BackgroundUltrasound has become the initial approach to evaluating thyroid nodules, facilitating the distinction between benign and malignant nodules based on composition, echogenicity, nodule border or margin, shape, the presence of calcifications, and nodule dimensions. The American College of Radiology (ACR) recommended the Thyroid Imaging Reporting and Data System (TI‐RADS) as a classification system to standardize thyroid ultrasound reports and to predict the probability of malignancy in thyroid nodules using a scoring system (TR1‐TR5) based on multiple ultrasound characteristics and nodule size. Fine‐needle aspiration (FNA) is recommended as the next step for nodules that warrant further workup. The authors assessed the accuracy of the ACR TI‐RADS based on the corresponding FNA cytology results (Bethesda system diagnoses I‐VI).MethodsACR TI‐RADS ultrasound reports and corresponding FNA cytology diagnoses from January 1, 2018 to August 30, 2018 were evaluated.ResultsFrom January 1, 2018 to August 30, 2018, 2306 thyroid ultrasound‐guided FNAs were performed at our institution. Of 2306 cases, 361 had ACR TI‐RADS reports available. The majority of FNAs were TR4 (180; 49.9%) or TR3 (108; 29.9%). No TR2 or TR3 nodules were associated with Bethesda category V or VI diagnoses. The majority of TR4 nodules (142 of 180; 78.9%) and TR5 nodules (42 of 65; 64.6%) exhibited benign (Bethesda category II) cytology. Fourteen TR5 cases (21.5%) had malignant (Bethesda category VI) cytology.ConclusionsAlthough there were no TR2 or TR3 malignant (Bethesda category VI) diagnoses, and there were only a few malignancies in the TR4 and TR5 categories, the current results reassert the notion that the ACR TI‐RADS scoring system shows at least some correlation between benign or malignant cytology diagnoses, as illustrated by the greater number of malignant cases in the higher ACR TI‐RADS categories.

Background:Solid pseudopapillary tumor is a rare pancreatic neoplasm with uncertain to low malignant potential. This is an uncommon neoplasm with many pseudonyms, occurring predominantly in young woman under the age of thirty years.Aims:To study the cytomorphological features of six cases of solid and pseudopapillary epithelial neoplasm of pancreas diagnosed on fine needle aspiration cytology (FNAC) in years 2005 to 2007 and its cyto-histological correlation.Materials and Methods:Image-guided FNAs was done in these six patients preoperatively. Alcohol-fixed smears were stained with Papanicolaou stain, cytomorphological findings were evaluated and diagnosis was made. Diagnosis was later confirmed by histology in all cases.Results:All six cases show characteristic cytological features such as hypercellular smears with presence of abundant delicate papillary fragments, dyscohesive cells, monomorphic tumor cells with delicate folded nuclear membranes, and foamy macrophages in the background.Conclusions:Preoperative correct diagnosis of solid pseudopapillary tumor of pancreas is possible on FNAC and by doing so it helps in management of this surgically curable neoplasm.

Objectives:Lymphovascular invasion (LVI) is a pathologic, microscopic finding associated with invasive cancer, and is a poor prognostic indicator, but has no reported imaging findings. This report presents the first documented case of LVI with seen by imaging. Linear branching microcalcifications were identified on mammography and clumped enhancement was noted on MRI, both imaging findings that are highly predictive of ductal carcinoma in situ (DCIS).Methods:Ultrasound guided core biopsy of the dominant mass was performed, confirming invasive ductal malignancy. Stereotactic biopsy performed on the microcalcifications was initially interpreted by pathology as DCIS.Results:Patient underwent mastectomy. Pathologic evaluation of the surgical specimen confirmed the invasive ductal malignancy. Microcalcifications were re-evaluated with immunohistochemistry (IHC) and re-classified as LVI. Radiology images and IHC stains are shown.Conclusion:This is the first report of LVI identified by imaging with findings that mimicked DCIS and initially mis-identified as DCIS by pathology as well. The implications of this overlap in radiologic appearance are discussed.

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Objectives The 2014 Bethesda System (TBS 2014) guidelines for reporting cervical cytology revised the age for reporting benign endometrial cells (BECs) from 40 years or older to age 45 years or older. We evaluated this change and further investigated if extending the reporting age to 50 years or older may be acceptable. Methods We reviewed cases with BECs reported on Papanicolaou tests in women age 40 years or older and 45 years or older before and after implementation of TBS 2014. Follow-up endometrial biopsy/curettage results were categorized as benign, endometrial hyperplasia with or without atypia, or malignant. Hyperplasia and malignant follow-up were considered clinically significant. Clinical data were documented. Results were compared for women age 40 to 44, 45 to 49, and 50 years or older. Results Follow-up in 15 (100%) women age 40 to 44 years was benign. In women age 45 to 49 years, 61 (96.8%) had benign follow-up, one (1.6%) had atypical hyperplasia, and one (1.6%) had malignant follow-up. In women age 50 years or older, 57 (86.5%) had benign follow-up, four (6%) had malignant follow-up, and seven (7.5%) had atypical or nonatypical hyperplasia. There was a significant difference in follow-up between the age groups of 40 to 49 and 50 or older (P = .023). Conclusions We conclude that the TBS 2014 revision was justified. Our data suggest that age 50 years or older rather than age 45 years or older may be an acceptable cutoff for reporting BECs.

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Fine-needle aspiration biopsies (FNABs) are a common modality used in the evaluation of salivary gland neoplasms. We present the cytologic and histologic features of a rare case of lymphoepithelioma-like carcinoma (LELC) in a 40-year-old Hispanic male with a 1.0-cm painless well-circumscribed parotid mass that had been present for 8 years. FNAB smears showed cohesive groups of intermediate-sized basaloid cells with vesicular nuclei, occasional pleomorphic nuclei and prominent nucleoli, and spindled morphology. Mature lymphocytes were seen in the background, either adjacent to the atypical epithelial cells or dispersed in the background. This lymphoid background raises considerations of salivary gland neoplasms that can have prominent lymphocytic backgrounds, such as acinic cell carcinoma and, more commonly, Warthin’s tumor or metastasis involving intraparotid lymph node. Surgical resection of the parotid showed syncytial sheets of predominantly undifferentiated cells with spindled to epithelioid morphology and occasional prominent nucleoli and focal areas of squamous differentiation. The background showed dense areas of lymphocytes with germinal center formation. Immunohistochemical (IHC) stains showed positive reactivity for p63, p40, and EBV in situ hybridization (EBV ISH) in the tumor cells and negative reactivity for p16. The findings were supportive of LELC if a metastasis from the nasopharynx was excluded. A subsequent nasopharyngeal biopsy was benign. Although histologic features of LELC are well established, we identified rare case reports describing the cytomorphology in the literature. Cytopathologists should be aware of this lesion as another salivary gland neoplasm that can show lymphocytes admixed with the tumor cells and a distinct lymphoid background. The basaloid appearance and cytologic atypia should distinguish it from acinic cell carcinoma and Warthin’s tumor. However, metastatic lesions should also be considered with a distinct lymphoid background and need to be clinically excluded before establishing the diagnosis of LELC.