Jimmie Stewart

Virtual microscopy: An educator's tool for the enhancement of cytotechnology students' locator skills

Virtual microscopy (VM) is being utilized as an educational tool in many areas of pathology. The aim of this study is to analyze the locator and diagnostic skills of cytotechnology students by using the Aperio T3 ScanScope®, and examine VMs viability as an educational tool in cytotechnology.

Virtual microscopy for cytology proficiency testing: are we there yet?

The objective of this study was to investigate the potential of virtual microscopy (VM) as an avenue for the delivery of mandatory cytology proficiency tests).

Added value, decreased cost: The evolving role of the cytotechnologist for preliminary screening and triage of thyroid aspirates

Immediate adequacy assessment for thyroid fine‐needle aspirations (FNAs) is standard practice in many cytopathology laboratories. A pathologist is usually present for these time consuming assessments. The purpose of this 5 month study (January 2008–May 2008) was to show that cytotechnologists can accurately provide the majority of immediate adequacy assessments for thyroid FNAs, saving both time and money for pathologists, clinicians, and patients. The study consisted of 167 thyroid nodule FNAs performed in twice weekly thyroid FNA clinics. A comparison was made of the immediate assessments by five participating cytotechnologists and the preliminary and final diagnoses by three pathologists. The cytotechnologist prepared the slides, assessed the air‐dried Hema‐Diff™ stained slides for adequacy, and the pathologist viewed the slides remotely via real‐time video streaming. Results were recorded in an Excel spreadsheet. There was a discordance rate of 1.2% when comparing the cytotechnologists adequacy interpretation and the pathologists preliminary diagnosis; both clinically insignificant. By cytotechnologist assessment, 79.0% of the cases were benign and 6.6% were nondiagnostic. 14.4% of the cases were assessed as cellular nodule or neoplastic lesion; all requiring pathologists preliminary diagnosis. Utilizing a cytotechnologist to provide adequacy, instead of a pathologist, saved

Kaposi sarcoma herpesvirus/human herpesvirus-8-negative effusion-based lymphoma: report of 3 cases and review of the literature.

464.10/case (2.38 passes/case) based on current gross technical and professional charges. On the basis of our findings, cytotechnologists can accurately provide immediate onsite adequacy assessments for thyroid nodule FNAs. Affording cytotechnologists the opportunity to preliminarily assess FNAs for adequacy also creates a new role in the laboratory. Furthermore, cost‐savings are realized for patients and the health care system. Diagn. Cytopathol. 2011.

Alveolar soft part sarcoma presenting as a breast mass in a 13-year-old female

Primary effusion lymphoma (PEL) is a rare subtype of large B‐cell lymphoma that arises in body cavities without detectable tumor masses. PEL is universally associated with Kaposi sarcoma herpesvirus (KSHV)/human herpesvirus‐8 (HHV8). Despite overlapping features, KSHV/HHV8‐negative effusion‐based lymphoma is a distinct entity from PEL. To date, 52 cases have been reported. The authors report 3 additional cases received in their laboratory from 2007 to 2012.

Fine-Needle Aspiration Cytology of Thyroid Nodules with Hürthle Cells: Cytomorphologic Predictors for Neoplasms, Improving Diagnostic Accuracy and Overcoming Pitfalls

Adolescent patients with breast lesions represent a unique population of patients whose differential diagnoses differ from adults. We report a clinically unsuspected case of alveolar soft part sarcoma (ASPS) presenting in the breast of a 13‐year‐old female. ASPS is a rare neoplasm that is usually present in the head, neck, or lower extremities. This rare case presentation gives us the opportunity to review the differential diagnosis of adolescent breast lesions. We also will review diagnostic features of ASPS on fine‐needle aspiration. These are relatively rare disease processes about which many cytopathology professionals may be unfamiliar. Diagn. Cytopathol. 2009.

Pancreatic involvement by metastasizing neoplasms as determined by endoscopic ultrasound-guided fine needle aspiration: A clinicopathologic characterization

Objectives: Hürthle cells (HCs) are follicular-derived oncocytic cells seen in a variety of neoplastic and nonneoplastic pathologic entities of the thyroid gland. This study was to report our experience of the surgical outcome on the finding of HCs on fine-needle aspiration biopsies (FNABs) of thyroid nodules, to identify cytologic predictors of HC neoplasms and an attempt to overcome diagnostic pitfalls. Study Design: This was a retrospective study of all FNAB of thyroid nodules with findings of HCs with subsequent surgical resection. The FNAB slides of 70 thyroid nodules were blindly reviewed for specific cytomorphologic characteristics. The cytologic findings were correlated with the corresponding final surgical pathology diagnosis. Results: The patients ranged in age from 25 to 78 years with a male:female ratio of 1:2. There were 19 false-negative and 4 false-positive cases. Overall high cellularity, scant colloid and >90% HCs on FNAB are consistently seen in a neoplastic HC process. All cases of Hashimotos thyroiditis were associated with prominent nucleoli and 92% of cases demonstrating transgressing vessels were neoplastic. Conclusion: Diagnostic accuracy can be improved by following the current Bethesda classification system. A constellation of cytomorphologic features in conjunction with clinical findings can be considered a strong predictor of a neoplastic process.

Cytopathologic diagnosis of esophageal glomus tumor presenting as an incidental posterior mediastinal mass in an 80-year-old male

Pancreatic tumors often represent primary neoplasms, however organ involvement with metastatic disease can occur. The use of endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) to determine the underlying pathology provides guidance of clinical management.

Pneumocystis jirovecii in a bronchoalveolar lavage specimen on ThinPrep® cytology.

Endoscopic ultrasound guided fine‐needle aspiration (FNA) of the upper gastrointestinal tract presents a diagnostic challenge to cytopathologists due to the broad differential diagnosis and morphologic overlap between various entities in this location. We report here an incidentally discovered case of esophageal glomus tumor presenting as a posterior mediastinal mass in an 80‐year old male. Glomus tumor is a rare soft tissue neoplasm with bland epithelioid morphology and cytoplasmic granularity. Literature review reveals only 6 published cases of esophageal glomus tumor in the general pathology literature. To our knowledge, this is the first report in the English literature to describe FNA cytology of an esophageal glomus tumor. This rare case presentation provides the opportunity to review the differential diagnosis for lesions of the upper gastrointestinal tract and their appearance on FNA in order to clarify an entity that is uncommon in everyday cytology practice. Diagn. Cytopathol. 2014;42:705–710.

Efficacy of endoscopic-guided fine-needle aspiration in the diagnosis of gastrointestinal spindle cell tumors

A 79-year-old female was seen for respiratory failure and autoimmune hemolytic anemia. She had a hip replacement 6 months prior to admission and had not been feeling well since. Approximately 4 months prior, she was found to have autoimmune hemolytic anemia, specifically cold agglutinin disease, for which she was placed on prednisone and rituximab. A month later, she developed a deep vein thrombosis and subsequent pulmonary embolus and was placed on warfarin. A CT scan on admission showed nodular opacities in the right lung. A bronchoalveolar lavage (BAL) was performed and processed using ThinPrep liquid based technology, which was negative for malignancy, but contained collections of organisms morphologically consistent with Pneumocystis jirovecii (Fig. C-1). Concurrent samples for calciflour white and toluidine blue were also positive for Pneumocystis jirovecii (Figs. C-2 and C-3). Pneumocystis was long thought to be a protozoan. DNA studies in the late 1980’s and early 1990’s determined Pneumocystis to be a fungus that is species specific; thus the name was changed to P. jirovecii in honor of Otto Jiroveci, who first described the human form. Pneumocystis pneumonia (PCP) increased significantly in the early 1980’s and was found to be associated with HIV. PCP has been the most common AIDS-defining opportunistic infection in the US. In the late 1990’s, highly active antiretroviral therapy (HAART) became available for HIV-positive patients and the number of cases of Pneumocystis infections dropped significantly. The incidence of PCP in non-HIV patients has historically been rare, but is often more severe. Due to increased use of immunosuppressive and chemotherapeutic agents, there have been increased numbers of reported cases in the recent literature. However, this increase may be offset by the use of PCP prophylaxis. Thus, the true incidence is difficult to determine. PCP is more likely found in bronchial washings, which sample the distal bronchial and alveolar spaces with diagnostic yield reported to be 82–94%. In BAL specimens, foamy alveolar casts can be identified and typically show clusters of organisms that are spherical to ovoid with a smooth contour. There is a frothy or bubbly appearance to the cast, which ultrastructurally is due to filopodia connecting the organisms. Although a variety of routine stains have been reported to visualize Pneumocystis in BAL specimens, including Giemsa, Wright, Gram, Hematoxylin, and eosin, the casts can be readily identified with Papanicolaou stain. Additionally, organisms stained by the Papanicolaou method give a distinct yellow-green fluorescence when viewed under ultraviolet light. The background in BAL specimens is typically clean. Potential mimics of P. jirovecii include erythrocytes, mucus, keratin, or Candida species in which case Grocott methenamine silver (GMS) may be helpful. In spite of the vigorous mixing in automated ThinPrep slide processing, these alveolar casts remained intact in this case.