Camilla J. Cobb

Core needle biopsy

Fine‐needle aspiration (FNA) biopsy is an established, highly accurate method for diagnosing palpable breast lesions. However, in some cases a definitive diagnosis cannot be made by FNA alone, either due to the inherent limitations of cytology itself or the ability to obtain adequate material for diagnosis. This study evaluated the usefulness of a supplemental core needle biopsy performed by a cytopathologist in conjunction with an FNA biopsy in select patients.

Clinical Significance of Atypical Glandular Cells in Conventional Pap Smears in a Large, High-Risk U.S. West Coast Minority Population

OBJECTIVE To determine the incidence of clinically significant lesions on subsequent histologic follow-up in high-risk, predominantly minority patients with atypical glandular cells (AGC). STUDY DESIGN A retrospective study was done on conventional Pap smears diagnosed as AGC of endocervical origin (AGC-EC), AGC of endometrial origin (AGC-EM) and AGC not otherwise specified (AGC-NOS) between January 1, 2003, and December 31, 2005. Histologic diagnoses were correlated with cytologic diagnoses. RESULT Confirmed AGC cases were divided into 4 categories: 187 AGC-NOS, 169 AGC-EC, 68 AGC and atypical squamous cells of undetermined significance (ASCUS) and 36 AGC-EM. A total of 105 patients (22.8%) had significant precancerous (cervical intraepithelial neoplasia [CIN] 2/3, adenocarcinoma in situ [AIS]) or malignant (carcinoma) histologic outcomes. CIN 2/3 was the most common significant histologic outcome in women with AGC and ASCUS and patients <35 years with AGC. Endometrial neoplasia was the most common significant outcome in women with AGC-NOS and AGC-EM Pap results and in AGC patients > or =35. In women with AGC-EC Pap results, glandular cervical neoplasia occurred in 8.3% and CIN 2/3 in 5.9% offollow-up biopsies. CONCLUSION AGC subtype and age significantly affect the probability of precancerous and malignant follow-up findings and anatomic site of neoplastic lesions. Access to newer screening technologies such as high-risk HPVDNA testing and liquid-based cytology will likely benefit such high-risk populations.

A case of amelanotic spindle-cell melanoma presenting as metastases to breast and axillary lymph node: Diagnosis by FNA cytology

Metastatic neoplasms to the breast are relatively rare. Spindle‐cell lesions of the breast are also uncommon. Here we present a case of fine‐needle aspiration (FNA) of an amelanotic, spindle‐cell melanoma metastatic to the breast and axillary lymph node. The patient was a 47‐yr‐old female who presented with a right breast mass, left axillary adenopathy, and a pigmented skin lesion on the back. FNA of the right breast and left axilla showed malignant, nonpigmented spindle cells that were weakly positive for HMB‐45 on immunocytochemistry. The skin biopsy showed a pigmented malignant melanoma with epithelioid features, and also weak positivity for HMB‐45. Although malignant melanoma is one of the more common tumors to metastasize to the breast, this is the first known case that showed exclusive spindle‐cell morphology. History and physical examination were crucial in making the correct FNA diagnosis. The cytologic differential diagnosis of spindle‐cell tumors of breast and the discordant morphology between the primary and metastatic melanotic lesions observed in this case are discussed. Diagn. Cytopathol. 2000;22:246–249.

Breast Fine-Needle Aspiration Samples Reported as Proliferative Breast Lesion : Clinical Utility of the Subcategory Proliferative Breast Lesion With Atypia

The fine‐needle aspiration (FNA) diagnosis of proliferative breast lesion is an indeterminate category. The aim of this correlative study was to determine whether a subcategory of “proliferative breast lesion with atypia” was achievable and whether this subcategory has management utility.

Role of cytopathology in the diagnosis and management of gastrointestinal tract cancers

Cytology of gastro-intestinal (GI) tract lesions can be used successfully to diagnose neoplastic and non-neoplastic conditions, especially when combined with biopsies. Cytologic evaluation is widely accepted as a cost-effective method that allows rapid interpretation and triaging of material. Technical advances over the years have allowed simultaneous visualization of abnormal tissue and procurement of needle aspirates, brushings and biopsies from mucosal and deeper seated lesions. Successful cytologic examination of the GI tract is highly dependent on the skill of the endoscopist, specimen preparation, the expertise of the pathologist, and the recognition of the limitations of cytology. This article reviews the key cytologic features of important GI tract lesions, differential diagnoses, and pitfalls, and addresses the advantages and limitations of different collection techniques.

Cytologic features of high-grade squamous intraepithelial lesion in ThinPrep Papanicolaou test slides: comparison of cases that performed poorly with those that performed well in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology

CONTEXT Conventional Papanicolaou (Pap) test slides of high-grade squamous intraepithelial lesions (HSILs) that are frequently misdiagnosed are known to have relatively few dysplastic cells. Whether this is true of cases of HSIL in ThinPrep Pap Test specimens is not known. OBJECTIVE To determine if cases of HSIL in ThinPrep specimens that are frequently missed have relatively few dysplastic cells. DESIGN The cytologic features of 16 ThinPrep cases of HSIL that performed poorly in the College of American Pathologists Interlaboratory Comparison Program were compared with 22 ThinPrep Pap Test cases that performed extremely well. RESULTS Significantly more cases that performed poorly had fewer than 250 dysplastic cells (13/16) than cases that performed well (3/22) (P <.001). CONCLUSION ThinPrep Pap Test cases with a diagnosis of HSIL that performed poorly in this program had significantly fewer dysplastic cells than those that performed well.

Fine needle aspiration cytology and diagnostic pitfalls in Warthin's tumor with necrotizing granulomatous inflammation and facial nerve paralysis: a case report.

BACKGROUND Warthins tumor can be associated with various secondary changes that challenge both clinical and cytologic diagnosis. CASE A 44-year-old man presented with a Warthins tumor (WT) that was associated with multiple secondary changes. The right parotid mass was present and mostly asymptomatic for 6 years, but during the 7th year, there was pain and ipsilateral facial nerve dysfunction following abrupt increase in size of the mass. Fine needle aspiration (FNA) yielded murky, brown, viscous fluid, and the residual mass was also aspirated. Cytologic examination showed acute, chronic and granulomatous inflammation and rare squamous cells in a background of finely granular necrotic debris. Oncocytes were not identified. Histologic examination of the excised mass revealed a WT with extensive necrotizing granulomatous inflammation, with acute and chronic inflammation, fibrosis and squamous metaplasia. Microorganisms were not identified by culture or by special stains of the FNA cell block and histologic sections. CONCLUSION The secondary changes observed in this case probably relate to spontaneous infarction of the WT. Awareness of the secondary changes that can occur in WT will help prevent misdiagnosis, which could result in inappropriate therapy, including unnecessary radical surgery.

Cytoplasmic vacuoles: Clue in the fine-needle aspiration diagnosis of melanoma

For the fine‐needle aspiration (FNA) diagnosis of melanoma recognition of characteristic morphologic features is key. In our practice we noted that cytoplasmic vacuoles in Romanowsky‐stained FNA smears of melanoma appeared to be a frequent finding.

Cytologic features of squamous cell carcinoma in ThinPrep slides: evaluation of cases that performed poorly versus those that performed well in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology

CONTEXT Although the cytologic features of squamous cell carcinoma in ThinPrep specimens are well known, whether these features are different in cases that are easily identified than in cases that are more difficult to identify is not known. OBJECTIVE To determine the cytologic features of squamous cell carcinoma in ThinPrep specimens that are easy to identify versus those that are difficult. DESIGN The cytologic features of 6 cases of squamous cell carcinoma that performed poorly in the College of American Pathologists Interlaboratory Comparison Program were compared with 14 cases that performed extremely well. RESULTS After evaluation of multiple criteria, 7 different cytologic features were analyzed based on review by a consensus panel blinded to the performance of the cases. The feature that was most strongly associated with cases that performed poorly was the presence of Trichomonas vaginalis (5/6 [83%] vs 0/14; P <.001). The presence of marked nuclear pleomorphism was more common in cases that performed well (4/14 [28%] vs 0/6; P =.27), but was not significant. The number of tumor cells, the number of normal cells, and the presence of keratinization, pleomorphism, nucleoli, and diathesis were not significant. The most common misdiagnosis after Trichomonas vaginalis was reparative change. CONCLUSIONS The presence of Trichomonas is characteristic of cases of squamous cell carcinoma in ThinPrep slides that are often misdiagnosed in this program. While Trichomonas is identified by participants in some of these cases, a significant percentage of participants interpreted the findings as reparative, without identifying the organism. These results emphasize the importance of distracting factors, whether identified or not, in evaluating gynecologic cytology.

Cytopathology of the pancreatobiliary tract–the agony, and sometimes, the ease of it

Pancreatic cytopathology is recognized as a rapid, reliable, safe and cost-beneficial modality of investigation of pancreatic mass lesions. Optimal cytodiagnosis depends on multiple factors including sample quality, and expertise of the cytopathologist and endoscopist. This article discusses key cytologic features of specific tumor types, specimen handling, differential diagnoses and pitfalls.