Iva Kinkorová Luňáčková, Ondrej Ondič, Jana Němcová, Kateřina Černá, Jan Chytra, Jiří Bouda
Objective
The limitations of PAP smears in diagnosing severe cervical glandular lesions motivate the development of ancillary methods to facilitate their detection. This prospective cytology–histology and molecular study aims to investigate methylation test performance by establishing the test sensitivity and its relevance to patient management.
Method
LBC samples were prospectively acquired after 3 months following the primary conventional PAP-smear screening diagnosis of AGC–NEO (atypical glandular cells, favour neoplastic) and AIS. An HPV test and methylation test were performed. Corresponding subsequent biopsy reports were collected.
Results
Seven hundred and seventy Pap tests were signed out as AGC–NEO+. Complete study data were available for 85 cases (AIS in 46 cases, EA in 39 cases) that were further analysed. The methylation test was positive in 95.3% (81/85) cases, negative in 3.5% (3/85, AIS in two cases, EA in one case) and unanalysable in one sample (1.2%). HPV genotyping revealed a multi-infection rate of 29%. The presence of HPV types 16 and 18 was detected in 84% (72/85) of lesions, and HPV type 45 in 12% (10/85).
Conclusions
The methylation test shows a high sensitivity of 95.3% and reliably identifies histologically confirmed AIS+ lesions. This argues for further investigation into its performance characteristics and consideration of its use, especially as a pre-surgical triaging test in sensitive cases if the AIS+ lesion is suspected in pregnant women or nullipara.
{"title":"The Methylation Test Is Highly Sensitive for HPV-Associated Endocervical Adenocarcinoma and Could Be Helpful as a Cytological Ancillary Test in Women With a PAP-Smear Diagnosis of Severe Glandular Lesion (AGC–NEO+)","authors":"Iva Kinkorová Luňáčková, Ondrej Ondič, Jana Němcová, Kateřina Černá, Jan Chytra, Jiří Bouda","doi":"10.1111/cyt.70001","DOIUrl":"10.1111/cyt.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The limitations of PAP smears in diagnosing severe cervical glandular lesions motivate the development of ancillary methods to facilitate their detection. This prospective cytology–histology and molecular study aims to investigate methylation test performance by establishing the test sensitivity and its relevance to patient management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>LBC samples were prospectively acquired after 3 months following the primary conventional PAP-smear screening diagnosis of AGC–NEO (atypical glandular cells, favour neoplastic) and AIS. An HPV test and methylation test were performed. Corresponding subsequent biopsy reports were collected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven hundred and seventy Pap tests were signed out as AGC–NEO+. Complete study data were available for 85 cases (AIS in 46 cases, EA in 39 cases) that were further analysed. The methylation test was positive in 95.3% (81/85) cases, negative in 3.5% (3/85, AIS in two cases, EA in one case) and unanalysable in one sample (1.2%). HPV genotyping revealed a multi-infection rate of 29%. The presence of HPV types 16 and 18 was detected in 84% (72/85) of lesions, and HPV type 45 in 12% (10/85).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The methylation test shows a high sensitivity of 95.3% and reliably identifies histologically confirmed AIS+ lesions. This argues for further investigation into its performance characteristics and consideration of its use, especially as a pre-surgical triaging test in sensitive cases if the AIS+ lesion is suspected in pregnant women or nullipara.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 6","pages":"568-571"},"PeriodicalIF":1.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cyt.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295406","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}
BCOR-CCNB3 sarcoma is an undifferentiated small round cell sarcoma characterised by distinct molecular genetic alterations. The diagnostic clues include tumour cells with oval to short spindle-shaped morphology, finely dispersed chromatin, inconspicuous nucleoli, and an arrangement around blood vessels that forms pseudopapillary structures.
{"title":"Unveiling Diagnostic Clues of BCOR-CCNB3 Sarcoma in Fine-Needle Aspiration Specimens","authors":"Qingjie Wang, Diwei Zhou, Jingmin Zhong, Zhecheng Yan, Zhaorong Niu","doi":"10.1111/cyt.70000","DOIUrl":"10.1111/cyt.70000","url":null,"abstract":"<p>BCOR-CCNB3 sarcoma is an undifferentiated small round cell sarcoma characterised by distinct molecular genetic alterations. The diagnostic clues include tumour cells with oval to short spindle-shaped morphology, finely dispersed chromatin, inconspicuous nucleoli, and an arrangement around blood vessels that forms pseudopapillary structures.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 6","pages":"610-613"},"PeriodicalIF":1.1,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276756","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}
Filariasis and its consequences are a major health problem in tropical countries, including the Indian subcontinent. Lymphatic filariasis affects 90 million people worldwide. Despite the huge number of people affected all around the world, it is quite infrequent to find microfilaria in routine cytological smears and body fluids. The breast is an uncommon site for the occurrence of a filarial nodule, and only a few cases have been documented. We report a case of a young female who presented with a painful right breast lump. Clinically suspected of neoplasm, and ultrasound was suspicious for filariasis. FNAC (fine needle aspiration cytology) was used to make the final diagnosis of filariasis.
{"title":"Breast Filariasis—Diagnosed by Fine Needle Aspiration Cytology: A Rare Case Report","authors":"Aarushi Soota, Anju Khairwa, Rohit Sharma, Mukesh Kumar","doi":"10.1111/cyt.13510","DOIUrl":"10.1111/cyt.13510","url":null,"abstract":"<div>\u0000 \u0000 <p>Filariasis and its consequences are a major health problem in tropical countries, including the Indian subcontinent. Lymphatic filariasis affects 90 million people worldwide. Despite the huge number of people affected all around the world, it is quite infrequent to find microfilaria in routine cytological smears and body fluids. The breast is an uncommon site for the occurrence of a filarial nodule, and only a few cases have been documented. We report a case of a young female who presented with a painful right breast lump. Clinically suspected of neoplasm, and ultrasound was suspicious for filariasis. FNAC (fine needle aspiration cytology) was used to make the final diagnosis of filariasis.</p>\u0000 </div>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 5","pages":"522-524"},"PeriodicalIF":1.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152740","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}
Fine-needle aspiration cytology of a pancreatic tumour revealed basaloid cells with immunocytochemical features of metastatic adenoid cystic carcinoma.
This article describes a rare case of pancreatic metastasis of adenoid cystic carcinoma diagnosed by fine-needle aspiration cytology. Immunocytochemical staining for MYB and CD117 provided critical diagnostic support, highlighting the utility of liquid-based cytology in rare metastatic tumours.
{"title":"Unusual Pancreatic Metastasis of Solid Subtype Adenoid Cystic Carcinoma: Reappraisal of MYB and CD117 Immunostaining Utility in Liquid-Based Cytology","authors":"Keita Jinnouchi, Yuki Teramoto, Miho Saeki, Masahiro Hirata, Hironori Haga","doi":"10.1111/cyt.13512","DOIUrl":"10.1111/cyt.13512","url":null,"abstract":"<p>Fine-needle aspiration cytology of a pancreatic tumour revealed basaloid cells with immunocytochemical features of metastatic adenoid cystic carcinoma.</p><p>This article describes a rare case of pancreatic metastasis of adenoid cystic carcinoma diagnosed by fine-needle aspiration cytology. Immunocytochemical staining for MYB and CD117 provided critical diagnostic support, highlighting the utility of liquid-based cytology in rare metastatic tumours.\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":"525-528"},"PeriodicalIF":1.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121380","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}
Magdalena M. Brune, Zubair Baloch, Lukas Bubendorf, Spasenija Savic Prince
The World Health Organization's (WHO) Reporting System for Lung Cytopathology intends to standardise the diagnosing and reporting of cytology specimens from the lung and aims at enhancing the communication between clinicians and (cyto)pathologists. It is closely connected to the 5th edition of the WHO Classification of Thoracic Tumours. The system includes five diagnostic categories, among them the ‘Malignant’ diagnostic category that incorporates both primary malignant tumours and metastases. Advancements in bronchoscopy have notably improved the diagnostic capacity of cytological specimens that represent the sole source of tumour material in approximately 40% of all lung carcinoma cases. An accurate diagnosis of malignancy and treatment-guiding classification into specific tumour types and subtypes can reliably be achieved with cytology specimens. They additionally serve as an excellent source for predictive immunocytochemistry (ICC) and molecular testing for targetable oncogenic alterations. This review article provides an overview of the key cytopathological features defining the ‘Malignant’ category of the WHO Reporting System for Lung Cytopathology for non-small cell carcinomas, neuroendocrine neoplasms and other specific carcinomas and malignancies which can be encountered in cytological specimens of the lung. It further describes the application of ancillary techniques, such as ICC and molecular testing, that have been successfully incorporated into different cytological sample types using various preparation methods.
{"title":"Diagnosing Malignant Epithelial Neoplasms of the Lung in Cytological Specimens: Cytomorphology, Ancillary Studies and Management","authors":"Magdalena M. Brune, Zubair Baloch, Lukas Bubendorf, Spasenija Savic Prince","doi":"10.1111/cyt.13511","DOIUrl":"10.1111/cyt.13511","url":null,"abstract":"<div>\u0000 \u0000 <p>The World Health Organization's (WHO) Reporting System for Lung Cytopathology intends to standardise the diagnosing and reporting of cytology specimens from the lung and aims at enhancing the communication between clinicians and (cyto)pathologists. It is closely connected to the 5th edition of the WHO Classification of Thoracic Tumours. The system includes five diagnostic categories, among them the ‘Malignant’ diagnostic category that incorporates both primary malignant tumours and metastases. Advancements in bronchoscopy have notably improved the diagnostic capacity of cytological specimens that represent the sole source of tumour material in approximately 40% of all lung carcinoma cases. An accurate diagnosis of malignancy and treatment-guiding classification into specific tumour types and subtypes can reliably be achieved with cytology specimens. They additionally serve as an excellent source for predictive immunocytochemistry (ICC) and molecular testing for targetable oncogenic alterations. This review article provides an overview of the key cytopathological features defining the ‘Malignant’ category of the WHO Reporting System for Lung Cytopathology for non-small cell carcinomas, neuroendocrine neoplasms and other specific carcinomas and malignancies which can be encountered in cytological specimens of the lung. It further describes the application of ancillary techniques, such as ICC and molecular testing, that have been successfully incorporated into different cytological sample types using various preparation methods.</p>\u0000 </div>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 5","pages":"467-478"},"PeriodicalIF":1.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121375","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}
Ciliated adenocarcinomas are rare non-terminal respiratory unit-type lung adenocarcinomas characterised by ciliated cells with nuclear atypia and glandular or papillary architecture. A few cases of ciliated adenocarcinoma of the lung have been reported. These adenocarcinomas are negative for TTF1 and have either KRAS (25%) or EGFR (9%) mutations. A case of a well-differentiated adenocarcinoma with papillary architecture, focal residual cilia, apical snouts, and CHEK2 and p53 mutations diagnosed at stage IV(T4NxM0) is reported. The article describes the cytomorphological features of this tumour, the potential pitfalls, diagnostic limitations, challenges identified in cytology specimens, and the necessary work-up for a definitive diagnosis. The differential diagnosis of papillary lesions of the lung and the clinical significance of CHEK2 mutations are also discussed in this article.
{"title":"Well-Differentiated Adenocarcinoma With Papillary Architecture, Focal Residual Cilia, Apical Snouts, and CHEK2 and p53 Mutations","authors":"Maria F. Gonzalez","doi":"10.1111/cyt.13508","DOIUrl":"10.1111/cyt.13508","url":null,"abstract":"<div>\u0000 \u0000 <p>Ciliated adenocarcinomas are rare non-terminal respiratory unit-type lung adenocarcinomas characterised by ciliated cells with nuclear atypia and glandular or papillary architecture. A few cases of ciliated adenocarcinoma of the lung have been reported. These adenocarcinomas are negative for TTF1 and have either KRAS (25%) or EGFR (9%) mutations. A case of a well-differentiated adenocarcinoma with papillary architecture, focal residual cilia, apical snouts, and CHEK2 and p53 mutations diagnosed at stage IV(T4NxM0) is reported. The article describes the cytomorphological features of this tumour, the potential pitfalls, diagnostic limitations, challenges identified in cytology specimens, and the necessary work-up for a definitive diagnosis. The differential diagnosis of papillary lesions of the lung and the clinical significance of CHEK2 mutations are also discussed in this article.</p>\u0000 </div>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 5","pages":"505-511"},"PeriodicalIF":1.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082215","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}
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}
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