Initial Cytology Research Articles

Molecular Cytology by One-Step Nucleic Acid Amplification (OSNA) Assay of Peritoneal Washings during D2 Gastrectomy in Advanced Gastric Cancer Patients: Preliminary Results.

The presence of peritoneal free cancer cells (FCC) in gastric cancer (GC) patients is a poor prognostic factor. D2 gastrectomy may induce exfoliated FCC spread from the primary tumour or involved lymph nodes (LN). Conventional cytology for FCC detection has several limitations, whereas prophylactic use of extensive intraoperative peritoneal lavage (IPL) does not improve survival. A prospective single-arm observational study was conducted to verify whether D2 gastrectomy causes an intraoperative increase of FCC in peritoneal fluid. Twenty-seven GC patients underwent D2 gastrectomy, followed by objective quantitative measurements of CK19 mRNA level reflecting FCC with One-Step Nucleic Acid Amplification (OSNA) assay. The IPL with 3000 mL of saline was performed twice: (1) after gastrectomy with D2 lymphadenectomy and (2) after alimentary tract reconstruction. The IPL samples were analysed by initial cytology and four (1–4) consecutive OSNA assays. Initial OSNA measurement (1) revealed positive results (≥24.6 cCP/μL) in 7 (29.6%) patients. Subsequent OSNA measurements showed a significant decrease in the FCC level after D2 gastrectomy (1 vs. 2; p = 0.0012). The first IPL induced a non-significant increase in the FCCs (2 vs. 3, p = 0.3300), but the second IPL reversed it to normal levels (3 vs. 4, p = 0.0.0574). The OSNA assay indicates a temporal intraoperative increase in the peritoneal FCC in advanced GC patients undergoing D2 gastrectomy. Two consecutive IPLs are necessary to reverse the increase of CK19 mRNA level in peritoneal washings.

Diagnostic Accuracy of B-Mode- and Contrast-Enhanced Ultrasound in Differentiating Malignant from Benign Pleural Effusions.

Purpose: To evaluate the value of CEUS in differentiating malignant from benign pleural effusions (PEs). Methods: From 2008 to 2017, 83 patients with PEs of unknown cause were examined using B-mode thoracic ultrasound (B-TUS), CEUS, and cytological examination. The extent of enhancement of the pleural thickening, the presence of enhancement of septa or a solid mass within the PE, and the homogeneity of the enhancement in the associated lung consolidation, were examined. Subsequently, the diagnostic value of cytology, B-TUS, and CEUS in differentiating malignant from benign PEs was determined. Results: With CEUS, markedly enhanced pleural thickening and inhomogeneous enhanced lung consolidation were significantly more frequently associated with malignancy (p < 0.05). In the subgroup analysis, the use of CEUS increased the sensitivity from 69.2 to 92.3 in patients with initial negative cytology but clinical suspicion of malignant PE; it also increased the specificity from 63.0 to 90.0, the positive predictive value from 69.2 to 92.3, the negative predictive value from 63.0 to 90.0, and the diagnostic accuracy from 66.7 to 87.5, in the evaluation of PE malignancy. Conclusion: The use of clinically based B-TUS and CEUS as a complementary method to cytological evaluation may be beneficial for evaluating a PE of unknown cause. CEUS patterns of enhanced pleural thickening and inhomogeneous enhanced lung consolidation may suggest a malignant PE.

A Fascinating Experience with A Rare Case of Granulomatous Mastitis

We Report a case of Idiopathic granulomatous mastitis in a 30 year old pregnant woman who came to our hospital with complaints of painful lump in her right breast because the results of initial aspiration cytology was mammary abscess with focal mastitis, incision and drainage was performed when MRI breast showed intermediate concern for malignancy – Excision biopsy was done. However the final histopathological diagnosis was granulomatous mastitis with no evidence of malignancy. A review of literature revealed that idiopathic granulomatous mastitis has a tendency to affect young woman with a history of child birth on oral contraceptive usage. Clinical diagnosis and imaging has often been difficult. Complete resection or corticosteroid therapy can be recommended as appropriate treatment. Since recurrence rate is as high as 50%, long term follow up is indicated in such patients.

Loss to follow-up of women with initial cervical cytology of ASC-US/LSIL in Tocantins, Brazil

Objective: The study aims to characterize loss to follow-up of women with initial cytological diagnosis of atypical squamous cells of undetermined significance, possibly non-neoplastic (ASC-US), or low-grade squamous intraepithelial lesion (LSIL), in Tocantins State, Brazil, from 2011 to 2013. Study Design: Cervical cytology data from the Information System on Uterine Cervical Cancer (SISCOLO) was used to identify women with initial diagnosis of ASC-US or LSIL in 2011. Nominal database record linkage was used to identify women with previous altered Pap smear results (who were excluded) and those who returned (versus failed to return) by the year 2013. Results: Record linkage identified 1,174 women with diagnoses of ASC-US (65.9%) or LSIL (34.1%) and without previous altered tests. According to the data, 55.9% and 53.5%, respectively, failed to undergo follow-up tests in the subsequent years. Conclusion: Failure to return for repeat cervical cytology suggests a missed opportunity for diagnosis and treatment of women with precursor lesions or cervical cancer not detected in the initial cytology, thus compromising the effectiveness of cervical cancer control in the State of Tocantins.

Would Women With Solid Organ Transplant Qualify for Triennial Cervical Cancer Screening as Recommended by the American College of Obstetricians and Gynecologists in 2016 and American Society for Colposcopy and Cervical Pathology in 2019?

The aim of the study was to assess the applicability and safety of cervical cancer screening guidelines recommended by the American College of Obstetricians and Gynecologists (2016) and American Society for Colposcopy and Cervical Pathology (2019) for women with solid organ transplants (SOTs). We analyzed data previously abstracted through December 2015 for 971 women (18-60 y) who received their first SOT at Mayo Clinic (Rochester, MN) from January 17, 1995, through December 31, 2011. Inclusion criteria were initial benign findings on cervical cytology after SOT and at least 1 subsequent cytologic screening. Of 415 women whose initial cytologic findings were benign, 310 met inclusion criteria. The cumulative incidence of abnormal cervical cytology among these 310 women was 4.3% (95% CI = 1.9%-6.7%) by 30 months and 11.2% (95% CI = 7.1%-15.4%) by 60 months after their initial benign results. Considering all women with SOT, 68.4% (284/415) had no documented abnormal cytologic findings within 60 months (26 had abnormality; 284 no abnormality; and 105 not assessed). In women with negative tests for human papillomavirus, high-grade squamous intraepithelial lesions were not documented on cytology with variable duration of follow-up. No cervical squamous cell carcinoma was identified. Of women with initial benign cervical cytology after SOT, more than two thirds would have been eligible for extended-interval screening. Further study is needed, particularly regarding the role of high-risk human papillomavirus testing.

The Prevalence of Thyroid Papillary Microcarcinoma in Patients With Benign Thyroid Fine Needle Aspiration.

IntroductionThyroid nodules are a very common clinical finding in the general population. We use fine needle aspiration (FNA) as the gold standard workup test for a thyroid nodule, as it is capable of differentiating malignant nodules from benign in the majority of cases. Usually, FNA is done for nodules that are more than 1 cm; small malignant lesions that are less than 1 cm in size can be missed. That’s why the risk of having undiagnosed microcarcinomas in an otherwise benign FNA needs to be explored.AimTo estimate the prevalence of thyroid papillary microcarcinoma in patients with benign FNA and evaluate and correlate the FNA cytological results with the final histopathological diagnoses.MethodsThis was a retrospective study of 1543 post-thyroidectomy patients who underwent FNA cytology, were classified according to the Bethesda scoring system, and were admitted to two tertiary care hospitals in Riyadh, Saudi Arabia, from 2010 to 2019.ResultsSix-hundred-seven (607) out of 1543 FNA cytology results were reported as benign, 215 as malignant, and 73 as suspicious of malignancy. On final histopathology diagnosis, 81/607 (13.34%) of benign cases and 35/215 (16.28%) of malignant cases did not meet the initial cytology and were confirmed as papillary microcarcinoma. In patients with microcarcinoma after initial benign FNA (89.2%) found to have benign multinodular changes, compared to only (31%) of initial malignant FNA patients.Conclusion When non-surgical intervention is chosen in patients with benign FNA, the possibility of coexisting microcarcinoma with its variable prognosis should be taken into account and explained to the patient.

Comparison of core-needle biopsy and repeat fine-needle aspiration for thyroid nodules with inconclusive initial cytology.

We aimed to compare the efficacy of ultrasound-guided core-needle biopsy (CNB) with repeat fine-needle aspiration (rFNA) cytology in thyroid nodules with inconclusive results in initial fine-needle aspiration cytology. We studied 402 patients who required a repeat biopsy of thyroid nodules using ultrasound-guided CNB (n = 192) or rFNA (n = 210) because of inconclusive results in initial FNA, corresponding to categories I, III, and IV of the Bethesda System for Reporting Thyroid Cytopathology. If repeat biopsy results were benign (category II), suspicious malignancy (category V), or malignancy (category VI), they were defined as "diagnostic results". The diagnostic yield and performances of repeat biopsy were analyzed and compared between the rFNA and CNB groups. The diagnostic results were obtained significantly higher in the CNB group than in the rFNA group (72.4% vs. 52.4%; P < 0.001). In the subgroup analysis, the diagnostic results were significantly higher in the CNB group than in the rFNA group for patients of categories I and III (P < 0.001 in both) in initial FNA. However, in patients with category IV nodules, there were no significant differences in diagnostic results between the two groups (P = 0.46). Compared to rFNA, ultrasound-guided CNB is useful and effective as a repeat biopsy option for thyroid nodules with non-diagnostic results (category I) and atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) (category III) in initial FNA.

The value of ultrasonography for the indication of fine-needle aspiration in autonomous thyroid nodules.

The risk of malignancy in autonomous thyroid nodules is considered to be very low in adults and fine-needle aspiration (FNA) is not recommended in these cases; however, some studies contest this. Just as ultrasonography (US) has been used to select nonautonomous nodules with initial benign cytology that deserve FNA repetition, this method may also be useful to select autonomous nodules that are candidates for FNA. In this prospective study, FNA was obtained in 48 adults patients with autonomous solitary nodules >1 cm with suspicious US features (at least two of the following findings: hypoechogenicity, microcalcification, irregular margins, taller than wider shape, predominantly or exclusively central vascularization). Cytology was benign in 28 patients (58.3%). Six patients (12.5%) had nondiagnostic cytology and histology revealed benign nodules in these cases. Cytology was indeterminate in nine other patients (18.5%). Of these, seven were adenomas and two were follicular carcinomas on histology. Finally, cytology suspicious for malignancy or malignant cytology was detected in five patients (10.4%), all of them confirmed histologically to be papillary carcinomas (the follicular variant in three). Thus, the frequency of malignancy was 14.6% (two follicular carcinomas and five papillary carcinomas), 8.3% in nodules with two suspicious findings vs 33.3% in nodules with ≥3 suspicious findings (P = .055). The results suggest that the presence of ultrasonographic findings suspicious for malignancy in autonomous thyroid nodules >1 cm is a criterion for the indication of FNA.

Gastric-type endocervical adenocarcinoma and cervical cytology: Experience at a general hospital and review of the literature.

Gastric-type endocervical adenocarcinoma (GAS) is an uncommon type of endocervical adenocarcinoma that is not associated with human papillomavirus infection. This diagnosis is relatively rare and may portend a worse prognosis than usual-type endocervical adenocarcinoma. Subtle morphological features make it an under-recognised diagnostic challenge. Study of the cytological features of individual cases is valuable in order to increase awareness of this entity. The pathology database of our institution was searched for the diagnosis of GAS and all cytological and surgical specimens for each patient were reviewed. The original cytological interpretation was compared to a retrospective central review interpretation. Clinical history and follow-up results were obtained from the electronic medical record. Four cases of GAS were identified. The findings on initial cervical cytology varied, with GAS found in both patients with negative cervical cytology and those with atypical glandular cells. Cytological findings included endocervical cells arranged in three-dimensional clusters and honeycomb sheets with abundant vacuolar cytoplasm, and in two patients, moderate nuclear atypia with irregular nuclear membranes, coarse chromatin, hyperchromatic nuclei, and prominent nucleoli. In one patient, GAS was incidentally discovered via thorough sampling of a cystic lesion in the superior portion of the endocervical canal. GAS is an aggressive human papillomavirus-independent type of endocervical adenocarcinoma with subtle morphological features and, as our study shows, varying clinical presentation. Given the aggressive nature of GAS and the difficulties in initial diagnosis, increased awareness of this entity among pathologists is crucial.

Is cervical cytology testing as a part of co-test unnecessary for HPV 16/18-infected women? A retrospective cohort study of 1647 women.

We aimed to present the biopsy results of women with HPV 16/18 infection and investigate whether cytology is necessary as a part of routine cervical cancer screening in women with HPV 16/18. This is a retrospective cohort study conducted on 1647 patients between the ages of 30 and 65 years with HPV 16/18 undergoing colposcopy-guided biopsy at a tertiary gynecological cancer center between January-2016 and January-2019. We compared the preinvasive lesion rates and the invasive cervical cancer rates of women with HPV 16/18 between the negative and the abnormal cytology group. Of the 1647 women, 1105 (67.1%) had negative cytology and 542 (32.9%) had abnormal cytology. Among women with initial negative cytology, cervical intraepithelial neoplasia (CIN) 2+ lesion was detected in 205 (18.6%) women. The rate of CIN 2+ lesion in women with abnormal cytology was 28%. There was a significant difference between negative and abnormal cytology group in terms of CIN 2+ lesion rates (P < .001). Among women with initial negative cytology, invasive cervical cancer was detected in 6 (0.5%) women. The rate of invasive cervical cancer in women with abnormal cytology was 8 (1.5%). There was no significant difference between negative and abnormal cytology group in terms of invasive cervical cancer rates (P = .082). The rate of cervical cancer among HPV 16/18-infected women with negative cytology is similar to women with abnormal cytology. Based on the results of this study, Pap testing could be unnecessary in HPV 16/18-infected women to diagnose invasive cervical cancer who will undergo colposcopy biopsy.

The Role of FNAC in the Diagnosis and Management of Warthin Tumour: Analysis of 74 Cases.

Introduction After pleomorphic adenoma, Warthin tumor gets its popularity as the second most common benign neoplasm of the parotid gland. Fine-needle aspiration cytology (FNAC) is the most cost-effective and minimally-invasive way to determine the histological character of a parotid gland tumor. Objective To determine the accuracy of FNAC in the diagnosis of Warthin Tumour. Methods A retrospective study conducted between 2014 and 2018. Out of 243 FNACs performed for parotid lesions, a histopathological correlation was established in 74 cases to reveal the accuracy of FNAC in the diagnosis of Warthin tumor. Results A total of 243 FNACs of parotid lesions were performed, and a histopathological correlation was established in 74 (30.4%) cases. Later on, we confirmed that 16 (21.6%) out of these 74 patients had cases of Warthin tumor. In total, 15 (20.3%) out of those 74 cases were confirmed as Warthin tumors on the initial cytology, which revealed a true positive concordance between the cytology and the final histological diagnosis; 55/74 (74%) were true negative results; on the other hand, 1/74 (1.4%) was a false negative, and 3/74 (4.1%) were false positive results. The sensitivity of the FNAC in the diagnosis of Warthin tumor was of 93%, while the specificity was of 94.8%, and the accuracy, of 94.6%. Conclusion In the present study, FNAC had a high diagnostic accuracy, reaching 94%.

Comparison of the reverse bevel versus Franseen type endoscopic ultrasound needle.

BACKGROUNDReverse bevel (RB) needle is widely used for endoscopic ultrasound fine needle biopsy (EUS-FNB). A 3-plane symmetrical needle with Franseen geometry (FG) has recently become available.AIMTo compare the clinical efficacy of FG to that of RB needle.METHODSA retrospective cohort study of all adult patients who underwent EUS-FNB for solid and mixed lesions either with 22G RB needle or 22G FG needle between January 2016 and February 2019 was undertaken. All cytology slides were reviewed by an independent gastrointestinal cytopathologist blinded to the needle used and the initial cytology report. The primary and secondary outcomes were to assess the sample adequacy using Euro-cytology criteria and the number of cell clusters, respectively.RESULTSTwo hundred and twenty six procedures were included in the study. RB needle was used in 128 procedures and FG needle in 98 procedures. The baseline characteristics of both groups were comparable. On multivariable analysis, FG needle (P = 0.02) and location of the lesion (P < 0.01) were independently associated with adequate tissue. Further, the use of FG needle (P = 0.04) and the size of the lesion (P = 0.02) were independently associated with acquisition of increased number of cell clusters.CONCLUSIONFG needle is superior to RB needle in acquiring adequate tissue and attaining higher number of cell clusters for solid and mixed lesions.

Predictors of Human papillomavirus (HPV) persistence after treatment of high grade cervical lesions; does cervical cytology have any prognostic value in primary HPV screening?

ObjectiveThis study aimed to determine the factors associated with Human Papillomavirus (HPV) persistence in women undergoing cervical excision for pre-invasive lesions, after they have been referred from a primary HPV screening program. MethodsA retrospective study design involving patients who were treated at a Cervical Disease Screening and Treatment Unit, in a university hospital setting. After initial treatment, cervical HPV infection status was analyzed at the sixth month, first year and then subsequently after the second year. ResultsTotally, 395 patients who were diagnosed with pre-invasive cervical lesions and who subsequently undergone cervical excision were identified. In the first-year visit after cervical excision, HPV 18 was cleared in almost all (95.8%) cases, followed by HPV 16 (69.9%) and other hrHPV types (65.6%). Available data documented that 88.6% of women reached clearance after the two-year follow-up. Univariate analysis revealed a significantly higher proportion of HPV clearance among women who were younger (p = 0.019), premenopausal (p = 0.002), and who had been found to have a negative cytology result on their initial Pap test (p = 0.018). However, only cervical cytology result remained as the independent predictor of HPV persistence on a multivariate logistic regression (OR 0.43; 95% CI 0.21–0.87; p = 0.019). ConclusionsA low risk of HPV persistence was found among every HPV genotype in women undergoing cervical excision for pre-invasive cervical lesions. Initial cervical cytology result was the only independent predictor of HPV clearance during surveillance, which indicates the prognostic value of Pap test in primary HPV screening.

Nonepitheliotropic lymphoma in a dog: case report

Cutaneous lymphoma is an uncommon neoplasm in dogs and Boxer, Shih Tzu, Cocker Spaniel, Basset Hound and Golden Retriever are predisposed breeds. This report describes the case of a 5-year-old mixed-breed female dog presenting ulcerated and fast-growing skin nodules. Initial cytology revealed a poorly differentiated round cell neoplasm. Excision of nodules was performed due to the emergence of new lesions. Histopathological examination was suggestive of histiocytoma. The lesions recurred after one year, and a surgical excision of nodules was performed. An immunohistochemical examination was carried out to refine the diagnosis, revealing positivity for CD3 markers in neoplastic cells and for HLA-DR in neoplastic lymphoid and reactive histiocytic cells; these findings, coupled with the morphological findings, were compatible with nonepitheliotropic cutaneous T-cell lymphoma. Its etiology has not yet been fully elucidated; however, recurrent skin inflammation may be a predisposing factor, which leads to chronic lymphocytic proliferation. Cutaneous lymphoma (CL) causes nonspecific lesions and its classification as epitheliotropic and nonepitheliotropic (NEL) throughout cutaneous signs is difficult, with NEL being the least described form. Animals affected by this form of lymphoma have lymphadenomegaly, firm and multiple nodules that can extend from the dermis to the subcutaneous layer, alopecic and/or ulcerated, often in chest, head and extremities, with rapid progression, which was compatible with the present case. Definitive diagnosis of CL is obtained through histopathology and immunohistochemistry. The aim is to report a case of nonepitheliotropic cutaneous lymphoma in a dog, with emphasis on its clinical, histopathological, and immunohistochemical aspects.

Value of repeated cytology for intraductal papillary mucinous neoplasms of the pancreas with high risk potential of malignancy: Is it a promising method for monitoring a malignant transformation?

ObjectivesThe efficacy of and indications for cytological reexamination to detect malignant changes in branch duct type intraductal papillary mucinous neoplasms (BD-IPMNs) have not been studied in detail. We conducted a retrospective study to evaluate the efficacy and indications of cytological reexamination by using pancreatic juice (repeated cytology) for BD-IPMNs. MethodsForty-five patients who underwent repeated cytology after a diagnosis of benignancy by using initial cytology were recruited for this study. ResultsThirty-eight patients, excluding 7 patients with lack of surveillance period after the final cytology, were classified into Malignancy (n = 13) and Benignancy groups (n = 25) on the bases of the findings from resected specimens or changes in BD-IPMNs after repeated cytology. The sensitivity and specificity to detect malignant changes in BD-IPMNs by using repeated cytology were 62% and 100%, respectively. For the 12 patients with mural nodules (MNs) ≥ 5 mm (67% of them were malignant), the sensitivity was 50%, whereas, for the 26 patients without MNs ≥ 5 mm (19% of them were malignant), it was 80%. In addition, malignant changes in BD-IPMNs after initial cytology occurred in 62% of the patients with changes in the MNs and 27% of the patients with an increase in the cyst size. ConclusionRepeated cytology can play a role in the determination for surgery even after a diagnosis of benignancy by using initial cytology, especially for BD-IPMNs without MNs ≥5 mm. In addition, changes in the MNs or cyst size may be appropriate indications for repeated cytology.

CONSIDERATIONS FOR CHYLOTHORAX IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Chylothorax is a rare complication of chronic lymphocytic leukemia (CLL). Diagnosis is challenging due to its rarity and nonspecific clinical presentation. We report a case of CLL-associated chylothorax. CASE PRESENTATION: A 71 year-old woman with no known medical history presented with dyspnea, weakness, and weight loss. Exam was significant for cachexia and respiratory distress with absent left-sided breath sounds. Labs were notable for WBC 376,800 cells/μL (91% lymphocytes and smudge cells), Hgb 7.1g/dL, platelets 557,000 cells/μL, LDH 408U/L, protein 6.6g/dL. A large left-sided pleural effusion was noted on chest radiograph. CT demonstrated a large left effusion with left lung atelectasis, hepatosplenomegaly, and mediastinal and abdominal lymphadenopathy. Peripheral flow cytometry was consistent with CLL (Rai Stage III). Lung ultrasonography demonstrated multiple septations. Thoracentesis and 8-French chest tube placement were performed. Pleural fluid studies: WBC 4,010 cells/μL (61% neutrophils, 34% lymphocytes), protein 4.4g/dL, LDH 568U/L, amylase 35U/L, and triglycerides 49mg/dL. Pleural fluid was sent for cytology and empiric antibiotics were started. Intrapleural alteplase and DNAse were instilled for 6 doses in attempt to reexpand the lung. Initial cytology and cultures were negative. Pleural fluid analysis was repeated hospital day 11, demonstrating triglycerides 189mg/dL and cholesterol 10mg/dL, consistent with chylothorax. Low fat diet, octreotide, chlorambucil and prednisone were initiated. Daily chest tube output was >500mL and she underwent CT venography. Interventional radiology attempted thoracic duct embolization but were unable to successfully cannulate it. Lymphoscintigraphy identified the thoracic duct leak. Cisterna chyli access via groin lymph node was aborted due to distress when the patient was supine. The patient chose to focus on comfort and the chest tube was removed. She was discharged to home hospice. DISCUSSION: Chylothorax from CLL is uncommon, reported in few cases. The rarity may be attributed to infrequent mediastinal lymphadenopathy in CLL.1,2 In the setting loculated pleural effusions, diagnosis may be difficult due to sampling error; chylothorax is diagnosed by pleural fluid triglycerides >110mg/dl. If levels are indeterminate, repeat analysis is warranted if suspicion remains high. Management focuses on treating the underlying disease and implementing a low fat diet with medium-chain triglycerides. Thoracic duct embolization may be an option for poor surgical candidates failing initial therapy.3 CONCLUSIONS: High suspicion for chylothorax must be maintained in CLL patients with pleural effusion to avoid delaying directed intervention. Reference #1: Zimhony et al. Chronic lymphocytic leukaemia complicated by chylothorax. Journal of internal medicine. 1994 Apr;235(4):375-7. Reference #2: Antón E. Chylothorax in hematologic malignancies. Chest. 2005 May 1;127(5):1866. Reference #3: Bender et al. The changing management of chylothorax in the modern era. European Journal of Cardio-Thoracic Surgery. 2015 Mar 1;49(1):18-24. DISCLOSURES: No relevant relationships by Scott Ferrara, source=Web Response No relevant relationships by Yonatan Greenstein, source=Web Response No relevant relationships by Omry Zuckerman, source=Web Response

Analysis of cytological false negatives of carcinoma of cervix

Analysis of cytological false negatives of carcinoma of cervix - JDPO- Print ISSN No: - 2581-3714 Online ISSN No:- 2581-3706 Article DOI No:- 10.18231/j.jdpo.2019.043, IP Journal of Diagnostic Pathology and Oncology-IP J Diagn Pathol Oncol

A rare case of primary tuberculosis in a solitary thyroid nodule

Tuberculosis (TB) of the thyroid gland is extremely rare with fewer than 200 cases reported worldwide. We report a case of primary TB of the thyroid in a 73-year-old gentleman with no risk factors for TB, presenting with a painless right neck mass of one week's duration. A pre-operative ultrasound scan reported a solid-cystic, right TIRADS 5 nodule, and initial fine needle cytology showed granulomatous inflammation and was negative for AFB on Ziehl-Neelsen stain. A right hemithyroidectomy was done subsequently, and histology demonstrated necrotizing granulomatous inflammation, but TB-PCR detected Mycobacterium DNA.Primary TB of the thyroid is rare and can manifest in patients with no apparent risk factors for TB. Initial cytology may only yield granulomatous inflammation and surgery is needed to ascertain the exact cause of granulomatous inflammation and additional TB-PCR can help clinch the diagnosis.

Is repeat fine needle aspiration required in thyroid nodules with initial benign cytology?

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Should we perform fine needle aspiration cytology of subcentimetre thyroid nodules? A retrospective review of local practice.

In light of the rising rate of incidentally detected subcentimetre thyroid nodules due to improved surveillance and diagnostic imaging, the decision of whether to perform fine needle aspiration cytology is increasingly pertinent. We aim to assess (1) the sampling adequacy of fine needle aspiration cytology, (2) malignancy rate, (3) thyroidectomy rate and (4) diagnostic accuracy of fine needle aspiration cytology. A total of 245 subcentimetre nodules in 220 patients underwent fine needle aspiration cytology between 2011 and 2014. Medical records were reviewed for cytology results, subsequent management and histopathological results in the event the patient underwent thyroidectomy. Sampling adequacy was calculated as the percentage of diagnostic results (Bethesda II-VI). Malignancy rate was defined as the percentage of Bethesda IV-VI diagnoses. Amongst patients with Bethesda IV-VI diagnoses who underwent thyroidectomy, their cytology reports were correlated with post-operative histopathological findings. The sampling adequacy of fine needle aspiration cytology was 77.1%. Malignancy rate (Bethesda IV-VI) was 9.7%. The respective malignancy rates in the < 5 mm nodule group and ≥ 5 mm nodule group were 6.67 and 10.0%. In total, 79.2% (19/24) of the malignant nodules underwent surgical excision. The rest declined surgery and/or were lost to follow-up. Amongst the malignant nodules which were surgically resected, 84.2% (16/19) had definitive malignant histology. Five of these demonstrated multifocal carcinoma and/or extrathyroidal extension of carcinoma on histology. Initial fine needle aspiration cytology and subsequent histopathological diagnoses matched in all cases except for three that had false-positive fine needle aspiration cytology results. Majority of our patients with suspicious cytology results subsequently underwent thyroidectomy, notwithstanding the relatively lower diagnostic accuracy of fine needle aspiration cytology in subcentimetre thyroid nodules.