Adenocarcinoma predominant pattern subtyping and nuclear grading in cytology: Is there a role in prognostication of advanced pulmonary adenocarcinomas?

Nambirajan, Aruna; Kaur, Harpreet; Jangra, Kirti; Kaur, Kanwalpreet; Madan, Karan; Mathur, S. B.; Iyer, V. K.; Jain, Deepali

doi:10.1111/cyt.12519

Cited by 9 publications

(11 citation statements)

References 26 publications

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“…Notably, both cases had been recognized as poorly differentiated adenocarcinomas on routine cytopathology reporting and were appropriately referred for molecular testing for EGFR / ALK / ROS1 . Overall, it appears that SMARCA4-dNSCLCs lack specific cytological features and resemble poorly differentiated adenocarcinomas on cytological examination [12]. Although the presence of cohesive clusters of intermediate to large-sized tumour cells with abundant clear cytoplasm appears to be a common feature of SMARCA4-dNSCLC, its specificity for SMARCA4-dNSCLC diagnosis can be determined only after a blinded review of a large number of aspirates from NSCLCs with and without BRG1 loss.…”

Section: Discussionmentioning

confidence: 99%

Cytology of SMARCA4-Deficient Thoracic Neoplasms: Comparative Analysis of SMARCA4-Deficient Non-Small Cell Lung Carcinomas and SMARCA4-Deficient Thoracic Sarcomas

et al. 2020

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Introduction: Inactivating mutations of the SMARCA4 (SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily A, member 4) gene and/or loss of the BRG1 (brahma-related gene 1) protein defines SMARCA4-deficient thoracic sarcoma (SMARCA4-dTS), an aggressive neoplasm with a usually fatal outcome. Similar SMARCA4 mutations/BRG1 loss is also seen in a subset of non-small cell lung carcinomas (NSCLCs; SMARCA4-dNSCLCs) that lack alterations in currently targetable oncogenic drivers, that is, EGFR, ALK, and ROS1. There is limited knowledge on the cytomorphological features of these SMARCA4-deficient thoracic neoplasms. Methods: We retrospectively analysed the cytology of 2 cases each of SMARCA4-dNSCLC and SMARCA4-dTS to understand their cytomorphological overlap, if any, and identify features that would prompt testing for BRG1 loss. Results: All 4 patients were males presenting with advanced disease, with a mean age of 41.5 years (SMARCA4-dTS) and 58.5 years (SMARCA4-dNSCLC) at presentation. The cytology of the 2 SMARCA4-dTSs was strikingly similar, showing predominantly singly dispersed rhabdoid phenotype tumour cells with perinuclear cytoplasmic condensations in an inflammatory or necrotic background. The cytology raised suspicion for a wide range of differentials, including melanoma, high-grade lymphoma, germ cell tumour, undifferentiated carcinoma, and undifferentiated sarcoma. SMARCA4-dNSCLCs, on the other hand, were recognizable as poorly differentiated (adeno)carcinomas and were easily distinguished from SMARCA4-dTSs, with both cases showing cohesive clusters of frequently large tumour cells with abundant pale cytoplasm. Conclusion: A diagnosis of SMARCA4-dTS is possible on cytology with appropriate ancillary testing and a high index of suspicion. The cytology of SMARCA4-dNSCLCs does not overlap with SMARCA4-dTS; rather, it resembles that of any poorly differentiated (adeno)carcinoma in the limited numbers analysed in this study.

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Section: Discussionmentioning

confidence: 99%

Cytology of SMARCA4-Deficient Thoracic Neoplasms: Comparative Analysis of SMARCA4-Deficient Non-Small Cell Lung Carcinomas and SMARCA4-Deficient Thoracic Sarcomas

et al. 2020

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“…All these features strongly support the diagnosis of ADC, and based on that a diagnosis of non‐mucinous ADC can be suggested (Figure 1). 11,12 However, it is preferred to use cell blocks or smears, if available, for confirmation of the diagnosis by ICC. Particularly, non‐keratinising poorly differentiated SQC is subject to misclassification as solid predominant ADC, in cytology as well as in small biopsy specimens.…”

Section: Cytological Features Of Adenocarcinoma (Adc)mentioning

confidence: 99%

Can cytology reliably subtype non‐small cell lung carcinomas?

Jain

Bubendorf

2021

Cytopathology

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Organization classification of lung tumours, recommends the subtyping of non-small cell lung carcinomas (NSCLC) into squamous cell carcinoma (SQC) and adenocarcinoma (ADC) histology. [1][2][3] In other words, emphasis is put on differentiating NSCLC into ADC and SQC in cytology as well as small biopsy specimens as a standard of care for accurate targeted therapy of these patients. It is therefore not sufficient to separate small cell lung carcinoma (SCLC) from NSCLC; further distinction of NSCLC is warranted. Morphology with or without immunocytochemistry (ICC) is a cornerstone of the correct identification of SCLC and the distinction of NSCLC into SQC and ADC. 4,5 Having stated so, it is also true that morphologically clearcut glandular and squamous differentiation is recognised in only 50%-60% of NSCLC cases. 6 The remaining cases require ancillary testing in the form of mucin stains and/or immunophenotyping by lineage-specific markers such as thyroid transcription factor-1 (TTF-1), Napsin A, p40 and cytokeratin 5/6 (CK5/6). 7,8

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“…Histological cores (blood clot cores or BCC) can be obtained from suctioning of the needle, but they are smaller than a true core biopsy . Nevertheless, cytological samples obtained using EBUS‐TBNA procedures have been found to yield histological and molecular diagnostic information comparable to small biopsies . Being minimally invasive, safe, cost‐effective and highly sensitive (~93%), EBUS‐TBNA has now replaced mediastinoscopy as the first‐line investigative modality for lymph node staging of patients with non‐small cell lung carcinoma …”

Section: Introductionmentioning

confidence: 99%

Endobronchial ultrasound‐guided transbronchial needle aspiration cytology in patients with known or suspected extra‐pulmonary malignancies: A cytopathology‐based study

et al. 2018

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Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the primary modality for mediastinal lymph node staging in lung carcinoma. We aimed to evaluate its utility in extra-pulmonary malignancies (EPM). EBUS-TBNA aspirations (2013 done in patients with known/suspected EPMs and mediastinal lymphadenopathy/masses was performed. All archived cytology/histology material was reviewed and categorised as positive, negative and unsatisfactory. Methods: Database search of Results:The selected 139 patients included 100 patients with known EPMs, 11 patients with known lymphoma, and 28 patients with suspected EPM of unknown primary. EBUS-TBNA was adequate in 110 patients (79%), including 21 patients who yielded only reactive lymphoid tissue. Satisfactory blood clot cores were obtained in 34 patients and contributed significantly to diagnosis and ancillary testing. Metastasis was detected in 45 patients with known EPM, predominantly originating from a known primary in the breast in females (56%) and squamous cell carcinomas of head and neck in males (60%). Granulomatous lymphadenopathy was identified in 16 patients with known EPM (16%). Lymphoma relapse and granulomatous lymphadenopathy were identified in three and four patients with known lymphoma, respectively. In patients with suspected EPM of unknown primary site, malignancy was confirmed in 21 patients, predominantly representing metastatic adenocarcinomas (n = 5) and neuroendocrine neoplasms (n = 5). Immunocytochemistry was performed in 16 of these cases and aided in characterisation of primary site/type of tumour in 12 cases.Conclusion: EBUS-TBNA is efficient for screening mediastinal lymph nodes/masses for malignancy in EPMs. Procuring sufficient material for ancillary testing would improve diagnostic accuracy and reduce need for resampling. K E Y W O R D Sblood clot cores, endobronchial ultrasound-guided transbronchial needle aspiration, extrapulmonary malignancy, lymphoma, mediastinal lymphadenopathy, metastases Aruna Nambirajan and Moanaro Longchar contributed equally and should be considered co-first authors.

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Adenocarcinoma predominant pattern subtyping and nuclear grading in cytology: Is there a role in prognostication of advanced pulmonary adenocarcinomas?

Abstract: Nuclear grade scoring on cytology is simple to perform, and is predictive of high grade patterns. Its inclusion in routine reporting of cytology samples of lung ADs may be valuable.

Cited by 9 publications

References 26 publications

Cytology of SMARCA4-Deficient Thoracic Neoplasms: Comparative Analysis of SMARCA4-Deficient Non-Small Cell Lung Carcinomas and SMARCA4-Deficient Thoracic Sarcomas

Cytology of SMARCA4-Deficient Thoracic Neoplasms: Comparative Analysis of SMARCA4-Deficient Non-Small Cell Lung Carcinomas and SMARCA4-Deficient Thoracic Sarcomas

Can cytology reliably subtype non‐small cell lung carcinomas?

Endobronchial ultrasound‐guided transbronchial needle aspiration cytology in patients with known or suspected extra‐pulmonary malignancies: A cytopathology‐based study

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