Cytomorphologic Features Research Articles

Thyroid nodules with DICER1 mutation or PTEN alteration: A comparative cytologic, clinical, and molecular study of 117 FNA cases.

DICER1 mutations and PTEN alterations are increasingly detected by thyroid fine-needle aspiration (FNA). Both are associated with nodular thyroid disease and cancer. The authors analyzed a large comparative thyroid FNA cohort with DICER1 mutation or PTEN alteration. A total of 117 thyroid FNAs with DICER1 or PTEN alterations were retrieved from the databases of two academic medical institutions. Demographic, clinical, and radiologic data were collected; FNA slides were analyzed for 29 cytomorphologic features. Of 117 thyroid FNAs, 36 (30.8%) had DICER1 mutation and 81 (69.2%) showed PTEN alteration. The DICER1 cohort had 33 (91.7%) females and three (8.3%) males (mean, 40.9 years); 61.8% had multinodular disease. FNAs were classified as atypia of undetermined significance (AUS), 23 (63.9%); follicular neoplasm (FN), 12 (33.3%); and malignant, 1 (2.8%). The PTEN subgroup had 66 (81.5%) females and 15 (18.5%) males (mean, 55.2 years) with increased multinodular disease (93.8%, p=.0016). PTEN FNAs had greater cytologic diversity: non-diagnostic, 2 (2.5%); benign, 5 (6.2%); AUS, 44 (54.3%); FN, 24 (29.6%); and malignant, 6 (7.4%). Both DICER1 and PTEN cases showed a range of resected tumor subtypes. The DICER1 cohort included thyroblastoma, and the PTEN group included anaplastic carcinoma. The cytomorphology of DICER1 and PTEN cases showed overlapping features, especially microfollicular patterns. Minor cytomorphologic differences included papillary patterns in DICER1 (p=.039), and oncocytic changes (p<.0001) in PTEN. DICER1 and PTEN FNAs reveal many cytologic similarities. DICER1 patients are younger, and PTEN patients had multinodular disease. Awareness of these genetic cohorts can identify patients at risk for thyroid cancer.

The Difficulties and Ease of Diagnosing Anaplastic Large Cell Lymphomas on Cytology.

Anaplastic large cell lymphoma (ALCL), a unique non-Hodgkin lymphoma (NHL), is a CD30-positive neoplasm of T-cell lineage. Its distinctive yet variable cytomorphology makes diagnosing fine needle aspiration cytology (FNAC) challenging. This study was undertaken to study the cytomorphology and the utility of immunocytochemical (ICC) stains on cytology in ALCL and to discuss their morphological differential diagnosis. The present study was conducted in the Department of Pathology of a tertiary care center. A retrospective review was done from January 2017 to July 2022, and all histopathologically and immunohistochemically (IHC) diagnosed cases of ALCL were taken and correlated with the cytological diagnosis. Twenty-one cases of histopathology examination and IHC-proven cases of ALCL were retrieved from the departmental archives and reviewed. The ages ranged from 3 to 80 years (median age 28 years). Commonly noted cytomorphologic features included singly dispersed large pleomorphic cells, hallmark cells, and Reed-Sternberg-like cells. CD15, CD30, epithelial membrane antigen, and anaplastic lymphoma kinase-1 were some of the ICC stains used in this study. All 21 cases had cytology correlation. Fourteen cases had concordant cyto-histological correlation. Seven cases of histopathologically proven ALCL were reported as Hodgkin lymphoma (HL) in three, ALCL/anaplastic diffuse large B-cell lymphoma, HL/ALCL, poorly differentiated carcinoma, and NHL in one case each on cytology. ALCL has a reasonably distinct cytomorphologic appearance and ICC staining pattern, and a careful interpretation of both helps arrive at a reliable FNAC diagnosis.

Enhancing Trichomonas vaginalis Identification in Cytology Students through Gamification.

Trichomonas vaginalis is a causative agent of trichomoniasis, a sexually transmitted disease. In the cytology course context, students are taught to identify the cytomorphological characteristics of this organism. However, the limited learning period hinders their ability to recognize this infection effectively. This study intended to evaluate the efficacy of gamification by utilizing a web-based online game to enhance students' capacity to recognize Trichomonas vaginalis infection in cytology. The study involved 50 Medical Laboratory Technology students who were randomly assigned to three groups. Group 1 (G1) participants received an interactive web-based online game called CytoUniverse, which comprised three components: a story-based game, a cytomorphology game, and a quiz focusing on Trichomonas vaginalis infection in cytology. Group 2 (G2) participants received the same information from a video lecture. Group 3 (G3) received both the web-based online game and the video lecture. The participants were assessed before the intervention (T1) and after the intervention (T2) to measure the effectiveness of the respective learning methods. IBM SPSS version 28 and GraphPad Prism version 9.0 were used to collect, tabulate, and analyze the data. By using descriptive analysis, the normality of the data was checked. Knowledge score and age were described as mean and standard deviation (SD) for numerical data. On the contrary, the categorical data, such as gender and group categories, were reported as frequencies and percentages. Fisher's exact test, paired t-test, and one-way ANOVA test were used in this study to determine the significance between groups. The study's results indicated a statistically significant improvement (P < 0.05) in knowledge scores at T2 compared to T1 for both G1 and G2 when compared to G3. However, there were no significant differences in knowledge scores between all groups for T1 or T2. In conclusion, gamification through a web-based online game may improve understanding of Trichomonas vaginalis infection. It looks to be a promising strategy for boosting students' knowledge and awareness to recognize Trichomonas vaginalis infection in cytology.

Significance of Various Diagnostic Modalities in Detection of Tuberculosis in Cervical Lymphadenopathy: A Study of 200 Cases.

Extrapulmonary tuberculosis (EPTB) makes for 25% of all instances of tuberculosis (TB) patients. The enigmatic clinical presentation of EPTB makes identification difficult since it simulates other chronic conditions such as neoplastic and inflammatory disorders and could culminate in treatment that is either insufficient or not required. For an affirmative and confirmed diagnosis, a substantial level of suspicion is imperative. The paucibacillary feature of EPTB makes diagnosis extremely difficult and necessitates the use of many diagnostic methods to arrive at a precise diagnosis. In December 2010, the World Health Organization recommended using GeneXpert/cartridge-based nucleic acid amplification test (CBNAAT) for the initial assessment of suspected cases of EPTB. Furthermore, fine-needle aspiration cytology (FNAC), Ziehl-Neelsen (ZN) stain, and the CBNAAT have to be utilized to exclude other possible origins of granulomatous inflammation. The goal of the current investigation is to comprehend how FNAC and ZN stains relate to CBNAAT and their diagnostic value. The evaluation included all suspected instances of tubercular lymphadenopathy, and adequate aspirates were obtained from the site of the enlarged cervical lymph nodes. Smears were made following FNAC and stained with ZN stain as well as hematoxylin and eosin stain. Simultaneously, CBNAAT and culture evaluations were conducted on the same aspirates. This cross-sectional study took place at a tertiary care center and encompassed 200 individuals with clinical manifestations of EPTB. There were 200 cases of suspected tubercular lymphadenitis (TBLN). According to the FNAC results, TBLN was detected in 71 (47.6%) of these 200 cases, followed by necrotizing lymphadenitis in 56 (37.5%), chronic caseating granulomatous lymphadenitis in 47 (31.5%), and reactive lymphadenitis in 26 (17.4%). They were correlated with CBNAAT results, which showed that all instances of tuberculous lymphadenitis, 85.71% of cases of necrotizing lymphadenitis, 55.32% of cases of chronic caseating granulomatous lymphadenitis, and 2 (7.69%) cases of reactive lymphadenitis were CBNAAT positive. CBNAAT should be utilized with FNAC and ZN staining to diagnose EPTB. The CBNAAT assay demonstrated a significant advantage in the identification of previously unidentified FNAC patients. Despite being a simple diagnostic tool, FNAC has a lower specificity and significantly lower precision than CBNAAT in correctly identifying cases of EPTB because it exhibits similar cytomorphological characteristics with lesions that are not associated with TB.

Cytomorphological features of sebaceous carcinoma of the breast.

Sebaceous carcinoma of the breast is an extremely rare histological subtype of breast cancer, with fewer than 30 cases reported to date. Because of its extremely rare histological presentation, there are few case reports that highlight its cytological findings. In this case report, the cytomorphological features of a sebaceous carcinoma of the breast are described in detail. Cytomorphological analysis revealed atypical cells presenting predominantly as loose clusters. No tubular or papillary structures were evident in the clusters and no mucin production was observed. The diagnosis of sebaceous carcinoma of the breast requires prominent sebaceous differentiation of cells. In Papanicolaou-stained smears, the differentiated tumor cells were found within the yellowish clusters. When these yellowish clusters were observed at high magnification and shifted out of focus, the sebaceous differentiation of tumor cells could be recognized. This finding is an advantage of observing Papanicolaou-stained specimens. Like previous reports, some individual cells showing sebaceous differentiation were also observed. In cases where many yellowish clusters appear, close observation of the interior of the clusters can confirm the presence of sebaceous differentiation of tumor cells and serve as a diagnostic clue for the cytological diagnosis of sebaceous carcinoma of the breast.

Comprehensive evaluation of cytomorphologic, histologic, and molecular features of DICER1-altered thyroid lesions on FNA: A multipractice experience.

DICER1 mutations, though infrequent, are encountered on preoperative molecular testing of indeterminate adult and pediatric thyroid fine-needle aspiration (FNA) specimens. Yet, published cytomorphologic features of DICER1-altered thyroid lesions are limited. Cytomorphological features of DICER1-altered thyroid lesions were examined in a multipractice FNA cohort with clinical, radiological, and histologic data. The cohort comprised 18 DICER1-altered thyroid FNAs, with 14 having slides available and eight having corresponding surgical resections. Smears, ThinPrep, and formalin-fixed cell block slides were reviewed and correlated with histology, when available. Clinical and radiologic data were obtained from the medical record. Most DICER1-altered FNAs were classified as atypia of undetermined significance (94.4%). DICER1 mutations occurred in codons 1709 (50%), 1810 (27.8%), and 1813 (22.2%). One patient had an additional DICER1 p.D1822N variant in both of their FNAs. Lesions were often hypoechoic (35.3%) and solid (47.1%) on ultrasound. Notable cytomorphologic features include mixed but prominent microfollicular or crowded component, variable colloid, and insignificant nuclear atypia. On resection (n=10), histologic diagnoses ranged from benign follicular adenoma and low-risk follicular thyroid carcinoma to high-grade follicular-derived nonanaplastic thyroid carcinoma. Subcapsular infarct-type change was the most common histologic change. There was no evidence of recurrence or metastasis in eight patients on limited follow-up. DICER1-altered thyroid lesions occurred frequently in young females and FNAs show RAS-like cytomorphology including crowded, mixed macro-/microfollicular pattern, and bland nuclear features. On resection, DICER1-altered thyroid lesions include benign (50%), low-risk lesions (30%), or high-risk malignancies (20%).

Role of S-100 immunocytochemistry in diagnosis of pure neuritic leprosy on fine needle aspiration cytology – A series of two interesting cases presented as nerve abscess

Pure neuritic leprosy (PNL) constitutes to 4.2 % of all leprosy cases in India. Histopathology is crucial for the diagnosis of PNL ,but fine needle aspiration cytology (FNAC) is now replacing it, as nerve biopsy is a cumbersome procedure and can lead to neurological deficits. FNAC, a minimally invasive procedure can play a significant role in primary diagnosis of PNL. Apart from the cytomorphological features , using ancillary tests can further improve the diagnostic accuracy of PNL. We present here two cases, who presented with a soft tissue swelling. FNAC attempted from the lesions yielded a necrotic material which on microscopy showed abundant caseous necrosis with epithelioid cell granulomas and there were also few spindle shaped cells of neural morphology seen in clusters as well as scattered in the necrotic background. S-100 immunostaing was attempted which highlighted the neuronal cells confirming the diagnosis of PNL.

Unveiling lipid-rich ("clear cell") pancreatic neuroendocrine tumor: A small series of two cases with literature review.

This study presents two cases of lipid-rich pancreatic neuroendocrine tumors (PanNETs), a rare variant posing significant diagnostic challenges in fine needle aspiration (FNA) cytology and small biopsies. The first case involves an elderly male with a pancreatic tumor, displaying distinct cytoplasmic vacuoles, while the second case is a middle-aged male present with a pancreatic tail mass exhibiting foamy cytoplasm and eccentric nuclei, infiltrating in the stroma. Both cases did not exhibit typical morphologic features of PanNET but demonstrated cytomorphologic features and infiltrative growth patterns that mimicked adenocarcinoma. Further work-up demonstrated that both tumors were immunoreactive for synaptophysin and chromogranin, and were interpreted as well-differentiated, PanNET, lipid-rich variant. The study highlights the overlapping morphological features between lipid-rich PanNETs and other pancreatic neoplasms and underscores the importance of comprehensive cytological and immunohistochemical analysis for accurately diagnosing this variant, particularly due to the risk of misinterpreting it as pancreatic adenocarcinoma. Recognizing lipid-rich PanNETs is crucial for appropriate clinical management, as their identification can significantly impact treatment decisions and patient outcomes.

Interobserver agreement and risk of malignancy using the International Academy of Cytology Yokohama System for reporting breast FNA biopsy in a liquid-based exclusive cohort.

Per the College of American Pathologist's National Breast Fine Needle Aspiration Biopsy (FNAB) Practice Survey, ∼40% of laboratories use liquid-based cytology (LBC) for breast FNAB. The reproducibility of the International Academy of Cytology Yokohama System (YS) for reporting breast FNAB on LBC was explored. Breast FNAB specimens submitted as LBC only (all ThinPrep) between January 2017 and January 2021 were retrieved. Cases without histopathologic follow-up were excluded. Clinical and radiologic information was collected. One cytologist and six cytopathologists rendered diagnoses per YS. All reviewers were blinded to the original diagnosis and histopathologic follow-up. The risk of malignancy was calculated. Concordance rates were calculated by a weighted Cohen Kappa score (κ). Review of 110 cases demonstrated substantial to near-perfect agreement between each reviewer (κ=0.73-0.91) and follow-up histopathology (κ=0.66-0.85). The agreement was lowest in the inadequate (κ=0.05) and atypical (κ=0.04) categories. The lack of concordance in the atypical category was common in cases with low cellularity or incomplete structural features. The risk of malignancy for inadequate, benign, atypical, suspicious for malignancy, and malignant categories were 12.5% (2/16), 3% (2/65), 67%, (8/12) 100% (1/1), and 100% (16/16). Interobserver agreement is excellent using the five YS categories in LBC. Lack of cellularity and incomplete architectural features were barriers to perfect agreement. Established pitfalls in the interpretation of LBC were cause for atypical diagnoses. Continuous training and education are recommended to avoid misdiagnosis because of the nonconventional cytomorphologic features of LBC and to improve inadequate and atypical rates within YS.

Lymphoma presenting as the first finding in pleural fluid cytology: A rare cytologic presentation

Malignant hemato-lymphoid neoplasms presenting as the initial finding in pleural effusion cytology is one of the rare challenges a pathologist may encounter in practice among lymphocyte-rich effusions. Meanwhile, effusion cytology is an easily available, inexpensive diagnostic tool in our setting. Cytomorphological features provide crucial insights into the nature of the disease, which along with immunocytochemistry may help in solidifying the diagnosis. Here we present a rare case of a 17-year-old patient, who initially presented with pleural effusion that turned out to be lymphoma on cytological examination. Cell blocks were prepared and immunocytochemistry was performed for CD5 and CD23. Tumor cells showed positivity for both CD5 and CD23, confirming the diagnosis of small lymphocytic lymphoma.

Fine needle aspiration biopsy of parathyroid; is it meaningful? A cytologic study of 81 cases with histological and clinical correlations.

Recognizing the parathyroid gland and distinguishing the parathyroid from thyroid lesions in fine needle aspiration (FNA) is challenging. This study aimed to identify cytomorphologic features suggestive of parathyroid origin and to assess the utility of cytopathology in conjunction with ancillary tests in the identification of parathyroid glands. Ultrasound (US) guided FNA of parathyroid gland and lesions in 81 patients were reviewed concerning clinical history and correlated to histopathologic findings in available cases. FNA smears were evaluated for cellularity, architectural patterns, cellular and nuclear features, and background of the smears. In 78 cases, FNA was supplemented by a measurement of parathormone (PTH) levels in the needle washout fluid (FNA-PTH assay) and/or GATA3/PTH/chromogranin-A immunostainings. Sixty-four cases were diagnosed cytologically as parathyroid lesions in conjunction with FNA-PTH assay and/or immunocytochemical examinations. In an additional nine cases, a diagnosis of parathyroid lesions was rendered after repeated FNA with FNA-PTH assay. The histolopathologic diagnosis of surgically excised cases (n = 75) included parathyroid adenoma (60 cases), atypical parathyroid adenoma (4 cases), parathyroid hyperplasia (10 cases), and parathyroid carcinoma (1 case). Major cytological findings of parathyroid tissue included high cellularity, scattered naked nuclei, cribriform and three-dimensional clusters, stippled chromatin, and oxyphilic cytoplasm while papillary pattern or colloid-like material was identified in three cases respectively. No nuclear grooves or inclusions were seen in any case. High cellularity scattered naked nuclei, cribriform and three-dimensional patterns, stippled chromatin and oxyphilic cytoplasm are cytomorphologic features that favour parathyroid origin. A combination of these features with FNA-PTH assay and/or GATA3, PTH, and chromogranin-A immunostainings on cytologic specimens aid in the identification of parathyroid glands and the distinguishing of parathyroid from thyroid lesions.

Cutaneous balloon-cell melanoma metastases to the axillary lymph node: Exploring cytomorphologic features and differential diagnoses on fine needle aspiration biopsy.

Balloon cell melanoma (BCM) is an exceptionally uncommon histological variant, making up <1% of all malignant melanomas. Diagnosing balloon cell melanoma on cytological specimens can be challenging due to its scarcity and its similarity to other medical conditions. A comprehensive clinical assessment and histological analysis, coupled with immunohistochemical staining, play a crucial role in distinguishing balloon cell melanoma from various benign and malignant skin conditions. The differential diagnoses encompass spitz nevus, balloon cell nevus, clear cell sarcoma of tendons and aponeuroses (melanoma of soft tissues), metastatic clear cell renal cell carcinoma, sebaceous carcinoma, and benign adnexal tumours like clear cell hidradenoma. Malignant melanoma encompasses a spectrum of histopathological subtypes, each with unique clinical and cytological characteristics. Notably, balloon-cell melanoma (BCM) emerges as an exceptionally rare and diagnostically challenging variant. Marked by the presence of distinct balloon-like, clear cytoplasmic vacuoles within melanoma cells, BCM stands apart from other melanoma subtypes. Despite its rarity, the distinctive cytological features of BCM make it a compelling subject of investigation, emphasizing the crucial role of Fine Needle Aspiration (FNA) cytology in ensuring accurate diagnosis and guiding subsequent management decisions.

Liquid-based Cytology as a Superior Tool Compared to Conventional Pap Smear in Detecting Cervical Cancer in Suspected Cases: A Comparative Study

Abstract Introduction: Screening programs has conventional cytology such as Conventional Pap Smear (CPS) have successfully reduced cervical cancer, but newer tests like Manual Liquid-based cytology (MLBC) and Human Papillomavirus testing might enhance screening. Materials and Methods: This was a cross sectional study conducted on 175 samples was processed for CPS and MLBC. Cytobrush was used for LBC which was suspended and detached in the preservative fluid and processed by manual method. Histopathological correlation and HPV DNA testing was also done. Results: MLBC showed higher specimen adequately, cellularity, clean background and uniform distribution of cells than CPS. Conclusion: MLBC showed improved specimen adequately, better cytomorphological features and higher detection of epithelial cell abnormality.

Association between clinical outcomes, peripheral blood and cytomorphologic features of bone marrow in visceral leishmaniasis

IntroductionAn intracellular parasite of mononuclear phagocytes, mainly distributed in the bone marrow and the spleen, causes visceral leishmaniasis. Complete blood count (CBC) reveals the poorly understood pathogenesis of anemia, leukopenia and thrombocytopenia. Our study aimed to compare the CBC with bone marrow cytomorphological features and their association with clinical outcomes to clarify this relevant issue. MethodsThe CBC and bone marrow of 118 patients were described by two hematologists and compared to check their association with each other and mortality. ResultsPeripheral cytopenias were common findings, particularly anemia, as seen in almost all patients. No relationship was found between values of hemoglobin, neutrophils and platelet count with fatal outcomes. The bone marrow was normocellular in 61.9% of the cases. Dysplasia figures were frequent and 49.1% of the samples had dysgranulopoiesis. Additionally, erythroid hyperplasia was found in 72% of the patients with severe anemia. Patients with reduced bone marrow cellularity, erythroid hypercellularity and dyserythropoiesis seem to have a riskier disease. ConclusionThe study results suggest that the bone marrow of patients with visceral leishmaniasis manifests a reactional pattern to the inflammatory event, thereby modulating cytokines and other colony growth factors. This compensatory response may be dysplastic and ineffective and generate peripheral cytopenias of varying intensity. Further studies are needed to clarify the signaling pathways involved, which may be used as therapeutic tools in the future.

Role of FNAC in Diagnosis of Malignant Lymphadenopathy: A Five-Year Cross-sectional Study at A Tertiary Care Centre, Mumbai, India

Introduction: Fine Needle Aspiration Cytology (FNAC) of the lymph node is a simple tool in the diagnosis of suspected and unsuspected primary and secondary lymph node malignancy. It is a useful first-line investigation to distinguish between infective and malignant lymphadenopathy, especially in a low-resource setting like our country. Aim: To study the utility of FNAC in the diagnosis of lymph node malignancy and to evaluate the efficacy of cytology in diagnosing the primary site of malignancy in case of metastasis. Materials and Methods: A cross-sectional retrospective and prospective study was conducted for a five-year period from July 2015 to June 2020, in the pathology department of Dr. RN Cooper Municipal General Hospital, Mumbai, Maharashtra, India. A total of 112 patients diagnosed with malignancy on FNAC of lymph nodes were studied. The FNAC procedure was performed by cytopathologists using a 23/24G needle attached to a 10 ml syringe. The alcohol-fixed smears were stained with Haematoxylin &amp; Eosin (H&amp;E) stain and Papanicolaou (PAP) stains, while the airdried smears were stained with Giemsa stain. Diagnosis was based on cytomorphological features and clinical presentation. Results: A total of 112 patients were diagnosed with malignancy on FNAC, of which 90 were males and 22 were females, with a male-to-female ratio of 4:1. Cytological analysis of these nodes revealed metastasis in 98 cases (87.50%) and lymphoma in 14 cases (12.50%). The maximum number of patients were in the 51-60 years age group, with 38 cases (33.92%). The most common site of involvement was cervical lymph nodes, with 75 cases (66.96%). The most common cytological diagnosis was metastatic squamous cell carcinoma in 65 cases (58.02%), followed by metastatic un-differentiated carcinoma in 26 cases (23.20%). Conclusion: Fine Needle Aspiration (FNA) is a simple, safe, accurate, cost-effective, and valuable tool in the evaluation of malignant lymphadenopathy. Malignant diseases were easily diagnosed by this simple diagnostic procedure. In the case of a diagnosis of lymphoma, surgery can be completely avoided. It helps in planning further surgical management for metastatic disease, where definitive operative intervention can be performed in one session. In the case of an un-detected primary tumour, FNAC directs further investigations towards the possible primary site.

THE EFFECT OF PARGILINE, SPERMINE AND THEIR COMBINATIONS ON ANDROGEN-DEPENDENT AND ANDROGEN-INDEPENDENT HUMAN PROSTATE CANCER CELLS in vitro

Summary. A series of studies on enhancing the cytotoxic effect of spermine on human prostate cells by affecting the enzymes of its metabolism has been continued. Aim: to investigate effects of pargyline, spermine and their combinations the survival, ζ-potential and surface charge and cytomorphological properties of human prostate cancer cells in culture. Object and methods: studies were conducted on cell cultures: differentiated androgen-dependent LNCaP cell line and low-differentiated androgen-independent DU-145 cell line. Cell survival was determined in the trypan blue assay. The effect of the investigated compounds, both individually and in combination, on the viability and proliferative activity of cells was assessed by the colorimetric method – by staining living cells with a solution of crystal violet in methanol. Biophysical parameters (ζ-potential and surface electric charge density) were determined according to the method cellular microelectrophoresis. Cytomorphological characteristics were studied on preparations of cells grown on coverslips, fixed and stained with hematoxylin and eosin (magnification 1000×). Results: for LNCaP cells, the IC50 of pargyline was 2.2 mM, and the IC50 of spermine was 1.5 mM. For DU-145 cells, the IC50 of pargyline was 2.35 mM, the IC50 of spermine was 5.0 mM. According to biophysical indicators, spermine caused an inversion of the sign of the electric charge in cells of the LNCaP line. Pargyline did not exert such an effect, the charge remained negative, demonstrating an inverse dependence on its concentration. The combination of pargyline and spermine increased the cytotoxic effect of spermine on LNCaP cells, but did not affect the value of their ζ-potential and surface charge density, the positive sign of which, caused by the effect of spermine, was preserved. At the same time, pargyline completely eliminated spermine-induced inversion of the sign of the total surface charge of DU-145 cells, returning it to the normal negative values. Conclusions: it is shown that the differentiated androgen-dependent cells of the LNCaP line with the combined use of pargyline and spermine demonstrated an enhancement of the cytotoxic effect of spermine. At the same time, low-differentiated cells of the DU-145 line, which do not have androgen receptors, were more resistant to the effects of both pargyline and pargyline in combination with spermine. Pargyline also reversed spermine-induced inversion of the sign of the total surface charge of DU-145 cells, returning it to normal negative values. Cytomorphological changes that occurred under the influence of both pargyline alone and in its combination with spermine demonstrate mainly the apoptotic pathway of cell death in the androgen-independent DU-145 line, while in the androgen-dependent LNCaP line, a smaller proportion of cells were in a state of apoptosis.

Lung adenocarcinomas with isolated TP53 mutation: A comprehensive clinical, cytopathologic and molecular characterization.

TP53 mutation is present in about 50.8% of lung adenocarcinomas, frequently in combination with other genetic alterations. However, a rare subset harbors the TP53 mutation alone. Next-generation sequencing was performed in 844 lung adenocarcinomas diagnosed by fine needle aspiration. Fourteen cases (1.7%) showed isolated TP53 alteration and were subjected to a comprehensive analysis. The average age at diagnosis was 65.7 years (range 48-79); 9 males and 5 females. All were smokers with an average pack-year of 40.7 (range 10-70). Ten had metastases, mostly in the brain (n = 4) and pleura (n = 4). After a follow-up period of up to 102 months, 9 died, 3 were alive free of disease, 1 was alive with disease, and 1 was lost to follow-up. The median survival was 12.2 months. Most tumors exhibited poor differentiation, composed of solid sheets with moderate to severe atypia, increased mitotic activity, and necrotic background. Half were positive for TTF-1 and showed p53 overexpression. PD-L1 was positive in 5 cases. Most alterations were missense mutations in exons 5-8, and this mutation type was associated with p53 overexpression. Tumors with combined missense mutation and truncated protein had higher PD-L1 expression along with a trend towards an increase in tumor mutational burden (TMB). CEBPA deletion of undetermined significance was the most common copy number alteration. Isolated TP53 mutation was seen in association with smoking, high-grade cytomorphologic features, adverse prognosis, and recurrent CEBPA deletions. These tumors tend to have strong PD-L1 expression and high TMB, suggesting potential benefit from immune checkpoint inhibitors. Hence, the recognition of this molecular group has prognostic and therapeutic implications.

Use of Absolute Alcohol in Preservation of Cell Morphology in Fluid Cytology at Various Temperatures: A Cross-sectional Study

Introduction: Fluid cytology and the examination of malignant cells play an important role in the treatment of critical cases. The Department of Pathology (Cytopathology laboratory) receives samples for fluid cytology and examines malignant cells, reporting the White Blood Cell (WBC) count in the received fluid and the morphological findings of the cells examined on smears. Degeneration of cells in these body fluid samples, especially if the samples are not stored under proper conditions, is a common problem faced by many laboratories. Even overnight storage (12 hours) of these body fluids at temperatures of 4-8ºC (domestic refrigerators) may still cause some degree of degenerative changes. This becomes problematic in cytopathological reporting of body fluids, particularly when the samples are limited in amount or are from areas that cannot be re-aspirated {e.g., Cerebrospinal Fluid (CSF)}. While alcohol is a common fixative used for cell fixation in cytopathology, it is rarely used for fixing cells in fluid samples. Aim: To test the usage of absolute alcohol as a fixative in body fluid samples received in the cytopathology laboratory, which have been stored for 12 hours at two temperatures: room temperature and 4-8ºC. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology at Subharti Medical College, Meerut, Uttar Pradesh, India. The study was conducted over the periods of two months, from February 2022 to March 2022. A total of 100 body fluid samples (including CSF, ascitic fluid, pleural fluids, etc.) sent for routine workup to the cytopathology laboratory were included in the study. Each body fluid sample (1 mL) was taken in two test tubes, and four drops of 100% (absolute) alcohol were added to both test tubes. The mixture of body fluid and absolute alcohol was then gently shaken, and one set of test tubes was kept at room temperature while the other set was kept at 4-8ºC. The data was tabulated in an MS Excel worksheet, and basic statistical analysis was performed. Results: The age range of cases whose samples were analysed was from one-week-old neonates to 65-year-old adults. The total number of fluid samples was 100, including 42 CSF samples, 23 ascitic fluid samples, 18 pleural fluid samples, and 17 Bronchoalveolar Lavage (BAL) fluid samples. Out of the 42 CSF samples, 15 showed preservation of morphology when the alcohol-body fluid mixture was kept at room temperature, while 22 cases showed preservation of the same mixture at 4-8ºC. Some samples showed no preservation (5 CSF), the reasons for which are discussed below. All the examined body fluids showed better preservation with alcohol at 4-8ºC. Conclusion: The addition of absolute alcohol as a fixative in fluids helps preserve the cytomorphological features of cells and provides better preservation for the diagnosis of fluid samples.

Lumps and Bumps on the Abdominal Wall: Role of Fine Needle Aspiration Cytology.

Abdominal wall masses often pose diagnostic challenges for clinicians due to their nonspecific symptoms. They include a wide spectrum of lesions ranging from inflammatory to tumor-like masses and malignancies. The majority of the malignant nodules are metastatic in origin and may be the initial presentation of a primary malignancy; hence, an early diagnosis is important. Fine-needle aspiration cytology (FNAC) is a valuable diagnostic tool in the evaluation of such lesions. This was a retrospective study of the cytomorphological spectrum of abdominal wall masses, conducted at a tertiary health care centre over a three-year period. The study included patients of all age groups presenting with an abdominal wall mass. These lesions were assessed by FNAC. The diagnosis was made on cytology smears and subsequently correlated with the histopathological diagnosis, wherever possible. Of the 70 cases, 21 were non-neoplastic and 49 neoplastic. A benign neoplasm was the most common lesion (52.9%), followed by non-neoplastic lesions (30%) and malignant neoplasms (17.1%). Lipoma was the most common benign neoplasm and metastasis was the commonest malignant neoplasm. The most common type of tumor metastasising was adenocarcinoma and the primary tumors were predominantly intra-abdominal. No false-negative results were seen. Most of the abdominal wall masses display a characteristic cytomorphology, which needs to be identified and recognized by a cytopathologist for an accurate diagnosis. FNAC plays an invaluable role in the detection of metastases, especially at sites such as the umbilicus, which may be the only manifestation of an underlying advanced malignant disease.

Diagnosis of Infarcted Breast Lesions on FNAC, a Blustering Fool: Short Case Series.

Fine-needle aspiration cytology (FNAC) is often used as a screening tool. Cytopathologist should be aware of various mimickers of the malignancy. One of these is infarction of benign breast lesions. Careful examination of cytomorphological features will avoid the misdiagnosis of malignancy in such cases. Six cases were diagnosed as benign breast lesion for 4 years and 5 months in our newly established tertiary referral center. Histopathology follow-up was available in one case. Of six cases, three cases (50%) were reported as fibroadenoma with infarction, two cases (33%) as benign breast lesion with infarction favor fibroadenoma, and one as breast lesion with infarction favor phyllodes tumor in view of recurrence. Most were in the second or third decade of their life. All cases showed dyscohesive cells with pyknotic nuclei. Monolayered sheets of necrotic cells were seen in the four cases (66%). Viable cells were seen in four cases. FNAC provides a rapid and accurate diagnosis of benign breast lesions with infarction in the hands of experienced pathologists who can help in better patient care. Small-sized uniform pyknotic nuclei of dyscohesive cells and regular nuclear membranes help to differentiate them from inflammatory and malignant lesions.