Preoperative Fine-needle Aspiration Cytology Research Articles

Renal Hemangioblastoma with Mixed Mullerian tumour of endometrium: A tale of two rare primary tumours

IntroductionRenal hemangioblastoma (RH) is a very rare benign tumour. Hemangioblastoma most commonly occurs in the central nervous system (CNS), and only few cases of RH have been reported as they occur most commonly as asymptomatic masses found incidentally. Mixed Mullerian tumour (MMT) of the uterus is a rarer and aggressive form of uterine malignancy. The detection of two primary rare tumours incidentally is a rare entity.Case presentationA 50-year-old female presented with abnormal uterine bleeding which on endometrial sampling was diagnosed as a rare variety of endometrial cancer, i.e. MMT or uterine carcinosarcoma. On preoperative imaging, a renal mass was also detected which was highly vascular and was mimicking renal cell carcinoma (RCC). Fine needle aspiration cytology (FNAC) was done from the renal mass to differentiate between RCC and metastasis, but it showed only blood cells. Patient underwent staging laparotomy for endometrial cancer and frozen section examination of the renal mass which was inconclusive with few atypical cells, and thus, patient underwent radical nephrectomy too. Histopathological examination revealed it to be a RH which is a very rare benign tumour.DiscussionRH is a rare benign tumour which does not require any treatment in majority of the patients. Only 26 cases of RH outside the CNS have been reported till date. MMT is a rare aggressive uterine tumour with an incidence of 1–2 % of all uterine neoplasms, which metastasizes early, and thus, early identification and treatment is the key. RH needs to be differentiated from RCC to avoid over treatment. Morphological findings are similar in RCC and RH; preoperative FNAC, PET scan, and intraoperative frozen section can be utilized to differentiate the two, in well-circumcised tumours and high index of suspicion. Occurrence of renal mass as an incidental finding in the preoperative work up of uterine malignancy directed us to the differentials of metastasis or another histologically distinct primary tumour. The presence of two rare primary tumours, i.e. RH and MMT in the same patient which are unrelated, is a rare entity.

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Diagnostic value of preoperative fine needle aspiration cytology in parotid gland tumors.

Salivary gland masses constitute a broad spectrum of lesions ranging from non-neoplastic to benign and malignant lesions. Parotid is the largest salivary gland and constitutes 75% to 80% of all salivary gland areas. 80% of parotid lesions are benign and 20% are malignant. Two-hundred and eight-six patients who underwent aspiration cytology in the pathology laboratory between January 1995 and January 2019, evaluated with a sufficient sample and diagnosed, and subsequently underwent surgical treatment were included in the study. 47.9% (137) of the patients were female and 52.1% (149) were male. The mean age was 58 years (range: 38-84 years). 13 (4.54%) of the cases were evaluated as non-diagnostic, 12 (4.1%) as atypia of undetermined significance, 196 (68.5%) as benign neoplasm, 43 (15%) as suspicious for malignancy, and 22 (7.86%) were evaluated as malignant. In the histopathological examination of the samples prepared from surgical specimens of 13 non-diagnostic cases, seven (53.8%) cases were reported as Warthin tumors, four (30.7%) as pleomorphic adenomas, and two (15.5%) were reported as lymph nodes with intraparotid localization. The diagnosis of Fine needle aspiration cytology (FNAC) in the parotid gland is difficult due to the rarity of malignant salivary gland neoplasms, the diversity of carcinoma types, and the similarity of cytologic findings of benign tumors and low-grade carcinomas. The diagnostic accuracy of preoperative FNAC is high for benign tumors and low for malignant tumors.

A Study of Correlation of Preoperative Fine Needle Aspiration Cytology (FNAC) With Postoperative Histopathological Examination (HPE) in Thyroid Swellings

A Study of Correlation of Preoperative Fine Needle Aspiration Cytology (FNAC) With Postoperative Histopathological Examination (HPE) in Thyroid Swellings

Effect of BRAF V600E mutation detection of fine-needle aspiration biopsy on diagnosis and treatment guidance of papillary thyroid carcinoma

ObjectiveThe aim of this study was to evaluate the diagnostic value of detection of BRAF V600E mutation in the fine-needle aspiration cytology (FNAC) specimens of thyroid nodules and the relationship between BRAF V600E mutation and the clinicopathological characteristics of papillary thyroid carcinoma (PTC). MethodsA total of 252 patients who underwent initial thyroid surgery were retrospectively analysed. All the patients underwent a preoperative FNAC at our institution, and the thyroid puncture cell fluid was used for both the cytological diagnosis and BRAF V600E mutational analysis using quantitative polymerase chain reaction. The Cochran-Mantel-Haenszel test was used to evaluate the diagnostic value of BRAF V600E mutation in FNAC fluid in diagnosing PTC. The association between BRAF V600E mutation and the clinicopathological parameters of PTC was analysed using the χ2 test. ResultsThrough FNAC, 21 (8%), 60 (24%), and 171 (68%) cases were cytologically diagnosed as benign, indeterminate, and malignant, respectively. Postoperatively, 242 cases were histopathologically diagnosed as PTCs and 10 as goitre nodules. In the FNAC samples, 12 (57 %) of the 21 benign, 48 (80 %) of the 60 indeterminate, and 152 (88.9 %) of the 171 malignant cases showed BRAF V600E mutation. The histopathological diagnosis was used as the gold standard. The sensitivity and specificity of BRAF V600E mutational analysis in the FNAC samples for the diagnosis of PTC were 91.7 % and 100 % in benign, 82.8 % and 100 % in the indeterminate, and 89.4 % and 100 % in the malignant cases, respectively. ConclusionBRAF V600E mutational analysis in FNAC samples of thyroid nodules can be used an effective supplementary diagnostic method at our institution. However, BRAF V600E mutation was not associated with aggressive characteristics in PTC.

Role of Fine Needle Aspiration Cytology in the Diagnosis of Parotid Gland Tumors: Analysis of 193 Cases.

Introduction Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings. Objective To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the diagnosis of parotid gland tumors. Methods A retrospective chart review of 193 patients who underwent preoperative FNAC and parotidectomy at the Aga Khan University Hospital, Karachi, Pakistan, from the period of January 2000 to December 2015 was performed. Results Out of 193 patients undergoing parotidectomy, 110 (57%) were males and 83 (43%) were females, the mean age being 48.21 and 43.76 years old, respectively. The mean duration of the symptoms was 41.33 months, and the most common symptom was preauricular swelling present in all patients, followed by pain, which was present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). Fine needle aspiration cytology was performed preoperatively and the results were compared with the final histopathology, which showed sensitivity of 88.9%, specificity of 97.9%, positive predictive value of 93%, negative predictive value of 96.7% and diagnostic accuracy of 95.8%. Conclusion Our results suggest that FNAC is relatively an accurate method for preoperative diagnosis of parotid swelling and can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis.

A study of correlation of pre-operative fine needle aspiration cytology and ultrasonography with post-operative histopathology in thyroid swellings

Background:Diseases of the thyroid gland can be due to inflammatory and neoplastic causes. Many diagnostic tests like ultrasound, thyroid nuclear scan and fine needle aspiration cytology (FNAC) are available for their evaluation. Histopathologically, they can be adenomas, colloid nodules, cysts, infectious nodules, lymphocytic or granulomatous nodules, congenital abnormalities or hyperplasia, or various types of malignancy. It is therefore crucial to have a clear diagnostic approach to ensure patients are managed appropriately and are not over or under-treated. Present study was done to evaluate FNAC and ultrasonography (USG) as a diagnostic method in thyroid swellings and to plan surgery accordingly.Methods: A prospective observational study was conducted among 60 adult patients undergoing thyroid surgery at Victoria and Bowring and Lady Curzon Hospital. They were investigated with FNAC and USG of thyroid, and were subjected to surgery and subsequent histopathological examination. The histopathological examination reports were correlated with the findings of FNAC and USG in order to evaluate their findings by statistical methods.Results:The sensitivity and specificity of FNAC was 87.5% and 98% respectively. All malignant lesions on FNAC were confirmed by histopathology indicating its excellence. Therefore FNAC helps in planning the correct management and avoids second surgery. And the sensitivity and specificity of USG was 75% and 86% respectively. Therefore combination of both FNAC and ultrasonography will improve the diagnostic accuracy to higher level and helps in better management. Conclusions:FNAC has high sensitivity and specificity, so it is closest to ideal test. However, a combination of both FNAC and ultrasound will give desirable results and so that we can avoid mismanagement.

Profile of parotid tumors visiting tertiary health care facility in North India

<p class="abstract"><strong>Background:</strong> Neoplastic lesions of head and neck presenting in a tertiary care facility were analyzed. This study is proposed to examine the epidemiological pattern of parotid tumors, histopathology correlations and relation of facial nerve with the parotid tumors.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective study of patients with head and neck neoplasms who presented to the ENT tumour clinic of Dayanand Medical College and Hospital over a period of 2 years i.e., from January 2018 to December 2019. Patients’ demographic profile, histopathological reports and pre-operative fine needle aspiration cytology reports were studied. </p><p class="abstract"><strong>Results:</strong> Total number of cases of head and neck neoplasms were 273 over a period of 2 years. Parotid tumours constituted 9.1% of the total head and neck neoplasm. Predominant age group in case of benign parotid tumors was 40-50 years, whereas in case of malignant neoplasms was 50-60 years. Posterior belly of digastric along with tragal pointer are the most consistent and reliable landmarks for Identification of facial nerve.</p><p><strong>Conclusions:</strong> Identification of trunk of facial nerve using anatomical landmarks is the keystone for parotid surgery. Posterior belly of digastric along with tragal pointer are the most consistent and reliable landmarks for Identification of facial nerve. </p>

PAROTİDEKTOMİ YAPILAN OLGULARIN HİSTOPATOLOJİK VE CERRAHİ SONUÇLARI: TEK MERKEZ DENEYİMİ

ABSTRACT Objective; The aim of this study was to retrospectively evaluate the age, sex, pre-operative fine needle aspiration cytology and incisional biopsy diagnosis, surgical procedure and histopathological results of 67 patients who underwent parotidectomy. Material and Method; The study included 67 parotidectomy patients operated between 2011-2019 for different lesions in Namik Kemal University Faculty of Medicine. The patients’s age, sex, fine needle aspiration cytology and biopsy results, histopathological and postoperative histopathological results and tumor sizes were evaluated. Fine needle aspiration cytology and incisional biopsy results were compared with histopathological data and efficacy of these methods were compared. Results; According to the parotidectomy results of 67 patients, 58(%86.5) were diagnosed as benign (Pleomorphic adenoma, Whartin, Sebaceous lymphadenoma, Sialolithiasis) and nine (13.5%) were diagnosed as malignant. Twenty patients underwent fine needle aspiration cytology and 25 patients underwent incisional biopsy before surgery. Of the 20 patients who underwent FNAC, 16 (80%) were diagnostic and four were non-diagnostic. Of the 25 patients who underwent incisional biopsy, 21 (84%) were diagnostic and four were non-diagnostic. Conclusion; 80% of salivary gland tumors that occur in the parotid are benign. The majority of these benign tumors (61-90%) are pleomorphic adenomas. In our study, 86,5% of the parotidectomy cases were benign tumors similar to the literature. 52% of these benign cases are pleomorphic adenoma, the second most common benign tumor is whartin and constitutes 43% of benign tumors.

Abstract P4-02-06: Automated molecular diagnosis of suspicious axillary lymph nodes in breast cancer patients

Abstract Background: Axillary lymph node metastasis is associated with a high risk of breast cancer recurrence and is the single most powerful predictor of patient prognosis. Various imaging tests alone or in combination with preoperative fine needle aspiration (FNA) cytology are used to evaluate suspicious lymph nodes (LNs). However, these methods have low sensitivity (70%) and their utility varies depending on the local surgical practice and experience of the cytologists. In previous work, we have demonstrated higher than 90% sensitivity/specificity of a panel of ten hypermethylated biomarkers in FNA to distinguish between cancer and benign breast lesions. Analysis of methylated genes in FNA of suspicious LNs may improve sensitivity of cancer detection and assist in staging disease more accurately. Methods: We used Quantitative Multiplex Methylation-Specific PCR (QM-MSP) to determine the utility of the 10-gene panel for detecting tumor cells in LN FNAs. Two studies were performed to test the accuracy of a newly developed automated, cartridge-based GeneXpert® Breast Cancer Detection Assay (RUO*). First, we conducted a prospective case-control study in China in breast cancer patients with palpable LNs undergoing sentinel lymph node biopsy. FNA specimens were collected intraoperatively from a single palpable LN and assayed. Histopathology of the same LN (88 metastatic and 104 benign), was used as the gold standard for comparison. Next, using the automated assay, a pilot validation study was conducted on archival ultrasound-guided FNAs (69 metastatic and 53 benign by cytopathology) collected preoperatively from enlarged axillary LNs in patients with and without breast cancer in the outpatient centers in China and U.S.A. We calculated sensitivity, specificity and area under the receiver operating characteristic curve (AUC) for the marker panel tested by the GeneXpert® assay compared to histopathology for the case control study, and cytopathology for the pilot validation study. We also compared its performance to the highly sensitive laboratory assay, QM-MSP. Results: In the case-control study in China, compared to histopathology, cytopathology of the palpable enlarged LNs achieved cancer detection sensitivity of 85% and specificity of 95% (ROC; AUC=0.898, 95% CI: 0.843-0.953). Using the GeneXpert® assay on the same samples, compared to histopathology, the methylated biomarker panel showed a sensitivity of 92.0% and a specificity of 98.1% based on receiver operating characteristic statistics (ROC; AUC = 0.960, 95% CI: 0.928-0.993). QM-MSP yielded a similar sensitivity of 91.8% and a specificity of 97.7% (ROC; AUC = 0.966, 95% CI: 0.934-0.998). In the pilot validation set, compared to cytopathology, the automated assay achieved a sensitivity of 94.2% and a specificity of 92.5% (ROC; AUC=0.976 (95%CI: 0.950-1.001). Conclusions: We have developed and piloted a 5-hour, automated GeneXpert® Breast Cancer Detection Assay (RUO*) on FNA to detect cancer in suspicious LNs. This assay performs with an accuracy equivalent to that of the highly sensitive but labor-intensive assay, QM-MSP. This test has the potential to determine axillary involvement with higher sensitivity than cytopathology within a very short time in the outpatient setting. A positive test preoperatively could provide guidance for decision-making regarding eligibility of patients for neoadjuvant treatment, post-mastectomy radiotherapy and breast reconstruction. Further evaluation of this automated assay in larger, blinded, prospective studies is warranted. Citation Format: Juanjuan Li, Bradley Downs, Leslie Cope, Xiuyun Zhang, Chuan-gui Song, Kejing Zhang, Yong Han, Mary Jo Fackler, Edwin Lai, Suzana Tulac, Neesha Venkatesan, Timothy Guzman, Chuang Chen, Jingping Yuan, Saraswati Sukumar. Automated molecular diagnosis of suspicious axillary lymph nodes in breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-02-06.

Fine Needle Aspiration Cytology of Thyroid Swellings With Histopathological Corellation

Background : To assess the diagnostic accuracy of aspiration cytology as a pre-operative screening procedure and this study was done to reach a consensus and to find out the best diagnostic tool for assessment of thyroid swellings pre-operatively.
 Materials and methods : A cross sectional study was carried out in the Department of Otolaryngology & Head Neck Surgery of Chittagong Medical College Hospital (CMCH) between March 2014 to March 2015. Total 50 patients were included in the study, where pre-operative Fine Needle Aspiration Cytology (FNAC) and post operative histopathology were done to find out the correlation. Data were analyzed and presented as both qualitative and quantitative data as applicable using SPSS version 20. The quantitative data were analyzed by mean, standard deviation. The qualitative data were analyzed by Mc NEMAR test (Mc NEMAR c2 test).
 Results : 50 cases were included in the study. FNAC revealed 40 non- neoplastic lesion, 5 papillary carcinoma, 4 follicular neoplasm and 1 was suspicious for malignancy. Histopathology revealed 38 non neoplastic and 2 neoplatic lesion among 40 non neoplastic cases. 5 cases which were diagnosed as papillary carcinoma thyroid on FNAC were also proved to be same on histopathology. Out of 4 follicular neoplasm 1 was non neoplastic and other 3 were neoplstic. The suspicious for malignancy lesion was proved as cystic papillary carcinoma on histopathology. The sensitivity of FNAC was 81.82%, specificity was 97.44%, positive predictive value was 90%, negative predictive value was 95% and accuracy was 94%.
 Conclusion : FNAC of Thyroid is more specific then sensitive with high accuracy rate. Therefore FNAC should be adopted as an initial investigation of thyroid disease.
 JCMCTA 2019 ; 30 (2) : 36-40

What do we know about the cytological features of pure intraductal carcinomas of the salivary glands?

Intraductal carcinomas (IDCs) are rare, poorly characterised salivary gland tumours. The cytological features of IDCs are even less known. In this paper, a systematic literature review of pure IDCs (without stromal invasion, not associated with other histotypes) of low-grade (LG-IDCs) and high-grade (HG-IDCs) was performed. The bibliographic research included multiple databases (PubMed, Scopus, Web of Science). Mild-moderate nuclear atypia favoured LG-IDCs, severe atypia favoured HG-IDCs. Preoperative fine-needle aspiration cytology (FNAC) was performed in 13/94 published cases (14%): 10 parotid; two oral; one submandibular. All the cases were histologically LG-IDCs, except two parotid IDCs. FNAC results included: negative for malignancy (three of 13 cases, 23%); tumour of uncertain malignant potential (seven of 13, 54%); malignancy (three of 13, 23%). The ductal component was identified in two cases; mucoepidermoid carcinoma was suggested in two additional cases. The grade was underestimated on FNAC evaluation in one HG-IDC as focal high-grade features were present on subsequent histological examination. The cases diagnosed as malignant tumours or describing intermediate atypia resulted in LG-IDCs on subsequent histology. Occasional mitoses were described only in one HG-IDC; this feature may have not been considered in the remaining published cases. FNAC and clinico-pathological correlation are important aids for clinicians and pathologists. FNAC could assist surgery even if an accurate diagnosis is sometimes impossible. Discrepancy in grading the nuclear atypia between the FNAC material and the resected specimen can occur, sometimes being unavoidable. Further studies are needed to better characterise this rare tumour.

A Case Report of Giant Cell Tumor of the Flexor Tendon Sheath in Index Finger.

IntroductionGiant cell tumor of the tendon sheath (GCTTS) is an uncommon benign soft tissue tumor of unknown etiology. It is seen more commonly in hand than ankle and foot. It presents as a painless and palpable swelling. Its diagnosis is mostly established by histopathology after surgical resection, although pre-operative imaging and fine-needle aspiration cytology (FNAC) support its suspicion. Herein, a case of GCT of flexor tendon sheath of the right index finger is reported due to its rarity.Case ReportA 46-year-old female presented with complaints of swelling over the front of the right index finger for 1½years. The swelling was spontaneous, painless, and very slowly progressive. Examination revealed a 2 cm × 1.5 cm firm swelling situated on the palmar aspect of the right index finger over distal part of middle phalanx and proximal part of the distal phalanx. Swelling was well defined, having smooth surface, uniformly firm consistency and could be moved sideways easily. X-ray of the hand showed localized soft tissue shadow in the involved area without any bony involvement. Ultrasonography of the finger showed soft tissue mass. FNAC examination reported the swelling as GCTTS. Excisional biopsy was done. Histopathology showed typical features of GCTTS.ConclusionGCTTS should be kept as a differential diagnosis in soft tissue tumors of hand in adults. FNAC followed by excisional biopsy is diagnostic and curative, but the patient should be followed up for detecting and managing recurrences.

A PARTICULAR PRESENTATION OF A DIFFUSE PEDUNCULATED LIPOMA OF THE SACRAL REGION

Background. Subcutaneous lipomas are one of the most common benign soft tissue tumors seen in clinical practice. They may occur at any age, affecting men more often than women. In therapeutically neglected cases, these lesions may have unusual clinical features. Our case highlights one such form that may be found amongst subcutaneous lipomas. Case report. A 37-year-old man came to the Surgical Clinic for treatment of an ulcerated, pedunculated tumor, measuring 14.5/8/7 cm, located in the sacral region. Clinically, liposarcoma was considered as the diagnosis. Although preoperative fine needle aspiration cytology (FNAC) of the tumor showed mature adipose tissue fragments on all cytological smears, surgical excision was performed, with intraoperative extemporaneous histological examination of the tumor. Histopathological results showed a lipoma with unusual associated features: ulceration of the overlying skin and fatty tissue necrosis, with formation of abscess areas. Conclusion. Therapeutically neglected subcutaneous lipomas may have unusual clinical features, leading to difficulties for both diagnosis and therapeutic approach. This case complements the existing data, from the point of view of the clinical presentation, as well as the histopathological characteristics that a subcutaneous lipoma may have.

Outcomes of treatment of mammary analogue secretory carcinoma of the parotid gland.

Mammary analogue secretory carcinoma (MASC) of the salivary gland is a newly-described, rare, malignant tumour. Few patients present with MASC of the parotid gland, so the exact characteristics, outcomes of treatment, and prognosis are unknown. The aim of this study was to analyse the clinical features and outcomes of treatment of MASC of the parotid gland in patients being treated at a single hospital. Five patients with histopathologically-confirmed MASC of the parotid gland between January 2015 and August 2018 were retrospectively enrolled. In all cases preoperative fine-needle aspiration cytology had failed to provide an accurate diagnosis. All patients underwent a macroscopically complete oncological resection. Two patients had postoperative radiotherapy (RT). On immunohistochemical examination all tumours stained for S-100 and mammaglobin but not for DOG1. There were no regional recurrences or distant metastases in any of the patients at their last follow-up. We obtained good results for patients with MASC of the parotid gland with surgical treatment and postoperative RT.

Fine needle aspiration cytology for parotid neoplasms: risk of malignancy through inconclusive results and lower grade tumors.

Fine needle aspiration cytology (FNAC) is a commonly performed procedure for parotid masses, although its accuracy in detecting malignancies widely varies through different series. We evaluated our single-center cohort of parotidectomies to highlight possible limitations of preoperative FNAC. Seven hundred and eighteen consecutive patients submitted to parotid surgery at San Raffaele Scientific Institute (Milan) were retrospectively evaluated (2002-2018). Five hundred and fifty four FNAC were analyzed. FNAC accuracy was assessed with and without inclusion of "inconclusive" results. The peculiar role of lower grade primary parotid cancers was investigated. FNAC reports were "diagnostic" in 502 cases (90.4%) and "inconclusive" in 52 (9.6%). Histopathology revealed 488 benign lesions (88.1%) and 66 malignancies (11.9%). FNAC sensitivity, specificity, PPV, NPV and accuracy in detecting malignancies were 59%, 99%, 89%, 95%, and 95%, respectively. Sensitivity fell to 48%, when "inconclusive" FNAC was computed. Within 66 parotid cancers, FNAC could discriminate malignancy in 32 cases (48.5%), provide proper grading in 21 (31.8%), and precise histopathological diagnosis in 15 (22.7%). Malignancy was more likely in patients with "inconclusive" FNAC than in those with "diagnostic" cytologies (23.1% vs 10.8%, p = 0.003). Low-intermediate-grade primary parotid cancers were associated to a higher rate of FNAC failure in comparison with high-grade ones (86.4% vs 19.0%; p < 0.001). FNAC is an important tool for preoperative assessment of parotid masses, though its sensitivity in detecting malignancy remains poor. "Inconclusive" FNAC results could further jeopardize FNAC accuracy and should elicit resorting to additional tests, especially when a lower grade parotid cancer is suspected.

Risk of malignancy in the various categories of the UK Royal College of Pathologists Thy terminology for thyroid FNA cytology: A systematic review and meta-analysis.

The UK Royal College of Pathologists Thy terminology for reporting thyroid fine-needle aspiration cytology (FNAC), first published in 2009 is used throughout the United Kingdom and Ireland, in some parts of Italy and Switzerland and elsewhere. There is no review of the literature or meta-analysis of the risk of malignancy (ROM) in the various categories of the UK Thy terminology. The goal of this study was to establish the published ROM for each Thy category and compare the results with other existing terminology systems for which similar meta-analyses are available. A comprehensive literature search of online databases was conducted in May 2019 to examine the ROMs for histologically proven nodules with preoperative FNAC classified according to the UK Thy terminology. Twenty-five articles were identified that showed results of both cytology and histology. Twelve of these articles were excluded to prevent a selection bias because they showed data in just 1 Thy category. In the remaining 13 articles, the pooled ROMs were as follows: Thy1, 12% (95% confidence interval [CI], 5%-22%); Thy2, 5% (95% CI, 3%-9%); Thy3, 22% (95% CI, 18%-26%); Thy3a, 25% (95% CI, 20%-31%); Thy3f, 31% (95% CI, 24%-39%); Thy4, 79% (95% CI, 70%-87%); and Thy5, 98% (95% CI, 97%-99%). This meta-analysis shows results comparable to those of meta-analyses of other internationally recognized reporting terminologies for the pooled ROMs for surgically excised nodules in the various Thy reporting categories. There is comparatively little difference (only 6%) between the pooled ROMs of Thy3a and Thy3f surgically excised nodules.

Multifocality in a Patient with Cribriform-Morular Variant of Papillary Thyroid Carcinoma Is an Important Clue for the Diagnosis of Familial Adenomatous Polyposis.

Background: Cribriform-morular variant of papillary thyroid carcinoma (CMV-PTC) is a rare subtype of PTC, which occurrs predominantly in young women. This disease much more frequently presents in patients with familial adenomatous polyposis (FAP). FAP is an autosomal dominant inherited disease, which arises from germline mutations in the adenomatous polyposis coli (APC) gene. To clarify the distinctive clinical features of CMV-PTC, a comparison study was performed between familial types and sporadic types. Methods: Between 2007 and 2018, 15 CMV-PTC patients underwent thyroidectomy in Samsung Medical Center. The clinical features of these patients were retrospectively reviewed. Results: All patients were women with a median age of 26 years (range 17-46 years). The median maximum diameter was 1.0 cm (range 0.4-3.5 cm). All tumors underwent immunostaining and showed nuclear and/or cytoplasmic staining for β-catenin. On ultrasonography, most nodules had benign-looking features (well-defined, hypoechoic, and oval to round shapes without calcification), but a few nodules had capsular invasion and taller than wide shape. On preoperative fine-needle aspiration cytology, five patients (33%) were diagnosed as CMV-PTC, nine (60%) as PTC, but one (7%) as follicular neoplasm or PTC-follicular variant. Six patients (40%) had FAP, and four of them had total colectomy due to FAP. Five of them had a family history of FAP or colon cancer, or thyroid cancer. Germline mutations in the APC gene were found in all six patients with CMV-PTC associated with FAP, and five of them had de novo mutations. All patients with FAP-associated CMV-PTC had multiple tumors. All CMV-PTC patients had excellent response to initial therapy. Conclusions: Because of the association between FAP or colon cancer with multifocal CMV-PTC, we confirm that mutational analysis of the APC gene and colonoscopy should be carried out in these patients when multiple thyroid tumors are found.

The role of protein inhibitor of activated STAT3 and miRNA-18a expressions in breast cancer

BackgroundBreast cancer is a disease characterized by progressive genetic abnormalities including mutations in tumor suppressor genes and oncogenes, as well as other chromosomal abnormalities. Protein inhibitor of activated signal transducer and activator of transcription 3 (PIAS3) is a member of the PIAS family of transcriptional modulators; its expression is altered in many cancers. Micro-ribonucleic acid (miRNA)-18a acts as an oncogene by negatively regulating PIAS3 and thus modulating the expression of signal transducer and activator of transcription 3 (STAT3) target genes. The aim of this work is to examine the expression levels of PIAS3 gene and miRNA-18a in breast cancer tissues and nearby non-tumor tissues. The samples of breast cancer and paired samples of non-cancerous tissue from the same resected breast were obtained from 25 patients undergoing surgery. Full history taking, complete physical examination, pre-operative fine-needle aspiration cytology or ultrasonic (U/S)-guided core biopsy from the breast mass, final surgical biopsy for pathological examination, and routine laboratory investigations were done. Estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor 2 (HER2) status were evaluated. Total RNA extraction followed by real-time reverse transcription-polymerase chain reaction (RT-PCR) for quantification of PIAS3 mRNA and miRNA-18a expressions was performed.ResultsThe mean value of PIAS3 mRNA fold expression was significantly lower in the tumor group (5.12 ± 9.85) compared to the normal group (8.38 ± 17.10) (p = 0.040). miRNA-18a fold expression was higher among tumor group (3.5 ± 7.4) than that of normal group (2.5 ± 3), however, it did not reach the level of statistical significance (p = 0.861). miRNA-18a fold expression had negative significant correlation with PIAS3 mRNA fold expression (p = 0.018). A significant association was observed between miRNA-18a expression in breast cancer tissues and the pathological grade of the tumor (p = 0.029).ConclusionsThe results of this study showed that PIAS3 mRNA and miRNA-18a might be of importance in breast cancer development and pathogenesis, and this may be reflected on the treatment strategies targeting STAT3 pathway. However, further studies with larger sample size are needed to validate these observations.

Impact of non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) on risk of malignancy in patients undergoing lobectomy/thyroidectomy for suspected malignancy or malignant fine-needle aspiration cytology findings: a systematic review and meta-analysis.

The second version of The Bethesda System for Reporting Thyroid Cytopathology endorsed the introduction of non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) as a distinct entity with low malignant potential into clinical practice. Consequently, the risk of malignancy (ROM) of cytological diagnoses has changed, but the magnitude of the change remains uncertain. The present systematic review was undertaken to obtain more robust information about the true impact of NIFTP on the ROM among patients undergoing surgery following a fine-needle aspiration cytology (FNAC) diagnosis of suspicious for malignancy (Bethesda V) or malignant (Bethesda VI). As they are managed surgically, these two diagnostic categories are the primary entities that are clinically impacted by the advent of NIFTP. Systematic review and meta-analysis. A comprehensive literature search of online databases was performed in November 2018. The search was conducted looking for data of histologically proven NIFTP with preoperative FNAC. One-hundred fifty-seven articles were identified and nine were included in the study. Overall, there were 13,752 thyroidectomies with a cancer prevalence of 45.7%. When NIFTP was considered non-malignant, the pooled risk difference for ROM was 5.5%. Applying meta-analysis, the pooled prevalence of NIFTP among nodules with FNAC of Bethesda V or Bethesda VI was 14 and 3%, respectively. This meta-analysis shows that the inclusion of NIFTP leads to a reduction in the ROM for the Bethesda V and Bethesda VI FNAC diagnostic categories by 14 and 3%, respectively. Clinicians should be aware of these data to avoid overtreatment.