Prostatic aspiration cytology

The results of cytological examination of 1280 transrectal fine needle aspiration biopsies of the prostate from 1122 patients over a period of 10 years are given. The technique was used for the diagnosis of prostatic carcinoma. The microscopic appearances including classification according to differentiation are described and illustrated. Of the 1280 aspirates examined 467 were diagnosed as carcinoma. In 469 cases, it was possible to compare the cytology with the results of histological examination. In this group, 255 cases of prostatic carcinoma were diagnosed: 53% by both cytology and histology, 20% by cytology alone and 27% by histology alone. The findings show that the Franzen needle biopsy technique has an important role to play in the diagnosis of carcinoma of the prostate.     

Histiocytic necrotizing lymphadenitis diagnosed by conventional cytology and liquid based cytology

Histiocytic necrotizing lymphadenitis (HNL; Kikuchi-Fujimoto disease) is a rare benign disorder. The diagnosis of HNL is established on recognizing the characteristic histologic findings from biopsy of the enlarged lymph nodes. Though diagnosis of HNL by fine-needle aspiration (FNA) was reported, the characteristic fine-needle aspiration cytologic features with conventional cytology and a liquid based cytology test (LCT) have not been well documented. In this study, 42 cases of suspicious necrotic lymph nodes were subjected to cytology and biopsy diagnosis. The lymph nodes were aspirated using a 10 mL disposable syringe with the percutaneous ultrasound guided. Samples were used for conventional cytology and LCT. Among 42 cases of suspicious necrotic lymph nodes, 37 of cases were histologically confirmed as HNL; 3 of cases were hyperplasia of lymphoid tissue; 1 case was tuberculosis of lymph node, and 1 case was classical Hodgkin lymphoma (nodular sclerosis type). 31 out of 37 (83.8%) cases of HNL were diagnosed by conventional cytology, 33 out of 37 (89.2%) were diagnosed by LCT. Our results indicate that no significant difference on accuracy rate between conventional cytology and LCT, but LCT has its advantages in the diagnosis of HNL.     

Cell block cytology. Improved preparation and its efficacy in diagnostic cytology

Cell blocks prepared from residual tissue fluids and fine-needle aspirations can be useful adjuncts to smears for establishing a more definitive cytopathologic diagnosis. They can be particularly useful for categorization of tumors that otherwise may not be possible from smears themselves. A modified cell block technique using an improvised ethanol formalin fixative (Nathan alcohol formalin substitute) followed by a simple paraffin processing schedule is described. This improved preparation offers excellent cytomorphologic features corresponding closely to cells in Papanicolaou-stained smears and ensures optimal preservation of histochemical and immunocytochemical properties. The technique is simple and reproducible and uses routine safe laboratory chemicals. The efficacy of cell blocks also is discussed.     

“SMART” cytology: The next generation cytology for precision diagnosis

Cytology plays an important role in diagnosing and managing human diseases, especially cancer, as it is often a simple, low cost yet effective, and non-invasive or minimally invasive diagnostic tool. However, traditional morphology-based cytology practice has limitations, especially in the era of precision diagnosis. Recently there have been tremendous efforts devoted to apply computational tools and to perform molecular analysis on cytological samples for a variety of clinical purposes. Now is probably the appropriate juncture to integrate morphology, machine learning, and molecular analysis together and transform cytology from a morphology-driven practice to the next level – “SMART” Cytology. In this article we will provide a rather brief review of the relevant works for computational analysis on cytology samples, focusing on single-cell-based multiplex quantitative analysis of biomarkers, and introduce the conceptual framework of “SMART (Single cell, Multiplex, AI-driven, and Real Time)” Cytology.     

Molecular testing in cytology

In the era of personalized medicine, molecular testing plays a critical role in patient care. The rapid advance of molecular techniques, especially next-generation sequencing, makes molecular diagnosis feasible in daily practice. Molecular testing can be used as a valuable ancillary test to increase diagnostic sensitivity and specificity, especially in small biopsy or cytology samples. In addition, molecular testing plays an important role in selecting patients for appropriate treatment by detecting therapeutic and predictive biomarkers in tissue or cytology samples. Molecular studies can be applied in all cytology samples, sometimes with better results than histology. As molecular testing has become essential for patient care and is often requested to be performed in cytology samples, it is critical for cytopathologists to understand the basics of molecular diagnostic methods, indications for molecular testing, and how to best utilize different cytologic samples for this purpose. In this special issue, experts in various areas of cytopathology and molecular pathology review the literature and discuss the basics of molecular techniques and the application of molecular testing in various types of cytology samples. It is our hope that after reading the articles in this special issue, the readers can know better about the possibilities of molecular cytology, a very exciting field of pathology.     

Crush cytology of pituicytoma

The crush cytology of a pituicytoma is reported. The lesion was resected from a 54-yr-old man with a 7-mo history of headache. The intraoperative crush smears revealed plump spindle cells with elongated, nonwavy nuclei, and moderate, finely granular cytoplasm with distinct cytoplasmic borders. These cells were arranged in cohesive fascicles exhibiting a storiform pattern focally. Cytologically, this lesion can be differentiated from pituitary adenoma, astrocytoma, meningioma, and schwannoma.     

Critical values in cytology

The concept of critical values (CVs) is well established in clinical pathology, and has only recently been suggested in surgical pathology. To evaluate CVs in cytology, we reviewed 2,000 cytology reports at two large academic medical centers. Cases considered CV included unexpected malignancy, disagreement between immediate interpretation and final diagnosis in fine-needle aspirations (FNAs), and evidence of microorganisms in non-gynecology (non-GYN) and FNA specimens. We identified 52 CV cases (2.6%), including 0.25% (1/400) GYN, 1.88% (15/800) non-GYN, and 4.5% (36/800) FNA. Most of these (42 cases) were unexpected malignancies. Documentation of physician notification was present in 30 out of 52 cases. We also did a survey with 22 cytopathologists and 13 clinicians at large academic medical centers. The participants were asked to rate 18 different possible CVs from 1 to 3 as follows: (1) no phone call necessary, (2) phone call within 24 hr, (3) phone call as soon as possible (ASAP). Participants could also list additional diagnoses they believed constituted a CV. Most respondents agreed on the need for a phone call ASAP in many situations, and important additional CV cases were suggested. We suggest that a consensus conference of leaders in anatomic pathology and clinicians might prove useful to propose guidelines for CVs in cytology.     

Testicular cytology in azoospermia

Two hundred-seventy-five azoospermic mates were subjected to fine-needle aspiration (FNA) cytologic study of testis with the aim of determining the cause of azoospermia; 534 aspirates from these patients were classified as follows: normal spermatogenesis (162), hypospermatogenesis (mild, moderate, or severe, 226), absence of spermatogenesis (130), maturation arrest (36), Sertoli-cell-only syndrome (14), and Leydig-cell hyperplasia (3). The morphology of cells was excellent in the cytologic preparations and various spermatogenic cells and Sertoli cells were easily recognized. Leydig cells were uncommonly seen, except in cases of Leydig-cell hyperplasia. Degenerative changes, possibly due to obstruction, were seen in 104 cases. The procedure was well tolerated by the patients. We conclude that FNA cytology is a useful investigative modality in the evaluation of azoospermic males.