Cytologic studies of in vivo fallopian tube specimens in patients undergoing salpingo-oophorectomy.

OBJECTIVES: Recent research shows that most high grade ovarian cancer (OC) originates from the fallopian tube (FT). Cytologic evaluation of FT cells may enable early detection of OC. MATERIAL AND METHODS: This was a prospective study with patients enrolled from 3 centers (October 2016- August 2017). Forty-two women undergoing salpingo-oophorectomy for a pelvic mass suspicious for malignancy or undergoing risk-reducing surgery for BRCA mutations were included in the study. At the time of scheduled surgery, a novel catheter was used to collect FT cells through hysteroscopy. A pathologist blinded to surgical or pathologic findings evaluated FT cytology, and results were compared to pathology. RESULTS: Of the 61 samples collected, 72% (44/61) met the adequacy criteria (≥5 clusters of cells with 20 cells in each cluster). Cytology classification criteria were established and applied to adequate samples. Forty-four samples were benign with mixed population of cells with round, oval, and spindled nuclei; 2-dimensional clusters; columnar cell configuration; flat sheets; cilia presence; no/mild nuclear pleomorphism; no nuclear membrane irregularities; and no nucleoli. Five samples had benign features with reactive nuclear and cytoplasmic changes and/or background inflammation, which were categorized as "reactive atypia." Two malignant samples had features of 3-dimensional (3D) clusters, loss of mixed population of cells; increased nuclear/cytoplasmic ratio; nuclear membrane irregularity and nucleoli presence. Three samples with some but not all of malignant features were categorized as "neoplastic" (anisonucleosis; small nucleoli and features suggestive of 3D clusters). Malignant/ neoplastic samples were labeled as "Positive" (n = 5) while benign/reactive samples were labeled as "Negative" (n = 39). A high concordance rate (95%, 42/44) was observed between cytology results and histology. CONCLUSIONS: We characterized cytologic features for pathologically distinct FT samples collected in vivo using a novel catheter and demonstrated its value in detecting OC.

Cytological sampling of fallopian tubes using a hysteroscopic catheter: A multi-center study.

OBJECTIVE: To assess the feasibility of a novel hysteroscopic catheter to collect fallopian tube cytologic samples and to correlate cytologic findings with histopathology. METHODS: This was a prospective, multicenter, single-arm pilot study. Women undergoing salpingo-oophorectomy for a pelvic mass suspicious for malignancy or for prevention of cancer for BRCA mutation carriers were recruited from 3 gynecologic oncology centers (October 2016-August 2017). Cytologic samples were collected from the fallopian tube using a novel FDA-cleared hysteroscopic catheter and evaluated by a pathologist blinded to surgical or pathologic findings. The correlation between cytologic results and final surgical pathology was assessed. RESULTS: Of the 50 patients enrolled, 42 were eligible. Hysteroscopies were completed in 40 patients with 78 fallopian tubes, of which 65 ostia (83%) were identified. Of these, 61 (72%) were successfully catheterized resulting in 44 (68%) cytology samples adequate for further evaluation: 5 were classified as positive (3 neoplastic and 2 malignant) and 39 as negative (34 benign and 5 reactive/atypical). A comparison of cytology results with fallopian tube histopathology showed a concordance rate of 95% (42/44). Of the two samples with discordant results, both had positive cytology but negative tubal pathology, and both were stage I ovarian cancers with malignant ovary histology. CONCLUSIONS: Deployment of the device yielded an evaluable cytologic sample in 68% of cases with a high rate of concordance with histopathology. Further evaluation of the device's ability to detect malignancy in high risk populations is warranted.

Clinicopathologic Features of a Series of Primary Renal CIC-rearranged Sarcomas With Comprehensive Molecular Analysis.

CIC-rearranged sarcomas rarely occur in visceral organs including the kidney. The most common fusion partner with CIC is the DUX4 gene, but variant fusion partners have also been reported. Herein, we describe the clinicopathologic features and comprehensive molecular profiling of 4 cases of primary renal CIC-rearranged sarcomas. All cases occurred in females, age range 13 to 82 years and included 3 resections and 1 needle biopsy specimen. There was a tendency for development of metastatic disease predominantly to the lungs and poor disease outcome despite different treatment strategies. Histologically, variable round cell (20% to 100%), spindle cell (0% to 80%), and rhabdoid morphologies (0% to 20%) were seen. By immunohistochemistry diffuse WT1 nuclear (2 to 3+, ∼90%) labeling was present in 1 case, with cytoplasmic staining in the others (3+, 40% to 75%). CD99 was focally positive in all 4 cases (≤10%); 1 case each was diffusely positive for c-myc (2 to 3+, ∼90%) and ETV4 (3+, ∼90%); 1 case was focally positive for c-myc (2+, ∼5%) and calretinin (2+, ∼5%); and all cases were negative for cytokeratin and NKX2.2. CIC rearrangement by fluorescence in situ hybridization was present in the 3 cases tested. Comprehensive genomic profiling (CGP) of 3 cases revealed a CIC-DUX4 fusion in 2 cases, and 1 CIC-NUTM1 fusion. All 4 CIC-rearranged renal sarcomas had low mutation burden, and except HLA-A and MLL mutations lacked genomic alterations in other oncogenic drivers. Material from the needle biopsy was insufficient for CGP but that case was positive with the DUX4 immunohistochemical stain as were the 2 CIC-DUX4 tumors. In conclusion, CIC-rearranged sarcomas rarely occur in the kidney with a tendency for poor outcome and in this series we illustrate an example with CIC-NUTM1 fusion, an emerging variant, at a visceral site. Testing by fluorescence in situ hybridization or CGP is optimal to avoid missing cases that harbor variant fusion partners.

A Rare Case of Plastic Bronchitis in an Adult Patient After Cardiopulmonary Bypass.

Plastic bronchitis is a rare life-threatening complication observed after cardiopulmonary bypass (CPB). We describe a case of a 54-year-old man in whom a fulminant case of plastic bronchitis developed after coronary artery bypass grafting (CABG) and mitral valve repair. A brief review of the literature is also presented.