Swati Mehrotra

The value of the UroVysion® FISH assay in the risk-stratification of patients with “atypical urothelial cells” in urinary cytology specimens: The Value of the UroVysion® FISH Assay

The aim of this study was to evaluate the potential use of the UroVysion® fluorescent in situ hybridization test (U‐FISH) to stratify the risk of urothelial carcinoma (UC) in patients with a diagnosis of “atypical urothelial cells” (AUC) in urinary tract cytology (UTCy).

Vanishing prostate cancer on radical prostatectomy (RP) in the PSA era: incidence and follow-up data from a cohort of 1,060 patients between 1998 and 2010

Sir: There have been a few studies investigating the incidence and prognostic relevance of the “vanishing cancer” phenomenon in the radical prostatectomy specimen (RP), in particular, in the last decade [1, 2]. We undertook this study to determine incidence and prevalence of “vanishing prostatic adenocarcinoma” at our institution and to correlate the outcome of these patients with histopathology findings. We searched our institutional database and identified a total of 18 patients with no residual cancer out of 1,060 radical prostatectomies performed between 1998 and 2010. Four patients were excluded from the analysis due to preoperative hormonal therapy (three cases) and immunotherapy (one case). In the remaining 14 cases, clinical data including age and PSA levels with biopsy data (highest Gleason score, highest percentage of carcinoma, number of biopsy sites, number of positive biopsy sites, use of immunohistochemistry, and number of previous biopsies) and RP data (number of examined slides, highest Gleason score, percentage of carcinoma, and presence of high-grade prostatic intraepithelial neoplasia) were extracted. In all 14 cases, the radical prostatectomy specimens were submitted entirely. The incidence of the vanishing cancer phenomenon was 1.3% in our series (14/1,060 RPs). Among the 14 RPs studied, residual cancer was not identified in 11 patients despite careful and extensive sampling. Three cases showed microscopic foci of cancer involving less than 0.5% of the tissue. The mean age of the patients was 59.09 (44–75). The total number of biopsy sites ranged from 2 to 14 with a mean of 7. The mean PSA was 5.8 units (3.6–9.0). The Gleason score in

Stratification of ovarian tumor pathology by expression of programmed cell death-1 (PD-1) and PD-ligand- 1 (PD-L1) in ovarian cancer

BackgroundOvarian cancer is the major cause of death among gynecologic cancers with 75% of patients diagnosed with advanced disease, and only 20% of these patients having a survival duration of five years. Treatments blocking immune checkpoint molecules, programmed cell death (PD-1) or its ligand PD-ligand- I (PD-L1) have produced a beneficial and prolonged effect in a subgroup of these patients. However, there is debate in the literature concerning the prognostic value of the expression of these molecules in tumors, with immunotherapy responsiveness, and survival.We evaluated the immune landscape of the ovarian tumor microenvironment of patients, by measuring the impact of the expression of tumor PD-1, PD-L1 and infiltrating lymphocytes on stage and grade of tumors and survival, in a cohort of 55 patients with gynecologic malignancies. Most patients under study were diagnosed with advanced disease ovarian cancer.ResultsOur studies revealed that a low density of PD-1 and of PD-L1 expressing cells in tumor tissue were significantly associated with advanced disease (P = 0.028 and P = 0.033, respectively). Moreover, PD-L1 was expressed significantly more often in high grade tumors (41.5%) than in low grade tumors of patients (7.7%) (P = 0.040). The presence of CD3 or of FoxP3 infiltrating cells with PD-L1 in patient tumors did not impact the significance of the association of PD-L1 with high grade tumors (P = 0.040), and our analyses did not show an association between the presence of PD-1 or PD-L1 and survival.ConclusionsWe conclude that a subgroup of advanced disease ovarian cancer patients with high grade tumors, expressing PD-L1, may be prime candidates for immunotherapy targeting PD-1 signaling.

“Medusa‐Head” cells, “Starfish” cells, and interconnecting long cytoplasmic processes as diagnostic cytologic clues for follicular dendritic cell sarcoma in fine needle aspiration samples

A 19-year-old woman with no significant medical history presented with a large mobile, nontender left neck mass posterior to the angle of the mandible that had not responded to a 3-week course of antibiotic treatment. The patient was otherwise asymptomatic and all her laboratory test results were within normal limits. A fine needle aspiration (FNA) of the neck mass performed at another hospital was diagnosed as showing “atypical cells”; upon review it was diagnosed as follicular dendritic cell sarcoma (FDCS). The most striking cytomorphologic feature seen in this highly cellular aspirate was the presence of long, slender, cytoplasmic processes surrounding the tumor cells circumferentially, and interconnecting them into a meshwork (Fig. 1A–D). These cytoplasmic processed were better seen in Diff-QuikVR preparations and were longer and more abundant in multinucleated cells. They appeared as long sweeping hair bundles, or like the serpents surrounding the head of the mythical monster Medusa (Fig. 2A– D). Shorter, less abundant or agglutinated cell processes were seen in Papanicolaou-stained smears and conferred the cells a starfish-like appearance (Fig. 3A–C). The tumor cells were frequently multinucleated or multilobated, and had pale granular or fibrillary cytoplasm. Their ovoid to spindle shaped nuclei had a thin chromatinic rim and irregular contours, showing grooves, clefts, notches and rare pseudoinclusions, finely granular, pale chromatin and visible to prominent nucleoli and even macronucleoli (Fig. 3D). The polygonal or spindle-shaped tumor cells were present singly, in syncytial sheets and loose cell aggregates of interconnected cells in a background of polymorphous lymphoid cells (Fig. 4A–C). The loose spindle or epithelioid cell aggregates interspersed with lymphocytes resembled either lymphohistiocytic aggregates of reactive lymph nodes of, due to the haphazard “fish-in-a-net” orientation or their nuclei, to granulomas (Fig. 4D). Cell block sections demonstrated atypical pleomorphic spindle cells with irregular nuclear contours, vesicular chromatin and prominent, sometimes multiple, nucleoli admixed with a small mature lymphocytes (Fig. 5A–C). The tumor cells stained for TTF-1, CD21, and CD23 (Fig. 5D), while D2-40, S-100, and CD68 were negative. Additional immunohistochemical stains performed at the outside institution were negative, including cytokeratins AE1/AE3, OSCAR, CK5, CK7, CK 8/18, and CK20, p16, S100, Melan A, CA-125, ER, thyroglobulin, PAX5, CD10, CD20, CD30, CD68, CD79a, ALK-1, cyclin D1, and MUM1. The small lymphocytes present in the background stained with CD45, CD3 and CD5. Department of Pathology, Loyola University Medical Center, Maywood, Illinois *Correspondence to: Stefan E. Pambuccian, MD, Department of Pathology, Loyola University Medical Center, 2160 S 1st Ave Suite 110 2242, Maywood, IL 60153. E-mail: spambuccian@lumc.edu Received 22 November 2016; Revised 22 December 2016; Accepted 3 January 2017 DOI: 10.1002/dc.23664 Published online 3 February 2017 in Wiley Online Library (wileyonlinelibrary.com).

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features in the pediatric age group.

The most common malignant thyroid neoplasm in children is papillary thyroid carcinoma (PTC). In 2015, the Endocrine Pathology Society introduced the terminology “noninvasive follicular thyroid neoplasm with papillary‐like nuclear features” (NIFTP) to replace the noninvasive follicular variant of PTC. The objective of the current study was to evaluate previously diagnosed PTC in the pediatric population, reappraise it for NIFTP, and discuss the impact of NIFTP on the risk of malignancy (ROM) for each The Bethesda System for Reporting Thyroid Cytopathology category in the pediatric population.

Association between chronic acetaminophen exposure and allergic rhinitis in a rat model.

Background Several population studies demonstrated an increased risk of allergic rhinitis in patients exposed to acetaminophen. However, no histologic studies have been conducted to assess the relationship between acetaminophen exposure and allergic rhinitis. Objective In this study, we investigated the association between chronic acetaminophen exposure and the development of allergic rhinitis in a rat model. Methods Ten female Sprague-Dawley rats were randomly assigned to either a control (n = 5) or an acetaminophen group (n = 5). The acetaminophen group received 200 mg/kg/day of acetaminophen suspended in yogurt via oral gavage for 120 days. The control group received only the yogurt vehicle. Allergic behavioral responses, including nose rub, eye rub, ear scratching, and neck and/or face scratching, were quantified. The rats were killed, and the noses were harvested. The portion of the nose, including the nasal septum and the inferior turbinates, was embedded in paraffin, sectioned, and stained with hematoxylin and eosin to quantify the inflammatory infiltrate. Results The average number of allergic responses per animal was 13.2 in the acetaminophen group versus 6.2 in the control group (p = 0.032). All the rats in the acetaminophen group (100%) had mast cells infiltrating the lamina propria of the inferior turbinate, whereas mast cells were detected in only 40% of the animals in the control group. The average number of mast cells per animal in the acetaminophen group was 134 versus 21 in the control group (p = 0.048). Conclusions Our study was the first to demonstrate a histologic association between chronic exposure to acetaminophen and rhinitis. Further research to elucidate the mechanism that underlies these findings is necessary.

Mystery Case: Diagnostic challenges in a young patient with hypereosinophilia

A 48-year-old woman with recent diagnosis of nonischemic cardiomyopathy and longstanding history of asthma and allergic rhinitis without additional vascular risk factors had intermittent chest pain and dyspnea for 6 weeks, treated with antibiotics and oral steroids without benefit. Subsequently, she developed bilateral leg edema, orthopnea, and chest pain, and was hospitalized twice at another institution. Transthoracic echocardiogram (TTE) demonstrated an ejection fraction (EF) of 30%. Cardiac catheterization was normal. CT of the chest showed a large pericardial effusion (∼300 mL) and bilateral pleural effusions. She had urgent pericardiocentesis and right thoracentesis, and was transferred to our institution for further evaluation and care.

Photo Quiz: A 55-Year-Old Male with Hoarseness of Voice and Laryngeal Mass

A 55-year-old male presented to the ear, nose, and throat (ENT) clinic with hoarseness that had lasted several weeks. His past medical history was significant for polycythemia vera and hypertension. He had a history of smoking 40 or more packs of cigarettes a year. On laryngeal examination, he was

Mulberry cells in the thyroid: warthin-finkeldey-like cells in hashimoto thyroiditis-associated lymphoma: WARTHIN-FINKELDEY CELLS IN HASHIMOTO THYROIDITIS-ASSOCIATED LYMPHOMA

Warthin‐Finkeldey type giant cells were first described in autopsies performed on young children who died during the highly lethal measles epidemic in Palermo during the winter of 1908. The cells had 8‐15 nuclei without identifiable cytoplasm within the germinal centers of lymphoid organs resembling megakaryocytes. We describe a case of Hashimoto thyroiditis with an enlarging substernal throid mass. The resection specimen contained many Warthin‐Finkeldey‐Like Cells (WFLC) in an extranodal marginal zone lymphoma (MALT type) with focal transformation to diffuse large B‐cell lymphoma. The WFLC showed nuclear features similar to those of neighboring follicular dendritic cells (FDCs), favoring the hypothesis that these cells might be the product of fusion of FDCs. This is supported by immunostaining results and the occurrence of similar cells in follicular dendritic cell sarcomas and in “dysplastic” FDCs in hyaline vascular type Castleman disease, a possible precursor of follicular dendritic cell tumors. Diagn. Cytopathol. 2017;45:212–216.

Enlarging Neck Mass in an Adolescent Boy

Case Report An otherwise healthy teenage boy presented with a mass on his right neck. The lesion had initially appeared 1 year before as a small lump that subsequently resolved. Seven months later he was involved in a motor vehicle accident resulting in minor neck trauma. Soon after, the mass reappeared and continued to enlarge. The lesion was asymptomatic except for tenderness and numbness of the right arm when direct pressure was applied. There was no history of recent foreign travel, fevers, weight loss, or night sweats. Purified protein derivative test was negative. Physical examination was notable for a 1-cm 9 6-cm firm, skincolored mass on the right neck (Fig. 1). There was no regional lymphadenopathy. Ultrasound showed a mildly heterogeneous vascular and bilobed mass deep to the sternocleidomastoid muscle. A fine needle aspiration was inconclusive and the patient was referred to otolaryngology for surgical excision of the mass (Figs. 2–4).