DICER1 Hotspot Mutations in Pleuropulmonary Blastoma: A Case Series From a Tertiary Center

Pleuropulmonary blastoma (PPB) is a potentially aggressive, rare childhood neoplasia. We investigated histopathological features, survival, and DICER1 hotspot mutations among PPB patients. Archive records at our institution were reviewed, covering a 20-year period. Thirteen children (6 males and 7 females) with a mean age of 30.5 (range 6-83) months were included. The tumor subtypes were type I in 6 (46%), type II in 4 (31%), and type III in 3 (23%). Only tumors with type II and type III histology showed anaplasia (4/7, 57%). Median follow-up was 28 (range 9-216) months. Three-year overall survival rate was 83.3% and 3-year progression-free survival rate was 25%. Progression was seen in 60% (3/5) of type I and 66.7% (4/6) of type II and type III cases. Two patients died of disseminated disease at 9 and 44 months. Hotspot missense mutations on DICER1 gene were detected in all 11 patients with available tumor tissue. We found an additional novel germline loss-of-function mutation (c.5436dupT; p.E1813*) in 1 case. To the best of our knowledge, this is the first study to investigate hotspot missense mutations on DICER1 gene among the largest series of Turkish children with PPB.

Comparison of conventional cytology and SurePath in split thyroid fine needle aspiration materials

OBJECTIVE

The aim of the present study was to compare the cytomorphological features and cytopathological diagnoses in thyroid aspiration materials prepared by SurePath® (SP) and conventional cytology (CC).

MATERIALS AND METHODS

Fine needle aspiration (FNA) materials from 180 thyroid nodules were divided into two groups to prepare three conventional smears and one SP slide. Twenty-nine cytomorphological features of thyroid lesions were compared in the CC and SP slides. The Kappa coefficiency was determined for each. The cytopathological diagnosis of CC and SP were compared.

RESULTS

The feature with the lowest Kappa coefficient was the haemorrhagic background, whereas nuclear molding had the highest Kappa coefficient. The rates of the atypical and suspicious cytopathological diagnostic categories were decreased, whereas the rates of benign and malignant categories were increased in SP. When the cytopathological diagnoses of CC and SP were compared with the histopathological diagnoses of the 31 thyroidectomy materials, the results were similar.

CONCLUSION

The common problems seen in CC, such as an excessive number of slides, a haemorrhagic background and air drying artefact in the SP method were not encountered. Through these advantages, the rate of the indeterminate cytopathological diagnosis was low in SP. In addition to those advantages, the increased rates of non-diagnostic cases, the difficulty in evaluating the cytomorphologic features owing to tridimensional structures and the smaller size of the cells and the presence of tridimensional structures uninterpreted microscopically were the disadvantages of SP. The present results showed that SP could be used instead of CC in thyroid cytopathology.

EGFR mutation testing using archival-stained smears in non-small cell lung carcinoma

OBJECTIVE

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have shown benefits regarding progression-free and overall survival in patients whose tumours show EGFR mutations. Most patients' lung cancer is metastatic when detected. Small tissue samples and cytological materials are widely used in diagnosis. The aim of the present study was to compare the EGFR mutation analysis results between cytology, small biopsies and resections.

METHODS

Archival material for EGFR testing was reviewed. Cell blocks and/or stained smears and tissue blocks were used where appropriate. The tumour cell count and percentage were recorded as well as the DNA content. The influence of TTF-1 immunoreactivity on EGFR testing was also investigated.

RESULTS

The study cohort included 300 unpaired specimens of 84 resections, 83 small biopsies and 133 cytological materials. EGFR mutation rates did not differ significantly for cytology, small biopsy and resections (P > 0.05). The higher tumour cell percentage in FNAs than in exfoliative cytology did not affect the EGFR mutation status. EGFR mutation rates were similar when either slides or cell blocks were used. Cytology slides revealed a higher tumour cell content and DNA concentration than the cell blocks. May-Grünwald-Giemsa (MGG)-stained smears had higher rates of the EGFR mutation than the Papanicolaou (Pap)-stained slides (P < 0.05). Tumours with negative immunoreactivity for TTF-1 are less likely to have an EGFR mutation (P < 0.05).

CONCLUSIONS

Cytological materials can be used successfully for mutation analysis in lung cancer.

Guidelines for the Cytopathologic Diagnosis of Epithelioid and Mixed-Type Malignant Mesothelioma: a secondary publication

OBJECTIVE

To provide practical guidelines for the cytopathologic diagnosis of malignant mesothelioma.

DATA SOURCES

Cytopathologists with an interest in the field involved in the International Mesothelioma Interest Group (IMIG) and the International Academy of Cytology (IAC) contributed to this update. Reference material includes peer-reviewed publications and textbooks.

RATIONALE

This article is the result of discussions during and after the IMIG 2012 conference in Boston, followed by thorough discussions during the 2013 IAC meeting in Paris. Additional contributions have been obtained from cytopathologists and scientists who could not attend these meetings, with final discussions and input during the IMIG 2014 conference in Cape Town.

The Bethesda system for reporting thyroid cytopathology: an institutional experience of the outcome of indeterminate categories

OBJECTIVE

In this study, we investigated the efficacy of the Bethesda system (TBS) for reporting thyroid cytopathology in determining the risk of malignancy for indeterminate cases. These cases comprised atypia or follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasia or suspicious for follicular neoplasia (FN/SFN) and suspicious for malignancy (SM) categories. AUS/FLUS cases were further subcategorized according to their patterns, and the malignancy rate for each subcategory was calculated.

METHODS

A total of 6310 thyroid fine needle aspiration (FNA) cases were analysed and 655 indeterminate cases were enrolled in the study. AUS/FLUS cases were further subcategorized into four patterns as follows: papillary thyroid carcinoma (PTC) pattern, microfollicle pattern, atypical cell pattern and Hürthle cell pattern.

RESULTS

Malignancy rates for AUS/FLUS, FN/SFN and SM were 18.9%, 45.7% and 71%, respectively. Malignancy rates for AUS/FLUS subcategories were as follows: PTC pattern, 28%; microfollicle pattern, 6.9%; atypical cell pattern, 22.2%; and Hürthle cell pattern, 0%.

CONCLUSION

The Bethesda system categorizes thyroid FNAs with increasing risk of malignancy as advocated. However, our findings suggest that the risk of malignancy for AUS/FLUS might be higher than estimated. Particularly, AUS/FLUS cases with focal features suggestive of PTC seem to be associated with a much higher risk of malignancy than other patterns.

A rare histological presentation of a common lung tumor: adenoleiomyomatous hamartoma

Hamartomas are the most common benign pulmonary tumors. They most often contain either chondromatous or lipomatous tissues. Thus, they show typical radiological findings which help to make a preoperative diagnosis of this benign tumor. We present a very rare case of a pulmonary hamartoma with atypical radiologic and histologic findings. Histological examination revealed the lesion to be an adenoleiomyomatous hamartoma.

Diagnostic terminology for reporting thyroid fine needle aspiration cytology: European Federation of Cytology Societies thyroid working party symposium, Lisbon 2009

A European Federation of Cytology Societies (EFCS) working party of 28 members from 14 European countries met at the European Congress of Cytology in Lisbon in September 2009, with two observers from the USA, to discuss the need for standardising thyroid FNA nomenclature in the light of the National Institute of Cancer (NCI) recommendations resulting from the State of the Science conference in Bethesda in 2007. The data were obtained through two questionnaires sent by email and a transcript of the live discussion at the congress, which is presented in full. The surveys and discussion showed that there were currently no national terminologies for reporting thyroid FNA in the different European countries except in Italy and the UK. Personal, 'local', surgical pathology and descriptive terminologies were in use. All but one of the working party members agreed that thyroid FNA reporting should be standardised. Whilst almost a third would adopt the NCI Bethesda terminology, which offers the advantages of a 'risk of cancer' correlation and is linked to clinical recommendations, more than half favoured a translation of local terminology as the first step towards a unified nomenclature, as has been done recently in the UK. There was some disagreement about the use of: a) the six-tiered as opposed to four or five-tiered systems, b) the use of an indeterminate category and c) the 'follicular neoplasm' category, which was felt by some participants not to be different from the 'suspicious of malignancy' category. The conclusions will be passed to the different national societies of cytology for discussion, who will be asked to map their local terminologies to the Bethesda classification, observe its acceptance by clinicians and audit its correlation with outcome.

An underrated potential risk of bronchiectasis: lymph node metastasis of a pulmonary tumorlet

Pulmonary tumorlets occur as the result of extensive scar caused by bronchiectasis or other inflammatory processes. They are minute lesions found in close association with the bronchioles and may rarely metastasize to lymph nodes. We present a 35-year-old male patient who underwent bilobectomy inferior with a diagnosis of bronchiectasis of 20 years duration. Histologic examination showed cystic bronchiectasis with areas of multiple neuro-endocrine tumorlets in addition to metastatic peribronchial lymph nodes. We emphasize the significance of early surgical treatment of bronchiectasis showing little to no response to medical therapy as well as peribronchial lymph node dissection.

An Underrated Potential Risk of Bronchiectasis: Lymph Node Metastasis of a Pulmonary Tumorlet

Pulmonary tumorlets occur as the result of extensive scar caused by bronchiectasis or other inflammatory processes. They are minute lesions found in close association with the bronchioles and may rarely metastasize to lymph nodes. We present a 35-year-old male patient who underwent bilobectomy inferior with a diagnosis of bronchiectasis of 20 years duration. Histologic examination showed cystic bronchiectasis with areas of multiple neuro-endocrine tumor-lets in addition to metastatic peribronchial lymph nodes. We emphasize the significance of early surgical treatment of bronchiectasis showing little to no response to medical therapy as well as peribronchial lymph node dissection.

Cystic lesions of the head and neck: cytohistological correlation in 63 cases

OBJECTIVE

To investigate the accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of cystic masses of the head and neck (H&N), excluding thyroid lesions.

METHODS

A total of 198 cases, 63 of whom had consequent surgical specimens, were retrieved from the files of two university hospitals and reviewed.

RESULTS

FNAC correctly diagnosed 25 of 36 neoplasms with a cystic component. Five Warthin's tumours, two squamous cell carcinomas, two mucoepidermoid carcinomas and two schwannomas yielded non-representative aspirates. Four of the missed Warthin's tumours and two mucoepidermoid carcinomas which were misdiagnosed as benign cysts were aspirated by their clinician. One branchial cleft cyst was cytologically interpreted as highly suspicious for carcinoma.

CONCLUSIONS

Disparate entities may present with similar cytological findings in the H&N region. A detailed description of differential diagnosis should be given in the cytology report in suspicious cases. Repeated aspirations from different sites of the lesion may reduce the false-negative rate.

Ascites and epithelial ovarian cancers: a reappraisal with respect to different aspects

Ascites is a common finding in patients with epithelial ovarian cancer (EOC). Clinico-pathologic correlations with respect to the presence of ascites, positive cytology and prognostic role of ascites, and the impact of ascitic volumes were not previously studied extensively. A total of 372 patients with EOC were retrospectively evaluated with respect to presence and amount of ascites, cytologic findings, and survival. Two groups were compared by using Chi-square, Student's t and Mann-Whitney U, binary logistic regression, Kaplan Meier and Cox-regression analysis tests, where appropriate. Omental metastasis (P < 0.001; OR: 3.21, 95% CI = 1.945-5.297) and mean number of metastatic lymph nodes (P= 0.008; OR: 1.063, 95% CI = 1.016-1.112) were significantly related with presence of ascites. Evaluation of ascitic volume at different thresholds revealed lymphatic-omental metastasis, and also the disease stage to be significantly different among patient groups at lower threshold values and the positive cytology and high-grade diseases at higher threshold values. In conclusion, presence of ascites correlates with both the intraperitoneal and also the retroperitoneal tumor spread. Amount of ascites has different correlations with the clinico-pathologic factors depending on the thresholds chosen. At lower volumes, lymphatic and omental metastasis seems to correlate with the development of ascites. Once ascites develops, tumor grade seems to be important for larger ascites volumes. Neither the presence of ascites or its volume nor the cytologic positivity was an independent predictor of survival.

Acute respiratory distress syndrome due toCryptococcus albiduspneumonia: Case report and review of the literature

Although cryptococcal infections due to Cryptococcus neoformans are frequently reported in the immunosuppressed patients, infections related to other Cryptococcus spp. are rarely reported. We are reporting a case of pulmonary infection and ARDS due to C. albidus in a patient receiving immunosuppressive therapy because of Still's disease. The diagnosis was made by tissue biopsy and culture. The patient responded to treatment with amphotericin B lipid complex 400 mg/day. The case is significant in that it reminds of yeasts as a cause of community acquired infection in the immunosuppressed patients.

Endobronchial lipoma in a patient with Churg-Strauss syndrome

Churg-Strauss syndrome (CSS) is a disorder characterized by hypereosinophilia and systemic vasculitis complicating a preexisting asthma. We report here a case of CSS with an endobronchial lesion, initially considered to be an endobronchial granuloma of CSS, which was finally diagnosed as a lipoma, a very rare benign tumor of the tracheobronchial tree. To our knowledge, this is the first case in the literature presenting with these two rare entities.

Effects of claritromycin on inflammatory parameters and clinical conditions in children with bronchiectasis1

BACKGROUND

The effects of the macrolides cannot be ascribed to their antibacterial action alone. Their immunoregulatory and anti-inflammatory functions are significant too. They are frequently used in the treatment of diffuse panbronchiolitis and cystic fibrosis (CF).

AIM

To evaluate the effects of a macrolide antibiotic [clarithromycin (CAM)] on the process of inflammation [by measuring IL-8, TNF-alpha, IL-10 levels and cell profiles in bronchoalveolar lavage (BAL) fluid], pulmonary function and sputum production in children with steady-state bronchiectasis, secondary to causes other than CF or primary immunodeficiencies.

METHODS

Seventeen patients randomized to the treatment group received CAM and supportive therapies for 3 months and 17 patients in the control group were given supportive therapies only.

RESULTS

Compared with the control group, the treatment group showed a significant decrease in IL-8 levels, total cell count, neutrophil ratios in BAL fluid and daily sputum production at the end of the third month. There was also a significant increase in the treatment group's BAL fluid macrophage ratios. The differences in pulmonary function test parameters were not significant.

CONCLUSION

Use of CAM in children with steady-state bronchiectasis results in laboratory improvement by reducing the inflammatory processes in the lungs. No corresponding clinical improvement could be shown but although this is possible with long-term use, trial validation is necessary.

Clinical results of a split sample liquid-based cytology (ThinPrep) study of 4,322 patients in a Turkish institution

PURPOSE

A prospective study was carried out to compare the efficacy of liquid-based cytology (ThinPrep) with the conventional Pap smear using a split-sample design in a Turkish university hospital outpatient gynecology clinic.

METHODS

4,322 consecutive patients were recruited for the study between 2002 and 2003. All the patients underwent conventional Pap tests followed by a ThinPrep test for screening of cervical cancer. The results were evaluated in terms of the Bethesda III classification. All the patients with abnormal tests underwent colposcopy and directed biopsy.

RESULTS

While 2.3% of the specimens were unsatisfactory for evaluation in the conventional Pap test group, this rate was 1.7% for the ThinPrep group. Epithelial cell abnormalities were observed in 42 (1.0%) patients in the conventional Pap test group and in 36 (0.8%) patients in the ThinPrep group. ASCUS was observed in 26 patients in the conventional Pap test group whereas the ThinPrep group had 20 cases of ASCUS as the leading cause of abnormal cytology. Biopsy of these cases revealed CIN 1 in two CIN 2-3 in three and cervical/endometrial adenocarcinoma in three patients. The ThinPrep application led to diagnoses of one additional case of CIN 2-3 and one case of adenocarcinoma among the negative or unsatisfactory for evaluation categories of the conventional Pap test group.

CONCLUSION

Despite an adverse bias introduced by the split-sample study design, application of ThinPrep showed an improved rate of specimen adequacy and increased sensitivity for more significant cervical precursor lesions over the conventional Pap test.

Brown tumour as a complication of secondary hyperparathyroidism in severe long-lasting vitamin D deficiency rickets

Brown tumour is a localised form of fibrous-cystic osteitis associated with primary or secondary hyperparathyroidism. Despite the fact that secondary hyperparathyroidism occurs in vitamin D deficiency rickets, no cases of rickets with brown tumour have so far been described. We present a 2.9-year-old girl who had brown tumour of the mandible due to severe vitamin D deficiency rickets. Treatment with vitamin D3 corrected the hyperparathyroidism rapidly which was followed by gradual regression in tumour size.

CONCLUSION

Brown tumour can develop in severe, long-standing vitamin D deficiency rickets and responds to vitamin D treatment.

Multiple bilateral chondromatous hamartomas of the lung. A rare entity mimicking metastatic carcinoma

Multiple chondromatous hamartomas are extremely rare and we have not found any bilateral presentation in the literature. We report the case of a 47-year-old woman presenting with a cough, chest pain and dyspnea. Chest x-ray and computed tomography revealed multiple and bilateral pulmonary nodules. A metastatic carcinoma was considered, but the open lung biopsy revealed a chondromatous hamartoma of the lung. The pathogenesis of hamartomas is discussed and the recent literature is reviewed.

Case report: squamous cell carcinoma of the skin metastasizing to the breast--imaging findings

An extremely rare case of metastatic squamous cell skin carcinoma to the breast is reported with imaging features. Ultrasonography and magnetic resonance imaging revealed well circumscribed, complex solid masses with papillary fronds projecting into cystic centres.

Subpulmonary and subaortic ridges in doubly committed subarterial ventricular septal defect: an echocardiographic study

BACKGROUND

Certain conditions, including discrete subaortic stenosis and right ventricular outflow tract obstruction are well-known associations with ventricular septal defect. However, the association of discrete type subpulmonary and subaortic stenosis with ventricular septal defect has not been described to date.

PATIENTS

In this report we present our experience in nine patients with doubly committed subarterial ventricular septal defect in whom associated discrete subpulmonary and subaortic stenosis were diagnosed by two-dimensional echocardiography. The mean age of the patients was 5.7 years, and eight of them were male. Two patients had additional hypertrophied anomalous muscle bundles with pressure gradients across the right ventricular outflow tract. Aortic valve prolapse was detected in two patients with one of them having mild aortic regurgitation.

INTERVENTION

Cardiac catheterization was performed in four patients, and three underwent surgery. Doubly committed subarterial ventricular septal defect was closed, and subpulmonary and subaortic ridges were resected in each patient. Histological findings were similar for both ridges, which were composed of thin, short and irregularly arranged elastic fibres covered by endothelial cells.

RESULTS

The finding of fibrous ridge on both sides of the doubly committed ventricular septal defect, where the turbulence is likely to be maximum, and the histopathological similarities of subpulmonary and subaortic ridges, may suggest a common mechanism for the development of fibrous ridges.

CONCLUSION

Serial echocardiographic assessment of patients with doubly committed ventricular septal defect is recommended.