BACKGROUND: The most important indicator for urologic surgeons at The Johns Hopkins Hospital to have a patient undergo cystoscopy is a cytologic diagnosis of high‐grade urothelial carcinoma. The template was designed to standardize diagnostic categories so clinicians can manage their patients uniformly. The template was based in part on the Bethesda System for cervical cytology. METHODS: According to the template, reactive/inflammatory changes were included in the negative group (no urothelial atypia or malignancy identified). The category atypical urothelial cells of undetermined significance (AUC‐US) was akin to atypical squamous cells of undetermined significance (ASC‐US), as was the category of atypical urothelial cells, favor high‐grade carcinoma (AUC‐H). The categories high‐grade urothelial carcinoma (HGUC) and low‐grade urothelial carcinoma also were added. RESULTS: The Pathology Data System at the Johns Hopkins Hospital was searched for cases that met the following criteria over a period from July 1, 2007 to June 30, 2009: all cytologic specimens from the urinary tract and all surgical specimens with a diagnosis of HGUC, regardless of invasion status. All cytologic specimens were then matched with biopsies during the same period, and all surgical specimens from patients who had a cytologic diagnosis of AUC‐US or AUC‐H were retrieved for 18 months after the end of the 2‐year study period. Greater than 50% of patients who had biopsy‐confirmed HGUC had a preceding cytologic diagnosis of AUC‐H or HGUC. When patients with AUC‐US were added to the analysis, 80% of patients with HGUC had at least 1 abnormal urinary cytology result. Of those patients who had a diagnosis of AUC‐H, 38% had urothelial cancer discovered at biopsy compared with only 10% of those with an AUC‐US diagnosis. CONCLUSIONS: The authors concluded that their template is effective in targeting those patients who need to undergo cystoscopy. Cancer (Cancer Cytopathol) 2013;121:15–20 © 2012 American Cancer Society.
Diagnostic yield and number of lymph nodes sampled using deep sedation is superior to moderate sedation in patients undergoing EBUS-TBNA. Prospective studies accounting for other factors including patient selection and cost are needed.
BACKGROUND: Chondroblastic osteosarcoma (COS) is a uniformly fatal bone malignancy if not diagnosed and treated appropriately in a timely manner. Fine-needle aspiration (FNA) of osseous lesions is routinely performed in major medical centers. Appropriate characterization of the tumor will significantly influence patient management and outcomes. METHODS:A retrospective review of the cytopathology archives of 2 large tertiary care centers for a 15-year period (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) revealed 17 cases of COS (9 primary, 6 recurrent, and 2 metastatic cases) in 16 patients. Clinical outcome and histopathologic follow-up were reviewed and correlated. RESULTS: There were 9 male and 7 female patients (male-tofemale ratio of approximately 1:1), ranging in age from 12 to 70 years (mean age, 29.2 years). The classic locations for osteosarcoma were commonly involved, such as the long bones around the region of the knee in 4 cases and the proximal humerus in 1 case. However, other "nonclassic" sites also were noted to be commonly involved, including the distal tibia or fibula (4 cases), sacroiliac region (4 cases), mandible (3 cases), and skull (1 case
Objectives: To review cytomorphologic characteristics of osteoblastic osteosarcoma (OOS), a variant of osteosarcoma, on fine-needle aspiration (FNA) and correlate them with histopathologic features and clinical outcomes. Study design: A retrospective review of the cytopathology archives of The Johns Hopkins Hospital revealed 22 cases of OOS on FNA in 20 patients (16 primary, 5 recurrent and 1 metastatic OOS). Results: There were 11 males and 9 females (male:female ratio 4:3) aged from 5 to 48 years (mean 17.1). Anatomic locations were: femur (7), humerus (3), tibia (4), fibula (1), iliac crest (1), pubis (1), sacrum (1), mandible (1) and soft tissue of the thigh (3). All except 1 presented with progressive pain and/or swelling. Sizes of the lesions ranged from 2.3 to 34 cm (mean 9.2). Initial FNA diagnoses were high-grade malignant neoplasm (5), osteosarcoma, non-conventional osteosarcoma (12) and OOS (5). Cytomorphologic characteristics were: moderate-high cellularity, discohesive/single cells, small tissue fragments, immature osteoid, bi-/multinucleated giant cells, plasmacytoid cells with basophilic, vacuolated cytoplasm, round to oval nuclei and macronucleoli. Cases with high-grade histology displayed pleomorphism and mitoses. Conclusions: OOS has a better prognosis than other osteosarcoma variants. The differential diagnosis of OOS includes reactive bone lesions, osteoblastoma, malignant sarcoma with an osteoid component and other osteosarcoma variants. A definitive diagnosis can be made on FNA with clinical and radiological correlation, thus facilitating immediate therapy.
Thyroid carcinomas and lung adenocarcinoma share cytomorphological features yet have different prognoses. Thyroid Transcription Factor-1 (TTF-1) is an immunohistochemical (IHC) marker used to confirm pulmonary and thyroid carcinoma, while Thyroglobulin (TGB) is expressed by thyroid carcinoma. The cytopathology archive of The Johns Hopkins Hospital was searched for cases of lung adenocarcinoma versus thyroid carcinoma with TTF-1 and TGB IHC. Forty-four cases of lung adenocarcinoma (25) and thyroid carcinoma (19) were retrieved. One was metastatic lung adenocarcinoma to the thyroid and three were metastatic papillary thyroid carcinoma (PTC) to the lung. The initial interpretation of two cases from bony lesions was metastatic lung adenocarcinoma. In light of additional clinical information and TGB immunostain, the diagnoses of these two cases changed to metastatic thyroid carcinoma. TTF-1 and TGB is a small immunostain panel that can differentiate lung adenocarcinoma from thyroid carcinoma and prevent misdiagnosis and its consequences.
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