Background: A number of categorization systems had been developed for the reporting of cytology specimens with the aim of providing uniform definitions, criteria, and diagnostic terminology. The intention of these systems is to improve reproducibility of diagnostic categorization with standardized estimates of malignancy risk. Required for the success of these systems is a high level of interobserver reproducibility for category assignment. Recently, the international system for serous fluid cytopathology (TIS) was proposed using the categories nondiagnostic, negative for malignancy, atypia of undetermined significance (AUS), suspicious for malignancy, and malignant. Little data exists documenting the interobserver agreement for these categories.Design: A search of the cytology records at the University of Missouri was performed for all pleural fluid specimens obtained between January 2014 and December 2019.A total of 200 specimens were reviewed independently by three board-certified cytopathologists. Specimens were characterized as nondiagnostic, negative, AUS, suspicious for malignancy, and malignant. Interobserver agreement was analyzed using Cohen's kappa.Results: Overall observer agreement was 68% and chance-corrected weighted agreement (weighted kappa) was 0.63. Agreement was good for categories negative and malignant, but poor for categories atypia of uncertain significance, and suspicious for malignancy. Conclusions:The TIS has performance characteristics similar to other cytologic classification schemes. Interobserver agreement is best for the negative (76%) and malignant (81%) categories. Interobserver agreement is poor for the category's AUS, and suspicious for malignancy. This is similar to interobserver agreement associated with other published categorization systems.
Background Sebaceous lymphadenomas and sebaceous lymphadenocarcinomas are uncommon neoplasms occurring predominately within the parotid gland. Cytomorphology of these neoplasms is rarely reported. Occasional reports have discussed the cytomorphological features of these neoplasms but criteria distinguishing sebaceous lymphadenomas from lymphadenocarcinomas have not been described. Methods The senior authors' consultation files and records of the University of Missouri were searched for all cases with a diagnosis of sebaceous adenoma, lymphadenoma, lymphadenocarcinoma, and adenocarcinoma. Slides from these cases were reviewed by the authors for cytologic features characteristic of these neoplasms. These features were compared with other salivary gland lesions in the differential diagnosis and for utility in separating benign from malignant sebaceous neoplasms. Results Three sebaceous lymphadenomas and one sebaceous lymphadenocarcinoma were found. Smears contained large numbers of mature lymphocytes dispersed in a watery or bloody background. Scattered among the lymphoid cells were small nests of epithelial cells characterized by a finely to coarsely vacuolated cytoplasm. The majority of cells contained bland nuclei with finely granular chromatin and conspicuous nucleoli. A second population of small basaloid cells was present. The single sebaceous lymphadenocarcinoma had a similar cytomorphology. Conclusions Sebaceous lymphadenomas can be distinguished from other neoplasms within the differential diagnosis due to their prominent lymphoid background and population of epithelial cells with a finely to coarsely vacuolated cytoplasm. The nuclei are bland but have conspicuous nucleoli. Based on our small series, cytomorphologic features are inadequate to definitively separate sebaceous lymphadenomas from lymphadenocarcinomas.
Isolated lesions of the sphenoid sinus, particularly malignancies, are rarely reported and exist largely within the Otolaryngology literature. Delayed diagnosis may necessitate neurosurgical involvement; therefore, neurosurgeons must be aware of the range of pathologies in this region in order to provide adequate treatment. We present an unusual case of an 89-year-old female with several weeks of worsening headaches, vision loss, and cranial neuropathies. Work-up at an outside hospital was non-diagnostic. After referral, an expansive and erosive lesion within the left sphenoid sinus was identified. A transsphenoidal approach for resection of the lesion yielded a primary non-salivary non-intestinal type sinonasal adenocarcinoma, as well as bacterial sinusitis and probable allergic fungal sinusitis. The patient was treated with antimicrobial medications as well as stereotactic radiosurgery. Her neurological deficits did not improve with treatment, and she ultimately expired 3.5 months post-operatively after transition to hospice. Primary sinonasal adenocarcinoma is a very rare pathology in this location. Surgical intervention is necessary to obtain an accurate diagnosis and proceed with appropriate treatment. Delayed diagnosis likely portends a worse prognosis.
Background The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has been shown to have moderate to good reproducibility for categorization of salivary gland fine‐needle aspiration (FNA) specimens. Less is known of its accuracy and interobserver reproducibility for categorization of the diagnostically difficult group of basaloid neoplasms. Methods Forty‐five salivary gland specimens with a basaloid morphology (pleomorphic and monomorphic adenomas and adenoid cystic carcinomas) were independently assigned by seven cytopathologists to one of the MSRSGC categories. Interobserver agreement was assessed for average agreement, chance expected agreement and by Cohen's κ and diagnostic accuracy. Correlation of the salivary gland neoplasm of unknown malignant potential (SUMP) category with histologic diagnosis and benign or malignant designation along with interobserver reproducibility were calculated. Results Average observed agreement for assignment to the MSRSGC was 46% and Cohen's κ = 0.2%. The SUMP category did not correlate with tumor type or with the benign or malignant nature of the neoplasm. Diagnostic specificity and sensitivity were 92% and 100% for consensus diagnosis, but were 76% and 77% for individual diagnoses. Conclusion The interobserver agreement in categorizing basaloid neoplasms by the MSRSGC is poorer than for salivary gland lesions overall. This reflects the difficulty in diagnosing basaloid neoplasms. Nonetheless, diagnostic accuracy appears similar to that of salivary gland neoplasms as a whole.
Epithelial-myoepithelial carcinoma (EMC) of the penis is a rare malignant tumor which has not previously been described in the literature. Genetic associations exist in EMC that could potentially help guide early diagnosis and treatment of this type of penile cancer. This serves as the first reported case of such cancer of the penis, and highlights the indolent course it takes to presentation, and the need for an appropriate histopathologic evaluation for the correct diagnosis.
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