Xiaobing Jin, Madelyn Lew, Brian Smola, Tao Huang, Xin Jing
Introduction
Our institution utilises diagnostic frameworks similar to WHO Reporting System for Lung Cytopathology (WHORSLC) for assessment of lung fine needle aspiration (FNA) specimens. This study reports risk of malignancy (ROM) across diagnostic categories for comparison with the WHORSLC published data.
Methods
A SNOMED search of the electronic pathology database in our institution (01/2022–12/2023) was conducted to retrieve endobronchial ultrasound (EBUS)-guided lung FNA specimens with a concurrent or subsequent surgical biopsy. Cytologic interpretation of these FNA specimens was performed using diagnostic frameworks similar to WHORSLC. Diagnostic distribution and ROM across the diagnostic categories were evaluated.
Results
Among the 280 identified specimens, 125 (45%) were categorised as malignant, followed by 62 (22%) non-diagnostic, 45 (16%) benign, 33 (12%) atypical, and 15 (5%) suspicious for malignancy (SFM). The corresponding biopsies revealed malignancy in all FNAs categorised as malignant or SFM, as well as 57%, 35%, and 20% of atypical, non-diagnostic, and 20% benign cases, respectively. Among the histology-proven malignancies across the diagnostic categories, the majority were primary lung carcinomas, which most commonly were adenocarcinoma. Non-pulmonary malignancies were mostly seen in atypical (36%) followed by non-diagnostic (27%), SFM (13%), and malignant (10%) categories.
Conclusion
EBUS-guided lung FNA specimens in our cohort categorised as malignant or SFM showed a higher ROM and cyto-histologic concordance (100%) than those reported by the WHORSLC. While our study resulted in a similar ROM for benign, atypical, and malignant categories, the ROM was lower for the non-diagnostic category. These findings contribute to the limited data available and may help further refine the ROM for different categories within the current WHORSLC framework.
{"title":"An Institutional Experience in Lung Endobronchial Ultrasound-Guided Fine Needle Aspiration: Comparing Risk of Malignancy With WHO Reporting System for Lung Cytopathology","authors":"Xiaobing Jin, Madelyn Lew, Brian Smola, Tao Huang, Xin Jing","doi":"10.1111/cyt.13509","DOIUrl":"10.1111/cyt.13509","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Our institution utilises diagnostic frameworks similar to WHO Reporting System for Lung Cytopathology (WHORSLC) for assessment of lung fine needle aspiration (FNA) specimens. This study reports risk of malignancy (ROM) across diagnostic categories for comparison with the WHORSLC published data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A SNOMED search of the electronic pathology database in our institution (01/2022–12/2023) was conducted to retrieve endobronchial ultrasound (EBUS)-guided lung FNA specimens with a concurrent or subsequent surgical biopsy. Cytologic interpretation of these FNA specimens was performed using diagnostic frameworks similar to WHORSLC. Diagnostic distribution and ROM across the diagnostic categories were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 280 identified specimens, 125 (45%) were categorised as malignant, followed by 62 (22%) non-diagnostic, 45 (16%) benign, 33 (12%) atypical, and 15 (5%) suspicious for malignancy (SFM). The corresponding biopsies revealed malignancy in all FNAs categorised as malignant or SFM, as well as 57%, 35%, and 20% of atypical, non-diagnostic, and 20% benign cases, respectively. Among the histology-proven malignancies across the diagnostic categories, the majority were primary lung carcinomas, which most commonly were adenocarcinoma. Non-pulmonary malignancies were mostly seen in atypical (36%) followed by non-diagnostic (27%), SFM (13%), and malignant (10%) categories.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EBUS-guided lung FNA specimens in our cohort categorised as malignant or SFM showed a higher ROM and cyto-histologic concordance (100%) than those reported by the WHORSLC. While our study resulted in a similar ROM for benign, atypical, and malignant categories, the ROM was lower for the non-diagnostic category. These findings contribute to the limited data available and may help further refine the ROM for different categories within the current WHORSLC framework.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 5","pages":"479-483"},"PeriodicalIF":1.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082214","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}
Isabella Sorice, Anna Maria Carillo, Maria Salatiello, Caterina De Luca, Rosa Maria Di Crescenzo, Vincenzo Damiano, Giovanni Dell’Aversana Orabona, Elena Vigliar, Giancarlo Troncone, Claudio Bellevicine
This article reports a rare case of metastatic clear cell renal cell carcinoma presenting as a parotid gland mass, clinically and cytologically mimicking a primary salivary gland neoplasm. It underscores the diagnostic value of integrating cytological evaluation with clinical history and immunocytochemical profiling.
{"title":"Clear Cell Neoplasm in Salivary Gland FNA? Maybe It’s From Kidney!","authors":"Isabella Sorice, Anna Maria Carillo, Maria Salatiello, Caterina De Luca, Rosa Maria Di Crescenzo, Vincenzo Damiano, Giovanni Dell’Aversana Orabona, Elena Vigliar, Giancarlo Troncone, Claudio Bellevicine","doi":"10.1111/cyt.13506","DOIUrl":"10.1111/cyt.13506","url":null,"abstract":"<p>This article reports a rare case of metastatic clear cell renal cell carcinoma presenting as a parotid gland mass, clinically and cytologically mimicking a primary salivary gland neoplasm. It underscores the diagnostic value of integrating cytological evaluation with clinical history and immunocytochemical profiling.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 4","pages":"426-429"},"PeriodicalIF":1.2,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010178","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}
Poorva Singh, Katlin T. Wilson, Linda Varghese, Jimmie Stewart
<p>Squamous cell carcinoma (SqCC) in the vitreous fluid is exceedingly rare and usually caused by metastasis from primary sites such as lung, breast, and cervix [<span>1-3</span>]. Metastases to the vitreous from other primary sites are even rarer; when they do occur, they are most commonly from cutaneous melanoma in patients previously treated with immune checkpoint inhibitors [<span>4</span>]. Most patients present with vision changes at advanced stages of malignancy with non-specific ocular symptoms, making diagnosis challenging [<span>2</span>]. Given the scarcity of literature on this entity, there are no consensus therapy guidelines for these patients. Reporting individual cases is crucial for expanding the knowledge base, guiding clinical suspicion, and improving management strategies, especially because timely and accurate diagnosis could potentially impact the quality of life of affected patients. Herein, we present a case of oropharyngeal SqCC with metastasis to the vitreous humour.</p><p>Our patient is a 57-year-old male with HPV-associated squamous cell carcinoma of the oropharynx initially diagnosed in 2015. He had multiple local recurrences and metastases to the bone, retroperitoneum, and lung throughout the course of chemoradiotherapy. While on therapy with capecitabine, he developed a sudden decrease in vision and floaters in the left eye and was referred for ophthalmic evaluation. The examination was significant for intraretinal lesions, raising suspicion for panuveitis and posterior cyclitis. A pars plana vitrectomy was performed and sent for cytologic examination wherein the cell block showed a cluster of cells with nuclear enlargement, nuclear membrane irregularities, coarse chromatin, prominent nucleoli, and atypical mitoses (Figure 1A). These cells were strongly and diffusely positive for pancytokeratin and p40 immunohistochemistry (IHC, Figure 1B), raising the suspicion for involvement by the patient's known squamous cell carcinoma. Since ocular adverse effects are common in patients taking anti-metabolite chemotherapeutic drugs such as capecitabine, as was the case in this patient, the clinical suspicion for metastatic disease was low [<span>5</span>]. Consequently, a membrane peel was obtained for corroboration of the cytologic findings. Surgical pathology examination of the epiretinal membrane confirmed the diagnosis of non-keratinising squamous cell carcinoma (Figure 2A) which stained strongly and diffusely with pancytokeratin (Figure 2B) and p16, serving as a surrogate marker for HPV (Figure 2C). The patient was counselled, and he elected to receive intravitreal Melphalan instead of local radiotherapy due to the marginally worse adverse effect profile of radiotherapy.</p><p>Non lymphatic distant metastases to the orbital soft tissue and vitreous humour have been documented to arise predominantly from breast and lung primaries, followed by a few articles reporting cervical SqCC as the primary tumor [<span>1-3</span>], o
玻璃体液中的鳞状细胞癌（SqCC）极为罕见，通常由原发部位如肺、乳腺和宫颈转移引起[1-3]。从其他原发部位转移到玻璃体的病例更为罕见；当它们确实发生时，它们最常见于先前接受免疫检查点抑制剂[4]治疗的皮肤黑色素瘤患者。大多数患者在恶性肿瘤晚期出现视力改变并伴有非特异性眼部症状，使诊断具有挑战性。鉴于文献的稀缺性，对这些患者没有共识的治疗指南。报告个案对于扩大知识库、指导临床怀疑和改进管理策略至关重要，特别是因为及时和准确的诊断可能会影响受影响患者的生活质量。在此，我们报告一个口咽部SqCC转移到玻璃体的病例。我们的患者是一名57岁男性，于2015年首次诊断为hpv相关的口咽部鳞状细胞癌。在整个放化疗过程中，他有多次局部复发和转移到骨、腹膜后和肺。在卡培他滨治疗期间，他突然出现左眼视力下降和飞蚊症，并被转介进行眼科评估。检查对视网膜内病变有重要意义，引起对全葡萄膜炎和后睫状体炎的怀疑。行玻璃体切除并送细胞学检查，细胞块显示细胞核增大，核膜不规则，染色质粗，核仁突出，有丝分裂不典型（图1A）。这些细胞的全细胞角蛋白和p40免疫组化呈强烈且弥漫性阳性（IHC，图1B），这增加了患者已知的鳞状细胞癌的怀疑。由于服用抗代谢物化疗药物如卡培他滨的患者眼部不良反应很常见，如本例患者，临床对转移性疾病的怀疑较低。因此，获得了膜剥离以证实细胞学结果。视网膜前膜的手术病理检查证实了非角化鳞状细胞癌的诊断（图2A），其泛细胞角蛋白（图2B）和p16染色强烈且弥漫性，作为HPV的替代标志物（图2C）。患者被告知，他选择接受玻璃体内美法兰而不是局部放疗，因为放疗的不良反应更严重。据文献记载，眼眶软组织和玻璃体癌的非淋巴远端转移主要发生在乳房和肺部原发肿瘤，随后有少数文章报道宫颈SqCC为原发肿瘤[1-3]，偶尔有黑色素瘤的病例报道，使用免疫检查点抑制剂治疗的癌症患者就更少了。值得注意的是，SqCC以非连续方式扩散到玻璃体的病例报告很少，而且非常少[2,6 -8]。与诊断眼部转移相关的挑战是由于其非特异性和模糊的表现。大多数转移性玻璃体受累的患者通常在恶性肿瘤晚期出现视力改变和突发性飞蚊症，预后差，临床前景不良2。先前的报道提到头颈部癌患者在诊断为眼部转移后的平均生存期为7个月[2,7,8]。其他原发性肾癌也有类似的不良预后，其中眼转移可能是疾病全身传播的最初迹象。最近的一项分析强调了在确定的恶性肿瘤患者出现眼部症状时进行全面评估的重要性，强调了解决局部和全身性疾病负担bbb的重要性。由于这些病例的罕见性，这种远端非淋巴转移的真实发生率尚不清楚。因此，眼科医生在评估有视力改变的SqCC患者时，通常对这种诊断保持低怀疑指数。唯一确定诊断的方法是玻璃体液取样，这是一种侵入性手术，许多晚期癌症患者可能不同意，导致很大比例的病例漏诊。随后文献病例的缺乏阻碍了共识治疗指南的制定或临床试验的建立。先前的一项研究对乳腺癌患者进行了尸检，发现超过三分之一的病例有眼部转移，这一比例明显高于之前报道的[10]。 本病例强调，有鳞状细胞癌病史的患者应保持高度怀疑的眼部细胞学标本。目前的文献强调，及时诊断是确定适当干预措施的关键。目前文献中的空白包括眼区转移后的估计预后，以及分析放射/化疗干预是否能提高这类病例的生存率。这些研究的进一步扩展可能包括生活质量指标，以便为玻璃体转移治疗的风险收益比决策提供信息。然而，这些病例的罕见性阻碍了共识治疗指南的制定。我们的病例不仅是不寻常的，而且是口咽转移到玻璃体液的SqCC的第一个报告之一。与先前报道的平均7个月相比，我们的患者在诊断为眼转移后的生存期明显较差。对于这些类型的病例，生存的真实程度、可能的干预措施和预后不良的生活质量改善措施都有待阐明。我们的病例强调了早期诊断的重要性，因为此时患者通常处于癌症晚期，可以从改进的治疗管理中受益，以提高生活质量。Poorva Singh：对病例报告的构思、临床病例的选择和手稿的初步起草做出了贡献。Katlin T. Wilson：进行文献综述，参与手稿的撰写和修订，并协助排版和图表准备。Linda Varghese：提供细胞病理学解释，监督稿件的发展，并严格修改稿件的知识内容。Jimmie Stewart：提供细胞病理学解释，对病例解释做出贡献，并对最终手稿进行批判性审查和批准。所有作者都符合ICMJE的作者资格标准，已经审阅并批准了稿件的最终版本，并同意对其内容负责。作者声明无利益冲突。
{"title":"Case Report—Cytopathological Diagnosis of Metastatic Squamous Cell Carcinoma in Vitreous Fluid","authors":"Poorva Singh, Katlin T. Wilson, Linda Varghese, Jimmie Stewart","doi":"10.1111/cyt.13507","DOIUrl":"10.1111/cyt.13507","url":null,"abstract":"<p>Squamous cell carcinoma (SqCC) in the vitreous fluid is exceedingly rare and usually caused by metastasis from primary sites such as lung, breast, and cervix [<span>1-3</span>]. Metastases to the vitreous from other primary sites are even rarer; when they do occur, they are most commonly from cutaneous melanoma in patients previously treated with immune checkpoint inhibitors [<span>4</span>]. Most patients present with vision changes at advanced stages of malignancy with non-specific ocular symptoms, making diagnosis challenging [<span>2</span>]. Given the scarcity of literature on this entity, there are no consensus therapy guidelines for these patients. Reporting individual cases is crucial for expanding the knowledge base, guiding clinical suspicion, and improving management strategies, especially because timely and accurate diagnosis could potentially impact the quality of life of affected patients. Herein, we present a case of oropharyngeal SqCC with metastasis to the vitreous humour.</p><p>Our patient is a 57-year-old male with HPV-associated squamous cell carcinoma of the oropharynx initially diagnosed in 2015. He had multiple local recurrences and metastases to the bone, retroperitoneum, and lung throughout the course of chemoradiotherapy. While on therapy with capecitabine, he developed a sudden decrease in vision and floaters in the left eye and was referred for ophthalmic evaluation. The examination was significant for intraretinal lesions, raising suspicion for panuveitis and posterior cyclitis. A pars plana vitrectomy was performed and sent for cytologic examination wherein the cell block showed a cluster of cells with nuclear enlargement, nuclear membrane irregularities, coarse chromatin, prominent nucleoli, and atypical mitoses (Figure 1A). These cells were strongly and diffusely positive for pancytokeratin and p40 immunohistochemistry (IHC, Figure 1B), raising the suspicion for involvement by the patient's known squamous cell carcinoma. Since ocular adverse effects are common in patients taking anti-metabolite chemotherapeutic drugs such as capecitabine, as was the case in this patient, the clinical suspicion for metastatic disease was low [<span>5</span>]. Consequently, a membrane peel was obtained for corroboration of the cytologic findings. Surgical pathology examination of the epiretinal membrane confirmed the diagnosis of non-keratinising squamous cell carcinoma (Figure 2A) which stained strongly and diffusely with pancytokeratin (Figure 2B) and p16, serving as a surrogate marker for HPV (Figure 2C). The patient was counselled, and he elected to receive intravitreal Melphalan instead of local radiotherapy due to the marginally worse adverse effect profile of radiotherapy.</p><p>Non lymphatic distant metastases to the orbital soft tissue and vitreous humour have been documented to arise predominantly from breast and lung primaries, followed by a few articles reporting cervical SqCC as the primary tumor [<span>1-3</span>], o","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 4","pages":"423-425"},"PeriodicalIF":1.2,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cyt.13507","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054518","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}
Jie-Qiong Wang, Ge Li, Shao-Hua Wang, Bo Yang, Yun Liu, Yu Wan, Cong-Gai Huang, Fan Li
Objective
Spontaneous infarction in salivary gland pleomorphic adenoma (PA) diagnosed by fine-needle aspiration cytology (FNAC) is rarely documented. This study aims to systematically analyse and summarise its cytopathological characteristics to reduce the risk of misdiagnosis and enhance diagnostic precision.
Methods
Five histopathologically confirmed cases (2017–2024) from two hospitals were retrospectively analysed. Clinical data, cytopathological findings and histopathology were reviewed, and causes of misdiagnosis were evaluated. Additionally, the cytopathological characteristics of salivary gland PA with spontaneous infarction were systematically analysed and comprehensively summarised, incorporating findings from relevant domestic and international literature.
Results
Only two cases (40%) were correctly diagnosed as PA or PA with infarction. Two cases (40%) were misdiagnosed as suspicious of malignancy, and one case (20%) was inconclusive. The cytopathological features are as follows: Fine-needle aspiration (FNA) specimens often appear as milky-white or brownish paste, with or without small tissue fragments. Microscopically, there is a background of necrotic debris with numerous scattered pleomorphic small cells resembling ‘naked nuclei’, characterised by hyperchromatic and irregular nuclei, accompanied by atypical squamous metaplastic cells, ‘ghost cells’ and eosinophilic cells with non-atypical nuclei, with or without the presence of tumour-associated glandular epithelial cells, myoepithelial cells, lymphocytes, neutrophils or other inflammatory cells, while mucinous or chondroid stroma is rarely observed or absent, and no abnormal mitotic figures are identified.
Conclusion
The cytological features of PA with spontaneous infarction can mimic malignancy. Recognising these features is crucial to reducing diagnostic errors and guiding appropriate management.
{"title":"Fine-Needle Aspiration Cytology Diagnosis of Pleomorphic Adenoma With Spontaneous Infarction in the Salivary Gland: A Multicenter Retrospective Study","authors":"Jie-Qiong Wang, Ge Li, Shao-Hua Wang, Bo Yang, Yun Liu, Yu Wan, Cong-Gai Huang, Fan Li","doi":"10.1111/cyt.13500","DOIUrl":"10.1111/cyt.13500","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Spontaneous infarction in salivary gland pleomorphic adenoma (PA) diagnosed by fine-needle aspiration cytology (FNAC) is rarely documented. This study aims to systematically analyse and summarise its cytopathological characteristics to reduce the risk of misdiagnosis and enhance diagnostic precision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Five histopathologically confirmed cases (2017–2024) from two hospitals were retrospectively analysed. Clinical data, cytopathological findings and histopathology were reviewed, and causes of misdiagnosis were evaluated. Additionally, the cytopathological characteristics of salivary gland PA with spontaneous infarction were systematically analysed and comprehensively summarised, incorporating findings from relevant domestic and international literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Only two cases (40%) were correctly diagnosed as PA or PA with infarction. Two cases (40%) were misdiagnosed as suspicious of malignancy, and one case (20%) was inconclusive. The cytopathological features are as follows: Fine-needle aspiration (FNA) specimens often appear as milky-white or brownish paste, with or without small tissue fragments. Microscopically, there is a background of necrotic debris with numerous scattered pleomorphic small cells resembling ‘naked nuclei’, characterised by hyperchromatic and irregular nuclei, accompanied by atypical squamous metaplastic cells, ‘ghost cells’ and eosinophilic cells with non-atypical nuclei, with or without the presence of tumour-associated glandular epithelial cells, myoepithelial cells, lymphocytes, neutrophils or other inflammatory cells, while mucinous or chondroid stroma is rarely observed or absent, and no abnormal mitotic figures are identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The cytological features of PA with spontaneous infarction can mimic malignancy. Recognising these features is crucial to reducing diagnostic errors and guiding appropriate management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 5","pages":"484-490"},"PeriodicalIF":1.1,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060575","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}
The suspicious for malignancy category is used by pathologists to indicate a certain degree of uncertainty but is still able to convey to the treating physician a risk stratification of the deferred diagnosis. The category of suspicious for malignancy can be used in a vast possibility of cytomorphological features and clinical scenarios. Suspicious for malignancy is often used when there is an insufficient number of neoplastic cells for the establishment of a final diagnosis, but in many situations, the number of suspicious cells may be abundant but discrepant with the clinical presentation. In addition, the pathologist must be aware of the many mimickers of malignancy that, when present, may prompt the use of the category. Therefore, there is a need for better illustrations of the use of the category, its pitfalls and suggestions on when the category of suspicious for malignancy can be upgraded for a more definite diagnosis using ancillary studies, even in scant material.
{"title":"Diagnostic Category: Suspicious for Malignancy","authors":"Andre L. Moreira, Fernando Schmitt","doi":"10.1111/cyt.13498","DOIUrl":"10.1111/cyt.13498","url":null,"abstract":"<div>\u0000 \u0000 <p>The suspicious for malignancy category is used by pathologists to indicate a certain degree of uncertainty but is still able to convey to the treating physician a risk stratification of the deferred diagnosis. The category of suspicious for malignancy can be used in a vast possibility of cytomorphological features and clinical scenarios. Suspicious for malignancy is often used when there is an insufficient number of neoplastic cells for the establishment of a final diagnosis, but in many situations, the number of suspicious cells may be abundant but discrepant with the clinical presentation. In addition, the pathologist must be aware of the many mimickers of malignancy that, when present, may prompt the use of the category. Therefore, there is a need for better illustrations of the use of the category, its pitfalls and suggestions on when the category of suspicious for malignancy can be upgraded for a more definite diagnosis using ancillary studies, even in scant material.</p>\u0000 </div>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 5","pages":"458-466"},"PeriodicalIF":1.1,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058668","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}
Chayanika Kala, Rajneesh Srivastava, Sanjay Kala, Lubna Khan, Neetu Purwar
Introduction
Fine Needle Aspiration Biopsy (FNAB) of the breast is a widely used diagnostic tool for detecting breast lesions, offering high sensitivity and positive predictive value. The International Academy of Cytology (IAC) established the Yokohama System in 2016 to standardise reporting of breast FNAB.
Objective
To categorise FNAB samples according to the IAC Yokohama System, assess the ROM for each category and evaluate the sensitivity, specificity and predictive values for malignancy diagnosis.
Methods
This prospective observational study involved predominantly younger adults with the majority presenting with a palpable breast mass. FNAB samples were collected, stained and examined microscopically. Categories were assigned according to the Yokohama System, and the results were compared with histopathological examination (HPE). Diagnostic metrics and ROM were calculated using statistical analysis.
Results
The study included 428 patients, with malignant cases comprising 49.5% of the samples, benign cases 43.5%, atypical cases 4.2%, suspicious for malignancy cases 1.9% and insufficient material 0.9%. The risk of malignancy (ROM) was 100% for malignant, 87.5% for suspicious for malignancy, 22.2% for atypical, 2.15% for benign and 25% for the insufficient category. Sensitivity, specificity and accuracy varied across groups, with group A, group B and group C showing accuracy at 92.99%, 97.66% and 95.3%, respectively.
Conclusion
The IAC Yokohama System effectively categorises breast FNAB samples, provides accurate diagnostic metrics for malignancy and aids clinical decision-making, particularly in resource-limited settings.
{"title":"Evaluating the Diagnostic Impact of the IAC Yokohama System for Breast Fine Needle Aspiration Biopsy Cytopathology: A Prospective Institutional Study","authors":"Chayanika Kala, Rajneesh Srivastava, Sanjay Kala, Lubna Khan, Neetu Purwar","doi":"10.1111/cyt.13499","DOIUrl":"10.1111/cyt.13499","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Fine Needle Aspiration Biopsy (FNAB) of the breast is a widely used diagnostic tool for detecting breast lesions, offering high sensitivity and positive predictive value. The International Academy of Cytology (IAC) established the Yokohama System in 2016 to standardise reporting of breast FNAB.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To categorise FNAB samples according to the IAC Yokohama System, assess the ROM for each category and evaluate the sensitivity, specificity and predictive values for malignancy diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective observational study involved predominantly younger adults with the majority presenting with a palpable breast mass. FNAB samples were collected, stained and examined microscopically. Categories were assigned according to the Yokohama System, and the results were compared with histopathological examination (HPE). Diagnostic metrics and ROM were calculated using statistical analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 428 patients, with malignant cases comprising 49.5% of the samples, benign cases 43.5%, atypical cases 4.2%, suspicious for malignancy cases 1.9% and insufficient material 0.9%. The risk of malignancy (ROM) was 100% for malignant, 87.5% for suspicious for malignancy, 22.2% for atypical, 2.15% for benign and 25% for the insufficient category. Sensitivity, specificity and accuracy varied across groups, with group A, group B and group C showing accuracy at 92.99%, 97.66% and 95.3%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The IAC Yokohama System effectively categorises breast FNAB samples, provides accurate diagnostic metrics for malignancy and aids clinical decision-making, particularly in resource-limited settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 5","pages":"491-497"},"PeriodicalIF":1.1,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010123","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}
Micronucleus (MN) and Nuclear Budding (NB) Have Been Used as an Important Stimulus for Nuclear Atypia in Revealing Chromosomal Damage and Cancer Risk. This Study Aims to Assess MN and NB as Nuclear Parameters and Explore Their Role in Differential Diagnosis of Thyroid FNA and “Bethesda System for Reporting Thyroid Cytology” (BSRTC).
Methods
The Study Included 350 Thyroid FNA Samples Categorised According to BSRTC. NB And MN Were Evaluated in 1000 Thyrocytes on FNA Slides. The Thyroidectomy Sections Were Divided Into Three Categories as ‘Malignant’, ‘Low-Risk’ and ‘Benign’.
Results
A Total of 350 Cases Were Classified as follows: 55 (15.71%) Benign, 159 (45.43%) Atypia of Undetermined Significance (AUS), 20 (5.71%) Follicular Neoplasm (FN), 48 (13.71%) Suspicious for Malignancy (SFM) and 68 (19.43%) Malignant. In comparison to all other cytopathologic diagnostic groups, the benign group had significantly lower levels of MN and NB (p < 0.001). The AUS group's MN and NB counts were significantly lower than those of the FN, SFM and malignant groups (MN for AUS-FN/SFM/M p < 0.001, NB for AUS-FN p = 0.01, NB for AUS-SFM/M p < 0.001, respectively). MN and NB counts were greater in the AUS group for cases with a malignant histopathologic diagnosis than for those with a benign histopathologic diagnosis (p < 0.001). MN and NB cut-off values > 5.50 and > 14.50, respectively, suggest high sensitivity and specificity of malignancy.
Conclusions
Increased Frequency of MN and NB closely associated with an increased risk of malignancy in thyroid FNA. Assessing MN and NB in thyroid FNA may help better stratify the risk in the AUS category.
{"title":"Micronucleus and Nuclear Budding Help to Identify Malignancy in Thyroid Fine Needle Aspiration Cytology","authors":"Nur Gizem Kocaoğlu Çelik, Ayşegül Aksoy Altınboğa, Tuba Dilay Kökenek Ünal","doi":"10.1111/cyt.13505","DOIUrl":"10.1111/cyt.13505","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Micronucleus (MN) and Nuclear Budding (NB) Have Been Used as an Important Stimulus for Nuclear Atypia in Revealing Chromosomal Damage and Cancer Risk. This Study Aims to Assess MN and NB as Nuclear Parameters and Explore Their Role in Differential Diagnosis of Thyroid FNA and “Bethesda System for Reporting Thyroid Cytology” (BSRTC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Study Included 350 Thyroid FNA Samples Categorised According to BSRTC. NB And MN Were Evaluated in 1000 Thyrocytes on FNA Slides. The Thyroidectomy Sections Were Divided Into Three Categories as ‘Malignant’, ‘Low-Risk’ and ‘Benign’.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A Total of 350 Cases Were Classified as follows: 55 (15.71%) Benign, 159 (45.43%) Atypia of Undetermined Significance (AUS), 20 (5.71%) Follicular Neoplasm (FN), 48 (13.71%) Suspicious for Malignancy (SFM) and 68 (19.43%) Malignant. In comparison to all other cytopathologic diagnostic groups, the benign group had significantly lower levels of MN and NB (<i>p</i> < 0.001). The AUS group's MN and NB counts were significantly lower than those of the FN, SFM and malignant groups (MN for AUS-FN/SFM/M <i>p</i> < 0.001, NB for AUS-FN <i>p</i> = 0.01, NB for AUS-SFM/M <i>p</i> < 0.001, respectively). MN and NB counts were greater in the AUS group for cases with a malignant histopathologic diagnosis than for those with a benign histopathologic diagnosis (<i>p</i> < 0.001). MN and NB cut-off values > 5.50 and > 14.50, respectively, suggest high sensitivity and specificity of malignancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Increased Frequency of MN and NB closely associated with an increased risk of malignancy in thyroid FNA. Assessing MN and NB in thyroid FNA may help better stratify the risk in the AUS category.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"37 1","pages":"76-85"},"PeriodicalIF":1.1,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063001","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}
This enigma portal case highlights the cytological features of Primary cutaneous Rosai–Dorfman Disease, which is a breast cancer survivor. The classic morphological features, key diagnostic points and differentials are discussed.
In this report, the classical cytological features of primary cutaneous Rosai–Dorfman disease isare highlighted.
{"title":"Primary Cutaneous Rosai–Dorfman Disease in a Treated Case of Breast Carcinoma—Cytological Diagnostic Enigma","authors":"Sherrin Jacob, Balamurugan Thirunavukkarasu, Sudheer Kumar Arava, Rajinder Parshad","doi":"10.1111/cyt.13496","DOIUrl":"10.1111/cyt.13496","url":null,"abstract":"<p>This enigma portal case highlights the cytological features of Primary cutaneous Rosai–Dorfman Disease, which is a breast cancer survivor. The classic morphological features, key diagnostic points and differentials are discussed.</p><p>In this report, the classical cytological features of primary cutaneous Rosai–Dorfman disease isare highlighted.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 5","pages":"544-546"},"PeriodicalIF":1.1,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029738","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}
Large tumour cells with abundant eosinophilic cytoplasm, coarse chromatin and irregular nuclear shapes are typical cytological signs of fumarate hydratase-deficient renal cell carcinoma. CK7-negative/CA9-negative/PAX8-positive and AKR1B10-positive/2SC-positive/FH-deficient immunophenotypes may serve as important diagnostic markers.
{"title":"The Cytopathological Diagnosis of Fumarate Hydratase (FH)-Deficient Renal Cell Carcinoma in Two Patients With FH Gene Mutation","authors":"Xianglan Zhu, Kaixin Lei, Xiaoyu Liu, Xueying Su","doi":"10.1111/cyt.13504","DOIUrl":"10.1111/cyt.13504","url":null,"abstract":"<p>Large tumour cells with abundant eosinophilic cytoplasm, coarse chromatin and irregular nuclear shapes are typical cytological signs of fumarate hydratase-deficient renal cell carcinoma. CK7-negative/CA9-negative/PAX8-positive and AKR1B10-positive/2SC-positive/FH-deficient immunophenotypes may serve as important diagnostic markers.</p>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 4","pages":"418-422"},"PeriodicalIF":1.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049474","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}
<div> <section> <h3> Objective</h3> <p>Identifying aggressive variants of throid papillary carcinoma correctly is paramount, as their diagnosis requires more extensive surgical interventions. Numerous cytologic scoring systems have been proposed to distinguish non-aggressive from aggressive variants. Oncocytic morphology is characterised by cells with abundant granular cytoplasm resulting from mitochondrial accumulation. This feature is particularly prominent in specific PTC variants. Tall cell and hobnail variants are aggressive variants with oncocytic morphology. The present study aims to evaluate the cytomorphological features of 51 histologically confirmed papillary thyroid carcinoma (PTC) cases with oncocytic morphology and to identify cytological features that could facilitate the distinction between aggressive (tall cell and hobnail) and non-aggressive (oncocytic and Warthin-like) variants during the FNA stage, thereby enabling early detection of aggressive variants.</p> </section> <section> <h3> Methods</h3> <p>We retrospectively examined the cytological features of cases diagnosed with histologically confirmed aggressive variants with poor prognosis (tall cell and hobnail) and non-aggressive variants with good prognosis (oncocytic and Warthin-like), obtained from the pathology department of our hospital between 2014 and 2020.</p> </section> <section> <h3> Results</h3> <p>39 cases (76.5%) classified into the good prognosis group, which included oncocytic variant (O-PTC) (33 cases) and Warthin-like variant (WL-PTC) (6 cases). The poor prognosis group included 12 cases (23.5%), comprising hobnail variant (HN-PTC) (2 cases) and tall cell variant (TC-PTC) (10 cases). The swirl pattern was significantly more frequent in the poor prognosis group (83.3% vs. 43.6%, <i>p</i> = 0.022), with a sensitivity of 83.3% and specificity of 56.4%. The presence of nuclear grooves was observed in all cases of the poor prognosis group (100%) while in 61.5% of the good prognosis group (<i>p</i> = 0.011). This feature exhibited 100% sensitivity and 38.4% specificity. Concerning cytoplasmic volume, scant-medium amount cytoplasmic volume was significantly more common in the poor prognosis group (66.7% vs. 20.5%, <i>p</i> = 0.005), showing 66.7% sensitivity and 79.4% specificity, and yielding the highest accuracy rate (76.4%) among all characteristics.</p> </section> <section> <h3> Conclusions</h3> <p>Oncocytic morphology-based approaches may help identify poor prognosis variants and guide clinical decisions. In our study, cellular swirls, grooves and scant-medium cytoplasmic volume were the most significant cytological indicators for identifying po
目的：正确识别甲状腺乳头状癌的侵袭性变异是至关重要的，因为它们的诊断需要更广泛的手术干预。已经提出了许多细胞学评分系统来区分非侵袭性和侵袭性变异。嗜瘤细胞形态的特征是由于线粒体积聚而形成的细胞具有丰富的颗粒状细胞质。这个特性在特定的PTC变体中尤为突出。高细胞变异体和鞋钉变异体是侵袭性变异体，具有癌细胞形态。本研究旨在评估51例组织学证实的甲状腺乳头状癌（PTC）嗜瘤细胞形态的细胞形态学特征，并确定细胞学特征，以便在FNA阶段区分侵袭性（高细胞和鞋钉）和非侵袭性（嗜瘤细胞和wartin样）变异，从而能够早期发现侵袭性变异。方法：回顾性分析我院病毒科2014 - 2020年经组织学证实预后较差的侵袭性变异体（高细胞型和鞋钉型）和预后较好的非侵袭性变异体（嗜瘤细胞型和沃辛样）的细胞学特征。结果：39例（76.5%）归为预后良好组，其中嗜瘤细胞变异体（O-PTC） 33例，wartin样变异体（WL-PTC） 6例。预后不良组12例（23.5%），其中鞋钉变异（HN-PTC） 2例，高细胞变异（TC-PTC） 10例。不良预后组漩涡型发生率更高（83.3%比43.6%,p = 0.022），敏感性为83.3%，特异性为56.4%。预后不良组中核沟的存在率为100%，而预后良好组中核沟的存在率为61.5% （p = 0.011）。该特征的敏感性为100%，特异性为38.4%。在细胞质体积方面，中微量细胞质体积在预后不良组中更为常见（66.7% vs. 20.5%, p = 0.005），敏感性为66.7%，特异性为79.4%，准确率最高（76.4%）。结论：基于肿瘤细胞形态的方法可能有助于识别预后不良的变异并指导临床决策。在我们的研究中，细胞漩涡、沟槽和少量的细胞质体积是鉴别预后不良变异的最重要的细胞学指标。尽管先前强调细胞宽度/高度比和泡沫INCIs用于TC-PTC的诊断，但在我们的研究中，两组之间没有发现显着差异。
{"title":"Can Aggressive Papillary Thyroid Carcinoma Variants With Oncocytıc Morphology (Tall Cell and Hobnail Variants) be Detected Cytologically? Is the Differentiation as Straightforward as Reported?","authors":"Burcu Özcan, Merve Cin, Zeynep Ece Demirbaş","doi":"10.1111/cyt.13502","DOIUrl":"10.1111/cyt.13502","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Identifying aggressive variants of throid papillary carcinoma correctly is paramount, as their diagnosis requires more extensive surgical interventions. Numerous cytologic scoring systems have been proposed to distinguish non-aggressive from aggressive variants. Oncocytic morphology is characterised by cells with abundant granular cytoplasm resulting from mitochondrial accumulation. This feature is particularly prominent in specific PTC variants. Tall cell and hobnail variants are aggressive variants with oncocytic morphology. The present study aims to evaluate the cytomorphological features of 51 histologically confirmed papillary thyroid carcinoma (PTC) cases with oncocytic morphology and to identify cytological features that could facilitate the distinction between aggressive (tall cell and hobnail) and non-aggressive (oncocytic and Warthin-like) variants during the FNA stage, thereby enabling early detection of aggressive variants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively examined the cytological features of cases diagnosed with histologically confirmed aggressive variants with poor prognosis (tall cell and hobnail) and non-aggressive variants with good prognosis (oncocytic and Warthin-like), obtained from the pathology department of our hospital between 2014 and 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>39 cases (76.5%) classified into the good prognosis group, which included oncocytic variant (O-PTC) (33 cases) and Warthin-like variant (WL-PTC) (6 cases). The poor prognosis group included 12 cases (23.5%), comprising hobnail variant (HN-PTC) (2 cases) and tall cell variant (TC-PTC) (10 cases). The swirl pattern was significantly more frequent in the poor prognosis group (83.3% vs. 43.6%, <i>p</i> = 0.022), with a sensitivity of 83.3% and specificity of 56.4%. The presence of nuclear grooves was observed in all cases of the poor prognosis group (100%) while in 61.5% of the good prognosis group (<i>p</i> = 0.011). This feature exhibited 100% sensitivity and 38.4% specificity. Concerning cytoplasmic volume, scant-medium amount cytoplasmic volume was significantly more common in the poor prognosis group (66.7% vs. 20.5%, <i>p</i> = 0.005), showing 66.7% sensitivity and 79.4% specificity, and yielding the highest accuracy rate (76.4%) among all characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Oncocytic morphology-based approaches may help identify poor prognosis variants and guide clinical decisions. In our study, cellular swirls, grooves and scant-medium cytoplasmic volume were the most significant cytological indicators for identifying po","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"37 1","pages":"53-65"},"PeriodicalIF":1.1,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027747","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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