Touch Preparations Research Articles

Adult Primary Extramedullary Spindle Cell Neoplasms of the Spinal Cord: Algorithmic Approach to a Frozen Section Dilemma

Abstract Introduction/Objective Spinal cord lesions can be designated as either (1) intramedullary, located within the spinal cord, or (2) extramedullary, located outside of the spinal cord, with further craterization as intradural and extradural. Neoplasms with a spindle cell phenotype can be challenging to optimally classify at the time of frozen section with immunohistochemistry necessary for optimal classification. This study looks at a spectrum of spinal cord tumors with a significant spindle cell component and offers an algorithmic approach for intraoperative consultation. Methods/Case Report A series of extramedullary spindle cell cases was compiled for comparison and contrast. A PubMed and Google literature search was undertaken. Results (if a Case Study enter NA) A total of 10 cases, age range 33-67, were compiled including meningioma with predominantly spindle cell features (WHO grade 1 and grade 2), solitary fibrous tumor, schwannoma lacking nuclear palisades and Verocay bodies, neurofibroma; malignant peripheral nerve sheath tumor, perineurioma, and spindle cell (tanycytic) ependymoma. During intraoperative consultation, touch preparations and frozen section features often overlapped. Radiologic localization of the neoplasm was essential to effective frozen section diagnosis as some lesions had a distinctly astrocytic phenotype. A general diagnosis was often employed, specifically spindle cell neoplasm with or without high-grade features. A differential diagnosis was provided when characteristic features were identified, including whorls, psammoma bodies, and intranuclear cytoplasmic inclusions favoring meningioma; abundant collagen between cells; nuclear palisades and Verocay bodies suggestive of Schwannoma; abundant extracellular matrix suggestive of neurofibroma; and perivascular pseudorosettes suggestive of extramedullary ependymoma variant. Conclusion This study provides a summary of extramedullary spinal region lesions that overlap with respect to imaging and frozen section characteristics. It emphasizes the need for clinical-radiologic-pathologic correlation on such lesions, the challenges in generating the differential diagnosis prior to histologic evaluation, and the pragmatism to rendering a diagnosis of spindle cell neoplasm with a differential diagnosis at frozen section.

Periodic Acid Schiff Staining to Detect Mott Cells, Aberrant Plasma Cells Containing Immunoglobulin Inclusions Called Russell Bodies.

Hematoxylin and eosin staining is widely used for routine histopathological analysis under light microscopic examination to determine alterations of tissue architecture and cellular components in animal studies. Aside from hematoxylin/eosin staining, periodic acid Schiff (PAS) staining is used to detect polysaccharides and carbohydrate-rich macromolecules, and is essential in immunological fields for evaluation of glomerular lesions of kidneys in autoimmune animals. Since erythrocytes are not stained by PAS, this stain is also helpful for identifying changes in immune cells in the red pulp of the spleen, which is filled with erythrocytes. This article describes a protocol to detect Mott cells, bizarre plasma cells containing immunoglobulin inclusion bodies (Russell bodies) in the cytoplasm. The protocol can be used for formalin-fixed, paraffin-embedded tissue sections, frozen tissue sections, tissue-touch preparations, blood films, and cytocentrifuged cell smears. © 2024 The Author(s). Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Detection of Mott cells by PAS staining in formalin-fixed, paraffin-embedded tissue sections Basic Protocol 2: Detection of Mott cells by PAS staining in frozen tissue sections, touch preparations, blood films, and cytocentrifuged cell smears.

Rapid On-Site Evaluation of Core Needle Biopsy of Renal Masses Using Touch Preparation: An Institutional Experience

Rapid On-Site Evaluation of Core Needle Biopsy of Renal Masses Using Touch Preparation: An Institutional Experience

Rapid On Site Evaluation of Fine Needle Aspiration versus Core Biopsy Touch Preparations: Diagnostic Value and Impact of Biopsy Site

Rapid On Site Evaluation of Fine Needle Aspiration versus Core Biopsy Touch Preparations: Diagnostic Value and Impact of Biopsy Site

Rapid on-site evaluation of FNA biopsies and rapid interpretation of core biopsy touch preparation slides: Correct utilization of current procedural terminology codes.

Rapid on-site evaluation of FNA biopsies and rapid interpretation of core biopsy touch preparation slides: Correct utilization of current procedural terminology codes.

Cytopathology and clinicopathological correlation of renal neuroendocrine neoplasms

Cytopathology and clinicopathological correlation of renal neuroendocrine neoplasms

The Role of Touch Preparation in Early Screening of Classic Hodgkin Lymphoma During Intraoperative Consultation

The Role of Touch Preparation in Early Screening of Classic Hodgkin Lymphoma During Intraoperative Consultation

A Raman topography imaging method toward assisting surgical tumor resection

AbstractAchieving complete tumor resection upon initial surgical intervention can lead to better patient outcomes by making adjuvant treatments more efficacious and reducing the strain of repeat surgeries. Complete tumor resection can be difficult to confirm intraoperatively. Methods like touch preparation (TP) have been inconsistent for detecting residual malignant cell populations, and fatty specimens like breast cancer lumpectomies are too fatty to process for rapid histology. We propose a novel workflow of immunostaining and topographic surface imaging of freshly excised tissue to ensure complete resection using highly sensitive and spectrally separable surface-enhanced Raman scattering nanoparticles (SERS NPs) as the targeted contrast agent. Biomarker-targeting SERS NPs are ideal contrast agents for this application because their sensitivity enables rapid detection, and their narrow bands enable extensive intra-pixel multiplexing. The adaptive focus capabilities of an advanced Raman instrument, combined with our rotational accessory device for exposing each surface of the stained specimen to the objective lens, enable topographic mapping of complete excised specimen surfaces. A USB-controlled accessory for a Raman microscope was designed and fabricated to enable programmatic and precise angular manipulation of specimens in concert with instrument stage motions during whole-surface imaging. Specimens are affixed to the accessory on an anti-slip, sterilizable rod, and the tissue surface exposed to the instrument is adjusted on demand using a programmed rotating stepper motor. We demonstrate this topographic imaging strategy on a variety of phantoms and preclinical tissue specimens. The results show detail and texture in specimen surface topography, orientation of findings and navigability across surfaces, and extensive SERS NP multiplexing and linear quantitation capabilities under this new Raman topography imaging method. We demonstrate successful surface mapping and recognition of all 26 of our distinct SERS NP types along with effective deconvolution and localization of randomly assigned NP mixtures. Increasing NP concentrations were also quantitatively assessed and showed a linear correlation with Raman signal with an R2 coefficient of determination of 0.97. Detailed surface renderings color-encoded by unmixed SERS NP abundances show a path forward for content-rich, interactive surgical margin assessment.

Efficacy of Robotic Bronchoscopy for Molecular Marker Analysis in Primary Lung Cancer

BackgroundMolecular testing has become a more frequent necessity in NSCLC management. Using next-generation sequencing, multiple targets for therapy can be identified with small amounts of nuclear material. The authors evaluated the performance of robotic-assisted bronchoscopy in acquiring tissue that meets pre-analytic criteria for PD-L1 immunohistochemistry and/or next-generation sequencing. Materials and MethodsPatients with a diagnosis of primary lung cancer identified through robotic bronchoscopy were retrospectively reviewed. Pathology reports were assessed for results of molecular testing and detection of programmed death-ligand 1 (PD-L1). An independent pathologist evaluated each specimen type (smears, cell block, tissue biopsy, and/or touch prep) to determine whether each tissue type would meet pre-analytic criteria for attempting next-generation sequencing and/or PD-L1 immunohistochemistry. ResultsSeventy-eight patients with primary lung were reviewed. By independent pathologic assessment of cytological smears, cell block, biopsy, and/or touch preparations, 72% of samples were found to be adequate for molecular and PD-L1 testing. Preanalytic adequacy (%) for next-generation sequencing (NGS) and PD-L1 staining was determined based on specimen type: cytological smear 48.6% for NGS; cell block 14.3% for NGS and 32.9% for PD-L1; biopsy 29.2% for NGS and 62.5% for PD-L1; and touch prep 61.4% for NGS. ConclusionRobotic-assisted bronchoscopy yielded samples that met preanalytic criteria for molecular testing in 72% of cases. These results support the use of robotic-assisted bronchoscopy for both the diagnosis and molecular testing of early-stage lung cancer.

Evaluation of Touch Preparations During CT-Guided Core Needle Biopsies of Lung Lesions

Evaluation of Touch Preparations During CT-Guided Core Needle Biopsies of Lung Lesions

Utility of cytopathologic diagnosis of adult solid renal lesions: An academic Institution's 10-year experience.

Fine needle aspiration (FNA) and/or needle core biopsy (NCB) are increasingly used for managing patients with renal lesions, especially small renal masses (SRMs). One of the treatment options for SMRs is active surveillance. Hence, accurate diagnosis of renal lesions is critical for treatment planning. The aim of this study is to investigate the utility of FNA and/or NCB in the diagnosis of adult renal lesions at our institute. Laboratory information system was queried over a period of 10 years (2011-2020) to identify cases of FNA and/or NCB with touch preparation (TP) of adult renal masses. Patient demographics, cytopathologic diagnoses, ancillary tests and follow-up surgical resection data were reviewed and correlated. A total 138 cases from 138 patients (male = 80, female = 58) were identified. Sixty-one (44.20%) cases had FNA and NCB, 48 (34.78%) had NCB only and 29 (21.01%) had FNA only. 118 (85.50%) cases had definitive diagnoses and 13 (9.42%) had indeterminant diagnoses and seven cases were non-diagnostic (5.07%). Most common benign and malignant diagnoses were oncocytoma and clear cell renal cell carcinoma (CCRCC). 41/138 (29.71%) cases had follow-up resection. There were no false positive or false negative cases. Subtyping was feasible in majority cases with only 3/138 (2.17%) misclassified cases. Majority of renal masses (85.50%) had definitive cytology diagnoses. Only three had misclassification. FNA and/or NCB are useful methods in diagnosing and subclassifying adult renal masses and showed high accuracy (91.89%) when compared to surgical resections.

Remotely operated robotic microscopy for rapid diagnosis of bronchoscopic cytology specimens.

Obtaining a diagnosis and treating pulmonary malignancies during the same anesthesia requires either an on-site pathologist or a system for remotely evaluating microscopic images. Cytology specimens are challenging to remotely assess given the need to navigate through dispersed and three-dimensional cell clusters. Remote navigation is possible using robotic telepathology, but data are limited on the ease of use of current systems, particularly for pulmonary cytology. Air dried modified Wright-Giemsa stained slides from 26 touch preparations of transbronchial biopsies and 27 smears of endobronchial ultrasound guided fine needle aspirations were scored for ease of adequacy assessment and ease of diagnosis on robotic (rmtConnect Microscope) and non-robotic telecytology platforms. Diagnostic classifications were compared between glass slides and the robotic and non-robotic telecytology assessments. Compared to non-robotic telecytology, robotic telecytology had a greater ease of adequacy assessment and non-inferior ease of diagnosis. The median time to diagnosis using robotic telecytology was 85 s (range 28-190 s). Diagnostic categories were concordant for 76% of cases in robotic versus non-robotic telecytology and 78% of cases in robotic telecytology versus glass slide diagnosis. Weighted Cohen's kappa scores for agreement in these comparisons were 0.84 and 0.72, respectively. Use of a remote-controlled robotic microscope improved the ease of adequacy assessment compared to non-robotic telecytology and enabled strongly concordant diagnoses to be expediently rendered. This study provides evidence that modern robotic telecytology is a feasible and user-friendly method of remotely and potentially intraoperatively rendering adequacy assessments and diagnoses on bronchoscopic cytology specimens.

Diagnosis of thoracic SMARCA4-deficient undifferentiated tumor in cytology.

Although alterations in SMARCA4-deficient occur in non-small cell lung carcinoma (SD-NSCLC), thoracic SMARCA4-deficient undifferentiated tumor (TSDUT) is recognized as a distinct entity in the 2021 World Health Organization Classification of Thoracic Tumors because of unique morphologic, immunophenotypic and molecular features, and worse survival compared with SD-NSCLC. Cytologic diagnosis of TSDUT is clinically important because of its aggressive behavior and because it is often diagnosed by fine-needle aspiration because TSDUTs are usually unresectable at presentation. Here, we identify cytologic features that can be used for recognition of TSDUT and distinction from SD-NSCLC. Cytomorphologic features were investigated in cytology specimens from patients with TSDUT (n=11) and compared with a control group of patients with SD-NSCLC (n=20). The presence of classic rhabdoid morphology, at least focally, was entirely specific for TSDUT (n=6, 55%) compared with SD-NSCLC (n=0) in this study. TSDUT more frequently showed tumor necrosis (n=11, 100% vs. n=8, 40%; p=.001), dominant single-cell pattern on aspirate smears or touch preparation slides (n=8 [of 9], 80% vs. n=3, 15%; p=.010), nuclear molding (n=5, 45% vs. n=1, 5%; p=.013), and indistinct cell borders (n=11, 100% vs. n=5, 25%; P<.001) compared with SD-NSCLC, respectively. Cytomorphologic features occurring more frequently in TSDUT include tumor necrosis, dominant single-cell pattern, nuclear molding indistinct cell borders, and focal rhabdoid cells. Presence of these features in a cytology specimen of an undifferentiated tumor, particularly in a patient with a thoracic mass, should raise suspicion for TSDUT and prompt appropriate ancillary workup.

Cytology-histology correlation, time to diagnosis and time to therapy when cytology is performed in addition to biopsies in malignant spinal lesions of previously unknown malignant disease.

e14007 Background: Metastatic spinal lesions are the first manifestation of malignant disease in up to 30% of patients (pts). Spinal care, diagnostic evaluation and initiation of systemic therapy are crucial for outcome in pts with advanced cancer. Histopathology (HP) from bone specimens is time consuming and decalcification procedure can hamper diagnostic information. The additional evaluation of spinal lesions by cytopathology (CP) has the potential to reduce time to diagnosis (TTD) and time to therapy (TTT). Therefore, we performed simultaneous analysis of CP and HP specimens from suspected malignant spinal lesions to evaluate the diagnostic value of additional CP. This work was supported by the German Society for Spine Surgery (DWG). Methods: We obtained CP specimens by transpedicular, intralesional aspiration through a Yamshidi needle or touch preparation from solid tissue samples. CP and HP specimens from spinal lesions were evaluated in parallel in 54 pts (CP/HP group). We analyzed sensitivity and specificity of CP in reference to HP. Furthermore, we compared the TTD and TTT of CP/HP group with a retrospective cohort of 103 patients in whom only HP was performed (HP group). Results: The collection of CP samples was feasible without elongation of surgery time or any complications for the pts. In 52/54 (96%) pts a CP-specimen was successfully obtained. Of the 52 pts analyzed, multiple myeloma was diagnosed in 10 pts, solid malignancy in 34, 1 pt had lymphoma and 7 did not show malignancy. The most common solid malignancies were prostate cancer (n=9), breast cancer (n=5) and adenocarcinoma of the lung (n=5). The sensitivity and specificity of CP in reference to HP is 98% and 71%, respectively. The concordance of CP and HP in differentiating between hematologic or solid neoplastic lesions is 94.2%. TTD in the CP/HP group was significantly shorter compared to HP group (1.7±1.8 and 8.6±3.6 d, respectively; p&lt;0.001). In addition, TTT in the CP/HP group was significantly shorter than in the HP group (19.3±14.4 d and 31.4±24.7 d; p=0.003). In 24.1% of pts a specific tumor therapy was initiated based on CP diagnosis before obtaining the results of HP. Conclusions: The evaluation of CP from malignant spinal lesions shows high sensitivity and concordance with HP and reduced TTD and TTT. Therefore, CP in addition to HP from spinal lesions of suspected malignancy has the potential to improve quality of life and prognosis in pts with advanced cancer. We therefore recommend the implementation of additional CP to HP in previously undiagnosed malignant spinal lesions.

Role of renal mass biopsy for diagnosis and management: Review of current trends and future directions.

The frequency of detection of renal masses has increased over recent decades, causing a concurrent increase in early intervention by surgery. Growing recognition that this approach was contributing to overtreatment led to the broader use of preoperative renal mass biopsy (RMB) by core biopsy and/or fine-needle aspiration. Because more options for management, such as active surveillance and personalized therapy, are becoming increasingly available, a diagnosis by RMB is becoming a valuable tool for risk stratification and clinical decision making. Guidelines from various professional organizations have outlined situations in which RMB should be used, and it has been shown to be safe and effective. Rapid on-site evaluation (ROSE) using touch preparations of core biopsy or fine-needle aspiration smears provides an immediate assessment of adequacy and appropriate triage. ROSE also ensures sufficient material to perform immunohistochemistry and molecular studies for more accurate characterization of renal masses and personalized treatment. The integral role of cytopathology laboratories in precision medicine can also be successfully used in optimizing the workup of RMB from ROSE to final diagnosis, prognostication, and personalized management of kidney tumors. Herein, the authors review their extensive experience working together with interventional radiology and urology colleagues to use core biopsy and ROSE at the time of RMB for diagnosis and management of these lesions.

Cytomorphology of renal angiomyolipoma: performance and accuracy of touch preparation of core needle biopsy.

The recognition of renal angiomyolipoma (AML) can be challenging based on cytology preparations such as touch preparation (TP) of core needle biopsy (CNB) and fine needle aspiration. This study evaluated the cytologic features and performance of TP of CNB during rapid onsite evaluation (ROSE) of renal AML. A pathology database search was performed between 2000 and 2021 for renal CNB specimens with ROSE using TP that were primarily favored AML on preliminary impression and/or confirmed AML on CNB or subsequent resection. Twenty confirmed AML were identified (90% female, median age 65.5 years). Sixteen (80%) were deemed adequate for diagnosis at the time of ROSE, and 9 of 16 (56%) had available onsite impression: AML was favored in 4 of 9 cases (44%). Examination of TP slides revealed spindle/epithelioid cells in 20 (100%), adipose tissue in 14 (70%), and blood vessels in 3 (15%). All AML cases were subsequently confirmed by immunohistochemistry. Additionally, 3 other cases with ROSE favoring AML revealed to be "renal parenchyma with fibrosis," clear cell papillary renal cell tumor and clear cell renal cell carcinoma. Onsite evaluation of TP ensures adequate material for diagnosis in most renal AML. Spindle/epithelioid cells were the most common component seen on TP, followed by adipose tissue. Blood vessels were rarely seen. While the recognition of AML at ROSE can be challenging, proper evaluation is important in obtaining adequate diagnostic tissue. Correlation with CNB and utilization of immunohistochemistry are crucial for arriving at the diagnosis.

Abstract No. 226 Evaluating Intra-Procedural Cytological Touch Preparation in Percutaneous Lung Biopsy

Abstract No. 226 Evaluating Intra-Procedural Cytological Touch Preparation in Percutaneous Lung Biopsy

Improvement of diagnosis in children with Burkitt lymphoma in Kenya: feasibility study for the implementation of fluorescence in situ hybridisation testing for MYC and the MYC/IGH translocation.

Indiana University (IU) initiated fluorescence in situ hybridisation (FISH) methodology for Burkitt Lymphoma (BL) to advance the accuracy and speed of diagnosis in the AMPATH Reference Laboratory at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. Standard diagnostic testing for BL at MTRH includes morphology of the biopsy specimen or aspirate and limited immunohistochemistry panels. Tumour specimens from 19 children enrolled from 2016 to 2018 in a prospective study to improve the diagnosis and staging of children with suspected BL were evaluated. Touch preps from biopsy specimens or smears from fine needle aspiration were collected, stained with Giemsa and/or H&E and reviewed by pathologists to render a provisional diagnosis. Unstained slides were stored and later processed for FISH. Duplicate slides were split between two laboratories for analysis. Flow cytometry results were available for all specimens. Results from the newly established FISH laboratory in Eldoret, Kenya were cross-validated in Indianapolis, Indiana. Concordance studies found 18 of 19 (95%) of specimens studied yielded analysable FISH results for one or both probe sets (MYC and MYC/IGH) in both locations. There was 94% (17/18) concordance of results between the two FISH laboratories. FISH results were 100% concordant for the 16 specimens with a histopathological diagnosis of BL and two of three non-BL cases (one case no result in IU FISH lab). FISH was similarly concordant with flow cytometry for specimens with positive flow results with the exception of a nasopharyngeal tumour with positive flow results for CD10 and CD20 but was negative by FISH. The modal turn-around time for FISH testing on retrospective study specimens performed in Kenya ranged between 24 and 72 hours. FISH testing was established, and a pilot study performed, to assess the feasibility of FISH as a diagnostic tool for the determination of BL in a Kenyan paediatric population. This study supports FISH in limited resource settings to improve the accuracy and speed of diagnosis of BL in Africa.

Адренергическая и холинергическая иннервация опухолеподобных образований голосовых складок у больных c вегетативными расстройствами

To develop therapeutic measures aimed at improving the voice and including exposure to specific mechanisms of the autonomic nervous system (ANS), it is necessary to know the features of the autonomic innervation of the vocal folds, which has a significant impact on the work of the vocal apparatus by regulating the trophic state of the elements forming it. Objective. Histochemical detection of adrenergic and cholinergic nerve fibers in tumor-like formations of vocal folds in patients with autonomic disorders. Materials and methods. A comprehensive examination of 64 patients with impaired voice function was carried out. During the examination, the medical history was studied, an objective examination of the upper respiratory tract according to generally accepted methods and with the help of video stroboscopic instrumentation, a cytological examination of touch preparation from the affected laryngeal area, and a study of the functional state of the ANS from the surgical material, including histological and histochemical examination of the removed tissue, were carried out. As a result, all patients were clinically diagnosed with a vocal fold polyp. Results. Histological, histochemical, and cytological studies have shown that in 80% of patients morphofunctional alterations of the vocal folds were combined with inadequate autonomic maintenance of activity. The data obtained allow us to assume that hyperplastic compensatory and adaptive responses of the laryngeal mucosa pass to pathological dystrophic changes and may contribute to deviations of the mucosal epithelium from normal histological differentiation toward atypia. Such changes create conditions for the development of benign and malignant tumors. Conclusion. In general, the data obtained give reason to believe that with prolonged dysfunction of the ANS a neurodystrophic process develops in the body, taking part in the pathogenesis of various diseases, including diseases of the larynx. With this in mind when performing preventive and therapeutic measures aimed at patients with tumor-like formations of the vocal folds, it is necessary to assess the functional state of the ANS and include measures to correct autonomic parameters in the general treatment and rehabilitation regimen.

Cytologic features of gynecologic germ cell tumors and carcinomas exhibiting germ cell tumor differentiation.

In this study, the authors sought to describe the cytologic features of primary gynecologic germ cell tumors and carcinomas exhibiting germ cell differentiation because little information currently exists. An institutional database search was performed to identify histologically confirmed gynecologic germ cell tumors and carcinomas with germ cell tumor differentiation. Available cytologic material was reviewed by three observers, and morphologic features were recorded in addition to patient age at original diagnosis, primary tumor site, site(s) from which the examined cytologic material was obtained, and the type of examined cytologic preparations. In total, 15 cytologic specimens from 12 women (aged 19-82years) were identified and included touch preparations of core biopsies from various sites (n=6), fine-needle biopsies (n=2), pelvic washings (n=1), ascitic fluids (n=4), pelvic cyst fluid (n=1), and endometrial aspirate (n=1). Of the 12 patients, seven had primary gynecologic germ cell tumors, four had gynecologic (ovarian and endometrial) tumors exhibiting somatic yolk sac tumor-like differentiation, and the remaining patient had an intestinal-type adenocarcinoma arising within an ovarian teratoma. There was morphologic overlap among many of the cases, although cytoplasmic vacuolation/granular cytoplasm was seen in 75% of primary yolk sac tumors or carcinomas with yolk sac tumor differentiation, and dense/squamoid cytoplasm was seen in 100% of teratomatous elements that were sampled. Germ cell tumors and somatic neoplasms exhibiting germ cell tumor differentiation occurring in adult women share some cytologic features and may be difficult to distinguish from one another, although some tumor types showed characteristic cytomorphologic findings.