Faculty Bibliography

Sclerosing hemangioma of the lung is a benign neoplasm with a widely debated histogenesis. It has a polymorphic histomorphology characterized by a biphasic cell population of "surface cells" and "round cells" arranged in four general patterns: Papillary, solid, angiomatous, and sclerotic. This variability in histomorphology makes it difficult to diagnose sclerosing hemangioma by fine needle aspiration (FNA). We present a case of sclerosing hemangioma diagnosed on FNA with immunohistochemistry performed on an accompanied cell block. The clinical presentation, cytomorphology, immunohistochemistry, and differential diagnoses are discussed.

Introduction: Metastatic neoplasms (MN) are rare in the pancreas. An accurate diagnosis is challenging because MNs mimic primary pancreatic neoplasms, both clinically and on cytology. However, the distinction is critical for patient management. In this study, we reviewed our experience in diagnosing MNs by EUS-FNA of the pancreas. Material and Methods: We searched our database for pancreatic EUS-FNA specimens with a diagnosis of MN from 1994 to 2014. The clinical history, radiologic findings and follow-up of these cases, if available, were reviewed. Results: There were 17 cases of MNs to the pancreas in 7 males and 10 females, ranging in age from 37 to 85 years (mean = 62). The primary malignancies included carcinomas of the lung (4), colon (3), breast (2), ovary (1), kidney (1), liver (1), melanoma (3) and sarcoma (2). The pancreatic head and neck were the most common locations (73%).16 cases (94%) had a known prior history of malignancy; the clinical history was not provided in one case. All cases presented as a single mass in the pancreas. The average tumor size was 1.9 cm (range: 0.5 - 4 cm). 12 cases (71%) were poorly-differentiated carcinomas, indistinguishable from a pancreatic adenocarcinoma without immunohistochemical (IHC) studies and/or clinical history. 12 (71%) cases were correctly diagnosed as MN, 3 (18%) cases had indeterminate tumor origin, and 2 (12%) were misdiagnosed as primary pancreatic adenocarcinoma. A correct diagnosis was reached by cytomorphology alone in 3 cases (18%); morphology and immunohistochemical stains in 7 cases (41%); and morphologic comparison to the prior tumors in 2 cases (12%). Conclusions: EUS-FNA is an effective approach to diagnose pancreatic tumors. MNs can be difficult to differentiate from primary pancreatic carcinomas based on cytology alone. Clinical history and adequate cell block for IHC studies are essential to reach an accurate diagnosis

Introduction: ThinPrep and SurePath are two widely used liquid-based cervical cytology preparation techniques. SurePath has a lower unsatisfactory rate, but is not approved by the FDA for human papillomavirus testing. For this reason, our laboratory switched to ThinPrep and had a markedly increased unsatisfactory rate (up to 7%) due to lubricants, blood/inflammation, and insufficient cellularity. Our SurePath unsatisfactory rate was less than 1%. Our patient population has limited access to care and restricted flexibility in scheduling gynecologic appointments. Glacial acetic acid treatment for bloody specimens is time-consuming and repeat Thinprep slides did not yield significant improvement. Materials and Methods: The residual samples from 270 specimens initially deemed unsatisfactory were reprocessed by removing methanol fixative with washes of Hank's balanced salt solution via centrifugation and resuspension in SurePath preservative. Specimens were then processed according to standard SurePath methodology and demonstrated preserved cellular morphology. Results: 168 cases (62%) were adequate specimens after reprocessing, yielding 163 negative for intraepithelial lesion (NILM) (97%), 4 atypical squamous cells of undetermined significance (ASCUS) (2.4%) and 1 low grade lesion (0.6%). 105 unsatisfactory cases were due to blood (43%), lubricant (20%), scant cellularity (29.5%), inflammation (4.8%), and blood/ lubricant (3%). Follow-up repeat cervical cytology for unsatisfactory specimens in 78 of 102 women demonstrated 12 unsatisfactory specimens, 59 NILMs, 6 ASCUS, and 1 low-grade lesion. Conclusion: SurePath technique utilizes a density reagent which acts as an effective filter to eliminate obscuring factors such as blood, lubricant, and inflammation, without increasing our unsatisfactory rates. With ThinPrep, the unsatisfactory rate is much higher. We processed ThinPrep specimens using SurePath methodology after the methanol fixative was removed. Well preserved cellular morphology and enriched cellularity was achieved. Reprocessing unsatisfactory ThinPrep with the SurePath density reagent is an effective way to decrease the unsatisfactory rate in cervical cytology specimens

INTRODUCTION: High-risk HPV (hrHPV) testing is now considered standard of care in the detection and management of cervical high-grade squamous intraepithelial lesions (HSIL/CIN 2-3) and their precursors. Recently, there has been concern in the scientific literature and lay media about the lack of data regarding the false-negative rate (FNR) of HPV testing on SurePathTM cytology specimens. This is a critical issue, since guidelines on the management of Pap test abnormalities rely heavily on HPV status. We undertook this study to determine whether HPV testing on SurePathTM specimens is less sensitive compared to reports in the literature for ThinPrep(R). METHODS: We identified women with new diagnoses of CIN 2, CIN 3, and squamous cell carcinoma (SCC) on biopsy or excision in 2009-2013. For each patient, we recorded all SurePathTM cytology and hrHPV HC2 (high-risk HPV Hybrid Capture 2) test results from within 5 years prior to histologic diagnosis. Using the histologic diagnosis as the gold standard, we calculated the sensitivities of cytology and hrHPV HC2 tests for the detection of CIN 2, 3, and SCC. Our findings are based only on women who underwent biopsy or excision after having an abnormal cytology and/or positive HPV result. RESULTS: In our cohort, the sensitivity of testing in the 5 years prior to histologic diagnosis of CIN 2, 3, and SCC (combined as a single group) is 98.4% for SurePathTM cytology, 95.3% for hrHPV HC2, and 100% if both tests are used together. No conclusion can be drawn regarding testing for SCC alone, because there was only one case of SCC. CONCLUSION: Our results show that the false-negative rate of hrHPV HC2 testing on SurePathTM specimens for the detection of CIN 2 and CIN 3 is low and comparable to that of ThinPrep(R) specimens. Diagn. Cytopathol. 2014. (c) 2014 Wiley Periodicals, Inc.

Amyloidomas are rare tumors composed of deposits of amyloid protein not associated with systemic amyloidosis. They can present as an initial manifestation of a systemic disease process or can be a completely localized phenomenon. We present a case of amyloidoma associated with insulin injection site found incidentally in an 80-year-old male with multiple co-morbidities who presented with diverticulitis associated bleeding. A subcutaneous abdominal mass was found on physical examination. Imaging revealed a 5 cm x 1.6 cm homogenous subcutaneous lesion. A fine-needle aspiration (FNA) and core biopsy were performed under ultrasound guidance to reveal amorphous material proven to be amyloidosis at insulin injection sites (AIns) type amyloid. The patient had no treatment for this lesion and has had his care triaged to his more serious health problems. This is the first case of AIns type amyloidoma associated with insulin injection site reported in cytology literature. We highlight the cytologic findings and diagnostic pitfalls. As the incidence of diabetes is increasing, cytopathologists may encounter this lesion more often on FNA.

Renal mucinous tubular and spindle cell carcinoma (MTSCC) was recently described as a distinct subtype of renal cell carcinoma (RCC) in the 2004 World Health Organization classification of kidney tumors. MTSCC is a rare low grade malignancy with < 100 cases reported in the literature. To the best of our knowledge, there are 5 case reports with a total of 6 patients describing its diagnosis by fine needle aspiration (FNA). All of these cases were diagnosed as conventional RCC on FNA. Subsequent excisions proved them to be MTSCC. We herein report a case in a 67-year-old male. He presented with abdominal pain and was found to have a new colon adenocarcinoma with metastasis to the liver and lungs. The extent of disease made the patient ineligible for surgical excision, and he received chemotherapy. Work-up also revealed a kidney mass which was later biopsied by FNA and core biopsy. The tumor was composed of epithelial and spindled cell components embedded in a myxoid background. It was positive for CK7, AMCAR, vimentin, and epithelial membrane antigen. The tumor was diagnosed as MTSCC. One year later the kidney mass remained stable. However, the patient developed new metastasis to the liver from colonic primary. The kidney mass was not resected. Although rarely encountered in FNA cytology of the kidney, we believe the cytologic features of this tumor are distinctive and are different from conventional and other subtypes of RCC. Therefore, its accurate diagnosis on FNA is possible once pathologists are aware that MTSCC should be considered in the differential diagnosis of kidney tumors.