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Background Methods Results Conclusion Posterior retroperitoneoscopic adrenalectomy (PRA) for isolated adrenal metastasis is minimally invasive, may prolong survival and improve quality of life. The current evidence base is scant.A multi‐site retrospective analysis of all cases of PRA for adrenal metastasis between 2011 and 2023, by four high‐volume adrenal surgeons was performed. Perioperative morbidity, disease‐free and survival outcomes were reported.Of 51 patients, 34(67%) male, mean age 63 ± 12 years, mean BMI 28; 49 PRAs for adrenal metastatectomy were completed (one abandoned due to tumour unresectability, one conversion to anterior laparoscopic approach) across 11 hospitals (49% public). Primary tumours included: 11 colorectal, 11 renal, 8 lung, 6 hepatocellular, 4 sarcoma, 3 breast, 2 melanoma, 2 ovarian and 1 each of pancreatic, oesophageal, testicular and prostate cancer. There were 12 synchronous (<6 months) and 39 metachronous (>6 months after primary diagnosis) tumours; 21 (42%) left sided, none bilateral. Mean operative time was 95 ± 34 minutes, mean maximal tumour diameter was 34 mm ± 13 mm and median length of hospitalization 1 ± 1 days. There were 8 (16%) complications; 1 ICU admission, 1 re‐admission for pneumonia and 6 Clavien‐Dindo grade I complications. There were 10 (20%) mortalities and a median overall survival of 29 months (range 7–123, n = 41). Disease recurred in 15 (40%) patients (n = 37), with a median disease‐free interval of 18 months (range 1–68). Port site recurrence occurred in 2 patients, both simultaneously with disseminated metastases.In carefully selected patients with adrenal metastases, PRA by high‐volume adrenal surgeons has minimal morbidity and short hospitalization. Surgery should be considered prior to local ablation. [ABSTRACT FROM AUTHOR]

Breast cancer is a pathology associated with high morbidity and mortality among women of all nations worldwide. The low efficiency or total absence of national screening programs, the presence of comorbid mental illnesses or dementia, general lack of information and underestimation of the problem among patients are factors that often lead to late diagnosis of breast cancer and, as a result, to high mortality. The article presents 2 clinical cases of advanced breast cancer in women who underwent surgical treatment in our clinic, which demonstrate the necessity of emergency reconstruction of Bulgarian national screening program. A brief statistical analysis of morbidity, mortality and effectiveness of screening in different countries is conducted.

Background Metastatic carcinomas to the jaws are a rare occurrence. Most notable primary sources within the literature are breast, lung and kidney, followed by GI, prostate and thyroid. In almost all instances, there is a primary site already identified, but very occasionally the metastases are the first sign of a problem. Notable other, less obvious, clinical expressions of malignancy are weight loss, loss of appetite, fever and chills. Again, these can present with no obvious site of a primary cancer. A unique feature of our case is the lack of primary symptoms.Case Description The patient initially presented for teeth extraction a year previously, followed by a slow but eventually large expansion of the left mandibular ramus. The underlying radiolucency gave no apparent signs or symptoms suggestive of malignancy. Incisional biopsy showed a glandular neoplastic proliferation with apparent thyroid follicles noted at the margins. Special imaging and immunostains confirmed a tissue origin in the thyroid gland. The patient was referred to Otolaryngology for definitive treatment. The jaw lesion was treated by radical surgical excision and the neck site was treated, after microscopic confirmation of a follicular thyroid carcinoma, via total thyroidectomy.Practical Implications This case illustrates the importance of interdisciplinary treatment and how it can lead to an optimal outcome for the patient's prognosis.

Introduction: Accurate and timely diagnosis of lymph node pathology is crucial for appropriate management and prognostication. This study aimed to compare the diagnostic accuracy of fine-needle aspiration cytology (FNAC) and excision biopsy in the diagnosis of various lymph node diseases. Materials and methods: A total of 250 patients with lymphadenopathy underwent FNAC and excision biopsy at a tertiary care center between September 2013 and September 2015. The diagnostic performance of FNAC was evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Tuberculosis lymphadenitis (TBLN) was the most common diagnosis, accounting for 41.6% of cases on FNAC and 46% on excision biopsy. FNAC had a sensitivity of 90.4% and a PPV of 100% in the diagnosis of TBLN. For metastatic carcinoma, FNAC demonstrated a sensitivity of 84.2%, a specificity of 98.71%, a PPV of 97.56%, and an NPV of 91.07%. The overall sensitivity of FNAC in the diagnosis of lymph node diseases was 83.6%, with a PPV of 100%. Conclusion: FNAC exhibited excellent diagnostic accuracy in the evaluation of TBLN and metastatic carcinoma, supporting its use as a reliable, minimally invasive, and cost-effective first-line investigation in the management of lymphadenopathy. While excision biopsy remains the gold standard, the high diagnostic performance of FNAC, as demonstrated in this study, highlights its clinical utility in guiding further diagnostic and treatment decisions. [ABSTRACT FROM AUTHOR]

Simple Summary: Ascites cytology serves as a cost-effective and noninvasive primary screening test for metastatic colorectal cancer (CRC). Diagnosing metastatic carcinoma of the peritoneum based on biopsy results is challenging, and analyzing ascitic aspiration cytology shows a limited sensitivity and specificity, along with a high variability between observers. Our study aimed to develop an artificial intelligence (AI) model that enhances pathologists' ability to accurately diagnose metastatic CRC within ascitic fluid, improving the diagnostic accuracy, specificity, and sensitivity. This deep learning approach demonstrated a high accuracy, sensitivity, and specificity in distinguishing between malignant and benign ascites. The findings from this proposed deep learning method hold significant promise for integrating AI into clinical practice to enhance the precision of diagnosing metastatic CRC cells in ascitic fluid. Ascites cytology is a cost-effective test for metastatic colorectal cancer (CRC) in the abdominal cavity. However, metastatic carcinoma of the peritoneum is difficult to diagnose based on biopsy findings, and ascitic aspiration cytology has a low sensitivity and specificity and a high inter-observer variability. The aim of the present study was to apply artificial intelligence (AI) to classify benign and malignant cells in ascites cytology patch images of metastatic CRC using a deep convolutional neural network. Datasets were collected from The OPEN AI Dataset Project, a nationwide cytology dataset for AI research. The numbers of patch images used for training, validation, and testing were 56,560, 7068, and 6534, respectively. We evaluated 1041 patch images of benign and metastatic CRC in the ascitic fluid to compare the performance of pathologists and an AI algorithm, and to examine whether the diagnostic accuracy of pathologists improved with the assistance of AI. This AI method showed an accuracy, a sensitivity, and a specificity of 93.74%, 87.76%, and 99.75%, respectively, for the differential diagnosis of malignant and benign ascites. The diagnostic accuracy and sensitivity of the pathologist with the assistance of the proposed AI method increased from 86.8% to 90.5% and from 73.3% to 79.3%, respectively. The proposed deep learning method may assist pathologists with different levels of experience in diagnosing metastatic CRC cells of ascites. [ABSTRACT FROM AUTHOR]

Background: Lymphadenopathy is one of the commonest clinical presentation of patients attending outdoor department. Fine needle aspiration cytology (FNAC) is simple rapid, accurate, cost effective and minimally invasive diagnostic tool for evaluating various palpable lymph node lesions. Aim: To evaluate different lesions of lymphnode by FNAC with specific objectives to classify various lesions causing lymphadenopathy into different categories by FNAC. To study the diagnostic role of FNAC in various pathological conditions of lymphnode and differentiate accuracy of FNAC in palpable lesions. Materials and methods: The present study was done during the period of July 2018 to June 2023 in the department of pathology, GMERS Medical College Junagadh. 10 ml syringe and 23/24 gauge needles were used for the procedure, material obtained was taken on slide and smears were prepared. Wet smears were stained with Haematoxylin and Eosin stain and dry smears with Giemsa stain. Results: A total of 400 cases were assessed. Cytological analysis of lymph nodes were done with maximum cases of chronic non-specific lymphadenitis 24.75% followed by chronic granulomatous lymphadenitis 19.5%. Metastatic lymph node comprised 9.5% followed by Non Hodgkins lymphoma of 0.5%. [ABSTRACT FROM AUTHOR]

Abstract Background We present an unusual case of a left axillary lymph node metastasis from a primary dedifferentiated endometrial carcinoma. This pattern of metastasis is likely the result of circulating tumor cells reaching the node through its arterial blood supply. Case presentation In this report, a 68-year-old white woman with a dedifferentiated endometrial carcinoma underwent a hysterectomy. She later developed an enlarged axillary lymph node due to metastatic dedifferentiated endometrial carcinoma, treated with chemotherapy and anti-programmed cell death protein 1 immunotherapy resulting in a complete clinical and radiological response. Conclusion A review of the literature reveals the rarity of blood-borne lymph node metastasis, especially with uterine carcinoma. Immunotherapy has shown promising results in the treatment of some subtypes of metastatic uterine carcinoma.

Background: We present an unusual case of a left axillary lymph node metastasis from a primary dedifferentiated endometrial carcinoma. This pattern of metastasis is likely the result of circulating tumor cells reaching the node through its arterial blood supply. Case presentation: In this report, a 68-year-old white woman with a dedifferentiated endometrial carcinoma underwent a hysterectomy. She later developed an enlarged axillary lymph node due to metastatic dedifferentiated endometrial carcinoma, treated with chemotherapy and anti-programmed cell death protein 1 immunotherapy resulting in a complete clinical and radiological response. Conclusion: A review of the literature reveals the rarity of blood-borne lymph node metastasis, especially with uterine carcinoma. Immunotherapy has shown promising results in the treatment of some subtypes of metastatic uterine carcinoma. [ABSTRACT FROM AUTHOR]

Primary gastric squamous cell carcinoma (SCC) is an extremely rare entity with very few cases reported worldwide. We present a case of a large locally advanced gastric mass with liver metastasis, with no involvement of the gastric mucosa. Clinical presentation, serum markers, imaging, endoscopy, and histopathology, created a dilemma in its diagnosis. However, immunohistochemistry helped in the diagnosis. This case serves as a reminder to consider primary gastric SCC as a differential while evaluating a gastric mass.

Neuroendocrine carcinoma is a high-grade carcinoma with morphological and immunohistochemical features of neuroendocrine differentiation. Poorly differentiated neuroendocrine carcinoma which has two subtypes (small cell or large cell type) is extremely rare, especially in head and neck cancers. Metastatic neuroendocrine carcinoma to the oral and maxillofacial region is even rarer. We report a rare case with metastatic neuroendocrine carcinoma to the mandibular gingiva from the duodenum papilla. Surgeons may consider metastatic tumors as well as primary tumors, because neuroendocrine tumors are extremely rare in oral and maxillofacial region.

The mechanisms by which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may spread to the human brain are poorly understood, and the infection of cancer cells in the brain by SARS-CoV-2 in Coronavirus disease 2019 (COVID-19) patients has been the subject of only one previous case report. Here, we report the detection of SARS-CoV-2 RNA by in situ hybridization in lung-cancer cells metastatic to the brain and adjacent brain parenchyma in a 63-year-old male patient with COVID-19. These findings suggest that metastatic tumors may transport the virus from other parts of the body to the brain or may break down the blood–brain barrier to allow for the virus to spread to the brain. These findings confirm and extend previous observations that cancer cells in the brain can become infected by SARS-CoV-2 in patients with COVID-19 and raise the possibility that SARS-CoV-2 can have a direct effect on cancer growth and outcome. [ABSTRACT FROM AUTHOR]

Extramedullary hematopoiesis (EMH) is a rare complication of solid tumor malignancies. We describe the first case of a patient who developed EMH in the pericardium secondary to metastatic gastrointestinal or pancreaticobiliary cancer. A 58-year-old man presented with recurrent episodes of fatigue and shortness of breath and was treated with thoracocentesis and pericardiocentesis for pleural and pericardial effusions, respectively. Owing to a markedly elevated alkaline phosphatase, a bone scan was performed and demonstrated diffuse sclerotic lesions. Evaluation of pleural effusion diagnosed metastatic adenocarcinoma, and cytospin morphology of the pericardial fluid demonstrated EMH. While EMH secondary to solid tumors is commonly suggested to be due to cytokine signaling, we propose the mechanism of EMH in this patient was due to extensive disruption of bone marrow hematopoiesis, similar to what is seen in myeloproliferative neoplasms.

Background: For the diagnosis of cervical lymphadenopathy, an open biopsy is recommended. When compared to open biopsy, fine-needle aspiration cytology (FNAC) is considered safe, less invasive, and cost-effective. However, its diagnostic efficacy remains in debates. This study was conducted to know that how accurately FNAC can detect the pathology as compared to an open biopsy. The purpose of this study was to assess the diagnostic efficacy of FNAC versus open biopsy in the diagnosis of cervical lymphadenopathy. Methods: It is a comparative study at Lahore General Hospital, Lahore, for 6 months. The study comprised 100 patients who had been diagnosed with chronic cervical lymphoma. All of the patients underwent FNAC, which was followed by an open biopsy. Calculating the sensitivity, specificity, and diagnostic accuracy of each technique was used to determine the diagnostic efficacy of the both techniques. Results: FNAC had a sensitivity and specificity of 92% overall. Non-Hodgkin's lymphoma, tuberculosis, Hodgkin's lymphoma, metastatic carcinoma, reactive hyperplasia, and chronic nonspecific lymphadenopathy had a diagnostic accuracy of 96.2%, 85.7%, 100%, 87.5%, 100%, and 100%, respectively. Conclusions: In the management of cervical lymphadenopathy, FNAC is a reliable and safe procedure with a high diagnostic efficacy. It should be used as the first line of examination.

Introduction: Cutaneous metastases represent 2% of skin tumors, with an overall incidence of 5.3%. Although rare, clinical presentations of cutaneous metastasis vary and can be mistaken for benign and malignant skin conditions. Methodology: This was a descriptive, retrospective review of all patients diagnosed with cutaneous metastasis seen at the Department of Dermatology from January 2013 to December 2019. Clinical and histopathologic data from the patients were collated from medical records, and slides were retrieved for review. Results: A total of 115 patients were included and 122 slides reviewed. There were more female than males, the mean age was 52.3 ± 14.0 years of age. The most common primary cancer was the breast, and accordingly, the most common location was anterior chest. Among the 122 slides reviewed from 104 patients, the most common histologic type was adenocarcinoma (72.1%), and showed the infiltrative pattern (26.2%). Other histologic types seen were melanoma (13.1%), leukemic infiltrates (11.5%), squamous origin (2.5%), and epithelioid sarcoma (0.8%). Lymphovascular invasion and dermal sclerosis were observed. Immunohistochemical stains were performed in only 13.9% of the cases. There was a high concurrence of the clinical with the histopathologic diagnosis (95.6%). Conclusion: Although rare, patients with cutaneous metastasis may present in dermatology clinics. Knowledge of clinical features and low threshold for doing biopsies may prove useful for these patients. Similarly, dermatopathologists should be able to recognize histologic features of cutaneous metastasis morphologically. Histologic features may be subtle and may be reminiscent of benign inflammatory conditions, hence judicious use of immunohistochemical staining is recommended.

This paper reviews the role of fine needle aspiration biopsy (FNAB) in assessing the axilla prior to definitive surgery or neoadjuvant therapy in breast cancer patients. The radiological criteria for biopsy are discussed and pathological techniques and pitfalls illustrated. The sensitivity and specificity of the technique and the clinical utility are addressed, with particular reference to the current controversies in the management of the axilla in the light of the American College of Surgeons Oncology Group Z0011 trial results. The low morbidity procedure of FNAB is recommended when the radiological and clinical features suggest a high yield from the abnormal axillary nodes, with consideration of core biopsy if an expected positive result is not obtained or the circumstances require tissue for ancillary studies. In conclusion, FNAB of the axilla is a highly sensitive procedure which can offer further valuable information to assist in clinical decision making. The technique is of particular value in the setting of a large primary tumour size and multiple enlarged nodes. A summary flow chart is provided to facilitate pre-operative management of the axilla and to encourage a universal approach.

Background: Claudin‐4 is a sensitive and specific marker for carcinoma in effusion cytology. The authors examined the diagnostic use of claudin‐4 versus MOC‐31 and Ber‐EP4 by comparing their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in differentiating carcinoma from mesothelioma and benign/mesothelial hyperplasia in effusion specimens. Methods: This retrospective study comprised a cohort of 229 cytology specimens, including 211 effusion fluid and 18 fine‐needle aspiration specimens. Cytologic categories included 134 carcinoma, 28 mesothelioma, 46 indefinite (suspicious and atypical), and 21 benign. Cell block sections were stained for claudin‐4 and compared with those previously stained for MOC‐31 and Ber‐EP4. Indefinite cases were further reclassified based on clinical and pathologic findings into benign (26 cases), mesothelioma (11 cases), and carcinoma (nine cases). Results: None of the mesotheliomas (0/39) or benign effusions (0/47) were positive for claudin‐4, whereas 134 of the 143 carcinoma specimens were positive. Compared to MOC‐31 and Ber‐EP4, claudin‐4 had the highest specificity and PPV (100% for each), followed by Ber‐EP4. Claudin‐4 showed high sensitivity (93.7%), albeit lower than MOC‐31. MOC‐31 had the lowest specificity and PPV but the highest sensitivity and NPV. Ber‐EP4 had the lowest sensitivity (91.6%). Conclusions: Claudin‐4 can be used as a single marker for carcinoma with high sensitivity and superior specificity compared with MOC‐31 and Ber‐EP4. Mesothelial lineage can be ruled out when claudin‐4 is positive. In equivocal cytology samples with few scattered cells of interest, a panel of claudin‐4 and Ber‐EP4 results in the highest combined sensitivity and specificity. The findings in this study demonstrate the high sensitivity and superior specificity of claudin‐4 as a single marker for carcinoma in cytology specimens and its ability to rule out mesothelial lineage with high certainty. The authors also identify the highly sensitive and specific combination of claudin‐4 and Ber‐EP4 in diagnosing equivocal specimens previously categorized as atypical or suspicious. [ABSTRACT FROM AUTHOR]

Extramedullary hematopoiesis (EMH) is a rare complication of solid tumor malignancies. We describe the first case of a patient who developed EMH in the pericardium secondary to metastatic gastrointestinal or pancreaticobiliary cancer. A 58-year-old man presented with recurrent episodes of fatigue and shortness of breath and was treated with thoracocentesis and pericardiocentesis for pleural and pericardial effusions, respectively. Owing to a markedly elevated alkaline phosphatase, a bone scan was performed and demonstrated diffuse sclerotic lesions. Evaluation of pleural effusion diagnosed metastatic adenocarcinoma, and cytospin morphology of the pericardial fluid demonstrated EMH. While EMH secondary to solid tumors is commonly suggested to be due to cytokine signaling, we propose the mechanism of EMH in this patient was due to extensive disruption of bone marrow hematopoiesis, similar to what is seen in myeloproliferative neoplasms. [ABSTRACT FROM AUTHOR]

Background: For the diagnosis of cervical lymphadenopathy, an open biopsy is recommended. When compared to open biopsy, fine-needle aspiration cytology (FNAC) is considered safe, less invasive, and cost-effective. However, its diagnostic efficacy remains in debates. This study was conducted to know that how accurately FNAC can detect the pathology as compared to an open biopsy. The purpose of this study was to assess the diagnostic efficacy of FNAC versus open biopsy in the diagnosis of cervical lymphadenopathy. Methods: It is a comparative study at Lahore General Hospital, Lahore, for 6 months. The study comprised 100 patients who had been diagnosed with chronic cervical lymphoma. All of the patients underwent FNAC, which was followed by an open biopsy. Calculating the sensitivity, specificity, and diagnostic accuracy of each technique was used to determine the diagnostic efficacy of the both techniques. Results: FNAC had a sensitivity and specificity of 92% overall. Non-Hodgkin's lymphoma, tuberculosis, Hodgkin's lymphoma, metastatic carcinoma, reactive hyperplasia, and chronic nonspecific lymphadenopathy had a diagnostic accuracy of 96.2%, 85.7%, 100%, 87.5%, 100%, and 100%, respectively. Conclusions: In the management of cervical lymphadenopathy, FNAC is a reliable and safe procedure with a high diagnostic efficacy. It should be used as the first line of examination. [ABSTRACT FROM AUTHOR]

Background: Cytomorphological distinction between hepatocellular carcinoma and metastatic tumors to the liver may be difficult, especially when these have poor differentiation. The present study was done to assess the diagnostic utility of hepatocyte paraffin-1 (HepPar-1), CD10, and CD34 in differentiating hepatocellular carcinoma from metastatic carcinoma. Materials and Methods: Ultrasound-guided fine-needle aspiration was performed on 50 patients with space-occupying lesions of liver suspicious for malignancy on clinical/radiologic findings. The cytological assessment was done on smears stained with May–Grünwald–Giemsa and hematoxylin and eosin. Cell blocks were prepared, and immunostaining for HepPar-1, CD10, and CD34 was done. Results: In these 50 patients, hepatocellular carcinoma was diagnosed in 7 and metastatic tumors in 43 cases. The sensitivity of smears in diagnosing hepatocellular carcinoma was 100% and the specificity was 95.3%, while the sensitivity and specificity of cell block were 100%. A canalicular pattern of CD10 immunoreactivity had a 100% positive predictive value for diagnosing hepatocellular carcinoma. CD10 had a sensitivity of 57.1% and 41.9% in identification of HCC and metastatic tumors, respectively. For the diagnosis of hepatocellular carcinoma, the sensitivity of CD34 was 85.7% and the specificity of sinusoidal pattern of immunoreactivity was 100%. The sensitivity and specificity of granular cytoplasmic staining pattern of HepPar-1 were 100% in hepatocellular carcinoma. Conclusions: The staining patterns of HepPar-1, CD10, and CD34 are highly specific in distinguishing hepatocellular carcinoma from metastasis. These three immunomarkers should be included in the immunocytochemical panel for differentiating hepatocellular carcinoma from metastatic carcinoma to the liver. [ABSTRACT FROM AUTHOR]

Introduction: Cutaneous metastases represent 2% of skin tumors, with an overall incidence of 5.3%. Although rare, clinical presentations of cutaneous metastasis vary and can be mistaken for benign and malignant skin conditions. Methodology: This was a descriptive, retrospective review of all patients diagnosed with cutaneous metastasis seen at the Department of Dermatology from January 2013 to December 2019. Clinical and histopathologic data from the patients were collated from medical records, and slides were retrieved for review. Results: A total of 115 patients were included and 122 slides reviewed. There were more female than males, the mean age was 52.3 ± 14.0 years of age. The most common primary cancer was the breast, and accordingly, the most common location was anterior chest. Among the 122 slides reviewed from 104 patients, the most common histologic type was adenocarcinoma (72.1%), and showed the infiltrative pattern (26.2%). Other histologic types seen were melanoma (13.1%), leukemic infiltrates (11.5%), squamous origin (2.5%), and epithelioid sarcoma (0.8%). Lymphovascular invasion and dermal sclerosis were observed. Immunohistochemical stains were performed in only 13.9% of the cases. There was a high concurrence of the clinical with the histopathologic diagnosis (95.6%). Conclusion: Although rare, patients with cutaneous metastasis may present in dermatology clinics. Knowledge of clinical features and low threshold for doing biopsies may prove useful for these patients. Similarly, dermatopathologists should be able to recognize histologic features of cutaneous metastasis morphologically. Histologic features may be subtle and may be reminiscent of benign inflammatory conditions, hence judicious use of immunohistochemical staining is recommended. [ABSTRACT FROM AUTHOR]

Endolymphatic sac tumour (ELST) is a rare low grade malignant epithelial tumour of the petrous temporal bone, thought to arise from papillary epithelium of the endolymphatic sac. They may occur sporadically or in association with Von-Hippel Lindau disease. ELST is extremely rare neoplasm with benign histopathological appearance and clinically destructive behaviour. Because of the rarity of this tumour, it can easily be confused with other tumours such as paraganglioma, middle ear adenoma, metastatic carcinomas or choroid plexus papilloma. We report here a rare case of ELST with review of literature and discuss the differentiating features of ELST from its mimickers, showing a papillary configuration. [ABSTRACT FROM AUTHOR]

This paper reviews the role of fine needle aspiration biopsy (FNAB) in assessing the axilla prior to definitive surgery or neoadjuvant therapy in breast cancer patients. The radiological criteria for biopsy are discussed and pathological techniques and pitfalls illustrated. The sensitivity and specificity of the technique and the clinical utility are addressed, with particular reference to the current controversies in the management of the axilla in the light of the American College of Surgeons Oncology Group Z0011 trial results. The low morbidity procedure of FNAB is recommended when the radiological and clinical features suggest a high yield from the abnormal axillary nodes, with consideration of core biopsy if an expected positive result is not obtained or the circumstances require tissue for ancillary studies. In conclusion, FNAB of the axilla is a highly sensitive procedure which can offer further valuable information to assist in clinical decision making. The technique is of particular value in the setting of a large primary tumour size and multiple enlarged nodes. A summary flow chart is provided to facilitate pre-operative management of the axilla and to encourage a universal approach. [ABSTRACT FROM AUTHOR]

Primary gastric squamous cell carcinoma (SCC) is an extremely rare entity with very few cases reported worldwide. We present a case of a large locally advanced gastric mass with liver metastasis, with no involvement of the gastric mucosa. Clinical presentation, serum markers, imaging, endoscopy, and histopathology, created a dilemma in its diagnosis. However, immunohistochemistry helped in the diagnosis. This case serves as a reminder to consider primary gastric SCC as a differential while evaluating a gastric mass. [ABSTRACT FROM AUTHOR]

Simple Summary: Positive UroVysionTM fluorescence in situ hybridization (U-FISH) is generally considered urothelial carcinoma (UC). However, in our clinical practice, we found that U-FISH also showed positive findings in non-urothelial carcinomas or even metastatic carcinomas. A review is needed to increase awareness to avoid misdiagnosis. This review focuses on summarizing the research status of U-FISH in UC, non-urothelial carcinoma and metastatic tumor, so as to strengthen urologists' comprehensive understanding of the application value of U-FISH and better complete the accurate diagnosis of urological cancers. UroVysionTM is a fluorescence in situ hybridization assay that was developed for the detection of bladder cancer (UC accounted for 90%) in urine specimens. It consists of fluorescently labeled DNA probes to the pericentromeric regions of chromosomes 3, 7, 17 and to the 9p21 band location of the P16 tumor suppressor gene, which was approved by the Food and Drug Administration (FDA) in 2001 and 2005, respectively, for urine detection in patients with suspected bladder cancer and postoperative recurrence monitoring. Furthermore, recent studies also demonstrated that U-FISH was useful for assessing superficial bladder cancer patients' response to Bacillus Calmette–Guérin therapy and in detecting upper tract urothelial carcinoma. Therefore, positive U-FISH was well known to urologists as a molecular cytogenetic technique for the detection of UC. However, with the continuous enrichment of clinical studies at home and abroad, U-FISH has shown a broader application space in the detection of various urinary primary tumors and even metastatic tumors. This review focuses on summarizing the research status of U-FISH in UC, non-urothelial carcinoma and metastatic tumor, so as to strengthen urologists' more comprehensive understanding of the application value of U-FISH and better complete the accurate diagnosis and treatment of urological cancers. [ABSTRACT FROM AUTHOR]

Objectives: Recent studies have shown that trichorhinophalangeal syndrome type 1 (TRPS1) is a sensitive and specific marker that shows positive staining in breast carcinoma. We conducted this study to evaluate the role of TRPS1 immunohistochemistry (IHC) in differentiating breast primary vs tumors from other primary sites in malignant pleural effusion cytology specimens (MPECSs).Methods: We selected 61 MPECS cases with cell block material available to analyze TRPS1 IHC staining. Of these 61 cases, 38 cases were metastatic carcinoma (MC) from a breast primary. We primarily selected MC cases confirmed as breast origin based on GATA binding protein 3 IHC positivity, except in two of the cases. The remaining 23 MPECS cases were from various primary sites, including urothelial (n = 6), Müllerian (n = 6), lung adenocarcinoma (n = 6), malignant melanoma (MM; n = 3), and squamous cell carcinoma (SqCC; n = 2).Results: TRPS1 expression was observed in 35 (92%) of 38 MCs of breast origin. The staining intensity was variable, with 18 (47%) cases showing strong nuclear expression. In comparison, no TRPS1 expression was seen in any cases of urothelial carcinoma, MM, and SqCC. However, four of six Müllerian MC cases demonstrated TRPS1 expression.Conclusions: TRPS1 is a new marker that can be used in an IHC panel to investigate breast origin in MPECS. [ABSTRACT FROM AUTHOR]