Franco Fulciniti

The expression pattern of CD10 and CD31 identifies fine fibrovascular stroma of grade 1‐endometrial endometrioid carcinomas in cytology

AbstractIntroductionThe objective of this study was to assess the diagnostic utility of CD10 in the differential diagnosis of grade 1‐endometrial endometrioid carcinoma (G1‐EEC) and the metaplastic changes associated with the endometrial glandular and stromal breakdown (EGBD) on liquid‐based cytological (LBC) samples.Methods(1) The type and distribution of CD10‐positive cells in EGBD and G1‐EEC patients were evaluated. (2) Based on the results from (1), histological and cytological specimens were double‐immunostained with CD31 and CD10 to confirm whether CD10‐positive tubular‐canalicular material found in (1) was represented by fine threads of endometrial‐type fibrovascular stroma. (3) Based on the results from (2), additional immunostaining of histological specimens was performed for CD146 and αSMA as markers of perivascular cells.Results(1) CD10 positive cells showed two main patterns of expression: cytoplasmic immunoreactivity in the form of dense brown granules in EGBD and tubular‐canalicular branching patterns in G1‐EEC. (2) The tubular‐canalicular material observed in cytological specimens of G1‐EEC samples co‐expressed CD10 and CD31, and was interpreted as representing fine threads of endometrial fibrovascular stroma in the corresponding histological samples. Conversely, metaplastic changes in EGBD cases, only a few CD31‐positive signals were found inside the condensed stromal clusters with CD10‐positive. (3) Cells surrounding the CD31‐positive vascular endothelial cells expressed CD146 and αSMA; moreover, some of the thin CD10‐positive fibrous stromal strands also co‐expressed αSMA.ConclusionsCD10 is a very useful immunomarker for distinguishing between G1‐EEC and the metaplastic changes of EGBD in LBC samples.

Cytologic presentation of ovarian large cell carcinoma with rhabdoid features detected on peritoneal washing. Report of one case with cyto‐histologic correlation and previously undescribed inactivating SMARCA‐4 mutations

AbstractThe SMARCA subgroup of genes belongs to the SWI1/SNF1 family, responsible for chromatin remodeling and repair within the nucleosome. The SMARCA4 gene is located on chromosome 19p13 and encodes the BRG1 (BRAhMA) protein. We report the cytological and histological findings in one case of large cell SMARCA4 deficient ovarian carcinoma with positive peritoneal washing in a 69‐year‐old woman. The neoplastic cells were present as singly lying or perivascular clusters and showed medium or large size, round to oval hyperchromatic nuclei, and scarce to moderate cytoplasms. Molecular pathology investigations performed on the ovarian surgical sample found two previously undescribed mutations in the SMARCA4 gene and additional mutations in the CTNNB1 (Beta Catenin gene) and in PIK3CA. To our knowledge, this case probably represents the third cytologic report of this variant of ovarian carcinoma and the first one with molecular pathologic study.

A review of the directly sampled endometrial cytology on LBC samples: Classification, microscopic criteria and beyond

AbstractThe Yokohama System for Reporting Endometrial Cytology (TYS) has been proposed by an expert meeting under the auspices of the International Academy of Cytology (IAC) in May 2016 at the IAC in Yokohama. Since its introduction, the TYS has been receiving worldwide acceptance, and this review aims to assess its global impact. The adoption of endometrial cytology as a diagnostic procedure has been hampered in the past by difficulties arising in interpreting the cellular findings due to a number of factors (such as excess blood, cellular overlapping and the complex physiology of endometrium). Recently, the use of liquid‐based cytology (LBC), with its ability to remove blood and mucus and to distribute cells uniformly in a thin layer on the slide, has provided an opportunity to re‐evaluate the role of endometrial cytology. LBC is a useful tool in the cytologic diagnosis and follow‐up of endometrial abnormalities, which remains complementary to the emerging molecular diagnostic cytopathology. The study of LBC from endometrial cytology could be challenging since it is affected by numerous look‐alikes and diagnostic pitfalls. This review discusses these various entities and takes into consideration the ancillary techniques that may be useful in the diagnostic procedure. In conclusion, our review of the published data suggests that the TYS is a valid classification scheme that has been widely accepted by cytopathologists globally, is highly reproducible and makes a valuable contribution to clinical therapeutic management. At present, molecular cytopathology is a rapidly evolving field of modern cytopathology, which underlines the effective interplay between genomics and cytology. This review aims to provide a comprehensive review of the drawbacks of endometrial cytopathology, particularly in terms of endometrial cancer diagnosis and molecular testing.