Nalini Gupta

A sub‐hepatic nodule in a young female: Chase the case

Sertoli-Leydig cell tumours (SLCTs) are rare, mixed sex-cord stromal tumours composed of varying proportions of both Sertoli and Leydig cells, which account for <0.5% of all ovarian tumours. The cytomorphologic features of SLCTs are not well described in literature. Herein, we describe the cytomorphologic features of an SLCT at an uncommon metastatic site in a young female. Sertoli-Leydig cell tumours (SLCTs) are rare, mixed sex-cord stromal tumours composed of varying proportions of both Sertoli and Leydig cells, which account for <0.5% of all ovarian tumours. The cytomorphologic features of SLCTs are not well described in literature. Herein, we describe the cytomorphologic features of an SLCT at an uncommon metastatic site in a young female.

Cervical cytology in the detection of uterine clear cell carcinoma: Diagnostic predictors from a case‐control study

AbstractIntroductionUterine clear cell adenocarcinoma (CCC) is a rare, aggressive malignancy with poor prognosis. The present study aimed to identify and describe its characteristic morphological features in cervical cytology.MethodsThis was a 3‐year retrospective case‐control study. Cases included cervical samples of histopathologically proven endometrial and cervical CCC. Controls included cervical samples of histopathologically proven endometrial serous carcinoma (n = 15), endometrioid adenocarcinoma (n = 20), and endocervical adenocarcinoma (n = 15). Twenty‐eight cytomorphological features were evaluated; the strength of association was determined by odds ratio (OR) and Cramer's V, and the diagnostic accuracy of statistically significant features was assessed.ResultsCases consisted of histopathologically proven 25 (34.7%) endometrial and 13 (18.0%) cervical CCC. Corresponding cervical samples were available for a total of 14 (36.8%) patients, of which 13 (92.8%) were positive for epithelial cell abnormality. On univariate analysis, three cytomorphological variables were significant predictors of uterine CCC: presence of dense cytoplasm (OR = 88; V = 0.72), deep nuclear membrane irregularities (OR = 17.5; V = 0.55), and coarse chromatin (OR = 21.3; V = 0.46). Dense cytoplasm had the highest positive predictive value (92%) and high specificity (97.8%), whereas coarse chromatin had the highest sensitivity (92.3%) and negative predictive value (96.7%).ConclusionsThe presence of dense cytoplasm and deep nuclear membrane irregularities in the tumour cells were strong predictors, and coarse chromatin a moderate predictor, of uterine CCC compared to its close cytological mimics.

Role of fractal dimension in distinguishing benign from malignant endometrial clusters in liquid‐based cervical samples

AbstractIntroductionExfoliated endometrial cells are often seen as hyperchromatic crowded groups (HCGs) in cervical samples. It is challenging for the cytopathologists to discriminate between HCGs of benign and malignant endometrial cells. Fractal dimension (FD) analysis has proved to be a useful tool in discriminating between different types of cell groups in previous studies.AimsThis study was conducted to evaluate the utility of FD for differentiating between benign and malignant endometrial HCGs, in liquid‐based cervical samples.MethodsTwo groups of cervical samples, with subsequent histopathology, were selected: Group A: 30 cases with benign endometrial HCGs; and Group B: 39 cases with malignant endometrial HCGs. Image J, NIH and FracLac software were used for selecting and measuring the FD of the HCGs. Student t‐test was used for statistical analysis.ResultsThe mean FD for benign endometrial HCGs (1.066943 ± 0.0699) was significantly lower than that of the malignant endometrial HCGs (1.086271 ± 0.05121; P = .001). Using receiver operator characteristic curve analysis, we determined that an FD cut‐off value of 1.01 would yield sensitivity of 90.3%, specificity of 26.1%, positive predictive value of 47.3% and negative predictive value of 78.6%.ConclusionThe measurement of FD of HCGs in cervical samples can serve as a useful screening adjunct to differentiate malignant from benign HCGs, owing to its high sensitivity. However, in view of its low specificity and positive predictive value, we recommend that cases labelled as malignant by the FD value be confirmed for malignancy by other methods.

Tall‐columnar glandular cells in SurePath™ liquid‐based cytology Pap sample: Learning from mimics/pitfalls

We offer a comprehensive depiction of the cytomorphological characteristics of lobular endocervical glandular hyperplasia (LEGH) as observed in SurePath™ liquid-based cytology (LBC), subsequently confirmed on cone biopsy. Lobular endocervical glandular hyperplasia (LEGH), a precursor to gastric-type adenocarcinoma (GAE) of the endocervix, is rare and reports of it in cervical cytology are scarce. We provide a thorough description of the cytomorphological features of LEGH observed in SurePath™ liquid-based cytology (LBC), later confirmed by cone biopsy. To the best of our knowledge, this is the first report documenting cytology of LEGH in LBC of a Pap sample.

Solitary cutaneous metastasis from an ovarian high‐grade serous carcinoma at the initial presentation: Cytologic diagnosis of a rare manifestation

AbstractCutaneous metastasis can rarely be the first manifestation of visceral malignancies and is commonly seen in advanced‐stage malignancies. It is infrequently seen in patients with ovarian malignancies and may develop either late in the course of the disease or at the initial presentation. Such cases are often associated with poor prognosis, and a prompt, precise tissue diagnosis is essential for appropriate patient management and better clinical outcome. Herein, we present a case of cutaneous metastasis in a young woman with an undiagnosed abdominopelvic mass that was diagnosed as metastatic high‐grade serous carcinoma (HGSC) on fine‐needle aspiration cytology (FNAC) supplemented by immunocytochemistry (ICC) on the cell block. The index case documents a unique and rare metastatic presentation of ovarian HGSC, as non‐Sister Mary Joseph anterior abdominal wall nodule, at the initial presentation. Additionally, it highlights the utility of minimally‐invasive FNA combined with ICC in prompt and accurate preoperative diagnosis of an underlying ovarian malignancy.

Ultrasound‐guided fine needle aspiration of ovarian masses: Assessment of diagnostic accuracy and risk stratification using a categorical reporting system

AbstractIntroductionThe present study was undertaken to assess the accuracy of fine needle aspiration cytology (FNAC) and cell‐block immunocytochemistry, and to estimate the risk of malignancy, using a categorical reporting system, in the diagnosis of ovarian masses.MethodsThis was a 5‐year retrospective study of FNAs of ovarian masses. The cytological diagnoses were categorised as inadequate, non‐neoplastic, benign neoplasms, indeterminate for malignancy, suspicious for malignancy and malignant neoplasms. The cytology was correlated with the corresponding histopathology to assess the diagnostic accuracy and risk of malignancy associated with each diagnostic category.ResultsOf a total of 66 703 FNAs performed during the study period, 580 (0.9%) were performed on ovarian masses. Of these, 40 (6.9%) were reported as non‐neoplastic; 76 (13.1%) as benign neoplasms; 14 (2.4%) as indeterminate for malignancy, 48 (8.3%) as suspicious for malignancy, 337 (58.1%) as malignant neoplasms and 65 (11.2%) as inadequate for interpretation. Immunocytochemistry (ICC) was performed on 99 (17%) aspirates. Subsequent histopathology was available in 208 (35.8%) cases. On cyto‐histopathological correlation, 183 (88%) were concordant and 25 (12%) were discordant. The overall sensitivity, specificity, positive and negative predictive values and diagnostic accuracy for diagnosing ovarian malignancy were 88.4%, 85.7%, 96.8%, 60.0% and 88% respectively. Risk of malignancy for each category was 80%, 0%, 4.5%, 66.7%, 88.5% and 98.5% respectively.ConclusionsUltrasound‐guided FNAC has high specificity and diagnostic accuracy for preoperative diagnosis of ovarian malignancies and hence is a valid diagnostic procedure in certain clinical situations. Reporting using a categorical system imparts uniformity and also provides the clinicians with an associated risk of malignancy to guide further management.

Metastatic germ cell tumour in effusion cytology

AbstractBackgroundGerm cell tumours infrequently metastasise to body cavities, where early detection on fluid samples is possible and can spearhead early treatment and survival.Materials and methodsA total of seven cases of metastatic germ cell tumours were retrieved out of 7500 effusion samples received for cytopathological examination from 2015 to 2021. Detailed cytological features of metastatic germ cell tumours in effusion samples were studied, along with a correlation between clinical, radiological, and histopathological features.ResultsA total of seven cases of metastatic germ cell tumours were analysed in effusion samples which included dysgerminoma (2), immature teratoma (2), yolk sac tumour (1), embryonal carcinoma (1), and mixed germ cell tumour (1). The smears showed predominantly discrete or loose clusters of cells. The cells with round nuclei and prominent nucleoli were helpful in detecting dysgerminoma and yolk sac tumours. Immature teratoma showed tiny groups of small cells and mature squamous cells. Serum tumour markers were raised in the majority of cases.ConclusionMetastatic germ cell tumours in effusion are uncommon, but detailed clinical history, including serum markers and characteristic cytological features, are helpful in their diagnosis.

Cytomorphological features of cervical small cell neuroendocrine carcinoma in SurePath™ liquid‐based cervical samples

AbstractSmall cell neuroendocrine carcinoma (SCNEC) of the cervix is a rare, highly aggressive tumour with poor prognosis and high propensity for distant metastases. The cytological features of SCNEC have rarely been described in cervical samples, and to the best of our knowledge, there are no previous reports using SurePath™ liquid‐based cytology. In the present report we present the cytomorphological features of histopathologically confirmed cases of cervical SCNEC in SurePath preparations. On cytological examination, all three cases demonstrated variable numbers of tumour cells, ranging from a few dispersed cells and tiny micro‐biopsies to large aggregates of small tumour cells with a high nucleus‐to‐cytoplasmic ratio, stippled chromatin, inconspicuous nucleoli, and scant cytoplasm. Immunocytochemistry for CD56 on the cervical preparation confirmed the diagnosis in one case. The presence of small tumour cells with characteristic stippled/salt‐and‐pepper type nuclear chromatin were the most consistent cytological features in these cases. Knowledge of these characteristic cytological features can help in suggesting a diagnosis of SCNEC in cervical samples which can then be confirmed by immunocytochemistry.

Ovarian Teratomas Unveiled: Pathologists’ Curiosity Reveals Intriguing Associations in the Enigmatic Realm

Mature and immature teratomas can coexist with other tumor types and they may undergo malignant change in any one of their elements. In the present study, we present our institutional experience of these rare associations with teratomas. This was a retrospective study over a period of 10 years (January 2014 to December 2023) on histopathologically diagnosed cases of ovarian teratomas. The clinicopathologic features of malignant transformation (MT), other associations, as well as co-existing tumors with ovarian teratomas were analyzed. There was a total of 602 (21%) ovarian teratomas out of all ovarian tumors (n=2858) reported during the study period. In all, 41/602(6.8%) cases were immature teratomas with the presence of gliomatosis peritonei in 7 cases. Mature cystic teratoma (MCT) cases also had gliomatosis peritonei (n=9) along with nodal gliomatosis in 3 cases. Neoplasms arising in teratomas (n=6) included carcinoid tumor (n=2), small cell neuroendocrine carcinoma (n=1), mucinous adenocarcinoma (n=2), and low-grade mucinous neoplasm of the appendix present within the teratoma (n=1). Of a total of 18 cases of struma ovarii, one case each of papillary thyroid carcinoma and follicular thyroid carcinoma was seen. Squamous cell carcinoma (n=4) was the commonest malignant transformation noted. Growing teratoma syndrome (n=4) and NMDA-associated encephalitis (n=3) associated with teratoma were also seen. Neoplasms/conditions co-existing with teratomas in the same ovary (n=9) included mucinous cystadenoma (n=1), serous cystadenofibroma (n=1), high-grade serous carcinoma (n=1), fibrothecoma (n=2), hydatid cyst (n=1), sclerosing stromal tumor (n=1), adult granulosa cell tumor (n=1), and metastatic signet ring cell carcinoma (n=1). Although the clinical course of MCT is typically indolent, pathologists should be aware of malignant transformation and other rare co-existing entities, highlighting the importance of adequate sampling of the tumors.