http://www.cytojournal.com/currentissue.asp Table of Contents:CytoJournal 2009 - 6(1) CytoJournal Medknow Publications1742-6413 Sejal S Shah William C Faquin Roberto Izquierdo Kamal K Khurana Original Article CytoJournal 2009 6(1):1-1doi:10.4103/1742-6413.45191 CytoJournal 10.4103/1742-6413.45191 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=1;epage=1;aulast=Shah http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=1;epage=1;aulast=Shah61 1 1 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=1;epage=1;aulast=Shah Sejal S Shah, William C Faquin, Roberto Izquierdo, Kamal K Khurana

CytoJournal 2009 6(1):1-1

Background: Fine needle aspiration (FNA) cytology is a popular, reliable and cost effective technique for the diagnosis of thyroid lesions. The aim of our study was to review cases of misclassified primary malignant neoplasms of the thyroid by FNA, and assess the causes of cytologic misdiagnosis and their impact on clinical management. Methods: Clinical data, FNA smears and follow-up surgical specimens of cases diagnosed with primary thyroid carcinoma were reviewed. Results: Of the 365 cases with a malignant diagnosis by FNA over a period of 11 years, nine (2.4 %) were identified with discrepant histologic diagnosis with regard to the type of primary thyroid malignancy. In addition, four cases were added from the consultation files of the Massachusetts General Hospital. Areas of difficulty contributing to misclassification included overlapping cytologic features (n = 6), rarity of tumors (n = 3), and sampling limitations (n = 4). Of the 13 cases, 12 underwent total or near total thyroidectomy and one patient had concurrent surgical biopsy. Measurement of serum calcitonin levels in one case, with an initial cytologic diagnosis of medullary carcinoma, prevented unnecessary lymph node dissection. Misclassification of medullary carcinoma as papillary carcinoma precluded lymph node dissection in one case. Further management decisions were based on the final histologic diagnosis and did not require additional surgery. Two cases of undifferentiated (anaplastic) thyroid carcinoma were misdiagnosed as papillary thyroid carcinoma. Both patients received total thyroidectomies, which may not otherwise have been performed. Conclusions: A small subset of primary malignant neoplasms of the thyroid may be misclassified with regard to the type of malignancy on FNA. The majority of primary malignant neoplasms diagnosed on FNA require thyroidectomy. However, initial cytologic misclassification of medullary carcinoma or undifferentiated carcinoma as other malignant neoplasms or vice versa may have an impact on clinical management.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=1;epage=1;aulast=Shah Caroline J Whitaker Elaine C Stamp William Young Lesley A Greenwood Original Article CytoJournal 2009 6(1):2-2doi:10.4103/1742-6413.45192 CytoJournal 10.4103/1742-6413.45192 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=2;epage=2;aulast=Whitaker http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=2;epage=2;aulast=Whitaker61 2 2 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=2;epage=2;aulast=Whitaker Caroline J Whitaker, Elaine C Stamp, William Young, Lesley A Greenwood

CytoJournal 2009 6(1):2-2

Background: Within the United Kingdom, the change from conventional to liquid based cytology (LBC) has brought with it the universal introduction of broom style samplers, as represented by the Cervex sampler. The aim of this study was to assess whether or not there were benefits associated with a change from wooden spatulae to broom style samplers for those countries where conversion to LBC might not be readily available or is not fully supported. Methods: A longitudinal study was designed to compare the performance of Cervex brushes and extended-tip wooden spatulae as sampling devices for conventionally prepared cervical smears. General Practices serving the population of Hull and East Yorkshire (UK) were provided with Cervex brushes for a period of nine months to routinely collect cervical smears. The results of 66,931 cervical smear tests were compared between those practices that were using extended-tip wooden spatulae before the trial and then returned to their use afterwards, and those who were previously using Cervex samplers and continued to use them throughout. Analyses comparing both specimen inadequacy, as recorded on the standard cervical screening request form (HMR101), and also the presence of identified transformation zone (TZ) elements in smears, both indicated significant advantages associated with the Cervex brush. Results: Inadequate smears decreased from 5.96% with extended-tip spatulae to 4.77% with Cervex brushes (p<0.001) and increased back to 7.34% when practices reverted to extended-tip spatulae after nine months. Under the same conditions, the proportion of smears containing identified TZ elements increased from 50.52% to 54.75% (p<0.001), before reverting to 45.47% (p<0.001). In contrast, for a control group of practices using the Cervex brush throughout, inadequate smears decreased in all phases of the study, with no significant variation in TZ sampling rates. Conclusions: Using the Cervex brush with conventional cytology significantly decreases inadequate smears and increases TZ sampling when compared to the extended-tip spatula and can offer improved cervical screening in countries unable or unwilling to convert to LBC.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=2;epage=2;aulast=Whitaker Reema Jaffar Sambit K Mohanty Ashraf Khan Andrew H Fischer Original Article CytoJournal 2009 6(1):3-3doi:10.4103/1742-6413.45193 CytoJournal 10.4103/1742-6413.45193 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=3;epage=3;aulast=Jaffar http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=3;epage=3;aulast=Jaffar61 3 3 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=3;epage=3;aulast=Jaffar Reema Jaffar, Sambit K Mohanty, Ashraf Khan, Andrew H Fischer

CytoJournal 2009 6(1):3-3

Background: Published criteria to distinguish benign colloid nodules from follicular neoplasms emphasize only three interdependent features: size of follicles, amount of colloid, and cellularity. There is a need for the validation of other independent criteria. Methods: This study quantified the significance of cystic change, defined as presence of macrophages, and the presence of hemosiderin in either the macrophages or follicular cells. The cohort consisted of 165 patients with fine needle aspiration (FNA) and histologic follow-up of either goiter (101), follicular adenoma (47), or follicular carcinoma (17). Papillary thyroid carcinomas and Hürthle cell neoplasms were excluded from the cohort, because these categories are known to show cystic change and hemosiderin. FNAs were reviewed blindly with the most cellular slide scored for the presence of macrophages and/or hemosiderin. Results: Hemosiderin within macrophages were seen in 67% (68 of 101) of the goiters and only 6% (four of 64) of follicular neoplasms ( P <.0001). All four follicular neoplasms with hemosiderin in macrophages were adenomas. Three of these four had equivocal features of a benign colloid nodule histologically. None of the 17 follicular carcinomas had hemosiderin in macrophages ( P <.12). Macrophages without hemosiderin also strongly distinguished goiters from neoplasms (83% vs 17%) but appears less useful as a criterion since macrophages were present within 3 of 17 follicular carcinomas. Hemosiderin within follicular epithelial cells was present in 18% (18 of 101) of goiters, whereas none of the 64 follicular neoplasms had intraepithelial hemosiderin ( P <.0003). Conclusions: If papillary thyroid carcinoma and Hürthle cell neoplasm are ruled out, our findings indicate that the presence of hemosiderin virtually excludes a clinically significant follicular neoplasm.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=3;epage=3;aulast=Jaffar Sharon Davis-Devine Sarah J Day Amy Anderson Ashley French Darcy Madison-Henness Naomi Mohar Danielle Tansy Adarsh Hiremath Jeffrey A Douglas Gregory G Freund Original Article CytoJournal 2009 6(1):4-4doi:10.4103/1742-6413.45495 CytoJournal 10.4103/1742-6413.45495 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=4;epage=4;aulast=Davis-Devine http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=4;epage=4;aulast=Davis-Devine61 4 4 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=4;epage=4;aulast=Davis-Devine Sharon Davis-Devine, Sarah J Day, Amy Anderson, Ashley French, Darcy Madison-Henness, Naomi Mohar, Danielle Tansy, Adarsh Hiremath, Jeffrey A Douglas, Gregory G Freund

CytoJournal 2009 6(1):4-4

Objective: Here we examine the diagnostic utility of the US Food And Drug Administration (FDA) approved Spatula + endocervical brush combination for the BD SurePath Pap Test (SPPT) and compare it to SPPT collection with the broom alone or to an off-label combination of broom + EC brush. This question is important due to lingering concerns over the value of EC detection to a satisfactory Pap test. Methods: 20,125 SPPT vials were examined for the collection devices contained. The SPPT collection device combinations allowed were: Rovers Cervex-Brush (broom, FDA approved), Medscand Pap Perfect Spatula + Medscand CytoBrush Plus GT (spatula + GT brush, FDA approved) or Rovers Cervex-Brush + Surgipath C-E Brush (broom + CE brush, off label). Results: Examination of SPPT vials revealed 11,130 collected with the broom, 4,687 collected with the spatula + GT brush and 2,921 collected with the broom + CE brush. Absence of an endocervical/transformation zone was seen in 22.86% of broom cases, 13.10% of spatula + GT brush cases (p= 0.00005 vs broom) and 10.17% of broom + CE brush cases (p= 0.00005 vs broom, p= 0.00005 vs spatula + GT brush). Importantly, LSIL detection was: broom 2.99%; spatula + GT brush 2.45% (p= 0.053 vs broom); broom + CE brush 4.18% (p= 0.034 vs broom, p= 0.0001 vs spatula + GT brush). Conclusion: When broom + brush combination is compared to broom alone or to spatula + GT brush, the broom + CE brush combination better sampled the endocervical/transformation zone and increased LSIL detection.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=4;epage=4;aulast=Davis-Devine Meenakshi Batrani Manju Kaushal AK Sen Rajbala Yadav NK Chaturvedi Case Report CytoJournal 2009 6(1):5-5doi:10.4103/1742-6413.45496 CytoJournal 10.4103/1742-6413.45496 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=5;epage=5;aulast=Batrani http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=5;epage=5;aulast=Batrani61 5 5 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=5;epage=5;aulast=Batrani Meenakshi Batrani, Manju Kaushal, AK Sen, Rajbala Yadav, NK Chaturvedi

CytoJournal 2009 6(1):5-5

Background: Histological diversity is the hallmark of pleomorphic adenoma, the most common salivary gland tumor. It may cause difficulty in cytological interpretation, due to limited and selective sampling. Case presentation: A 16-year-old female patient presented with right cheek swelling. Fine needle aspiration cytology showed squamous cells, basaloid cells, and foamy cells, along with extracellular keratin and foreign body giant cells. Characteristic metachromatic fibrillary chondromyxoid stroma, which is usually seen in pleomorphic adenoma, was not seen in the aspirate. A diagnosis of mucoepidermoid carcinoma was given on cytology. Subsequent resection revealed an encapsulated pleomorphic adenoma, with extensive squamous metaplasia and appendageal differentiation on histology. Conclusion: This case illustrates that pleomorphic adenoma with squamous metaplasia presents a potential for misinterpretation as mucoepidermoid carcinoma on cytology. We discuss the various pitfalls and the features that are helpful in distinguishing these two lesions.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=5;epage=5;aulast=Batrani Liron Pantanowitz Maryanne Hornish Robert A Goulart Review Article CytoJournal 2009 6(1):6-6doi:10.4103/1742-6413.48606 CytoJournal 10.4103/1742-6413.48606 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=6;epage=6;aulast=Pantanowitz http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=6;epage=6;aulast=Pantanowitz61 6 6 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=6;epage=6;aulast=Pantanowitz Liron Pantanowitz, Maryanne Hornish, Robert A Goulart

CytoJournal 2009 6(1):6-6

With the introduction of digital imaging, pathology is undergoing a digital transformation. In the field of cytology, digital images are being used for telecytology, automated screening of Pap test slides, training and education (e.g. online digital atlases), and proficiency testing. To date, there has been no systematic review on the impact of digital imaging on the practice of cytopathology. This article critically addresses the emerging role of computer-assisted screening and the application of digital imaging to the field of cytology, including telecytology, virtual microscopy, and the impact of online cytology resources. The role of novel diagnostic techniques like image cytometry is also reviewed.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=6;epage=6;aulast=Pantanowitz Jose A Jimenez-Heffernan Eva Tejerina Pilar Gonzalez-Peramato Blanca Vicandi Ana Lopez-Garcia Letter To Editor CytoJournal 2009 6(1):7-7doi:10.4103/1742-6413.49164 CytoJournal 10.4103/1742-6413.49164 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=7;epage=7;aulast=Jimenez-Heffernan http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=7;epage=7;aulast=Jimenez-Heffernan61 7 7 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=7;epage=7;aulast=Jimenez-Heffernan Jose A Jimenez-Heffernan, Eva Tejerina, Pilar Gonzalez-Peramato, Blanca Vicandi, Ana Lopez-Garcia

CytoJournal 2009 6(1):7-7

]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=7;epage=7;aulast=Jimenez-Heffernan Hussain G Ahmed Dalia AI Elemirri Original Article CytoJournal 2009 6(1):8-8doi:10.4103/1742-6413.51332 CytoJournal 10.4103/1742-6413.51332 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=8;epage=8;aulast=Ahmed http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=8;epage=8;aulast=Ahmed61 8 8 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=8;epage=8;aulast=Ahmed Hussain G Ahmed, Dalia AI Elemirri

CytoJournal 2009 6(1):8-8

Background: Death from cancer is high in Sudan, with low survival rates, as most of the patients present with advanced disease. Most patients receive high and repeated doses of radiotherapy or chemotherapy. The aim of this study was to investigate the feasibility of using cytological evaluation to detect oral epithelial atypia amongst these patients. As a part of the continuous development in cancer therapy, this case control study was conducted in Khartoum, Sudan. Methods: Papanicolaou stained oral mucosal cells were obtained from 100 cancer patients receiving radiotherapy and/or chemotherapy (ascertained as cases), 50 cancer patients not exposed to either therapy (control 1), and 50 apparently healthy individuals (control 2). Statistical analysis: The data was analyzed by using a computer SPSS program, to obtain the Chi-square test. Results: Without prior knowledge of the subjects' group, oral epithelial atypia was detected in 7% of the cases. Inconclusive features of cytological atypia were observed in 13% of the cases. Atypia was not observed in both the control groups. Inflammatory infiltrate and viral cytopathic effects were identified in 32% and 8% of the cases respectively. Conclusion: Cytological atypia, viral infections, and inflammatory infiltrates were detected after exposure to radiotherapy and/or chemotherapy.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=8;epage=8;aulast=Ahmed GS Gomez-Macias R Garza-Guajardo J Segura-Luna O Barboza-Quintana Original Article CytoJournal 2009 6(1):9-9doi:10.4103/1742-6413.52831 CytoJournal 10.4103/1742-6413.52831 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=9;epage=9;aulast=Gomez-Macias http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=9;epage=9;aulast=Gomez-Macias61 9 9 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=9;epage=9;aulast=Gomez-Macias GS Gomez-Macias, R Garza-Guajardo, J Segura-Luna, O Barboza-Quintana

CytoJournal 2009 6(1):9-9

Background: Fine needle aspiration biopsy (FNAB) is a simple, sensitive, quick and inexpensive method in which operator experience is essential for obtaining the best results. Methods: A descriptive study in which the aspiration biopsy cases of the Pathology and Cytopathology Service of the University Hospital of the UANL (2003-2005) were analyzed. These were divided into three study groups: Group 1, FNAB performed by a pathologist; Group 2, FNAB performed by specialists who are not pathologists, Group 3, FNAB guided by an imaging study with immediate evaluation by a pathologist. The samples were classified as adequate and inadequate for diagnosis, the organ, the size and characteristics of the lesions were taken into consideration. Results: A total of 1905 FNAB were included. In Group 1: 1347 were performed of which 1242 (92.2%) were adequate and 105 (7.7%) were inadequate. Of the 237 from Group 2, 178 were adequate (75.1%) and 59 inadequate (24.8%); in Group 3 there were 321 of which 283 (88.1%) were adequate and 38 (11.8%) inadequate. A statistically significant difference was found between FNAB performed by Group 1 (p&lt; 0.001) and the other groups. A multivariate analysis was done where the organ punctured, the study groups, the size and characteristics of the lesion by study group were compared, finding that the most important variable was the person who performed the procedure. Conclusion: The experience and training of the person performing the aspiration biopsy, as well as immediate evaluation of the material when it is guided, substantially reduces the number of inadequate samples, improving the sensitivity of the method as well as reducing the need for open biopsies to reach a diagnosis.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=9;epage=9;aulast=Gomez-Macias Gilda da Cunha Santos Marcia Lanzoni de Alvarenga Vinicius Freitas Borlot Michel Antonio Kiyota Moutinho Marcello Fabiano de Franco Case Report CytoJournal 2009 6(1):10-10doi:10.4103/1742-6413.52832 CytoJournal 10.4103/1742-6413.52832 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=10;epage=10;aulast=Santos http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=10;epage=10;aulast=Santos61 10 10 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=10;epage=10;aulast=Santos Gilda da Cunha Santos, Marcia Lanzoni de Alvarenga, Vinicius Freitas Borlot, Michel Antonio Kiyota Moutinho, Marcello Fabiano de Franco

CytoJournal 2009 6(1):10-10

Penile neoplasms are rare and can be primary or represent metastasis or local recurrence. The most common primary cancer of the penis is squamous cell carcinoma, accounting for 95% of all cancers. In spite of the rich vascularity of the organ, penile metastases are uncommon. Cutaneous metastasis of urothelial carcinoma (UC) is extremely rare and generally accepted as the late manifestation of a systemic spread. By 1998, approximately 500 cases of penile metastasis had been reported worldwide. However, only few case reports and series of fine-needle aspiration cytology (FNAC) of penile tumors have been documented. We report a case of penile metastasis from UC diagnosed by FNAC and describe the cytomorphological findings with an emphasis on cercariform cells. Although not commonly used, FNA of penile nodules can be effective in diagnosing recurrence or metastasis and avoiding surgical procedures, thus being an excellent initial procedure in the diagnostic approach.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=10;epage=10;aulast=Santos Sonya Naryshkin Brenda L Schultz Original Article CytoJournal 2009 6(1):11-11doi:10.4103/1742-6413.53360 CytoJournal 10.4103/1742-6413.53360 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=11;epage=11;aulast=Naryshkin http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=11;epage=11;aulast=Naryshkin61 11 11 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=11;epage=11;aulast=Naryshkin Sonya Naryshkin, Brenda L Schultz

CytoJournal 2009 6(1):11-11

Background: The reliability of patient history and clinical information on Pap test requisitions has been questioned but not previously objectively determined. The effect of incomplete/inaccurate information on quality of patient care has not been previously quantified. Our objectives were (1) to find out how clinicians and their assistants viewed the requisition slip, and whether they understood the reasons for supplying the information requested, (2) to measure the completeness and accuracy of information on the requisition slips, and (3) to determine whether the clinical information and patient history provided on Pap test requisitions could be relied upon to accurately assign a Pap test to the laboratory's &quot;high-risk rescreen&quot; pool. Methods: Clinicians and their assistants were surveyed. A total of 899 consecutive Pap test requisition slips were reviewed. Patient history and clinical information from the slips were compared to data from our laboratory information system and/or electronic patient medical records. Results: Most survey respondents felt that proper completion of requisitions was important, but only 17% of clinicians and less staff realized that negative high-risk Pap tests underwent a quality assurance rescreen. Clinicians and/or staff recorded the last menstrual period, specimen source, and clinical information on the requisition slips 96%, 97%, and 88% of the time, respectively. Of 695 Pap tests with applicable computerized records, 172 (25%) qualified for high-risk rescreen based upon information provided on the requisition slip alone. An additional 52 Pap tests (7%), or 23% of the total high-risk Pap tests were discovered to be of high risk only after review of the electronic records. Conclusions: Clinicians and staff were receptive to discussions concerning the completion of requisition slips, but laboratory expectations could be better communicated. Requisition slips were properly completed with a high frequency, but the check boxes did not elicit all the information expected, so revision was necessary. The high accuracy of the completion of requisition slips permitted 77% of high-risk Pap tests to be identified via the requisition slip alone. Our findings challenge the conventional anecdotal impressions of &quot;notoriously unreliable&quot; information on Pap test requisition slips, but our experience may not be applicable to other settings.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=11;epage=11;aulast=Naryshkin R Marshall Austin Chengquan Zhao View Point CytoJournal 2009 6(1):12-12CytoJournal http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=12;epage=12;aulast=Austin http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=12;epage=12;aulast=Austin61 12 12 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=12;epage=12;aulast=Austin R Marshall Austin, Chengquan Zhao

CytoJournal 2009 6(1):12-12

]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=12;epage=12;aulast=Austin Vamseedhar Annam Mohan H Kulkarni Rekha B Puranik Original Article CytoJournal 2009 6(1):13-13doi:10.4103/1742-6413.53887 CytoJournal 10.4103/1742-6413.53887 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=13;epage=13;aulast=Annam http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=13;epage=13;aulast=Annam61 13 13 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=13;epage=13;aulast=Annam Vamseedhar Annam, Mohan H Kulkarni, Rekha B Puranik

CytoJournal 2009 6(1):13-13

Objectives: The objectives were to correlate the modified fluorescent method with the conventional Ziehl-Neelsen (ZN) method for the detection of acid-fast bacilli (AFB) and, also to study the efficacy and advantages of using the auramine-rhodamine stain on lymph node aspirates under fluorescent microscopy. Methods: In 108 consecutive patients with a clinical suspicion of tuberculosis (TB) presenting with lymphadenopathy, fine needle aspirations were performed. Smears from the aspirates were processed for routine cytology, the conventional ZN method, and the modified fluorescent method. The significance of the modified fluorescent method over the conventional ZN method was analyzed using the chi-square test. Results: Out of 108 aspirates, 102 were studied and remaining 6 were excluded from the study due to diagnosis of malignancy in 4.04% (4/6) and inadequate aspiration in 2.02% (2/6). Among the 102 aspirates, 44.11% (45/102) were positive for AFB on the conventional ZN method, 58.9% (60/102) were indicative of TB on cytology, while the smear positive increased to 81.37% (83/102) on the modified fluorescent method. Conclusions: Fluorescent microscopy has the advantage of speed and ease of screening, and reduces observer fatigue. The modified fluorescent method was found to be more advantageous than routine cytology and conventional ZN method, particularly in paucibacillary cases. The bacillary positivity rates were higher in the modified fluorescent method than in the ZN method. Hence, the modified fluorescent method can be an adjuvant when used with routine cytology for the identification of AFB.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=13;epage=13;aulast=Annam Sylvain Okonda Colleen Wright Pam Michelow Original Article CytoJournal 2009 6(1):14-14doi:10.4103/1742-6413.54916 CytoJournal 10.4103/1742-6413.54916 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=14;epage=14;aulast=Okonda http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=14;epage=14;aulast=Okonda61 14 14 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=14;epage=14;aulast=Okonda Sylvain Okonda, Colleen Wright, Pam Michelow

CytoJournal 2009 6(1):14-14

Background: Cancer of the cervix is the most common cancer in women in Swaziland where most women never undergo cervical screening. The extremely high prevalence of HIV/AIDS in Swaziland complicates the management of preinvasive and invasive cervical cancer. The purpose of this study was to assess the current status of cervical cytology in Swaziland, its strengths and limitations. Methods: The study is a retrospective review of 12,188 conventional cervical smears received by the Central Public Health Laboratory in Swaziland from June 2004 to May 2006. Results: Review of results showed very high rates of cytologic abnormalities with 43.2% of smears screened reported as abnormal. The percentages of abnormalities were as follows: atypical squamous cells of undermined significance (ASC-US), 19.8%; atypical squamous cells, cannot exclude HSILs (ASC-H), 8.8%; low-grade squamous intraepithelial lesions (LSIL), 9.0%; high-grade squamous intraepithelial lesions (HSIL), 4.6%; squamous cell carcinomas, 0.5%; atypical endocervical cells, 0.6%; and atypical endometrial cells, 0.4%. Just over 5% of smears were inadequate. The highest rates of HSILs and invasive squamous carcinoma occurred in women aged 50-59 years. Conclusions: This study underscores the need to reduce the incidence of cervical cancer and its precursor lesions in Swaziland women. Based on studies of human papillomavirus (HPV) types in other Southern African countries, current HPV vaccines would reduce the incidence and mortality from cervical cancer in the future, but cervical screening would still be required, both for women already infected with the HPV and for HPV subtypes not covered by current vaccines. The most cost-effective combination of screening modalities such as visual inspection, HPV DNA testing, and cytology should be investigated. Cervical cancer reduction needs to be managed within the greater framework of the HIV/AIDS epidemic.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=14;epage=14;aulast=Okonda M Ruhul Quddus Theresa Neves Mary E Reilly Margaret M Steinhoff C James Sung Original Article CytoJournal 2009 6(1):15-15doi:10.4103/1742-6413.54917 CytoJournal 10.4103/1742-6413.54917 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=15;epage=15;aulast=Quddus http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=15;epage=15;aulast=Quddus61 15 15 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=15;epage=15;aulast=Quddus M Ruhul Quddus, Theresa Neves, Mary E Reilly, Margaret M Steinhoff, C James Sung

CytoJournal 2009 6(1):15-15

Background: Published reports have demonstrated that introduction of the ThinPrep Imaging System (Imager) to the cytology screening services has increased the detection rate of high-grade squamous intraepithelial lesions (HSILs). In accordance with recent clinical treatment guidelines, patients with atypical squamous or glandular cells of undetermined significance (ASC-US or AGUS) are often tested for high-risk HPV infection using the Hybrid Capture HPV DNA test. We took the opportunity to investigate whether the Imager had resulted in any significant differences in our diagnostic categories, as well as whether the Imager increased the detection of high-risk HPV-DNA-positive (HRHPV+) ASC-US or AGUS. Materials and Methods: Cytology cases with the diagnosis of ASC-US and AGUS were retrieved from the archival files of our institution during periods of 11 months prior to and 11 months after the introduction of the Imager. The total number of cases in each category was correlated with results of reflex high-risk HPV DNA testing when the latter were available. All AGUS diagnoses were correlated with subsequent biopsy follow-up. Statistical analyses were performed using the chi-Square test with Yate's Correction and Fisher's Exact test. Results: A total of 108,371 and 104,555 of ThinPrep ® Pap Test (TPPT) cases were reviewed during 11 months pre- and post-imager introduction. The ASC-US rate was 5.4% in the pre-Imager and 5.3% in the post-Imager period. The HPV reflex test was 38% and 34% positive respectively in the pre- and post-Imager period ( P &gt;0.124). Similarly, 0.14% and 0.12% AGUS were found in the pre- and post-Imager period. The positive HPV reflex test was 14% versus 23% ( P = 0.1690). The abnormal biopsy follow-up rate in the AGUS category was increased from 20.9% in the pre-Imager period to 31% in the post-Imager period ( P = 0.1471). The ASCUS/SIL ratios were 1.9 and 1.6 respectively. Conclusions: The ASC-US and AGUS rates did not change statistically before and after the introduction of the Imager in our cytology laboratory. Although use of the Imager did not increase detection of HPV+ ASC-US, it did appear to increase the detection rate of HPV+ AGUS and subsequent abnormal biopsy follow-up rates in all categories. However, the increase in the detection rate did not reach the point of statistical significance]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=15;epage=15;aulast=Quddus Michael J Thrall Ellen J Giampoli Original Article CytoJournal 2009 6(1):16-16doi:10.4103/1742-6413.54919 CytoJournal 10.4103/1742-6413.54919 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=16;epage=16;aulast=Thrall http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=16;epage=16;aulast=Thrall61 16 16 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=16;epage=16;aulast=Thrall Michael J Thrall, Ellen J Giampoli

CytoJournal 2009 6(1):16-16

Background: Patients with cirrhosis develop ascites for physiologic reasons that are unrelated to malignant progression. However, physicians performing paracentesis in these patients, often send fluid to the cytology laboratory, sometimes specifically looking for hepatocellular carcinoma (HCC). We have investigated the diagnostic yield of these specimens. Materials and Methods: A computerized pathology database search for all ascites fluid cases submitted to the cytology laboratory at a major liver transplant center between November 2004 and April 2008 was performed. Clinical history was obtained for each case. Patients with cirrhosis, with or without HCC, were included in the study. Cytologic diagnoses were compiled and follow-up information was obtained for cases with non-negative findings. Results: A total of 167 specimens from 133 patients ranging from 29 to 85 years of age (mean 56 years) were submitted over the said time period. The causes of cirrhosis included: alcohol - 44; Hepatitis C - 30; Hepatitis B - 6; non-alcoholic steatohepatitis - 7; cryptogenic - 18; other single causes - 6; and multifactorial (alcohol and hepatitis viruses) - 22. Hepatocellular carcinoma (HCC) was present or strongly suspected in 17 patients and had been previously resected in two others. The status of fifteen patients was post liver transplant, with recurrent liver failure. Human immunodeficiency virus was present in seven patients and eight patients had a history of non hepatic malignancies. Among the specimens, 162 were negative, two had atypical lymphocytes worked up for lymphoma, and three had atypical epithelioid cells; none was positive for HCC. Immunohistochemistry demonstrated a mesothelial origin for the atypical epithelioid cells in two cases; in the third case, the patient died shortly after the specimen was collected, with no radiological evidence of HCC. Conclusion: Ascites fluid cytology specimens in patients with cirrhosis, even those known or suspected to have HCC, are almost always negative. Atypical cells seen in such specimens should be treated with skepticism since the likelihood that they represent peritoneal spread of HCC is low.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=16;epage=16;aulast=Thrall R Marshall Austin Barbara Benstein Joel Bentz Sandra Bigner Gregory G Freund Gregory La Rocco Ibrahim Ramzy Lynnette Savaloja Vinod B Shidham Commentary CytoJournal 2009 6(1):17-17doi:10.4103/1742-6413.55885 CytoJournal 10.4103/1742-6413.55885 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=17;epage=17;aulast=Austin http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=17;epage=17;aulast=Austin61 17 17 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=17;epage=17;aulast=Austin R Marshall Austin, Barbara Benstein, Joel Bentz, Sandra Bigner, Gregory G Freund, Gregory La Rocco, Ibrahim Ramzy, Lynnette Savaloja, Vinod B Shidham

CytoJournal 2009 6(1):17-17

]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=17;epage=17;aulast=Austin Husain A Saleh Jining Feng Farah Tabassum Opada Al-Zohaili Muji Husain Tamara Giorgadze Original Article CytoJournal 2009 6(1):18-18doi:10.4103/1742-6413.55894 CytoJournal 10.4103/1742-6413.55894 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=18;epage=18;aulast=Saleh http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=18;epage=18;aulast=Saleh61 18 18 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=18;epage=18;aulast=Saleh Husain A Saleh, Jining Feng, Farah Tabassum, Opada Al-Zohaili, Muji Husain, Tamara Giorgadze

CytoJournal 2009 6(1):18-18

Background: Fine needle aspiration biopsy (FNAB) is a common and excellent procedure for the evaluation of thyroid lesions that require surgical resection. At times, the FNAB diagnosis can be difficult, particularly of follicular-patterned lesions. Previous studies have shown that some immunohistochemical (IHC) markers may be helpful in establishing more accurate diagnosis. In this study, our goal was to evaluate four of the recently investigated markers in differentiating benign from malignant thyroid nodules on FNABs. Materials and Methods: We performed IHC staining of galectin-3, Ret oncoprotein (Ret), HBME-1, and cytokeratin 19 (CK19), on cell block sections of thyroid FNAB cases that had corresponding surgical resections. They included 44 benign lesions (37 hyperplastic or cellular nodules, HN; and 7 follicular adenomas, FA) and 27 malignant tumors (6 follicular carcinoma, FC; 19 classic papillary carcinoma, PTC; and 2 follicular variant of papillary carcinoma, FVPC). The stains were done according to the standard avidin-biotin-peroxidase method. Results: Statistical analysis showed that immunoexpression was significantly higher in the malignant group for all four markers. The sensitivity for positive expression for all benign lesions versus malignant tumors was as follows: 10/44 (22.7%) versus 25/27 (92.6%) for galectin-3; 14/44 (31.8%) versus 23/27 (85%) for Ret; 12/44 (27.3%) versus 24/27 (88.8%) for HBME-1; and 13/44 (29.5%) versus 23/27 (85%) for CK19. The sensitivity and specificity was highest for galectin-3 (92.6% and 77.3%, respectively) followed by HMBE-1 (88.9% and 72.7%, respectively). When combining the markers' expressions, the panel of galectin-3 + HBME-1 showed the highest sensitivity and specificity (90.7% and 75%, respectively), but this was, however, lower than galectin-3 alone (92.3% and 77.3%, respectively). Conclusion: We conclude that galectin-3 is the best single marker in differentiating benign from malignant thyroid lesions with the highest sensitivity and specificity. The galectin-3 + HBME-1 was the best combination for distinguishing benign from malignant lesions. Because they were the best two independent and combined markers, we recommend the use of the galectin-3 + HBME-1 panel to enhance the diagnostic accuracy of follicular-patterned thyroid lesions on FNABs.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=18;epage=18;aulast=Saleh Andrew A Renshaw Fadi Brimo Manon Auger Original Article CytoJournal 2009 6(1):19-19doi:10.4103/1742-6413.56359 CytoJournal 10.4103/1742-6413.56359 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=19;epage=19;aulast=Renshaw http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=19;epage=19;aulast=Renshaw61 19 19 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=19;epage=19;aulast=Renshaw Andrew A Renshaw, Fadi Brimo, Manon Auger

CytoJournal 2009 6(1):19-19

Background: Measuring the sensitivity of screening in gynecologic cytology in real life is problematic. However, other quality measures may correlate with sensitivity, including the atypical squamous cells (ASC)/squamous intraepithelial lesion (SIL) ratio. Whether these other measures can function as &quot;surrogate indicators&quot; for sensitivity and improve the assessment of sensitivity in the laboratory is not known. Materials and Methods: We compared multiple quality measures with true screening sensitivity in a variety of situations. Results: The abnormal rate, ASC rate, and ASC/SIL ratio were all highly correlated (r = .83 or greater) with sensitivity when the overall laboratory sensitivity was low (85%) but became less correlated (.64 or less) or uncorrelated when the screening sensitivity was higher (88% or 95%, respectively). Sensitivity was more highly correlated with the abnormal rate than the ASC/SIL ratio at low screening sensitivity. While thresholds could be set that were highly sensitive and specific for suboptimal screening, these thresholds were often less than one standard deviation away from the mean. Conclusion: The correlation of the abnormal rate and the ASC/SIL ratio with sensitivity depends on overall sensitivity. Standards to define minimum screening sensitivity can be defined, but these standards are relatively narrow. These features may limit the utility of these quality measures as surrogates for sensitivity.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=19;epage=19;aulast=Renshaw Min Yi Ngae Clinton D Crowder Klint Kjeldahl Roberto Gamez Samantha Paulson Daniel M McKeon Priti Goyal Stefan E Pambuccian Letter To Editor CytoJournal 2009 6(1):20-20doi:10.4103/1742-6413.56360 CytoJournal 10.4103/1742-6413.56360 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=20;epage=20;aulast=Ngae http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=20;epage=20;aulast=Ngae61 20 20 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=20;epage=20;aulast=Ngae Min Yi Ngae, Clinton D Crowder, Klint Kjeldahl, Roberto Gamez, Samantha Paulson, Daniel M McKeon, Priti Goyal, Stefan E Pambuccian

CytoJournal 2009 6(1):20-20

]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=20;epage=20;aulast=Ngae Fadi Brimo Gizelle Popradi Rene P Michel Manon Auger Case Report CytoJournal 2009 6(1):21-21doi:10.4103/1742-6413.56361 CytoJournal 10.4103/1742-6413.56361 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=21;epage=21;aulast=Brimo http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=21;epage=21;aulast=Brimo61 21 21 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=21;epage=21;aulast=Brimo Fadi Brimo, Gizelle Popradi, Rene P Michel, Manon Auger

CytoJournal 2009 6(1):21-21

Primary effusion lymphoma (PEL) is a human herpes virus-8 (HHV8)-associated large-cell non-Hodgkin lymphoma localized in body cavities and presenting as pleural, peritoneal, or pericardial lymphomatous effusions. It typically affects immunocompromised patients and usually involves only one body site. We describe herein a case of PEL affecting three body cavity sites in an immunocompetent patient. A 69-year-old HIV-negative man presented with upper gastrointestinal bleeding and ascites. An examination of the fluid by cytology showed large atypical lymphocytes with abundant basophilic cytoplasm, either central or eccentric nuclei having irregular outlines, and multiple prominent nucleoli. The neoplastic cells showed positive staining for CD45, CD3, HHV8 latent nuclear antigen (LNA), and Epstein-Barr virus-encoded RNA. A diagnosis of PEL was rendered. Despite chemotherapy and valganciclovir, the disease progressed to involve the pleural and pericardial cavities and the patient died 5 months following the initial diagnosis. Although PEL is a B-cell lymphoma, it is usually of null phenotype by immunohistochemistry, and can rarely aberrantly express T-cell markers, as seen in the current case. The key to the diagnosis of PEL rests on identifying HHV8 in the neoplastic cells. Therefore, restricting the term of PEL only to those cases that are HHV8 positive is important in order to differentiate PEL from other lymphomas that can present as serous effusions and that carry, in general, a more favorable prognosis than PEL]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=21;epage=21;aulast=Brimo Kulwinder S Dua Aravind S Vijayapal Janis Kengis Vinod B Shidham Case Report CytoJournal 2009 6(1):22-22doi:10.4103/1742-6413.56362 CytoJournal 10.4103/1742-6413.56362 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=22;epage=22;aulast=Dua http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=22;epage=22;aulast=Dua61 22 22 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=22;epage=22;aulast=Dua Kulwinder S Dua, Aravind S Vijayapal, Janis Kengis, Vinod B Shidham

CytoJournal 2009 6(1):22-22

A 51-year-old male presented with a 4-month history of abdominal pain, decreased appetite, and postprandial bloating. A CT scan showed a solitary, 5.3 &#935; 4.4 cm, cystic lesion in the body/tail of the pancreas. Endoscopic retrograde cholangiopancreatography did not show communication between the pancreatic duct and the cystic lesion. Endoscopic ultrasound (EUS) examination revealed a 6.9 &#935; 2.4 cm cystic lesion in the body/tail region of the pancreas without septae or solid components. The pancreatic parenchyma, pancreatic duct, and common bile duct were unremarkable. EUS-guided fine needle aspiration (EUS-FNA) was performed using a 22-gauge EchotipTM needle. Only a few drops of viscous fluid could be aspirated. Papanicolaou-stained direct smears and SurePath (Autocyte) preparations were evaluated. The direct smears were hypocellular; however, the concentration method producing liquid-based cytology preparation showed detached ciliary tufts (degenerated debris with ciliated cellular fragments of cell tops without nuclei) and occasional intact ciliated cells consistent with a ciliated foregut cyst. Although benign, the cyst was resected to alleviate the symptoms. The surgical pathology confirmed the benign preoperative interpretation of the ciliated foregut cyst. To the best of our knowledge, this is the &#64257;rst case of pancreatic ciliated foregut cyst reported to be diagnosed preoperatively by EUS-FNA. For a proper preoperative cytologic diagnosis, the needle rinses should be processed adequately. Otherwise, these hypocellular specimens with mucin may be misinterpreted as mucinous cystic lesions.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=22;epage=22;aulast=Dua Jose Jeronimo Mark A Barone Silvana Luciani Ricky Lu Jacqueline Sherris Julie Torod Vivien Tsu Letter To Editor CytoJournal 2009 6(1):23-23doi:10.4103/1742-6413.57780 CytoJournal 10.4103/1742-6413.57780 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=23;epage=23;aulast=Jeronimo http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=23;epage=23;aulast=Jeronimo61 23 23 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=23;epage=23;aulast=Jeronimo Jose Jeronimo, Mark A Barone, Silvana Luciani, Ricky Lu, Jacqueline Sherris, Julie Torod, Vivien Tsu

CytoJournal 2009 6(1):23-23

]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=23;epage=23;aulast=Jeronimo Ruba A Halloush Elena Lavrovskaya Dina R Mody Donna Lager Luan Truong Original Article CytoJournal 2009 6(1):24-24doi:10.4103/1742-6413.58950 CytoJournal 10.4103/1742-6413.58950 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=24;epage=24;aulast=Halloush http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=24;epage=24;aulast=Halloush61 24 24 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=24;epage=24;aulast=Halloush Ruba A Halloush, Elena Lavrovskaya, Dina R Mody, Donna Lager, Luan Truong

CytoJournal 2009 6(1):24-24

Introduction: Systemic amyloidosis (SA) has a broad nonspecific clinical presentation. Its diagnosis depends on identifying amyloid in tissues. Abdominal fat pad fine needle aspiration (FPFNA) has been suggested as a sensitive and specific test for diagnosing SA. Materials and Methods: Thirty-nine FPFNA from 38 patients (16 women and 20 men, age range 40-88 years) during a 15-year period were reviewed. Smears and cell blocks were stained with Congo red (CR). A panel of antibodies (serum amyloid protein, serum amyloid A, albumin, transthyretin, kappa light chain and lambda light chain) was used on six cell blocks from five patients. The FNA findings were correlated with clinical and histological follow-up. Results: FPFNAs were positive, confirmed by CR in 5/39 (13%), suspicious in 1/39 (3%), negative in 28/39 (72%), and insufficient for diagnosis in 5/39 (13%) of cases. In all the positive cases, SA was confirmed within 2-16 weeks. Among the 28 negative cases, SA was diagnosed in 21, the rest were lost to follow-up. Among the insufficient cases, SA was diagnosed in four and one was lost to follow-up. Specificity was 100%, whereas sensitivity was 19%. SA typing using cell block sections was successful in three, un-interpretable in one, and negative in two cases. Conclusion: FPFNA for SA is not as good as previously reported. This may be due to different practice setting, level of experience, diagnostic technique, or absence of abdominal soft tissue involvement. A negative result of FPFNA does not exclude SA. Immune phenotyping of amyloid is possible on cell block.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=24;epage=24;aulast=Halloush Ruchika Gupta Sandeep R Mathur S Datta Gupta Prashant Durgapal Venkateswaran K Iyer Chandan Jyoti Das Shalimar Subrat K Acharya Case Report CytoJournal 2009 6(1):25-25doi:10.4103/1742-6413.58951 CytoJournal 10.4103/1742-6413.58951 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=25;epage=25;aulast=Gupta http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=25;epage=25;aulast=Gupta61 25 25 http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=25;epage=25;aulast=Gupta Ruchika Gupta, Sandeep R Mathur, S Datta Gupta, Prashant Durgapal, Venkateswaran K Iyer, Chandan Jyoti Das, Shalimar , Subrat K Acharya

CytoJournal 2009 6(1):25-25

Hepatic epithelioid hemangioendothelioma (EH) is a rare vascular neoplasm. An accurate radiologic diagnosis is usually difficult due to the presence of multiple nodules, simulating metastatic carcinoma. Though histologic features of this tumor are well described, cytologic reports of hepatic EH are very few in the available literature. We describe a case of a young healthy adult male who was found to have multiple hepatic masses on radiologic investigations. A guided fine needle aspiration demonstrated a poorly differentiated neoplasm. The diagnosis was made on core biopsy assisted by immunohistochemistry, which showed characteristic features of EH. He is doing well 14 months after diagnosis, without surgical excision or chemotherapy. An accurate diagnosis of hepatic EH on aspiration cytology requires an adequate specimen and awareness of its cytologic features, including discohesive atypical cells with intracytoplasmic lumina and intranuclear inclusions. Since this tumor is usually unresectable but has a favorable prognosis as compared to hepatocellular carcinoma, a correct diagnosis is essential for appropriate management and prognostication.]]> http://www.cytojournal.com/article.asp?issn=1742-6413;year=2009;volume=6;issue=1;spage=25;epage=25;aulast=Gupta