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In the lung and mediastinum, salivary gland type tumors (SGTTs) can occur as either primary tumors or metastases from tumors arising in the major or minor salivary glands. This study reviewed the cytology cases of SGTTs in the lung and mediastinum diagnosed over a six-year period at our institution. The specimens included a total of 22 exfoliative or aspiration cytology specimens identified in 16 patients. Two of the cases were primary tumors: adenoid cystic carcinoma (ACC) of the trachea and mucoepidermoid carcinoma (MEC) of the thymus. The remaining 20 tumors were metastases from the parotid, submandibular gland, tongue, nasal cavity, or soft palate. Eight of the 16 patients (50%) had a diagnosis of ACC, four (25%) had salivary duct carcinomas, two (12.5%) had MECs, one (6.25%) was a basaloid tumor, and one (6.25%) was polymorphous low grade adenocarcinoma. In our series, these SGTTs were more commonly metastatic in the lung or mediastinum (87.5% of the patients), and the most common histological subtype was ACC, followed by SDC. This study also illustrates the cytomorphologic features and diagnostic pitfalls of these unusual SGTTs., (Copyright © 2011 Wiley Periodicals, Inc.)

Background: The Bethesda System for Reporting Thyroid Cytopathology is largely based on data from adult studies. Although thyroid nodules in children are rare, the rate of malignancy is high. The authors' aim was to analyze the cytomorphology and mutational profiles in pediatric thyroid fine-needle aspirations (FNAs)., Methods: Thyroid FNAs from patients 21 years old or younger were identified from the authors' pathology archive, categorized using the Bethesda System for Reporting Thyroid Cytopathology, and correlated with histological and molecular follow-up., Results: A total of 179 samples from 142 patients were identified, including 96 cases (54%) with histological follow-up and 66 cases (37%) with molecular data. The diagnoses included 21 (12%) unsatisfactory, 82 (46%) negative, 43 (24%) atypia or follicular lesion of undetermined significance, 19 (11%) suspicious for follicular neoplasm, 6 (3%) suspicious for malignancy, and 8 (4%) positive for malignancy. The rate of malignancy in each category was 0%, 7%, 28%, 58%, 100%, and 100%, respectively. Of the 66 FNAs with molecular data, there were 11 (17%) positive for mutations. All mutation-positive FNAs were papillary thyroid carcinomas (PTCs) on resection. The overall sensitivity and specificity in this population were 80% and 100%, respectively., Conclusions: This study demonstrates that thyroid FNA in children is a sensitive and highly specific tool. There was a 17% positivity rate for a genetic mutation, which correlated with malignancy in all cases. In comparison to adults, there was a higher prevalence of RET/PTC mutations and lower prevalence of BRAF mutations, which may in part explain the less aggressive nature of PTCs reported in children., (Copyright © 2012 American Cancer Society.)

Fine-needle aspiration (FNA) biopsy is a quick, cost-effective, and safe diagnostic modality that provides answers to guide treatment and management in patients with lymphadenopathy. In adults and children, there are a range of non-neoplastic, non-infectious etiologies for lymphadenopathy. These include reactive lymphoid hyperplasia (RLH), dermatopathic lymphadenitis (DLN), Rosai-Dorfman disease, Castleman disease, Kimura disease, Kikuchi-Fujimoto disease, and lymphadenopathy associated with autoimmune and metabolic/storage disease. Other benign nodal entities that may be encountered include lymph node infarction, foreign body reactions, drug reactions, extramedullary hematopoeisis, and benign inclusions. This article reviews the practical role of FNA in the evaluation of these benign, non-infectious causes of lymphadenopathy and focuses on their cytomorphology and differential diagnosis., (Copyright © 2012 Wiley Periodicals, Inc.)

Toxoplasma gondii usually causes an asymptomatic and then latent infection in human adults; however, a potentially fatal disseminated form can occur in immunocompromised patients. Given that the diagnosis of acute Toxoplasma infection, as opposed to latent disease, relies on finding direct evidence of T. gondii infection in tissue, pathologic examination is critical. There have only been a few reports describing the cytomorphology of Toxoplasma in exfoliative cytology, and no reports of the findings in Thin Prep. In this report, we describe a fatal case of toxoplasmosis in a cardiac transplant patient that was diagnosed by respiratory cytopathology. Although the extracellular organisms were well visualized on the Wright-Giemsa stained cytospin, they were only faintly seen on the Pap-stained cytospin trapped within mucin and were not easily appreciated on the ThinPrep slides nor the H&E stained cell block sections. An immunohistochemical stain for Toxoplasma performed on the cell block was strongly positive, and an autopsy performed on the patient confirmed disseminated infection. Our case illustrates that the diagnosis of Toxoplasma in exfoliative cytology specimens can be challenging since organisms are not well visualized on ThinPrep or Pap-stained material; therefore, Wright-Giemsa stained material can be particularly helpful., (Copyright © 2011 Wiley Periodicals, Inc.)

Exfoliative and aspiration cytologies play a major role in the management of patients with human immunodeficiency virus infection. Common cytology samples include cervicovaginal and anal Papanicolaou tests, fine needle aspirations, respiratory specimens, body fluids, Tzanck preparations, and touch preparations from brain specimens. While the cytopathologists need to be aware of specific infections and neoplasms likely to be encountered in this setting, they should be aware of the current shift in the pattern of human immunodeficiency virus-related diseases, as human immunodeficiency virus patients are living longer with highly active antiretroviral therapy and suffering fewer opportunistic infections with better antimicrobial prophylaxis. There is a rise in nonhuman immunodeficiency virus-defining cancers (e.g., anal cancer, Hodgkin's lymphoma) and entities (e.g., gynecomastia) from drug-related side effects. Given that fine needle aspiration is a valuable, noninvasive, and cost-effective tool, it is frequently employed in the evaluation and diagnosis of human immunodeficiency virus-related diseases. Anal Papanicolaou tests are also increasing as a result of enhanced screening of human immunodeficiency virus-positive patients for cancer. This paper covers the broad spectrum of disease entities likely to be encountered with human immunodeficiency virus-related cytopathology.

Lymphomatous involvement of an adrenal gland during the course of a lymphoma is common, but a primary presentation of adrenal insufficiency in a patient with lymphoma involving both adrenal glands is rare. We describe a 36-year-old man with non-Hodgkin lymphoma (NHL) who presented with adrenal insufficiency. His evaluation consisted of several imaging modalities, including positron emission tomography-computed tomography (PET-CT) scans, which were helpful in defining the extent of disease prior to treatment and in monitoring the patient's response to treatment. Our case illustrates the importance of preoperative evaluation to exclude a lymphoma, particularly in patients with bilateral renal and/or adrenal masses.

52-year-old patient presented with palpitation and well tolerated monomorphic ventricular tachycardia. He had normal echocardiogram and coronary angiogram 3 months prior to presentation. Surface EKG revealed regular wide-complex tachycardia with right bundle branch block morphology and right inferior axis. In conjunction with recent negative cardiac evaluation, this suggested idiopathic focal ventricular tachycardia from anterolateral basal left ventricle. CARTO based activation mapping confirmed the presence of VT focus in that area. Radiofrequency ablation at the site of perfect pacemap resulted in a partial suppression of the focus. Echocardiogram was subsequently performed because of progressive dyspnea. It revealed asymmetrical thickening of posterolateral left ventricle, with delayed enhancement on contrast magnetic resonance imaging. Fine needle aspiration of abdominal fat stained with Congo red confirmed the diagnosis of systemic AL amyloidosis due to IgG lambda-light chain deposition. Consequently, the patient underwent placement of implantable defibrillator and hematopoetic stem cell transplantation. He remains in excellent functional status 18 months after presentation.

Background: In the fine-needle aspiration biopsy (FNAB) diagnosis of B-cell non-Hodgkin lymphomas (B-NHL), the role of flow cytometry (FC) can be limited because of nondiagnostic findings. Fluorescence in situ hybridization (FISH) studies, similar to FC, can be helpful in establishing clonality and in subclassifying the lymphoma. The aim of the current study was to determine whether FISH studies performed on unstained direct smears improved the ability to diagnose and/or subclassify B-NHL on FNAB., Methods: A total of 181 cases of B-NHL diagnosed by FNAB were retrieved. The cytomorphology, ancillary study results, clinical information, and available pathologic follow-up were reviewed., Results: Of the 181 cases, FISH studies were performed in 106 cases (59%). The indications for FISH studies were for subclassification (59 cases; 56%) and nondiagnostic or unavailable FC results (47 cases; 44%). Of the 59 cases submitted for subclassification, 23 cases (39%) were successfully subclassified. The 47 cases with nondiagnostic or unavailable FC results included cases in which FC demonstrated a surface immunoglobulin-negative population (19 cases; 40%), had insufficient cellularity (18 cases; 38%), yielded negative results (6 cases; 13%), or had no specimen submitted (4 cases; 9%). In this group, 26 cases (55%) demonstrated an immunoglobulin heavy-chain gene rearrangement and/or chromosomal translocation., Conclusions: The results of the current study illustrate that FISH studies performed on unstained direct smears play a complementary role to FC in establishing the diagnosis and/or subclassification of B-NHL. Thus, the preparation of unstained smears at the time of FNAB can be helpful for potential FISH studies., ((c) 2009 American Cancer Society.)

Epithelioid hemangioendothelioma (EHE) is an uncommon vascular tumor with biological behavior intermediate between hemangioma and angiosarcoma. It rarely occurs in the oral cavity. We report a case of an 81-yr-old woman with a 2-mo history of a 2 x 2 cm2 submucosal buccal mass. Fine needle aspiration (FNA) smears were paucicellular and showed mainly single atypical large epithelioid cells in a bloody background. The atypical cells had abundant dense cytoplasm, some with fine vacuoles. Occasionally, cells with large cytoplasmic lumina were seen. Cytology preparations from fresh tissue received for frozen section revealed numerous neoplastic cells with large intracytoplasmic lumina, some of which contained red blood cells. In addition, cells with distinct intranuclear inclusions were present. Histologic sections and immunohistochemical stains confirmed the diagnosis of EHE. Although the histologic features of EHE are well recognized, reports of FNA cytology findings are sparsely existent in the literature as several case reports. The characteristic cytological features of EHE are reviewed in this report. We believe that the diagnosis of this rare tumor can be suggested when an adequate FNA specimen is obtained., (2006 Wiley-Liss, Inc.)

We recently demonstrated in an immortalized thyroid cell line that integrin stimulation by fibronectin (FN) simultaneously activates two signaling pathways: Ras/Raf/MAPK kinase (Mek)/Erk and calcium Ca2+/calcium calmodulin-dependent kinase II (CaMKII). Both signals are necessary to stimulate Erk phosphorylation because CaMKII modulates Ras-induced Raf-1 activity. In this study we present evidence that extends these findings to normal human thyroid cells in primary culture, demonstrating its biological significance in a more physiological cell model. In normal thyroid cells, immobilized FN-induced activation of p21Ras and Erk phosphorylation. This pathway was responsible for FN-induced cell proliferation. Concurrent increase of intracellular Ca2+ concentration and CaMKII activation was observed. Both induction of p21Ras activity and increase of intracellular Ca2+ concentration were mediated by FN binding to alphavbeta3 integrin. Inhibition of the Ca2+/CaMKII signal pathway by calmodulin or CaMKII inhibitors completely abolished the FN-induced Erk phosphorylation. Binding to FN induced Raf-1 and CaMKII to form a protein complex, indicating that intersection between Ras/Raf/Mek/Erk and Ca2+/CaMKII signaling pathways occurred at Raf-1 level. Interruption of the Ca2+/CaMKII signal pathway arrested cell proliferation induced by FN. We also analyzed thyroid tumor cell lines that displayed concomitant aberrant integrin expression and signal transduction. These data confirm that integrin activation by FN in normal thyroid cells generates Ras/Raf/Mek/Erk and Ca2+/CaMKII signaling pathways and that both are necessary to stimulate cell proliferation, whereas in thyroid tumors integrin signaling is altered.