Application of cell block preparation in effusion cytology: Analysis of mismatched diagnosis and utility of immunostaining

Objective: To analyze the mismatched cases between liquid-based cytology (LBC) and cell block in effusion cytology and to confirm the utility of cell block. Methods: One hundred eighty-two samples of effusions were examined. Cell blocks were prepared from residual samples after LBC preparation, and the details about the diagnostic concordance and difference in cytological characteristics were investigated. Cell block immunostaining was performed to predict the histological type and the primary site of the carcinoma in 32 cases. ALK rearrangement and EGFR mutation were also analyzed using the cell block. Results: The diagnostic concordance rate between LBC and cell block was 97.3%. Diagnoses using LBC and cell block were mismatched in five cases. By immunostaining, the histological type was determined in 91.0% of carcinomas, and primary sites were identified in 76.5% of adenocarcinomas. ALK rearrangement was examined in two cases of lung carcinoma and EGFR mutation was examined in four cases of lung carcinoma. Conclusion: A high concordance rate between LBC and cell block in effusion cytology was found. The main cause of the mismatched diagnosis was the small amount of atypical cells in LBC or cell block. We also showed the utility of cell block in immunostaining and DNA analysis

Clinicopathological characteristics of duodenal epithelial neoplasms: Focus on tumors with a gastric mucin phenotype (pyloric gland-type tumors).

OBJECTIVE:Epithelial tumors less commonly occur in the duodenum than in the stomach or large intestine. The clinicopathological characteristics of duodenal epithelial tumors remain a matter of debate. We therefore studied resected specimens to investigate the clinicopathological characteristics of duodenal epithelial tumors. MATERIALS AND METHODS:Among duodenal epithelial tumors resected endoscopically or surgically in our hospital, we studied the clinicopathological characteristics of 110 adenomas or intramucosal carcinomas. The grade of atypia of all tumors was classified into 3 groups according to the World Health Organization (WHO) 2010 classification. The tumors were immunohistochemically evaluated to determine the frequency of differentiation toward fundic glands. RESULTS:As for patient characteristics, there were 76 men (75.2%) and 25 women (24.8%), with a median age of 65 years (range, 34 to 84). The tumors most commonly arose in the first to second part of the duodenum. Many lesions were flat, and the median tumor diameter was 8.0 mm. The lesions were classified into 2 types according to mucin phenotype: intestinal-type tumors (98 lesions, 89.1%) and gastric-type tumors (12 lesions, 10.9%). Intestinal-type tumors were subdivided into 2 groups: tubular-type tumors (91 lesions, 82.7%) and tubulovillous-type tumors (7 lesions, 6.4%). Gastric-type tumors were classified into 2 types: foveolar type (3 lesions, 2.7%) and pyloric gland-type (PG) tumors (9 lesions, 8.2%). The grade of atypia was significantly higher in gastric-type tumors (p<0.01). PG tumors were gastric-type tumors characterized by pyloric glands and findings suggesting differentiation toward fundic glands. CONCLUSIONS:About 10% of the duodenal tumors had a gastric-type mucin phenotype. Gastric-type tumors showed high-grade atypia. In particular, PG tumors showed similarities to PG tumors of the stomach, such as differentiation toward fundic glands

Differentiation of pyloric-gland type to fundic glands.

<p>(A) HE-stained image, showing proliferation of atypical glands associated with mildly enlarged nuclei. (B) Differentiation into fundic glands (pepsinogen-1). Tumor glands are positive for pepsinogen-1. (C) Differentiation into fundic glands (H,K-ATPase). Similar to pepsinogen-1, H,K-ATPase-positive cells can be seen in tumor glands.</p