Comparison of the sensitivity and specificity of urine cytology, urinary nuclear matrix protein-22 and multitarget fluorescence in situ hybridization assay in the detection of bladder cancer

This study aimed to compare the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of urine cytology, BladderChek nuclear matrix protein-22 (NMP22) and UroVysion fluorescence in situ hybridization (FISH) tests in patients with newly diagnosed bladder cancer, those with recurrent bladder cancer, and those with bladder cancer but in remission during surveillance. Material and methods. Voided urine samples obtained from 178 patients with suspected or known bladder cancer about to undergo diagnostic or surveillance cystoscopy and 25 control subjects without the disease were divided into four and used for urine culture and cytology, NMP22 BladderChek and UroVysion FISH tests

Prevalence and Correlation of Human Papilloma Virus and its Types with Prognostic Markers in Patients with Invasive Ductal Carcinoma of the Breast in Kuwait

Objectives: This study aimed to document the association of human papilloma virus (HPV) and its types in breast carcinoma tissues in Kuwaiti women, and correlate this with known prognostic markers. Methods: The clinicopathological data of archived tissue from 144 cases of invasive ductal breast carcinoma were studied (age, histological grade, size of tumour, lymph node metastases, oestrogen/progesterone receptors and human epidermal growth factor receptor 2 status). HPV frequency was documented using immunohistochemistry (IHC) and chromogenic in-situ hybridisation (CISH). HPV types were documented by CISH using HPV probes. CISH and IHC techniques were compared and HPV correlated with prognostic parameters. Results: The HPV prevalence as determined by CISH and IHC was 51 (35.4%) and 24 (16.7%) cases, respectively. The sensitivity of HPV by IHC was 37.3% and specificity was 94.6%. The sensitivity and specificity of HPV-CISH compared to HPVIHC was statistically significant (P <0.001). HPV-CISH was seen in 51 cases. A combination of HPV 6 and 11, and 16 and 18 was seen in 2 (3.9%) cases, and a combination of HPV 6, 11, 31 and 33 was seen in 7 (13.7%) cases. All three HPV probes: 6 and 11, 16 and 18, as well as 31 and 33 were present in 2 (3.9%) cases. The prevalence of HPVCISH in the Kuwaiti and non-Kuwaiti populations was 27 (52.9%) and 19 (37.2%), respectively. No correlation was observed with the prognostic parameters. Conclusion: The frequency of HPV in breast carcinoma cases in Kuwait was 35.4% (CISH). Of those, 52.9% were Kuwaitis in whom both low- and high-risk HPV types were detected

Interpreting a Diagnosis of Atypical Squamous Cells of Undetermined Significance in Cervical Cytology and its Association with Human Papillomavirus: A retrospective analysis of 180 cases in Kuwait

Objectives: Atypical squamous cells of undetermined significance (ASC-US) represent a diagnostic challenge during cervical cytology. This study aimed to review and identify high-risk human papillomavirus (HR-HPV) genotypes among previously diagnosed ASC-US cases in Kuwait. Methods: This retrospective study analysed 180 cases diagnosed as ASC-US between June 2017 and May 2018 at the Mubarak Al-Kabeer Hospital, Kuwait. Cervical specimens were assayed to determine the presence of HR-HPV DNA; subsequently, positive cases underwent genotyping and were categorised into three groups (HPV 16, HPV 18/45 and other HR-HPV types). Results: In total, ASC-US was confirmed in only 105 cases (58.3%), with the remaining cases reclassified as negative for intraepithelial lesions or malignancy (NILM; 32.2%) and epithelial cell abnormalities (ECA; 9.4%). Of these, HRHPV DNA was present in 20 ASC-US (19%), one NILM (1.7%) and six ECA (35.3%) cases. There were 62 Kuwaiti and 43 non-Kuwaiti women with confirmed ASC-US; of these, three (4.8%), six (9.7%) and four (6.5%) Kuwaitis and one (2.3%), one (2.3%) and five (11.6%) non-Kuwaitis had HPV 16, both HPV 16 and 18/45 and other HRHPV genotypes, respectively. Of those with HR-HPV DNA, the NILM case had the HPV 18/45 genotype, while the six ECA cases had the HPV 16 (n = 1), both HPV 16 and 18/45 (n = 1) and other HR-HPV (n = 4) genotypes. Conclusion: Overall, HR-HPV DNA was present in 19% of ASC-US cases compared to 1.7% of NILM cases initially misdiagnosed as ASC-US. Re-review of cervical cytology diagnoses may reduce unnecessary costs associated with HR-HPV genotyping. Keywords: Cervical Smears; Atypical Squamous Cells of Undetermined Significance; Human Papilloma Virus; Cytological Techniques; Papanicolaou Test; Kuwait

Trends in Epithelial Cell Abnormalities Observed on Cervical Smears over a 21-Year Period in a Tertiary Care Hospital in Kuwait

Objectives: This study aimed to analyse trends in epithelial cell abnormalities (ECAs) in cervical cytology at a tertiary care hospital in Kuwait. Methods: ECAs in 135,766 reports were compared over three seven-year periods between 1992 and 2012. Conventional Papanicolaou (Pap) smear tests were used in the first two periods and ThinPrep (Hologic Corp., Bedford, Massachusetts, USA) tests were used in the third. Results: Significant increases in satisfactory smears, atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells of undetermined significance/atypical glandular cells (AGUS/AGCs) were seen in the second and third periods (P <0.001). No significant increases were observed among low-grade squamous intraepithelial lesions (LSILs) or high-grade squamous intraepithelial lesions (HSILs) (P >0.05). An increase was noted in carcinomas between the first and second periods although a significant decline was seen in the third (P <0.014). Conclusion: Satisfactory smears, ASCUS and AGUS/AGC increased during the study period although no significant increases in LSILs, HSILs or carcinomas were observed

Evaluation of pulmonary infiltrates in patients with haematological malignancies using fibreoptic bronchoscopy and bronchoalveolar lavage

Background : Chest infection is the major cause of morbidity and mortality among patients with haematological malignancies. Conventional diagnostic methods - chest x-ray , blood and sputum culture have limited yield . We used fibreoptic bronchoscopy and bronchoalveolar lavage to evaluate nature of pulmonary infiltrates on chest x-ray. Patients and Methods : 25 patients with haematological malignancies with fever and pulmonary infiltrates were studied. Patients median age was 32 years, ranging from 16 to 65 years. There were 21 males and 4 females. Initial evaluation included - detailed physical examination including chest to see for any focus of infection. In all patients , base line blood counts (total and differential), chest x-ray and cultures from blood and other body fluids were taken before starting broad spectrum antibiotics . Those not responding over next 48-72 hours received gram positive coverage followed by amphotericin-B therapy . Patients with persistent fever and pulmonary infiltrates were subjected to fibre-optic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) and samples were collected for bacterial, fungal, AFB and viral studies. The findings were correlated with Chest x-ray and CT scan. Results The median time for FOB and BAL was 16 days (range, 3 to 32 days) after the clinical diagnosis of chest infection.. BAL fluid examination/culture grew microbial isolates in 21 of 25 patients (84%). Of thesebacteria alone were present in 10, fungi alone in 1 and polymicrobial isolates were seen in 10 patients (40%). Later included- a combination of bacteria and fungi - in 2 patients, bacteria and AFB - 6 and a combination of bacteria, AFB and fungi were seen in 2 patients. BAL changed the radiological diagnosis in 14 patients (56% diagnostic utility). Therapy was modified according to BAL results in 6 patients (therapeutic utility of 24 %). Concordance between radiological and BAL findings were found only in 5 patients (20%). FOB procedure was tolerated well, with mild and reversible complications (throat pain, transient hypoxia, tachycardia) in some patients. Conclusions: Infections are the main cause of pulmonary infiltrates in patients with haematological malignancies. Bacterial , fungal and mycobacterium tubercular organisms are the main isolates. Isolation of ESBL positive organisms and polymicrobial isolates suggest inclusion of appropriate initial empirical antibiotics in these patients to prevent development of resistant organisms. Higher frequency of AFB isolates (32%) was the surprising finding and need to be confirmed in future studies

Prevalence of Infectious Organisms Observed in Cervical Smears Between 1997–2014 at Mubarak Al-Kabeer Hospital, Kuwait

Objectives: This study aimed to examine gynaecological infectious agents observed in conventional and modified Papanicolaou cervical smears (CS) at a tertiary care hospital in Kuwait. Methods: This retrospective study analysed 121,443 satisfactory CS samples collected between 1997–2014 at the Mubarak Al-Kabeer Hospital, Kuwait. Conventional CS samples were obtained between 1997–2005, while modified CS were obtained between 2006–2014 following the introduction of ThinPrep® testing (Hologic Corp., Bedford, Massachusetts, USA). All samples were initially screened by cytoscreeners before being analysed by cytopathologists to determine the presence of specific infectious agents. Results: Overall, 8,836 (7.28%) of the cervical samples had infectious agents; of these, 62.48% were conventional and 37.52% were modified CS samples. The most frequently observed infectious agents were Candida species (76.05%), Trichomonas vaginalis (9.72%), human papillomavirus (HPV; 9.3%), Actinomyces-like organisms (3.23%), Chlamydia trachomatis (1.27%) and the herpes simplex virus (HSV; 0.43%). There were significantly more cases of Candida species, HPV-associated changes, C. trachomatis, T. vaginalis and Actinomyces-like organisms detected in conventional compared to modified CS samples (P <0.050 each). However, there was no statistically significant difference in the frequency of HSV-associated changes (P = 0.938). The presence of two infectious agents in the same sample was identified in 0.87% of samples. Conclusion: Among CS samples collected during an 18-year period, Candida species were most frequently detected, followed by T. vaginalis and HPV. The identification of potential infectious agents is a valuable additional benefit of Papanicolaou smear testing. Keywords: Cervical Smears; Papanicolaou Test; Infection; Candida; Trichomonas vaginalis; Human Papilloma Virus; Cytology; Kuwait

Microfilariae in fine needle aspiration smears from lesions of nodular leprosy

Microfilariae have been observed in various cytologic materials, like aspirates from breast,7 bone marrow,9 thyroid,8,10 epididymis,4 and exfoliated material, like cervicovaginal smears,3 urine,5 effusions, and bronchial and laryngeal brushings.2 Various neoplasms, like meningioma, hemangioblastoma, retroperitoneal fibromyxoma, osteoclastoma, metastatic carcinoma of the scapula and carcinoma of the cervix,1 have also been associated with the incidental presence of microfilariae. We would like to document a case in which microfilariae were coincidentally encountered in fine needle aspirate smears of nodular leprosy. A 18-year-old male attended the dermatology outpatient department of our hospital with complaints of multiple erythematous, scaly plaques and nodules, and hypopigmented, hypoanesthetic macules all over the body, for two months. He was clinically diagnosed as having borderline lepromatous leprosy (BL) and referred to us for fine needle aspiration (FNA) and punch biopsy of the lesions. One of the lesions on the forearm was aspirated, using a 23-gauge needle, with the \u93nonaspiration\u94 technique. The smears were stained with Papanicolaou stain, May-Gr\ufcnwald-Giemsa stain and modified Ziehl-Nielsen (ZN) stain. The smears showed epithelioid cell granulomas, macrophages and chronic inflammatory cells (Figure 1A). Staining by the modified ZN method revealed acid-fast bacilli singly and in globi. These features were considered diagnostic of borderline leprosy. All three FNA smears revealed microfilariae (Figures 1A and 2). Skin biopsy from the same lesion showed perivascular and periappendageal granulomatous inflammation (Figure 1B). Cutaneous nerves were inflamed and partially destroyed in places. The biopsy was interpreted as BL (BT/BB in the Ridley- Jopling classifications). Multiple serial sections, however, failed to reveal microfilariae. Microfilariae have been detected at many body sites. The pathogenesis is thought to be vascular or lymphatic obstruction by the microfilariae, leading to extravasation and subsequent appearance of the larvae in tissue fluids and exfoliated material.9 A literature search failed to reveal any reports of microfilariae in leprosy lesions. The finding of microfilariae at such an unusual site may also be caused by the fact that larvae may be present in the blood and aspiration may lead to rupture of blood vessels, leading to hemorrhage and release of microfilariae into the tissue space

Fine-needle aspiration cytology of meningiomas with unusual presentations

Meningiomas are not often aspirated unless they erode the skull, occur intraorbitally, or present as swelling in the head and neck region. We describe the cytologic findings of fine-needle aspiration cytology (FNAC) in four cases of meningioma that presented with swellings in the head and neck region. The patients underwent surgery, and the diagnosis of meningioma was confirmed. Three of the four cases were reported as aggressive meningiomas on histopathology

Microfilariae of Wuchereria bancrofti in cyst fluid of tumors of the brain: A report of three cases

Microfilariae of various nematodes, including Loa loa, Dirofilariae, and Onchocerca volvulus, have been identified in the central nervous system (CNS). The CNS, however, is a rare site for the isolation of microfilariae of Wuchereria bancrofti. To the best of our knowledge, the presence of microfilariae of W. bancrofti in tumor cyst fluids or cerebrospinal fluid has not been reported to date. We report three cases in which microfilariae were identified in the cyst fluid of tumors of the brain. Cyst fluid aspirated from space-occupying lesions in the thalamus and C6-D1 spinal segments in a 46-yr-old man and a 35-yr-old man, respectively, showed numerous microfilariae of W. bancrofti, along with fragments of tumor suggestive of glioma. In the third case, in a 12-yr-old boy, the fluid from the space-occupying lesion in the third ventricle showed microfilariae in a necrotic dirty background with a few squames and cholesteral crystals. Histopathologic examination of the tumor showed an anaplastic astrocytoma and a low-grade astrocytoma in the first two cases, respectively, and a craniopharyngioma in the third case. No microfilariae were identified on the histology sections

Fine needle aspiration diagnosis of a benign metastasizing leiomyoma of the abdominal wall

We describe here the case of a 42 year-old female with a benign, metastasizing leiomyoma (BML) of the abdominal wall diagnosed by fine needle aspiration. The patient had undergone myomectomy for uterine leiomyomas eight years ago. BMLs are composed of well-differentiated smooth muscle and are uncommon tumors that are more often seen in the lungs; soft tissues and skeletal muscle are rarely involved