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Background Endoscopic Ultrasound has been used in the clinical arena for almost 35 years and it is now well-integrated in everyday hospital practice. Method We conducted a systematic review of the available English-language articles. Objective The purpose of this review is to summarize all the relevant indications to endoscopic ultrasound and analyze its relevant data in terms of accuracy and clinical outcomes. Results More than 5000 scientific papers published in the literature have demonstrated its high accuracy for the diagnosis and staging of a variety of benign and malignant conditions. Staging indications include gastroesophageal and rectal cancers. Diagnostic, staging and therapeutic indications include diseases of the pancreaticobiliary area. Finally, differential diagnosis of submucosal tumors represents another important indication to this technique.

Context.— Thyroid nodules have a prevalence of approximately 70% in adults. Fine-needle aspiration (FNA) is a minimally invasive, cost-effective, standard method to collect tissue from thyroid nodules for cytologic examination. However, approximately 15% of thyroid FNA specimens cannot be unambiguously diagnosed as benign or malignant. Objective.— To investigate whether clinically actionable data can be obtained using next-generation sequencing of residual needle rinse material. Design.— A total of 24 residual needle rinse specimens with malignant (n = 6), indeterminate (n = 9), or benign (n = 9) thyroid FNA diagnoses were analyzed in our clinical molecular diagnostics laboratory using next-generation sequencing assays designed to detect gene mutations and translocations that commonly occur in thyroid cancer. Results were correlated with surgical diagnoses and clinical outcomes. Results.— Interpretable data were generated from 23 of 24 residual needle rinse specimens. Consistent with its well-known role in thyroid malignancy, BRAF V600E mutations were detected in 4 malignant cases. An NRAS mutation was detected in 1 benign case. No mutations were detected from specimens with indeterminate diagnoses. Conclusions.— Our data demonstrate that residual thyroid FNA needle rinses are an adequate source of material for molecular diagnostic testing. Importantly, detection of a mutation implicated in thyroid malignancy was predictive of the final surgical diagnosis and clinical outcome. Our strategy to triage thyroid nodules with indeterminate cytology with molecular testing eliminates the need to perform additional FNA passes into dedicated media or to schedule additional invasive procedures. Further investigation with a larger sample size to confirm the clinical utility of our proposed strategy is underway.

Background: Fine-needle aspiration (FNA) of the thyroid is a widely accepted confirmatory test for thyroid cancer with high sensitivity and specificity. FNA is a simple procedure that is learned by many clinicians to enable accurate diagnosis of thyroid cancer. However, it is assumed that because the FNA test is a relatively simple procedure, its cytologic results are reliable regardless of the operator’s experience. The aim of this study was to evaluate the differences in the diagnostic indices of FNA between operators with different levels of experience. Methods: A total of 694 thyroid FNA specimens from 469 patients were reviewed, and were separated based on the experience of the clinicians who performed the procedure. One hundred and ninety were categorized in the experienced group, and 504 in the inexperienced group. All FNA results were then compared with histological data from surgically resected specimens, and the sample adequacy and diagnostic accuracy of the groups were compared. Results: The age, gender, and nodule size and characteristics were similar in both groups. The sample adequacy rate was not significantly different between the experienced and nonexperienced groups (96.3% vs. 95.4%, P=0.682). However, the non-experienced group had a higher false-negative rate than the experienced group (6.4% vs. 17.2%, P=0.038), and the sensitivity of the FNA test also tended to be lower in the nonexperienced group (95.6% vs. 88.9%, P=0.065). Conclusion: These results suggest that FNA operators who have less experience may miss cases of thyroid cancer by performing the procedure incorrectly. As such, the experience of the FNA operator should be considered when diagnosing thyroid cancer. When clinicians are being trained in FNA, more effort should be made to increase the accuracy of the procedure; therefore, enhanced teaching programs and/or a more detailed feedback system are recommended.

Purpose The aim of this study was to evaluate the characteristic features of oral and maxillofacial swellings that could be seen on ultrasonographic examinations. Materials and Methods Fifty patients with oral and/or maxillofacial swellings were randomly selected, thorough case histories and clinical examinations were done, ultrasonographic examinations with Doppler imaging were performed, and the features of every group were studied. Finally, histopathological evaluations were performed to identify the final diagnosis, according to which patients were classified into 5 groups; group I: inflammatory/space infection and abscess swellings, group II: cystic swellings, group III: lymph node swellings, group IV: benign swellings, and group V: malignant neoplastic swellings. Results A significant association (P

Subcutaneous fat necrosis of the newborn is an unusual form of panniculitis, with few cases described in medical literature. The disease affects newborns at term or post-term, with normal general health. We describe two cases of newborns affected by the disease. One of them already had lesions since birth. Also, we discuss the use of puncture for diagnostic assistance.

Periphere Lymphknotenschwellungen haben unterschiedliche Ursachen. Neben einer Lymphadenopathie bzw. Lymphadenitis im Zusammenhang mit infektiosen und nicht-infektiosen Entzundungen konnen sie Ausdruck einer lymphatischen Systemerkrankung oder des metastatischen Befalls durch solide Tumoren sein. Die Feinnadelaspiration peripherer Lymphknoten ist eine den Patienten kaum belastende Methode, die in kurzester Zeit und mit minimalem technischem Aufwand eine zuverlassige Aussage zu Dignitat und Atiologie und damit eine Weichenstellung fur die weiterfuhrende Diagnostik zulasst. Mit einer diagnostischen Genauigkeit zwischen 84 und 97 % lassen sich bei richtiger Durchfuhrung maligne Veranderungen von benignen abgrenzen. Bei lymphatischen Systemerkrankungen gestattet die Feinnadelpunktion in aller Regel eine Verdachtsdiagnose. Zur exakten Klassifizierung muss aber eine histologische Beurteilung erfolgen.

Zusammenfassung. Maligne periphere Nervenscheidentumore (MPNST) sind selten. Insbesondere bei Patienten mit bekannter Neurofibromatose Typ 1 (von Recklinghausen), sollte jedoch an diese Entität von Tumoren gedacht werden. Die Indikation für eine offene Biopsie oder Exzision sollte grosszügig gestellt werden. Im Folgenden berichten wir über einen raren Fall eines MPNST, der die Wichtigkeit der schnellen Diagnostik und Therapie aufzeigt.

Background/Aims In this study we aimed to determine the rate of concordance of endoscopic ultrasonography (EUS)-guided fine needle aspiration (FNA) diagnosis with the final diagnosis obtained by surgery or endoscopic resection and follow-up in upper gastrointestinal subepithelial lesions. Methods We retrospectively studied patients with subepithelial lesions who underwent EUS at our center from 2007 to 2011. Results We had a final diagnosis in 67 patients (mean age±SD, 51.23±12.48 years; 23 [34.3%] female, 44 [65.6%] male). EUS-FNA was performed in all of the patients. On-site pathology was not performed. In nine of the patients, the obtained material which was obtained was insufficient. The cytologic examination was benign in 31 and malignant in 27 of the patients. Based on the final diagnosis, the EUS-FNA had a sensitivity of 96%, a specificity of 100%, and a diagnostic yield of 85%. Conclusions The diagnostic yield of EUS-FNA, in the absence of the on-site cytopathologist, is feasible for the diagnosis of subepithelial lesions of the upper gastrointestinal system.

Background: Metastatic cancer infrequently involves the pancreas. When the pancreas hosts a metastatic tumor, cytopathological evaluation of fine-needle aspirate material is a crucial part of the diagnostic process. In this study, we show two institutions' experience with cytopathological diagnosis of pancreatic metastasis. Methods: Databases of institutional experience at The Johns Hopkins Hospital and Ohio State University Medical Center were queried for cases of metastatic tumors in the pancreas that underwent fine-needle aspiration. Demographic and pathological features were compiled and the cytomorphology was reviewed. Results: Forty-two cases of tumor metastasis to the pancreas were found. Over the time of this review, 5,495 aspirates were performed, and 43% (2,389/5,495) had malignant cytological findings. Thus, the 42 cases of metastatic disease to the pancreas comprised 0.8% of all pancreas aspirates and 1.8% of the malignant ones. Renal cell carcinoma was the most common metastasis, followed by melanoma and non-small cell lung carcinoma. Among the other tumors in this series, 2 cases each of rare metastases such as the fibrolamellar variant of hepatocellular carcinoma and solitary fibrous tumor were also seen. Conclusion: The pancreas is rarely involved with metastatic disease, but when it is involved the most common tumor is renal cell carcinoma followed by melanoma and non-small cell lung cancer. Clinical history and awareness of the primary pancreatic mimickers are necessary for arriving at the correct diagnosis. As conventional pancreatic adenocarcinoma is uncommon in children and young adults, history of other tumors - even ones that usually follow an indolent course - is essential.

Solid pseudo-papillary tumor (SPT) of the pancreas is a rare pancreatic tumor, well known for its predilection for young women. As the tumor has favorable prognosis, differentiating it from other pancreatic tumors with aggressive behavior is necessary. We present a rare case of SPT and review the literature about SPT cases published from India.

Some of the main applications of molecular techniques using cellular materials obtained from tumors by means of non-gynecological exfoliative cytology or fine-needle aspiration are briefly described in this review.

Objective Cytology samples can sometimes yield cell blocks of low cellularity that are inadequate for cytomorphological evaluation and ancillary studies. The purpose of this study was to analyse the value of cell count based-triaging of samples for cell block preparation. Methods Cell blocks were prepared from different cytology samples using HistoGel™ according to the manufacturer's instructions following cell count assessment. The adequacy of cell blocks was semi-quantitatively scored as empty, scanty, moderate or highly cellular by evaluating corresponding haematoxylin and eosin (H&E) sections. Cell blocks with moderate and highly cellular H&E sections were considered adequate whereas cell blocks with empty and scanty cells in H&E sections were inadequate for cytomorphological evaluation. The average, range and a median number of cells (×106) embedded in adequate and inadequate cell blocks were compared. Results Among 54 cell blocks prepared from fine needle aspiration biopsies (FNAs, 32), effusions (4), brushings (13) and cell lines (5), 20 cell blocks (37%) yielded moderate or highly cellular H&E sections and were considered adequate whereas 34 (63%) cell blocks were empty or scanty and thus considered inadequate. The average (± SD) number of cells (×106) embedded in adequate and inadequate cell blocks was 2.1 ± 4.3 and 0.5 ± 0.3, respectively. Samples containing at least 1 × 106 cells yielded adequate cell blocks in 12/16 cases (75%) whereas samples with less than 1 × 106 cells in 13/38 (34%) cases. Conclusion The present study showed that cell count-based triaging of cytology samples could reduce the number of low cellular cell blocks.

Made available in DSpace on 2018-12-11T17:07:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-09-01 Made available in DSpace on 2018-11-26T16:56:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-09-01 Item merged in doublecheck by Luana Priscila Costa (luana@reitoria.unesp.br) on 2019-02-15T13:02:23Z Item was identical to item(s): 164068, 175934 at handle(s): http://hdl.handle.net/11449/161849, http://hdl.handle.net/11449/173653 MS Student in Stomatology Oral Oncology Center Department of Pathology and Clinical Propedeutics Araçatuba Dental School UNESP – Universidade Estadual Paulista Medical Assistant Department of Pathology School of Medicine University of Campinas UNICAMP Assistant Professor Department of Pathology and Clinical Propedeutics Araçatuba Dental School UNESP – Universidade Estadual Paulista Adjunct Professor Oral Oncology Center Department of Pathology and Clinical Propedeutics Araçatuba Dental School UNESP – Universidade Estadual Paulista Assistant Professor Oral Oncology Center Department of Pathology and Clinical Propedeutics Araçatuba Dental School UNESP – Universidade Estadual Paulista MS Student in Stomatology Oral Oncology Center Department of Pathology and Clinical Propedeutics Araçatuba Dental School UNESP – Universidade Estadual Paulista Assistant Professor Department of Pathology and Clinical Propedeutics Araçatuba Dental School UNESP – Universidade Estadual Paulista Adjunct Professor Oral Oncology Center Department of Pathology and Clinical Propedeutics Araçatuba Dental School UNESP – Universidade Estadual Paulista Assistant Professor Oral Oncology Center Department of Pathology and Clinical Propedeutics Araçatuba Dental School UNESP – Universidade Estadual Paulista

Inflammatory pseudotumor (IPT) is a rare benign mass-forming disease that can arise anywhere throughout the body, mimicking a wide spectrum of other conditions. Its diagnosis can be challenging, especially when it involves uncommon sites. The authors report a patient of an atypical localization of IPT, occurred as an enlarging bulk in the infraorbital nerve channel in a patient who presented with facial numbness. Clinical and radiological aspects similar to schwannoma led to misdiagnosis and over-treatment. The differential diagnosis of an infraorbital mass should include IPT and the least invasive treatment should be preferred, as steroid therapy being the first-line treatment for IPT.

The review is focused on new information about the presentation and management of thyroid nodules in children and adolescents.Palpable thyroid nodules are uncommon in children but many children have nodules detected by radiologic imaging. How to evaluate them, when to suspect thyroid cancer, and how best to follow apparently benign nodules has become an area of great interest. The American Thyroid Association recently published treatment guidelines for children with thyroid nodules and cancers but much has been learned since that publication.Personal and family history, ultrasound features, and fine needle aspiration cytology are used to determine the risk of cancer in thyroid nodules, which are then managed according to cancer risk.

Department of Pediatric Surgery, Medical College and Hospital, Kolkata, India.Corresponding author: Mainak Dutta – Department of Otorhinolaryngology and Head-Neck Surgery – Medical College and Hospital, 88, College Street – Zip code: 700073 – Kolkata, West Bengal, India Phone: +91 9830737587 – E-mail: duttamainak@yahoo.comReceived on: Mar 4, 2014 – Accepted on: Aug 20, 2014DOI: 10.1590/S1679-45082015AI3096

Objective: Fine-needle aspiration (FNA) cytology is a safe and cost-effective technique for the diagnosis of lymphoproliferative processes, especially when correlated with clinical and imaging studies. However, cytology alone may be unable to detect a lymphoid neoplastic process, as architectural features are less obvious than in histologic preparations and, in certain cases, reactive processes may mimic lymphoma. Flow cytometry (FC) has been recognized as an important ancillary technique in the diagnosis of lymphoid neoplasms and it can be used in conjunction with FNA in the evaluation of lymphoproliferative processes. Study Design: We performed a review of the published literature concerning FC applied to the detection of salivary glands and thyroid lymphoproliferative processes, which are frequently related to autoimmune diseases and difficult to diagnose by cytomorphology alone. Results: FC is able to detect and subtype non-Hodgkin lymphomas and may contribute to the exclusion of a neoplastic process in cytologically unclear cases. Conclusions: FC can be successfully applied in the differential diagnosis of lymphoproliferative processes in the head and neck region. The FNA-FC combined approach can reduce time to therapy and may prevent unnecessary surgical biopsies.

Recent increases in the number of thyroid fine-needle aspiration (FNAs) biopsies and the popularity of on-site evaluation for adequacy (OSEA) have led many practices, including ours, to rely on cytotechnologists for performing OSEA. We retrospectively analyzed the accuracy of a cytotechnologist against that of a cytopathologist in performing OSEA and making the final diagnosis. Of 2,261 thyroid FNA specimens evaluated over a 33-month period under ultrasound guidance with OSEA, the cytotechnologist attended 64.7% (1,462/2,261) of the procedures whereas the cytopathologist attended 35.3% (799/2,261). There was no difference in the adequacy downgrade rate for cytotechnologists compared with that for cytopathologists during this study period (4.1% vs 5.0% downgrade rate, P = .33). Regardless of who rendered the OSEA, subadequate specimens had a higher rate of indeterminate diagnosis (25.2%) than those specimens deemed adequate at the time of OSEA (11.9%, P = .00001). These results indicate that the accuracy of cytotechnologists is comparable with that of cytopathologists in conducting OSEA of the thyroid.

MicroRNAs (miRNAs) sind kleine (20–24 Nukleotide), nichtkodierende Ribonukleinsauren, die durch Regulation der Genexpression auf der posttranskriptionalen Ebene in physiologische Prozesse wie Wachstum, Differenzierung und Apoptose eingreifen. Insbesondere fur das papillare Schilddrusenkarzinom wurde eine typische Uberexpression mehrerer miRNAs (u. a. miRNA 146b, 221 und 222) gezeigt. Im vorliegenden Artikel werden die Moglichkeiten und Probleme der miRNA-Analyse an durch Feinnadelbiopsie gewonnenem Material aus Schilddrusenknoten beschrieben und diskutiert. Insbesondere die Analyse von definierten Kombinationen von miRNAs sollte zu einer Steigerung der Aussagekraft dieser Methode und einem verbesserten Management der Patienten mit hypofunktionellen Schilddrusenknoten fuhren.

Primary tuberculosis (TB) of the breast is a very rare condition. We present a 50-year-old patient who presented with primary TB of the breast. The significance of the radiological findings, the importance of histological diagnosis and treatment, and the possibility of co-existence with breast cancer are discussed.

The molecular work-up of thyroid nodules on fine needle aspiration (FNA) cytology samples has given clinicians a new level of diagnostic information. We focus this review on the molecular techniques used in the diagnosis of thyroid cancer, especially BRAF, and the resulting management considerations that are raised.BRAF testing offers both diagnostic and prognostic information; it has been used along with the Bethesda Thyroid FNA Classification System to offer preoperative guidance in the management of thyroid nodules. Various authors have successfully utilized molecular panels on cytologic specimens including mutations and rearrangements such as RAS and RET/PTC. Preoperative mutation detection allows initial management decisions to be made with a greater clinical confidence.BRAF molecular testing holds promise as a possible diagnostic tool for indeterminate FNAs, and as a determinant for planning initial clinical management of thyroid nodules. Further developments in the molecular approach to thyroid cancer are expected to allow greater individualization of patient care.

Resume Introduction Le traitement du cancer du penis, meme si bien codifiee, n’est pas toujours bien connue du fait de sa rarete. Le but de cet article est de rapporter la prise en charge des tumeurs du penis en 2010. Patients et methodes Cet article fait une synthese de ce qui a ete expose lors du forum du Comite de cancerologie de l’Association francaise d’urologie (CC-AFU) qui a eu lieu lors du congres de l’AFU. Resultats Le role de l’urologue est de diagnostiquer les lesions peniennes precancereuses et les cancers debutants pour limiter le risque de traitements mutilants. En cas de doute, il faut realiser une biopsie avec orientation de la piece. Le bilan de la tumeur penienne repose essentiellement sur l’examen clinique. L’IRM penienne peut aider pour apprecier l’extension en profondeur. Le traitement de la tumeur penienne est au maximum conservateur, soit par chirurgie, soit par curietherapie. Le risque de recidive locale est de 20 %, mais n’influence pas la survie. La prise en charge ganglionnaire doit etre systematique, bilateral et realisee lors du diagnostic. Les tumeurs superieures ou egales a pT1b et/ou superieures ou egales a grade 2 sont a risque d’extension ganglionnaire. Le bilan d’extension ganglionnaire et a distance est clinique et radiologique (tomodensitometrie et/ou une TEP-TDM au 18F-FDG). Le curage ganglionnaire inguinal a un role curatif. Le type de curage inguinal (modifie et/ou total) est fonction de l’examen clinique, paraclinique et de la cytoponction des adenopathies. Dans certains cas un curage iliaque associe est recommande. La place et le type de chimiotherapie restent a definir. Ce traitement est base au moins sur l’administration de Cisplatine. Conclusion Le traitement d’un cancer du penis necessite une prise en charge de la tumeur locale le plus conservateur possible. La prise en charge des aires ganglionnaires inguinales est primordiale car a une valeur pronostique. Elle doit etre faite lors du diagnostic initial et est fonction de l’examen clinique et paraclinique.

Objective: Cytological examination is inexpensive and relatively simple to carry out and deserves utilization in breast cancer screening. We investigated the status of cytological diagnosis at seven facilities in southern Fukuoka Prefecture, Japan. Methods: We collected data on the criteria for cytological judgments and status of breast cytological diagnosis at seven different facilities in this region. Results: Among 5693 individuals who underwent breast cytological examination, analyses were conducted on 1250 individuals (22.0%) in whom cytological diagnoses were confirmed by histological diagnoses. Among these patients, cytological diagnosis had an absolute sensitivity of 71.9%, a specificity of 76.0%, a false-negative value of 6.7% and a false-positive value of 0.08%. At three facilities with relatively large numbers of cases (.300), excluding a facility for specialized breast disease, similar trends of high complete sensitivity (94.3, 95.6 and 97.1%, respectively) and low absolute sensitivity (60.4, 74.8 and 57.2%, respectively) were found. No false-negative or false-positive cases were seen in individual facilities with relatively low numbers of cases (,150). Conclusions: The accuracy of cytological diagnosis at the facilities we surveyed was relatively high compared with the goals of assessment of diagnostic accuracy. However, the performance was dependent on the facility type, i.e. number of cases, staff involved and whether it was specialized or not, making the diagnosis specific for this region. We recommend that management of the accuracy of cytological diagnosis be undertaken jointly by multiple facilities to establish systems in Japan that lead to more useful diagnostic tools.