Inter- and intra-observer concordance of cyberpathology in twenty-five cases.

To study the feasibility of anatomical pathology consultation in cyberspace (cyberpathology) and to determine inter- and intra-observer concordance. Twenty-five consecutive cytology and histopathology cases are photographed using a digital camera placed against the eyepiece, and uploaded to an image-server in the Internet. Participants view the images, rate their confidence, and provide a diagnosis. They then view the original glass slides and provide a final diagnosis. The diagnoses are compared for inter- and intra-observer concordance. Participants are confident of their diagnoses based on viewing images on the Internet. The intra-observer concordance exceeds 95% individually, and 96% overall. Inter-observer concordance was 100% in a subset of cases. Cyberpathology as described is both available and affordable and is a valid alternative to slide-based anatomic pathology consultation.

Cervical Cancer Screening for the Reluctant - HPV Testing of Air-Dried Vaginal Discharge.

Despite the availability of the PAP test, cervical cancer continues to cause considerable morbidity and mortality. Many women default cervical cytology for a variety of reasons. This demands the development of alternative screening strategies, such as HPV testing on self-procured cervical-vaginal specimens in order to capture this group of women. We investigated the self-procured air-dried vaginal discharge for HPV testing. We recruited 82 patients with HPV-associated cervical lesions and 36 patients with normal cervical pathology. Participants were briefed and informed consents obtained. Each was then given a kit containing written instructions, a slim napkin, an empty zip-lock plastic bag for soiled napkin specimen, and a return envelope. After wearing the napkin for the day, the patient removes it, dries it, and returns the specimen by mail. Specimens were batched and a 0.5 cm area of each stained napkin was tested for HPV by PCR. Specimens from all 26 patients with high-grade (CIN 2 or above) HPV-induced cervical lesions and 4 of 36 normal subjects tested positive for HPV, giving a sensitivity and specificity of 100% and 88.9%, respectively. We propose offering to women who refuse cervical cytology the alternative screening strategy of testing of self-procured air-dried vaginal discharge for HPV. This method of cervical cancer screening is also suitable for people living in remote regions of the world.

T-cell/histiocyte-rich diffuse large B-cell lymphoma. Report of a case diagnosed by fine needle aspiration biopsy with immunohistochemical and molecular pathologic correlation.

BACKGROUND: T-cell-rich B-cell lymphoma (TCRBL) is a lymphoma of B-cell type associated with a prominent component of T cells (constituting > 50% of the cellular population). We report the first case of TCRBL diagnosed by fine needle aspiration (FNA). It was confirmed by subsequent lymph node excision biopsy. CASE: A 37-year-old woman presented with a short history of chest wall pain. Examination revealed induration, warmth and armorlike swelling of the right anterior chest wall, axilla and upper arm, with matted lymph nodes in the ipsilateral axilla and supraclavicular fossa. FNA showed a polymorphic, lymphoid aspirate, among which were many small lymphocytes, significant numbers of centroblastlike cells and a few markedly atypical lymphoid cells with convoluted nuclei. Histiocytes, freely lying karyorrhectic debris and mitotic figures were readily identified. Plasma cells, eosinophils and Reed-Sternberg cells were not seen. The cell block contained similar cells, with larger lymphoid cells scattered among smaller lymphocytes. Immunohistochemical studies showed that the larger cells were B cells. Molecular studies on the cell block confirmed an immunoglobulin gene rearrangement. CONCLUSION: TCRBL is a distinct type of lymphoma that can be accurately diagnosed by FNA.

Clear-cell sarcoma diagnosis by fine-needle aspiration: cytologic, histologic, and ultrastructural features; potential pitfalls; and literature review.

A definitive diagnosis of clear-cell sarcoma of soft parts (CCSSP) is possible by fine-needle aspiration (FNA) biopsy alone. The aspirates are markedly cellular, consisting predominantly of discohesive cells but also of cohesive cells. The cytoplasm is eosinophilic and eccentric. The nuclei are round and contain macronucleoli. CCSSP should be considered when FNA of a soft-tissue tumor shows uncharacteristically high cellularity and relatively uniform cells with macronucleoli. Cohesion of some tumor cells does not rule out CCSSP. Melanin pigment and cytoplasmic clearing are infrequent and not necessary for the diagnosis. Sufficient material should always be procured for immunohistochemical studies on the cell block. Seven other cases are found in the literature, all correctly diagnosed by FNA. Although it is rare, CCSSP is a highly malignant tumor that can be diagnosed readily by FNA without resorting to incisional biopsy.