Subtyping salivary gland neoplasm of uncertain malignant potential based on cell type demonstrates differential risk of malignancy

BACKGROUND The newly unveiled Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has proposed salivary gland neoplasm of uncertain malignant potential (SUMP) as an indeterminate category. The category is reserved for fine‐needle aspiration (FNA) cases that are diagnostic of a salivary gland neoplasm but cannot be further designated as a specific tumor type. The objective of the current study was to evaluate the clinical utility of subtyping SUMP cases based on different cell types. METHODS A retrospective search of cytology databases at 2 institutions for salivary gland FNAs from 2006 through 2017 was conducted. The cytologic diagnosis of each case was reclassified according to the MSRSGC. Histologic follow‐up was retrieved for correlation. Cases reclassified as SUMP that had a follow‐up pathologic diagnosis were subject to cytology review and subtyping into oncocytic/squamoid, basaloid, or myoepithelial subtypes based on cytomorphology. The risk of malignancy (ROM) for each subtype was analyzed. RESULTS There were 92 SUMP cases, which comprised 5.9% of 1560 consecutive salivary gland FNAs within the 12‐year study period. Histologic follow‐up was available for 59 patients. After cytology review, there were 18 cases (30.5%) of oncocytic/squamoid subtype, 25 (42.4%) of basaloid subtype, and 16 (27.1%) of myoepithelial subtype. Pathologic correlation revealed an ROM of 61.1% (11 of 18 cases) for the oncocytic/squamoid subtype, 40.0% (10 of 25 cases) for the basaloid subtype, and 18.8% (3 of 16 cases) for the myoepithelial subtype. The differences in ROM among the 3 subtypes were statistically significant (P = .0476). CONCLUSIONS Subtyping SUMP cases into categories based on cell type demonstrated differential ROMs for better clinical stratification. Future prospective studies are mandatory to confirm this finding

Application of the Milan System for Reporting Salivary Gland Cytopathology: A Retrospective 12-Year Bi-institutional Study

Objectives Multi-institutional studies are required for the validation of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC). Methods A total of 1,560 fine-needle aspirations of the salivary glands were retrieved from two institutions for a 12-year period. The diagnoses were reclassified based on the MSRSGC. Risk of malignancy (ROM) for each category was calculated based on 694 histologic follow-up cases. Results The ROM for each category was: 18.3% for nondiagnostic, 8.9% for nonneoplastic, 37.5% for atypia of undetermined significance (AUS), 2.9% for benign neoplasm, 40.7% for salivary gland neoplasm of uncertain malignant potential (SUMP), 100% for suspicious for malignancy, and 98.3% for malignant. The sensitivity, specificity, positive predictive rate, and negative predictive rates were 89%, 99%, 98%, and 96%, respectively. Conclusions The results of the current study are in keeping with the MSRSGC. The indeterminate categories of AUS and SUMP showed intermediate ROMs at 37.5% and 40.7%, respectively

Peripheral primitive neuroectodermal tumor of the ovary with torsion

AbstractPeripheral primitive neuroectodermal tumors (pPNETs) of the ovary are rare monophasic teratomas, and fewer than 100 cases have been reported in the literature. pPNETs mainly involve young women during their reproductive age, therefore, accurate diagnosis followed by multimodal treatment should be taken into consideration for fertility preservation. We report a patient with stage IA pPNET of the ovary presenting with acute abdominal pain secondary to torsion that was successfully managed by fertility-sparing surgery and six courses of combination chemotherapy with vincristine, Adriamycin, and cyclophosphamide. She has had a disease-free survival of >3 years. This brief review demonstrates the clinical course of pPNET and summarizes the literature to show that clinical stage at the time of diagnosis is the most important prognostic factor and that the vast majority of recurrences are observed within 10 years

Thyroid Fine-Needle Aspiration in Taiwan: The History and Current Practice

In Taiwan, thyroid cancer is the most common endocrine gland malignancy and the incidence of thyroid cancer has increased four-fold in the past two decades. Fine-needle aspiration is an accurate and cost-effective method of evaluating thyroid nodules and has been the gold-standard diagnostic tool for thyroid tumors in Taiwan since the 1980s. This article reviews the history, current practice, reporting systems, training, and quality assurance for thyroid fine-needle aspiration cytology in Taiwan

Recurrent ovarian mixed germ cell tumor with unusual malignant transformation: a case report

Abstract Background The value of this report is the identification of late recurrence with an extremely unusual combination of malignant transformation. In particular, the retroconversion of immature to mature teratoma as well as a somatic-type malignant transformation were both observed postchemotherapeutically in our case. Case presentation We report the case of a 20-year-old girl who completed fertility-sparing surgery and chemotherapy under the diagnosis of ovarian mixed germ cell tumor (immature teratoma and yolk sac tumor) and experienced subsequent recurrence 4 years after a second debulking surgery with a somatic type malignant transformation (teratoma with melanoma and leiomyosarcoma). Multiple metastases developed after a third debulking surgery, and the patient survived for 18 additional months. Conclusions Recurrent disease after repeated cytoreduction and chemotherapy hints a poor outcome despite a generally excellent long-term survival rate among ovarian germ cell malignancies. It is important for clinicians to distinguish those at risk of poorer outcomes and establish individualized postoperative surveillance. Fertility-compromising surgery may be considered in selected patients

鋼琴彈奏者之手部變異性

[[abstract]]本研究使用普爾曼螺旋分析（Pullman spiral analysis）（Pullman, 1998）以探討高技能鋼琴彈奏者之手部變異性，此動作變異性之指標為手指震顫，包括震顫嚴重程度、動作流暢度、不規則性及緊張度等變項。實驗參加者為20位主修鋼琴且慣用手為右手之大學生（平均年齡為21.75 ± 0.65歲），實驗要求其分別以左手和右手自然地握住一電子感應筆來畫數個螺旋形狀，左右手之試作次數各為10次；在前測與後測之間，參加者皆練習二個小時較快節奏之鋼琴彈奏練習。本研究以重覆量數二因子變異數分析，檢驗畫螺旋形狀之前後測與左右手交替使用在以下四個依變項之效果：手部動作之震顫嚴重程度、動作流暢度、不規則性及緊張度。主要研究結果為（1）上述二個自變項皆未在練習彈奏快節奏鋼琴二個小時後對震顫嚴重程度有所影響，及（2）右手動作較左手流暢，但左手則較右手顯現出較高之規律性。本研究提出以下結論：雖然鋼琴彈奏者之手部震顫程度並不顯著，研究發現以右手為慣用手之鋼琴彈奏者的右手表現出較不規律、但卻較為流暢之手部動作型態，相反地，其左手則表現出較為規律卻較不流暢之動作結果，究其原因可能與鋼琴彈奏者常以左手練習較為穩定之和弦彈奏有關。本研究發現有助於瞭解音樂知覺之相關知識，尤其是在鋼琴彈奏方面之音樂知識領域。 By utilizing the Pullman spiral analysis (Pullman, 1998), the purpose of the study was to examine the degree of severity (DOS), movement smoothness, irregularity, and tightness of highly skilled piano players, using finger tremors as the index of movement variability. Twenty piano major college-aged students (21.75 ± 0.65 years old) with right dominant hands participated in the study. They were asked to hold an electronic pen and draw several spirals in a natural position, with both hands performing the task 10 times. Two-hour-long piano practice sessions with a relatively fast tempo occurred between the pretests and posttests. The before/after piano playing sessions and the right/left hands were used as the two independent variables in the experiment. The major dependent variables included the DOS, movement smoothness, irregularity, and tightness. The two-way repeated measure ANOVA was applied to examine the effect of the piano playing and hands on the dependent variables. The results determined that: (1) No significant DOS differences exist in before/after piano playing, nor in the interchange between right/left hands; and (2) the right hands appear to generate smoother movements than the left hands, F(1, 19) = 59.68, p ＜ .001, η^2 = .76. However, the left hands displayed more regular movement features than the right ones, F(1, 19) = 24.37, p ＜ .001, η^2 = .56. The conclusion of the study was that, although no apparent practice effect appears in the piano players' hands, their right hands displayed a relatively higher irregularity, but with smoother playing. The pianists' left hands, however, assumingly trained more often in a chord-playing manner, displaying relatively more regularity with less smooth playing. The results of the study are useful in broadening the knowledge and understanding of the prolific perceptions of music, particularly in the arena of piano playing