Diagnostic Cytopathology最新文献

Invasive breast carcinoma of no special type constitutes the majority of breast cancers in women. Special subtypes with distinctive morphology comprise approximately 25% of breast cancers and cause diagnostic challenges. Adenoid cystic carcinoma (ADCC), a salivary gland-type carcinoma of the breast, is an exceptionally rare entity that shares morphological features and genetic mutations with its salivary gland counterpart. Both cytology and histopathological features of ADCC are unique and allow accurate diagnosis even at unusual sites, such as the breast. Basaloid cells in spherical globules, cords, and cylinders filled with eosinophilic hyaline material are diagnostic cytology findings. Histopathology shows cribriform and pseudo-cystic spaces containing hyaline material. ADCC is an indolent tumor with a good prognosis, even though it is triple-negative on immunohistochemistry. Hence, accurate diagnosis of this unusual tumor with good prognosis is crucial to prevent overtreatment of the patient. Here, we present the cyto-histopathological features and immunohistochemical findings of a rare case of adenoid cystic carcinoma of the breast and discuss its association with a radial scar, which is extremely rare.

Background: Lymphadenopathy is the enlargement of lymph nodes that can be caused by various factors, ranging from infectious to malignant. Fine-needle aspiration cytology (FNAC) is a simple, minimally invasive, and cost-effective diagnostic method for lymphadenopathy.

Objective: This study aimed to evaluate the cytopathological patterns and diagnostic accuracy of fine-needle aspiration in patients presenting with lymphadenopathy.

Methods: A retrospective, hospital-based study was conducted at Hiwot Fana Comprehensive Specialized University Hospital in Eastern Ethiopia, from January 2019 to December 2022. Patients with lymphadenopathy and FNAC were included in this study. Data were collected by extracting information from cytopathology reports. Descriptive statistics were used to describe the independent variables. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with cancerous lymphadenopathy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed to evaluate the diagnostic accuracy of FNAC.

Result: This study included a total of 741 patients with lymph node FNAC. Of those patients, 75.9% were under the age of 30, and 53.4% were male. Cervical lymphadenopathy accounted for 528 (71.3%) of the total lymphadenopathy cases. More than half were diagnosed with tuberculous lymphadenitis (386; 52.1%), followed by reactive lymphadenopathy (226; 30.5%), lymphomas (8.9%), and secondary metastasis (6.7%). The likelihood of malignant lymphadenopathy increased with age, male sex, and involvement of two or more lymph node regions. Lymph node FNAC had an overall diagnostic accuracy of 92.06% with a sensitivity of 86.44%, specificity of 93.78%, PPV of 80.95%, and NPV of 95.77% as compared with lymph node histopathology.

Conclusion: FNAC remains a simple, valid, reliable, rapid, and cost-effective method for diagnosis, treatment, or indicating further diagnostic work-up in resource-limited countries, such as Ethiopia. FNAC has high diagnostic accuracy, preventing unnecessary surgical removal of lymphadenopathy for diagnosis. However, clinicopathological correlation, repeating the FNAC, or performing an incisional lymph node biopsy is recommended for enhanced efficiency.

Introduction: Salivary gland tumors are rare but diverse, with a higher prevalence of benign tumors in the parotid gland and a greater incidence of malignancy in other glands. Fine needle aspiration (FNA), enhanced by the Milan Reporting System, is widely used to evaluate these tumors. This study aimed to assess the diagnostic accuracy of the Milan Reporting System in a Saudi Arabian setting.

Methods: This retrospective study included 117 patients from the western region of Saudi Arabia who underwent salivary gland FNA cytology with histological confirmation. Data were analyzed to evaluate demographic variables, Milan system category distribution, and diagnostic accuracy using SPSS Version 25.

Results: The study cohort had a slight male predominance, with most patients being middle-aged or older. Tumors were most commonly found in the parotid glands. Pleomorphic adenoma and squamous cell carcinoma were the most frequent benign and malignant tumors, respectively, in this study. The Milan Reporting System demonstrated excellent diagnostic performance, with high sensitivity (87.9%), specificity (99.5%), Positive Predictive Value (98.1%), and Negative Predictive Value (96.4%). The system correctly classified all benign tumors, indicating high diagnostic concordance and showed high sensitivity for malignant tumors. Statistical analysis revealed a significant correlation between the Milan Reporting System and histological diagnosis (p = 0.000).

Conclusion: Our study evaluated the Milan Reporting System for salivary gland cytopathology in the western region of Saudi Arabia, revealing it to be a highly reliable screening tool for salivary gland tumors. The system demonstrated exceptional performance, particularly for common entities, such as pleomorphic adenoma and squamous cell carcinoma. This promotes early and accurate detection. However, when malignancy is suspected but the Milan Reporting System results are negative, it is crucial to perform additional confirmatory tests (such as repeating the FNA or performing a core biopsy) to avoid missing a diagnosis of cancer.

Background: Thyroid nodules are common in clinical practice, and fine-needle aspiration cytology (FNAC) remains the primary test for malignancy risk assessment. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) standardizes interpretation and guides management. This study evaluated the distribution of Bethesda categories, risk of neoplasia (RON) and malignancy (ROM), and the impact of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) on risk stratification.

Methods: A retrospective review of 2578 thyroid FNACs (2016-2024) was conducted at King George's Medical University, Lucknow. Cytological diagnoses were classified using TBSRTC (2017 and 2023). Histopathological correlation was available in 1043 cases (40.5%). RON and ROM were calculated for each category, with ROM assessed before and after excluding NIFTP. Smears were independently reviewed by two cytopathologists, and diagnostic metrics (sensitivity, specificity, accuracy) were derived using histopathology as reference; 95% confidence intervals were estimated by exact binomial methods.

Results: Most cases were Benign (73.2%), followed by Malignant (7.2%) and Follicular Neoplasm (6.1%). Malignancy was confirmed in 245 cases. ROM ranged from 3.7%-9.9% (Benign) to 58.6%-100% (Malignant), showing a progressive rise across categories. Reclassification of NIFTP notably reduced ROM for indeterminate categories (AUS: 43.2% → 31.8%; FN: 40.2% → 28.4%; SM: 52.4% → 42.9%).

Conclusion: TBSRTC reliably stratifies malignancy risk in thyroid nodules. Reclassification of NIFTP has a substantial impact on ROM in indeterminate categories, underscoring the need for precise cytologic-histologic correlation and regional validation to optimize patient management.

Malignant mesothelioma (MM) is a rare yet aggressive neoplasm that arises from mesothelial cells lining the thoracic and abdominal cavities, the pericardium, and the tunica testis. Characterized by rapid progression, high invasiveness, and a poor prognosis, MM poses significant clinical challenges. SMARCB1, also referred to as INI-1, hSNF5, or BAF47, is located on chromosome 22q11.2 and serves as a critical subunit of the SWI/SNF chromatin remodeling complex. INI-1 functions as a tumor suppressor and plays a vital role in DNA damage repair and regulation of cell growth. Case Presentation: A 37-year-old Chinese male with no history of asbestos exposure but a 10-year smoking history (30 cigarettes per day) presented with a cough lasting one month and a fever persisting for one day. Computed tomography (CT) showed multiple enlarged supraclavicular lymph nodes measuring up to 30 × 15 mm bilaterally. An ultrasound-guided fine-needle aspiration (FNA) of the left supraclavicular lymph nodes was subsequently performed. The SurePath-prepared liquid-based cytopathology (LBC) using Papanicolaou-staining revealed tumor cells organized in clusters with indistinct borders. The cells exhibited abundant cytoplasm and pleomorphic round nuclei, which displayed prominent nucleoli and mitotic activity. Additionally, scattered lymphoid fragments were observed in the background. The FNA sample was formalin-fixed and paraffin-embedded for cell block; 4-μm thick sections were prepared. Histological examination using HE-stained cell block revealed a solid sheet-like tumor growth characterized by minimal stroma and the absence of fibrovascular cores. The neoplastic cells had well-defined borders, abundant eosinophilic (partially clear) cytoplasm, and round-to-oval nuclei displaying focal atypia, finely dispersed chromatin, and prominent nucleoli. Immunohistochemistry (IHC) demonstrated positive staining for CK(pan), calretinin, D2-40, and SMARCA4, whereas NapsinA, TTF-1, P40, NUT, and WT-1 yielded negative results. The confirmed loss of INI-1 expression ultimately led to the diagnosis of metastatic INI-1 deficient MM. Conclusion: This case highlights the cytomorphological features and immunophenotype of INI-1 deficient MM diagnosed through FNA. An accurate diagnosis requires a thorough clinicopathological correlation and a comprehensive IHC panel.

Neutrophil cannibalism or engulfment by tumor cells is a feature often associated with aggressive malignancies. Although metastatic squamous cell carcinoma is commonly diagnosed by fine needle aspiration cytology, there are only rare reports of neutrophil cannibalism by squamous cell carcinoma in current cytology literature. We present two cases of metastatic squamous cell carcinoma featuring prominent neutrophil cannibalism diagnosed by fine needle aspiration cytology, describe their unique cytologic features, and discuss the prognostic implications of this diagnosis.