Cytomorphologic diagnosis of adult granulosa cell tumors at the metastatic sites with an emphasis on the cytologic mimics.

INTRODUCTION: Adult granulosa cell tumor (AGCT) is a rare ovarian sex-cord malignancy notorious for late recurrences and metastases. The cytologic features of AGCT at the metastatic sites have been documented sporadically. Hence, knowledge of the characteristic cytomorphologic features is essential for an accurate diagnosis and distinguishing it from its pathologic mimics, especially at the metastatic sites. MATERIALS AND METHODS: This was a retrospective study conducted over six years. The cytopathology electronic database was searched for the fine needle aspirates (FNA) reported as metastatic AGCT. A detailed cytomorphologic assessment was done for multiple cytologic features, including overall cellularity, cellular arrangement of the tumor cells, cell size, cell shape, nuclear pleomorphism, nuclear grooving, chromatin pattern, nucleolar prominence, mitotic figures, amount and character of cytoplasm, and the extracellular background. RESULTS: There were 6 cases reported as metastatic AGCT on aspiration cytology. The smears in all the cases were cellular, with tumor cells arranged in loose aggregates, three-dimensional clusters, perivascular papillary fronds, and scattered singly. The most consistent cytologic features included microfollicular arrangement of monomorphic tumor cells with round-oval nuclei, fine chromatin, longitudinal nuclear grooving, and scant cytoplasm. Typical Call-Exner bodies and metachromatically stained extracellular hyaline material were noted sporadically. None of the smears showed anaplasia, prominent macronucleoli, atypical mitoses, or necrosis. CONCLUSIONS: The current study not only outlines the distinct cytologic attributes of AGCTs across various metastatic locations but also highlights its prevalent cytologic mimics. Additionally, it outlines key clinicopathologic traits that can aid in distinguishing and precisely diagnosing these tumors through cytological analysis.

Primary leiomyosarcoma of the parotid gland: Aspiration cytology with emphasis on differential diagnosis.

Most salivary gland neoplasms are of epithelial origin. Sarcomas of the parotid gland, including leiomyosarcoma, are exceedingly rare mesenchymal tumours. A definitive diagnosis of leiomyosarcoma is challenging on cytomorphology alone. We herein describe a case of a 41-year-old woman who presented with parotid gland swelling. The patient was previously diagnosed with leiomyosarcoma of the parotid gland on histopathology. Fine needle aspiration cytology was done from this recurrent swelling. Cytomorphology combined with cell block immunocytochemistry was fruitful in confirming the tumour recurrence. Primary and recurrent/metastatic leiomyosarcoma of the parotid gland is a rarity and cannot be distinguished on cytology. Such a distinction is based on the known history of prior malignancy, which was forthcoming in the present case, or after an exhaustive work-up. Pertinent clinical history and radiology provide leads for the cytopathologist. They must be sought so that immunocytochemistry can be applied judiciously and a precise/nearly precise cytological diagnosis rendered, as it guides patient management. The diagnosis is challenging on cytology as the spindle cell lesions of the parotid gland range from reactive to benign to malignant tumours.

Fine needle aspiration cytology of metastatic tumours to the thyroid.

BACKGROUND: Metastasis to the thyroid gland from non-thyroid sites is relatively rare and often poses a diagnostic difficulty on fine-needle aspiration cytology, as it often mimics primary thyroid neoplasms. METHODS: All cases of fine needle aspiration cytology (FNAC) of metastasis to the thyroid gland (2014-2022) were selected from the pathology database. The detailed cytopathological features and histopathology of the cases were studied. RESULTS: There was a total of 18 cases of secondary tumours of the thyroid. All cases had confirmed histopathological data. The most common primary tumours in our study were squamous cell carcinoma of the oesophagus (nine cases) followed by infiltrating ductal carcinoma of the breast (four cases), and one case each of renal cell carcinoma, neuroendocrine carcinoma of the lung, adenocarcinoma stomach and malignant melanoma and squamous cell carcinoma from vallecula. CONCLUSION: Metastasis to thyroid carcinoma is relatively uncommon. A history of malignancy, the presence of malignant cells amid benign thyroid follicular cells, unusual malignancy in a FNAC smear and immunocytochemistry are helpful in diagnosing such cases.

Digital cytology: Current status and future prospects.

AIMS: In this paper, we reviewed the basic principle and the currentstatus of digital cytopathology. MATERIALS AND METHODS: We reviewed the published papers on digitalcytology and analysed its future prospects. RESULTS: Virtualcytology using digital platform is being increasingly used to render diagnosisrather than conventional glass slide microscopy. Whole slide imaging (WSI)offers the prospect of true virtual microscopy and in the near future, may evenreplace glass slides in routine practice. It may be pivotal in diagnosing andtraining pathology graduates faster and more accurately. CONCLUSION: The digital cytopathology is a promising field and may have great impact indiagnosis, research and teaching.

An emerging era of computational cytology.

BACKGROUND: The significant advancement in digital imaging, data management, advanced computational power, and artificial neural network have an immense impact on the field of cytology. The amalgamation of these areas has generated a newer discipline known as computational cytology. AIMS AND OBJECTIVE: In To discuss the various important aspects of computational cytology. MATERIALS AND METHODS: We reviewed the different studies published in English during the last few years on computational cytology. RESULT: Computational cytology is a newer and emerging discipline in pathology that deals with the patient's meta-data and digital image data to make a mathematical model to produce diagnostic interpretations and predictions. The role of the cytologist is now changing from a simple observational scientist and slide interpreter to a dynamic and integrated multi-parametric prediction-based scientist. CONCLUSION: In the current stage, the cytologist must understand the situation and should have a vision of the complete scenario on computational cytology.

An artificial neural network for the prediction of the risk of malignancy in category III Bethesda thyroid lesions.

BACKGROUND: The diagnosis of cases of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) by fine needle aspiration cytology (FNAC) is challenging for both cytopathologists and clinicians. It is extremely difficult to predict the risk of malignancy based on cytological features alone. AIMS AND OBJECTIVES: In this study, we attempted to construct an artificial neural network (ANN) model to predict the risk of malignancy in FNAC cases of AUS/FLUS in thyroid lesions based on cytological features. MATERIALS AND METHODS: We included two groups of AUS/FLUS cases: (1) 29 cases of histopathologically proven malignancy, and (2) 32 cases that had either been histopathologically proven to be benign, or for which no progress of malignancy on follow-up had been observed in the last 2 years. Cytological characteristics were analysed semi-quantitatively by two independent observers (TS and PD). Based on these data, we tried to generate an artificial neural network (ANN) model to differentiate between malignant and benign cases. The performance of the ANN was assessed using the confusion matrix and receiving operator curve. RESULTS: There were 29 malignant cases of AUS/FLUS (histopathologically proven) and 32 benign/follow-up cases in this study. There were 41 cases in the training set, 9 cases in the validation set and 11 cases in the test set. In the test group, the ANN model successfully distinguished between all benign (5/5) and malignant cases (6/6). The area under the receiver operating curve was 1. CONCLUSION: The present ANN model is well structured and coherent to distinguish malignant from benign outcomes in AUS/FLUS cases on cytology smears with no error. This is an open-ended ANN model, and additional parameters and more cases could be included to make the model more robust.

Extensive spindling in medullary thyroid carcinoma posing a diagnostic challenge: A case report.

Medullary thyroid carcinoma is a neuroendocrine tumor derived from parafollicular or 'C' cells with sporadic and familial forms. Fine needle aspiration cytology is a quick way to establish the diagnosis. Sometimes a usual tumor may show prominent spindling on cytomorphology due to sampling issues, which poses a diagnostic challenge. When encountering spindled tumor cells on cytology smears from the thyroid, differential diagnoses encompass many benign and malignant lesions. We present cytological findings of the usual type of medullary thyroid carcinoma showing extensive spindling on cytology smears, which was a diagnostic dilemma. An accurate diagnosis was reached with the judicious use of immunocytochemistry on the cell block. We also discuss the available literature, differential diagnoses, and how to troubleshoot.

Fine needle aspiration cytology of a space-occupying lesion in the liver.

The fine needle aspiration cytology and histopathology of a space-occupying lesion in the liver.

Metastatic germ cell tumour in effusion cytology.

BACKGROUND: Germ cell tumours infrequently metastasise to body cavities, where early detection on fluid samples is possible and can spearhead early treatment and survival. MATERIALS AND METHODS: A total of seven cases of metastatic germ cell tumours were retrieved out of 7500 effusion samples received for cytopathological examination from 2015 to 2021. Detailed cytological features of metastatic germ cell tumours in effusion samples were studied, along with a correlation between clinical, radiological, and histopathological features. RESULTS: A total of seven cases of metastatic germ cell tumours were analysed in effusion samples which included dysgerminoma (2), immature teratoma (2), yolk sac tumour (1), embryonal carcinoma (1), and mixed germ cell tumour (1). The smears showed predominantly discrete or loose clusters of cells. The cells with round nuclei and prominent nucleoli were helpful in detecting dysgerminoma and yolk sac tumours. Immature teratoma showed tiny groups of small cells and mature squamous cells. Serum tumour markers were raised in the majority of cases. CONCLUSION: Metastatic germ cell tumours in effusion are uncommon, but detailed clinical history, including serum markers and characteristic cytological features, are helpful in their diagnosis.

An exceptionally rare case of metastatic osteoclast-like giant cell-rich variant of anaplastic thyroid carcinoma: A diagnostic challenge.

Osteoclast-like giant cell-rich variant of anaplastic thyroid carcinoma is extremely uncommon. In this paper we describe one such case in a 50 year-old male. The patient presented with enlarged cervical lymph node after initial total thyroidectomy. The fine needle aspiration cytology (FNAC) smear showed abundant multinucleated osteoclastic-like giant cells and scattered large bizarre tumour cells. FNAC of such cases may often be mistaken as osteoclast-like giant cell-rich lesions.

Renal metastasis from papillary thyroid carcinoma: A diagnostic dilemma.

In this paper, first time a rare case of solitary metastasis of papillary carcinoma of thyroid in the kidney diagnosed by fine needle aspiration cytology has been described.