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Salivary Gland Neoplasm of Uncertain Malignant Potential (SUMP) (Milan IVB) and Its Subgroups: A Multi-Institutional Analysis of Risk of Neoplasm and Malignancy

Xia, Rong; Hindi, Issa; Savant, Deepika; Khader, Samer; Lajara, Sigfred; Belovarac, Brendan; Das, Kasturi; Chau, Karen; Abdelwahed, Mohammed; Ali, Amr; Szeto, Oliver; Hernandez, Osvaldo; Sun, Wei; Liu, Cheng Z; Zhou, Fang; Simsir, Aylin; Brandler, Tamar C
OBJECTIVES/OBJECTIVE:Fine needle aspiration (FNA) plays a crucial role in their initial assessment of salivary gland neoplasms. In the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), the category of Salivary Gland Neoplasm of Uncertain Malignant Potential (SUMP) categorizes lesions with ambiguous features. This study aims to investigate the risk of neoplasm (RON) and risk of malignancy (ROM) within different subgroups of SUMP lesions using data from three large academic institutions. METHODS:We analyzed salivary gland (FNA) cases from three academic institutions post-MSRSGC implementation. Salivary gland FNA cases categorized as Milan IVB (SUMP) with subsequent surgical pathology follow-up were analyzed. Cases were divided into basaloid, oncocytic, and clear cell SUMP subtypes, with RON and ROM assessed and compared. RESULTS:Out of 1377 MSRSGC cases, 231 were SUMP (16.8%), with 101 subjected to surgical pathology follow-up. The overall ROM for SUMP was 20.8%, with variations of 10% to 29.5% observed amongst institutions, but no significant difference was observed among three institutions (p = 0.15). Basaloid and oncocytic SUMP displayed 17.1% and 20.5% ROM, respectively, without significant disparity. However, all clear cell SUMP cases were malignant on surgical resection. CONCLUSIONS:This study highlights the variability in ROM for SUMP lesions and the significantly higher ROM in SUMP cases with clear cell features. These findings emphasize the importance of accurately subcategorizing SUMP lesions, particularly those with clear cell features, for appropriate clinical management.
PMID: 39162245
ISSN: 1097-0339
CID: 5680562

Cytomorphologic and Molecular Features of Hyalinizing Trabecular Tumor of Thyroid: Smears and ThinPrep [Meeting Abstract]

Xia, Rong; Sun, Wei; Gupta, Mala; Hernandez, Osvaldo; Chen, Fei; Liu, Cheng; Simsir, Aylin; Shi, Yan
ORIGINAL:0017411
ISSN: 2213-2945
CID: 5743672

Mammary Adenoid Cystic Carcinoma: Improving Preoperative Size Assessment With MRI

Kieturakis, Alexander J; Hernandez, Osvaldo J; Gao, Yiming
PMID: 37132552
ISSN: 1546-3141
CID: 5544872

Case report: Primary adenocarcinoma NOS of the thymus and cytological features

Willner, Jonathan; Hernandez, Osvaldo; Azour, Lea; Moreira, Andre L
Aspirates of mediastinal neoplasms pose a unique diagnostic challenge due to the overlapping histologic characteristics of mediastinal lesions and the morphologic similarities between mediastinal neoplasms and those originating at other sites. Presented here is the first reported description of the cytomorphologic features of adenocarcinoma NOS of the thymus in aspirate and pleural effusion specimens. The morphologic similarities between thymic and metastatic adenocarcinomas and variable immunohistochemical staining patterns of thymic epithelial neoplasms underscore the importance of pathology-radiology correlation and the careful consideration of the clinical context in the interpretation of cytology specimens.
PMID: 37212382
ISSN: 1097-0339
CID: 5508252

Active Surveillance for Atypical Ductal Hyperplasia and Ductal Carcinoma In Situ

Miceli, Rachel; Mercado, Cecilia L; Hernandez, Osvaldo; Chhor, Chloe
Atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS) are relatively common breast lesions on the same spectrum of disease. Atypical ductal hyperblasia is a nonmalignant, high-risk lesion, and DCIS is a noninvasive malignancy. While a benefit of screening mammography is early cancer detection, it also leads to increased biopsy diagnosis of noninvasive lesions. Previously, treatment guidelines for both entities included surgical excision because of the risk of upgrade to invasive cancer after surgery and risk of progression to invasive cancer for DCIS. However, this universal management approach is not optimal for all patients because most lesions are not upgraded after surgery. Furthermore, some DCIS lesions do not progress to clinically significant invasive cancer. Overtreatment of high-risk lesions and DCIS is considered a burden on patients and clinicians and is a strain on the health care system. Extensive research has identified many potential histologic, clinical, and imaging factors that may predict ADH and DCIS upgrade and thereby help clinicians select which patients should undergo surgery and which may be appropriate for active surveillance (AS) with imaging. Additionally, multiple clinical trials are currently underway to evaluate whether AS for DCIS is feasible for a select group of patients. Recent advances in MRI, artificial intelligence, and molecular markers may also have an important role to play in stratifying patients and delineating best management guidelines. This review article discusses the available evidence regarding the feasibility and limitations of AS for ADH and DCIS, as well as recent advances in patient risk stratification.
PMID: 38416903
ISSN: 2631-6129
CID: 5707872

Salivary Gland Neoplasm of Uncertain Malignant Potential (SUMP) (Milan IVB) and its Subgroups: Analysis of Risk of Neoplasm and Malignancy [Meeting Abstract]

Hindi, Issa; Brandler, Tamar; Belovarac, Brendan; Szeto, Oliver; Hernandez, Osvaldo; Sun, Wei; Liu, Cheng; Zhou, Fang; Simsir, Aylin
ISI:000990969800333
ISSN: 0023-6837
CID: 5525452

The Milan System for Reporting Salivary Gland Cytopathology

Hindi, Issa; Simsir, Aylin; Szeto, Oliver; Hernandez, Osvaldo; Sun, Wei; Zhou, Fang; Brandler, Tamar C
OBJECTIVES/OBJECTIVE:Our study assesses whether the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) offers any benefit over the original cytology classification, and measures interobserver agreement. METHODS:Four cytopathologists retrospectively blindly classified preoperative cytology by MSRSGC from 101 resected salivary tumors. Consensus MSRSGC diagnoses were correlated with surgical pathology diagnoses and compared with the original cytology classification. Diagnostic parameters were calculated for both systems. Interobserver variability was assessed. RESULTS:The original cytology classification vs MSRSGC had sensitivity, specificity, positive predictive value, and negative predictive value of 75.0% vs 78.3%, 97.1% vs 98.0%, 91.2% vs 94.7%, and 90.1% vs 90.0%, respectively. The original cytology classification risk of neoplasm (RON) was 91.7% for "negative for malignancy" and 100.0% for other categories. The MSRSGC RON was 71.4% in category II (nonneoplastic) and 100.0% in all other categories. The original cytology classification risk of malignancy (ROM) ranged from 0.0% for "atypical" to 100.0% for "positive for malignancy." The MSRSGC ROM ranged from 0.0% in categories I (nondiagnostic) and III (nonneoplastic) to 100.0% in category VI (malignant). Weighted agreement using the MSRSGC was 92% (Gwet AC1, 0.84); unweighted agreement was 69% (Gwet AC1, 0.64). MSRSGC category IVA (benign neoplasm) was most likely to show interobserver agreement, with complete agreement in 67% of cases. CONCLUSIONS:The MSRSGC performs similarly to the original cytology classification and shows relatively high interobserver agreement.
PMID: 35849113
ISSN: 1943-7722
CID: 5278882

Myopericytoma of the Parotid and Molecular Profiling: Report of a Rare Case and Review of the Literature

Roig, Nicholas J; Wu, Michelle; Hernandez, Osvaldo; Liu, Cheng Z; Brandler, Tamar C
Myopericytomas are uncommon tumors defined by their round to spindle shaped cells often arranged in a concentric pattern of perivascular growth. They are typically well-circumscribed, nodular, slow-growing lesions that occur in the soft tissue of the extremities. Here, we present a 30-year-old female with a 2.4 cm myopericytoma occurring in the deep lobe of the parotid gland. The diagnosis was made with detailed histopathologic and immunohistochemical findings and positive identification of the specific mutation for PDGFRβ p.Asp666Lys by next generation sequencing (NGS). This is the first case report of a parotid myopericytoma with a genetic testing that shows a particular mutation that has been linked to myopericytomatosis.
PMID: 34970937
ISSN: 1940-2465
CID: 5108302

p16 immunostaining in fine-needle aspirations of the head and neck: determining the optimal positivity threshold in HPV-related squamous cell cancer

Wang, Qian; Zhou, Fang; Snow, Justin T; Simsir, Aylin; Hernandez, Osvaldo; Levine, Pascale; Szeto, Oliver; Sun, Wei; Givi, Babak; Brandler, Tamar C
INTRODUCTION/BACKGROUND:There is no consensus for interpretation of p16 immunohistochemistry (IHC) in cytology preparations. Our study aims to assess p16 IHC staining in formalin-fixed cytology cell blocks (CBs) from head and neck squamous cell carcinoma (HNSCC) fine-needle aspiration (FNA) specimens in comparison with surgical pathology p16 staining and to determine the reproducibility of p16 IHC scoring in CBs. METHODS:) was calculated to assess inter-rater reliability. RESULTS:= 0.79 (95% CI: 0.61-0.98). CONCLUSION/CONCLUSIONS:p16 IHC performed on cytology CBs can serve as a surrogate marker for the detection of HPV with high sensitivity and specificity levels. Using a threshold lower than that recommended for surgical pathology for the interpretation of p16 positivity may be appropriate for FNA cytology CB preparations. All cytopathologists in our study displayed reproducible high sensitivity and specificity values at the >10% threshold.
PMID: 34326027
ISSN: 2213-2945
CID: 4950022

Genetic profile of primary mucinous cystadenocarcinoma of the breast-A case report [Case Report]

Lin, Lawrence Hsu; Hernandez, Osvaldo; Zhu, Kelsey; Guth, Amber; Cotzia, Paolo; Darvishian, Farbod
Primary mucinous cystadenocarcinoma of the breast is a rare neoplasm with few reports in the literature. Here, we report for the first time a comprehensive genetic profile of a primary mucinous cystadenocarcinoma of the breast, using next-generation sequencing 580 cancer-associated gene panel. Mutations in TP53, RB1, and BAP1 were identified. The findings suggest that this tumor is driven mostly by abnormalities in tumor suppressor genes, primarily involved in cell cycle control and chromatin remodeling. Molecular characterization of additional primary mucinous cystadenocarcinomas of the breast is warranted and might provide information related to its biology and behavior.
PMID: 34180564
ISSN: 1524-4741
CID: 4926202