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The aim of the study was to determine the value and limitations of cytology in diagnosis of Hodgkin's lymphoma (HL) and anaplastic large cell lymphoma (ALCL) as well as differentiation between these two entities. We analysed the FNA cytodiagnoses and histopathological reports, as well as treatment and survival in 89 newly diagnosed consecutive patients with these lymphomas treated in our clinical department. These patients (40 male, 49 female; age range 16-93 years; 44 in clinical stages I-II; 38 with B symptoms) were diagnosed and treated during a period of 64 months (1.1. 2004-1.5.2009). The FNA cytodiagnoses were available in 86 patients and the pathohistological diagnoses were available in 84 patients. Cytology revealed 65 classic HL, 18 ALCL and three patients in which diagnosis was not informative. Among 65 FNA cytodiagnoses of HL, comparison with histopathology was made in 61 cases and the histopathological diagnoses were as follows: 56 (91.8%) HL; three ALCL; one diffuse large B cell lymphoma and one marginal zone B cell lymphoma. In the group of 18 FNA cytodiagnoses of ALCL eight patients (53.3%) had definitive diagnosis of ALCL (either as T-cell or O type), five (33.3%) of HL and in three cases a histopathological diagnosis could not be made. These results confirm the value of FNA in diagnostic procedure in patients with HL and ALCL, especially in HL group of patients. Since we have an almost uniform group of patients according to therapeutic approach, we did univariate analyses and found out that patients with FNA cytodiagnoses of HL, younger than 55 years, with early stage of the disease and without B symptoms had significantly longer overall survival (OS). FNA cytodiagnosis has clinical relevance in differentiation between HL and ALCL.

The aim of this study is to establish possibilities of using cytology in the diagnosis of parathyroid gland adenoma. 475 patients, all suspected to have parathyroid gland disease, were examined over a three-year period (from 1 of January 2006 to 31 of December 2008) in the Clinical Department of Nuclear Medicine and Radiation Protection, University Hospital Center Zagreb, Croatia. Ultrasound guided fine needle aspiration biopsy (UG-FNAB) of suspected occurrences determined by ultrasound was done. Samples obtained by UG-FNAB were air-dried and stained using the May-Grünwald-Giemsa (MGG) staining procedure. PTH levels were determined in all punctate and sera obtained on the day of UG-FNAB. Samples adequate for cytological analysis were obtained from 288 patients, while 187 punctates did not contain epithelial elements. The parathyroid hormone (PTH) analysis was made for all punctates. The adenoma was diagnosed via morphological characteristics in 71 out of 288 punctates that were proven adequate for cytological analysis. Increased PTH levels were later on established in all diagnosed adenomas. All patients with cytology-based diagnosis of parathyroid gland adenoma were sent to surgery, and the cytological diagnosis was confirmed by pathohistology. In three cases, the parathyroid gland adenoma was established by pathohistology, although in these cases the cytological diagnosis was negative. The cytological diagnosis of parathyroid gland adenoma can be considered reliable in 96% of cases, provided that the echosonographic structure and localisation of the punctured node is noted, and assuming that material adequate for cytological analysis is obtained by FNAB. Possible pitfalls are oncocytic types of parathyroid adenoma, intranuclear inclusions and papillary formation of epithelial cells, and cystic degeneration of nodules. These errors can be avoided by defining the PTH level on the same punctate.

Thyroid fine needle aspiration cytology (FNAC) is the most accurate and cost effective method in the evaluation of the thyroid nodule and has been commonly used in adults. Thyroid nodules are uncommon in younger patients (1-2%). Our aim was to determine some relevant clinical and cytological parameters in this demographic group. Ultrasound-guided thyroid FNACs performed from May 1995 to June 2008 in patients under 18 years of age were retrospectively reviewed. The following clinical parameters were retrieved: age and gender, number of nodules, and nodule size. Cytological parameters included cytologic diagnosis and cyto-pathohistological correlation. Total of 236 cases, representing 206 patients under 18 years of age, were retrieved from a total of 11748 thyroid FNAC cases (2.0%). The patient's age ranged from 2 to 18 years (mean 14). There were 180 (87.4%) females and 26 (12.6%) males with a female/male ratio 4:1. For 56 patients data concerning the number of nodules were recorded. 20 (35.7%) patients did not have any nodules, 20 (35.7%) patients had solitary thyroid nodule and 16 (28.6%) patients had multiple nodules. The size of nodules ranged from 0.4-5.4 cm (mean 1.4 cm). The cytologic diagnoses were: unsatisfactory (9), cyst fluid (7), benign (204), cellular follicular lesion/follicular neoplasm (9) and papillary thyroid carcinoma (7). The prevalence of malignancy among cytologic diagnoses was 3.4%. 21 patients had surgical follow up. 5 patients (23.8%) had thyroid malignancies (all papillary carcinomas). The remainder had benign thyroid lesions; follicular adenomas (8), multinodular goiters (5), diffuse goiters (2) and Hashimoto thyreoiditis (1). There were no false negative or false positive cytologic diagnoses. The prevalence of thyroid malignancies among cytologic diagnoses was similar to those reported in adults. In limited number of patients with surgical follow up there were no false negative or false positive cytologic diagnoses.

Fine-needle aspiration (FNA) biopsy has become a well established technique in the diagnosis, staging, and follow-up of patients with head and neck lesions. As in lymphoma diagnostics, FNA serves as a screening method in evaluating potentially affected lymph node for open or core biopsy. According to the World Health Organization classification of lymphoid neoplasms, today it is important to recognize cell morphology and reveal its phenotype, then combine it with different genotypic information and clinical data to provide appropriate therapy. The aim of this study was to assess the efficacy of FNA and immunocytochemistry based lymphoma diagnostic in head and neck region. We conducted a retrospective study during a period of three years where cases with either FNA diagnosis or clinical suspicion of newly recognized or relapsing lymphoma were reviewed. In the study were included patients that were referred to our laboratory from hematology department, in whom head and neck lymphadenopathia was found and lymph node FNA preceded other procedures. Two hundred eighty-five aspirations from 248 patients fulfilled study criteria. Adequate specimens were diagnosed as lymphoma in 100 cases (36%), in 65 male and 35 female patients, 76 in patients with newly discovered disease and 24 in patients with prior lymphoma diagnosis. Overall sensitivity of FNA specimens in the diagnosis of head and neck lymphomas was 90%, specificity 88%, predictive value of a positive result 97%, and predictive value of negative result 61%. Based on our results FNA corroborated with immunophenotyping by immunocytochemistry can be method of choice in primary lymphoma diagnosis as a method complementary to histopathology in lymphoma diagnostics.

We described two examples with misleading presentations to draw attention to the role of clinical cytology as apart of multidisciplinary approach to breast lesions. In the first case--Paget's disease of the nipple, there was no obvious clinical and radiological evidence of breast cancer, while the second case--primary non-Hodgkin lymphoma of the breast imitated advanced breast carcinoma. The question is whether accurate and fast diagnoses can be made without cytological examinations. It must be kept in mind that first-hand clinical information and contact with the patient is necessary in rendering accurate cytological diagnoses.

We investigated if the use of two tumor markers, galectin-3 and CD44v6, could improve diagnostic accuracy of thyroid fine needle aspiration biopsy (FNAB) in cytologically indeterminate lesions (CIL). 351 patients with CIL [cellular follicular lesion/suspicious follicular neoplasm/suspicious Hürthle cell neoplasm (CFL/sFN/sHCN), Hürthle cell neoplasm (HCN), and follicular neoplasm (FN)] and surgical follow-up were investigated. 251 patients had FNAB diagnoses made without help of tumor markers and the rest of 100 patients had FNAB diagnoses made with a known expression of tumor markers determined by the reverse transcription (RT)-PCR. Risk of malignancy in all 351 patients with CIL was 6.8%. In the group with FNAB made without RT-PCR, there were 140 CFL/sFN/sHCN with the risk of malignancy of 4.2%, 92 FN with the risk of malignancy of 13.0%, and 19 HCN with the risk of malignancy of 5.2%. In the group with FNAB made with RT-PCR, there were 49 CFL/sFN/sHCN with the risk of malignancy of 2.0%, 40 FN with the risk of malignancy of 7.5%, and 11 HCN with the risk of malignancy of 9.0%. In the group with at least one positive tumor marker (N = 69), the risk of malignancy was 3.1% for CFL/sFN/sHCN, 11.1% for FN, and 10.0% for HCN. In the group with negative tumor markers (N = 31) there were no malignancies. The use of tumor markers, galectin-3 and CD44v6, determined by RT-PCR improves only sensitivity of thyroid FNAB in CIL. In most patients with CIL, and negative both tumor markers, conservative approach is advisable.

Today lymphomas are defined according to a combination of morphology, immunophenotype, genetic features and clinical presentation, so beside the pure cytomorphologic analysis in diagnosis of lymphoma ancillary techniques such as cytochemistry, immunocytochemistry, molecular diagnosis and flow cytometry (FC) are often used. Our goal was to determinate how is information given by fine-needle aspiration cytology (FNAC) and FC correlated with pathohistologic diagnosis and to evaluate ability to diagnose and subclassify malignant lymphomas by FNAC and FC. This study is a retrospective chart review of patients with suspicion of lymphoma processed at University Hospital Dubrava in Zagreb. After analysis 50 patients fulfilled inclusion criteria for this study (FNAC diagnosis with or without FC and consecutive confirmatory pathohistological diagnosis). When analyzing accuracy of FNAC according to suspicion of lymphoma or NHL and differential diagnosis lymphoma sensitivity was 97.7%, specificity 85.7% and the diagnostic accuracy was 96%. When analyzing accuracy of FNAC according to the subclassification of lymphoma, sensitivity was 74.4%, specificity 85.7% and the diagnostic accuracy 76%. Combined FNAC and FC improved sensitivity, positive predictive value, negative predictive value and diagnostic accuracy. Sensitivity was 79.1% and the diagnostic accuracy 80%. We have shown that these methods can distinguish benign lymphadenopaties from lymphomas and also subclassify lymphomas and quickly provide clinicians with that information.

US-guided fine needle aspiration cytology is currently the best diagnostic tool for thyroid nodules. The aim of this research was to make a detailed and objective determination of the morphological characteristics of cells in cytological smears in an attempt to distinguish benign from malignant follicular tumors. The research included 62 patients with cytologically diagnosed follicular or oncocytic tumors, and 15 patients with nodular hyperplasia. Echographic findings were divided into three groups: isoechogenic, hypoechogenic and hyperechogenic nodules. We analyzed the cellularity of the smear, cohesion between follicular cells, acinar formations, bare nuclei, characteristics of the nucleus and the cytoplasm, and the presence of colloid. The statistical analysis of cytological parameters has indicated that none of the cytological parameters alone is discriminating enough between non-tumor and tumor changes, or benign and malignant follicular thyroid nodules. The analysis of age, sex, nodule size and ultrasound findings has not shown the correlation between any of these parameters with the malignant or benign follicular tumors. The cytological analysis of the smears for patients with follicular tumors, in combination with clinical data and other diagnostic methods, contributes to more precise diagnostics, but is not sufficient for the differentiation between benign and malignant follicular tumors.