Differentiating reactive mesothelial cells (RMs) from metastatic adenocarcinoma cells (MAC) in serous fluids based on cytomorphologic features alone can be very challenging. Various immunocytochemical (ICC) markers have been used to maximize the diagnostic accuracy, however, cytopathologists still encounter difficulties in effusion cytologic diagnosis. The aim of this study was to evaluate previous and recent ICC stains to identify the most sensitive and specific markers and the best panel for differentiating RM from MAC. Cell block sections from 41 MAC and 43 RM effusions cases were subjected to ICC staining for MOC-31, BerEp4, carcinoembryonic antigen (CEA), calretinin, HBME-1, CK5/6, and D2-40. For the MAC cases, the sensitivity of BerEp4, MOC-31, and CEA was 82.9, 92.6, and 17%, respectively, and the specificity was 95.3, 93, and 100%, respectively. For the RM cases, the sensitivity of calretinin, CK5/6, D2-40, and HBME-1 was 95.3, 27.9, 58.1, and 93%, respectively, and the specificity was 70.7, 73.1, 75.6, and 82.9%, respectively. The results show that BerEp4 and MOC-31 are highly sensitive and specific for detecting MAC, whereas calretinin and HBME1 are highly sensitive but only modestly specific for detecting RM cases (P < 0.05). Forced entry logistic regression revealed that using MOC-31, BerEp4, HBME-1, and calretinin, is an excellent panel for making correct diagnosis with 97.6% sensitivity in detecting MAC and 90.7% specificity in detecting RM. We conclude that adding a panel of MOC-31, BerEp4, calretinin, and HBME-1 immunostains to routine cytomorphologic features can greatly enhance the diagnostic accuracy of serous effusions.
Epithelial myoepithelial carcinomas (EMC) are rare carcinomas of the salivary glands. We report here the 6th case of this tumor which arises at the nasal cavity. In case of any histopathological report shows up a pleomorphic adenoma in an unusual site, we highly recommended the use of immunohistochemistry assay as an important tool for the diagnosis of this tumor.
INTRODUCTION: Endoluminal stenosis of proximal bronchi (ESPB) is a rare and severe manifestation of pulmonary sarcoidosis. CASE PRESENTATION: A 42 year old African American gentleman with history of night sweats and wheezing presented to the hospital with sudden onset chest pain due to right sided pneumothorax. CT chest revealed hemorrhagic bullae occupying most of the right middle lobe (RML) with partial collapse of the right upper lobe (RUL) and mediastinal lymphadenopathy. Mediastinoscopy was performed with right middle lobectomy followed by flexible bronchoscopy which revealed 90% stenosis of RUL bronchus, 70% stenosis of the bronchus intermedius (BI) and normal left bronchial tree. Pathology revealed necrotic tissue from RML and non-caseating granulomas from a station 2R lymph node. After an extensive negative workup to rule out other etiologies, the patient was diagnosed with pulmonary sarcoidosis. He was started on 50 mg of prednisone daily followed 6 months later with methotrexate 15 mg weekly. A repeat airway exam at 6 months showed continued stenosis of the RUL bronchus and BI. He was therefore sent for balloon dilation of his BI. Eight months later CT chest revealed partial re-expansion of the RUL collapse. DISCUSSION: ESPB is defined as bronchoscopic narrowing of at least 50% of the bronchial lumen (1). Although an obstructive ventilatory deficit is described in up to 63% of patients with pulmonary sarcoidosis, the prevalence of ESPB was reported in 0.72% of 2500 patients in a study conducted by Chambellan el al in 2005, highlighting how rare this manifestation of disease is. Of the patients with multiple stenosis in this study, only one patient had significant narrowing of the BI (0.6% of all patients). Early treatment within three months of diagnosis correlated with better outcomes, with corticosteroids remaining the first line treatment. Endobronchial airway procedures have been described for patients with incomplete response to medical therapy. Lung transplantation remains a definitive option in selected cases of refractory and late stage disease. CONCLUSIONS: Early diagnosis and treatment of ESPB carries the best prognosis; however refractory disease is challenging and may require advanced airway procedures for treatment. Pulmonologists should have a heightened awareness of potential treatment challenges including airway intervention to improve outcomes for patients.
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