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.
Epithelioid malignant peripheral nerve sheath tumor (MPNST) is a rare and aggressive soft tissue sarcoma variant, seldom presenting with lymph node or pleural metastasis. We report a rare instance of a 22-year-old female with recurrent epithelioid MPNST metastasizing to cervical lymph nodes and pleural fluid—a phenomenon rarely documented in literature. Clinical history, cytomorphological assessment, and immunohistochemistry were pivotal in establishing the diagnosis. This case underscores the diagnostic complexity and extreme rarity of epithelioid MPNST metastasizing to serous cavities.
Respiratory cytology plays a vital role in the early diagnosis of pulmonary diseases, particularly lung cancer, which remains a leading cause of cancer-related mortality worldwide. To enhance standardization and reduce inter-observer variability in lung cytology reporting, the World Health Organization (WHO), in collaboration with the IAC and IARC, introduced a new five-tiered reporting system for lung cytopathology in 2023. This study aims to retrospectively apply the WHO system to respiratory samples at a tertiary care center in India and evaluate diagnostic performance and risk of malignancy (ROM) for each category.
A retrospective observational study was conducted from June 2022 to May 2024, analyzing 736 respiratory cytology samples, including BAL, EBUS-TBNA, bronchial wash, bronchial brush, and sputum. Samples were reclassified using the WHO system, and 193 cases had histopathological correlation. ROM was calculated for each category, and diagnostic performance metrics sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) were assessed using histopathology as the gold standard. Given that histologic correlation was available in only 26.2% of cases, diagnostic performance estimates were interpreted with caution and may have been influenced by verification bias.
Of the total cases, 10.2% (75/736) were insufficient/inadequate, 80.1% (589/736) benign, 3.0% (22/736) atypical, 2.0% (15/736) suspicious, and 4.7% (35/736) malignant. The ROM was 43.7% for insufficient, 39.7% for benign, 50.0% for atypical, 75.0% for suspicious, and 100% for malignant. Bronchial brush demonstrated the highest DA (81.3%), while BAL had low sensitivity (10.0%) despite high specificity (98.5%). EBUS-TBNA showed moderate sensitivity (50.0%) and lower specificity (55.6%).
The WHO Reporting System provides an effective framework for stratifying respiratory cytology samples. While categories such as malignant and suspicious showed high diagnostic reliability, false negatives in benign and inadequate categories highlight the need for integrated clinical and radiological assessment. Bronchial brush and wash emerged as the most diagnostically accurate specimen types. Further prospective studies are warranted to validate these findings across broader clinical settings.
Cardiac amyloidosis is a restrictive cardiomyopathy caused by extracellular deposition of misfolded proteins. Abdominal fat pad fine-needle aspiration (FPFNA) has been described as a minimally invasive diagnostic tool for systemic and cardiac amyloidosis.
We present a step-by-step description of the aspiration technique, including sample handling, Congo red staining under polarized light, accompanied by illustrative images.
Abdominal fat pad FPFNA is a simple, inexpensive, and safe procedure. According to published data, it offers moderate to high sensitivity, especially in advanced disease, and can reduce the need for more invasive biopsies.
Folate receptor-⍺ (FR-⍺) is an attractive target for targeted therapy. Mirvetuximab soravtansine (MIRV) has been approved by the United States Food and Drug Administration (FDA) for treating adult patients with FR-⍺ positive, platinum-resistant epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer. Therefore, identifying and detecting FR-⍺ has become an essential part of precision medicine. This study aimed to evaluate the feasibility of detecting FR-⍺ protein expression in serous cavity effusions using cell blocks (CBs) and compare the results with surgical pathology biopsy or resection specimens. Furthermore, we investigated potential variations in FR-⍺ expression pre- and post-chemotherapy.
Immunohistochemical (IHC) staining of FR-⍺ was performed on the serous cavity effusion specimens from 35 patients with epithelial ovarian cancer, along with matched surgical pathological (SP) biopsy or resection specimens, following the manufacturer's guidelines for IHC analysis.
Positive staining was observed in 30 (85.7%) and 32 (91.4%) serous cavity effusion CB and tissue samples, respectively. A total of 31 (88.5%) tissue and 28 (80%) effusion CB samples exhibited moderate-to-strong FR-⍺ expression in at least 25% of tumor cells. A cutoff of 25% for FR-⍺ expression positivity was used to demonstrate high concordance (96.4%) between cytology CBs and tissue specimens. We recommend a cutoff of 75% viable tumor cells with moderate-to-strong membrane staining as “positive” in CBs for greater reliability, which aligns with FDA-approved criteria. A reasonable consistency was observed in FR-⍺ expression between the pre-treatment serous cavity effusion CB specimens and the new biopsy specimens obtained after multiline treatment.
We demonstrated that serous effusion CB specimens may be effective for FR-⍺ biomarker detection; FR-⍺ maintains stable expression pre- and post-chemotherapy, and patients can benefit from MIRV.
Granular cell tumor (GCT) is a rare mesenchymal neoplasm that is believed to originate from Schwann-like mesenchymal cells. It affects more women than men with an F:M ratio of 5:4 and can involve various body sites such as peripheral soft tissues, trunk, and head and neck. Multiple lesions can be seen in up to 15% patients. Most of GCT are benign with indolent behavior. Rare cases show cytological atypia and considered histologically malignant; or show metastasis and considered clinically malignant. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is widely used nowadays for the diagnosis of epithelial malignancies of the gastrointestinal tract and pancreatobiliary tract. Its efficacy for submucosal and intramural mesenchymal lesions is focused primarily on gastrointestinal stromal tumors (GIST) because of their higher incidence compared with other mesenchymal lesions. Biliary tract GCT is rarely reported in the literature. Preoperative diagnosis of GCT has important therapeutic and prognostic value. Formulating such a diagnosis using cytologic smears alone is extremely challenging, but a definitive and accurate diagnosis is possible when cytomorphology is coupled with optimal cellularity and immunohistochemistry studies on the concurrent cellblock or tissue biopsy. Here we report the first case of biliary GCT diagnosed by EUS-FNA cytology and concurrent biopsy without surgical resection, which endorses the clinical utility of EUS-FNA cytology on evaluating biliary lesions and broaden our differential diagnosis of biliary neoplasms.
Rosette-forming epithelioid osteosarcoma is an extremely rare type of osteosarcoma. This report describes a man in his early 50s with a destructive right iliac bone/acetabulum mass showing osseous destruction and extensive soft tissue involvement. Cytohistologic examination revealed osteosarcoma with epithelioid neoplastic cells arranged in rosettes. The neoplastic cells were immunoreactive for SATB2, TTF1, and CDX2. The osteoid was better appreciated in the H&E-stained materials. The cytohistological features, immunohistochemical profile, and differential diagnoses are discussed. Attention to details regarding the identification of osteoid in both cytology and histology materials is emphasized.
Fine-needle aspiration cytology (FNAC) remains widely used for the evaluation of palpable breast lesions, particularly in resource-limited settings, though histopathology is the gold standard. The International Academy of Cytology (IAC) Yokohama System provides a standardized five-tier reporting framework with defined risk of malignancy (ROM). This study aimed to evaluate its diagnostic performance, reproducibility, and applicability in a tertiary care setting.
A total of 548 breast FNACs from 533 patients were reclassified both prospectively and retrospectively according to the IAC Yokohama categories. Histological correlation was available in 228 cases. Interobserver agreement was assessed among two senior cytopathologists and one junior pathologist using unweighted and weighted kappa statistics. Diagnostic performance was calculated against histology using three definitions of test positivity (Cat-5 only; Cat-4 & 5; Cat-3–5).
A total of 548 FNACs from 533 patients were reclassified using the IAC Yokohama system: Cat-1 (36, 6.6%), Cat-2 (318, 58.0%), Cat-3 (14, 2.6%), Cat-4 (25, 4.6%), and Cat-5 (155, 28.3%). Histological correlation was available in 228 cases. The observed ROM was 50% for Cat-1, 7.9% for Cat-2, 45.5% for Cat-3, 93.8% for Cat-4, and 100% for Cat-5. Diagnostic accuracy improved with reclassification: in Group A (Cat-5 positive), sensitivity increased to 78.4% and specificity was 100%; in Group B (Cat-4 & 5 positive), sensitivity was 90.9% and specificity was 97.9%; and in Group C (Cat-3–5 positive), sensitivity reached 94.7% with a specificity of 89.6%. ROC analysis confirmed superior discrimination for the Yokohama system (AUC 0.94 vs. 0.88 for the original). Interobserver reproducibility was excellent, with weighted kappa values of 0.954 (P1 vs. P2), 0.942 (consensus vs. P3), and 0.939 (P2 vs. P3). Agreement was highest in benign and malignant categories and lowest in atypical and suspicious groups.
The IAC Yokohama System showed high diagnostic accuracy, excellent reproducibility, and reliable risk stratification. By reducing false negatives and minimizing equivocal reporting, it improved alignment with histology compared with the conventional descriptive system, supporting its routine use in breast cytology practice.
Asteroid bodies are rare cytoplasmic inclusions within multinucleated giant cells, most classically associated with sarcoidosis but also encountered in other granulomatous and reactive conditions. Their recognition in cytology is uncommon and diagnostically challenging. We present the case of a 30-year-old female with a post-traumatic forehead swelling in which fine needle aspiration cytology (FNAC) revealed numerous foreign body-type giant cells containing asteroid bodies. This case highlights the cytomorphological spectrum of asteroid bodies outside systemic sarcoidosis, their differential diagnoses, and their clinical relevance.
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