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Ciliated hepatic foregut cysts are uncommon solitary cysts of the liver that originate from the embryologic foregut. Clinically and radiographically, these lesions can be difficult to distinguish from neoplasms. Recent reports have demonstrated that ciliated hepatic foregut cysts may undergo dysplastic progression, supporting the argument to excise these cysts when discovered. Fewer than 100 cases have been described in the literature since the first description of a ciliated hepatic foregut cyst in 1857. We present a patient who recently underwent laparoscopic excision of a ciliated hepatic foregut cyst, review the literature, and propose the rationale for attempting removal of these cysts via a laparoscopic approach.

Background:The cytologic diagnosis of atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) is controversial because of variation in how it is applied in practice, as well as uncertainty about patient management. We aimed to assess the percentage of thyroid fine-needle aspiration biopsies (FNABs) with AUS/FLUS diagnoses in different North American and European practice settings (e.g. community, academic, etc.), assess whether patients were managed according to current guidelines, and determine patient outcomes.Materials and Methods:A detailed questionnaire survey was posted in secure websites used separately by cytopathologists and cytotechnologists. The questionnaire was posted from August 1 through December 31, 2013.Results:Endocrinologists and cytopathologists performed 51.7% and 37.1% of thyroid FNABs, respectively. The Bethesda reporting system for thyroid FNAB was used in 90% of practices. The rate of AUS/FLUS varied widely among institutions, with 46.1% of represented institutions reporting AUS/FLUS rates of 3–10%. The median follow-up rate of patients with an initial AUS/FLUS diagnosis was 70% (range, 10–100%). For the majority of represented institutions (86.4%), patients with initial AUS/FLUS diagnosis had follow-up with endocrinologists. Of repeat AUS/FLUS thyroid FNABs, a median of 52% was considered benign, and 18% were suspicious of or positive for malignancy (median, 10% and 7.5%, respectively).Conclusions:Reporting of the AUS/FLUS category varied widely among different institutions. The median follow-up rate was lower than published guidelines. The most common follow-up diagnosis was benign thyroid nodule. Improved standardization of cytologic criteria should be adopted to reduce such variation.

Introduction: Endobronchial ultrasound (EBUS)-guided sampling of the mediastinum has traditionally been performed by fine needle aspiration (FNA) for cytologic evaluation. The ProCore fine needle biopsy, used primarily to obtain intra-abdominal tissue core biopsies, has not been widely used for EBUS. The aim of this study was to evaluate our experience with EBUS-Procore of mediastinal nodes, and to compare its diagnostic utilization to that of conventional EBUS-FNA. Material and Methods: A retrospective review of all EBUS cases of mediastinal masses using a ProCore needle from December 2013 to March 2014 was performed. Patient demographics, anatomic site, number of procedure passes, on-site immediate evaluation, final pathology reports, and ancillary test results were recorded. All specimen slides and cell blocks were evaluated scoring lesion and contamination cellularity (0 Z acellular, 1 Z scant, 2 Z moderate, and 3 Z abundant). Results: There were 18 EBUS cases of mediastinal lymph nodes using Procore in patients (12 female, 6 male) of average age 57 years (range, 3380 years). FNA was followed by Procore biopsy in all cases, except one where only Procore was performed. Cases included benign (granulomas), atypical, and malignant (carcinoma) diagnoses. More FNAs were satisfactory (with 2 unsatisfactory cases) than Procores (with 7 unsatisfactory cases). The 2 non-diagnostic FNA cases remained unsatisfactory with subsequent Procore. More passes were performed with FNA (4/case) than Procore (2.6/case). On average, FNA provided greater cellularity of lesional material (smear score Z 2; cell block score Z 1.4) than Procore (smear score Z 1.4; cell block score Z 1.4). However, FNAs contained more bronchial contamination (smear score Z 1.6; cell block score Z 1) than Procore (smear score Z 1; cell block score Z 0.4). Both sample types contained similar bronchial and blood contamination. Ancillary studies (special stains, immunostains, FISH, molecular) were equally successful using cell blocks from both specimen types. Conclusions: Our preliminary experience shows that EBUS-guided Procore sampling of mediastinal lymph nodes is feasible. Although FNA samples appear to provide more diagnostic cellular material in this pilot series, fewer subsequent Procore passes were required to achieve satisfactory specimens. Procore specimens also contained less obscuring bronchial contamination. Evaluation of more cases and more experience with this new technique is necessary to determine if the diagnostic yield using Procore during EBUS can be improved.

evaluation) were assessed in patients who were judged as hypovascular in CECT. Results: All patients with SPNs and 11 patients with NENs were diagnosed as hypovascular based on the definition of weak contrast effect of tumors compared with surrounding parenchyma in arterial phase. When we diagnosed hypovascular in CECT as SPNs, sensitivity, specificity and accuracy were 100%, 69%, 77%, respectively. Seven of 11 patients with SPNs and 2 of 11 patients with NENs had a rapidly falling off appearance in echo intensity within one minute, and when we diagnosed a rapidly falling off appearance as SPNs, sensitivity, specificity and accuracy were 63%, 82%, 73%, respectively. All patients with SPNs depicted a focally colored-signal type and 7 of 11 patients with NENs were a diffusely colored-signal type, and when we diagnosed a focally colored-signal type as SPNs, sensitivity, specificity and accuracy were 100%, 64%, and 82%, respectively. The TIC-based quantitative analysis revealed an only echo intensity velocity ratio of elevation as a significantly different parameter between SPNs and NENs. When we diagnosed echo intensity velocity ratio of elevation!1.294 as SPNs, sensitivity, specificity and accuracy were 89%, 80%, 84%, respectively. Combination of these three findings of CE-EUS enabled sensitivity, specificity and accuracy to rise up to 100%, 82%, 90%, respectively. Conclusions: CEEUS was useful in the differential diagnosis between SPNs and NENs providing novel vascular information.

Background:Bronchial brush (BB) cytology carries low sensitivity for detecting neuroendocrine carcinomas (NECs), including typical carcinoid (TC) tumors of the lung. We aimed to investigate the detection of neuroendocrine tumors including TC through BB routine cytology cell block (CB), immunohistochemistry (IHC), and fluorescencein situhybridization (FISH).Materials and Methods:A SNOMED search showed 187 lung biopsy or resection specimens from 2008 through 2011 containing neuroendocrine or carcinoid in the diagnosis. Residual BB specimens retained in PreservCyt were used to prepare a ThinPrep slide for FISH analysis. CBs were stained with H and E and IHC for chromogranin and synaptophysin.Results:Of the 187 cases, 16 had residual BB material available within 1 year of diagnosis and were used in CB preparation for IHC and FISH slides. Cytologic evaluation determined 1 case positive for malignancy (small cell lung carcinoma [SCLC]), 1 suspicious for adenocarcinoma, and 14 negative for malignancy. On the basis of histologic diagnosis, FISH was performed. SCLC showed polysomy (86% abnormal cells); 2 TC tumors showed a gain of 7p12 (15% abnormal cells) and a gain of 5q15 (72% abnormal cells), respectively. Two cases had CBs with positive immunoreactivity for chromogranin and synaptophysin. The sensitivity for detection of NEC was 18.8%, 15.4%, and 25% for cytologic evaluation, CB, and FISH, respectively.Conclusion:Neuroendocrine tumors, including TC are difficult to detect with BB cytologic evaluation, most likely because tumor cells lack in the specimen. Assessment of further studies is needed to explore the role of cytology and ancillary methods for detection of these tumors.