Elizabeth Davaro

Bilateral Cystic Endosalpingiosis in Cervical Lymph Nodes Mimicking Metastatic Papillary Thyroid Carcinoma Morphologically on Cytology: A Case Report and Literature Review of Diagnostic Challenges

ABSTRACTThe presence of cystic lymph nodes in the neck can present a challenging differential diagnosis, with considerations often including metastatic papillary thyroid carcinoma (PTC), cystic squamous cell carcinoma, and congenital cysts. The cytologic overlap between benign Müllerian inclusions and PTC features adds complexity, especially in unusual locations. A 45‐year‐old woman with a history of ovarian serous borderline tumor (SBT) and non‐invasive Müllerian implants presented with cystic lymphadenopathy in the neck. Imaging revealed multiple suspicious, partially cystic lymph nodes. Fine‐needle aspirations (FNA) from two nodes showed moderate cellularity, monolayered epithelial sheets, and nuclear features suggestive of PTC. FNA cytology, thyroglobulin level, and immunocytochemical profile revealed benign Müllerian cells within lymph nodes. Subsequent histologic evaluation of the excised lymph nodes confirmed cystic endosalpingiosis. This case emphasizes the value of comprehensive clinical‐pathologic correlation and appropriate ancillary studies in the evaluation of cystic lymphadenopathy. Awareness of benign Müllerian inclusions and their mimicry of metastatic disease is essential for accurate diagnosis and optimal patient management.

Efficacy of Cobas HPV testing for predicting grade 2+ cervical intraepithelial neoplasia in a cancer prevention center and a gynecologic oncology clinic: A single‐institution experience

AbstractBackgroundTo evaluate the efficacy of Cobas human papillomavirus (HPV) testing to predict cervical intraepithelial neoplasia of grade 2 or higher (CIN2+), Cobas HPV testing results were correlated with follow‐up biopsy in patients from Cancer Prevention Center (CPC) and Gynecologic Oncology Clinic (GOC) of The University of Texas MD Anderson Cancer Center.MethodsInstitutional data for patients who underwent Cobas HPV and Papanicolaou (Pap) cytology cotesting from 2019 to 2020 were retrospectively reviewed. Surgical follow‐up results were compared with Cobas HPV testing results in two populations.ResultsA total of 2226 patients, including 921 women (mean age, 55.2 years) seen at the CPC and 1305 women (mean age, 49.3 years) seen at the GOC, were included. Specimens from GOC patients had a significantly higher HPV positivity rate than did those from CPC patients (22.9% vs. 10.1%; p < .001). Cobas HPV testing was positive in all seven CPC patients with surgical follow‐up results showing CIN2+. Among 36 GOC patients with CIN2+ lesions, five patients had HPV−/Pap+ testing results. Although only seven CPC patients had CIN2+, Cobas HPV testing showed 100% sensitivity for predicting CIN2+ in this group. Sensitivity for CIN2+ was 86.5% in the GOC group, whereas 13.9% of GOC patients with CIN2+ had negative HPV testing results.ConclusionsCobas HPV testing was highly efficacious for predicting CIN2+ lesions in the low‐risk CPC population, which supports HPV primary screening for cervical cancer in low‐risk populations. For high‐risk patients, especially those with a history of CIN2+/cervical cancer, HPV/Pap cotesting may still be necessary to maintain a high clinical sensitivity for CIN2+.