Three cases of macrofollicular variant of papillary thyroid carcinoma

The macrofollicular variant of papillary thyroid carcinoma [MFPTC] is a well-established entity with characteristic large follicles containing pale colloid and lined by cells with nuclear features of papillary thyroid carcinoma [PTC]. In this study, we present three cases of MFPTC, along with a brief review of the literature. For all three of our cases, the histology of the resected specimen showed predominantly macrofollicular structures lined by cells with nuclear characteristics of PTC. Immunohistochemically, the three cases show positivity for galactin-3, cytokeratin-19, and HBME-1. These cases will help us in understanding the distinction from other benign and malignant follicular lesions of the thyroid, which is of utmost importance. The key to diagnosis is a high-power examination of any macrofollicular lesion of the thyroid

HER2/neu immunostaining in invasive breast cancer: analysis of false positive factors

HER2/neu gene amplification by Fluorescent in situ hybridization and protein expression by immunohistochemistry have been used for prognosis and guidance for the treatment of invasive ductal carcinoma of the breast with Trastuzumab. False positive results are a significant problem where immunohistochemistry is exclusively used to test HER2/neu protein over expression. A minority of cases of breast cancer scoring HER2 [3+] by immunohistochemistry using Hercep test may not be associated with amplification of the HER2/neu gene by FISH, a test which is a more specific and sensitive than immunohistochemistry. This study aims to examine the factors contributing to false positive results by immunohistochemistry and subsequently not showing HER2/neu gene amplification by FISH analysis. A retrospective analysis of 18 cases [3+] by immunohistochemistry in the pathology laboratory not associated with HER2/neu gene amplification was performed. The histological review of these cases was done, the technical error [i.e staining of blood vessels or benign ducts] and the interpretation errors were evaluated. Polysomy 17 was absent in all the cases studied by FISH analysis. By immunohistochemistry, five of the 18 cases were purely interpretation errors and the remaining were a combination of technical and interpretational errors. False positive results related to technical and interpretational errors can be prevented by properly educating the technologist and pathologist to perform high quality immunostains and to render an accurate diagnosis respectively. This issue is of utmost importance as it may have deleterious effects on the selection of therapeutic arsenal in invasive ductal carcinoma of the breast

Combined modality cytopathologic diagnosis of lung malignancy: a feasible proposition?

Primary carcinoma of lung is a major health problem with a generally grim prognosis. Cytology is reliable and useful method in the diagnosis of bronchogenic carcinoma. However, an orderly approach to diagnosis, using a variety of cytologic diagnostic procedures helps us to separate benign and malignant lesions of lung and allows early diagnosis and cytologic typing of various pulmonary malignant lesions. That provides perspective selection of best therapy for individual patient. We have reached to a conclusion from the present study that multiple types of tissue sampling techniques including bronchial brushing, transbronchial needle aspiration [TBNA], CT-guided transcutaneous needle aspiration [TCNA] and bronchial biopsy should be performed since the diagnostic results improve when combination of techniques are employed