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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
The cytological features of PA with spontaneous infarction can mimic malignancy. Recognising these features is crucial to reducing diagnostic errors and guiding appropriate management.
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.
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.
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.
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.
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.
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.
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).
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’.
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.
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.
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