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Clinical histories, endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) material, and immunohistochemical stains performed on cell block samples of 6 solid-pseudopapillary tumors of the pancreas (SPTPs) were reviewed in the cases of 5 females (13-58 years) and 1 man (57 years); all had abdominal pain. Preliminary cytologic diagnoses at endoscopy included 1 SPTP 2 low-grade neoplasms, and 3 pancreatic endocrine tumors. Variable numbers of branching fragments with central capillaries and myxoid stroma were seen in the smears of 5 of 6 cases but were more apparent in the cell block material of all cases. The cells had bland nuclear features and rare grooves. Extensive necrosis was noted in 1 case and rare mitotic figures in 1. SPTPs showed strong cellular immunoreactivity for vimentin and focal weak keratin reactivity. Neuron-specific enolase, alpha1-antitrypsin, and alpha1-antichymotrypsin stains performed in 2 cases were strongly positive. Subsequent surgical resection confirmed all diagnoses. EUS-guided FNA diagnosis of SPTP is accurate. The characteristic branching papillae with myxoid stroma are best seen in cell block slides. Clinical setting, cytomorphologic features, and immunostains of the cell block help distinguish SPTP from pancreatic endocrine tumors, acinar cell carcinoma, and papillary mucinous carcinoma.

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BACKGROUND Insular carcinoma of the thyroid (ICT) first was reported in 1984. To the authors' knowledge, few cytology reports have been published since that time. The authors describe the cytologic features of six tissue‐proven ICTs and propose criteria that suggest its diagnosis. METHODS Four cases were thyroid fine‐needle aspiration (FNA) samples. Two cases were FNAs of metastases. All cases were found to be classic ICT on examination of primary or metastatic surgical specimens. RESULTS Three cases originally were diagnosed as carcinoma, including two FNAs of metastatic sites and one thyroid FNA. Two additional thyroid FNAs were diagnosed as suspicious for malignancy, favor follicular neoplasm. One case was termed a neoplasm, favor follicular type. Smears showed high cellularity and scanty colloid. Three cases were found to contain some microfollicles. One case showed a few papillae. Necrosis and mitosis were rare. Cells were round with pale, poorly defined cytoplasm. Nuclei were round and monomorphic with finely granular chromatin, mild hyperchromasia, smooth nuclear membranes, and small nucleoli. Nuclear grooves and inclusions were rare. CONCLUSIONS Three cases were diagnosed as suspicious for follicular neoplasm, the main differential diagnosis of ICT. Both tumors exhibited high cellularity and scanty colloid. However, ICT showed a predominance of single cells whereas follicular neoplasms reveal microfollicles with more nuclear atypia. There is cytologic overlap between these two neoplasms. Papillary thyroid carcinoma should be distinguished from ICT easily because the latter usually does not reveal the classic cytologic features associated with the former. ICT should be considered in the differential diagnosis of follicular neoplasms. Features favoring ICT are predominance of single cells, small loose nests of cells with few microfollicles, and little nuclear atypia. Cancer (Cancer Cytopathol) 1999;87:196–202. © 1999 American Cancer Society.

Clinical histories, endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) material, and immunohistochemical stains performed on cell block samples of 6 solid-pseudopapillary tumors of the pancreas (SPTPs) were reviewed in the cases of 5 females (13-58 years) and 1 man (57 years); all had abdominal pain. Preliminary cytologic diagnoses at endoscopy included 1 SPTP 2 low-grade neoplasms, and 3 pancreatic endocrine tumors. Variable numbers of branching fragments with central capillaries and myxoid stroma were seen in the smears of 5 of 6 cases but were more apparent in the cell block material of all cases. The cells had bland nuclear features and rare grooves. Extensive necrosis was noted in 1 case and rare mitotic figures in 1. SPTPs showed strong cellular immunoreactivity for vimentin and focal weak keratin reactivity. Neuron-specific enolase, alpha1-antitrypsin, and alpha1-antichymotrypsin stains performed in 2 cases were strongly positive. Subsequent surgical resection confirmed all diagnoses. EUS-guided FNA diagnosis of SPTP is accurate. The characteristic branching papillae with myxoid stroma are best seen in cell block slides. Clinical setting, cytomorphologic features, and immunostains of the cell block help distinguish SPTP from pancreatic endocrine tumors, acinar cell carcinoma, and papillary mucinous carcinoma.

Introduction Due to the Covid-19 social distancing restrictions, in March 2020, Weill Cornell Medicine-Qatar decided to replace students’ clinical instruction with novel online electives. Hence, we implemented an innovative online and remote pathology curriculum, anchored on virtual microscopy and Zoom videoconferencing: ideal tools to support online teaching. Objective To assess a new curriculum implementation at Weill Cornell Medicine-Qatar. Materials and Methods This for-credit, 2-week elective included 6 synchronous Zoom sessions where complex clinicopathological cases were discussed in small groups. We used open access digital microscopy slides from the University of Leeds’ Virtual Pathology Library (http://www.virtualpathology.leeds.ac.uk/slides/library/). Students independently prepared for these sessions by reviewing cases, slides, readings, and questions in advance (asynchronous self-directed learning anchored on a flipped classroom model), and wrote a final review of a case. An assessment and feedback were given to each student. Results Four elective iterations were offered to a total of 29 students, with learners and faculty spread over 4 countries. During the Zoom sessions, students controlled the digital slides and offered their own diagnoses, followed by group discussions to strengthen autonomy and confidence. We surveyed learners about the elective’s performance (program evaluation). Students conveyed high levels of satisfaction about the elective’s overall quality, their pathology learning and online interactions, with minimal challenges related to the remote nature of the course. Discussion and Conclusions Technological innovations mitigate sudden disruptions in medical education. A remote curriculum allows instruction at any distance, at any time, from anywhere, enhancing educational exchanges, flexibility and globalization in medical education.

Multinucleate giant cells (MGCs) occur in a variety of inflammatory, hyperplastic, and neoplastic thyroid disorders. They also have been recognized as a feature of papillary thyroid carcinoma (PTC), particularly in fine-needle aspiration biopsies (FNAB). However, the origin of the MGCs and their comparative frequencies in histologic and cytologic preparations have not been established. Therefore, histologic sections from 76 cases of PTC were examined and immunohistochemical analyses for epithelial and histiocytic markers were performed. Giant cells were identified in histologic sections of 35 cases (46%) of PTC. In cytologic preparations, MGCs were identified in 12 of 22 cases (55%).Multinucleate giant cells (MGCs) occur in a variety of inflammatory, hyperplastic, and neoplastic conditions of the thyroid gland, including Hashimoto's disease, multinodular goiter, follicular adenoma, and subacute thyroiditis. ' These cells have also been recognized as a distinctive feature of papillary thyroid carcinoma (PTC) in fine-needle aspiration biopsies (FNAB).2 However, the frequency of MGCs in routine histopathologic material and their origin (epithelial versus histiocytic) have not been established. Therefore, the goals of this investigation were to determine the frequency of MGCs in routine histologic sections and cytologic preparations of PTC and to determine their origin using immunohistochemical markers of epithelial and histiocytic differentiation. 3,4 The patients included 54 females and 22 males with a mean age of 44.52 years (range 16-87 years). Hematoxylin-and-eosin-stained sections were reviewed from all cases independently by both authors. An average number of four slides were examined per case (range 2-6 slides), and the presence or absence of MGCs was recorded. All sections were examined at medium power (X100) to determine whether MGCs were present. In those cases with MGCs, the sections were examined at high power (X400), and the numbers of MGCs were counted in at least 50 high power fields in areas of highest MGC density. MATERIALS AND METHODS SeventyThe presence of MGCs was assessed in 22 additional fine-needle biopsies of PTC. The cytologic preparations were examined at medium power (X100), and MGCs were recorded as being present or absent.In 10 cases of PTC containing MGCs, additional sections were stained for a variety of markers of epithelial and histiocytic differentiation. Antibodies against the following antigens were used: thyroglobulin and lysozyme (Dako Labs, Carpinteria, CA, dilution 1:750); a-1-antichymotrypsin (Dako Labs, Indianapolis, IN, dilution 1:800); KP1/CD68 (Dako Labs, dilution 1:50); AEI/ AEIII keratins (Boehringer-Mannheim, Indianapolis, IN, dilution 1:100). Immunohistochemical stains were performed on 5jt thick paraffin sections of formalin-fixed tissue. The sections were deparaffinized in xylene and hydrated in graded alcohols. They were then incubated in 765

EES shows cytologic features similar to ES of bone, with a spectrum of changes ranging from the typical appearance in a majority of cases to intermediate and atypical variants in a minority of cases. CD99/O13 immunocytostaining and/or molecular studies, particularly in the intermediate and atypical variants, may help in establishing a definitive fine-needle aspiration diagnosis, thus avoiding an open surgical biopsy.