Try a new search

Format these results:

Searched for:

person:simmsa01

in-biosketch:true

Total Results:

15


Bronchiolar Adenoma/Pulmonary Ciliated Muconodular Papillary Tumor

Shirsat, Hemlata; Zhou, Fang; Chang, Jason C; Rekhtman, Natasha; Saqi, Anjali; Argyropoulos, Kimon; Azour, Lea; Simms, Anthony; Melamed, Jonathan; Hung, Yin P; Roden, Anja C; Mino-Kenudson, Mari; Moreira, Andre L; Narula, Navneet
OBJECTIVES/OBJECTIVE:To describe the histologic features that are helpful in the diagnosis of the rare bronchiolar adenomas/ciliated muconodular papillary tumors (BAs/CMPTs) during intraoperative consultation. METHODS:Multi-institutional retrospective review of frozen sections of 18 BAs/CMPTs. RESULTS:In 14 of 18 cases, BA/CMPT was the primary reason for sublobar lung resection, and in 4 cases, BA/CMPT was an incidental finding intraoperatively for resections performed for carcinoma in other lobes. There were 11 proximal-type/classic BAs/CMPTs and 7 distal-type/nonclassic BAs/CMPTs. Only 3 (16.7%) of 18 were correctly diagnosed at the time of frozen section, all of which were proximal type/classic. The remainder were diagnosed as adenocarcinoma (n = 7); invasive mucinous adenocarcinoma (n = 1); non-small cell lung carcinoma (n = 1); cystic mucinous neoplasm, favor adenocarcinoma (either mucinous or colloid type) (n = 1); favor adenocarcinoma, cannot exclude CMPT (n = 1); atypical proliferation (n = 2); mucinous epithelial proliferation (n = 1); and mucous gland adenoma (n = 1). CONCLUSIONS:BA/CMPT can potentially be misdiagnosed as carcinoma during intraoperative consultation. On retrospective review of the frozen sections, the presence of the following may help to avoid misdiagnosis: a mixture of bland ciliated columnar cells, mucinous cells, and, most important, a basal cell layer, as well as a lack of necrosis, significant atypia, and mitoses.
PMID: 33313677
ISSN: 1943-7722
CID: 4717512

Scoring of Programmed Death-Ligand 1 Immunohistochemistry on Cytology Cell Block Specimens in Non-Small Cell Lung Carcinoma

Hernandez, Andrea; Brandler, Tamar C; Chen, Fei; Zhou, Fang; Xia, Yuhe; Zhong, Judy; Moreira, Andre L; Simms, Anthony; Sun, Wei; Wei, Xiao Jun; Simsir, Aylin
OBJECTIVES/OBJECTIVE:Recent investigations have shown strong correlations between cytology and surgical non-small cell lung carcinoma (NSCLC) specimens in programmed death-ligand 1 (PD-L1) immunohistochemical (IHC) evaluations. Our study aims to evaluate the reproducibility of PD-L1 IHC scoring in NSCLC cytology cell blocks (CBs) and to assess the impact of CB cellularity, method of sample collection, and observer subspecialty on scoring agreement. METHODS:PD-L1 IHC was performed on 54 NSCLC cytology CBs and was scored independently by seven cytopathologists (three of seven with expertise in pulmonary pathology). Three-tier scoring of negative (<1%), low positive (1%-49%), and high positive (≥50%) and interrater agreement were assessed. RESULTS:Total and majority agreement among cytopathologists was achieved in 48% and 98% of cases, respectively, with κ = 0.608 (substantial agreement; 95% confidence interval, 0.50-0.72). Cytopathologists with pulmonary pathology expertise agreed in 67% of cases (κ = 0.633, substantial agreement), whereas the remaining cytopathologists agreed in 56% of cases (κ = 0.62, substantial agreement). CB cellularity (P = .36) and sample collection type (P = .59) had no statistically significant difference between raters. CONCLUSIONS:There is substantial agreement in PD-L1 IHC scoring in cytology CB specimens among cytopathologists. Additional expertise in pulmonary pathology, sample collection type, and CB cellularity have no statistically significant impact on interobserver agreement.
PMID: 32589185
ISSN: 1943-7722
CID: 4493632

Adult rhabdomyoma presenting as thyroid nodule on fine-needle aspiration in patient with Birt-Hogg-Dubé syndrome: Case report and literature review

Black, Margaret; Wei, Xiao-Jun; Sun, Wei; Simms, Anthony; Negron, Raquel; Hagiwara, Mari; Chidakel, Aaron R; Hodak, Steven; Persky, Mark S; Shi, Yan
Extracardiac rhabdomyoma is an uncommon benign striated muscle tumor with a predilection for the head and neck region. However, it is extremely rare for extracardiac rhabdomyoma to present as a thyroid nodule. We report a case of rhabdomyoma diagnosed by thyroid fine-needle aspiration (FNA) in a patient with Birt-Hogg-Dubé (BHD) syndrome. A 60-year-old man with BHD syndrome presented for recurrent pneumothorax. Chest CT incidentally identified a thyroid nodule. Subsequent sonography confirmed a 4.44 × 2.28 × 2.82 cm solid, hypoechoic nodule with smooth margins in the right upper pole. Ultrasound-guided FNA revealed many clusters and scattered isolated large polygonal cells with abundant granular cytoplasm and small peripherally located nuclei. Vague striations in the cytoplasm were focally identified. No follicular cells or colloid was present. Immunocytochemistry on one direct smear slide demonstrated diffuse positivity for desmin, supporting muscular differentiation. Subsequent surgery identified an adult rhabdomyoma originating from the inferior constrictor muscle of the neck and anteriorly displacing the thyroid. Because the mass was intimately associated with the thyroid gland, it was initially mistaken for a thyroid nodule on ultrasound. Diagnosis of rhabdomyoma on FNA is challenging, especially when rhabdomyoma mimics a thyroid nodule on imaging. The differential diagnosis includes Hurthle cell neoplasm, granular cell tumor, colloid nodule, and normal striated skeletal muscle. Adequate radiologic data and familiarity with the cytologic features of rhabdomyoma are critical for an accurate diagnosis.
PMID: 32187885
ISSN: 1097-0339
CID: 4352812

Impact of Known HPV Status on Cytopathologists for NILM Pap Tests When Information is Too Much [Meeting Abstract]

Shafizadeh, N; Simsir, A; Sun, W; Xiao-Jun, wei; Simms, A; Brandler, C; Yee-Chang, M; Modi, L; Zhong, H; Xia, Y
Introduction: TBS diagnostic category rates, ASCUS/(+)hrHPV (high risk HPV) ratio, and cytotechnologist's (CT'S) concordance with the CP's final diagnosis are used as common quality monitors in gyn cytology. Additionally, extending monitoring of the hrHPV (+) rate to NILM and SIL cases has been proposed as quality indicators for cytopathologist's (CP's) performance. At our institution, Pap tests are finalized without the knowledge of hrHPV status. We investigated the impact of known hrHPV status on CPs' interpretation of cases previously screened as NILM, and stipulated its potential consequence on quality metrics. Material(s) and Method(s): 60 Pap tests previously resulted as NILM, half hrHPV (+) and half hrHPV (-), were reviewed blindly by 5 CPs in two rounds at 4 months interval. At first round, correct hrHPV results were provided to the CPs. At second round, incorrect (reversed) hrHPV results were given. McNemar chi-squared test was used to analyze the impact of knowing the hrHPV test result on Pap test interpretation. Kappa coefficient was calculated to test intra-observer agreement between the first and second review of the same slides for each CP. Result(s): ASCUS (13%) was the most upgraded diagnosis followed by 12 LSILs (2%) and 2 HSILs (0.3%). There were no significant differences in Pap test interpretation based on hrHPV status for 3 CPs and marked differences for 2 CPs (Table 1). Intra-observer agreement between round 1 and round 2 diagnoses varied from moderate to poor (Table 2). Conclusion(s): Knowledge of hrHPV status significantly biases some but not all CPs. hrHPV (+) to NILM, ASCUS and SIL ratios may not be the most objective parameters for evaluation of CP performance under these circumstances. This bias has further implications for CT performance evaluation because it impacts CT discordance rate measured against CPs final diagnosis. [Figure presented] [Figure presented]
EMBASE:2002932045
ISSN: 2213-2945
CID: 4120372

Sarcomatoid carcinoma in cytology: Report of a rare entity presenting in pleural and pericardial fluid preparations

Basu, Atreyee; Moreira, Andre L; Simms, Anthony; Brandler, Tamar C
Sarcomatoid carcinoma is rarely found in pleural or pericardial fluid, with very few cases published to date. Here, we describe a 59-year-old female who presented with cough persisting for 5 months. Chest CT scan revealed a 6.0 cm cavitary mass in the left lung base with bulky mediastinal and hilar lymphadenopathy. An additional 1.2 cm right adrenal mass was seen and was suspicious for metastatic disease. The patient developed dyspnea, tachycardia, pleuritic chest pain and generalized weakness and was admitted to the hospital. She was found to have pleural and pericardial effusions, which were drained and sent to cytology. The fluid revealed enlarged highly pleomorphic malignant cells, some displaying multinucleation with irregular nuclear borders, coarse chromatin and prominent nucleoli. Tumor cells were positive for CK7 and Vimentin and negative for MOC-31, Ber-EP4, B72.3, Sox10, Melan-A, TTF-1, Napsin-A and CK20. A concurrent surgical biopsy of the tumor mass displayed immunopositivity for AE1/AE3 and CAM5.2. The tumor was negative for p40, TTF-1, calretinin, D2-40 and STAT6. A diagnosis of sarcomatoid carcinoma with giant cells and spindle cells was rendered. Sarcomatoid carcinomas of the lung are very uncommon consisting of 1% of non-small-cell lung carcinomas and are even more unusual in cytology specimens. Despite its rarity, it is important to keep this entity in mind in the differential diagnosis of a fluid specimen with bizarre nuclear atypia and the above staining pattern.
PMID: 30908904
ISSN: 1097-0339
CID: 3778732

Papillary thyroid carcinoma metastatic to the pancreas: Case report

Cho, Margaret; Acosta-Gonzalez, Gabriel; Brandler, Tamar C; Basu, Atreyee; Wei, Xiao-Jun; Simms, Anthony
Papillary thyroid carcinoma (PTC) is generally associated with an excellent long-term outcome. Distant metastasis is rare with only 5-7% of patients developing distant disease. Metastasis of PTC to the pancreas is an exceedingly rare occurrence. To date, few cases have been reported. We present the case of an 81-year-old man with past medical history of PTC status post total thyroidectomy with local recurrence treated with radioactive iodine and selective neck dissection. Ten years after his initial diagnosis, PET-CT scan revealed a new hypermetabolic 1.1 cm × 0.9 cm left lower lobe lung nodule and hypermetabolism in the proximal body of the pancreas. Follow-up MRI cholangiogram showed a 1.0 × 0.8 cm T1 hypointense lesion in the proximal body of the pancreas. Endoscopic ultrasound-guided fine-needle aspiration biopsy of the pancreatic mass showed neoplastic epithelial cells arranged in papillary clusters with fibrovascular cores and syncytial sheets with high nuclear to cytoplasmic ratio, visible nucleoli, nuclear pallor, focal nuclear grooves, and rare intranuclear pseudoinclusions. Immunohistochemical stains performed on the smears showed positive nuclear expression of TTF-1 and PAX-8. The findings were consistent with metastatic PTC. Surgical resection of the lung nodule confirmed metastatic PTC. Pancreatic metastases usually occur after long time intervals with reports of up to 8 years in PTC. This makes the diagnosis more challenging, and metastatic disease should always be in the differential diagnosis in cases presenting with a pancreatic mass, especially in patients with a prior malignancy.
PMID: 30479026
ISSN: 1097-0339
CID: 3657862

Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP); An Interobserver Study of Key Cytomorphologic Features From a Large Academic Medical Center

Brandler, Tamar C; Cho, Margaret; Wei, Xiao-Jun; Simms, Anthony; Levine, Pascale; Hernandez, Osvaldo; Oweity, Thaira; Zhou, Fang; Simsir, Aylin; Rosen, Lisa; Sun, Wei
OBJECTIVE:Because of the indolent nature of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) and potential requisite for conservative treatment, it is crucial to identify features of this entity pre-operatively. Our group recently published our findings that there are several cytomorphologic features that may be used as clues to distinguish NIFTP, PTC and follicular adenoma (FA) on fine-needle aspiration (FNA). Therefore, we aimed to determine the interobserver reproducibility of these findings. METHODS:Pre-surgical FNA slides from NIFTP (n=30), classic PTC (n=30) and FA (n=30) collected from 1/2013-8/2016 were reviewed by 7 cytopathologists blindly. Presence of selected cytomorphologic features was recorded and compared to determine percent agreement and inter-rater reliability among study cytopathologists using Gwet's AC1 statistics. RESULTS:For all the cytomorphologic features, the overall percent agreement amongst the pathologists ranged between 65.1% and 86.8% (Gwet's AC1 0.30 to 0.80). There was substantial or almost perfect agreement (Gwet's AC1 >0.60) in seven cytomorphologic features in the classic PTC group, in six features in the NIFTP group, and in five features in the FA group. There were no features with poor agreement (Gwet's AC1<0.0). CONCLUSIONS:The current study supports the reproducibility of our previous findings. The high level of agreement amongst pathologists for these groups, and particularly the NIFTP group, supports the notion that when viewed in combination as a cytologic profile, these cytomorphologic features may assist the cytopathologist in raising the possibility of NIFTP pre-operatively. This can potentially aid clinicians in deciding whether more conservative treatment may be appropriate.
PMID: 30230094
ISSN: 1365-2303
CID: 3300612

Scoring of Programmed Death-Ligand 1 (PD-L1) Immunohistochemistry (IHC) on Cytology Specimens in Non-Small Cell Lung Carcinoma (NSCLC): An Inter-observer Agreement Study [Meeting Abstract]

Hernandez, Andrea; Chen, Fei; Brandler, Tamar; Zhou, Fang; Xia, Yuhe; Zhong, Judy; Moreira, Andre; Simms, Anthony; Wei, Xiao-Jun; Sun, Wei; Simsir, Aylin
ISI:000478081100367
ISSN: 0023-6837
CID: 4047582

Association of PD-L1 Expression with Histological Grade and Mutational Profile in Lung Adenocarcinoma [Meeting Abstract]

Basu, Atreyee; Narula, Navneet; Simms, Anthony; Shirsat, Hemlata; Zhou, Fang; Moreira, Andre
ISI:000478081103300
ISSN: 0023-6837
CID: 4047752

Scoring of Programmed Death-Ligand 1 (PD-L1) Immunohistochemistry (IHC) on Cytology Specimens in Non-Small Cell Lung Carcinoma (NSCLC): An Inter-observer Agreement Study [Meeting Abstract]

Hernandez, Andrea; Chen, Fei; Brandler, Tamar; Zhou, Fang; Xia, Yuhe; Zhong, Judy; Moreira, Andre; Simms, Anthony; Wei, Xiao-Jun; Sun, Wei; Simsir, Aylin
ISI:000478915500349
ISSN: 0893-3952
CID: 4048082