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Introduction: The 6 categories of the Bethesda System for Reporting Thyroid Cytology (TBSRTC) with associated risk of malignancy (ROM) provide evidence-based clinical management guidelines. This study aimed to determine the ROM and accuracy of FNAB in South Africa (SA)., Methods: Thyroid specimens from 3 pathology laboratories registered between January 2015 and December 2019 were considered for inclusion. ROM was obtained per TBSRTC category by cytohistological correlation and dividing the total number of specimens with malignant histology by the total number of cases operated. Accuracy was calculated based on the Bethesda category and eventual malignant histology., Results: Seventeen thousand seven hundred and seventy-three histology and 4,791 cytology cases were identified. Of the 4,791 cytology cases, 931 (19%) underwent surgery. More than a third (333, 35.8%) of cases were confirmed as malignant following histological assessment, with the majority being benign (584, 62.7%). The ROM for the nondiagnostic and benign categories was 24.3% and 20.5%. The highest ROM was for category VI (91.5%), followed by categories V (69.5%), IV (51.9%), and III (38.8%). Thyroid FNAB had a sensitivity of 73%, specificity of 74%, and overall accuracy of 74%., Conclusion: Bethesda categories II and IV have a relatively higher ROM in SA compared to findings from other developed countries. The diagnostic accuracy of thyroid FNAB in SA and the high rate of nondiagnostic diagnoses (38%) require further investigation. A national thyroid registry could provide location-specific data to aid the implementation of appropriate local policies and national guidelines for practicing thyroid surgeons., (© 2024 S. Karger AG, Basel.)

Introduction: Microsecretory adenocarcinoma (MSA) is a novel entity defined by distinctive histology, a specific immunophenotype, and unique molecular fusion MEF2C::SS18. It occurs mainly in intra-oral minor salivary glands and the skin, with only one reported case affecting the parotid gland. To the best of our knowledge, no cytomorphological features of MSA have been published to date. We report the first case of fine-needle aspiration biopsy (FNAB) cytology of MSA diagnosed in the parotid gland., Case Presentation: A 48-year-old man presented with a 3.5 × 2.5-cm parotid mass. FNAB of the tumour revealed a cellular smear comprising a predominantly epithelial cell population showing luminal differentiation with secretory features and a distinctive background matrix with both myxoid and mucinous qualities. Scattered, but conspicuous multinucleated giant cells were present, a feature not commonly observed in salivary gland aspirates. Histology of the excised tumour revealed classic features of MSA with supportive immunohistochemistry and SS18 break apart fusion detected by fluorescence in situ hybridisation (FISH). Next-generation sequencing confirmed a MEF2C::SS18 gene fusion., Conclusion: MSA is a rare neoplasm and should be considered in the cytological differential diagnosis of low-grade salivary gland neoplasms. Its unique cytomorphological features should raise the possibility of MSA in salivary gland FNABs. The diagnosis can be established on cellular cell block preparations using immunohistochemistry and FISH or PCR., (© 2024 S. Karger AG, Basel.)

Objective: This study aims to determine the diagnostic utility of the International Academy of Cytology (IAC) Yokohama System for reporting breast cytopathology in lesions of the male breast., Study Design: Fine-needle aspiration biopsy (FNAB) reports between 2015 and 2019 were retrospectively recategorized according to the 5-tiered IAC Yokohama Reporting System. Our database yielded a total of 1,532 FNAB reports from breast lesions, obtained from 1,350 male patients. The risk of malignancy (ROM) and diagnostic performance of FNAB were determined using follow-up histopathological diagnosis and/or clinical follow-up, where available, for each category., Results: The category distribution were as follows: inadequate, 40%; benign, 57%; atypical, 0.6%; suspicious for malignancy, 0.7%; and malignant, 1.6%. The ROM in each category was nondiagnostic, 11%; benign, 3%; atypical, 28%; suspicious for malignancy, 56%; and malignant, 100%. The sensitivity, specificity, positive predictive value, and negative predictive value were recorded as 63, 100, 100, and 84.6% respectively, when only malignant cases were considered as positive tests., Conclusion: This study validates the IAC Yokohama System for reporting male breast cytopathology. In accordance with the aim of the Yokohama System to establish best practice guidelines for reporting breast cytopathology, this comprehensive scheme facilitates comparisons between local and international institutions. The ROM acts as an internal audit for quality assurance within one's own laboratory and provides guidance for clinical management. It highlights inefficiencies such as high inadequacy rates for category 1 and also features strengths with impressive specificity for categories 4 and 5., (© 2020 S. Karger AG, Basel.)

Immunochemistry is now an established ancillary technique in lung cancer diagnosis. Not only does it help in supporting the morphological diagnosis of malignancy, but its role now extends to the determination of cell lineage, ascertaining the primary site of tumour origin and contributing to decisions on prognosis and treatment. Early detection and confirmation of lung cancer facilitate early treatment decisions. Lung cancer management now has a multidisciplinary approach which includes cytopathologists and clinicians. Some clinicians may not understand what immunochemistry is and what its role is in lung cancer diagnosis, prognosis and therapy. The purpose of this paper is to define immunochemistry, on the background of basic respiratory airway epithelial structure and cancer biology, and discuss its application in the diagnosis, treatment and determination of prognosis of lung cancer., (Copyright © 2011 S. Karger AG, Basel.)