Search

Introduction : Cytological diagnosis of sarcomas requires detailed cytomorphological assessment and integration of immunocytochemistry and/or molecular testing. The role of exfoliative cytology, as compared to aspiration cytology, is less understood. This case series describes well-differentiated/dedifferentiated liposarcomas in effusions, with cytomorphological features, ancillary test results and clinical outcomes detailed. Methods : A computerized search of the department pathology archives was performed for sarcomatous effusions with histological diagnosis or clinical history of well-differentiated/dedifferentiated liposarcoma. Clinical progress, cytology slides, immunocytochemistry and molecular test results were reviewed. Results : Six patients were identified. In 5 patients with clinical follow up, 4 (80%) were deceased within 5 months of malignant effusion. One patient was alive with 12 years disease-free survival after radical resection with adjuvant radiotherapy. Three patients showed dedifferentiation on histology, and high-grade (dedifferentiated) tumor cells were present in effusion cytology of 2 patients. Two showed well-differentiated components only on biopsy, but high-grade (dedifferentiated) tumor cells were identified in cytology. The high-grade tumor cells displayed marked nuclear irregularity, enlargement, size variation, with macronucleoli and multinucleation. Well-differentiated lipomatous components were demonstrated in 4 patients (66.7%), comprising of multivacuolated lipoblasts and atypical lipocytes. CDK4 and MDM2 immunoreactivity in all 3 cases with cell blocks, and CDK4 and MDM2 amplification in one were successfully demonstrated. Conclusion : Lipomatous and dedifferentiated components can be sampled and cytomorphologically identified on effusion fluids of liposarcomas, with sufficient cellularity for immunocytochemistry and molecular testing. Although generally associated with poor prognosis, long disease-free survival with sarcomatous effusion is possible with radical surgery and adjuvant treatment. [ABSTRACT FROM AUTHOR]

The diagnosis of mesothelioma has historically been challenging, especially on serous fluid cytology (SFC). Distinguishing between reactive and neoplastic mesothelial cells can be difficult on cytomorphology alone. However, additional ancillary tests, such as BRCA1 associated protein-1 immunohistochemistry and fluorescence in situ hybridization for cyclin-dependent kinase inhibitor 2A deletion, can provide a sensitive and highly specific method of proving malignancy. SFC specimens diagnosed as mesothelioma, suspicious for mesothelioma (SM), and atypical mesothelial cells (AMCs) since 2012 were identified by querying the laboratory information system. Clinical data and pathologic parameters were gathered. One hundred ten cases of mesothelioma, SM, and AMC were identified. Of these, 61 cases had a definitive diagnosis of mesothelioma on SFC. Average age at SFC diagnosis was 67 years (26-87 years), with most patients being male (67%). Out of the 61 cases, 11 cases (18%) had an initial diagnosis of mesothelioma made on SFC specimens, with 5 of these 11 cases being in patients that never received a histologic diagnosis of mesothelioma. Ancillary studies were utilized in all 11 cases. An initial diagnosis of metastatic mesothelioma was made on SFC in 9 cases (15%). For 6 of these 9 cases, the SFC diagnosis was the sole diagnosis of metastatic mesothelioma without a companion histologic diagnosis. In addition, 15 cases were diagnosed as SM, with 11 of these cases following a definitive mesothelioma diagnosis. Thirty-four cases were diagnosed as AMC, with 27 cases following a definitive mesothelioma diagnosis. The diagnosis of mesothelioma can be reliably made on SFC with the appropriate cytomorphology criteria and/or confirmatory ancillary testing. • Mesothelioma diagnosis requires distinction between benign and malignant mesothelium. • Ancillary tests provide sensitive and highly specific methods of proving malignancy. • Serous fluid cytology provides the potential for early mesothelioma diagnosis. • These specimens may be optimal in diagnosis of occult metastatic disease. [ABSTRACT FROM AUTHOR]

Bladder cancer ranks as the 9th most common malignancy worldwide within the urinary system. Urothelial carcinoma stands as the predominant histologic type in the United States and Western Europe, constituting approximately 90% of bladder cancer cases. While common sites of metastasis for urothelial carcinoma typically involve regional and distinct lymph nodes, the liver, lungs, and bones, instances of metastasis to the pericardium are rare. Roughly 10% of urothelial carcinoma cases exhibit cardiac metastasis, often remaining clinically asymptomatic. Hereby, the authors present a rare case of symptomatic pericardial infiltration originating from urothelial carcinoma in a 32-year-old male. The patient initially presented with a two-week history of progressive dyspnoea on exertion and had been previously diagnosed with high-grade transitional cell carcinoma with squamous differentiation upon histopathological examination and urothelial carcinoma on a Positron Emission Tomography (PET) scan 12 months earlier. Following neoadjuvant chemotherapy and radiotherapy, the patient exhibited a partial response to the treatment. However, despite the effectiveness of the therapies, he developed dyspnoea and pericardial effusion. Although pericardial involvement in advanced malignancies is not uncommon, symptomatic cardiac metastasis from urothelial carcinoma remains rare. Radiographic studies revealed right-sided pleural effusion, while a Computed Tomography (CT) scan of the thorax and upper abdomen (plain and contrast) displayed severe bilateral pleural effusion, pericardial effusion, and metastatic deposits in the mediastinal lymph nodes. Electrocardiography indicated sinus tachycardia, inverted T-waves in leads V1 to V5, and flattening of the T-wave in V6. The patient underwent pericardial tapping, yielding approximately 50 cc of pericardial fluid. A 10 cc of the pericardial fluid was subsequently sent for examination in the Pathology Department, with fluid cytology results indicating the presence of malignant cells.

Objective: Knowledge of proper collection, storage, preservation, and processing techniques is critical to ensuring proper handling and analysis of fluid cytology specimens. This study was conducted to determine the effect of anticoagulation, pre-smearing acetic acid treatment technique, and saline rehydration technique on morphological assessment, reproducibility, and reporting in fluid cytology. Material and Methods: The study was carried out in the cytopathology laboratory over 2 months (April–May 2022), where 100 effusion samples were analyzed. At least 20–40 mL of fluid was collected in heparinized and non-heparinized containers for each patient. Samples were processed in cytospin and stained with Giemsa and Papanicolaou stains. For 70 hemorrhagic specimens, an extra smear was prepared from the sediment and subjected to the saline rehydration technique as per the Indian Academy of Cytologists (IAC) guidelines. Seventy-three hemorrhagic specimens whose quantity received was more than 35 mL were subjected to the pre-smearing technique. These smears were evaluated for (a) the presence or absence of blue background/any other background staining, (b) cellularity, (c) cell morphology and (d) the presence/absence of microclots. Results: Heparinized samples showed no compromise in cellular morphology or cellularity although a blue background was observed in an occasional case. The pre-smearing technique had less background hemorrhage and preserved cell characteristics. The post-smearing saline rehydration technique did not compromise the cellularity but distorted morphology and showed background staining. Conclusion: The pre-smearing acetic acid treatment showed better-preserved cellularity and cytomorphology with the absence of background staining when compared to the post-smearing saline rehydration technique. [ABSTRACT FROM AUTHOR]

Ovarian clear cell carcinoma (OCCC) is a rare subtype of ovarian epithelial carcinoma. Patients with low-stage disease have an excellent prognosis, while the prognosis for those with high-stage disease is poor. Neoplastic cells in abdominopelvic washings upstages the patient to at least FIGO 1C3. Positive cytology confers a worse prognosis when compared to similar stage patients with negative cytology. This study aims to investigate the diagnostic performance of abdominopelvic fluid cytology specimens in cases with pure OCCC and reaffirm the importance of accurate cytologic detection and its impact on patient prognosis. The laboratory information system was queried to identify all patients treated for ovarian clear cell carcinoma at our institution over a period of 20 years with a companion abdominopelvic fluid cytology specimen at the time of surgical resection. Cases were sorted by the FIGO stage of the corresponding oophorectomy specimen. Cytology results, patient demographics, fluid volume, immunohistochemical results, and follow-up data were recorded. A total of 143 cases were identified. The overall detection rate was 38%, with 54 of 143 cases positive for malignancy. Cytologic detection rates increased as FIGO stages increased. Fifty percent of stage 1C cases were upstaged on cytology alone. Ascites fluids performed better among stage 1 cases compared to pelvic wash specimens (77% detection rate versus 23%). Stage 1 patients with positive cytology trended towards a worse prognosis compared to those with negative cytology. Positive cytology in low stage cases of OCCC has significant prognostic and therapeutic implications. Our large cohort further underscores the importance of accurate cytologic detection and subsequent staging in this setting. [ABSTRACT FROM AUTHOR]

Background: To standardize the reporting pattern across various institutions, recently the international system for reporting serous fluid cytology (ISRSFC) was introduced. The objective of the present study was to classify serous fluids into various categories as per the ISRSFC, derive the risk of malignancy for each category and determine the diagnostic efficacy of fluid cytology when ISRSFC was applied. Methodology: Cross-sectional study involving 235 cases of serous effusion over a duration of two years. All the cases were reclassified as per ISRSFC into five categories. Descriptive statistics was derived. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was determined in 74 cases wherein final diagnosis was confirmed by clinical findings, radiology, or cell block. Results: Out of total 235 cases of fluid examined, distribution of cases in the diagnostic categories were as follows, 11 (4.6%) in nondiagnostic (ND), 208 (88.51%) in negative for malignancy (NFM), 5 (2.12%) in atypia of undetermined significance (AUS), 2 (0.85%) in suspicious for malignancy (SFM) and 9(3.82%) in malignant (MAL)category. Out of 208 cases of NFM, mesothelial cells were seen in only 8 (3.8%) cases. The risk of malignancy was 0% each in ND and NFM, 40% in AUS, 100% each in SFM and MAL. Sensitivity and specificity of fluid cytology was 100% and 96.6% respectively while PPV and NPV was 81.81% and 100 % respectively. Conclusion: ISRSFC is easy to apply and has high diagnostic efficacy. Most of the serous effusions fall in negative for malignancy category. Mesothelial cells are not important for specimen adequacy. [ABSTRACT FROM AUTHOR]

Background: To standardize the reporting pattern across various institutions, recently the international system for reporting serous fluid cytology (ISRSFC) was introduced. The objective of the present study was to classify serous fluids into various categories as per the ISRSFC, derive the risk of malignancy for each category and determine the diagnostic efficacy of fluid cytology when ISRSFC was applied. Methodology: Cross-sectional study involving 235 cases of serous effusion over a duration of two years. All the cases were reclassified as per ISRSFC into five categories. Descriptive statistics was derived. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was determined in 74 cases wherein final diagnosis was confirmed by clinical findings, radiology, or cell block. Results: Out of total 235 cases of fluid examined, distribution of cases in the diagnostic categories were as follows, 11 (4.6%) in nondiagnostic (ND), 208 (88.51%) in negative for malignancy (NFM), 5 (2.12%) in atypia of undetermined significance (AUS), 2 (0.85%) in suspicious for malignancy (SFM) and 9(3.82%) in malignant (MAL)category. Out of 208 cases of NFM, mesothelial cells were seen in only 8 (3.8%) cases. The risk of malignancy was 0% each in ND and NFM, 40% in AUS, 100% each in SFM and MAL. Sensitivity and specificity of fluid cytology was 100% and 96.6% respectively while PPV and NPV was 81.81% and 100 % respectively. Conclusion: ISRSFC is easy to apply and has high diagnostic efficacy. Most of the serous effusions fall in negative for malignancy category. Mesothelial cells are not important for specimen adequacy.

Bladder cancer ranks as the 9th most common malignancy worldwide within the urinary system. Urothelial carcinoma stands as the predominant histologic type in the United States and Western Europe, constituting approximately 90% of bladder cancer cases. While common sites of metastasis for urothelial carcinoma typically involve regional and distinct lymph nodes, the liver, lungs, and bones, instances of metastasis to the pericardium are rare. Roughly 10% of urothelial carcinoma cases exhibit cardiac metastasis, often remaining clinically asymptomatic. Hereby, the authors present a rare case of symptomatic pericardial infiltration originating from urothelial carcinoma in a 32-year-old male. The patient initially presented with a two-week history of progressive dyspnoea on exertion and had been previously diagnosed with high-grade transitional cell carcinoma with squamous differentiation upon histopathological examination and urothelial carcinoma on a Positron Emission Tomography (PET) scan 12 months earlier. Following neoadjuvant chemotherapy and radiotherapy, the patient exhibited a partial response to the treatment. However, despite the effectiveness of the therapies, he developed dyspnoea and pericardial effusion. Although pericardial involvement in advanced malignancies is not uncommon, symptomatic cardiac metastasis from urothelial carcinoma remains rare. Radiographic studies revealed right-sided pleural effusion, while a Computed Tomography (CT) scan of the thorax and upper abdomen (plain and contrast) displayed severe bilateral pleural effusion, pericardial effusion, and metastatic deposits in the mediastinal lymph nodes. Electrocardiography indicated sinus tachycardia, inverted T-waves in leads V1 to V5, and flattening of the T-wave in V6. The patient underwent pericardial tapping, yielding approximately 50 cc of pericardial fluid. A 10 cc of the pericardial fluid was subsequently sent for examination in the Pathology Department, with fluid cytology results indicating the presence of malignant cells. [ABSTRACT FROM AUTHOR]

Introduction: The liquid-based cytology (LBC) has shown significant advantages over conventional preparation in cervical cytology. The use of LBC in aspiration and exfoliative nongynecologic cytology has been on the rise since the last few years with relatively few studies being available depicting its role in fine-needle aspiration cytology (FNAC) from other sites. The study aimed to determine the diagnostic efficacy of LBC in nongynecological exfoliative as well as FNAC samples and compare the conventional and LBC methods for cytomorphological differences. Materials and Methods: This is a cross-sectional, analytical study that included the samples collected from two tertiary care centers over 8 months (January 2022 to August 2022). A total of 168 consecutive samples of aspiration and exfoliative nongynecological cytology were included. In each case, two passes were carried out one for a conventional smear (CS) and the other for LBC by Eziprep/Thin Prep (TP) method followed by smear staining with H and E stain and Leishman's stain. The slides were studied by two observers for cellularity, background (blood and necrotic cell debris), informative background (such as colloid, stromal fragments, etc.), presence of monolayer cells, and cell architecture with nuclear and cytoplasmic details by a semiquantitative scoring system. Statistical analysis was performed using Wilcoxon signed-rank test on the SPSS program and histopathology correlation was attempted wherever available by using OpenEpi software version 3. Results: The mean age was 40 years, with the majority being females (70%). The TP smears were qualitatively superior to CS with statistical differences observed in fluid cytology. There was no statistical difference observed at other sites; except TP being superior to CS with regard to the background in breast cytology. The arithmetic mean in TP was higher than CS in all the parameters. Conclusions: The cytology smears of TP were qualitatively superior to CS in aspiration and nongynecological cytology. Overall diagnostic accuracy was comparable in both techniques. [ABSTRACT FROM AUTHOR]

Background: A five-tiered reporting system for effusion fluid cytology has been published by the Indian Academy of Cytologists (IAC). Only a single study has evaluated the applicability of this system in routine reporting. Aims: We intend to evaluate the practical utility of this system in routine reporting of ascitic fluid cytology. Materials And Methods: Nine hundred and sixty-one cases of ascitic fluid cytology were included in this study. The clinical, radiological, cytomorphological, and follow-up data of these cases were reviewed. All cases were recategorized according to the proposed IAC system, and the risk of malignancy (ROM) for each category was estimated. Results: Age of the patients ranged from 1 to 92 years, and fluid volume ranged from 10 ml to 3 l. The number of cases included in each category and their respective ROM were as follows: category 1: 41, 21.42%; category 2: 805, 14.9%; category 3: 5, 33.3%; category 4: 31, 90%; and category 5:79, 96.4%. Conclusions: The new IAC guidelines for the serous fluid is representative, informative, and could be easily applied at our institutional level. We used the recommended diagnostic categories for reclassifying the ascitic fluid samples based on their cytosmear findings and conclude that the system has enormous utility at each level starting from the collection of fluid samples till the delivery of the report.

Introduction: Cytological analysis of effusion specimens provides critical information regarding the diagnosis and staging of malignancies, thus guiding their treatment and subsequent monitoring. Keeping in view the challenges encountered in the morphological interpretation, we explored convolutional neural networks (CNNs) as an important tool for the cytological diagnosis of malignant effusions., Materials and Methods: A retrospective review of patients at our institute, over 3.5 years yielded a dataset of 342 effusion samples and 518 images with known diagnoses. Cytological examination and cell block preparation were performed to establish correlation with the gold standard, histopathology. We developed a deep learning model using PyTorch, fine-tuned it on a labelled dataset, and evaluated its diagnostic performance using test samples., Results: The model exhibited encouraging results in the distinction of benign and malignant effusions with area under curve (AUC) of 0.8674, F-measure or F1 score which denotes the harmonic mean of precision and recall, to be 0.8678 thus, demonstrating optimal accuracy of our CNN model., Conclusion: The study highlights the promising potential of transfer learning in enhancing the clinical pathology laboratory efficiency when dealing with malignant effusions., (© 2024 Wiley Periodicals LLC.)

Background: A five-tiered reporting system for effusion fluid cytology has been published by the Indian Academy of Cytologists (IAC). Only a single study has evaluated the applicability of this system in routine reporting. Aims: We intend to evaluate the practical utility of this system in routine reporting of ascitic fluid cytology. Materials And Methods: Nine hundred and sixty-one cases of ascitic fluid cytology were included in this study. The clinical, radiological, cytomorphological, and follow-up data of these cases were reviewed. All cases were recategorized according to the proposed IAC system, and the risk of malignancy (ROM) for each category was estimated. Results: Age of the patients ranged from 1 to 92 years, and fluid volume ranged from 10 ml to 3 l. The number of cases included in each category and their respective ROM were as follows: category 1: 41, 21.42%; category 2: 805, 14.9%; category 3: 5, 33.3%; category 4: 31, 90%; and category 5:79, 96.4%. Conclusions: The new IAC guidelines for the serous fluid is representative, informative, and could be easily applied at our institutional level. We used the recommended diagnostic categories for reclassifying the ascitic fluid samples based on their cytosmear findings and conclude that the system has enormous utility at each level starting from the collection of fluid samples till the delivery of the report. [ABSTRACT FROM AUTHOR]

Background: In the last decade, analysis of malignant cells and flora in gastric lavage (GL) has provided interesting data on pathogenesis of gastric cancer (GC). For this study, combining such two aspects into one cyto-microbiologic category, we tested the prognostic role of the presence/absence of cancer cells (GL1/GL0) and bacterial microbiota (MB1/MB0) in our GC population. Material and Methods: Between April 2012 and August 2019, 79 surgical patients with GC were prospectively investigated with the determination of GL MB. Results: Compared with GL1 MB0, GL1 MB1 strongly correlated with advanced GC, portended poorer overall survival (OS) (45.8 months vs 20.5 months, P = 0.049), and resulted a significant (P = 0.008) and an independent (P = 0.013) prognostic factor unfavorable for OS. Conclusion: In the light of our results, the cyto-microbiologic parameter of GL MB should be used to gain a better prognosis of GC patients. Administration of antimicrobial treatment for MB1 subjects should be entertained because it could reduce the risk of oncogenesis.

Extramedullary multiple myeloma is seen in advanced and aggressive disease and occurs due to plasma cell infiltration of sites other than the bone marrow. Myelomatous ascites or pleural effusion is seen in less than 1% of cases and can be differentiated from infectious etiologies based on fluid cytology. [ABSTRACT FROM AUTHOR]

Abstract Extramedullary multiple myeloma is seen in advanced and aggressive disease and occurs due to plasma cell infiltration of sites other than the bone marrow. Myelomatous ascites or pleural effusion is seen in less than 1% of cases and can be differentiated from infectious etiologies based on fluid cytology.

Background: Filariasis is a major health problem in India. Despite the high prevalence, microfilariae are rarely found in cytology smears. Most of the cases are incidentally found, solely or in association with other pathologies. Aims and Objectives: This study was undertaken to analyse the prevalence and cytological findings of cases of incidentally found microfilariae in cytology smears (fine needle aspiration cytology [FNAC]/exfoliative cytology) from different parts of the body. Materials and Methods: This was a retrospective study over 3 years, in which cases of microfilariae in aspirates from swelling of different locations, body fluids, and pap smears were reviewed, and the clinicopathological data analysed. Results and Analysis: Out of 11 530 cases of FNAC, 8700 cases of fluid cytology, and 9000 of conventional cervicovaginal smears, 12 cases (0.04%) of incidental findings of microfilariae were documented in cytology smears. The cases were diagnosed from lymph node (one case), hand (one case), scrotal area (one case), axilla (one case), breast (one case), subcutaneous tissue (three cases), urine (three cases), and Pap smear (one case). We found eosinophilia in one case (8.3%) of filarial lesions. We found two cases of incidental findings of microfilariae in association with malignant lesions. Conclusion: Cytology smear examination can play an important role in diagnosing occult filariasis in clinically unsuspected cases in association with other pathologies. [ABSTRACT FROM AUTHOR]

Background: The literature on bone and soft tissue sarcomas (BSTSs) involving effusions and cerebrospinal fluid (CSF) is very limited. Methods: A computerized search for fluid cytology with a sarcoma diagnosis from 2000 to 2020 was performed. All available cases, including the clinical follow‐up, were reviewed. Results: A total of 57 fluids specimens from 36 BSTSs were identified (9 rhabdomyosarcomas, 6 angiosarcomas, 5 epithelioid hemangioendotheliomas, 3 dedifferentiated liposarcomas, 2 chondrosarcomas, 1 extraskeletal myxoid chondrosarcoma, 3 Ewing sarcomas, 2 undifferentiated sarcomas, 3 osteosarcomas, 1 synovial sarcoma, and 1 hybrid low‐grade fibromyxoid sarcoma/sclerosing epithelioid fibrosarcoma). There were 22 males and 14 females. The age range was 4 to 82 years (median, 45 years). Sites of involvement included pleural fluid (n = 38), peritoneal fluid (n = 14), and CSF (n = 5). Twenty‐four cytology cases were available for review. The cytologic features were nonspecific and ranged from dyshesive to clusters of round, epithelioid, pleomorphic, and occasionally spindle‐shaped malignant cells that could easily mimic other non‐BSTS malignant tumors. The diagnosis of BSTS was made by comparison with a prior specimen and/or ancillary studies (molecular or immunohistochemical stains). The prognosis was poor because 95% of the patients died of their disease. Conclusions: The incidence of BSTS in fluid cytology is extremely rare, and it can have cytologic features similar to those of non‐BSTS malignancies. Although, in most cases, a comparison with a prior known BSTS specimen may suffice, the use of ancillary studies is extremely helpful in arriving at the correct diagnosis. However, in cases with no known prior malignancy, including BSTS in the differential diagnosis is prudent for preventing misdiagnosis. Bone and soft tissue sarcomas involving body cavities and cerebrospinal fluid are extremely rare. The cytologic findings are nonspecific and could mimic adenocarcinoma and non–small cell carcinoma, especially in pleural and peritoneal fluid. In patients with a prior sarcoma diagnosis, a comparison with a prior specimen may suffice. However, in the absence of a prior known malignancy, ancillary tests (immunohistochemical and/or molecular studies) are helpful in preventing misdiagnosis. [ABSTRACT FROM AUTHOR]

This paper tends to present a systematic review of the applications of Artificial Intelligence (AI) in the field of medical diagnosis vis-a-vis fluid cytology. The study is based on the research articles published in various reputed international and national journals and the conference proceedings from 1990 to till date. AI-based systems are becoming useful as alternative approaches to conventional techniques and are also becoming integral components of many diagnostic systems. Artificial intelligence is being increasingly used to solve complex practical problems in various areas and is becoming more and more popular nowadays. The use of AI for tackling various problems in medical science has diversified significantly during this period. It emerges as a dominant technique for addressing various difficult research problems. This paper follows the trend and evolution of application-based research during the last three decades. It also presents a technical comparison of novel methodologies developed by the researchers to deal with diagnostic problems in the analysis of body cavity fluids. Abnormalities in body cavity fluids lead to various serious disorders like meningitis, subarachnoid hemorrhage, CNS malignancy, demyelinating disease, heart failure, pulmonary embolism, cirrhosis, pneumonia, pleurisy, and pericarditis, arthritis, joint Infection and joint hemorrhage. Moreover, the paper includes recent research articles published during 2018 and 2019 to present the recent progress in this domain. [ABSTRACT FROM AUTHOR]

Background: Pelvic washings for patients with endometrial cancer is recommended but not used for staging. The International System for Reporting Serous Fluid Cytology (TIS) has standardized diagnostic categories, but the criteria remain incomplete. The 3 primary goals of this study were to 1) investigate features that distinguish atypical/indeterminate from malignant specimens, 2) measure the level of agreement between chart and reviewer diagnoses, and 3) determine whether the number of years in practice had an effect on the diagnoses rendered. Methods: Pelvic washings and surgical pathology specimens for 52 patients with a chart diagnosis of atypical/indeterminate, suspicious, or malignant cytology and 52 age‐matched controls with a negative chart diagnosis were included, reviewed blindly by 2 cytopathologists, and assigned a study diagnosis. Morphologic features were assessed. Agreement between original chart diagnoses and reviewer diagnoses were assessed as well as effect of years in practice. Results: The overall cellularity in cell block (CB) slides for the malignant category was significantly increased compared with the atypical/indeterminate category (P <.0001). In addition, the number of atypical groups in ThinPrep for malignant washings was significantly increased compared with the atypical category (P <.001) and the negative and suspicious categories (P <.0001) in the CB. Overall agreement between the original and adjudicated diagnoses was high (γ = 0.983). There was no significant difference between diagnoses rendered and years in practice. Conclusion: The overall cellularity and number of atypical cells can be used to distinguish between malignant and atypical pelvic washing specimens. There is high reproducibility in the diagnostic categories and high agreement among pathologists, regardless of practice experience. These findings can help refine the criteria for TIS. There are cytologic features, such as total cellularity and the number of atypical groups, that differ between atypical/indeterminate and malignant pelvic washing specimens in patients with endometrial cancer. There is high diagnostic precision among pathologists in diagnosing these pelvic washing specimens. These findings may aid in determining criteria for the newly reported TIS system. [ABSTRACT FROM AUTHOR]

Clear Cell Sarcoma of Kidney (CCSK) is a highly malignant renal tumour. The mean age of diagnosis is between 12-36 months. Due to heterogeneous histological appearance and age group affection similar to wilms tumour, it often leads to misdiagnosis. It has a tendency to metastasise distantly to bone and its therapeutic response differs from other childhood kidney tumours. So use of Immunohistochemical (IHC) markers becomes essential in many cases in differentiating CCSK from other paediatric renal neoplasms. It is extremely rare in adults, till now only 26 adult cases have been reported in the medical literature. Here, the case of a 49-year-old male presenting with haematuria and pedal oedema is reported. On radiological examination, he had a large left renal mass with tumour extension to Left Renal Vein (LRV) and Inferior Vena Cava (IVC) as thrombi. Histology and Immunohistochemistry (IHC) study revealed CCSK ruling the other differentials. This case is presented for its rarity in adult patients, unusual clinical feature of widespread vascular invasion rather than bone metastasis, simulating Renal Cell Carcinoma (RCC) and aggressive clinical behaviour. The diagnostic challenges faced by pathologist and clinicians further necessitate the proper diagnosis of the tumour for better management of such cases.

Background: In the last decade, analysis of malignant cells and flora in gastric lavage (GL) has provided interesting data on pathogenesis of gastric cancer (GC). For this study, combining such two aspects into one cyto-microbiologic category, we tested the prognostic role of the presence/absence of cancer cells (GL1/GL0) and bacterial microbiota (MB1/MB0) in our GC population. Material and Methods: Between April 2012 and August 2019, 79 surgical patients with GC were prospectively investigated with the determination of GL MB. Results: Compared with GL1 MB0, GL1 MB1 strongly correlated with advanced GC, portended poorer overall survival (OS) (45.8 months vs 20.5 months, P = 0.049), and resulted a significant (P = 0.008) and an independent (P = 0.013) prognostic factor unfavorable for OS. Conclusion: In the light of our results, the cyto-microbiologic parameter of GL MB should be used to gain a better prognosis of GC patients. Administration of antimicrobial treatment for MB1 subjects should be entertained because it could reduce the risk of oncogenesis. [ABSTRACT FROM AUTHOR]

Background: For the detection of malignancy in the serous fluids of the body, cytological examination of the fluid is very important. It is also of prime importance and seems difficult to differentiate the malignant cells from reactive mesothelial cells during fluid cytology. The cell block preparation is a useful and additive diagnostic tool when cellular features in cytology are inconclusive or suspicious. The aim of the study was to assess the utilization of the cell technique as an additional tool along with the conventional smears that we are using in routine practice. Methods: 200 body (effusion) fluids were examined by the conventional cytological smears as well as by the cell block technique. Conclusion: The diagnostic yield increases when we use the cell block preparation method along with the conventional smears because the architectural patterns and cell morphology are very well preserved in cell block as compared to the smears. [ABSTRACT FROM AUTHOR]

Background: The International System for Reporting Serous Fluid Cytopathology was recently proposed as a tiered structure to provide consistent reporting terminology for serous effusions. Because of the variation in reporting practices for indeterminate serous effusions, namely, the atypia of undetermined significance (AUS) and suspicious for malignancy (SFM) groups, the authors retrospectively reviewed cases in these 2 categories at their institution and determined the associated risk of malignancy (ROM). Methods: Pleural, peritoneal, and pericardial effusions that were reported as AUS or SFM over a 1‐year period were reviewed, and their associated ROMs were calculated based on confirmation of malignancy by previous and/or subsequent fluid and/or tissue biopsy specimens from the same general location. Results: In total, 145 AUS and 98 SFM serous effusion cases were identified. The AUS category was used when the cells in question lacked the requisite quantitative (cell number) and/or qualitative (morphologic) features for a definitive diagnosis. Immunohistochemistry (IHC) or flow cytometry (FCM) was available in 15% of cases (n = 22) with inconclusive results. The ROM based on 69 cases with available follow‐up results was 39%. In contrast, the SFM category demonstrated cells that were morphologically suspicious for malignancy but sparse, precluding IHC or FCM (n = 63; 64%) or yielding inconclusive results (n = 35; 36%). The ROM in the SFM category, based on follow‐up results of 61 cases, was 64%. Conclusions: The ROM for SFM was significantly higher than that for AUS (P <.01), supporting separate diagnostic categories for these 2 groups. There is considerable variation in the reporting practices for indeterminate serous effusions, namely, the categories atypia of undetermined significance and suspicious for malignancy, with limited literature on their associated risk of malignancy. The reporting practice at a single institution is examined and demonstrates that the risk of malignancy in the suspicious for malignancy category is significantly higher than that for the atypia of undetermined significance category, thus providing support for retaining these as 2 separate diagnostic categories in the tiered reporting system for serous effusions. [ABSTRACT FROM AUTHOR]

Objectives: Fine-needle aspiration (FNA) of ovarian cyst fluid remains useful for certain clinical circumstances despite low sensitivity and potential safety concerns. The current study aimed to reevaluate the performance of ovarian cystic fluid cytology following American College of Obstetricians and Gynecologists guidelines using a single-institution cohort., Methods: A total of 507 ovarian cyst FNA cases from 2013 to 2023 were reviewed. Patients' demographics and clinical and radiologic information were collected through the electronic database. The performance was calculated using corresponding surgical pathology diagnosis as the gold standard., Results: Overall, cytologic diagnoses were nondiagnostic (ND), negative for malignancy (NFM), atypical (ATY), suspicious for malignancy (SFM), and malignant (M) in 5 (1.0%), 478 (94.3%), 14 (2.7%), 2 (0.4%), and 8 (1.6%) cases, respectively. Among 349 specimens (68.8%) that had a corresponding surgical pathology, the rate of malignancy (including borderline tumors) was 1.2% (4 of 325) in NFM, 72.7% in ATY (8 of 11), and 100% in both SFM (2 of 2) and M (8 of 8) specimens. Considering NFM and ATY as negative results and SFM and M as positive results, overall, the sensitivity of ovarian cystic fluid cytology was 45.4% and the specificity was 100%., Conclusions: As an uncommon test, ovarian cystic fluid cytology has moderate sensitivity and high specificity. Despite limitations, ovarian cystic FNA cytology remains a valuable diagnostic tool in certain aspects., (© The Author(s) 2024. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The cell block (CB) technique is a generalized method utilized for the diagnostic evaluation of body cavity fluids. Ascites cytology is one of the most important diagnostic processes for epithelial ovarian cancer. However, in clinical practice, the usefulness of the CB method to diagnose this tumor remains unelucidated. Between 2008 and 2017, 15 peritoneal or pleural fluid samples obtained from patients with ovarian or peritoneal carcinoma or other gastrointestinal malignancies were preoperatively subjected to a diagnostic evaluation to predict the histological type and original organ. The CBs were made from 10% formalin neutral buffer solution fixed sediments of fluid samples after cytological smears were made by conventional method. Four-mm thickness sections were prepared from the cell blocks and stained with immunohistochemical method, using 16 kinds of antibodies and hematoxylin eosin staining method. The cellularity, architectural patterns, and morphological details were also studied. The median (range) age of patients was 73 (35-87) years. The clinical features were identified as follows: pleural effusion in 4, ovarian mass in 7, peritoneal dissemination in 12, para-aortic nodal swelling in one, and liver tumor in one (some overlapping). Five patients had a history of prior malignancy. Finally, we could accurately diagnose the histological type in 9 patients based on subsequent biopsy, surgery, and autopsy. In all 9 women, the clinical diagnosis, CB diagnosis and final pathological diagnosis were consistent. The CB technique may be a helpful modality for evaluating fluid cytology to obtain a final histopathologic diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Sarcomas presenting as malignant effusions are rare, and diagnosing them on fluid cytology requires expertise and clinicoradiological correlation as cells undergo morphological changes, mimicking carcinoma or mesothelioma., Case Presentation: We present a case of a 70-year-old man with abdominal distention and pain, initially suggestive of carcinoma on peritoneal fluid cytology. However, subsequent analysis with immunohistochemistry on the cell block revealed diffuse nuclear positivity for MDM2, leading to the diagnosis of dedifferentiated liposarcoma., Conclusion: The cytological diagnosis of dedifferentiated liposarcoma is challenging and requires a high index of suspicion, with clinicoradiological correlation. Utilizing immunohistochemistry on cell block samples enhances diagnostic accuracy and guides appropriate patient management., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Objective: Extranodal natural killer/T‐cell lymphoma, nasal type (ENKTL) is an aggressive extranodal lymphoma of NK‐cell or T‐cell lineage. Its clinical features overlap with those of several sinonasal mass lesions. While the histopathological features are well described, diagnosis is often difficult, owing to presence of extensive coagulative necrosis, so that repeated biopsies may sometimes be necessary for correct diagnosis. Literature on cytological findings of ENKTL is limited. Methods: Cytomorphological features of cases of histologically confirmed ENKTL having corresponding cytology samples were reviewed retrospectively, to identify distinctive features that could possibly suggest this entity. Results: Aspirates from five patients were studied: four from cervical nodes, one from cheek swelling and one from pleural fluid. Two aspirates were reported as positive for malignancy, two as atypical lymphoid proliferation and one was non‐diagnostic. Pleural fluid was reported as malignant, favouring a diagnosis of carcinoma. On cytology, aspirates showed medium to large cells with folded, indented nuclei and abundant pale cytoplasm, some with tongue‐like cytoplasmic protrusions. A distinctive feature was presence of large loose clusters of tumour cells with arborising capillaries running through them. Interestingly, necrosis was consistently absent. Subsequent biopsies from palate (three cases) and nasal masses (two cases) confirmed the diagnosis of ENKTL. Conclusions: Suspicion of ENKTL on cytology is crucial for timely diagnosis to avoid diagnostic delay, especially when only highly necrotic biopsy samples are available. Awareness of distinctive cytomorphological features is required to make fine needle aspiration an effective diagnostic tool for initial diagnosis and for evaluation of possible recurrences. The cytological features of extranodal NK/ T‐cell lymphoma (ENKTL), nasal type, are not well documented, hampering accurate diagnosis. This study describes detailed cytomorphological features of ENKTL on fine needle aspirates as well as fluid cytology, which recapitulate the histomorphological features of this entity. [ABSTRACT FROM AUTHOR]

Background: Parasitic infestation is one of the serious health problems in developing countries. Parasitic infestation is usually asymptomatic and does not cause disease as it may eventually lead to the death of both organism and host. Materials and Methods: This was a retrospective study done over a period of 5 years from 2013 to 2018. The study included 26 cases of parasitic infestations diagnosed on fine-needle aspiration cytology (FNAC) as well as fluid cytology. Results: Hydatidosis, cysticercosis, and filariasis were the parasitic infestations observed in this study, of which hydatidosis was the most common infestation. The predominant age group was 20–85 years old, with a mean age of presentation being 55 years. There was male predominance with a male–female of 9:1. Conclusion: FNAC and fluid cytology are rapid diagnostic tools that aid in the early diagnosis of parasitic infestations. In parasitic infestations presenting as visceral cystic lesions, thorough examination with proper clinical correlation aid in early management. In cases with coexistent malignancy, cytology plays a major role in the diagnosis of silent carriers of infection. [ABSTRACT FROM AUTHOR]

Clear Cell Sarcoma of Kidney (CCSK) is a highly malignant renal tumour. The mean age of diagnosis is between 12-36 months. Due to heterogeneous histological appearance and age group affection similar to wilms tumour, it often leads to misdiagnosis. It has a tendency to metastasise distantly to bone and its therapeutic response differs from other childhood kidney tumours. So use of Immunohistochemical (IHC) markers becomes essential in many cases in differentiating CCSK from other paediatric renal neoplasms. It is extremely rare in adults, till now only 26 adult cases have been reported in the medical literature. Here the case of a 49-year-old male presenting with haematuria and pedal oedema is reported. On radiological examination, he had a large left renal mass with tumour extension to Left Renal Vein (LRV) and Inferior Vena Cava (IVC) as thrombi. Histology and IHC study revealed CCSK ruling the other differentials. This case is presented for its rarity in adult patients, unusual clinical feature of widespread vascular invasion rather than bone metastasis, simulating Renal Cell Carcinoma (RCC) and aggressive clinical behaviour. The diagnostic challenges faced by pathologist and clinicians further necessitate the proper diagnosis of the tumour for better management of such cases. [ABSTRACT FROM AUTHOR]

Introduction Gout may manifest with crystal-induced arthropathy and/or soft tissue tophi. Demonstration of monosodium urate (MSU) crystals is necessary to establish the diagnosis. Despite the fact that alcohol is an ideal fixative to preserve MSU crystals, very few fine-needle aspiration (FNA) cases of gout have been published. Materials and Methods A retrospective review was performed for FNA cases diagnosed as tophaceous gout. Samples included unstained smears or smears stained with Diff-Quik or Papanicolaou stain, and formalin-fixed paraffin-embedded cell block stained with hematoxylin and eosin (H&E). Results We identified 22 FNA cases involving 18 men and 4 women. Only 7 patients had a clinical history of gout and 5 were taking gout medication. At least 4 patients presented with a clinical diagnosis of rule out sarcoma. All had soft tissue masses from either upper (n = 5) or lower (n = 17) extremities. Extracellular polarizing needle-shaped crystals with negative birefringence were present and visible on unstained, Diff-Quik, or Papanicolaou-stained conventional smears as well as in H&E-stained cell blocks in all cases. Conclusions Our study demonstrates that MSU crystals are readily detectable under polarization on direct smears with or without staining. FNA cytology can serve as an alternative to core needle biopsy or synovial biopsy in not only confirming a diagnosis of tophaceous gout, but also in eliminating a diagnosis of soft tissue sarcoma in those patients where clinical and/or radiologic features were concerning for malignancy. [ABSTRACT FROM AUTHOR]

Background: Filariasis is a major health problem in India. Despite the high prevalence, microfilariae are rarely found in cytology smears. Most of the cases are incidentally found, solely or in association with other pathologies. Aims and Objectives: The study was undertaken to analyze the prevalence and cytology findings of cases of incidentally found microfilariae in cytology smears (fine-needle aspiration cytology [FNAC]/body fluids) from different body parts. Materials and Methods: This was a retrospective study over 5 years, where the cases of microfilariae in aspirates from swelling of different locations and body fluids were reviewed, and clinic-pathological data were analyzed. Results and Analysis: Out of 16,738 cases of FNAC and 882 cases of fluid cytology, 22 cases (0.124%) of incidental finding of microfilaria were documented in cytology smears. The cases were diagnosed from lymph nodes (5 cases), skin and soft tissue (4 cases), scrotal (4 cases), breast (3 cases), thyroid (2 cases), and pleural fluid (2 cases). We found eosinophilia in 15 cases (68.18%) of filarial lesions. We found two cases of incidental findings of microfilariae in association with malignant lesions. Conclusion: Filariasis should be considered as differential diagnosis of swelling of lymph nodes, skin, soft tissue, inguinoscrotal region, and other sites as well. Careful screening of cytology smears may help in detection of incidental cases in the association of other pathologies. [ABSTRACT FROM AUTHOR]

Background: Stool microscopy and concentration techniques are the two most important and necessary aspects of diagnostic parasitology. In an era when there is increased disease burden due to intestinal parasites, an early and appropriate diagnosis is warranted. Direct microscopy is usually labor intensive and tedious. Materials and Methods: Thirty-two fresh fecal specimens from patients presenting with eosinophilia and/or anemia (hemoglobin levels <10 g%), HIV-positive patients, and in patients clinically suspected of harboring parasites, were collected for the study. All the positive samples were processed by both the standard methodology, i.e., formalin-ethyl acetate sedimentation technique and Mini Parasep® SF method, by the standard operating procedure of our laboratory and the manufacturer's instruction. Stool pellet concentrates were subjected to saline/iodine wet mount, modified acid fast staining for intestinal coccidian parasites and trichrome staining for Blastocystis hominis. The average number of organisms counted in 0.5 ml of pellet was used for comparison of the two techniques. Results: The morphology of eggs was maintained in both the techniques; however, the wet mount prepared from the sedimentation technique had more background fecal debris in comparison to the Parasep® technique. The parasite yield was equal for both the techniques while Mini parasep had the advantage of less distortion of parasite morphology. Conclusion: We found that Parasep® offered a better parasitic yield, a better workflow capacity, and a reduced turnaround time, which would further benefit resource-restrained laboratories and those with a high sample turnover. [ABSTRACT FROM AUTHOR]

Histoplasmosis has been observed in patients with immunosuppression in the form of isolated pulmonary involvement and disseminated disease. However, very few cases of this type that involved pleural effusion have been reported, and none have been reported in a case individual with mixed-phenotype acute leukemia (MPAL). Herein, we report a case involving a 23 year old Punjabi man having fever and breathlessness in the postinduction therapy period for mixed-phenotype acute leukemia (MPAL) with diagnosis of histoplasmosis based on the results of pleural fluid cytologic testing. The diagnosis of histoplasmosis may be missed in routine pleural fluid cytology testing; however, a high degree of suspicion for opportunistic infections in patients with immunocompromised state can aid diagnosis. [ABSTRACT FROM AUTHOR]

A 10-year-old, female spayed mixed-breed or cross-bred dog was referred to the Small Animal Teaching Hospital of the University of Liverpool due to tachypnea, dyspnea, and pleural effusion not responding to diuretics and antibiotics. The chest was drained and cytology of the pleural fluid was consistent with a modified transudate with presence of atypical cells initially attributed to mesothelial hyperplasia and dysplasia. Computed tomography detected, in addition to the bilateral pleural effusion, diffuse pleural thickening, multiple pleural and pulmonary nodules, and a mineralized and lytic mass in the left scapula. Imaging findings were suggestive of a primary bone tumor with intrathoracic metastasis. Cytology of the left scapular and pleural masses revealed a malignant neoplasm highly suggestive of osteosarcoma. The diagnosis was confirmed by demonstration of a positive cytochemical reaction for alkaline phosphatase on prestained cytology slides. This finding prompted review of the initial interpretation of the pleural effusion cytology. The presence of neoplastic osteoblasts in the thoracic fluid was identified by a combination of cytochemistry, cell pellet immunohistochemistry, and transmission electron microscopy findings. In this report, a multidisciplinary integrated diagnostic approach was used to diagnose and confirm a neoplastic pleural effusion due to osteosarcoma metastasis in a dog. [ABSTRACT FROM AUTHOR]

Background Tuberculous effusions are common. Classically, they are described as bacteria poor and lymphocyte rich. Our experience, however, has been more varied. We compiled this rare group of bacteria-positive tuberculous fluids to document their cytologic spectrum and to look for possible predictors of bacillary positivity. Methods Fifty-one cases of bacillary positive fluids were identified and their clinicopathological details were noted. Per case, the smear background was assigned as either clear, caseous, suppurative, granular proteinaceous or frankly hemorrhagic. Fine, punched-out vacuoles in the smear background were also noted. The bacillary load in each case was classified from scanty to 3+. Eventually, the clinicopathologic variables were tabulated for frequency and studied for any association with bacillary presence. Results Only 19 of the 51 patients had a history of tuberculosis. Retropositive patients comprised a small proportion (9.8%) and did not always indicate strong (3+) bacillary positivity. The granular proteinaceous background was the most frequent (35%) pattern. Only a suppurative background was associated with strong bacillary positivity. Fine vacuoles were seen almost always with caseous and granular proteinaceous backgrounds but without statistical significance. Conclusion Tuberculous effusions can have diverse smear backgrounds, not necessarily one rich in caseous material. When tuberculosis is known or clinically suspected, non-classical findings such as abundant neutrophils or suppurative background should not dissuade one from requisitioning mycobacterial stains. In fact, acid-fast stains should probably routinely accompany Giemsa slides of clinically idiopathic effusions in endemic areas since it is still the cheapest and fastest method for a conclusive diagnosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Patel et al.)

Introduction Pleural and peritoneal/ascites fluid samples with many lymphocytes are commonly received in the cytology laboratory. It is often difficult to distinguish reactive lymphocytes from hematopoietic malignancy based on morphology alone, however. Flow cytometry can be a useful adjunct in body fluids, although literature on this subject is limited. Materials and methods This study is a single-institution 5-year retrospective review of 377 fluid samples from 341 patients with corresponding flow cytometry analysis. The cytologic findings were correlated with the flow cytometry results and clinical data, as available. Results Of 4158 pleural fluids received over 5 years, 325 (7.8%) had corresponding flow cytometry analysis. Of these 325 samples, 57 (17.5%) were positive for hematopoietic malignancy by flow cytometry. Of the positive cases, only 24 (8.7%) represented a new diagnosis of hematopoietic malignancy (ie, did not have a known history). Of 3020 peritoneal/ascites fluids received over 5 years, 52 (2%) had corresponding flow cytometry. Of these, 8 were positive for hematopoietic malignancy, and only 2 represented a presumed new diagnosis. Conclusions Routine flow cytometry analysis for pleural and peritoneal/ascitic fluids is of limited utility, with only rare cases positive for hematopoietic malignancy without a known history. Of these cases, many had atypical cells that suggested a positive diagnosis. Conversely, in cases with a known history, about 75% were positive for hematopoietic malignancy. Our study suggests that the utility of flow cytometry for pleural and peritoneal/ascitic fluids is limited, and should be used sparingly in cases without atypical cytologic features, high clinical suspicion, or known history. [ABSTRACT FROM AUTHOR]