Koray Ceyhan

The diagnostic value of on‐site cytopathological evaluation and cell block preparation in fine‐needle aspiration cytology of liver masses

Objective:  The aims of this study were to evaluate the typing accuracy of conventional smear (CS), cell block (CB) preparations and combined use of both procedures (CS + CB) for the diagnosis of hepatic malignancies and to determine whether immediate on‐site cytopathological evaluation improves the diagnostic yield of liver fine‐needle aspiration cytology (FNAC).

Atypical presentation of hepatocellular carcinoma: a mass on the left thoracic wall

BackgroundHepatocellular carcinoma is a common malignancy for which chronic hepatitis B infection has been defined as the most common etiologic factor. The most frequent metastatic sites are the lung, bone, lymphatics, and brain, respectively. Metastases to the chest wall have been reported only rarely.Case presentationWe report a patient with hepatocellular carcinoma who presented with an isolated metastatic mass on the left anterolateral chest wall in the axillary region.ConclusionsMetastasis of HCC should be included in the differential diagnosis of rapidly growing lesions in unusual localizations, particularly in patients with chronic liver disease even if a primary tumor can not be radiologically identified.

Rapid on-site evaluation and low registration error enhance the success of electromagnetic navigation bronchoscopy.

BACKGROUND: Electromagnetic navigation bronchoscopy (EMN) is a novel technology which allows localizing peripheral lung lesions and mediastinal lymph nodes for sampling and thus increasing diagnostic yield of Flexible Bronchoscopy. OBJECTIVES: A prospective study was conducted to investigate the diagnostic yield of EMN with lower average fiducial target registration error (AFTRE) and rapid on-site evaluation (ROSE). METHODS: Consecutive patients with peripheral lung lesion (PL) or enlarged mediastinal lymph node (MLN) which could not be diagnosed by conventional techniques and/or if the patients were not suitable for such interventions were included. The navigation procedure was continued once registration error was reached below/equal to the absolute value of 5 mm. ROSE was performed by an expert cytopathologist. RESULTS: A total of 76 patients; 22 having only PLs, 41 having only MLNs, and 13 having both PLs and MLNs together were enrolled. Thirty-two of 35 PLs (91.4%) and 85 of 102 MLNs (83.3%) were successfully sampled. Overall diagnostic yield was 89.5%. PLs and MLNs were further grouped according to their size (PLs: <20 mm vs ≥20 mm, MLNs: <15 mm vs ≥15 mm). The sampling yield was independent of size for both PL and MLN (P = 1.00, P = 0.38). In diagnostic EMN cases, mean AFTRE was 4.33 ± 0.71 mm, whereas it was 5.16 ± 0.05 mm (P = 0.008) in nondiagnostics. The total duration of procedure was 36.17 ± 9.13 min. Pneumothorax was observed in three patients (3.9%). CONCLUSION: EMN with low AFTRE in combination with ROSE is a reliable method with high sampling and/or diagnostic rate in PLs and MLNs.

Congenital absence of portal vein associated with nodular regenerative hyperplasia of the liver and pulmonary hypertension

We present a 15-year-old girl with congenital absence of the portal vein, pulmonary arterial hypertension and multiple liver lesions proven to be nodular regenerative hyperplasia with biopsy. Ultrasonography, computed tomography, and magnetic resonance imaging findings of the liver lesions and Type I portosystemic shunt are presented.

Intrathyroidal Ectopic Thymus in Children Retrospective Analysis of Grayscale and Doppler Sonographic Features

The purpose of this study was to define grayscale and color Doppler sonographic features of an ectopic intrathyroidal thymus and to differentiate it from other thyroid nodule etiologies.

Acute suppurative thyroiditis following fine‐needle aspiration biopsy in an immunocompetent patient

The thyroid gland is remarkably resistant to infectious agents owing to several protective mechanisms. Acute suppurative thyroiditis after fine‐needle aspiration (FNA) in an immunocompetent patient is very rare. We report the case of a 50‐year‐old immunocompetent male patient who presented with painful cervical swelling, fever, and chills after an FNA of the thyroid. His physical and laboratory examination suggested an acute suppurative thyroiditis. Repeat FNA results were consistent with thyroid abscess. Physicians should be aware of the probability of acute bacterial thyroiditis after FNA.

Electromagnetic navigation‐guided TBNA vs conventional TBNA in the diagnosis of mediastinal lymphadenopathy

Conventional transbronchial needle aspiration (C‐TBNA) is a safe method for the diagnosis of hilar and mediastinal lymphadenopathy (MLN). However, diagnostic yield of this technique varies considerably. Electromagnetic navigation bronchoscopy (ENB) is a new technology to increase the diagnostic yield of flexible bronchoscopy for the peripheral lung lesions and MLN. The aim of this prospective study was to compare the diagnostic and sampling success of ENB‐guided TBNA (ENB‐TBNA) in comparison with C‐TBNA while dealing with MLN.

Radiologic-pathologic conference of the University of Ankara Medical School: metaplastic breast carcinoma with osteochondrosarcomatous differentiation.

5Department of Surgery, Ankara University Medical School, Ankara, Turkey. 75-year-old woman presented with a 6-month history of painless palpable mass in her right breast. Mammography revealed a 4-cm oval calcified mass in the upper outer right breast (Figs. 1A and 1B). A second 1cm lobulated mass was detected in the 12o’clock region. The patient underwent incisional biopsy of the palpable mass, which revealed invasive ductal cancer with osteochondrosarcomatous differentiation (Fig. 1C). Chest radiography and a bone scan were negative for distant metastasis. The patient underwent a right mastectomy. Histopathologic evaluation revealed a second 1.5cm focus of osteochondrosarcomatous metaplastic cancer in the 12-o’clock position in addition to residual metaplastic cancer at the A

Multinodular hydropic leiomyoma of the uterus with perinodular hydropic degeneration and extrauterine extension

Multinodular hydropic leiomyoma (MHL) of the uterus is one of the rarest variants of uterine leiomyomas and can create some diagnostic problems. Only five cases have been reported previously. We describe an MHL with perinodular hydropic degeneration in a 48‐year‐old woman. Gross examination revealed a large and predominantly intramural, edematous multinodular uterine tumor and extrauterine, small grape‐like nodules overlying the lateral surface of the uterine serosa. Histologically, the tumor was composed of extra‐intrauterine benign, small smooth muscle nodules with perinodular hydropic degeneration, prominent intramural dissecting growth pattern, and satellite nodules closely resembling vascular invasion. Immunohistochemically, these cells stained for desmin, smooth muscle actin and vimentin. The patient had no evidence of disease for 18 months after hysterectomy. Multinodular hydropic leiomyoma is a clinically benign tumor and should not be confused with intravenous leiomyomatosis and some other unusual leiomyoma variants.

Cytopathologic features of pituitary carcinoma with cervical vertebral bone metastasis : A case report

BACKGROUND Pituitary carcinomas are extremely rare tumors of the adenohypophysis. The presence of craniospinal and/or systemic extracranial metastases is the only reliable criterion for the diagnosis of pituitary carcinoma. To date, only 2 cases have been reported correctly by fine needle aspiration biopsy (FNAB). We present an additional case of pituitary carcinoma with FNAB features. CASE A 60-year-old woman presented with clinical features of Cushings disease and a pituitary tumor. She underwent transsphenoidal resection of the tumor. The initial diagnosis was an adrenocorticotrophic hormone (ACTH)-producing invasive pituitary adenoma. The patient presented again with neck pain 6 years after the operation. Magnetic resonance imaging revealed metastatic tumor masses at the level of C5-C6 of the cervical vertebrae. Intraoperative fine needle aspiration and incomplete excision of metastatic tumors were performed. Cytologically, tumor cells were composed of a combination of loose groups and single cells. Neoplastic cells had a relatively monotonous appearance and displayed characteristic neuroendocrine tumor features. Immunocytochemistry from cell block sections revealed AE1/ AE3, synaptophysin chromogranin A and ACTH positivity in the tumor cells. CONCLUSION Pituitary carcinoma with extracranial systemic metastases demonstrates typical neuroendocrine features on fine needle aspiration. In the differential diagnosis, metastatic neuroendocrine carcinomas should be kept in mind. In the absence of sufficient clinical data, these 2 entities cannot be distinguished correctly through the cytologic features.