Faculty Bibliography

BACKGROUND Primary angiosarcoma of the breast is a rare neoplasm, accounting for less than 0.04% of all breast cancers. Epithelioid angiosarcoma is even more unusual with only a handful of cases reported in literature. Differentiating this from other breast malignancy is a challenge. There have been conflicting reports regarding factors that affect prognosis. We present a case of primary epithelioid angiosarcoma of the breast, and also discuss the prognostic and differential diagnostic issues. CASE REPORT A 70-year old female presented with slowly enlarging fungating mass in the right breast with a necrotic center and serosanguineous discharge. Initial biopsy done at an outside institution reported the lesion as carcinosarcoma. Histologic sections showed cellular, infiltrative neoplasm with extensive necrosis and ectatic vascular proliferations lined by plump endothelial cells. Infiltrative cells were spindle-shaped with vacuolated cytoplasm and marked anisonucleosis in myxoid background. Mitotic activity was brisk. CAM5.2, AE1/AE3, and CD31 were positive. Proliferation index was high. Estrogen receptors (ER), progesterone receptors (PR), human epidermal growth factor receptor 2 (HER2)/neu were negative. CONCLUSIONS Primary epithelioid angiosarcoma of the breast can present as a diagnostic dilemma in needle biopsies. This malignancy may mimic carcinoma or benign endothelial lesions. This entity is important to be recognized because it carries poor prognostic risk and requires distinct treatment modalities different from the usual epithelial breast neoplasms.

Liquid-based preparations (LBPs) have largely replaced conventional Papanicolaou smears (CPS) for cervical samples in the United States and in many other industrialized countries. The two FDA-approved LBP currently in use include ThinPrep (TP), (Hologic Inc., Bedford, MA) and SurePath (SP), (BD Diagnostic, Burlington, NC). Split-sample and direct-to-vial studies have shown that LBPs show an overall improvement in sample collection and processing, reduce artifacts that interfere in diagnosis, are more sensitive, can be utilized for ancillary tests and are a cost-effective replacement for CPS. Comparative analyses of diagnostic accuracy indicate that LBPs perform at least as well as CPS. However, the added advantages of standardized, automated preparations and screening, reduced unsatisfactory rate, improved specimen adequacy and ability to perform human papillomavirus (HPV) test, are enough to continue use of LBP. The cytologic features in LBP are similar to CPS with subtle differences, particularly in background information. There are also subtle differences between the two LBPs, SP and TP, which are reflective of different sampling devices, collection media, and processing techniques. Architecturally, LBP shows smaller cell clusters and sheets and more dyscohesion. Cytologically, enhanced nuclear features and smaller cell size are more prominent. Advances in liquid-based Papanicolaou's (Pap) test have lead to well-defined patient management guidelines by the American Society for Colposcopy and Cervical Pathology. Herein, we review these aspects of Pap test including, morphology, automation, ancillary tests (HPV and immunochemistry), pertinent QA/QC monitors, patient management guidelines, and review of pertinent literature.

Fine needle aspirations biopsies, CT-guided and endobronchial ultrasound-guided, as a mode of diagnosing and/or staging lung carcinoma, are becoming more frequent. Also, there is greater necessity for classification of lung cancers into subcategories of squamous cell carcinoma and adenocarcinoma for appropriate management. Cytomorphology, based on smears alone, allows this classification in many instances. The aim of the current study was to explore the potential of cell blocks to increase the specificity of diagnosis. The morphological characteristics of sixty-two lung carcinomas were examined. Less well-differentiated squamous cell carcinomas were more readily classified as such on cell blocks. Likewise, cell block sections with architectural patterns including strips of cells, papillae and nests of cells correlated with bronchioalveolar, papillary and acinar/mixed subtypes of adenocarcinoma on follow-up histology. In conclusion, cell blocks provide additional morphological clues and material for ancillary studies for classification of lung carcinomas.

BACKGROUND:Rhabdomyosarcomas, particularly those of gynecologic origin, are very rare in adults. As a result, there is little literature on the optimal staging procedure and treatment modalities for this population. CASE/METHODS:A 43-year-old woman presented with a long-standing history of menorrhagia and was subsequently diagnosed with embryonal rhabdomyosarcoma of the cervix. She underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, lymph node dissection, omentectomy, and appendectomy, which also revealed a synchronous tubular carcinoid tumor of appendiceal origin. Plans for treatment involve adjuvant chemotherapy with vincristine, dactinomycin, and cyclophosphamide. CONCLUSION/CONCLUSIONS:This case adds to the small body of literature surrounding cervical embryonal rhabdomyosarcoma in women over the age of 40 years and proposes that appendectomy be considered during surgical management.