Block Preparation Research Articles

IMMUNOHISTOCHEMICAL STUDY OF DESMIN, EPITHELIAL MEMBRANE ANTIGEN AND CALRETININ IN PLEURAL FLUID CELL BLOCK PREPARATIONS

Background: Distinction between reactive mesothelial cells, malignant mesothelioma and carcinoma is challenging in both biopsy and cytologic material. This study was conducted to differentiate benign/ reactive mesothelial proliferation from malignant mesothelial proliferations and metastatic adenocarcinoma by using immunohistochemical (IHC) markers Desmin (DES), Epithelial membrane antigen (EMA) and Calretinin (CAL) in pleural uid cell block (CB) preparations. A two year descriptive study (Oct.2016- Sept.2018). 46 pleural uids samples sentMethods : to the Dept. of Pathology, RIMS for routine examination and histopathological examination by CB preparation were studied using IHC markers EMA,DES and CAL following H & E stain. Out of 46 cases, 9(19.6%) cases were diagnosed as benign, 23(50.0%) as reactive andResults: 14(30.4%) as adenocarcinoma on H & E section by CB preparations within an age range 34 to 80 years (Mean±SE, 60.32±12.13). Following IHC staining with EMA, DES & CAL, 11(23.9%) cases were conrmed as benign, 17(37.0%) as reactive, 16(34.8%) as adenocarcinoma and 2(4.3%) cases as malignant mesothelioma. This study showed that EMA, DES and CAL helpful in conrming benign or reactive mesothelialConclusions: and malignant mesothelial with epithelial cells which will be helpful in providing appropriate diagnosis in difcult cases and provide better patient management.

Diagnostic Utility Of Fluid Cytology By Conventional Smear And Cell Block Method In Pleural Effusion

The cytological examinations of serous effusions have been well-accepted, and a positive diagnosis is often considered a definitive diagnosis. The study was planned to determine the diagnostic utility of fluid cytology by conventional smear and cell block method in pleural effusion. This was a hospital-based open cohort observational study conducted on patients diagnosed with pleural effusion. The study period was one year, and patients were recruited using a nonprobability sampling method. The fluid samples were subjected to the conventional smear examination, followed by cell block preparation. The overall morphologic details, cellularity, architecture, and nuclear and cytoplasmic details were studied and compared in conventional smear and cell block techniques. The samples were categorized as unsatisfactory, benign, suspicious for malignancy, or malignancy. The study was conducted on 113 pleural fluid samples. The study demonstrated that the cell block technique improved the cellular yield and established diagnosis in malignant effusions.

Diagnostic utility of cellblock technique in reporting body fluid cytology

Introduction: Body fluids are processed by routine cytology techniques like preparing a slide and staining it with PAP stain. By this method it is difficult to give definitive diagnosis particularly to the cases where some abnormal cells seen suspicious of malignancy. In our study we utilized cell lock technique for reporting body fluid cytology. Objectives: Our objective is to prepare cellblock from body fluid, to use it for diagnosis of benign and malignant lesions and also to check advantage and drawbacks of cell block technique over the conventional cytology examination. Materials and Method: This study was carried out in medical collage hospital in Department of Pathology. We selected total 52 body fluids with good cellularity for cell block preparation. Result: Out of 52 cases 45 were diagnosed as benign and 7 as malignant using cell block technique. Conclusion: We conclude with findings that cell block technique is better than routine cytology technique. By cell block technology tissue architecture can be well appreciated and definite diagnosis can be given. Also, we can utilize cell block for definitive diagnostic methods like Immunohistochemistry.

Using American Type Culture Collection Cell Lines to Evaluate Interlaboratory Variables for Estrogen Receptor and Human Epidermal Growth Factor Receptor 2 Immunostaining.

Most laboratories currently use patient tissues for validating immunohistochemical stains. To explore advantages of using cell lines with known antigenicity as a validation method. Five American Type Culture Collection (ATCC) cell lines with known negative, low positive, and moderate to strong estrogen receptor (ER) expression as well as negative, equivocal, and positive human epidermal growth factor receptor 2 (HER2) expression were cultured and made into cell blocks. One block from each cell line was fixed in formalin and another in ethanol before cell block preparation. Two sets of paired unstained slides from each block were sent to 10 different laboratories for HER2 and ER staining to be stained on runs from different days according to each laboratory's defined protocol. The 10 study participants evaluated 40 slides in a blinded fashion. For ER expression, all 80 interpretations for the ER strong and moderate positive cell lines had the target ER-positive result, and 74 of 80 ER-negative cell lines (92.5%) had agreement with the intended negative result. The ER low positive cell line showed varied but positive expression among all observers. The HER2 (3+)-positive cell lines yielded a target interpretation of 3+ in 65 of 80 interpretations (81.2%). For the HER2-negative cell line 69 of 78 interpretations (88.5%) were consistent with the target response (0 or 1+). No significant variation was observed between the ethanol- and non-ethanol-exposed cell lines, or between runs by the same laboratory. Variation from target results clustered within laboratories. This study indicates that variability between laboratories can be identified by using cell lines for quantitative or semiquantitative immunohistochemistry when using cultured cell lines of known antigenicity. These cell lines could potentially play a role in aiding anatomic pathology laboratories in validating immunohistochemistry tests for formalin- and ethanol-fixed tissues.

Papanicolaou society of cytopathology system for reporting pancreaticobiliary cytology: Risk stratification and cytology scope - 2.5-year study.

Objectives:Diagnosis of pancreatic lesions remains a clinical challenge. Early and accurate diagnosis is extremely important for improving the therapeutic usefulness of pancreatic cancers and Endoscopic ultrasonography - fine needle aspiration (EUS-FNA) cytology has come up with this advantage. For current study the authors evaluated the diagnostic accuracy of EUS-FNAC by applying PSC system for reporting pancreaticobiliary cytology and Calculated the malignancy risk associated with the diagnostic categories.Material and Methods:A retrospective study over the period of 2.5 years (April 2017 to Oct 2019) 60 patients in our cohort EUS-FNAC guided unstained fixed and unfixed slides received of pancreatic lesion and were stained with Papanicolau and Giemsa using standard technique and immunocytochemistry, where required Application of Papanicolaou Society of Cytopathology system for reporting pancreaticobiliary cytology Histopathological and clinical follow-up were retrieved.Results:Our study has comparable results with sensitivity, specificity, PPV, and NPV of 92.8%, 100%, 100%, and 92.59%, respectively. Fuurthermore, a diagnostic accuracy of 96.2%. Risk of malignancy is lower for benign and indeterminate category whereas it is higher for suspicious and malignant categories.Conclusion:The application of the new proposed terminology for pancreaticobiliary cytology brings standardization. Final diagnosis can be reached by the multidisciplinary approach of EUS-FNA cytology, cell block preparation, immunocytochemistry, and immunohistochemistry; if required, can be adopted as an alternative approach to biopsy. The present study showed high sensitivity and specificity for EUS-FNA in the diagnosis of pancreatic carcinoma, which may influence the treatment plans of both surgeons and oncologists.

ИССЛЕДОВАНИЯ МАССИВА И ОСНОВНЫХ ПАРАМЕТРОВ СИСТЕМЫ РАЗРАБОТКИ СЛОЖНОСТРУКТУРНЫХ МЕСТОРОЖДЕНИЙ ОБЛИЦОВОЧНОГО КАМНЯ УЗБЕКИСТАНА

The scientific paper has investigated a range and parameters of the block stone mining system in Uzbekistan. Scientific researches, made by leading scientists in this field, have been closely reviewed. Methods of assessment of fracturing and blockiness of massif based on correlation between linear and area indices of natural separations in massif have been applied. A technological scheme of face orientation in relation to fracture systems has been developed. Possible technical productivity of stone blocks extraction using different methods of preparation for excavation has been determined. Rational areas of various methods of stone block preparation for excavation and optimum technological parameters are established.

Boron Cage Triggered Micellization of a Neutral–Cationic Block Copolymer and Preparation of Boron-Containing Layer-by-Layer Microparticles

The preparation of a polymer carrier for a boron delivery agent is presented through a combination of experimental and computational studies. A dodecahydro-closo-dodecaborate (B12H12)2– (B12) anion was used as a model boron-containing agent due to its high boron content. Quaternized poly(2-vinyl pyridine)-b-poly(ethylene oxide) (QP2VP-b-PEO) was chosen as a model neutral–cationic block copolymer to construct the carrier. The electrostatic association between QP2VP and B12 induced the self-assembly of QP2VP-b-PEO, resulting in micelles with (B12 + QP2VP)-core and PEO-corona. The mechanism of formation of (B12 + QP2VP)-b-PEO micelles was examined through density functional theory (DFT) calculations and classical simulations. (B12 + QP2VP)-b-PEO micelles were found to be undurable in biological medium. To enhance stability, micelles were utilized as building blocks together with poly(N-vinyl caprolactam) (PVCL) and tannic acid (TA) to construct layer-by-layer (LbL) microparticles. Cytotoxicity and cellular association of LbL particles were assessed using the HepG2 cell line. Multilayered particles were found to show no cellular cytotoxicity. Association studies and the boron content of treated cells through inductively coupled plasma optical emission spectroscopy (ICP-OES) showed that LbL microparticles were extensively associated with and successfully delivered boron to HepG2 cells. This study reveals the challenges and possible solutions to obtain stable self-assembled structures in a cell culture medium. These findings contribute to a fundamental understanding of the structure–property relationship in self-assembled micelles/LbL particles and provide a basis for further development of boron-containing polymer vehicles for boron neutron capture therapy.

Cell Block Method: An Imperative Tool for Cytological Diagnosis of Oral Potentially Malignant Lesions

Globally, oral squamous cell carcinoma (OSCC) is one of the commonest reported malignancies usually arising from oral potentially malignant lesions (OPMLs) such as leukoplakia, erythroplakia, oral submucous fibrosis (OSMF) and oral lichen planus (OLP). Hence timely and early diagnosis of these disorders is of prime importance to halt their malignant transformation. A search of published works was done using the online databases of PubMed, Scopus, Web of Science, and Cochrane Library”. Data from resource-constrained laboratory settings worldwide shows limited documentation of the efficacy of advanced cytological techniques, including LBC and cell block preparations. The oral mucosa can be a suitable area for regular cytological screening due to its easy accessibility. Liquid-based cytology (LBC) can preserve the cellular details and reduce the overlapping of cells, enabling precise interpretation, reducing false-negative results and aiding in the diagnosis of premalignant and malignant lesions of the oral cavity with more accuracy compared to exfoliative cytology. The remaining sample in LBC can be used in cell block formation and various ancillary tests like immunocytochemistry, immunofluorescence, and molecular studies. Literature showed a scarcity of data available regarding Pakistan. Therefore, the review is aimed to explore the cell block method as a minimally invasive technique for reducing morbidity and mortality associated with OSCC. Keywords: Cell Biology; Oral Squamous Cell Carcinoma; Malignancy.

Analysis of Isocitrate Dehydrogenase (IDH) expression in astrocytoma patients: cases of South Sulawesi, Indonesia

Background: Astrocytoma is the most common primary intracerebral tumor in adults and causes high morbidity and mortality. Most patients with astrocytomas, especially diffuse gliomas, have a poor prognosis. Recent genetic and epigenetic studies have shown that mutations in the Isocitrate Dehydrogenase (IDH) gene play an important role in the pathogenesis and prognosis of gliomas, thus facilitating IDH1 mutations in the population to become an important marker, not only to assist in the diagnosis and prognostic factors of these gliomas but also to develop therapeutic targets as currently available. This study aims to see differences in the expression of the IDH in each astrocytoma classification. Methods: A cross-sectional analytic study was conducted at the Anatomical Pathology Laboratory, Faculty of Medicine, Universitas Hasanuddin, from October 2020 to August 2021. The research sample came from 65 paraffin block preparations for primary brain tumors with the diagnosis of Diffuse Astrocytoma (DA), Anaplastic Astrocytoma (AA) and Glioblastoma (GB). The immunohistochemical staining was performed using the monoclonal antibody IDH1-R132H. The microscopic assessment was carried out using a light microscope. Data were analyzed using SPSS version 20 for Windows. Results: There was a significant relationship between the expression of IDH1-R132H in each astrocytoma classification (p=0.008). The prevalence of astrocytoma with negative IDH1-R132H expression (IDH-wildtype) is lower by 21 samples (32.3%) compared to astrocytoma with positive IDH1-R132H expression (IDH-mutant), which is 44 samples (67.7%). Conclusion: There are significant differences in the expression of IDH1-R132H in Diffuse Astrocytoma, Anaplastic Astrocytoma and Glioblastoma, where the proportion of IDH-mutant status is higher than IDH-wildtype and IDH1 mutation status has a significant relationship with tumor grade.

Evaluation of DNA/RNA quality from cell block of malignant mesothelioma and lung adenocarcinoma.

Cell blocks were prepared using the malignant mesothelioma cell lines MESO4 and H226 and non-small cell lung carcinoma cell line HCC78. The cells were fixed using 10% neutral buffered formalin and four different fixatives for liquid cytology. Fixed cells were formed into cell clusters using sodium alginate or centrifugation, and paraffin-embedded cell blocks were prepared. Cell blocks were morphologically evaluated by hematoxylin and eosin and immunocytological staining, and the nucleic acid quality was evaluated by DNA/RNA extraction, qPCR, and next-generation sequence analysis. D2-40 and WT1 staining differed depending on the fixation solution and the cell cluster formation method; however, the degree of nucleic acid degradation was not impaired by any method. Although the morphological evaluation of cytology specimens is affected by the method of cell block preparation, it is still useful for nucleic acid extraction and gene panel analysis, as long as there are sufficient amounts of tumor cells.

The diagnostic performance of combined conventional cytology with smears and cell block preparation obtained from endoscopic ultrasound-guided fine needle aspiration for intra-abdominal mass lesions.

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the primary method for tissue acquisition of intra-abdominal masses. However, the main limitation of cytology alone is the lack of tissue architecture and inadequate samples. This study aimed to evaluate the diagnostic performance of combined conventional cytology and cell block preparation obtained from EUS-FNA of intra-abdominal masses without Rapid On-site Evaluation (ROSE). Cytologic smears and cell block slides of 166 patients undergoing EUS-FNA during 2010-2015 were reviewed by an experienced cytopathologist blinded to clinical data. 125 patients had neoplastic lesions. Pancreatic adenocarcinoma was the most common etiology (35.5%), followed by lymph node metastasis (27.7%). The mean mass size was 2.5±1.3 cm. The mean number of passes was 1.9±1.28. Tissue adequacy for conventional cytology and cell block preparation was 78.9% and 78.1%, respectively. Factors associated with tissue adequacy were assessed. For cytology, lesions of > 2.1 cm, masses in the pancreatic body or tail, malignancy, and pancreatic cancer were positively associated with adequate cellularity. For cell block preparation, lesions of > 3 cm and malignancy were associated with increased tissue adequacy. The conventional cytology alone had a sensitivity of 68.5%, a specificity of 95.7%, and an area under the receiver operating characteristics (AUROC) of 0.821. The cell block preparation alone had a sensitivity of 65.4%, a specificity of 96%, and an AUROC of 0.807. The combined conventional cytology and cell block preparation performed significantly better than either method alone (p<0.05), as demonstrated by an increased AUROC of 0.853. Furthermore, cell block detected malignancy in 9.3% of cases where the cytologic smears failed to identify malignant cells. The combined conventional cytology and cell block preparation increased the diagnostic accuracy of EUS-FNA compared to either method alone. This approach should be implemented in routine practice, especially where ROSE is unavailable.

Diagnostic Accuracy of Cell Block Preparations and Clinical Features Affecting It in Vitreoretinal Lymphoma.

Purpose: The purpose of this study was to examine the diagnostic accuracy of the cell block (CB) method and clinical features affecting it in patients with vitreoretinal lymphoma (VRL). Methods: This study enrolled 38 eyes in 33 VRL patients, and 7 eyes in 7 patients with idiopathic uveitis who underwent diagnostic vitrectomy. Medical records including the results of CB cytology, interleukin (IL)-10/-6 concentrations, and immunoglobulin heavy chain gene (IgH) rearrangement were retrospectively searched. Results: Patients with VRL comprised 16 women and 17 men, and the age of onset ranged from 44 to 85 years (mean: 70 years). CB preparations detected large malignant cells in 35 eyes (92%), whereas the other 3 VRL eyes were negative. Two of the latter three eyes showed subretinal infiltrates, which existed in 7 of 35 CB-positive eyes. Intravitreal IL-10 and -6 concentrations were 1866 ± 4088 pg/mL and 98 ± 139 pg/mL, respectively, and the rate of IL-10/-6 >1 was 86.9%. The presence of IgH monoclonality was 63.2%. In patients with uveitis, CB specimens revealed no atypical but small inflammatory cells. IL-6 concentration was 311.1 ± 240 pg/mL, whereas IL-10 was undetectable in six eyes, and the IL-negative rate was 85.7%. Six eyes (85.7%) with uveitis showed no IgH monoclonality. Conclusions: Diagnostic accuracy of CB preparations in VRL could achieve an equivalent outcome to IL ratio calculation and IgH monoclonality detection. The appearance of subretinal infiltrates may diminish the CB positivity.

Does pleural fluid cell block is an alternative to Thoracoscopy guided diagnostic techniques in malignant pleural effusion? Study of 500 cases in tertiary care setting in India

Background: Malignant pleural effusion missed routinely because of less diagnostic yield of conventional fluid cytology like fluid cytology. Fluid cell block is underutilsed techniques routinely and less utilized in diagnostic panel due to lack of expertise in filed of cytopathology. Materials and methods: Prospective multicentric study conducted during Jan 2014 to June 2020 in Venkatesh chest hospital, and Pulmonary Medicine, MIMSR medical college Latur, to find out diagnostic yield of conventional pleural fluid cytology&amp; pleural fluid ‘cell block’ in malignant pleural effusion and compare yield of pleural fluid cell block with conventional cytology technique. The study included 500 cases of unexplained, exudative pleural effusion with ADA&lt;30/IU/liter and pleural fluid cytology is either positive for malignant cell with or without cell type differentiation, or cytology suspicious for malignant cell. All cases were subjected to cell block preparation. Statistical analysis was done by using chi-test. Observation and analysis: In study of 500 cases, mean age of group was 68±9.5 years and adenocarcinoma were predominant malignancy in 79% cases, mesothelioma in 6% cases, squamous cell carcinoma in 7% cases &amp; 8% cases were having primary tumor outside the thoracic cavity. In study cases pleural fluid cytology was positive in 42% cases (210/500), and pleural fluid cell block was positive in 96% cases (480/200) in detecting malignant pleural effusion (p&lt;0.0001), Remaining six and two cases were diagnosed by using image guided and thoracoscopy guided pleural biopsies respectively. IHC was done in all pleural fluid cell block preparation for calretinin, cytokeratin and EGFR. Conclusion: Pleural fluid cell block is sensitive, superior, cost effective and specific diagnostic method over conventional pleural fluid cytology. 'Cell block' specimens are enough for primary diagnosis and IHC analysis necessary for cell typing. It will decrease need for more invasive and costlier diagnostic methods like thoracoscopy and image guided pleural biopsies. We recommend cell block for every exudative pleural fluid sample with ADA&lt;30 IU/liter.

CORROBORATION OF FINE NEEDLE ASPIRATION CYTOLOGY FINDINGS WITH CELL BLOCK STUDY OF MALIGNANT LUNG LESIONS USING IMMUNOSTAINS (TTF1, NAPSIN A, P40 AND CHROMOGRANIN A).

Background: Malignancy of the lung has been rising steadily worldwide and exact sub typing has become a necessity for targeted therapy. FNAC alone has its limitations in sub categorization of lung malignancy because of lack of architecture. Cell block preparation from FNAC material with immunohistochemistry panel would supplement the FNAC nding. Objectives: To determine the utility of cell block study using immunostains (TTF 1, Napsin A, p40 and Chromogranin A) in corroborating the ndings of FNAC in the study of malignant lung lesions. Materials and methods: A hospital based cross sectional study was done on the FNAC sample from lung masses followed by cell block study and immunohistochemical staining for (CHROMOGRANIN A, NAPSIN A, p40, TTF1). Data was analyzed using IBM SPSS statistics version 21 Software. Results: A total of 32 (54.2%) cases were found malignant and 27 (47.3%) cases were found benign. A total 59 cell block were prepared from 32 cases positive for malignancy (PFM) and 27 cases negative for malignancy(NFM). After cell block and immunohistochemical studies, 2 benign lesion were recategorized as malignant and 3 malignant cases recategorized as benign lesion. There was a substantial agreement found between FNAC diagnosis and IHC diagnosis as in both cases the kappa value (฀ coefcient) were found to be 0.747 (between 0.61 - 0.80). Conclusion: The cell block from the aspirated material revealed further architectural and immunohistochemical features which not only conrmed the FNAC diagnosis but helped to recategorize 2 benign and 3 malignant lesion.

Experience of Endoscopic Ultrasound Fine Needle Aspiration in Tertiary Care Hospital

OBJECTIVE: The objective of the study is to determine the spectrum of endoscopic ultrasound fine needle aspiration ( EUS FNA) in the diagnosis of the pancreas, GIT, hepatopancreatobiliary tract, mediastinal lymph node and hepatic lymh node by using rapid on-site evaluation (ROSE). METHODOLOGY: A retrospective study was conducted at the department of Histopathology and endoscopy suit (Liaquat National Hospital and Medical College) during the period of March 2019 to March 2022. A total of 55 patients undergoing EUS FNA were included in our study. 22 gauge needle was used for performing EUS FNA and stained with PAP alcohol fixed slides while stained with Diff –Quick air dried slides, as well as sample, also needed for cell block preparation. RESULTS: The mean age of the patient was 56.1. A total of 55 patients were included among them 33 patients were males and 22 females. The most common site was the pancreas, 38 cases with diagnosed as 68.4% were adenocarcinoma, mediastinal lymh node 9 cases 6.4%, gastric 4 cases 7.3%, rectal 1 case 1.8%, duodenal 1 case 1.8%, hilar mass 1 case 1.8% and hepatic lymh node 1 case 1.8%. CONCLUSION: EUS FNA is a valuable, safe procedure that can be done under conscious sedation but rare complications included bleeding and pancreatitis. It provides at least a cost-effective mode of provisional diagnosis for the diagnosis and cost-effective testing of the pancreas, GIT, post mediastinum or related organs. Close interaction with cytopathologists is essential to improve diagnostic yields. The final diagnosis is based upon the correlation of clinical, EUS and cytological features along with relevant immunohistochemical markers on paraffin embedded block.

Role of pleural fluid “Cell Block” in malignant pleural effusion: Underutilized, sensitive, and superior over conventional fluid cytology; Does it will decrease need for thoracoscopy guided procedures?

Background: Malignant pleural effusion missed routinely because of less diagnostic yield of conventional fluid cytology. Materials and Methods: Prospective multicentric study conducted during January 2014 to June 2016 in Venkatesh chest hospital, and Pulmonary Medicine, MIMSR medical college Latur, to find diagnostic yield of conventional pleural fluid cytology and pleural fluid “cell block” in malignant pleural effusion and compare yield of pleural fluid cell block with conventional cytology technique. The study included 200 cases of unexplained, exudative pleural effusion with Adenosine deaminase (ADA) ≤30/IU/l and pleural fluid cytology is either positive for malignant cell with or without cell type differentiation, or cytology suspicious for malignant cell. All cases were subjected to cell block preparation. Statistical analysis was done by using Chi-test. Observation and Analysis: In study of 200 cases, mean age of group was 68 ± 9.5 years and adenocarcinoma was predominant malignancy in 72% cases, mesothelioma in 10% cases, squamous cell carcinoma in 7% cases and 9% cases were having primary tumor outside the thoracic cavity. In study cases, pleural fluid cytology was positive in 42% cases (84/200), and pleural fluid cell block was positive in 96% cases (192/200) in detecting malignant pleural effusion (P < 0.0001). Remaining six and two cases were diagnosed by using image-guided and thoracoscopy-guided pleural biopsies, respectively. Immunohistochemistry (IHC) was done in all pleural fluid cell block preparation for calretinin, cytokeratin, and epidermal growth factor receptor. Conclusion: Pleural fluid cell block is sensitive, superior, cost-effective, and specific diagnostic method over conventional pleural fluid cytology. “Cell block” specimens are enough for primary diagnosis and IHC analysis necessary for cell typing. It will decrease the need for more invasive and costlier diagnostic methods like thoracoscopy and image-guided pleural biopsies. We recommend cell block for every exudative pleural fluid samples with ADA <30 IU/l.

Utility of SOX11 for the diagnosis of solid pseudopapillary neoplasm of the pancreas on cytological preparations.

The diagnosis of solid pseudopapillary neoplasm (SPN) on fine needle aspiration specimens can be challenging because of morphological overlap with other pancreatic neoplasms, including pancreatic neuroendocrine tumour (PanNET). SRY-related high-mobility group box 11 (SOX11) is a recently described sensitive and specific marker for SPN diagnosis. However, SOX11 immunocytochemistry on cytological smears has not been reported. We evaluated the utility of SOX11 for diagnosis of SPN on cytological preparations. SOX11 immunocytochemistry was performed on Papanicolaou-stained smears and/or corresponding cell blocks from aspirates of 7 SPN and 10 PanNET cases identified between 2005 and 2020. Findings were compared with those for beta-catenin, a frequently used diagnostic marker for SPN. Six smears and 6 cell blocks from SPN cases and 8smears and 10 cell blocks from PanNET cases were available for immunostaining. For SPN, nuclear staining for SOX11 was seen in 6 of 6 (100%) smears and 5 of 6 (83%) cell blocks, with equivocal staining in 1 cell block. In contrast, 7 of 8 (88%) smears and 9 of 10 (90%) cell blocks were negative for SOX11 for PanNet, with equivocal staining seen in 1 case. Beta-catenin immunocytochemistry showed nuclear staining in 6 of 7 (86%) SPN cases and no staining in all 10 (100%) PanNET cases. SOX11 detected by immunocytochemistry can serve as a useful diagnostic marker for SPN, in addition to beta catenin, and can be performed on cytological smears in cases without a cell block preparation.

Immunohistochemical Expression of SOX2 in Benign and Malignant Ovarian Serous Tumors at the Anatomic Pathology Unit H. Adam Malik Hospital Medan

Background: Ovarian neoplasms are most often found in women with an incidence of 80% of benign tumors and the rest are malignant tumors of the ovary. Ovarian cancer in Indonesia ranks third most cases that occur in women after breast cancer and liver cancer. Serous epithelial ovarian tumors are the most common subtype of ovarian cancer. SOX2 (SRY/sex determining region Y-box2) is a transcription factor that plays a role in cell proliferation and is also a marker of cancer stem cells. The presence of these cancer stem cells will affect the success of therapy because they are resistant to chemotherapy and radiotherapy. Aim: Knowing how to assess the expression and how the immunohistochemical expression of SOX2 in benign and malignant ovarian serous tumors. Method: This study is a descriptive analytic study using surgical tissue paraffin block preparations from patients with a diagnosis of benign and malignant ovarian serous tumors in the Anatomical Pathology Unit of HAM Hospital Medan with 39 cases. This research has been approved by the Health Research Ethics Commission, Faculty of Medicine, University of North Sumatra. Results: Based on the immunohistochemical staining of SOX2, the benign subtype was found to be low in expression (71.4%), the low-grade subtype to have high expression (18.2%) and the high-grade subtype to have more high expression (81.8%). Conclusion: In this research it was found that the highest expression of SOX2 was found in the benign subtype with low expression, but in the high-grade serous subtype high expression was found.

Pulmonary actinomycosis: cytomorphological features.

Pulmonary actinomycosis is an uncommon infectious disease. Although the gold standard for diagnosis is histological examination with bacterial culture of lung tissue, cytology samples offer a fast and low-cost alternate diagnostic procedure. The cytology literature on this topic is limited to mostly case reports. Therefore, the aim of this study was to review cytological material in a series of patients with a diagnosis of pulmonary actinomycosis to characterize the main cytomorphological findings. Different cytological respiratory samples including sputum smears, bronchoalveolar lavages (BALs), transthoracic or endobronchial fine needle aspiration cytology (FNAC) and cell block preparations were used for retrospective examination. For all cases patient age, gender, symptoms, and radiological chest findings were recorded. A total of 26 cytological respiratory samples (14 sputum smears, 9 FNAC, two BALs) including direct smears and 6 cell blocks from 9 patients were examined. In sputum smears the most remarkable findings were the presence of dark cotton ball masses with projections like spider legs and/or mouse tails (75% of the samples). Sulfur granules were observed in 4 (40%) of the sputum smears and within FNAC cases. Various respiratory cytology samples including sputum smears, FNAC and BALs can reveal cytomorphological findings diagnostic of pulmonary actinomycosis. Characteristic cytological findings compatible with a diagnosis of this infection include cotton ball masses and less frequently sulfur granules.

EMA-AND USEFUL IMMUNOCYTOCHEMICAL MARKER AT DIFFERENTIATION OF GLANDULAR MALIGNANT CELLS FROM ATYPICAL MESOTHELIAL CELLS ON CELL BLOCK PREPARATION OF BODY EFFUSIONS

The detection of the malignant cells by cytologic method has long been practised. The detected malignant cells are difficult to be typed specially in the situations of overlapping cytomorphology. The conventional cytologic preparation may harbour lower number of malignant cells but the method of cell block offers high detection rates of such malignant cells. Still the problem remains when the evaluation is short by morphological features and requires immunoexpression studies. The commonest situation encountered of overlap cytomorphology is the distinction between well differentiated adenocarcinoma from reactive mesothelial cells with atypia in effusion. Such a distinction is not only important for the purposes of diagnosis but also for prognostification by stage and management of the patient .The review presents the experiences of the past studies over utility of EMA in detection and segregation of the cells of well differentiated adenocarcinoma infiltrating the effusions from reactive atypical mesothelial cells. The present review is compiled from the publications from various institute across the globe and shares the authors experience for the utility of epithelial membrane antigen over the cell block of effusions at distinction of overlap cytomorphology. Compilation of the study by inclusion of articles by 1,2,3,3,4,5,6,7,8,9,10.The articles were searched through google engine and Pubmed search. The 10 articles dealing onto the role of EMA as a immunocytochemical marker have affirmed the high sensitivity and specificity of EMA at seggregating glandular malignant cells from atypical mesothelial cells on cell block preparation of body effusions.The range of sensitivity and specificity for EMA was found to be 81% -100% and 98.86 -100% respectively.The positive predictive value range from 92-97% and negative predictive value ranging from 88.64 – 100%. All the studies reviewed confirmed the high value of significance (P value for EMA). The systematic review carried out re-affirms the role of EMA in the situations of of indistinguishable cytomorphology of adenocarcinoma from that of benign , reactive , atypical mesothelial cells. The overall diagnostic utility of EMA was conducted to br over 90% in such situations.