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Diagnostic Challenges in the Cytology of Thymic Epithelial Neoplasms
Willner, Jonathan; Zhou, Fang; Moreira, Andre L
Thymic epithelial neoplasms are rare tumors that constitute the majority of anterior mediastinal masses. They are classified as thymomas, thymic carcinomas, and thymic neuroendocrine neoplasms. Biopsy diagnosis is not common, and most tumors are surgically resected. Biopsy, including cytology, is indicated when a non-surgical entity is suspected or in cases of locally advanced disease. Smears of thymomas consist of round or spindle epithelial cells admixed with varying amounts of lymphocytes depending on the type of thymoma. Smears of thymic carcinoma and thymic neuroendocrine neoplasms are often indistinguishable from corresponding tumor types from other organs. Accurate cytological diagnosis can be difficult due to the histological diversity of thymomas, as well as the morphological features that certain thymic tumors share with similar tumors from other organs. However, fine needle aspiration (FNA) of anterior mediastinal masses can provide clinically actionable information and can be used to determine whether lesions require surgical, systemic, or local noninvasive treatments. Ancillary studies, namely, immunocytochemical stains, flow cytometry, and radiology, are important tools in the evaluation of thymic aspirates. This review discusses the utility and limitations of thymic FNAs and illustrates the diagnostic features and pitfalls of these specimens.
PMCID:9024685
PMID: 35454918
ISSN: 2072-6694
CID: 5218662
Assessment of the feasibility of frozen sections for the detection of spread through air spaces (STAS) in pulmonary adenocarcinoma
Zhou, Fang; Villalba, Julian A; Sayo, Treah May S; Narula, Navneet; Pass, Harvey; Mino-Kenudson, Mari; Moreira, Andre L
Spread through air spaces (STAS) is reportedly associated with worse prognosis in sublobar resections of lung adenocarcinoma. Recently, it was proposed that STAS detected on frozen sections can be an indication for lobectomy instead of sublobar resection. We undertook this study to evaluate the reliability of STAS assessment on frozen sections compared to permanent sections, as well as the associations among STAS, tumor grade, and recurrence-free survival (RFS) after sublobar resection. A total of 163 stage I lung adenocarcinoma resections with frozen sections were identified retrospectively. For each case, and for frozen and permanent sections separately, the presence or absence of STAS, as well as the tumor grade, were recorded. Compared to permanent sections, STAS detection on frozen sections had low sensitivity (55%), low positive predictive value (48%), and fair agreement (K = 0.34), whereas there was higher specificity (80%) and negative predictive value (85%). Accuracy was 74%. Tumor grade assessment on frozen sections showed higher sensitivity (77%), positive predictive value (90%), agreement (K = 0.72), specificity (94%), and accuracy (87%), and the same negative predictive value (85%). High-grade histology on frozen sections was associated with shorter RFS (p = 0.02), whereas STAS on frozen sections was not (p = 0.47). Our results suggest that the intraoperative detection of STAS has low sensitivity and positive predictive value. False-positive results may lead to overtreatment of patients with lung cancer. The determination of tumor grade on frozen sections offers better sensitivity and specificity, plus it is associated with RFS, whereas STAS on frozen sections is not. Further study is needed to explore the utility of assessing tumor grade on frozen sections.
PMID: 34326485
ISSN: 1530-0285
CID: 5004082
Molecular cytology of the respiratory tract and pleura
Zhou, Fang; Shum, Elaine; Moreira, Andre L
There is growing evidence that molecular testing is feasible on all types of cytological preparation, which is fortunate as more diagnostic markers and biomarkers for targeted therapies are discovered for use in pulmonary and pleural malignancies. In this article we will discuss the pre-analytic, analytic, and post-analytic (interpretive) considerations for successful implementation of molecular tests for diagnostic and predictive markers in respiratory and pleural cytology. The vast majority of laboratories are familiar with, and have validated their molecular protocols for, formalin-fixed paraffin-embedded surgical specimens, which are not directly applicable to cytology specimens. Thus, rigorous validation must be performed for each type of fixative and cytology preparation before it is implemented in the clinical setting.
PMID: 34333812
ISSN: 1365-2303
CID: 4988462
The Common Thread: A Case of Synchronous Lung Cancers and a Germline CHEK2 Mutation [Case Report]
Carey, Edward T; Ferreira, Virginia; Shum, Elaine; Zhou, Fang; Sabari, Joshua K
Patients with one form of cancer are at increased risk for another, and this is true for lung cancer, where synchronous primary lung cancers are an increasing multifaceted challenge.1,2 Here, we present the case of a middle age woman who was found to have bilateral lung masses. Biopsy and subsequent testing revealed unique synchronous lung adenocarcinomas, each with unique genetic signatures. Despite having two unique tumors, she was found to have CHEK2 mutations in both tumors and in germline testing. Because of this extensive testing that showed unique tumors, she was ultimately diagnosed with stage IIIb and IA2 lung cancers, and this changed her treatment options. Consideration of unique primary tumors leads to thorough diagnostics, which changed this patient's diagnosis, prognosis, and treatment. We hope this case raises awareness for multiple primary tumors, as well as CHEK2 as an important oncogene.
PMID: 34246541
ISSN: 1938-0690
CID: 4938102
Evidence for Continuity of Interstitial Spaces Within and Outside the Human Lung [Meeting Abstract]
Ordner, Jeffrey; Chiriboga, Luis; Zeck, Briana; Majd, Mariam; Zhou, Fang; Moreira, Andre; Ko, Jane; Imam, Rami; Wells, Rebecca; Theise, Neil; Narula, Navneet
ISI:000770361803213
ISSN: 0893-3952
CID: 5243392
Grading of Lung Adenocarcinomas: Comparison of Paired Biopsies and Resections [Meeting Abstract]
Basu, Atreyee; Zhou, Fang; Narula, Navneet; Moreira, Andre
ISI:000770361803175
ISSN: 0893-3952
CID: 5243382
Detection of Novel Fusions in Salivary Gland Type Tumors Using a Custom NGS RNA Sequencing Fusion Panel [Meeting Abstract]
Hasan, Hasanain; Hindi, Issa; Zhou, Fang; Jour, George; Liu, Cheng; Brandler, Tamar
ISI:000770360202150
ISSN: 0023-6837
CID: 5243222
Cytomorphology of Poorly Differentiated Thyroid Carcinoma: Useful Features to Examine on Fine Needle Aspiration [Meeting Abstract]
Kim, Christine; Chen, Fei; Shafizadeh, Negin; Zhou, Fang; Sun, Wei; Liu, Cheng; Simsir, Aylin; Brandler, Tamar
ISI:000770360200248
ISSN: 0023-6837
CID: 5243172
Detection of Novel Fusions in Salivary Gland Type Tumors Using a Custom NGS RNA Sequencing Fusion Panel [Meeting Abstract]
Hasan, Hasanain; Hindi, Issa; Zhou, Fang; Jour, George; Liu, Cheng; Brandler, Tamar
ISI:000770361802150
ISSN: 0893-3952
CID: 5243362
Evidence for Continuity of Interstitial Spaces Within and Outside the Human Lung [Meeting Abstract]
Ordner, Jeffrey; Chiriboga, Luis; Zeck, Briana; Majd, Mariam; Zhou, Fang; Moreira, Andre; Ko, Jane; Imam, Rami; Wells, Rebecca; Theise, Neil; Narula, Navneet
ISI:000770360203213
ISSN: 0023-6837
CID: 5243252