Cytologic Findings Research Articles

Fine-needle aspiration cytology of palisading adenocarcinoma: The first cytology report of a newly described salivary gland neoplasm.

Here, we report the first cytology findings of the newly characterized entity, palisading adenocarcinoma of the salivary gland, diagnosed in the sublingual gland of a 61-year-old female. The liquid-based cytology showed a moderately cellular aspirate containing three-dimensional clusters and trabeculae of tumor cells of various sizes. The cells had dark ovoid nuclei, finely granular chromatin, inconspicuous to punctate nucleoli, and ample cyanophilic cytoplasm with indistinct cell borders. In conventional smears, the cells displayed frequent crush artifacts and anisonucleosis resembling endocrine-type atypia. The background was clean, devoid of secretions, and contained singly dispersed tumor cells with stripped nuclei. Interestingly, concentrically laminated globules of extracellular matrix surrounded by the tumor cells were identified. Mitotic figures and tumor necrotic debris were absent. The cytologic findings correlated with the histologic findings of the excision specimen. The cytologic differential diagnosis and tumor grading of palisading adenocarcinoma were briefly discussed.

The role of hormone dosages in the assessment of cervical lesions by FNA: A descriptive analysis of 762 cases

IntroductionThe use of Hormone Dosage (HD) in Fine Needle Aspiration Biopsy (FNA) needle washout fluid, introduced in the 1990s, initially aimed at measuring Thyroglobulin (TG). Elevated TG concentration in an extrathyroidal cervical lesion suggests metastases of Well-Differentiated Thyroid Carcinomas (WDTC). Over the years, HD has evolved to incorporate Calcitonin (CT) and Parathormone (PTH), improving sensitivity and specificity in diverse clinical scenarios. Despite varying cutoffs in the literature, existing data underscore significant advancements in diagnostic accuracy. MethodsThis paper presents a case series of 762 cervical lesions with FNA cytology and HD in different cervical regions. ResultsIt was possible to establish the histogenesis of the lesion based on a combination of the FNA cytology and PTH HD findings, so PTH was useful to determine parathyroid origin in all regions, Thyroglobulin (TG) and PTH together provide insights on cell origin in difficult cases. Thyroglobulin (TG) dosage enhances the accuracy of detecting well-differentiated thyroid carcinomas. In post-thyroidectomy by bed lesions, dosages help to determine non-thyroid/parathyroid lesions. DiscussionThe case series and review underscore the valuable contribution of HD in fine-needle aspiration for the evaluation of cervical lesions. By integrating HD with cytological, ultrasound, and clinical data, clinicians can enhance the accuracy and specificity of FNA in diagnosing various cervical lesions, ultimately improving patient care and management.

Cytological Findings of Cylindroma: Differential Diagnosis and Literature Review

Cytological Findings of Cylindroma: Differential Diagnosis and Literature Review

Juxtaglomerular Cell Tumor With Cytohistological Correlation: A Case Report.

Juxtaglomerular cell tumors (JCT) are uncommon renin-secreting tumors of the kidney with cytologic findings of JCT rarely reported. We describe a case of JCT in a 37-year-old man with uncontrolled hypertension that was cured by removal of the tumor via partial nephrectomy. Cytology material was prepared by scraping of the freshly sectioned tumor mass and stained with Diff-Quik and Papanicolaou stains. Cytohistological findings and immunohistochemistry studies are discussed regarding diagnosis and differential diagnoses.

DIAGNOSTIC EFFICACY OF FNAC IN THYROID LESIONS, CLASSIFIED ACCORDING TO BETHESDA SYSTEM WITH CYTOHISTOLOGICAL CORRELATION

Objective: The objective of the study is to estimate the diagnostic accuracy (DA) of fine needle aspiration cytology (FNAC) in thyroid lesions with cytohistological correlation. Methods: The study was a cross-sectional study which was conducted in the Department of Pathology, Rabindranath Tagore Medical College, M.B.G. Hospital, Udaipur, Rajasthan, from December 2022 to December 2023. A total of 201 thyroid aspirations were performed, and the smears were classified according to The Bethesda system. Cytological and histopathological findings were compared in 132 cases that proceeded to surgery. Sensitivity, specificity, negative predictive value (NPV), positive predictive value, and DA were calculated using standard statistical methods. Results: The distribution of thyroid lesions on cytology was as follows: Non-diagnostic (1%), benign (92%), atypia of unknown significance (1%), follicular neoplasia (3%), suspicious for malignancy (2%), and malignant (1%). The sensitivity, specificity, positive predictive value, NPV, and DA in our study were 78.94%, 100%, 100%, 96%, and 96.9%, respectively. Conclusion: FNAC’s cost-effectiveness, patient-friendly nature, swift results, and high sensitivity, specificity, and accuracy render it a primary diagnostic tool for assessing patients with thyroid swelling preoperatively. The Bethesda system categorizes thyroid lesions cytologically, aiding in their diagnosis and subsequent management. Histopathological correlation facilitates the assessment of DA and ensures quality assurance.

Case Series of Thermal Cautery Artifact in Urine Cytology: An Uncommon Finding but a Potential Pitfall.

Therapeutic modalities used in bladder lesions/neoplasms (electrocautery, fulguration, and laser) could produce morphologic alterations leading to diagnostic challenges. While often seen on histology, they can present in urine cytology as atypia or even raise the concern for malignancy. Herein, we present clinicopathologic findings of four patients with cautery artifact in urine cytology. The authors' lists and a computerized search of urine cytology with features of thermal cautery artifact were collated. Slides and clinicopathologic variables (prior specimens, concurrent and follow-up surgical specimens, age, sex, manner of urine collection, cystoscopy, and treatment procedure during cystoscopy) were reviewed. Four cases were identified. Procedures performed during cystoscopy included laser therapy (n = 2), postbiopsy cauterization (n = 1), and fulguration (n = 1). All cases showed spindled cells with delicate bipolar cytoplasm, "cigar-shaped" nuclei, smooth to slightly irregular nuclear membranes, and arranged singly and loosely cohesive to lamellar stacks. Few atypical well-preserved, undistorted cells were identified in 2/4. The concurrent biopsies showed superficial cellular fragments with thermal artifact (n = 1) and rare atypical cells (n = 2). Follow-up biopsies in two cases had high-grade urothelial carcinoma both of which were diagnosed as atypical urothelial cells on cytology. Thermal cautery artifact in urine cytology is rare and can be seen following laser, electrocautery, and fulguration. The spindling artifact can render some degree of difficulty in assessing for the presence of urothelial atypia both in cytology and biopsy. Familiarity with these cytologic features, knowledge of the treatment procedure, attention to the cytologic findings of well-preserved cells and repeat sampling in cases with atypical urothelial cells in patients with history of malignancy is essential.

Nerve Sheath Tumor in a Cynomolgus Macaque (Macaca fascicularis) and Diagnostic Differentiation from Amelanotic Melanoma

AbstractThere are few reports describing spontaneous neoplasms in cynomolgus macaques, despite the frequent use of this species in laboratory research. This report describes cytologic, histologic, and immunohistochemical findings of a cutaneous to subcutaneous nerve sheath tumor located within the haired skin of the abdomen of a 2.5-y-old, intact, female, captive Mauritius cynomolgus macaque. The nerve sheath tumor was well demarcated, partially encapsulated, densely cellular, and extended from the subcutis to the most superficial dermis, abutting the epidermis. Neoplastic cells formed intersecting streams and had a high mitotic count (18 per 2.37 mm2). Due to the substantial morphologic overlap of this neoplasm with amelanotic melanoma, particularly the close association with the epidermis, immunohistochemistry was required for definitive diagnosis. Neoplastic cells were immunoreactive to vimentin, S-100, SOX10, laminin, collagen IV, and CD56, and negative for melan-A, tyrosinase, MITF, and HMB45. This immunohistochemical profile is diagnostic for nerve sheath tumor based on human and canine criteria and rules out amelanotic melanoma. Despite incomplete excision, the nerve sheath tumor had not grossly recurred after 1 mo, at which point the animal was euthanized for unrelated reasons. This report underscores the importance of using an immunohistochemical panel in cases of cutaneous and subcutaneous spindle cell neoplasms, as there is substantial morphologic and immunohistochemical overlap between nerve sheath tumors and melanocytic neoplasms due to their shared neuroectodermal origin. To our knowledge, this is the first report of a nerve sheath tumor in a cynomolgus macaque, and one of the few reports of spontaneous neoplasia in this species.

Eggshell Calcifications at Thyroid Ultrasound: A Sample-focused Analysis of Cytological Findings and Post-thyroidectomy Pathological Correlates

Eggshell calcifications at thyroid ultrasound are connected to the challenging field of thyroid nodules and/or malignancy from a multidisciplinary perspective. Calcifications may be found in malignant and benign tumors; typically, micro-calcifications are identified in the papillary type of cancer, being equivalent to psammoma bodies in the pathological report. The risk of macro-calcifications, however, is more nuanced; recent data suggest a potential connection with a differentiated malignancy as well. Eggshell calcifications, a distinct type of macro-calcification, are generally considered benign findings, especially uninterrupted forms. Yet, the real incidence is not clear, which is why the topic remains open. In this narrative review, we analyzed eggshell calcifications in relationship with cytological diagnosis upon fine needle aspiration and post-thyroidectomy histological report. A PubMed-based search of the English-language papers using several keywords identified 171 articles. We only included original studies (no timeline restriction). After removing duplicates and applying the inclusion and exclusion criteria, 14 original studies were analyzed. The number of subjects per study varied (N=61 to 2678) so did the number of analyzed nodules per study (a maximum of 2902). Some studies found connections with benign features; others revealed a higher risk of malignancy at fine needle aspiration. Data remain heterogeneous, and oftentimes, studies investigated it only as a secondary endpoint. A high TI-RADS score is important in malignancy prediction, while eggshell calcification might add to the positive predictive value, yet, this trait is difficult to classify as a standalone element. Nevertheless, an interrupted pattern does not exclude thyroid cancer.

Viability and diagnostic potential of tissues obtained through cryobiopsy

BackgroundTransbronchial lung cryobiopsy is primarily used for diagnosing interstitial lung diseases and tumors, providing larger tissue samples with reduced tissue crushing than traditional biopsies. However, freezing during cryobiopsy may damage cells, potentially affecting diagnostic methods that require live cells, such as flow cytometry (FCM). We aimed to determine the extent of freezing-related cell damage in cryobiopsies using cells cultured in vitro. MethodsTo investigate the relationship between freezing duration and sample volume, Jurkat cells underwent freezing for durations ranging from 2 to 6 s, with 1-s intervals, using either 1-mm- or 1.7-mm cryoprobes. FCM was conducted to assess both cell viability (2, 4, and 6 s) and cell-surface molecule expression (3 and 6 s) over varying freezing times. Additionally, we describe a clinical case involving a 70-year-old man suspected of malignant lymphoma, in which tissue samples were obtained via both forceps biopsy and cryobiopsy methods to compare the pathological and cytological features between the methods. ResultsHarvested cell count increased with freezing duration, with a notable increase in viable cell percentage. Moreover, cells distant from the cryoprobe exhibited higher survival rates under milder freezing conditions. FCM revealed significantly higher marker expression levels in viable cryobiopsy samples than in non-viable samples. The clinical case demonstrated that cryobiopsy yields a significant proportion of live cells (>90%), with cytological findings consistent with those of non-frozen samples. ConclusionsCryobiopsy may be beneficial for histopathological diagnosis, providing sufficient viable cells for FCM, and can be used for diagnosing malignant lymphomas and other pulmonary conditions.

Evaluation of Ascitic Fluid Cytology in a Tertiary Hospital in South-Western Nigeria: A 7-year Retrospective Study

Background: Ascites is the pathological accumulation of fluid within the peritoneal cavity of varied etiology. Various abnormalities can be detected through cytological analysis of ascitic fluid. Ascitic fluid cytology (AFC) is a rapid and cost-effective means of evaluating ascites to establish its nature and cause. Aim: To evaluate ascitic fluid cytological findings over a seven-year period and to correlate the cytological features with the clinical profile of the patients. Materials and Methods: This was an observational retrospective study conducted in a healthcare facility in south-western Nigeria. The reports of AFC tests performed from January 1, 2016 to December 31, 2022 were retrieved to obtain the following information for analysis: Age, Gender, Tribe, Year of the test, Provisional diagnosis, and Cytological diagnosis. Results: The data of a total number of 121 patients were analyzed; 61 males (50.4%) and 60 females (49.6%) with a mean (±SD) age of 51.51 ± 15.22. Decompensated cirrhosis was the commonest clinical diagnosis 65 (53.7%) followed by hepatocellular carcinoma 11 (9.1%). Ascitic fluid cytological findings showed 45 (37.2%) were positive for malignant cells; 46 (38.0%) were negative for malignant cells; 13 (10.7%) were suspicious for malignancy; 9 (7.4%) were acellular smears; and 8 (6.6%) were inflammatory smears. The ascitic fluid of only 4 out of 11 patients with hepatocellular carcinoma tested positive for malignant cells, giving a sensitivity of 36.4%. Conclusion: AFC remains very useful in the diagnostic work-up of patients with ascites but should not be completely relied upon in confirming a malignancy, other additional diagnostic investigations should be deployed.

Evaluation of endocervical curettage (ECC) in colposcopy for detecting cervical intraepithelial lesions.

Diagnostic challenges in colposcopy arise especially in women aged 50 or older, with postmenopausal status and transformation zone type 3 (TZ3). Endocervical curettage (ECC) is a valuable tool for diagnosing intracervical lesions. The aim of this retrospective analysis was to evaluate the use of ECC in colposcopy for detecting cervical intraepithelial lesions. A retrospective study was carried out of colposcopies performed in the certified Dysplasia Unit at Erlangen University Hospital between July 2016 and June 2023. Pap and human papillomavirus (HPV) results were correlated with the histologic findings via ECC, obtained during examinations or surgery. The primary outcome was the rate of accuracy between the colposcopic and histologic findings with regard to cytology, age of patients, and type of transformation zone (TZ). A total of 429 colposcopies in 413 women with histologic samples obtained via ECC were included in the final analysis. In all, 355 women had TZ3. Among patients with TZ3, evidence of high-grade lesions and invasive carcinoma was also found in women with normal or low-grade abnormal cytology. For patients with normal colposcopic findings, cervical intraepithelial neoplasia (CIN) 2 and CIN3/adenocarcinoma in situ (AIS) were found in 56 patients (16%), and invasive carcinoma was found in four patients (0.1%). This analysis suggests that ECC is a valuable tool in the diagnosis of cervical intraepithelial neoplasia, especially for patients who present with a normal colposcopy of the cervix and vagina but have either recurrent abnormal cytologic findings or high-grade abnormal cytology indicating CIN2 + .

Cytologic features of gastric-type endocervical adenocarcinoma: Three cases report and literature review.

Cervical gastric-type adenocarcinoma shows gastric differentiation, and the tumor cell morphology appears benign and unrelated to human papillomavirus, which makes cervical gastric-type adenocarcinoma highly susceptible to misdiagnosis as normal glandular epithelium in cytologic diagnosis. We present 3 cases of gastric-type adenocarcinoma, with the first being a 57-year-old female with abnormal uterine bleeding and fluid drainage. The second patient was a 63-year-old female, and the third was a 59-year-old female with irregular vaginal bleeding after menopause. The 3 patients were diagnosed with cervical gastric-type adenocarcinoma by combining their history, clinical data, cytopathology, histopathology, and immunohistochemistry. Patient 1 underwent total hysterectomy and adnexectomy, but refused radiotherapy and chemotherapy. Patient 2 received a chemotherapeutic regimen, and patient 3 was treated with traditional Chinese medicine. Patient 1 was followed-up for 9 months and is currently in good general condition, while patients 2 and 3 were not followed-up. The "drunken honeycomb" cell arrangement is diagnostically important in liquid-based cytology, especially when three-dimensional spheroids are present, and may be a characteristic cytological finding of well-differentiated cervical gastric-type adenocarcinoma.

Flow Cytometry for the Detection and Quantification of Mast Cells in Lymph Nodes: A Prospective Study in 64 Dogs With Mast Cell Tumour.

Nodal metastasis is a negative prognostic factor in dogs with mast cell tumours (MCTs), thus early detection enables more informed decision-making and provides valuable prognostic information. The aim of this study is to assess the concordance between histopathologic findings of LNs and cytology and flow cytometry (FC), respectively, and to evaluate the ability of FC to differentiate between metastatic (HN2-HN3) and non-metastatic (HN0-HN1) LNs. Overall, 117 LNs from 64 dogs with first occurring MCTs were submitted for cytology, histology and FC. LNs were cytologically and histologically classified according to Krick and Weishaar systems, respectively. Using FC, mast cells (MCs) were identified as IgE+ CD117+ CD5- CD21- cells and quantified as a percentage. When compared with histologic classification, cytology showed an accuracy of 88.2% in distinguishing between metastatic and non-metastatic LNs but did not detect 25.3% of metastatic cases. FC revealed an increase in the median percentages of MCs across histologic classes, progressing from HN0 to HN3. ROC curves pinpointed 0.3% as the optimal cut-off for distinguishing between metastatic and non-metastatic LNs, with an accuracy of 84.3%. A 1.1% cut-off proved valuable in identifying HN3 LNs. The combined interpretation of cytology and FC increased accuracy to 92.2%. An algorithm for guiding the combined interpretation of cytology and FC is suggested based on these findings. In conclusion, FC proves beneficial in enhancing the early detection of metastatic LNs, particularly when utilised alongside cytology. Histopathology remains essential for confirmation, enabling the discrimination of HN classes or, in doubtful cases, for the detection or exclusion of nodal metastases.

Cardiac Angiosarcoma with Unusual Cytologic Features Causing Cardiac Tamponade in a Young Adult Patient

Abstract Introduction/Objective Cardiac angiosarcoma is a rare endothelial malignancy with poor prognosis, frequent metastasis, and short median survival of only a few months. The disease has a wide age spectrum and can occur in young adult patients. The cytological diagnosis of cardiac angiosarcomas is challenging as cases are rare and its cytology is not extensively described or reported in literature. Here, we describe a rare case of cardiac angiosarcoma with unusual cytologic features. Methods/Case Report Our patient is a 30 year old male presenting with three days of worsening dyspnea and palpitations and was discovered on ultrasound to have large pericardial effusion compressing the right ventricle and causing cardiac tamponade. CT/MRI imaging revealed a 4.5 x 4.3 x 2.6 cm mass inside the right ventricle with extra- cardiac invasion through the pericardium and into the anterior mediastinum. Pericardiocentesis yielded 1.5 liters of hemorrhagic, brown, pericardial fluid with elevated LDH and protein levels. Cytology of the pericardial fluid revealed numerous tumor cells occurring singly or in monolayered, acinar clusters or cohesive spheres containing amorphous, eosinophilic cores made of collagen as evidenced on trichrome stain. The tumor cells possessed hyperchromatic, irregular, variably sized nuclei, prominent nucleoli, and cytoplasmic vacuoles. The tumor cells were positive for vimentin, CD31, and CD34, and showed high Ki67 proliferation index > 50%. A catheter-mediated biopsy of the right ventricular mass revealed spindled and epithelioid tumor cells strongly positive for CD31, CD34, and vimentin, focally positive for Factor VIII and AE1/AE3, and showing high Ki67 proliferation index of roughly 50%. The cytological, histological, and immunohistochemical findings were most consistent with cardiac angiosarcoma as the diagnosis. The patient eventually developed worsening chronic left chest pain and expired from cardiac arrest six months after his diagnosis. Results (if a Case Study enter NA) NA Conclusion We report a rare case of cardiac angiosarcoma with unusual cytologic features, manifesting as acinar clusters and cohesive spheres with collagenous cores that are not typical of malignant endothelial neoplasms. Currently there are no effective, standardized therapies that can significantly prolong survival for this malignancy, and treatment is often palliative. The cytological diagnosis of cardiac angiosarcoma is challenging given the rarity of this disease and the paucity of literature describing its cytology.

HPV-Independent Cervical Adenocarcinoma Discovered by Cytology-Based Screening: A case report of gastric type adenocarcinoma of the uterine cervix from cytopathology to histopathology

Abstract Introduction/Objective In recent years, the relative prevalence of adenocarcinoma has increased, comprising 20–25% of all cervical carcinomas in developed countries. Approximately 15% of cervical adenocarcinomas are unrelated to human papilloma virus (HPV) infection. With the shift toward HPV primary testing, an increased understanding of HPV-independent cervical adenocarcinomas becomes more important. Methods/Case Report This case report demonstrates a rare case of gastric-type adenocarcinoma (GAS) of the cervix discovered during a routine well-woman exam. Patient-reported episodes of vaginal spotting were noted prior to screening. HPV testing by PCR on the initial pap smear was negative. Cytology findings raised concerns about endocervical glandular cell abnormalities. Subsequent cervical biopsy revealed GAS, a finding supported by positive CK7, MUC5AC, CDX2, and aberrant (mutant) p53 expression by immunohistochemistry. HPV independence was further confirmed by negative results on mRNA ISH for high-risk HPV and HPV16/18. Results (if a Case Study enter NA) NA Conclusion Here we discuss the impact of cytology-based screening on HPV-independent cervical cancers, with focus on adenocarcinoma. While the move to primary HPV screening has been shown to be effective at identifying HPV-related neoplasms, it ineffectively addresses HPV-independent malignancies. In this particular population, cytology-based screening remains indispensable. The described case demonstrated subtle cytologic features consistent with endocervical glandular abnormality, ultimately correlating with subsequent histologic findings of HPV-independent GAS. Negative HPV results combined with subtle cytomorphologic changes displayed by some adenocarcinomas on PAP smear could present a significant diagnostic pitfall. Additionally, p16+ expression attributable to aberrant p53 pathways (rather than HPV) may further contribute to potential diagnostic errors. While further research into best practices for early detection of HPV-independent cervical neoplasias should be conducted, this team suggests both clinical survey and referral for cytologic screening following reports of abnormal vaginal bleeding and/or watery discharge and screener education focused on cervical GAS.

Cervical Cytological and Colposcopic Findings in Cases Associated with Prolonged Use of Intrauterine Devices versus Long Acting Injectable Contraceptive Agents

Cervical Cytological and Colposcopic Findings in Cases Associated with Prolonged Use of Intrauterine Devices versus Long Acting Injectable Contraceptive Agents

9182 Metastatic Extra-Gastrointestinal Stromal Tumor Presenting As Hypoglycemia

Abstract Disclosure: O. faour: None. D. John: None. S.K. Suryanarayanan: None. A.A. Rizvi: None. Introduction: Non islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome seen in association with solid abdominal tumors of mesenchymal and epithelial origin. We report a case of metastatic extra-gastrointestinal stromal tumor (E-GIST) presenting with severe hypoglycemia as its initial manifestation. CASE DESCRIPTION: A 46-year-old patient was found to have a blood glucose of <45 mg/dl during a routine clinic visit with her primary care physician. Although she was asymptomatic, she was sent to the emergency room (ER) for further evaluation. She had a history of prediabetes managed by lifestyle modification. She has been experiencing multiple episodes of hypoglycemia previously which fulfilled the Whipple’s triad in the preceding months. These hypoglycemic episodes included loss of unconsciousness, falls in the shower with head injury, and several hospital visits. Serum glucose in the ER was 14 mg/dl and hypoglycemia persisted despite continuous dextrose solution. Physical examination was notable for a distended, non-tender abdomen and cervical lymphadenopathy. CT scan showed a 15 cm mass in the liver, multiple large masses in the mesentery, and a 11 cm lesion in the left pelvis. There were enlarged lymph nodes in the abdomen, chest, and neck. Serum chemistries drawn when the patient was hypoglycemic revealed potassium level of 2.7 mg/dl (3.5-5.5) an insulin level of <1.0 mIU/L (5-25), C-peptide <0.1 ng/mL (0.5-2), cortisol 13.8 mcg/dL (5-25), and insulin-like growth factor-2 (IGF-2) was 270 ng/mL (38-267). The IGF-2/IGF-1 molar ratio was 3.4 (normal <3:1). The sulfonylurea drug screen came back negative. Upper and lower endoscopies were unrevealing. Biopsy of the liver lesion showed cytology and immunohistochemical findings consistent with a epithelioid metastatic extra-gastrointestinal stromal tumor. A provisional diagnosis of NICTH was made. The patient responded well to intravenous glucose, oral carbohydrate intake and high-dose corticosteroids. She was subsequently started on therapy with the tyrosine kinase inhibitor (TKI) imatinib. Discussion: Paraneoplastic hypoglycemia is often seen in association with metastatic epithelial and mesenchymal tumors. IGF-2 and incompletely processed pro-IGF-2 activates autocrine, paracrine, and endocrine pathways that lead to tumor growth, fasting hypoglycemia, rarely of acromegalic features. Treatment with octreotide, diazoxide, and glucagon is generally ineffective, while glucocorticoid use and surgical intervention are helpful in ameliorating the hypoglycemia. Tumor-directed therapy with TKIs, primarily imatinib, appears promising in achieving remission. Our case is a clinical reminder that hypoglycemia secondary to NICTH can be the predominant presenting feature in patients with underlying E-GIST. Presentation: 6/3/2024

Relation between Urine Cytological Findings and Renal Function in Patients with Kidney Stones in Taif, Saudi Arabia

Background and Objectives: Urine serves as a vital diagnostic fluid, and urine cytology analysis plays a crucial role in identifying urinary system illnesses such as bladder cancer and kidney stones. The Paris System for Reporting Urinary Cytology establishes a uniform method for diagnosing urinary tract cancer. This study aimed to provide valuable insights that can inform diagnostic strategies related to kidney stones and ultimately improve patient outcomes via the early detection of the cellular changes associated with kidney stones and their relation to kidney function tests. Materials and Methods: A comparative study was conducted and comprised two groups: group 1, consisting of 50 patients diagnosed with kidney stones, and group 2, comprising 50 patients diagnosed with other kidney diseases. Renal function tests and urinalysis (via the PAP staining of urine cellular deposits to detect nuclear changes) were performed, and the results were analyzed. Results: There was a statistically significant increase in urinary red blood cells, white blood cells, and nuclear reactive atypical changes in urinary sediments of kidney stone patients compared to the patients without stones, while there was a decrease in the estimated glomerular filtration rate (eGFR). eGFR showed a 96.7% specificity in detecting cases with nuclear reactive atypia. Conclusions: eGFR emerges as a reliable diagnostic marker for the comprehensive assessment of kidney stones, particularly when associated with nuclear atypia. The significant correlation between the indicators of chronic kidney disease, such as decreased eGFR, and the presence of kidney stones emphasizes the urgent need for efficient diagnostic practices.

Primary ileal myeloid sarcoma presenting with bowel obstruction: a case report

BackgroundMyeloid sarcoma (MS) is an extramedullary tumor constituted by myeloid blasts or immature myeloid cells. It frequently occurs in conjunction with acute myeloid leukemia (AML); however, it can exceptionally manifest in patients without leukemia. Here, we present a rare case of primary MS originating in the small bowel without evidence of bone marrow involvement.Case representationA 33 year-old female with no relevant medical history was admitted to our hospital with recurrent abdominal pain. Computed tomography (CT) revealed bowel obstruction due to thickening of the ileum wall, which was suspected to be an ileal tumor. Initially, ectopic endometriosis was suspected because of abdominal pain associated with the menstrual cycle and changes observed on a follow-up CT scan. The lesion could not be detected by double-balloon endoscopy. Despite conservative treatment, the obstruction persisted, and laparoscopic partial ileal resection was performed, which revealed extensive involvement of the ileum and mesentery. Additionally, the mesentery of the resected ileum was extremely thickened. Histopathological and immunohistochemical examinations of the surgical specimen indicated ileal MS. Bone marrow aspiration after discharge was negative for cytological findings of leukemia, leading to a final diagnosis of primary ileal MS. Her postoperative course was uneventful, and she is currently undergoing systemic chemotherapy tailored to AML at another hospital.ConclusionsEven though MS of the small bowel is rare and may not be considered preoperatively, similar surgical treatment to that of other small bowel malignancies can ensure proper postoperative diagnosis and appropriate chemotherapy. Given the potential need for chemotherapy, ensuring surgical safety that allows for its rapid initiation is critical.

Fine Needle Aspiration Cytology of Ovarian Tumors With Histopathological Correlation: A Revisit to Borderline Category

Abstract Background: Borderline ovarian tumors (BOTs) comprise 15%–20% of all ovarian epithelial malignancies. The majority of them are serous tumors followed by mucinous tumors. Pre-operative cytological diagnosis plays an important role with histopathology being the gold standard. The present study aimed to assess the sensitivity, specificity, and diagnostic accuracy of cytology in the diagnosis of epithelial ovarian tumors with special emphasis on the cytologically borderline category. Materials and Methods: The present study was conducted in our institute over five years from January 2017 to December 2022. This was a retrospective study and included 92 patients with ovarian masses who were subjected to ultrasound-guided fine needle aspiration (FNA) as a preliminary diagnostic procedure. Cytology smears were examined and categorized as benign, borderline, and malignant. The sensitivity, specificity, and diagnostic accuracy were assessed considering histopathology as the gold standard. Results: In the present study, 92 ovarian FNA cytology were performed. Aspirates were adequate in all but 10 cases. Out of 82 cases, 75 were epithelial tumors. Twelve cases of BOTs were compiled and cytological findings were assessed. Conclusion: To conclude, diagnosis of BOTs on cytology is difficult, however, aspiration from multiple sites from the lesion, critical cytomorphological assessment, and cell-block preparation with immunocytochemistry/immunohistochemistry can overcome the pitfalls.