Cytomorphological and immunophenotypic characteristics of blastic plasmacytoid dendritic cell neoplasm involving central nervous system: a case report and review of literature.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive hematopoietic neoplasm derived from precursors of plasmacytoid dendritic cells. We describe cytomorphological and immunophenotypic features of BPDCN in cerebrospinal fluid (CSF) in a 66-year-old patient who presented with delayed central nervous system relapse. Morphological examination showed dense infiltration by monotonous population of intermediate-sized cells, resembling blasts. Nuclei had irregular contour with fine chromatin and prominent nucleoli. The cells had scant, pale blue, agranular cytoplasm. In some cells, intracytoplasmic vacuoles were also seen. No lymphoglandular bodies were seen. No mitosis or karyorrhexis were observed. On immunophenotyping, these cells were positive for CD45dim, CD123dim, HLA-DR, CD56, CD36bright, TCL1, CD4, CD117, CD38dim and negative for CD13, CD33, CD34, CD14, CD64 and CD16. The relevance of clinical suspicion, cytological recognition, and inclusion of BPDCN specific immunophenotypic markers is emphasized.

FNA diagnosis of poorly differentiated thyroid carcinoma. A review of the recent literature.

Poorly differentiated thyroid carcinoma (PDTC) is a follicular cell-derived tumour that was recognised as a distinct entity by the World Health Organisation in 2004. The natural history and pathological features of PDTC are reported to be intermediate between those of well-differentiated and undifferentiated (anaplastic) thyroid carcinomas. Preoperative identification of PDTC could facilitate better initial patient management in many cases, namely more extensive surgery, without any delay. However, according to some experts, a diagnosis of PDTC can only be rendered on histologic specimens based on criteria recommended in the Turin proposal. Although high-grade features (namely necrosis and mitoses) can be recognised in FNA material, other cytomorphological features have limited value for the preoperative diagnosis of PDTC and specific features for a definitive diagnosis of PDTC have not yet been clearly defined. Here, we review the current status and future prospects for cytological recognition of PDTC; we emphasise the features that should raise suspicion of this rare condition in FNA cytology and provide an update on molecular features and management of PDTC. Despite proposed histological criteria for the diagnosis of PDTC, its recognition on routine thyroid cytology presents a notable challenge. Current and future advances in molecular testing could contribute to the cytological diagnosis of PDTC.

Cytological features of endolymphatic sac tumors: Case studies with review of literature.

Endolymphatic sac tumors are extremely rare, locally aggressive neoplasms that arise from the endolymphatic sac or duct, primarily in the intraosseous portion. These neoplasms show diverse histomorphological architectures and despite a bland cytologic appearance, can locally recur. Although the clinicopathological and radiological features of this entity are well characterized, the literature on cytological features is extremely sparse. Herein, we describe the cytological features of the endolymphatic sac tumors and discuss the relevant differential diagnoses.

The role of Pap smear in the diagnostics of endocervical adenocarcinoma.

In the high-income countries, the amount of cervical adenocarcinomas is on the rise. The pap smear sampling has a low sensitivity and a low specificity for endocervical malignancies, and there are only a few cytomorphological features, that are specifically associated with glandular atypia. In this study, 298 pap smears of 60 patients with endocervical adenocarcinoma or adenocarcinoma in situ (AIS) and 30 patients with high-grade intraepithelial lesion (HSIL) in histology were reviewed. The pap smear type (screening/clinical), the HPV status and the time from sampling to the histological confirmation of diagnosis were recorded for each case. Despite that no cytomorphological features could be associated with adenocarcinoma statistically, 70% of the pap smears were initially correctly diagnosed as an endocervical glandular lesion. Palisading cell borders, nuclear pleomorphism and the lack of single atypical cells present simultaneously were found to be associated with adenocarcinoma and AIS with the corresponding ORs of 5.89 (95% CI 1.96-17.70), 3.71 (95% CI 1.14-12.02) and 10.76 (95% CI 1.20-59.50). This combination of features was seen in smears taken up to 5 years before the histological diagnosis. Of all our screening samples, 10.9% were HPV-positive. There were no HPV-negative samples among patients with adenocarcinoma.

Accuracy of Subclassification and Grading of Renal Tumors on Fine Needle Aspiration Cytology Alone.

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.

Fine-needle aspiration cytology of extra mammary metastatic lesions in the breast: A retrospective study of 36 cases diagnosed during 18 years.

BACKGROUND: Metastatic tumors in the breast require treatment according to origin and type of tumor. It is important to recognize these lesions in fine-needle aspiration cytology (FNAC) in order to avoid unnecessary mastectomy or non-relevant chemotherapy. The aim of this study was to evaluate the cytological features of metastatic tumors and possible criteria that could alert us as to the possibility of a metastasis from an extra mammary malignancy. METHODS: The material included 36 confirmed or suspected metastases in the breast registered in the pathology files at Oslo University Hospital, Ulleval, during 1990-2007. There were a total of 6,325 cases of malignant breast FNAC, representing 30 men and 6,295 women. Smears were evaluated for the amount of material, presence or absence of myoepithelial cells, microcalcifications, mitoses and necrotic material. All carcinomas were graded. RESULTS: There were seven men (7/30 = 23.3%) and 29 women (29/6,295 = 0.46%). The primary tumor was known in 22 cases (22/36 = 61.1%). No other primary tumor was known and metastatic lesion was not initially suspected in 14 cases (14/36 = 38.9%). The most common origin was lung (15/36 = 41.7%). In five cases (5/36 = 13.9%), the origin remained uncertain. CONCLUSIONS: Metastases from extra mammary sites are (relatively) common in males (23.3%). In women, metastatic lesions are rare (0.46%). A large proportion of them (88%) are high-grade adenocarcinomas and poorly differentiated carcinomas that may resemble grade 3 ductal carcinomas. Unusual clinical and/or radiological presentation in combination with high-grade malignant cells should alert us to consider the possibility of a metastasis.

Diagnostic cytological features and differential diagnosis of subacute granulomatous (De Quervain's) thyroiditis.

BACKGROUND: The aims of the study are to identify the diagnostic cytological features of subacute granulomatous thyroiditis (SGT), to compare our results with previous literature studies, and to investigate the cytological changes in SGT that mimic other thyroid lesions. METHODS: This retrospective study was conducted with 69 cases. The cytology slides were re-evaluated. The diagnostic cytomorphological features of the disease were identified. The results were compared with the literature. Differential diagnosis of the disease is discussed with the results obtained. RESULTS: The diagnostic cytological features consisted of lymphocytes, multinucleated giant cells, loose epithelioid histiocyte groups, granulomas, isolated epithelioid histiocytes, colloid, and neutrophil leukocytes. The highest degree of concordance between our results and the published literature was the presence of giant cells while the lowest was for microfollicles. Some reactive cytological features of SGT were similar to other benign or malignant diseases of the thyroid. CONCLUSION: SGT is a rare and self-limiting disease. Cytological features are not specific. The diagnosis should be confirmed by clinical and laboratory results. Reactive atypia in the early phase of the disease and microfollicles in the late phase may lead to a false cytological diagnosis, thus resulting in unnecessary resection. To prevent such misdiagnoses, cytopathologists should be aware of the reactive cytological changes in this disorder.

Histological characterization of Passiflora pohlii Mast. root tips cryopreserved using the V-Cryo-plate technique.

Cryopreservation stands out as the main strategy to ensure safe and cost efficient long-term conservation of plant germplasm, especially for biotechnological materials. However, the injuries associated with the procedure may result in structural damage and low recovery rates after cooling. Histological analysis provides useful information on the effects of osmotic dehydration, LN exposure, and recovery conditions on cellular integrity and tissue organization, allowing the determination of the critical steps of the cryopreservation protocol and, thus, the use of optimized treatments. Passiflora pohlii Mast. (Passifloraceae) is a native species from Brazil with potential agronomic interest. Recent studies showed the presence of saponins in its roots, which presented antioxidant activity. The goal of this work was to develop a cryopreservation technique for root tips of in vitro-derived plants of P. pohlii using the V-Cryo-plate technique and to characterize the anatomical alterations that occurred during the successive steps of the protocol. Root tips were excised from in vitro plants and precultured before adhesion to cryo-plates and then treated for different periods with the plant vitrification solutions PVS2 or PVS3. Treatment with PVS2 for 45 min resulted in higher recovery (79%) when compared with PVS3 (43%). The greatest number of adventitious roots per cryopreserved explant was also observed after a 45-min exposure to PVS2. Plasmolysis levels were higher in cortical cells of cryopreserved explants treated with PVS2, while pericycle and central cylinder cells were not damaged after this treatment. Thirty days after rewarming, no plasmolysis could be detected, regardless of the experimental conditions.

Clinical and cytological features in diagnosis of peripheral tubercular lymphadenitis - A hospital-based study from central India.

BACKGROUND: Tuberculosis lymphadenitis is difficult to diagnose clinically, and often the laboratory confirmation is not available in resource-poor countries. We describe here the symptoms, clinical characteristics, and results of cytological analysis in peripheral tuberculous lymphadenitis patients. METHODS: One hundred and fifty-six patients with peripheral lymph node for cytological evaluation presenting to Department of Pathology, Acharya Vinoba Bhave Rural Hospital, Wardha, India were included in this study. RESULTS: Sixty-nine cases were tuberculous lymphadenitis, with female to male ratio of 1.3:1. One or more constitutional symptoms were present in 59.4% of patients, with 89.9% of lymph nodes ≥2×2cm and the most common site of involvement was cervical lymph node (70.3%). The lymph nodes were multiple (85.5%), either discrete or matted. Cytomorphologically, hemorrhagic aspirate was observed in 29 cases, well-formed epithelioid cell granuloma with caseous necrosis was seen in 34 cases, and Zeihl Neelsen staining was positive in 45 cases. Correlation between character of aspirate and cytomorphological pattern was found highly significant. CONCLUSION: These data suggest that constitutional symptoms and clinical and cytological features help in diagnosing cases of peripheral tubercular lymphadenitis and also open new frontiers to further research that affects the cytological features of these cases.

Cytological Features Associated with Ureaplasma Urealyticum in Pap Cervical Smear

Purpose: Ureaplasma urealyticum is associated with several obstetric complications and increases the importance of risk management in pregnant women. Furthermore, U. urealyticum has been identified as a cofactor that interacts with human papillomavirus infection in cervical cancer onset. The aim of this study was to assess specific cytological features of U. urealyticum infection in Pap smears to determine whether additional microbiological testing should be performed for pregnant women with a high possibility of U. urealyticum infection. Methods: Liquid-based cytology specimens (LBC) from cervical swabs of a total of 55 women, including 33 pregnant women who were negative for intraepithelial lesion or malignancy (NILM) on Pap testing and with U. urealyticum diagnosed without any other infectious microbes and 22 U. urealyticum-negative controls, were used in this study. We evaluated the localization of U. urealyticum by immunofluorescence, cytological features of secondary changes in squamous cells caused by inflammation, and the specimen background in Pap smears. Results: Based on analysis of Pap smears, a significant relationship was observed between U. urealyticum infection and cannonballs (p < 0.05) as well as predominance of coccoid bacteria (p < 0.05). A large number of U. urealyticum were detected in cannonballs by immunofluorescence. Conclusion: In the present study, cytological features in Pap smears of U. urealyticum infected samples, which have hardly been understood thus far, were assessed. The cytological features included cannonballs and predominance of coccoid bacteria. Our results might help in determining whether additional microbiological testing should be performed for pregnant women with a high possibility of U. urealyticum infection.

Cytological Features of the Large Cell Variant of Small Cell Ovarian Carcinoma in Young Patients with Hypercalcemia: Histological Findings and Review of the Literature.

OBJECTIVE: To present the cytological features of a very rare and lethal ovarian neoplasm occurring in the young. STUDY DESIGN: We reviewed the cytological findings as they presented in touch imprints obtained from an ovarian mass sent to our department for frozen section investigation. RESULTS: Smears were highly cellular. The cells were of intermediate size with a moderate amount of microvacuolated, pale, or eosinophilic cytoplasm with indistinct cell borders. The nuclei were of round or oval shape with mild to moderate atypia and indistinct nucleoli. CONCLUSIONS: The diagnosis of small cell carcinoma of the ovary can be challenging even histologically. Cytology can be an invaluable adjunct to hematoxylin-eosin sections both pre- or intraoperatively. Although it is a very rare occurrence and cytological results are almost absent in the literature, our case can make cytopathologists more acquainted with the cytological features of this rare tumor entity especially in association with a characteristic clinical profile. Furthermore, the cytological features of small cell carcinoma of the ovary, large cell variant, have only rarely been described in the literature.

Primary granulosa cell tumor of retroperitoneal origin: A rare presentation with emphasis on cytomorphology.

The most frequently occurring retroperitoneal tumors are those of the kidneys, adrenal glands, and the pancreas. A primary retroperitoneal tumor composed of granulosa cells and developing far away from the normal location of the ovary is less frequently observed. A 69-year-old female patient presented with abdominal discomfort. Computerized tomography (CT) of the abdomen revealed a solid heterogeneous mass lesion measuring 11.2 cm × 8 cm × 12 cm consistent with retroperitoneal hematoma. Ultrasonography (USG)-guided aspiration smears revealed cytological features suggestive of adult-type granulosa cell tumor (AGCT). As the patient had a history of hysterectomy with bilateral salpingo-oophorectomy 22 years ago for leiomyoma, a diagnosis of extraovarian AGCT was made. Intraoperatively, the tumor was removed in piecemeal that showed yellowish areas with extensive necrosis and hemorrhage. Histopathological examination of the excised mass and inhibin positivity confirmed the diagnosis. Primary retroperitoneal extraovarian GCT is a rare tumor with only 12 cases reported in medical literature in English.

Loose cell clusters with vascular coats: Zellballen pattern of paraganglioma on cytology.

Paragangliomas are uncommon tumors arising in paraganglion tissue, which is well represented in the head and neck. A correct pre-operative cytological diagnosis helps in planning early and optimal surgery. Cytologic features in carotid body tumor and extra adrenal paragangliomas have been well described and documented. In addition to the acinar and discrete arrangement of cells, smears also showed a few large loose clusters of cells enveloped by thin vascular channels-the so-called zellballen pattern, a diagnostic feature on histopathology. Zellballen pattern of paraganglioma on cytology is not a common finding and hence is being reported.

Role of cytological characteristics of benign thyroid nodules on effectiveness of their treatment with levothyroxine.

INTRODUCTION: Levothyroxine (LT4) therapy has been used for the treatment of euthyroid nodular goiter, but there are controversial results about its usefulness. We aimed to evaluate the possible role of benign nodules' cytological characteristics in response to LT4 therapy. MATERIAL AND METHODS: In total, 93 patients with 128 nodules were included in the study; 74 of the nodules were treated with LT4 (group 1), and 54 of them had no medication (group 2). The subgroups consisted of adenomatous nodules, colloid nodules and cystic nodules. RESULTS: In group 1, mean thyroid volume and mean nodule volume were reduced significantly (p = 0.002 and p = 0.022, respectively) with low-normal level thyrotropin (TSH) suppression (between 0.3 mIU/ml and 1.0 mIU/ml), while there were no significant changes in group 2. When we evaluated changes of the initial and last nodule volumes in cytological subgroups, only colloid nodules in group 1 had significant reduction (p = 0.040) and the others had no significant changes. By omitting the colloid nodules, when the other nodules were revaluated, there were no significant changes in either group. CONCLUSIONS: On the basis of these results, obtained from a large sample of Anatolian patients, it is possible that LT4 therapy leads to significant reductions of both thyroid volume and nodule size in colloid nodules, but not in other kinds of benign nodules.