Differential diagnosis of traditional serrated adenomas and tubulovillous adenomas: a compartmental morphologic and immunohistochemical analysis.

AIM: Traditional serrated adenomas are the rarest member of the serrated polyps, that have endoscopic and morphologic similarities with conventional adenomas, tubulovillous adenomas, in particular. We aimed to compare the histopathologic and immunohistochemical features of TSAs showing overt dysplasia with conventional TVAs in a compartmental manner using digitalized images. PATIENTS AND METHODS: For 25 TSAs and 25 TVAs, extent of the morphologic features including cytoplasmic eosinophilia, mid-zonal nuclei, ECFs, slit-like serration, brush border, gastric foveolar-like epithelium and goblet cells were evaluated. Immunohistochemistry was perfomed using primary antibodies including CK7, CK20, MUC2, MUC5AC, MUC6, B-catenin, Ki67, p53, p16, MLH1, MSH2, MSH6 and PMS2. RESULTS: Eosinophilic cells, mid-zonal nuclei, slit-like serration and ECF were significantly more extensive in TSAs compared to TVAs (p<0,001) while gastric epithelium was also more extensive in TSA cohort with a lower significance (p<0,01). Cut-offs for these features yielding the highest sensitivity and specificity in discriminating TSAs from TVAs were determined ; mid-zonal nucleus resulted as the best discriminating histopathologic feature (100%, 92%) followed by eosinophilia (88%, 92%),and slit-like serration (84%, 92%) with highest sensitivity and specificities, respectively. Compartmental immunohistochemical evaluation revealed that CK20 and CK7 were mainly expressed in ECF while MUC5AC together with CK7 were found in epithelial compartment more frequently in TSAs compared to TVAs. P16 was more common in TSAs in all compartments whereas Ki67 and p53 were restricted to dysplastic compartments in both polyp groups. CONCLUSIONS: The present study demonstrated that mid-zonal nuclei, eosinophilic cells and slit-like serration followed by ECF proved to be the most discriminatory features for TSAs.The correct diagnosis of TSAs will allow to develop appropriate treatment and follow up modalities which seem to be crucial as their progression rate may be different from TVAs.

THE ASSOCIATION BETWEEN LYMPH NODE METASTASIS AND MOLECULAR MARKERS IN DIFFERENTIATED THYROID CANCER.

CONTEXT: There is no consensus regarding routine usage and benefits of molecular markers for prediction of prognosis and assessment of risk groups in differentiated thyroid cancer (DTC). OBJECTIVE: We aimed to investigate NIS, Galectin-3, PTEN, P53 and Ki67 expressions in tumor tissue and metastatic lymph nodes in PTC and their association with lymph node metastasis and prognosis. MATERIAL AND METHODS: Ninety two papillary thyroid cancer patients who underwent total thyroidectomy and central lymph node dissection were included in this study. NIS, Galectin-3, PTEN, P53 and Ki67 immunohistochemical stainings were performed for all surgical tumor tissues and metastatic lymph nodes of the 38 patients. Age, gender, tumor size, multifocality, capsular invasion, extrathyroidal extension and lymphocytic thyroiditis were assessed retrospectively. RESULTS: Seventy three females (79.3%) and nineteen males (20.7%) were included in this study. Risk of lymph node metastasis was higher in tumors with capsular invasion and extrathyroidal extension (p=0.03 and p < 0.001). NIS, PTEN and Galectin-3 protein expressions in tumor tissue were not associated with gender, tumor size, multifocality, extrathyroidal extension, capsular invasion, lymph node metastasis and tumor recurrence. Mean Ki 67 proliferation index was 2.08±0.95%. Ki 67 proliferation index was associated with tumor size (p=0.012). Intensity and expression of NIS and PTEN in tumor tissue were concordant with intensity and expression in metastatic lymph nodes (p<0.001). Ki 67 proliferation index in tumor was concordant with metastatic lymph nodes (p=0.02). CONCLUSIONS: NIS, PTEN, Galectin-3, Ki67 and P53 expressions were not associated with the risk of lymph node metastasis in PTC patients. Routine analysis of these markers does not seem to be favorable. Further studies with new markers are necessary to determine prognostic predictors.

Diagnostic terminology for reporting thyroid fine needle aspiration cytology: European Federation of Cytology Societies thyroid working party symposium, Lisbon 2009.

A European Federation of Cytology Societies (EFCS) working party of 28 members from 14 European countries met at the European Congress of Cytology in Lisbon in September 2009, with two observers from the USA, to discuss the need for standardising thyroid FNA nomenclature in the light of the National Institute of Cancer (NCI) recommendations resulting from the State of the Science conference in Bethesda in 2007. The data were obtained through two questionnaires sent by email and a transcript of the live discussion at the congress, which is presented in full. The surveys and discussion showed that there were currently no national terminologies for reporting thyroid FNA in the different European countries except in Italy and the UK. Personal, 'local', surgical pathology and descriptive terminologies were in use. All but one of the working party members agreed that thyroid FNA reporting should be standardised. Whilst almost a third would adopt the NCI Bethesda terminology, which offers the advantages of a 'risk of cancer' correlation and is linked to clinical recommendations, more than half favoured a translation of local terminology as the first step towards a unified nomenclature, as has been done recently in the UK. There was some disagreement about the use of: a) the six-tiered as opposed to four or five-tiered systems, b) the use of an indeterminate category and c) the 'follicular neoplasm' category, which was felt by some participants not to be different from the 'suspicious of malignancy' category. The conclusions will be passed to the different national societies of cytology for discussion, who will be asked to map their local terminologies to the Bethesda classification, observe its acceptance by clinicians and audit its correlation with outcome.

Curcumin prevents oxidative renal damage induced by acetaminophen in rats.

Acetaminophen (APAP) can cause life-threatening renal damages and there is no specific treatment for APAP-induced renal damage. The aim of this study was to investigate the protective effects of curcumin (CMN) on APAP-induced nephrotoxicity. Nephrotoxicity was induced in male Wistar Albino rats by the administration of a single dose of 1000 mg/kg APAP intraperitoneally (i.p.). Some of these rats also received i.p. CMN (200mg/kg) at 30 min after the administration of APAP. Twenty-four hours after the administration of APAP, all the rats were sacrificed with a high dose of ketamine. Urea and creatinine levels were measured in the blood, and the levels of malondialdehyde (MDA) and glutathione (GSH), and antioxidant enzyme activity were determined in the renal tissue. Histopathological changes were studied. APAP administration caused elevated levels of renal MDA, and marked depletion of GSH levels and antioxidant enzyme activity, and deteriorated the renal functions as assessed by the increased plasma urea and creatinine levels as compared to control rats. CMN markedly reduced the elevated MDA levels, significantly increased the antioxidant enzyme activity and normalized the altered renal morphology in rats treated with APAP. CMN might be a potential candidate agent against APAP-induced nephrotoxicity, but further studies are required to identify this issue before clinical application becomes possible.

A case with diffuse uterine leiomyomatosis and review of the literature.

Leiomyomas and diffuse uterine leiomyomatosis are smooth muscle tumors of the uterus. Diffuse uterine leiomyomatosis is a benign and extremely rare condition in which the uterus is symmetrically enlarged as a result of the almost complete replacement of the myometrium by innumerable poorly defined, confluent nodules. The etiology of these neoplasms is not completely understood. Initial symptoms of the diffuse uterine leiomyomatosis usually are abdominal pain and abnormal uterine bleeding. Similar to uterine leiomyomas, patients with leiomyomatosis present with menorrhagia, dysmenorrhea, abdominal pain, infertility, and pelvic pressure. Hormonal treatment usually fails to control the symptoms, anemia, or tumor growth after treatment is stopped. As a result, despite patients being in the third or fourth decades of life, hysterectomy has been the only permanent treatment option offered to patients for treatment of the symptoms related to uterine fibroids in diffuse leiomyomatosis. A case of a patient with a huge uterine mass (2,650 g in weight) who underwent hysterectomy due to diffuse uterine leiomyomatosis is presented together with a review of the literature.

Cystic lesions of the head and neck: cytohistological correlation in 63 cases.

OBJECTIVE: To investigate the accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of cystic masses of the head and neck (H&N), excluding thyroid lesions. METHODS: A total of 198 cases, 63 of whom had consequent surgical specimens, were retrieved from the files of two university hospitals and reviewed. RESULTS: FNAC correctly diagnosed 25 of 36 neoplasms with a cystic component. Five Warthin's tumours, two squamous cell carcinomas, two mucoepidermoid carcinomas and two schwannomas yielded non-representative aspirates. Four of the missed Warthin's tumours and two mucoepidermoid carcinomas which were misdiagnosed as benign cysts were aspirated by their clinician. One branchial cleft cyst was cytologically interpreted as highly suspicious for carcinoma. CONCLUSIONS: Disparate entities may present with similar cytological findings in the H&N region. A detailed description of differential diagnosis should be given in the cytology report in suspicious cases. Repeated aspirations from different sites of the lesion may reduce the false-negative rate.

Comparison of fine-needle aspiration and open biopsy of testis in sperm retrieval and histopathologic diagnosis.

This study aimed to compare the diagnostic value of testicular fine-needle aspiration (FNA) with open biopsy in infertile males with azoospermia or severe oligozoospermia and to evaluate the reliability of testicular sperm extraction by FNA. A total of 76 testes of 40 patients, 34 with azoospermia, four oligozoospermia and two patients who underwent orchidectomy as a result of cancer of prostate were included. Detailed clinical and laboratory examinations were performed and two semen analyses were obtained from each patient. A 20-ml 26 gauge 13-mm needle was used for FNA and smears were stained with May-Grunwald-Giemsa and Papanicolaou stain. An open biopsy was performed in each patient after FNA and the samples were stained with haematoxylen-eosin. Smears and histological stains were examined and compared under light microscopy by the same pathologist. In 69 of the 76 testes (90%) FNA cytology results agreed with the histology. In four testes, the aspirate was unsatisfactory and in three testes, spermatocytic arrest was found cytologically while subsequent biopsies revealed diffuse fibrosis. In 15 of 16 patients (93.7%) with normal and hypospermatogenesis, spermatozoa had been extracted by FNA. Spermatozoa could not be obtained after neither FNA nor open biopsy in the remaining 24 patients. Testicular FNA in infertile males is a simple, reliable and minimally invasive diagnostic tool. It is as effective as open biopsy for testicular sperm extraction and good results can be achieved in experienced hands.

Salivary duct carcinoma ex pleomorphic adenoma: analysis of the findings in fine-needle aspiration cytology and histology.

Salivary duct carcinoma (SDC) is an uncommon and highly aggressive neoplasm that reveals histopathologic features resembling infiltrating duct carcinoma of the breast and prostate. SDC arising on the basis of preexisting pleomorphic adenoma (PA) is very rare. This report describes the fine-needle aspiration (FNA) cytology of a case of SDC ex PA. FNA smears were cellular with cells with large, pleomorphic nuclei, some prominent nucleoli, and finely vacuolated cytoplasm. The neoplastic cells were forming groups, sheets, and papillary structures and a cribriform pattern was present in some sheets. Mitotic figures were frequently seen. Necrosis was prominent in the background. Histologic sections of the tumor revealed areas of comedo carcinoma, papillary carcinoma, and infiltrative carcinoma as well as multiple foci of PA. The presence of a cribriform pattern, tumor cells resembling breast ductal carcinoma cells, and a necrotic background are helpful features for an accurate cytodiagnosis of SDC.

Fine-needle aspiration cytology and immunocytochemistry of Hodgkin's disease, suppurative type.

We describe 3 cases of Hodgkin's disease (HD) of unusual suppurative type, which were diagnosed on fine-needle aspirates. The smears were dominated by neutrophils, macrophages, and cellular debris. Only a few large, atypical cells of Hodgkin and Reed-Sternberg type were observed. The differential diagnoses of such smears include infectious mononucleosis, tuberculosis, metastatic lymph node involvement, non-Hodgkin's large-cell anaplastic Ki-1-positive lymphomas, T-cell-rich B-cell lymphomas, and peripheral T-cell lymphomas of mixed type. Immunocytochemistry identified the large atypical cells as CD 30 (BerH2)-positive and negative for CD 45 (LCA) in cytospin material from 2 patients, which allowed a conclusive diagnosis of HD.

Fine needle aspiration (FNA) cytology in tuberculous lymphadenitis.

UNLABELLED: Sixty-three lymph node aspirates were screened and 32 aspirates revealing granulomatous lymphadenitis with or without caseation necrosis were re-evaluated. The most characteristic morphological features among these cases were epithelioid cell clusters with or without caseation necrosis. When clusters were thick, careful observation of the periphery of the clusters helped to find epithelioid cells. Caseation necrosis revealed a typical macroscopic and microscopic appearance. Ziehl-Neelsen staining was negative in all smears and histological sections. Polymerase chain reaction (PCR) amplification technique was applied to 23 of the cases in which the cytological diagnoses were consistent with tuberculosis. Mycobacterium tuberculosis was demonstrated in 19 (82.60%) cases. IN CONCLUSION: (i) it is necessary to perform several aspirations from different sites of the enlarged lymph node; (ii) the diagnosis of 'granulomatous lymphadenitis, consistent with tuberculosis' can be given, even though the acid-fast stains are negative; (iii) additional techniques such as PCR give supportive information; (iv) an open biopsy is recommended if there is a discrepancy with the clinical impression.

Fine needle aspiration cytology of hepatoblastoma. A report of two cases.

BACKGROUND: Hepatoblastoma is the most common primary hepatic tumor in children. The literature contains few examples of fine needle aspiration (FNA) cytology of these tumors. CASES: A 5-month-old and 4-month-old underwent ultrasonography-guided FNA for the preoperative investigation of hepatic masses. The smears were stained with May-Grünwald-Giemsa and Papanicolaou stain. Alcohol-fixed smears were used for immunocytochemistry. All smears revealed cells with round/oval nuclei, prominent nucleoli and vacuolated cytoplasm, arranged in groups and acinar structures. The groups were embedded in a myxoid stroma. alpha-Fetoprotein was positive in all, and vimentin was positive in some tumor cells. The cytologic findings resembled the histologic counterpart in one case, and the other case agreed with the clinical/radiologic prediagnosis. Immunocytochemistry was supportive. CONCLUSION: FNA cytology can be diagnostic in many other childhood tumors as well as hepatoblastomas. Detailed descriptions of cytomorphologic features of hepatoblastoma will help FNA to be used confidently on these tumors.

Brush technique in ocular surface cytology.

New techniques are being searched for the evaluation of cellular morphology and population of ocular surface. Impression cytology is one of the most preferred techniques in ocular surface sampling in dry eye, keratitis, and conjunctivitis. We evaluated and compared the efficacy of impression and brush cytology in 63 patients. All of the samples collected by the brush technique were sufficient for diagnosis: 88% of the slides revealed abundant cells and 12% adequate number of cells. In 21% of the samples observed by impression cytology the cell number was inadequate for diagnosis. In 58% of them the cells were abundant and in 21% few cells were observed. This study proved the value of brush cytology in collecting ocular surface cells.

Histologic alterations in the thyroid gland after fine-needle aspiration.

To evaluate the histologic alterations due to the fine-needle aspiration (FNA), a comparative study between 20 aspirated and 20 nonaspirated thyroidectomy specimens was performed. The most common findings in the aspirated group were hemorrhage (80%) and vascular proliferation and/or vascular thrombosis (45%). In one of the aspirated cases with the cytologic diagnosis of follicular neoplasm, histologic sections revealed prominent vascular and endothelial proliferation. Fibrosis, cystic degeneration, and infarction were other histologic findings in the aspirated group. Hemorrhage was seen in 45% and cystic degeneration in 25% of the nonaspirated cases. Fifty percent of the nonaspirated cases did not have any additional findings. In conclusion, knowledge of previous FNA application and awareness of possible histologic alterations due to the needling is necessary while evaluating the histologic sections of the thyroidectomy specimens.