Maxillary sinusitis resulting from ostium plugging by dislodged bone graft: case report.

PURPOSE: To report an unusual case of severe maxillary sinusitis resulting from ostial plugging by dislodged bone graft material used for sinus elevation procedure. PATIENTS AND METHODS: A 49-year-old female presented to the oral surgery clinic with severe right maxillary sinusitis after a sinus elevation procedure and placement of a dental implant. She had completed an extended course of multiple antibiotics without culture and sensitivity studies or resolution of sinusitis. RESULTS: A CT scan was obtained which showed a dental implant protruding into the right maxillary sinus, sinusitis of the right ethmoid and maxillary sinuses, and dislodged bone graft material obstructing the ostium into the middle nasal meatus. The dental implant was removed, the patient was referred for functional endoscopic sinus surgery, and her sinusitis subsequently rapidly resolved. CONCLUSIONS: Surgeons performing this or similar procedures should be aware of the possible complications that can arise from foreign debris introduced into the maxillary sinuses. Also, the avoidance of empirically changing antibiotic regimens and the early use of CT scans should be considered.

Interobserver agreement in the cytologic grading of atypia in neoplastic pancreatic mucinous cysts with the 2-tiered approach.

BACKGROUND: The accurate cytologic grading of epithelial atypia in fine-needle aspirates of pancreatic mucinous cysts has important implications for clinical management. The Papanicolaou Society of Cytopathology has recommended a 2-tiered system of low-grade (LG) and high-grade (HG) for grading this atypia. Using this approach, this study examined the interobserver agreement within a group of cytopathologists at the Cleveland Clinic. METHODS: Twenty cases of fine-needle aspiration of pancreatic neoplastic mucinous cysts with documented histologic follow-up and representative lesional cells were selected. Blinded to the histologic outcome, 4 cytopathologists were independently asked to assign the highest grade of atypia with the 2-tiered system of LG and HG atypia for these cases. The interobserver agreement was calculated with the κ statistic. RESULTS: The overall raw agreement in the grading of atypia was 60%. The overall chance-adjusted agreement was fair (κ = 0.28). On the basis of the histologic outcomes, the cases were stratified into group A (HG dysplasia or worse) and group B (LG or intermediate-grade [IG] dysplasia on follow-up). Group A (n = 12) showed good chance-adjusted agreement (κ = 0.65). For group B, the chance-adjusted agreement among the observers was poor (κ = 0.03). CONCLUSIONS: This study shows that the cytologic recognition of HG dysplasia or worse as HG atypia in pancreatic mucinous cysts has a good degree of interobserver reproducibility among cytopathologists. In contrast, a problematic area with a lack of agreement appears to be the cytologic recognition of LG and IG dysplasia as LG atypia. Additional studies with the development of reproducible criteria and educational tools may help with this challenging distinction. Cancer Cytopathol 2016;124:909-916. © 2016 American Cancer Society.

The utility of repeated cytologic evaluation of cerebrospinal fluid in individuals with metastatic breast cancer.

INTRODUCTION: Metastasis of breast cancer to the central nervous system, either in the brain parenchyma or leptomeninges (LMC), is a late feature of the disease . Detection of malignant cells in the cerebrospinal fluid (CSF) is the diagnostic standard for LMC. Repeated CSF examinations are often performed following an initial diagnosis positive for malignancy. This study evaluates the significance of repeated CSF evaluation in women with metastatic breast cancer to the central nervous system. MATERIALS AND METHODS: Cases of adenocarcinoma of breast diagnosed by CSF cytology from 1990 through 2012 documenting: age, radiologic findings, treatment modality, and the number of repeated CSF cytology specimens and their respective interpretations. RESULTS: Fifty-one patients were identified; 28 patients (54.9%) had a single initial positive CSF performed and 23 (45.1%) had multiple CSF cytology samples (range = 2-25, mean = 5.5). Despite interval "negative" and "atypical cells" results on CSF cytology specimens, all 23 patients with multiple samples had at least one follow-up positive CSF cytology sample. CONCLUSION: The prognosis of the patients with an initial CSF diagnosis of adenocarcinoma was poor, regardless of the respective interpretations on the repeated CSF specimens, even in the presence of interval negative CSF.