Ghassan Tranesh

High diagnostic accuracy of core needle biopsy of soft tissue tumors: An institutional experience

Core needle biopsy (CNB) has been suboptimal in the subclassification and grading of mesenchymal tumors. Recent advances in molecular diagnostics have shown promise in improving this area. The institutional experience with CNBs of soft tissue lesions on cytology cases and correlated histologic follow‐up has been evaluated. It also addressed the advantageous use of ancillary techniques, including immunohistochemistry and molecular studies.

Metastatic Chordoma: A Diagnostic Challenge on Fine Needle Aspiration

Chordomas are primary low grade malignant tumors of bone that usually arise within both ends of axial skeleton. The Notochord is a midline, ectoderm-derived structure that defines the phylum of chordates. Chordomas may pose difficult diagnostic challenges when encountered in secondary locations, such as lungs or other parenchymatous organs. We report the cytologic findings of a metastatic chordoma sampled through CT-scan guided fine needle aspiration (FNA) of lower lobe lung nodule in a 54-year-old man diagnosed with recurrent chordoma involving the lumber spine and paraspinal region.

Significance of finding benign endometrial cells in women 40–45 versus 46 years or older on Papanicolaou tests and histologic follow-up

Background: The 2014 Bethesda System recommends reporting the finding of benign-appearing, exfoliated endometrial cells on Papanicolaou (Pap) tests in women aged 45 years and older. We aimed to determine the significance of normal endometrial cells on liquid-based Pap tests in women aged 40 years and older and to correlate this finding with clinical factors and cytologic/histologic follow-up. Materials and Methods: We retrospectively identified all women aged 40 years and older who had benign endometrial cells (BECs) on Pap tests at our institution during a 6-year period. Histologic follow-up and outcomes were evaluated. Results: Among 18,850 Pap tests during the study period, 255 (1.4%) had findings of BECs and 159 (62.4%) of these women had follow-up Pap tests or subsequent tissue sampling by surgical procedures. Of the 159 cases, only 4 (2.5%) had significant endometrial pathologic processes, all endometrial endometrioid adenocarcinoma (three women had postmenopausal bleeding and 1 was perimenopausal with menorrhagia). No women between ages 40 and 45 years had significant pathologic findings and only one woman between 46 and 50 years (47 years) had an endometrial endometrioid carcinoma (1.5%). Women older than 47 years have higher odds (5.38) of having a significant endometrial lesion (P = 0.029) than those who are ≤47. Conclusion: Clinically significant endometrial lesions occurred predominantly in women older than 50 years (4.6%) and in only one woman between ages 46 and 50 years (1.5%). Therefore, endometrial sampling should be performed in women aged 47 years and older with BECs, especially when additional clinical indicators (e.g., postmenopausal bleeding) are recognized.

Metastatic Monophasic Synovial Sarcoma: A challenging Diagnosis on Fine Needle Aspiration with Broad Differential Diagnosis

Synovial sarcomas (SS) are rare soft tissue sarcomas that usually arise near large extremity joints. SS may pose difficult diagnostic challenges on cytology when encountered as a monophasic variant. We report a 27-year-old woman diagnosed with metastatic monophasic synovial sarcoma by a CT-scan guided fine needle aspiration (FNA) biopsy of a left lower lung lobe nodule. We reviewed the literature on the epidemiologic, cytohistological spectrum, immunophenotypic, and the molecular findings and discussed the differential diagnosis for this rare entity.

The Yield of Sputum Smear Direct Microscopy Using Ziehl-Neelsen Stain in Comparison with Lowenstein Jensen Culture on the Diagnosis of Pulmonary Tuberculosis in Tripoli-Libya

Background: In the developing countries, Tuberculosis is one of leading causes of morbidity and mortality. The detection and identification of Mycobacterium tuberculosis is considered a great challenge for clinical microbiologists. Albeit Ziehl-Neelsen (ZN) smear is being a rapid diagnostic tool for TB, the culture on Lowenstein Jensen (LJ) medium is considered the golden diagnostic tool for TB in the developing countries. Objectives: To evaluate the validity and reliability of ZN smear of acid-fast bacilli compared to the culture on LJ medium. Design and Settings: This study is the first in Libya which was conducted from January 2016 to December 2016 in the Administration of TB & Leprosy Control, National Centre for Disease Control, Libya. Patients and methods: The retrospective analytic comparative cross-sectional study included patients visiting TB OPD clinic at NCDC, including transferred patients from other healthcare facilities and hospitals. A total of 2783 specimen of suspected pulmonary TB cases were processed for both direct smear and culture. The direct smears were stained with ZN method (1% Carbolfuchsin, 3% Hydrochloric acid Ethanol and 0.1% methylene blue). Specimens were observed under 100-x oil immersion lens, whilst cultures were inoculated on LJ medium after digestion and decontamination of the clinical specimens. Results: Of total 2783 study subjects, 203 (7.29%) were smear positive while 327 (11.74%) were culture positive. Out of 203 smear positive pulmonary cases, 154 (47.094%) were found to be positive on LJ culture. A total of 2407 pulmonary cases were negative on the smear and LJ culture for Mycobacterium tuberculosis. Conclusion: This preliminary study indicated the low sensitivity of sputum smear direct microscopy for early diagnosis of TB, while culture on LJ remains the golden standard modality.

Metastatic prostatic stromal sarcoma: A challenging diagnosis on fine-needle aspiration with broad differential diagnosis

Prostatic stromal sarcomas (PSS) are rare solid organ mesenchymal sarcomas. PSS may pose difficult diagnostic challenges on fine needle aspiration biopsy. We report a 48-year-old man diagnosed with metastatic high grade prostatic stromal sarcoma by a CT-scan guided fine needle aspiration (FNA) biopsy of a right lower lung lobe nodule. We reviewed the literature on the epidemiologic, cyto-histological, and immunophenotypic findings and discussed the differential diagnosis for this rare entity.