Utilization of ancillary studies in the cytologic diagnosis of respiratory lesions: The papanicolaou society of cytopathology consensus recommendations for respiratory cytology.

The Papanicolaou Society of Cytopathology has developed a set of guidelines for respiratory cytology including indications for sputum examination, bronchial washings and brushings, CT-guided FNA and endobronchial ultrasound guided fine needle aspiration (EBUS-FNA), as well as recommendations for classification and criteria, ancillary testing and post-cytologic diagnosis management and follow-up. All recommendation documents are based on the expertise of committee members, an extensive literature review, and feedback from presentations at national and international conferences. The guideline documents selectively present the results of these discussions. The present document summarizes recommendations for ancillary testing of cytologic samples. Ancillary testing including microbiologic, immunocytochemical, flow cytometric, and molecular testing, including next-generation sequencing are discussed. Diagn. Cytopathol. 2016;44:1000-1009. © 2016 Wiley Periodicals, Inc.

[Airway granular cell tumor].

The paper describes the clinical, morphological, and immunohistochemical characteristics of 13 granular cell tumors of the upper airway. These tumors are shown to have virtually the same histological and immunohistochemical features as granular cell tumors at another site. The histogenesis of these tumors is discussed. There are currently a number of more or less solid grounds for considering them as neurogenic tumors to be close to schwannomas. At the same time one cannot ignore the fact that there is morphological and immunohistochemical evidence for that the granular cell tumors have rather cytotypical than histotypical properties, which cannot implicitly assign them to nerve tissue tumors. Most likely, the granular cell tumors belong to a histogenetically heterogeneous mixed group, in this connection their place in the classification of tumors needs further investigation, by applying the criteria developed by Russian histologists and oncomorphologists.

[Aero-digestive tract squamous intra-epithelial neoplasia]. / Néoplasie intra-épithéliale épidermoïde des voies aéro-digestives supérieures.

Aero-digestive tract squamous intra-epithelial neoplasia is a disease whose genetic and epigenetic features lead to clinical signs and well codified histologic features. This publication aims to review the molecular alterations which have been identified in these lesions, to clarify the clinical manifestations and to discuss the proposed histological classification.

[TNM 2010. What's new?]. / TNM 2010. Was ist neu?

In the seventh edition of the TNM Classification of Malignant Tumours there are several entirely new classifications: upper aerodigestive mucosal melanoma, gastrointestinal stromal tumour, gastrointestinal carcinoid (neuroendocrine tumour), intrahepatic cholangiocarcinoma, Merkel cell carcinoma, uterine sarcomas, and adrenal cortical carcinoma. Significant modifications concern carcinomas of the oesophagus, oesophagogastric junction, stomach, appendix, biliary tract, lung, skin, prostate and ophthalmic tumours, which will be not addressed in this article. For several tumour entities only minor changes were introduced which might be of importance in daily practice. The new classifications and changes will be commented on without going into details.

Tumour biology and histopathology of neuroendocrine tumours.

The tumours of the disseminated/diffuse neuroendocrine cell system are a group of neoplasms sharing uniformly appearing cells which differ from each other in their biology, prognosis and genetics. In the lung they are called carcinoid and small/large-cell neuroendocrine carcinomas. In the gastroenteropancreatic compartment they are classified as well-differentiated neuroendocrine tumours or carcinomas and poorly differentiated neuroendocrine carcinomas. Depending on their localization these neoplasms reveal distinct phenotypes with respect to pathology, immunohistochemistry, and hormonal syndromes. Their clinical behaviour--ranging from benign and low-grade to high-grade malignancy--can be predicted on the basis of clinicopathological criteria. Currently extensive work is being performed to unravel the genetic background.

Smoking as a confounder in ecologic correlations of cancer mortality rates with average county radon levels.

Cohen has reported a negative correlation between lung cancer mortality and average radon levels by county. In this paper, the correlation of U.S. county mortality rates for various types of cancers during the period 1970-1994 with Cohen's radon measurements is examined. In general, quantitatively similar, strongly negative correlations are found for cancers strongly linked to cigarette smoking, weaker negative correlations are found for cancers moderately increased by smoking, whereas no such correlation is found for cancers not linked to smoking. The results indicate that the negative trend previously reported for lung cancer can be largely accounted for by a negative correlation between smoking and radon levels across counties. Hence, the observed ecological correlation provides no substantial evidence for a protective effect of low level radon exposure.

Cancers of the upper aerodigestive tract in Ontario, Canada, and the United States.

BACKGROUND: Squamous cancers of the upper aerodigestive tract (UADT) are related to the use of tobacco and/or alcohol, and in North America they are more common among the poor. They are usually locoregionally confined at diagnosis, and local treatment with surgery and/or radiation therapy is often curative. This study compares the incidence and survival of this group of diseases in Canada and the U.S., two North American neighbors with many cultural similarities but significant differences in their health care and social programs. METHODS: To describe and compare the case mix, incidence, and outcome of squamous cancers of the UADT in Ontario, Canada, and the U.S., we used the Ontario Cancer Registry (OCR) and the Surveillance, Epidemiology, and End Results (SEER) registries in the U.S. to identify all cases of cancer with International Classification of Disease (ICD) codes 141, 143-9, 160-1, and a subset of 140, which were diagnosed between 1982 and 1994. ICD-O histology codes were placed into clinically relevant groupings, and ICD-9 site codes were grouped into sites as defined by the International Union Against Cancer and the American Joint Committee on Cancer. Age-adjusted incidence rates were calculated for each site. For the SEER registry, race specific incidence rates were also calculated. Observed and expected survival were plotted by site and registry, and from these, relative survival was calculated. Survival was compared during the first 5 years after diagnosis and during the next 5 years among patients who had survived the first 5 years. RESULTS: Of the 16,577 and 42,990 cases identified in the OCR and SEER registries, respectively, squamous cancer was by far the most common histology (94.1% in OCR, 94.6% in SEER) and will form the main subject of this report. The distribution of squamous cancers by site, subsite, age, and gender were remarkably similar in the two populations. Overall, the incidence was about 17% higher in the U.S. than in Ontario, and this difference was seen for all sites except the nasopharynx, which was more common in Ontario. The higher incidence in the U.S. in part reflects the much higher rate for African Americans than for Americans of other ethnic backgrounds. During the first 5 years after diagnosis, when most deaths from UADT cancer occur, there was a significant relative survival difference in favor of the U.S. for cancer of the supraglottis, and in favor of Ontario for cancer of the oral cavity. There was a nonsignificant trend in favor of Ontario for cancer of the nasopharynx. Within the SEER population, for all sites except the nasopharynx, 5-year relative survival was considerably worse for African Americans than for Americans of other ethnic backgrounds. Examination of survival beyond 5 years after diagnosis for patients who had survived the first 5 years revealed that for all sites, the observed survival continued to diverge markedly from the expected survival. The excess mortality ranged from less than 20% for glottic and nasopharyngeal cancers to about 30-40% for oropharyngeal and supraglottic cancers. CONCLUSIONS: Despite remarkable similarities in case mix between the two countries, UADT cancers were more frequent in the SEER population of the U.S. than in Ontario, and this was partly attributable to the much higher incidence among African Americans. Significant differences between the registries in 5-year survival were seen for several sites. African Americans with UADT cancers had much worse prognoses than did Americans of other ethnic backgrounds. Patients who survive their UADT cancer remain at a higher-than-expected risk of death even after they have been cured.

[Statistics and prehospital diagnosis of malignant neoplasms of upper respiratory tract in Russia]. / Statistika i dogospitalnaia diagnostika zlokachestvennykh novoobrazovanii verkhnikh dykhatelnykh putei v Rossii.

In 1990 in Russia there were 12,264 newly diagnosed cases of upper respiratory tract cancer and 7562 relevant lethal cases. The authors provide data on such cancer incidence rate by site, groups of population, sex, age, type of tumor. Standardized incidence and mortality rates for various regions of Russia are indicative of the trend to the rates increase and relevant economic losses. The emphasis is on late diagnosis of ENT cancer, as 70-85% of the patients start anticancer treatment in advanced stages of the disease. This shows unsatisfactory situation in prehospital diagnosis of such tumors, numerous cases of misdiagnosis. The authors express their concern about poor oncological qualification of the practicing ENT specialists and urge improvements in current system of otorhinolaryngological training, performance of updated prophylactic and diagnostic measures.

[Use of mortality data for the study of the distribution of respiratory tract tumors in Italy: characteristics and quality of the data]. / Uso dei dati di mortalità per lo studio della diffusione dei tumori dell'apparato respiratorio in Italia: caratteristiche e qualità dei dati.

This paper reviews Italian studies that deal with the accuracy of death certificates in patients with cancers of the respiratory system, particularly cancers of the larynx, lung, and pleura. These studies consider death certificates vs postmortem examinations, diagnoses histologically confirmed, and clinical and cancer registry records. The large number of cases cured by surgery is reflected in the lower levels of larynx cancers mortality vs incidence. Site misclassifications, and erroneous reports of cancer on death certificates for patients cured of the disease, lead to an overreporting of death certification vs autopsies. The death certificates for lung cancer have a high agreement with clinical diagnoses, but present underreporting when compared to autopsies, which frequently discover tumors at postmortem examination. Pleura cancer is often misclassified as lung cancer. Improvement in death certification over time could have influenced the observed increase in the mortality trend for this tumor.

Prognostic factors in cervical lymph node metastasis in upper respiratory and digestive tract carcinomas: study of 1,713 cases during a 15-year period.

A prospective study of 1,713 patients with squamous cell carcinoma of the head and neck submitted to neck dissection between 1957 and 1973 is presented. We confirm the prognostic significance of the histological analysis of the nodal metastasis. Capsular rupture is the most important factor regardless of the primary site or tumor size. The presence of tumor emboli within lymphatics, the number of invaded nodes, and the number of nodes with capsular rupture are of significance though to a lesser extent. Classification of the clinical characteristics or the nodes provided, in 70% of the patients, a good prediction of histological involvement. In the clinical estimation of histological invasion, an important parameter is the size of the largest node detected, and we suggest this characteristic should be included in the TNM classification of UICC.

[Morphological typing of respiratory tract tumors]. / Morfologická typizace nádoru dýchacího ústrojí.

A group of 224 tumours of the respiratory tract was used to present experience with the standard histological classification, as proposed by WHO--incl. the revised version of pulmonary tumour classification which is under preparation. Electron microscopic facts from the authors' own material as well as from recent literature served in particular as a stimulus for the critical evaluation of some details of the standard classification. It served also as the basis for recommendations for rational modifications for its use in particular in Czech and Slovak speaking areas: 1. Prefer in respiratory pathways the term papilloma from respiratory epithelium to "transient" papilloma and not differentiate exophytic and inverted forms. 2. Respect the differentiation of bronchial adenomas and carcinoids, but identify atypical carcinoids with small-cell (oat-cell) carcinomas. 3. As to other carcinomas of the respiratory pathways to differentiate only between squamous carcinomas (spindle-cell and verrucal), glandular (in addition to adenoid cystic and mucoepidermoid) and undifferentiated. 4. In the section of pulmonary carcinomas to abandon completely large-cell carcinomas and to describe tumours which cannot be included in other groups as undifferentiated carcinomas. 5. Avoid in the other respect satisfactory classification pattern of pulmonary carcinomas subvariants (in particular in the group of glandular carcinomas) and include exceptional units in the group "others". 6. Arrange the group of malignant lymphomas according to the extrapulmonary classification pattern and include there from the group of tumourous lesions so-called lymphoproliferative processes, eosinophil granuloma and gangrenescent granuloma. 7. Use consistent with the nomenclature in the sphere of the nervous system the term olfactory neuroblastoma and omit its rare sub-variants.

Histopathological types of nasopharyngeal carcinoma in a low-risk area: Japan.

NPC in Japan was studied histopathologically by examining 816 NPCs from among 3 338 biopsies from patients with tumours of the nasopharynx and other parts of the upper respiratory system. In addition, a comparative study on NPC among Taiwanese and an immunoserological study were carried out. When comparing histological types of malignant tumours of the upper respiratory tract, poorly-differentiated squamous-cell carcinoma predominated only in those of the nasopharynx. Malignant nasopharyngeal tumours in Japanese patients were characterized by two histological features: predominance of squamous-cell carcinoma, especially of the poorly-differentiated type, and a relatively high frequenty of malignant lymphoma. An analysis of 731 cases of NPC showed that a vast majority (86.7%) were poorly-differentiated and a minority (13.3%) well-differentiated squamous-cell carcinomas. The former included 45.8% spindle-polygonal-cell carcinomas, 26.6% transitional-cell carcinomas ana 14.3% lymphoepitheliomas. Although the transitional-cell carcinomas and lymphoepitheliomas showed a peculiar morphology, it was confirmed that they are of a squamous nature. A comparative study of the histology of NPCs in a high-risk area, Taiwan, and in a low-risk area, Japan, revealed considerable differences between the two groups. Well-differentiated carcinomas were infrequent in both groups but were more frequent in Japanese than in Taiwanese, while the frequency of poorly-differentiated carcinomas, especially transitional-cell carcinomas and lymphoepitheliomas, was much higher among Taiwanese. A seroepidemiological study on the relation of anti-VCA antibody titres to histological type of tumour in 84 Japanese NPC patients revealed that the rate of positivity and the geometric mean of the titres were considerably higher in patients with lymphoepitheliomas. Althougropathological study along this line would appear to be important, since the results obtained in Japanese NPC cases may suggest that EBV genomes in NPC cells vary with the grade of differentiation of NPC.