Diagnostic Cytopathology最新文献_第8页

“Atypical Glandular Cells” on Cervical Cytology: Correlation Between Glandular Cell Component Volume and Histological Follow-Up 宫颈细胞学上的“非典型腺细胞”：腺细胞组成体积与组织学随访的关系。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2025-10-20 DOI: 10.1002/dc.70033

Havva Gokce Terzioglu, Alessa Aragao, Julieta E. Barroeta

Background

Atypical glandular cells (AGC) in cervical cytology, as defined by the Bethesda System, indicate nuclear atypia beyond reactive changes but without definitive features of malignancy. Although clinically significant because it prompts follow-up procedures, no quantitative threshold exists for AGC diagnosis. This study evaluated whether the volume of glandular cell clusters (GCC), regardless of atypia, influences AGC interpretation and may contribute to unnecessary sampling.

Methods

Following IRB approval, all cervical cytology cases diagnosed as AGC between January 2014 and June 2024 were retrieved, along with 100 random negative for intraepithelial lesion or malignancy (NILM) cases, and were manually re-screened with quantification of glandular cell clusters (GCC) defined as a group of ≥ 6 cohesive glandular cells irrespective of origin (endocervical versus endometrial) and the results were correlated with follow-up findings including endocervical and endometrial sampling.

Results

Of 301 AGC cases, 186 cases had slides available for review and follow-up data; two were excluded due to unsatisfactory quality. Eight cases were reclassified as unsatisfactory because of insufficient squamous cells and absence of atypia, most of which exhibited high GCC (mean 59). Notably, 140 cases (76.6%) showed no significant glandular pathology on follow-up, and in 111 cases (60.6%) the follow-up was negative. Overall, increased GCC correlated significantly with AGC interpretation compared to NILM cases (p = 0.01), even when histologic follow-up was negative.

Conclusion

Higher GCC volumes may influence AGC diagnoses, even in cases lacking true cytologic atypia, potentially leading to unnecessary interventions. Greater awareness of this tendency and adherence to established cytologic criteria may improve diagnostic precision within the AGC category.

背景：宫颈细胞学中的非典型腺细胞（AGC），根据Bethesda系统的定义，表明核非典型性超过反应性改变，但没有明确的恶性肿瘤特征。虽然临床意义重大，因为它提示随访程序，没有定量阈值存在的AGC诊断。本研究评估了腺细胞簇（GCC）的体积是否会影响AGC的解释，并可能导致不必要的采样。方法:在IRB批准后，检索了2014年1月至2024年6月期间诊断为AGC的所有宫颈细胞学病例，以及100例上皮内病变或恶性肿瘤（NILM）随机阴性病例。并通过量化腺细胞簇（GCC）进行人工重新筛选，GCC定义为一组≥6个内聚腺细胞，不论其来源（宫颈内膜与子宫内膜），结果与随访结果相关，包括宫颈内膜和子宫内膜取样。结果：301例AGC病例中，186例有载玻片可用于复查和随访；2个因质量不合格而被排除。8例因鳞状细胞不足和无异型性而被重新分类为不满意，其中大多数表现为高GCC（平均59）。140例（76.6%）随访未见明显腺体病变，111例（60.6%）随访阴性。总体而言，与NILM病例相比，GCC增加与AGC解释显著相关（p = 0.01），即使组织学随访为阴性。结论：更高的GCC体积可能影响AGC的诊断，即使在没有真正的细胞学非典型性的病例中，也可能导致不必要的干预。提高对这种倾向的认识，并遵守既定的细胞学标准，可以提高AGC类别的诊断准确性。

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引用次数: 0

Primary Synovial Sarcoma of the Parotid Gland: A Diagnostic Challenge With Cyto-Histological Correlation and Review of Literature 腮腺原发性滑膜肉瘤：细胞组织学相关性诊断的挑战和文献回顾。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2025-10-18 DOI: 10.1002/dc.70035

Chayasmita Mali, Naveen Kumar Ramachandran, Yookarin Khonglah, Biswajit Dey, Donboklang Lynser, Vandana Raphael, Sumanta Das

Synovial sarcoma is a malignant mesenchymal tumor of uncertain histogenesis that most commonly affects young adults' distal extremities, with the parotid being a very uncommon site. With fewer than 50 cases being reported in the literature and morphological similarities to many benign and malignant parotid lesions, it is challenging to diagnose this lesion. We report a 30-year-old female who presented with a rapidly enlarging, painful mass in the left parotid region with facial nerve palsy. The initial FNAC performed outside was interpreted as a pleomorphic adenoma. Repeat FNAC at our institution revealed a cellular spindle cell neoplasm with raised mitotic activity, suggesting a malignant spindle cell tumor. Histological features from trucut biopsy showed a highly cellular cell tumor comprising tumor cell arrangement in a predominantly fascicular pattern with positive immunostaining for EMA and BCL2, with negative myogenic, melanocytic, neural, and myoepithelial markers. Considering synovial sarcoma as our top differential diagnosis, fluorescence in situ hybridization (FISH) was performed using the SS18 dual color break-apart probe. FISH revealed SS18 break-apart in 60% of tumor cell nuclei, establishing the diagnosis of synovial sarcoma. Given its treatment consequences, which include surgery with post-operative radiotherapy and chemotherapy, it is imperative to identify this entity at an early stage, even though the prognosis is still uncertain. This case highlights the importance of a multimodal strategy incorporating cytology, histology, and molecular for definite diagnosis and patient management.

滑膜肉瘤是一种组织发生不确定的恶性间充质肿瘤，最常见于年轻人的远端肢体，腮腺是一个非常罕见的部位。由于文献报道的病例不足50例，并且与许多良性和恶性腮腺病变形态相似，因此诊断具有挑战性。我们报告一个30岁的女性谁提出了一个迅速扩大，痛苦的肿块在左侧腮腺区与面神经麻痹。最初在室外进行的FNAC被解释为多形性腺瘤。在我们的机构重复FNAC显示一个梭形细胞肿瘤，有丝分裂活性升高，提示恶性梭形细胞肿瘤。肿瘤活检的组织学特征显示为高度细胞性肿瘤，肿瘤细胞以束状排列为主，EMA和BCL2免疫染色阳性，肌源性、黑素细胞、神经和肌上皮标志物阴性。考虑到滑膜肉瘤是我们最重要的鉴别诊断，我们使用SS18双色分离探针进行了荧光原位杂交（FISH）。FISH显示60%的肿瘤细胞核中SS18破裂，确定滑膜肉瘤的诊断。考虑到其治疗后果，包括手术和术后放疗和化疗，即使预后仍不确定，也必须在早期识别该实体。该病例强调了结合细胞学、组织学和分子学的多模式策略对明确诊断和患者管理的重要性。

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引用次数: 0

Cytomorphology Subtypes of the Salivary Gland Neoplasm of Unknown Malignant Potential (SUMP) Category in the Milan System and Histologic Correlation 米兰系统中未知恶性潜能涎腺肿瘤（SUMP）类别的细胞形态学亚型及其组织学相关性。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2025-10-18 DOI: 10.1002/dc.70037

Sofia Veríssimo Pedrosa, João Almeida, Helena Barroca

Introduction

The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) offers a reliable framework for stratifying malignancy risk of salivary gland lesions. Salivary gland neoplasms of uncertain malignant potential (SUMP) are a heterogeneous group of lesions displaying neoplastic characteristics that cannot be definitively categorized as benign or malignant. This study evaluates the cytomorphologic characteristics of SUMP cases at our institution and correlates them with final histopathological outcomes.

Material and Methods

A retrospective review of all SUMP cases diagnosed in our department from January 2018 to October 2024 was conducted. Cytology slides available were re-examined by three experienced cytopathologists and categorized into four subgroups based on key cytomorphologic features: (1) basaloid, (2) oncocytic, (3) clear cell, and (4) mixed features. Surgical follow-up diagnoses performed at our institution were collected.

Results

From a total of 495 salivary gland FNA specimens, 39 (7.9%) were initially diagnosed as SUMP. After reassessment, 35 cases of SUMP were confirmed, and 27 had surgical follow-up. The overall risk of a neoplastic lesion was 92.5%, with a malignancy risk of 18.5%. The subgroup with clear cell features exhibited the highest risk of malignancy, at 66.7%, while the oncocytic/oncocytoid and basaloid subgroups showed low malignancy risk (up to 10%).

Discussion and Conclusion

This study supports the subclassification of SUMP lesions based on key cytomorphologic features, as it aids in refining the risk assessment and management of these ambiguous lesions. The identification of high-risk groups can help guide clinical decisions regarding follow-up.

简介：唾液腺细胞病理学报告米兰系统（MSRSGC）为唾液腺病变恶性风险分层提供了可靠的框架。涎腺不确定恶性潜能肿瘤（SUMP）是一组异质性病变，表现出肿瘤特征，不能明确归类为良性或恶性。本研究评估了我院SUMP病例的细胞形态学特征，并将其与最终的组织病理学结果联系起来。材料与方法：回顾性分析我科2018年1月至2024年10月诊断的所有SUMP病例。现有的细胞学切片由三位经验丰富的细胞病理学家重新检查，并根据关键的细胞形态学特征分为四个亚组：(1)碱性细胞，(2)嗜瘤细胞，(3)透明细胞，(4)混合特征。收集在本院进行的外科随访诊断。结果：495例唾液腺FNA标本中，39例（7.9%）最初诊断为SUMP。经重新评估，35例确诊为SUMP， 27例进行手术随访。肿瘤病变的总风险为92.5%，恶性风险为18.5%。具有清晰细胞特征的亚组显示出最高的恶性肿瘤风险，为66.7%，而嗜瘤细胞/嗜瘤细胞和基底细胞亚组显示出较低的恶性肿瘤风险（高达10%）。讨论和结论：本研究支持基于关键细胞形态学特征的SUMP病变亚分类，因为它有助于改进这些模糊病变的风险评估和管理。高危人群的识别有助于指导临床随访决策。

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引用次数: 0

Clinical Utility and Limitations of Ultrasound-Guided Axillary Lymph Node Fine-Needle Aspiration Cytology in Breast Cancer Management 超声引导下腋窝淋巴结细针穿刺细胞学在乳腺癌治疗中的临床应用及局限性。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2025-10-16 DOI: 10.1002/dc.70032

Aoi Morishita, Tomoyuki Shimada

Background

Accurate axillary staging is critical for selecting appropriate treatment strategies in breast cancer. Ultrasound (US) and ultrasound-guided fine-needle aspiration cytology (US + FNAC) are widely used to evaluate axillary lymph nodes. The study assessed the diagnostic accuracy of US and US + FNAC and examined whether axillary dissection (AD) is necessary in patients with positive US + FNAC findings.

Methods

We analyzed 646 axillae from 642 breast cancer patients who underwent surgery at Hiraka General Hospital between 2013 and 2024. All patients underwent axillary US, and US + FNAC was performed on morphologically suspicious nodes. Sensitivity, specificity, PPV, and NPV of US and US + FNAC were determined using postoperative pathology as the reference standard. The number of nodal metastases was compared between patients undergoing primary surgery and those receiving primary systemic therapy (PST).

Results

In the primary surgery group (n = 516), US sensitivity, specificity, PPV, and NPV were 30.9% (38/123), 94.1% (370/393), 62.3% (38/61), and 81.3% (370/455), respectively. Corresponding values for US + FNAC were 80.6% (29/36), 100% (22/22), 100% (29/29), and 75.9% (22/29). US + FNAC showed significantly higher sensitivity and PPV than US alone. Among US + FNAC-positive cases, 55.2% (16/29) had ≥ 3 metastatic nodes, compared with 6.9% (2/29) of negative cases. In the PST group (n = 130), US sensitivity was ≤ 88.1% (37/42), and US + FNAC sensitivity was ≤ 92.6% (25/27). Of the 46 US + FNAC-positive patients, 45.7% (21/46) became node-negative after PST, whereas 26.1% (12/46) had ≥ 3 positive nodes.

Conclusion

US + FNAC improves diagnostic accuracy for axillary staging; however, standard AD may constitute overtreatment in some FNAC-positive patients. Selective de-escalation of axillary surgery should therefore be considered.

背景：准确的腋窝分期对于选择合适的乳腺癌治疗策略至关重要。超声（US）和超声引导细针穿刺细胞学（US + FNAC）被广泛用于腋窝淋巴结的评估。该研究评估了US和US + FNAC的诊断准确性，并检查了US + FNAC阳性患者是否需要腋窝清扫（AD）。方法：我们分析了2013年至2024年期间在Hiraka综合医院接受手术的642名乳腺癌患者的646个腋窝。所有患者均行腋窝超声检查，形态学可疑淋巴结行超声+ FNAC检查。以术后病理为参考标准，测定US和US + FNAC的敏感性、特异性、PPV、NPV。比较了接受原发性手术和接受原发性全身治疗（PST）的患者之间淋巴结转移的数量。结果：原发性手术组（n = 516）的US敏感性为30.9%(38/123)，特异性为94.1% (370/393)，PPV为62.3% (38/61)，NPV为81.3%（370/455）。US + FNAC对应值分别为80.6%（29/36）、100%（22/22）、100%（29/29）和75.9%（22/29）。US + FNAC的敏感性和PPV均明显高于US单用。在US + fnac阳性病例中，55.2%（16/29）的转移淋巴结≥3个，而阴性病例的转移淋巴结为6.9%（2/29）。PST组（n = 130） US敏感性≤88.1% (37/42)，US + FNAC敏感性≤92.6%（25/27）。46例US + fnac阳性患者中，45.7%（21/46）在PST后变为淋巴结阴性，而26.1%（12/46）有≥3个阳性淋巴结。结论：US + FNAC提高了腋窝分期的诊断准确性；然而，在一些fnac阳性患者中，标准AD可能构成过度治疗。因此，应考虑选择性降低腋窝手术的风险。

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引用次数: 0

High-Grade Non-Hodgkin Lymphoma, Diffuse Large B-Cell Lymphoma Type Masquerading as Thyroid Malignancy and Inflammatory Breast Carcinoma: A Case Report 伪装为甲状腺恶性和炎性乳腺癌的高级别非霍奇金淋巴瘤、弥漫性大b细胞淋巴瘤1例报告。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2025-10-15 DOI: 10.1002/dc.70030

Ambili R. Nath, Sonia Mary Thomas, Betsy Jose, Lillykutty Pothen, Jessy Mathew Mangalathil

This case report describes a 75-year-old female who presented with generalized tiredness and neck swelling, initially raising suspicion of a primary thyroid malignancy. Fine-needle aspiration of the thyroid nodule was suspicious for malignancy (Bethesda Category V). Further evaluation revealed an inflammatory mass lesion in the right breast which was clinically diagnosed as inflammatory carcinoma and multiple enlarged lymph nodes including axillary, cervical, supraclavicular, and inguinal nodes. Immunocytochemistry on fine needle aspiration cytology (FNAC) and biopsies and immunohistochemistry of the breast lesion and lymph nodes in the patient ultimately revealed disseminated High-Grade Non-Hodgkin Lymphoma (NHL), Diffuse Large B-Cell Lymphoma (DLBCL) type. This case highlights the diagnostic challenges linked to atypical presentations of lymphoma mimicking other primary malignancies of solid organs.

本病例报告描述了一位75岁的女性，她表现为全身疲劳和颈部肿胀，最初怀疑是原发性甲状腺恶性肿瘤。细针穿刺甲状腺结节可疑为恶性肿瘤（Bethesda分类V）。进一步检查发现右乳炎性肿块病变，临床诊断为炎性癌，多发肿大淋巴结包括腋窝、宫颈、锁骨上和腹股沟淋巴结。患者乳腺病变和淋巴结的细针穿刺细胞学（FNAC）、活检和免疫组织化学最终显示弥漫性高级别非霍奇金淋巴瘤（NHL）、弥漫性大b细胞淋巴瘤（DLBCL）型。这个病例强调了与非典型淋巴瘤的诊断挑战，这些淋巴瘤模仿了实体器官的其他原发性恶性肿瘤。

引用次数: 0

Reproducibility and Diagnostic Utility of a Simplified Oil Red O Test in Infant Bronchoalveolar Lavage Samples 简化油红O试验在婴儿支气管肺泡灌洗液样本中的重复性和诊断效用。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2025-10-12 DOI: 10.1002/dc.70031

Emily Wheeler, Jennifer Kernodle-Zimmer, Melissa Randolph, Harvey Cramer, Hector Mesa

<div> <section> <h3> Introduction</h3> <p>Aspiration in infants is a diagnostic challenge. The lipid-laden macrophage index (LLMI) developed in 1987 has been used as a supportive test; however, numerous recent studies have questioned its value and reproducibility. We evaluated a simplified LLMI in bronchoalveolar lavage (BAL) specimens from a pediatric cohort to assess its diagnostic utility.</p> </section> <section> <h3> Methods</h3> <p>BALs from infants were prospectively collected over a 6-month period for Oil Red O (ORO) staining to evaluate aspiration. BALs from adults with non-aspiration pathologies were simultaneously collected for comparison. Clinical and demographic data were gathered to assess the diagnostic accuracy of the test. Only samples containing ≥ 100 evaluable macrophages and free of obscuring blood or inflammation were included. Positive staining was assessed at low magnification (10×), with only clearly positive cells (Colombo-Hallberg scores 3 and 4) considered. A dichotomous threshold of < 50% or ≥ 50% positive macrophages was established through multidisciplinary consensus. To ensure consistency, a training session was conducted for the entire cytopathology division on the newly developed interpretation criteria.</p> </section> <section> <h3> Results</h3> <p>88/134 (66%) pediatric BAL samples with suspected aspiration and 63/75 (84%) adult samples with various non-aspiration pathologies were adequate for analysis. Aspiration status in children was determined using multidisciplinary aerodigestive group evaluation (MAGE) and videofluoroscopic swallow study (VFSS). Test performance was assessed at various cutoffs. In the pediatric cohort (mean age 16.5 months, 58% male), aspiration was diagnosed in 47% by MAGE. Strong associations were seen with atopia/asthma (83%), functional dysphagia (64%), and congenital/developmental disorders (43%). A significant difference in ≥ 50% lipid-laden macrophage involvement was observed between pediatric (12%) and adult (51%) samples (<i>p</i> < 0.00001). Using MAGE and VFSS as gold standards, the test showed poor discriminatory power for detecting aspiration in infants (AUC 0.506–0.587). A 10% cutoff yielded the best performance (AUC 0.587, sensitivity 27%, specificity 93%), while a 50% cutoff offered practical advantages in workflow and reproducibility.</p> </section> <section> <h3> Conclusions</h3> <p>The modified LLMI demonstrates limited diagnostic value for aspiration in infants. While a 10% cutoff offers slightly improved performance, the test may be phased out in favor of more reli

婴儿误吸是一个诊断难题。1987年开发的脂质负载巨噬细胞指数（LLMI）被用作支持测试；然而，最近的许多研究质疑其价值和可重复性。我们评估了来自儿科队列的支气管肺泡灌洗（BAL）标本的简化LLMI，以评估其诊断效用。方法：前瞻性收集6个月的婴儿bal，进行油红O （ORO）染色以评估吸入情况。同时收集非吸入性病变成人bal进行比较。收集临床和人口统计数据以评估该测试的诊断准确性。只纳入含有≥100个可评估巨噬细胞且无模糊血液或炎症的样品。在低倍率（10倍）下评估阳性染色，仅考虑明显阳性细胞（Colombo-Hallberg评分3和4）。结果的二分类阈值：88/134（66%）疑似误吸的儿科BAL样本和63/75（84%）具有各种非误吸病理的成人样本足以进行分析。采用多学科气消化组评估（MAGE）和视频透视吞咽研究（VFSS）来确定儿童的吸入状态。测试性能在不同的截止点进行评估。在儿科队列（平均年龄16.5个月，58%为男性）中，47%的患者通过MAGE诊断出误吸。与弱视/哮喘（83%）、功能性吞咽困难（64%）和先天性/发育障碍（43%）有很强的相关性。在儿童（12%）和成人（51%）样本中，脂质巨噬细胞累及≥50%的比例存在显著差异(p)。结论：改良LLMI对婴儿误吸的诊断价值有限。虽然10%的临界值可以略微提高性能，但该测试可能会逐步淘汰，取而代之的是更可靠的诊断方法。

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引用次数: 0

Improving Peritoneal Staging in Gastric Cancer: Time to Move Past Cytology Alone 胃癌腹膜分期的改善：单纯细胞学检查是时候了。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2025-10-10 DOI: 10.1002/dc.70029

Eoghan Burke

引用次数: 0

Clinical and Prognostic Features of Malignant Thyroid Nodules With Atypia of Undetermined Significance Cytology: Evaluation of Nuclear Atypia-Based Subgroups 恶性甲状腺结节不典型性的临床和预后特征：基于核不典型亚群的评估。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2025-10-06 DOI: 10.1002/dc.70027

Yusuf Öztürk, Naile Kökbudak, Muhammet Kocabaş, Melia Karaköse, Mustafa Kulaksizoğlu, Feridun Karakurt

Background

The aim of this study was to evaluate the clinical and prognostic characteristics of thyroid nodules that were initially diagnosed as atypia of undetermined significance (AUS) and subsequently confirmed as malignant following surgery. The study also aimed to investigate their subclassification based on nuclear atypia.

Methods

Patients who underwent thyroid surgery and were diagnosed with differentiated thyroid carcinoma between January 2016 and December 2024, and who had undergone a preoperative fine-needle aspiration biopsy (FNAB), were categorized retrospectively into three groups based on their cytological classification: AUS, suspicious for malignancy (SFM) and malignant (M). The clinicopathological and prognostic characteristics of these groups were then compared. Patients in the AUS group were also categorized according to the presence of nuclear atypia for further analysis.

Results

Of the 775 patients, 11.7% were assigned to the AUS group, 35.1% to the SFM group, and 53.2% to the M group. Nodules in the AUS group were significantly smaller in diameter and exhibited fewer invasive features compared to those in the SFM and M groups (p < 0.05). The M group showed higher rates of advanced TNM staging, lymph node metastasis, and distant metastasis. Patients in the AUS group demonstrated the highest proportion of low-risk classification (93.4%) and the highest rate of excellent response to therapy (96.7%), with no observed recurrence or progression. No significant differences in invasiveness were found between AUS-nuclear atypia (AUS-N) and AUS-other atypia (AUS-O) subgroups, both of which exhibited similarly indolent profiles.

Conclusion

Malignant nodules diagnosed as AUS exhibited an indolent course and an excellent prognosis. Our findings suggest that less aggressive, more individualized treatment strategies should be considered for AUS cases, and emphasize the potential prognostic value of nuclear atypia-based subclassification.

背景：本研究的目的是评估甲状腺结节的临床和预后特征，这些结节最初被诊断为不确定意义的异型性（AUS），随后在手术后被证实为恶性。本研究还旨在探讨其基于核非典型性的亚分类。方法：将2016年1月至2024年12月间行甲状腺手术并确诊为分化型甲状腺癌的患者，术前行细针穿刺活检（FNAB），根据其细胞学分类分为AUS、可疑恶性（SFM）和恶性(M)三组。比较两组患者的临床病理及预后特点。AUS组患者也根据有无核异型进行分类，以便进一步分析。结果：775例患者中，11.7%分配到AUS组，35.1%分配到SFM组，53.2%分配到M组。与SFM组和M组相比，AUS组的结节直径明显更小，侵袭性特征更少(p结论：诊断为AUS的恶性结节病程缓慢，预后良好。我们的研究结果表明，对于AUS病例应考虑较少的侵略性，更个性化的治疗策略，并强调基于核非典型亚型的潜在预后价值。

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引用次数: 0

TFE3-Rearranged PEComa(-Like Neoplasm) of the Chest Wall Diagnosed by Fine-Needle Aspiration: A Case Report 细针穿刺诊断胸壁tfe3重排PEComa（样肿瘤）1例。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2025-10-04 DOI: 10.1002/dc.70026

Shah Dev, Matthew Miller, Tom Hu, Cindy McGrath, Roseann I. Wu

We report a rare TFE3-rearranged perivascular epithelioid cell tumor (PEComa) of the parasternal chest wall diagnosed preoperatively by fine-needle aspiration (FNA) cytology. The smears and cell block showed epithelioid cells with clear to granular cytoplasm and prominent nucleoli. Immunohistochemistry (IHC) demonstrated strong nuclear TFE3 expression and melanocytic marker positivity (diffuse HMB-45, focal Melan-A) with absent smooth muscle marker staining. FISH confirmed a TFE3 rearrangement, and next-generation sequencing identified an SFPQ:TFE3 fusion. The integrated cytologic and molecular workup enabled definitive classification as a TFE3-rearranged PEComa before surgical resection. This case highlights the diagnostic utility of cytologic material for translocation-associated neoplasms and the importance of molecular subtyping for prognosis and treatment.

我们报告一例罕见的胸骨旁胸壁tfe3重排血管周围上皮样细胞瘤（PEComa），术前通过细针穿刺（FNA）细胞学诊断。涂片和细胞块显示上皮样细胞，细胞质清晰至颗粒状，核仁明显。免疫组织化学（IHC）显示核TFE3表达强烈，黑素细胞标记物（弥漫性HMB-45，局灶性黑色素- a）阳性，未见平滑肌标记物染色。FISH证实了TFE3重排，下一代测序鉴定了SFPQ:TFE3融合。综合细胞学和分子检查使手术切除前明确分类为tfe3重排PEComa。本病例强调了细胞学材料对易位相关肿瘤的诊断作用，以及分子分型对预后和治疗的重要性。

引用次数: 0

The Role of Fine Needle Aspiration Biopsy and Rapid Onsite Evaluation in the Diagnosis of Kidney Lesions 细针穿刺活检和快速现场评估在肾脏病变诊断中的作用。

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Diagnostic Cytopathology

Pub Date : 2025-09-21 DOI: 10.1002/dc.70025

Zehra Şahin, Şenay Erdoğan Durmuş, Deniz Ünlüer Kapışkay, Ahmet Baş, Nesrin Uygun

Background

Although core needle biopsy is widely preferred for evaluating renal lesions, fine needle aspiration (FNA) combined with rapid on-site evaluation (ROSE) remains a valuable diagnostic method in selected cases. This study aims to assess the diagnostic efficacy of renal FNA and highlight the impact of ROSE on achieving definitive diagnoses.

Methods

This retrospective study included 273 patients who underwent ultrasound- or CT-guided FNA for renal lesions between 2010 and 2018 at Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine. Lesions were evaluated based on size, radiologic features, localization, ROSE status, and number of smears. Cytopathological results were categorized as nondiagnostic, limited, non-neoplastic, or neoplastic. Histopathological correlation was assessed in available cases. Statistical analyses were performed using SPSS v25.0, with p < 0.05 considered significant.

Results

Of the 273 cases, 218 (79.8%) yielded diagnostic results. Definitive diagnosis rates increased with lesion size and were significantly higher in solid (86.3%) and mixed (91.4%) lesions compared to cystic lesions (60%) (p = 0.001). ROSE was performed in 177 cases, significantly improving diagnostic yield compared to cases without ROSE (85.8% vs. 68.7%, p = 0.001). Histopathological follow-up was available in 119 cases, with an overall cytological–histological concordance of 84%, reaching 98% in cases with adequate material.

Conclusion

Renal FNA remains a reliable and accurate diagnostic method when combined with ROSE, especially in well-sampled cases. It aids in identifying both primary and metastatic tumors and can guide clinical decision-making, particularly when surgery is not feasible.

背景：虽然核心穿刺活检被广泛用于评估肾脏病变，但细针穿刺（FNA）联合快速现场评估（ROSE）在某些病例中仍然是一种有价值的诊断方法。本研究旨在评估肾FNA的诊断效果，并强调ROSE对获得明确诊断的影响。方法：本回顾性研究纳入了2010年至2018年间在伊斯坦布尔大学cerrahpa医学院接受超声或ct引导下肾病变FNA治疗的273例患者。根据病变的大小、放射学特征、定位、ROSE状态和涂片数量来评估病变。细胞病理学结果分为非诊断性、有限性、非肿瘤性和肿瘤性。对可用病例进行组织病理学相关性评估。结果：273例患者中，218例（79.8%）获得诊断结果。明确诊断率随病变大小而增加，实性病变（86.3%）和混合性病变（91.4%）明显高于囊性病变（60%）（p = 0.001）。177例患者行ROSE检查，与未行ROSE检查的患者相比，显著提高了诊断率（85.8% vs. 68.7%, p = 0.001）。组织病理学随访119例，总体细胞学-组织学一致性为84%，在材料充足的病例中达到98%。结论：肾FNA联合ROSE仍然是一种可靠和准确的诊断方法，特别是在样本充足的病例中。它有助于识别原发性和转移性肿瘤，并可以指导临床决策，特别是在手术不可行的情况下。

{"title":"The Role of Fine Needle Aspiration Biopsy and Rapid Onsite Evaluation in the Diagnosis of Kidney Lesions","authors":"Zehra Şahin, Şenay Erdoğan Durmuş, Deniz Ünlüer Kapışkay, Ahmet Baş, Nesrin Uygun","doi":"10.1002/dc.70025","DOIUrl":"10.1002/dc.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although core needle biopsy is widely preferred for evaluating renal lesions, fine needle aspiration (FNA) combined with rapid on-site evaluation (ROSE) remains a valuable diagnostic method in selected cases. This study aims to assess the diagnostic efficacy of renal FNA and highlight the impact of ROSE on achieving definitive diagnoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 273 patients who underwent ultrasound- or CT-guided FNA for renal lesions between 2010 and 2018 at Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine. Lesions were evaluated based on size, radiologic features, localization, ROSE status, and number of smears. Cytopathological results were categorized as nondiagnostic, limited, non-neoplastic, or neoplastic. Histopathological correlation was assessed in available cases. Statistical analyses were performed using SPSS v25.0, with <i>p</i> < 0.05 considered significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 273 cases, 218 (79.8%) yielded diagnostic results. Definitive diagnosis rates increased with lesion size and were significantly higher in solid (86.3%) and mixed (91.4%) lesions compared to cystic lesions (60%) (<i>p</i> = 0.001). ROSE was performed in 177 cases, significantly improving diagnostic yield compared to cases without ROSE (85.8% vs. 68.7%, <i>p</i> = 0.001). Histopathological follow-up was available in 119 cases, with an overall cytological–histological concordance of 84%, reaching 98% in cases with adequate material.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Renal FNA remains a reliable and accurate diagnostic method when combined with ROSE, especially in well-sampled cases. It aids in identifying both primary and metastatic tumors and can guide clinical decision-making, particularly when surgery is not feasible.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":"54 1","pages":"6-13"},"PeriodicalIF":1.0,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112169","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}

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