Fallopian tube cytology as a diagnostic tool for adnexal malignancy: the CytoSaLPs score

INTRODUCTION

During the past decade, the theory that high-grade extrauterine pelvic tumors originate from the fallopian tube has been strongly suggested. Our study aims to illuminate the possible role of tubal cytology as an accessory identification tool for gynecologic extrauterine malignancies, allowing in the long term the implementation of population-level cytologic tube evaluation during all benign gynecologic surgeries that do not result in salpingectomy.

MATERIALS AND METHODS

We ex vivo collect salpingeal epithelial cells from the fibria directly from fresh fallopian tube specimens from women undergoing salpingectomy for any indication. The cytomorphologic characteristics of the salpingeal cells are subsequently evaluated and categorized into malignant and non-malignant. Finally, the ipsilateral adnexa are examined with the SEE-FIM (Sectioning and Extensively Examining the FIMbriated End) protocol and the pathology reports are corelated with the cytologic findings. Our research protocol is ongoing and is designed to include a total of 300 patients in order to confirm the sensitivity and specificity of salpingeal cytology as a method in the early diagnosis of extrauterine gynecologic malignancies.

RESULTS

So far, we have obtained 343 salpingeal brushings from a total of 214 patients. The sensitivity of cytology regarding distinguishing malignant from non-malignant tumors is 69.64% (95% CI: 55.90%-81.22%), and its specificity 75.96% (95% CI: 70.59%-80.79%). Cytology's positive predictive value (PPV) is 16.33% (95% CI: 12.57%-20.67%), while the negative predictive value (NPP) reached 92.77% (95% CI: 89.56%-95.04%). In general, the diagnostic accuracy of the cytologic evaluation reaches 74.93% (95% CI: 66.99%-79.43%).

CONCLUSIONS

Salpingeal cytomorphologic evaluation appears to be a promising method for early detection of adnexal cancer.

The Utility of Fallopian Tube Cytology in the Early Detection of Extrauterine Serous Gynecological Malignancies: A Narrative Literature Review

INTRODUCTION

The aim of the study was to analyze the published evidence for the use of fallopian tube brush cytology for the early detection of extrauterine serous gynecological cancer.

METHODS

We systematically searched the literature and, additionally, cross-checked on the bibliographies of selected articles. The inclusion criteria involved studies assessing the utility of fallopian tube brush cytology and its applications in the diagnosis, screening, or follow-up of extrauterine serous gynecological cancer.

RESULTS

The search strategy resulted in 21 abstracts or full-text articles, 5 of which met the inclusion criteria. The year of publication ranged from 2016 to 2022, and a total of 193 fallopian tube samples were investigated. Cytobrush, Tubebrush©, and Cytuity™ were used to obtain salpingeal samples for liquid-based cytology evaluation.

CONCLUSIONS

Our findings indicate that, at present, there is a lack of satisfying evidence-based data in the literature which would support the implementation of fallopian tube brush cytology as an adjunctive tool for early detection of extrauterine serous gynecological cancer. Thus, we believe that there is need for well-designed clinical studies to assess the effectiveness and diagnostic accuracy of the method as well as to validate the cytological criteria for the diagnosis and prediction of gynecological malignancies.

Microglandular hyperplasia-like mucinous adenocarcinoma of the endometrium: A rare case report

BACKGROUND

Microglandular hyperplasia (MGH) is a proliferation of endocervical glands, related to estrogen stimulation, mainly occurring in the reproductive age group. The differential diagnosis includes endometrial adenocarcinoma with MGH-like pattern (MGA), a distinction that may be particularly problematic in curettage specimen.

CASE SUMMARY

A 57-year-old, postmenopausal woman was admitted in our hospital for surgical treatment. She had been diagnosed with a uterine leiomyoma, after complaints of irregular vaginal bleeding. She underwent dilatation and curettage (D&C) and subsequent total abdominal hysterectomy with bilateral salpingo-oophorectomy. D&C were compatible with MGA. Histologically, a proliferation of small glands, without intervening stroma, with mucin production, accumulation of neutrophils in the gland lumen and stroma, mild nuclear atypia and rare mitoses, were seen. In the hysterectomy specimen, the endometrium was thickened, but without apparent tumor formation. On microscopic examination, a residual similar adenocarcinoma was seen in the isthmus and more conventional-of endometrioid and mucinous type, in the rest of the endometrium.

CONCLUSION

MGH-like proliferation with mild cytologic atypia, detected in the endometrial curettage specimen of a postmenopausal woman, should alert pathologists for MGA of the endometrium. VIM, p16, PAX-2, CD10 and CD34 may help in the differential diagnosis.

Contralateral Axillary Lymph Node Enlargement in a Woman with Silent Silicone Breast Implant Rupture 30 Years After Breast Cancer Diagnosis: A Lesson to Be Learnt

Background: Silicone lymphadenopathy is a recognized complication of silicone implant rupture. It occurs when silicone droplets migrate from breast implants to lymph nodes, resulting in the formation of granulomas (known as siliconoma) and lymph node enlargement. The ipsilateral axillary lymph nodes are most commonly involved but it can also affect contralateral axillary, supraclavicular, internal mammary and mediastinal lymph nodes.Case presentation: A 60-year-old woman with a history of left breast cancer who had undergone modified radical mastectomy (MRM) followed by left breast reconstruction with implant (30 years ago) presented with right axillary lymph nodes enlargement. An excisional biopsy of the two larger lymph nodes was performed to rule out malignancy. Pathologic examination showed features of silicone lymphadenopathy. Further examination with Ultrasound and MRI confirmed breast implant rupture. Conclusion: Silicone lymphadenopathy following breast augmentation and reconstruction primarily affects the ipsilateral axillary nodes. Contralateral lymph node involvement is rare and may occur several years after breast cancer diagnosis and can be the first sign of breast implant rupture. Although, the need to exclude malignancy in such cases is of outmost importance, silicone lymphadenopathy should also be considered in the differential diagnosis.

Tall cell carcinoma with reversed polarity: A case report of a very rare breast tumor entity and mini-review

Tall cell carcinoma with reversed polarity (TCCRP) is a very rare variant of carcinoma of the breast, resembling the tall cell variant of papillary thyroid carcinoma, first described in 2003, recently recognized as a separate entity in the 5th edition of the WHO (World Health Organization) Blue Book Classification of breast tumors with alternative terminology of tall cell variant of papillary breast carcinoma and solid papillary carcinoma with reversed polarity. Here, we report an additional case of this rare tumor in a 71-year-old woman, and the problems correlating with its diagnosis.

Coexistence of Gastric Cancer and Multiple Small Gastrointestinal Stromal Tumors: Report of a Unique Case and Review of the Literature

Background

In recent years, the synchronous occurrence of tumors of different histotypes arising in the same organ has been reported more frequently in the literature. The simultaneous development of adenocarcinoma and gastrointestinal stromal tumor (GIST) has been documented rarely.

Summary

The coexistence of primary gastric adenocarcinoma and GIST has been detected incidentally on gastric mucosa, serosa or occasionally intramurally, at surgery, or gastroscopy for other reasons. We present a case of a 79-year-old male patient who underwent surgery for an advanced gastric carcinoma, where multiple nodules of GIST were incidentally discovered during the work-up of his gastrectomy specimen.

Key Message

GISTs range from small "low-risk" tumors to sarcomas. Small GISTs are found incidentally during unrelated surgery or autopsy. Multiple GISTs are extremely rare and usually associated with hereditary diseases.

Practical Implications

In any case of gastrointestinal neoplasm, the surgeon and pathologist should be alert to perform a thorough investigation. Our case could provide further awareness and insight into the entity of concurrent tumors.