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Follicular-patterned lesions of the thyroid form the largest and most heterogeneous group of lesions ranging from benign, nonneoplastic, follicular hyperplasias to follicle-forming, infiltrating carcinomas. These lesions have overlapping cytologic features, and fine-needle aspiration (FNA) is not always a reliable tool in their differential. Follicular neoplasia (FN) on cytology, sometimes categorized as “indeterminate,” has been a major cause of debate for thyroid pathologists and clinicians alike.

Lymph node involvement is seen in approximately one quarter of women with surgically staged ovarian serous tumors of low malignant potential (serous borderline tumors), and this finding apparently does not adversely impact their overall survival. To help illuminate some of the pathomechanisms underlying this novel phenomenon, in which a largely noninvasive epithelial neoplasm is able to exit its primary site and be transported to lymph nodes with such a substantial frequency, we investigated whether significant differences in lymphatic vessel density exist between ovarian serous borderline tumors that show lymph node involvement and those that do not. The lymphatic vessel density of 13 conventional ovarian serous borderline tumors (i.e. tumors without stromal microinvasion, micropapillarycribriform areas, or invasive implants) with at least 1 positive lymph node (study group) was compared with the lymphatic vessel density of an age- and disease extent–matched control group of 13 similarly selected lymph node–negative ovarian serous borderline tumors. Lymphatic vessel density was determined by counting the total number of vascular spaces immunohistochemically stained by the lymphatic endothelium marker D2-40 in 5 consecutive microscopic fields (×20 objective, field area of 1 microscopic field, 0.95 mm2) in the most vessel-dense areas and calculating the average value per microscopic field. The peritumoral lymphatic vessel density was significantly higher than the intratumoral lymphatic vessel density in both groups. However, no statistically significant differences were found between the study and control groups regarding intratumoral lymphatic vessel density (8.0 vs. 7.61; P0.77), peritumoral lymphatic vessel density (20.33 vs. 21.0; P0.79), or combined, that is, peritumoral plus intratumoral lymphatic vessel density (27.81 vs. 28.62; P0.83). Our findings, in conjunction with others in the medical literature, do not support a role for tumor lymphatics in nodal metastasis in this neoplasm. We discuss the possibility that nodal deposits may represent metastatic disease from secondary tumor implants.

Abstract: To measure discrepancies in diagnoses and recommendations impacting management of proliferative lesions of the breast, a questionnaire of five problem scenarios was distributed among over 300 practicing pathologists. Of the 230 respondents, 56.5% considered a partial cribriform proliferation within a duct adjacent to unequivocal ductal carcinoma in situ (DCIS) as atypical ductal hyperplasia (ADH), 37.7% of whom recommended reexcision if it were at a resection margin. Of the 43.5% who diagnosed the partially involved duct as DCIS, 28.0% would not recommend reexcision if the lesion were at a margin. When only five ducts had a partial cribriform proliferation, 35.7% considered it as DCIS, while if ≥20 ducts were so involved, this figure rose to 60.4%. When one duct with a complete cribriform pattern measured 0.5, 1.5, or 4 mm, a diagnosis of DCIS was made by 22.6, 31.3, and 94.8%, respectively. When multiple ducts with flat epithelial atypia were at a margin, 20.9% recommended reexcision. Much of these discrepancies arise from the artificial separation of ADH and low-grade DCIS and emphasize the need for combining these two under the umbrella designation of ductal intraepithelial neoplasia grade 1 (DIN 1) to diminish the impact of different terminologies applied to biologically similar lesions.

In general, mesenchymal tumors are only rarely encountered in the uterine cervix, where they constitute less than 1% of all malignancies. In this report, the salient clinicopathologic features of the reported cases of primary mesenchymal lesions of the cervix are comprehensively reviewed. Included are lesions displaying skeletal muscle, smooth muscle, adipocytic, myofibroblastic, fibrohistiocytic, fibroblastic, neural, nerve sheath, neuroectodermal and vascular/pericytic differentiation, as well as those whose line(s) of differentiation is (are) currently uncertain. Where applicable, supplemental and unpublished data from the files of the Armed Forces Institute of Pathology (Washington, DC) are also detailed. For the published cases, the overall ratio of benign to malignant cases is approximately 1.9:1. The most commonly reported mesenchymal malignancies, listed in order of decreasing frequency, are embryonal rhabdomyosarcoma (approximately 150 cases), leiomyosarcoma (approximately 30 cases), undifferentiated endocervical sarcoma (17 cases), alveolar soft part sarcoma (11 cases), Ewing sarcoma (9 cases), malignant peripheral nerve sheath tumor (8 cases), and liposarcoma (4 cases). The most commonly reported benign mesenchymal tumors, reported with almost equal frequency, are hemangioma and leiomyoma. Each of the aforementioned lesions is associated with a relatively distinct clinicopathologic profile. Generalizations about the poor prognosis associated with “cervical sarcomas” are therefore no longer appropriate, and each case must be evaluated within the context of the reported cases of that specific histologic subtype.

Cytotechnologists and pathologists often perform onsite evaluations of thyroid fine‐needle aspirations (FNAs) to provide immediate feedback regarding whether adequate material has been obtained for cytologic diagnosis. The current study was designed to determine whether onsite adequacy assessment results in a significant decrease in nondiagnostic specimens between ultrasound (US)‐guided FNAs of the thyroid and those performed by palpation alone.A search was performed to identify in‐house thyroid FNAs performed between January 1, 2000 and December 31, 2003 that were obtained under US guidance or by palpation only. It was then recorded whether an onsite adequacy assessment was performed. The submitting physician and final diagnosis also were recorded for each case. Contingency tables were constructed and evaluated using chi‐square analysis.Of 1502 in‐house thyroid FNAs included in the current study, 981 (65.3%) were performed under US guidance and 521 (34.7%) were performed with palpation alone. Onsite adequacy assessment of the aspirated material was performed in 323 cases (21.5%), whereas 1179 cases (78.5%) were performed without onsite evaluation. Of the 418 palpation‐guided FNAs that were performed without adequacy assessment, 70 (16.7%) were reported to be nondiagnostic, whereas of the 103 palpation‐guided FNAs with immediate evaluation, only 7 (6.8%) were determined to be inadequate for diagnosis. This difference was statistically significant (P < 0.025). Of 761 US‐guided FNAs without immediate adequacy assessment, 54 (7.1%) were nondiagnostic, which was not statistically different from the nondiagnostic rate of 4.5% (10 of 220 cases) for US‐guided FNAs with onsite evaluation. However, when these US‐guided FNAs were divided further into 2 groups based on the experience of the radiologist performing the FNA, the nondiagnostic rate in the group of experienced radiologists was only 5.4% (or 32 of 592 US‐guided FNAs), even though onsite evaluation was not performed. Among radiologists with less experience, adequacy assessment significantly reduced the nondiagnostic rate from 13.0% (22 of 169 FNAs without adequacy assessment) to 4.5% (10 of 220 FNAs with adequacy assessment) (P < 0.01).The results of the current study demonstrate that onsite adequacy assessment of thyroid FNAs significantly reduces the number of nondiagnostic aspirates. However, the benefit of onsite evaluation, at least for US‐guided FNAs, depends on the experience of the radiologist. In the current study, experienced radiologists with a relatively low nondiagnostic rate did not benefit from onsite adequacy assessment. This finding confirms the importance of experience in the performance of FNA, but suggests that onsite adequacy assessment may assist the less experienced operator. Cancer (Cancer Cytppathol) 2005. © 2006 American Cancer Society.

Distinguishing between low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL) can be difficult on certain Pap tests, hindering interobserver concordance. We investigate variables influencing interpretation of LSIL versus HSIL in Pap test slides rejected from the College of American Pathologists PAP Education Program.