Nassar, Aziza

Thyroid cancers exist in multiple forms. Papillary and follicular carcinomas of the thyroid are often referred to as well-differentiated thyroid cancers. Well-differentiated thyroid cancers rarely present as a distant metastatic cancer on initial diagnosis. Papillary thyroid cancer tends to have a good prognosis; however, if distant metastasis of PTC is present, there is usually a poor clinical outcome with a less favorable prognosis. In this study, we report a 90-year-old female who presented with right-sided abdominal discomfort. A renal ultrasound revealed bilateral upper pole renal masses. A percutaneous biopsy was ordered, and the microscopic examination revealed bilateral renal metastasis with a follicular variant of papillary thyroid carcinoma. The patient underwent thyroidectomy and sustained radiation therapy for her bilateral renal metastases. She died 6 years after her initial diagnosis, due to sepsis. This is the second study in literature to report bilateral renal metastasis of follicular variant of papillary thyroid cancer.

BackgroundIn the US, 60% to 80% of oropharyngeal squamous cell carcinomas (OPSCCs) are associated with human papillomavirus (HPV). However, until recently, no consensus existed about when and how to test for HPV in patients with head and neck cancers. We aimed to evaluate the use of p16 and HPV testing at our institution because p16 immunohistochemistry is reportedly a reliable surrogate marker for HPV detection in OPSCCs.MethodsWe identified all cases at our institution of primary or metastatic squamous cell carcinoma (SCC) of the head and neck with a concurrent p16 immunostain analysis from January 1, 2013, through August 31, 2018. Patient demographic data, tumor characteristics, p16 result, and any HPV result (in situ hybridization and E6 and E7 RNA test) were captured.ResultsWe identified 104 patients. Most primary tumors (53/57 [93.0%]) and metastases (40/47 [85.1%]) were positive for p16. Thirty‐seven cases (35.6%) had reflex high‐risk HPV (HR HPV) testing performed. Of the 35 p16‐positive cases, 6 had discrepant HR HPV results (p16+/HPV−). We identified 47 p16 immunostains that were performed on lymph nodes with primary tumors of unknown origin. Most were cytology cases (34/47 [72.3%]), and most were p16 positive (40/47 [85.1%]). Neither tumor differentiation nor tumor keratinization was predictive of p16 positivity. Tumors with basaloid differentiation were universally p16 positive.Conclusionp16 immunohistochemistry accurately identifies HPV‐positive OPSCC. Cytology specimens have an important role in characterizing SCC of unknown origin. HR HPV testing is not routinely required, and results may be discrepant with p16 findings.

We describe a primary hepatic neuroendocrine tumor of a 57-year-old Thai woman who presented in 2004 with a suspicious mass in the left hepatic lobe. She underwent left hepatectomy for the 10.5-cm mass, calledintermediate grade neuroendocrine carcinoma of unknown origin,likely metastatic. The tumor recurred in 2007, then calledrecurrent primary hepatic neuroendocrine tumor(PHNET), and the patient underwent liver transplant. Because of similarity between the neuroendocrine tumor and a thyroid tumor—specifically, follicular-like characteristics—immunohistochemical stains for thyroglobulin, TTF1, and calcitonin were performed. However, all were negative. All imaging studies revealed no evidence of a primary lesion other than the liver mass. In 2008, the patient’s liver transplant failed because of ischemic cholangiopathy, and she underwent a second liver transplant. Seven years later, in 2015, she presented with metastatic neuroendocrine tumor of intermediate grade to the lung, consistent with metastatic PHNET. She underwent left upper-lobe wedge resection to remove the tumor. The patient is alive with no evidence of disease at 13 years after initial diagnosis. This rare variant of PHNET had thyroid-like morphologic characteristics but there is no evidence of primary thyroid tumor or thyroid markers in the primary and recurrent hepatic tumors and lung metastasis.

BackgroundCore needle biopsy (CNB) has been suboptimal in the subclassification and grading of mesenchymal tumors. Recent advances in molecular diagnostics have shown promise in improving this area. The institutional experience with CNBs of soft tissue lesions on cytology cases and correlated histologic follow‐up has been evaluated. It also addressed the advantageous use of ancillary techniques, including immunohistochemistry and molecular studies.MethodsArchived cytologic CNB material and reports of patients with soft tissue lesions were retrieved and CNB results with final resection results were compared. Cases were re‐reviewed and data were analyzed with descriptive statistics.ResultsFrom archived data, 215 cases were extracted of 99 female and 116 male patients (mean [range] age, 59.9 [12–95] years). Categories were malignant (n = 157), suspicious (n = 16), and benign (n = 42). In total, 161 (74.9%) had subsequent surgical resection—130 were malignant; 8, suspicious; and 23, benign. Of the malignant or suspicious cases, 138 had follow‐up histologic resections, with 97.9% concordance. The most common malignant tumor was liposarcoma (n = 41; 29.7%), followed by undifferentiated pleomorphic sarcoma (30; 21.7%). Of benign tumors, 23 (54.8%) had follow‐up surgical resection. Low‐grade gastrointestinal stromal tumor was the most common benign tumor (26.1%), followed by fibromatosis (21.7%). Cytohistologic correlation for all categories showed 96.9% concordance. Molecular ancillary studies correctly classified malignant tumors in 37 (26.8%) of the 138 cases.ConclusionCNB is a reliable modality for evaluating soft tissue neoplasms, with high histologic concordance rate. Diagn. Cytopathol. 2016;44:291–298. © 2016 Wiley Periodicals, Inc.

BackgroundThyroid fine‐needle aspiration (FNA) is used to assess appropriate management of nodular thyroid lesions safely, but Bethesda category III (atypia of undetermined significance/follicular lesion of undetermined significance) and category IV (follicular neoplasm/suspicious for follicular neoplasm) lesions are problematic. This study aimed to evaluate the Afirma Gene Expression Classifier (GEC) results for lesions in those categories.MethodsMedical records of patients with thyroid FNA and GEC results were obtained from archived material. Results were compared to thyroidectomy histologic diagnoses.ResultsAmong 66 patients with FNA results (47 women and 19 men aged 26–89 years [mean, 59.4 years]), surgical reports were available for 38. Afirma GEC results were “nondiagnostic” for 10 of 66 (15.2%), “benign” for 22 (33.3%), and “suspicious” for 34 (51.5%). Surgical diagnosis was available for 38 of 66 patients (57.6%); GEC results for 6 (15.8%) of these were “nondiagnostic,” 27 (71.0%) were “suspicious,” and 5 (13.2%) were “benign.” One of 6 (16.7%) samples with “nondiagnostic” results, 1 of 5 (20%) with “benign” results, and 15 of 27 (55.6%) with “suspicious” results were malignant on histology. Papillary carcinoma was the most common tumor type (15 of 38; 39.5%).ConclusionsAfirma GEC results minimize the number of unnecessary operations. Afirma GEC testing may be reserved for FNAs with a category III diagnosis on follow‐up cytologic examination. We recommend a conservative approach for “suspicious” Afirma GEC results if Hürthle cells are seen with FNA. Diagn. Cytopathol. 2015;43:966–970. © 2015 Wiley Periodicals, Inc.

ObjectiveIn fine needle aspiration cytology (FNAC), the category of benign thyroid lesions (BTL), which constitutes 65–70% of all thyroid FNAC, and can be correctly diagnosed by morphology alone, is an important entity. A diagnosis of BTL denotes a lesion managed with follow‐up unless found in conjunction with compressive symptoms. Although this diagnosis can be quite simple, there are cases in which the scant cellular or colloid component may pose diagnostic issues. Herein, we describe the experiences of evaluating BTL at two large academic institutions. We evaluated the clinical importance of a correct diagnosis of BTL to define the exact inherent risk of a false‐negative result (FNR).MethodsFrom January 2008 through to June 2013, 506 (3.6%) out of 15 850 patients with BTL underwent surgery. All nodules were sampled under sonographic guidance (US) and processed either with liquid‐based cytology (LBC), Diff‐Quik® smears or alcohol‐Papanicolaou staining methods.ResultsThe histological follow‐up of 506 BTL series included 493 benign and 13 malignant lesions. The latter group included four follicular carcinomas (FC), two classic variants of papillary thyroid carcinoma (PTC), one macrofollicular PTC and six follicular variants of PTC (FVPC). The malignancy rate for the BTL category was 2.5%.ConclusionsWhen diagnosed by expert cytopathologists, BTL represents a robust diagnosis and might reduce the number of FNR. Additional diagnostic experience and a large case series could enable cytopathologists to recognise all the morphological entities of BTL. An important additional aid is the extensive sampling of the lesions to reduce issues related to a low cellularity.

Background:The cytologic diagnosis of atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) is controversial because of variation in how it is applied in practice, as well as uncertainty about patient management. We aimed to assess the percentage of thyroid fine-needle aspiration biopsies (FNABs) with AUS/FLUS diagnoses in different North American and European practice settings (e.g. community, academic, etc.), assess whether patients were managed according to current guidelines, and determine patient outcomes.Materials and Methods:A detailed questionnaire survey was posted in secure websites used separately by cytopathologists and cytotechnologists. The questionnaire was posted from August 1 through December 31, 2013.Results:Endocrinologists and cytopathologists performed 51.7% and 37.1% of thyroid FNABs, respectively. The Bethesda reporting system for thyroid FNAB was used in 90% of practices. The rate of AUS/FLUS varied widely among institutions, with 46.1% of represented institutions reporting AUS/FLUS rates of 3–10%. The median follow-up rate of patients with an initial AUS/FLUS diagnosis was 70% (range, 10–100%). For the majority of represented institutions (86.4%), patients with initial AUS/FLUS diagnosis had follow-up with endocrinologists. Of repeat AUS/FLUS thyroid FNABs, a median of 52% was considered benign, and 18% were suspicious of or positive for malignancy (median, 10% and 7.5%, respectively).Conclusions:Reporting of the AUS/FLUS category varied widely among different institutions. The median follow-up rate was lower than published guidelines. The most common follow-up diagnosis was benign thyroid nodule. Improved standardization of cytologic criteria should be adopted to reduce such variation.

BACKGROUNDThe Papanicolaou Society of Cytopathology has recently published a new proposal for pancreaticobiliary cytology terminology. For the current study, the authors applied this new classification for pancreaticobiliary cytology to a set of previously diagnosed endoscopic ultrasound (EUS)‐guided fine‐needle aspiration (EUS‐FNA) samples and correlated the results with those from the corresponding available final surgical specimens.METHODSPancreatic FNA specimens were retrospectively collected from a 12‐month period at the Mayo Clinic in Jacksonville, Florida. Cases with cytohistologic disagreement were reviewed to assess the reasons for discrepancies. The sensitivity and specificity of EUS‐FNA specimens were assessed using the Pearson chi‐square test.RESULTSOne hundred fifty‐five pancreatic FNA specimens were retrieved. The median patient age was 70 years (range, 25‐93 years). Eleven specimens previously classified as negative and 3 previously classified as non‐diagnostic were reclassified as neoplastic:other, as well as all specimens primarily classified as atypical or positive for neoplasm and half the specimens primarily classified as suspicious. All positive specimens remained within their same categories in the revised classification. Sixteen patients (10.3%) had surgical resection specimens available, and complete or partial agreement with FNA results was achieved in 13 of those surgical specimens (81.2%). Reasons for discrepancy comprised sampling errors in 5 specimens and an interpretation error in 1 specimen. Overall, sensitivity was 66.7%, specificity was 66.7%, the positive predictive value was 88.9%, and the negative predictive value was 33.3%.CONCLUSIONSThe application of the new proposed terminology for pancreaticobiliary cytology had a greater impact among specimens that were previously classified as atypical and suspicious. EUS‐FNA of the pancreas is a highly accurate method, and its use, allied with the new proposed terminology, may ultimately contribute to better outcomes. Cancer (Cancer Cytopathol) 2015;123:488–94. © 2015 American Cancer Society.