We conclude that cases diagnosed as ASC-H should be followed-up with caution as they are strongly associated with dysplasia of any grade (63.1%), especially high-grade dysplasia (38.8%). Reflex HPV DNA testing is an important predictor of dysplasia with a positive predictive value of 87.2% in our study.

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an important and accurate modality for the diagnosis of solid and cystic lesions of the pancreas. The objectives of this retrospective study are to review the pertinent cytologic criteria for diagnosing SPNs and to evaluate the diagnostic utility of EUS-FNA. A total of 924 pancreatic FNAs were performed at our institution from January 2002 through February 2013. Of these, four cases (three females, mean age 17 years; one male, age 61 years) were identified with a diagnosis of SPN initially rendered on cytologic material obtained by EUS-FNA and subsequently confirmed by histopathologic examination of the resection specimen. No on site evaluation was conducted for any of these cases. Cytologic smears were assessed by two independent reviewers for the presence of the following diagnostic features: a highly cellular aspirate; the presence of myxoid or hyalinized fibrovascular stalks lined by neoplastic cells with pale to finely granular cytoplasm and indistinct cell borders; and monotonous, round to oval nuclei containing delicate granular nuclear chromatin, inconspicuous nucleoli, and nuclear grooves and inclusions. Cell block material was available for confirmatory immunohistochemical studies in one case. Three of the four cases were diagnosed as SPNs, and one was deemed to be a pancreatic endocrine neoplasm (islet cell tumor) on cytologic evaluation. Of the remaining three cases determined to be a SPN on cytology, two were confirmed histologically by review of available slides obtained from the surgical resection specimens. The most consistent cytologic features for diagnosing SPNs by EUS-FNA in our series was the presence of a highly cellular aspirate containing several hyalinized fibrovascular stalks lined by monotonous neoplastic cells with round to oval nuclei and nuclear grooves. We conclude that EUS-FNA is an accurate and effective diagnostic tool in the diagnosis of SPNs of the pancreas.

Background: Renal cell carcinoma rarely metastasizes to the pancreas. Diagnosing a neoplasm that is metastatic to the pancreas by fine-needle aspiration (FNA) cytology is often challenging. A detailed clinical history may prove to be beneficial. Case Reports: A total of 729 pancreatic FNAs were performed from January 2005 through August 2012 at our institution. Among these, we found 3 patients with a prior history of a malignant renal neoplasm who presented with a pancreatic mass: 2 in the tail and 1 in the head. Radiographically, they ranged in size from 2.5 to 7.0 cm. Microscopic evaluation of cytologic material obtained during endoscopic ultrasound-guided FNA (EUS-FNA) revealed cohesive clusters of atypical cells with clear cytoplasm and prominent nucleoli surrounded by a thin capillary network. The neoplastic cells were immunoreactive with CD10 (cases 2 and 3). A diagnosis of metastatic clear cell renal cell carcinoma was rendered for each case based on the morphologic features and immunohistochemical staining pattern of the neoplastic cells. Histologic comparison with the available slides of the corresponding primary renal neoplasm confirmed the diagnosis. Conclusion: We conclude that EUS-FNA of pancreatic masses is an important, effective, and accurate diagnostic modality for early diagnosis of both primary and metastatic neoplasms of the pancreas.

Glioblastoma is a rare and aggressive primary brain tumor with incidence of 5 per 100,000 annually. We report a 50-year-old woman diagnosed with glioblastoma within 3 years of induction of fingolimod therapy for relapsing-remitting multiple sclerosis. Fingolimod, an immunomodulating agent used in the treatment of relapsing-remitting multiple sclerosis, has also been suggested to impart a cardioprotective role in heart failure and arrhythmia via activation of P21-activated kinase-1 (Pak1). In the brain, Pak1 activation has been shown to correlate with decreased survival time amongst patients with glioblastoma. A molecular mechanism underlying a link between fingolimod use and glioblastoma development may involve activation of Pak1. To our knowledge, this is the first report of a potential association between fingolimod use and glioblastoma development.

Summary The packaging and shipment of biospecimens is a multistep process for which a distinct set of regulations needs to be followed, depending on whether a biospecimen is shipped domestically or internationally and whether the shipment contains hazardous materials. Shipments may be delayed if these regulations are not followed. Once learned, the process is straightforward. Major principles include double or triple packaging, adequate absorbent material, appropriate coolant, accurate labeling and complete documentation. Training in packaging and shipping is often offered at major biomedical institutions and is a requirement for shipping biohazards.