Virological and cytological changes in tears and conjunctiva of patients with COVID-19

Purpose: To analyze the presence of severe acute respiratory syndrome coronavirus 2 (SARS?CoV?2) in tears/conjunctival epithelium and assess the cytomorphological changes in the conjunctival epithelium of coronavirus disease 2019 (COVID?19) patients. Methods: In this pilot study, patients with moderate to severe COVID?19 were recruited from the COVID ward/intensive care unit of the institute. Tears and conjunctival swabs were collected from COVID?19 patients and sent to the virology laboratory for reverse transcription polymerase chain reaction (RT?PCR) testing. Conjunctival swabs were used to prepare smears, which underwent cytological evaluation and immunocytochemistry for SARS?CoV?2 nucleocapsid protein. Results: Forty?two patients were included. The mean age of participants was 48.61 (range: 5–75) years. Seven (16.6%) patients tested positive for SARS?CoV?2 ribonucleic acid in tears samples, four (9.5%) of which were positive on conjunctival swab by RT?PCR in the first test. Cytomorphological changes were observed significantly more in smears from patients with positive RT?PCR on tear samples, including bi?/multi?nucleation (p = 0.01), chromatin clearing (p = 0.02), and intra?nuclear inclusions (p < 0.001). One case (3.2%) showed immunopositivity for SARS?CoV?2; this patient had severe disease and the lowest Ct values for tear and conjunctival samples among all positive cases. Conclusion: Conjunctival smears from patients with COVID?19 revealed cytomorphological alterations, even in the absence of clinically significant ocular infection. However, viral proteins were demonstrated within epithelial cells only rarely, suggesting that although the conjunctival epithelium may serve as a portal for entry, viral replication is possibly rare or short?lived.

Role Of Scrape Cytology In The Intraoperative Diagnosis Of Tumour

Background: Intra operative pathological assessment has offered a very valuable service in patient management. The present study was done to evaluate the status of intraoperative cytology as a diagnostic and supportive investigation for various tumours. To evaluate the utility of imprint /scrape cytology for the rapid diagnosis ofAim and objectives: surgically removed specimens. 70 surgically removed specimens from various organs andMaterials and Methods: systems were studied. Smears were taken from each specimen before formalin fixation and stained by modified rapid H&E and Papanicolaou staining. Cytological diagnosis was made and then results were compared with the histological diagnosis taking the latter as the gold standard. Out of the 70 cases sampled, 70 were satisfactory forResults: evaluation. Overall accuracy rate was 87.14 % .Six cases of false positive diagnosis and 3 false negative diagnosis were made .Positive predictive value was 75% and negative predictive value was 93.47%. Imprint /scrapeConclusions: cytology is a good complement for the rapid diagnosis in histopathological study of tumor/tumor like lesions and intra operative cytology can be used an adjunct to frozen section.

Comparison between imprint cytology and frozen sections in intraoperative consultation of ovarian tumours

Background: The ovaries frequently are the site for various primary tumors. Correct intraoperative diagnosis is crucial. The application of imprint cytology is very useful where frozen section facility is not available. The present study is a comparison of imprint cytology and frozen section during intraoperative consultation for various types of benign and malignant ovarian neoplasms in different age groups.Methods: Seventy-six cases of ovarian tumors were examined using both imprint cytology and frozen section and evaluated, taking histopathological report as gold standard. The histopathological diagnoses consisted of benign (54), borderline (9), and malignant (13). The malignant tumors consisted of various types including serous carcinoma, mucinous carcinoma, endometrioid carcinoma, clear cell carcinoma and carcinoid.Results: All 54 benign cases were accurately diagnosed as benign by imprint cytology. With frozen section 53 cases were correctly diagnosed as benign but one case was over diagnosed as borderline. Among 13 malignant cases 11 (84.6%) were correctly diagnosed with both techniques. Borderline tumors were not able to be diagnosed with imprint smear, 3 out of 9 cases were correctly diagnosed with frozen section.Conclusion: When compared with frozen section, imprint cytology is a simple, inexpensive and useful diagnostic tool in intraoperative diagnosis of benign and malignant ovarian tumors. Imprint smear is not useful in borderline tumors where only frozen section is useful. Imprint cytology can be used as an adjunct to frozen section for better diagnosis.

Diagnosis comparison of intraoperative imprint cytology and frozen section for sentinel lymph node metastasis in breast cancer / 肿瘤研究与临床

Objective To evaluate whether intraoperative imprint cytology can be used as a diagnostic method of sentinel lymph node metastasis for breast cancer patients in China. Methods A total of 154 breast cancer patients diagnosed histologically as ductal carcinoma in situ or T1-3N0M0 invasive breast cancer who underwent intraoperative sentinel lymph node biopsy from July 2012 to August 2015 in Shanxi Dayi Hospital were enrolled. The sentinel lymph node was detected by using standard dual tracer method. Intraoperative diagnosis was performed with imprint cytology as well as frozen section, and the final diagnosis was assessed by using paraffin pathology after surgery. Results The area under the receiver operator characteristic curve (AUC) for the diagnosis of sentinel lymph node metastasis by intraoperative frozen section and imprint cytology was 0.854 and 0.755, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate of imprint cytology were 52.1 ％ (25/48), 99.1 ％ (105/106), 96.2 ％ (25/26), 82.0 ％ (105/128), 84.4 ％ (130/154) respectively, and the corresponding diameters of frozen section were 70.8 ％ (34/48), 100.0 ％ (106/106), 100.0 ％ (34/34), 88.3 ％ (106/120), 90.9 ％ (140/154) respectively. There was no statistically significant difference between the two groups (P>0.05). The frozen section result was highly consistent with paraffin pathology, with a Kappa value of 0.7698; while the Kappa value of imprint cytology was 0.5874, which was moderately consistent with paraffin pathology. ConclusionsThere is no significant difference between imprint cytology and frozen section in the intraoperative diagnosis of sentinel lymph node metastasis. The consistency between frozen section and paraffin pathology is high. After standardized operations and professional training, imprint cytology can be considered as a substitute of intraoperative sentinel lymph node diagnosis in breast cancer patients.

Role of Imprint cytology in rapid diagnosis of ovarian neoplasms with histopathology correlation

Background: Imprint cytology plays a major role in rapid intraoperative diagnosis of lesions similar to frozen sections. Besides its speed and simplicity, it also provides excellent cellular details. Although histopathology is considered to be gold standard in diagnosis of ovarian neoplasms, yet the delay involved may at times affect the course of treatment. The optimal management of benign and malignant ovarian neoplasms is different especially in patients who want to retain fertility. This calls for a rapid intraoperative diagnosis which will decide further management. Aim and objectives: To study the imprint cytology of ovarian neoplasms and compare with histopathology findings, to establish the reliability of imprint smears in intraoperative diagnosis by statistical evaluation. Material and methods: The present study was done at MNJ Institute of Oncology, Hyderabad, a tertiary care center for period of one and half years i.e. from January 2017 to June 2018. The study was done on 40 fresh unfixed ovarian specimens sent for imprint cytology. Multiple imprint smears was taken from fresh resected masses after detailed gross examination. The findings were noted and compared to subsequent histopathology sections. Results: In the present study, out of 40 cases, 21 (52.5%) were benign, 9(22.5%) were borderline, 10(25%) were malignant based on imprint cytology smears. On histopathology sections, 22 (55%) were benign, 1(2.5%) was borderline and 17(42.5%) were malignant. The overall accuracy was 87.5% on imprint smears. Annapoorna Sireesha, B. Triveni, Sangeeta Parmer, K. Srilaxmi, Sai Mallikarjun. Role of Imprint cytology in rapid diagnosis of ovarian neoplasms with histopathology correlation. IAIM, 2018; 5(11): 56-62. Page 57 Conclusion: Imprint cytology is an excellent, simple, inexpensive, useful diagnostic tool in intraoperative diagnosis of ovarian neoplasms. This forms an important step in intraoperative decision-making for better management.

Evaluation of the relevance of touch imprint cytology in the diagnosis of various neoplastic lesions.

Background: Imprint is a very simple and rapid technique for tissue diagnosis. Imprint is a touch preparation in which tissue is touched on a slide and it leaves behind its imprint in the form of cells on the glass slide. In present study we have correlated the cytological diagnosis by imprint with histological diagnosis and tried to evaluate the accuracy and usefulness of this. Methods: The study was conducted in department of Pathology of Pt J.N.M. Medical College, Raipur (C.G) India. From neoplastic lesions imprint smears were prepared immediately after resection of surgical specimen. After preparation of imprint smears specimens were processed by routine histopathological processing. Final reports of both processes were compared to know accuracy of diagnosis by imprint cytology. Results: Out of total 110 cases, 25 cases were benign and 85 cases were malignant. Out of the 25 benign cases, 14 (56%) were diagnosed correctly and correlated with histological diagnosis. while 11 (44%) cases were false negative. No false positive cases were there. Out of 85 malignant lesions 78 (91.76%) were diagnosed correctly and correlated on histopathology, while 7 (8.23%) were false negative. Overall diagnostic accuracy by imprint smear after histological correlation was 83.63% increasing to 91.76% for malignant lesions. Conclusions: With an accuracy rate of 83.63% we can say that imprint cytology is a quick reliable simple and cost effective procedure.

Diagnostic Accuracy of Imprint Cytology and Frozen Section for CNS Tumor.

The present study was a cross-sectional type of descriptive one carried out with the objective of determining the diagnostic accuracy of imprint cytology and frozen section of central nervous system tumors. A purposively selected sample of 33 clinically diagnosed patients with CNS tumors has been included for the study. The relevant data on CNS tumors were collected by using imprint cytology, frozen section and paraffin section. The sensitivity of imprint cytology was 75.0% and specificity was 55.17% respectively. On the other hand positive predictive value of imprint cytology was 18.75% and negative predictive value was 94.11%. The sensitivity of frozen section was 100% and specificity was 86.21% respectively. Comparing the findings of the frozen section to histopathology, the positive predictive value was 50.0% and negative predictive value was 100%. The sensitivity and specificity of imprint cytology was lower in comparison to frozen section and paraffin section. Still then imprint cytology is preferred, because it can be carried out rapidly and easily. It will also be a very helpful aid especially when facilities for frozen section are limited but neurosurgical-procedure is available. A well designed research with adequate sample size should be carried out to get better diagnostic accuracy of imprint cytology in central nervous system tumors.

Study of Tumors by Imprint Cytology.

Introduction: The intraoperative diagnostic accuracy of a tumor is an essential part in patients’ work-up. If the surgeon finds it malignant during surgery, widespread dissection including lymph nodes can be done simultaneously and thus preventing the need of second surgery. Objective: The aim of this study is to determine the accuracy of imprint cytology (IC) for the intraoperative diagnosis in patients with tumor and its usefulness in low facility set up. The diagnostic accuracy of IC has been compared with histopathological examination (HPE), the gold standard diagnostic. Material and methods: This study included 55 patients presenting as a tumor mass of different organs with clinically diagnosed as malignant. In the operation theater, smears for IC were made from cut surfaces of tumors. These ware stained with Papanicolaou stain and hematoxylin and eosin (H&E) stain. The results of IC were compared with HPE using H&E staining. Results: This study included tumor specimens of five from lymph nodes, three from cervix, 31 from breast, four from gastrointestinal tract (GIT), three from parotid gland, five from ovary, one from uterine corpus and three from skin. Table 3 shows categorization of benign and malignant tumors. Locally infiltrative tumors have been shown in benign tumor list. The result of my study is as follows: IC for benign and locally infiltrative tumors gave 100% accuracy and that for malignant tumor it was 34/35 (97%) accuracy. The only case which was misdiagnosed as reactive lymph node (LN), which was turned out to be as Hodgkin’s lymphoma. Conclusion: Intraoperative IC is a useful method for evaluating tumors. The simplicity of technique can be used at small centers with low facility set-up.

Role of Imprint Cytology in Diagnosis of Lymph Node Lesions.

Introduction: Imprint cytology is proved to be rapid inexpensive tool in the diagnosis of various lymph node lesions. Objective: The present study was conducted to correlate the diagnostic accuracy, sensitivity and specificity of imprint cytology of various lymph node lesions with histopathological diagnosis. 102 cases were included in the study comprising inflammatory lesion, tubercular lymphadenitis, lymphomas and metastatic carcinomas. Material and Method: From 102 cases of lymph node excision, imprint smears were taken and stained with Hematoxylin & Eosin and Papanicolaou stains. The findings of imprint cytology were then compared with final histopathological diagnosis. Result: When compared with final histopathological diagnosis, imprint smears showed overall diagnostic accuracy of 97.8% with sensitivity and specificity of 95.05% and 98.69% respectively. Accuracy rate for metastatic lymphadenopathy was 100%, whereas, for tubercular lymphadenitis it was 98.04% and for lymphomas 96.04%. Conclusion: Imprint cytology proved to be very useful for diagnosis of metastatic tumour as it gave 100% diagnostic accuracy, sensitivity and specificity. Imprint cytology is also considered to be useful in superficial ulcers to differentiate between benign and malignant lesions without surgical intervention.

Diagnostic values of imprint cytology in sentinel lymph node examination during breast cancinoma operation: an analysis of 169 cases / 临床与实验病理学杂志

Purpose To study the diagnostic value of imprint cytology and to improve the accuracy of the rapid diagnosis of sentinel lymph node (SLN) during the operation of breast cancer.Methods 169 SLNs during 67 operations of breast cancer were detected by both frozen section and imprint cytology, and the results were compared with the histopathological diagnosis of permanent sections.Results Of 169 SLNs, 163 cases were diagnosed correctly with frozen section (163/169, 96.45%); 162 cases were diagnosed correctly with imprint cytology (162/169,95.86%);and 166 cases were diagnosed correctly by combination of imprint cytology and frozen section (166/169,98.22%).Conclusions Combination of imprint cytology and frozen section could increase the accuracy of the rapid diagnosis of SLN in breast cancinoma operation.

Accuracy of frozen-section combined with imprint and fine needle aspiration biopsy in thyroid nodules.

Thyroid malignancy can be found on 5% of thyroid nodules. In order to better managed of thyroid nodules, skills to differentiate benign from malignant cases were needed. Fine needle aspiration biopsy (FNAB) was done preoperatively while frozen section (FS) and imprint cytology (IC) should be done intra-operatively. The objective of this research paper is to evaluate the diagnostic accuracy of FNAB versus frozen section combined with imprint cytology (FS+IC) in thyroid nodules at the Anatomic-Pathology Department FMUI-CM Hospital, Jakarta. This diagnostic test, used data from clinico-pathological records in Anatomic Pathology Department, Faculty of Medicine University of Indonesia / Dr.Cipto Mangunkusumo General Hospital, Jakarta, Indonesia during 1999-2003. Specimens with complete data of FNAB results, data of FS and slides of IC. All formalin fixed`specimens were reevaluated and used as the golden standard. Sensitivity, spesificity and accuracy of FS+IC were higher than FNAB (86.8% vs 73.7% ; 99.0% vs 83.9% ; 94.8% vs 80.5% respectively). If the results of FNAB were concordant with the result of FS+IC, the combined examination yields accuracy of 95.1%. The evaluation of frozen section combined with imprint cytology is very useful, because this examination significantly showed high accuracy in diagnosing thyroid malignancy.

Touch Imprint Cytology Contributed to the Frozen Section Diagnosis of Merkel Cell Carcinoma : A Case Report / 대한세포병리학회지

Merkel cell carcinoma (MCC), a rare primary cutaneous small cell neuroendocrine carcinoma, is a tumor with distinct cytological features. In many cases, immunohistochemical staining (IHC) is required for the differentiation from other small round cell malignancies. Here we describe the cytological findings of Merkel cell carcinoma; these findings contributed to the diagnosis prior to performing IHC. A lower eyelid mass was excised and submitted for frozen section diagnosis. The frozen section diagnosis was consistent with a malignancy, but the more specific diagnosis was limited by the lack of specific histological features. Touch imprint cytology revealed a high cellularity with loosely cohesive small to large sized cells. The tumor cells showed hyperchromatic nuclei with fine chromatin and inconspicuous nucleoli, and thin-rimmed-cytoplasm including the characteristic eosinophilic button-like paranuclear inclusion, previously described as a pathognomonic cytological finding of MCC; this was not found in the H&E frozen section. In conclusion, we suggest that the touch imprint cytology may help in the differential diagnosis of small round cell neoplasms prior to performing IHC especially in frozen section diagnosis.

Imprint Cytologic Feature of Pleuropulmonary Blastoma: A Case Report / 대한세포병리학회지

Pleuropulmonary blastoma (PPB) is an unusual intrathoracic blastoma presenting in childhood and characterized by a biphasic neoplastic population of undifferentiated, small round blastemal cells and larger spindle-shaped sarcomatous cells with entrapped benign epithelial-lined structures. We experienced the cytologic features of PPB in imprint smear from the pleural-based huge mass of the middle lobe of the right lung in a 4-year-old boy. The smears showed high cellularity composed of small ovoid blastemal elements and scattered spindle mesenchymal tumor cells. Lobectomy and pathologic investigation confirmed the diagnosis. PPB seems to be a tumor in which accurate diagnosis may be achieved by cytology if appropriate clinical information were given. Timely and accurate diagnosis of PPB by cytology paves the way for attempting preoperative treatment in future cases.

Evaluation of intraoperative touch imprint cytology diagnosis of sentinel lymph nodes in breast cancer / 中国癌症杂志

The surgery of the breast cancer has dramatically changed,sentinel lymph node(SLN) is one of the aspects.SLN biopsy can precisely predict the status of axillary basin.If the SLN is negative,the patients can spare the unnecessary axillary lymph node dissection(ALND) and reduce the morbidity of the surgery.One of the most important issues with sentinel node biopsy is the intraoperative pathological evaluation of the sentinel nodes.Accurate intraoperative pathological examination of sentinel nodes would enable the selection of candidates for ALND during the initial operation,eliminating the need for second surgery.This article will review the two techniques(touch imprint cytology and frozen section) employed for intraoperative examination of SLN and compare these two methods.And evaluate the role of touch imprint cytology and existing problems in introperative diagnosis of the sentinel lymph nodes and raise the probably ways to improve the sensitivity of touch imprint cytology initially.

Imprint Cytologic Feature of Extraskeletal Osteosarcoma: A Case Report / 대한세포병리학회지

Extraskeletal osteosarcoma is an uncommon tumor originated from soft tissue without evidence of skeletal involvement. It usually affects adults and its common locations are extremity, buttock, and retroperitoneum. Although the histologic feature of this tumor is well known, there have been few reports on the fine needle aspiration cytologic findings. We report the imprint cytologic feature of extraskeletal osteosarcoma. The patient was a 49-year-old man with a mass of the left anterior chest for 2 years. On the imprint preparation, the smears showed malignant round, polygonal or spindle cells with coarsely clumped chromatin and occasionally prominent nucleoli. The malignant cells occur singly, in clusters, or associated with amorphous eosinophilic osteoid. Mitotic figures are also seen.

The Significance of Nuclear Size in Nuclear Grade of Invasive Ductal Carcinoma of the Breast / 대한세포병리학회지

To make the objective standard of nuclear size in grading nuclear pleomorphism of invasive ductal carcinoma of the breast, we measured maximal nuclear diameter of tumor cells on imprint cytology slides and histologic sections from 65 cases by using computer-based image analysis system(Optimas 6.0). The maximal diameter of red blood cells were also measured to evaluate the ratio of maximal nuclear diameter of tumor cells to maximal diameter of red blood cells. The mean values of maximal nuclear diameter of tumor cells on imprint cytology slides and histologic sections were 7.56 micrometer, 7.53 micrometer in nuclear grade 1, 8.92+/-0.98 micrometer, 9.02+/-0.74 micrometer in nuclear grade 2, and 12.90+/-1.47 micrometer, 12.44+/-1.41 micrometer in nuclear grade 3, respectively. There were no significant differences between values of imprint cytology and histologic section. The ratio of maximal nuclear diameter of tumor cells to maximal diameter of red blood cells were 1.3-1.4:1 in nuclear grade 1, 1.6-1.7:1 in nuclear grade 2, and 2.2-2.3:1 in nuclear grade 3. These values would be guidelines for grading nuclear pleomorphism of invasive ductal carcinoma of the breast on routine surgical pathology work.

Imprint Cytologic Features of Fibroadenoma of the Breast with Extensive Infarction: A Case Report / 대한세포병리학회지

Spontaneous Infarction of fibroadenoma of the breast is very uncommon and may lead to difficulties in clinical and pathological diagnosis. Most reported cases occured in young women during pregnancy or lactation. This report describes imprint cytologic features of an infarcted fibroadenoma in a 19-year-old young woman without evidence of pregnancy. The smears revealed many individually scattered degenerated or necrotic epithelial or spindle stromal cells and naked nuclei on dirty necrotic background. A few sheets of cohesive uniform epithelial cells and a few fragments of stromal cells were also present. Most of the epithelial cells had pyknotic and hyperchromatic nuclei, however, cellular atypism such as pleomorphism, prominent nucleoli or mitosis were not present. Though the necrotic ductular and glandular outline of this case may bear a superficial resemblance to adenocarcinoma, obvious cytologic atypia or mitosis, even in the necrotic areas, were not present.

A Case of Hutch's Diverticulum Associated with Severe Bilateral Vesicoureteral Reflux

We experienced a case of primary hepatic actinomycosis which was initially diagnosed by means of fine needle aspiration. The patient was a 31-year-old emaciated man with a 2-month history of 10 kg weight loss, right upper quadrant pain and flank pain. The liver was palpable and tender on physical examination. Computerized tomography scan of the liver showed two ill-defined hypodense masses in gallbladder fossa and inferior pole of right lobe. Hepatocellular carcinoma was clinically suspected. A CT-guided fine needle aspiration was performed. Microscopically, smears showed numerous radiating clusters of filamentous bacteria with many neutrophils and monocytes in necrotic background. The symptoms were improved by incision and drainage and massive administration of penicillin.

p 53 Protein Expression in Imprint Cytology of Breast Carcinoma / 대한세포병리학회지

This study was carried out to determine the usefulness of imprint cytology for detecting p 53 protein in breast carcinoma. NCL-DO7(Novocastra, U.K.) was used to detect p53 protein immunocytochemically. A total of 33 cases was studied. Immunostaining of imprint cytology with NCL-DO7 was positive in 64%(21\33) and showed relatively high coincident rate (80 %) with immunostaining of formalin-fixed, paraffin - embedded specimen. p 53 protein was related to negative estrogen receptor status, but not to the nuclear grade, lymph node metastasis, or tumor size. The fact that p53 protein expression was not related to nuclear grade might be due to predominance of nuclear grade 3. It was easier to determine the nuclear grade is one of the most important prognostic factors, in imprint cytology than in tissue specimen. p53 protein tended to be stained more strongly in imprint cytology than in tissue.