Cytologic Diagnosis Of Malignancy Research Articles

The Cytological Diagnosis of a Malignant Effusion Is Independent of the Volume of Fluid Processed.

The relationship between pleural fluid volume and cytological diagnosis of malignancy has been often investigated with conflicting conclusions on whether or not a minimum fluid volume should be defined. The primary objective of this retrospective investigation is to evaluate the relationship between fluid volume and cytological diagnosis of malignancy. A total of 511 body fluid specimen reports received between January 2018 and December 2019 were examined to investigate the relationship between diagnosis of malignancy to volume and biochemical properties. Pleural fluid (n = 252) and peritoneal fluid (n = 250) specimens were binned into two volume groups (< 75 mL, ≥ 75 mL). Pericardial fluid specimens (n = 9) were excluded due to small sample size. Prevalence of malignancy for pleural and peritoneal fluids was 20.2% and 20.08%, respectively, with no significant difference between the two volume groups. Malignant pleural effusions were associated with a serum to fluid protein ratio > 0.5 and malignant peritoneal effusions were associated with a serum ascites albumin gradient (SAAG) < 1.1 g/dL. Our study did not find a significant difference in the diagnosis of malignancy between volumes ≥ 75 mL and < 75 mL in either pleural or peritoneal fluid. Fluid volume is, therefore, not an adequacy criterion for detecting malignancy in either pleural or peritoneal fluid. Our analysis on the biochemical properties of each malignant fluid type was supportive of current use of Light's criteria and SAAG for effusion fluid evaluation.

Childhood sarcomas: fine-needle aspiration cytopathology with an emphasis on the use of molecular studies.

In children and adolescents, most sarcoma subtypes have a simple karyotype with a single genetic alteration; cytologic findings combined with ancillary testing can lead to a specific diagnosis. The goal of this study was to review the use of fine-needle aspiration in conjunction with immunohistochemistry and molecular studies as a part of an integrated, multidisciplinary diagnostic workup for bone and soft tissue sarcomas in this population. We searched for cases aged ≤18 years old with a malignant bone or soft tissue tumor that had corresponding cytology specimens from 3 institutions. Clinical data, cytologic findings and diagnoses, histologic diagnoses, and ancillary testing were documented. Of 99 cases, 55% were male with a mean age of 12 years. Ninety-four cases (95%) had a specific histologic diagnosis, and 84 cases (85%) were primary neoplasms. Ninety-four cases (95%) had a malignant cytologic diagnosis, and 71 cases (72%) had a specific cytologic diagnosis concordant with the histologic diagnosis. Among primary tumors with a specific histologic diagnosis, a specific cytologic diagnosis was made in 63 cases (79%). After excluding osteosarcoma, 74% of the tumors (n = 50) had molecular studies. Specific genetic alterations supporting a definitive diagnosis were found in 42 cases (84%), the majority of which were demonstrated using Fluorescence In Situ Hybridization (n = 33, 79%). We found that fine-needle aspiration in conjunction with core needle biopsy, immunohistochemistry, and molecular studies allowed cytopathologists to accurately classify sarcomas in a pediatric age group.

Comparative study of conventional Ziehl−Neelsen and bleach concentration method in detecting acid-fast bacilli in fine-needle aspiration material of lymph nodes

Background: Tuberculosis (TB), specific infectious disease, affects most of the organs of the human body. Extrapulmonary TB manifests commonly as lymphadenopathy. Emergence of acquired immunodeficiency syndrome warrants the rapid diagnosis to limit its spread. Aim and Objectives: The application of bleach concentration method in detecting tubercle bacilli in the material obtained by fine-needle aspiration (FNA) of lymph nodes, evaluating sensitivity of bleach concentration method over conventional direct smear method in diagnosing tubercular lymphadenitis, detecting bacilli in the background of granuloma formation. Materials and Methods: The prospective, hospital-based, cross-sectional study was carried out in a study population of 78 patients where 15 cases got eliminated following the cytological diagnosis of malignancy and inadequacy of sample. Patients with lymphadenopathy underwent FNA after clinical examination, history taking, and informed consent. The aspirated material was stained with Leishman, H and E, conventional Ziehl−Neelsen (ZN), and bleach concentration method. Data were collected and statistical analysis done. Results: The predominant age group affected was (16–30) years with male preponderance. 44.44% cases were cytomorphologically diagnosed with tuberculous lymphadenitis. Acid-fast Bacilli (AFB) was found in 23 cases by conventional ZN method and 39 cases by bleach concentration method. Sensitivity of bleach method was 92.35% compared to 54.76% in conventional ZN method. Bacilli positivity was more in cases presenting with necrosis than with granuloma alone. Conclusion: Bleach method for detecting AFB is more sensitive than conventional ZN method. It is safe, inexpensive, easy to perform, requires no additional equipment, and safe to handle in laboratory.

Molecular Testing of Nodules with a Suspicious or Malignant Cytologic Diagnosis in the Setting of Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP).

Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is an indolent thyroid tumor characterized by frequent RAS mutations and an absence of the BRAF V600E mutation commonly seen in classical papillary thyroid carcinoma (cPTC). The ability to differentiate potential NIFTP/follicular variant of papillary thyroid carcinoma (FVPTC) from cPTC at the time of fine-needle aspiration (FNA) can facilitate conservative management of NIFTP. The aim of the current study was to investigate how molecular testing may add to cytologic assessment in the pre-operative differentiation of potential NIFTP/FVPTC and cPTC. We had previously evaluated cytologists' ability to prospectively distinguish potential NIFTP/FVPTC from cPTC in a cohort of 56 consecutive FNAs diagnosed as malignant or suspicious for malignancy. We utilized this cohort to perform molecular analysis. Detected molecular abnormalities were stratified into two groups: (1) those supporting malignancy and (2) those supporting a diagnosis of potential NIFTP/FVPTC. The cytologists' characterization of cases and the detected molecular alterations were correlated with the final histologic diagnoses. Molecular testing was performed in 52 (93%) of the 56 cases. For the 37 cases cytologists favored to be cPTC, 31 (84%) had a molecular result that supported malignancy (28 BRAF V600E mutations, 2 NTRK1 fusions, 1 AGK-BRAF fusion). For the 8 cases that were favored to be NIFTP/FVPTC by cytologists, 7 (88%) had a molecular result that supported conservative management (1 NRAS mutation, 6 wild-type result). Seven cases were designated as cytomorphologically indeterminate for NIFTP/FVPTC or cPTC, of which 6 (86%) had a molecular result that would have aided in the pre-operative assessment of potential NIFTP/FVPTC or cPTC/malignancy. These included 3 BRAF V600E mutations in nodules that were cPTC on resection, an HRAS mutation, and a wild-type result in the 2 nodules that were NIFTP, and a TERT promoter mutation along with an NRAS mutation in a poorly differentiated thyroid carcinoma. For nodules with an FNA diagnosis of suspicious for malignancy or malignant, cytologists can differentiate most cases of potential NIFTP/FVPTC from cPTC. However, molecular testing may be valuable for a subset of cases, especially those that are indeterminate for potential NIFTP/FVPTC versus cPTC based on cytologic features alone.

Molecular analysis of residual ThinPrep material from thyroid FNAs increases diagnostic sensitivity.

Molecular testing for genetic alterations associated with malignancy is a potential triage approach for thyroid fine-needle aspiration (FNA) samples with indeterminate cytology. Because liquid-based FNA material allows for efficient RNA extraction, the authors analyzed residual material for common point mutations and rearrangements. Thyroid FNAs were classified according to The Bethesda System for Reporting Thyroid Cytopathology after routine ThinPrep slide preparation. Residual samples from malignant and indeterminate cases were submitted for molecular analysis, along with a random cohort of nondiagnostic and benign aspirates. Blinded analysis of BRAF and RAS point mutations and RET/PTC and PAX8/PPARγ rearrangements was correlated with subsequent follow-up. Adequate results were obtained in 402 of 597 cases (67%). Mutations or rearrangements were detected in 24 of 117 cytologically indeterminate specimens (21%) (17 RAS rearrangements, 6 BRAF rearrangements, and 1 PAX8/PPARγ rearrangement). BRAF mutations were preferentially associated with malignant cytologic diagnoses (22 of 42 cases; 52%), with less frequent detection in the suspicious for malignancy category (4 of 27 cases; 15%) and very low detection in all other categories (1%-4%). Surgical follow-up confirmed malignancy in all 21 BRAF-mutated cases, 42% of RAS-mutated cases (10 of 24 cases), and 37% of cases with no detected mutation (39 of 105 cases). Molecular analysis is feasible on residual ThinPrep material with the advantage of not requiring additional FNA procedures. The majority of BRAF mutations are identified in cases classified cytologically as malignant, and, to a lesser extent, as suspicious for malignancy. The usefulness of BRAF testing is limited by the low rate of BRAF-positive cases in other categories, thereby highlighting the need to identify other genetic drivers of clinically aggressive thyroid cancers.

Analysis of morphological markers of chromosomal instability in ascitic fluid

Chromosomal instability (CI) plays a major role in the carcinogenesis. Micronuclei, nuclear budding, chromatin bridges,and multipolar mitoses are the morphological markers of CI and have never been studied in routine cytological specimens. Aims of the study is to analyze the significance of morphological markers of CI in malignant and benign ascitic fluid smears. A total of sixty benign and 40 malignant ascitic fluid samples were selected for this study. All the cases with malignant ascitic fluid showed histopathological evidence of malignancy in ovary and omentum. Chromatin bridges, multipolar mitosis (MPM), micronuclei and nuclear budding were counted in 1000 cells in representative May Grunwald Giemsa (MGG) stained smears. The CI markers were correlated with the cytological diagnosis of effusion. The mean number of micronuclei, nuclear budding, chromatin bridge and multipolar mitoses found in malignant effusions were 13.2611.79, 10.1067.07, 2.5362.67, 1.964.5, respectively. The mean number of micronuclei, nuclear budding, anaphase bridges, and MPM found in benign effusion cases were 0.566761.07934, 0.516761.33, 0.66760.25, and 0, respectively. The student t test showed significant differences between malignant and benign ascitic fluid samples for each marker of CI. This is the first comprehensive study of morphological markers of CI in ascitic fluid smears. This study has shown strong correlation between markers of CI and cytological diagnosis of malignancy. In future, the knowledge of these markers can be applied to diagnose malignancy in suspected cases of effusion in difficult situations.

Diagnostic accuracy and pitfalls of fine needle aspiration cytology and scrape cytology in oral cavity lesions

Background — The oral cavity can be home for a wide variety of lesions. To date, biopsy has remained the gold standard for diagnosing these lesions. Purpose — This study was carried out to assess the diagnostic accuracy of cytology in the oral lesions and to address the cytologic-histologic correlation. Patients and Methods — This prospective study included 72 patients with intraoral lesions. Fine needle aspiration cytology (FNAC) or scrap cytology was performed. The smears were immediately fixed in 95% alcohol for Papanicolaou staining. If there was sufficient material, cell block was prepared. When indicated immunocytochemical study was ordered. Final cytologic results were then compared with the definitive histopathological diagnoses which were considered the gold standard. Results — Cytologically, 28 patients (38.9%) were diagnosed as benign/atypical and 44 (61.1%) as malignant/suspicious. The most common benign cytologic diagnosis was inflammation (42.9% of benign cases). The most common malignant cytologic diagnosis was squamous cell carcinoma (36.4%). Cytologic diagnoses were compared with histopathologic ones. There were 3 false negative cases and one false positive case. The sensitivity was 93.5%; specificity was 96.2%; positive predictive value (PPV) was 97.7%; negative predictive value (NPV) was 89.3% with a diagnostic accuracy of 94.4%. P-value was <0.001. Kappa was 0.882. Conclusion — FNAC was found to be highly accurate in the diagnosis of oral lesions. Detailed cytomorphologic examination coupled with clinical data and appropriate immunocytochemical study, in some cases, can lead to an accurate diagnosis. Overlapping features of some tumors, especially in minor salivary gland, as well as limitation of sampling, were responsible for the inaccurate diagnoses.

ProExC as an adjunct marker to improve cytological detection of urothelial carcinoma in urinary specimens

ProEx C is an antibody cocktail targeting the expression of topoisomerase IIα and minichromosome maintenance protein-2. ProEx C staining is being used to assist in diagnoses of the gynecological specimens. This study was designed to determine the utility of ProEx C in urine cytology samples for improving the detection of urothelial carcinomas where a significant number of urine cytology specimens are diagnosed as "atypia." Sixty urinary specimens (12 negative, 13 positive, and 35 atypical cases) were stained with ProEx C, and ProEx C results were recorded as positive when nuclear staining was only seen in at least one morphologically atypical urothelial cell. All 12 benign cytology samples showed negative staining with ProEx C. Twelve of 13 cases that had a malignant cytologic diagnosis showed a positive nuclear staining of the malignant cells. Eighteen of 35 cases with atypical cytologic diagnoses showed positive nuclear staining. Of the 35 cases with "atypia," 17 had a malignant histopathologic follow-up. In this study, ProEx C stain had an overall sensitivity of 78.4%, specificity of 95.7%%, positive predictive value of 96.7%, and negative predictive value of 73.3% for the detection of urothelial carcinoma. ProEx C stain is a useful adjunct test to urine cytologic analysis, even in specimens with limited cellularity. In urinary smears, this test is most useful in stratification of the "atypical" diagnoses into benign and malignant subsets. To the authors' knowledge, this is the first study of ProEx C application in urine cytology as an adjunct marker for detection of urothelial carcinoma.

Use of Liquid-Based Cytology (LBC) and Cell Blocks from Cell Remnants for Cytologic, Immunohistochemical, and Immunocytochemical Diagnosis of Malignancy

Great advances in screening have lowered the death rate from cervical cancer in the advanced countries. The major advances in cervical cancer screening include the Papanicolaou (Pap) test and liquid-based cytology (LBC). In this study, we aimed to use cell remnants from LBC specimens from uterine cervix and endometrium, aspirates from breast and thyroid tumors, and liquid samples (ascites, pleural effusion, and urine). Cell blocks made from cell remnants of LBC specimens were immunohistochemically or immunocytochemically stained for several biomarkers including certain tumor markers such together with hematoxylin and eosin staining for accurate diagnosis of malignancies in different samples. The findings from the cell blocks stained with these biomarkers combined with those from Pap stain led to easily diagnosis of the presence or absence of malignancies. Our findings suggest the utility of LBC and cell blocks from cell remnants in cytologic diagnosis in certain specimens.

Interest of fine-needle aspiration cytology in thyroid nodule

The aim of the present study was to evaluate our technique of thyroid fine-needle aspiration cytology (FNAC), its limitations and means of improvement by comparing our results with those of literature. Thyroid FNAC results from 117 consecutive patients (May 2006 to July 2007) were categorized into four groups: benign, with suspected malignancy, malignant and unrepresentative. The FNAC results were compared with histopathologic analysis after thyroidectomy. All "benign" and "malignant" FNAC findings were confirmed on final histology. All "suspect" FNAC findings were benign on histology. Cytological diagnosis of malignancy was consistent with histological examination in all cases. Sensitivity was 100% (no false negatives), specificity 67% (28% false positives), positive predictive value 72% and negative predictive value 100%. There was a significant difference in the proportion of "unrepresentative" results between two of the operators performing aspiration (51% versus 29.2%). The main pitfall of FNAC in thyroid pathology is the "suspect" category, for which positive diagnosis is founded on histological criteria alone. The second limitation identified in this study was the high number of "unrepresentative" aspirates. However, the technique remains useful.

Primary papillary thyroid carcinoma previously treated incompletely with radiofrequency ablation

Radiofrequency ablation (RFA) recently has been applied to benign thyroid nodules, mainly for the cosmetic reasons, and limited cases of local recurrences or focal distant metastases of well-differentiated thyroid cancer, in the high-risk reoperative condition or for the palliative purpose. But no report has been made on the RFA for primary thyroid cancer to date. We report on a patient with primary papillary carcinoma of thyroid gland who had undergone RFA before the cytological diagnosis of malignancy, later referred and treated with robotic surgery successfully. We can learn the following lessons from our case; (1) the RFA for operable primary thyroid malignancy should be avoided, because of the possibility of remnant viable cancer and undetectable nodal metastasis, and (2) robotic or endoscopic thyroid surgery may be a feasible operative method for benign or malignant thyroid nodules previously treated with RFA.

Preparation of thyroid FNA material for routine cytology and BRAF testing: A validation study

V600E BRAF mutation is emerging as an independent marker of papillary thyroid carcinoma aggressive behavior. Papillary thyroid carcinomas harboring this mutation should be extensively resected. However, this requires an unquestionable cytological diagnosis of malignancy. Thus, cytological specimens should be properly handled to provide both morphological and molecular information. Here, we assessed whether our method of preparation of fine-needle aspiration material is suitable for both tests. A series of 128, routinely performed, fine-needle aspirations was analyzed. Each nodule was punctured three times. A representative Diff-Quik smear prepared from the first two passages was evaluated onsite. When microscopy was diagnostic (n = 44), the third needle pass was dedicated to harvest material for BRAF testing; in the remaining cases (n = 84), additional direct smears for cytology were prepared and the remaining material in the needle plus the needle rinsing was collected for BRAF testing. Cellularity was adequate in 126/128 (98%) cases. Cytological diagnoses were inadequate (2%), benign (85%), follicular lesion of undetermined significance (5%), follicular neoplasms (2%), suspicious for malignancy (2%), and malignant (4%). Higher average of extracted DNA concentration was observed in the dedicated pass group (25.9 vs 7.95 ng/microl). However, the rate of successful exon 15 BRAF amplification was similar with (43/44; 97.7%) or without (79/84; 94%) the dedicated pass. Thus, our protocol is suitable for both tests. Whenever necessary BRAF testing may also be performed on the residual samples of thyroid nodules, without interfering with routine cytology.

Value of rapid assessment cytology in the surgical management of head and neck tumors in a Nigerian mission hospital

Fine-needle aspiration (FNA) or touch preparation with rapid assessment is a valuable diagnostic tool with a reported accuracy of diagnosis similar to intraoperative frozen section consultation. The Nigeria Christian Hospital partners with health care professionals from the United States to provide surgical care for rural residents of Aba, Nigeria. Frozen section diagnosis is impractical in this setting because of very limited resources. Therefore, intraoperative rapid assessment FNA or touch preparation to guide surgical management was performed on all mass lesions, and the results were evaluated. FNA was performed just before surgery using a 22-gauge needle attached to a 10-mL syringe and/or an intraoperative touch preparation was performed on biopsies of lesions that failed to yield cellular aspirates. Smears were prepared and stained with hematoxylin and eosin, and an immediate diagnosis was rendered. Tissue samples from the same resected/biopsied cases were fixed in 10% formalin and later transported to Vanderbilt University Medical Center Department of Pathology for processing. Cytologic and histologic correlations were then performed. More than 100 patients underwent surgery for head and/or neck masses during the 2-week periods between November 2002 and November 2003. Of these patients, 98 had either preoperative FNA and/or intraoperative touch preparation performed. Twenty-seven patients were male and 71 were female; the ages ranged from 2 months to 70 years. Sites sampled included the following: thyroid (n = 40); facial/jaw area (n = 19); parotid/submandibular gland (n = 13); scalp/skull region (n = 7); cervical lymph nodes (n = 5); neck (n = 5); other (n = 4); supraclavicular lymph nodes (n = 3); and oral cavity (n = 2). On cytologic analysis, there were 79 benign diagnoses, 17 malignant diagnoses, and 2 nondiagnostic samples. A benign versus malignant cytologic diagnosis was accurate in 97 of 98 cases. In conclusion, rapid assessment cytology was invaluable in the surgical treatment of many of the patients.

Role of immunocytochemistry in fine needle aspiration cytology diagnosis of mammary lesions of breast

To study the value of immunocytochemical study for cyclin D1, c-erbB-2, Ki-67, p21(CIP1/WAF1) and 34betaE12 in fine needle aspiration cytology (FNAC) diagnosis of mammary lesions. One hundred and thirty-five cases of breast diseases, all with FNAC performed and follow-up histologic correlation available, were enrolled into the study. These included 43 cases of benign non-proliferative diseases, 45 cases of benign proliferative diseases and 47 cases of mammary carcinoma. Immunostaining for cyclin D1, c-erbB-2, Ki-67, p21(CIP1/WAF1) and 34betaE12 was carried out on FNAC smears and paraffin sections of the corresponding biopsy specimens. The statistical significance was analyzed using SPSS11.5 software. No statistically significant difference was observed in the expression of cyclin D1, c-erbB-2, Ki-67, p21(CIP1/WAF1) and 34betaE12 within the groups of benign non-proliferative and benign proliferative breast diseases. On the other hand, a significant difference in immunostaining results was found between benign breast lesions and mammary carcinoma (P < 0.001). A panel of cyclin D1, 34betaE12 and c-erbB-2 immunostaining is highly sensitive and specific in confirming the diagnosis of mammary carcinoma in FNAC samples. A positive reaction for cyclin D1 and c-erbB-2, when coupled with a negative reaction for 34betaE12, showed to be the most reliable supportive evidence for the malignant cytologic diagnosis. When taking the results of either cyclin D1 or 34betaE12 immunostaining into consideration, the sensitivity and specificity for diagnosing carcinoma was 95.7% and 94.3% respectively. On the other hand, when any of the three immunostains suggested carcinoma, the diagnostic sensitivity and specificity became 97.9% and 92.0% respectively. If the immunostaining results of any two of the three markers suggested carcinoma, the diagnostic sensitivity and specificity became 72.3% and 100% respectively. Within the carcinoma group, the degree of expression of cyclin D1, p21(CIP1/WAF1) and 34betaE12 showed little difference amongst different cytologic grades (according to Robinson cytologic grading system). There were however differences in expression of c-erbB-2 and Ki-67. Highest expression rate was observed in grade 3 carcinoma, while lowest expression rate was observed in grade 1 carcinoma (only in 40.0% and 33.3% of cases respectively). Whenever either cyclin D1 positivity or 34betaE12 negativity was demonstrated, the diagnostic accuracy for grade 1 and grade 2 carcinoma was 93.3% and 96.2 % respectively. Immunocytochemical study using a panel of antibodies for cyclin D1, c-erbB-2, and 34betaE12 has significant diagnostic value in distinguishing between benign breast diseases and mammary carcinoma in FNAC samples. Cyclin D1 and 34betaE12 are especially useful in confirming the cytologic diagnosis of low-grade cancer.

Validation of a Five-Tier Cytodiagnostic System for Thyroid Fine Needle Aspiration Biopsies Using Cytohistologic Correlation

Approximately 70-80% of thyroid fine needle aspiration biopsies (FNAB) can distinguish benign from malignant thyroid nodules. However, much interpretive diagnostic difficulty arises with the remaining 20-30% of cases. These problematic thyroid aspirations have been placed in various diagnostic categories, which collectively have led to confusion and a negative impact on the clinical management of patients with thyroid nodules. We present our experience using a five-tier system, including the diagnostic terminology: benign, indeterminate, suspicious, malignant, and unsatisfactory. Thyroid FNABs were diagnosed using a five-tier system from 200 consecutive patients and the subsequent surgical excisions were correlated. Overall, there was an excellent association between the five diagnostic categories and predicting benign versus neoplastic thyroid nodules (LR = 96.06, X(2) = 76.49, and phi = 0.618, df = 4, p < 0.0001). A negative cytologic diagnosis carries a negative predictive value of 92%, while an indeterminate, suspicious, and malignant cytologic diagnosis carries a positive predictive value of 50, 71, and 100% respectively. The estimated sensitivity for an indeterminate, suspicious, or malignant cytologic diagnosis varied from 70 to 89%, while the specificity increased from 57 to 92 to 100%, respectively. The data presented shows that the five diagnostic categories of thyroid FNAB are excellent at distinguishing benign from neoplastic thyroid nodules. Both the indeterminate and suspicious categories, while not statistically different from each other in predicting benign from neoplasia, are statistically different from obviously benign and obviously malignant categories. These results support the need for an indeterminate and/or suspicious category.

P‐cadherin expression in glandular lesions of the uterine cervix detected by liquid‐based cytology

To study P-cadherin aberrant expression as a possible marker for cervical adenocarcinomas in cytological samples. We studied P-cadherin immunoexpression in liquid-based cervical cytology samples of biopsy-proven cervical lesions. We found a statistically significant correlation between P-cadherin expression and a cytological diagnosis of malignancy, either glandular or squamous (P < 0.0001). Twenty-two of 33 malignant cases showed P-cadherin membrane staining. None of the 30 benign cases tested showed membrane staining, but three of them displayed an aberrant nuclear P-cadherin expression. We concluded that P-cadherin can be used to discriminate between malignant and benign cervical cytological specimens, but not to discriminate glandular from squamous lesions.

Differentiated thyroid carcinoma during childhoodand adolescence: a report of 4 cases

Background : Thyroid carcinoma is uncommon in children, but there has been a rising incidence in recent time. This study was undertaken to determine the pattern in Kano. Patients and Methods : Four cases of differentiated thyroid carcinoma (DTC) in children and adolescents seen between October 1997 and September 2005 were retrospectively studied. The parameters studied included the demographic, and clinicopathologic characteristics, and treatment outcome. Results : There were 3 females and 1 male (M: F=1:3), with a mean age of 13.2 years. All the patients presented with asymptomatic thyroid nodule, with cytological diagnosis of malignancy in 3. There were no serious complications after total thyroidectomy. Histological examination confirmed the diagnosis of papillary thyroid carcinoma in 3 patients, and one case of follicular thyroid carcinoma. Two out of the 3 papillary thyroid cancers were multicentric. Follow up was poor, the longest period being one year. Conclusion : DTC in children and adolescence present most commonly as a solitary thyroid nodule. Fine needle aspiration cytology (FNAC) is an important means in preoperative investigations. Total thyroidectomy by experienced thyroid surgeons, has reduced morbidity and mortality. Keywords : solitary thyroid nodule, FNAC, papillary thyroid carcinoma, total thyroidectomy, childhood African Journal of Paediatric Surgery Vol. 2(1) 2005: 20-23

Thyroid Cytology and Risk of Thyroid Cancer: Differences Among Indeterminate Specimens

To assess the potential for stratification of indeterminate cytologic findings on fine-needle aspiration (FNA) of thyroid nodules in an effort to improve therapeutic strategies. We attempted to determine the malignant risk associated with various indeterminate FNA cytologic patterns by correlation of specimens with the final histologic diagnosis. For this analysis, we identified 294 computerized medical records of surgically treated thyroid nodules during a 5-year period at our institution with the corresponding FNA cytology reports available. Of the 294 surgical cases, 162 with a positive or indeterminate cytologic report were selected, reviewed, and classified. Of 52 patients with positive cytologic findings on FNA, 51 (98%) had a final histologic report of a malignant thyroid nodule. Of 110 patients with indeterminate specimens, 30 (27%) had a final histologic diagnosis of thyroid carcinoma. The presence of nuclear atypia was predictive of thyroid carcinoma in 75% of patients, a Hürthle cell cytologic pattern was associated with a malignant thyroid nodule in 33%, and a hypercellular smear was suggestive of malignant involvement in 26% of cases. The lowest rate of malignant potential was associated with cytologic microfollicular and scant colloid alone subtype (6%). The results of this study show that indeterminate thyroid cytologic specimens can be subdivided into groups with different malignant risks. A microfollicular cytologic pattern in the absence of a hypercellular smear or nuclear atypia does not support a recommendation of surgical treatment. A malignant cytologic diagnosis has a high positive predictive value for detection of thyroid cancer.

The β subunit of human chorionic gonadotropin lacks specificity for malignant cells in serous effusions

The cytologic diagnosis of malignancy is frequently straightforward. For difficult cases, multiple immunostains and immunostain panels have been investigated without consensus. β-human chorionic gonadotropin (hCG) has been reportedly expressed in malignancies, but not in normal tissue. HCG also has been reported as a specific marker of metastases in serous fluids when detected with laboratory assays. We investigated the clinical utility of hCG in this cytologic setting. A total of 97 cases of benign and malignant effusions were studied. Each case was immunostained with monoclonal hCG using the avidin–biotin technique and diaminobenzidine as a chromogen. Additionally, a mucicarmine stain was performed on most cases. Cases were evaluated for hCG expression and mucin in a blinded fashion. After the cases were reviewed, the diagnoses were unblinded and staining patterns were evaluated. Of the 47 benign cases studied, 23 (49%) exhibited immunoreactivity to hCG in at least 5% of mesothelial cells present. In contrast, 28 of 44 (64%) adenocarcionomas exhibited a similar degree of immunostaining. In all, 21 (48%) of the adenocarcinomas were also positive for mucin; five of these mucin-positive cases were negative for hCG. The combination of mucin and hCG detected 33 of 44 (75%) adenocarcinomas. We conclude that hCG lacks the specificity for malignant cells to be of clinical use in effusion cytology.

Pre-Operative Identification of Malignancy in Cystic Lesions of Pancreas by EUS-FNA

Background: Cytologic and biochemical analysis of the cyst aspirate obtained by EUS-FNA is of limited value in identifying malignancy in cystic pancreatic neoplasms. In this study, we evaluated the safety and accuracy of performing EUS-FNA of the cyst wall and the septum(a) for identifying malignancy in these lesions. Materials and methods: 41 consecutive patients who had EUS-FNA for suspected cystic neoplasm of the pancreas with abnormal CT or MRI demonstrating a hypodense lesion in pancreas were included. Patients were excluded if they had a history of moderate or severe acute pancreatitis (requiring hospitalization for more than 5 days) within 6 months prior to EUS-FNA. Five patients who met the inclusion criteria were subsequently excluded from final analysis because of 1) insufficient follow up (n=2) or 2) had EUS-FNA aspirates characteristic of a psuedocsyt (n=3). Complete aspiration of the cyst was attempted and then FNA of the cyst wall was done. In case of multiloculated cysts, the thickened areas of the cyst wall or the septum(a) were targeted with the FNA needle. FNA specimens were assessed immediately by an attending cytologist. 1-6 passes were made till a preliminary diagnosis malignancy could be made or when both, the endosonographer and the cytologist were satisfied about adequacy of sampling. Final diagnosis was based on definitive cytology that was positive for malignancy, surgical pathology or clinical follow-up of at least one year. Results: The size of cysts ranged from 1 cm to 8 cm. Three patients developed cyst infection that was successfully treated with intravenous antibiotics. There were no other procedure related complications. In 12 patients, a cytologic diagnosis of malignancy was made (11 definite, 1 suspicious). Fourteen patients were diagnosed to have benign mucinous neoplasm by EUS-FNA and three of these patients had a final diagnosis of malignancy. Ten patients were diagnosed with non-mucinous benign cystic lesions and all of these patients have no clinical evidence of malignancy after 1 year follow-up. EUS-FNA was 80% sensitive and 92% accurate for diagnosing malignancy in our study patients. Conclusions: EUS-FNA of the cyst wall and solid components of the cyst is safe and accurate in pre-operative identification of malignancy in cystic neoplasms of the pancreas.