Urinary Bladder Masses, Rare Subtypes, and Masslike Lesions: Radiologic-Pathologic Correlation.

Urinary bladder masses are commonly encountered in clinical practice, with 95% arising from the epithelial layer and rarer tumors arising from the lamina propria, muscularis propria, serosa, and adventitia. The extent of neoplastic invasion into these bladder layers is assessed with multimodality imaging, and the MRI-based Vesical Imaging Reporting and Data System is increasingly used to aid tumor staging. Given the multiple layers and cell lineages, a diverse array of pathologic entities can arise from the urinary bladder, and distinguishing among benign, malignant, and nonneoplastic entities is not reliably feasible in most cases. Pathologic assessment remains the standard of care for classification of bladder masses. Although urothelial carcinoma accounts for most urinary bladder malignancies in the United States, several histopathologic entities exist, including squamous cell carcinoma, adenocarcinoma, melanoma, and neuroendocrine tumors. Furthermore, there are variant histopathologic subtypes of urothelial carcinoma (eg, the plasmacytoid variant), which are often aggressive. Atypical benign bladder masses are diverse and can have inflammatory or iatrogenic causes and mimic malignancy. © RSNA, 2022 Online supplemental material is available for this article.

Reactivity with the EpCAM-specific antibodies MOC-31 and Ber-Ep4 in plasma cell neoplasms: a potential diagnostic pitfall in cytology samples.

OBJECTIVE: Epithelial cell adhesion molecule (EpCAM) is a protein expressed on surfaces of healthy epithelia, and is overexpressed in dysplasias and carcinomas. Immunohistochemistry (IHC) utilizing antibodies that react with EpCAM, such as MOC-31 and Ber-EP4, distinguish reactive mesothelial cells from carcinomas in serous effusions. IHC is crucial in effusions with singly dispersed atypical cells, a scenario with a broad differential, including hematopoietic malignancies. Plasma cell neoplasms (PCN) are the second most common hematopoietic malignancy, manifesting as multiple myeloma or plasmacytoma, with 6% of cases developing serous cavity involvement. Most PCNs are readily recognizable; however, variants that deviate from the classic cytomorphology risk erroneous diagnosis. This study demonstrates EpCAM expression in a subset of PCNs, highlighting a potential diagnostic pitfall in serous effusion cytology. METHODS: A 10-year retrospective search for cytology specimens with a diagnosis of PCN was performed. All cases demonstrating CD138/CD38 and monoclonal immunoglobulin expression, and adequately cellular cell block were included. IHC analysis for MOC-31 and Ber-EP4 was performed using Ventana Benchmark Ultra. Scoring was performed as follows: total IHC score equals the positive proportion (0 = no positive tumor cells; 1 = <1%; 2 = 1-10%; 3 =11-33%; 4 = 34-66%; 5 = 67-100%) plus staining intensity (0, no staining; 1, weak; 2, moderate; 3, strong). A score > 4 was considered positive. RESULTS: 2 of 28 (7%) PCNs demonstrated positivity for MOC-31 and Ber-Ep4. CONCLUSION: A subset of PCNs in cytology samples show positivity for MOC-31 and Ber-EP4 which could result in misinterpretation as carcinoma.

Whole slide image with image analysis of atypical bile duct brushing: Quantitative features predictive of malignancy.

BACKGROUND: Whole slide images (WSIs) involve digitally capturing glass slides for microscopic computer-based viewing and these are amenable to quantitative image analysis. Bile duct (BD) brushing can show morphologic features that are categorized as indeterminate for malignancy. The study aims to evaluate quantitative morphologic features of atypical categories of BD brushing by WSI analysis for the identification of criteria predictive of malignancy. MATERIALS AND METHODS: Over a 3-year period, BD brush specimens with indeterminate diagnostic categorization (atypical to suspicious) were subjected to WSI analysis. Ten well-visualized groups with morphologic atypical features were selected per case and had the quantitative analysis performed for group area, individual nuclear area, the number of nuclei per group, N: C ratio and nuclear size differential. RESULTS: There were 28 cases identified with 17 atypical and 11 suspicious. The average nuclear area was 63.7 µm(2) for atypical and 80.1 µm(2) for suspicious (+difference 16.4 µm(2); P = 0.002). The nuclear size differential was 69.7 µm(2) for atypical and 88.4 µm(2) for suspicious (+difference 18.8 µm(2); P = 0.009). An average nuclear area >70 µm(2) had a 3.2 risk ratio for suspicious categorization. CONCLUSION: The quantitative criteria findings as measured by image analysis on WSI showed that cases categorized as suspicious had more nuclear size pleomorphism (+18.8 µm(2)) and larger nuclei (+16.4 µm(2)) than those categorized as atypical. WSI with morphologic image analysis can demonstrate quantitative statistically significant differences between atypical and suspicious BD brushings and provide objective criteria that support the diagnosis of carcinoma.

Feasibility and usefulness of troponin I testing in insurance medicine.

OBJECTIVE: Ascertain the prevalence of elevated Troponin I levels in applicants for insurance to assess the utility of routine measurement of Troponin I in this population. BACKGROUND: Patients presenting with chest pain, who are determined not to be experiencing an acute coronary event, but are noted to have increased levels of Troponin have higher mortality rates than a control population. Elevated levels of Tropoins in the general population are also associated with increase in all cause mortality. Therefore elevated Troponin levels in asymptomatic individuals could be considered a cardiac risk marker. METHODS: Blood samples from Insurance applicants and Health & Wellness participants were analyzed for Troponin I by the Siemens ADVIA Centaur immunoanalyzer. Since such samples are in transit for a day, we determined the rate of degradation of Troponin I on 24-hour storage at room temperature and extrapolated the time-zero values. RESULTS: About 1.5% (10 of 697) of the patients had Troponin levels above 0.04 ng/mL. This rate is higher than would be expected in a healthy general population. Three samples (0.43%) had levels > 0.06 ng/mL, which would be considered elevated and indicative of myocardial injury. CONCLUSIONS: Given the low percentage Troponin I elevations in the general population applying for life insurance, it may not be cost effective to routinely measure Troponin I levels in blood specimens submitted for insurance purposes, except for high value policies. It may be prudent collect data on Troponin I levels in Insurance applicants for better defining the risk models of cardiovascular disease.