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ABSTRACT: BACKGROUND: Rare studies have reported the application of multiple ancillary tests to the diagnosis of lymphoproliferative disorder in serous effusions. In the current study, the authors evaluated the effectiveness of using an algorithm for the triage of serous effusions and the contribution of ancillary studies to achieve a specific subtype of lymphoproliferative disorder. METHODS: Serous effusion samples that had a final diagnosis of lymphoproliferative disorder or suspicious for lymphoma were selected from cases that were diagnosed between 2001 and 2010. Data were collected on patient and sample characteristics as well as results from immunophenotype and molecular studies. RESULTS: In total, 168 serous effusions were identified from 110 patients. The most common site of involvement was the pleural cavity (n = 133) followed by the peritoneal cavity (n = 30) and pericardial cavity (n = 5). The volume of serous effusions ranged from 2 mL to 1000 mL (mean, 238 mL). In 42 patients (38.2%), serous effusions were the primary source of diagnosis. In 129 patients who had a diagnosis of LPD, either generic (n = 82) or specific (n = 47) ancillary tests were performed as a single test in 58 samples (67.4%) or as a combination of multiple studies in 19 samples (23.2%). Immunophenotyping was successful in almost all samples that had a specific subtype with 16 B-cell and 4 T-cell lymphomas being diagnosed. More samples with a specific subtype of lymphoma underwent molecular tests compared with those who had a generic diagnosis (19.1% vs 13.4%). CONCLUSIONS: Successful, specific subtyping of lymphoproliferative disorders was achieved in approximately 33% of cases that were tested for ancillary studies following an approach for the triage and aliquoting of serous effusion samples. Cancer (Cancer Cytopathol) 2012. © 2012 American Cancer Society.
Cancer Cytopathology 12/2012; · 3.33 Impact Factor
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Cancer Cytopathology 07/2012; · 3.33 Impact Factor
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Diagnostic Cytopathology 01/2012; · 1.16 Impact Factor
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ABSTRACT: Introduction: The value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been established for staging mediastinal lymph nodes in lung carcinoma patients with radiologically enlarged lymph nodes, but its utility for evaluation of primary lymph node disorders is not well defined. The objective of this study was to evaluate the usefulness of EBUS-TBNA with on-site assessment and triage of sample for multiple ancillary techniques, for the diagnosis and subclassification of lymphomas and non-neoplastic lesions involving mediastinal lymph nodes. Methods: One hundred and twenty consecutive patients who underwent EBUS-TBNA between January 2008 and August 2009 were reviewed. The final cytological diagnosis was based on air-dried Romanowsky and alcohol-fixed Papanicolaou stained direct smears, immunohistochemistry, immunophenotyping, and fluorescence in situ hybridization (FISH). Results: A total of 38 cases were included in this study consisting of eight reactive lymphoid hyperplasia, 20 granulomatous lymphadenitis (17 non-necrotizing and 3 necrotizing granulomatous inflammations), 3 Hodgkin lymphomas and 7 non-Hodgkin lymphomas (1 small lymphocytic lymphoma (SLL), 1 SLL with scattered Reed-Sternberg cells, 1 marginal zone lymphoma, and 4 large B cell lymphomas). Cultures performed in 13 cases were negative for AFB and fungi. Immunophenotyping and immunohistochemistry for MIB1 in six cases, and FISH in five cases provided necessary information for subclassification. Conclusions: EBUS-TBNA is a minimally invasive procedure which provides sufficient sample for definitive primary diagnosis and classification of malignant lymphoma and granulomatous inflammation in patients with mediastinal lymphadenopathy. Rapid on-site specimen assessment is invaluable for appropriate assignment of sample to ancillary studies. Diagn. Cytopathol. 2011; © 2011 Wiley-Liss, Inc.
Diagnostic Cytopathology 05/2011; · 1.16 Impact Factor
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ABSTRACT: B-cell lymphomas with concurrent IGH/BCL2 and MYC gene rearrangements, termed dual-translocation or double-hit lymphomas (DTLs), rarely are identified. They usually are characterized by highly aggressive behavior, a poor prognosis, and complex karyotypes. The objective of this study was to review and describe the cytomorphologic findings in different types of cytologic preparations and clinicopathologic characteristics of patients with DTLs.
Patient samples with IGH/BCL2 and MYC rearrangements that were detected by fluorescence in situ hybridization during the period from October 2003 to September 2009 were selected for morphology review. Clinical data and results from additional studies were collected from patient reports.
Cytologic samples from 14 patients (5 men and 9 women) were reviewed. The most common cytomorphologic pattern was a mixed cell population consisting predominantly of large cells (88.2%), mainly centroblasts (94.1%), with dark blue cytoplasm (76.4%) accompanied by apoptotic bodies (64.7%), with marked cellular pleomorphism (94.1%). Nuclear segmentation was present in 64.7% of samples, conferring a "coffee bean" nucleus, and cytoplasmic vacuoles were observed in 46.6% of samples. Immunophenotyping revealed the expression of CD20, CD19, surface immunoglobulin, and CD10 in 13 samples. Other chromosomal aberrations were also identified. Seven patients died of their disease, and the time from progression to death ranged from 1 month to 16 months.
Large cells with deeply basophilic cytoplasm, cytoplasmic vacuoles, and frequent segmented nuclei, particularly in fine needle aspirate smears and especially in patients with clinically aggressive and/or unusual clinical features, should trigger a fluorescence in situ hybridization analysis for IGH/BCL2 and MYC translocation to identify this entity.
Cancer Cytopathology 05/2011; 119(4):254-62. · 3.33 Impact Factor
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ABSTRACT: Two cases are described of crystal storing histiocytosis (CSH) associated with extranodal marginal zone lymphoma, presenting as lung and subcutaneous masses respectively. Fine-needle aspiration of subcutis and smears prepared from the resected lung masses showed negative images. Cytology slides of both cases were reviewed to identify cytomorphological features for the differential diagnosis between immunoglobulin crystals and mycobacteria. The crystals in CSH consist of straight and needle shaped rods with pointed or angular edges and are more variable in thickness than the uniformly thin mycobacteria. Mycobacteria show a haphazard distribution, whereas crystals are frequently present in parallel arrays. Small lymphoid or plasma cells are identified in the background of CSH, whereas a necrotic and inflammatory background is seen in mycobacteriosis. Additional samples for culture in the case of mycobacteriosis, or flow cytometry and molecular clonality testing in the case of CSH can provide critical data for a definitive diagnosis. Diagn.Cytopathol. 2012. © 2011 Wiley Periodicals, Inc.
Diagnostic Cytopathology 05/2011; 40(10):916-9. · 1.16 Impact Factor
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ABSTRACT: Fluorescence in situ hybridization (FISH) results from fine needle aspirates (FNA) of B-cell non-Hodgkin lymphomas (NHLs) were reviewed to 1) investigate the value added by using specific gene rearrangement probes to lymphoma diagnosis, prognosis, and subtyping; and 2) evaluate the prevalence of cytogenetic alterations other than specific translocations.
FISH results from assays performed on cytospin preparations from NHL FNAs over a 6-year period (2003-2009) were selected. Immunophenotyping, clinical data, and cytomorphologic data were reviewed according to the current World Health Organization (WHO) classification system. Hybridized probes, the purpose for the assay (subtyping or prognosis), and the cytogenetic abnormalities observed were retrieved from cytology reports. Data was categorized according to specific rearrangements and other chromosomal abnormalities.
Successful results were obtained in 284 (95.3%) of 298 cases from 282 patients. Abnormalities were found in 216 (76%) cases and 68 (24%) did not show alteration. Among cases submitted for subtyping, 198 showed FISH-positive results, and specific gene rearrangements were found in 122 (61.6%) cases as follows: follicular 82, mantle cell 21, marginal zone 3, "dual hit" 13, and Burkitt lymphoma 3. In 21 cases, abnormalities were useful for prognosis. Nonspecific alterations alone or in combination with translocations were found in 98 cases.
FISH performed on cytospin preparations was useful for confirmation of specific subclasses of NHL and may also provide valuable prognostic information. Cytogenetic abnormalities other than specific translocations were frequently found and could provide supportive evidence for a definitive diagnosis of lymphoma in FNA.
Cancer Cytopathology 10/2010; 118(5):250-8. · 3.33 Impact Factor
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ABSTRACT: Cutaneous metastases rarely develop in patients with internal malignancy. Cholangiocarcinoma, a malignant cancer of the bile duct, is a relatively rare adenocarcinoma and has a poor prognosis. Few reports have mentioned cutaneous metastases of cholangiocarcinoma, and the most of them were due to direct tumor seeding by percutaneous procedures. Herein, we report a case of cholangiocarcinoma with distant cutaneous metastases in a 60-year-old man.
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 11/2009; 54(5):342-5.
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ABSTRACT: To evaluate the efficacy of CellSlidetrade mark (CS) method in liquid-based gynecologic cytology.
We compared 1221 specimens prepared by both CS and conventional techniques to evaluate specimen adequacy and cytologic diagnoses. Sensitivity and specificity of these techniques were analyzed in 54 cases using the available histological data.
Quality limiting factors, such as obscuring inflammation or blood, were markedly reduced in CS (0.2%) compared to the conventional smear (4.9%). There was a complete agreement in the Bethesda 2001 diagnosis between these methods in 1132 cases (92.7%) out of 1221. 16.7% more ASC cases and 37.5% more low-grade squamous intraepithelial lesions (LSIL) and 21.4% more high-grade SIL (HSIL) were detected on the CS slides than on the conventional smears. Sensitivity rates, relative to histological data, were 91.4% (CS) and 74.3% (conventional) and specificity rates were same (89.5%) for ASC and more severe lesions. Infectious organisms (Trichomonas and Candida, etc.) were readily identifiable in both methods.
CS preparation is more sensitive and equally specific in detecting epithelial abnormalities when compared to the conventional smear. In addition, it has a lower incidence of unsatisfactory results with hypocellularity or >75% obscuration of cells.
Gynecologic Oncology 01/2006; 99(3):597-602. · 3.89 Impact Factor
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ABSTRACT: The autoinfective filariform larva of Strongyloides stercoralis causes hyperinfection in immunosuppressed hosts. Here we report on the case of a male patient who was admitted to the emergency room at Gwangju Veterans Hospital with a complaint of dyspnea, and who was receiving corticosteroid therapy for asthma. Many slender larvae of S. stercoralis with a notched tail were detected in Papanicolaou stained sputum. They measured 269 +/- 21.2 microm in length and 11 +/- 0.6 microm in width. The esophagus extended nearly half of the body length. The larvae were identified putatively as autoinfective third-stage filariform larvae, and their presence was fatal. The autoinfective filariform larva of S. stercoralis has not been previously reported in Korea.
The Korean Journal of Parasitology 07/2005; 43(2):51-5. · 1.04 Impact Factor
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ABSTRACT: Objective.To evaluate the efficacy of CellSlide™ (CS) method in liquid-based gynecologic cytology.Methods.We compared 1221 specimens prepared by both CS and conventional techniques to evaluate specimen adequacy and cytologic diagnoses. Sensitivity and specificity of these techniques were analyzed in 54 cases using the available histological data.Results.Quality limiting factors, such as obscuring inflammation or blood, were markedly reduced in CS (0.2%) compared to the conventional smear (4.9%). There was a complete agreement in the Bethesda 2001 diagnosis between these methods in 1132 cases (92.7%) out of 1221. 16.7% more ASC cases and 37.5% more low-grade squamous intraepithelial lesions (LSIL) and 21.4% more high-grade SIL (HSIL) were detected on the CS slides than on the conventional smears. Sensitivity rates, relative to histological data, were 91.4% (CS) and 74.3% (conventional) and specificity rates were same (89.5%) for ASC and more severe lesions. Infectious organisms (Trichomonas and Candida, etc.) were readily identifiable in both methods.Conclusions.CS preparation is more sensitive and equally specific in detecting epithelial abnormalities when compared to the conventional smear. In addition, it has a lower incidence of unsatisfactory results with hypocellularity or >75% obscuration of cells.
Gynecologic Oncology.
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ABSTRACT: To evaluate the accuracy of fine needle aspiration (FNA) of thyroid lesions at our institution and to ascertain its usefulness in determining the therapeutic approach.
The authors reviewed the results of 1,613 cases of FNA cytology of thyroid nodules performed from 1999 to 2001 at the Department of Pathology, Chonnam National University Hospital. Cytologic diagnoses were compared with histologic diagnoses in 207 cases that included both FNA and thyroid surgery.
The sensitivity for the detection of neoplasms (carcinoma and follicular adenoma) was 78.4% and the specificity 98.2%. A false positive diagnosis was made in 1 case (1.8%) and false negative ones in 28 cases (21.5%). The diagnostic accuracy was 84.4%, with a positive predictive value of 99.0% and negative predictive value of 66.3%. The predictive value of a cytologic diagnosis was 100% in papillary carcinoma.
FNA is a useful test in determining the therapeutic approach of thyroid lesions.
Acta cytologica 47(5):727-32. · 0.49 Impact Factor
