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Cytomorphology of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): An interobserver study from a large academic medical center [Meeting Abstract]

Brandler, T; Cho, M; Wei, X -J; Simms, A; Levine, P; Hernandez, O; Oweity, T; Zhong, J; Zhou, F; Simsir, A; Sun, W
Introduction: Because of the indolent nature and potentially conservative treatment of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP)- an entity recently removed from the malignant papillary thyroid carcinoma (PTC) category, it is crucial to identify features of this entity pre-operatively. Our group has recently published our findings that several statistically significant associations appear to be present between cytomorphologic features and surgical diagnosis that may be used as clues to distinguish NIFTP, PTC and follicular adenoma (FA) on fine-needle aspiration (FNA). Therefore, we set out to determine the reproducibility of these results. Materials and Methods: Pre-surgical FNA slides from NIFTP (n=30), classical PTC (n=30) and FA (n=30) collected from 1/2013-8/2016 were reviewed by 7 cytopathologists blind and independently. Presence of cytomorphologic features was recorded and compared to determine concordance amongst cytopathologists. For each feature, the concordance was compared between NIFTP, PTC and FA by Fisher's Exact Test. Utilizing the majority consensus for presence or absence of each cytomorphologic feature, differences amongst NIFTP, PTC and FA presurgical FNAs were assessed for each feature by Fisher's Exact Test. Results: For all the cytomorphologic features, the concordance rates amongst the pathologists ranged between 78 to 93%. The concordance rates were similar between the NIFTP, PTC and FA groups (Table 1). Comparing each cytomorphologic feature (present/absent determined by majority consensus) amongst the NIFTP, PTC and FA groups displayed statistically significant differences for all features (Table 2). Conclusions: The current study supports our previous findings that there are cytomorphologic differences between the three surgical pathology groups-NIFTP, PTC and FA, and shows that these results are reproducible. The presence or absence of each feature viewed in combination as a profile may assist the cytopathologist in raising the possibility of NIFTP pre-operatively, potentially aiding clinicians in deciding whether a more conservative treatment plan is appropriate. (Table Presented)
ISSN: 2213-2945
CID: 2781022

Metastatic carcinoid tumor to the breast: report of two cases and review of the literature

Lee, Shimwoo; Levine, Pascale; Heller, Samantha L; Hernandez, Osvaldo; Mercado, Cecilia L; Chhor, Chloe M
The breast is an unusual site for carcinoid metastasis. Due to increasing survival rates for carcinoid tumors, however, awareness of their rare complications is important. Carcinoid metastasis to the breast typically presents as a palpable breast mass or a mass on screening mammogram. Because imaging findings are nonspecific, the diagnosis is established through histological findings of neuroendocrine features corresponding with the known primary carcinoid pathology. Correctly distinguishing metastatic carcinoid from primary breast carcinoma is crucial to avoid more invasive procedures required for the latter. Two cases of metastatic carcinoid to the breast are presented with review of the literature.
PMID: 27907837
ISSN: 1873-4499
CID: 2329432

Polyacrylamide gel breast augmentation: report of two cases and review of the literature

Margolis, Nathaniel E; Bassiri-Tehrani, Brian; Chhor, Chloe; Singer, Cory; Hernandez, Osvaldo; Moy, Linda
Polyacrylamide gel (PAAG) injection remains an uncommon method of breast augmentation. Providers must recognize the clinical and radiological manifestations to optimize management. The clinical and radiological findings of PAAG injection may mimic malignancy and silicone breast augmentation. We described two patients with prior PAAG breast augmentation with physical exam and imaging findings concerning for malignancy. We reviewed the literature on PAAG breast augmentation and compare PAAG to silicone breast augmentation. The management of such patients is discussed.
PMID: 25670236
ISSN: 1873-4499
CID: 1579782

Nonimage-guided fine needle aspiration biopsy of palpable axillary lymph nodes in breast cancer patients

Marti, Jennifer L; Ayo, Diego; Levine, Pascale; Hernandez, Osvaldo; Rescigno, John; Axelrod, Deborah M
Synopsis We report the utility of office-based, nonimaged guided fine needle aspiration of palpable axillary lymph nodes in breast cancer patients. We examine the sensitivity and specificity of this procedure, and examine factors associated with a positive fine needle aspiration biopsy result. Abstract: Although the utility of ultrasound-guided fine needle aspiration biopsy (FNA) of axillary lymph nodes is well established, there is little data on nonimage guided office-based FNA of palpable axillary lymphadenopathy. We investigated the sensitivity and specificity of nonimage-guided FNA of axillary lymphadenopathy in patients presenting with breast cancer, and report factors associated with a positive FNA result. Retrospective study of 94 patients who underwent office-based FNA of palpable axillary lymph nodes between 2004 and 2008 was conducted. Cytology results were compared with pathology after axillary sentinel node or lymph node dissection. Nonimage-guided axillary FNA was 86% sensitive and 100% specific. On univariate analysis, patients with positive FNA cytology had larger breast tumors (p = 0.007), more pathologic positive lymph nodes (p < 0.0001), and were more likely to present with a palpable breast mass (p = 0.006) or with radiographic lymphadenopathy (p = 0.002). FNA-positive patients had an increased presence of lymphovascular invasion (p = 0.001), higher stage of disease (p < 0.001), higher N stage (p < 0.0001), and higher rate of HER2/neu expression (p = 0.008). On multivariate analysis, radiographic lymphadenopathy (p = 0.03) and number of positive lymph nodes (p = 0.04) were associated with a positive FNA result. Nonimage-guided FNA of palpable axillary lymphadenopathy in breast cancer patients is an inexpensive, sensitive, and specific test. Prompt determination of lymph node positivity benefits select patients, permitting avoidance of axillary ultrasound, sentinel lymph node biopsy, or delay in receiving neoadjuvant therapy. This results in time and cost savings for the health care system, and expedites definitive management
PMID: 22098412
ISSN: 1524-4741
CID: 149784

Encapsulated well-differentiated follicular thyroid adenocarcinomas [Letter]

Waisman, Jerry; Hernandez, Osvaldo; Yu, Rena
PMID: 20962619
ISSN: 0147-5185
CID: 966342

Incidence of Pleomorphic and Classic Lobular Carcinoma In Situ in Percutaneous Biopsies of the Breast: An Institutional Review [Meeting Abstract]

Lee, J; Mercado, C; Hernandez, O; Moy, L; Toth, H
ISSN: 0361-803x
CID: 111947

Non-image guided fine needle aspiration of palpable axillary lymph nodes in breast cancer patients [Meeting Abstract]

Marti, JL; Ayo, D; Levine, P; Hernandez, O; Rescigno, J; Axelrod, DM
ISSN: 0008-5472
CID: 93514

Comparison of thyroid fine aspiration and core needle biopsy [Letter]

Waisman, Jerry; Hernandez, Osvaldo; Ljung, Britt-Marie
PMID: 18481406
ISSN: 0002-9173
CID: 94167

Plasmablastic lymphoma involving breast: a case diagnosed by fine-needle aspiration and core needle biopsy [Case Report]

Wang, Jun; Hernandez, Osvaldo J; Sen, Filiz
Plasmablastic lymphoma (PBL) is a rare lymphoma originating from B-cells with terminal differentiation. Most common anatomic site involved by PBL is the oral cavity. Involvement of other body sites has only rarely been reported. Herein, we report a rare case of EBV-negative PBL involving the breast of an HIV positive 47-year-old woman. The patient presented with decreased vision and photophobia. During physical examination, she was found to have bilateral breast masses and multiple lymphadenopathy. Fine-needle aspiration of one of the breast masses showed large malignant cells with plasmacytoid features. Immunohistochemical studies performed on the core biopsy showed that the tumor cells were positive for common leukocyte antigen CD45 and plasma cell marker CD138, but negative for the pan-B cell markers CD20 and CD79a. Molecular genetic studies showed clonal rearrangement of the immunoglobulin kappa light chain gene. This is the first case of PBL involving the breast reported in English cytological literature
PMID: 18335555
ISSN: 8755-1039
CID: 79244

PAX2: a reliable marker for nephrogenic adenoma

Tong, Guo-Xia; Melamed, Jonathan; Mansukhani, Mahesh; Memeo, Lorenzo; Hernandez, Osvaldo; Deng, Fang-Ming; Chiriboga, Luis; Waisman, Jerry
Nephrogenic adenoma is a rare lesion of the urinary tract. The diagnosis usually is straightforward when characteristic microscopic and clinical findings are present, and the entity is familiar. However, misdiagnosis, in particular of adenocarcinoma of the prostate gland, may occur. Immunohistochemical stains often are needed to make such a distinction, but currently available markers offered only partial help. It recently was demonstrated that nephrogenic adenoma in renal transplant patients originated from the renal tubular epithelium. This newly proved, but long sought information may be helpful in the differential diagnosis of neophrogenic adenoma. In this study, we investigated the expression of a renal transcription factor, PAX2, in 39 nonrenal transplant-related nephrogenic adenomas, 100 adenocarcinomas of the prostate gland, and 47 urothelial carcinomas of the urinary tract. A strong and distinct nuclear staining of PAX2 was found in all 39 cases of nephrogenic adenoma (100%), but not in normal prostate tissue, normal urothelium, adenocarcinomas of the prostate gland, and invasive urothelial carcinomas. Focal CD10 was detected in six of 13 nephrogenic adenomas in the superficial papillary component and in normal prostate epithelium, normal urothelium, lymphocytes, adenocarcinoma of the prostate gland, and urothelial carcinoma. There was no uroplakins detected in nephrogenic adenoma. Therefore, these findings are suggesting that nephrogenic adenoma in nonrenal transplant patients may also arise from the renal epithelium, as did the comparable lesions after transplantation. PAX2 is a specific and sensitive immunohistochemical marker in identification and differential diagnosis of nephrogenic adenoma.Modern Pathology advance online publication, 6 January 2006; doi:10.1038/modpathol.3800535
PMID: 16400326
ISSN: 0893-3952
CID: 62129