Cytological features of choricarcinoma in a Pap smear: A case report and literature review

Choriocarcinoma is an aggressive malignant trophoblastic tumor that mostly occurs during reproductive years. Cytological features of choriocarcinoma in gynecologic Pap smears have not been described. Herein, we report a case of choriocarcinoma in a Pap smear of a patient who had a history of choriocarcinoma with metastatic disease. Diagn. Cytopathol. 2016;44:324–328. © 2015 Wiley Periodicals, Inc.     

Metastatic urinary tract cancers in pap test: Cytomorphologic findings and differential diagnosis

Although the cervical Pap test was devised for the detection of primary cervical neoplasia, it can provide additional diagnostic information, and in some cases, be diagnostic for noncervical processes. The diagnosis of metastatic extrauterine cervical cancers on the Pap test is extremely rare; and in most cases, it is the result of an ovarian or fallopian tube primary. Further, urinary tract cancers, including renal and urinary primaries are exceedingly rare. To our knowledge, six surgical cases of metastatic clear cell renal cell carcinoma (RCC) have been described. We report the first case of metastatic clear cell RCC detected on the cervical Pap test. Additionally, to our knowledge, we report the second case of metastatic high‐grade urothelial carcinoma detected on the cervical Pap test. Both patients had a history of malignancy, which underscore the importance of broadening the differential diagnosis to rule out cytomorphologic features consistent with a patient's primary diagnosis when interpreting the cervical Pap test. Diagn. Cytopathol. 2016;44:1078–1081. © 2016 Wiley Periodicals, Inc.     

Cokeromyces recurvatus isolated from pleural and peritoneal fluid: case report.

The zygomycetous mold Cokeromyces recurvatus was isolated from the pleural and peritoneal fluids of a 64-year-old man with a history of peptic ulcer disease and alcohol abuse. The patient presented to the hospital with severe abdominal pain and a ruptured duodenal ulcer. This is one of the few times that C.recurvatus has been isolated from a human source, and the organism may have contributed to the death of this patient.     

Screening for cervical cancer in HIV-infected women receiving care in the United States

OBJECTIVE: We examined the sociodemographic, clinical and provider factors associated with screening for cervical cancer among HIV-infected women. METHODS: We studied a national sample representing 43,490 women receiving treatment of HIV infection who completed first follow-up surveys of the HIV Cost and Service Utilization Study (HCSUS). All women were asked, "In the past 12 months, have you had a Pap test?" Women reporting an abnormal Pap test result were asked whether they had been told antibiotics could cure abnormal cells, and whether they were scheduled for another Pap test or for a colposcopy within 3 months. RESULTS: Of the population represented, 81% had had a Pap test in the past 12 months. Women who reported having a gynecologist and primary care physician at the same clinical site were almost twice as likely (odds ratio, 1.9; 95% confidence interval, 1.3-3.0) as other women to report Pap testing. Among women who reported abnormal Pap test results and were not told antibiotics could cure abnormal cells, 95% were scheduled for a repeat Pap test or colposcopy, but 15% of the women had not received their repeat Pap test or colposcopy. CONCLUSION: Although Pap test rates and appropriate referral for abnormal findings were high among HIV-tested women, many women with initially abnormal Pap test results did not actually receive follow-up Pap testing or colposcopy. Providing gynecologic care at the same site as primary HIV care would likely improve delivery of needed gynecologic care for women.     

Poorly differentiated squamous cell carcinoma of the cervix with sarcomatoid differentiation: Report of a case with cytohistological correlation

Sarcomatoid squamous cell carcinoma (SSCC) of the uterine cervix is a rare malignancy with uncertain pathogenesis and aggressive clinical behavior. The diagnosis of this tumor poses a challenge to the cytopathologist since accurate diagnosis is based on identification of two malignant components, that is, epithelial and sarcomatoid. Most cases usually lack the sarcomatoid component on Papanicolaou test (Pap test). Therefore, a poorly differentiated carcinoma or malignant neoplasm is the most often rendered diagnosis. To date, less than 20 cases have been reported. Most of these cases were diagnosed by histopathologic findings. To our knowledge, cytomorphologic findings of SSCC on a liquid‐based Pap test, with utility of cell block sections, in recognition of the two components of tumor, with follow‐up histopathologic correlation have not been described. A case of SSCC occurring in a 57‐year‐old postmenopausal woman, describing the cytologic features on a liquid‐based Pap‐test, histopathologic findings of subsequent cervical biopsy, differential diagnosis, and role of ancillary studies are illustrated and discussed. Diagn. Cytopathol. 2017;45:137–142. © 2016 Wiley Periodicals, Inc.     

American society of cytopathology workload recommendations for automated pap test screening: Developed by the productivity and quality assurance in the era of automated screening task force

Based on current literature and the best available research to date, the current FDA workload limits for automated image‐assisted screening, including the ThinPrep Imaging System and the FocalPoint GS, of 100 slides/day (imaged only slides counted as 0.5) are extremely high and may be associated with significant reduction in sensitivity. This task force has proposed six recommendations relating to cytotechnologist (CT) workload in automated image‐guided Pap test screening, which have already been endorsed by major pathology professional societies. These evidence‐based recommendations, however, pertain only to gynecologic specimens with image‐assisted screening, as there is no current available data to justify modifying screening practices regarding non‐gynecologic specimens. The proposed recommendations are as follow: 1) CT workday should not include more than 7 hours of Pap test screening in a 24‐hr period, and an 8‐hr shift day must include at least 2 paid mini‐breaks of 15 minutes each and a 30‐minute lunch break. 2) Future Studies examining CT workload should use actual hours of screening rather than lesser number of hours extrapolated to 8‐hour days. 3) Average laboratory CT workload should NOT exceed 70 slides/day (slides counted per 2010 FDA bulletin). 4) Proportion of imaged slides that undergo full manual review should be at least either 15%, or twice (2×) the epithelial cell abnormality (ECA) rate, whichever is greater. 5) ECA‐adjusted workload measure is a promising method for calculating and monitoring CT workload, but further studies of this method are necessary before full endorsement. 6) CT productivity and workload limits are just one aspect of a good quality assurance program in a cytology laboratory, so other quality indicators to assess CT performance are essential. Diagn. Cytopathol. 2013. © 2012 Wiley Periodicals, Inc.     

Gynecologic health in cartilage‐hair hypoplasia: A survey of 26 adult females

Cartilage‐hair hypoplasia (CHH) is a rare metaphyseal chondrodysplasia significantly affecting adult height and quality of life. Immunodeficiency and increased risk for malignancies contribute to significant morbidity. Little is known about gynecologic health in CHH. We performed a questionnaire study of 26 women (mean age 42.3 years) with genetically confirmed CHH, inquiring about pubertal development, menstrual cycle, use of contraception, pregnancies, gynecologic infections, and gynecologic cancers. Mean age at menarche and menopause was 12.7 and 46.1 years, respectively. Mean length of menstrual cycle was 27 days. Contraception was used by 76%, most commonly condom (60%), and combined contraception (60%). Despite significant short stature (mean height 121 cm) and potentially small pelvic diameters, 10 CHH women (38%) had been pregnant. Six of these women reported miscarriages and three had, induced pregnancy terminations. Eight women had in total, 19 deliveries. Abnormal Pap smear was reported in five patients and cervical cancer once. Our findings of normal timing of puberty and menopause suggest a fairly normal length of the fertility period in women with CHH. However, many patients expressed concerns regarding the safety of pregnancy and lack of prepregnancy counseling. Immunodeficiency may predispose CHH women to prolonged HPV infections. This study highlights the importance of careful gynecologic follow‐up for these patients.     

Myeloid sarcoma identified on liquid‐based cervical cytology samples: A report of two cases

The purpose of the Papanicolaou (Pap) smear is to detect primary squamous lesions of the uterine cervix. Although most successful at detection of squamous lesions, the Pap may also detect metastatic carcinomas, sarcomas, and melanomas. We report two rare cases of myeloid sarcoma (MS) of the uterine cervix identified on screening Pap smears with concurrent confirmatory cervical biopsies. The purpose of our study is to identify and report cytologic features of MS on Pap smears utilizing a liquid‐based ThinPrep method, which has not been previously documented in literature. Two Pap smears were identified from the pathology laboratory information system, both with positive cervical biopsy findings of MS. Both women, age 40 and 39, presented with ureteral obstruction, hydronephrosis, and past medical histories significant for acute myeloid leukemia (AML). On imaging, cervical masses were identified, and subsequent work‐up with Pap smears and biopsies were performed. Cytologic examination of the ThinPrep Pap smears were negative for squamous intraepithelial lesion. Atypical hematologic cells were seen in the background with irregular nuclear contours, increased nuclear to cytoplasmic ratios, variably prominent nucleoli, and variable amounts of agranular cytoplasm. The biopsy confirmed these findings to represent MS. MS is defined as a tumor mass of myeloblasts or immature myeloid cells occurring in an extramedullary site. This rarely involves the female genital tract, about 50 reported cases. Although very rare, MSs in the setting of a history of AML are able to be identified on liquid‐based ThinPrep smears.     

A case of plasmablastic lymphoma diagnosed on liquid‐based pap test

Primary gynecological lymphomas are rare and difficult to diagnose with Pap test. Herein, we report an uncommon case of plasmablastic lymphoma in a 61‐year‐old female with human immunodeficiency virus that presents with vaginal bleeding. The following case report shows the cytological features on liquid‐based Pap test, cell block studies with diagnostic immunohistochemistry, discussion of the diagnostic difficulties, and a literature review. Diagn. Cytopathol. 2014;42:956–958. © 2013 Wiley Periodicals, Inc.     

Cokeromyces recurvatus, a mucoraceous zygomycete rarely isolated in clinical laboratories.

Cokeromyces recurvatus Poitras was isolated from an endocervical specimen obtained from a 37-year-old, insulin-dependent diabetic. The patient's diabetic condition had been well controlled for 10 years, and she had no other known medical problem. This is only the fourth time that this zygomycete has been recovered from a human source. While there was no evidence of tissue invasion in the present patient, the observation of fungus-like structures in two separate Papanicolaou-stained cervical smears prepared 1 year apart suggests that C. recurvatus may be capable of colonizing endocervical tissue.     

The many faces of SRPK1

Serine–arginine protein kinase 1 (SRPK1) phosphorylates proteins involved in the regulation of several mRNA‐processing pathways, including alternative splicing. SRPK1 has been recently reported to be overexpressed in multiple cancers, including prostate cancer, breast cancer, lung cancer, and glioma. Several studies have shown that inhibition of SRPK1 has anti‐tumoural effects, and SRPK1 has therefore become a new candidate for targeted therapies. Interestingly, in terms of molecular mechanism, SRPK1 seems to act heterogeneously, and has been reported to affect several processes in different cancers, e.g. angiogenesis in prostate and colon cancer, apoptosis in breast and colon cancer, and migration in breast cancer. A recent report adds to this puzzle, showing that the main effect of SRPK1 overexpression in non‐small‐cell lung carcinoma is to stimulate a stem cell‐like phenotype. This pleiotropy might be related to preferential activation of different downstream signalling pathways by SRPK1 in various cancers. © 2016 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.     

Metastatic ductal carcinoma of the breast to the thyroid gland diagnosed with fine needle aspiration: A case report with emphasis on morphologic and immunophenotypic features

Metastases to the thyroid are uncommon [<0.2% of thyroid fine needle aspirations (FNA)]. Of metastases to the thyroid, breast carcinoma is relatively common. The diagnosis of metastasis to the thyroid has important therapeutic and prognostic implications. To our knowledge, a morphologic and immunophenotypic comparison of metastatic ductal carcinoma of the breast and primary thyroid carcinomas has not been reported. Here, we report the case of a 37‐year‐old female with a history of metastatic ductal carcinoma of the breast (modified Bloom‐Richardson grade 2; ER+, PgR+, HER2+) diagnosed 6 years prior. She developed hoarseness, prompting a CT scan. Multiple thyroid nodules were found, including a 1.5 cm hypoechoic, solid, irregularly‐shaped nodule. On FNA, cells were arranged singly and in crowded groups, varied in size and degree of pleomorphism, and exhibited rare nuclear grooves, inconspicuous nucleoli, and rare intracytoplasmic lumina with no nuclear pseudoinclusions or colloid (Figs. 1A and B). These findings raised the differential of papillary thyroid carcinoma (Fig. 1C), follicular neoplasm (Fig. 1D), medullary carcinoma (Fig. 1E), parathyroid (Fig. 1F), and metastatic breast carcinoma. Immunostaining for GATA‐3 (+), ER (+), PAX‐8 (?), and TTF‐1 (?) was consistent with metastatic breast carcinoma (Fig. 2). We conclude that metastatic breast carcinoma to the thyroid may morphologically mimic primary thyroid carcinoma on FNA; a panel of immunomarkers, such as GATA‐3, hormonal marker(s), PAX‐8, and TTF‐1, may be useful in some cases. GATA‐3 immunostaining for metastatic breast carcinoma was helpful in our case and has not been previously reported in a thyroid metastasis sampled by FNA. Diagn. Cytopathol. 2016;44:530–534. © 2016 Wiley Periodicals, Inc.     

Cytological diagnosis of adult T‐cell leukemia/lymphoma in sputum

Adult T‐cell leukemia/lymphoma (ATLL) is a rare and often aggressive T‐cell leukemia/lymphoma that has been linked to infection by the human T‐cell lymphotropic virus type 1 (HTLV‐1). ATLL can involve multiple organs including the respiratory airway. A 53‐year‐old Trinidadian woman presented with productive cough and progressive shortness of breath. Her past medical history included duodenal strongyloidosis, skin rash, and hypercalcemia. Radiological studies showed increased interstitial markings. Sputum cytology showed atypical pleomorphic, small‐to‐medium‐sized, lobated lymphocytes with irregular and hyperchromatic nuclei resembling “flower cells” which were CD3±/CD20? by immunocytochemistry. A lung biopsy showed interstitial, peribronchiolar, and subpleural infiltration by a CD3±/CD25± atypical lymphocytic infiltrate. Together with peripheral blood findings and positive HTLV‐1 serology, the diagnosis of ATLL was made. We suggest that sputum evaluation in patients with ATLL risk factors can be diagnostic. Diagn. Cytopathol. 2016;44:416–418. © 2016 Wiley Periodicals, Inc.     

Quality assurance in gynecologic cytology. What is practical?

The quality of gynecologic cytology has been questioned in the last two years. This author's hospital laboratory has a sizable outpatient gynecologic cytology and biopsy practice from which data have been obtained in several different quality assurance projects. In this article the author analyzes those data with respect to detection of false negative cytology screening errors, specimen sampling errors, precision in cytology and biopsy interpretation, and productivity of quality assurance methods. Sampling errors in obtaining cytology specimens are a major problem to be addressed by cytology quality assurance. The most sensitive and efficient method for detection of false negative cytologic results in this laboratory was rescreening of previous negative Papanicolaou's (Pap) smears in patients presenting for the first time with an abnormal Pap smear. Data indicate that the currently mandated requirement for rescreening 10% of a laboratory's negative Pap smears should be reconsidered and rescinded in certain circumstances.     

Clonorchis sinensis ova in bile juice cytology from a patient with severe hyperbilirubinemia and portal vein thrombosis

Infection with the trematode Clonorchis sinensis is the most common human fluke infection in East Asian populations. Although this infection is associated with obstructive jaundice or choledocholithiasis, portal vein thrombosis has not been reported. Here, we report the first case of a 60‐year‐old man who had both C. sinensis infection and portal vein thrombosis with severe hyperbilirubinemia (75.4 mg/dl). He initially presented with abdominal pain and jaundice. Computed tomography revealed gallstones, common bile duct calculus, and thrombus in the left main branch of the portal vein. A nasobiliary tube was inserted under endoscopic retrograde cholangiography. Cytology of the bile juice revealed many C. sinensis eggs. The abdominal pain and jaundice improved following choledocholithotomy and combination treatment with a chemotherapeutic agent and anti‐coagulant. This case suggests that inflammation around the portal vein as a result of C. sinensis infection has the potential to evoke portal vein thrombosis. Such cases should be treated with both a chemotherapeutic agent and anti‐coagulant therapy. In conclusion, the possibility of infection with C. sinensis should be considered in patients presenting with hyperbilirubinemia and portal vein thrombosis, particularly in East Asian populations. Diagn. Cytopathol. 2016;44:223–225. © 2015 Wiley Periodicals, Inc.     

Pemphigus vulgaris of the cervix: Diagnostic difficulties associated with the Pap test

Pemphigus vulgaris (PV) is a rare mucocutaneous disease caused by the abnormal production of antibodies against epithelial cell surface glycoproteins, resulting in loss of cell adhesion and intraepithelial blister formation. Cervical involvement in PV has been poorly reported, and there is little information regarding the criteria about consequential cytological changes identified in a Papanicolaou‐stained cervicovaginal smear (Pap smear). Here, we report a case of PV manifesting in the cervix as well as the difficulty associated with the cytomorphological identification and interpretation of acantholytic cells. This case involved a 40‐year‐old patient with no history of Pap test abnormalities and no prior diagnosis of PV. In the cytological assessment, cells were identified both in isolation and in clusters that exhibited round nuclei of increased volume, inconspicuous nucleoli, and perinuclear halos. The patient underwent a cervical biopsy that revealed vesiculobullous lesions and morphological pattern consistent with PV. A skin biopsy confirmed this diagnosis. We concluded that knowledge of PV cytomorphology is important because difficulties associated with the identification and interpretation of acantholytic cells might be responsible for false positive diagnoses of cervical neoplasia. However, a suspected diagnosis of PV is possible if the cytological findings are carefully correlated with the clinical data. Diagn. Cytopathol. 2015;43:635–637. © 2015 Wiley Periodicals, Inc.     

Cytologic findings following intraoperative use of FlosealR hemostatic matrix: A potential diagnostic pitfall in fluid aspiration cytology

We report the case of a 62‐year‐old woman who underwent laparoscopic hysterectomy, bilateral salpingo‐oophorectomy, and lymph node dissection for endometrial endometrioid carcinoma FIGO grade 1. Cytologic examination of the pelvic washing specimen showed an acellular matrix with frayed edges and cracking artifact. Upon investigation, it became apparent that this could represent hemostatic matrix Floseal^R that had been used intraoperatively at the lymphadenectomy site. Laboratory replication of the cytologic findings with a Floseal^R sample confirmed it. This is the first reported case of Floseal^R in pelvic washing cytology and represents a potential diagnostic pitfall. Diagn. Cytopathol. 2016;44:1117–1119. © 2016 Wiley Periodicals, Inc.     

Impact of ASC‐H terminology on the detection of HSILs in medically underserved California women

In this study we evaluated CDP: EWC, a large public health screening program for low‐income women to determine whether the ASC‐H term, introduced in the 2001 revision to the Bethesda System, has facilitated the detection of the most serious precancerous cervical lesions such as CIN‐II–III/CIS, including accuracy of detection and minimizing diagnostic delays. Pap test and biopsy data from the period 2003–2006 were compared with those from 1995–1999, and included analysis of a subset of rarely and never‐screened for each study period. More ASC‐H Pap tests were followed by CIN‐II+ biopsies (20%) than ASCUS Pap tests (5%). Thirteen percent of ASC‐H showed CIN‐III/CIS on follow‐up biopsy. Following the introduction of ASC‐H, negative and LSIL Pap tests followed by CIN‐III/CIS biopsies decreased from 5.6% to 0.37% and 9.2% to 4.4%, respectively. Fewer CIN‐III/CIS cases were preceded by Pap tests with negative and ASCUS results in 2003–2005 as compared with 1995–1999. The number of days from screening to diagnosis for women aged 25–39 years with ASC‐H Pap test results (58 days) was less than for ASCUS results (78 days) for the current study period. In this high‐risk multi‐ethnic population, ASC‐H more effectively communicates equivocal findings likely to represent HSIL leading to more rapid follow‐up. The incidence of CIN‐II or CIN‐III/CIS following ASC‐H Pap tests is lower than generally appreciated for this population, including for rarely or never‐screened high‐risk women. Fewer CIN‐III/CIS lesions were detected following negative and ASCUS Pap results. Compliance with follow‐up is less than ideal for this population. Diagn. Cytopathol. 2009. © 2008 Wiley‐Liss, Inc.     

Unusual microbial organisms seen in two cervical smears

Very infrequently, unusual microbial organisms are encountered in routine cervical Pap tests. We herein report two such cases in two asymptomatic women. Case 1. A Pap smear of a 16‐year‐old‐female showed rare glandular cells with cytologic features consistent with Cytomegalovirus infection. Case 2. A Pap smear of a 36‐year‐old female exhibited rare fungal organisms characterized by thin septate hyphae branching into secondary branches (metulae) which carried multiple flask‐shaped philiades most consistent with Penicillium species that were “most likely representing contamination.” We discuss the cytomorphological features and the differential diagnosis and provide a brief review of the literature on these topics. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Down‐Regulation of miR‐19a as a Biomarker for Early Detection of Silicosis

The accumulated data indicate that there is significant genetic heterogeneity underlying the etiology of silicosis. Recent reports have revealed that microRNAs (miRNAs) play an important role in regulating pulmonary fibrosis. This study, therefore, aimed to identify some miRNAs as biomarkers for silicosis, and to explore the early diagnostic value of biomarkers for silicosis. Total RNAs were collected from the peripheral blood leukocytes of 23 silicosis patients and 23 healthy controls, the different miRNAs were screened using microarrays. The potential biomarker miRNAs were identified by quantitative real‐time polymerase chain reaction (qPCR) and receiver operating characteristic (ROC) curves. Eighteen differential miRNAs in leukocytes were up‐regulated and twenty differential miRNAs were down‐regulated in the silicosis group, compared with the control group. The expression levels of miR‐181a and miR‐19a were 0.8854 ± 0.1037 and 0.2929 ± 0.0342 by the relative quantitation method 2^?△△CT of qPCR, respectively. The sensitivity and specificity for miR‐181a at a cut‐off value of 1.8917 were 70% and 75%, respectively, whereas, those for miR‐19a at a cut‐off value of 3.6828 were 95% and 95%, respectively. Thus, miR‐19a in peripheral blood leukocyte could be used as an effective biomarker for silicosis. Anat Rec, 299:1300–1307, 2016. © 2016 Wiley Periodicals, Inc.