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Background: Well-differentiated papillary mesothelioma (WDPM) is an uncommon tumor usually arising in the peritoneum and mostly an incidental finding during abdominal and pelvic surgery. Its natural history and association with other neoplasms is not clearly understood. We present a rare case of WDPM in association with high-grade endometrial carcinoma. To our knowledge, there are only two previously reported cases in the English literature of WDPM in association with endometrial carcinoma., Case: A 62-year-old woman underwent pelvic surgery for a high-grade endometrial adenocarcinoma. At laparotomy an extensive peritoneal nodular fibrotic reaction was present, raising the clinical possibility of metastatic disease; however, intraoperative frozen section reported this as a mesothelial reaction. Cytologic examination of peritoneal washings revealed cohesive clusters of reactive-appearing mesothelial cells, some with papillary morphology, and no evidence of adenocarcinoma. The peritoneal biopsies showed no metastatic carcinoma. The endometrial tumor was an endometrioid adenocarcinoma., Conclusion: The cytologic diagnosis of WDPM may be difficult because it is an uncommon entity and there are overlapping features with other neoplastic and nonneoplastic lesions of the female genital tract and peritoneum. Compounding this, WDPM may occur in association with other neoplasms. We highlight the potential for surgical and pathologic misinterpretation of this entity.

Background: Micropapillary carcinoma is a rare but unique histologic variant of urothelial carcinoma with an aggressive clinical course. In spite of well-defined clinicopathologic characteristics, the cytomorphologic features in urine specimens have been only rarely described., Case: A 78-year-old man presented with gross hematuria, showing a large mass on cystoscopy. Urine cytology contained tight clusters of atypical cells, originally interpreted as high-grade urothelial carcinoma or adenocarcinoma. Final diagnosis was made by histology and immunohistochemical study. On retrospective cytologic review, most presented as small cohesive cellular clusters in the clean background, showing micropapillae without fibrovascular core, morules and occasional rosette-like microacinar structures. A small number of singly scattered cells were also noted. Tumor cells had high-grade nuclear features and occasional cytoplasmic vacuoles. The inside-out pattern was confirmed on cell block by immunohistochemistry for epithelial membrane antigen. Immunoreactivity of E-cadherin disappeared, especially in the cytoplasmic membrane toward the fibrocollagenous stroma., Conclusion: Micropapillary carcinoma had a somewhat characteristic cytologic appearance reflecting part of the histologic features. Cytopathologists should keep in mind the possibility of this rare entity when evaluating small papillary tumor clusters. Careful cytologic examination in combination with cell block morphology and immunohistochemistry may allow early accurate diagnosis and appropriate management.

Background: Papillary squamous cell carcioma is rare form of squamous cell carcinoma of the uterine cervix occurring in women in the sixth decade of life and is frequently misdiagnosed as high-grade intraepithelial lesion. Few reports with cytologic study have been performed, especially with cytology in liquid-based specimens., Case: A 58-year-old woman who had 8 gestations (no abortions) and mitral cardiopathy treated with coumarin medication was referred for transvaginal bleeding of 20 days' duration. Specular examination showed an exophytic, easily bleeding lesion occupying all of the uterine cervix and superior third of the vagina. Liquid-based cytology showed squamous cells, mostly basaloid but some bizarre or in fiber, with clearly atypical nuclei. Second-generation hybrid capture for high-risk human papillomavirus was positive, with a viral load of 404 relative light unit/positive control B, and the tumor expressed p16(INK4a)., Conclusion: This report adds further experience with liquid-based cytology to the existing conventional and liquid-based cytologic findings, particularly in the Brazilian female population.

Objective: To study diagnostic efficacy of direct smears (DS) vs. cell block (CB) alone in hemorrhagic thyroid fine needle aspirations (FNAs) performed without a cytotechnologist or cytopathologist., Study Design: Ultrasound-guided thyroid FNAs from an offsite location were retrospectively searched during a 53-month period. Aspirates in the initial 13 months were submitted as air-dried DSs. Subsequent specimens were submitted as CBs. Each case was classified into 1 of 4 categories: (1) nondiagnostic, (2) nonneoplastic, (3) follicular lesions and (4) papillary thyroid carcinoma (PTC)., Results: There were 77 aspirates: DS = 20 (26%) and CB = 57 (74%). Two cases had both DSs and CBs. Diagnoses of DS: nondiagnostic = 12 (60%); nonneoplastic = 7 (35%); follicular lesion = 1 (5%). Diagnoses of CB cases: nondiagnostic = 4 (7.0%); nonneoplastic = 43 (75.4%); follicular lesion, including 1 Hürthle cell neoplasm = 7 (12.3%), PTC = 3 (5.3%). Repeat FNAs on 4 nondiagnostic cases (3 DSs, 1 CB) utilizing the CB-only technique were diagnostic and included nodular goiter, follicular neoplasm, PTC, and reactive lymph node., Conclusion: Without onsite assessment, CB alone is superior to DSs for hemorrhagic thyroid FNAs. It shows increased diagnostic efficacy and slide reduction and obviates repeat FNAs.

Background: Preoperative diagnosis of cases of renal calculus complicated with papillary renal cell carcinoma (RCC) by image analysis is usually difficult., Case: A 50-year-old man who had a past history of renal calculus suffered from macrohematuria and abdominal pain for one month was admitted to our hospital. Ultrasonographic examination revealed a 4-cm tumor shadow in the right kidney; it was hypovascular in arteriography. Papillary cell clusters with abundant cytoplasm were found by the cytologic examination of voided urine. Their nuclei were oval and situated eccentrically in the cytoplasm. The nuclear/cytoplasmic ratio was increased. Fine, granular chromatin was distributed evenly, and the nuclear membrane was thin and nearly smooth. Several small nucleoli were evident. All these findings were indicative of a diagnosis of papillary RCC. Histology of nephrectomy specimens confirmed the diagnosis., Conclusion: Voided urine cytology can be useful for screening and follow-up of patients with papillary RCC.

Background: Recent studies have shown a correlation between lymphocytic thyroiditis and papillary carcinoma of the thyroid. It is thought that autoimmune thyroiditis could be a risk factor for the development of thyroid carcinoma, mainly for the papillary variant., Case: A 59-year-old female presented with a history of enlargement in the neck and five months of dysphagia. Clinical examination showed generalized expansion and an increase in the hardness of the thyroid gland. Hormonal outline showed subclinical hypothyroidism with serum levels of TSH slightly elevated (5 micrograms/dL; range, 0.25-4). Thyroglobulin antibodies and thyroperoxidase titers were moderately positive. Given these results, a diagnosis of chronic thyroiditis was made. Thyroid ultrasound scan showed diffuse gland irregularity and the presence of a solitary nodule (2.3 cm in diameter) localized in the right lobe. Fine needle aspiration biopsy (FNAB) of the nodule was performed under ultrasound guidance., Conclusion: Although clinical and laboratory results supported the diagnosis of autoimmune thyroiditis only, FNAB of the nodular lesion provided evidence of a rare case of papillary carcinoma, tall cell variant, confirmed by histologic results.

The cytologic and histologic findings are reported in a case of papillary carcinoma arising within a thyroid gland pathologically enlarged by histiocytosis X. Fine needle aspiration (FNA) biopsies of a thyroid nodule in a patient with longstanding histiocytosis X produced a scanty amount of colloid, a moderately dense mixed inflammatory infiltrate and numerous small papillary fragments lined by cuboidal-to-columnar cells. Both the inflammatory cells and the epithelial cells showed nuclear grooves; the two populations of neoplastic cells were distinguished, and the correct diagnosis of the nodule was made, by recognizing the greater amount of granular cytoplasm of the mononucleated Langerhans' cells. The rare involve-of the thyroid by histiocytosis X is reviewed; this case, which appears to be the first reported instance of the co-occurrence of histiocytosis X and papillary carcinoma of the thyroid, indicates that patients with histiocytosis X should be observed for the development of thyroid carcinoma and that FNA biopsy can make the distinction between the two conditions.

The occasional coexistence of papillary carcinoma of the thyroid with nodular goiter or hyperparathyroidism may in some cases result in a significant discrepancy between the clinical impression and the fine needle aspiration (FNA) biopsy diagnosis, leading to the suspicion that a false-positive FNA diagnosis was obtained. Two such cases are presented in which consultation between the cytopathologist and the surgeon was helpful in achieving a correct diagnosis and ensuring proper therapy. Awareness of these variations in the clinical presentation of papillary carcinoma of the thyroid will aid the cytopathologist in the resolution of such apparent discrepancies.

The cytologic diagnosis of the coexistence of lymphocytic thyroiditis (LT) and thyroid neoplasms presented certain problems. Fine needle aspirations of 117 "cold' nodules were reviewed because they were or should have been diagnosed as LT. Of five cases of LT plus lymphoma, two were correctly diagnosed and three were diagnosed as LT only. All seven cases of LT plus papillary carcinoma were correctly identified, as were four of those in patients operated upon for LT plus a cellular neoplasm. From a total of 1,600 biopsies, 7 "probable' and 5 "possible' cancers were LT at operation. The causes of diagnostic error were identified as: (1) similarity of epithelial cell nuclear atypia in LT and cellular neoplasm, (2) inexperience and (3) inadequate sampling. The presence of diffuse thyroid abnormality, of significant titers of antithyroglobulin and antimicrosomal antibodies and of chemical evidence of thyroid insufficiency should alert the examiner to the possibility of LT. Large needle biopsy may clarify difficult cases.