RESUMO
Undifferentiated SMARCA4-deficient carcinoma of the esophagus and gastroesophageal junction is a rare, highly aggressive, and diagnostically challenging malignancy. Here we present a case series of high-grade undifferentiated malignant neoplasms of the esophagus and gastroesophageal junction that share SMARCA4 loss by immunohistochemistry and demonstrate a rhabdoid phenotype. Five cases are presented, including 4 men and 1 woman with an age range of 48-79 years. Interestingly, only one case showed intestinal metaplasia (Barrett's esophagus) and no cases demonstrated glandular dysplasia or glandular differentiation. In all, the lesional cells were immunoreactive with antibodies to keratins (3/5), CD34 (2/4), and CD138 (4/5). SMARCA4 expression was diffusely lost in all cases, whereas SMARCB1 expression was intact. OncoScan™ assay demonstrated loss of SMARCA4 in all cases analyzed. Additional OncoScan™ findings included abnormalities of CDKN2A in 2 of 3 cases, abnormalities of TP53 in 2 of 3 cases, and abnormalities of PTPRD in 2 of 3 cases, among other abnormalities.
Assuntos
Carcinoma , Tumor Rabdoide , Humanos , Tumor Rabdoide/patologia , Carcinoma/patologia , Junção Esofagogástrica/patologia , Biomarcadores Tumorais/metabolismo , DNA Helicases/genética , Proteínas Nucleares , Fatores de TranscriçãoRESUMO
Lymph node metastasis is the most important prognostic factor for breast cancer patients. In addition to the number of nodes involved and the largest metastatic focus, extranodal extension (ENE) is also used to subclassify breast cancer patients into different risk groups. More recently, pathologists are required to report the size/extent of ENE per the new CAP guideline, as it seems to be associated with more axillary nodal burden and/or a worse prognosis. Although the definition of ENE is largely understood and agreed upon among pathologists around the world, evaluation and reporting for the size of ENE are not. To understand current practice, we conducted an international survey among pathologists who are interested in breast pathology. A total of 70 pathologists responded. The results showed that (1) 98% of the participants reported the presence or absence of ENE and 61% also reported the size of ENE in millimeter (mm). (2) There was no uniform method of measuring the size of ENE; 47% measured the largest dimension regardless of orientation, while 30% measured the largest perpendicular distance from the capsule. (3) The most common factors affecting the accuracy in diagnosis of ENE are the presence of lymphovascular invasion (LVI), lack of capsule integrity, and the presence of fatty hilar or fatty replacement of a lymph node. (4) 71% felt that the H&E stain is adequate to evaluate ENE, deeper levels and IHC analysis for vascular and cytokeratin markers can be helpful if needed. (5) 75% agreed that there is an urgent need to standardize the measurement and reporting for ENE. Our survey highlights the variation in ENE evaluation and the need for its standardization in breast cancer patients with axillary node metastasis.
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Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Extensão Extranodal , Metástase Linfática/diagnóstico , Metástase Linfática/patologia , Linfonodos/patologia , Prognóstico , Queratinas , Estudos RetrospectivosRESUMO
INTRODUCTION: Telecytology offers a suitable solution to the cost and time efficiency questions on rapid onsite evaluation (ROSE). An increasing number of institutions are adopting new telecytology systems to meet the increasing ROSE requests, although there is no agreement on the details of how a telecytology validation study needs to be conducted. We propose a standardized approach for telecytology validation studies that could be done in a variety of practices. MATERIALS AND METHODS: Consecutive cases from 6 months prior were chosen to reflect a case mix comparable to real life. A fellow assessed the slides at the ROSE site while 6 cytopathology faculty convened in a conference room with a television screen, and noted the adequacy, diagnostic category, and specific diagnoses. All participants were blinded to the original adequacy assessment and final diagnoses. For each case, evaluation time and the slides counts were noted. RESULTS: Fine-needle aspiration specimens from 52 patients were included in the study. Of these, 13 cases were used in the first "test" session. The adequacy concordance rates ranged between 92.3% and 100%, with an overall concordance rate of 94.8%. The diagnostic category concordance rates ranged between 90.3% and 95.5%, with an overall concordance rate of 91.9%. The specific diagnosis concordance rates ranged between 84.6% and 92.9%, with an overall concordance rate of 88.1%. CONCLUSIONS: Validation of telecytology requires a standardized approach just like any other new technology. In this study, we propose an efficient and accurate method for cytopathology departments of various case volumes to conduct telecytology validation studies.
Assuntos
Biópsia por Agulha Fina , Biópsia por Agulha Fina/métodos , HumanosRESUMO
BACKGROUND: The Paris System for Reporting Urinary Cytology (TPS) uses hyperchromasia as major diagnostic criterion for high-grade urothelial carcinoma (HGUC). The purpose of the study was to evaluate cases that were diagnosed as HGUC by TPS and determine whether there are different chromatin distribution patterns (ie, subsets). METHODS: Digital image annotations were performed on microscopic images of HGUC urine specimens with surgical biopsy/resection follow-up. Median gray values were generated for each cell. Neutrophils (polymorphonuclear leukocyte [PMN]) were also enumerated in each case to serve as an internal control. A HGUC/PMN ratio was generated for each case, and the cases were distributed. RESULTS: Sixty-nine HGUC cases yielded 2660 cells, including 2078 HGUC (30.1 cells/case) and 582 PMNs (8.4 cells/case). The average median gray value of an HGUC was 50.6 and of a PMN was 36.8 (P < .0001). Eight of 69 cases (11.6%) contained nuclei that, on average, were darker than or as dark as a PMN (extremely dark, ie, "India ink"). Fifty-one of 69 cases (74.0%) contained nuclei that, on average, were slightly brighter than a PMN (hyperchromatic). Ten of 69 cases (14.5%) contained nuclei that, on average, were much brighter than a PMN (hypochromatic). Within a single case, all cases showed heterogeneity with the hypochromatic cases showing the most dramatic effect. CONCLUSIONS: Digital image analysis reveals that there are large variations in chromasia between cases including a subset of cases with hypochromasia and another with extremely dark or "India ink" nuclei. There was much heterogeneity of chromasia seen within a single sample.
Assuntos
Carcinoma de Células de Transição , Neoplasias da Bexiga Urinária , Neoplasias Urológicas , Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/patologia , Citodiagnóstico/métodos , Feminino , Humanos , Masculino , Neoplasias da Bexiga Urinária/patologia , Urina , Neoplasias Urológicas/urina , Urotélio/patologiaRESUMO
BACKGROUND: Fine needle aspiration (FNA) of renal masses can distinguish between benign and malignant neoplasms in 73-94% of cases. Previous studies suggested the correct subclassification of renal cell carcinomas (RCCs) by cytomorphology can be achieved in up to 80% of cases. However, as RCCs become increasingly subclassified by molecular signatures, correct subclassification based on cytology alone is increasingly difficult. DESIGN: Two FNA passes (2 stained with Diff-Quik® and 2 with the Papanicolaou method) were performed on all fresh nephrectomy specimens for a 1-year period. There were 30 cases in this study, with 29 primary renal tumors and 1 case of metastatic lung adenocarcinoma. Each case was assigned a random number and came with 2 slides (1 from each staining method). Eight cytopathologists were asked to provide a diagnosis and the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading if applicable. Fleiss' Kappa and Cohen's Kappa equations were used to look at inter-rater variability. RESULTS: When compared to the surgical pathology diagnosis, the average percent correct diagnosis for all cytopathologist was 35%. Chromophobe RCCs had the best average percent accuracy at 72% followed by clearcell RCC at 48%. Average accuracy for grading RCCs was 40%. Inter-rater variability among the cytopathologists for all RCC diagnoses was fair with a Fleiss' Kappa coefficient of 0.28. For the WHO/ISUP grade, the weighted coefficient for each pathologist ranged from 0.11 to 0.45, ranging from fair to moderate, respectively. CONCLUSIONS: Renal tumors are difficult to classify on cytopathology alone. Core needle biopsy and ancillary studies are necessary if diagnosis will change management.
Assuntos
Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Corantes Azur , Biópsia por Agulha Fina , Carcinoma de Células Renais/classificação , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/classificação , Neoplasias Renais/cirurgia , Azul de Metileno , Gradação de Tumores , Variações Dependentes do Observador , Teste de Papanicolaou , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , XantenosRESUMO
INTRODUCTION: According to the Clinical Laboratory Improvement Amendments 1988 regulations, 5-year retrospective review (5YRR) of normal Papanicolaou tests in patients with a newly diagnosed high grade squamous intraepithelial lesion or above (HSIL+) is mandatory. Since this mandate has been in place, a multitude of changes have taken place in the screening and management guidelines of cervical cancer. The aim of this study is to assess the role of this mandate in our laboratory and to investigate the lessons learned. MATERIAL AND METHODS: The cytopathology electronic database and institutional quality assurance records at Loyola University Medical Center were searched from January 2009 to December 2019 to identify all Papanicolaou tests diagnosed as new "HSIL and above" (HSIL+). Major discrepancy (2+) was defined as initial negative diagnosis changed to HSIL+. RESULTS: A total of 153,083 Papanicolaou tests were performed during this period; out of these, 1452 (0.94%) were diagnosed as HSIL+. A total of 695 HSIL+ Papanicolaou tests had a negative prior Papanicolaou and in 615 of 695 there was agreement with the initial negative diagnosis. In 61 Papanicolaou tests, the initial diagnosis was changed from negative and they were reclassified on review as 3 HSIL, 9 ASC-H, 7 AGC, and 42 ASCUS or LSIL. Major discrepancy rate was calculated as 3 of 695 (0.43%). None required an amended report. CONCLUSIONS: It is important to revisit the 5YRR as a method of implementing the quality indicators in gynecologic cytology so that the process retains its value without overburdening cytology laboratories and personnel.
Assuntos
Técnicas Citológicas , Teste de Papanicolaou , Lesões Intraepiteliais Escamosas/diagnóstico , Técnicas Citológicas/métodos , Técnicas Citológicas/normas , Feminino , Humanos , Notificação de Abuso , Teste de Papanicolaou/métodos , Teste de Papanicolaou/normas , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/patologia , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Lesões Intraepiteliais Escamosas/patologiaAssuntos
Carcinoma/patologia , Detecção Precoce de Câncer , Urina/citologia , Neoplasias Urológicas/patologia , Urotélio/patologia , Carcinoma/genética , Carcinoma/urina , Humanos , Microscopia , Técnicas de Diagnóstico Molecular , Gradação de Tumores , Valor Preditivo dos Testes , Urinálise , Neoplasias Urológicas/genética , Neoplasias Urológicas/urinaAssuntos
Adenocarcinoma de Pulmão , Derrame Pleural/patologia , Adenocarcinoma de Pulmão/complicações , Adenocarcinoma de Pulmão/patologia , Idoso , Carcinoma de Células em Anel de Sinete/diagnóstico , Humanos , Pulmão/patologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Masculino , Metástase NeoplásicaRESUMO
INTRODUCTION: The Paris System (TPS) for Reporting Urinary Cytology (UCyto) was published in 2016, but to date, no study addressing the unsatisfactory (UNSAT) category has been published. We aimed to identify the negative predictive value (NPV) for UNSAT UCyto after the implementation of TPS at our institution. METHOD: For the period from January 1, 2017, to December 31, 2019, we identified all cases with UNSAT diagnosis on UCyto specimens and available cytologic and/or surgical pathology follow-up within 6 months from the UNSAT diagnosis. Cases were deemed true negative (TN) if the follow-up was "negative for high-grade urothelial carcinoma" (NHGUC). Information regarding previous medical history, clinical indications, and specimen type were tabulated and analyzed. RESULTS: From 6348 UCyto specimens, there were 230 (3.6%) UNSAT diagnoses made on 209 patients (112 [53.6%] men and 97 [46.4%] women) with a median age of 64 years. Of these, 116 UCyto specimens from 106 patients, which had cytologic and/or surgical pathology follow-up within 6 months, were further studied. Most UNSAT UCyto specimens were bladder washing/barbotage (BW/BB), and the most common indication for UCyto was cancer surveillance. The main cause of UNSAT UCyto was low cellularity. There were 5 false-negative (FN) results for high-grade urothelial carcinoma (HGUC), which corresponds to an overall NPV of 84.4%. NPV was highest for patients with UCyto for hematuria, and for patients with BW/BB as UCyto specimen type. CONCLUSIONS: Our results show that UNSAT diagnoses have a lower NPV than that typical of NHGUC diagnoses, and should be managed accordingly.
Assuntos
Carcinoma/patologia , Detecção Precoce de Câncer , Urina/citologia , Neoplasias Urológicas/patologia , Urotélio/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma/cirurgia , Carcinoma/urina , Bases de Dados Factuais , Reações Falso-Negativas , Feminino , Humanos , Masculino , Microscopia , Pessoa de Meia-Idade , Gradação de Tumores , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Urinálise , Neoplasias Urológicas/cirurgia , Neoplasias Urológicas/urina , Adulto JovemRESUMO
INTRODUCTION: The Paris System for Reporting Urinary Cytology (TPS) was developed for standardization purposes and it placed an emphasis on screening for high-grade urothelial carcinoma (HGUC). Since then, it has shown to reduce atypia rates and better correlate with surgical specimens. The aim of this study was to calculate the negative predictive value (NPV) of urinary cytology for detecting HGUC using TPS and compare these data to our recently published pre-TPS cohort. As a screening test, it is imperative that TPS has a high NPV. MATERIAL AND METHODS: A search of our institution's pathology database for the term "negative for HGUC" from January 1, 2016, to December 31, 2017, was conducted. A true negative was defined as a patient with at least 1 subsequent negative urine cytology/surgical biopsy specimen or the patient being clinically negative for 6 months. NPV rates were calculated based on the data obtained. RESULTS: The cohort consisted of 2960 urine cytology specimens from 1894 patients. A total of 99 false negatives were identified, generating a NPV of 96.7% (2861/2960). This NPV is identical to our previously published pre-TPS cohort (years 2012-2013; NPV: 96.7%). The clinical indication most effected NPV, with a history of urothelial carcinoma with a NPV of 93.9% followed by hematuria at 98.9%. The atypia rate in years 2012-2013 was 8.2% and in 2016-2017 it was 5.7% (P < 0.001). CONCLUSIONS: We demonstrate that TPS did not alter the NPV for detecting HGUC compared to our pre-TPS cohort. We believe that TPS is an effective reporting system for screening HGUC in urinary cytology.
Assuntos
Carcinoma/patologia , Detecção Precoce de Câncer , Urina/citologia , Neoplasias Urológicas/patologia , Urotélio/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/urina , Bases de Dados Factuais , Reações Falso-Negativas , Feminino , Humanos , Masculino , Microscopia , Pessoa de Meia-Idade , Gradação de Tumores , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Urinálise , Neoplasias Urológicas/urina , Adulto JovemRESUMO
INTRODUCTION: The introduction of a new generation of core needle biopsies (CNBs) for endoscopic procedures has prompted reconsideration of the role of cytopathologists in the handling of small biopsies. The American Society of Cytopathology (ASC) has therefore conducted a survey with the intention of elucidating current practices regarding the handling of small CNBs. MATERIALS AND METHODS: The membership of the ASC was invited by email to participate in an online survey over a 2-month period. The survey consisted of 20 multiple choice questions with 2-8 possible responses per question. RESULTS: Of 2651 members contacted by e-mail, 282 (10.6%) responded to the survey questions, including 196 pathologists (69.5%) and 86 cytotechnologists (30.5%). Of these, 265 respondents were from the US/Canada (94.0%), with 156 from academic institutions (58.9%) and 109 from non-academic practices (41.1%); 17 were from other countries (6.0%). In 18.8% of all practices, cytopathologists sign out >90% of small CNBs from endoscopic and radiologically guided procedures; in 36.5% of practices >90% are signed out by surgical pathologists; the remainder have such cases divided more evenly between cytopathologists and surgical pathologists. Responses show that 78.0% of all respondents are interested in signing out more small biopsies in the future, and 80.5% desire increased small biopsy-related resources from the ASC. CONCLUSIONS: The survey responses indicate that practices currently vary widely across institutions. Most indicated an interest in greater incorporation of small biopsies into the practice of cytopathology.
Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Conhecimentos, Atitudes e Prática em Saúde , Patologistas/psicologia , Patologia Cirúrgica/métodos , Sociedades Médicas , Cirurgiões/psicologia , Inquéritos e Questionários , Biópsia com Agulha de Grande Calibre/métodos , Canadá , Humanos , Laboratórios Hospitalares , Agulhas/classificação , Medicina de Precisão/métodos , Estados UnidosRESUMO
BACKGROUND: Body fluid cytology (BFC) is an important tool in the diagnosis and staging of malignancy and is aided by the judicious use of immunohistochemistry (IHC). The aim of this study was to determine the usage rates of IHC stains in BFC, their type and indications, and their diagnostic impact. We also attempted to estimate the optimal rate of IHC use in BFC by comparing the entire laboratory's and each individual cytopathologist's IHC use rates with their respective indeterminate and malignant diagnosis rates. METHODS: We conducted a retrospective study of IHC stain use in BFC during a 5.5-year interval (2013-2018) and determined the laboratory's and each individual cytopathologist's IHC usage patterns according to the final diagnosis, site, and indications for their use. RESULTS: A total of 477 out of 4144 (11.5%) BFC cases had 2128 individual immunostains performed, with an average of 4.5 immunostains per case. Individual cytopathologists used IHC stains on 6.7% to 22% of their BFC cases. Pathologists with higher rates of IHC stain use than the laboratory's mean were less experienced and had higher rates of indeterminate but not of malignant diagnoses. The most common indication for the use of IHC stains was differentiating mesothelial from malignant cells. MOC31, calretinin, Ber-EP4, CD68, and D2-40 were the most commonly used of the 67 different IHC stains used in BFC. CONCLUSIONS: The laboratory's mean may represent the optimal IHC use rate, as higher IHC use rates did not lead to more diagnostic certainty or higher pickup rates of malignant cells.
Assuntos
Biomarcadores Tumorais/metabolismo , Líquidos Corporais/metabolismo , Citodiagnóstico/métodos , Imuno-Histoquímica/métodos , Neoplasias/diagnóstico , Líquidos Corporais/citologia , Diagnóstico Diferencial , Humanos , Neoplasias/metabolismo , Patologistas/normas , Patologistas/estatística & dados numéricos , Patologia Clínica/métodos , Patologia Clínica/normas , Patologia Clínica/estatística & dados numéricos , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Coloração e Rotulagem/métodosRESUMO
BACKGROUND: The Paris System for Reporting Urinary Cytology (TPS) defines clear morphologic criteria to classify urinary specimens into 7 diagnostic categories. According to TPS, a nuclear-to-cytoplasmic ratio (N:C ratio) >0.7 and hyperchromasia must be observed to render a diagnosis of high-grade urothelial carcinoma (HGUC). TPS was established using only liquid-based preparation techniques, and to the authors' knowledge it is unknown whether TPS can be applied using other preparation methods. METHODS: In the current prospective study, voided urine samples from patients with HGUC and negative for HGUC (NHGUC) were prepared using both ThinPrep and cytospin methods. ImageJ image processing software was used to measure the N:C ratio and hyperchromasia. For each patient, the N:C ratio and degree of hyperchromasia of urothelial cells present in both cytopreparations were compared. RESULTS: A total of 10 HGUC cases and 9 NHGUC cases, represented by a total of 688 cells (mean, 36.7 cells in HGUC cases; and mean, 35.8 cells in NHGUC cases), were evaluated in the current study. An overall comparison of HGUC cells with NHGUC cells demonstrated that HGUC cells had a higher average N:C ratio (0.5465 vs 0.2846) and greater hyperchromasia as measured by the average nuclear pixel gray value (100.8 vs 120.7). The N:C ratio was statistically different in 4 NHGUC cases, demonstrating higher N:C ratios in the ThinPrep preparations. Hyperchromasia was found to be statistically different in 6 cases, 5 of which demonstrated increased hyperchromasia in the ThinPrep specimens. CONCLUSIONS: The morphologic features of HGUC cells appear to be similar in samples prepared using the ThinPrep and cytospin methods, and therefore TPS criteria may be applied successfully in laboratories that use these methods.
Assuntos
Carcinoma de Células de Transição/diagnóstico , Técnicas de Preparação Histocitológica/métodos , Urina/citologia , Neoplasias Urológicas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/normas , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/urina , Núcleo Celular/patologia , Citoplasma/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores/normas , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Neoplasias Urológicas/patologia , Neoplasias Urológicas/urina , Urotélio/citologia , Urotélio/patologiaAssuntos
Medula Óssea/patologia , Histiocitose/patologia , Adolescente , Adulto , Idoso , Biópsia , Criança , Cristalização , Diagnóstico Diferencial , Humanos , Lactente , Coloração e RotulagemRESUMO
Vaping-associated pulmonary injury (VAPI) is a severe respiratory disorder associated with the inhalation of nicotine, tetrahydrocannabinol, cannabidiol, or other active substances through a personal vaporizer ("vaping"). Within 2 months after its description, the disease has reached epidemic proportion, affecting over 2000 people and resulting in a number of fatalities. The substance(s) responsible for the lung injury are still unknown, and the pathophysiology of the disease is still incompletely understood. The manifestations of the disease are protean, and the insidiously starting respiratory, gastrointestinal, and constitutional symptoms may initially resemble a viral flu-like illness. The disease may increase in severity, requiring hospitalization, and in more severe cases, mechanical ventilation. The diagnosis of VAPI currently relies on the identification of pulmonary infiltrates on imaging studies in patients who have used vaping products, after excluding infections and other plausible alternative diagnoses. Because VAPI is currently a diagnosis of exclusion, some authors have suggested the use of lipid-laden macrophages (LLM) as a diagnostic test to confirm the disease. We review the current state of the knowledge about the pathologic basis of VAPI, and the literature on the analytic performance of the LLM test to better understand the potential utility of this test in the diagnosis of VAPI. Our review finds little evidence to suggest the use of LLM in the diagnosis of VAPI, since its underlying pathology is acute lung injury, which is unrelated to LLM, and the frequency of their detection varies greatly in different reported series.
Assuntos
Lesão Pulmonar Aguda/diagnóstico , Lesão Pulmonar Aguda/etiologia , Líquido da Lavagem Broncoalveolar/imunologia , Gotículas Lipídicas/metabolismo , Macrófagos Alveolares/metabolismo , Vaping/efeitos adversos , Lesão Pulmonar Aguda/epidemiologia , Lesão Pulmonar Aguda/imunologia , Adolescente , Adulto , Idoso , Sistemas Eletrônicos de Liberação de Nicotina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto JovemRESUMO
The color of urine, once considered by uroscopists to give the most important clues to the diagnosis, still can provide some diagnostic clues in modern medicine. Pigmented cells are an uncommon and surprising find in urine cytology and can at the same time provide important diagnostic clues or represent a dangerous pitfall. We present a review of the significance of pigmented cells in urine cytology. The presence of intracellular pigment granules; their color, size, shape, and variation in size and shape; as well as their staining reactions with special stains can provide useful diagnostic insight, especially when interpreted in the cytologic context (type of pigmented cell and its degree of atypicality) and patient's clinical context. The main differential diagnosis of cytoplasmic pigmented granules includes hemosiderin, lipofuscin, and melanin, each having a different pathogenesis and significance. The goal of this paper is to describe the morphological, histochemical, and ultrastructural characteristics of the pigments seen in urinary cytology, and to review the benign and malignant conditions associated with them.
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Citodiagnóstico/métodos , Citoplasma/química , Lipofuscina/urina , Pigmentos Biológicos/urina , Urina/citologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cor , Diagnóstico Diferencial , Feminino , Hemossiderina/urina , Humanos , Masculino , Melaninas/urina , Melanoma/diagnóstico , Melanoma/urina , Melanose/diagnóstico , Melanose/urina , Pessoa de Meia-Idade , Pigmentação , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/urinaRESUMO
INTRODUCTION: Rosai-Dorfman disease (RDD) is a rare usually self-limited non-Langerhans cell histiocytosis of unknown etiology. Nodal and extranodal RDD appear to represent distinct conditions with different molecular alterations and prognosis. They also pose different diagnostic challenges on biopsies and fine-needle aspiration (FNA) cytology. The aim of this study was to report on 3 cases of intra-abdominal RDD and perform an extensive review of the literature on FNA findings of RDD. MATERIALS AND METHODS: We reviewed FNA specimens from cases diagnosed histologically or cytologically as RDD during the past 10 years. We searched the PubMed and Google Scholar databases for cases of RDD sampled by FNA. RESULTS: We identified 3 cases of intra-abdominal RDD, involving the kidney, periportal lymph node, and pancreas. FNA of the latter was hypocellular with fibrosis and was nondiagnostic. FNA of the first 2 yielded hypercellular smears that were diagnosed as RDD due to the identification of emperipolesis occurring in large uni- or binucleated histiocytes with large nuclei, fine chromatin, and prominent nucleoli in smears and cell-block sections. Immunohistochemistry showed positive staining for S100 and CD68 and negative staining for CD1a. The large histiocytes with emperipolesis were more difficult to identify histologically and their demonstration required immunohistochemical stains. CONCLUSION: Our experience and an extensive review of the literature suggest that extranodal RDD can be diagnosed on FNA, and that the recognition of histiocytes with emperipolesis may be less challenging cytologically than histologically. The fibrosis frequently seen in extranodal RDD may lead to nondiagnostic aspirates, however.
Assuntos
Histiocitose Sinusal/diagnóstico , Rim/patologia , Linfonodos/patologia , Pâncreas/patologia , Doenças Raras/diagnóstico , Cavidade Abdominal , Adulto , Antígenos CD/imunologia , Antígenos CD1/imunologia , Antígenos de Diferenciação Mielomonocítica/imunologia , Biópsia por Agulha Fina , Emperipolese , Evolução Fatal , Feminino , Histiócitos/imunologia , Histiócitos/metabolismo , Histiocitose Sinusal/tratamento farmacológico , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Doenças Raras/tratamento farmacológico , Proteínas S100/imunologia , Esteroides/uso terapêutico , Resultado do Tratamento , Adulto JovemRESUMO
Leydig cell tumors are rare sex cord-stromal tumors that account for less than 1% of all testicular tumors. Less than 10% of these tumors show metastatic malignant behavior. Herein we present a case of metastatic malignant Leydig cell tumor in an iliac lymph node diagnosed on fine-needle aspiration (FNA) in a 70-year-old man. The patient was referred from an outside institution with lymphadenopathy and had a past medical history of lymphoplasmacytic lymphoma/Waldenström's macroglobulinemia and past surgical history of orchiectomy. An iliac lymph node FNA was performed demonstrating large discohesive plasmacytoid cells with indistinct cell borders; abundant and finely granular cytoplasm; round, eccentric nuclei with evenly distributed chromatin; and prominent nucleoli. The tumor cells were positive for inhibin and negative for calretinin and keratin leading to the diagnosis of metastatic malignant Leydig cell tumor. Review of the patient's history and of previous pathologic material, careful evaluation of cytomorphologic features, and the judicious use of immunohistochemistry can allow an accurate diagnosis of metastatic Leydig cell tumor.