Biliary papillomatosis is a rare tumor of the intrahepatic and extrahepatic biliary tree, and its FNA findings have not been reported. The cytologic features of 3 cases of intrahepatic biliary papillomatosis were studied and compared with 5 cases of chol-Key Words: biliary papillomatosis; intraductal papillary tumor; cholangiocarcinoma; biliary tumor; liver; FNA; cytology Biliary papillomatosis (BP) or intraductal papillary tumor is a rare tumor characterized by multiple papillary adenomas involving extensive areas of the intrahepatic and/or extrahepatic biliary tree, and has a great potential for multicentric malignant transformation. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Preoperative diagnosis is usually difficult. Tumors involving the extrahepatic bile ducts can be confirmed by endoscopic means, including biopsy and brush cytology. For intrahepatic tumors, the imaging techniques often reveal a mass lesion. No diagnostic radiologic features have been documented. 21,22 To our knowledge, fine-needle aspiration (FNA) findings of this rare entity have not been reported. In this study, we describe the FNA cytologic characteristics of 3 cases of BP of the liver, only one of which was correctly diagnosed preoperatively based on the cytology. It appears that the main differential diagnosis in cytology is cholangiocarcinoma; a comparative study is also made. Materials and MethodsThree cases of intrahepatic BP with FNA of the tumor before surgical resection were encountered. The available clinical information was studied. Both the cytologic and histologic sections were reviewed, and their findings were correlated. The cytologic smears of 5 consecutive cases of cholangiocarcinoma (tubular type of adenocarcinoma) confirmed by clinical investigation and/or subsequent excision were reviewed. Their findings were compared to the present 3 cases in an attempt to identify those cytologic features that should allow the recognition of BP.In all cases, the aspiration was performed with ultrasound guidance. Direct smears prepared from the aspirates were wet fixed in 95% ethanol and stained with hematoxylineosin (H&E) and Papanicolaou stains. Tissue fragments aspirated into the syringe and remaining in the needle were rinsed into and fixed in a 7.5% neutral-buffered formalin solution. Cell blocks were prepared with 3% agar as an adjuvant and processed according to a schedule with slightly shortened xylene steps. The standard 4-m sections were stained with H&E.
AimsVenous invasion (VI) is a powerful yet under‐reported prognostic factor in colorectal cancer (CRC). Efforts to improve its detection have largely focused upon histological assessment, with less attention paid to tissue‐sampling strategies. This study aimed to prospectively determine the number of tumour blocks required to optimise VI detection in CRC resections. In addition, the relationship between linear spiculation (LS) and extramural venous invasion (EMVI) was investigated.Methods and resultsA standardised tissue sampling protocol was developed and applied prospectively to 217 CRC resections [AJCC 8th edition, stage 1 (n = 32); stage 2 (n = 84); stage 3 (n = 87); stage 4 (n = 14); and post‐neoadjuvant therapy (n = 46)]. Elastin stains were performed on all tumour blocks. VI was identified in 55% of cases (EMVI = 37%; IMVI alone = 18%). The sensitivity of VI detection increased with increasing numbers of tumour blocks submitted [one block (35%), three blocks (66%), five blocks (84%), six blocks (95%) and seven blocks (97%)]. Similar findings were observed for EMVI [one block (35%), three blocks (73%), five blocks (89%), six blocks (96%) and seven blocks (96%)]. LS was identified macroscopically in 22% of specimens. In cases where no neoadjuvant therapy had been given, EMVI was significantly associated with LS (71% in LS+ cases versus 29% in LS– cases; P < 0.001). In addition, tumour blocks targeting LS were associated with a fivefold higher rate of EMVI compared with blocks that did not (P < 0.001).ConclusionsOur findings demonstrate the impact of tissue sampling and quality of gross examination on VI detection and may inform practices in future CRC protocols.
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