Juan Xing

Cerebrospinal Fluid Cytology of Lyme Neuroborreliosis: A Report of 3 Cases with Literature Review

Lyme disease can affect the central nervous system causing a B-cell-predominant lymphocytic pleocytosis. Since most reactions to infection in the cerebrospinal fluid (CSF) are typically T-cell predominant, a B-cell-predominant lymphocytosis raises concern for lymphoma. We present 3 Lyme neuroborreliosis cases in order to illustrate the challenging cytomorphological and immunophenotypic features of their CSF specimens. Three male patients who presented with central nervous system manifestations were diagnosed with Lyme disease. The clinical presentation, laboratory tests, CSF cytological examination and flow-cytometric studies were described for each case. CSF cytology showed lymphocytic pleocytosis with increased plasmacytoid cells and/or plasma cells. Flow cytometry showed the presence of polytypic B lymphocytes with evidence of plasmacytic differentiation in 2 cases. In all cases, Lyme disease was confirmed by the Lyme screening test and Western blotting. In such cases of Lyme neuroborreliosis, flow cytometry of CSF samples employing plasmacytic markers and cytoplasmic light-chain analysis is diagnostically helpful to exclude lymphoma.

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Pilot Study to Evaluate the Utility of the ProCore Biopsy Needle for Lymph Node Sampling

Objective: The ProCore ultrasound biopsy needle, used primarily to obtain intra-abdominal tissue core biopsies, has not been widely used for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In this pilot study we evaluated the utility of the ProCore needle for sampling mediastinal or hilar lymph nodes during EBUS-TBNA. Design: Thirty-two patients were identified using both ProCore and conventional fine-needle aspiration (FNA) needles for sampling mediastinal or hilar lymph nodes (the study group). Another 33 patients underwent EBUS-TBNA using an FNA needle only (the control group). Specimen satisfactory rates were compared between the study and control groups. Aspirate smears and cell blocks were evaluated for the cellularity of lesional cells and bronchial contamination in a subset of patients in the study group. Results: Overall, the ProCore needle did not show additive value to specimen adequacy when comparing the satisfactory rates of the study and control groups (94 vs. 89%). The ProCore needle also did not procure significantly more lesional cells than the FNA needle. Conclusion: Our experience shows that the ProCore needle does not provide additive value when performing an FNA of mediastinal or hilar lymph nodes. The evaluation of more cases with this new technique is necessary to better determine the clinical utility of using ProCore during EBUS-TBNA.

Clinical Trial Cytology: Use of On-Site Evaluation of Small Biopsy and FNA Samples for Clinical Trials and Biomarker Research Studies: Clinical Trial Cytology

After increased requests for biopsies for clinical trials and biomarker research, the University of Pittsburgh Medical Center created a clinical trial research service that partnered pathology, radiology, and medicine to facilitate rapid on‐site evaluation (ROSE) of fine‐needle aspiration (FNA) and/or core needle biopsy (CNB) samples to confirm the presence of tumor in these studies.