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Goh LY, Limbachia K, Moonim M, Morley AMS. Primary lacrimal sac melanoma: a case report describing the novel use of fine needle aspiration cytology (FNAC) for diagnosis, together with literature review and immunotherapy treatment update. Orbit 2024; 43:270-279. [PMID: 36069101 DOI: 10.1080/01676830.2022.2119264] [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: 07/24/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
Primary lacrimal sac melanoma (PLSM) is exceedingly rare and associated with high morbidity and mortality. Unfortunately, PLSM often presents insidiously resulting in delayed detection and poor prognosis. A 69-year-old Black man was suspected of having a lacrimal sac tumour following presentation with a left sided watery eye, bloody tears, and a lacrimal mass. Due to the patient's implantable pacemaker, defibrillator, and high anticoagulation, an ultrasound-guided FNAC was performed instead of incisional biopsy, revealing a PLSM. Diagnosis was confirmed following complete tumour resection with free flap reconstruction and neck dissection. Unfortunately, disease progression ensued despite further neck dissection and three cycles of both pembrolizumab and iplimumab. This is the first description of FNAC to accurately diagnose PLSM and highlights its use as an accurate, rapid, and minimally invasive technique that may allow an earlier screening diagnosis of lacrimal sac tumours. We also discuss the outcome of immunotherapy in recent similar cases.
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Affiliation(s)
- Li Yen Goh
- Department of Ophthalmology, Guy's and St Thomas' Hospital NHS Trust, London, UK
| | - Ketan Limbachia
- Department of Ophthalmology, Guy's and St Thomas' Hospital NHS Trust, London, UK
| | - Mufaddal Moonim
- Department of Histopathology, Guy's and St Thomas' Hospital NHS Trust, London, UK
| | - Ana M S Morley
- Department of Ophthalmology, Guy's and St Thomas' Hospital NHS Trust, London, UK
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Juhlin CC, Baloch ZW. The 3 rd Edition of Bethesda System for Reporting Thyroid Cytopathology: Highlights and Comments. Endocr Pathol 2024; 35:77-79. [PMID: 38032439 DOI: 10.1007/s12022-023-09795-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/01/2023]
Affiliation(s)
| | - Zubair W Baloch
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Shahab J, Ahuja S, Singh M, Verma P, Ranga S. Comparison of liquid based cytology and conventional smears on lymph node aspirates: A cytomorphological study. Cytojournal 2024; 21:7. [PMID: 38469400 PMCID: PMC10927237 DOI: 10.25259/cytojournal_22_2023] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/06/2023] [Indexed: 03/13/2024] Open
Abstract
Objective In an era of minimally invasive and rapid diagnostic technologies, fine-needle aspiration cytology (FNAC) is most useful when it comes to patients with lymphadenopathies especially of the cervical region. Liquid-based cytology (LBC) is an alternative processing method which is used for both gynecological and non-gynecological samples. Because of the remarkable advantages of LBC smears in gynecological samples, nowadays, many studies have been done to assess its utility in various other lesions. Hereby, with the help of this study, we would like to evaluate the efficiency of LBC smears in comparison to conventional FNAC smears conventional smears (CS) on lymph node aspirates. Material and Methods A retrospective study was done over a 1-year period in which 253 cases of lymph node aspirates were included in the study. The slides were prepared using standard conventional and LBC techniques and compared for adequacy, cellularity, cell architecture, necrosis, background debris, presence of cells in monolayer sheets, and nuclear/cytoplasmic details. Results Of the total 253 cases, 171 (67.6%) were and 67 (26.5%) were diagnosed as non-neoplastic and malignant, respectively. Although the LBC smears were useful in the diagnosis of malignant cases, they did pose some challenges especially in the non-neoplastic lymph node aspirates due to loss of the background necrosis. In addition, the cellular yield in LBC smears was low in comparison to CS. Conclusion LBC smears from lymph node aspirates results in better diagnostic accuracy for malignant cases due to better cellular and nuclear details. However, for non-neoplastic etiology, it should not be considered better than CS as loss of the background necrosis and inflammation may result in an incorrect diagnosis.
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Affiliation(s)
- Juhi Shahab
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sana Ahuja
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Mukul Singh
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Pooja Verma
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sunil Ranga
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Jain A, Rai AK, Jain M. Spheno-Orbital Tuberculosis: A Rare Case. Indian J Otolaryngol Head Neck Surg 2024; 76:1134-1137. [PMID: 38440423 PMCID: PMC10908962 DOI: 10.1007/s12070-023-04175-5] [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: 07/27/2023] [Accepted: 08/21/2023] [Indexed: 03/06/2024] Open
Abstract
A 9-year-old girl presented with progressive, painless protrusion of the right eye for 2 months. She also complained of multiple bilateral neck swellings for 2 months. On examination, there was proptosis of the right eye with the eyeball displaced downwards and forwards. The extra ocular movements of the right eye showed limitation of abduction. The vision was normal in both eyes. A detailed clinical evaluation with investigations led to a diagnosis of spheno-orbital tuberculosis. Prompt initiation of anti-tubercular therapy (ATT) led to resolution of the lesion.
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Affiliation(s)
- Avani Jain
- Department of ENT, ESIC Medical College and Hospital, Faridabad, India
| | - Anil Kumar Rai
- Department of ENT, ESIC Medical College and Hospital, Faridabad, India
| | - Manjula Jain
- Department of Pathology, ESIC Medical College and Hospital, Faridabad, India
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Garg K, Kapila S, Gulati A, Azad RK, Thakur JS. Sonographic and Cytological Evaluation of Salivary Gland Tumors. Indian J Otolaryngol Head Neck Surg 2023; 75:3427-3431. [PMID: 37974681 PMCID: PMC10646000 DOI: 10.1007/s12070-023-04020-9] [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: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Salivary gland tumours are relatively uncommon, but they have a multifaceted clinical presentation and varied morphological configuration. The investigations required for these tumours remain debatable. We conducted a study to determine the accuracy of various modalities used in salivary gland tumours. METHODS We enrolled 72 subjects, consisting of 44 females and 28 males, with a mean age of 40.93 ± 16.51 years (range: 15 to 79 years), suffering from various salivary gland tumours. The tumour distribution included 42 parotid gland tumours (58.33%), followed by 21 submandibular gland tumours (29.16%), three sublingual gland tumours (4.16%), and six minor salivary gland tumours (8.33%). These individuals were subjected to clinical examination, sonography, and fine needle aspiration cytology as per indications. The results of each modality were compared to surgical pathology to find sensitivity and accuracy. RESULTS The clinical examination was found to be least sensitive (83.8%) as compared to FNAC (97.6%), and ultrasound (100%). Ultrasound had the highest diagnostic accuracy (86.2%) as compared to clinical examination (80.6%) and FNAC (82.6%). CONCLUSION Although sonography was found to have the highest sensitivity and accuracy as compared to fine needle aspiration cytology and clinical examination, the difference was subtle, as both sonography and fine needle aspiration cytology had a statistically significant correlation with histopathology.
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Affiliation(s)
- Komal Garg
- Dept of Otolaryngology-Head and Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, HP.171001 India
| | - Sumala Kapila
- Dept of Radiodiagnosis, Indira Gandhi Medical College, Shimla, HP.171001 India
| | - Anchana Gulati
- Dept of Pathology, Indira Gandhi Medical College, Shimla, HP.171001 India
| | - Ramesh K Azad
- Dept of Otolaryngology-Head and Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, HP.171001 India
| | - Jagdeep S Thakur
- Dept of Otolaryngology-Head and Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, HP.171001 India
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Shahab J, Maheshwari R, Singh M, Sharma R, Ahluwalia C, Zaheer S, Ahuja S. Cytomorphology of mesenchymal lesions in a tertiary care centre and its correlation with histopathology. Cytojournal 2023; 20:36. [PMID: 37942308 PMCID: PMC10629282 DOI: 10.25259/cytojournal_2_2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/13/2023] [Indexed: 11/10/2023] Open
Abstract
Objectives Fine needle aspiration cytology (FNAC) is a minimally invasive method for sampling a heterogenous lesion. It is one of the first-line investigations in the evaluation of soft tissue tumours. However, the heterogeneity of mesenchymal lesions pose a challenge to the cytological diagnosis. The present study aims at evaluation of the cytomorphological findings of mesenchymal lesions on FNAC along with their histopathological correlation. Material and Methods This was a retrospective study conducted over a period of 1 year from January 2021 to January 2022. All the patients of cytologically diagnosed mesenchymal lesions on their FNA aspirates were included in the study. Cytomorphology of the May Grunwald Giemsa and Papanicolaou stained slides were examined and correlated with clinical and histopathological details wherever available. Results Out of the 90 patients, 69 (76.7%) were males and 21 (23.3%) were females. Maximum number of cases were in 4-5th decade of life. The lower limb was found to be the most common site (57.8%) for the mesenchymal lesions. Majority of the cases on FNA in our study were found to be benign - 79 (87.8%), while only 11 cases were malignant (12.2%). On cytological examination, spindle cell lesions were most common followed by adipocytic lesions. Based on the cyto-histological correlation, sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of FNAC in diagnosis of mesenchymal lesion was 78.6%, 100%, 92.5%, 100% and 94.1% respectively. Conclusion FNAC is a simple and minimally invasive tool that plays an important role in triaging patients with good specificity and sensitivity.
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Affiliation(s)
- Juhi Shahab
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rashi Maheshwari
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Mukul Singh
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rohit Sharma
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Charanjeet Ahluwalia
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sufian Zaheer
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sana Ahuja
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Singh A, Rawat S, Kumar G, Singh US, Sagar M. Solitary superficial angiomyxoma of the ear pinna: a diagnostic dilemma with a review of literature. Arch Clin Cases 2023; 10:128-132. [PMID: 37767055 PMCID: PMC10521636 DOI: 10.22551/2023.40.1003.10258] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
Superficial angiomyxoma is an extremely rare subcutaneously placed myxoid soft tissue neoplasm. There are few case reports with fine needle aspiration cytological and histopathological findings available for this tumor because of its rarity. Here, we describe a case of superficial angiomyxoma in a 24-year-old girl who had a solitary left ear pinna mass without a Carney's complex at the time of presentation or at the end of two years of follow-up next to the surgical removal of the tumor. The clinical, cytomorphological, and histological findings, together with the immunohistochemical markers, in a case of superficial angiomyxoma are described in this rare case report for the first time in the English literature.
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Affiliation(s)
- Anurag Singh
- Department of Pathology, King George Medical University, Lucknow, India
| | - Shalini Rawat
- Department of Pathology, King George Medical University, Lucknow, India
| | - Gulshan Kumar
- Department of Pathology, King George Medical University, Lucknow, India
| | - Uma Shankar Singh
- Department of Pathology, King George Medical University, Lucknow, India
| | - Mala Sagar
- Department of Pathology, King George Medical University, Lucknow, India
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Yadav SK, Chandana BK, Panwar H, Chaurasia JK, Jayashankar E, Asati D. Role of cytopathology in diagnosing phaeohyphomycosis masquerading as nerve abscess in a lepromatous leprosy patient: A case report. Int J Surg Case Rep 2023; 110:108741. [PMID: 37657385 PMCID: PMC10509889 DOI: 10.1016/j.ijscr.2023.108741] [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: 08/09/2023] [Revised: 08/26/2023] [Accepted: 08/26/2023] [Indexed: 09/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Phaeohyphomycosis is a rare fungal infection primarily affecting immunocompromised individuals. Its clinical manifestations are diverse, and diagnosis can be challenging, particularly when lesions mimic other conditions. CASE PRESENTATION A 66-year-old male, with a history of irregular leprosy treatment and prolonged steroid use, presented with symptoms suggestive of a nerve abscess. On examination, cystic swellings were observed on the left thumb and leg. Histopathological examination and fine needle aspiration cytology (FNAC) revealed melanized hyphae, leading to a final diagnosis of phaeohyphomycosis. The patient was treated with oral itraconazole, leading to regression in lesion size. CLINICAL DISCUSSION Leprosy patients on long-term steroids are especially susceptible. The pathogenicity of these fungi in immunocompetent people is believed to be due to melanin in their cell walls, which defends against host defenses. Diagnosis involves histopathological examinations, staining, and fungal culture. Treatment involves surgical excision and antifungal drugs. If untreated, it can lead to severe complications including fatal brain infections. CONCLUSION This case highlights the unusual presentation of phaeohyphomycosis mimicking a nerve abscess in a leprosy patient. It underscores the importance of a high degree of clinical suspicion in diagnosing such rare infections, particularly in immunocompromised individuals. It also emphasizes the value of FNAC in reaching a definitive diagnosis. Prompt diagnosis and appropriate treatment are essential to prevent potentially serious outcomes.
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Affiliation(s)
- Shakti Kumar Yadav
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, India.
| | - B K Chandana
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Hemlata Panwar
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Jai Kumar Chaurasia
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - E Jayashankar
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Dinesh Asati
- Department of Dermatology, All India Institute of Medical Sciences, Bhopal, India
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Parmar RA, Patel KA. Fine Needle Aspiration Cytology's Role in the Diagnosis of Ovarian Tumor. J Midlife Health 2023; 14:159-164. [PMID: 38312758 PMCID: PMC10836434 DOI: 10.4103/jmh.jmh_82_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/04/2023] [Accepted: 07/22/2023] [Indexed: 02/06/2024] Open
Abstract
Fine needle aspiration cytology (FNAC) is a cost-effective, minimally invasive technique for diagnosing a wide range of benign and malignant lesions. However, there are a number of reasons why its use is limited in the diagnosis of ovarian cancer, such as the fear of tumor cells spilling into the peritoneal cavity and the difficulty of subtyping with cytology alone. In experienced hands, FNAC is a safe, cost-effective procedure with acceptable diagnostic accuracy. In ovarian cystic lesions, secondary degenerative changes and the sample's low cellularity were the primary causes of false negative FNAC results. Preparing cell block can partially avoid this, so we recommend doing so. All of the clinical and sonographic findings, in addition to the FNAC findings, the preparation of the cell block, and the application of immunohistochemistry, need to be taken into consideration in order to arrive at an accurate diagnosis.
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Affiliation(s)
- Riddhi A. Parmar
- Department of Pathology, All India Institute of Medical Sciences, Rajkot, Gujarat, India
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Gkionis IG, Giakoumakis MI, Liva D, Tsioulos G, Matalliotakis M, Vrontaki M, Giakoumakis KI, Cavallo G, Laliotis A. Zuska's disease in a male patient. The critical role of ultrasound imaging in diagnosis and management of this rare entity. Radiol Case Rep 2023; 18:2149-2153. [PMID: 37089980 PMCID: PMC10120369 DOI: 10.1016/j.radcr.2023.03.010] [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: 02/02/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 04/25/2023] Open
Abstract
Zuska's disease is a pathologic entity characterized by the formation of subareolar breast abscess caused by the obstruction of lactiferous ducts. Although Zuska's disease is found relatively often in female patients, only 19 male cases have been reported. That makes Zuska's diagnosis challenging in males, leading to significant morbidity and high recurrence rates. Clinical evaluation and imaging techniques, especially ultrasound and mammography, are considered the cornerstones for the diagnosis of Zuska's disease, whereas fine-needle aspiration cytology is necessary in order to exclude malignancy. Multiple treatment approaches have been used including conservative antibiotic therapy, drainage of the abscess and surgical excision of the lactiferous ducts. We present the case of a 57 year old male who was diagnosed with Zuska's disease and treated via ultrasound-guided drainage of the abscess. Having a high level of suspicion, performing appropriate imaging tests and offering definite treatment, is the only way to decrease morbidity and recurrence.
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Affiliation(s)
- Ioannis G. Gkionis
- Department of General Surgery, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion 71409, Crete, Greece
- Corresponding author.
| | - Michail I. Giakoumakis
- Department of General Surgery, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion 71409, Crete, Greece
| | - Dimitra Liva
- Department of Radiology and Imaging Diagnostics, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion, Crete, Greece
| | - Georgios Tsioulos
- Department of Radiology and Imaging Diagnostics, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion, Crete, Greece
| | - Michail Matalliotakis
- Department of Obstetrics and Gynaecology, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion, Crete, Greece
| | - Maria Vrontaki
- Department of Cytopathology, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion, Crete, Greece
| | | | - Gerardina Cavallo
- Department of Radiology and Imaging Diagnostics, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion, Crete, Greece
| | - Aggelos Laliotis
- Department of General Surgery, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion 71409, Crete, Greece
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Mu WN, Li JH, Liu Y, Wen Y, Liu X. Clinical application of ultrasound-guided Core Needle Biopsy Histology and Fine Needle Aspiration Cytology in Cervical Lymph Nodes. Pak J Med Sci 2023; 39:752-756. [PMID: 37250537 PMCID: PMC10214824 DOI: 10.12669/pjms.39.3.6630] [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: 05/16/2022] [Revised: 07/15/2022] [Accepted: 01/29/2023] [Indexed: 11/02/2023] Open
Abstract
Objectives To investigate the difference of application of core needle biopsy histology and fine needle aspiration cytology in cervical lymphadenopathy. Methods A retrospective analysis was made on 80 patients with cervical lymphadenopathy admitted to Baoding No.1 Central Hospital from to October 2018 to February 2020, and they were randomly divided into two groups: core needle group and fine needle group. Patients in the core needle group were given core needle biopsy histology, while those in the fine needle group were given fine needle aspiration cytology, and the puncture results and surgical complications were compared between the two groups. Results The accuracy rates of the core needle group and the fine needle group in the diagnosis of malignant cervical lymph nodes were 95.83% and 72.22% respectively, with a statistically significant difference (χ²=4.683, p=0.030). The sensitivity, specificity, positive predictive value and negative predictive value of the core needle group were 100.00%, 93.75%, 95.83% and 100.00% respectively, while those of the fine needle group were 86.67%, 90.00%, 86.67% and 90.00% respectively, with no statistically significant differences between the two groups (p>0.05). The complication rate in the core needle group was 22.50%, which was higher than the 5.00% in the fine needle group (χ²=5.165, p=0.023). Conclusions No significant difference was observed between core needle biopsy histology and fine needle aspiration cytology in diagnosing cervical lymphadenopathy, but the former has a high complication rate.
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Affiliation(s)
- Wei-na Mu
- Wei-na Mu, Department of Ultrasound, Baoding No.1 Central Hospital, Baoding 071000, Hebei, China
| | - Jian-heng Li
- Jian-heng Li, Hebei University, Baoding 071000, Hebei, China
| | - Ying Liu
- Ying Liu Department of Ultrasound, Baoding Baoshihua Oriental Hospital, Baoding 071051, Hebei, China
| | - Ying Wen
- Ying Wen Department of Ultrasound, The 82 Group Army Hospital of the People’s Liberation Army of China, Baoding 071000, Hebei, China
| | - Xin Liu
- Xin Liu, Department of Ultrasound, Baoding No.1 Central Hospital, Baoding 071000, Hebei, China
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Montella M, Lucà S, Ronchi A, Marino FZ, Caputo A, Sica A, Zeppa P, Franco R, Cozzolino I. How to Diagnose Anaplastic Large Cell Lymphoma on Cytological Samples? A Series with Emphasis on Diagnostic Clue and Pitfalls. Acta Cytol 2023:1-10. [PMID: 36634640 DOI: 10.1159/000528533] [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: 09/07/2022] [Accepted: 11/28/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Anaplastic large cell lymphoma (ALCL) is a rare mature T-cell non-Hodgkin's lymphoma characterized by large and pleomorphic neoplastic CD30-positive T cells. ALCL includes different subtypes with different clinical and biological features: systemic ALCL, primary cutaneous ALCL, breast implant-associated ALCL (BIA-ALCL). Anaplastic lymphoma kinase (ALK) is overexpressed and rearranged in some systemic cases. Diagnosis of ALCL may be challenging on cytological samples, but the correct diagnosis is mandatory for the management of the patient. METHODS A retrospective series of 12 ALCLs diagnosed by cytology is reported. Cytological samples included lymph nodes and skin lesions fine needle aspiration cytology, peritoneal effusion, and periprosthetic fluid. Microscopic evaluation was performed on direct smears, cell-block sections, and cytocentrifugated slides. Immunocytochemistry was performed on cell-block sections, direct smears, and cytocentrifugated slides. Molecular evaluation by fluorescent in-situ hybridization (FISH) was performed on cell-block sections. RESULTS The series included 4 ALK+ ALCLs, 5 ALK- ALCLs, and 3 BIA-ALCLs. FNAC was performed on lymph nodes in 8 cases and on skin lesion in 1 case. In this last case, a peritoneal effusion was also evaluated. Breast periprosthetic fluids were evaluated in 3 cases. A large immunocytochemical panel was performed in each case, and FISH in 3 cases, demonstrating ALK rearrangement in a case of ALK+ ALCL. A final diagnosis was rendered in all cases. In the case of skin lesion, the differential diagnosis between systemic ALCL and primary cutaneous ALCL was possible. CONCLUSION The cytological diagnosis of ALCL may be challenging, and the proper management of the collected sample is mandatory. The rapid on-site evaluation and the realization of a cell block are strongly recommended. Immunocytochemistry is mandatory for the diagnosis and a large antibodies panel is needed as differential diagnosis includes many different neoplasms. FISH may be useful to evaluate ALK rearrangements. When properly managed, cytology can lead to a reliable final diagnosis of ALCL.
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Affiliation(s)
- Marco Montella
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefano Lucà
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Federica Zito Marino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alessandro Caputo
- Pathology Unit, San Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - Antonello Sica
- Oncohaematology Unit, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pio Zeppa
- Pathology Unit, San Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Immacolata Cozzolino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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Ren Y, Shi Y, Zhou Z, Yang D, Xie J, Zhang Z, Wang J. Ultrasonographic and cytological characterization of ultrasound-guided fine-needle aspiration cytology of cervical lymph nodes for false-negative and false-positive diagnosis. Eur Arch Otorhinolaryngol 2022; 280:2463-2470. [PMID: 36571612 DOI: 10.1007/s00405-022-07802-z] [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: 11/20/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The primary goal of this study was to examine the ultrasound and cytological characteristics of inconsistent cases (false negatives and false positives)of ultrasound-guided fine-needle aspiration cytology (US-FNAC) of cervical lymph nodes, to investigate factors influencing the diagnostic accuracy of fine-needle aspiration, and to improve diagnostic efficiency. METHODS The results of US and FNAC of cervical lymph nodes in 562 cases treated at our institution from February 2019 to June 2021 were retrospectively analyzed. FNAC cytology results were compared with the final diagnostic results (242 surgical resections/core-needle biopsy, 320 cases followed up for more than 1 year), and the final diagnostic results were taken as the gold standard, and the ultrasound features and clinicopathology-related features were systematically retrospectively analyzed in cases of inconsistency. RESULTS The overall diagnostic accuracy of US-FNAC for cervical lymph nodes was 94.9%, with a false-negative rate of 6.7% and a false-positive rate of 3.8%. Analyzing the cases, sampling error due to factors associated with ultrasound features, such as larger, more numerous nodes, non-solid, hypoechoic, inhomogeneous, and increased vascularity are the main causes of false-negative diagnosis, while smaller nodules, overlapping cytologic patterns, and overinterpretation by pathologists are associated with false-positive FNAC results. CONCLUSIONS Proper interpretation of cytomorphologic and ultrasound features can improve diagnostic accuracy, and diagnostic misdiagnosis should be carefully observed, the identification of both features should be enhanced to reduce interpretation errors and sampling errors and to reduce the rate of misdiagnosis and missed diagnoses in fine needle aspiration of lymph nodes.
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Affiliation(s)
- Yiqun Ren
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Yucong Shi
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Zubang Zhou
- Department of Ultrasound, Gansu Provincial Hospital, No. 204 West Dong-Gang Road, Lanzhou, Gan su, 730000, China.
| | - Daxiong Yang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Jinhui Xie
- Department of Ultrasound, Gansu Provincial Hospital, No. 204 West Dong-Gang Road, Lanzhou, Gan su, 730000, China
| | - Zhi Zhang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Jiao Wang
- Gansu University of Traditional Chinese Medicine, Lanzhou, China
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14
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Lasolle H, Lopez J, Pattou F, Borson-Chazot F, Bardet S, Groussin L, Buffet C. SFE-AFCE-SFMN 2022 Consensus on the management of thyroid nodules : Role of molecular tests for cytologically indeterminate thyroid nodules. Ann Endocrinol (Paris) 2022; 83:395-400. [PMID: 36283464 DOI: 10.1016/j.ando.2022.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The SFE-AFCE-SFMN 2022 consensus deals with the management of thyroid nodules, a condition that is a frequent reason for consultation in endocrinology. In more than 90% of cases, patients are euthyroid, with benign non-progressive nodules that do not warrant specific treatment. The clinician's objective is to detect malignant thyroid nodules at risk of recurrence and death, toxic nodules responsible for hyperthyroidism or compressive nodules warranting treatment. The diagnosis and treatment of thyroid nodules requires close collaboration between endocrinologists, nuclear medicine physicians and surgeons, but also involves other specialists. Therefore, this consensus statement was established jointly by 3 societies: the French Society of Endocrinology (SFE), French Association of Endocrine Surgery (AFCE) and French Society of Nuclear Medicine (SFMN); the various working groups included experts from other specialties (pathologists, radiologists, pediatricians, biologists, etc.). Because of the emerging role of molecular fine-needle cytology diagnostics, the French Endocrine Society convened a panel of experts to review the evidence for the diagnostic value of molecular tests performed on cytologically indeterminate thyroid nodules.
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Affiliation(s)
- Hélène Lasolle
- Fédération d'endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; Inserm U1290, université Claude-Bernard Lyon 1, Lyon, France
| | - Jonathan Lopez
- Département de biochimie et de biologie moléculaire, centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Cancer Research Center of Lyon, Lyon 1 University, Lyon, France
| | - François Pattou
- Service de chirurgie générale et endocrinienne, CHRU de Lille, Université de Lille, Lille, France
| | - Françoise Borson-Chazot
- Département de médecine nucléaire, centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Stéphane Bardet
- Département de médecine nucléaire, centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Lionel Groussin
- Service d'Endocrinologie, AP-HP, hôpital Cochin, université de Paris, Paris, France
| | - Camille Buffet
- Sorbonne université, GRC n°16, GRC tumeurs thyroïdiennes, service des pathologies thyroïdiennes et tumorales endocrines, AP-HP, hôpital Pitié-Salpêtrière, 75013 Paris, France.
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15
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Singh K, Kumar Mishra A, Kour A, Gupta A. Novel Approach for Management of Extremely Rare Pleomorphic Adenoma of Soft Palate (Minor Salivary Glands). Indian J Otolaryngol Head Neck Surg 2022; 74:1989-1991. [PMID: 36452514 PMCID: PMC9702112 DOI: 10.1007/s12070-020-01946-2] [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: 03/15/2020] [Accepted: 06/30/2020] [Indexed: 11/26/2022] Open
Abstract
Salivary gland tumours account for 2-3% of tumours occurring in head and neck region, majority of them being benign. Pleomorphic Adenoma present mainly in Parotid gland and Sub-mandibular gland and rarely in minor salivary glands. The tumours of minor salivary glands are generally malignant. The commonest sites of intra oral Pleomorphic adenoma are palate, lip and buccal mucosa. Here I describe a very rare case of Pleomorphic Adenoma in minor salivary glands and its novel management using CO2 Laser. There was no recurrence seen after a follow-up period of around one year.
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Affiliation(s)
| | | | | | - Arun Gupta
- Armed Forces Medical College, Pune, Maharashtra India
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16
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Tay WJ, Tan GZL, Wu B, Petersson F. Oncocytic low-grade myoepithelial carcinoma ex pleomorphic adenoma - A rare case illustrating key learning points. Ann Diagn Pathol 2022; 60:152011. [PMID: 35905533 DOI: 10.1016/j.anndiagpath.2022.152011] [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: 06/27/2022] [Revised: 07/08/2022] [Accepted: 07/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Oncocytic myoepithelial carcinoma ex pleomorphic adenoma neoplastic is a rare neoplastic event and may not display overt malignant radiological features. METHODS Using routine histopathology and immunohistochemistry, we characterize a case of low-grade oncocytic carcinoma ex pleomorphic adenoma. RESULTS The tumor arose in the left parotid gland in a 59 year old female. Computed tomography (CT) imaging demonstrated a well-defined, lobulated, enhancing lesion with relative central stellate hypoenhancement. Histologically, the tumor displayed a multi-nodular, non-destructive, invasive pattern, low mitotic activity (one mitotic figure per 10 high power fields) and a small remnant focus of pleomorphic adenoma. The neoplastic cells showed significant expression of cytokeratin 5/6, S-100 protein, smooth muscle actin and p63. CONCLUSION Low-grade oncocytic carcinoma ex pleomorphic adenoma is a challenging histopathological diagnosis which can be established with use of immunohistochemistry, generous tumor sampling and recognition of the multi-nodular, non-destructive, pattern of invasion. In the absence of clear-cut tumor encroachment into external structures, its malignant nature may not be easily identified on pre-operative imaging.
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Affiliation(s)
- Wan Jing Tay
- Department of Pathology, National University Health System, Singapore, Singapore
| | - Gideon Ze Lin Tan
- Department of Pathology, National University Health System, Singapore, Singapore
| | - Bingcheng Wu
- Department of Pathology, National University Health System, Singapore, Singapore
| | - Fredrik Petersson
- Department of Pathology, National University Health System, Singapore, Singapore.
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17
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Canberk S, Thodou E, Bongiovanni M. Small-Cell Malignancies of Thyroid: Challenge Solved? Acta Cytol 2022; 66:307-318. [PMID: 35016187 DOI: 10.1159/000520876] [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: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022]
Abstract
"Small-cell malignancies of thyroid" is an unsolved dilemma. This term represents an umbrella terminology in thyroid, encompassing for a small group of tumors in which some of them are well-recognized tumors like medullary thyroid carcinoma, poorly differentiated thyroid carcinoma, and primary thyroid lymphomas and teratoma, whereas the remaining are less known as primary neuroendocrine carcinoma of thyroid, primary extraskeletal Ewing family tumors, and adamantinoma-like Ewing sarcoma. When the issue comes to evaluate a cytological sample predominantly composed of small-cell morphology, metastatic small-cell carcinomas to thyroid also should be excluded. In this review, our group focused on the main cytomorphological and clinical clues of each entity that help to set up a correct differential diagnosis. The literature discussions were also included for the entities that are not yet recognized by the mother publication WHO. A key point of the issue's simple algorithm based on FNAC with small-cell morphology of thyroid was suggested by the authors.
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Affiliation(s)
- Sule Canberk
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
- Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal
- Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal
| | - Eleni Thodou
- Department of Pathology, Faculty of Medicine, University of Thessaly, Larisa, Greece
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18
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Zhou J, Li Q, Luo B, Fu X, Ou C, Gao X, Xu Z, Feng D, Yang K. Primary desmoplastic small round cell tumor of the submandibular gland: a case report and literature review. Diagn Pathol 2022; 17:6. [PMID: 34996495 PMCID: PMC8742402 DOI: 10.1186/s13000-021-01183-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Desmoplastic small round cell tumor (DSRCT) is a sporadic, highly malignant tumor with a poor prognosis. The abdomen and pelvis have been reported as the primary localization sites. However, to the best of our knowledge, there are few reports on primary DSRCT in the submandibular gland. Case presentation We report a case of a 26-year-old Chinese man with a mass in the right submandibular gland. Imaging studies showed a hypoechoic mass in the right submandibular region. Intraoperative pathology revealed that the tumor tissue was composed of small round tumor cells and a dense desmoplastic stroma. On immunostaining, the tumor cells showed markers of epithelial, mesenchymal, myogenic, and neural differentiation. The EWSR1 gene rearrangement was detected by fluorescence in situ hybridization. Based on the overall morphological features and immunohistochemical findings, a final diagnosis of DSRCT was made. The patient was treated with comprehensive anti-tumor therapy mainly based on radiotherapy and chemotherapy. Conclusions DSRCT is an uncommon malignant neoplasm with rare submandibular gland involvement. In this report, we have described a case of DSRCT in the submandibular gland and reviewed the literature on DSRCT over the past 5 years. Considering the importance of differential diagnosis between DSRCT, especially with rare extra-peritoneal involvement, and small round blue cell tumors, a full recognition of the clinicopathological features will help to better diagnose this neoplasm. Supplementary Information The online version contains supplementary material available at 10.1186/s13000-021-01183-3.
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Affiliation(s)
- Jiayu Zhou
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Qingling Li
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Baihua Luo
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaodan Fu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Chunlin Ou
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaomei Gao
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhijie Xu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Deyun Feng
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Keda Yang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China.
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19
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Hajiioannou J, Gkrinia E, Brotis GA, Saratziotis A, Nepka C, Korais C, Skoulakis C. Diagnostic accuracy of fine needle aspiration cytology in parotid gland lesions. Hippokratia 2022; 26:25-31. [PMID: 37124281 PMCID: PMC10132389] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND This study aimed to estimate the fine needle aspiration cytology's (FNAC) diagnostic accuracy in differentiating neoplastic from inflammatory lesions (Q1) and malignant from their benign counterparts (Q2). METHODS We present a retrospective case series covering a single University Hospital and six attending head and neck surgeons over eight years (January 2011 to July 2017). We concentrated on adults with clinically suspected parotid gland lesions. We offered all patients FNAC biopsy preoperatively, and the final diagnosis was established based on the findings of the final histology. The FNAC and histology results were cross-tabulated in a 2 x 2 contingency table, from which we calculated the diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values. RESULTS From 212 consecutive patients reviewed, and after excluding thirteen cases (8 %) of valid but non-diagnostic FNAC, 161 cases (50 females and 111 males) fulfilled set eligibility criteria. The most common diagnosis was Warthin tumors (53 patients, 34 %), followed by pleomorphic adenomas (52 patients, 33.5 %). The sensitivity and specificity of FNAC in differentiating neoplastic from non-neoplastic lesions and in segregating malignant from benign conditions were estimated to be as high as 50 % and 97 %, and 98 % and 93 %, respectively. CONCLUSION FNAC is moderately effective in differentiating non-neoplastic from neoplastic disease and highly accurate in selecting malignant lesions from benign ones. Although the lack of FNAC sensitivity can occasionally be problematic, it still comprises a valuable tool in salivary gland surgery. HIPPOKRATIA 2022, 26 (1):25-31.
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Affiliation(s)
- J Hajiioannou
- Department of Head and Neck Surgery, University Hospital of Larissa, Larissa, Greece
| | - E Gkrinia
- Department of Head and Neck Surgery, University Hospital of Larissa, Larissa, Greece
| | - G A Brotis
- Department of Neurosurgery, University Hospital of Larissa, Larissa, Greece
| | - A Saratziotis
- Department of Head and Neck Surgery, University Hospital of Larissa, Larissa, Greece
| | - C Nepka
- Histopathology Department, University Hospital of Larissa, Larissa, Greece
| | - C Korais
- Department of Head and Neck Surgery, University Hospital of Larissa, Larissa, Greece
| | - C Skoulakis
- Department of Head and Neck Surgery, University Hospital of Larissa, Larissa, Greece
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20
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Kihara M, Miyauchi A, Hirokawa M, Masuoka H, Higashiyama T, Onoda N, Ito Y, Miya A. Long-term outcomes of cytologically benign thyroid tumors: a retrospective analysis of 3,102 patients at a single institution. Endocr J 2021; 68:1373-1381. [PMID: 34275959 DOI: 10.1507/endocrj.ej21-0252] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Some thyroid tumors that are cytologically diagnosed as benign may be pathologically diagnosed as malignant. Here, we investigated the long-term outcomes of patients with thyroid tumors with benign cytology, and the factors for malignancy. We retrospectively reviewed the cases of 3,102 patients with thyroid tumors >1 cm cytologically diagnosed as benign at our hospital during a 1-year period from January 2007. The median follow-up duration for all patients was 68.7 (range 0.0-168.7) months. Immediate surgery and delayed surgery were performed in 393 and 148 patients, respectively. Eventually, 541 (17.4%) of the 3,102 patients underwent a thyroidectomy, and 2,561 (82.6%) were observed without surgery. Among the surgically treated patients, the tumors of 525 (97.0%) and 16 (3.0%) were pathologically diagnosed as benign and malignant, respectively. There was no significant difference in age, gender, tumor size, serum thyroglobulin level at surgery, or the tumor volume-doubling rate (TV-DR) between the benign and malignant cases. Only the ultrasonographic findings based on our hospital's classification system were directly and significantly linked to pathological diagnosis (p < 0.01). Among the tumors of the 667 patients who were followed without surgery for >10 years, 89.9% remained unchanged and 7.2% were reduced in size. Ultrasonographic evaluation provides important information for therapeutic decision-making regarding surgery versus observation for cytologically benign tumors.
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Affiliation(s)
- Minoru Kihara
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Akira Miyauchi
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | | | - Hiroo Masuoka
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | | | - Naoyoshi Onoda
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Yasuhiro Ito
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Akihiro Miya
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
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21
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Liu J, Liu X, Guo Z, Lv X, Mao W, Xu D, Wang L. Ultrasound-guided fine needle aspiration cytology of Para-aortic lymph node metastasis in uterine cervical cancer: diagnostic accuracy and impact on clinical decision making. BMC Cancer 2021; 21:964. [PMID: 34452609 PMCID: PMC8393715 DOI: 10.1186/s12885-021-08492-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The main aim of this study was to ascertain the effectiveness of ultrasound-guided fine needle aspiration cytology (US-FNAC) in the diagnosis of para-aortic lymph node (PALN) metastasis in uterine cervical cancer and to establish its potential impact on clinical therapeutic decision making. METHODS We retrospectively reviewed clinical data from 92 patients diagnosed with cervical cancer with PALN enlargement between 2010 and 2018. Cytological results obtained with US-FNAC were classified by the same experienced cellular pathologists. Diagnostic indicators were determined on the basis of biopsy, imaging and clinical follow-up results. Univariate and multivariate analyses were used to assess the differences of influencing factors. The effect of US-FNAC on clinical decision making was evaluated. RESULTS Cytological results of US-FNAC were categorized as malignancy (n = 62; 67.4%), suspicious malignancy (n = 11; 12.0%), undetermined (n = 5; 5.4%), benign (n = 10; 10.9%), and inadequate (n = 4; 4.3%). Satisfactory biopsy samples were obtained from 95.7% of PALNs sampled (88/92). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAC in distinguishing benign from malignant cases were 90.1% (95% CI: 0.809-0.953), 100% (95% CI: 0.561-1), 100% (95% CI: 0.938-1), 46.7% (95% CI: 0.223-0.726) and 90.9% (95% CI: 0.848-0.970), respectively. Univariate analysis indicated significant differences in experience of puncture physicians (radiologists) between the correct and wrong diagnosis groups (P < 0.05), which was further confirmed as an independent predictor of diagnostic accuracy in multivariate analysis (p = 0.031, OR = 0.077, 95% CI: 0.354-0.919). All patients tolerated the US-FNAC procedure well and only nine presented slight abdominal discomfort. The therapeutic strategies for 74 patients (80.4%) were influenced by US-FNAC findings. CONCLUSIONS US-FNAC was a relatively safe and effective technique for examination of enlarged para-aortic lymph nodes and may therefore serve as a routine diagnostic tool to guide clinical decision making for management of cervical cancer.
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Affiliation(s)
- Junping Liu
- Department of Ultrasound, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang Province, China
| | - Xin Liu
- Department of Ultrasound, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang Province, China
| | - Zhengying Guo
- Department of Pathology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang Province, China
| | - Xiaojuan Lv
- Department of Gynecologic Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang Province, China
| | - Weimin Mao
- Zhejiang Key Laboratory of the Diagnosis & Treatment Technology on Thoracic Oncology, No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang Province, China
| | - Dong Xu
- Department of Ultrasound, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang Province, China
| | - Lijing Wang
- Department of Ultrasound, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang Province, China.
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22
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Hayashi T, Akiyama N, Kanematsu R, Higuchi M, Suzuki A, Tanaka A, Yamao N, Kuma S, Hirokawa M, Miyauchi A. Potential role of mobile rapid on-site evaluation ® in thyroid fine-needle aspiration cytology to reduce delayed repeated aspiration. Endocr J 2021; 68:865-870. [PMID: 34121039 DOI: 10.1507/endocrj.ej21-0010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Rapid on-site evaluation of fine-needle aspiration cytology is time-consuming and requires specialized cytopathology staff. Mobile Rose® is a newly developed device for rapid on-site evaluation of fine-needle aspiration cytology. This study aimed to investigate the potential role of Mobile Rose® in reducing delayed repeated aspiration of the thyroid. A total of 120 cytological samples were collected and observed using Mobile Rose® after fine-needle aspiration cytology between September and October 2020, with immediate assessment of minimal or no cell clusters after conventional smear preparation. After qualifying and scoring, needle washout materials were prepared using the BD CytoRichTM method and correlated with cytology results. The average turn-around time of Mobile Rose® was found to be 1.5 minutes. Sensitivity, specificity, positive predictive value, and negative predictive value were 94.4%, 100%, 100%, and 57.1%, respectively. False-negative results were attributed to small aggregates of cells that were difficult to distinguish from the background and artifacts. Mobile Rose® may represent an important innovation for rapid on-site evaluation that is fast, has high diagnostic performance, does not require the presence of specialized cytology staff, and can reduce delayed repeated aspiration of the thyroid gland. However, further minor improvements and confirmation are required.
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Affiliation(s)
- Toshitetsu Hayashi
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe 650-0011, Japan
| | - Noriko Akiyama
- Cytology Department, Osaka Cytopathology Laboratories Co., Ltd, Osaka 533-0024, Japan
- Yamachu Co., Ltd, Medical Equipment Research and Development Corporation, Chiba 292-0838, Japan
| | - Risa Kanematsu
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe 650-0011, Japan
| | - Miyoko Higuchi
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe 650-0011, Japan
| | - Ayana Suzuki
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe 650-0011, Japan
| | - Aki Tanaka
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe 650-0011, Japan
| | - Naoki Yamao
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe 650-0011, Japan
| | - Seiji Kuma
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe 650-0011, Japan
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe 650-0011, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
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Hallikeri K, Babu B, Sudhakaran A, Monteiro R. Cell Block and Its Impact in the Diagnosis of Jaw Lesions over Fine Needle Aspiration Cytology. Acta Cytol 2021; 65:361-367. [PMID: 34237724 DOI: 10.1159/000517166] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/09/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine the role and efficacy of fine needle aspiration cytology (FNAC) and cell block in diagnosis of jaw lesions and compare the agreement between FNAC and cell block to predict the diagnosis. METHOD The sample comprised 51 cases, including 12 odontogenic keratocysts (OKCs), 8 ameloblastomas, 22 radicular cysts, 7 dentigerous cysts, and 1 each of intraosseous mucoepidermoid carcinoma (MEC) and adenomatoid odontogenic tumor (AOT). FNAC samples remaining after hematoxylin and eosin (H&E)-stained cytosmear diagnosis were centrifuged at 3,000 rpm for 10 min. The supernatant was discarded and sediment mixed with 2-3 mL alcohol and filtered. To this, 10% formalin was added, filtered, taken for routine processing, and stained with H&E. The result of FNAC smear and cell block was compared with histopathological diagnosis. RESULTS On cytological examination of the smears, 7 OKCs and 22 radicular cysts were diagnosed, whereas ameloblastomas, AOT, intraosseous MEC, and dentigerous cysts were not. This gave an agreement of 56.8% with the biopsy reports. Cell block sections stained with H&E of 12 OKCs, 22 radicular cysts, 1 MEC, and 3 cases of ameloblastoma offered a diagnosis in accordance with the biopsies giving an agreement of 74.5%, while dentigerous cyst and AOT failed to do so. In comparison with FNAC, additionally 5 cases of OKC and 1 of MEC could be detected, and in ameloblastoma, out of 8 cases, only 3 yielded a concordant diagnosis through the cell block technique. CONCLUSION In comparison with FNAC, the architectural pattern and the morphology of the cells were better preserved by the cell block technique. This substantiates that cell block could be used as an ancillary technique to aid in definitive diagnosis of head and neck swellings.
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Affiliation(s)
- Kaveri Hallikeri
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, India
| | - Biji Babu
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, India
| | - Archana Sudhakaran
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, India
| | - Roshni Monteiro
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, India,
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Gorostiaga I, Martinez-Aracil A, Catón B, Perez-Rodriguez A. Central papillary adenoma of the lung diagnosed in a bronchoscopy-guided FNA: Cytological and histological characterization of this rare entity. Rev Esp Patol 2021; 54:206-210. [PMID: 34175035 DOI: 10.1016/j.patol.2020.07.002] [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] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/24/2020] [Accepted: 07/20/2020] [Indexed: 06/13/2023]
Abstract
Pulmonary papillary adenoma (PA) is an unusual tumor with only 32 reported cases to date. We present a case of a 69-year-old man, a smoker from the age of 12, with a central mass in the pulmonary left lower lobe identified in a PET-CT scan. Microscopical analysis of the Fine Needle Aspiration (FNA) samples showed fragments of a tumor comprised of abundant papillary structures lined by a monolayer of cytologically bland columnar to cuboidal epithelial cells. The immunohistochemical stains were positive for CK7, TTF-1 and EMA in the epithelial cells, and negative for MYC. Based on the imaging tests, histological features and immunohistochemical profile, the tumor was diagnosed as pulmonary PA. The cytologic and histologic features of this rare entity are described in detail and the value of FNA as an essential presurgical diagnostic procedure is emphasized.
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Affiliation(s)
- Iñigo Gorostiaga
- Osakidetza Basque Health Service, Araba University Hospital, Pathology Service, Alava, Vitoria-Gasteiz, Spain
| | - Adriano Martinez-Aracil
- Osakidetza Basque Health Service, Araba University Hospital, Pathology Service, Alava, Vitoria-Gasteiz, Spain
| | - Blanca Catón
- Osakidetza Basque Health Service, Araba University Hospital, Pathology Service, Alava, Vitoria-Gasteiz, Spain
| | - Alvaro Perez-Rodriguez
- Osakidetza Basque Health Service, Araba University Hospital, Pathology Service, Alava, Vitoria-Gasteiz, Spain.
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Mistry SK, Pratap R, Maddox A. Fine needle aspiration cytology of a level IIB lymph node-what's your differential? Cytopathology 2021; 32:687-689. [PMID: 34033157 DOI: 10.1111/cyt.12999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/08/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | - Rohit Pratap
- West Hertfordshire Hospitals NHS Trust, Hemel Hempstead, UK
| | - Anthony Maddox
- West Hertfordshire Hospitals NHS Trust, Hemel Hempstead, UK
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Sood T, Supriya M, Thopil J, Surendra V, Patel BB. One stop neck lump clinic: a boon for quick diagnosis and early management. Eur Arch Otorhinolaryngol 2021; 278:4951-4954. [PMID: 33689020 DOI: 10.1007/s00405-021-06729-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/26/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION One-stop neck lump clinics (OSNLC) are gaining popularity worldwide especially in the UK hospitals following NICE recommendation. The main aim of this speciality clinic is a quick diagnosis and early management while simultaneously improving patient experience. OBJECTIVES To analyse and compare the efficacy of OSNLC and general ENT/Head and neck clinic with specifics to a number of appointments required for formulating management plan and a number of 'one stop' visits. DESIGN Retrospective observational study SETTING: Regional Head and Neck Cancer Center (Secondary care hospital) PARTICIPANTS: Patients referred by General practitioner with symptoms of a neck lump MAIN OUTCOME MEASURES: Patients seen in general ENT/Head and neck and OSNLC in 2 phases to understand the difference in a number of appointments, one-stop visits, the requirement of Ultrasound and efficiency of Fine needle aspiration. RESULTS AND CONCLUSIONS Improved efficacy of OSNLC was noted as patients seen in the clinic required a lesser number of appointments, reached a faster diagnosis and management plan when compared to patients seen in general ENT clinic.
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Affiliation(s)
- Tarun Sood
- ENT, Northampton General Hospital NHS Trust, Northampton, UK.
| | - Mrinal Supriya
- ENT, Northampton General Hospital NHS Trust, Northampton, UK
| | - Jacob Thopil
- ENT, Northampton General Hospital NHS Trust, Northampton, UK
| | - Vishak Surendra
- ENT, Northampton General Hospital NHS Trust, Northampton, UK
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Gan FJ, Zhou T, Wu S, Xu MX, Sun SH. Do medullary thyroid carcinoma patients with high calcitonin require bilateral neck lymph node clearance? A case report. World J Clin Cases 2021; 9:1343-1352. [PMID: 33644201 PMCID: PMC7896685 DOI: 10.12998/wjcc.v9.i6.1343] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/24/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In clinical work, 85%-90% of malignant thyroid diseases are papillary thyroid cancer (PTC); thus, clinicians neglect other types of thyroid cancer, such as medullary thyroid carcinoma (MTC).
CASE SUMMARY We report a 53-year-old female patient with a preoperative calcitonin level of 345 pg/mL. There was no definitive diagnosis of MTC by preoperative fine-needle aspiration cytology or intraoperative frozen pathology, but the presence of PTC and MTC was confirmed by postoperative paraffin pathology. The patient underwent total thyroidectomy and bilateral central lymph node dissection. Close follow-up at 1.5 years after surgery revealed no signs of recurrence or metastasis.
CONCLUSION The issue in clinical work-up regarding types of thyroid cancer provides a novel and challenging idea for the surgical treatment of MTC. In the absence of central lymph node metastasis, it is worth addressing whether patients with high calcitonin can undergo total thyroidectomy and bilateral central lymph node dissection without bilateral lateral neck lymph node dissection.
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Affiliation(s)
- Feng-Jiao Gan
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Tie Zhou
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Shun Wu
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Meng-Xi Xu
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Su-Hong Sun
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
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Sharma S, Shukla KS, Rajwanshi A. Meningothelial meningioma in an unusual site: Thinking out of the box. Cytopathology 2021; 32:278-280. [PMID: 33247960 DOI: 10.1111/cyt.12944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/06/2020] [Accepted: 11/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sudha Sharma
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kumar Sangam Shukla
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynaecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sandhu S, Raman DK, Sood A, Sinha P, Singh PY, Dixit PK. Cytomorphological Patterns of Nerve Aspirates in Pure Neuritic Leprosy-A Single Centre Cross-Sectional Observational Study. J Cytol 2021; 38:14-20. [PMID: 33935387 PMCID: PMC8078620 DOI: 10.4103/joc.joc_182_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/17/2020] [Accepted: 11/30/2020] [Indexed: 11/04/2022] Open
Abstract
Background Pure neuritic leprosy (PNL) poses a diagnostic challenge because of absence of skin patches, inconclusive skin biopsies and nerve conduction studies. Nerve biopsy though the diagnostic gold standard, is invasive, requires expertise, and may not be feasible in all cases. Fine needle aspiration cytology (FNAC) of accessible thickened nerves can be utilized as a minimally invasive diagnostic modality in PNL. This study was carried out to describe cytomorphological patterns of nerve aspirates in patients of PNL for diagnosis and classification of leprosy and study its advantage, if any, over skin biopsy. Methods Twenty-seven treatment naive clinically diagnosed patients of PNL were included in this cross-sectional study carried out from January 2017 to December 2018 at a tertiary care centre in Western India. FNAC was done from a clinically involved nerve and aspirates were evaluated for cytomorphological characteristics and the presence of Acid-Fast Lepra bacilli. Results Nerve aspirates were diagnostic in 10 (37%) patients while 17 (63%) aspirates showed non-specific or no inflammation. Of the diagnostic aspirates, six (22.2%) were classified as tuberculoid leprosy, three (11.1%) as lepromatous and one (3.7%) as borderline leprosy. Mycobacterium leprae were demonstrated among three (11.1%) of these aspirates. In comparison, only three (11.1%) skin biopsies were diagnostic of leprosy with features of indeterminate spectrum. Remaining 24 skin biopsies showed normal histology in 20 (74.1%) cases to perivascular lymphocytic infiltrate in four (14.8%) cases. Conclusion Our study demonstrates that FNAC of clinically thickened nerves has a better diagnostic yield than skin biopsy in PNL and shows all spectrums of leprosy. It also offers the advantage of sampling major nerve trunks without the fear of residual neurological deficit. However, most of the smears were paucicellular and a negative aspirate does not rule out leprosy.
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Affiliation(s)
- Sunmeet Sandhu
- Department of Dermatology, Command Hospital, Airforce Bangalore, India
| | - Deep K Raman
- Department of Pathology, Command Hospital, Lucknow, India
| | - Aradhana Sood
- Department of Dermatology, Base Hospital, Lucknow, India
| | - Preema Sinha
- Department of Dermatology, Base Hospital, Lucknow, India
| | - Prince Y Singh
- Department of Dermatology, Command Hospital, Chandimandir, Haryana, India
| | - Prashant K Dixit
- Department of Medicine, Command Hospital, Airforce Bangalore, India
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Sakamoto A, Matsuzuka T, Yamaya Y, Suzuki S, Iwadate M, Suzuki S, Hashimoto Y, Suzuki O, Suzuki S, Yokoya S, Ohira T, Yasumura S, Ohto H, Kamiya K, Shimura H. Cytological examination of the thyroid in children and adolescents after the Fukushima Nuclear Power Plant accident: the Fukushima Health Management Survey. Endocr J 2020; 67:1233-1238. [PMID: 32814723 DOI: 10.1507/endocrj.ej20-0235] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Fukushima Daiichi Nuclear Power Plant accident occurred on March 11 2011, following the Great East Japan Earthquake and tsunami. Radioactive materials, including I-131, were released into the environment after the accident. Shortly after, the prefectural government initiated the Fukushima Health Management Survey for monitoring the long-term health conditions of the residents of Fukushima Prefecture. In the survey, thyroid ultrasonography was scheduled for all people aged 18 years or younger who were living in Fukushima Prefecture at the time of disaster. The total number of examinees was approximately 370,000 in the Preliminary Baseline Survey (PBLS), and 380,000 in the first Full-scale Survey (FSS). First, thyroid ultrasonography was performed as the Primary Examination. When a thyroid nodule that meets the fine needle aspiration cytology (FNAC) guideline is detected, thyroid FNAC is performed. By the end of June 2017, the cytological specimens of 187 examinees had been interpreted as Malignant or Suspicious for Malignancy (SFM). In this article, the cytological results of whole categories are presented using the criteria of The Bethesda System for Reporting Thyroid Cytopathology. The total numbers of examinees with SFM or Malignant in PBLS and at the first FSS were 106 (62.0%) and 71 (38.0%), respectively. The data of the cytological results of SFM and Malignant were already reported. However, this is the first report of cytological data from categories other than SFM and Malignant. The results of the current study will contribute to future research into the thyroid conditions of children and adolescents.
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Affiliation(s)
- Atsuhiko Sakamoto
- Thyroid Examination Expert Committee, Diagnostic Criteria Subcommittee for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Pathology and Laboratory Medicine, Omori Red Cross Hospital, Tokyo 143-8527, Japan
| | - Takashi Matsuzuka
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Yukie Yamaya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Satoru Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Manabu Iwadate
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Thyroid and Endocrinology, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Satoshi Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Thyroid and Endocrinology, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Yuko Hashimoto
- Department of Pathology, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Osamu Suzuki
- Department of Pathology, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Shinichi Suzuki
- Department of Thyroid and Endocrinology, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Susumu Yokoya
- The Thyroid and Endocrine Center, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8553, Japan
| | - Hiroki Shimura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Laboratory Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
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Ronchi A, Caputo A, Pagliuca F, Montella M, Marino FZ, Zeppa P, Franco R, Cozzolino I. Lymph node fine needle aspiration cytology (FNAC) in paediatric patients: Why not? Diagnostic accuracy of FNAC in a series of heterogeneous paediatric lymphadenopathies. Pathol Res Pract 2020; 217:153294. [PMID: 33290901 DOI: 10.1016/j.prp.2020.153294] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/22/2022]
Abstract
Fine needle aspiration cytology (FNAC) can be a precious tool for the evaluation of lymphadenopathies in children and adolescents. The purpose of this study was to analyse the diagnostic accuracy of FNAC in a paediatric lymph node series. We report a series of 76 patients, aged up to 19 years, who underwent lymph node FNAC. In our series, 57 cases were diagnosed as non-neoplastic, including benign reactive hyperplasia and other inflammatory lesions, 18 cases were diagnosed as malignant and 1 case was diagnosed as suspicious for lymphoproliferative process, not otherwise specified. Sensitivity, specificity, positive predictive value and negative predictive value were 93 %, 100 %, 100 % and 98 %, respectively. Diagnostic accuracy resulted 98.6 %. FNAC is an accurate, minimally invasive method with minimal complications that allows evaluation of paediatric lymphadenopathies and a correct triage of reactive/inflammatory and neoplastic lymphadenopathies. The application of rapid on-site evaluation, the realization of a cell block and the application of ancillary diagnostic tests, including at least immunocytochemistry and flow cytometry, allows to achieve an excellent diagnostic performance.
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Affiliation(s)
- Andrea Ronchi
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Caputo
- Department of Pathology of the Azienda Ospedaliera Universitaria "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Francesca Pagliuca
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Montella
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Zito Marino
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Pio Zeppa
- Department of Pathology of the Azienda Ospedaliera Universitaria "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Renato Franco
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy.
| | - Immacolata Cozzolino
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
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Sharma P, Gupta R, Bhardwaj S, Mahajan M. Cytomorphological Evaluation of Synovial Lesions in a Tertiary Care Centre in North India: A Retrospective Study. J Cytol 2020; 37:166-169. [PMID: 33776255 PMCID: PMC7984514 DOI: 10.4103/joc.joc_66_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/26/2020] [Accepted: 09/22/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Numerous pathological processes involve synovium and periarticular tissues that are characteristic and in some cases specific to a particular disease. Synovial fluid is a thick, stringy fluid found in the cavity of synovial joint. Examination of the synovium plays a key role in the diagnosis of many joint diseases. Aims: The aim of this study was to study the spectrum of synovial lesions on fine needle aspiration cytology (FNAC) and to compare the cytological diagnosis with histopathological findings. Material and Methods: This retrospective diagnostic analytical study was carried out in the Department of Pathology. Sixty-six patients with suspected synovial lesions referred from other departments who underwent FNAC during 1 year from January 2017 to December 2017 were included in the study. The slides along with records of the patients were retrieved and findings recorded. Histopathological evaluation was performed wherever possible and compared with cytological diagnosis. Results: Non-neoplastic lesions accounted for 80.3% cases followed by benign tumors (15.2%). Ganglion cyst was the commonest non-neoplastic lesion (60.6%, 40/66), while tenosynovial giant cell tumor was the commonest neoplasm (12.1%, 8/66) observed in our study. Solitary case of synovial sarcoma was also observed. Histopathological evaluation was performed in 14 cases and FNAC had overall diagnostic accuracy of 85.7% in diagnosis of these lesions. Conclusions: FNAC is a useful tool with high diagnostic accuracy in the evaluation of synovial lesions.
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Affiliation(s)
- Poonam Sharma
- Department of Pathology, Government Medical College, Jammu (J&K), India
| | - Rajat Gupta
- Department of Pathology, Government Medical College, Jammu (J&K), India
| | - Subhash Bhardwaj
- Department of Pathology, Government Medical College, Jammu (J&K), India
| | - Manik Mahajan
- Department of Radio-Diagnosis and Imaging, Government Medical College, Jammu (J&K), India
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Xavier-Júnior JCC, Abrantkoski Borges F, Pizzello Zogheib RJ, Camilo-Júnior DJ. Bethesda System Categories of Fine Needle Aspiration Cytology Are Not Associated with Thyroid Nodule Location: A Single Institution Experience. Acta Cytol 2020; 65:22-26. [PMID: 32877898 DOI: 10.1159/000510175] [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: 06/20/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Thyroid isthmus is defined as the thin band connecting thyroid tissue between both lateral thyroid lobes. Recently, a possible association between thyroid nodules located in the isthmus and malignancy was proposed. The aim of this study was to compare the frequency of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) categories between nodules from the isthmus and nodules from both thyroid lobes. METHODS All fine needle aspiration cytology procedures performed between January 2016 and December 2019 at the Pathology Institute of Araçatuba, São Paulo, Brazil, were analyzed. For each nodule, at least 2 conventional slides were produced (1 stained by Giemsa and the other by hematoxylin and eosin). All cases were reported according to the TBSRTC. Clinical information (gender, age, and localization) and ultrasound data (size of nodules) were collected from medical requisition forms. To assess the association between the frequency of TBSRTC categories and nodule location, univariate analysis was performed using the χ2 test or Fisher's exact test, as appropriate. A p value <0.05 was considered statistically significant. Nodules located in transition between the isthmus and a right or left lobe were included in the isthmus group. RESULTS Considering the p value between the TBSRTC categories and thyroid nodule location, statistic association was not observed: nondiagnostic or unsatisfactory (p = 0.1442), atypia of undetermined significance or follicular lesion of undetermined significance (p = 0.3296), follicular neoplasm or suspicious for a follicular neoplasm (p = 0.0817), suspicious for malignancy (p = 0.8464), and malignant (p = 0.1082). CONCLUSION In the studied population, nodules located in the isthmus were not related to any Bethesda System category.
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Affiliation(s)
- José Cândido Caldeira Xavier-Júnior
- Pathology Institute of Araçatuba, São Paulo, Brazil,
- School of Medicine, Centro Universitário Católico Unisalesiano Auxilium, São Paulo, Brazil,
| | | | - Rodrigo José Pizzello Zogheib
- Pathology Institute of Araçatuba, São Paulo, Brazil
- School of Medicine, Centro Universitário Católico Unisalesiano Auxilium, São Paulo, Brazil
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Abstract
The indications for surgery of benign goiter should be balanced and professional as the prevalence of benign nodular goiter in Germany is high and not all goiters must be surgically treated. Thyroid nodules are detected in up to 76% of healthy people using modern high-resolution ultrasound (US) and only a few of these nodules are malignant or symptomatic. Even today a thorough medical history, detailed examination of the neck region, a qualified US of the thyroid gland, a 99m-technetium scintigraphy and fine needle aspiration help to select patients who will benefit from thyroid surgery. In the last 10 years several thyroid imaging reporting and data systems (TI-RADS) classifications have been introduced. The TI-RADS classification is a standardized assessment of thyroid nodules and risk stratification system in thyroid US which helps to select those nodules with a high risk of cancer. Asymptomatic euthyroid nodular goiter without any suspicion of malignancy and scintigraphically cold thyroid nodules without any other evidence of malignancy are not indications for thyroid surgery. The decision to operate should be made on an interdisciplinary basis in conformity with the relevant guidelines and exhaustion of diagnostic tools.
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Affiliation(s)
- K Holzer
- Sektion Endokrine Chirurgie, Klinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
| | - D K Bartsch
- Klinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Marburg, Marburg, Deutschland
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Pachori G, Toor SS, Sharma R, Bayla T. Utility of Image Guided Fine Needle Aspiration Cytology in Intra-Thoracic Lesions with Emphasis on Lung Cancer Detection. J Cytol 2020; 37:136-140. [PMID: 33088032 PMCID: PMC7542043 DOI: 10.4103/joc.joc_109_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 03/26/2020] [Accepted: 05/11/2020] [Indexed: 01/09/2023] Open
Abstract
Background and Aims Fine Needle aspiration cytology has emerged as an essential pre-biopsy investigation to rule out or confirm malignancy in superficial as well as deep seated lesions. Radiological assistance has proved to be a blessing for obtaining adequate samples. With unwavering leading position of lung cancer in terms of incidence and mortality, it has become necessary to study the trends of our population and assess the usefulness of techniques aiding in early diagnosis. The objective is to obtain prevalence of lung cancer and utility of various methods in obtaining cytological material for assessment in intrathoracic lesions. Material and Methods We conducted an observational analytic study at a tertiary care teaching hospital over a period of 3.5 years including a total of 307 patients with suspected lung malignancy. Samples were collected using image guided techniques including Fibre-optic bronchoscopy (FOB), Ultra-sonography (USG) and Computed tomography (CT). The smears were processed as per standard institutional protocol and were evaluated by a senior pathologist. Results Squamous cell carcinoma was the most frequent type of Primary lung malignancy, followed by adenocarcinoma. The malignancies were more common in males and in age group of 61 to 70 years. Conclusion Respiratory cytology remains the initial mode of investigation in intra-thoracic malignancies. The high sensitivity, low-cost and rapidity of the results works its advantages for both the patient and the clinician. High cellular yield obtained with the use of trans-bronchial needle aspiration and bronchial brushing rationalizes their use as a screening test to establish both malignant as well as non-malignant diagnoses. Further improvement in utilization of the available modalities and addition of ancillary testing can reduce the need of invasive procedures.
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Affiliation(s)
| | | | | | - Tushar Bayla
- Government, Medical College, Bhilwara, Rajasthan, India
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De D, Dutta S, Tarafdar S, Kar SS, Das U, Basu K, Mukhopadhyay P, Ghosh S. Comparison between Sonographic Features and Fine Needle Aspiration Cytology with Histopathology in the Diagnosis of Solitary Thyroid Nodule. Indian J Endocrinol Metab 2020; 24:349-354. [PMID: 33088759 PMCID: PMC7540823 DOI: 10.4103/ijem.ijem_349_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/26/2020] [Accepted: 07/11/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND High resolution ultrasonography (USG) is the first-line investigation in evaluation of euthyroid nodules. Thyroid imaging reporting and data system (TIRADS) is an USG-based risk stratification system for classifying thyroid nodules. Subjects with high-risk category of TIRADS undergo fine needle aspiration cytology (FNAC) and FNAC findings are reported according to Bethesda classification. Bethesda categories are used for determining risk of malignancy. Data regarding sonographic classification of thyroid nodule and its cytological association with respect to final histopathological diagnosis remains scarcely available in India. AIMS AND OBJECTIVE The study evaluated euthyroid nodules for risk of malignancy and compared sonographic features and FNAC (Bethesda classification) findings with histopathology of excised samples. MATERIAL AND METHODS This was a single-center observational study on 137 consecutive subjects of solitary euthyroid nodule. All subjects underwent USG according to TIRADS and FNAC where applicable. Surgical biopsy report was used as a gold standard. RESULTS The sensitivity, specificity, accuracy, positive predictive and negative predictive value of FNAC were 80%, 90%, 85%, 86%, and 86.6% and TIRADS were 80%, 47.2% 61%, 51.3%, and 77.3%, respectively. FNAC classification was equally sensitive and more specific than TIRADS. Among individual USG parameters, micro-calcification was most sensitive (80%) and specific (86%). Irregular margin and taller-than-wider shape had a specificity of 89% and 92%, respectively. 3 patients (14.28%) with benign cytology and suspicious USG features (specifically TIRADS 4 & 5) undergoing surgery had malignancy in final HPE. CONCLUSIONS USG and FNAC are equally sensitive in diagnosing malignant thyroid nodule but FNA is more specific (90%). It's a minimally invasive method which can be used to distinguish malignant from benign lesions with a high degree of accuracy (85%). In patient having high risk feature on USG, a benign cytology needs to be repeat FNAC and they should undergo surgical biopsy for confirmation.
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Affiliation(s)
- Debanu De
- Department of Radiodiagnosis, IPGME&R, Kolkata, West Bengal, India
| | - Susmita Dutta
- Department of Radiodiagnosis, IPGME&R, Kolkata, West Bengal, India
| | - Soham Tarafdar
- Department of Endocrinology and R.G. KAR Medical College, Kolkata, West Bengal, India
| | - Suvrendu S. Kar
- Department of Medicine, R.G. KAR Medical College, Kolkata, West Bengal, India
| | - Utpalendu Das
- Department of Radiodiagnosis, IPGME&R, Kolkata, West Bengal, India
| | - Keya Basu
- Department of Pathology, IPGME&R, R.G. KAR Medical College, Kolkata, West Bengal, India
| | - Pradip Mukhopadhyay
- Department of Endocrinology and R.G. KAR Medical College, Kolkata, West Bengal, India
| | - Sujoy Ghosh
- Department of Endocrinology and R.G. KAR Medical College, Kolkata, West Bengal, India
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Abstract
The indications for surgery of benign goiter should be balanced and professional as the prevalence of benign nodular goiter in Germany is high and not all goiters must be surgically treated. Thyroid nodules are detected in up to 76% of healthy people using modern high-resolution ultrasound (US) and only a few of these nodules are malignant or symptomatic. Even today a thorough medical history, detailed examination of the neck region, a qualified US of the thyroid gland, a 99m-technetium scintigraphy and fine needle aspiration help to select patients who will benefit from thyroid surgery. In the last 10 years several thyroid imaging reporting and data systems (TI-RADS) classifications have been introduced. The TI-RADS classification is a standardized assessment of thyroid nodules and risk stratification system in thyroid US which helps to select those nodules with a high risk of cancer. Asymptomatic euthyroid nodular goiter without any suspicion of malignancy and scintigraphically cold thyroid nodules without any other evidence of malignancy are not indications for thyroid surgery. The decision to operate should be made on an interdisciplinary basis in conformity with the relevant guidelines and exhaustion of diagnostic tools.
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Tan HM, Nga ME, Petersson F. Ectopic Cervical Thyroid Tissue Affected by Fibrosing Hashimoto's Thyroiditis Mimicking Multifocal Metastatic Papillary Thyroid Carcinoma-A Hard Lesson Learnt from an Unusual Case. Head Neck Pathol 2021; 15:328-33. [PMID: 32451873 DOI: 10.1007/s12105-020-01174-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
We describe a case of ectopic cervical thyroid tissue which was involved by fibrosing Hashimoto's thyroiditis and which mimicked metastatic papillary thyroid carcinoma both on fine needle aspiration cytology and biopsy. The patient underwent total thyroidectomy which revealed fibrosing Hashimoto's thyroiditis, but no carcinoma. The entire thyroidectomy specimen was submitted for histopathological assessment. Even in the resected thyroidectomy specimen, there were cytological changes that were strongly reminiscent of papillary thyroid carcinoma. However, interpreted in the correct clinico-pathological context, these cytological alterations were deemed to be reactive secondary to the fibro-inflammatory process.
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Kundu R, Handa U, Punia RS, Singla N, Chander J, Attri AK. Phaeohyphomycosis: Cytomorphologic Evaluation in Eleven Cases. Acta Cytol 2020; 64:406-412. [PMID: 32203955 DOI: 10.1159/000506432] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/11/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Phaeohyphomycosis caused by phaeoid fungi is a type of mycosis emerging worldwide which causes a wide variety of clinical manifestations. STUDY DESIGN A retrospective analysis of 11 cases diagnosed with fungal inflammation on cytology over a period of 6 years (2013-2018) was done along with culture/histopathologic confirmation. RESULTS Of the total of 11 cases, 9 cases presented with subcutaneous swellings and 1 case each with brain and lung lesions. The age range was 30-83 years (mean: 53.6); 8 patients were male and 3 were female. Cytologic smears showed fungal profiles with septate tortuous hyphae, as well as swollen and narrow, yeast-like swellings with an irregular breadth of the hyphae in all cases. The fungal profiles were visualized on a Masson-Fontana stain. The background showed inflammatory cells, giant cells, and necrosis in variable proportions. Five cases were diagnosed as phaeohyphomycosis on cytology, whereas 3 cases were misdiagnosed as aspergillus and 2 as candida. In 1 case, typing of the fungus was not done. Histopathology was available in 5 cases, and in all these a diagnosis of phaeohyphomycosis was reached. Ten of the 11 cases had confirmation on fungal culture. CONCLUSIONS Phaeoid fungi are rarely seen in routine cytologic practice. Careful evaluation of cytologic smears and an awareness of the characteristic morphologic features of phaeohyphomycosis are helpful in arriving at a correct diagnosis. Fine needle aspiration cytology provides a rapid diagnosis, enabling prompt therapy.
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Affiliation(s)
- Reetu Kundu
- Government Medical College and Hospital, Chandigarh, India,
| | - Uma Handa
- Government Medical College and Hospital, Chandigarh, India
| | | | - Nidhi Singla
- Government Medical College and Hospital, Chandigarh, India
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Kamalkant Shastri S, Joshi A. Modified Ultrafast Papanicolaou Stain in Ultrasound Guided FNAC of Intra-abdominal Lesions. Iran J Pathol 2020; 15:66-74. [PMID: 32215021 PMCID: PMC7081759 DOI: 10.30699/ijp.2020.98405.1971] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/23/2020] [Indexed: 11/18/2022]
Abstract
Background & Objective: Modified Ultra-fast Papanicolaou (MUFP) stain has been developed from Papanicolaou stain (PAP) with the goal to improve staining quality, minimize staining time for obtaining immediate cytological diagnosis and to check specimen adequacy during Ultrasound guided Fine needle Aspiration Cytology (US guided FNAC). The aim of this research was to study the cytomorphological features of intra-abdominal lesions with help of US guided FNAC and to assess the diagnostic utility of Modified Ultrafast Papanicolaou stain in cytological diagnosis. Methods: This cross-sectional study enrolled consecutive 100 subjects in N.K.P Salve Institute of Medical Sciences and Research Centre, Nagpur, which is a tertiary teaching hospital in India, from July 2015 to June 2017 who underwent US guided FNAC for Intra-abdominal lesions. Fine needle aspiration was done under ultrasound guidance and the smears were divided into two groups. Wet smears were fixed in 95% ethyl alcohol for conventional PAP staining and air dried for MUFP. After staining, results were evaluated on basis of the cytological features. Scores were given according to four parameters namely background of smears, staining pattern, cell morphology and nuclear staining. Quality index was calculated from the ratio of score achieved to the possible maximum score. Results: The most common organs involved were ovaries (46 %) followed by liver (11%) and most common lesions were malignant (68 %). The cytological characteristic showed significant difference in all four parameters (P<0.05) when MUFP stain smears were compared with PAP stain smears. There was also statistically significant difference when cumulative score and Quality Index were compared (P<0.001) between the two stains. Conclusion: The US guided Fine needle aspiration (FNA) is simple, safe, rapid and inexpensive technique useful in cytological diagnosis. MUFP stain is fast, reliable and has better diagnostic utility for cytological diagnosis when compared to PAP stain.
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Affiliation(s)
- Sweta Kamalkant Shastri
- Department of Pathology, N.K.P Salve Institute of Medical Sciences and Research Centre, Nagpur, Maharashtra, India
| | - Archana Joshi
- Department of Pathology, N.K.P Salve Institute of Medical Sciences and Research Centre, Nagpur, Maharashtra, India
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Pistolese CA, Lamacchia F, Tosti D, Anemona L, Ricci F, Censi M, Materazzo M, Vanni G, Collura A, DI Giuliano F, Perretta T, Buonomo OC. Reducing the Number of Unnecessary Percutaneous Biopsies: The Role of Second Opinion by Expert Breast Center Radiologists. Anticancer Res 2020; 40:939-950. [PMID: 32014938 DOI: 10.21873/anticanres.14027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/09/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The research objectives of this study were the estimation of the number of misdiagnosed breast lesions by non-expert-center-breast-radiologists (NEBR) and the investigation of the discordant rate (DR) calculated between initial and second opinion. Moreover, this study evaluated the impact of second opinion and the factors associated with DR. MATERIALS AND METHODS A total of 399 patients were sent to our Tertiary Breast Cancer (BC) Center to perform fine needle aspiration/core needle biopsy (FNAC/CNB) after external examination. Lesions were reclassified according to Breast Imaging-Reporting and Data System (BI-RADS). External examinations were classified as breast-expert, not-breast-expert and physicians as expert-center-breast-radiologists (EBR), NEBR, and non-radiologists (NR). Personal/family history of breast cancer (BC), breast-density and presence of prior imaging were collected. RESULTS DR was 74.3%. After second opinion, FNAC/CNB was proposed in 25.7% of cases and 2 additional cancers were detected. About 59.5% of unnecessary FNAC/CNB were avoided. Dense breast, no prior imaging examination and BC family-history were associated with higher DR (p-value<0.001); personal BC-history was associated in NEBR evaluations (p-value=0.0383). CONCLUSION Second opinion review of outside examinations at expert BC Center may decrease unneeded biopsy, reducing health-care costs.
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Affiliation(s)
- Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Feliciana Lamacchia
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Daniela Tosti
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Francesca Ricci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Michela Censi
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Marco Materazzo
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Alberto Collura
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Francesca DI Giuliano
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
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Abstract
Background Carcinoma ex pleomorphic adenoma (CA-ex-PA) is extremely unusual in minor salivary glands of oral cavity. CAex-PA is a carcinomatous change as a primary or as a recurrence of pleomorphic adenoma. Objective Due to resemblance of clinical symptoms of Ca ex PA and benign pleomorphic adenoma, it is mandatory for surgeons to keep high degree of clinical alertness, considering the peculiarity of this tumor. Case Report 54-year-old male presented with swelling on left side in the pre-auricular region from the middle of zygomatic arch to mastoid process and from tragus of the ear up to angle of mandible. Fine needle aspiration cytology revealed a mixture of benign and malignant components. Total left parotidectomy with left radical neck dissection followed by reconstruction with cervicodeltopectoral flap was performed. Combination of chemotherapy and radiotherapy were given to patient. Histologic examination and pre-operative fine needle aspiration cytology confirmed the diagnosis of Carcinoma ex pleomorphic adenoma (CA-ex-PA). Two-year follow-up of patient showed no recurrence of the lesion. Conclusion Due to the similarity in the clinical symptoms of CA-ex-PA and benign pleomorphic adenoma, it is vital that clinicians maintain a high degree of clinical vigilance, considering the oddity of this malignancy.
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Affiliation(s)
- Deepak Khanna
- Department of Head, neck and oncology, D.Y.Patil University School of medicine, Nerul, Navi Mumbai, Maharashtra state, India, Zip code – 400706
| | - Tanay Chaubal
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia, Zip code – 57000
| | - Ranjeet Bapat
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia, Zip code – 57000
| | - Anshad Mohamed Abdulla
- Department of Pediatric dentistry and Orthodontic Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia, Pincode- 61471
| | - Sunil Thomas Philip
- Department of Pedodontics and Preventive Dentistry, Noorul Islam College of Dental Sciences, Trivandrum, Kerala, India
| | - Suraj Arora
- Department of Restorative Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia, Pincode- 61471
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Thotambailu AM, Bhandary BSK. A Study of Clinicopathological Profile of Salivary Gland Swellings. Indian J Otolaryngol Head Neck Surg 2019; 71:253-7. [PMID: 31741969 DOI: 10.1007/s12070-018-1258-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/30/2018] [Indexed: 10/18/2022] Open
Abstract
Salivary gland diseases usually present as a swelling of the affected gland. These lesions are commonly encountered in day to day practice. A salivary gland swelling can present in a variety of locations, depending on the salivary gland affected. The purpose of the study is to know the incidence of salivary gland swellings and the usefulness of FNAC in evaluating these swellings. The present study is a time bound prospective study of fifty consecutive cases of salivary gland swellings admitted in our hospital during the period November 2014-August 2016. Most of the patients underwent pre-operative work up with FNAC and patients indicated for surgery underwent surgery and HPE. Salivary gland swelling occurred more commonly in 3rd decade of life and equal number of cases were seen in both genders. Most of the patients presented with salivary gland swelling (98%). 21 (42%) were non neoplastic, 29 (58%) were neoplastic swellings, 18 (36%) were benign of which pleomorphic adenoma was the most common and 11 (22%) were malignant of which adenoid cystic carcinoma was the most common. Parotid gland was the most common gland involved. Fine needle aspiration cytology was highly sensitive for benign tumours and highly specific for malignant tumours. FNAC should be first choice of investigation in evaluating the salivary gland pathologies. Early diagnosis and subsequent appropriate management carries good prognosis.
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Canberk S, Montezuma D, Ince U, Tastekin E, Soares P, Bongiovanni M, Schmitt FC. Variants of Papillary Thyroid Carcinoma: An Algorithmic Cytomorphology-Based Approach to Cytology Specimens. Acta Cytol 2019; 64:288-298. [PMID: 31634886 DOI: 10.1159/000503576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/23/2019] [Accepted: 09/19/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Thyroid cancer accounts for 1% of cancer cases in developed countries, in which papillary thyroid carcinoma (PTC) is the most common type. There are multiple variants of PTC described to date, some of them with aggressive behavior and poor clinical outcome. These variants are well described and accepted in recent guidelines of many international societies, and the prognostic and management implications are well laid out. Due to their established clinical importance and to guide appropriate surgical management, it is now imperative in clinical practice, including cytopathology, to differentiate aggressive variants from nonaggressive ones. This review aims to describe the variants of PTC and to provide a practical algorithmic approach to facilitate the cytological diagnosis of these variants. SUMMARY Subtyping PTC variants on fine needle aspiration cytology (FNAC) is challenging even for the most experienced cytopathologist. To facilitate a correct subtyping on FNAC, we propose a stepwise approach that is mainly designed for conventional smear methodology. This approach requires first to stratify the lesions into oncocytic and nononcocytic features before analyzing further details in cell morphology and pattern. Key Messages: (1) Subtyping in PTC is possible on cytopathology. (2) The main aim of the cytopathologist is to differentiate aggressive from nonaggressive variants. (3) The subtyping of PTC can help in the surgical management of the patients.
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Affiliation(s)
- Sule Canberk
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal,
- Institute of Pathology and Molecular Immunology, University of Porto, Porto, Portugal,
- Subdivision of Cytopathology, Department of Pathology, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey,
| | - Diana Montezuma
- Department of Pathology, Portuguese Institute of Oncology of Coimbra, Coimbra, Portugal
| | - Umit Ince
- Subdivision of Cytopathology, Department of Pathology, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Ebru Tastekin
- Department of Pathology, Trakia University, Edirne, Turkey
| | - Paula Soares
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- Institute of Pathology and Molecular Immunology, University of Porto, Porto, Portugal
- Cancer Signaling and Metabolism, Medical Faculty of Porto University, Porto, Portugal
| | - Massimo Bongiovanni
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Fernando C Schmitt
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- Institute of Pathology and Molecular Immunology, University of Porto, Porto, Portugal
- Cancer Signaling and Metabolism, Medical Faculty of Porto University, Porto, Portugal
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Abstract
Salivary gland tumor comprises of approximately 3 to 10% of neoplasms of the head and neck region. Parotid gland is the most commonly involved salivary gland with an incidence of 62% followed by submandibular gland and other minor salivary gland tumors. However clinical course of benign and malignant tumors resemble each other in clinical findings, we require histopatholocal or cytological diagnosis for planning of management. To analyze parotid tumors retrospectively with following objectives. (1) Demographic distribution of parotid tumors. (2) To evaluate cytological and histopathological findings of parotid tumors. (3) Correlation of cytological and histopathological findings of parotid tumors. It was a retrospective observational study involving 31 patients who presented with parotid region swelling. Pre operative FNAC (fine needle aspiration cytology) and post operative histopathology were correlated. Surgical management depended on nature of disease. Correlation of FNAC and Histopathology: among 27 cases pre operative FNAC and post operative histopathology was same and in only 3 cases reports differed. One FNAC was inconclusive. In present study, Sensitivity of FNAC is 81.81%, Specificity is 94.73% and accuracy is 90%. FNAC is usually the first investigative modality, as it is a minimally invasive, cheap, OPD procedure that can differentiate benign from malignant tumors. Knowing preoperative pathological nature of disease can help in planning of surgical process.
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Affiliation(s)
- Nirali Chauhan
- Department of Otorhinolaryngology and Head and Neck Surgery, Smt. B. K. Shah Medical Institute and Research Centre, Piparia, Waghodia, Vadodara, Gujarat 391760 India
| | - Jinesh Atulkumar Shah
- Department of Otorhinolaryngology and Head and Neck Surgery, Smt. B. K. Shah Medical Institute and Research Centre, Piparia, Waghodia, Vadodara, Gujarat 391760 India
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Bharathi MB, Kumar MV, Singh V, Rakesh BS, Nag KH. Correlation of Primary Tumour Size and Central Compartment Lymph Nodes Metastasis in Well Differentiated Thyroid Malignancies in a Tertiary Care Centre. Indian J Otolaryngol Head Neck Surg 2019; 71:341-5. [PMID: 31559201 DOI: 10.1007/s12070-019-01621-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022] Open
Abstract
Central compartment lymph nodes are the first to be involved in thyroid carcinoma and associated with higher chances of recurrence. (1) Recurrence and revision surgery can be associated with a high risk of vocal cord paralysis and hypocalcemia. (2) However, the need for central compartment lymph nodes dissection routinely in all cases of thyroid malignancies is controversial considering the risk to recurrent laryngeal nerve and parathyroids. (3) The aim of the study was to evaluate the incidence of central compartment lymph nodes metastasis in well differentiated thyroid malignancy and their correlation with size of the primary tumour along with incidence of postoperative hypocalcemia and recurrent laryngeal nerve injury after central compartment lymph node dissection. Observational study 30 patients diagnosed as well-differentiated thyroid carcinoma after fine needle aspiration cytology and planned for total thyroidectomy and central compartment lymph node dissection in the Department of ENT at a tertiary care hospital in Mysuru were studied. After surgery, histopathological examination (HPE) of thyroid and lymph node specimen was done. Postoperatively, all patients were evaluated for hypocalcemia and recurrent laryngeal nerve injury. The incidence of central compartment lymph node metastasis after HPE was 66.6%. 80% cases with tumor size ≤ 1 cm and 64% cases having tumor size > 1 cm showed central compartment lymph node involvement. Overall Incidence of transient Hypocalcaemia was 40%. No case of recurrent laryngeal nerve palsy was observed. In well-differentiated thyroid malignancies we found a high incidence of central compartment lymph node involvement which was even higher with primary tumour of smaller size (≤ 1 cm). We did not find any incidence of permanent hypocalcemia and recurrent laryngeal nerve injury. So based on our study we emphasize on elective central compartment lymph node clearance to avoid recurrence.
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Abstract
Objective: To assess the Solitary thyroid nodules by surgeon- performed ultrasound-guided FNAC and evaluate with the histopathological findings. Methods: This study includes 100 Consecutive patients of a solitary thyroid nodule which were presented to the Outpatients Department of Surgery during the period of two years from September 2016 to August 2018. Exclusion criteria were patients with extra-thyroid swelling, diffuse goiter and multinodular goiter. All patients with a solitary thyroid nodule underwent Surgeon –performed ultrasound-guided FNAC in the department of Radiology. After thyroid surgery, thyroid specimens were sent for histopathology and evaluate with FNAC findings. Results: The study included hundred patients with solitary thyroid nodule, 75(75%) female and 25 (25%) male with a ratio of F 3:1M. The age of the patients ranged from 15-75 years with a mean age of 35 years. The result of 100 cases of Surgeon –performed Ultrasound –guide FNAC of a solitary thyroid nodule were inconclusive in 10 cases (10%), Non-neoplastic in 60 cases (60%) and Neoplastic lesions in 30 cases (30%). After evaluation of findings from FNAC and histopathology, four cases with benign FNAC (adenomatous/colloid Goiter) turnout as neoplastic (papillary carcinoma) on histopathology and six cases with neoplastic FNAC (papillary carcinoma), just two cases turnout as benign (nodular colloid goiter with cystic degeneration) on histopathology. In present study Surgeon – performed Us FNAC has found to be 87.5% sensitive, 95.3% specific and 92.0% diagnostic accuracy. Conclusion: Surgeon – performed Ultrasound-guided FNAC is a safe, simple and accurate technique in the diagnosis of solitary thyroid nodule.
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Affiliation(s)
- Muhammad Ayoob Jat
- Dr. Muhammad Ayoob Jat, Assistant Professor Surgery, Department of Surgery, College of Medicine, Northern Border University, Arar, KSA
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Altinboga AA, Altunkaya C, Ahsen H, Gumuskaya B, Topaloglu O, Ulusoy S, Kilinc İ, Cakir B, Erdogan F. Diagnosing atypia of undetermined significance in thyroid fine needle aspiration samples using nuclear scoring. Ann Diagn Pathol 2019; 41:112-115. [PMID: 31233903 DOI: 10.1016/j.anndiagpath.2019.06.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/17/2019] [Accepted: 06/07/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Atypia of undetermined significance (AUS) is an indeterminate category in the Bethesda system for reporting thyroid cytopathology. Cytological features described as atypia are not always observed in every case, and it is difficult to determine how the small population of cells with enlarged nuclei, a few grooves, and rare elongated nuclei should be classified. Therefore, there is inter-intra observer variability considering these cell types, even though the cytological criteria are well defined. Therefore, this study aimed to establish a nuclear scoring system to help in the differential diagnosis of AUS. METHODS Fine needle aspiration (FNA) samples that showed AUS and had surgical follow-up were included in this study. The aspirate was scored for the presence of intanuclear cytoplasmic inclusions, nuclear grooves, overlapping, enlargement, and elongation individually. The total nuclear score for each case was calculated. Statistical analysis of the association between each nuclear feature and the presence of papillary thyroid cancer (PTC) in the surgical specimens was performed. Cut-off points from the total score of these nuclear features were also calculated. RESULTS Nuclear grooves and overlapping were more common in malignant cases (p < 0.001 and p = 0.048, respectively). A cut-off point of ≥5.5 for the total score was sensitive and specific for defining malignancy. CONCLUSION The risk of PTC was higher in nodules with more prominent nuclear overlapping or nuclear groove in their FNA samples. In order to achieve a more confident AUS diagnosis, our scoring system can be helpful for thyroid FNA samples.
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Affiliation(s)
| | - Canan Altunkaya
- Kirikkale University, Department of Pathology, 71451 Kirikkale, Turkey
| | - Hilal Ahsen
- Ankara Ataturk Training and Research Hospital, Department of Pathology, 06800 Ankara, Turkey
| | - Berrak Gumuskaya
- Ankara Yildirim Beyazit University, Department of Pathology, 06800 Ankara, Turkey
| | - Oya Topaloglu
- Ankara Yildirim Beyazit University, Department of Endocrinology and Metabolism, 06800 Ankara, Turkey
| | - Serap Ulusoy
- Ankara Ataturk Training and Research Hospital, Department of General Surgery, 06800 Ankara, Turkey
| | - İbrahim Kilinc
- Ankara Ataturk Training and Research Hospital, Department of General Surgery, 06800 Ankara, Turkey
| | - Bekir Cakir
- Ankara Yildirim Beyazit University, Department of Endocrinology and Metabolism, 06800 Ankara, Turkey
| | - Fazli Erdogan
- Ankara Yildirim Beyazit University, Department of Pathology, 06800 Ankara, Turkey
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Santosh T, Puneeta N, Patro MK, Gaikwad P. Fine needle aspiration as a diagnostic tool in cysticercosis: a case series. J Med Case Rep 2019; 13:92. [PMID: 30922414 PMCID: PMC6440104 DOI: 10.1186/s13256-018-1957-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cysticercosis is a zoonotic disease. It is caused by the larval form of the pork tapeworm Taenia solium. This disease is a public health problem in a country like India, but its incidence is underestimated. With the advent of fine needle aspiration cytology with rapid on-site evaluation, early detection of this disease is possible, especially when the lesion is in anatomically approachable superficial locations. CASE REPORT We had four cases of cysticercosis diagnosed by fine needle aspiration cytology with on-site evaluation using toluidine blue stain, followed by Giemsa and Papanicolaou stain. Our cases included three Hindu male patients of age 30 years, 23 years, 17 years and an 26 year old Hindu female. CONCLUSION Fine needle aspiration cytology diagnosis of cysticercosis can be easily made provided the reporting cytologist is aware of the morphological criteria. Rapid on-site evaluation can further help in taking additional material and caution during staining process.
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Affiliation(s)
- Tummidi Santosh
- Department of Pathology & Laboratory Medicine, AIIMS, Bhopal, MP, India.
| | - Nagiredla Puneeta
- Department of Oral and Maxillofacial Pathology, Maitri College of Dentistry and Research Centre, Anjora, Durg, CG, India
| | - Manoj Kumar Patro
- Department of Pathology, Government Medical College & Hospital, Balangir, Odisha, India
| | - Pravin Gaikwad
- Department of Oral and Maxillofacial Pathology, Maitri College of Dentistry and Research Centre, Anjora, Durg, CG, India
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50
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Liu SL, Sun XS, Li XY, Tang LQ, Chen QY, Lin HX, Liang YJ, Yan JJ, Lin C, Guo SS, Liu LT, Li Y, Xie HJ, Tang QN, Liang H, Guo L, Mai HQ. The diagnostic and prognostic values of plasma Epstein-Barr virus DNA for residual cervical lymphadenopathy in nasopharyngeal carcinoma patients: a retrospective study. Cancer Commun (Lond) 2019; 39:14. [PMID: 30925939 PMCID: PMC6441165 DOI: 10.1186/s40880-019-0357-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 03/19/2019] [Indexed: 01/27/2023] Open
Abstract
Background Currently, the diagnosis and treatment of nasopharyngeal carcinoma (NPC) patients with residual cervical lymphadenopathy following radical radiotherapy with or without chemotherapy are challenging. We investigated the prognosis of NPC patients with residual cervical lymphadenopathy and assessed the diagnostic and prognostic values of Epstein-Barr virus (EBV) DNA in these patients. Methods This study included 82 NPC patients who were diagnosed with suspected residual cervical lymphadenopathy following completion of antitumor therapy. Their plasma EBV DNA levels were measured using quantitative polymerase chain reaction (qPCR) before the initiation of treatment and before neck dissection. Fine needle aspiration cytology (FNAC) was performed in 21 patients. All patients had undergone neck dissection and postoperative pathological examination to identify the nature of residual cervical lymphadenopathy. The overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS) were calculated using the Kaplan–Meier method and compared using the log-rank test. The Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable analysis was used to estimate the effect of potential prognostic factors on survival. Results Following a median follow-up of 52.6 months, compared with patients with negative postoperative pathological findings for residual cervical lymphadenopathy, the patients with positive findings had a significantly lower 3-year PFS rate (49.9% vs. 83.3%, P = 0.008). Among NPC patients with residual cervical lymphadenopathy, the patients with preoperative plasma EBV DNA > 0 copy/mL had a lower 3-year PFS rate than did those with no detectable EBV DNA (43.7% vs. 61.1%, P = 0.031). In addition, combining FNAC with preoperative EBV DNA detection improved the diagnostic sensitivity. Multivariable analysis demonstrated that residual cervical lymphadenopathy with positive postoperative pathological result was an independent prognostic factor for PFS and that detectable preoperative plasma EBV DNA was an independent prognostic factor for OS. Conclusions Using FNAC combined with preoperative EBV DNA detection improves the sensitivity in diagnosing NPC with residual cervical lymphadenopathy. Compared with patients with undetectable EBV DNA, patients with detectable preoperative plasma EBV DNA have worse prognosis and may require a more aggressive treatment strategy.
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Affiliation(s)
- Sai-Lan Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Xue-Song Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Xiao-Yun Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Lin-Quan Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Qiu-Yan Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Huan-Xin Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Yu-Jing Liang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Jin-Jie Yan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Chao Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Shan-Shan Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Li-Ting Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Yang Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Hao-Jun Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Qing-Nan Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Hu Liang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Ling Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.
| | - Hai-Qiang Mai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.
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