Faculty Bibliography

Introduction: The Bethesda System (TBS) uses a two-tiered approach to cervical squamous intraepithelial lesions (SILs). Occasionally, Paps with evident low grade SIL (LSIL) also have some features suggestive but not diagnostic of high grade SIL (HSIL). These Paps in our and other institutions are reported as 'LSIL, Cannot Exclude HSIL' (LSIL-H). LSIL-H has been shown to represent an intermediate risk (between LSIL and HSIL) for harboring a high grade lesion/carcinoma (HGD+) on biopsy. However, TBS 2014 continues to discourage its use to prevent the re-emergence of a threetiered reporting system. We review our experience with LSIL-H and discuss the best approach to report such Paps if the LSIL-H category is abandoned. Materials and Methods: Abnormal Paps were identified between January and June 2014 which had surgical follow-up within six months. Their biopsy outcomes were compared. Statistical analysis was performed using the Fisher's exact test. Results: Table 1 summarizes surgical diagnoses for each abnormal Pap category (total n=571). The differences in detection rates of HGD+ between LSIL and LSIL-H Pap was significant (p=0.000), whereas between LSIL-H and 'Atypical squamous cells, cannot exclude HSIL' (ASC-H) was not (p=0.101). If the LSIL-Hcategory is abandoned and LSIL-Hcases are reported as ASC-H, the rate ofHGD+ for theASC-H categorywould decrease from 55% to 41% (p=0.3). Alternatively, if LSIL-H cases are downgraded to LSIL, the rate of HGD+ for the LSIL category would rise from 7% to 9% (p=0.27). Conclusions: The 'LSIL-H' category indeed detects more HGD+ than LSIL, and fewer HGD+ than ASC-H. If LSIL-H is eliminated, Paps with this finding are best reported as ASC-H to ensure that women with potential HGD+ undergo colposcopy in a timely manner. Reporting LSIL-H as LSIL may delay colposcopy since management of LSIL Pap depends on multiple factors (age, HPV status, etc). (Table Presented)

Introduction: Differentiating squamous cell carcinoma (SCC) from adenocarcinoma (ACA) can be challenging in cytology specimens. This distinction has major implications for lung carcinomas. We've been utilizing p63, and for the last 2 years, its n-terminally truncated variant, p40, to identify squamous differentiation. Recent literature showed p40 to have a better specificity for this purpose. We evaluated our experience to determine if p63 can be eliminated from our diagnostic panel to maximize cost savings and tissue preservation in cell blocks. Materials and Methods: 115 cytology cases of pulmonary ACAs and SCCs were identified with both p40 and p63 staining. All IHC was performed on cell blocks. Slides were scored for intensity and extent of staining using a 0- 3+ scale (intensity: 0, none; 3+, equivalent to positive control; extent/ percent of tumor cells staining: 0: none; 1+: 1-25%; 2+: 25-50%; and 3+: 50-100%). Results: Table 1 depicts our results. All SCCs and adenosquamous carcinomas (100%) were positive for both p40 and p63 regardless of specimen site. Overall, 15% of ACAs were positive for p40, and 16% were positive for p63, regardless of specimen site. Eleven percent (11%) of ACAs were positive for p40 in lung FNAs, and 21% were positive for p63. ACAs in effusion specimens resulted in more cases with p40 positivity (28%) compared to lung FNAs; this was not the case for p63 (21% in lung FNAs versus 11% in effusions). Conclusions: Our results demonstrate that p40 and p63 antibodies stain all SCCs in cytology specimens. However, despite prior reports claiming superior results for p40, we found that p40 yields a discernible level of false positivity in lung ACAs similar to p63. False positive rate for p40 in ACAs is highest in effusions and is not negligible. Therefore, it is not clear if p40 is preferable to p63 in cytology specimens. (Table Presented)

BACKGROUND: Chondroid syringoma (CS) is a rare benign adnexal tumor of the skin with a resemblance to pleomorphic adenoma of salivary gland, most commonly involving the head and neck region. In the present literature, reports of the cytologic appearance of CS are scarce as it is rarely encountered by fine needle aspiration (FNA). CASE PRESENTATION: A 67-year-old woman presented with a 1 year history of a 1 cm subcutaneous nodule in the right axilla. FNA biopsy was performed revealing an epithelial-mesenchymal biphasic neoplasm suggesting CS. Surgical excision confirmed the diagnosis and demonstrated extensive ossification, an extremely rare feature, with only seven reported cases, all located on the head. CONCLUSION: CS is a rare benign adnexal tumor of the skin, often overlooked due to its unremarkable clinical presentation. FNA is a reliable tool for the diagnosis of CS and helps guide optimal surgical management. Diagn. Cytopathol. 2016. (c) 2016 Wiley Periodicals, Inc.