Cytopathology最新文献

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.

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.

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.

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.