Salivary duct carcinoma (SDC) is a relatively rare, highly aggressive tumor with a poor prognosis that can be challenging to distinguish on cytology specimens. Awareness of the cytomorphologic and immunocytochemical findings is essential in arriving at a definitive diagnosis. This case report describes the primary diagnosis of a metastatic SDC on effusion fluid cytology.
Therapeutic modalities used in bladder lesions/neoplasms (electrocautery, fulguration, and laser) could produce morphologic alterations leading to diagnostic challenges. While often seen on histology, they can present in urine cytology as atypia or even raise the concern for malignancy. Herein, we present clinicopathologic findings of four patients with cautery artifact in urine cytology.
The authors' lists and a computerized search of urine cytology with features of thermal cautery artifact were collated. Slides and clinicopathologic variables (prior specimens, concurrent and follow-up surgical specimens, age, sex, manner of urine collection, cystoscopy, and treatment procedure during cystoscopy) were reviewed.
Four cases were identified. Procedures performed during cystoscopy included laser therapy (n = 2), postbiopsy cauterization (n = 1), and fulguration (n = 1). All cases showed spindled cells with delicate bipolar cytoplasm, “cigar-shaped” nuclei, smooth to slightly irregular nuclear membranes, and arranged singly and loosely cohesive to lamellar stacks. Few atypical well-preserved, undistorted cells were identified in 2/4. The concurrent biopsies showed superficial cellular fragments with thermal artifact (n = 1) and rare atypical cells (n = 2). Follow-up biopsies in two cases had high-grade urothelial carcinoma both of which were diagnosed as atypical urothelial cells on cytology.
Thermal cautery artifact in urine cytology is rare and can be seen following laser, electrocautery, and fulguration. The spindling artifact can render some degree of difficulty in assessing for the presence of urothelial atypia both in cytology and biopsy. Familiarity with these cytologic features, knowledge of the treatment procedure, attention to the cytologic findings of well-preserved cells and repeat sampling in cases with atypical urothelial cells in patients with history of malignancy is essential.
The relationship between pleural fluid volume and cytological diagnosis of malignancy has been often investigated with conflicting conclusions on whether or not a minimum fluid volume should be defined. The primary objective of this retrospective investigation is to evaluate the relationship between fluid volume and cytological diagnosis of malignancy.
A total of 511 body fluid specimen reports received between January 2018 and December 2019 were examined to investigate the relationship between diagnosis of malignancy to volume and biochemical properties. Pleural fluid (n = 252) and peritoneal fluid (n = 250) specimens were binned into two volume groups (< 75 mL, ≥ 75 mL). Pericardial fluid specimens (n = 9) were excluded due to small sample size.
Prevalence of malignancy for pleural and peritoneal fluids was 20.2% and 20.08%, respectively, with no significant difference between the two volume groups. Malignant pleural effusions were associated with a serum to fluid protein ratio > 0.5 and malignant peritoneal effusions were associated with a serum ascites albumin gradient (SAAG) < 1.1 g/dL.
Our study did not find a significant difference in the diagnosis of malignancy between volumes ≥ 75 mL and < 75 mL in either pleural or peritoneal fluid. Fluid volume is, therefore, not an adequacy criterion for detecting malignancy in either pleural or peritoneal fluid. Our analysis on the biochemical properties of each malignant fluid type was supportive of current use of Light's criteria and SAAG for effusion fluid evaluation.
Serous effusion fluids serve as crucial cytological materials in diagnosing the underlying causes of fluid accumulation in various body cavities. The International System for Reporting Serous Fluid Cytopathology (TIS) outlined atypia of undetermined significance (AUS) and suspicious for malignancy (SFM) as two intermediate categories for atypical fluids.
In our study, cases diagnosed as “atypical” by an experienced cytopathologist in the Hacettepe University Department of Pathology, between 2014 and 2023, were re-categorized according to TIS. The risk of malignancy (ROM) for AUS and SFM categories was calculated. Additionally, cases were re-evaluated according to the 5-tier categorical system by two observers with different level of experience.
A total of 3501 effusion fluids were included in the study, evaluated between 2014 and 2023. 50.7% of the cases were male, and 49.3% were female. 55.2% of the cases were pleural fluid, 41.5% were peritoneal fluid, and 3.3% were pericardial fluid. Two hundred sixty five cases (7.6%) were non-diagnostic, 2160 (61.7%) were negative for malignancy, 111 (3.2%) were AUS, 83 (2.4%) were SFM, and 883 (25.2%) were malignant (M). ROM calculated 27% for AUS, 49% for SFM 49%. The interobserver agreement for AUS was 46% with kappa value of 0.162, and 42% for SFM with kappa value of 0.188.
The differentiation of atypical cases into AUS and SFM is effective in determining the ROM. The interobserver agreement tends to be lower in intermediate categories compared to others, emphasizing the potential significance of clinical expertise in diagnosis.
A. Almajnooni, M. Vega, L. Cheng, P. Gattuso, and M. K. Allen-Proctor, “Middle Ear Adenoma: Cytohistologic Features and Differential Diagnosis,” Diagnostic Cytopathology 51, no. 4 (2023): E137–E141, https://doi.org/10.1002/dc.25103.
There is a missing affiliation for the first author (Almajnooni, A.). The missing affiliation is: Department of Pathology, Qunfudah College of Medicine, Umm Al-Qura University, Makkah, Saudia Arabia.
We apologize for this error.
The Paris System (TPS) diligently detects high-grade urothelial carcinoma (HGUC) and creates a uniform, standardized, reproducible reporting system for urine cytology. However, many centres might still use a common reporting system (CRS). The study aims to compare TPS and CRS for urine cytology with histology correlation.
It was a cross-sectional study done from July 2016 to December 2022.
The study included 829 urine cytology samples (96% voided urine) from 478 patients. Histology correlation was available for 138 (16.6%) samples of 115 patients. The frequency of NHGUC, AUC, HGUC and SHGUC was 40.6%, 17.4%, 12.2% and 5.5%, respectively, in TPS. In contrast, in CRS, the frequency of NM, AUS, SM and PM was 69.2%, 13.3%, 4.5% and 13.0%, respectively. TPS and CRS had 64% agreement overall with the kappa test (κ-value 0.479, moderate strength). The agreement between TPS and CRS was 39.8% for NHGUC, 10.97% for AUC and 10.85% for HGUC. After combining a few TPS categories, the agreement increased to 87.7% (κ-value 0.7640, good strength). Histological concordance for AUC, HGUC and NHGUC was 75%, 31.8% and 31.3% in TPS, and it was 50% and 33.3% for AUS and PM, respectively, in CRS. The sensitivity and specificity of TPS and CRS against histology were 37.5% vs. 26.0%, p = 0.0005 and 76.5% vs. 85.3%, p = 0.0083, respectively.
TPS and CRS have moderate strength of agreement for urine cytology. TPS was more sensitive than CRS. It may be easy for institutes to transition to a newer TPS system if they still use a CRS.
Pancreatoblastoma is a rare malignant neoplasm. Cytologic diagnosis is challenging due to the tumor's heterogeneity and requirement of the presence of squamoid nests. Commonly affects children, but the tumor rarely is seen in adult patients. We are reporting three cases from two patients. First patient was a 38-year-old male with a mass in the pancreatic body and numerous hepatic lesions. Fine-needle aspiration (FNA) of the pancreas showed a biphasic malignancy, predominantly composed of a primitive component with intermingled squamoid nests. Subsequent Liver FNA from the same patient showed a similar biphasic malignancy. NUT carcinoma was the top differential and was ruled out by molecular testing. Second patient was a 24-year-old female with a history of pancreatoblastoma related to Gardner's syndrome initially diagnosed in 2015 at age 17, status post distal pancreatectomy and chemotherapy. Celiac lymph node FNA in 2021 showed few cohesive clusters of atypical epithelioid cells, which were highlighted by beta-catenin. Lastly, the literature was reviewed; differential diagnosis and ancillary testing were discussed.
Cell blocks (CB) are an established technique in non-gynecological cytology, but experience in gynecological cytology is still relatively limited. In this study, we compared the diagnostic agreement between liquid-based cytology (LBC) and CB using whole slide digital imaging (WSI).
WSI of 82 specimens (41 LBC and 41 CB) were evaluated independently by three observers.
The overall agreement was 0.463 for all 82 cases including both LBC and CB, 0.439 for LBC alone, and 0.484 for CB alone. Agreement was highest for HSIL, NILM, cancers and lower for borderline (ASC-US, ASC-H). There was no significant difference in agreement between LBC and CB.
WSI of CB can be used for the diagnosis of cervical lesions and may be particularly useful in cases with high atypical cellularity or large hyperchromatic cell groups.
Fumarate hydratase (FH)-deficient renal cell carcinoma (RCC) is a rare, aggressive, hereditary subtype of renal cancer that requires careful diagnostic considerations. We report a case of a 33-year-old Asian woman who presented with a 20-day history of hematuria. Imaging studies revealed a solid tumor in the lower pole of the right kidney with lymph node metastases. Urinary cytology revealed benign squamous cells, inflammatory cells, and atypical epithelial cells, suggestive of high-grade urothelial carcinoma. Following a right nephrectomy, the tumor displayed papillary structures composed of cells exhibiting atypical, elongated nuclei with eosinophilic nucleoli and peripheral halos. Immunohistochemical staining demonstrated negative FH expression. Genetic analysis identified a somatic missense mutation in the FH gene, confirming the diagnosis of FH-deficient RCC. This case highlights the importance of integrating cytological, histological, and genetic analyses for accurate diagnosis of FH-deficient RCC.
Cytology has long been a major screening method for cervical cancer prevention. Human papillomavirus (HPV) testing has recently been introduced for cervical cancer screening, and HPV tests become a major screening method in some countries. To seek the optimal strategy considering the cost-effectiveness for cervical cancer screening, we compared the performance of primary LBC, primary HPV test, and LBC plus HPV co-test in real practice.
From March 2016 to June 2018, 3742 patients were included in this study. Liquid-based cytology (LBC), HPV test, and histopathological assessment were performed in 3727, 1063, and 508 cases, respectively. The sensitivity, specificity, and cost–benefit effects of primary HPV, primary LBC, and co-test algorithms were simulated for 317 cases with LBC, HPV, and histopathological results.
On the LBC, 13.0% of the cases were diagnosed with atypical squamous cells of undetermined significance or higher grade lesions. In the HPV test, high-risk HPV was found in 43.5%, and 11.9% was positive for HPV type 16 or 18. Among the three simulated algorithms, the co-test demonstrated the best sensitivity (97.5%) and the lowest specificity (50.3%). The primary LBC demonstrated the best specificity (53.5%) and a slightly better sensitivity, compare with the primary HPV (95.1% vs. 93.8%). Using the primary LBC algorithm, 82.0% can be determined without additional HPV test, whereas 50.1% could be determined without additional LBC using the primary HPV algorithm.
The primary LBC algorithm for uterine cervical cancer (UCC) screening is comparable to the primary HPV algorithm and has the best cost–benefit effect among the three algorithms.
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