Diagnostic Cytopathology最新文献_第6页

Pleomorphic Liposarcoma Cytologically Detected in Hemosiderotic Pleural Effusion: Pitfalls Mitigated by Cytologic Clues and Cellblock Immunocytochemistry 血性胸腔积液中细胞学检测出的多形性脂肪肉瘤：通过细胞学线索和细胞阻断免疫细胞化学减少陷阱。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2024-08-27 DOI: 10.1002/dc.25399

Badr AbdullGaffar, Tasnim Keloth

Sarcomatous serous effusions are uncommon and diagnostically challenging. Dedifferentiated and pleomorphic liposarcomas are rare tumors in pleural effusions revealing highly pleomorphic tumor cells mimicking carcinoma, mesothelioma, melanoma, and other sarcomas. Hematothoracic effusions further complicate the cytologic diagnosis. Correct cytologic recognition is important. We report pleomorphic liposarcoma cytologically detected in effusion fluid in a 56-year-old man who presented with a massive unilateral pleural effusion. ThinPrep showed hemorrhagic effusion fluid characterized by lysed red blood cells, foamy macrophages, and siderophages intermixed with highly pleomorphic predominantly naked mononuclear and giant nuclei. The aggregated siderophages and vacuolated macrophages could be mistaken for tumor cells, whereas the bare nuclei may be missed as nonspecific degenerate changes. Cellblock sections showed highly pleomorphic mononuclear and multinucleated giant tumor cells with diagnostic lipoblasts, intermixed with foamy macrophages and siderophages. Cellblock immunocytochemistry showed staining for vimentin and S-100 protein in the tumor cells. Other lineage-specific immunomarkers were negative. CD68 and calretinin revealed frequent background macrophages and scarce mesothelial cells. The tumor cells were negative for MDM2 and CDK4. The entertained cytopathologic diagnosis was pleomorphic liposarcoma. Core needle biopsy was procured from the mass. The histopathologic features and immunoprofile of the tissue specimen matched the cytopathologic and immunocytochemical findings confirming the cytologic diagnosis of pleomorphic liposarcoma. Pleomorphic liposarcoma is an unexpected cytologically challenging finding in effusions, particularly when compounded by pitfalls introduced by hemosiderotic fluid. Attention to certain cytologic clues mitigate pitfalls. Cellblock is a valuable diagnostic tool when integrated with relevant negative and positive immunocytochemical markers.

肉瘤性浆液性渗出液并不常见，在诊断上具有挑战性。脱分化和多形性脂肪肉瘤是胸腔积液中罕见的肿瘤，可显示高度多形性的肿瘤细胞，模仿癌、间皮瘤、黑色素瘤和其他肉瘤。血胸腔积液使细胞学诊断更加复杂。正确的细胞学识别非常重要。我们报告了在一名 56 岁男性的渗出液中细胞学检测到多形性脂肪肉瘤的病例，该患者出现大量单侧胸腔积液。ThinPrep 显示出血性渗出液的特征是溶解的红细胞、泡沫状巨噬细胞和嗜酸性粒细胞与高度多形性的裸单核和巨核混杂在一起。聚集的嗜酸性粒细胞和空泡状巨噬细胞可能被误认为是肿瘤细胞，而裸核则可能被误认为是非特异性变性变化。细胞块切片显示高度多形的单核和多核巨型肿瘤细胞，带有诊断性脂母细胞，与泡沫状巨噬细胞和嗜酸性粒细胞混杂在一起。细胞块免疫细胞化学显示，肿瘤细胞中有波形蛋白和S-100蛋白染色。其他细胞系特异性免疫标志物呈阴性。CD68 和钙网蛋白显示，背景巨噬细胞频繁出现，间皮细胞稀少。肿瘤细胞的 MDM2 和 CDK4 阴性。细胞病理学诊断为多形性脂肪肉瘤。对肿块进行了穿刺活检。组织病理学特征和组织标本的免疫图谱与细胞病理学和免疫细胞化学结果相符，证实了多形性脂肪肉瘤的细胞学诊断。多形性脂肪肉瘤是一种意想不到的具有细胞学挑战性的流出液发现，尤其是当血丝液带来的隐患时更是如此。注意某些细胞学线索可减少误诊。细胞阻滞与相关的阴性和阳性免疫细胞化学标记物相结合，是一种有价值的诊断工具。

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引用次数: 0

Cytologic Findings and Ancillary Tests Results of Sclerosing Pneumocytoma: Our Institutional Experience 硬化性肺细胞瘤的细胞学发现和辅助检查结果：我们机构的经验。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2024-08-20 DOI: 10.1002/dc.25396

Maria Luisa C. Policarpio-Nicolas, Sydnee Webb, Elizabeth M. Azzato, Rema Rao Chaari, Erika Hissong, Jennifer A. Brainard

Introduction

Sclerosing pneumocytoma (SP) is a rare benign tumor and a potential diagnostic pitfall. Our aim was to review the cytologic features of our surgically diagnosed SP cases including the clinical, immunohistochemical and available molecular findings.

Materials and Methods

A computerized search from 2013 to 2020 for surgical cases with corresponding cytology specimens diagnosed as SP was performed. The clinical data, cytology, and surgical specimens were collated for analysis.

Results

Six cytology specimens were collected. All were female (mean age = 35). Three have incidental lung nodules and three with cough. Cytologic findings showed variable architectural pattern (papillary, solid, singly scattered, acinar/rosette-like) and cellular heterogeneity (surface, stromal, epithelioid, plasmacytoid cells). Atypia was identified in 4/6 cases. The original cytology diagnoses were negative = 1, SP = 2 and adenocarcinoma = 3. The latter diagnoses were amended to SP after review of the surgical specimens. The three false positive cases on review have cytologic features mimicking adenocarcinoma. Immunohistochemical stains showed tumor cells (surface and stromal) were positive for TTF-1, and EMA with only the surface cells positive for pancytokeratin and Napsin A. Though two cases sent for molecular testing were negative for AKT1 or CTNNB1 exon 3 mutation, our panel did not evaluate AKT1 exon 4.

Conclusions

SP is a diagnostic pitfall with 50% initially misdiagnosed as adenocarcinoma. Integrating the clinical/radiologic findings, cytologic features, and performance of immunohistochemistry on cell block are helpful in avoiding misdiagnosis. Molecular testing for recurrent mutations, if present, could be helpful for diagnosis and possible therapy options. However, routinely used molecular testing may not always capture relevant molecular markers for SP.

简介：硬化性肺细胞瘤（SP硬化性肺细胞瘤（SP）是一种罕见的良性肿瘤，也是一个潜在的诊断陷阱。我们的目的是回顾经手术确诊的SP病例的细胞学特征，包括临床、免疫组化和现有的分子研究结果：对 2013 年至 2020 年期间诊断为 SP 的手术病例及相应的细胞学标本进行了计算机检索。对临床数据、细胞学和手术标本进行整理分析：结果：共收集到六份细胞学标本。所有标本均为女性（平均年龄 = 35 岁）。其中三例为偶发性肺结节，三例伴有咳嗽。细胞学结果显示了不同的结构模式（乳头状、实性、单个散在、针尖状/玫瑰花状）和细胞异质性（表面细胞、基质细胞、上皮样细胞、浆细胞）。4/6的病例中发现了非典型细胞。最初的细胞学诊断为阴性 = 1 例、SP = 2 例和腺癌 = 3 例。在对手术标本进行复查后，后一项诊断被修正为 SP。经复查，3 例假阳性病例的细胞学特征与腺癌相似。免疫组化染色显示肿瘤细胞（表面和基质）的TTF-1和EMA阳性，只有表面细胞的pancytokeratin和Napsin A阳性。尽管送去进行分子检测的两个病例的AKT1或CTNNB1第3外显子突变均为阴性，但我们的专家小组并未对AKT1第4外显子进行评估：SP是一个诊断陷阱，50%的病例最初被误诊为腺癌。综合临床/放射学检查结果、细胞学特征和细胞块免疫组化结果有助于避免误诊。如果存在复发性突变，分子检测有助于诊断和可能的治疗方案。然而，常规使用的分子检测并不总能捕捉到与 SP 相关的分子标记物。

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引用次数: 0

Salivary Gland Neoplasm of Uncertain Malignant Potential (SUMP) (Milan IVB) and Its Subgroups: A Multi-Institutional Analysis of Risk of Neoplasm and Malignancy 恶性潜能不确定的唾液腺肿瘤（SUMP）（米兰 IVB）及其亚组：肿瘤和恶性肿瘤风险的多机构分析。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2024-08-20 DOI: 10.1002/dc.25394

Rong Xia, Issa Hindi, Deepika Savant, Samer Khader, Sigfred Lajara, Brendan Belovarac, Kasturi Das, Karen Chau, Mohammed Abdelwahed, Amr Ali, Oliver Szeto, Osvaldo Hernandez, Wei Sun, Cheng Z. Liu, Fang Zhou, Aylin Simsir, Tamar C. Brandler

Objectives

Fine needle aspiration (FNA) plays a crucial role in their initial assessment of salivary gland neoplasms. In the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), the category of Salivary Gland Neoplasm of Uncertain Malignant Potential (SUMP) categorizes lesions with ambiguous features. This study aims to investigate the risk of neoplasm (RON) and risk of malignancy (ROM) within different subgroups of SUMP lesions using data from three large academic institutions.

Methods

We analyzed salivary gland (FNA) cases from three academic institutions post-MSRSGC implementation. Salivary gland FNA cases categorized as Milan IVB (SUMP) with subsequent surgical pathology follow-up were analyzed. Cases were divided into basaloid, oncocytic, and clear cell SUMP subtypes, with RON and ROM assessed and compared.

Results

Out of 1377 MSRSGC cases, 231 were SUMP (16.8%), with 101 subjected to surgical pathology follow-up. The overall ROM for SUMP was 20.8%, with variations of 10% to 29.5% observed amongst institutions, but no significant difference was observed among three institutions (p = 0.15). Basaloid and oncocytic SUMP displayed 17.1% and 20.5% ROM, respectively, without significant disparity. However, all clear cell SUMP cases were malignant on surgical resection.

Conclusions

This study highlights the variability in ROM for SUMP lesions and the significantly higher ROM in SUMP cases with clear cell features. These findings emphasize the importance of accurately subcategorizing SUMP lesions, particularly those with clear cell features, for appropriate clinical management.

目的：细针穿刺术（FNA）在唾液腺肿瘤的初步评估中起着至关重要的作用。在米兰唾液腺细胞病理学报告系统（MSRSGC）中，恶性潜能不确定的唾液腺肿瘤（SUMP）类别将特征不明确的病变归为一类。本研究旨在利用三所大型学术机构的数据，调查不同亚组 SUMP 病变的肿瘤风险（RON）和恶性风险（ROM）：我们分析了三个学术机构在实施MSRSGC后的唾液腺（FNA）病例。我们分析了被归类为米兰 IVB（SUMP）的唾液腺 FNA 病例，并进行了后续手术病理随访。病例被分为基底细胞型、肿瘤细胞型和透明细胞型 SUMP 亚型，并对 RON 和 ROM 进行了评估和比较：结果：在1377例MSRSGC病例中，231例为SUMP（16.8%），其中101例进行了手术病理随访。SUMP的总体ROM为20.8%，各机构之间的差异在10%至29.5%之间，但三家机构之间无明显差异（P = 0.15）。基底细胞和肿瘤细胞SUMP的ROM分别为17.1%和20.5%，无明显差异。然而，所有透明细胞 SUMP 病例在手术切除时均为恶性：本研究强调了SUMP病变ROM的可变性，以及具有透明细胞特征的SUMP病例ROM明显较高。这些发现强调了对 SUMP 病变，尤其是具有透明细胞特征的 SUMP 病变进行准确分类以进行适当临床管理的重要性。

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引用次数: 0

Pitfalls in Cytological Diagnosis of Extra Adrenal Paraganglioma and Pheochromocytoma: Experience From a Tertiary Care Center 肾上腺外副神经节瘤和嗜铬细胞瘤细胞学诊断的误区：一家三级医疗中心的经验。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2024-08-17 DOI: 10.1002/dc.25390

Raktim Mukherjee, Soumya Dey, Farjana Khatun, Firdous Wasim Sk, Oindrila Das, Debansu Sarkar, Krishnendu Maiti, Uttara Chatterjee

Background

Pheochromocytoma and extra-adrenal paragangliomas increasingly coming into light nowadays because of improved imaging techniques and biochemical investigations. There is sparse literature available regarding cytological findings of adrenal and extra-adrenal paragangliomas.

Material and Methods

We studied 16 cytological specimens retrospectively over a period of 3 years, where subsequent histological diagnosis of phaeochromocytoma or paraganglioma was available.

Results

A total of 16 cytology specimens were studied. Nine patients had adrenal SOLs and seven patients had extra-adrenal lesions. Age range was 12 to 60 years Majority of the cytology smears were cellular (87.5%). The smears were composed of small clusters as well as dispersed plasmacytoid cells with eccentric nuclei containing salt and pepper chromatin and moderate to abundant granular cytoplasm. Large cellular clusters mimicking the Zellballen pattern was present in one case. Anisonucleosis was mild to moderate, except in three cases where marked anisonucleosis posed diagnostic challenges. The background was hemorrhagic in all cases, however, two cases in addition had necroinflammatory background. All cases lacked mitotic activity and cytoplasm was delicate with indistinct cell borders. Bare oval nuclei were a frequent finding. Nuclear grooves or cytoplasmic vacuoles were absent. In 12 out of 16 cases, the initial cytological diagnosis correlated with final histological diagnosis, with an overall diagnostic accuracy of 75%. Four misdiagnosed cases had some atypical cytological features like marked anisonucleosis, necroinflammatory background, and presence of prominent nucleoli.

Conclusion

Here we have highlighted some of the distinguishing cytological features that can help in cytological diagnosis of paragangliomas. Hemorrhagic background with plasmacytoid morphology, granular cytoplasm, naked nuclei, and absence of mitosis are useful clues.

背景：由于成像技术和生化检查的改进，嗜铬细胞瘤和肾上腺外副神经节瘤日益受到关注。有关肾上腺和肾上腺外副神经节瘤细胞学检查结果的文献很少：我们对 16 例细胞学标本进行了为期 3 年的回顾性研究，这些标本的组织学诊断结果为嗜铬细胞瘤或副神经节瘤：共研究了 16 份细胞学标本。结果：共研究了 16 份细胞学标本，其中 9 例为肾上腺 SOL，7 例为肾上腺外病变。年龄介于 12 岁至 60 岁之间，大部分细胞涂片为细胞涂片（87.5%）。涂片由小的细胞团和分散的浆细胞组成，细胞核偏心，含有盐和胡椒染色质以及中等至大量颗粒状细胞质。其中一个病例出现了模仿 Zellballen 模式的大细胞簇。除三例病例的明显异核现象给诊断带来困难外，其他病例的异核现象均为轻度至中度。所有病例的背景均为出血性，但有两例病例还伴有坏死性炎症背景。所有病例均缺乏有丝分裂活动，细胞质细腻，细胞边界不清。经常发现裸椭圆形核。核沟或细胞质空泡缺失。在 16 个病例中，有 12 个病例的最初细胞学诊断与最终组织学诊断相关，总体诊断准确率为 75%。4例误诊病例具有一些不典型的细胞学特征，如明显的无核、坏死性炎症背景和突出的核小体：在此，我们强调了一些有助于副神经节瘤细胞学诊断的细胞学特征。出血背景与浆细胞形态、颗粒状胞质、裸核和无有丝分裂是有用的线索。

{"title":"Pitfalls in Cytological Diagnosis of Extra Adrenal Paraganglioma and Pheochromocytoma: Experience From a Tertiary Care Center","authors":"Raktim Mukherjee, Soumya Dey, Farjana Khatun, Firdous Wasim Sk, Oindrila Das, Debansu Sarkar, Krishnendu Maiti, Uttara Chatterjee","doi":"10.1002/dc.25390","DOIUrl":"10.1002/dc.25390","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pheochromocytoma and extra-adrenal paragangliomas increasingly coming into light nowadays because of improved imaging techniques and biochemical investigations. There is sparse literature available regarding cytological findings of adrenal and extra-adrenal paragangliomas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We studied 16 cytological specimens retrospectively over a period of 3 years, where subsequent histological diagnosis of phaeochromocytoma or paraganglioma was available.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 16 cytology specimens were studied. Nine patients had adrenal SOLs and seven patients had extra-adrenal lesions. Age range was 12 to 60 years Majority of the cytology smears were cellular (87.5%). The smears were composed of small clusters as well as dispersed plasmacytoid cells with eccentric nuclei containing salt and pepper chromatin and moderate to abundant granular cytoplasm. Large cellular clusters mimicking the Zellballen pattern was present in one case. Anisonucleosis was mild to moderate, except in three cases where marked anisonucleosis posed diagnostic challenges. The background was hemorrhagic in all cases, however, two cases in addition had necroinflammatory background. All cases lacked mitotic activity and cytoplasm was delicate with indistinct cell borders. Bare oval nuclei were a frequent finding. Nuclear grooves or cytoplasmic vacuoles were absent. In 12 out of 16 cases, the initial cytological diagnosis correlated with final histological diagnosis, with an overall diagnostic accuracy of 75%. Four misdiagnosed cases had some atypical cytological features like marked anisonucleosis, necroinflammatory background, and presence of prominent nucleoli.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Here we have highlighted some of the distinguishing cytological features that can help in cytological diagnosis of paragangliomas. Hemorrhagic background with plasmacytoid morphology, granular cytoplasm, naked nuclei, and absence of mitosis are useful clues.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":"52 12","pages":"747-755"},"PeriodicalIF":1.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Extra-Adrenal Paraganglioma on Fine-Needle Aspiration Cytology: A Case Series 细针抽吸细胞学显示的肾上腺外副神经节瘤：病例系列。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2024-08-17 DOI: 10.1002/dc.25397

Aribah Atiq, Zubaria Rafique, Ujyara Maryam Lone, Azra Bashir, Faria Waqar Khan, Akhtar Sohail Chughtai

Paragangliomas (PGs) are rare tumors that most commonly occur in the head and neck region and along the sympathetic chain. Fine-needle aspiration cytology is not commonly used for the diagnosis of PG due to the potential risk of hemorrhage and hypertensive crisis. As a result, limited studies describe the cytological features of PGs. In this case series, we will discuss the fine-needle aspiration features of three cases of extra-adrenal PGs. The cellular arrangement in smears was either singly scattered or loosely cohesive clusters. The cells were polygonal with pleomorphic nuclei, abundant granular cytoplasm, and bland chromatin. Cellblock showed two types of cells with focal acinar formation. Immunohistochemistry also confirmed the diagnosis. These results were also in keeping with radiological findings. Fine-needle aspiration cytology, along with clinicoradiological findings, can help in making an accurate preoperative diagnosis of PG.

副神经节瘤（PG）是一种罕见的肿瘤，最常发生在头颈部和交感神经链。由于存在出血和高血压危象的潜在风险，细针穿刺细胞学检查并不常用于诊断副神经节瘤。因此，描述 PG 细胞学特征的研究非常有限。在本病例系列中，我们将讨论三例肾上腺外 PG 的细针穿刺特征。涂片中的细胞排列为单个散在或松散内聚。细胞呈多角形，核多形性，胞浆颗粒丰富，染色质平淡。细胞切片显示有两种类型的细胞，并有局灶性的尖头形成。免疫组化也证实了这一诊断。这些结果也与放射学检查结果一致。细针穿刺细胞学检查和临床放射学检查结果有助于对 PG 作出准确的术前诊断。

引用次数: 0

Unsatisfactory Pap Test Results: A Critical Patient Management Problem Pre-Analytically Addressed by the Cytopathology Laboratory 子宫颈抹片检查结果不满意：细胞病理学实验室分析前处理的一个重要患者管理问题。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2024-08-15 DOI: 10.1002/dc.25398

Mohamad M. Gafeer, Susan Alperstein, Robert Appleby, Jose-Scarpa Carniello, Jonas J. Heymann, Abha Goyal, Momin T. Siddiqui

Background

The unsatisfactory rate of Pap tests (PT) is an important quality assurance (QA) metric for a cytopathology laboratory. At our institution, an unsatisfactory PT slide is followed by a second ThinPrep (TP) slide. The aim of this study is to evaluate this QA practice.

Methods

Our laboratory processes an unsatisfactory TP PT with a follow-up second TP slide with or without glacial acetic acid. The correlation between the unsatisfactory rate and the second slide rate test was examined.

Results

A total of 2739 cases with a second TP slide were prepared for an unsatisfactory initial TP PT. After second slide preparation, 780 cases (28%) remained unsatisfactory. Using Spearman's rank correlation test, there was a notable negative correlation between the unsatisfactory rate and the second slide rate (rho = −0.42). Of those PTs recategorized as satisfactory TP, 1742 were negative for intraepithelial lesion or malignancy (NILM) (89%), 135 as atypical squamous cells of undetermined significance (ASC-US) (7%), 37 as low-grade squamous intraepithelial lesion (LSIL) (1.9%), 11 as atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H) (0.6%), 8 as high-grade squamous intraepithelial lesion (HSIL) (0.4%), and 20 as atypical glandular cells (AGC) (1%). The final Bethesda categorization for all cases and the human papilloma virus (HPV) data was tabulated.

Conclusions

A second slide preparation significantly reduced the unsatisfactory rate of the PT. This also had a significant impact by detecting clinically significant lesions. HPV testing can also be performed on slides reclassified from unsatisfactory to ASC-US or higher.

背景：巴氏试验（PT）的不满意率是细胞病理学实验室的一项重要质量保证（QA）指标。在我院，不满意的 PT 切片会进行第二次薄层切片（TP）。本研究旨在评估这一质量保证做法：我们实验室在处理不合格的 TP 切片时，会使用或不使用冰醋酸进行第二次 TP 切片的后续处理。研究了不满意率与第二次玻片率检测之间的相关性：共有 2739 个病例因初次 TP PT 不满意而进行了第二次 TP 切片制备。第二次制片后，仍有 780 个病例（28%）不合格。通过斯皮尔曼等级相关性检验，不满意率与第二次切片率之间存在明显的负相关（rho = -0.42）。在重新归类为满意 TP 的 PT 中，1742 例为上皮内病变或恶性肿瘤（NILM）阴性（89%），135 例为意义未定的非典型鳞状细胞（ASC-US）（7%），37 例为低级别鳞状上皮内病变（LSIL）（1.9%），11 个为不能排除高级别鳞状上皮内病变的非典型鳞状细胞（ASC-H）（0.6%），8 个为高级别鳞状上皮内病变（HSIL）（0.4%），20 个为非典型腺细胞（AGC）（1%）。所有病例的最终贝塞斯达分类和人类乳头状瘤病毒（HPV）数据已制成表格：结论：第二次制片大大降低了 PT 的不满意率。结论：第二次切片制备大大降低了 PT 的不满意率，同时还能发现有临床意义的病变。HPV检测也可以在从不满意率重新分类为ASC-US或更高的玻片上进行。

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引用次数: 0

A Retrospective Cytomorphologic Analysis of Salivary Gland Fine Needle Aspirates Classified as Salivary Gland Neoplasm of Uncertain Malignant Potential: A 6-year Institutional Experience 涎腺细针吸痰细胞形态学回顾性分析--归类为恶性可能性不确定的涎腺肿瘤：6年机构经验。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2024-08-14 DOI: 10.1002/dc.25395

Shweta Agarwal

Background

The Milan System for Reporting Salivary Gland Cytopathology is an effective reporting system for salivary gland fine needle aspirations with well-established risks of malignancy. Salivary gland neoplasm of uncertain malignant potential (SUMP) comprises a heterogenous group of lesions which have features that can be recognized as at least neoplastic but preclude further classification into benign or malignant. In this study, we reviewed the cytomorphologic features of salivary gland fine needle aspirations diagnosed as SUMP at our institution (over the past 6 years) and correlated those with the final diagnosis on surgical follow up.

Design

A retrospective search was performed to identify cases classified as SUMP at our institution from January 2018 to February 2024. Cytology slides were reviewed, and cases were subclassified based on key cytomorphologic features into the following categories: (1) basaloid, (2) oncocytic, (3) with clear cell features and (4) mixed features (myoepithelial/oncocytoid/squamoid features). Histologic diagnosis was recorded if available.

Results

A total of 36 cases of SUMP were identified; 31/36 had surgical follow up; final diagnosis included 22 benign lesions (2 non-neoplastic and 20 benign neoplasms), and nine malignant lesions. The overall risk of neoplasm and risk of malignancy were 93.5% and 29% respectively, with the oncocytic sub-category recording the highest ROM (42.8%). Mucoepidermoid carcinoma was the most common malignant diagnosis and pleomorphic adenoma the most common benign diagnoses.

Conclusions

Our study supports the subclassification of SUMP lesions based on key cytomorphologic features, thereby aiding in refining this ambiguous entity and providing a precise risk assessment.

背景：米兰唾液腺细胞病理学报告系统（Milan System for Reporting Salivary Gland Cytopathology）是一种有效的唾液腺细针穿刺报告系统，其恶性风险已得到充分证实。恶性潜能不确定的唾液腺肿瘤（SUMP）包括一组异质性病变，其特征至少可被认定为肿瘤性，但无法进一步分为良性或恶性。在本研究中，我们回顾了本院（过去 6 年）诊断为 SUMP 的唾液腺细针穿刺的细胞形态学特征，并将这些特征与手术随访的最终诊断结果进行了关联：通过回顾性检索，确定我院在2018年1月至2024年2月期间归类为SUMP的病例。对细胞学切片进行审查，并根据关键的细胞形态学特征将病例细分为以下几类：(1)基底细胞型；(2)肿瘤细胞型；(3)透明细胞型；(4)混合型（肌上皮型/肿瘤细胞型/鳞状上皮型）。如果有组织学诊断结果，则予以记录：共发现 36 例 SUMP；31/36 进行了手术随访；最终诊断包括 22 例良性病变（2 例非肿瘤和 20 例良性肿瘤）和 9 例恶性病变。肿瘤总风险和恶性风险分别为93.5%和29%，其中肿瘤细胞亚类的ROM最高（42.8%）。黏液表皮样癌是最常见的恶性诊断，而多形性腺瘤则是最常见的良性诊断：我们的研究支持根据关键的细胞形态学特征对 SUMP 病变进行亚分类，从而有助于完善这一模糊的实体并提供精确的风险评估。

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引用次数: 0

Comparison of Claudin-4, BerEP4, Carcinoembryonic Antigen and MOC31 in Serous Fluids Metastases Demonstrate High Sensitivity of Claudin-4 at Low Cellularity 比较血清液转移瘤中的 Claudin-4、BerEP4、癌胚抗原和 MOC31 发现，低细胞度的 Claudin-4 具有高灵敏度。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2024-08-13 DOI: 10.1002/dc.25393

Joshua J. X. Li, Joanna K. M. Ng, Julia Y. Tsang, Yuen Ting Tsang, Ko Fung Mak, Gary M. Tse

Introduction

Claudin-4 has been described as a highly sensitive immunocytochemical marker for detection of metastatic carcinoma cells in effusion cytology specimens. This study aims to challenge the performance of claudin-4 in different types of malignancies and low cellularity specimens, by comparison with other markers in a large cohort of carcinomatous effusion specimens.

Methodology

Cell block preparations from peritoneal and pleural fluid specimens were retrieved, with malignant (carcinoma) diagnoses confirmed by review of hospital diagnosis code and pathology reports. Claudin-4, BerEP4, CEA, and MOC31 immunocytochemistry were performed and scored by expression proportion and intensity. Tumor cellularity was assessed for subgroup analysis of low cellularity specimens.

Results

Totally 147 specimens (70 pleural, 77 peritoneal) of 68 lung, 62 breast, 9 gynecological, and 7 gastrointestinal carcinomas were retrieved. The average proportion expression of claudin-4 was highest (89.6%, vs. CEA 40.5%, BerEp4 18.6%, MOC31 16.8%) and the percentage of strong expression was highest for claudin-4 (72.1%). Expression levels of claudin-4 were consistently higher than other markers in subgroups of all primary sites. The difference was more significant for low cellularity specimens. High (≥50%) proportion expression was seen for 96.61% of cases for claudin-4 (vs. BerEp4 8.77%, CEA 46.55%, MOC31 8.77%, p < 0.001). These factors contributed to a low concordance between claudin-4 and BerEp4, CEA and MOC31 (K = 0.010–0.043).

Conclusion

Claudin-4 is more sensitive than CEA, BerEp4 and MOC31, suitable for low cellularity specimens of most types of metastatic carcinoma and is a robust immunocytochemical marker for carcinoma that can be used solitarily.

简介克劳丁-4是一种高灵敏度的免疫细胞化学标记物，可用于检测渗出液细胞学标本中的转移癌细胞。本研究的目的是通过在大量癌性渗出物标本中与其他标记物进行比较，对 Claudin-4 在不同类型恶性肿瘤和低细胞度标本中的表现提出质疑：方法：从腹膜和胸腔积液标本中提取细胞块制剂，并通过查看医院诊断代码和病理报告确认恶性（癌）诊断。对Claudin-4、BerEP4、CEA和MOC31进行免疫细胞化学分析，并根据表达比例和强度进行评分。对肿瘤细胞度进行评估，以便对低细胞度标本进行分组分析：结果：共采集了 147 份标本（70 份胸膜标本，77 份腹膜标本），包括 68 例肺癌、62 例乳腺癌、9 例妇科癌和 7 例胃肠癌。克劳丁-4的平均表达比例最高（89.6%，而CEA为40.5%，BerEp4为18.6%，MOC31为16.8%），克劳丁-4的强表达比例最高（72.1%）。在所有原发部位的亚组中，Claudin-4的表达水平始终高于其他标志物。低细胞度标本的差异更为明显。在96.61%的病例中，Claudin-4的表达比例较高（≥50%）（与BerEp4 8.77%、CEA 46.55%、MOC31 8.77%相比，P 结论：Claudin-4比CEA、BerEp4和MOC31更敏感，适用于大多数类型转移癌的低细胞度标本，是一种可单独使用的强效免疫细胞化学标记物。

{"title":"Comparison of Claudin-4, BerEP4, Carcinoembryonic Antigen and MOC31 in Serous Fluids Metastases Demonstrate High Sensitivity of Claudin-4 at Low Cellularity","authors":"Joshua J. X. Li, Joanna K. M. Ng, Julia Y. Tsang, Yuen Ting Tsang, Ko Fung Mak, Gary M. Tse","doi":"10.1002/dc.25393","DOIUrl":"10.1002/dc.25393","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Claudin-4 has been described as a highly sensitive immunocytochemical marker for detection of metastatic carcinoma cells in effusion cytology specimens. This study aims to challenge the performance of claudin-4 in different types of malignancies and low cellularity specimens, by comparison with other markers in a large cohort of carcinomatous effusion specimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Cell block preparations from peritoneal and pleural fluid specimens were retrieved, with malignant (carcinoma) diagnoses confirmed by review of hospital diagnosis code and pathology reports. Claudin-4, BerEP4, CEA, and MOC31 immunocytochemistry were performed and scored by expression proportion and intensity. Tumor cellularity was assessed for subgroup analysis of low cellularity specimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Totally 147 specimens (70 pleural, 77 peritoneal) of 68 lung, 62 breast, 9 gynecological, and 7 gastrointestinal carcinomas were retrieved. The average proportion expression of claudin-4 was highest (89.6%, vs. CEA 40.5%, BerEp4 18.6%, MOC31 16.8%) and the percentage of strong expression was highest for claudin-4 (72.1%). Expression levels of claudin-4 were consistently higher than other markers in subgroups of all primary sites. The difference was more significant for low cellularity specimens. High (≥50%) proportion expression was seen for 96.61% of cases for claudin-4 (vs. BerEp4 8.77%, CEA 46.55%, MOC31 8.77%, <i>p</i> < 0.001). These factors contributed to a low concordance between claudin-4 and BerEp4, CEA and MOC31 (<i>K</i> = 0.010–0.043).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Claudin-4 is more sensitive than CEA, BerEp4 and MOC31, suitable for low cellularity specimens of most types of metastatic carcinoma and is a robust immunocytochemical marker for carcinoma that can be used solitarily.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":"52 12","pages":"731-737"},"PeriodicalIF":1.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/dc.25393","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Interobserver Variability in HER-2 Immunostaining Interpretation of Metastatic HER2 Low Breast Cancers in Cytology Specimens 细胞学标本中转移性 HER2 低乳腺癌的 HER-2 免疫染色解读的观察者间差异。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2024-08-10 DOI: 10.1002/dc.25392

Niyati Desai, Courtney F. Connelly, Simon Sung, Adela Cimic, Swikrity U. Baskota

Background

Approximately, 55% of breast carcinomas are reported to be HER-2 low breast carcinomas. Trastuzumab-Deruxtecan is a new FDA-approved targeted therapy for HER-2 low metastatic breast carcinomas, making it essential that all efforts are made to identify these tumors in specimens submitted for pathologic examination. Cytology specimens are often the first and only modality of this assessment due to the ease of specimen procurement. This study aimed to determine the variability in HER-2 immunostaining interpretation among observers using cytologic specimens from metastatic sites.

Design

A pathology database search was made to identify metastatic breast carcinoma reported in cytology specimens. A manual search was then done to identify cases of HER-2 low category, H&E cell block and HER-2 neu immunostain slides were retrieved for a total of 50 cases. Reviewer #1 and #2 independently interpreted HER-2 immunostain of all 50 cases. Only discordant cases were sent for reviewer-3 interpretation. All three were blinded by the metastatic site, and original HER-2 interpretation.

Results

Of 50 cases, 11 cases (22%) were reported as concordant scores between reviewer #1 and reviewer #2 but had a discordant original IHC report. Additionally, 4 cases (8%) had discordant reporting of HER2 IHC stain between reviewer #1 and reviewer #2 making a total of 15 cases (30%) with overall discordant results.

Conclusion

This study highlights the interobserver variability of HER-2 immunostain interpretation for HER-2 low category of breast carcinomas. We recommend the need for more robust laboratory techniques including molecular for uniform identification of these unique targetable metastatic breast carcinoma groups.

背景：据报道，约 55% 的乳腺癌为 HER-2 低乳腺癌。曲妥珠单抗-德鲁司康是美国食品及药物管理局（FDA）批准的一种新的靶向疗法，可用于治疗HER-2低的转移性乳腺癌，因此必须尽一切努力在提交病理检查的标本中识别这些肿瘤。细胞学标本由于易于获取，通常是进行这种评估的第一种也是唯一一种方式。本研究旨在确定使用转移部位细胞学标本的观察者对 HER-2 免疫染色判读的差异性：设计：通过病理数据库搜索，确定细胞学标本中报告的转移性乳腺癌。然后进行人工搜索，以确定 HER-2 低类别病例，共检索到 50 例 H&E 细胞块和 HER-2 neu 免疫染色切片。1 号和 2 号审查员对所有 50 个病例的 HER-2 免疫印迹进行独立解读。只有不一致的病例才交由第三评审员解读。所有三位审稿人都对转移部位和最初的 HER-2 解释进行了盲法处理：结果：在 50 个病例中，有 11 个病例（22%）在 1 号和 2 号审查员的报告中得分一致，但原始 IHC 报告不一致。此外，4 个病例（8%）的 HER2 IHC 染色报告在 1 号审查员和 2 号审查员之间不一致，因此共有 15 个病例（30%）的总体结果不一致：本研究强调了HER-2免疫染色法对HER-2低分类乳腺癌的解释在观察者之间存在变异。我们建议需要更强大的实验室技术（包括分子技术）来统一鉴定这些独特的可靶向转移性乳腺癌群体。

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引用次数: 0

Pitfalls in the Cytological Diagnosis of Nodal Hodgkin Lymphoma 结节性霍奇金淋巴瘤细胞学诊断中的陷阱。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2024-08-08 DOI: 10.1002/dc.25389

Uma Handa, Rasheeda Mohamedali, Rajpal Singh Punia, Simrandeep Singh, Ranjeev Bhagat, Phiza Aggarwal, Manveen Kaur

Background

Hodgkin lymphoma (HL) is a hematopoietic neoplasm characterized by malignant Reed–Sternberg (RS) cells in an inflammatory background. Although the cytological features of HL are well elucidated in literature, yet many postulated factors cause its misdiagnosis. This study aims to assess the diagnostic reliability of fine needle aspiration cytology (FNAC) in HL and evaluate the factors contributing to a false-negative and false-positive diagnosis, taking histopathology as the gold standard.

Methods

This was a retrospective study in which 47 cases of HL diagnosed on histopathology were compared with their prior cytological diagnosis.

Results

The patient's age ranged from 3 to 80 years (median: 36 years) with a M:F ratio of 2.9:1. Lymph node aspirations were performed from multiple anatomical sites, out of which the cervical was the most common (57.8%). FNAC was inconclusive in two cases due to unsatisfactory smears. The false-negative diagnosis of reactive lymphadenitis was given in four cases, and false-positive in four cases, which included three cases of non-HL, and one case of malignant small round blue cell tumor. The overall diagnostic accuracy of FNAC in the diagnosis of HL was 82.2%.

Conclusions

The cytological diagnosis of HL can be challenging when classic RS cells are absent. Contributing factors for a false-negative diagnosis include obscuring reactive inflammatory cells, fibrosis of the involved lymph nodes, partial involvement of the lymph node, and misinterpretation. A thorough clinical examination with evaluation of FNAC smears from multiple areas, and ancillary tests help improve the diagnostic accuracy of cytological diagnosis.

背景：霍奇金淋巴瘤（HL）是一种以炎症背景下的恶性里德-斯登堡（RS）细胞为特征的造血肿瘤。虽然文献中对霍奇金淋巴瘤的细胞学特征做了很好的阐释，但仍有许多假定因素导致其误诊。本研究旨在评估细针穿刺细胞学（FNAC）对HL的诊断可靠性，并以组织病理学为金标准，评估导致假阴性和假阳性诊断的因素：这是一项回顾性研究，对47例经组织病理学诊断的HL病例与之前的细胞学诊断进行了比较：患者年龄从3岁到80岁不等（中位数：36岁），男女比例为2.9:1。淋巴结穿刺来自多个解剖部位，其中宫颈淋巴结穿刺最常见（57.8%）。由于涂片结果不理想，有两个病例的 FNAC 检查没有得出结论。4例假阴性诊断为反应性淋巴结炎，4例假阳性诊断为反应性淋巴结炎，其中3例为非HL，1例为恶性小圆形蓝细胞瘤。FNAC诊断HL的总体准确率为82.2%：结论：当典型的RS细胞缺失时，HL的细胞学诊断可能具有挑战性。导致假阴性诊断的因素包括：反应性炎症细胞被遮盖、受累淋巴结纤维化、淋巴结部分受累以及误诊。全面的临床检查、多部位 FNAC 涂片评估和辅助检查有助于提高细胞学诊断的准确性。

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引用次数: 0