cells with macronucleoli.
      Citation: CytoJournal 2007 4(1):15-15
      PubDate: Sun,15 Jul 2007
      DOI: 10.1186/1742-6413-4-15
      Issue No: Vol. 4, No. 1 (2007)
       
  • Barriers to adoption of recent technology in cervical screening

    • Authors: Darshana Jhala, Isam Eltoum
      Pages: 16 - 16
      Abstract: Darshana Jhala, Isam Eltoum
      CytoJournal 2007 4(1):16-16
      The Pap smear is one of the modern success stories in the field of preventive medicine. Since its introduction as a screening test, there has been a dramatic reduction in the incidence of cervical cancer. However, the search for a better screening test continues. The new technologies, including liquid-based cytology (LBC), Human Papilloma Virus (HPV) testing and automated or machine-assisted screening have been introduced. However, there is continuous debate about whether society's limited resources are better spent on reaching the underserved rather than on these technologies. Another question is whether these technologies create yet another kind of disparity in delivering preventive care. For example, despite the wide use of LBC (99% of tests submitted to our laboratory are LBC), conventional Pap smears are still used to screen/follow up some women. It is not clear why some providers continue to prefer conventional smear over LBC and what are the barriers for adopting LBC in cervical cancer screening. We hypothesize the lower cost of conventional compared to LBC Pap testing, patient's lower socio-economic indices, a patient's medical history and provider's subspecialty/training all appear to play a role in the choice of using conventional Pap testing rather than LBC. Unintentionally, this choice results in repeat testing, delayed treatment and potentially higher costs than intended. The ultimate goal of this review article is to understand and explore possible barriers and disparities to adopting new technology in cancer screening.
      Citation: CytoJournal 2007 4(1):16-16
      PubDate: Thu,16 Aug 2007
      DOI: 10.1186/1742-6413-4-16
      Issue No: Vol. 4, No. 1 (2007)
       
  • Unsuspected multiples myeloma presenting as bilateral pleural effusion - a
           cytological diagnosis

    • Authors: Kajal Kiran Dhingra, Niti Singhal, Sonu Nigam, Shayama Jain
      Pages: 17 - 17
      Abstract: Kajal Kiran Dhingra, Niti Singhal, Sonu Nigam, Shayama Jain
      CytoJournal 2007 4(1):17-17
      Background: Multiple Myeloma presenting as a pleural effusion is extremely rare. It is usually a late complication and is associated with a poor prognosis.Case Presentation: A 40-year-old male presented with dyspnea and fever of six months duration. Clinical diagnosis of pulmonary tuberculosis was considered. X-ray chest showed bilateral pleural effusion. Pleural cytology revealed numerous plasma cells, some of which were binucleated and atypical. Cytological differential diagnosis included: Myelomatous effusion and Non-Hodgkin's Lymphoma deposit (Immunoblastic type). Bone marrow biopsy, serum protein electrophoresis and bone scan confirmed the diagnosis of multiple myeloma (Plasmablastic type).Conclusion: Myelomatous pleural effusion as an initial presentation although extremely rare, should always be considered in presence of atypical plasma cells irrespective of age.
      Citation: CytoJournal 2007 4(1):17-17
      PubDate: Fri,7 Sep 2007
      DOI: 10.1186/1742-6413-4-17
      Issue No: Vol. 4, No. 1 (2007)
       
  • Desmoplastic melanoma morphology on Thinprep: A report of two cases

    • Authors: Becky L Van Ells, James E Madory, Rana S Hoda
      Pages: 18 - 18
      Abstract: Becky L Van Ells, James E Madory, Rana S Hoda
      CytoJournal 2007 4(1):18-18
      Background: Desmoplastic melanoma is a variant of malignant melanoma that can range in appearance from sarcomatoid to scar-like. Cytomorphology of desmoplastic melanoma has been previously described on conventional smears; however, to our knowledge, detailed cytomorphology on ThinPrep has so far not been described. Herein, we describe the cytomorphology of two cases of desmoplastic melanoma on fine needle aspiration processed as ThinPrep slides and compare it to that seen on conventional smears. Pertinent immunocytochemical stains, performed on ThinPrep slides are also discussed. Case presentation: The first case is a woman with a history of desmoplastic melanoma of the scalp with previous local recurrences and lymph node metastasis with a new submandibular mass. The second case is a man with a previously resected desmoplastic melanoma with his first local recurrence. Conventional smears, including air-dried Diff-Quik-stained and alcohol-fixed Papanicolaou-stained smears, demonstrated aggregates of pleomorphic spindle cells admixed with fibrous stroma and single spindle cells. In both cases, nuclei were elongated and plump with irregular nuclear contours, deep grooves, and folds. Chromatin was dark and coarse with either inconspicuous or multiple prominent nucleoli. Cytoplasm was located at the nuclear poles and was fine, wispy, and delicate. The background was clean with no evidence of necrosis or melanin pigment. Papanicolaou-stained ThinPrep slides were prepared from needle rinses and demonstrated excellent correlation of nuclear and cytoplasmic detail of single spindle cells to that seen on conventional smears with the exception of only slight decrease in nuclear size; however, nuclear and cytoplasmic detail of spindle cells embedded in stroma was markedly attenuated. Confirmatory immunostain for S-100 protein in both cases was performed on ThinPrep slides demonstrating crisp cytoplasmic staining in the spindle cells. Conclusion: The cytomorphology of desmoplastic melanoma shows excellent correlation between cytomorphology of single spindle cells on conventional smears and on ThinPrep slides. The major difference noted on ThinPrep slides was attenuated nuclear and cytoplasmic detail of spindle cells embedded in fibrous stoma.
      Citation: CytoJournal 2007 4(1):18-18
      PubDate: Wed,19 Sep 2007
      DOI: 10.1186/1742-6413-4-18
      Issue No: Vol. 4, No. 1 (2007)
       
  • Pathologist performed fine needle aspirations & implementation of JCAHO
           Universal Protocol and "Time out"

    • Authors: Momin T Siddiqui
      Pages: 19 - 19
      Abstract: Momin T Siddiqui
      CytoJournal 2007 4(1):19-19
      The adherence to the principles of the Universal Protocol for preventing wrong site, wrong procedure and wrong person surgical or invasive procedures is a requirement for all Joint Commission accredited organizations. Fine needle aspirations are considered invasive procedures, and cytopathologists performing this procedure need to be cognizant and compliant with the requirements of this Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Protocol. This article gives background perspective on the development of the Universal Protocol. It also elaborates the JCAHO National Patients Safety Goals regarding the performance of fine needle aspirations. The compliance with the Universal Protocol for performance of fine needle aspirations is now mandated for all cytopathologists who perform fine needle aspirations and this present paper provides a guideline for fulfilling the requirements of the Universal Protocol for practicing cytopathologists.
      Citation: CytoJournal 2007 4(1):19-19
      PubDate: Thu,20 Sep 2007
      DOI: 10.1186/1742-6413-4-19
      Issue No: Vol. 4, No. 1 (2007)
       
  • Scope of FNAC in the diagnosis of soft tissue tumors-A study from a
           tertiary cancer referral center in India

    • Authors: Bharat Rekhi, Biru D Gorad, Anagha C Kakade, RF Chinoy
      Pages: 20 - 20
      Abstract: Bharat Rekhi, Biru D Gorad, Anagha C Kakade, RF Chinoy
      CytoJournal 2007 4(1):20-20
      Background: Fine needle aspiration cytology (FNAC) forms one of the first diagnostic tools in the evaluation of tumors. Its role in diagnosing soft tissue tumors (STT) has been fairly documented, as well as debated. Present study was aimed at evaluating its scope in diagnosing 127 cases of soft tissue tumors. Methods: Conventional Pap and MGG staining was available in all the cases. Immunocytochemistry (ICC) was performed in 15 cases. Histopathological details were available in 115 cases. Results: 50% cases were referred for a primary diagnosis, while 26.8% & 22.8% cases were evaluated for recurrent and metastatic lesions, respectively. Extremities were the commonest sites. On FNAC, 101 cases (79.5%) were labeled as malignant, whereas 10 cases (7.9%) were labeled as benign. The remaining 16 cases (11%) were not categorized and were labeled as 'unsure/not specified'. Histopathological confirmation in 115 cases, gave a diagnostic accuracy of 98%, with a positive predictive value of 98% in malignant cases and a negative predictive value of 100% in benign cases. Two cases were false positive. Among the various cytological categories, 60 cases (47.2%) were of spindle cell type, followed by 32 (25.2%) of round cell type and 14 cases (11%) of lipomatous type. Other 12 cases (9.4%) were of pleomorphic type; 7 (5.5%) cases of epithelioid type and remaining 2 cases were of myxoid type. All the round cell, pleomorphic and myxoid type of tumors were sarcomas, whereas 73.3% cases of spindle cell type were labeled as 'malignant'. Exact cytological sub typing was offered in 58 cases, with rhabdomyosarcoma (RMS) as the most frequently sub typed tumor. The two false positive malignant cases were of fibromatosis and a pigmented schwannoma, on biopsy. Out of 28 metastatic lesions, lymph nodes were the commonest site for metastasis, with epithelioid tumors that formed highest percentage of metastatic cases. Conclusion: FNAC is fairly specific and sensitive in STT diagnoses for primary, recurrent and metastatic lesions. The cytological types, especially round cell and pleomorphic sarcomas, can be quickly identified. Clinicopathological correlation with ICC as an adjunct, are valuable in exact sub typing.
      Citation: CytoJournal 2007 4(1):20-20
      PubDate: Wed,31 Oct 2007
      DOI: 10.1186/1742-6413-4-20
      Issue No: Vol. 4, No. 1 (2007)
       
  • Hairy cell leukemia : A diagnosis by endoscopic ultrasound guided fine
           needle aspiration

    • Authors: Regina S Meara, Vishnu Reddy, Juan Pablo Arnoletti, Darshana Jhala, Shyam Varadarajulu, Nirag Jhala
      Pages: 1 - 1
      Abstract: Regina S Meara, Vishnu Reddy, Juan Pablo Arnoletti, Darshana Jhala, Shyam Varadarajulu, Nirag Jhala
      CytoJournal 2006 3(1):1-1
      Background: Endosonography (EUS) guided FNA is a relatively new imaging modality which is increasingly used for sampling deep-seated lymph nodes in the diagnosis and staging of various malignancies, both primary as well as metastatic. It is also useful for staging of non-Hodgkin's lymphoma as well as diagnosing recurrence. The diagnosis of leukemia on FNA samples from deep-seated lymphadenopathy poses an even greater challenge. Hairy cell leukemia (HCL) is an uncommon, but distinct, lympho-proliferative disorder of B cell origin. It usually affects the spleen and bone marrow and uncommonly involves lymph nodes. There are only a few cases reported where HCL was diagnosed on FNA specimens. Case presentation: We report the first case of HCL accurately rendered on EUS-FNA samples. Conclusion: This report underscores the concept that the presence of a cytopathologist in the endoscopy suite plays an important role in providing accurate diagnoses of lymphoid lesions biopsied with EUS-FNA.
      Citation: CytoJournal 2006 3(1):1-1
      PubDate: Mon,23 Jan 2006
      Issue No: Vol. 3, No. 1 (2006)
       
  • Thank you reviewers- CytoJournal 2006

    • Authors: Vinod B Shidham, Barbara F Atkinson
      Pages: 2 - 2
      Abstract: Vinod B Shidham, Barbara F Atkinson
      CytoJournal 2006 3(1):2-2
      The Editorial Board of CytoJournal devotes significant efforts, time, and resources to review numerous manuscripts. As it is impossible to include all the experts on the editorial board, there is always a need for additional peers who are requested to join periodically to act as 'academic editors' and reviewers. We take this opportunity to thank all the reviewers and academic editors who offered their time and efforts by participating in peer-review process for CytoJournal manuscripts. We request their continued enthusiasm to support this important academic exercise.
      Citation: CytoJournal 2006 3(1):2-2
      PubDate: Fri,3 Feb 2006
      DOI: 10.1186/1742-6413-3-2
      Issue No: Vol. 3, No. 1 (2006)
       
  • Cytologic findings of peripheral T-cell lymphoma (PTCL) with high
           epitheloid cell content (Lennert's lymphoma) in imprint smear. A
           case report

    • Authors: Yahya Daneshbod
      Pages: 3 - 3
      Abstract: Yahya Daneshbod
      CytoJournal 2006 3(1):3-3
      Background: Lymphoepitheloid lymphoma is a T-cell lymphoma with peculiar histologic picture with massive proliferation of epitheloid cell clusters intermingled with many, mostly small-sized lymphoid cells. The cytomorphologic features in imprint of a case of lymphoepitheloid T-cell lymphoma is described together with diagnostic pitfalls. Case report: A 74 years old man presented with weight loss, anemia and fever. Physical examination showed bilateral cervical lymphadenopathy with hepatosplenomegaly. With the clinical impression of hypersplenic syndrome vs lymphoma, excisional biopsy of a lymph node was performed and both imprints and histologic sections made. Cytologic findings showed uniform isolated small lympocytes with closely intermingled scattered and aggregates of epitheloid cells. Histologic sections were diagnosed as lymphoepitheloid lymphoma (Lennert's lymphoma). Conclusion: Cytologic findings of this variant of lymphoma is distinctive enough for a correct initial suggestive diagnosis. However the presence of high content of epitheloid cell clusters can cause cytologic misinterpretation with other benign and malignant conditions.
      Citation: CytoJournal 2006 3(1):3-3
      PubDate: Mon,6 Feb 2006
      DOI: 10.1186/1742-6413-3-3
      Issue No: Vol. 3, No. 1 (2006)
       
  • Randomized clinical evaluation of self-screening for anal cancer
           precursors in men who have sex with men

    • Authors: Thomas M Lampinen, Mary Lou Miller, Keith Chan, Aranka Anema, Dirk van Niekerk, Arn J Schilder, Robert Taylor, Robert S Hogg
      Pages: 4 - 4
      Abstract: Thomas M Lampinen, Mary Lou Miller, Keith Chan, Aranka Anema, Dirk van Niekerk, Arn J Schilder, Robert Taylor, Robert S Hogg
      CytoJournal 2006 3(1):4-4
      Background: Self-collection of anorectal swab specimens could greatly facilitate the completion of prerequisite studies and future implementation of anal cancer screening among men who have sex with men (MSM). We therefore compared self- versus clinician- collection procedures with respect to specimen adequacy for cytological evaluation, concordance of paired cytological results, and concordance of cytological with biopsy results. Methods: Paired self- and clinician- collected anorectal Dacron ® swabs for liquid-based (Thin Prep ® ) cytological evaluation were collected in random sequence from a mostly HIV-1 seronegative cohort of young MSM in Vancouver. Slides were reviewed by one cytopathologist. Presence of any cytological abnormality (atypical squamous cells of uncertain significance, ASCUS, or above) prompted referral for high-resolution anoscopy and possible biopsy. Results: Among 222 patient-clinician specimen pairs, most were adequate for cytological evaluation, though self-collected specimens were less likely to be so (83% versus 92%, McNemar's test p < 0.001). Cytological abnormalities, noted in 47 (21%) of self-collected and 47 (21%) of clinician-collected specimens (with fair agreement, kappa = 0.414) included, respectively: ASCUS (5%, 5%), and low-grade (13%, 13%) and high-grade (3%, 3%) squamous intraepithelial lesions. Among 12 men with biopsy-confirmed high-grade neoplasia, most had abnormal cytological results (including 6 patient and 9 clinician swabs) but few (2 patient and 1 clinician swab) were high-grade. Conclusion: Self-collection of anorectal swab specimens for cytologic screening in research and possibly clinical settings appears feasible, particularly if specimen adequacy can be further improved. The severity of biopsy-confirmed anorectal disease is seriously underestimated by cytological screening, regardless of collector.
      Citation: CytoJournal 2006 3(1):4-4
      PubDate: Mon,20 Mar 2006
      DOI: 10.1186/1742-6413-3-4
      Issue No: Vol. 3, No. 1 (2006)
       
  • First CytoJournal Peer-Reviewer's Retreat in 2006 - Open access,
           peer-review, and impact factor

    • Authors: Vinod B Shidham, Lynn Sandweiss, Barbara F Atkinson
      Pages: 5 - 5
      Abstract: Vinod B Shidham, Lynn Sandweiss, Barbara F Atkinson
      CytoJournal 2006 3(1):5-5
      CytoJournal organized its first Peer-Reviewer's Retreat of 2006 during the United States and Canadian Academy of Pathology Annual Meeting at Atlanta on Feb 12, 2006. The major topics discussed were open access, peer review, and impact factors. Representative participants volunteered to join the task force to prepare an instructional guide for peer-reviewing cytopathology manuscripts. Concern about the impact factor for CytoJournal was discussed. A feedback to its readers and authors was recommended. Impact factor calculation needs at least three years of journal statistics. It is only possible after two years from the time a journal is first accepted by Thomson-ISI for citation tracking. CytoJournal is still too new for an impact factor to be calculated. However, general progress of CytoJournal suggests an encouraging pattern for high impact factor.
      Citation: CytoJournal 2006 3(1):5-5
      PubDate: Mon,27 Mar 2006
      Issue No: Vol. 3, No. 1 (2006)
       
  • Ultrasound guided fine needle aspiration biopsy of parathyroid gland and
           lesions

    • Authors: Haytham Dimashkieh, Savitri Krishnamurthy
      Pages: 6 - 6
      Abstract: Haytham Dimashkieh, Savitri Krishnamurthy
      CytoJournal 2006 3(1):6-6
      Background: Parathyroid gland and their tumors comprise a small proportion of non-palpable neck masses that are investigated by ultrasound (US) guided fine needle aspiration biopsy. We reviewed our institution's cases of US guided FNAB of parathyroid gland and their lesions to determine the role of cytology for the preoperative diagnosis of parathyroid gland and their lesions. Method: All cases of FNAB of parathyroid gland and lesions in the last 10 years were reviewed in detail with respect to clinical history and correlated with the histopathologic findings in available cases. The cytologic parameters that were evaluated included cellularity assessed semiquantitatively as scant, intermediate or abundant (500 cells), cellular distribution (loose clusters, single cells/naked nuclei, rounded clusters, two- and three-dimensional clusters, and presence of prominent vascular proliferation), cellular characteristics (cell size, nuclear shape, presence/absence of a nucleolus, degree of mitosis, amount of cytoplasm, and appearance of nuclear chromatin), and background (colloid-like material and macrophages). Immunostaining for parathyroid hormone (PTH) was performed on selected cases using either destained Pap smears or cell block sections. Results: Twenty cases of US-guided FNAB of parathyroid glands and their lesions including 13 in the expected locations in the neck, 3 in intrathyroid region, 3 in thyroid bed, and 1 metastatic to liver were studied. Majority of the cases showed intermediate cellularity (51-500 cells) with round to oval cells that exhibited a stippled nuclear chromatin, without significant pleomorphism or mitotic activity. The cells were arranged in loose two dimensional groups with many single cells/naked nuclei around the groups. Occasionally macrophages and colloid like material was also encountered. There was no significant difference in the cytomorphologic features between normal gland, hyperplasia adenoma, or carcinoma. Immunocytochemical analysis for PHT was performed for 14 cases (6 destained smears and 8 cell blocks) which showed distinct cytoplasmic positivity. Conclusion: US-guided FNAB is a useful test for confirming the diagnosis of not only clinically suspected parathyroid gland and lesions but also for detecting parathyroid glands in unexpected locations such as in thyroid bed or within the thyroid gland. Although there is significant overlap in the cytomorphologic features of cells derived from parathyroid and thyroid gland, the presence of stippled nuclear chromatin, prominent vascular proliferation with attached epithelial cells, and frequent occurrence of single cells/naked nuclei are useful clues that favor parathyroid origin. Distinction of the different parathyroid lesions including hyperplasia, adenoma, and carcinoma cannot be made solely on cytology. Immunostaining for PTH can be performed on destained Pap smears and cell block sections which can be valuable for confirming parathyroid origin of the cells.
      Citation: CytoJournal 2006 3(1):6-6
      PubDate: Tue,28 Mar 2006
      DOI: 10.1186/1742-6413-3-6
      Issue No: Vol. 3, No. 1 (2006)
       
  • Aspergillosis with pulmonary echinococcosis

    • Authors: Nalini Gupta, Julie Arora, Raje Nijhawan, Ritesh Aggarwal, Anupam Lal
      Pages: 7 - 7
      Abstract: Nalini Gupta, Julie Arora, Raje Nijhawan, Ritesh Aggarwal, Anupam Lal
      CytoJournal 2006 3(1):7-7

      Citation: CytoJournal 2006 3(1):7-7
      PubDate: Thu,30 Mar 2006
      DOI: 10.1186/1742-6413-3-7
      Issue No: Vol. 3, No. 1 (2006)
       
  • Sclerosing lobular hyperplasia of breast : Cytomorphologic and
           histomorphologic features : A case report

    • Authors: Payal Kapur, Dinesh Rakheja, Dominick C Cavuoti, Sarah F Johnson-Welch
      Pages: 8 - 8
      Abstract: Payal Kapur, Dinesh Rakheja, Dominick C Cavuoti, Sarah F Johnson-Welch
      CytoJournal 2006 3(1):8-8
      Background: Mammary sclerosing lobular hyperplasia is an uncommon benign lesion of adolescent and young women. Fine-needle aspiration cytology of mammary sclerosing lobular hyperplasia is said to show characteristic features that include an absence of stromal fragments.Case presentation: In this article, we describe a case of sclerosing lobular hyperplasia that occurred in the right breast of a 12-year-old girl. Fine-needle aspiration cytology showed some fibroadenoma-like features including the presence of stromal fragments, while branched tubular fragments were not seen. The diagnosis of sclerosing lobular hyperplasia was made on histologic examination that showed preserved acinar architecture with lobular hyperplasia and sclerosis of intralobular and interlobular stroma.Conclusion: Fine-needle aspiration cytology features of mammary sclerosing lobular hyperplasia are not diagnostic and overlap with those of fibroadenoma; however, a distinction between the two benign entities is of no clinical significance. The definitive diagnosis of sclerosing lobular hyperplasia requires histopathologic evaluation.
      Citation: CytoJournal 2006 3(1):8-8
      PubDate: Mon,3 Apr 2006
      DOI: 10.1186/1742-6413-3-8
      Issue No: Vol. 3, No. 1 (2006)
       
  • Fine-needle aspiration of follicular lesions of the thyroid. Diagnosis and
           follow-Up

    • Authors: M Salih Deveci, Güzin Deveci, Virginia A LiVolsi, Zubair W Baloch
      Pages: 9 - 9
      Abstract: M Salih Deveci, Güzin Deveci, Virginia A LiVolsi, Zubair W Baloch
      CytoJournal 2006 3(1):9-9
      The differential diagnosis of a follicular lesion/neoplasm in thyroid FNA specimens includes hyperplastic/adenomatoid nodule, follicular adenoma and carcinoma, and follicular variant of papillary thyroid carcinoma. In our laboratory we separate follicular lesions of thyroid into hyperplastic/adenomatoid nodule (HN), follicular neoplasm (FON) and follicular derived neoplasm with focal nuclear features suspicious for papillary thyroid carcinoma (FDN).This study reports our experience with 339 cases diagnosed as FON and 120 as FDN.All cases were evaluated for histologic diagnosis, age, sex and size of the nodule. Histopathologic follow-up was available in all cases. The malignancy rate was 22% (74/359) and 72% (86/120) for cases diagnosed as FON and FDN, respectively. In the FON category almost half of the malignant cases were papillary carcinoma. The risk of malignancy was higher in patients younger than 40 yr (53% vs. 30%) than in patients 40 year or more years old and greater in males (41% vs. 33%) than females. No statistically significant relationship was noted between the sizes of the nodules and benign vs. malignant diagnosis.According to this study it is important to divide follicular patterned lesions of thyroid into FON and FDN in the cytology specimens due to significantly different risk of malignancy (22% vs. 72%). In addition, clinical features, including gender and age can be part of the decision analysis in selecting patients for surgery.
      Citation: CytoJournal 2006 3(1):9-9
      PubDate: Fri,7 Apr 2006
      Issue No: Vol. 3, No. 1 (2006)
       
  • Utility of BRAF V600E mutation detection in cytologically indeterminate
           thyroid nodules

    • Authors: Leslie R Rowe, Brandon G Bentz, Joel S Bentz
      Pages: 10 - 10
      Abstract: Leslie R Rowe, Brandon G Bentz, Joel S Bentz
      CytoJournal 2006 3(1):10-10
      Background: Fine needle aspiration (FNA) is widely utilized for evaluation of patients with thyroid nodules. However, approximately 30% are indeterminate for malignancy. Recently, a mutation in the BRAF gene has been reported to be the most common genetic event in papillary thyroid carcinoma (PTC). In this retrospective study, we assessed the utility of BRAF V600E mutation detection for refining indeterminate preoperative cytologic diagnoses in patients with PTC. Methods: Archival indeterminate thyroid FNAs and corresponding formalin-fixed, paraffin-embedded (FFPE) surgical samples with PTC were identified in our patient files. DNA extracted from slide scape lysates and 5 μm FFPE sections were evaluated for the BRAF V600E mutation using LightCycler PCR and fluorescent melting curve analysis (LCPCR). Amplification products that showed deviation from the wild-type genomic DNA melting peak, discordant FNA and FFPE matched pairs, and all benign control samples, underwent direct DNA sequencing. Results: A total of 19 indeterminate thyroid FNAs demonstrating PTC on FFPE surgical samples were included in the study. Using BRAF mutation analysis, the preoperative diagnosis of PTC was confirmed in 3/19 (15.8%) FNA samples that could not be conclusively diagnosed on cytology alone. However, 9/19 (47.4%) FFPE tissue samples were positive for the V600E mutation. Of the discordant pairs, 5/6 FNAs contained less than 50% tumor cells. Conclusion: When used with indeterminate FNA samples, BRAF mutation analysis may be a useful adjunct technique for confirming the diagnosis of malignancy in an otherwise equivocal case. However, overall tumor cell content of some archival FNA smear slides is a limiting factor for mutation detection.
      Citation: CytoJournal 2006 3(1):10-10
      PubDate: Mon,10 Apr 2006
      DOI: 10.1186/1742-6413-3-10
      Issue No: Vol. 3, No. 1 (2006)
       
  • Scientific issues related to the cytology proficiency testing regulations

    • Authors: George Birdsong, Lydia Howell, Karen Atkison, R Marshall Austin, Marluce Bibbo, Thomas A Bonfiglio, Diane D Davey, Catherine Keebler, Dina Mody, Lynnette Savaloja, Jacalyn Papillo, Marianne Prey, Stephen Raab, Brenda L Schultz, Diane Solomon
      Pages: 11 - 11
      Abstract: George Birdsong, Lydia Howell, Karen Atkison, R Marshall Austin, Marluce Bibbo, Thomas A Bonfiglio, Diane D Davey, Catherine Keebler, Dina Mody, Lynnette Savaloja, Jacalyn Papillo, Marianne Prey, Stephen Raab, Brenda L Schultz, Diane Solomon
      CytoJournal 2006 3(1):11-11
      The member organizations of the Cytology Education and Technology Consortium believe there are significant flaws in current cytology proficiency testing regulations. The most immediate needed modifications include lengthening the required testing interval, utilizing stringently validated and continuously monitored slides, changing the grading scheme, and changing the focus of the test from the individual to laboratory level testing. Integration of new computer-assisted and located-guided screening technologies into the testing protocols is necessary for the testing protocol to be compliant with the law.
      Citation: CytoJournal 2006 3(1):11-11
      PubDate: Tue,18 Apr 2006
      DOI: 10.1186/1742-6413-3-11
      Issue No: Vol. 3, No. 1 (2006)
       
  • Fast drying of Fine Needle Aspiration slides using a hand held fan :
           Impact on turn around time and staining quality

    • Authors: Mirza A Baig, Lamia Fathallah, Jining Feng, Mujtaba Husain, David G Grignon, Mousa A Al-Abbadi
      Pages: 12 - 12
      Abstract: Mirza A Baig, Lamia Fathallah, Jining Feng, Mujtaba Husain, David G Grignon, Mousa A Al-Abbadi
      CytoJournal 2006 3(1):12-12
      To analyze the impact of using a hand held fan to speed the air-drying process during immediate adequacy evaluation of Fine Needle Aspirations. The effect on turn around time and staining quality is evaluated.Two mirror image air-dried smears for each pass were prepared. One was subjected to a small hand-held fan with a fan diameter of 7 cm held an average distance of 3 to 5 cm from the slide. The other smear was left to dry without a fan. A total of 93 consecutive pairs were evaluated over a 2-month duration.The average time needed for air-drying using the fan was 73 seconds (range 10-300 seconds, standard error 6.986), while it was 200 seconds (range 15-645 seconds, standard error 17.799) for those without fan. This difference was statistically significant (p < 0.001). Smears were then evaluated for single cells, cell clusters and background material and no appreciable difference in stain quality was noted between the 2 groups.The use of a small hand-held fan for air-drying shortened the drying time for FNA adequacy by an average of 127 seconds (63% time reduction) for each pass. The quality of staining was comparable. Using a fan is highly recommended.
      Citation: CytoJournal 2006 3(1):12-12
      PubDate: Wed,19 Apr 2006
      DOI: 10.1186/1742-6413-3-12
      Issue No: Vol. 3, No. 1 (2006)
       
  • T-cell lymphoproliferative disorder of hand-mirror cell morphology
           presenting in an eosinophilic loculated peritoneal effusion, with omental
           "caking"

    • Authors: Richard Siderits, Janusz Godyn, Dearon Tufankjian, Osman Ouattara
      Pages: 13 - 13
      Abstract: Richard Siderits, Janusz Godyn, Dearon Tufankjian, Osman Ouattara
      CytoJournal 2006 3(1):13-13
      Background: Cells with "hand mirror" morphology have not, to the best of our knowledge, been described in a primary effusion sample. This paper describes a case of T-cell lymphoma with eosinophilia in a patient with suspected peritoneal carcinomatosis. Rarely, a T-cell lymphoproliferative process may mimic primary peritoneal carcinomatosis, clinically suggested by a presentation in CT imaging of omental caking with bilateral massive loculated effusions in a patient without lymphadenopathy or splenomegaly. Methods: A 60 year old caucasian male presented with vague abdominal discomfort and increasing abdominal girth. Computed tomography showed a two centimeter thick omental cake and a small loculated effusion. The clinical presentation and imaging findings were most consistent with peritoneal carcinomatosis. Cytologic evaluation of the effusion was undertaken for diagnostic study. Results: Rapid intraprocedural interpretation of the effusion sample showed a monomorphic population of cells with "hand-mirror" cell morphology exhibiting cytoplasmic extensions (uropodia) with 3-5 course dark cytoplasmic granules and a rim of vacuolated cytoplasm capping the opposing "mirror head" side. These cells were seen within a background of mature eosinophils. Flow cytometric evaluation of the ascites fluid demonstrated an atypical T-cell population with the following immunophenotype: CD2-, CD3+, CD4-, CD5-, CD7-, CD8+, CD56+. T-cell receptor (TCR) gene rearrangement was positive for clonal TCR-gamma gene rearrangement, supporting the diagnosis of a T-lymphoprolifereative disorder. Conclusion: A T-cell lymphoproliferative process may present with "hand mirror" morphology in an effusion sample. These cells may show polar cytoplasmic vacuolization and 3-5 course granules within the "handle" of these unique cells. Cytoplasm shows peripheral constriction around the nucleus.
      Citation: CytoJournal 2006 3(1):13-13
      PubDate: Mon,8 May 2006
      DOI: 10.1186/1742-6413-3-13
      Issue No: Vol. 3, No. 1 (2006)
       
  • ASC-H in Pap test--definitive categorization of cytomorphological spectrum

    • Authors: Mamatha Chivukula, Vinod B Shidham
      Pages: 14 - 14
      Abstract: Mamatha Chivukula, Vinod B Shidham
      CytoJournal 2006 3(1):14-14
      Objective: The American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines for management of ASC-H is colposcopic examination followed by biopsy. HPV testing (HPVT) is recommended after a negative biopsy result. More definitive interpretation of ASC-H could prevent discomfort and minimize the cost. The purpose of this study was to evaluate association of various cytomorphological patterns of ASC-H with various clinical scenarios. Methods: We reviewed SurePath™ (TriPath Imaging, Inc. Burlington, NC, USA) cervical smears interpreted as ASC-H in 161 women (mean age, 37 {15 to 78} years), over 24 months (2002 to 2003). HPVT (Digene, Hybrid Capture ® II HPV test, Digene Corporation, Gaithersburg, MD, USA) was performed in 20% of cases (33/161) and biopsy results were available in 54 cases (19 with and 35 without HPVT). Results: HPVT was positive in 64% (21/33) cases, and negative in 36% (12/33) cases. In the follow-up biopsies of 71% (15/21) of cases with positive HPVT, 27% showed HPV changes or CIN1, 27% showed CIN2-3, and 46% were negative for epithelial abnormality. Follow-up biopsies from cases with negative HPVT (33%, 4/12 cases), 8% showed CIN1 and 25% were negative for any epithelial abnormality. Six cytomorphological patterns of ASC-H correlated with different clinical categories in relation to HPVT and biopsy results. 35% (19 out of 54 ASC-H cases in which biopsy results were available) could be interpreted definitively as HSIL by cytopathology, 11% (6/54) cases as LSIL with cyanophilic atypical parakeratotic pattern, and 31% (17/54) cases as reactive, with HPV status. The interpretation had to be continued as ASC-H in 22% (12/54) cases. Conclusion: ASC-H demonstrated a spectrum of cytomorphological patterns. Some of these patterns in liquid-based cervical smears may be more specifically interpreted as LSIL, HSIL, or benign if HPV status is known.
      Citation: CytoJournal 2006 3(1):14-14
      PubDate: Wed,10 May 2006
      DOI: 10.1186/1742-6413-3-14
      Issue No: Vol. 3, No. 1 (2006)
       
  • High grade squamous intraepithelial lesion in inmates from Ohio : Cervical
           screening and biopsy follow-up

    • Authors: Daniela M Proca, Soraya Rofagha, Sedigheh Keyhani-Rofagha
      Pages: 15 - 15
      Abstract: Daniela M Proca, Soraya Rofagha, Sedigheh Keyhani-Rofagha
      CytoJournal 2006 3(1):15-15
      Background: Cervical carcinoma remains the second leading cause of cancer death in women worldwide and sexual behavior is regarded as the main contributing factor. We studied cervical cytology screening with surgical biopsy follow-up in women prisoners and compared the findings to those in the general population. Methods: We reviewed 1024 conventional cervical smears, 73 cervical biopsies and 2 loop electrosurgical excision procedure (LEEP) specimens referred to us from the Correctional Center in Columbus, Ohio during a 12-month period. The results were compared to 40,993 Pap smears from the general population for the same 12-month period. Results: High grade squamous intraepithelial lesion (HGSIL) was diagnosed in 1.3% of the cervical smears from the inmate population versus 0.6% in the general population (p < 0.01). The unsatisfactory rate was 1.6% compared to 0.3% in the general population (p < 0.01). Among the study population, follow-up tissue diagnosis was obtained in 24.3% of the abnormal cytology results (ASCUS, LGSIL, and HGSIL). Of the HGSIL Pap smears, 61.5% had a subsequent tissue diagnosis. Thirty-nine biopsies (52% of the all inmate biopsies and LEEP) showed CIN II/III (cervical intraepithelial neoplasia II/III). Eight of these thirty-nine follow-up biopsies diagnosed as CIN II/III had a previous cervical cytology diagnosis of ASCUS. The average age for HGSIL was 30.5 years (S.D. = 5.7) and for low grade squamous intraepithelial lesion (LGSIL) was 27.2 years (S.D. = 6.1). Conclusion: A significantly higher prevalence of HGSIL cervical cytology and unsatisfactory smears was encountered in female inmates, with tissue follow-up performed in less than two thirds of the patients with HGSIL. These results are in keeping with data available in the literature suggesting that the inmate population is high-risk and may be subject to less screening and tissue follow-up than the general population. Clinicians should proceed with urgency to improve screening and follow-up with treatment. The inmate population should be targeted for HPV vaccination promptly after FDA approval.
      Citation: CytoJournal 2006 3(1):15-15
      PubDate: Wed,10 May 2006
      DOI: 10.1186/1742-6413-3-15
      Issue No: Vol. 3, No. 1 (2006)
       
  • Fine needle aspiration cytology of bone tumours--the experience from the
           National Orthopaedic and Lagos University Teaching Hospitals, Lagos,
           Nigeria

    • Authors: Obiageli E Nnodu, SO Giwa, Samuel U Eyesan, Fatima B Abdulkareem
      Pages: 16 - 16
      Abstract: Obiageli E Nnodu, SO Giwa, Samuel U Eyesan, Fatima B Abdulkareem
      CytoJournal 2006 3(1):16-16
      Background: Due to difficulty in confirming clinical suspicions of malignancy in patients presenting with bone tumours, the cost of surgical biopsies where hospital charges are borne almost entirely by patients, competition with bone setters and healing homes with high rate of loss to follow up; we set out to find if sufficient material could be obtained to arrive at reliable tissue diagnosis in patients with clinical and radiological evidence of bone tumours in our hospitals. Methods: After initial clinical and plain radiographic examinations, patients were sent for fine needle aspirations. Aspirations were carried out with size 23G needles of varying lengths with 10 ml syringes in a syringe holder (CAMECO, Sebre Medical, Vellinge, Sweden). The aspirates were air dried, stained by the MGG method and examined microscopically. Histology was performed on patients who had subsequent surgical biopsy. These were then correlated with the cytology reports. Results: Out of 96 patients evaluated, [57 males, 39 females, Mean age 31.52 years, Age Range 4-76 years,] material sufficient for diagnosis was obtained in 90 patients. Cytological diagnosis of benign lesions was made in 40 patients and malignant in 47. Of these, 27 were metastases, osteogenic sarcoma 16, giant cell tumour 19, infection 11. Histology was obtained in 41 patients. Correct diagnosis of benignity was made in 17 out of 18 cases, malignancy in 21 out of 22 cases. One non-diagnostic case was malignant. The accuracy of specific cytological diagnosis was 36/41 (87.8%) and incorrect in 5/41 (12.2%). Conclusion: We conclude that FNAC can be useful in the pre-operative assessment of bone tumours especially where other diagnostic modalities are unavailable.
      Citation: CytoJournal 2006 3(1):16-16
      PubDate: Thu,15 Jun 2006
      DOI: 10.1186/1742-6413-3-16
      Issue No: Vol. 3, No. 1 (2006)
       
  • Lack of BRAF mutations in hyalinizing trabecular neoplasm

    • Authors: Zubair W Baloch, Kanchan Puttaswamy, Marcia Brose, Virginia A LiVolsi
      Pages: 17 - 17
      Abstract: Zubair W Baloch, Kanchan Puttaswamy, Marcia Brose, Virginia A LiVolsi
      CytoJournal 2006 3(1):17-17
      The hyalinizing trabecular neoplasm (HTN) of the thyroid is an unusual and controversial lesion. Some consider it a peculiar type of papillary thyroid carcinoma (PTC) because of its nuclear features and presence of psammoma bodies. Others consider it an adenoma. Molecular studies have found RET/PTC translocations in some examples, supporting HTN as a PTC; however mutations in BRAF (another marker for PTC) have not been found.We report two cases of classic HTN and a case of trabecular PTC and show BRAF mutations in the latter and not in HTN. Trabecular growth pattern is insufficient for a diagnosis of HTN and lesions with such a pattern and nuclear features of PTC are cancers. Morphologically classic HTN are not associated with metastatic potential and should be considered adenomas.
      Citation: CytoJournal 2006 3(1):17-17
      PubDate: Tue,25 Jul 2006
      Issue No: Vol. 3, No. 1 (2006)
       
  • Immunohistochemical detection of hTERT in urothelial lesions : A potential
           adjunct to urine cytology

    • Authors: Walid Khalbuss, Steve Goodison
      Pages: 18 - 18
      Abstract: Walid Khalbuss, Steve Goodison
      CytoJournal 2006 3(1):18-18
      Background: Urine cytology has a critical role in evaluation for bladder carcinoma. Due to the low sensitivity of this technique, ancillary modalities such as the detection of markers of malignancy by immunochemistry are desirable. Promising factors in this context are components of the human telomerase enzyme complex. Telomerase repairs and extend telomeres, which when eroded beyond a critical limit trigger a senescence checkpoint. Accordingly, while absent in normal somatic cells, telomerase activity has been detected in the great majority of malignant tumor specimens tested, and so has potential value for the recognition of malignant cells in clinical specimens.Methods: In this study, we investigated whether the immunohistochemical detection of the catalytic subunit of telomerase (hTERT) can aid cytology in the diagnosis of bladder lesions. Findings from the retrospective evaluation of over 100 cell blocks, including urine sediments from confirmed malignant and benign conditions, were compared with routine urine cytology data.Results: The presence of hTERT protein was indicative of the transformation of urothelia to a malignant phenotype. Nucleolar hTERT was expressed in 27 (93%) of 29 samples obtained from patients with confirmed primary bladder cancer. Conversely, hTERT was detectable in only 3 (0.8%) of 39 samples from benign conditions. The hTERT assay showed higher diagnostic sensitivity (84.8%) than published urine cytology data (~65%) for confirmed bladder carcinoma, however, the hTERT assay was less specific than cytology (65.2% vs. ~95% respectively).Conclusion : As a highly sensitive marker, immunohistochemical hTERT detection in urine sediments represents a reliable adjunct to cytology in the accurate diagnosis of urothelial neoplasms.
      Citation: CytoJournal 2006 3(1):18-18
      PubDate: Thu,10 Aug 2006
      DOI: 10.1186/1742-6413-3-18
      Issue No: Vol. 3, No. 1 (2006)
       
  • Cytodiagnosis of multiple myeloma presenting as orbital involvement : A
           case report

    • Authors: Alok Sharma, Manju Kaushal, Nishith K Chaturvedi, Rajbala Yadav
      Pages: 19 - 19
      Abstract: Alok Sharma, Manju Kaushal, Nishith K Chaturvedi, Rajbala Yadav
      CytoJournal 2006 3(1):19-19
      Background: Plasma cell neoplasms represent autonomous proliferations of plasma cells and can manifest as diffuse myeloma with systemic involvement (plasma cell myeloma or multiple myeloma), monoclonal gammopathy of undetermined significance (MGUS), or as variants of plasma cell myeloma such as indolent myeloma, smoldering myeloma, osteosclerotic myeloma, plasma cell leukaemia and non-secretory myeloma. Localized neoplastic proliferation of plasma cells presents as solitary plasmacytoma of bone or extramedullary plasmacytoma. Involvement of orbit can occur as a solitary plasmacytoma, or as part of systemic involvement in multiple myeloma, the clinical outcome being significantly worse in the latter setting.Orbital involvement in multiple myeloma is very rare with less than 50 cases reported in the literature. Early cytological diagnosis of such lesions is vital for timely institution of appropriate therapy. As far as we are aware only six previous cases of cytological diagnosis of multiple myeloma involving the orbit are on record.Case presentation: A 37 year old male presented with low grade fever showing evening rise, headache, diplopia and swelling in the right periorbital and temporal region. Imaging studies revealed destructive lesion of sphenoid, frontal bone and zygomatic arch with soft tissue component extending to infratemporal fossa and orbit. A fine needle aspirate from the temporal region swelling showed features of a plasmacytoma, and subsequent workup confirmed the presence of systemic disease. A final diagnosis of multiple myeloma with orbital involvement at presentation was made.Conclusion: Present case describes the extremely rare presentation of multiple myeloma with orbital involvement and highlights the utility of cytology in such lesions. Fine needle aspiration diagnosis of plasmacytoma at extramedullary sites offers an opportunity for non-invasive verification of systemic involvement, and thus plays a major role in early diagnosis and management of these patients.
      Citation: CytoJournal 2006 3(1):19-19
      PubDate: Thu,10 Aug 2006
      DOI: 10.1186/1742-6413-3-19
      Issue No: Vol. 3, No. 1 (2006)
       
  • Biphasic parapharyngeal synovial sarcoma : A cytologic and immunocytologic
           report of a case

    • Authors: Bijan Khademi, Yahya Daneshbod, Shahrzad Negahban, Khosrow Daneshbod, Massud Kaviani, Mohammad Mohammadianpanah, Mohammad J Ashraf
      Pages: 20 - 20
      Abstract: Bijan Khademi, Yahya Daneshbod, Shahrzad Negahban, Khosrow Daneshbod, Massud Kaviani, Mohammad Mohammadianpanah, Mohammad J Ashraf
      CytoJournal 2006 3(1):20-20
      Background: Synovial sarcoma is a rare soft tissue sarcoma in the head and neck region and parapharyngeal space. There is no previous cytologic report of synovial sarcoma of parapharynx. The cytologic and immunocytochemical findings of a parapharyngeal biphasic synovial sarcoma together with diagnostic pitfalls are described.Case report: A 21-year-old girl presented with a 6-month history of progressive right arm pain, neck mass and upper aerodigestive tract obstruction. On physical examination there was a large painless mass arising from the right-sided parapharyngeal space causing airway obstruction. Initial magnetic resonance imaging (MRI) revealed a large tumor in the right-sided parapharyngeal space. Fine needle aspiration through cervical region was performed and was reported as benign spindle cell tumor. Smears were cellular and composed mostly of tight and loose clusters of spindle cells. Epitheloid cells could also be identified intermingled with them. She underwent near total resection of the tumor. Pathologic report disclosed the diagnosis of synovial sarcoma. She then received postoperative adjuvant external radiotherapy.Conclusion: Due to rarity of this tumor in this region and nonspecific cytologic features, we could not differentiate this tumor from the other more common spindle cell neoplasms. Considering synovial sarcoma in this region and immunocytochemistry can be helpful in rendering a correct initial diagnosis of this tumor.
      Citation: CytoJournal 2006 3(1):20-20
      PubDate: Mon,14 Aug 2006
      DOI: 10.1186/1742-6413-3-20
      Issue No: Vol. 3, No. 1 (2006)
       
  • The Best in CytoJournal: 2005

    • Authors: Michael B Cohen
      Pages: 21 - 21
      Abstract: Michael B Cohen
      CytoJournal 2006 3(1):21-21
      CytoJournal opened its doors in late 2004 and 2005 was the first full year of publication. In order to celebrate this event as well as recognize the contributing authors works, CytoJournal has initiated a Best Article of the Year, in this case 2005. This year's Best of CytoJournal: 2005 is an excellent review of thyroid FNAB.
      Citation: CytoJournal 2006 3(1):21-21
      PubDate: Wed,13 Sep 2006
      Issue No: Vol. 3, No. 1 (2006)
       
  • Alveolar proteinosis in a patient recovering from Pneumocystis carinii
           infection : A case report with a review of literature

    • Authors: Petio V Kotov, Vinod B Shidham
      Pages: 22 - 22
      Abstract: Petio V Kotov, Vinod B Shidham
      CytoJournal 2006 3(1):22-22
      Background: Pulmonary alveolar proteinosis is a rare lung disorder, which was first reported as idiopathic condition in 1958. The prevalence of acquired pulmonary alveolar proteinosis has been estimated to be 0.37 per 100,000 population. The cause of this condition is not entirely clear. We present alveolar proteinosis in a case recently treated for pulmonary Pneumocystis carinii infection.Case presentation: A 25-year-old Caucasian female presented with shortness of breath during management of acute pancreatitis. She had a heart-transplant six years ago, a distal pancreatectomy secondary to pancreatitis two years ago, chronic renal failure secondary to Prograft taken for six years to suppress transplant rejection, and a more recent history of Pneumocystis carinii infection treated in the preceding 21 days with augmented doses of Bactrim (Trimethoprim, Sulfamethoxazole). She had bilateral pleural effusions with radiological and clinical features suspicious for interstitial lung disease. Cytopathologic evaluation of broncho-alveolar lavage (BAL) showed hyaline alveolar casts admixed with amorphous debris and scant chronic inflammatory cells, consistent with alveolar proteinosis. GMS and PAS stains were negative for P. carinii. Direct Fluorescent Antibody (DFA) test for P. carinii performed on the BAL specimen in our Microbiology Lab had been repeatedly negative.Conclusion: Cytopathological findings in bronchoalveolar lavage, with clinical differential diagnosis of interstitial lung disease, were diagnostic. Pulmonary alveolar proteinosis after recent treatment for P. carinii infection suggests a relationship of pulmonary alveolar proteinosis with P. carinii infection in the immunocompromised patient.
      Citation: CytoJournal 2006 3(1):22-22
      PubDate: Thu,12 Oct 2006
      DOI: 10.1186/1742-6413-3-22
      Issue No: Vol. 3, No. 1 (2006)
       
  • Diffuse large B cell lymphoma of thyroid as a masquerader of anaplastic
           carcinoma of thyroid, diagnosed by FNA : A case report

    • Authors: Yahya Daneshbod, Shapour Omidvari, Khosrow Daneshbod, Shahrzad Negahban, Mehdi Dehghani
      Pages: 23 - 23
      Abstract: Yahya Daneshbod, Shapour Omidvari, Khosrow Daneshbod, Shahrzad Negahban, Mehdi Dehghani
      CytoJournal 2006 3(1):23-23
      Background: Both thyroid lymphoma and anaplastic carcinoma of thyroid present with rapidly growing mass in eldery patients. Anaplastic carcinoma has high mortality rate and combination of surgery, radiation therapy and multidrug chemotherapy are the best chance for cure. Prognosis of thyroid lymphoma is excellent and chemotherapy for widespred lymphoms and radiotherapy with or without adjuvant chemotherapy for tumors localized to the gland, are the treatment of choice.Case report: This article reports a 70 year old man presenting with diffuse neck swelling and hoarseness of few weeks duration. Fine needle aspiration was done and reported as anaplastic carcinoma of thyroid which thyroidectomy was planned. The slides were sent for second opinion. After review, with initial diagnosis of anaplastic carcinoma versus lymphoma, immunocytochemical study was performed. Smears were positive for B cell markers and negative for cytokeratin, so with the impression of diffuse large B cell lymphoma, the patient received two courses of chemotherapy by which the tumor disappeared during two weaks.Conclusion: Despite previous reports, stating easy diagnosis of high-grade thyroid lymphoma on the grounds of cytomorphological features we like to emphasize, overlapping cytologic features of the curable high grade thyroid lymphoma form noncurable anaplastic thyroid carcinoma and usefulness of immunocytochemistry to differentiate these two disease.
      Citation: CytoJournal 2006 3(1):23-23
      PubDate: Thu,19 Oct 2006
      DOI: 10.1186/1742-6413-3-23
      Issue No: Vol. 3, No. 1 (2006)
       
  • Combined applications of fine needle aspiration cytology and flow
           cytometric immunphenotyping for diagnosis and classification of non
           Hodgkin lymphoma

    • Authors: Pranab Dey, Thasneem Amir, Aisha Al Jassar, Salem Al Shemmari, Sanjay Jogai, Ganapathi M Bhat, Aisha Al Quallaf, Zahia Al Shammari
      Pages: 24 - 24
      Abstract: Pranab Dey, Thasneem Amir, Aisha Al Jassar, Salem Al Shemmari, Sanjay Jogai, Ganapathi M Bhat, Aisha Al Quallaf, Zahia Al Shammari
      CytoJournal 2006 3(1):24-24
      Aims and objectives: In this present study we have evaluated the feasibility of sub-classification of non-Hodgkin's lymphoma (NHL) cases according to World Health Organization's (WHO) classification on fine needle aspiration cytology (FNAC) material along with flow cytometric immunotyping (FCI) as an adjunct.Materials and methods: In this five years study, only cases suggested or confirmed as NHL by FNAC were selected and FCI was performed with a complete panel of antibodies (CD3, CD2, CD 4, CD5, CD8, CD7, CD10, CD19, CD20, CD23, CD45, κ and λ) by dual color flow cytometry. Both cytologic findings and FCI data were interpreted together to diagnose and sub-classify NHL according to WHO classification. Wherever possible the diagnoses were compared with cytology.Results: There were total 48 cases included in this study. The cases were classified on FNAC as predominant small cells (12), mixed small and large cells (5) and large cells (26). In five cases a suggestion of NHL was offered on FNAC material and these cases were labeled as NHL not otherwise specified (NHL-NOS). Flow cytometry could be performed in 45 cases (93.8%) and in rest of the three cases the material was inadequate because of scanty blood mixed aspirate. Light chain restriction was demonstrated in 30 cases out of 40 cases of B-NHL (75%). There were 15 cases each of ? and ? light chain restriction in these 30 cases. With the help of combined FCI and FNAC, it was possible to sub-classify 38 cases of NHL (79%) according to WHO classification. Combined FNAC and FCI data helped to diagnose 9 cases of small lymphocytic lymphoma (SLL), 2 cases of mantle cell lymphoma (MCL), 4 cases of follicular lymphoma (FL), 17 cases of diffuse large B lymphoma (DLBL) and 6 cases of lymphoblastic lymphoma. Histopathology diagnosis was available in 31 cases of NHL out of which there were 14 recurrent and 17 cases of primary NHL. Out of 15 DLBL cases diagnosed on FCI and FNAC, histology confirmed 14 cases and one of these cases was diagnosed as Burkitt's lymphoma on histology. Cases of FL (4), SLL (3) and MCL (2) were well correlated with histopathology. Out of the five cases suggestive of NHL on cytology, histopathology was available in four cases. Histology diagnosis was given as DLBL (1), SLL (1), anaplastic large cell lymphoma (1) and FL transformed into large cell NHL (1). Considering histopathology as gold standard, diagnostic specificity of combined FNAC and FCI was 100% (31/31) and sensitivity in sub-classification was 83.8% (26/31).Conclusion: FNAC combined with FCI may be helpful in accurately sub-classifying NHL according to WHO classification. Many of the subtypes of NHL such as FL and MCL which were previously recognized as a pure morphologic entity can be diagnosed by combined use of FNAC and FCI. Other ancillary investigations such as chromosomal changes, cell proliferation markers etc. may be helpful in this aspect.
      Citation: CytoJournal 2006 3(1):24-24
      PubDate: Fri,27 Oct 2006
      DOI: 10.1186/1742-6413-3-24
      Issue No: Vol. 3, No. 1 (2006)
       
  • Rapid assessment of fine needle aspiration and the final diagnosis--how
           often and why the diagnoses are changed

    • Authors: Carolyn Woon, Ricardo H Bardales, Michael W Stanley, Edward B Stelow
      Pages: 25 - 25
      Abstract: Carolyn Woon, Ricardo H Bardales, Michael W Stanley, Edward B Stelow
      CytoJournal 2006 3(1):25-25
      Background: On-site rapid interpretation (RI) of fine needle aspiration (FNA) has been shown to increase the diagnostic yield of FNA and decrease the need for repeat diagnostic procedures. Because the pathologist interprets only a fraction of the sample and has limited resources available at such times, an occasional RI diagnosis will be changed at the time of the final diagnosis. We investigated how often these changes in diagnoses occur and the possible reasons for the changes.Methods: All cytology reports from 1/1/02 to 12/31/03 from a single institution were reviewed. Cases with RI with discrepant final diagnoses were noted. The discrepant diagnoses were categorized depending on how they were changed. Possible sources for changed diagnoses were noted.Results: Between 1/1/02 and 12/31/03 there were 1368 RIs of FNAs. Of these 80 (5.8%) had discrepancies between the RIs and final diagnoses. Seventy-eight cases had additional slides and/or cell block at time of final diagnosis. 16 cases had ancillary studies available at final diagnosis. Consultant pathologists were used in 7 cases. Different pathologists interpreted the RI and final diagnosis in 31 cases.Conclusion: Although uncommon, discrepancies between RIs and final diagnoses occur 5.8% of the time at our institution. Most commonly, this involves a change of diagnosis from either "non-diagnostic" or "benign" to "malignancy". Although much of this is likely due to the presence of additional material and information at the time of final diagnosis, the number of cases that had different pathologists involved in the RI and final diagnosis suggests that inter-observer variability may also play some role.This data was originally presented at the 2005 meeting of the United States and Canadian Academy of Pathology in San Antonio, Texas, March, 2005.
      Citation: CytoJournal 2006 3(1):25-25
      PubDate: Mon,6 Nov 2006
      DOI: 10.1186/1742-6413-3-25
      Issue No: Vol. 3, No. 1 (2006)
       
  • Atlas of Salivary Gland Tumor Cytopathology, Oral & Surgical Pathology -
           CD-ROM Disk 2: by Kini S. & Dardick I. Pathology Images Inc, 2006

    • Authors: Zainab Basir
      Pages: 26 - 26
      Abstract: Zainab Basir
      CytoJournal 2006 3(1):26-26
      This CD-ROM version of Atlas of Salivary Gland Tumor Cytopathology, Oral & Surgical Pathology is an excellent and concise tool for easy reference during sign out of cytology and surgical cases. It is also invaluable as a teaching tool for residents and fellows.Atlas of Salivary Gland Tumor Cytopathology, Oral & Surgical Pathology CD-ROM (ISBN 0-9736518-0-7), Published by Pathology images Inc Ottawa, Ontario K2B 7L4, Canada
      Citation: CytoJournal 2006 3(1):26-26
      PubDate: Tue,21 Nov 2006
      Issue No: Vol. 3, No. 1 (2006)
       
  • Dynamic telecytopathology of on site rapid cytology diagnoses for
           pancreatic carcinoma

    • Authors: Burton Kim, David C Chhieng, David R Crowe, Darshana Jhala, Nirag Jhala, Thomas Winokur, Mohamad A Eloubeidi, Isam E Eltoum
      Pages: 27 - 27
      Abstract: Burton Kim, David C Chhieng, David R Crowe, Darshana Jhala, Nirag Jhala, Thomas Winokur, Mohamad A Eloubeidi, Isam E Eltoum
      CytoJournal 2006 3(1):27-27
      Background: Diagnosis of pancreatic lesions can be accurately performed by endoscopic ultrasound guided fine needle aspiration (EUS-FNA) with onsite cytopathologists to assess specimen adequacy and to determine a preliminary diagnosis. Considerable time is needed to perform on-site assessments. This takes away work time of cytopathologists and prohibits them from serving remote locations. It is therefore logical to ask if real-time telecytopathology could be used to assess specimen adequacy and if telecytopathology diagnosis has the same level of agreement to the final diagnosis as that of onsite evaluation. In this study, we compare agreement between cytodiagnoses rendered using telecytopathology with onsite and final interpretations.Method: 40 Diff-Quik-stained EUS-FNA were re-evaluated retrospectively (patient ages 31-62, 19:21 male:female, 15 non-malignant lesions, 25 malignant lesions as classified by final diagnosis). Each previously assessed by a cytopathologist and finally reviewed by the same or different cytopathologist. Blinded to the final diagnosis, a resident pathologist re-screened all slides for each case, selected a slide and marked the diagnostic cells most representative of the lesion. Blinded to the diagnosis, one cytopathologist assessed the marked cells through a real time remotely operated telecytopathology system (MedMicroscopy). Diagnosis and time spent were recorded. Kappa statistic was used to compare agreements between telecytopathology vs. original onsite vs. final diagnoses.Results: Time spent for prescreening ranged from 1 to 5 minutes (mean 2.6 +/- 1.3 minutes) and time spent for telecytopathology diagnosis ranged from 2-20 minutes (mean 7.5 +/- 4.5 minutes). Kappa statistics, K, was as follows: telecytopathology versus onsite diagnosis K, 95% CI = 0.65, 0.41-0.88, for telecytopathology versus final K, 95% CI = 0.61, 0.37-0.85 and for onsite diagnosis versus final K, 95% CI = 0.79, 0.61-0.98. There is no significant difference in agreement between onsite and telecytopathology diagnoses. Kappa values for telecytopathology were less than onsite evaluation when compared to the final diagnosis; however, the difference was not statistically significant.Conclusion: This retrospective study demonstrates the potential use of telecytopathology as a valid substitute for onsite evaluation of pancreatic carcinoma by EUS-FNA.
      Citation: CytoJournal 2006 3(1):27-27
      PubDate: Mon,11 Dec 2006
      DOI: 10.1186/1742-6413-3-27
      Issue No: Vol. 3, No. 1 (2006)
       
  • Malignant atypical cell in urine cytology : A diagnostic dilemma

    • Authors: Alka Bhatia, Pranab Dey, Nandita Kakkar, Radhika Srinivasan, Raje Nijhawan
      Pages: 28 - 28
      Abstract: Alka Bhatia, Pranab Dey, Nandita Kakkar, Radhika Srinivasan, Raje Nijhawan
      CytoJournal 2006 3(1):28-28
      Aims: The aim of this study was to find out the characteristic morphology of malignant atypical cells which were missed on routine cytology of urine.Materials and methods: In this retrospective study, we examined detailed cytomorphology of 18 cases of atypical urinary cytology which were missed on routine examination and were further proved on histopathology as transitional cell carcinoma (TCC) of bladder. The cytological features of these cases were compared with 10 cases of benign urine samples.Results: There were 11 cases of high grade TCC and 7 cases of low grade TCC on histopathology of the atypical urine samples. Necrosis in the background and necrosed papillae were mostly seen in malignant atypical cells. The comet cells and cells with India ink nuclei (single cells with deep black structure-less nuclei) were only observed in malignant atypical cells. The most consistent features in malignant atypical cells were: i) high nuclear and cytoplasmic (N/C) ratio ii) nuclear pleomorphism iii) nuclear margin irregularity iv) hyperchromasia and v) chromatin abnormalitiesConclusion: The present study emphasizes that nuclear features such as high N/C ratio, hyperchromasia and chromatin abnormalities are particularly useful for assessing the malignant atypical cells. Other cytological features such as comet cells and cells with India ink nuclei are also helpful for diagnosis but have limited value because they are less frequently seen.
      Citation: CytoJournal 2006 3(1):28-28
      PubDate: Fri,15 Dec 2006
      DOI: 10.1186/1742-6413-3-28
      Issue No: Vol. 3, No. 1 (2006)
       
  • Liver metastases of pancreatic acinar cell carcinoma with marked nuclear
           atypia and pleomorphism diagnosed by EUS FNA cytology : A case report with
           emphasis on FNA cytological findings

    • Authors: Hong Q Peng, Peter Darwin, John C Papadimitriou, Cinthia B Drachenberg
      Pages: 29 - 29
      Abstract: Hong Q Peng, Peter Darwin, John C Papadimitriou, Cinthia B Drachenberg
      CytoJournal 2006 3(1):29-29
      Background: Acinar cell carcinoma of the pancreas is a rare neoplasm. Although this tumor has been well characterized histologically, the morphological patterns in Fine Needle Aspiration Cytology have not been well defined. Unlike ductal adenocarcinomas, endocrine tumors, and solid pseudopapillary tumors of the pancreas with their characteristic FNA cytological features, acinar cell carcinomas pose a particular diagnostic challenge by sharing many cytomorphologic features with endocrine tumors of the pancreas.Case presentation: A 37-year-old man presented with lower chest and left upper quadrant abdominal pain. Computed tomography revealed a 7.8 x 7.3 cm irregular, partially cystic mass in the body and tail of the pancreas, and two lesions in the liver compatible with metastases. Subsequently, the patient underwent endoscopic ultrasound-guided fine needle aspiration on one of the two metastatic liver masses.FNA cytology revealed abundant, loosely cohesive clusters of malignant epithelial cells with vaguely acinar and trabecular formations. The pleomorphic nuclei had fine granular chromatin and occasionally small nucleoli. There were scant to moderate amounts of cytoplasm. Scattered, strikingly large tumor cells with giant nuclei, prominent mitoses and associated necrosis were evident. A pancreatic endocrine tumor was suspected initially, but acinar cell carcinoma of the pancreas was confirmed by immunohistochemistry, cytochemical and ultrastructural studies.Conclusion: We describe a case of pancreatic acinar cell carcinoma with unusual cytomorphologic features mimicking an endocrine tumor of pancreas, encountered in endoscopic ultrasound-guided fine needle aspiration of a metastatic liver mass and discuss the diagnostic approach for this unusual pancreatic tumor in fine needle aspiration cytology.
      Citation: CytoJournal 2006 3(1):29-29
      PubDate: Sat,30 Dec 2006
      DOI: 10.1186/1742-6413-3-29
      Issue No: Vol. 3, No. 1 (2006)
       
  • Desmoplastic Infantile Ganglioglioma: cytologic findings and differential
           diagnosis on aspiration material

    • Authors: Oluwole Fadare, M Rajan Mariappan, Denise Hileeto, Arthur W Zieske, Jung H Kim, Idris Tolgay Ocal
      Pages: 1 - 1
      Abstract: Oluwole Fadare, M Rajan Mariappan, Denise Hileeto, Arthur W Zieske, Jung H Kim, Idris Tolgay Ocal
      CytoJournal 2005 2(1):1-1
      Background :Desmoplastic infantile ganglioglioma (DIG) is a rare WHO Grade I tumor of infancy that is characterized by large volume, superficial location, invariable supratentoriality, fronto-parietal lobe predilection and morphologically, by an admixture of astroglial and neuroepithelial elements in a desmoplastic milieu. With over 50 cases described, the histologic and radiographic spectrum of DIG has been well-characterized. The superficial location of DIGs may render them greatly amenable to preoperative assessment utilizing aspiration cytology; however, the cytologic features of this rare tumor have only been reported once previously. Case Presentation :We present herein cytomorphologic findings from the intraoperative aspiration of a typical case of DIG diagnosed in a 1-year-old male. As evaluated on a single liquid-based preparation, the specimen showed low cellularity and was comprised predominantly of a population of dispersed (occasionally clustered) large neuronal cells with eccentrically located hyperchromatic nuclei (which were occasionally binucleated) and abundant unipolar cytoplasm. Rare smaller astroglial cells were intermixed. Despite the tumor's characteristic desmoplastic histologic appearance, no stromal fragments were identified on the aspiration material. Conclusions :A differential diagnosis is presented and analyzed in detail and it is concluded that when these large neuronal cells are encountered in an aspirate of a brain mass in a child, a combination of clinical, radiologic and immunohistochemical parameters can eliminate most of the differential possibilities.
      Citation: CytoJournal 2005 2(1):1-1
      PubDate: Tue,11 Jan 2005
      Issue No: Vol. 2, No. 1 (2005)
       
  • Remembering George L. Wied, M.D., February 7, 1921-July 25, 2004

    • Authors: Dorothy L Rosenthal
      Pages: 2 - 2
      Abstract: Dorothy L Rosenthal
      CytoJournal 2005 2(1):2-2
      A personal tribute to George L. Wied, M.D., a founder of the medical subspecialty, cytopathology, who died July 25, 2004.
      Citation: CytoJournal 2005 2(1):2-2
      PubDate: Tue,8 Feb 2005
      DOI: 10.1186/1742-6413-2-2
      Issue No: Vol. 2, No. 1 (2005)
       
  • CytoJournal's move to fund Open Access

    • Authors: Vinod B Shidham, Anthony F Cafaro, Barbara F Atkinson
      Pages: 3 - 3
      Abstract: Vinod B Shidham, Anthony F Cafaro, Barbara F Atkinson
      CytoJournal 2005 2(1):3-3
      CytoJournal is published by an independent publisher BioMed Central, which is committed to ensuring that the peer-reviewed biomedical research is Open Access. Since its launch, BioMed Central has graciously supported the processing of all the articles published during CytoJournal' s first 6 months. However, for long term viability, CytoJournal has to achieve financial viability to support publication expenses. From 1st March, 2005, authors will be asked by the publisher to pay a flat article-processing charge. This editorial discusses how a significant proportion of authors may not have to pay this fee directly under a variety of different mechanisms such as institutional and society memberships with BioMed Central.
      Citation: CytoJournal 2005 2(1):3-3
      PubDate: Thu,10 Feb 2005
      DOI: 10.1186/1742-6413-2-3
      Issue No: Vol. 2, No. 1 (2005)
       
  • The Anal Pap smear : Cytomorphology of squamous intraepithelial lesions

    • Authors: Shehla Arain, Ann E Walts, Premi Thomas, Shikha Bose
      Pages: 4 - 4
      Abstract: Shehla Arain, Ann E Walts, Premi Thomas, Shikha Bose
      CytoJournal 2005 2(1):4-4
      Background: Anal smears are increasingly being used as a screening test for anal squamous intraepithelial lesions (ASILs). This study was undertaken to assess the usefulness and limitations of anal smears in screening for ASILs. Methods: The cytomorphological features of 200 consecutive anal smears collected in liquid medium from 198 patients were studied and findings were correlated with results of surgical biopsies and/or repeat smears that became available for 71 patients within six months. Results: Adequate cellularity was defined as an average of 6 or more nucleated squamous cells/hpf. A glandular/transitional component was not required for adequacy. Dysplastic cells, atypical parakeratotic cells and bi/multinucleated cells were frequent findings in ASIL while koilocytes were infrequent. Smears from LSIL cases most frequently showed mildly dysplastic and bi/multinucleate squamous cells followed by parakeratotic cells (PK), atypical parakeratotic cells (APK), and koilocytes. HSIL smears contained squamous cells with features of moderate/severe dysplasia and many APKs. Features of LSIL were also found in most HSIL smears. Conclusions: In this study liquid based anal smears had a high sensitivity (98%) for detection of ASIL but a low specificity (50%) for predicting the severity of the abnormality in subsequent biopsy. Patients with cytologic diagnoses of ASC-US and LSIL had a significant risk (46-56%) of HSIL at biopsy. We suggest that all patients with a diagnosis of ASC-US and above be recommended for high resolution anoscopy with biopsy.
      Citation: CytoJournal 2005 2(1):4-4
      PubDate: Wed,16 Feb 2005
      DOI: 10.1186/1742-6413-2-4
      Issue No: Vol. 2, No. 1 (2005)
       
  • Anal screening cytology

    • Authors: Gladwyn Leiman
      Pages: 5 - 5
      Abstract: Gladwyn Leiman
      CytoJournal 2005 2(1):5-5
      This issue of CytoJournal contains an article on screening for anal intraepithelial neoplasia in high-risk male patients. This accompanying Editorial focuses on current understanding of this relatively new disease entity, with insights as to the potential role of screening cytopathology in the epidemiology, pathophysiology and clinical management of this HIV and HPV related anal lesion, which predominates in male patients living long-term with AIDS. Mention is made of techniques of obtaining samples, methods of preparation, and morphologic classification. Issues of anoscopic confirmation, as well as topical and surgical management are emphasized. The similarity of initial experiences in anal screening to problems encountered early in cervical cancer screening programs several decades ago, are highlighted.
      Citation: CytoJournal 2005 2(1):5-5
      PubDate: Wed,16 Feb 2005
      DOI: 10.1186/1742-6413-2-5
      Issue No: Vol. 2, No. 1 (2005)
       
  • Desmoplastic small round cell tumour : Cytological and immunocytochemical
           features

    • Authors: Nara M Granja, Maria D Begnami, Jeni Bortolan, Adhemar Longatto Filho, Fernando C Schmitt
      Pages: 6 - 6
      Abstract: Nara M Granja, Maria D Begnami, Jeni Bortolan, Adhemar Longatto Filho, Fernando C Schmitt
      CytoJournal 2005 2(1):6-6
      Background: Desmoplastic small round cell tumor (DSRCT) is a rare and highly aggressive neoplasm. The cytological diagnosis of these tumors can be difficult because they show morphological features quite similar to other small round blue cells tumors. We described four cases of DSRCT with cytological sampling: one obtained by fine needle aspiration biopsy (FNAB) and three from serous effusions. The corresponding immunocytochemical panel was also reviewed. Methods: Papanicolaou stained samples from FNAB and effusions were morphologically described. Immunoreaction with WT1 antibody was performed in all cytological samples. An immunohistochemical panel including the following antibodies was performed in the corresponding biopsies: 34BE12, AE1/AE3, Chromogranin A, CK20, CK7, CK8, Desmin, EMA, NSE, Vimentin and WT1. Results: The smears showed high cellularity with minor size alteration. Nuclei were round to oval, some of them with inconspicuous nucleoli. Tumor cells are clustered, showing rosette-like feature. Tumor cells in effusions and FNA were positive to WT1 in 3 of 4 cytology specimens (2 out 3 effusions and one FNA). Immunohistochemical reactions for vimentin, NSE, AE1/AE3 and WT1 were positive in all cases in tissue sections. Conclusion: The use of an adjunct immunocytochemical panel coupled with the cytomorphological characteristics allows the diagnosis of DSRCT in cytological specimens.
      Citation: CytoJournal 2005 2(1):6-6
      PubDate: Fri,18 Mar 2005
      DOI: 10.1186/1742-6413-2-6
      Issue No: Vol. 2, No. 1 (2005)
       
  • Fine needle aspiration biopsy of the liver : Algorithmic approach and
           current issues in the diagnosis of hepatocellular carcinoma

    • Authors: Aileen Wee
      Pages: 7 - 7
      Abstract: Aileen Wee
      CytoJournal 2005 2(1):7-7
      The role of fine needle aspiration biopsy (FNAB) in the evaluation of focal liver lesions has evolved. Guided FNAB is still useful to procure a tissue diagnosis if clinical, biochemical and radiologic findings are inconclusive. Major diagnostic issues include: (i) Distinction of benign hepatocellular nodular lesions from reactive hepatocytes, (ii) Distinction of well-differentiated hepatocellular carcinoma (WD-HCC) from benign hepatocellular nodular lesions, (iii) Distinction of poorly differentiated HCC from cholangiocarcinoma and metastatic carcinomas, (iv) Determination of histogenesis of malignant tumor, and (v) Determination of primary site of origin of malignant tumor. This review gives a general overview of hepatic FNAB; outlines an algorithmic approach to cytodiagnosis with emphasis on HCC, its variants and their mimics; and addresses current diagnostic issues. Close radiologic surveillance of high-risk cirrhotic patients has resulted in the increasing detection of smaller lesions with many subjected to biopsy for tissue characterization. The need for tissue confirmation in clinically obvious HCC is questioned due to risk of malignant seeding. When a biopsy is indicated, core needle biopsy is favored over FNAB. The inherent difficulty of distinguishing small/early HCC from benign hepatocellular nodular lesions has resulted in indeterminate reports. Changing concepts in the understanding of the biological behavior and morphologic evolution of HCC and its precursors; and the current lack of agreement on the morphologic criteria for distinguishing high-grade dysplastic lesions (with small cell change) from WD-HCC, have profound impact on nomenclature, cytohistologic interpretation and management. Optimization of hepatic FNAB to enhance the yield and accuracy of diagnoses requires close clinicopathologic correlation; combined cytohistologic approach; judicious use of ancillary tests; and skilled healthcare teams.
      Citation: CytoJournal 2005 2(1):7-7
      PubDate: Wed,8 Jun 2005
      DOI: 10.1186/1742-6413-2-7
      Issue No: Vol. 2, No. 1 (2005)
       
  • Preoperative diagnosis of a mediastinal granular cell tumor by EUS-FNA : A
           case report and review of the literature

    • Authors: Sarah M Bean, Mohamad A Eloubeidi, Isam A Eltoum, Robert J Cerfolio, Darshana N Jhala
      Pages: 8 - 8
      Abstract: Sarah M Bean, Mohamad A Eloubeidi, Isam A Eltoum, Robert J Cerfolio, Darshana N Jhala
      CytoJournal 2005 2(1):8-8
      We report the first case of a posterior mediastinal granular cell tumor initially diagnosed on cytologic material obtained via endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in a 51-year-old male with a prior history of colon cancer. Aspirates obtained were cellular and composed of polygonal cells with abundant granular cytoplasm and small, round dark nuclei. An immunoperoxidase stain performed on the cell block for antibodies to S-100 protein showed strong, diffuse staining of the cytoplasmic granules. Electron microscopy performed on the cell block revealed numerous cytoplasmic lysosomes. This is the first case report in the English literature of a definitive preoperative diagnosis of a mediastinal granular cell tumor utilizing material obtained via EUS-FNA.
      Citation: CytoJournal 2005 2(1):8-8
      PubDate: Wed,8 Jun 2005
      DOI: 10.1186/1742-6413-2-8
      Issue No: Vol. 2, No. 1 (2005)
       
  • FNAB cytology of extra-cranial metastasis of glioblastoma multiforme may
           resemble a lung primary: A diagnostic pitfall

    • Authors: Mamatha Chivukula, HE Dincer, Julie A Biller, Hendrikus G Krouwer, Grant Simon, Vinod Shidham
      Pages: 9 - 9
      Abstract: Mamatha Chivukula, HE Dincer, Julie A Biller, Hendrikus G Krouwer, Grant Simon, Vinod Shidham
      CytoJournal 2005 2(1):9-9
      Background :As extra-cranial metastasis of glioblastoma multiforme (GBM) is rare, it may create a diagnostic dilemma especially during interpretation of fine needle aspiration biopsy (FNAB) cytology. Case presentation :We present transbronchial FNAB findings in a 62-year-old smoker with lung mass clinically suspicious for a lung primary. The smears of transbronchial FNAB showed groups of cells with ill-defined cell margins and cytological features overlapping with poorly differentiated non-small cell carcinoma. The tumor cells demonstrated lack of immunoreactivity for cytokeratin, thyroid transcription factor-1, and usual neuroendocrine markers, synaptophysin and chromogranin in formalin-fixed cellblock sections. However, they were immunoreactive for the other neuroendocrine immunomarker, CD56, suggesting neural nature of the cells. Further scrutiny of clinical details revealed a history of GBM, 13 months status-post surgical excision with radiation therapy and systemic chemotherapy. The tumor recurred 7 months earlier and was debulked surgically and with intra-cranial chemotherapy. Additional evaluation of tumor cells for glial fibrillary acidic protein (GFAP) immunoreactivity with clinical details resulted in final interpretation of metastatic GBM. Conclusion :Lack of clinical history and immunophenotyping may lead to a diagnostic pitfall with possible misinterpretation of metastatic GBM as poorly differentiated non-small cell carcinoma of lung in a smoker.
      Citation: CytoJournal 2005 2(1):9-9
      PubDate: Mon,20 Jun 2005
      Issue No: Vol. 2, No. 1 (2005)
       
  • Review of "Fine Needle Aspiration Cytology of the Liver: Diagnostic
           algorithm a Southeast Asian Perspective" by A Wee and P Sampatankul

    • Authors: Isam A Eltoum
      Pages: 10 - 10
      Abstract: Isam A Eltoum
      CytoJournal 2005 2(1):10-10

      Citation: CytoJournal 2005 2(1):10-10
      PubDate: Tue,21 Jun 2005
      Issue No: Vol. 2, No. 1 (2005)
       
  • Diagnostic utility of p16 immunocytochemistry for Trichomonas in urine
           cytology

    • Authors: Liron Pantanowitz, Q Jackie Cao, Robert A Goulart, Christopher N Otis
      Pages: 11 - 11
      Abstract: Liron Pantanowitz, Q Jackie Cao, Robert A Goulart, Christopher N Otis
      CytoJournal 2005 2(1):11-11
      We present a case in which p16 immunocytochemistry helped establish the diagnosis of Trichomonas in urine from a male patient. Based on this finding, we recommend p16 immunocytochemistry as a diagnostic tool for unexpected patients or specimen types in which potential trichomonads are identified following routine cytologic evaluation.
      Citation: CytoJournal 2005 2(1):11-11
      PubDate: Wed,29 Jun 2005
      Issue No: Vol. 2, No. 1 (2005)
       
  • Fine-needle aspiration of the thyroid: an overview

    • Authors: Gia-Khanh Nguyen, Mark W Lee, Jody Ginsberg, Tina Wragg, Darcy Bilodeau
      Pages: 12 - 12
      Abstract: Gia-Khanh Nguyen, Mark W Lee, Jody Ginsberg, Tina Wragg, Darcy Bilodeau
      CytoJournal 2005 2(1):12-12
      Thyroid nodules (TN) are a common clinical problem. Fine needle aspiration (FNA) of the thyroid now is practiced worldwide and proves to be the most economical and reliable diagnostic procedure to identify TNs that need surgical excision and TNs that can be managed conservatively. The key for the success of thyroid FNA consists of an adequate or representative cell sample and the expertise in thyroid cytology. The FNA cytologic manifestations of TNs may be classified into seven working cytodiagnostic groups consisting of a few heterogenous lesions each to facilitate the differential diagnosis. Recent application of diagnostic molecular techniques to aspirated thyroid cells proved to be useful in separating benign from malignant TNs in several cases of indeterminate lesions.
      Citation: CytoJournal 2005 2(1):12-12
      PubDate: Wed,29 Jun 2005
      Issue No: Vol. 2, No. 1 (2005)
       
  • Hodgkin lymphoma: flow me?

    • Authors: Michael W Beaty, Kim R Geisinger
      Pages: 13 - 13
      Abstract: Michael W Beaty, Kim R Geisinger
      CytoJournal 2005 2(1):13-13
      Combining fine needle aspirate cytology with flow cytometry immunophenotyping for the rapid diagnosis of lymphoproliferative lesions is commonplace practice in many institutions. Yet, a definitive diagnosis of Hodgkin lymphoma in many cases remains elusive, requiring subsequent tissue biopsy confirmation. In this issue of CytoJournal, Hernandez et al explore the potential role of using the increased CD4/CD8 T-cell ratio in lymph node fine needle aspiration specimens as a specific feature in diagnosing Hodgkin lymphoma. CD4/CD8 T-cell ratio comparisons are made with cytomorphologic diagnoses of reactive, atypical, non-Hodgkin lymphoma, and Hodgkin lymphoma cases.
      Citation: CytoJournal 2005 2(1):13-13
      PubDate: Thu,8 Sep 2005
      Issue No: Vol. 2, No. 1 (2005)
       
  • Is an increase in CD4/CD8 T-cell ratio in lymph node fine needle
           aspiration helpful for diagnosing Hodgkin lymphoma? A study of 85 lymph
           node FNAs with increased CD4/CD8 ratio

    • Authors: Osvaldo Hernandez, Thaira Oweity, Sherif Ibrahim
      Pages: 14 - 14
      Abstract: Osvaldo Hernandez, Thaira Oweity, Sherif Ibrahim
      CytoJournal 2005 2(1):14-14
      Background :An elevated CD4/CD8 T-cell ratio on flow cytometry (FCM) analysis has been reported in the literature to be associated with Hodgkin lymphoma (HL). The purpose of our study was to determine the diagnostic significance of an elevated CD4/CD8 ratio in lymph node fine needle aspiration (FNA) specimens. Design :Between 1996 and 2002, out of 837 lymph node FNAs submitted for flow cytometry analysis, 85 cases showed an elevated CD4/CD8 ratio, defined as greater than or equal to 4, without definitive evidence of a lymphoproliferative disorder. The cytologic diagnoses of these 85 cases were grouped into four categories: reactive, atypical, Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL). Histologic follow-up was available in 17/85 (20%) of the cases. Results :5 of the 64 cases in which FCM and cytology did not reveal evidence of a lymphoproliferative disease had tissue follow-up because of persistent lymphadenopathy and high clinical suspicion. 3/5 (60%) confirmed the diagnosis of reactive lymphadenopathy. The two remaining cases (40%) were positive for lymphoma (1HL, 1NHL). 8/15 cases called atypical on cytology had histologic follow-up. 7/8 (87.5%) cases were positive for lymphoma (3HL, 4NHL). 3/4 cases called HL on cytology had tissue follow-up and all 3 (100%) confirmed the diagnosis of HL. One case diagnosed as NHL on cytology was found to be a diffuse large B-cell lymphoma. In summary, out of 17 cases with histologic follow-up 4/17 (24%) were reactive with CD4/CD8 T-cell ratio of 4.1-29, 7/17 (41%) were HLs with CD4/CD8 T-cell ratio of 5.3 - 11, and 6/17 (35%) were NHLs with CD4/CD8 T-cell ratio of 4.2 - 14. Conclusion :An elevated CD4/CD8 ratio on FCM is a nonspecific finding which may be seen in both reactive and lymphoproliferative disorders. The cytomorphologic features of the smear are more relevant than the sole flow cytometric finding of an elevated CD4/CD8 ratio.
      Citation: CytoJournal 2005 2(1):14-14
      PubDate: Fri,9 Sep 2005
      Issue No: Vol. 2, No. 1 (2005)
       
  • Efficiency of an inexpensive liquid-based cytology performed by
           cytocentrifugations: a comparative study using the histology as reference
           standard

    • Authors: Christian Garbar, Corinne Mascaux, Veronique Fontaine
      Pages: 15 - 15
      Abstract: Christian Garbar, Corinne Mascaux, Veronique Fontaine
      CytoJournal 2005 2(1):15-15
      Background :Although liquid-based cytology (LBC) is now recommended for cervical cancer screening, it requires expensive automated devices and materials. To evaluate the efficiency of inexpensive LBC methods relying on an inexpensive fixative liquid, Easyfix ® , we compared the results obtained by the liquid-based cytology (LBC) diagnoses performed by cytocentrifugations (Papspin ® and Turbitec ® ) with those obtained by histology. Furthermore, we evaluated the efficiency of the fixative liquid, Easyfix ® , to preserve HPV DNA in the collected samples. Method :266 LBC were compared with 174 colposcopies and 91 Loop Electrosurgical Excision Procedure (LEEP). Among the LBC, 51 were performed using the Papspin ® system and 215 were performed using the Turbitec ® system. To control the quality of the preservation liquid, Easyfix ® , we correlated the results of HCII assays with those of HPV PCR. Results :For Papspin ® and Turbitec ® systems, the sensitivities were respectively 82.6% (95% CI: 61.2-95.0%, p < 0.001) and 75.0% (95% CI: 64.4-89.8%, p < 0.001) and the specificities were 92.6% (95%CI: 76.5-99.1%, p < 0.001) and 96.2% (95% CI: 91.3-98.7%, p < 0.001). We find no statistical difference between the results of the both systems (p = ns). The sensitivity of the HCII was 86.4% (95% IC: 77.4-92.8%, p < 0.001) and the specificity was 39.4% (95% CI: 31.2-48.1%, p < 0.001). The comparison between HCII and HPV-PCR shows a good correlation: the kappa was 0.89. Conclusion :LBC performed by cytocentrifugations are inexpensive, reduce inadequate smears, show excellent efficiency and allow HPV detection by molecular biology.
      Citation: CytoJournal 2005 2(1):15-15
      PubDate: Thu,15 Sep 2005
      Issue No: Vol. 2, No. 1 (2005)
       
  • Disseminated primary diffuse leptomeningeal gliomatosis: a case report
           with liquid based and conventional smear cytology

    • Authors: Masha Bilic, Cynthia T Welsh, Zoran Rumboldt, Rana S Hoda
      Pages: 16 - 16
      Abstract: Masha Bilic, Cynthia T Welsh, Zoran Rumboldt, Rana S Hoda
      CytoJournal 2005 2(1):16-16
      Background :Primary diffuse leptomeningeal gliomatosis is a rare neoplasm confined to the meninges without evidence of primary tumor in the brain or spinal cord parenchyma. Cerebrospinal fluid diversion via ventriculoperitoneal shunt may be used as a therapeutic modality. Herein, we describe the first report of cytologic findings of a case of this neoplasm with shunt-related peritoneal metastasis. Case presentation :A 19-year-old male presented with a 6-month history of severe headaches. He had bilateral papilledema on physical exam. Cerebrospinal fluid examination was negative. Four months later a ventriculoperitoneal shunt was placed. Shortly thereafter, he was diagnosed with primary diffuse leptomeningeal gliomatosis based on the biopsy of an intradural extramedullary lesion adjacent to the lumbar spinal cord at a referral cancer center. The histology featured an infiltrating growth pattern of pleomorphic astrocytes with diffuse positivity for glial fibrillary acidic protein. A couple of months later he presented at our institution with ascites and an anterior peritoneal mass. Repeat cerebrospinal fluid cytology and fine needle aspiration of the mass confirmed disseminated gliomatosis. Cytologic characteristics included clusters of anaplastic cells of variable size, high nuclear to cytoplasm ratio and scant to moderate cytoplasm. Occasional single bizarre multinucleated cells were seen with eccentric "partial wreath-like" nuclei, clumped chromatin and prominent nucleoli. Patient expired 13 months after initial presentation. Conclusion :Disseminated primary diffuse leptomeningeal gliomatosis should be considered in the differential diagnosis of chronic aseptic meningitis and in the presence of a peritoneal tumor in patients with ventriculoperitoneal shunts. Immunocytochemistry may be of diagnostic value.
      Citation: CytoJournal 2005 2(1):16-16
      PubDate: Tue,20 Sep 2005
      Issue No: Vol. 2, No. 1 (2005)
       
  • Fine needle aspiration biopsy diagnosis of metastatic neoplasms of the
           breast. A three-case report

    • Authors: Raquel Garza-Guajardo, Nora Mendez-Olvera, Juan Pablo Flores-Gutierrez, Silvia Hernandez-Martinez, Cann Michelle Candanosa-Mc, Jesus Ancer-Rodriguez, Oralia Barboza-Quintana
      Pages: 17 - 17
      Abstract: Raquel Garza-Guajardo, Nora Mendez-Olvera, Juan Pablo Flores-Gutierrez, Silvia Hernandez-Martinez, Cann Michelle Candanosa-Mc, Jesus Ancer-Rodriguez, Oralia Barboza-Quintana
      CytoJournal 2005 2(1):17-17
      Metastases to the breast are unusual lesions that make up approximately 2% of all malignant mammary neoplasms and may mimic both benign and malignant primary neoplasms from a clinical point of view, as well as in imaging studies. Arriving at a correct diagnosis is therefore essential in order to establish appropriate management.We present three cases of metastatic neoplasms diagnosed through fine needle aspiration biopsy and immunocytochemistry. The cytological diagnoses were: medulloblastoma in an 18-year-old woman, melanoma in a 26-year-old man, and an exceptional case of ovarian sarcoma originating from a granulosa cell tumor with metastases to both breasts. A metastatic disease should be considered in the differential diagnosis of a palpable mass in the breast, especially if there is a history of an extramammary malignant neoplasm. Fine needle aspiration biopsy is the method of choice for the management of these cases.Whenever possible the exam of the material obtained should be compared to the previous biopsy, which is usually enough to arrive at a correct diagnosis, thus preventing unnecessary surgical procedures.
      Citation: CytoJournal 2005 2(1):17-17
      PubDate: Tue,20 Sep 2005
      Issue No: Vol. 2, No. 1 (2005)
       
  • Primary small cell neuroendocrine carcinoma of the urinary bladder with
           coexisting high-grade urothelial carcinoma: a case report and a review of
           the literature

    • Authors: Marilyn Bui, Walid E Khalbuss
      Pages: 18 - 18
      Abstract: Marilyn Bui, Walid E Khalbuss
      CytoJournal 2005 2(1):18-18
      Primary neuroendocrine carcinomas of the urinary bladder are rare. Here, we report a case of an 82-year-old man who presented with hematuria and was found to have an ulcerated lesion in the bladder. A diagnosis of small neuroendocrine cell carcinoma with coexisting minor high-grade urothelial components was rendered. In this report, the clinical, cytological, histological, and immunohistochemical features of this case are described, and a review of the literature about this neoplasm is presented. The differential diagnoses of small cell tumor in urinary bladder washing specimens are discussed.
      Citation: CytoJournal 2005 2(1):18-18
      PubDate: Fri,4 Nov 2005
      Issue No: Vol. 2, No. 1 (2005)
       
  • Fine needle aspiration diagnosis of extracranial glioblastoma multiforme:
           Case report and review of the literature

    • Authors: Stacey Schultz, Gregory S Pinsky, Nancy C Wu, Marc C Chamberlain, A Sonali Rodrigo, Sue E Martin
      Pages: 19 - 19
      Abstract: Stacey Schultz, Gregory S Pinsky, Nancy C Wu, Marc C Chamberlain, A Sonali Rodrigo, Sue E Martin
      CytoJournal 2005 2(1):19-19
      Background :Hitherto uncommon, the incidence of extracranial metastases of primary brain malignancies may increase, with improved treatment methods and longer patient survival. Fine needle aspiration biopsy is a simple, safe and reliable method to diagnose metastatic malignancy. It has definite advantages over tissue biopsy, which is more invasive and is of higher risk to the patient. Ours is a case of glioblastoma multiforme, which metastasized to the scalp and was diagnosed on fine needle aspiration biopsy. Only a few articles document the cytological features of extracranial glioblastoma multiforme, diagnosed by fine needle aspiration biopsy. Case presentation :We report the case of an elderly female who presented with focal neurological symptoms. She was diagnosed radiologically with an intracranial lesion in the left temporal region, which was subsequently resected. Histology revealed a glioblastoma multiforme confirmed by immunohistochemistry. The tumor recurred subsequently and the patient was treated with chemotherapy, intraoperatively. At a later stage, she presented with a scalp mass on which fine needle aspiration biopsy was performed. The cytomorphological features aided by immunohistochemistry supported a diagnosis of metastatic glioblastoma multiforme. The mass was later resected and histology confirmed the fine needle aspiration diagnosis of glioblastoma multiforme. Conclusion :Reports of extracranial metastases of primary brain tumors are few. When they do occur, the primary cause is implantation during surgery or biopsy. However, spontaneous metastases to other organs do occur rarely. We believe fine needle aspiration biopsy to be very useful in the diagnosis of metastatic glioblastoma multiforme. The ability to use a cellblock for immunohistochemical studies is greatly advantageous and helpful in differentiating this tumor, from other malignancies that can occur in the scalp. A detailed discussion of the material obtained from fine needle aspiration biopsy of metastatic glioblastoma multiforme is presented, as well as a review of previous accounts in the literature.
      Citation: CytoJournal 2005 2(1):19-19
      PubDate: Mon,14 Nov 2005
      Issue No: Vol. 2, No. 1 (2005)
       
  • Primary fallopian tubal transitional cell carcinoma with exfoliation of
           malignant cells in cervical Pap smear

    • Authors: Nalini Gupta, Radhika Srinivasan, Raje Nijhawan, Lakhbir Kaur Dhaliwal
      Pages: 20 - 20
      Abstract: Nalini Gupta, Radhika Srinivasan, Raje Nijhawan, Lakhbir Kaur Dhaliwal
      CytoJournal 2005 2(1):20-20

      Citation: CytoJournal 2005 2(1):20-20
      PubDate: Fri,9 Dec 2005
      Issue No: Vol. 2, No. 1 (2005)
       
  • Fine needle aspiration cytology of primary thyroid lymphoma: A report of
           ten cases

    • Authors: Nalini Gupta, Raje Nijhawan, Radhika Srinivasan, Arvind Rajwanshi, Pinaki Dutta, Anil Bhansaliy, SC Sharma
      Pages: 21 - 21
      Abstract: Nalini Gupta, Raje Nijhawan, Radhika Srinivasan, Arvind Rajwanshi, Pinaki Dutta, Anil Bhansaliy, SC Sharma
      CytoJournal 2005 2(1):21-21
      Primary lymphoma is an uncommon malignancy of the thyroid, comprising of 0.6 to 5 per cent of thyroid cancers in most series. Primary thyroid lymphomas (PTL) occur most commonly in elderly women and are commonly of B- cell origin. These frequently present in clinical stage IE and IIE. We report here ten cases of PTL diagnosed over a period of about 7 years in our institute. Out of these ten cases, nine were diagnosed on fine needle aspiration cytology (FNAC) and one case was misdiagnosed as lymphocytic thyroiditis. This case was diagnosed as Non- Hodgkin's lymphoma on surgical specimen. Five patients are disease free and doing well, while two died of disease and the other two were lost to follow-up. One patient is currently on chemotherapy. The salient clinical, biochemical, radiological features, FNA findings along with diagnostic difficulties are discussed.
      Citation: CytoJournal 2005 2(1):21-21
      PubDate: Fri,9 Dec 2005
      Issue No: Vol. 2, No. 1 (2005)
       
  • CytoJournal joins 'open access' philosophy

    • Authors: Vinod B Shidham, Anthony Cafaro, Barbara F Atkinson
      Pages: 1 - 1
      Abstract: Vinod B Shidham, Anthony Cafaro, Barbara F Atkinson
      CytoJournal 2004 1(1):1-1
      Welcome to CytoJournal ! We would like to introduce you to your journal, one that is run by and for the scientific cytopathology community with incontestable benefits of Open Access, and support from Cytopathology Foundation, Inc. http://www.cytopathology-foundation.org/index.html webcite CytoJournal is a peer-reviewed, PubMed indexed, online journal, publishing research in the field of cytopathology and related areas, with world wide free access.
      Authors submitting to CytoJournal retain the copyright to their hard earned work.
      Citation: CytoJournal 2004 1(1):1-1
      PubDate: Thu,29 Jul 2004
      DOI: 10.1186/1742-6413-1-1
      Issue No: Vol. 1, No. 1 (2004)
       
  • Optimization of an immunostaining protocol for the rapid intraoperative
           evaluation of melanoma sentinel lymph node imprint smears with the
           'MCW melanoma cocktail'

    • Authors: Vinod B Shidham, Richard Komorowski, Virgilia Macias, Sushma Kaul, Glen Dawson, William W Dzwierzynski
      Pages: 2 - 2
      Abstract: Vinod B Shidham, Richard Komorowski, Virgilia Macias, Sushma Kaul, Glen Dawson, William W Dzwierzynski
      CytoJournal 2004 1(1):2-2
      Background: In the management of cutaneous melanoma, it is desirable to complete the regional lymphadenectomy during the initial surgical procedure for wide excision of biopsy site and sentinel lymph node (SLN) biopsy. In this study, we optimized and evaluated a rapid 17 minutes immunostaining protocol. The discriminatory immunostaining pattern associated with the 'MCW Melanoma Cocktail' (mixture of Melan- A, MART- 1, and tyrosinase) facilitated the feasibility of intraoperative evaluation of imprint smears of SLNs for melanoma metastases. Methods: Imprint smears of 51 lymph nodes from 25 cases (48 SLNs and 3 non-SLNs, 1 to 4 SLNs/case) of cutaneous melanoma were evaluated. Results: Sixteen percent, 8/51 lymph nodes (28%, 7/25 cases) were positive for melanoma metastases in immunostained permanent sections with the 'MCW melanoma cocktail'. All of these melanoma metastases, except 1 SLN from 1 case, were also detected in rapidly immunostained wet-fixed and air-dried smears (rehydrated in saline and postfixed in alcoholic formalin). The cytomorphology was superior in air-dried smears, which were rehydrated in saline and postfixed in alcoholic formalin. Wet-fixed smears frequently showed air-drying artifacts, which lead to the focal loss of immunostaining. None of the 5 SLNs from 5 cases exhibiting capsular nevi showed a false positive result with immunostained imprint smears. Conclusions: Melanoma metastases can be detected intraoperatively in both air-dried smears and wet-fixed smears immunostained with the MCW Melanoma cocktail. Air-dried smears rehydrated in saline and postfixed in alcoholic formalin provide superior results and many practical benefits.
      Citation: CytoJournal 2004 1(1):2-2
      PubDate: Fri,6 Aug 2004
      DOI: 10.1186/1742-6413-1-2
      Issue No: Vol. 1, No. 1 (2004)
       
  • The big problem of the missing cytology slides

    • Authors: Ken M Gatter
      Pages: 3 - 3
      Abstract: Ken M Gatter
      CytoJournal 2004 1(1):3-3
      Cytology slides are often unique and irreplaceable. Unlike surgical pathology cases, where additional paraffin sections can be cut, cytology slides often cannot be duplicated because there are only a few direct smears or the diagnostic material is present on a single slide. Cytology slides are often "sent out" to other physicians, laboratories or hospitals, typically so that the pathologist at the institution where the patient will receive treatment can review the slides. Less often, a cytology lab sends out the slides for a second opinion or as part of the discovery process in a lawsuit, where they may or may not be defendants. Rarely, unique and irreplaceable cytology slides are lost. This article presents a hypothetical scenario that is based on reported state appellate court decisions. The article discusses some of the legal issues that will affect the defendant cytologist/cytology lab and the "expert cytologist," and suggests some steps a cytologist/cytology lab can take to minimize the risk of repercussions from a lost unique and irreplaceable cytology slide.
      Citation: CytoJournal 2004 1(1):3-3
      PubDate: Fri,24 Sep 2004
      DOI: 10.1186/1742-6413-1-3
      Issue No: Vol. 1, No. 1 (2004)
       
  • Second edition of 'The Bethesda System for reporting cervical
           cytology' - Atlas, website, and Bethesda interobserver
           reproducibility project

    • Authors: Ritu Nayar, Diane Solomon
      Pages: 4 - 4
      Abstract: Ritu Nayar, Diane Solomon
      CytoJournal 2004 1(1):4-4
      A joint task force of the American Society of Cytopathology (ASC) and the National Cancer Institute (NCI) recently completed a 2-year effort to revise the Bethesda System "blue book" atlas and develop a complementary web-based collection of cervical cytology images. The web-based collection of images is housed on the ASC website, which went live on November 5 th , 2003; it can be directly accessed at http://www.cytopathology.org/NIH/ .
      Citation: CytoJournal 2004 1(1):4-4
      PubDate: Thu,21 Oct 2004
      DOI: 10.1186/1742-6413-1-4
      Issue No: Vol. 1, No. 1 (2004)
       
  • Merkel cell carcinoma in a malignant pleural effusion : Case report

    • Authors: Misty M Payne, Anne E Rader, Denis M McCarthy, William H Rodgers
      Pages: 5 - 5
      Abstract: Misty M Payne, Anne E Rader, Denis M McCarthy, William H Rodgers
      CytoJournal 2004 1(1):5-5
      Background: Merkel cell (neuroendocrine) carcinoma is a small round blue cell malignant neoplasm that primarily presents in the skin. The diagnosis of Merkel cell carcinoma in a pleural fluid is challenging because of the morphological similarity to many other malignant neoplasms. Immunohistochemical stains can be essential to establish the diagnosis of Merkel cell carcinoma. Case presentation: A 77 year-old woman presented with a mass in her right buttock thought clinically to be a boil or sebaceous cyst. Upon histopathologic review including immunohistochemical analysis, a diagnosis of Merkel cell carcinoma was rendered. Wide-excision and sentinel lymph node biopsy revealed negative margins and no evidence of metastasis. Ten months later she complained of bone pain and a bone scan revealed multiple lesions. An abdominal CT scan revealed a T4 vertebral mass and local radiotherapy was administered. Two months later the patient presented with shortness of breath. A chest radiograph showed an effusion and thoracentesis was performed. The fluid was confirmed to contain metastatic Merkel cell carcinoma by cytology and immunohistochemical analysis. Conclusions: Merkel cell carcinoma is an aggressive neoplasm that can, despite careful surgical management, occasionally present as a malignant pleural effusion in a relatively short time period. Immunohistochemical analysis can aid in confirming this rare outcome.
      Citation: CytoJournal 2004 1(1):5-5
      PubDate: Thu,18 Nov 2004
      DOI: 10.1186/1742-6413-1-5
      Issue No: Vol. 1, No. 1 (2004)
       
  • FNAC of Bacillus- Calmette- Guerin lymphadenitis masquerading as
           Langerhans cell histiocytosis

    • Authors: Nalini Gupta, Vijay Kumar, Raje Nijhawan, Radhika Srinivasan, Arvind Rajwanshi
      Pages: 6 - 6
      Abstract: Nalini Gupta, Vijay Kumar, Raje Nijhawan, Radhika Srinivasan, Arvind Rajwanshi
      CytoJournal 2004 1(1):6-6
      Bacillus Calmette Guerin (BCG) lymphadenitis is a well known entity. Disseminated BCG infection usually presents as generalized lymphadenopathy, skin rash and hepatosplenomegaly and at times, can pose a diagnostic challenge to clinicians. There are only a few published studies on the cytological findings of BCG lymphadenitis. In this letter we report the fine needle aspiration cytology (FNAC) of BCG lymphadenitis clinically masquerading as Langerhans cell histiocytosis (LCH). FNA smears showed sheets of foamy macrophages and many polymorphs in a dirty necrotic background with many macrophages as well as polymorphs showing negatively stained rod like structures within their cytoplasm. Zeihl Neelson stain revealed that these cells were heavily loaded with acid fast bacilli (AFB). In the index case, AFB were also seen within the cytoplasm of polymorphs, which has not been documented earlier in the literature.
      Citation: CytoJournal 2004 1(1):6-6
      PubDate: Tue,21 Dec 2004
      DOI: 10.1186/1742-6413-1-6
      Issue No: Vol. 1, No. 1 (2004)
       
 
 
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