Post-thyroid FNA testing and treatment options: A synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference

The National Cancer Institute (NCI) sponsored the NCI Thyroid Fine Needle Aspiration (FNA) State of the Science Conference on October 22–23, 2007 in Bethesda, MD. The 2-day meeting was accompanied by a permanent informational Web site and several on-line discussion periods between May 1 and December 15, 2007 ( http://thyroidfna.cancer.gov ). This document addresses follow-up procedures and therapeutic options for suggested diagnostic categories. Follow-up options for “nondiagnostic” and “benign” thyroid aspirates are given. The value of ultrasound examination in the follow-up of “nondiagnostic” and “benign” thyroid aspirates is discussed. Ultrasound findings requiring reaspiration or surgical resection are described as are the timing and length of clinical and ultrasonographic surveillance for cytologically “benign” nodules. Options for surgical intervention are given for the diagnostic categories of “atypical/borderline,” “follicular neoplasm,” “suspicious for malignancy” and “malignant” ( http://thyroidfna.cancer.gov/pages/info/agenda/ ). Diagn. Cytopathol. 2008;36:442–448. © 2008 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/58659/1/20832_ftp.pd

Immunohistochemistry of endometrial stromal sarcoma

Twenty-three cases (12 low grade, 11 high grade) of endometrial stromal sarcoma were studied with monoclonal antibodies to vimentin, keratin, desmin, muscle actin, epithelial membrane antigen, and collagen type IV, using the avidin-biotin immunoper-oxidase method. Tumors were highly variable in the expression of these antigens. Some tumors contained both epithelial and smooth muscle-related antigens; others were immunoreactive only for the intermediate filament vimentin. Immunoreactivity patterns for metastases or recurrences were similar to the respective primary tumor and no correlation was observed between tumor grade and antigen expression. Normal myometrium, when present, was keratin-positive and variably epithelial membrane antigen-positive. We conclude that endometrial stromal sarcoma, as well as normal myometrium, may express both epithelial and/or muscle-related antigens. These findings most likely reflect a common mesodermal-mullerian derivation and illustrate the intimate relationship of the endometrial stromal cell to the endometrial glands and myometrium. Knowledge of these immunore-activity patterns is essential when evaluating poorly differentiated uterine tumors or spindle cell tumors presenting in extrauterine locations. © 1991

Infection-associated vascular lesions in acquired immunodeficiency syndrome patients

Several reports have recently appeared in the literature describing unique non-neoplastic vascular lesions in patients with the acquired immunodeficiency syndrome (AIDS). These lesions may be mistaken clinically and histologically for Kaposi\u27s sarcoma. The terms epithelioid angiomatosis, epithelioid or histiocytoid hemangioma, and pyogenic granuloma have all been used to describe a similar entity in which cat scratch disease bacillus (CSDB) was subsequently identified. Lesions closely resembling this entity occur in patients with bartonellosis. We report a case of a cutaneous vascular lesion on the hand of an AIDS patient in which cytomegalovirus (CMV) and organisms consistent with CSDB were both found. Simultaneous infections with CMV and CSDB have not been previously described. The presence of these organisms in and around endothelial cells may provide the common stimulus for the formation of these reactive vascular proliferations. © 1989

Frozen section analyses as predictors of lymphatic spread in patients with early-stage uterine cancer

Many gynecologic oncologists use intraoperative frozen section (IFS) assessment of histologic grade and depth of myometrial invasion (DOI) as predictors of final grade and stage in women with endometrial cancer. This clinical decision method has never been critically examined. We retrospectively reviewed charts of patients with a preoperative diagnosis of uterine endometrioid adenocarcinoma and an intraoperative frozen section assessment of histologic grade and depth of myometrial invasion. Intraoperative predictors combining intraoperative frozen section assessment of histologic grade and depth of myometrial invasion were established and compared with final grade and surgical stage. We then modeled the risks of pelvic and paraaortic lymph node metastases for each predictor. There were 129 patients who met inclusion criteria. Thirty-six patients had the IAG1 predictor; 17 (47%) were stage IAG1 on final pathology. Ten patients had the IAG2 predictor; 3 (30%) were stage IAG2 on final pathology. Thirty-four patients had the IBG1 predictor; 18 (53%) were stage IBG1 on final pathology. Forty-nine patients had the IBG2 predictor; 34 (69%) were stage IBG2 on final pathology. Our decision models predict that the IAG1 predictor has a 1% risk of paraaortic and a 2% risk of pelvic lymph node metastases. The IAG2 and IBG1 predictors have a 2% risk of paraaortic and a 4% risk of pelvic lymph node metastases. The IBG2 predictor has a 2% risk of paraaortic and a 6% risk of pelvic lymph node metastases. The combination of intraoperative frozen section analysis for histologic grade and depth of myometrial invasion does not correlate well with final pathologic grade and stage. Data from our models suggest a significant risk of lymph node spread even for patients with seemingly low-risk disease. Until better markers of lymphatic spread exist, we recommend complete surgical staging of all patients with endometrial cancer