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Chu YH, Hardin H, Zhang R, Guo Z, Lloyd RV. In situ hybridization: Introduction to techniques, applications and pitfalls in the performance and interpretation of assays. Semin Diagn Pathol 2019; 36:336-341. [PMID: 31227426 DOI: 10.1053/j.semdp.2019.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In situ hybridization (ISH) has become a common laboratory technique used for the analysis of gene expression and for the localization of specific DNA and RNA molecules in cells. Many different methods of performing ISH have been described. These techniques have evolved into important tools in basic scientific research and in clinical diagnoses. One of the goals of ISH is to localize gene sequences in situ and to visualize the products within cells while preserving cell integrity. This allows for meaningful anatomical and histological interpretation of the localized product(s) within heterogeneous tissues. Because of the possibility of false positive and false negative results that may occur with ISH assays, familiarity with the pathophysiology of the molecules that are analyzed and the cellular processes involved as well as with limitations of the assays can help to avoid erroneous diagnoses with clinical specimens.
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Affiliation(s)
- Ying-Hsia Chu
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Hangzhou, China
| | - Heather Hardin
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Hangzhou, China
| | - Ranran Zhang
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Hangzhou, China
| | - Zhenying Guo
- Department of Pathology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Ricardo V Lloyd
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Hangzhou, China.
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Singha J, Khan K, Chatterjee S. Diagnostic utility of CD10 immunohistochemical staining on cellblock in differentiating hepatocellular carcinoma from secondary malignancies of liver. INDIAN J PATHOL MICR 2019; 61:510-515. [PMID: 30303139 DOI: 10.4103/ijpm.ijpm_788_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Differentiation of hepatocellular carcinoma (HCC) from metastatic malignancy in liver may be difficult at times on fine-needle aspiration cytology, especially in case of moderate-to-poorly differentiated tumors. The benefit of cell-block technique is the recognition of histologic pattern of diseases along with application of a wide variety of immunohistochemical (IHC) stains to differentiate hepatic malignancies. In this study, CD10 IHC staining was done on cellblocks prepared from aspirates of clinicoradiologically/cytologically suspected malignant liver neoplasms to differentiate HCC from malignancies metastasizing to liver. Objective The objective of the study was to assess the diagnostic utility of CD10 IHC stain on cell-block preparation for differentiating primary from Secondary malignancies of liver. Materials and Methods Formalin-fixed, paraffin-embedded cellblocks of 61 cases (25 cases of HCC and 36 cases of metastatic carcinoma) were prepared from a fine-needle aspirate of the suspected malignant liver neoplasm and immunostained using monoclonal antibody against CD10. Results Twenty-two (88%) of 25 cases of HCC were positive for CD10 with a canalicular staining pattern. Two (8%) were positive for CD10 with membranous and one (4%) with cytoplasmic staining pattern. Conclusion CD10 immunostaining on cellblock is useful in discriminating HCC and metastatic carcinoma of the liver with a diagnostic accuracy of 88.52%.
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Affiliation(s)
- Joydeb Singha
- Department of Pathology, North Bengal Medical College, Siliguri, West Bengal, India
| | - Kalyan Khan
- Department of Pathology, North Bengal Medical College, Siliguri, West Bengal, India
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Lin CC, Lin CJ, Hsu CW, Chen YC, Chen WT, Lin SM. Fine-needle aspiration cytology to distinguish dysplasia from hepatocellular carcinoma with different grades. J Gastroenterol Hepatol 2008; 23:e146-52. [PMID: 17532784 DOI: 10.1111/j.1440-1746.2007.04924.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Distinguishing dysplasia from hepatocellular carcinoma (HCC) by fine-needle aspiration (FNA) cytology is difficult. The aim of this study was to diagnose HCC and the distinction of liver cell dysplasia from HCC with different grades by interpreting and scoring the cyto-morphological features. METHODS Eighty-three cirrhotic patients undertook a sonography-guided FNA and subsequent needle biopsy for the tumor. HCC was confirmed in 68 cases and cirrhosis with dysplasia in 15 cases by pathology and follow-up for longer than 2 years. Eighteen cytological features were scored as degree of one, two or three according to their presence or prominence. RESULTS Two cases of well-differentiated HCC were diagnosed as negative for HCC initially. The sensitivity, specificity, false positive, false negative and accuracy were 97%, 100%, 0%, 3% and 97.6% for FNA cytology in the diagnosis of HCC, respectively. The score of dysplasia was 20.8 +/- 1.3 (mean +/- SD) and lower than 26.2 +/- 3.4 in Edmondson's grade I HCC (P < 0.01), 28.9 +/- 2.9 in grade II HCC (P < 0.01), and 34.9 +/- 4.3 in grade III/IV HCC (P < 0.01). The score was also significantly lower in grade II HCC than in grade III/IV HCC (P < 0.01). CONCLUSIONS FNA yielded a high accuracy in the distinction of dysplasia from HCC with different grades. There is a good correlation in cyto-morphological scores of liver cell dysplasia and HCC with different grades. Dysplasia displayed the lowest score and the score increased in order from dysplasia to grade III/IV HCC.
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Affiliation(s)
- Chen-Chun Lin
- Liver Research Unit, Chang-Gung Memorial Hospital, Chang-Gung University, Taipei, Taiwan
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Brown DB, Gonsalves CF. Percutaneous Biopsy before Interventional Oncologic Therapy: Current Status. J Vasc Interv Radiol 2008; 19:973-9. [DOI: 10.1016/j.jvir.2008.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 02/20/2008] [Accepted: 02/25/2008] [Indexed: 01/08/2023] Open
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Fukuda H, Inokuti Y. Aspiration biopsy using new ceramic-coated stainless steel puncture needle. J Biomed Mater Res B Appl Biomater 2004; 71:392-7. [PMID: 15386495 DOI: 10.1002/jbm.b.30098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of this study was to determine the medical applicability of a newly developed ceramic-coated stainless steel puncture needle for performing liver biopsies. A ceramic coating was applied to a stainless steel needle using a high-density plasma coating technique. The collected specimen was dipped in 10% formalin, embedded in paraffin, sliced into 4 microm-thick sections, and stained with hematoxylin-eosin (HE). Tissue specimens were observed under a low vacuum of 664 Pa using an environmental scanning electron microscope (ESEM-2700). The surface of the tissue severed by the ceramic-coated needle was smoother than that by the stainless steel 21G ultrasonic biopsy needle according to microscopic image stained with HE, interference microscopic images, and ESEM images. In conclusion, damage to samples collected by the ceramic-coated needle is less than that by the ordinary needle.
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Affiliation(s)
- Hiroyuki Fukuda
- Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-shi, 260-0856, Japan.
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Yang GCH, Yang GY, Tao LC. Cytologic features and histologic correlations of microacinar and microtrabecular types of well-differentiated hepatocellular carcinoma in fine-needle aspiration biopsy. Cancer 2003; 102:27-33. [PMID: 14968415 DOI: 10.1002/cncr.20000] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Well-differentiated hepatocellular carcinoma (HCC) in fine-needle aspiration (FNA) biopsy is characterized by trabeculae three or more cells thick wrapped by peripheral endothelium. The authors encountered another pattern that did not fulfill these classic criteria for malignancy yet was proven to be HCC in clinical follow-up. The objective of this study was to characterize the cytologic features of this pattern with histologic correlations. METHODS Over a period of 6.5 years, 14 of 123 cases (11.4%) of HCC from 428 liver aspirates showed the unusual pattern. Their cytologic features were compared with 14 cases of nonneoplastic liver on FNA smears that were processed with Ultrafast Papanicolaou stain, and their histologic features were compared on cell blocks with hematoxylin and eosin stain and reticulin stain. RESULTS The unusual type of well differentiated HCC in FNA smears was characterized by numerous, small hepatocytes with minimal nuclear atypia but reduced cytoplasm, grouped together in microacini of five or more cells and microtrabeculae one or more cells thick of irregular thickness with no apparent peripheral endothelium. Transgressing capillaries were found when the smears were inspected carefully. In histology nine cases that were the compact type of HCC, two cases that were the microacinar type of HCC, and three cases that were the microtrabecular type of HCC. All FNAs showed deficient reticulin framework. All 14 cases of nonneoplastic liver aspirate were characterized by the presence of large tissue fragments that were resistant to smearing. CONCLUSIONS Well differentiated HCC may present as microtrabeculae of irregular thickness one or more cells thick with inapparent peripheral endothelium or as microacini mimicking neuroendocrine carcinoma.
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Affiliation(s)
- Grace C H Yang
- Department of Pathology, New York University School of Medicine, New York, New York 10016, USA.
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Crapanzano JP. Cytology of low-grade endocrine neoplasms involving liver: A series of 24 specimens, including 4 with hepatoid or glandular features. Diagn Cytopathol 2003; 30:31-8. [PMID: 14696142 DOI: 10.1002/dc.10417] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Low-grade endocrine neoplasms (LGENs) involving the liver usually show typical endocrine features. Occasionally these tumors display cytologic characteristics that mimic hepatocellular carcinoma (HCC) or adenocarcinoma (ACA). Twenty-four liver FNABs from 22 patients were reviewed. Twenty specimens showed cytologic characteristics typical of LGENs, including small to medium-sized cells with salt-and-pepper or granular chromatin, moderate to high N/C ratios, and inconspicuous or absent nucleoli. Plasmacytoid cells were observed in 19 cases. Immunocytochemical stains (ICCs) confirmed endocrine differentiation in 9 cases. 4 FNABs were comprised of larger tumor cells that displayed cytologic features that overlapped with HCC or ACA, including transgressing or wrapping endothelium, moderate to abundant cytoplasm, and conspicuous nucleoli. LGENs involving the liver typically demonstrate characteristic cytologic features. Cases comprised of larger cells with abundant cytoplasm, conspicuous nucleoli, and transgressing or wrapping endothelium may pose diagnostic difficulties. ICCs and plasmacytoid morphology are beneficial in classifying the endocrine origin of these tumors.
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Affiliation(s)
- John P Crapanzano
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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Wieczorek TJ, Pinkus JL, Glickman JN, Pinkus GS. Comparison of thyroid transcription factor-1 and hepatocyte antigen immunohistochemical analysis in the differential diagnosis of hepatocellular carcinoma, metastatic adenocarcinoma, renal cell carcinoma, and adrenal cortical carcinoma. Am J Clin Pathol 2002; 118:911-21. [PMID: 12472285 DOI: 10.1309/kkdp-mnd2-w794-p9eh] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
We compared the effectiveness of thyroid transcription factor-1 (TTF-1, cytoplasmic reactivity) and hepatocyte antigen (HPA) as markers for characterization of hepatocellular carcinoma (HCC) and as discriminators to distinguish HCC from its histologic and cytologic mimics. Formalin-fixed, paraffin-embedded sections of 258 specimens, including 76 HCCs, 85 metastatic adenocarcinomas, 75 renal cell carcinomas (RCCs), and 22 adrenal cortical carcinomas (ACCs), were evaluated. Specimens included tissue sections and cytologic material (cell blocks). Following heat-induced epitope retrieval, immunohistochemical studies were performed using an indirect immunoperoxidase technique. Cytoplasmic reactivity for TTF-1 was noted for 54 (71%) of 76 HCCs, 3 (4%) of 85 adenocarcinomas, none of 72 RCCs, and none of 22 ACCs. Cytoplasmic reactivity for HPA was observedfor 50 (66%) of 76 HCCs, 1 (1%) of 83 adenocarcinomas, none of 74 RCCs, and none of 21 ACCs. Cytoplasmic reactivity for TTF-1 and HPA is highly specific for HCC, although a minority of HCCs, particularly poorly differentiated tumors, may be nonreactive. Thus, these markers are usefulfor the characterization of HCC in tissue sections and cell blocks and are highly effective for distinguishing these tumors from other neoplasms included in the differential diagnosis.
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Affiliation(s)
- Tad J Wieczorek
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Granados R, Aramburu JA, Murillo N, Camarmo E, de la Cal MA, Fernandez-Segoviano P. Fine-needle aspiration biopsy of liver masses: diagnostic value and reproducibility of cytological criteria. Diagn Cytopathol 2001; 25:365-75. [PMID: 11747233 DOI: 10.1002/dc.10025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are many helpful cytological criteria for the diagnosis of liver fine-needle aspiration biopsies (FNABs), but none of them are pathognomonic of primary or metastatic tumors. We analyzed the diagnostic value and reproducibility of 28 cytological parameters in FNABs from 140 hepatic masses, including 29 benign lesions, 49 hepatocellular carcinomas (HCCs), and 62 metastatic tumors, encompassing 48 adenocarcinomas (ACAs). Five different observers evaluated each sample, and the interobserver and intraobserver agreement was studied. Multivariable analysis showed that the criteria more closely associated with malignancy were irregular nuclear contour, three-dimensional cell groups, and atypical naked nuclei. Capillaries separating tumor cells and granular cytoplasm were strongly associated with HCCs, while eccentrically placed nuclei and necrosis were most commonly seen in ACAs and in metastatic tumors. The intraobserver and interobserver agreement was excellent for the final cytological diagnosis, and there was fair to very good interobserver agreement for 22 of the 28 criteria studied. Architectural features were less reproducible than pure cytological criteria. Intraobserver variability was not influenced by the years of experience in the field. A precise and strict definition of terminology rendered a better reproducibility of the cytological criteria.
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Affiliation(s)
- R Granados
- Department of Pathology, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
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Suterwala S, Volk EE, Danforth RD. Aspiration biopsy of osseous metastasis of occult hepatocellular carcinoma: Case report, literature review, and differential diagnosis. Diagn Cytopathol 2001; 25:63-7. [PMID: 11466816 DOI: 10.1002/dc.2004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Fine-needle aspiration (FNA) cytology is a reliable technique for rapid diagnosis in virtually every organ of the body, including bone lesions. We report on the FNA findings in a 61-yr-old male of an osteolytic sacral lesion, which determined the diagnosis of an unsuspected metastatic hepatocellular carcinoma. In this case, the diagnosis was confirmed by FNA biopsy without resorting to surgical biopsy.
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Affiliation(s)
- S Suterwala
- Department of Pathology, St. John Hospital and Medical Center, Detroit, Michigan 48236-2172, USA
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Gupta RK, Naran S, Lallu S, Fauck R. Fine needle aspiration diagnosis of neuroendocrine tumors in the liver. Pathology 2000; 32:16-20. [PMID: 10740799 DOI: 10.1080/003130200104501] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Ten neuroendocrine tumors (NET) in the liver are presented, in which the diagnosis was made on fine needle aspiration cytology and cell blocks from the aspirate. In seven of the patients with liver metastasis, a biopsy-proven extrahepatic primary NET had been previously diagnosed, while in three patients no extrahepatic neoplasm could be identified, suggesting that the NET may have been a primary in the liver. Based on cytomorphological findings the cases were typed as either round cell type, spindle cell type or polygonal cell type. In all cases, immunopositivity for neuroendocrine markers provided reliable evidence of the cell of origin and distinguished them from well-differentiated hepatocellular carcinoma, adenocarcinomas and other neoplasms, which sometimes may present a diagnostic dilemma.
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Affiliation(s)
- R K Gupta
- Valley Diagnostic Laboratories Ltd., Wellington Hospital, New Zealand
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