Science, Medicine, and Cytology: an educational program of the Diversity, Equity, and Inclusion Committee of the American Society of Cytopathology.

INTRODUCTION: As our field of pathology continues to grow, our trainee numbers are on the decline. To combat this trend, the ASC Diversity, Equity, and Inclusion Committee established the Science, Medicine, and Cytology SumMer Certificate program to improve exposure to pathology/cytopathology with a focus on diversity, equity, and inclusion. Herein, we report our findings of the first 2 years of the program. MATERIALS AND METHODS: An online course was developed targeting students who are underrepresented in medicine at the high school and college level. It consisted of several didactic sessions, presenting the common procedures involving cytopathologists and cytologists. Interviews with cytopathologists were also included. Participants were surveyed for demographic information and provided course evaluations. RESULTS: In the first year of the program (2021), 34 participants completed the program, which increased to 103 in 2022. In both years there was a diversity in participant demographic backgrounds; however, only a minority of participants self-identified as being underrepresented in medicine. A vast majority (>85%) of participants in both years were high school or college students. In 2021, 100% of participants stated that the program format was effective and 94% thought the content was appropriate for their level of education; in 2022 the results were similar. In 2021, 66% considered health care as a potential career; this value increased in 2022 to 83%. In 2021 and 2022, 31% and 38%, respectively, considered cytology as a career. CONCLUSIONS: Evaluations were excellent, generating interest in cytopathology. Barriers in reaching underrepresented minorities exist and additional work is needed. Expansion to a wider audience may increase outreach.

TRPS1 function beyond breast: A retrospective immunohistochemical study on non-breast cytology specimens.

INTRODUCTION: Trichorhinophalangeal syndrome type 1 (TRPS1) has emerged as a reliable immunohistochemistry (IHC) marker for identifying breast origin in metastatic carcinomas. This study investigates the utility of TRPS1 IHC in non-breast cytology specimens. MATERIALS AND METHODS: A retrospective search of our pathology database for the year 2021 identified fluids (pleural and peritoneal) and liver, lung and bone fine needle aspirations (FNAs) with surgical follow-up confirming non-breast metastatic carcinomas. Cell blocks from cases with sufficient neoplastic cells underwent immunostaining using a rabbit polyclonal antibody against human TRPS1. Cases lacking tumor on deeper levels after the original work-up were excluded from the study. Two pathologists independently interpreted the TRPS1 staining. RESULTS: Of 136 cases assessed, 31 (22.79%) exhibited positive TRPS1 staining, while 105 (77.21%) were nonreactive. Positivity rates were observed in tumors of Mullerian cell origin, gastrointestinal tract (GIT), and lung origin at 28.85%, 25%, and 21.57%, respectively. Of the tumors of Mullerian cell origin 10 (66.67%) were serous carcinomas, 4 (26.67%) were endometrioid carcinomas, and one (6.67%) was a clear cell carcinoma. Lung tumors comprised seven (63.64%) squamous cell carcinomas and four (36.36%) adenocarcinomas, while the gastrointestinal tumors consisted of 14 (80%) adenocarcinomas and one (20%) squamous cell carcinoma. CONCLUSIONS: Although recognized as a sensitive marker for mammary carcinomas, TRPS1 immunostaining was also detected in Mullerian, lung, and GIT carcinomas. This highlights the significance of being cautious when depending solely on TRPS1 immunostaining to distinguish metastatic breast tumors.

Bilateral localized primary parotid gland amyloidosis: A rare entity with literature review.

Amyloidosis of the salivary glands is a rare occurrence. Due to non-specific clinical presentation, the diagnosis can be overlooked. Here we present a case of a localized bilateral parotid glands AL kappa-light chain amyloid deposition without systemic involvement, as well as a literature review. Fine needle aspiration (FNA) of a right parotid lesion was performed with rapid on-site evaluation (ROSE). Slides showed characteristic amyloid staining with Congo red and typical Apple-green birefringence under polarized light microscopy. Amyloid in the head and neck can be misinterpreted as other materials such as colloid, keratin, necrosis, hyaline degeneration especially when the condition is not suspected.

Utility of TRPS-1 immunohistochemistry in diagnosis of metastatic breast carcinoma in cytology specimens.

INTRODUCTION: At present, GATA binding protein 3 (GATA-3) is the most frequently used diagnostic immunohistochemical (IHC) marker for breast carcinoma (BC). However, it is not specific and has very low sensitivity for triple-negative BC (TNBC). SRY-box transcription factor 10 (SOX-10) and trichorhinophalangeal syndrome type 1 (TRPS-1) have been suggested for inclusion in the diagnostic workup of TNBC. TRPS-1 has not been established in cytology specimens as a diagnostic IHC marker for metastatic BC (MBC). Hence, in the present study we evaluated the utility of TRPS-1 in diagnosing MBC in cytology specimens. MATERIALS AND METHODS: MBC cases diagnosed on cytology specimens from January to October 2020 were included in the present study. Only cases with hormonal status available and ≥20 tumor cells on cell blocks were included in the study. The cell blocks were assessed for TRPS-1, GATA-3, and SOX-10 IHC marker positivity (intensity and percentage of tumor cells). The results were correlated with the specimen type (fine needle aspiration [FNA] versus body fluid) and various BC prognostic subgroups. RESULTS: We analyzed 61 cases, including 33 body fluid and 28 FNA (13 lymph node, 10 bone, 2 liver, 2 soft tissue, and 1 lung) specimens. TRPS-1 had 97.2% positivity in ER/PR+ (estrogen receptor/progesterone receptor-positive) MBC compared with GATA-3, which had 100% positivity in the same group. TRPS-1 showed high positivity in 35 of 37 cases (94.6%) and intermediate positivity in 1 (2.6%) and was negative/low positive in 1 case (2.7%). In contrast, GATA-3 showed high positivity for all 37 cases (100%). SOX-10 showed positivity in only 1 of 37 cases (2.7%), with intermediate positivity. In the HER2+ (human epidermal growth factor receptor 2-positive) group, TRPS-1 showed high positivity in 5 of 7 cases (71.4%), intermediate positivity in 1 case (14.3%), and negativity in 1 case (14.3%). However, GATA-3 showed high positivity in 6 of 7 cases (85.7%) and negative/low positivity in 1 case (14.3%). SOX-10 was negative in all 7 cases. In TNBC, TRPS-1 showed high positivity in 16 of 17 cases (94%) and intermediate positivity in 1 (5.9%), and GATA-3 showed high positivity in 9 (53%), intermediate positivity in 2 (11.8%), and low positive/negative in 6 of the 17 cases (35.3%). TRPS-1 expression was significantly higher than GATA-3 expression for the number of positive cases (P = 0.07), mean percentage of positive tumor cells (P = 0.005), and intensity of reactivity (P = 0.005). SOX-10 expression was present in only 5 of 17 cases (29%), with a mean percentage of positivity in the tumor cells of 26.5% and intensity of 0.8. No differences were found in the IHC results between the different specimen types (FNA versus fluid) in any group. CONCLUSIONS: TRPS-1 is a highly sensitive new diagnostic IHC marker for breast carcinoma, with a similar positivity rate in ER/PR+ and HER2+ BC compared with GATA-3 and a higher positivity rate than GATA-3 and SOX-10 in TNBC in cytology specimens. In particular, when only a few clusters of tumor cells are present on the cell block, TRPS-1 can be highly useful, because its mean percentage of positive tumor cells and intensity are higher than those of other IHC markers.

Adequacy of pleural fluid cytology for comprehensive molecular analysis of lung adenocarcinoma: Experience of a large health-care system.

Objectives: Pleural fluid evaluation is an effective modality for identifying actionable genetic mutations to guide therapy in lung carcinoma. Clinicians requesting molecular studies often send large volumes of fluid to be processed that is not possible or cost effective and is hence not standard of practice in most cytopathology laboratories. We wanted to establish the characteristics of an adequate specimen that would yield reliable results with current molecular testing platforms. Material and Methods: A review of 500 malignant pleural effusions, from pulmonary and non-pulmonary sources, was undertaken over a 4-year period. Of these 44 cases (from 42 patients) that were positive for primary lung adenocarcinoma were included in the study. Molecular analysis was performed on 42 specimens. A complete next generation sequencing (NGS) panel was performed on 36 specimens. Individual testing for estimated glomerular filtration rate, KRAS, anaplastic lymphoma kinase, and ROS1 was performed on six specimens. The number of malignant cells and proportion of tumor to non-tumor nucleated cells (T: NT) on cell blocks was recorded as <20%, 20-50% and >50%. Results: The minimum volume on which a complete NGS panel could be performed was 20 ml with cell count of 1000 and T: NT proportion of 20-50%. The minimum number of tumor cells required for successful molecular analysis for T: NT proportion of <20%, 20-50%, and >50% was 300, 250, and 170 cells, respectively. Conclusion: We concluded that tumor cell proportion, rather than specimen volume, is of prime importance for determining the efficacy of pleural fluid for molecular studies. Evaluation of both absolute and relative numbers of tumor cells is critical for assessing the adequacy and predicting successful yield for molecular analysis.

The role of cytology as an effective tool in management of omental and peritoneal lesions: Experience of a large health care system.

BACKGROUND: The aim of this study is to assess the efficacy of cytology in omental or peritoneal lesions. METHODS: A retrospective review of the pathology database for cytology cases of peritoneal or omental nodules over a 3-year period (2016-2018) was conducted. The cases consisted of either FNA only (FO); FNA and Core biopsy (FCB) or Touch prep and core biopsy (TCB). Cases were further divided based on the prior history of carcinoma. Concordance rates of cytologic diagnosis with histologic diagnosis were studied. RESULTS: Out of 104 cytology cases reviewed, 60 (57.7%) had prior history of cancer (PHC) and 44 (42.3%) had no prior history of cancer (NPHC). Of the cases with PHC, 43(71.66%) were recurrence, 10 (16.66%) were second cancer, and 7 (11.66%) were non-neoplastic lesions. Of the cases with NPHC, 38 (86.4%) had a second cancer diagnosis, while 6 (13.6%) were non-neoplastic. For FO only cases, 11 of 35 (31.4%) had follow up and 9 of 11 (81.8%) were concordant. For FCB cases, 6 out of 39 (15.4%) had follow up and 6 (100%) were concordant. For TCB cases, 9 out of 30 (30%) had follow up and 9 (100%) were concordant. A definite diagnosis was reached in 30/35, 39/39, and 29/30 cases in FO, FCB, and TCB, respectively. CONCLUSION: In summary, cytologic evaluation of omental lesions is an effective tool in providing accurate diagnosis and guiding further management. Also, the results based on our study show that the combined techniques are superior at reaching a definitive diagnosis.

Schwannoma-Like Pleomorphic Adenoma: Two Cases and a Review of the Literature.

Schwannoma-like pleomorphic adenoma is a rare variant of the common benign salivary neoplasm, pleomorphic adenoma. This entity's cytomorphology closely mimics a schwannoma, potentially making a diagnosis of cytologic preparations or of surgical specimens a challenge. To the best of our knowledge, there are only six previous reports of schwannoma-like pleomorphic adenoma with eight total cases in the English language literature prior to the addition of the two cases detailed in this report. Our report includes what we believe to be the first documented case of this entity occurring in the submandibular gland. One of our cases occurred in the submandibular gland of a 90-year-old woman and the other occurred in the left parotid gland of a 40-year-old woman. We also examine the diagnostic considerations used to differentiate these two entities.

Risk stratification of salivary gland cytology utilizing the Milan system of classification.

BACKGROUND: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is based on risk stratification. Our study is a retrospective review of salivary gland fine needle aspiration cytology (FNAC) with the goal of determining the risk of malignancy (ROM) in each of the categories proposed by the MSRSGC. METHODS: FNAC of salivary gland lesions with corresponding surgical resection specimens were retrieved over a 5-year period. Metastatic tumors were excluded. BothFNAC and corresponding surgical resections were reviewed blindly and classified as per criteria published by the MSRSGC. The ROM for each of the diagnostic categories was determined and compared with the ROM published by the MSRSGC. RESULTS: The total number of entities and ROM in 199 reviewed cases were as follows: Nondiagnostic 18 (9.2%) (ROM 0%), non-neoplastic 4(2%) (ROM 0%), atypia of undetermined significance (AUS) 12(6%) (ROM 33%), benign neoplasm 118(59.2%) (ROM 0.8%), salivary gland neoplasm of uncertain malignant potential (SUMP) 22(11%) (ROM 40.9%), suspicious for malignancy 3(1.5%) (ROM 100%), malignant 22(11%) (ROM 100%). CONCLUSION: The ROM reported in our study was mostly concordant with ROM published by the MSRSGC. This classification is helpful for the management of categories; nondiagnostic, non-neoplastic, benign neoplasm, suspicious for malignancy and malignant. The management is not standardized for the category, salivary gland neoplasm of uncertain malignant potential, as clinical information plays an important role in planning surgical procedures at an individual basis. Further studies will need to be performed using this new classification to help define appropriate management and predict ROM more accurately.

Determining the molecular test for indeterminate thyroid nodules best suited for our practice: A quality assurance study.

INTRODUCTION: Currently, molecular studies are widely used as a guiding tool in further management of cytologically indeterminate thyroid nodules. At our institution, clinicians have recently expressed concern over receiving "less positive molecular results" upon switching from an extended 14 gene mutation panel (EGMP) to a 7 gene mutation panel (GMP). Our goal is to compare outcomes of these two tests in regards to the performance characteristics and clinical impact. MATERIALS AND METHODS: All thyroid fine-needle aspiration (FNA) biopsy specimens sent for molecular studies from 2016 to 2017 were retrospectively studied. Cytopathology diagnosis, pertinent clinical findings, molecular results, and follow-up (F/U) surgical and cytology diagnoses were recorded. RESULTS: Of the total 165 cases sent for molecular tests 86 (52%) were GMP and 79 (47%) EGMP. There were 21 (24%) and 40 (50%) cases with positive GMP and EGMP results, respectively. Within these positive cases (n = 61), there were a total of 33 (54%) patients who underwent surgical resection and 28 (45%) patients had no follow-up. The molecular findings and surgical pathologic diagnoses obtained are illustrated in Figures 1 through 4 for GMP and EGMP, respectively. CONCLUSIONS: The selection of molecular testing should be directed toward optimizing patient care and facilitate clinical management. This quality assurance study helped in understanding the complexities associated with test selection best suited for our institution and in educating clinicians.

Adequate at rapid on-site evaluation (ROSE), but inadequate on final cytologic diagnosis: Analysis of 606 cases of endobronchial ultrasound-guided trans bronchial needle aspirations (EBUS-TBNA).

BACKGROUND: EBUS-TBNA is a minimally invasive, reliable technique with high sensitivity and accuracy. ROSE plays a crucial role in triaging specimens to guide management. This study analyzes aspirates that were deemed "adequate" on ROSE, but inconclusive upon final cytologic interpretation. DESIGN: EBUS-TBNAs from 2015 and 2016 were retrospectively reviewed and analyzed for ROSE adequacy versus final cytologic diagnosis. Concurrent and subsequent procedures were evaluated to determine the outcome of ROSE-adequate cases with inconclusive final cytologic diagnosis of non-diagnostic (ND), atypical (ATY), and suspicious for malignancy (SUS). Interpretation at ROSE was determined to be "appropriate" if published criteria for lymph node adequacy were met. RESULTS: A total of 606 cases of EBUS-FNA with ROSE were obtained of which 61% were deemed adequate. 5% of cases deemed "adequate" at ROSE resulted in inconclusive final interpretation with 4 ND, 7 ATY, and 6 SUS. Their distribution, anatomic location, presence or absence of diagnostic aspirate, appropriateness of ROSE adequacy statement, and any concurrent or subsequent procedures on the same or different site as well as any impact on management was reviewed. Cytotechnologist (CT) experience ranged from 1 to 25 years. CONCLUSIONS: ROSE and final cytology discrepant cases formed a very small fraction of total number of EBUS-TBNA cases with onsite evaluation. None of these discordant cases had any major clinical impact. There will remain a small fraction of cases that will be inappropriately deemed as "adequate" at ROSE due to the challenging nature of the procedure.

Lack of transformation zone in cervical Pap tests, should it be a concern? A quality assurance initiative.

BACKGROUND: Bethesda guidelines do not require presence of transformation zone (TZ) for a cervical Pap test to be deemed adequate. However, clinicians are concerned with specimens that are reported to lack TZ. METHODS: We analyzed 566 ThinPrep cases reported as negative for intraepithelial lesion or malignancy (NILM) with no cervical abnormality detected in previous 4 years (2007-2011). These cases were divided into two cohorts; those with TZ (ETZ) and those without TZ (NTZ). Patients' age, HPV status, time of sample collection (>14 days after last menstrual period), subsequent management, interval of subsequent Pap test (<1, 1-3, and >3 years), and result of subsequent examination were compared over a 5-year period. RESULTS: The rate of abnormal Pap test on 5 year follow-up was not statistically significant (P < .9520) between cohorts. Our data demonstrates lack of statistical significance between the variables studied. Five year follow-up of all abnormal Pap smears were analyzed (93% ETZ and 7% NTZ). Of the ETZ group, 25% ASCUS remained as ASCUS and 75% were reported as NILM in subsequent Pap smears. Additionally, 75% of the LSIL were subsequently reported as NILM and 25% reported as ASCUS. One patient reported as HSIL underwent hysterectomy. Two Pap smears performed two years after surgery were negative. Within the NTZ group, one case of ASCUS was NILM upon follow-up. CONCLUSION: Pap smears with NTZ were not at a higher risk for subsequent detection of cervical abnormalities, making earlier repeat testing unnecessary. Rescreening cases without TZ is neither cost effective nor necessary.

Fine-needle aspiration biopsy of lytic bone lesions: An institution's experience.

OBJECTIVES: Fine needle aspiration (FNAB) is an effective, minimally-invasive, inexpensive, diagnostic technique. The objective of this study was to evaluate the accuracy of FNAB in the diagnosis of bone lesions. METHODS: FNABs of bone lesions diagnosed at our institution over a 2-year period were retrospectively analyzed. RESULTS: 241 samples were reviewed. Patients included 121 males and 120 females, with ages ranging from 4-95 years (mean = 66 years). Of these 241 cases, 43.2% had FNAB and 56.8% had FNAB with core needle biopsy (CNB). The cytologic diagnoses were categorized as nondiagnostic, benign, atypical, suspicious, and positive for malignant cells. Total of 84.3% of FNABs were diagnostic. Of the malignant cases, 78.5% were metastases from nonosseous primary sites, 17.1% were lymphoproliferative lesions, and 4.4% were primary bone tumors. The most common site of metastasis was the pelvic bones (43.5%) followed by the vertebral column (38.7%). Breast (21%), lung (12.7%), and prostate (11.3%) were the most common identifiable primary site in metastatic cases. FNA smears and cell blocks allowed identification of metastatic lesions in 94.3% cases with immunohistochemistry (IHC). Obtaining a concomitant CNB did not result in a statistically significant increase in overall diagnostic yields (P = .20), ascertaining presence of metastatic lesion (P = .96) or ability to identify site of primary tumor in cases of metastasis (P = .53) compared to FNAB alone. Diagnostic accuracy was improved by reviewing clinical history, performing cell block, and IHC. CONCLUSIONS: FNAB is a reliable tool for diagnosis of bone lesions with comparable diagnostic sensitivity to CNB.

Quality assessment and improvement of "Unsatisfactory" liquid-based cervicovaginal papanicolaou smears.

OBJECTIVES: The quality of cervicovaginal smears determines the success of cytology in screening programs for cervical cancer. Bethesda 2014 revisited the adequacy criteria for atrophic smears and redefined the squamous cell count in the "unsatisfactory" category. In this study, we evaluated the smear quality of Thinprep liquid-based cervicovaginal Papanicolaou cytology slides (TPS) that were previously deemed unsatisfactory, to determine reasons for such categorization. In addition, we attempted to establish the impact of the new adequacy criteria on the rate and management of unsatisfactory diagnosis. METHODS: About 234 unsatisfactory TPS were examined. The reasons for unsatisfactory were noted. The number of squamous cells was recounted, as per the new Bethesda criteria, in borderline adequacy cases that showed an atrophic pattern. RESULTS: The leading cause for unsatisfactory TPS was lubricating gel, followed by blood, as observed in older and younger age groups, respectively (Figure 1). Eleven borderline cases were reclassified as "satisfactory" using the new Bethesda cell count, with 27% above 60 years of age. About 82% of these borderline cases were negative for intraepithelial lesion or malignancy on repeat testing. CONCLUSIONS: There was no difference of management or change in rate of unsatisfactory when patients above 60 were reclassified into the satisfactory category using the new Bethesda count. However, a larger study is needed to evaluate whether the new recommendation for minimum cellularity can be implemented in patients above a certain age cut-off. The study highlights the need for improvement in collection practices and education of practitioners.

Utility of intraoperative frozen sections for thyroid nodules with prior fine needle aspiration cytology diagnosis.

INTRODUCTION: The objective of this study was to evaluate the role of intraoperative frozen section (IFS) in determining the course of surgery in thyroid nodules with a prior fine needle aspiration (FNA) biopsy diagnosis. In addition, reliability of FNA interpretation to guide surgical management without IFS was investigated. MATERIAL AND METHODS: This is a retrospective study of all patients who had a FNA biopsy, IFS, and final pathology performed on a thyroid nodule over a 9 month period. The extent of surgery at the time of the IFS was recorded. Subsequent change in surgical procedure following the IFS diagnosis was noted in each of the Bethesda diagnostic categories. RESULTS: 55% of the cases were deferred at IFS overall, with 68 and 86% in Bethesda III and IV categories, respectively. Overall, there was a change in management in 6% of cases. CONCLUSIONS: Our study does not support the use of IFS for nodules with prior FNA interpretation of Bethesda II, III, IV and VI as management was not significantly changed. IFS is of value for nodules with prior FNA diagnosis of Bethesda I for interpretation of nodule, and Bethesda V for planning surgery. A confirmatory diagnosis could not be rendered at IFS for lesions with follicular architecture, which comprised most of the cases in Bethesda III and IV.

How "suspicious" is that nodule? Review of "suspicious" Afirma gene expression classifier in high risk thyroid nodules.

BACKGROUND: The Afirma gene expression classifier (GEC) is being increasingly utilized to confirm the benign nature of indeterminate FNA cytology results thus avoiding unnecessary surgical procedures. However the "suspicious" result of the Afirma GEC does not classify these indeterminate nodules further in determining appropriate management. This study investigated the outcome of the thyroid nodules deemed to be "suspicious" by the Afirma GEC in a high risk population. METHODS: The pathology database was searched for all thyroid nodules with Afirma test results over a three year period, 2013-2015. All thyroid nodules with a "suspicious" Afirma GEC result were investigated. Patient medical records were retrospectively reviewed for clinical history, FNA results, radiologic findings, management and follow-up. RESULTS: Afirma result was suspicious in 69 cases. On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). On surgical resection 82% were benign, with 45% follicular adenoma (FA), and 37% nodular goiter (NG). The remaining 18% were malignant. CONCLUSION: The rate of malignancy in nodules suspicious by Afirma was 18.3% (11/60). The rate of malignancy in nodules suspicious for neoplasm (SN) on cytology interpretation was 31.2% (5/16). False positive rate of Afirma was 56% (32/57). We conclude that cytology interpretation has a higher rate of predicting malignancy, in nodules interpreted as SN, when compared with the Afirma test, by almost twofold Diagn. Cytopathol. 2017;45:308-311. © 2016 Wiley Periodicals, Inc.

Young Investigator Challenge: Building an ultrasound-guided FNA clinic-our 5-year experience: From project to practice.

BACKGROUND: The authors' fine-needle aspiration (FNA) clinic opened in 2010, allowing cytopathologists to increase their proficiency and experience in FNA performance. Here, they report their 5-year experience. METHODS: The FNA clinic log book and the institution's database were retrospectively reviewed to record patients' demographics, the number of FNAs performed per year by each cytopathologist, the number of passes, rapid on-site evaluation (ROSE) and diagnosis, adequacy-diagnosis concordance, and follow-up histology when available. The numbers and types of cases per year and variations among cytopathologists were compared. RESULTS: In total, 474 cases were identified within a 5-year time-frame. The discrepancy rate between the on-site and final diagnoses decreased progressively, from 4.4% to 2.4%. The nondiagnostic rate decreased from 2011 to 2015, with the exception of 2014, when an increase was noted, possibly because of a lower number of cases. Cytopathologists' performance was assessed over a 3-year period. The number of passes for each FNA decreased over time. The cytology-histology concordance was 100% over time for all cytopathologists. There was a diagnostic discrepancy between the ROSE and final diagnoses for 3 of 104 cases in 2013 and for 3 of 124 cases in 2015. The total number of passes was not consistently recorded until 2014, when a final report template was instituted. The technique improved over time because of accumulated experience, constant practice with phantoms, and attending the College of American Pathologists' training in ultrasound-guided FNA. CONCLUSIONS: FNAs performed by cytopathologists have a high-rate of ROSE/adequacy and a low diagnostic discrepancy rate. Cytopathologists as interventionalists provide optimal care and excellent patient satisfaction. Cancer Cytopathol 2017;125:161-168. © 2016 American Cancer Society.

Urine cytology of nonurothelial malignancies-a 10-year experience in a large multihospital healthcare system.

BACKGROUND: Urine cytology is the most frequently utilized test to detect urothelial cancer. Secondary bladder neoplasms need to be recognized as this impacts patient management. We report our experience on nonurothelial malignancies (NUM) detected in urine cytology over a 10-year period. METHODS: A 10-year retrospective search for patients with biopsy-proven NUM to the urothelial tract yielded 25 urine samples from 14 patients. Two cytopathologists blinded to the original cytology diagnosis reviewed the cytology and histology slides. The incidence, cytomorphologic features, diagnostic accuracy, factors influencing the diagnostic accuracy, and clinical impact of the cytology result were studied. RESULTS: The incidence of NUM was <1%. The male:female ratio was 1.3. An abnormality was detected in 60% of the cases; however, in only 4% of the cases, a primary site was identified accurately. Of the false negatives, 96% was deemed as sampling errors and 4% was interpretational. Patient management was not impacted in any of the false-negative cases due to concurrent or past tissue diagnosis. CONCLUSION: Colon cancer was the most frequent secondary tumor. Sampling error attributed to the false-negative results. Necrosis and dirty background was often associated with metastatic lesions from colon. Obtaining history of a primary tumor elsewhere was a key factor in diagnosis of a metastatic lesion. Hematopoietic malignancies remain to be a diagnostic challenge. Cytospin preparations were superior for evaluating nuclear detail and background material as opposed to monolayer (Thinprep) technology. Diagnostic accuracy was improved by obtaining immunohistochemistry. Diagn. Cytopathol. 2016. © 2016 Wiley Periodicals, Inc. Diagn. Cytopathol. 2017;45:22-28. © 2016 Wiley Periodicals, Inc.

Prevalencia del déficit de vitamina D en una población de embarazadas que se asisten en el Centro Hospitalario Pereira Rossell / Prevalence of vitamin D Deficiency in pregnant women who are followed in the Pereira Rossell Hospital Center

Introducción: la falta de vitamina D (Vit D) en las embarazadas puede perjudicar la salud de la madre y del niño si no es diagnosticada y tratada adecuadamente. Su déficit está relacionado con diversas complicaciones obstétricas, como la preeclampsia y la diabetes gestacional y del recién nacido, bajo peso al nacer e hipocalcemia; pobre crecimiento posnatal, fragilidad ósea y aumento de la incidencia de enfermedades autoinmunes. Múltiples estudios muestran que la falta de Vit D ocurre con una extraordinaria frecuencia que oscila entre 18% y 84% dependiendo de la población estudiada, sin embargo no tenemos datos nacionales. Objetivo: conocer la prevalencia de deficiencia e insuficiencia de Vit D en una población de mujeres embarazadas de un hospital público de Montevideo, el Centro Hospitalario Pereira Rossell. Material y método: se realizaron cuestionarios especialmente confeccionados y extracciones de sangre en embarazadas del tercer trimestre para creatininemia, calcio total en sangre, albuminemia, PTH intacta y 25 (OH) Vit D, previa firma de consentimiento informado. Se consideró como deficiencia severa una concentración de Vit D < 10 ng/ml; deficiencia 10-20 ng/ml; insuficiente 20-30 ng/ml, y suficiente > 30 ng/ml. Resultados: de 71 muestras analizadas, 3 (4,3%) tuvieron niveles de suficiencia, 18 tuvieron insuficiencia (25,7%), 30 deficiencia (42,9%) y 19 severa deficiencia (27,1%). Conclusiones: tal como ocurre a nivel internacional el déficit de Vit D en la población estudiada se presenta con una frecuencia extraordinaria. Se requiere la pronta atención de este problema para evitar complicaciones en la embarazada y en el recién nacido.

Abstract Introduction: vitamin D deficiency in pregnant women may be harmful or the mother’s and the child’s health if it is not adequately diagnosed and treated. Its deficiency has been associated to several obstetric complications such as pre-eclampsia and gestational diabetes and diabetes of the newborn, low birth weight and hypocalcemia; poor postnatal growth, bone fragility and increase if autoimmune disorders. Multiple studies show that vitamin D deficiency happens very frequently, between 18% and 84%, depending on the population studied. However, there are no national data. Objective: to learn about the prevalence of vitamin D deficiency and insufficiency in a population of pregnant women in the Pereira Rossell Hospital center, a public hospital of Montevideo, Method: surveys that were specially designed and blood tests in pregnant women during their third trimester of pregnancy for creatininemia, total calcium in blood and albuminemia, serum 25(OH)D3 and intact PTH were determined, upon the signature of an informed consent. A concentration of vitamin D < 10 ng/ml was considered to be a severe deficiency, 10-20 ng/ml was deficient, 20-30 ng/ml was insufficient and > 30 ng/ml was considered to be sufficient. Results: out of 71 samples analysed, 3 (4.3%) revealed sufficient levels, 18 were insufficient (25.7%), 30 were deficient (42.9%) and 19 were severely deficient (27.1%). Conclusions: just as it happens globally, vitamin D deficiency in the population studied is extraordinarily frequent. Attention needs to paid to this issue to avoid complications in pregnant women and newborns.

Resumo Introdução: a falta de vitamina D (Vit D) em gestantes pode prejudicar a saúde da mãe e da criança se não é diagnosticada e tratada adequadamente. Sua deficiência está relacionada com diversas complicações obstétricas, como a pré-eclâmpsia e a diabetes gestacional e, do recém-nascido como baixo peso ao nascer e hipocalcemia, pobre crescimento pós-natal, fragilidade óssea e aumento da incidência de doenças autoimunes. Vários estudos mostram que a falta de Vit D tem uma frequência extraordinária que varia entre 18% e 84% dependendo da população estudada, no entanto não temos dados nacionais. Objetivo: conhecer a prevalência de deficiência e insuficiência de Vit D em uma população de gestantes de um hospital público de Montevidéu, o Centro Hospitalar Pereira Rossell. Material e método: foram realizadas entrevistas e foram tomadas amostras de sangue gestantes no terceiro trimestre para dosificacão de creatininemia, cálcio total, albuminemia, PTH intacta e 25 (OH) Vit D; previamente foi solicitada a assinatura de consentimento informado. Foram classificadas como deficiência severa concentrações de Vit D < 10 ng/ml; deficiência valores entre 10-20 ng/ml, insuficiente 20-30 ng/ml, e suficiente > 30 ng/ml. Resultados: das 71 amostras analisadas, 3 (4,3%) apresentaram níveis de suficiência, 18 insuficiências (25,7%), 30 deficiências (42,9%) e 19 deficiências grave (27,1%). Conclusões: a deficiência de Vit D na população estudada se apresenta com una frequência extraordinária como o informado a nível global. É necessário atender este problema rapidamente para evitar complicações na gestante e no recém-nascido.

Fine-needle aspiration cytology of mammary analog secretory carcinoma masquerading as low-grade mucoepidermoid carcinoma: case report with a review of the literature.

BACKGROUND/AIM: The primary role of fine-needle aspiration cytology (FNAC) of salivary gland masses is to determine the underlying process and guide further management. The objective of our study is to provide a comprehensive review of cytologic features and ancillary studies of mammary analog secretory carcinoma (MASC), discuss differential diagnosis and review recent advances in the understanding of its biologic behavior. CASE: A 23-year-old female underwent ultrasound-guided FNA of a slowly enlarging parotid mass. Smears displayed branching clusters of bland vacuolated polygonal cells in a secretory proteinaceous background. Eosinophilic cells with eccentric nuclei and inconspicuous nucleoli were also noted. Based on positive intracellular mucin staining and the lack of extracellular-matrix material, the cytologic diagnosis rendered was 'suspicious for low grade mucoepidermoid carcinoma'. Superficial parotidectomy revealed an MASC confirmed by fluorescence in situ hybridization (FISH) studies for ETV6 translocation. CONCLUSION: MASC should be included in the differential diagnosis of mucinous salivary lesions with cystic changes on FNA. Immunohistochemistry for mammaglobin and S-100 helps in excluding morphologic mimics. FISH helps to confirm the diagnosis. Age alone should not be a deterrent in diagnosing a carcinoma.