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At present, GATA binding protein 3 (GATA-3) is the most frequently used diagnostic immunohistochemical (IHC) marker for breast carcinoma (BC). However, it is not specific and has very low sensitivity for triple-negative BC (TNBC). SRY-box transcription factor 10 (SOX-10) and trichorhinophalangeal syndrome type 1 (TRPS-1) have been suggested for inclusion in the diagnostic workup of TNBC. TRPS-1 has not been established in cytology specimens as a diagnostic IHC marker for metastatic BC (MBC). Hence, in the present study we evaluated the utility of TRPS-1 in diagnosing MBC in cytology specimens.MBC cases diagnosed on cytology specimens from January to October 2020 were included in the present study. Only cases with hormonal status available and ≥20 tumor cells on cell blocks were included in the study. The cell blocks were assessed for TRPS-1, GATA-3, and SOX-10 IHC marker positivity (intensity and percentage of tumor cells). The results were correlated with the specimen type (fine needle aspiration [FNA] versus body fluid) and various BC prognostic subgroups.We analyzed 61 cases, including 33 body fluid and 28 FNA (13 lymph node, 10 bone, 2 liver, 2 soft tissue, and 1 lung) specimens. TRPS-1 had 97.2% positivity in ER/PR+ (estrogen receptor/progesterone receptor-positive) MBC compared with GATA-3, which had 100% positivity in the same group. TRPS-1 showed high positivity in 35 of 37 cases (94.6%) and intermediate positivity in 1 (2.6%) and was negative/low positive in 1 case (2.7%). In contrast, GATA-3 showed high positivity for all 37 cases (100%). SOX-10 showed positivity in only 1 of 37 cases (2.7%), with intermediate positivity. In the HER2+ (human epidermal growth factor receptor 2-positive) group, TRPS-1 showed high positivity in 5 of 7 cases (71.4%), intermediate positivity in 1 case (14.3%), and negativity in 1 case (14.3%). However, GATA-3 showed high positivity in 6 of 7 cases (85.7%) and negative/low positivity in 1 case (14.3%). SOX-10 was negative in all 7 cases. In TNBC, TRPS-1 showed high positivity in 16 of 17 cases (94%) and intermediate positivity in 1 (5.9%), and GATA-3 showed high positivity in 9 (53%), intermediate positivity in 2 (11.8%), and low positive/negative in 6 of the 17 cases (35.3%). TRPS-1 expression was significantly higher than GATA-3 expression for the number of positive cases (P = 0.07), mean percentage of positive tumor cells (P = 0.005), and intensity of reactivity (P = 0.005). SOX-10 expression was present in only 5 of 17 cases (29%), with a mean percentage of positivity in the tumor cells of 26.5% and intensity of 0.8. No differences were found in the IHC results between the different specimen types (FNA versus fluid) in any group.TRPS-1 is a highly sensitive new diagnostic IHC marker for breast carcinoma, with a similar positivity rate in ER/PR+ and HER2+ BC compared with GATA-3 and a higher positivity rate than GATA-3 and SOX-10 in TNBC in cytology specimens. In particular, when only a few clusters of tumor cells are present on the cell block, TRPS-1 can be highly useful, because its mean percentage of positive tumor cells and intensity are higher than those of other IHC markers.

Psycho-social wellbeing infers psychological wellbeing and social wellbeing of an individual and whenever an individual is able to control his emotions or handle them in proper way then it is called as emotional adjustment. Psychosocial wellbeing and emotional adjustment of an adolescent brings a proper and positive direction to foster in life. The present study has been carried out to explore the level of psycho-social wellbeing and emotional adjustment level of adolescents on the basis of gender. The study also attempts to find out the relationship between psycho-social wellbeing and emotional aspect. Descriptive study was conducted among 115 adolescents (61 boys and 54 girls) who were selected by using proportionate stratified random sampling technique. For this purpose, 7 high schools were selected by simple random sampling technique. For the assessment of the psycho-social wellbeing and emotional adjustment, Wellbeing Index developed by prof. (Dr.) Vijayalaxmi Chouhan and Dr. Varsha Sharma (2016) and Adjustment Inventory for School Students developed by A.K.P. Sinha and R.P. Singh (revised 2017) has been used. Data was analyzed by using t-test and Pearson’s Product Moment Method. The study revealed that majority of students belong to the average level of psycho-social wellbeing and emotional adjustment level. There is a significant difference between adolescent boys and girls regarding the level of psycho-social wellbeing. But there exists no difference in the level of emotional adjustment. The study also revealed that there is no correlation between psycho-social wellbeing and emotional aspect of adolescents.

Background: Intravesical Bacillus Calmette-Guerin (BCG) is used as a standard adjuvant therapy for non-muscle invasive urothelial cancer. Most patients tolerate the treatment well, with mild side effects. Systemic complications are extremely rare, occur due to BCG dissemination and are associated with immunocompromised state and urothelial breach. Case presentation: We present a case of a 78-year-old male, a former smoker, with history of non-invasive urothelial carcinoma status post partial resection followed by intravesical BCG therapy. An autopsy was performed due to the sudden nature of his death. Autopsy showed multiple necrotizing granulomas in the brain, atrium, ventricles, lungs, kidneys, and urinary bladder. Stains for acid fast bacilli and fungi were negative. In addition, bilateral lungs showed evidence of bronchopneumonia secondary to cytomegalovirus. Conclusion: Granulomatous myocarditis arising from BCG therapy is extremely rare. Our patient with urothelial cancer treated with BCG developed multi organ granulomas, most likely due to a hypersensitivity reaction to intravesical BCG. Arrhythmia induced by granulomatous myocarditis was the cause of his death. Though there have been few cases of systemic BCG-osis causing fatal sepsis leading to death, a cardiac cause of death is unique.

PurposeThe paper makes an endeavour to explore the efficacy of service learning (SL) pedagogy in inculcating the value of diversity, equity and inclusion (DEI) with a focus on management education in India.Design/methodology/approachThe research methodology comprises a systematic survey of select relevant literature on SL and applying a novel approach to bring out certain key traits of SL initiatives. The paper also tries to decipher how the identified key traits could be regarded as contributing to the ethos of DEI among the learners. Based on insights from the systematic literature review and identified research gaps, an in-depth study of three SL initiatives in India, have been undertaken to demonstrate how implementation of the SL pedagogy in management education creates an impact on the attributes of DEI and inculcates an inclusive mindset.FindingsAlthough the design, process and learning outcomes of SL pedagogy varies depending on the context, there is commonality in the core attributes that emerges from the literature review which has a potential impact on inculcation of the values of inclusion and appreciation of diversity. The select case studies successfully expand on the list of these identified relevant attributes. The findings have also been corroborated by participants' reflection.Research limitations/implicationsThe paper is, however, limited in its scope of assessing the impact in creating an inclusive mindset. To gauge whether such impact is pervasive and persists in the long run, one needs to examine if these values are carried forward by the participants in their professional and daily life. It would, therefore, be more meaningful to carry out a primary survey of the participants, who took part in such SL initiatives, to understand whether the values have really been assimilated in the real life. This is outside the scope of this paper but does open the scope for further research.Practical implicationsThe paper would be highly relevant for the accreditation agencies who are increasingly prescribing the role that business schools can and should play towards inculcating the ethos of diversity and inclusion among future business leaders and managers. For the administrators of business schools and other higher education institutions who may be considering how to incorporate the ethos of diversity and inclusion in the curriculum and pedagogy, the paper will provide some direction through the SL route. The detailed exposition of the three SL initiatives will enlighten the administrators or the faculty responsible for designing and delivering any SL programme in other business schools or higher educational institutions as to how to go about developing and delivering such an initiative. To the extent such SL initiatives succeed in leaving a lasting impact on the participants regarding ethos of inclusion and diversity, the business implications in the long run could be immense.Social implicationsThe purpose of the paper by itself establishes its social relevance. The very fact that the paper is focused on SL initiatives that involve social problem-solving approaches through hands-on working on social projects and working with communities the social implications are rather obvious.Originality/valueGiven the paucity of information and analysis on potential fit of SL for fostering DEI especially in developing countries, the present paper contributes to the existing body of literature and aptly fills the void. It builds a theoretical construct relating SL with the traits of DEI and then bridges theory and practice by demonstrating the efficacy of three SL programmes in Indian context to internalise the elements of DEI.

This paper deals with the approximate computation of the reachability gramian for linear time-varying(LTV) systems over a finite time interval. To this end, we use state trajectory information obtained by simulating the system for various inputs and initial conditions. We propose three techniques for computing the reachability gramian. The first two techniques use state variable data of the original LTV system realization while the third uses state variable data of the modified adjoint of the original LTV realization. We demonstrate the workability of these methods with the help of a numerical example. Similar to our work, Perev (2018); Perev (2019) deal with computing finite interval gramians of linear time-varying systems using system trajectory information. However, our methods avoid the computation of the state-transition matrix, which is essential in Perev’s work.

The aim of this study is to assess the efficacy of cytology in omental or peritoneal lesions.A retrospective review of the pathology database for cytology cases of peritoneal or omental nodules over a 3-year period (2016-2018) was conducted. The cases consisted of either FNA only (FO); FNA and Core biopsy (FCB) or Touch prep and core biopsy (TCB). Cases were further divided based on the prior history of carcinoma. Concordance rates of cytologic diagnosis with histologic diagnosis were studied.Out of 104 cytology cases reviewed, 60 (57.7%) had prior history of cancer (PHC) and 44 (42.3%) had no prior history of cancer (NPHC). Of the cases with PHC, 43(71.66%) were recurrence, 10 (16.66%) were second cancer, and 7 (11.66%) were non-neoplastic lesions. Of the cases with NPHC, 38 (86.4%) had a second cancer diagnosis, while 6 (13.6%) were non-neoplastic. For FO only cases, 11 of 35 (31.4%) had follow up and 9 of 11 (81.8%) were concordant. For FCB cases, 6 out of 39 (15.4%) had follow up and 6 (100%) were concordant. For TCB cases, 9 out of 30 (30%) had follow up and 9 (100%) were concordant. A definite diagnosis was reached in 30/35, 39/39, and 29/30 cases in FO, FCB, and TCB, respectively.In summary, cytologic evaluation of omental lesions is an effective tool in providing accurate diagnosis and guiding further management. Also, the results based on our study show that the combined techniques are superior at reaching a definitive diagnosis.

The title of our panel promises to explore whether investor-state dispute settlement (ISDS) is a barrier, a facilitator, or neither regarding the global fight against climate change. This is an issue of urgent concern because there is a growing consensus that the world economy needs to transition away from fossil fuels aggressively to avoid the worst case climate scenarios, which would require a massive flow of investment out of fossil fuel production and into the production of renewable energy sources (RES). Broadly speaking, state policymakers have two sets of tools at their disposal to encourage that transition: (1) tools to encourage investment in RES (carrots); and (2) tools to discourage investment and hasten divestment in hydrocarbon production (sticks). One way to frame the question is whether the ISDS system—designed as it is to protect foreign investment in a largely policy-neutral way—acts more as a facilitator of carrot-side policies, more as a barrier to stick-side policies, or neither? Put somewhat differently, does a strong ISDS system that would facilitate RES investment necessarily cause regulatory chill of stick-side policies aimed at divestment from fossil fuels, or is there a way to harmonize these seemingly divergent goals?

BACKGROUND Next generation sequencing (NGS) to detect actionable genetic abnormalities is standard of care in advanced stage lung adenocarcinoma. Many studies have shown that the molecular results obtained from fine needle aspiration cytology material are comparable to those obtained from formalin-fixed tissue samples. We undertook this study to validate DNA extraction from cytology material for molecular studies and to find any correlation between DNA yield, pattern of tumour cells and tumour fraction. METHODS DNA was extracted from 34 cytology slides of pulmonary adenocarcinoma cases with predetermined EGFR mutation status. Cytology slides were reviewed for pattern of tumour distribution and tumour fraction. NGS was performed on five slides with variable DNA and compared with original results. RESULTS There were 14 alcohol-fixed and 20 air-dried smears. The mean DNA yield was 1.74 μg and median of 0.4 μg (range, 0.02-21 μg). Tumour fractions varied from 10% to 90%. No correlation was found between tumour fraction and DNA yield (P = 0.14). The mean DNA yield was high in slides with tumour throughout the slide (sheets or scattered clusters) as compared to rare scattered clusters and/or single cells. EGFR mutation was found in four of the five cases sent for NGS lung panel while one case revealed BRAF mutation. CONCLUSIONS DNA with good quantity and quality can be extracted from the cytology slides for NGS irrespective of type of fixation. DNA yield has better correlation with distribution pattern of tumour cells on the slides rather than tumour fraction.

Objectives:Pleural fluid evaluation is an effective modality for identifying actionable genetic mutations to guide therapy in lung carcinoma. Clinicians requesting molecular studies often send large volumes of fluid to be processed that is not possible or cost effective and is hence not standard of practice in most cytopathology laboratories. We wanted to establish the characteristics of an adequate specimen that would yield reliable results with current molecular testing platforms.Material and Methods:A review of 500 malignant pleural effusions, from pulmonary and non-pulmonary sources, was undertaken over a 4-year period. Of these 44 cases (from 42 patients) that were positive for primary lung adenocarcinoma were included in the study. Molecular analysis was performed on 42 specimens. A complete next generation sequencing (NGS) panel was performed on 36 specimens. Individual testing for estimated glomerular filtration rate, KRAS, anaplastic lymphoma kinase, and ROS1 was performed on six specimens. The number of malignant cells and proportion of tumor to non-tumor nucleated cells (T: NT) on cell blocks was recorded as 50%.Results:The minimum volume on which a complete NGS panel could be performed was 20 ml with cell count of 1000 and T: NT proportion of 20–50%. The minimum number of tumor cells required for successful molecular analysis for T: NT proportion of 50% was 300, 250, and 170 cells, respectively.Conclusion:We concluded that tumor cell proportion, rather than specimen volume, is of prime importance for determining the efficacy of pleural fluid for molecular studies. Evaluation of both absolute and relative numbers of tumor cells is critical for assessing the adequacy and predicting successful yield for molecular analysis.

Objectives Fine needle aspiration (FNAB) is an effective, minimally-invasive, inexpensive, diagnostic technique. The objective of this study was to evaluate the accuracy of FNAB in the diagnosis of bone lesions. Methods FNABs of bone lesions diagnosed at our institution over a 2-year period were retrospectively analyzed. Results 241 samples were reviewed. Patients included 121 males and 120 females, with ages ranging from 4-95 years (mean = 66 years). Of these 241 cases, 43.2% had FNAB and 56.8% had FNAB with core needle biopsy (CNB). The cytologic diagnoses were categorized as nondiagnostic, benign, atypical, suspicious, and positive for malignant cells. Total of 84.3% of FNABs were diagnostic. Of the malignant cases, 78.5% were metastases from nonosseous primary sites, 17.1% were lymphoproliferative lesions, and 4.4% were primary bone tumors. The most common site of metastasis was the pelvic bones (43.5%) followed by the vertebral column (38.7%). Breast (21%), lung (12.7%), and prostate (11.3%) were the most common identifiable primary site in metastatic cases. FNA smears and cell blocks allowed identification of metastatic lesions in 94.3% cases with immunohistochemistry (IHC). Obtaining a concomitant CNB did not result in a statistically significant increase in overall diagnostic yields (P = .20), ascertaining presence of metastatic lesion (P = .96) or ability to identify site of primary tumor in cases of metastasis (P = .53) compared to FNAB alone. Diagnostic accuracy was improved by reviewing clinical history, performing cell block, and IHC. Conclusions FNAB is a reliable tool for diagnosis of bone lesions with comparable diagnostic sensitivity to CNB.

Merkel cell carcinoma (MCC) is a rare entity that most commonly arises from the skin. Angiosarcoma (AS) is a rare malignancy with a predilection for elderly males, has endothelial differentiation and a notoriously poor prognosis despite aggressive therapy. Herein, we report an angiosarcoma colliding with a MCC, in a patient with a past medical history of squamous cell carcinoma, status-post radiation therapy. More specifically, our case represents a collision tumor, a rare entity composed of two histologically distinct neoplasms which coincide together at the same location. This case represents the first documented report of such a presentation. With that being said, its clinical course, prognosis, pathogenesis, and molecular profile, currently remains unclear. Importantly, neoplasms are increasingly being found to be associated with radiation therapy, of which our patient had received. Ultimately, however, with the lack of c-MYC immunohistochemical staining, and a short duration between radiation exposure and presentation, the AS in our case was likely coincidental.

The Paris Agreement advances a heterogeneous approach to international climate cooperation. Such an approach may be undermined by carbon leakage—the displacement of emissions from states with more to less stringent climate policy constraints. Border carbon adjustments offer a promising response to leakage, but they also raise concerns about their compatibility with international trade law. This Article provides a comprehensive analysis of border carbon adjustments and proposes a way to design them that balances legal, administrative, and environmental considerations.

BRAF (v-raf murine sarcoma viral oncogene homolog B1) and MEK (mitogen-activated protein kinase kinase) inhibitors have been shown to improve clinical outcomes in tumours presenting with mutations in the BRAF gene. The most common form of BRAF mutation is V600E/K and has been shown to occur in thyroid cancers. Treatment data for patients harbouring less frequent BRAF mutations are limited. In vitro studies have shown that mutations in codons 599–601 increase kinase activity similar to that in V600E mutations, which suggests that BRAF and MEK inhibitors could be an effective treatment option. Here, we report a case of a patient with thyroid carcinoma harbouring a rare amino acid insertion in codon 599 of the BRAF gene (T599_V600insT) treated with a BRAF and MEK inhibitor.

Background The authors' fine-needle aspiration (FNA) clinic opened in 2010, allowing cytopathologists to increase their proficiency and experience in FNA performance. Here, they report their 5-year experience. Methods The FNA clinic log book and the institution's database were retrospectively reviewed to record patients' demographics, the number of FNAs performed per year by each cytopathologist, the number of passes, rapid on-site evaluation (ROSE) and diagnosis, adequacy-diagnosis concordance, and follow-up histology when available. The numbers and types of cases per year and variations among cytopathologists were compared. Results In total, 474 cases were identified within a 5-year time-frame. The discrepancy rate between the on-site and final diagnoses decreased progressively, from 4.4% to 2.4%. The nondiagnostic rate decreased from 2011 to 2015, with the exception of 2014, when an increase was noted, possibly because of a lower number of cases. Cytopathologists' performance was assessed over a 3-year period. The number of passes for each FNA decreased over time. The cytology-histology concordance was 100% over time for all cytopathologists. There was a diagnostic discrepancy between the ROSE and final diagnoses for 3 of 104 cases in 2013 and for 3 of 124 cases in 2015. The total number of passes was not consistently recorded until 2014, when a final report template was instituted. The technique improved over time because of accumulated experience, constant practice with phantoms, and attending the College of American Pathologists' training in ultrasound-guided FNA. Conclusions FNAs performed by cytopathologists have a high-rate of ROSE/adequacy and a low diagnostic discrepancy rate. Cytopathologists as interventionalists provide optimal care and excellent patient satisfaction. Cancer Cytopathol 2017;125:161-168. © 2016 American Cancer Society.

Background The Afirma gene expression classifier (GEC) is being increasingly utilized to confirm the benign nature of indeterminate FNA cytology results thus avoiding unnecessary surgical procedures. However the “suspicious” result of the Afirma GEC does not classify these indeterminate nodules further in determining appropriate management. This study investigated the outcome of the thyroid nodules deemed to be “suspicious” by the Afirma GEC in a high risk population. Methods The pathology database was searched for all thyroid nodules with Afirma test results over a three year period, 2013–2015. All thyroid nodules with a “suspicious” Afirma GEC result were investigated. Patient medical records were retrospectively reviewed for clinical history, FNA results, radiologic findings, management and follow-up. Results Afirma result was suspicious in 69 cases. On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). On surgical resection 82% were benign, with 45% follicular adenoma (FA), and 37% nodular goiter (NG). The remaining 18% were malignant. Conclusion The rate of malignancy in nodules suspicious by Afirma was 18.3% (11/60). The rate of malignancy in nodules suspicious for neoplasm (SN) on cytology interpretation was 31.2% (5/16). False positive rate of Afirma was 56% (32/57). We conclude that cytology interpretation has a higher rate of predicting malignancy, in nodules interpreted as SN, when compared with the Afirma test, by almost twofold Diagn. Cytopathol. 2017;45:308–311. © 2016 Wiley Periodicals, Inc.

Introduction The purpose of the study is to determine the impact of subdividing the “atypical” cytology interpretation into two groups: Atypical urothelial cells of uncertain significance (AUC-US) and Atypical urothelial cells suspicious for high-grade urothelial carcinoma (AUC-H/SHGUC), on management of patients with no prior history of UC. Materials and method This is a retrospective study of “atypical” urine cytology with subsequent tissue examination occurring within six months. Cytology reports with “atypical” interpretation were reclassified into AUS-UC and AUC-H based on morphologic features identified by the Johns Hopkins system and the Paris system for urine cytology. Follow-up and categorical outcomes were compared between the reclassified AUC-US and AUC-H groups. Results There was no significant difference (P

Background EBUS-TBNA is a minimally invasive, reliable technique with high sensitivity and accuracy. ROSE plays a crucial role in triaging specimens to guide management. This study analyzes aspirates that were deemed "adequate" on ROSE, but inconclusive upon final cytologic interpretation. Design EBUS-TBNAs from 2015 and 2016 were retrospectively reviewed and analyzed for ROSE adequacy versus final cytologic diagnosis. Concurrent and subsequent procedures were evaluated to determine the outcome of ROSE-adequate cases with inconclusive final cytologic diagnosis of non-diagnostic (ND), atypical (ATY), and suspicious for malignancy (SUS). Interpretation at ROSE was determined to be "appropriate" if published criteria for lymph node adequacy were met. Results A total of 606 cases of EBUS-FNA with ROSE were obtained of which 61% were deemed adequate. 5% of cases deemed "adequate" at ROSE resulted in inconclusive final interpretation with 4 ND, 7 ATY, and 6 SUS. Their distribution, anatomic location, presence or absence of diagnostic aspirate, appropriateness of ROSE adequacy statement, and any concurrent or subsequent procedures on the same or different site as well as any impact on management was reviewed. Cytotechnologist (CT) experience ranged from 1 to 25 years. Conclusions ROSE and final cytology discrepant cases formed a very small fraction of total number of EBUS-TBNA cases with onsite evaluation. None of these discordant cases had any major clinical impact. There will remain a small fraction of cases that will be inappropriately deemed as "adequate" at ROSE due to the challenging nature of the procedure.

Applying carbon charges, not trade tariffs, to imports would bolster the Paris Agreement, argue Michael Mehling and colleagues. Applying carbon charges, not trade tariffs, to imports would bolster the Paris Agreement.

Introduction Currently, molecular studies are widely used as a guiding tool in further management of cytologically indeterminate thyroid nodules. At our institution, clinicians have recently expressed concern over receiving "less positive molecular results" upon switching from an extended 14 gene mutation panel (EGMP) to a 7 gene mutation panel (GMP). Our goal is to compare outcomes of these two tests in regards to the performance characteristics and clinical impact. Materials and methods All thyroid fine-needle aspiration (FNA) biopsy specimens sent for molecular studies from 2016 to 2017 were retrospectively studied. Cytopathology diagnosis, pertinent clinical findings, molecular results, and follow-up (F/U) surgical and cytology diagnoses were recorded. Results Of the total 165 cases sent for molecular tests 86 (52%) were GMP and 79 (47%) EGMP. There were 21 (24%) and 40 (50%) cases with positive GMP and EGMP results, respectively. Within these positive cases (n = 61), there were a total of 33 (54%) patients who underwent surgical resection and 28 (45%) patients had no follow-up. The molecular findings and surgical pathologic diagnoses obtained are illustrated in Figures 1 through 4 for GMP and EGMP, respectively. Conclusions The selection of molecular testing should be directed toward optimizing patient care and facilitate clinical management. This quality assurance study helped in understanding the complexities associated with test selection best suited for our institution and in educating clinicians.

Background The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is based on risk stratification. Our study is a retrospective review of salivary gland fine needle aspiration cytology (FNAC) with the goal of determining the risk of malignancy (ROM) in each of the categories proposed by the MSRSGC. Methods FNAC of salivary gland lesions with corresponding surgical resection specimens were retrieved over a 5-year period. Metastatic tumors were excluded. BothFNAC and corresponding surgical resections were reviewed blindly and classified as per criteria published by the MSRSGC. The ROM for each of the diagnostic categories was determined and compared with the ROM published by the MSRSGC. Results The total number of entities and ROM in 199 reviewed cases were as follows: Nondiagnostic 18 (9.2%) (ROM 0%), non-neoplastic 4(2%) (ROM 0%), atypia of undetermined significance (AUS) 12(6%) (ROM 33%), benign neoplasm 118(59.2%) (ROM 0.8%), salivary gland neoplasm of uncertain malignant potential (SUMP) 22(11%) (ROM 40.9%), suspicious for malignancy 3(1.5%) (ROM 100%), malignant 22(11%) (ROM 100%). Conclusion The ROM reported in our study was mostly concordant with ROM published by the MSRSGC. This classification is helpful for the management of categories; nondiagnostic, non-neoplastic, benign neoplasm, suspicious for malignancy and malignant. The management is not standardized for the category, salivary gland neoplasm of uncertain malignant potential, as clinical information plays an important role in planning surgical procedures at an individual basis. Further studies will need to be performed using this new classification to help define appropriate management and predict ROM more accurately.

Aims: This study was done to clinically verify the symptomatology of Formic acid by ascertaining the symptoms improved during verification and to incorporate new findings (if any) to the known symptomatology of Formic acid. Methods: A multicentric observational clinical verification study was conducted at nine research centers of Central Council for Research in Homoeopathy to verify the proving symptoms of rarely used medicine, Formic acid. Two hundred and seventy participants having symptomatological similarity with Formic acid were included and prescribed in 6C, 30C, 200C, and 1M potencies, as per need of each case. The data were compiled in a specially designed Excel spreadsheet for further analysis. The collected data were presented in terms of descriptive statistics. Prevalence of the symptoms in the responding and nonresponding population was compared using Chi-square or Fisher's exact test. Results: Out of 266 followed up patients, 215 cases responded (80.8%) with 95% confidence interval of 0.75-0.85. The number of symptoms verified was as follows: proving symptoms (n = 11) and new observations (n = 22). The widely emerged new general symptoms, i.e., clean tongue, disturbed sleep, loose stool, tastelessness, and profuse sweat may be worth consideration during prescription of Formic acid. Conclusions: The proving symptoms of Formic acid could be verified clinically, but the correlation of patient-specific symptom needs cautious interpretation. Further replication on larger sample and estimation of likelihood ratio in real-time clinical practice are needed.

Background: Intraductal tubulopapillary neoplasm of the pancreas (ITPN) is a rare tumor which was first described in 2009. We report a case with cytologic and histologic findings and discuss the pitfalls in diagnosing this entity on cytology. Case: An 82-year-old female presented with a pancreatic body mass measuring 3.3 cm. Endoscopic ultrasound-guided fine-needle aspiration showed cells in cohesive clusters with high-grade nuclear atypia. Immunohistochemistry (IHC) showed the neoplastic cells to be positive for CK19, CD56 and chromogranin (focal). Ki-67 was high at 50-60%, and chymotrypsin was negative. On the basis of this pattern of staining, the cytologic diagnosis rendered was ‘favors high-grade neuroendocrine carcinoma'. Distal pancreatic resection revealed a cystic 4-cm mass. Histologically, the tumor was seen arising from the duct with a solid growth pattern, tubule formation and papillary structures. IHC showed the tumor to be negative for chromogranin, synaptophysin, CD56, trypsin and chymotrypsin. The Ki-67 index was 70%. The final diagnosis was noninvasive ITPN. Conclusion: We review the literature and discuss the cytomorphologic features and IHC patterns characteristic of this new entity on cytology material in addition to the pitfalls of the cytologic diagnosis.

BACKGROUND Cadherin-17 (intestinal peptide-associated transporter) and SATB2 (SATB homeobox 2) immunoexpression has recently been described in surgical pathology to have value in establishing the colorectal origin of metastatic adenocarcinoma. However, to the authors' knowledge, the role of these markers in metastatic colorectal adenocarcinoma (MCA) in cytology has not been addressed to date. In the current study, the authors evaluated the contribution of cadherin-17 and SATB2 to the diagnosis of MCA in cytology specimens and compared these two novel markers with the standard gastrointestinal immunohistochemistry panel in an attempt to identify the optimal panel. METHODS A total of 43 MCA cytology cases and 68 metastatic noncolorectal adenocarcinoma (non-MCA) cytology controls were stained for SATB2; cadherin-17; and the standard panel of cytokeratin (CK) 7, CK20, and Caudal-Type Homeobox Transcription Factor 2 (CDX2). Staining intensity and percentage of positive cells were recorded. Sensitivity and specificity values for immunostains individually and in combination were computed and compared. RESULTS Despite specificities of 83.8% and 91.2%, respectively, for cadherin-17 and SATB2, when critically examining the new immunostains together with the standard panel, there was no significant difference noted with regard to prediction of MCA (vs non-MCA) compared with the standard panel alone (P

The November 2014 breakthrough on the Trade Facilitation Agreement might have gone some way in infusing a new lease of life to the WTO as an institution, the same can hardly be said for most of the other Doha Round issues that still appear to be trapped in a blind alley. The issue of the creation of a multilateral register of Geographical Indications (GIs) for wines and spirits is one such area. Despite several years of wrangling, arriving at a landing zone on this issue still appears to be a far-fetched dream, if the mood expressed by the WTO Members in the December 2014 informal meeting on the multilateral register is anything to go by! Written against this backdrop, the present article has two objectives. First, it makes an attempt to trace the historical, legal as well as economic reasons underlying the protracted debates on GIs under the WTO and beyond – which have widely been referred to as one between the ‘Old World’ (e.g., the EU, Switzerland) and the ‘New World’ (e.g., the US, Australia, Canada, Argentina, Chile, etc.). Second, the article provides a snapshot of the long-drawn WTO negotiations on the multilateral register for wines and spirits under the Doha Round.

BACKGROUND The annual incidence of urothelial carcinoma continues to increase, and it is projected that greater than 70,000 new cases will occur in the year 2015. However, as much as 23% of cytologic specimens will demonstrate some degree of atypia without meeting the criteria for urothelial carcinoma and thus will be reported as atypical. METHODS The authors conducted 2 laboratory information searches and 1 survey. In total, 311 patients who had atypical cytology-biopsy pairs available were identified from the initial data search. The second data search identified 942 patients who had fluorescence in situ hybridization (FISH) results available. RESULTS There was fair agreement between FISH results and cytology results (κ = 0.34; 95% confidence interval, 0.27-0.41). The analysis did not reveal any benefits of using additional atypical subcategories beyond the 2 suggested in the literature. It was determined that 2 strategies would provide an optimal balance: standardizing patient management and facilitating the adoption of universally recognized templates. CONCLUSIONS When combining cytology and the 2-tiered atypical classification system with FISH testing, a marked increase in sensitivity and an accompanying decrease in specificity were observed compared with either test individually. Thus, highly sensitive FISH testing may help to identify high-risk patients among those in the group with uncertain atypical findings. Cancer (Cancer Cytopathol) 2015. © 2015 American Cancer Society.

BACKGROUND Bethesda guidelines do not require presence of transformation zone (TZ) for a cervical Pap test to be deemed adequate. However, clinicians are concerned with specimens that are reported to lack TZ. METHODS We analyzed 566 ThinPrep cases reported as negative for intraepithelial lesion or malignancy (NILM) with no cervical abnormality detected in previous 4 years (2007-2011). These cases were divided into two cohorts; those with TZ (ETZ) and those without TZ (NTZ). Patients' age, HPV status, time of sample collection (>14 days after last menstrual period), subsequent management, interval of subsequent Pap test ( 3 years), and result of subsequent examination were compared over a 5-year period. RESULTS The rate of abnormal Pap test on 5 year follow-up was not statistically significant (P

Background: This study investigates the use of The Paris System (TPS) for Reporting Urinary Cytopathology and examines the performance of individual and combined morphological features in atypical urine cytologies. Methods: We reviewed 118 atypical cytologies with subsequent bladder biopsies for the presence of several morphological features and reclassified them into Paris System categories. The sensitivity and specificity of individual and combined features were calculated along with the risk of malignancy. Results: An elevated nuclear-to-cytoplasmic ratio was only predictive of malignancy if seen in single cells, while irregular nuclear borders, hyperchromasia, and coarse granular chromatin were predictive in single cells and in groups. Identification of coarse chromatin alone yielded a malignancy risk comparable to 2-feature combinations. The use of TPS criteria identified the specimens at a higher risk of malignancy. Conclusion: Our findings support the use of TPS criteria, suggesting that the presence of coarse chromatin is more specific than other individual features, and confirming that cytologic atypia is more worrisome in single cells than in groups.