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Viscuse PV, Slack-Tidwell RS, Zhang M, Rohra P, Zhu K, San Lucas FA, Konnick E, Pilie PG, Siddiqui B, Logothetis CJ, Corn P, Subudhi SK, Pritchard CC, Soundararajan R, Aparicio A. Evaluation of the Aggressive-Variant Prostate Cancer Molecular Signature in Clinical Laboratory Improvement Amendments (CLIA) Environments. Cancers (Basel) 2023; 15:5843. [PMID: 38136389 PMCID: PMC10741546 DOI: 10.3390/cancers15245843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
Aggressive-variant prostate cancers (AVPCs) are a subset of metastatic castrate-resistant prostate cancers (mCRPCs) characterized by defects in ≥ two of three of TP53, RB1, and PTEN (AVPCm), a profile linked to lineage plasticity, androgen indifference, and platinum sensitivity. Men with mCRPC undergoing biopsies for progression were assessed for AVPCm using immunohistochemistry (IHC), next-generation sequencing (NGS) of solid tumor DNA (stDNA), and NGS of circulating tumor DNA (ctDNA) assays in CLIA-certified labs. Biopsy characteristics, turnaround times, inter-reader concordance, and inter-assay concordance were assessed. AVPCm was detected in 13 (27%) patients via IHC, two (6%) based on stDNA, and seven (39%) based on ctDNA. The concordance of the IHC reads between pathologists was variable. IHC had a higher detection rate of AVPCm+ tumors with the shortest turnaround times. stDNA had challenges with copy number loss detection, limiting its detection rate. ctDNA detected the greatest proportion of AVPCm+ tumors but had a low tumor content in two thirds of patients. These data show the operational characteristics of AVPCm detection using various assays, and inform trial design using AVPCm as a criterion for patient selection or stratification.
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Affiliation(s)
- Paul V. Viscuse
- Department of Medicine, University of Virginia, Charlottesville, VA 22903, USA;
| | - Rebecca S. Slack-Tidwell
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Miao Zhang
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (K.Z.)
| | - Prih Rohra
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (K.Z.)
| | - Keyi Zhu
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (K.Z.)
| | - F. Anthony San Lucas
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Eric Konnick
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA; (E.K.)
| | - Patrick G. Pilie
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Bilal Siddiqui
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Christopher J. Logothetis
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Paul Corn
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sumit K. Subudhi
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Colin C. Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA; (E.K.)
| | - Rama Soundararajan
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Ana Aparicio
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Shehabeldin A, Rohra P, Sellen LD, Zhao J, Alqaidy D, Aramin H, Hameed N, Perez YE, Lai Z, Tong YT, Milton DR, Edgerton ME, Fuller G, Hansel D, Prieto VG, Ballester LY, Aung PP. Utility of Whole Slide Imaging for Intraoperative Consultation: Experience of a Large Academic Center. Arch Pathol Lab Med 2023:496084. [PMID: 37756559 DOI: 10.5858/arpa.2023-0105-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 09/29/2023]
Abstract
CONTEXT.— In the United States, review of digital whole slide images (WSIs) using specific systems is approved for primary diagnosis but has not been implemented for intraoperative consultation. OBJECTIVE.— To evaluate the safety of review of WSIs and compare the efficiency of review of WSIs and glass slides (GSs) for intraoperative consultation. DESIGN.— Ninety-one cases previously submitted for frozen section evaluation were randomly selected from 8 different anatomic pathology subspecialties. GSs from these cases were scanned on a Leica Aperio AT2 scanner at ×20 magnification (0.25 μm/pixel). The slides were deidentified, and a short relevant clinical history was provided for each slide. Nine board-certified general pathologists who do not routinely establish primary diagnoses using WSIs reviewed the WSIs using Leica Aperio ImageScope viewing software. After a washout period of 2-3 weeks, the pathologists reviewed the corresponding GSs using a light microscope (Olympus BX43). The pathologists recorded the diagnosis and time to reach the diagnosis. Intraobserver concordance, time to diagnosis, and specificity and sensitivity compared to the original diagnosis were evaluated. RESULTS.— The rate of intraobserver concordance between GS results and WSI results was 93.7%. Mean time to diagnosis was 1.25 minutes for GSs and 1.76 minutes for WSIs (P < .001). Specificity was 91% for GSs and 90% for WSIs; sensitivity was 92% for GSs and 92% for WSIs. CONCLUSIONS.— Time to diagnosis was longer with WSIs than with GSs, and scanning GSs and uploading the data to whole slide imaging systems takes time. However, review of WSIs appears to be a safe alternative to review of GSs. Use of WSIs allows reporting from a remote site during a public health emergency such as the COVID-19 pandemic and facilitates subspecialty histopathology services.
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Affiliation(s)
- Ahmed Shehabeldin
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
| | - Prih Rohra
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
| | - Linton D Sellen
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
| | - Jianping Zhao
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
| | - Doaa Alqaidy
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
| | - Hermineh Aramin
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
| | - Nadia Hameed
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
| | - Ydamis Estrella Perez
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
| | - Zongshan Lai
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
| | - Yi Tat Tong
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
| | - Denái R Milton
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
| | - Mary E Edgerton
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
| | - Gregory Fuller
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
| | - Donna Hansel
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
| | - Victor G Prieto
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
| | - Leomar Y Ballester
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
| | - Phyu P Aung
- From the Departments of Pathology (Shehabeldin, Rohra, Sellen, Zhao, Alqaidy, Aramin, Hameed, Perez, Lai, Tong, Edgerton, Fuller, Hansel, Prieto, Ballester, Aung) and Biostatistics (Milton), The University of Texas MD Anderson Cancer Center, Houston. Shehabeldin, Rohra, Ballester
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Viscuse PV, Zhang M, Rohra P, Slack Tidwell R, Pritchard CC, Subudhi SK, Pilié PG, Logothetis C, Corn PG, Aparicio A. Evaluation of the aggressive variant prostate cancer molecular profile (AVPCm) in CLIA environments. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
250 Background: 20-30% of prostate cancers respond poorly to androgen receptor (AR)-directed therapies and have an atypical, virulent course. The aggressive variant prostate cancers ( AVPC) encompass virulent androgen indifferent tumors and are characterized by combined defects in ≥ 2/3 of TP53, RB1, and PTEN (AVPC-m). Post-hoc analysis in a phase I/II trial indicated a benefit of carboplatin+cabazitaxel in men with AVPCm+ metastatic castrate resistant prostate cancer (mCRPC). We assess the feasibility of detecting the AVPCm in CLIA-certified environments. Methods: Men with progression of mCRPC undergoing biopsies for standard molecular profiling at MD Anderson Cancer Center (MDACC) were eligible. TP53, RB1, and PTEN expression was assessed by immunohistochemistry (IHC) and read by 2 pathologists independently. Next generation sequencing of solid tumor DNA (stDNA) and circulating tumor DNA (ctDNA) was performed on the MDACC Molecular Diagnostics Laboratory and the University of Washington OncoPlex ctDNA platforms respectively . Results: Of 64 eligible patients, 49 (77%), 37 (58%), and 54 (84%) had results reported for IHC, stDNA, and ctDNA respectively. Concordance of IHC reads between pathologists was variable: Kappa 0.78, 0.67, and 0.91 for TP53, RB1, and PTEN respectively. 36 (66.7%) ctDNA samples had low tumor content, such that false negatives could not be excluded. AVPC-m was detected in 14 (29%) of patients by IHC per the original reading pathologist, 2 (5%) by stDNA NGS, and 7 (39%) by ctDNA NGS. Median turnaround times for IHC, stDNA and ctDNA were 12 (2-35), 28 (12-56) and 16 (11-56) days respectively. Conclusions: We show the operational characteristics of the AVPCm detection using CLIA certified assays. IHC detected a greater proportion of patients with AVPCm+ tumors than stDNA, likely due, partly, to the challenges of copy number loss detection. ctDNA detected the greatest proportion of AVPCm+ tumors but was not evaluable in two thirds of patients. These data serve to inform the design of clinical trials using AVPCm as a criterion for patient selection or stratification. [Table: see text]
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Affiliation(s)
| | - Miao Zhang
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Prih Rohra
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | - Ana Aparicio
- University of Texas MD Anderson Cancer Center, Houston, TX
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Rohra P, Ding C, Yoon EC, Gan Q. A pilot study: Comparison of TRPS1 and GATA3 immunoperoxidase staining using cytologic smears in entities reportedly positive for GATA3. Cancer Cytopathol 2022; 130:930-938. [PMID: 35790088 DOI: 10.1002/cncy.22623] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/10/2022] [Accepted: 06/20/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Metastatic breast carcinoma (mBC) is frequently encountered and may be challenging to diagnose as the tumor cells can morphologically resemble carcinomas of other primary origins. An additional challenge is that direct smears are often the only sample type available for immunostaining studies in cytology. Trichorhinophalangeal syndrome GATA-binding type 1 1 (TRPS1) is a highly sensitive marker for BC compared to the commonly used marker GATA3, especially in triple-negative BC (TNBC), in histologic samples. However, its sensitivity and specificity in mBC and other GATA3-positive tumors have not been studied. METHODS The authors identified the following cytology cases: 37 GATA3-positive mBC cases and 19 available cases that were deemed mBC but were GATA3-negative during the original case workup and five cases of each of eight epithelioid entities known to have high rates of GATA3 positivity and commonly seen in cytology practice. Immunostainings of TRPS1 and GATA3 were performed on the chosen smears following standard protocols. RESULTS TRPS1 was positive in all 37 GATA3-positive mBC cases and in 18 of the 19 GATA3-negative mBC cases. TRPS1 was negative in all five of the seven frequently GATA3-positive epithelioid entities, with the exception of salivary duct carcinomas where GATA3 was positive in a rate ranging 60%-100% among them. CONCLUSIONS TRPS1 is as sensitive as GATA3 in GATA3-positive mBC and is more sensitive than GATA3 in TNBC. TRPS1 is negative in most GATA3-positive nonbreast tumors. Thus, the combination of TRPS1 and GATA3 could be used to differentiate breast primary from others in most situations.
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Affiliation(s)
- Prih Rohra
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cady Ding
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Esther C Yoon
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Qiong Gan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Rohra P, Mir F, Park JW, Pool M, Gattuso P, Cheng L. A small round blue cell tumor in urine: cytomorphology and differential diagnosis. Cytojournal 2021; 18:18. [PMID: 34512789 PMCID: PMC8422448 DOI: 10.25259/cytojournal_45_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/14/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Prih Rohra
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, United States
| | - Fatima Mir
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, United States
| | - Ji-Weon Park
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, United States
| | - Mark Pool
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, United States
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, United States
| | - Lin Cheng
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, United States
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Rohra P, Ocampo Gonzalez FA, Yan L, Mir F, Furlan K, Basu S, Barua A, Cheng L, Park JW. Effect of the Paris system for reporting urinary cytology with histologic follow-up. Diagn Cytopathol 2021; 49:691-699. [PMID: 33600080 DOI: 10.1002/dc.24723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 01/19/2021] [Accepted: 02/02/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Paris system (TPS) for Reporting Urinary Cytology provides a standardized reporting system whose main focus is the diagnosis of high-grade urothelial carcinoma (HGUC). We conducted a study to see the impact of The Paris System on our cytologic diagnoses with associated histology. MATERIALS AND METHODS We reviewed our pathology database regarding urinary specimens in the year before implementation of The Paris System and the year after. We gathered the data regarding cytologic diagnosis and concurrent/subsequent histology. RESULTS Over a 1-year period from 2016-2017, 486 urine cytology specimens were identified before implementation of The Paris System and diagnosed as follows: 83% benign/negative, 10% atypical, 2% suspicious, 5% HGUC, 0.2% low grade urothelial neoplasm (LGUN), and 0.2% unsatisfactory. Over a next 1-year period from 2017 to 2018, 602 specimens used TPS and diagnosed as follows: 85% negative for HGUC, 6% atypical, 3% suspicious, 4% HGUC, 0.17% LGUN, and 2% unsatisfactory. Although, not listed as a standardized category in The Paris System, our institution used "Negative for high-grade, cannot rule out low-grade urothelial neoplasm (NHL)" as a subcategory of Negative for HGUC. 4% of the cases fell into this category. Focusing on the Atypical category before TPS, histology was available in 15/49 (31%) cases. Of these, 40% had HGUC. Regarding the Atypical category after TPS, histology was available in 21/36 (58%) cases. Of these, 52% were HGUC. For the NHL category, concurrent histology was available in 13/26 (50%) cases. Of these, 67% were low grade urothelial neoplasms. CONCLUSION Our study showed that TPS lowered the rate of Atypical from 10% to 6%. After the implementation of TPS, Atypical corresponded to a higher rate of high-grade urothelial carcinoma. Also, the NHL subcategory had a high positive predictive value for diagnosing low grade urothelial neoplasms.
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Affiliation(s)
- Prih Rohra
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Lei Yan
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Fatima Mir
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Karina Furlan
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Sanjib Basu
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Animesh Barua
- Departments of Cell and Molecular Medicine, Pathology and OB/GYN, Rush University Medical Center, Chicago, Illinois, USA
| | - Lin Cheng
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Ji-Weon Park
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
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Furlan K, Miller I, Rohra P, Mir F, Ocampo Gonzalez FA, Gattuso P. Well-differentiated liposarcoma primary from thymic stroma: Case report and literature review. Exp Mol Pathol 2020; 116:104517. [PMID: 32791064 DOI: 10.1016/j.yexmp.2020.104517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/30/2020] [Accepted: 08/07/2020] [Indexed: 11/16/2022]
Abstract
Primary liposarcoma of thymic stroma is an exceptionally rare tumor. Histological findings are often definitive for diagnosis, however due to the variability of nuclear atypia and the overlapping with other adipocytic tumors, ancillary techniques are helpful as confirmatory tools. Currently, Fluorescent in situ hybridization for MDM2 is the gold standard for diagnosis of well-differentiated and dedifferentiated liposarcomas, however a panel of immunohistochemical stainings, including MDM2, CDK4 and p16 is available as alternative method, helping to distinguish liposarcoma from its benign counterpart lipoma, especially in borderline cases. We describe the case of a young female diagnosed with a well-differentiated lipomatous tumor primary of thymic stroma with near cut-off result for MDM2-FISHand positive immunohistochemical staining for the panel described above. We discuss the challenges in the diagnosis of this rare entity andpresent an updated literature review.
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Affiliation(s)
- Karina Furlan
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America.
| | - Ira Miller
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America
| | - Prih Rohra
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America
| | - Fatima Mir
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America
| | - Fernando A Ocampo Gonzalez
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America
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Furlan K, Reddy V, Alabkaa A, Rohra P, Mir F, Gattuso P. Metastatic head and neck cutaneous basal cell carcinomas: a retrospective observational study. Arch Dermatol Res 2020; 313:439-443. [PMID: 32776227 DOI: 10.1007/s00403-020-02120-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/07/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022]
Abstract
Cutaneous basal cell carcinoma is usually an indolent and slow-growing tumor with potential for local invasion and recurrence; however, metastatic events are exceedingly rare. The annual incidence of metastasis is estimated to range between 0.00281 and 0.05%. A retrospective search in the pathology database of a single tertiary institution was performed in the period between 1999 to 2019. Primary cutaneous metastatic basal cell carcinomas had paraffin blocks and glass slides retrieved. A total of 8673 cases was identified. The overall prevalence of metastatic tumors was 0.05% (4/8673). The median patient's age at diagnosis was 61 years old (range 52-79). The most common primary site of tumor was nose (2/4) and the most common histological subtype was infiltrative. The sampled lymph nodes were identified during primary tumor resection, except for 1 patient who had a sentinel lymph node biopsy performed as a surgeon individual decision. One patient had hematogenous spread to the pleura, diagnosed 5 years after diagnosis. In summary, this study adds new data to the current literature in metastatic primary cutaneous basal cell carcinomas and highlights the importance of early diagnosis and appropriate surgical excision in an effort to prevent local advanced disease, recurrence and lymphovascular dissemination.
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Affiliation(s)
- Karina Furlan
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, Chicago, IL, 60612, USA.
| | - Vijaya Reddy
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, Chicago, IL, 60612, USA
| | - Anas Alabkaa
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, Chicago, IL, 60612, USA
| | - Prih Rohra
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, Chicago, IL, 60612, USA
| | - Fatima Mir
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, Chicago, IL, 60612, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, Chicago, IL, 60612, USA
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9
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Mir F, Rohra P, Aakash N, Furlan K, Cheng L, Ghai R, Reddy V, Gattuso P. Acinic cell carcinoma of the salivary gland associated with lymphoid-rich stroma. A diagnostic dilemma on cytology: Study of two cases. Diagn Cytopathol 2020; 49:E55-E59. [PMID: 32761994 DOI: 10.1002/dc.24571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 01/12/2023]
Abstract
A lymphoid-rich stroma is a common finding in salivary gland tumors. Several reports documented this association with acinic cell carcinoma (ACC). However, cytologic studies reporting this phenomenon are rare and mainly confined to sporadic single case reports. We present the cytologic features of two cases of ACCs of the parotid gland displaying a lymphoid-rich background and discuss the cytologic differential diagnoses of this uncommon ACC variant.
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Affiliation(s)
- Fatima Mir
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Prih Rohra
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Nfn Aakash
- Department of Pathology, University of Texas Health Science Center, Houston, Texas, USA
| | - Karina Furlan
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Lin Cheng
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Ritu Ghai
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Vijaya Reddy
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
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Mir F, Rohra P, Aakash N, Furlan K, Ghai R, Reddy V, Cheng L, Gattuso P. Fine needle aspiration of an intrathyroidal parathyroid carcinoma mimicking a primary thyroid anaplastic carcinoma: A case report with review of the literature. Diagn Cytopathol 2020; 49:E14-E19. [PMID: 32749783 DOI: 10.1002/dc.24560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/20/2020] [Accepted: 07/09/2020] [Indexed: 11/12/2022]
Abstract
Intrathyroidal parathyroid carcinoma is an uncommon malignancy. A 46-year-old male presented with a left neck mass. Computed tomography (CT) scan revealed a hypodense mass in the left thyroid lobe along with evidence of metastatic lymphadenopathy. Aspiration of the left thyroid nodule was performed, and a diagnosis of malignancy was rendered, favoring a primary anaplastic carcinoma. Based on the cytologic diagnosis, the patient underwent a total thyroidectomy. Before the surgery, intact parathyroid hormone (PTH) and calcium level (PTH = 78 pg/mL; Calcium = 10.6 mg/dL) were found to be minimally elevated. On gross examination, a 3.2 cm mass within the left inferior thyroid lobe was seen. Histopathologic examination and ancillary studies supported the diagnosis of a parathyroid carcinoma. We, hereby present, an exceedingly rare presentation of an intrathyroidal parathyroid carcinoma with only minimal elevation of PTH and calcium, mimicking a primary anaplastic thyroid carcinoma on cytologic examination.
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Affiliation(s)
- Fatima Mir
- Rush University Medical Center, Chicago, Illinois, USA
| | - Prih Rohra
- Rush University Medical Center, Chicago, Illinois, USA
| | - Nfn Aakash
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Karina Furlan
- Rush University Medical Center, Chicago, Illinois, USA
| | - Ritu Ghai
- Rush University Medical Center, Chicago, Illinois, USA
| | - Vijaya Reddy
- Rush University Medical Center, Chicago, Illinois, USA
| | - Lin Cheng
- Rush University Medical Center, Chicago, Illinois, USA
| | - Paolo Gattuso
- Rush University Medical Center, Chicago, Illinois, USA
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Furlan K, Rohra P, Mir F, Gattuso P. Non-human-papillomavirus-related malignancies of the vulva: A clinicopathological study. J Cutan Pathol 2020; 47:917-922. [PMID: 32511773 DOI: 10.1111/cup.13768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Malignant tumor of the vulva is the fourth gynecological malignancy in frequency. Close to 70% of all vulvar malignancies are related to high-risk human papillomavirus (HPV) infection. METHODS A search for non-HPV-related malignant tumors of the vulva was performed in the last 20 years (2000-2020) in the pathology database of a single tertiary institution. We aim to estimate the prevalence of non-HPV-related malignancies in our population, describe clinicopathological features of these tumors and investigate the expression of some potential therapeutic targets. RESULTS A total of 71 patients were recovered; 26 patients (36%) had the diagnosis of extramammary Paget disease, 17 patients (24%) had basal cell carcinomas, 17 patients (24%) had primary melanomas, 10 patients (14%) had metastatic disease to the vulva and one patient (1%) had a primary dermatofibrosarcoma protuberans. Fifty-four percent of patients with extramammary Paget disease had a secondary malignancy and 12.5% had invasive disease. Programmed death-ligand 1 (PDL-1) was positive in seven out of nine primary melanomas and Her2/neu was overexpressed in six out of seven extramammary Paget disease. CONCLUSION Non-HPV-related malignancies are important differential diagnoses in patient with vulvar lesions. Additional research is necessary to further understand these complex malignancies and potential new therapeutic targets.
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Affiliation(s)
- Karina Furlan
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Prih Rohra
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Fatima Mir
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
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Furlan K, Rohra P, Mir F, Sethi S, Almajnooni A, Gattuso P, Moore N. Mycobacterium Spindle Cell Pseudotumor Caused by Mycobacterium xenopi: A First Described Association of a Rare Entity Presenting in the Lung. Int J Surg Pathol 2019; 28:316-320. [PMID: 31601138 DOI: 10.1177/1066896919879745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mycobacterial spindle cell pseudotumor (MSP) is a rare benign lesion characterized by a proliferation of bland spindle-shaped histiocytes with vague granulomatous formation, positive for acid-fast bacilli staining. This lesion is usually reported in the lymph nodes and skin of immunocompromised patients; only 6 cases primary in the lung have been reported in the English literature to this date. In this article, we present the case of a 42-year-old female status post failed kidney-pancreas transplant with subsequent multiple kidney transplants, on chronic immunosuppression, who developed a mass in the left lower lobe consistent with MSP. Mycobacterium xenopi was identified in lung tissue culture, an association never previously described in literature. This case report alerts for the possible association of this rare form of non-tuberculous mycobacteria in the pathogenesis of MSP and highlights the importance of this differential diagnosis in lung masses of immunocompromised patients.
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Affiliation(s)
| | - Prih Rohra
- Rush University Medical Center, Chicago, IL, USA
| | - Fatima Mir
- Rush University Medical Center, Chicago, IL, USA
| | - Shenon Sethi
- Rush University Medical Center, Chicago, IL, USA
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Rohra P, Yan L, Mir F, Farrell MR, Gattuso P, Cheng L. Follicular cystitis in urine cytology: A clinical and cytopathologic study. Diagn Cytopathol 2019; 47:1223-1228. [DOI: 10.1002/dc.24267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/15/2019] [Accepted: 05/30/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Prih Rohra
- Department of PathologyRush University Medical Center Chicago Illinois
| | - Lei Yan
- Department of PathologyRush University Medical Center Chicago Illinois
| | - Fatima Mir
- Department of PathologyRush University Medical Center Chicago Illinois
| | - M. Ryan Farrell
- Division of UrologyRush University Medical Center Chicago Illinois
| | - Paolo Gattuso
- Department of PathologyRush University Medical Center Chicago Illinois
| | - Lin Cheng
- Department of PathologyRush University Medical Center Chicago Illinois
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Javidiparsijani S, Brickman A, Lin DM, Rohra P, Ghai R, Bitterman P, Reddi V, Al-Khudari S, Gattuso P. Is Regional Lymph Node Metastasis of Head and Neck Paraganglioma a Sign of Aggressive Clinical Behavior: A Clinical/Pathologic Review. Ear Nose Throat J 2019; 100:447-453. [PMID: 31566000 DOI: 10.1177/0145561319863373] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Head and neck paraganglioma is a rare neoplasm of the paraganglia. It accounts for <1% of all head and neck tumors. It usually has benign clinical course; however, malignant paraganglioma can only be diagnosed by showing metastatic disease. We undertook a retrospective study to assess the clinical significance of regional lymph nodes metastases in head and neck paragangliomas. DESIGN From 1993 to 2016, primary head and neck paragangliomas are identified. The patient clinical and histopathologic materials were reviewed. RESULTS Sixty-five specimens from 62 patients (3 patients with more than 1 specimens) with head and neck paragangliomas were recorded (49 female and 13 males) with mean age of 54 (24-78 years). The locations of the tumors were as follows: carotid body: 30, glomus tympanicum: 11, glomus jugulare: 14, parapharyngeal space: 3, and 1 case each of larynx, skull base, paraglottic area, infratemporal fossa, mastoid, cerebellopontine (CP) angle, and pyriform sinus. On histopathology, we found 5 cases of sclerosing variant. Thirty-two (52%) of the 62 patients had regional lymph node biopsy. Four (12%) of the 32 show metastatic paraganglioma (3 females and 1 male with mean age = 35). Two of the 5 cases of sclerosing variant had positive lymph nodes. No evidence of local recurrence or distant metastasis in the patients with positive lymph nodes with a 6 to 11 years follow-up. One of the 28 patients with negative lymph nodes developed metastatic disease to lumbar spine in 5 years. CONCLUSION Metastatic paraganglioma to regional lymph nodes may have indolent clinical behavior, with disease-free survival of up to 11 years. The incidence of metastatic disease in lymph nodes was 4 (12%) of 32. Forty percent (2/5) of the cases with sclerosing variant of paraganglioma had lymph node metastases indicating that this tumor may have a more aggressive histological behavior.
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Affiliation(s)
| | - Arlen Brickman
- Department of Pathology, 2461Rush University, Chicago, IL, USA
| | - Diana Murro Lin
- Department of Pathology, 2461Rush University, Chicago, IL, USA
| | - Prih Rohra
- Department of Pathology, 2461Rush University, Chicago, IL, USA
| | - Ritu Ghai
- Department of Pathology, 2461Rush University, Chicago, IL, USA
| | | | - Vijaya Reddi
- Department of Pathology, 2461Rush University, Chicago, IL, USA
| | - Samer Al-Khudari
- Department of Otorhinolaryngology (ENT), Head and Neck Surgery, 2461Rush University, Chicago, IL, USA
| | - Paolo Gattuso
- Department of Pathology, 2461Rush University, Chicago, IL, USA
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Yan L, Rohra P, Cheng L, Gattuso P. Pleural Effusion in Pulmonary and Extrapulmonary Blastomycosis. Acta Cytol 2019; 64:241-247. [PMID: 31266012 DOI: 10.1159/000500973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/14/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Pleural effusion secondary to blastomycosis infection is an uncommon clinical manifestation of the disease. We undertook a retrospective study to assess the incidence and involvement of pleural effusion in patients with blastomycosis infection. STUDY DESIGN Institutional cytology and surgical pathology records were searched from December 1995 to October 2017 for cases of blastomycosis. The cytologic, surgical pathology, and clinical pertinent information was reviewed in detail. RESULTS A total of 77 cases of blastomycosis infection were recorded, with a male-to-female ratio of 1.7:1.0. Forty-eight cases of blastomycosis were pulmonary (62.3%), while 29 cases of blastomycosis were found in extrapulmonary sites (37.7%). The diagnosis of pulmonary blastomycosis was established by 24 lung biopsies/wedge resections, 22 bronchial alveolar lavages, and 2 lung fine needle aspirations. The 29 cases of extrapulmonary blastomycosis included 13 cases of bone (44.8%), 8 cases of skin (27.6%), 6 cases of soft tissue (20.7%), and 2 cases of brain infections (6.8%). Twenty-eight of 48 pulmonary cases were complicated by unilateral or bilateral pleural effusion (58.3%) detected by imaging studies. Four of the 28 pleural effusions were aspirated and examined by cytology. Two of the 4 pleural fluid cytologies showed involvement by blastomycosis (50%). In the extrapulmonary blastomycosis group, 9 of 29 patients showed unilateral or bilateral pleural effusions (31.0%), including 4 cases of bone, 4 cases of skin, and 1 case of brain involvement. Only 2 of the 9 pleural effusions were aspirated for cytology study. One of the 2 pleural fluid cytologies showed blastomycosis (50%). CONCLUSION Pleural effusion detected by imaging is common in blastomycosis patients. Blastomycosis can involve pleural fluid in both pulmonary and extrapulmonary diseases. A broad infectious differential that includes blastomycosis should be considered to make a timely diagnosis and initiate antifungal therapy to prevent systemic infection and further dissemination of the disease.
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Affiliation(s)
- Lei Yan
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA,
| | - Prih Rohra
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Lin Cheng
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
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Rohra P, Mir F, Lin DM, Furlan K, Javidiparsijani S, Lucero D, Gattuso P. Role of fine-needle aspiration in post liver transplant patients: A clinical/cytological review. Diagn Cytopathol 2018; 47:434-438. [PMID: 30593732 DOI: 10.1002/dc.24133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/29/2018] [Accepted: 11/26/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Fine-needle aspiration (FNA) of superficial and deep-seated lesions has been used with high sensitivity and specificity in the diagnosis of neoplastic and nonneoplastic lesions. However, literature of FNA in posttransplant patients is sparse, especially in postliver transplant. We undertook a retrospective study to evaluate the utility of FNA in the clinical management of post liver transplant patients. METHODS We searched our institution's surgical/cytologic databases (November1993-February2016) to identify liver transplant cases and FNA procedures performed on allograft liver recipients. Institutional IRB approval was obtained for this study. RESULTS 886 liver allograft recipients were reviewed, 41(5%) of which were transplanted for hepatocellular carcinoma. 62/886(7%) underwent an FNA procedure. 39males and 23females included with mean age of 58years. Mean time between transplant and FNA was 34months. 21/62(34%) were malignant neoplasms, most common malignancy was adenocarcinoma: 8cases(3lung,3pancreas,1colon,1cholangiocarcinoma)and 8cases of transplanted hepatocellular carcinoma patients had recurrence, 6 in the allograft liver and 1case each of metastasis to the iliac bone and periportal lymph node. 3cases were squamous-cell carcinoma (2lung and 1scalp). 2cases were posttransplant lymphoproliferative disorders. 34/62(55%) cases were benign aspirates from various organs (8lung,6liver,5pancreas,4breast,3thyroid,3lymph-nodes and 1case each of salivary gland, bile-duct,intraabdominal,abdominal wall,and oral cavity) 0.6/62(10%) cases were inflammatory. 22cases had histologic correlation: 5true-positives,16true-negatives,1false-negative (a patient with parotid mucoepidermoid carcinoma whose FNA diagnosis was sialadenitis), and no false-positive. The sensitivity was 83% and the specificity was 100%. The positive predictive value was 100% and the negative predictive value was 94%. CONCLUSIONS This review shows that 40/62(65%) of the aspirates were benign lesions, indicating that a conservative approach is recommended in the clinical management of these patients, especially since the interval between transplant and FNA was on average 34months. FNA is a safe, minimally invasive method to follow-up these patients.
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Affiliation(s)
- Prih Rohra
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Fatima Mir
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Diana Murro Lin
- Department of Pathology, The University of Alabama, Birmingham, Alabama
| | - Karina Furlan
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | | | - David Lucero
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
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Mir F, Alnajar H, Rohra P, Naumaan A, Cheng L, Gattuso P. Metastatic granular cell tumor to the breast diagnosed by fine needle aspiration cytology: A case report with review of the literature. Diagn Cytopathol 2018; 47:226-229. [DOI: 10.1002/dc.24060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Fatima Mir
- Department of PathologyRush University Medical Center Chicago Illinois
| | - Hussein Alnajar
- Department of PathologyEvanston Hospital, NorthShore University Health System Evanston Illinois
| | - Prih Rohra
- Department of PathologyRush University Medical Center Chicago Illinois
| | - Anam Naumaan
- Department of PathologyRush University Medical Center Chicago Illinois
| | - Lin Cheng
- Department of PathologyRush University Medical Center Chicago Illinois
| | - Paolo Gattuso
- Department of PathologyRush University Medical Center Chicago Illinois
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Rohra P, Mahmud W, Bitterman P, Reddy V, Gattuso P. 232 Micromedullary Thyroid Carcinoma: A Clinicopathologic Review. Am J Clin Pathol 2018. [DOI: 10.1093/ajcp/aqx123.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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