BACKGROUND: Fine-needle aspiration (FNA) biopsy is the most frequently used method for thyroid nodule evaluation.However, up to 30% of cases are considered indeterminate. Surgery is typically recommended for these cases, but up to two-thirds of indeterminate cases are found to be benign. The Afirma test is used for the preoperative classification of thyroid nodules with indeterminate cytology. This study reviews the authors' institutional experience with Afirma. METHODS:A cohort of 132 cases of thyroid FNA with Afirma testing was selected from the study files and relevant information was recorded and analyzed. At the study institution, Afirma is mainly performed on atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) cases when diagnosed as such on repeat FNA. RESULTS:The cohort included 98 female (74%) and 34 male (26%) patients. Cytology diagnosis was AUS/FLUS in 68 cases (51.5%), follicular neoplasm (FN) in 39 cases (29.5%), and FN with oncocytic features (FNOF) in 25 cases (19.0%).Of the FNOF cases with suspicious Afirma findings, 2 (15%) were malignant and 11 (85%) were benign. Of the FN cases with suspicious Afirma findings, 9 (53%) were malignant and 8 (47%) were benign. Of the AUS/FLUS cases with suspicious Afirma findings, 10 (63%) were malignant and 6 (37%) were benign. CONCLUSIONS: The Afirma classifier is a useful

The histiocytic disorders Langerhans cell histiocytosis (LCH) and Erdheim-Chester disease (ECD), can both present with multisystem involvement, with the central nervous system and the bone, skin, neuroendocrine, cardiac, respiratory, and gastrointestinal systems potentially affected. The 2 entities occasionally can be difficult to distinguish. Both rarely affect the orbit and the central nervous system, and although there are rare reports of patients with coexistent LCH and ECD, there are no reported cases of the 2 diseases that involve both the orbital and neuroendocrine systems. We report 2 such cases, and review the literature of cases of LCH and ECD occurring in the same patient. The presentation of LCH and ECD in certain patients suggests a possible abnormality in the common CD34 progenitor cell. The coexistence of the 2 disease states should be suspected in patients with atypical presentations of either disorder.

Background:Head and neck squamous cell carcinoma is often associated with human papillomavirus (HPV) infection. Positive HPV status has been associated with increased response to treatment and improved prognosis in terms of recurrence-free and overall survival. In certain instances, diagnosis is performed through fine-needle aspiration of lymph nodes with metastatic carcinoma, often demonstrating extensive tumor necrosis. We evaluated the effect of tumor necrosis on deoxyribonucleic acid (DNA) adequacy for HPV molecular testing.Materials and Methods:Retrospective review of the pathology files at our institution identified cases of squamous cell carcinoma (SCC) diagnosed by fine-needle aspiration (FNA) on which HPV DNA molecular testing was performed. The cases were classified according to percent tumor necrosis into three categories (<10% necrosis, 10-70% necrosis and >70% necrosis) and the percentage of cases with adequate HPV DNA for molecular testing in each of the categories was compared. When available, p16 immunohistochemistry performed on the cases was compared with HPV status by molecular testing.Results:A total of 70 cases from 67 patients were included in the study. Adequate DNA for molecular HPV testing was obtained from samples of 47 cases (67%) while samples from 23 cases (33%) were inadequate for molecular testing. Of the adequate samples, 36 (77%) were positive and 11 (23%) were negative for high-risk HPV. Adequate DNA for testing was obtained in 22 out of 33 cases showing no necrosis (67%), 10 out of 16 cases showing partial necrosis (63%) and in 13 out of 17 cases showing extensive necrosis (76%).Conclusion:Our study found that HPV molecular testing is not influenced by percent tumor necrosis or method by which FNA was performed. We believe that a portion of the FNA specimen obtained from head and neck lesions diagnosed as SCC during the rapid on-site evaluation should be sent for HPV DNA testing, independent of the amount of tumor necrosis, thus guaranteeing availability of specimen for HPV testing.