Howard Her Juing Wu

The significance of “low‐grade squamous intraepithelial lesion, cannot exclude high‐grade squamous intraepithelial lesion” as a distinct squamous abnormality category in Papanicolaou tests

Early cytologic detection and treatment of high‐grade squamous intraepithelial lesion (HSIL) is critical to cervical cancer prevention. The term atypical squamous cells (ASC), cannot exclude HSIL (ASC‐H) was introduced in 2001 in the Bethesda System (TBS 2001) to define changes suggestive, but not diagnostic, of HSIL in the absence of unequivocal squamous intraepithelial lesion (SIL). Previous studies showed that women with ASC‐H cytology are at an increased risk of harboring underlying histopathologic HSIL. TBS 2001, however, did not address the significance of finding ASC‐H changes in a background of unequivocal low‐grade SIL (LSIL). There may be a tendency for cytologists to lump these changes with either LSIL or HSIL, depending on their level of comfort. In their laboratory, the authors have referred to these changes as “LSIL, cannot exclude HSIL” (LSIL‐H).

Comparison of 34βE12 and P63 in 100 consecutive prostate carcinoma diagnosed by needle biopsies

P63, a homologue of p53, was recently identified as a useful basal cell-specific marker. We compared the sensitivity and specificity of p63 with the widely used high-molecular-weight keratin 34βE12 for the diagnosis of prostate carcinoma in needle biopsies. We selected 100 consecutive prostate carcinoma diagnosed by needle biopsies with an adequate number of cancerous glands on the slide. We chose 1 representative hematoxylin and eosin-stained slide from each case and gave it a Gleason score. The same paraffin block was retrieved for 34βE12 and p63 stains. We compared staining patterns of 34βE12 and p63 on both malignant glands and benign glands and recorded basal cell density (percentage of basal cells with positive staining in the benign glands). The cases were divided into 3 groups according to the Gleason score: 5 to 6 (31 cases), 7 (46 cases), and 8 to 10 (23 cases). In 20 cases, focal and patchy staining in a basal cell distribution in malignant glands (range, 1%–20%; mean, 6.6%) was demonstrated (19 by both stains and 1 by 34βE12 only). In 1 case with a Gleason score of 9, the cancer cells, not the basal cells, were stained focally by p63 but not by 34βE12. Higher-grade tumors demonstrated higher numbers of malignant glands with basal cell staining (1.65% for Gleason 7, 1.26% for Gleason 8–10, compared with 0.42% for Gleason 5–6). The overall specificity of the absence of basal cell staining in the malignant glands for 34βE12 and p63 was 98.63% and 98.60%, respectively. In 17 cases, both stains revealed total absence of basal cell staining in some benign glands (range, 1%–10%; mean, 3.5%). The overall sensitivity in identifying basal cells in benign glands was 99.48% and 99.44% for 34β12 and p63, respectively. Basal cell density was higher for 34βE12 in comparison with p63 (92% vs. 87%). For diagnosing prostate carcinoma in the needle biopsies, p63 is as specific and sensitive ospitalHospital as as 34βE12 and therefore can be used as a complementary basal cell-specific stain for 34βE12 in difficult cases.

Can GEWF solution improve the retrieval of lymph nodes from colorectal cancer resections

CONTEXT Lymph node status is an important prognostic factor in colorectal cancer staging. OBJECTIVE To determine whether the use of GEWF solution (glacial acetic acid, ethanol, distilled water, formaldehyde) increases the yield of lymph nodes (LNs) from colorectal cancer specimens. DESIGN A prospective study investigated the usefulness of GEWF in identifying LN from colorectal cancer resection specimens. After standard formalin fixation, approximately half of the specimens were placed in GEWF solution, and the remainder were used as a control. The number of LNs, patient sex, length of specimen, site of the specimen, tumor staging, and the number of positive LNs were analyzed. The numbers of retrieved and metastasis-positive LNs were recorded and compared with specimens from the previous year, in which no GEWF solution was used. Residents were educated on the importance of LN status before the study. Data were analyzed using independent-sample t tests. The residents also completed a subjective survey at the conclusion of the study. RESULTS A total of 85 specimens, 45 (53%) with GEWF and 40 (47%) without GEWF, were examined by 11 residents. The mean number of retrieved LNs using GEWF was slightly higher than the control group (19.96 vs 18.30); however, there was no statistical significance (P = .53). The mean number of LNs from the current study (2004- 2005) is significantly higher than that from the previous year (2003-2004) (19.17 vs 11.51, P < .001). CONCLUSIONS GEWF did not increase the yield of LNs from colorectal cancer specimens. However, application of the guideline for a minimum of 12 LNs significantly increased the LN retrieval.

Fine-needle aspiration cytology of well-differentiated inflammatory liposarcoma: a case report with histologic follow-up.

Inflammatory liposarcoma is an unusual variant of well‐differentiated liposarcoma. We report on the fine‐needle aspiration (FNA) cytology findings of a retroperitoneal well‐differentiated inflammatory liposarcoma from a 63‐yr‐old white female. The smears showed numerous dispersed inflammatory cells, with the majority being reactive lymphoid cells and plasma cells. There were scattered, large, atypical cells containing multiple or hyperlobated nuclei with coarse chromatin and abundant ill‐defined cytoplasm. The large atypical cells, as well as the inflammatory cells, were also found within the fibrous tissue fragments. The follow‐up surgical resection of the tumor demonstrated a well‐differentiated inflammatory liposarcoma with coexistent dedifferentiated areas and lipoma‐like, well‐differentiated liposarcoma. With the appropriate anatomic and radiographic settings, the FNA cytology findings of abundant, reactive inflammatory cells and scattered, large, atypical tumor cells that are CD15‐, CD30‐, and cytokeratin‐negative are highly suggestive of a well‐differentiated inflammatory liposarcoma. Diagn. Cytopathol. 1999;20:229–232.