Simon Sung

Molecular testing on endobronchial ultrasound (EBUS) fine needle aspirates (FNA): Impact of triage

Endobronchial ultrasound (EBUS)‐guided fine needle aspiration (FNA) is performed to diagnose and stage lung cancer. Multiple studies have described the value of Rapid On‐Site Evaluation (ROSE), but often the emphasis is upon diagnosis than adequacy for molecular testing (MT). The aim was to identify variable(s), especially cytology‐related, that can improve MT.

Fine needle aspiration of pilomatrixoma: Cytologic features on thinprep and diagnostic pitfalls

Dear Editor, Pilomatrixoma (Px) or calcifying epithelioma of Malherbe is composed of basaloid cells and squamoid cells with ghost nuclei (shadow cells) within a cellular stroma, calcium deposits, and multinucleated giant cells. Sampling certain components can lead to diagnostic misinterpretation. Moreover, given the rarity of cytologic specimens and widespread use of liquid-based preparations (LBP), awareness of the cytology of Px and diagnostic pitfalls is important. Herein, we compare cytomorphologic features of Px on ThinPrep [(TP), Hologic Inc. Boxborough, MA] with CS in a case series. Furthermore, we review the differential, diagnostic pitfalls, and ancillary testing for Px in cytologic specimens. A retrospective search of the New York Presbyterian-Weill Cornell Medicine archival pathology database from 2007 to 2016 yielded 113 histologic Px specimens. Six cases had pre-operative cytology (5.4%) and one had a concurrent preoperative biopsy. The mean age was 24.1 years (range 3 months–70 years) with a male:female ratio of 1.5:1. Fine-needle Aspiration (FNA) with a 25-gauge needle was processed as one air-dried Diff-Quik (DQ) stained and one alcohol-fixed Papanicolaou (Pap) stained CS. Residual specimen when collected in CytoLyt (Hologic Inc., Boxborough, Massachusetts) was processed as one Papstained TP and one hematoxylin and eosin (H&E)-stained cell block (CB) slide. Four cases had CS and TP, one had CS only and one had TP only. Four cases were diagnosed as Px, one case was diagnosed as an inflamed epidermal inclusion cyst and one case was diagnosed as “suspicious for squamous cell carcinoma (SCC).” Immunohistochemistry was performed on CB material with anti-b-catenin monoclonal antibody (14; BD 610154) as per manufacturer instructions. The DQ and Pap smears showed high cellularity with mostly ghost cells in syncytia, single cells and clusters with dense, orangeophilic

Adult exogenous lipoid pneumonia: A rare and underrecognized entity in cytology – A case series

Background: Exogenous lipoid pneumonia (ELP) is a rare benign entity without specific clinical or imaging presentation. Although cytological studies – either bronchoalveolar lavage (BAL) or fine-needle aspiration (FNA) – may be pursued in patients with ELP, a definitive diagnosis is frequently rendered only on histology. The aim of this study is to highlight the cytological features of ELP. Methods: A search of cytopathology (CP) and surgical pathology (SP) diagnoses of ELP was conducted. The corresponding clinical and imaging features were obtained, and the morphology, particularly the presence and size of the intracytoplasmic vacuoles and background, was assessed. Results: Nine cases of ELP were identified, including eight with corresponding CP and SP. A neoplasm was suspected in three based on imaging, but ELP was not in the differential clinically or radiographically in any. Among the cases, six patients had BALs and three FNAs. All of the samples showed multiple large vacuoles within macrophages with at least some equal to or larger than the size of the cell nucleus. Similar vacuoles were noted extracellularly on smears. Conclusions: ELP is typically described in case reports in the clinical or radiological literature. To the best of our knowledge, this represents the largest series of adult ELP in CP. When large vacuoles are present in macrophages in cytology specimens, at least a suspicion of ELP can be suggested to initiate appropriate therapy, identify/remove the inciting agent, and preclude a more invasive procedure.