Dimitrios Tamiolakis

EUS - Fine- Needle Aspiration Biopsy (FNAB) in the Diagnosis of Pancreatic Adenocarcinoma: A Review.

Solid masses of the pancreas represent a variety of benign and malignant neoplasms of the exocrine and endocrine tissues of the pancreas. A tissue diagnosis is often required to direct therapy in the face of uncertain diagnosis or if the patient is not a surgical candidate either due to advanced disease or comorbidities. Endoscopic ultrasound (EUS) is a relatively new technology that employs endoscopy and high-frequency ultrasound (US). EUS involves imaging of the pancreatic head and the uncinate from the duodenum and imaging of the body and tail from the stomach. It has been shown to be a highly sensitive method for the detection of pancreatic masses. It is superior to extracorporeal US and computed tomographic (CT) scans, especially when the pancreatic tumor is smaller than 2-3 cm. Although EUS is highly sensitive in detecting pancreatic solid masses, its ability to differentiate between inflammatory masses and malignant disease is limited. Endoscopic retrograde cholangiopancreatography (ERCP) brushing, CT-guided biopsies, and transabdominal ultrasound (US) have been the standard nonsurgical methods for obtaining a tissue diagnosis of pancreatic lesions, but a substantial false-negative rate has been reported. Transabdominal US-guided fine-needle aspiration biopsy (US-FNAB) has been used for tissue diagnosis in patients with suspected pancreatic carcinoma. It has been shown to be highly specific, with no false-positive diagnoses. With the advent of curvilinear echoendoscopes, transgastric and transduodenal EUS-FNAB of the pancreas have become a reality EUS with FNAB has revolutionized the ability to diagnose and stage cancers of the gastrointestinal tract and assess the pancreas. Gastrointestinal cancers can be looked at with EUS and their depth of penetration into the intestinal wall can be determined. Any suspicious appearing lymph nodes can be biopsied using EUS/FNAB. The pancreas is another organ that is well visualized with EUS. Abnormalities such as tumors and cysts of the pancreas can be carefully evaluated using EUS and then biopsied with FNAB. There are many new applications of EUS using FNAB. Researchers are looking to deliver chemotherapeutics into small pancreatic cancers and cysts. Nerve blocks using EUS/FNAB to inject numbing medicines into the celiac ganglia, a major nerve cluster, are now routinely performed in patients with pain due to pancreatic cancer. The aim of this study is to perform a review of the literature regarding the usefulness of EUS/FNAB in the diagnosis of pancreatic adenocarcinoma.

Apoptosis and cell proliferation correlated with tumour grade in peritoneal fluids of patients with serous ovarian cancer

A. Kalogeraki, I. Karvela‐Kalogeraki, P. E. Petraki, I. Zois, D. Tamiolakis and E. N. Stathopoulos 
Apoptosis and cell proliferation correlated with tumour grade in peritoneal fluids of patients with serous ovarian cancer

ERCC1 expression correlated with EGFR and clinicopathological variables in patients with non-small cell lung cancer. An immunocytochemical study on fine-needle aspiration biopsies samples

PURPOSE Expression of ERCC1 has not been well described in fine-needle aspiration biopsies (FNABs) in patients with non-small cell lung cancer (NSCLC). We investigated the expression of ERCC1 in correlation with EGFR expression and clinicopathological factors in patients with NSCLC in order to determine if these play a role in the prognosis of the disease. METHODS We studied 45 patients, 34 with adenocarcinoma and 11 with squamous cell carcinoma. Of these 45 patients, 35 were males and 10 females, aged between 45 and 83 years, 30 smokers and 15 non-smokers. Eighteen (18) tumors were of stage I, twelve (12) stage II and fifteen (15) stage III. To investigate the expression of ERCC1 and EGFR (scores 0, 1, 2, 3), immunocytochemistry was performed on air dried specimens (FNABs) using monoclonal antibodies by alkaline-phosphatase (APAAP) method. RESULTS ERCC1 expression was detected in tumors from 27 patients (60%) and EGFR in 10 patients (22.2%). ERCC1 was expressed more frequently in males (65.7%) in patients >65 years old (64%), in smokers (66.7%) and in stage I (66.7%). Negative ERCC1 expression was significantly associated with the presence of EGFR. EGFR was expressed only in adenocarcinomas and more frequently in women (70%) and non smokers (53.3%). CONCLUSIONS ERCC1 expression was identified as positive (scores 2+ and 3+) in the majority of NSCLCs and seems to be an independent prognostic marker of longer survival. In addition EGFR expression was positive (scores 2+ and 3+) in the minority of NSCLCs and only in adenocarcinomas, more frequently in ERCC1-negative (scores 0 and 1+) tumors, suggesting that it is not an independent prognostic marker for the outcome of the patients suffering from NSCLC.

Fine Needle Aspiration Biopsy (FNAB) in the Diagnosis of Hepatocellular Carcinoma: A Review.

Abstract Hepatocellular carcinoma (HCC) is the fifth more common cause of cancer and the third leading cause of cancer deaths worldwide. Despite advances in surgical and non surgical modalities in the treatment of HCC, a number of controversies regarding appropriate diagnostic procedures continue to evolve. A consensus statement from the European Association for the study of Liver Diseases (EASL) has been formulated to help clinicians standardize diagnostic approaches. In nodules greater than 2 cm diameter in size, diagnosis can be made if any 2 imaging studies (ultrasonography, computed tomography, magnetic resonance imaging or hepatic arteriography) show increased vascularity. Alternatively only one imaging study with an Alpha fetoprotein level more than 400ng/mL is diagnostic. Fine needle aspiration biopsy (FNAB) should be performed in cases of indeterminate radiology and in lesions sized between 1 and 2 cm. The aim of this review is to familiarize pathologists in the FNAB diagnosis of HCC in an appropriate and timely fashion.

Primary effusion lymphoma with aberrant T-cell phenotype in an iatrogenically immunosuppressed renal transplant male: Cytologic diagnosis in peritoneal fluid

Primary effusion lymphoma (PEL) is an unusual class of non‐Hodgkins lymphoma that develops in body cavities, without associated mass lesions. It has been linked to human herpes virus 8 (HHV‐8), an etiological factor of Kaposis sarcoma. Although PEL is a B‐cell lymphoma, the neoplastic cells are usually of the “null” phenotype by immunocytochemistry. The relative infrequency of this entity, the absence of wide casuistic allowing a better characterization, and its unfavorable outcome, strongly support the need of a deeper knowledge. We report the clinico‐biological findings of a 49‐year‐old male who was iatrogenically suppressed patient for 29 years because of renal transplantation. This case was diagnosed cytologically as peritoneal PEL and confirmed histologically on peritoneal biopsies. The immune status for both HHV‐8 and Epstein–Barr virus (EBV) was evaluated and showed positive immunostaining only for the former. The combination of the immunocytochemistry results with the existence of a clonal rearrangement in the immunoglobulin heavy chain gene (identified by PCR) was compatible with the diagnosis of PEL. The presence of T‐cell markers was consistent with the diagnosis of PEL with an aberrant T‐cell phenotype. Diagn. Cytopathol. 2015;43:144–148.

Schwannoma of right cerebellopontine angle. A cytologic diagnosis

Schwannomas affect mainly head and neck peripheral nerves, are benign tumors and derive from Schwann cells. Schwannoma of right cerebellopontine angle is extremely rare to diagnose by cytology. We report one such rare case presenting the cytological features in material obtained during the resection of the tumor. Case report: A 47-year-old female was diagnosed by MRI with a tumor of right cerebellopontine angle.. Cytologic material from the tumor was obtained intraoperatively and diagnosed cytologically as a neurilemoma. Conclusion: This case is presented here to focus the ability of cytology in diagnosis of schwannoma in intraoperative material of the tumor, using immunohistochemistry and confirmed by histology- immunohistochemistry.Schwannomas affect mainly head and neck peripheral nerves, are benign tumors and derive from Schwann cells. Schwannoma of right cerebellopontine angle is extremely rare to diagnose by cytology. We report one such rare case presenting the cytological features in material obtained during the resection of the tumor. Case report: A 47-year-old female was diagnosed by MRI with a tumor of right cerebellopontine angle.. Cytologic material from the tumor was obtained intraoperatively and diagnosed cytologically as a neurilemoma. Conclusion: This case is presented here to focus the ability of cytology in diagnosis of schwannoma in intraoperative material of the tumor, using immunohistochemistry and confirmed by histology-immunohistochemistry. (www.actabiomedica.it)

Recurrent Cerebellar Desmoplastic/Nodular Medulloblastoma in Cerebrospinal Fluid (CSF) in the Elderly. A Cytologic Diagnosis.

Abstract Desmoplastic medulloblastoma is a rare subtype of medulloblastoma in childhood and more rare in adults. Cerebrospinal fluid (CSF) occurrence is frequent and important for treatment and prognosis. We report the CSF cytologic features of recurrent desmoplastic/nodular medulloblastoma in a 30-aged male.

Cytology of Pericardial Effusion due to Malignancy.

Abstract Background. Malignant pericardial effusion occurs in one tenth of all cancers. It is a very serious disorder that is mainly a secondary process due to metastasis because primary neoplasms of the pericardium such as mesotheliomas, sarcomas being exceedingly rare. Pericardial effusions with a cardiac tamponade constitute a surgical emergency and the pericardiocentesis represents the first class therapeutic recommendation. Pericardial effusion specimens are uncommon and to the best of our knowledge the current study is the largest systematic evaluation of pericardial fluid cytology performed to date. Material and Methods. Pericardial effusion specimens from 145 patients collected over a 10 year period were studied by cytology and results were compared with pericardial histology results. The minimum pericardial fluid volume used for adequate cytologic diagnosis in these patients was more than 60 mL. Results. Cytological diagnosis revealed malignant pericardial exudates in 100% of the studied patients. There was no any false negative result in comparison with histology. Conclusions. Cytology provides an immediate and accurate means of diagnosis. Immunocytology is very important in the diagnostic evaluation.

Abdominal primary extra-gastrointestinal stromal tumor (E-GIST). A cytologic diagnosis in ascitic fluid.

Dear Editor, We present a case of a primary abdominal Extra-gastrointestinal stromal tumor (E-GIST) in a75 years old female patient. E-GISTs are rare, non-epithelial, mesenchymal tumors arising from the soft tissues of the abdomen - mesentery and retroperitoneum. These tumors are histologically and cytologically similar to the stromal tumors of gastrointestinal tract, composed of round or fusiform cells or a mixture of both in a myxoid background. The recognition of these tumors is important because of their aggressive biological behavior, the metastatic potential and the high rate of recurrence.

Familial mesothelioma in first degree relatives

Occupational asbestos exposure is believed to be the primary etiologic link to mesothelioma. However, in the evaluation of familial mesothelioma, it is important to consider the possibility of household exposure to asbestos. In this study, we report a family in which the father with prolonged occupational asbestos exposure developed malignant pleural mesothelioma and his daughter 14 years later mesothelioma in situ with focally early invasion. Several reports of familial aggregations of mesothelioma strongly support that genetic factors in collaboration with environmental exposure may contribute etiologically to an as yet unknown fraction of occurrence of this disease. Diagn. Cytopathol. 2013.