Impact of rapid on-site evaluation on diagnostic accuracy of EUS-guided fine-needle aspiration of solid pancreatic lesions: experience from a single center.

BACKGROUND: The use of ROSE in EUS-FNA pancreatic lesions is still controversial in many centers. In this study, we aimed to demonstrate the contribution of ROSE to the diagnostic accuracy, as well as its assistance to the pathologist/cytopathologist. METHODS: 162 EUS-FNA biopsies were included in the study. EUS-FNA cytology results were reported according to the six-tiered system of Papanicolaou Cytopathology Society and compared to their final diagnosis with histopathology and/or clinical follow-ups regarding malignancy. The diagnostic yield, the difference in diagnostic accuracy, and the contribution of ROSE to providing the pathologist with adequate tissue uptake (number of slides and cell blocks) for further examination were compared in the ROSE and non-ROSE patient groups. RESULTS: In the non-ROSE group, the diagnostic accuracy according to the final diagnoses was 96% and the sensitivity was 94.44%, specificity 100%, PPV 100%, NPV 87.50%; while diagnostic accuracy was 97.09%, sensitivity 97.47%, specificity 95.83%, PPV 98.77%, NPV 92% in patients with ROSE. There was no significant difference in diagnostic accuracy between those with and without ROSE (p: 0.078). In diagnostic cases, the number of passes, slides and cell blocks were significantly higher in patients with ROSE than those without ROSE (p: 0.003, p: 0.007, p: 0.012, respectively). ROSE was independently associated with diagnostic yield when evaluated by number of passes, slides, cell blocks in regression analysis (p: 0.001, OR: 5.07, confidence interval: 1.89-13.5). CONCLUSION: ROSE may increase the acquisition of sufficient tissue, but it does not have an advantage in diagnostic accuracy. ROSE may raise the number of slides, which may assist the pathologist for the diagnosis. If the lesion is solid and/or contains a solid component, diagnostic yield is higher in patients where ROSE is available. Therefore, ROSE still maintains its applicability in terms of increasing the diagnostic efficiency and making the final diagnosis.

The Journey of Material From Clinic to Pathology Laboratory: How Much Do Clinical Residents Know About This Process?

Introduction. Pathology plays a major role in the management of patients. Specimen delivery to a pathology laboratory is the first step in the process. Sending materials to the pathology laboratory should be included as part of residency training. The aim of this study was to determine the level of knowledge and daily practice of residents who send materials to pathology laboratory. Methods. A 34-item questionnaire asking questions about biopsy/resection and cytology material handling and transportation was answered by 154 residents. Likert scaling and multiple-choice questions with a single answer were used to evaluate the responses. Their daily routines and levels of knowledge were statistically analyzed. Results. The mean age of the respondents was 29.1 ± 3.04 (range: 24-42 years), and 63% of the residents were male. The residents of the university hospital claimed that the clinical information they had learned about transferring material to the pathology laboratory was "sufficient" or "very sufficient" (statistically significant, P = .04). Correct answers about the process of sending biopsy/resection materials of experienced residents were statistically higher, while there was no statistical significance for questions about cytology materials (P = .005, P = .24, respectively). Conclusion. The pathway to correct diagnosis builds on an understanding of the significance of pathology material. In residency training, knowledge about delivering biopsy/resection material to pathology laboratory is mostly acquired through experience. Experienced residents seem to be less familiar with cytology materials. Clinicopathological meetings may solve the main problems, but both clinics and pathology departments need to emphasize this process.

Actinomycosis of parotid gland after maxillary molar extraction, case report and review of literature.

Although actinomycosis is frequently seen in the cervicofacial region, it is very rare in the parotid gland. Furthermore, it can be confused with salivary gland malignancies in imaging. The most important underlying causes are cervicofacial trauma, tooth extraction history and poor oral hygiene. A 43-year-old male patient was admitted to otorhinolaryngology department with a complaint of progressive swelling on his cheek. The histopathological examination of fine-needle aspiration (FNA) biopsy showed acute suppurative polymorphous leukocytes and actinomycese hyphae balls within histiocytes. The patient was started on amoxicillin 2 gm per day for two months. With antibiotherapy, the swelling in the patient's parotid gland decreased and completely healed at the end of six months. Primary parotid actinomycosis has been rarely reported in the literature, differential diagnosis is usually problematic as both clinical and radiological findings may mimic parotid tumour; however, it can be useful to apply FNA cytology for a quick diagnosis and treatment.

Immunohistochemical Evaluation of BAP1 Expression in Breast Cancer with Known BRCA1 and BRCA2 Mutations and Comparison with Histopathological Features.

Introduction. BRCA-mutated breast cancers have specific pathological characteristics. BAP1 is a tumor suppressor gene that is important in many cancers with different pathways. The relationship between BRCA1 mutation and BAP1 immunohistochemical staining is still unclear. Our aim is to determine whether BAP1 immunohistochemical expression indicates BRCA mutation status in breast carcinomas with specific pathological characteristics. In addition, we aim to determine the histopathological characteristics of tumors according to BRCA mutations. Methods. Histomorphology, molecular subtypes and BAP1 immunohistochemical expression patterns of the BRCA1/BRCA2 mutated and non-mutated tumors were evaluated. The BAP1 immunohistochemical stain was applied to nine tumor tissues with the BRCA1 mutation, six tumor tissues with the BRCA2 mutation, and 16 tumor tissues without any BRCA mutation. Pearson's chi square test and the Fisher Freeman Halton test were used to analyze the associations between the datas. The statistical significance was considered as P value of <.05. Results. Immunohistochemical BAP1 loss was not detected in any mutated or non-mutated tumor group. BRCA1 mutated tumors had the statistically highest histopathological grade (P = .04) and BRCA1/2 mutated tumors had significant immunohistochemical triple negative expression pattern (P = .01). Conclusions. Intrinsic and histopathological characteristics may vary between BRCA1 mutated and non-BRCA1 mutated tumors. Also, BAP1 loss was not detected in BRCA mutated breast tumors because of several effects of BAP1 that are non-related with BRCA in the cell cycle.

Ossified uncertain malignant potential gastric glomus tumor with tumor thrombus.

Glomus tumor is a rare mesenchymal tumor composed of perivascular glomus bodies. The most common presentation area of these tumors is peripheral soft tissue, particularly in the distal part of extremities. They rarely can occur in the gastrointestinal tract and the most common location is the stomach. Preoperative diagnosis of this tumor can be difficult because of rarity and overlapping features with other mesenchymal lesions with regard to clinical and pathological findings. Therefore, to exclude differential diagnosis and make a definitive diagnosis is possible only with histopathological examination. In this case, we evaluated glomus tumor of stomach according to 2019 WHO Digestive System Tumors and accurate diagnosed was Uncertain Malignant Potential Gastric Glomus Tumor.