A 59-year-old male presented with left upper abdominal pain and weight loss for 3 months. Cytomorphology of a pancreatic neoplasm has been highlighted.
A 59-year-old male presented with left upper abdominal pain and weight loss for 3 months. Cytomorphology of a pancreatic neoplasm has been highlighted.
Quiz focusing on the cytological analysis of urine in a case of urinary tract infection caused by E. coli, and its management with ceftriaxone treatment.
Cytology specimens are less invasive than tissue biopsies, and in some cases of non-small cell lung cancer (NSCLC), they may be the only available material. The expression of programmed death ligand-1 (PD-L1) and indoleamine 2-3 dioxygenase 2 (IDO-2) predicts the response to new treatment modalities. The aim of the study was to investigate the validity of cell blocks prepared from cytology for evaluation of PD-L1 and IDO-2 expression in NSCLC and to compare the expression of these markers in cell blocks and the corresponding tissue sample.
This cross-sectional study included 32 specimens of bronchoalveolar lavage (BAL) cytology and their cell block preparations. Among them, 20 cases also had bronchoscopic biopsy. PD-L1 and IDO-2 immune staining were done for all cases.
A statistically significant association is observed between high PD-L1 expression and both tumour size (p = 0.00014) and grade (p = 0.00001). High IDO-2 expression is associated with low TILs (p = 0.03). Results of PD-L1 and IDO-2 expression in bronchoscopic biopsy and cell block preparations of the same cases showed no statistical difference (p = 0.246).
There was no significant difference in PD-L1 and IDO-2 expression between cytological and bronchoscopic biopsies of lung cancer, which supports the effective use of cytological specimens and reduces the need for more invasive procedures.
We report a rare case of primary effusion lymphoma (PEL) diagnosed cytologically in an HIV-negative patient with end-stage renal disease, highlighting diagnostic challenges and expanding the clinical continuum of PEL beyond immunocompromised settings.
Pleural mesothelioma (PM) is an aggressive malignancy in which pleural effusion cytology is often the first diagnostic material. MTAP immunohistochemistry, while not a stand-alone diagnostic tool, may serve as a useful adjunct when combined with other markers in the evaluation of pleural mesothelioma. However, the diagnostic relevance of nuclear versus cytoplasmic MTAP loss in cytology specimens remains unclear.
We retrospectively analysed pleural effusion cytology samples from 48 histologically confirmed PM cases (2017–2022). Dual-colour fluorescence in situ hybridization (FISH) was performed for p16/CDKN2A, while MTAP immunohistochemistry (Proteintech 2B1G6 clone) was assessed for nuclear and cytoplasmic loss, further subclassified as focal or diffuse. Associations between MTAP loss and p16/CDKN2A deletion were evaluated using Fisher's exact test.
MTAP loss was observed in 21 cases (43.8%), while homozygous p16/CDKN2A deletion was detected in 33 cases (68.8%). Concurrent MTAP loss and p16/CDKN2A deletion occurred in 15 cases (31.3%). Nuclear and cytoplasmic MTAP loss were perfectly concordant in terms of presence (p < 0.001), although their staining patterns differed: diffuse nuclear loss often corresponded to focal rather than diffuse cytoplasmic loss. No significant association was observed between MTAP staining patterns and p16/CDKN2A deletion (p > 0.05).
Our findings demonstrate that while nuclear and cytoplasmic MTAP loss are concordant in presence, staining patterns and antibody clone selection affect correlation with p16/CDKN2A deletion. Given that pleural effusion cytology is often the initial diagnostic step in PM, standardised MTAP testing protocols are needed to ensure reproducibility and minimise false-negative interpretations, rather than implying improved diagnostic accuracy.
A 45-year-old man was admitted with B symptoms and pancytopenia. Peripheral blood smear analysis demonstrated numerous small lymphoid cells with occasional blasts and moderate myelemia. Bone marrow aspiration showed a marked infiltration by lymphoid cells (97%) morphologically consistent with chronic lymphocytic leukaemia. However, flow cytometry ultimately confirmed the diagnosis of B-cell acute lymphoblastic leukaemia. Molecular testing revealed a missense mutation in exon 10 of the ZEB2 gene (p.H1038R). The patient received treatment according to the GRAALL 2024, in combination with rituximab. Chemoresistance was observed at day 8, leading to an allogeneic haematopoietic stem cell transplant. This observation illustrates the diagnostic difficulty raised by unusual morphologic variants of acute lymphoblastic leukaemia.
This study applied an ensemble learning model combining six transfer learning architectures to detect malignancy in effusion cytology.
In this current study, we had a total of 110 cases of effusion cytology consisting of 59 benign and 51 malignant cases. We took a total of 755 representative microphotographs from the Papanicolaou's stained smear. The ensemble learning model consists of DenseNet121, Xception, ResNet50, MobileNetV2, InceptionV3, and VGG16 with a soft voting technique. After initial feature extraction, fine-tuning was performed by unfreezing the final layers of each backbone. The neural network was implemented in Jupyter Notebook.
The model achieved sensitivity, specificity, accuracy, precision, negative predictive value, F1 score, and AUROC of 0.92, 0.89, 0.90, 0.89, 0.92, 0.91, and 0.96, respectively.
To our knowledge, this is the first study applying a six-model ensemble deep learning approach in effusion cytology. The combined transfer learning framework demonstrated excellent diagnostic performance and may serve as a future tool for carcinoma detection in effusion cytology.
Melanin-rich cytologic specimens, particularly those from melanocytic lesions, present diagnostic challenges due to pigment-induced obscuration of cellular details and interference with immunocytochemistry (ICC) interpretation. These limitations are especially pronounced in cell transfer preparations, which differ significantly from tissue sections in cellular distribution and density. Existing bleaching protocols are inconsistent, often incomplete in pigment removal and can compromise cellular morphology. This study aimed to develop and evaluate an automated platform incorporating optimised melanin bleaching, ICC and cytomorphologic staining to enhance diagnostic accuracy in heavily pigmented cytologic samples.
Ten melanoma cell transfer smears were processed using an optimised protocol. Slides underwent melanin bleaching with 10% hydrogen peroxide at 60°C for 25 min, followed by automated ICC for Melan-A and SOX-10. Chromogenic detection was performed using either 3,3′-diaminobenzidine (DAB) or alkaline phosphatase (AP). In a parallel workflow, Papanicolaou (Pap) staining was performed after bleaching to assess cytomorphologic preservation.
The integrated protocol completed bleaching and staining within 2 h, with bleaching effectively removing melanin pigment while enhancing nuclear and cytoplasmic visibility without compromising morphological detail. Post-bleaching Pap staining preserved cytologic features, enabling accurate morphological interpretation. Both markers exhibited strong, specific immunoreactivity with either chromogen; however, AP yielded superior contrast and clearer antigen localisation. In contrast, residual melanin occasionally masked DAB signals, limiting interpretability.
This automated protocol, combining melanin bleaching, Pap staining and ICC, improves visualisation and diagnostic interpretation of melanin-rich cytologic specimens. The bleaching step preserves cellular and antigenic integrity, while AP chromogen provides enhanced clarity in the presence of residual pigment. This reproducible and practical workflow facilitates more accurate cytopathologic evaluation of melanocytic lesions.
Liquid biopsy is transforming cancer diagnostics and management by enabling minimally invasive molecular profiling through blood. Beyond plasma, cytology specimens such as pleural effusions, cerebrospinal fluid and urine offer valuable sources for molecular testing. In this narrative review, we highlight the central role of cytopathology in integrating liquid biopsy into clinical practice, discussing pre-analytical and analytical challenges across different samples and exploring the contribution of artificial intelligence in improving both morphological and molecular interpretation.
A 39-year-old man was diagnosed with acute lymphoblastic leukaemia (B-ALL) with SYNRG::ZNF384 and P2RY8::CRLF2 gene fusions. He was treated according to the GRAALL 2014 and underwent an allogeneic transplantation, achieving complete remission. Twenty-five months later, he developed pancytopenia. The bone marrow examination showed blasts with an immunophenotype consistent with minimally differentiated acute myeloid leukaemia (AML M0). Although the P2RY8::CRLF2 fusion persisted, no molecular evidence of a lineage switch was detected. This rare presentation underlines the diagnostic challenges of acute leukaemias. The patient was finally treated with azacitidine and venetoclax.
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