Fine Needle Aspiration Biopsy of Follicular Thyroid Tumors

US-guided fine needle aspiration cytology is currently the best diagnostic tool for thyroid nodules. The aim of this research was to make a detailed and objective determination of the morphological characteristics of cells in cytological smears in an attempt to distinguish benign from malignant follicular tumors. The research included 62 patients with cytologically diagnosed follicular or oncocytic tumors, and 15 patients with nodular hyperplasia. Echographic findings were divided into three groups: isoechogenic, hypoechogenic and hyperechogenic nodules. We analyzed the cellularity of the smear, cohesion between follicular cells, acinar formations, bare nuclei, characteristics of the nucleus and the cytoplasm, and the presence of colloid. The statistical analysis of cytological parameters has indicated that none of the cytological parameters alone is discriminating enough between non-tumor and tumor changes, or benign and malignant follicular thyroid nodules. The analysis of age, sex, nodule size and ultrasound findings has not shown the correlation between any of these parameters with the malignant or benign follicular tumors. The cytological analysis of the smears for patients with follicular tumors, in combination with clinical data and other diagnostic methods, contributes to more precise diagnostics, but is not sufficient for the differentiation between benign and malignant follicular tumors

Granular Cell Tumor – Clinically Presented as Lymphadenopathy

Granular cell tumors are relatively uncommon benign lesions occurring in almost any part of the body. We report the cytological diagnosis of granular cell tumor in 25-year-old male patient who presented with an inguinal mass clinically suspected to be a lymphadenopathy. Fine needle aspiration revealed polygonal cells with abundant, granular cytoplasm and eccentrically located vesicular nuclei and inconspicuous nucleoli. The histopathological examination of the surgical excision confirmed the diagnosis. If resection is complete, local surgical excision is curative for benign granular cell tumors. Granular cell tumor has a characteristic cytological appearance, and fine-needle aspiration cytology has been suggested to be diagnostic modality of choice

Granular Cell Tumor – Clinically Presented as Lymphadenopathy

Granular cell tumors are relatively uncommon benign lesions occurring in almost any part of the body. We report the cytological diagnosis of granular cell tumor in 25-year-old male patient who presented with an inguinal mass clinically suspected to be a lymphadenopathy. Fine needle aspiration revealed polygonal cells with abundant, granular cytoplasm and eccentrically located vesicular nuclei and inconspicuous nucleoli. The histopathological examination of the surgical excision confirmed the diagnosis. If resection is complete, local surgical excision is curative for benign granular cell tumors. Granular cell tumor has a characteristic cytological appearance, and fine-needle aspiration cytology has been suggested to be diagnostic modality of choice

Interobserver Variability in Cytologic Subclassification of Squamous Intraepithelial Lesions – The Bethesda System vs. World Health Organization Classification

The aim of the study was to compare interobserver variability for The Bethesda System (TBS) and World Health Organization (WHO) classification of cervical squamous intraepithelial lesions. A total of 1,000 conventional Papanicolaou smears (156 positive and 884 negative) were examined »blindly« by three cytologists and one cytotechnician. The degree of observer agreement was expressed by kappa statistics using a program for the calculation of interobserver variation and association »Agree« (Svanholm and Jergensen, 1989). Kappa (x) was determined for each cytologic diagnosis within a particular classification and total for either classification. The association with and separation from other diagnoses was determined for each cytologic diagnosis in the form of conditional probability (Pj). In WHO classification, the diagnoses of dysplasia media and dysplasia gravis showed poor reproducibility (x=0.114 and x= 0.259, respectively), the diagnosis of dysplasia levis good reproducibility (x=0.639), and the diagnosis of carcinoma in situ excellent reproducibility (x=0.762). WHO classification yielded pool x of 0.741. In TBS classification, the diagnosis of LSIL showed good, and HSIL excellent reproducibility (x=0.542 and x=0.763, respectively). TBS classification yielded pool x of 0.699. Dysplasia media (Pj=0.121) and dysplasia gravis (Pj=0.274) were found to be morphologically poorly defined, and carcinoma in situ (Pj=0.777) and dysplasia levis (Pj=0.651) well defined diagnoses. LSIL was morphologically moderately defined (Pj=0.587) and HSIL well defined (Pj=0.789) diagnosis. Accordingly, TBS does not substantially improve diagnostic reproducibility of the cytologic diagnoses of squamous intraepithelial lesions, while providing considerably less information to the clinician than the four-grade dysplasia/CIS terminology, thus eliminating the opportunity of choosing a different procedure for the diagnosis of dysplasia media, which is of utmost importance in the population of young nulliparae

Citodijagnostika folikularnih tumora štitnjače

US-guided fine needle aspiration cytology is currently the best diagnostic tool for thyroid nodules. The aim of this research was to make a detailed and objective determination of the morphological characteristics of cells in cytological smears in an attempt to distinguish benign from malignant follicular tumors. The research included 62 patients with cytologically diagnosed follicular or oncocytic tumors, and 15 patients with nodular hyperplasia. Echographic findings were divided into three groups: isoechogenic, hypoechogenic and hyperechogenic nodules. We analyzed the cellularity of the smear, cohesion between follicular cells, acinar formations, bare nuclei, characteristics of the nucleus and the cytoplasm, and the presence of colloid. The statistical analysis of cytological parameters has indicated that none of the cytological parameters alone is discriminating enough between non-tumor and tumor changes, or benign and malignant follicular thyroid nodules. The analysis of age, sex, nodule size and ultrasound findings has not shown the correlation between any of these parameters with the malignant or benign follicular tumors. The cytological analysis of the smears for patients with follicular tumors, in combination with clinical data and other diagnostic methods, contributes to more precise diagnostics, but is not sufficient for the differentiation between benign and malignant follicular tumors.Citološka punkcija pod kontrolom ultrazvuka je nedovoljno osjetljiva i specifična za razlikovanje benignih i malignih folikularnih tumora. Cilj istraživanja je bio utvrditi citomorfološke karakteristike stanica punktata histološki verificiranih folikularnih i onkocitnih tumora te odrediti vrijednost pojedinih citoloških parametara u diferencijaciji benignih i malignih tumora. U istraživanje je uključeno 62 ispitanika s citološkom dijagnozom folikularnog ili onkocitnog tumora te 15 ispitanika s čvorastom hiperplazijom. Ehografski, čvorovi su bili izoehogeni i hipoehogeni, a prema veličini su podijeljeni u skladu sa pT klasifikacijom SZO. Semikvantitativno je analizirana celularnost uzorka, kohezija me|u stanicama, morfologija nakupina, gole jezgre, karakteristike jezgre i citoplazme te koloid. Statisti~ki, ni jedan od citolo{kih parametara sam za sebe nije dovoljan diskriminirajući faktor između netumorskih i tumorskih promjena, kao ni između benignih i malignih folikularnih tumora štitnjače. Analizom dobi, spola, veličine čvora ni UZV nalaza nije dokazana povezanost bilo kojeg od ovih parametara s malignim ili benignim folikularnim tumorom. Citološka analiza punkata u kombinaciji sa kliničkim podacima i drugim dijagnostičkim metodama doprinosi preciznijoj dijagnostici, ali sama za sebe nije dostatna za diferencijaciju benignih i malignih folikularnih tumora

Granular cell tumor

Granular cell tumors are relatively uncommon benign lesions occurring in almost any part of the body. We report the cytological diagnosis of granular cell tumor in 25-year-old male patient who presented with an inguinal mass clinically suspected to be a lymphadenopathy. Fine needle aspiration revealed polygonal cells with abundant, granular cytoplasm and eccentrically located vesicular nuclei and inconspicuous nucleoli. The histopathological examination of the surgical excision confirmed the diagnosis. If resection is complete, local surgical excision is curative for benign granular cell tumors. Granular cell tumor has a characteristic cytological appearance, and fine-needle aspiration cytology has been suggested to be diagnostic modality of choice.Granular cell tumor je relativno neuobičajena dobročudna promjena koju je moguće naći na bilo kojem dijelu tijela. Autori prikazuju bolesnika sa tvorbom u preponi za koju se posumnjalo da je povećani limfni čvor. Citološkom punkcijom su nađene poligonalne stanice obilne zrnate citoplazme sa ekscentrično smještenim vezikularnim jezgrama i nezamjetnim nukleolima. Histopatološki pregled odstranjene tvorbe je potvrdio citološku dijagnozu. Resekcija tvorbe je i jedini terapijski postupak za dobročudne granular cell tumore. Zbog karakteristične citološke slike granular cell tumora, citološka punkcija je metoda izbora u njegovoj dijagnostici

An Unusual Tumour of the Breast: Cytological Findings

The epithelioid variant of malignant peripheral nerve sheath tumour (MPNST), or epithelioid malignant schwannoma is an unusual form of MPNST that closely resembles carcinoma or melanoma as the tumour is composed predominantly of Schwann cells with a polygonal epithelioid appearance. It has been estimated that 5% or fewer MPNST belong to this group. The tumours follow a distribution similar to that of the ordinary MPNST, mostly occurring in patients 20–50 years of age, and may arise in the deep and superficial soft tissues of almost every anatomical site, with rapid growth and aggressive biological behaviour. Most of the tumours reported in the literature originated in major nerves. It is the cases in which the origin from a nerve cannot be documented that pose the most challenging problems in diagnosis. MPNST are some of the most difficult soft tissue tumours to diagnose by fine needle aspiration (FNA) and the results vary greatly depending upon a number of factors including the experience and skill of the aspirator and interpreting cytopathologist. The first description of the cytomorphological features was in 1989 by Molenaar et al. The majority of the cases described in the literature are isolated reports. Difficulties in the FNA diagnosis of schwannoma have been reported by many authors, especially of epithelioid malignant schwannoma. The aim of this paper is to present our case of FNA of epithelioid malignant peripheral sheath tumour of the breast with special reference to the cytological findings

Interobserver varijabilnost u citološkoj subklasifikaciji skvamoznih intraepitelnih lezija

The aim of the study was to compare interobserver variability for The Bethesda System (TBS) and World Health Organization (WHO) classification of cervical squamous intraepithelial lesions. A total of 1,000 conventional Papanicolaou smears (156 positive and 884 negative) were examined »blindly« by three cytologists and one cytotechnician. The degree of observer agreement was expressed by kappa statistics using a program for the calculation of interobserver variation and association »Agree« (Svanholm and Jergensen, 1989). Kappa (x) was determined for each cytologic diagnosis within a particular classification and total for either classification. The association with and separation from other diagnoses was determined for each cytologic diagnosis in the form of conditional probability (Pj). In WHO classification, the diagnoses of dysplasia media and dysplasia gravis showed poor reproducibility (x=0.114 and x= 0.259, respectively), the diagnosis of dysplasia levis good reproducibility (x=0.639), and the diagnosis of carcinoma in situ excellent reproducibility (x=0.762). WHO classification yielded pool x of 0.741. In TBS classification, the diagnosis of LSIL showed good, and HSIL excellent reproducibility (x=0.542 and x=0.763, respectively). TBS classification yielded pool x of 0.699. Dysplasia media (Pj=0.121) and dysplasia gravis (Pj=0.274) were found to be morphologically poorly defined, and carcinoma in situ (Pj=0.777) and dysplasia levis (Pj=0.651) well defined diagnoses. LSIL was morphologically moderately defined (Pj=0.587) and HSIL well defined (Pj=0.789) diagnosis. Accordingly, TBS does not substantially improve diagnostic reproducibility of the cytologic diagnoses of squamous intraepithelial lesions, while providing considerably less information to the clinician than the four-grade dysplasia/CIS terminology, thus eliminating the opportunity of choosing a different procedure for the diagnosis of dysplasia media, which is of utmost importance in the population of young nulliparae.Cilj rada je bio usporediti interobserver varijabilnost za The Bethesda System (TBS) i World Health Organization (WHO) klasifikaciju skvamoznih intraepitelnih lezija cerviksa uterusa. Set od 1000 konvencionalnih Papa razmaza (156 pozitivnih i 884 negativnih) »na slijepo« su pregledala 3 citologa i jedan citotehničar. Stupanj slaganja je izražen kappa statistikom pomoću programa za računanje interobserver varijacija i asocijacija »Agree« (Svanholm i Jergensen, 1989.). Weighted je određen za svaku citološku dijagnozu unutar klasifikacije, kao i za klasifikacije u cijelosti. Za svaku citološku dijagnozu je određena povezanost, odnosno razgraničenost s drugim dijagnozama u obliku uvjetne vjerojatnosti (Pj). Kod WHO klasifikacije su slabo reproducibilne dijagnoze dysplasia media (=0,114) i dysplasia gravis (=0,259), prilično dobro je reproducibilna dijagnoza dysplasia levis (=0,639), a odlično je reproducibilna dijagnoza carcinoma in situ (=0,762). Za klasifikaciju u cijelosti je 0,741. Kod TBS klasifikacije LSIL je prilično dobro reproducibilna dijagnoza (=0,542), dok je HSIL odlično reproducibilna dijagnoza (=0,763). Za klasifikaciju u cijelosti je 0,699. Dysplasia media (P=0,121) i dysplasia gravis (Pj=0,274) su morfološki slabo definirane dijagnoze, carcinoma in situ (Pj=0,777) i dysplasia levis (Pj=0,651) su dobro definirane dijagnoze. LSIL (Pj=0,587) je morfološki srednje definirana dijagnoza, dok je HSIL (Pj=0,789) dobro definirana dijagnoza.TBS ne popravlja bitno dijagnostičku reproducibilnost citoloških dijagnoza za skvamozne intraepitelne lezije, a kliničaru daje znatno manje informacija nego četverodijelna dysplasia / CIS terminologija i time oduzima mogućnost različitog postupka za dijagnozu dysplasia media što je osobito važno za populaciju mladih nulipara i trudnica

Imprint Cytology in Laryngeal and Pharyngeal Tumours

Objective: The aim of this study was to evaluate the role of cytology in providing a reliable diagnosis upon which the clinician can base further investigative or treatment strategies in patients with laryngeal and pharyngeal tumours. Methods: Imprint cytology diagnoses from 174 patients were correlated with the histological result of a corresponding biopsy. Results: We found that the imprint cytology proved to be a useful, quick and reliable method with complete diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive values of 97%, 96%, 100%, 100% and 92% respectively. Conclusion: Imprint cytology allows diagnostic statements in a shorter time than is possible with histological sections and proves a useful adjunct in evaluating laryngeal and pharyngeal lesions. The validity of the method depends on the care with which the specimen is sampled and on the experience of the investigator