Ji-Weon Park

Cytomorphology, clinicopathologic, and cytogenetics correlation of myelomatous effusion of serous cavities: A retrospective review: MYELOMATOUS EFFUSION OF SEROUS CAVITIES

Myelomatous effusions (ME) of the serous cavities are rare. Identification of the atypical plasma cells in the body fluids may be critical for prognostic considerations.

Utility of core biopsy with concurrent ROSE FNA in the diagnosis of pancreatic tumor-does the biopsy add any diagnostic benefit?

Endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) and endoscopic ultrasound‐guided core‐needle biopsy (EUS‐CNB) are widely used for diagnosis of pancreatic tumors. The aim of our study was to compare the diagnostic performance of ROSE EUS‐FNA and EUS‐CNB for diagnosis of pancreatic malignancy during the same EUS.

Reactive histiocytic proliferation in the pleural fluid mimicking metastatic signet ring adenocarcinoma

Reactive nodular and diffuse histiocytic proliferations of mesothelial and non‐mesothelial lined sites have been sporadically reported in the literature. However, there is no cytologic literature describing this process. We report a case of reactive histiocytic proliferation mimicking a metastatic signet ring adenocarcinoma in pleural fluid from a 33‐year‐old white male. Ancillary studies such as immunohistochemistry should be used to elucidate the cell of origin and avoid diagnostic errors.

93 Unsatisfactory Pap Smears With Concurrent Human Papilloma Virus (HPV) Testing: One Institution’s Experience With Follow-up Cytologic, HPV, and Histologic Results

carcinoma (RCC), thought to arise mostly in the setting of hereditary leiomyomatosis-renal cell carcinoma syndrome (HLRCC) with germline mutation of fumarate hydratase (FH). Due to the aggressiveness of these tumors and frequent lack of ascertainable family history, these tumors may first present as metastases, which may be sampled for cytology. Nonetheless, cytologic features of FH-deficient RCC have not been reported. Herein, a total of eight cytologic samples from seven patients (two women and five men, 25–69 years old) with confirmed FH-deficient RCCs were identified and evaluated retrospectively. Cytology samples included three cases of malignant effusions (one pleural and two ascites), two direct renal aspirates, and one each aspirates of supraclavicular node, liver metastasis, and pleural/chest wall metastasis. Cytologic preparations were generally sparsely cellular but with striking, markedly enlarged malignant cells, presenting as small clusters and abortive papillae in a hemorrhagic and inflammatory background. Individual cells showed markedly enlarged, pleomorphic nuclei with prominent or macronucleoli and moderate amount of cytoplasm. On Diff-Quik-stained smears and cell blocks, cytoplasmic vacuolation, ranging from delicately flocculent to bubbly or vacuolated, was visible. Prominent, inclusion-like nucleoli with perinucleolar halos (hallmark of FH-deficient RCC) were visible, focally in every case, particularly on Pap stain and H&E cell block sections. In conclusion, in cytologic preparations, rudimentary features characteristic of FH-deficient RCC may be identified. While identified retrospectively here, we argue that with appropriate clinical correlation, especially with ascertainment of any syndromal stigmata as context, the cytomorphology is sufficiently distinctive to trigger recognition and confirmatory workup for this aggressive variant.

Schistosoma haematobium: A Delayed Cause of Hematuria

A 22-year-old African American man with recurrent episodes of gross hematuria for 6 months presented to the clinic for evaluation. A thorough history revealed that the patient emigrated from Mozambique to the United States 12 years ago. Urine culture was negative for a urinary tract infection. Cystoscopy revealed 4 lesions in the bladder. Biopsy of the bladder lesion revealed severe cystitis and Schistosoma haematobium. The patient later confirmed that he used to swim in rivers and streams back in Africa. He completed a course of praziquantel and his gross hematuria resolved.

Metastatic Signet-Ring Cell Carcinoma of the Bladder in Cerebrospinal Fluid.

Primary bladder signet‐ring cell carcinoma (SRCC) is extremely rare and associated with an aggressive course. To our knowledge, we describe the first metastatic bladder SRCC identified in cerebrospinal fluid (CSF). A 68‐year‐old male with 1 year history of primary bladder SRCC with spinal metastasis presented with multiple falls and loss of consciousness. Brain imaging showed high signal in the frontoparietal sulci and superior cerebellum. CSF analysis was significant for increased leukocytes with monocyte predominance while protein and glucose values were within normal range. There was a hypercellular population of pleomorphic tumor cells with signet‐ring morphology, similar to those seen in his diagnostic bladder biopsies. The signet‐ring cells were positive for cytokeratin 7 and 20 and negative for CDX‐2 and prostate‐specific antigen. The patients clinical condition rapidly deteriorated and he died less than a week after presentation. At autopsy, brain sections revealed signet ring cells in the meninges overlying the cerebrum, cerebellum, brainstem, spinal cord, and pituitary with superficial invasion of the brain parenchyma. No brain parenchymal lesions were present. This case illustrates a unique complication of primary bladder SRCC. Diagn. Cytopathol. 2017;45:73–76.

Vaginal fine-needle aspiration: A useful alternative to biopsy: VAGINAL FNA

Vaginal fine‐needle aspiration (FNA) is infrequently performed to assess palpable lesions. We perform the first multi‐institutional study to evaluate this procedure.

Cytomorphology and Clinicopathologic Correlation of the Recurrent and Metastatic Adult Granulosa Cell Tumor of the Ovary: A Retrospective Review.

Granulosa cell tumors (GCT) of the ovary are low grade tumor with a potential ability of late pelvic recurrences and distant metastases. However, there is sparse literature on the cytopathologic features of metastatic granulosa cell tumors (MGCT). Between 2000 and 2014, eight cases of MGCT were diagnosed by FNA. Clinical, cytologic, and histopathologic features were reviewed. The age ranged from 34 to 84 years. Metastases were found in abdominal wall (4 cases), pelvic mass (1 case), liver (2 cases), and lung (1 case). The time to metastasis ranged from 1 to 14 years. All cases were hypercellular, with both large and small overlapping cell clusters and individual cells. The cytologic features included: naked nuclei (8/8 cases), Call‐Exner bodies (2/8 cases), and prominent metachromatic stroma (3/8 cases). Moderate cytoplasm (4/8 cases) to scant delicate cytoplasm (4/8 cases) was seen. Cytoplasmic vacuoles were also noted (6/8 cases). N/C ratios were high although lower than small round cell tumors like lymphoma. Prominent, central nucleoli were also present (6/8 cases) as well as nuclear grooves (2/8 cases). Cell block was available in 3/8 cases and all were positive for inhibin immunostain. Histologic examination of the metastatic tissue confirmed MGCT. The important cytologic features of GCT like uniformity of tumor cells, nuclear grooves and Call‐Exner bodies are occasionally present in MGCT. Prominent nucleoli and many naked nuclei were frequent. Therefore, the accurate interpretation of cytologic findings of MGCT requires cytohistologic correlation and inhibin positivity to avoid unnecessary surgical interventions for diagnostic purposes. The possibility of late recurrence of GCT should be kept in mind. Diagn. Cytopathol. 2016;44:1058–1063.