Cytopathology最新文献

Objective: An accurate fine-needle aspiration (FNA) diagnosis of adrenal lesions may be challenging. This study was to investigate roles of imaging guidance, rapid on-site evaluation (ROSE) and additional tissue sampling in FNA diagnosis of adrenal lesions.

Methods: Adrenal FNA cases were retrieved from pathology archive. Patients' demographics, lesion size and location, imaging guidance methods, cytologic diagnoses and histopathologic diagnoses were reviewed and analysed.

Results: The study cohort included 72 cases of left (86%) and right (14%) adrenal lesions. Endoscopic ultrasound (EUS) and computed tomography (CT) were used in 47 (65%) and 25 (35%) cases, respectively. Left adrenal lesions were sampled mostly by EUS-FNA (73%), whereas right adrenal lesions by CT-guided FNA (80%). There were no differences between the EUS-FNA and CT-FNA groups in terms of non-diagnostic rate and cytologic diagnostic categories. The non-diagnostic rate and cytologic diagnostic categories were the same between ROSE and non-ROSE groups. In a subset of 18 cases with concurrent core tissue biopsy, a definite diagnosis was rendered in all biopsy cases including three cases with a non-diagnostic or indeterminate cytology diagnosis.

Conclusion: Our study demonstrates that FNA has great efficacy for evaluation of adrenal lesions, either via EUS or CT guidance. Incorporation of ROSE evaluation into FNA procedure does not directly affect the performance of FNA biopsy but may help direct additional tissue sampling to salvage the cases with a non-diagnostic or indeterminate cytology diagnosis, increasing diagnostic yield.

Background: Traditional teaching dictated that patients with recurrent thyroid cysts undergo excision owing to a 12% risk malignancy. Ultrasound evaluation now determines management of these patients augmented by fine needle biopsy. In UK, a non-diagnostic category for thyroid cysts (Thy1c) exists, whereas the Bethesda system combines 'non-diagnostic-cyst fluid only' into Category I along with paucicellular and acellular results. The aim was to assess the ability of Thy1c cytology to exclude malignancy.

Methods: We undertook a retrospective study of patients undergoing thyroidectomy with Thy1c cytology from analysis of the Unit database. Additionally, we made a retrospective search in our pathology database for reports combining 'papillary thyroid carcinoma' with 'cyst' or 'cystic' and compared histology with cytology.

Results: Between 2003 and 2023 115 patients (97 women, median age 44y, range 16-72) underwent thyroidectomy following Thy1c cytology. Indications for surgery included recurrent cyst (90%); compressive symptoms (9%) and one thyrotoxicosis. In no patient was the primary diagnosis malignant; multinodular goitre was commonest (87.76%); benign cyst (19.16%); follicular adenoma (5.4%) and coincidental pT1a classical papillary thyroid carcinoma (PTC) (4.3%). In the retrospective audit, 61 pathology reports contained 'PTC' and 'cyst'/'cystic'. The cystic element was in primary tumour (31.51%); nodal metastasis (17.28%) and adjacent benign disease (13.21%). Only 5 (8%) patients had Thy1c cytology; 4 had pT1a tumours and one a benign cyst and a 19 mm PTC.

Conclusion: Thy1c category reliably excludes significant malignancy. For patients with symptomatic cysts, ultrasound assessment and Thy1c cytology can guide the clinician to treat with either ablation or resection without the fear of mistreating a thyroid cancer.

Objective: Molecular testing is recommended for risk stratification of atypia of undetermined significance (AUS) nodules in the USA; however, it is not routinely performed in some countries owing to limited availability and affordability. Here, we propose a risk stratification algorithm for AUS nodules when molecular testing is unavailable.

Methods: We examined 304 (4.3%) AUS nodules among 7073 thyroid fine-needle aspiration cytology specimens examined at Kuma Hospital from January 2020 to December 2020. Clinical data were obtained from the medical records of Kuma Hospital.

Results: AUS with nuclear atypia and AUS-other each accounted for half of the total AUS nodules. The repeat aspiration rate was 19.7%; 61.7% of the nodules were reclassified as benign or malignant upon repeat aspiration. Resection rate and overall risk of malignancy (ROM) were 32.6% and 12.8%, respectively. Architectural atypia showed the lowest (1.1%) overall ROM in the AUS nodules. For AUS with nuclear atypia, nodules ≤ 10 mm in size showed significantly lower overall ROM than those of > 10 mm, and nodules with ultrasonographically low suspicion showed significantly lower overall ROM than those with intermediate to high suspicion. AUS nodules with atypical lymphoid cells, possible medullary thyroid carcinoma, or possible parathyroid lesion were confirmed using flow cytometry, biochemical testing using needle washout fluid or immunocytochemistry, respectively.

Conclusions: Our proposed clinical management algorithm for each subdivision according to cytological findings, based on repeat aspiration rates, ROM, ultrasound findings and results of ancillary tests except for molecular testing, should be useful for the clinical management of AUS nodules.

This is the first case report describing the diagnostic value of dot-shaped inclusions associated with promyelocytic leukaemia nuclear bodies (PML-NBs) to define JC virus-infected glial cells in an intraoperative cytopathological diagnosis for progressive multifocal leukoencephalopathy (PML).

Objective: Analyse and summarise the reasons for failure in the digital acquisition of thyroid liquid-based cytology (LBC) slides and the technical challenges, and explore methods to obtain reliable and reproducible whole digital slide images for clinical thyroid cytology.

Method: Use the glass slide scanning imaging system to acquire whole-slide image (WSI) of thyroid LBC in sdpc format through different. Statistical analysis was conducted on the different acquisition methods, the quality of the glass slides, clinical and pathological characteristics of the case, TBSRTC grading and the quality of WSI.

Results: The WSI obtained by different scanning methods showed a high level of consistency in quality (W = 0.325, p < 0.001), especially between fully automatic scanning with different focus densities (W = 0.9, p < 0.001). A total of 2114 images were obtained through different methods of multi-layer fusion and multi-point focusing scanning, with scan success rates of 100.0%, 100.0%, 100.0% and 23.6%, respectively. The correlation between the quality of thyroid LBC glass slides and the image quality of thyroid LBC WSI was statistically significant (p < 0.001). The correlation between TBSRTC grading and the quality of thyroid LBC digital WSI was statistically significant (p < 0.001).

Conclusions: Although the quality of glass slides has a significant impact, the success rate and image quality of malignant tumour scanning are both high. Overall, the risk of missed diagnosis of malignant tumours is low. In the future, we also need to improve the performance and algorithm of the scanner in cases of sparse cells.

Background: Sialoblastoma is an uncommon salivary gland neoplasm seen predominantly in the paediatric age group. It poses diagnostic challenges to the pathologists because of its rarity.

Case report: Here, we present the cytological features of a case of sialoblastoma in 5-month-old baby boy on imprint cytology. The smears were fairly cellular and composed of clusters and dispersed population of small round basaloid cells with occasional duct formation.

Conclusion: Sialoblastoma should be considered in the differential diagnosis of paediatric salivary gland tumours. It needs to be differentiated from other small round cell tumours of childhood and tumours composed of basaloid cells. Here, we discuss the cytological differentials of sialoblastoma along with a summary of prior published cases.

This is an interesting case of rhabdomyosarcoma, presenting at an unusual site and diagnosed on FNAC. The smears depict the typical malignant small round cell morphology and tigroid background. It illustrates the role of cell block and immunohistochemistry as important ancillary adjuncts to morphology.

NTRK (neurotropic tropomyosin receptor kinase)-rearranged spindle cell tumours represent a rare group of molecularly defined soft tissue neoplasms. These tumours, excluding infantile fibrosarcomas, are characterised by NTRK gene rearrangements and exhibit a range of histomorphologies, including spindle, epithelioid or rhabdoid cells with invasive growth. Their prognosis correlates with histological grade, and surgical resection is the primary treatment. The abnormally expressed oncogenic receptor tyrosine kinases TRK-A, TRK-B and TRK-C in this tumour have been shown to be therapeutical targetable, which may improve patient prognosis. We report a 17-year-old male patient presenting with a left axillary mass. Both fine-needle aspiration cytology (FNAC) and surgical resection specimens were submitted for examination. Comprehensive analysis of cytomorphology, immunohistochemical staining results and next-generation sequencing (NGS) data led to a final diagnosis of NTRK-rearranged spindle cell tumour. By comparing cytological and histological morphologies, we identified diagnostic clues in cytological specimens. NTRK-rearranged spindle cell tumours' definitive diagnosis enables targeted therapy. Fine-needle aspiration cytology, being minimally invasive, offers the potential for earlier and more definitive diagnoses, thereby improving patient treatment options.

Objective: Fine-needle aspiration cytology (FNAC) from bone lesions has been proven to be a useful diagnostic tool but lacks standardisation. The aim of the study was to evaluate the diagnostic utility of FNAC as a basis to propose and test a reporting system for bone reporting cytopathology.

Methods: This retrospective study is based on patients with bone lesions, that were approached by cytology at Skåne University Hospital, Sweden between 2015 and 2023. The diagnostic performance was measured by sensitivity, specificity and accuracy analyses. All diagnoses were then distributed in six categories: (I) Non-diagnostic, (II) Benign, (III) Atypia, (IV) Bone neoplasm of uncertain significance, (V) Suspicious for malignancy and (VI) Malignant. The risk of malignancy (ROM) in each category was calculated.

Results: The final cohort consisted of 721 cases. Bone cytology was able to differentiate between benign and malignant lesion with a sensitivity of 89% and a specificity of 99%. The overall diagnostic accuracy was 65% but varied significantly among different types of lesions. Within the tested diagnostic categories, the ROM was (I) 48%, (II) 6.7%, (III) 69%, (IV) 28%, (V) 93% and (VI) 100%.

Conclusion: FNAC from bone lesions is a sensitive and specific diagnostic tool with high diagnostic accuracy among various tumour types. This study provides valuable insights for the development of a standardised reporting system for bone cytopathology.