URINE CYTOLOGY AND AXILLARY TESTING FOR INTERPRETATION AND FOLLOW-UP OF URINARY TUMORS.

Microscopic appearance of cells in urine cytological samples is the formal diagnostic approach adjunct to cystoscopy for the detection and follow-up of urinary tumors. However, cystoscopy is a surgical method and cytology may miss low-grade papillary tumors. Several assays and markers have been developed to assist in this. When combined with conventional cytology, uro-oncological diagnostic performance is improved. We review the value of these non-invasive modalities in comparison with urine cytomorphology in the work-up of urothelial malignancies.

Diagnosis and immunocytochemical characterization of an EBV related diffuse B large cell lymphoma of the retroperitoneum from cell block preparations obtained by means of EUS guided FNA.

Diffuse large B cell lymphoma (DLBCL) in the retroperitoneum has been scarcely reported and the diagnostic workup is challenging due to difficulties in access to tissue. A 73-year-old female presented to the gastroenterology clinic, with recent-onset atypical abdominal pain and alternating constipation and diarrhea.

Invasive Aspergillus tracheobronchitis in a patient with hairy cell leukemia and previous Plasmodium falciparum infection.

Invasive Aspergillus tracheobronchitis is a relatively rare form of invasive pulmonary aspergillosis characterized by invasion of the tracheobronchial tree by Aspergillus spp. Invasive pulmonary aspergillosis is predominantly detected in severely immunocompromised patients. Notably however, pulmonary and tracheobronchial cases of invasive aspergillosis have also been reported, particularly in the context of severe malaria caused by Plasmodium falciparum. Herein, we present a case of invasive Aspergillus tracheobronchitis in a patient with hairy cell leukemia and previous Plasmodium falciparum infection.

Cytological diagnosis of Langerhans cell histiocytosis. Apropos 2 cases.

Langerhans cell histiocytosis (LCH) comprises a wide spectrum of clinical presentations in children and adults, ranging from favorable lesions to aggressive disseminated disease. We present 2 cases where cytology introduced the diagnosis of LCH in the appropriate clinicoradioliogical settings. Cytology can serve accurately in LCH interpretation based on the characteristic cytomorphology and selected immunocytochemistry, so unwarranted biopsy can be overruled and treatment can be adjusted largely where histopathology services are unavailable. Diagnosis may be difficult in cases with scant or insufficient cellular material.

Cytological diagnosis of unifocal Langerhans cell histiocytosis in the temporomandibular joint.

Unifocal Langerhans cell histiocytosis (LCH) presents as a solitary focal bone lesion characterized by clonal proliferation of CD1a (+) and langerin(+) dendritic cells, derived from the bone marrow. In 38-69% of cases BRAF-V600E mutation is revealed. It gains attention to maxillofacial surgeons due to involvement of the orofacial region and early onset of jaws symptoms. If overlooked, massive deconstruction of tissues, occurs. We present a case of LCH of the temporomandibular joint in a 14 aged child where fine needle aspiration favorably contributed in an accurate diagnosis combined with the appropriate clinicoradioliogical findings. This can overrule unwarranted biopsy and monitor the treatment largely where aproach to histopathology services is restricted.

Intraoperative squash Cytology of diffuse glioma not otherwise specified, of the Cerebellum.

OBJECTIVE: Diffuse glioma arises anywhere in the CNS, but most frequent in the cerebral hemispheres. The tumor tends to be seen in children and in younger adults aged 20-30. We report one such case in an older female patient presenting the intraoperative cytology of the tumor. CASE REPORT: A 48-year-old female was diagnosed by MRI with a tumor of cerebellum. Cytologic material was obtained during the resection of the tumor and diagnosed cytologically as glioma. CONCLUSION: This case is presented to focus the ability of the intraoperative cytology in diagnosis of the glioma, using immunocytology and confirmed by histo- immunohistology.

Cerebrospinal fluid and intraoperative squash cytology of childhood ependymoma.

Ependymomas are glial neoplasms of central nervous system originated from the ependymal lining of the brain ventricles and spinal cord central canal, and rarely exfoliated into cerebrospinal fluid (CSF). In this case we report the cytomorphological and immunocytomorphological features of ependymoma in CSF and intraoperative squash preparations, confirmed by histology. Case report. The patient  was a nineteen months old female presented at the University hospital of Heraklion, Crete, in a hemicoma, and was intubated. Computed tomography, scanning and magnetic resonance imaging (MRI), were performed and a mass in the posterior fossa was found. A sample of cerebrospinal fluid (CSF) was sent for cytologic evaluation. A diagnosis of ependymoma was rendered, followed by tumor resection, during which intraoperative squash smears for cytologic interpretation were obtained. Cytological consultation disclosed a grade II ependymoma (WHO grade II), with focally anaplastic features (WHO grade III).

Osteoclast: like giant cell undiferrentiated pancreatic tumor diagnosed by means of EUS guided FNA.

OBJECTIVE: Osteoclast-like giant cell tumours are rare abdominal malignant neoplasms mainly arising in the pancreas. Because of their rarity, clinical and cytopathology reports are very limited, and sonographic features have not been clearly specified ; these tumors are easily misdiagnosed by ultrasound as mucinous cystic tumors (MCTs)  or solid pseudopapillary neoplasms (SPNs). CASE STUDY: We report a case of osteoclast  like giant cell tumor arising in the pancreas of an 80 year old female patient offered by EUS-FNA cytology on direct and cell block slides. A biphasic pattern composed by a malignant mononuclear cell component and a giant cell component were hallmarks to the diagnosis. CONCLUSION: Our case highlights the performance of EUS-FNA in the diagnostic approach of  abdominal tumours and the significance of cell block method in the interpretation of osteoclast-like giant cell pancreatic tumour.

Epidemiology of surgical treatment of nonmelanoma skin cancer of the head and neck in Greece.

BACKGROUND: Nonmelanoma skin cancer (NMSC) constitutes the most common malignancy in Caucasians. Epidemiological data derive, mainly, from studies in the United States, Australia, and Northern Europe, whereas data from Mediterranean Europe are scarce. OBJECTIVE: To provide information on the epidemiology of surgically treated NMSC of the head and neck in the region of Thrace, Northern Greece, and to evaluate the surgical treatment given. METHODS: A retrospective review of patients surgically treated from 2004 to 2006 was conducted. Data on demographics, histology and skin cancer characteristics, and treatment efficacy and recurrence rate were extracted and analyzed. RESULTS: One hundred seventy-nine NMSCs of the head and neck were excised and histopathologically confirmed in 160 patients, with the majority (58.7%) classified as Fitzpatrick skin type III. Histology included 125 basal cell carcinomas (BCCs) and 54 squamous cell carcinomas (SCCs). The mean age was 70.6 +/- 10.1 (range 38-97). Tumor size ranged between 2 and 50 mm. Excision with 5-mm margins was performed in every case, and the defects were closed mainly using local flaps. Incomplete excision was limited to 3.9% of cases, and the recurrence rate was 1.7%. The study revealed similar characteristics between BCC and SCC regarding age and sex but significant differences in terms of location and size. CONCLUSIONS: Surgical resection achieves a satisfactory NMSC clearance rate in the head and neck.

Accessory parotid gland carcinoma ex pleomorphic adenoma. Case study diagnosed by fine needle aspiration.

OBJECTIVE: The accessory parotid gland is salivary tissue separated from the main parotid gland and lying on masseter muscle. It has secondary duct emptying into the Stensen's duct. The accessory parotid gland exists in 21-61% of individuals. However, the appearance of an accessory parotid tumor is rare, with a reported frequency of 1-7.7% of all parotid gland tumors. Carcinoma ex pleomorphic adenoma arises from a pre-existing benign mixed tumor. Most of these tumors will have malignant epithelial component, but not malignant stromal component. Reports of Fine Needle Aspiration Cytological (FNAC) diagnosis of malignant mixed tumor are uncommon and have been limited to cases arising in the parotid. We report a case of carcinoma ex pleomorphic adenoma of the accessory lobe of the parotid, and address the cytopathology features and pitfalls of this condition. CASE: A 73 aged female presented with a right nontender midcheek mass. The lesion had been present 18 months, with a recent increase in size. FNA was performed and the smears demonstrated features indicative of pleomorphic adenoma admixed with findings indicative of a poorly differentiated carcinoma. CONCLUSION: FNAC can accurately diagnose carcinoma ex pleomorphic adenoma when strongly fixed requirements are implemented.

Schwannoma of right cerebellopontine angle. A cytologic diagnosis.

Schwannomas affect mainly head and neck peripheral nerves, are benign tumors and derive from Schwann cells. Schwannoma of right cerebellopontine angle is extremely rare to diagnose by cytology. We report one such rare case presenting the cytological features in material obtained during the resection of the tumor. Case report: A 47-year-old female was diagnosed by MRI with a tumor of right cerebellopontine angle.. Cytologic material from the tumor was obtained intraoperatively and diagnosed cytologically as a neurilemoma. Conclusion: This case is presented here to focus the ability of cytology in diagnosis of schwannoma in intraoperative material of the tumor, using immunohistochemistry and confirmed by histology- immunohistochemistry.

FNA Cytology in pediatric small cell glioblastoma.

Small cell glioblastoma is a high anaplastic variant of GBM characterized by a monomorphic proliferation of small or medium cells with oval nuclei and scanty cytoplasm. CASE STUDY: The cytologic findings of a small cell glioblastoma in 11-year-old male and histologic features of the tumor using immunocytohistochemistry are reported. CONCLUSION: The accurate preoperative diagnosis of a small cell glioblastoma is crucial to developing a curative surgical plan. Cytology- confirmed by histology- provides a convenient, safe and effective approach to solving a challenging differential diagnosis.

Recurrent Cerebellar Desmoplastic/Nodular Medulloblastoma in Cerebrospinal Fluid (CSF) in the Elderly. A Cytologic Diagnosis.

Desmoplastic medulloblastoma is a rare subtype of medulloblastoma in childhood and more rare in adults. Cerebrospinal fluid (CSF) occurrence is frequent and important for treatment and prognosis. We report the CSF cytologic features of recurrent desmoplastic/nodular medulloblastoma in a 30-aged male.

EUS - Fine- Needle Aspiration Biopsy (FNAB) in the Diagnosis of Pancreatic Adenocarcinoma: A Review.

Solid masses of the pancreas represent a variety of benign and malignant neoplasms of the exocrine and endocrine tissues of the pancreas. A tissue diagnosis is often required to direct therapy in the face of uncertain diagnosis or if the patient is not a surgical candidate either due to advanced disease or comorbidities. Endoscopic ultrasound (EUS) is a relatively new technology that employs endoscopy and high-frequency ultrasound (US). EUS involves imaging of the pancreatic head and the uncinate from the duodenum and imaging of the body and tail from the stomach. It has been shown to be a highly sensitive method for the detection of pancreatic masses. It is superior to extracorporeal US and computed tomographic (CT) scans, especially when the pancreatic tumor is smaller than 2-3 cm. Although EUS is highly sensitive in detecting pancreatic solid masses, its ability to differentiate between inflammatory masses and malignant disease is limited. Endoscopic retrograde cholangiopancreatography (ERCP) brushing, CT-guided biopsies, and transabdominal ultrasound (US) have been the standard nonsurgical methods for obtaining a tissue diagnosis of pancreatic lesions, but a substantial false-negative rate has been reported. Transabdominal US-guided fine-needle aspiration biopsy (US-FNAB) has been used for tissue diagnosis in patients with suspected pancreatic carcinoma. It has been shown to be highly specific, with no false-positive diagnoses. With the advent of curvilinear echoendoscopes, transgastric and transduodenal EUS-FNAB of the pancreas have become a reality EUS with FNAB has revolutionized the ability to diagnose and stage cancers of the gastrointestinal tract and assess the pancreas. Gastrointestinal cancers can be looked at with EUS and their depth of penetration into the intestinal wall can be determined. Any suspicious appearing lymph nodes can be biopsied using EUS/FNAB. The pancreas is another organ that is well visualized with EUS. Abnormalities such as tumors and cysts of the pancreas can be carefully evaluated using EUS and then biopsied with FNAB. There are many new applications of EUS using FNAB. Researchers are looking to deliver chemotherapeutics into small pancreatic cancers and cysts. Nerve blocks using EUS/FNAB to inject numbing medicines into the celiac ganglia, a major nerve cluster, are now routinely performed in patients with pain due to pancreatic cancer. The aim of this study is to perform a review of the literature regarding the usefulness of EUS/FNAB in the diagnosis of pancreatic adenocarcinoma.

Cytology of Pericardial Effusion due to Malignancy.

BACKGROUND: Malignant pericardial effusion occurs in one tenth of all cancers. It is a very serious disorder that is mainly a secondary process due to metastasis because primary neoplasms of the pericardium such as mesotheliomas, sarcomas being exceedingly rare [corrected]. Pericardial effusion specimens are uncommon and to the best of our knowledge the current study is the largest systematic evaluation of pericardial fluid cytology performed to date. MATERIAL AND METHODS: Pericardial effusion specimens from 145 patients collected over a 25 [corrected] year period were studied by cytology [corrected]. The minimum pericardial fluid volume used for adequate cytologic diagnosis in these patients was more than 60 mL. RESULTS: Cytological diagnosis revealed malignant pericardial exudates in 100% of the studied patients [corrected]. CONCLUSIONS: Cytology provides an immediate and accurate means of diagnosis. Immunocytology is very important in the diagnostic evaluation.

Aspiration and Brushing Cytology in tumors and tumor-like conditions of the tongue: A Study of 27 Cases.

BACKGROUND: Lesions of the tongue have a broad differential diagnosis ranging from benign idiopathic processes to infections, cancers, and infiltrative disorders. An important thing to remember is that most tongue lesions will resolve spontaneously or with simple therapy within a week, if not, they should be biopsied or evaluated further for a definitive diagnosis of a potentially serious disorder. Some tongue lesions may be clues to other underlying illnesses which require further evaluation Tongue lesions are traditionally evaluated by surgical biopsy. Most of them, however, are easily accessible by fine-needle aspiration (FNA) or brushing. STUDY DESIGN: Fifteen males and twelve females aged from 15 to 72 were examined in our institution over a period of 15 years and 27 lesions, were evaluated by fine-needle aspiration cytology (FNAC) or brushing cytology. RESULTS: The lesions were located at the mobile aspect of the tongue.10 malignant tumors were diagnosed: 9 cases of squamous cell carcinoma (SCC), and 1 non-Hodgkin lymphoma (NHL). In addition, 13 benign tumors (7 cases of papillomas / fibromas, 3 cases of hemangiomas, 2 cases lymphangiomas, and 1 case of lipoma), and 4 nonneoplastic benign conditions (3 traumatic ulcers and 1 hematoma) were found. There were no false-positive diagnoses. There were no clinical complications resulting from FNA or brushing. CONCLUSION: Cytologic examination is rapid, safe, accurate, inexpensive, and patient-friendly for establishing preoperative diagnosis in tumors and tumor-like conditions of the tongue, and we recommend this method as the first diagnostic step in the evaluation of these lesions.

Fine Needle Aspiration Biopsy (FNAB) in the Diagnosis of Hepatocellular Carcinoma: A Review.

Hepatocellular carcinoma (HCC) is the fifth more common cause of cancer and the third leading cause of cancer deaths worldwide. Despite advances in surgical and non surgical modalities in the treatment of HCC, a number of controversies regarding appropriate diagnostic procedures continue to evolve. A consensus statement from the European Association for the study of Liver Diseases (EASL) has been formulated to help clinicians standardize diagnostic approaches. In nodules greater than 2 cm diameter in size, diagnosis can be made if any 2 imaging studies (ultrasonography, computed tomography, magnetic resonance imaging or hepatic arteriography) show increased vascularity. Alternatively only one imaging study with an Alpha fetoprotein level more than 400ng/mL is diagnostic. Fine needle aspiration biopsy (FNAB) should be performed in cases of indeterminate radiology and in lesions sized between 1 and 2 cm. The aim of this review is to familiarize pathologists in the FNAB diagnosis of HCC in an appropriate and timely fashion.