Acta Cytologica最新文献

Introduction: We evaluated concordance between Milan System for Reporting Salivary Gland Cytopathology (MSRSGC)-based categorization of salivary gland masses/lesions screened by fine-needle aspiration cytology (FNAC) and final histopathologic diagnoses, aiming to identify factors predictive of concordance, with the goal of appropriate case management.

Methods: The study was retrospective and involved 101 cases of salivary mass/lesion examined by FNAC. We compared MSRSGC categories against the final histopathologic classes (non-neoplasm, benign neoplasm, or malignant neoplasm) and calculated diagnostic concordance in each class. Concordance was defined as: MSRSGC categorization of a lesion as a category II lesion and a histopathologic classification as a non-neoplasm; MSRSGC categorization of a lesion as a category IV-A lesion and a histopathologic classification as a benign neoplasm; or MSRSGC categorization of a lesion as a category V or VI lesion and a histopathologic classification as a malignant neoplasm. We then compared clinicopathologic factors between concordant and discordant cases.

Results: Diagnostic concordance for non-neoplasms, benign neoplasms, malignant neoplasms, and total cases was 81.8% (9/11), 81.7% (58/71), 66.6% (8/12), and 79.8% (75/94), respectively, with no significant between-class difference. We found the shortest distance from the body surface to the salivary lesion differed significantly between the concordant group and the discordant group (5.35 mm vs. 7.30 mm), and the optimal cutoff was determined to be 8.00 mm (p < 0.01).

Conclusion: Based on the distance of either <8 mm or ≥8 mm from the body surface to the mass/lesion, we believe our proposed FNAC algorithm of treatment strategies is a reliable guide for otolaryngologists on evaluating salivary gland lesions.

Introduction: Since no universal cytological classification system for lung cancer has been established, the Japanese Lung Cancer Society and the Japanese Society of Clinical Cytology (JSCC) jointly established and reported four cytological categories: negative for malignancy, atypical cells, suspicious for malignancy, and malignancy. In 2022, the WHO Reporting System for Lung Cytopathology was published. This system presented five cytological classifications, including the four cytological category classifications above and insufficient/inadequate/nondiagnostic. The creation of a classification alone is not practical in actual clinical practice. Thus, we evaluated the reproducibility of the classification through tutorials and identified the issues and problems involved in the wide dissemination of this classification.

Methods: Forty-two cases were selected from those used in previously published articles, and diagnosis and tutorial systems were created. The first diagnostic round and tutorial and the second diagnostic round were conducted on the web. Participants were recruited via the JSCC website and emails. Images (×100 and ×400) of the lesions to be diagnosed were categorizing by 4 cytological categories (benign, atypical, suspicious for malignancy, malignant), 7 suggestive pathological diagnoses, and 4 cytological features. The mean correct or incorrect answer rates for the 42 cases and the mean correct response rates for 105 participants were compared between the first and second rounds using McNemar's test and t tests to identify cases with diagnostic difficulties and high tutorial effects.

Results: Comparing the correct response to cytological categories, the results showed that 17 of 42 cases improved significantly. The mean number of correct answers for the four cytological categories increased significantly from 16.0 (38.1%) in the first round to 20.3 (48.3%) in the second round (p < 0.001). For the seven suggestive pathological diagnoses, the mean number of correct answers increased significantly from 20.3 (48.3%) in the first round to 25.1 (59.8%) in the second round (p < 0.001). The mean number of correct responses increased significantly from 40.2 (38%) in the first round to 51.5 (49%) in the second round (p = 0.0147). Four cases were difficult to match even after the tutorial and three cases were highly affected by the tutorial. The most important basis for diagnoses was nuclear findings in the first and second rounds.

Conclusion: Comprehensive tutorials on diagnostic criteria are needed to effectively implement this system globally. In particular, devising ways to appropriately diagnose cancers with mild atypia or without characteristic morphology is important.

Background: Familial neoplastic syndromes are distinguished by the presence of specific neoplasms which serve as critical indicators for their suspicion and diagnosis. Among these, only a limited subset includes tumors with distinctive oncocytic features, highlights the necessity for pathologists and clinicians to pursue further investigation in affected patients and their families.

Summary: Advances in genetic research and diagnostic pathology have highlighted the germline predispositions underlying these tumors, which manifest across multiple organ systems, including thyroid, parathyroid, renal, and adrenal glands. This review examines the clinical, pathological, and molecular features of oncocytic neoplasms in the context of hereditary syndromes such as Carney complex, Li-Fraumeni syndrome, DICER1 syndrome, Birt-Hogg-Dubé syndrome, hyperparathyroidism-jaw tumor syndrome, hereditary leiomyomatosis and renal cell carcinoma syndrome, tuberous sclerosis syndrome, Beckwith-Wiedemann syndrome, and SDH-deficient hereditary paraganglioma/pheochromocytoma syndrome. It emphasizes the importance of recognizing syndromic associations through histopathological clues, genetic testing, and family history to facilitate accurate diagnosis and tailored management.

Key message: By integrating clinical insights with molecular data, this paper sheds light on the mechanisms driving oncocytic transformation and underscores the role of pathologists in identifying hereditary cancer syndromes.

Background: Oncocytic differentiation in pancreatic neoplasms is uncommon but can be seen in a wide range of neoplasms which range from borderline to highly aggressive behavior. Certain tumors, such as intraductal oncocytic papillary neoplasm (IOPN) of the pancreas, are oncocytic by default but many, such as pancreatic neuroendocrine tumors (PanNETs), can be oncocytic in a rare subset, often with clinical significance (like aggressive behavior). As such, the differential diagnosis can be broad and expertise is critical in teasing out the true diagnosis to guide treatment.

Summary: The differential diagnosis of an oncocytic neoplasm in the pancreas includes IOPN, acinar cell carcinoma, pancreatic ductal adenocarcinoma, PanNET, solid pseudopapillary neoplasms, and an array of other tumors (including metastatic disease). As the differential diagnosis is broad and diagnostic biopsies are often small, delineating these entities often requires examination of the clinical features, cytology, and immunohistochemistry, with molecular findings being useful in particularly difficult cases.

Key messages: Corroboration between clinical/radiology findings, cytologic features, histologic features, immunohistologic results, and molecular abnormalities is all extremely useful in delineating a specific entity among the broad differential diagnosis of entities with oncocytic differentiation in the pancreas.

Introduction: Nowadays, there is an increasing adoption of digital pathology for diagnostic purposes.

Aim: Herein we study the feasibility of cytopathological diagnosis by whole-slide imaging (WSI) in daily practice.

Methods: One hundred and ten consecutive non-gynecologic cytopathology cases, originally diagnosed under light microscopy (LM) by two pathologists, were scanned at ×40. Then, cases were diagnosed on WSI, by the same pathologist who originally rendered the conventional diagnosis. The pathologists were blinded to the diagnosis made by LM, but they had access to the same clinical information. The washout period was at least 3 months. WSI diagnoses were compared to the original LM diagnoses, and cases were considered concordant if the two types of diagnosis were identical.

Results: LM and the WSI diagnoses were concordant in 87.3% [95% CI: 79.6; 92.9] of cases. Intra-observer agreement was lowest for thyroid fine-needle aspiration cytology (only 1 case out of 5). After the exclusion of thyroid cases, the concordance rate between WSI and LM was 90.5% [95% CI: 83.2%; 95.3%].

Conclusion: Primary cytological diagnosis can be done using our digital system.

Introduction: This study critically evaluates adherence to Pap test screening practices in cytology-based cervical cancer screening in the state of Amazonas over a 10-year period.

Materials and methods: A retrospective analysis was conducted of the results of cytological screening examinations (Pap test) in Amazonas State from 2013 to 2023. For this purpose, Brazilian public databases Cervical Cancer Information System (SISCOLO) and Cancer Information System (SISCAN) (from the Department of Information and IT of the Unified Health System [DATASUS]) were consulted.

Results: There was a decrease in the number of Pap tests performed during the period from 2019 to 2021, likely related to the COVID-19 pandemic. This was followed by a subsequent increase in the post-pandemic period. Notably, in municipalities with fewer than 10,000 annual Pap examinations there was a decrease in the average number of tests when comparing the years 2016-2018 to 2013-2015, and an even greater decrease during the pandemic.

Conclusions: There is considerable variation in utilization of the cytological Pap test across different municipalities. This lack of uniformity throughout the state likely compromises the capacity to detect early stage cervical intraepithelial lesions.

Introduction: The use of cytological specimens in cancer genome medicine has garnered considerable attention, but the long-term quality of nucleic acids from unstained specimens remains unclear. This study aimed to evaluate the quality of nucleic acids extracted from unstained specimens fixed with 95% ethanol or spray fixation over varying durations.

Methods: Two lung cancer cell lines were prepared using the auto-smear method and fixed with 95% ethanol, and spray-fixed specimens were stored for 30 min, 1 day, 3 days, 1 week, 2 weeks, 1 month, 3 months, and 6 months. DNA was extracted using a DNA extraction kit, and quality was assessed using agarose gel electrophoresis and PCR.

Results: Nucleic acids extracted from unstained specimens showed no fragmentation after 6 months of fixation and were amplifiable by PCR, regardless of the fixation method.

Conclusion: Nucleic acids extracted from unstained specimens preserved high quality over 6 months, suggesting that such specimens are suitable for genetic testing. This finding has significant implications for the long-term storage and clinical application of cytological specimens in cancer genome medicine.

Introduction: Around 85% of non-small cell lung cancers (NSCLCs) are diagnosed at an advanced stage (IIIB to IV), where therapeutic options depend on molecular analysis. However, diagnostic material for molecular testing is often represented by cytological samples which are generally scarce and span a wide range of preparation types. Thus, the primary objective is to efficiently manage materials for molecular profiling. This study aims to evaluate the suitability of different cytological samples to assess morphological and molecular characteristics of advanced NSCLC.

Methods: Sixty-seven cytological samples obtained from patients with advanced NSCLC were utilized. The series encompassed different procedure types (fine-needle aspiration cytology, transbronchial needle aspiration, effusions) processed by cell blocks in 54% (n = 36), direct smears in 33% (n = 22), and liquid-based cytology (LBC) in 13% (n = 9). Cytological diagnoses were routinely performed, and molecular analysis was conducted using next-generation sequencing (NGS) and real-time polymerase chain reaction (RT-PCR) methods.

Results: Adequate quantity and quality of nucleic acids were obtained from all the samples, allowing molecular profiling. Combined NGS and RT-PCR analysis showed wild-type profiles in 62.7% (n = 42) and mutated profiles in 37.3% (n = 25) of the samples. Kirsten Rat Sarcoma Virus (KRAS) mutations were identified in 19.5% (n = 13) of samples, EGFR mutations in 10.4% (n = 7) and v-raf murine sarcoma viral oncogene homolog B (BRAF) mutations in 2.9% (n = 2). Identified chromosomal alterations were v-erb-b2 avian erythroblastic leukemia viral oncogene homolog 2 (ERBB2) duplication in 2.9% (n = 2).

Conclusions: The cytological sample types examined in this study proved to be suitable for molecular testing, in addition to conventional morphologic diagnosis, showing versatility and adaptability to different clinical contexts. Molecular testing on cytological samples is accurate and fast, representing a valid tool for molecular profiling of advanced NSCLC.

Background: The thyroid gland is a treasure trove of pathology ranging from the benign to the overtly malignant. Both neoplastic and nonneoplastic thyroid lesions can exhibit oncocytic change. Here we present an overview of cytologic and histopathologic findings encountered in these oncocytic neoplasms with a focus on the molecular aspects that drive their tumorigenesis.

Summary: Oncocytic change is unique to a subset of thyroid lesions ranging from nonneoplastic nodular hyperplasia to high-grade malignancy. It can also be encountered in non-follicular-derived neoplasms as well as in the adjacent parathyroid glands. At the genetic level, these lesions demonstrate a different genetic signature from classic follicular-derived lesions, often involving alterations of mitochondrial genes.

Key messages: Oncocytic change can be seen in nonneoplastic and neoplastic thyroid pathology. Rarely, oncocytic change can be seen in medullary thyroid carcinoma and certain subtypes of papillary thyroid carcinoma as well as the parathyroid gland. Oncocytic neoplasms of the thyroid harbor molecular alterations often involving mitochondrial genes, which is distinct from other thyroid neoplasia.