Atypical presentation of bilateral Epstein-Barr virus dacryoadenitis: a case report of corticosteroid resistant orbital inflammation.

Epstein-Barr virus is a known cause of dacryoadenitis that is typically sensitive to corticosteroid treatment. When affecting the orbit, particularly the lacrimal gland, Epstein-Barr virus may cause chronic proptosis and a bilateral lacrimal mass effect. We provide a case of bilateral Epstein-Barr virus associated dacryoadenitis initially resistant to corticosteroid treatment requiring biopsy and confirmation by polymerase chain reaction of lacrimal tissue. Herein, we discuss the presentation with associated magnetic resonance imaging and histopathologic images, diagnostic dilemma, and treatment of an atypical case.

Orbital extranodal marginal zone lymphoma arising during pregnancy: a case report.

A 37-year-old, previously healthy woman presented during her first trimester of pregnancy with a two-week history of rapidly progressive proptosis in the left eye. Clinical examination revealed limited left supraduction and diplopia in upward gaze. Orbital magnetic resonance imaging showed a medial orbital mass adjacent to the globe with secondary proptosis. Pathologic examination of a biopsied specimen of the orbital mass and subsequent immunophenotyping by flow cytometry revealed an extranodal marginal zone B-cell lymphoma. Clinical and histological features as well as a review of the literature are described.

Intraoperative Squash and Touch Preparation Cytology of Brain Lesions Stained with H+E and Diff-Quik™: A 20-Year Retrospective Analysis and Comparative Literature Review.

OBJECTIVE: Squash preparation (SP) is a rapid technique for the intraoperative assessment of brain lesions. Only a few studies have employed touch preparation (TP) cytology and Diff-QuikTM (DQ) staining in conjunction with SP. Our study aimed to assess the diagnostic efficacy of SP of brain lesions at our institution, ascertain the additional effect of TP and DQ staining, examine factors affecting the sensitivity and specificity of our methods, and compare our findings with those of previous investigations. STUDY DESIGN: Our database was searched for all SP/TP of brain lesions examined from January 1996 to December 2016. RESULTS: During this 20-year study period, our search revealed 400 brain lesions diagnosed by SP/TP cytology. There were 338 (84.5%) neoplasms and 62 (15.5%) nonneoplastic lesions. The most common neoplasms were glioblastoma multiforme (24.6%), metastatic cancer (18.3%), meningioma (16.9%), astrocytoma (11.5%), lymphoma (8.3%), oligoastrocytoma (3.3%), and pituitary adenoma (3.3%). There was discordance between the SP/TP and histological diagnoses in 19/338 (5.6%) cases, i.e., 12 misclassifications of tumor subtype and 7 sampling errors. No false-positive cases were detected. CONCLUSION: Brain SP/TP stained with H+E/DQ demonstrated high sensitivity (97.9%), specificity (100%), and overall diagnostic accuracy (95.3%). The combined methods, in particular, aided in the diagnosis of brain tumors prone to smearing artifacts and certain metastatic malignancies.

The Clinical Significance of Endometrial Cells Detected on Pap Testing: The Impact of Revisions to the 3rd Edition of the Bethesda System for Reporting Cervical Cytology.

GOALS: This study aims to examine the effects of raising the reporting age for benign endometrial cells (BEC) on Papanicolaou (Pap) tests according to the 2014 3rd edition of the Bethesda System for Cervical Cytology, as well as the sequelae of the 2012 American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines recommending endometrial asessment only for postmenopausal or symptomatic premenopausal women. PROCEDURES: We retrospectively examined clinical and histologic data from 4438 women aged ≥40 with BEC on Pap tests, of whom 608 (14%) were biopsied. RESULTS: Fifty-three (8.7%) histologic abnormalities were discovered upon biopsy. There was no significant difference (p=0.52) in abnormalities found between premenopausal women aged ≥40 and premenopausal women aged ≥45. Furthermore, there were no high-grade cancers in women between ages 40-44. There were also 3 high-grade cancers in patients aged 46, 46, and 49. Each of these women was asymptomatic and premenopausal. CONCLUSION: Our results affirm the raising of the reporting age of BEC on Pap tests from 40 to 45 in our patient population. Because there were 3 asymptomatic, premenopausal patients with high-grade cancers in our 45-49 age group, we cannot completely adhere to the ASCCP guidelines nor can we advocate raising the reporting age further to 50. Other laboratories must review their own follow-up data to validate appropriate reporting criteria for BEC for their patients.

Metastatic neoplasms to the pancreas diagnosed by fine-needle aspiration/biopsy cytology: A 15-year retrospective analysis.

BACKGROUND: Metastatic tumors to the pancreas are rarely encountered and diagnostically challenging. We aspired to determine the incidence and origin of all metastases to the pancreas at our institution, and to examine their clinicopathologic and cytomorphologic features. We also sought to ascertain the effect of endoscopic ultrasound (EUS) guidance implementation. METHODS: A search of our database was undertaken to review all pancreatic FNA and/or CNB examined from January 2000 through December 2014. RESULTS: During our 15-year study, 636 patients underwent pancreatic FNA/CNB, including 252 (40%) computerized tomography (CT) and 384 (60%) EUS-guided biopsies. Malignancy was diagnosed in 221 (35%). Only 16 had metastases to the pancreas, comprising 2.5% of pancreatic biopsies and 7.2% of malignancies. Three (18.8%) presented with their first manifestation of cancer. EUS guidance was utilized in 50%, with rapid on-site evaluation (ROSE) employed in 14 (88%). The most common primary site was lung (6,38%), followed by 3 (19%) each of renal and gastrointestinal malignancies. The remaining included malignant melanoma, Merkel and gallbladder small cell carcinomas, and olfactory neuroblastoma. CONCLUSION: Cytologic diagnosis of metastasis to the pancreas is rare in our institution, comprising only 2.5% and 7.2% of total and malignant pancreatic FNA/CNB, respectively. FNA/CNB with ROSE proved to be an effective diagnostic modality, thereby obviating the need for more invasive procedures in the setting of pancreatic metastases. EUS-FNA was equally effective as CT-guided biopsies in achieving specimen adequacy and definitive diagnoses. We also present the first known case of a metastatic olfactory neuroblastoma to the pancreas diagnosed by imprint cytology.

Metastatic genitourinary cancer diagnosed by body fluid cytology: clinicopathologic and cytomorphologic correlation.

INTRODUCTION: Malignant effusions secondary to genitourinary cancers constitute less than 5% of metastatic malignancies. Because of their rarity, definitive cytodiagnosis may be challenging. Our study aims to examine the incidence of malignant fluids secondary to genitourinary cancers in our institution, and to characterize their clinicopathologic and cytomorphologic features. METHODS: A search of our database was undertaken for all body fluids reviewed from January 2003 through April 2014 at our institution. RESULTS: During this 11.3-year study period, our search revealed 8255 body fluids. Of these, 1341 (16.2%) were malignant with only 15 (0.2%) due to a genitourinary primary, constituting a mere 1.1% of all malignant fluids. Eight cases (53%) were urothelial carcinomas, 6 (40%) were renal cell carcinomas, and 1 was a bladder leiomyosarcoma (7%). No prostate cancers were found. Seven (47%) involved the pleura, 6 (40%) were in the peritoneum, and 2 (13%) were in the cerebrospinal fluid (CSF). None were detected in the pericardium. Genitourinary metastases comprised 1.9% of peritoneal, 0.8% of pleural, 1.9% of CSF malignant fluids. CONCLUSION: Metastatic genitourinary cancers in body fluids are rare, comprising only 0.2% of all fluids and 1.1% of all malignancies. The cytomorphologic features of metastatic urothelial and renal cell carcinoma, although similar to those described in the literature, are nonspecific. To our knowledge, this is the first reported case of metastatic bladder leiomyosarcoma in ascites diagnosed by effusion cytology. Because leiomyosarcoma in body fluids can demonstrate epithelioid features and cohesiveness, it may be confused with metastatic carcinomas.

Efficacy of endoscopic ultrasound-guided fine-needle aspiration and core needle biopsy in the diagnosis of upper gastrointestinal submucosal lesions.

INTRODUCTION: Endoscopic ultrasonographically guided fine-needle aspiration (EUS-FNA) has been increasingly utilized to evaluate submucosal lesions of the upper gastrointestinal (UGI) tract. Our study aims to determine the efficacy of UGI EUS-FNA/core needle biopsy (CNB), including the frequency and cytomorphologic features of encountered submucosal lesions, and to investigate contributing factors including the role of rapid on-site evaluation (ROSE). METHODS: We analyzed all UGI submucosal lesions diagnosed at our institution by EUS-FNA/CNB from September 2008 through August 2015. RESULTS: During this 8-year study period, 94 patients underwent 110 UGI EUS-FNA/CNB, including 89 (81%) gastric, 11 (10%) duodenal, and 10 (9%) esophageal lesions. Twenty-seven (25%) were gastrointestinal stromal tumors (GISTs), followed by 13 (12%) leiomyomas, 5 (5%) schwannomas, 4 (4%) gastric adenocarcinomas, 3 (3%) neuroendocrine tumors (NETs), and 3 (3%) pancreatic heterotopias. All GISTs, leiomyomas, and NETs were ultimately diagnosed by EUS biopsies, as well as 75% of adenocarcinomas, 60% of schwannomas, and 33% of pancreatic heterotopias. The specificity of EUS-FNA/CNB for these 6 most commonly encountered lesions was 100%, with sensitivity of 82%. Sensitivity was 100% for esophageal and duodenal biopsies, and 80% and 75% for gastric and gastroesophageal procedures, respectively. Factors that contributed to poor yield included the lack of ROSE, small lesional size, lesion location and histology, and needle type. Neither number of needle passes nor operator experience appeared to influence specimen adequacy. CONCLUSION: EUS-FNA/CNB is an effective modality for diagnosing UGI submucosal lesions. Awareness of potential errors due to sampling of the bowel wall, lesional cystic degeneration, as well as pancreatic heterotopia and Brunner gland hamartoma is essential in order to avoid false diagnoses.

A Rare Case of Lateral Canthal Gouty Tophus Presenting as an Eyelid Mass.

A 41-year-old man with a history of gout presented with an enlarging eyelid growth. Clinical examination revealed a mildly indurated nodule at the lateral canthus. Following resection, histopathological examination revealed needle-shaped, crystalline material surrounded by multinucleated giant cells, findings consistent with gouty tophus. This represents just the sixth case of gouty tophus of the eyelid reported in the literature.

Recurrent papillary thyroid carcinoma with pleural metastasis diagnosed by effusion cytology: a report of cases with clinicopathologic correlation.

Papillary thyroid carcinoma (PTC) is typically an indolent disease characterized by slow growth and a favorable prognosis. In rare instances, this disease may metastasize to the pleura and manifest as a malignant pleural effusion. We report 3 female patients of Japanese/Okinawan ancestry with a history of PTC who presented with hydrothorax. Cytologic examination in conjunction with immunohistochemical staining enabled a definitive diagnosis of metastatic PTC. Molecular analysis of the mitogen activated protein kinase (MAPK) and phosphatidylinositol 3-kinase (PI3K) pathways demonstrated the presence of the v-raf murine sarcoma viral oncogene homolog B (BRAF)(V600E) mutation in 2 of our 3 patients, with the absence of any other clinically significant mutations in all cases. Further investigation is necessary to elucidate the molecular and environmental mechanisms involved in this aggressive manifestation of PTC.