Esther Diana Rossi

Simultaneous immunohistochemical expression of HBME-1 and galectin-3 differentiates papillary carcinomas from hyperfunctioning lesions of the thyroid

Aims : The histological diagnosis is critical for the postsurgical management and follow‐up of thyroid malignancies. The differential diagnosis between papillary carcinoma and hyperfunctioning lesions, either with papillary hyperplasia or with a follicular architecture, can create real diagnostic difficulty. The aim of this study was to evaluate the expression of several antibodies considered to be markers of malignancy in malignant and hyperfunctioning thyroid neoplasms and to include the most effective of them in a diagnostic panel.

A meta-analytic review of the Bethesda System for Reporting Thyroid Cytopathology: Has the rate of malignancy in indeterminate lesions been underestimated?

The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) provides a 6‐tier diagnostic framework using uniform criteria in reports of thyroid aspirates. One of the major advantages of this framework is its association with defined risks of malignancy, allowing standardized management algorithms for each diagnosis. The objective of the current meta‐analysis was to demonstrate the feasibility of using TBSRTC among specimens in the atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) and follicular neoplasm or suspicious for neoplasm (FN/SFN) categories. The authors also evaluated both the morphologic features and the risk of malignancy in the presence of Hurthle cells.

Thyroid fine needle aspiration cytology processed by ThinPrep: an additional slide decreased the number of inadequate results.

E. D. Rossi, F. Morassi, G. Santeusanio, G. F. Zannoni and G. Fadda 
Thyroid fine needle aspiration cytology processed by ThinPrep: an additional slide decreased the number of inadequate results

Diagnostic efficacy of conventional as compared to liquid-based cytology in thyroid lesions. Evaluation of 10,360 fine needle aspiration cytology cases

OBJECTIVE To evaluate the efficacy of thyroid fine needle aspiration cytology (FNAC) processed by liquid-based cytology (LBC) as compared to conventional smears (CS) in 10,360 consecutive cases in 3 reference periods. STUDY DESIGN In 1997-1998, 2,394 FNACs had CS; in 2001-2002, 3,463 had both CS and LBC; and in 2004-2005, 4,503 had only LBC. Three arbitrary parameters of efficacy were chosen to compare the two different methods: rate of inadequacy (IR), rate of indeterminacy (INDR) and rate of malignancy (MR). In the same biennia 6,184 thyroidectomy specimens were examined. RESULTS IR was, respectively, 8.4% in 1997-1998, 18.4% in 2001-2002 and 13.3% in 2004-2005. MR was respectively 2.2%, 2.5% and 2.2%. INDR was 16.6% in 1997-1998, 23.3% in 2001-2002 and 15.9% in 2004-2005. In each biennium, respectively, 16.9%, 27.6% and 28% of malignant neoplasms were histologically diagnosed. CONCLUSION LBC was used as an alternative method in the cytologic diagnosis for the preoperative selection of thyroid neoplasms, decreasing indeterminate diagnoses without MR changes.

Analysis of immunocytochemical and molecular BRAF expression in thyroid carcinomas: A cytohistologic institutional experience

It has been generally demonstrated that the valine‐to‐glutamic acid substitution at position 600 (V600E) in the v‐Raf murine sarcoma viral oncogene homolog B1 (BRAF) gene is an effective diagnostic/prognostic marker mainly for papillary thyroid carcinoma (PTC). The detection of this mutation typically has been achieved using DNA‐based techniques. The recently introduced monoclonal V600E antibody (clone VE1) is likely to be an alternative strategy for detecting this mutation in thyroid lesions. The authors investigated molecular and immunocytohistochemical BRAF analyses in a prospective series of samples from patients with PTC.

Evaluation of hilar biliary strictures by using a newly developed forward-viewing therapeutic echoendoscope: preliminary results of an ongoing experience

BACKGROUND Obtaining a definitive tissue diagnosis in patients with hilar biliary strictures (HBS) is often difficult. OBJECTIVE To describe our experience using a newly developed forward-viewing linear echoendoscope (FVL-EUS) with FNA as a primary diagnostic tool in patients with HBS. DESIGN Case series. SETTING A tertiary care, academic medical center. PATIENTS Four patients with HBS who underwent the procedure. MAIN OUTCOME MEASUREMENTS Performance of FNA with the FVL-EUS. RESULTS Visualization and puncture of the primary lesion with a definitive tissue diagnosis was obtained in all of the 4 cases performed. Metastatic hilar cholangiocarcinoma and recurrent neuroendocrine tumor were diagnosed in 2 patients and followed by placement of a self-expandable metal stent, when possible. In the other 2 patients, a diagnosis of resectable hilar cholangiocarcinoma and poorly differentiated adenocarcinoma of unclear origin without evidence of vascular involvement was made, and plastic stents were placed before surgery; the first patient was found to have peritoneal metastases, and resection was aborted, and in the second patient, a gallbladder tumor was diagnosed in the surgical specimen. LIMITATION The small number of patients. CONCLUSIONS These preliminary data suggest that FVL-EUS used as a primary tool for the evaluation of patients with HBS may be of value and should be further explored in properly designed studies with a meaningful number of patients.

The impact of FNAC in the management of salivary gland lesions: Institutional experiences leading to a risk-based classification scheme

Fine‐needle aspiration cytology (FNAC) has proven its value as an essential step in the diagnosis of salivary gland lesions. Although the majority of salivary gland lesions, especially those that are common and benign, can be diagnosed with ease on FNAC, limited cellularity and morphologic lesion heterogeneity can pose diagnostic challenges and lead to false‐positive and false‐negative diagnoses. This study presents the institutional experience of FNAC of salivary gland lesions from 2 academic centers.

The role of liquid-based cytology and ancillary techniques in pleural and pericardic effusions: An institutional experience

Fine‐needle aspiration cytology (FNAC) of serous membrane effusions may fulfil a challenging role in the diagnostic analysis of both primary and metastatic disease. From this perspective, liquid‐based cytology (LBC) represents a feasible and reliable method for empowering the performance of ancillary techniques (ie, immunocytochemistry and molecular testing) with high diagnostic accuracy.

Granular cell tumour on conventional cytology and thin-layer smears

Granular cell tumour (GCT) is an uncommon neoplasm first described in 1926 as granular cell myoblastoma, occurring anywhere in the body, including the breast subcutis, although the tongue is the most common anatomical site. The histogenesis of this tumour is still controversial but its distinctive morphological picture and its marked S-100 cytoplasmic positivity favour the theory of the neural or neuroectodermal origin. GCT generally pursue a benign course, although they may be clinically misdiagnosed as breast cancers. GCT have a distinctive cytological appearance, so fine needle aspiration cytology (FNAC) has been suggested as an effective method for an accurate diagnosis even if some reports focus on the difficulties in the cytological differential diagnosis with other malignant epithelial neoplasms, especially breast carcinoma. A 58-year-old woman underwent an FNAC on a superficial hypoechoic firm 1.2 cm mass of the right breast, which increased very slowly in size and without regional lymphadenopathy. Two consecutive manual guidance aspirations were made with material equally divided between conventional slides (CS) and a thin layer cytology (TLC) vial. The material for the CS was fixed in 95% ethyl alcohol and the TLC material was stored in the Cytolit solution (Cytyc Co., Marlborough, MA, USA) which is haemolytic and fixative at the same time; both were stained with Papanicolaou. The remnant aspirated material was stored in the preservative solution Preservcyt(Cytyc Co., Marlborough, MA, USA) to be used for immunocytochemistry (ICC). ICC stains were carried out on the TLC slides using antibodies against cytokeratins (CAM 5.2), CD68 and S-100. The cytological picture (Figures 1 and 2) showed, most prominent in the TLC slide, a marked cellularity with a uniform population of round plump cells with granular cytoplasms, central round nuclei with fine nuclear chromatin and eccentrically located nucleoli. No mitotic figures or necrosis were detected. The immunocytochemical stains, carried out on the TLC slides, were strongly positive for S-100 (Figure 3) and negative for CD68 and CAM 5.2, confirming the diagnosis of GCT. The patient underwent a wide local resection of the tumour for a definitive diagnosis: a frozen section was performed to confirm the diagnosis and the resected breast specimen was histologically diagnosed as benign GCT. The immunohistochemical stains confirmed the diagnosis and 2 years after surgery the patient is doing well and is free of recurrence. The cytological finding of round cells with abundant granular cytoplasm either isolated or in small clusters encompasses a number of differential diagnoses. Benign differential diagnoses include Whipple’s disease, atypical infectious diseases, fat necrosis and reactive postoperative granuloma. In the breast region, apocrine metaplasia, lactating adenoma, fibrocystic changes and apocrine carcinoma should also be considered. Neoplastic entities in the differential diagnosis of GCT include rhabdomyomas, alveolar soft part sarcoma, metastatic renal cell carcinoma and apocrine breast carcinoma which often looks like GCT cells, so immunocytochemical stains may significantly help. A definitive diagnosis of breast GCT is rarely made prior to the histological examination because of the similarity to breast cancer, although there are reports that FNAC is effective in making a correct diagnosis. If Correspondence: Guido Fadda, MD, Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Largo Francesco Vito, 1-00168 Rome, Italy. Tel.: +3906 3015 4433; Fax: +3906 3015 5883; E-mail: guidofadda@rm.unicatt.it

Diagnostic Approach to Fine Needle Aspirations of Cystic Lesions of the Salivary Gland

Fine needle aspiration (FNA) has diagnostic and therapeutic value in the management of salivary gland cysts. Rendering an accurate diagnosis from an aspirated salivary gland cyst is challenging because of the broad differential diagnosis, possibility of sampling error, frequent hypocellularity of specimens, morphologic heterogeneity, and overlapping cytomorphology of many cystic entities. To date, there have been no comprehensive review articles providing a practical diagnostic approach to FNA of cystic lesions of salivary glands. This article reviews the cytopathology of salivary gland cysts employing 2017 World Health Organization terminology, addresses the accuracy of FNA, and presents The Milan System approach for reporting in cystic salivary gland cases. The utility of separating FNA specimens from salivary gland cysts, based upon the presence of mucin and admixed lymphocytes in cyst fluid is demonstrated. A reliable approach to interpreting FNA specimens from patients with cystic salivary gland lesions is essential to accurately determine which of these patients may require subsequent surgery.