Routine Cytological Examination Research Articles

Exploring the prevalence of Human Papillomavirus (HPV) genotypes in PAP smear samples of women in northern region of United Arab Emirates (UAE): HPV Direct Flow CHIP system-based pilot study.

The aim of this study was to explore the prevalence of low and high-risk HPV genotypes in PAP smear samples of women in northern region of the UAE using HPV direct flow CHIP method. A cross-sectional retrospective study was conducted between September 2021 to April 2022. A total of 104 liquid-based cervical cytology samples were obtained from women aged 20-59 years attending the Gynaecology out-patient department of Thumbay University Hospital and other hospitals of Northern Emirates of UAE, processed for the routine cytological examination to identify and differentiate morphological changes of the PAP smear samples. HPV genotyping was performed using HPV direct flow CHIP method. In total, 112 HPV genotypes were detected in 63 women (60.57%) included 18 abnormal cytological and 45 normal epithelial samples. 63 LR and 49 HR HPV genotypes were identified in all the 63 positive samples. Highest rate of infection with multiple LR and HR HPV genotypes were detected in women aged 40-49 years (25.9%) and 20-29 years (23.5%). Infection by HPV6 (13.46%), HPV11 (9.61%), HPV16 (9.61%), HPV62/81 (7.69%) and HPV45 (7.69%) were the most common genotypes. A moderate increase than expected incidence of HPV45 and 62/81 (7.69%) were detected. Co-infection with multiple low and high-risk genotypes is present in 20.2% cases; in that, HPV6 (15.9%) was the most common followed by HPV62/81 (12.7%) and HPV16 (11.11%). The prevalence of HPV18 was found to be 1.6%. The genotypes 6, 45, 16, 11, 67, 62/81 were the most common HPV infections in the women between the age group of 21 and 59-years-old. A moderate increase of HPV45, 62/81 and much less prevalence of HPV18 were detected in the study population. 43.27% of the normal epithelia were positive to different low and high-risk HPV genotypes. This finding highlights the importance of molecular genotyping of HPV to emphasize the cervical screening triage.

Extracorporeal bladder vibration assay enables early detection and recurrence monitoring for bladder cancer

AbstractCystoscopy is the current gold standard for diagnosing bladder cancer (Bca), but its invasive nature often results in patient discomfort. This study aims to debise a new strategy to enhance BCa detection. We collected data from 30 BCa patients between January and June 2022. We obtained spontaneously voided urine specimens from these patients before and after administering extracorporeal bladder vibration. These specimens underwent routine cytologic examination and fluorescence in situ hybridization (FISH). Furthermore, we conducted a follow‐up 3 months postoperation. We recollected urine specimens before and after extracorporeal bladder vibration, repeating the cytologic examination and FISH. Our findings indicated an increase in the number of exfoliated cells in patients' urine postvibration compared to previbration. The liquid‐based cell staining results showed an increased detection rate of abnormal cells in the urinary sediment of patients with both low and high‐grade urothelial carcinoma postvibration. Similarly, the FISH results revealed an increased detection rate of CEP3 and CEP7 positive cells postvibration. Additionally, 3 months postoperation, we found abnormal cells in the urine of one patient previbration and in three patients postvibration. Further cystoscopic biopsy confirmed that these three patients had developed tumor recurrence. Our study substantiates that the extracorporeal bladder vibration assay significantly enhances BCa detection and the prediction of tumor recurrence. This method is simple, quick, and cost‐effective, making it a promising approach worthy of widespread clinical application.

Cryptococcal meningoencephalitis with Actinomyces odontolyticus sepsis: a case report and literature review

BackgroundThe combined infection of actinomyces odontolyticus sepsis and cryptococcal encephalitis is rare in routine clinical practice. Thus, we presented this case report and literature review to provide clues to improve such patients' diagnoses and treatment processes.Case presentationThe main clinical manifestations of the patient were high fever and intracranial hypertension. Then, we completed the routine cerebrospinal fluid examination, biochemical detection, cytological examination, bacterial culture, and India ink staining. Firstly, the blood culture suggested actinomyces odontolyticus infection, considering the possibility of actinomyces odontolyticus sepsis and intracranial actinomyces odontolyticus infection. Accordingly, the patient was administered penicillin for treatment. Although the fever was slightly relieved, the symptoms of intracranial hypertension did not relieve. After 7 days, the characteristics of brain magnetic resonance imaging and the results of pathogenic metagenomics sequencing and cryptococcal capsular polysaccharide antigen suggested that cryptococcal infection. Based on the above results, the patient was diagnosed with a combined infection of cryptococcal meningoencephalitis and actinomyces odontolyticus sepsis. Anti-infection therapy with ‘penicillin, amphotericin, and fluconazole’ was provided, improving the clinical manifestations and objective indexes.ConclusionThe combined infection of Actinomyces odontolyticus sepsis and cryptococcal encephalitis is first reported in this case report, and combined antibiotics with ‘penicillin, amphotericin, and fluconazole’ are effective.

CONSTRAINTS RELATED TO THE CYTOPATHOLOGICAL EXAMINATION THAT FAVOR THE LATE DIAGNOSIS OF CERVICAL CANCER

Cervical cancer, also known as cervical cancer, is a malignant tumor that develops in the cervix, mainly caused by persistent infection by some types of Human Papillomavirus, present among the female population and responsible for high rates of morbidity and mortality. mortality in the world. In women, cervical cancer can be more lethal due to low adherence to health services, as well as the lack of periodic Pap smear. Therefore, knowing the relevance of this theme, this study was developed with the aim of identifying, in the literature, the obstacles related to the Pap smear that favor the late diagnosis of cervical cancer. This is an integrative review carried out in scientific data sources: Scientific Electronic Online Library (SciELO), Latin American and Caribbean Literature on Health Sciences (LILACS) and Nursing Database (BDENF). Searches for studies were carried out from June to November 2022. The descriptors selected for the data search were: cervical neoplasms, cervical intraepithelial neoplasia, late diagnosis, all registered in the Health Sciences Descriptors (DECS). As inclusion criteria for the selection of scientific articles we have: articles published from 2017 to 2022, in Portuguese; available and complete articles. Exclusion criteria were: monographs, thesis, dissertation, publications of repeated articles in the databases. From the analysis of the literature, several obstacles that influence the evasion of women from the health systems were evidenced. In this aspect, the literature has shown that female evasion of the cytological examination is directly related to the lack of information about the importance of the Pap smear. Thus, low adherence to routine consultations and cytological examination is considered a predisposing factor for the occurrence of health problems. Such resistance, which is still quite common in primary care services, is a reflection especially of sociocultural and traditional issues that are related to religious beliefs and archaic practices. In this regard, women have been developing home practices to promote self-care. The search for health services and for gynecological consultations, in most cases, is only sought by women when they develop symptoms of pain, vaginal discharge or complaints related to anomalies, bad smell and bleeding. In addition, recent research indicates that women who live in conditions of social vulnerability are more likely to develop diseases. Faced with this reality, health professionals, especially nurses working in primary care, face numerous challenges for the early screening of cervical cancer.

Histomorphological Spectrum of Pleural Biopsy Specimen of Exudative Pleural Effusion in a Tertiary Care Hospital in Bangladesh

Background: The commonest manifestation of pleural pathology is pleural effusion. Most of the time, in spite of routine biochemical and cytological examination of pleural fluid we can’t evaluate the etiology of pleural effusion. Aim: Aim of present study was to make an etiological diagnosis of exudative pleural effusion by pleural biopsy and histopathological examination. Study design and setting: Fifty consecutive patients of pleural effusion were selected from the outpatient and indoor department of a tertiary medical college hospital in Sylhet. It was a prospective and observational study. It was conducted over a period of one and a halfyears. Material and method: In all the cases, cytological examination of pleural fluid (for malignant cell) and pleural biopsy by Abram’s needle were done. Subsequently, histopathological diagnoses were made to determine the etiology of effusion. Results: Out of 50 subjects, males outnumbered females, Age is ranged between 19 and 85 years. According to the histopathological examination of the submitted pleural biopsy specimen, granulomatous inflammation is the most common etiology (40%) followed by chronic inflammation of non-specific origin (38%) and malignancy (22%). Conclusion: This study represents the result of the experience acquired over one and half years in the histopathological interpretation of pleural biopsies and its correlation with cytology of the pleural fluid. Pleural biopsy is a useful, minimally invasive procedure with no or little complication and has more sensitivity and specificity than pleural fluid cytology smears.

The importance of morphometric parameters in differentiating benign/reactive urothelial cells from low-grade urothelial carcinoma: computer-assisted study on urine specimens

Background. Urine cytology is deemed a sensitive method in detection of high-grade urothelial carcinoma. In contrast, detection of low-grade urothelial carcinoma (LGUC) and its differentiation from reactive lesions is difficult with urinary cytology. Objective. Our study aims to determine the effectiveness of morphometric parameters in differentiating reactive urothelial cells from LGUC by cytological examination of urine specimens. Methods. Voided urine samples were used for the study, while the cases were randomized into two groups: those diagnosed with LGUC (first group; N=10) and those which were not diagnosed with LGUC (second group; N=10). The morphometric parameters of major nuclear diameter (MaND), minor nuclear diameter (MiND), mean nuclear area (MNA), cell diameter (CD), mean cell area (MCA), as well as MaND/CD, MiND/CD, MiND/MaND and MNA/MCA ratios were measured on 100 urothelial cells for each case through ScopeImage® 9.0 software. Results. A statistically significant difference was found between the mean values of MiND/CD (p=0.017) and MNA/MCA (p=0.002) ratios of groups. The mean value of both parameters in the first group constituted 0.2 and higher, and below 0.2 in the second group. Conclusion. The ratios of MiND/CD and MNA/MCA in urothelial cells proved significantly higher in patients with LGUC than benign/reactive cases. The reliability of these findings in differentiating LGUC from benign/reactive lesions needs to be verified through studies examining a large number of cases. These parameters can be assessed much faster through a special software enabling an automatic measurement and thus can be used in routine cytological examination.

Prevalence of pathological lesions diagnosed by cytology in cats, with association of diagnosis to age, breed and gender

Cytology is the diagnostic procedure of the microscopic evaluation of cells. It is becoming increasingly important and more frequently used in veterinary diagnostics, having many advantages including simplicity, speed and low cost. To determine the pathological changes diagnosed by cytology in cats, as well as the distribution of age, breed and gender in the diagnosed changes, we performed a retrospective study on slides submitted to the Department of Veterinary Pathology for routine cytological examination. The archive was searched for all feline cytology slides submitted from 2009 to 2018. All the slides were re-evaluated and classified into one of the four pathological processes: ‘neoplasia’, ‘inflammation’, ‘other condition’ or ‘non-diagnostic sample’. Breed, age, gender and the tissue from which the lesion was sampled were noted from the submission form, and statistically analyzed. The most frequent type of pathological process diagnosed was neoplasia, which reflects the high prevalence of neoplastic diseases in cats reported in literature data. Pathological changes were mostly diagnosed in domestic shorthaired cats of both sexes, with an average age of 8.4 years, but no breed, age or gender predisposition was found. The most evaluated tissue was skin, probably due to its accessibility and the ease of obtaining a sample from skin lesions. The most frequent neoplasia were malignant and the most frequent diagnosis was round cell neoplasia. Cats affected with round cell neoplasia had a significantly lower average age (7.3 years) than cats diagnosed with epithelial and mesenchymal neoplasia (9.9 and 10.3 years, respectively), probably reflecting the common retroviral infection in Croatian cats.

A Comparative Study of Thyroid Cytology Reporting by Bethesda System and Routine Cytology in a Teaching Institute of Sub Himalayan Region

Introduction: Fine needle aspiration cytology (FNAC) is an important preoperative diagnostic tool for thyroid lesions which are endemic in the Sub-Himalayan belt. But sometimes, the FNAC procedures are unable to guide clinicians for definite management. Bethesda System for Reporting Thyroid Cytology (BSRTC) has been formulated to be more sensitive and specific than routine cytological examination in diagnosis of thyroid swellings and act a better tool than the latter due to its objectivity. It may, thus, improve the clinical management of thyroid diseases and even may prevent unnecessary thyroidectomy. Aims and Objective: The study is aimed to compare the interpretation of thyroid FNAC smears by conventional reporting and by BSRTC in patients of thyroid swellings in the Sub-Himalayan regions. Material and Methods: This observational study was done at the Department of Pathology from July 2015 to June 2016. Total 145 cases of thyroid swellings were included for study and reported by both BSRTC and conventional (routine) reporting system. Each of the reporting system was correlated with the available histopathological findings and statistical assessments were performed. Results: Among the total 145 cases, colloid nodules followed by thyroiditis were most common benign conditions in both the reporting systems and among the malignancies; papillary carcinoma was the most predominant. Statistical assessment showed that sensitivity, specificity as well as positive and negative predictive values was higher in BSRTC compared to the conventional reporting system. Conclusion: BSRTC is more accurate than conventional reporting system for thyroid cytology and its management strategy can help to prevent unnecessary thyroidectomy.

Evaluation of tissue trauma and healing on the basis of tumour necrosis factor-alpha, interleukin-6, and C-reactive protein in peripheral blood during and after pyometra in bitches

In this study, inflammation in the blood of bitches with pyometra (PG) was compared before and 15 days after ovariohysterectomy (OVH). The results were compared with those for control dioestrus bitches (CG) to reveal the evidence of inflammation in blood after a routine surgery. Inflammation was tracked by tumour necrosis factor-alpha (TNF-α), interleukine-6 (IL-6) and C-reactive protein (CRP), using immunocytochemistry (ICC) and immunofluorescence capture of blood cells in cell blocks. ICC is performed mainly during routine cytological examinations, whereas the use of cell blocks in blood examination is uncommon. Insofar as we know, this is the first study using cell block techniques on canine blood samples. Three commercially available antibodies against TNF-α, IL-6 and CRP, forming two panels, were evaluated. A standard streptoavidin-biotin complex technique was used for ICC. TNF-α and IL-6 labelling was scored for colour and intensity, and CRP for immunofluorescence capture. TNF-α and IL-6 colour and intensity scores differed significantly between the PG and CG groups, and were higher in PG before OVH (P<0.01, P<0.01, P<0.001, P<0.01, respectively). IL-6 intensity was significantly greater in PG 15 days after OVH (P<0.05). CRP capture in PG was strong before OVH and high in both groups 15 days later. Low-dose anti-inflammatory agents or an anti-cytokine therapy may be useful in pyometra treatment in the future because these treatments may offer protection from systemic inflammatory response syndrome before and after OVH. .

Role of pleural biopsy in diagnosis of unilateral pleural effusion:study of 50 cases in Rangpur Medical College & Hospital, Rangpur

Background: Pleural effusion remains the most common manifestation of pleural pathology. Sometime it is difficult to differentiate between tuberculous and malignant pleural effusion on routine cytological and biochemical examination. So pleural biopsy is an important tool for evaluating undiagnosed pleural effusion.Aim: To find out the role of pleural biopsy in the diagnosis of unilateral pleural effusion.Methods: This observational study was conducted in the Indoor patient department of Medicine in Rangpur Medical College Hospital from 01.01.2014 to 30.06.2014. All patients having unilateral pleural effusion above the age of 15 years irrespective of sex, race and religion was enrolled in this study.Results: Total fifty cases were enrolled in this study. Age of the patients varied from 16 to 78 years (Mean ±SD, yrs: 47±31.0). Thirty six (72%) patients were male and fourteen (28%) were female. 9 patients (18%) were of higher socio-economic status, 13 (26%) patients were from lower class, and 28 (56%) were from middle class. Majority (36%) of the patients were farmer, followed by 22% were businessman, 18% were service holder and 16% were housewives. Out of 50 patients, Nineteen patients (38%) were smoker and rests (62%) were non-smoker. Common presenting complaints were fever (78%), respiratory distress (62%), cough (56%), chest discomfort (38%) and weight loss (32%). General physical examination findings revealed 62% having different grades of anaemia followed by clubbing in 22% cases. Respiratory system examination revealed 56% having left sided pleural effusion followed by 44% right sided pleural effusion. 36% shows shifting of trachea. Regarding pleural fluid analysis, color of pleural fluid was straw in most cases (42%) and sixteen cases (32%) had hemorrhagic fluid. Mean total cell count in pleural fluid was 1449.1/c.mm. Most (88%) had lymphocyte predominance. Mean protein in pleural fluid was 5.6 gm/liter. Radiological examination revealed that maximum patient (56%) having left sided effusion and total 18 patients having shift of trachea. Close pleural biopsy for histopathological study revealed maximum (36%) were different types of malignancy, 24% chronic granulomatous inflammation consistent with tuberculosis, 16% shows non-specific chronic inflammation and 24% cases showed no abnormal findings or pleural tissue not available or inadequate tissue for histological report. Out of total 18 cases of malignancy, 08 revealed adenocarcinoma, 03 revealed metastatic adenocarcinoma, 02 revealed non-hodgkin’s lymphoma, 02 malignant mesothalioma and 03 of them revealed poorly differenciated carcinoma.Conclusion: In this study male are predominant. Most of the respondent was non-smoker. Most common presenting complains were fever, respiratory distress, cough, chest discomfort and weight loss. Most of general physical examination findings were anamia and clubbing. Respiratory system examination findings were features suggestive of pleural effusion (56% left sided and 44% right sided), 36% having shift of trachea. chest x-ray findings of most (56%) of the study population were left sided pleural effusion. Close pleural biopsy for histopathological study revealed maximum (36%) were different types of malignancy followed by chronic granulomatous inflammation consistent with tuberculosis (24%).Bangladesh J Medicine Jul 2016; 27(2) : 62-67

Preoperative Evaluation of Thyroid Epithelial Lesions by DNA Ploidy and Galectin-3 Expression in FNAC

AIM: This study aimed to investigate the value of DNA ploidy and galectins-3 immunostain in the preoperative evaluation of thyroid epithelial lesions.MATERIAL AND METHODS: Sixty patients presenting with thyroid enlargement were included in this study and referred by clinicians for FNA. Routine cytological evaluation was done on PAP  stained slides according to the WHO criteria and at least three slides were prepared for routine cytological examinations. The nuclear DNA analysis was performed at the Pathology Department, National Research Center using the Leica Qwin 500 Image Analyzer (LEICA Imaging Systems Ltd, Cambridge, England). Galectin-3 expression was investigated in all tissues using streptavidin-biotin technique.RESULTS: Conventional Fine needle aspiration cytology (FNAC) of 60 cases could diagnose malignancy with a sensitivity of 60%, negative predictive value (NPV) 71.4%, and overall diagnostic accuracy of 80%. The aneuploidy was significantly associated with malignancy, with sensitivity 90.9%, specificity 83.3% and accuracy 88.3%. On using galectin-3 immunocytochemichal stain on cell blocks prepared from FNA the values were improved, sensitivity 93.3% specificity 86.7% and overall accuracy 90% and it was noticed that galectin-3 over expression was significantly associated with malignancy.CONCLUSIONS: From the results of this study we can consider that DNA ploidy and Galectin-3 could refine the FNA results and increase its sensitivity as a screening test from sensitivity(60%) to reach sensitivity (93.3%), thus decreasing the false negative cases. From this study, it is concluded that the application of ancillary techniques as galectin-3 immunocytochemical markers may become a reliable indicator for surgical intervention, DNA ploidy measurements on the other hand may be of value in galectin-3 negative cases to determine the behavior of the lesion in such cases & refine the preoperative assessment by out ruling false negative cases.

Preoperative Evaluation of Thyroid Epithelial Lesions by DNA Ploidy and Galectin-3 Expression in FNAC

AIM: This study aimed to investigate the value of DNA ploidy and galectins-3 immunostain in the preoperative evaluation of thyroid epithelial lesions. MATERIAL AND METHODS: Sixty patients presenting with thyroid enlargement were included in this study and referred by clinicians for FNA. Routine cytological evaluation was done on PAP stained slides according to the WHO criteria and at least three slides were prepared for routine cytological examinations. The nuclear DNA analysis was performed at the Pathology Department, National Research Center using the Leica Qwin 500 Image Analyzer (LEICA Imaging Systems Ltd, Cambridge, England). Galectin-3 expression was investigated in all tissues using streptavidin-biotin technique. RESULTS: Conventional Fine needle aspiration cytology (FNAC) of 60 cases could diagnose malignancy with a sensitivity of 60%, negative predictive value (NPV) 71.4%, and overall diagnostic accuracy of 80%. The aneuploidy was significantly associated with malignancy, with sensitivity 90.9%, specificity 83.3% and accuracy 88.3%. On using galectin-3 immunocytochemichal stain on cell blocks prepared from FNA the values were improved, sensitivity 93.3% specificity 86.7% and overall accuracy 90% and it was noticed that galectin-3 over expression was significantly associated with malignancy. CONCLUSIONS: From the results of this study we can consider that DNA ploidy and Galectin-3 could refine the FNA results and increase its sensitivity as a screening test from sensitivity(60%) to reach sensitivity (93.3%), thus decreasing the false negative cases. From this study, it is concluded that the application of ancillary techniques as galectin-3 immunocytochemical markers may become a reliable indicator for surgical intervention, DNA ploidy measurements on the other hand may be of value in galectin-3 negative cases to determine the behavior of the lesion in such cases & refine the preoperative assessment by out ruling false negative cases.

The value of the NMP22 test for superficial bladder cancer diagnosis and follow-up.

In this study, we investigated the efficacy of nuclear matrix protein 22 (NMP22) in the diagnosis and surveillance of bladder cancer. Patients with hematuria or who applied for cystoscopic control of proven bladder cancer were prospectively enrolled in this study. Routine cytologic examination and NMP22 test were performed on the voided urine sample obtained before the cystoscopy. The patients who had been diagnosed with bladder cancer were categorized according to stage, grade, number, size of the tumor and risk of the disease. Then the diagnostic performance of the NMP22 and the cytology test, alone or in combination, were evaluated separately using ROC curves in the diagnosis and surveillance groups. A total of 87 patients (87/136) were investigated because of hematuria. The sensitivity, specificity, positive and, negative predictive values, and positive likelihood ratio (LR+) of the NMP22 test were 70, 80, 68, 81, and 3.42%, respectively. While, the sensitivity, specificity, positive and, negative predictive values, and positive likelihood ratio (LR+) of the cytology examination were 27, 96, 82, 68, and 7.36%, respectively. There were 49 patients in the bladder cancer group. The sensitivity, specificity, positive, and negative predictive values and positive likelihood ratio (LR+) of the NMP22 test in these patients were 33, 76, 31, 78 and 1.37%, respectively. The sensitivity, specificity, positive and, negative predictive values, and positive likelihood ratio (LR+) of the cytology examination were 25%, 97%, 75%, 80% and 9.25, respectively. NMP22 test can be used as an adjunctive tool for the detection of bladder cancer, but its diagnostic performance is limited in surveillance when used alone or in combination with a cytology examination.

Molecular analysis of residual ThinPrep material increases sensitivity and allows molecular diagnostics for non-diagnostic samples

Molecular testing of routinely available thyroid nodule fine needle aspiration (FNA) material has many advantages. Recently, we described the molecular testing of air-dried smears. Now, we performed molecular testing on liquid based FNA material and analyzed the remaining CytoLyt-FNA material for BRAF, RAS, RET/PTC and PAX8/PPARG mutations. Thyroid FNAs were classified according to the Bethesda System for Reporting Thyroid Cytopathology after routine cytological examination. The remaining material from all available cases was used for blinded analysis of BRAF, NRAS, HRAS, KRAS point mutations and RET/PTC and PAX8/PPARG rearrangements by high resolution melting PCR/pyrosequencing, and qPCR, respectively. A total of 597 consecutive cases were collected and stored at 8 °C for up to 6 months. Molecular analysis was possible for 391 cases. Higher volumes of remaining material (> 2 ml) were associated with higher diagnostic success rates (23% vs. 79%, p < 0.001, chi-squared test). Mutations and rearrangements were detected in 11.5% of atypias of undetermined significance, 33% suspicious cases, 47.1% malignant cases, 7.1% follicular neoplasms, 9.3% benign cases, and 2.5% non-diagnostic (molecular analysis possible for 63.2%) samples. Compared to histology (available for 211 samples), cytology and molecular analysis increased sensitivity, specificity, PPV, and NPV compared to cytology alone to 86.7%, 98.1%, 98.7%, and 81.5%, respectively, considering 13 mutation-positive but histologically benign cases as true positives. Mutational analysis is feasible on residual ThinPrep material and has the advantage of not requiring additional FNA procedures or dedicated passes, special preservation, or storage. Its reflex use can be valuable in the preoperative determination of the extent of surgery for mutation-positive cases, help to clarify 12% of AUS cases, decrease the rate of false negatives for benign cases, and allow molecular diagnostics for 63.2% of the non-diagnostic samples.

Przydatność oznaczania stężenia PTH w popłuczynach z igły do biopsji aspiracyjnej cienkoigłowej w identyfikowaniu patologicznych przytarczyc — analiza czynników wpływających na skuteczność tej metody

The aim of this investigation was to assess the usefulness of the measurement of PTH concentration in the material obtained during FNAB (PTH-FNAB) in the identification of pathological parathyroids in patients with frequently coexisting thyroid abnormalities (nodular goitre, chronic thyroiditis, previous thyroidectomy). Additionally, the influence of the size of goitre, parathyroid localisation and size on the results of PTH-FNAB measurement was examined. Fifty patients with primary hyperparathyroidism and sonographically detected focal lesion that was suggestive of parathyroid gland were included in this study. PTH-FNAB results were correlated with the outcome of routine cytological examination and biochemical indices of hyperparathyroidism, SPECT-CT (33 patients) and histopathological examination (20 patients). Positive PTH-FNAB was observed in 80% of patients, and in more than 70% of persons with non-diagnostic smears or smears 'contaminated' with thyroid follicular cells. In the group of operated patients, sensitivity of PTH-FNAB (95.0%) was higher than SPECTCT (64.3%, p < 0.05). Presence of nodular goitre and/or chronic thyroiditis exerts a two times stronger negative effect on percentage of negative results of SPECT-CT than of PTH-FNAB. On the other hand, lower frequency of positive PTH-FNAB but not SPECT-CT was observed when the thickness of the thyroid was ≥ 20 mm (50% v. 87.5%, p < 0.05) and when the thickness of a lesion suspected of parathyroid pathology was ≤ 5 mm (66.7% v. 93.3%, p < 0.05). In patients with thyroid abnormalities, PTH-FNAB measurements show advantages over routine biopsy and SPECT-CT in the identification of typically located pathological parathyroids.

Cervical Cancer Treatment in Pregnancy

Cancer in pregnancy is a rare phenomenon. It is estimated to occur in 1:1000 pregnancies. Especially the incidence ofcervical cancer in pregnancy is approximately 1/1000-10000 pregnancies. As matenal age increases, most cancer age-relatedcancer incidence changes. Thus cervical cancer diagnosed during pregnancy increases along with the delay of childbearing.Pregnancy is an exceptional opportunity for the early diagnosis of cervical cancer. Because routine antenatal care includesvisual inspection, cytological examination and bimaual palpation. Although cervical cancer during pregnancy is usually operable,fetal maturity is another problem. So both patient and medical team breaks out argument. During pregnancy, high estrogen levelcan change the cervix. The change is normal physiological feature in pregnancy. But it can lead to an overestimation ofpossible lesion. There is no definitive evidence that the pregnant state shifts the characters of cervical cancer. The managementof cervical cancer during pregnancy depends on gestational age at diagnosis, stage of disease and patient desire for thepregnancy. So multidisciplinary approach is required for which includes obstetrician, gynecologic oncology, surgeon, radiationoncologist, neonatalogist, pathology.

A Simplified Flow Cytometric Immunophenotyping Procedure for the Diagnosis of Effusions Caused by Epithelial Malignancies

Epithelial malignancies frequently metastasize to the serous cavities and result in symptomatic effusions. Cytology has high specificity but moderate sensitivity for the diagnosis of a malignant effusion. We developed and validated a simple, rapid, 3-color flow cytometric panel using the adhesion molecule Ber-EP4 to detect epithelial cells in effusions. One hundred ninety-five consecutive benign and malignant effusions received for routine cytologic examination were analyzed. Eighty-three fluid specimens were benign and 76 were malignant as judged by follow-up data. Ber-EP4-positive cells were detected with flow cytometry in 89.3% of malignant effusions. The sensitivity and specificity of flow cytometry was 88.15% and 97.64% compared with 73.68% and 100% on cytologic examination alone for the presence of a malignant effusion. Flow cytometry is a useful adjunct to cytology for the diagnosis of a malignant effusion and is particularly useful if the cytologic diagnosis is atypical/suspicious or if the cytologic preparations are hypocellular or hemorrhagic.

Detection of carcinoma micrometastases in bone marrow of dogs and cats using conventional and cell block cytology

The presence of human breast carcinoma micrometastases in bone marrow is associated with poor overall survival, poor breast-cancer-specific survival, poor disease-free survival, and poor distant disease-free survival. In veterinary practice, the detection of micrometastases as a component of clinical staging is a routine practice for lymphomas and mast cell tumors, but not for carcinomas. This prospective study evaluated whether the identification of micrometastases from various carcinomas in dogs and cats in bone marrow using cell block cytology is technically feasible and whether it correlates with routine cytologic examination. Thirteen dogs and 4 cats with various types of carcinomas were available for analysis. Routine and cell block cytologic evaluation combined with immunocytochemical staining with antibodies to CKAE1/AE3 and CK7 were performed on all bone marrow samples. Bone marrow micrometastasis was demonstrated by both methods in 2 dogs with advanced disease. In one case cells were immunoreactive for both CKAE1/AE3 and CK7. This study demonstrates that cell block cytology is a practical and useful method for bone marrow evaluation and is suitable for cytokeratin immunocytochemical analysis.

Identification of occult disseminated tumor cells by recombinant herpes simplex virus expressing GFP (HSV(GFP))

To develop a novel rapid protocol for the detection of occult disseminated tumor cells by a recombinant herpes simplex virus expressing GFP (HSV(GFP)). Tumor cells of seven cell lines were exposed to HSV(GFP) and then examined for GFP expression by fluorescence microscopy. Various numbers of tumor cells (10, 100, 1000, 10 000) were mixed into 2 ml human whole blood, separated with lymphocytes separation medium, exposed to HSV(GFP), incubated at 37°C for 6 - 24 h and then counted for the number of green cells under the fluorescence microscope. Some clinical samples including peripheral blood, pleural effusion, ascites, spinal fluid from tumor-bearing patients were screened using this protocol in parallel with routine cytological examination. HSV(GFP) was able to infect all 7 tumor cell lines indicating that the HSV(GFP) can be used to detect different types of tumor cells. The detection sensitivity was 10 cancer cells in 2 ml whole blood. In the clinical samples, there were 4/15 positive by routine cytological examination but 11/15 positive by HSV(GFP), indicating a higher sensitivity of this new protocol. Recombinant herpes simplex virus-mediated green fluorescence is a simple and sensitive technique for the identification of occult disseminated cancer cells including circulating tumor cells (CTCs).

Circulating tumor cells in the cerebrospinal fluid: “tapping” into diagnostic and predictive potential

Metastatic spread of breast cancer into the central nervous system (CNS) carries an especially ominous prognosis. Successful treatment depends on early and accurate diagnosis [1]. Therefore, it is of paramount clinical importance to develop sensitive and specific methods to detect circulating tumor cells (CTCs) in the cerebrospinal fluid (CSF). Routine cytological examination of the cerebrospinal fluid for tumor cells has many limitations including low sensitivity necessitating repeated lumbar punctures to increase the diagnostic yield [2]. In the October issue of Oncotarget, Patel et al developed a method to adapt the FDA approved CellSearch platform to isolate CTCs from the CSF after spiking them into blood [3]. This novel approach adds a “molecular dimension” to the detection of malignant epithelial cells in the CSF. It hones in on single cells and begins to characterize their surface markers thus opening the door to a better understanding of their role in the metastatic cascade. The CellSearch system defines CTCs as EpCAM+, Cytokeratin+, CD45- nucleated cells. These cells, when isolated from the CSF, may represent a special subpopulation of CTCs capable of surviving the perilous journey in the blood stream and subsequent invasion of the CNS. The next logical step in understanding the biology of this unique cell population will be to search for markers that would predict special affinity for homing into and invading the CNS, surviving and proliferating (i.e. stem cell markers) or for drug resistance [4]. Studying ER/PR and HER-2 concordance between primary or metastatic tumor sites and CTCs in the CSF could also have profound implications. Further studies are needed to create surface marker and genetic “profiles” of this important subset of CTCs. This study also demonstrated correlation between CTC counts in the CSF and the administration of chemotherapeutic agents, a pattern that mirrors that observed with CTCs in the peripheral blood of patients with metastatic breast cancer. Previous studies have confirmed the validity of circulating tumor cell counts in predicting progression free survival (PFS) and overall survival (OS) in patients with metastatic breast cancer. For instance, in one study of metastatic breast cancer, patients with more than 5 CTCs had lower PFS (2.7 months vs. 7.0 months, P 18 months, P<0.001). These differences persisted at the first follow-up visit after the initiation of therapy [5]. It would be interesting to see if larger studies confirm similar prognostic and predictive correlation between CTC counts in the CSF and survival or response to therapy. Our understanding of the role of CTCs in the biology of metastases continues to evolve. This valuable study sheds the light on a subset of CTCs capable of invading the blood brain barrier to reach the CNS. Further characterization and profiling of CTCs in the CSF is likely to yield valuable insights into the biology and the behavior of this important subset of cells and to improve our understanding of how CNS metastases occur. Correlation between CTCs counts, their biological characteristics and clinical outcomes will continue to make this area both promising and clinically relevant.