Natalie Banet

The Use of Cytology Specimens in Isolation for Diagnosis of High-Grade Serous Carcinoma Prior to Initiation of Neoadjuvant Chemotherapy: A 3-Year Experience at a Large Referral Hospital

Introduction: Selected patients with pelvic high-grade serous carcinoma (HGSC) receive neoadjuvant chemotherapy prior to resection. Guidelines allow cytopathology fluids to be used to confirm this diagnosis before neoadjuvant chemotherapy, which can be less invasive and costly. This study examines how often cytology fluids are used for this purpose at our institution. Methods: Specimens of HGSC on cytology were searched for over 3 years. Results: Of 54 specimens, 44 of 54 (81%) were effusions, 10 of 54 (19%) were washings. The majority (32/54; 59%) of specimens were abdominal, the remaining were pleural (22/54; 41%). Most 32 of 54 (59%) were post therapy/diagnosis. A minority of specimens (14/54; 26%) had a concurrent surgical pathology specimen. In all, 34 of 52 (65%) patients were Stage 3, 13 of 52 (25%) Stage 4, and 5 of 52 (10%) Stage 2. Only 6 of 54 (11%) specimens were used solely for initial diagnosis with no concurrent surgical pathology specimen. All 6 were effusions; 5 of 6 (83%) were abdominal and 1 of 6 (17%) was pleural. Immunohistochemistry was performed on a majority (30/54; 56%) of specimens, with PAX8 being the most common, (30/54; 56%) and was positive in all specimens. Mutational p53 staining was noted in 20 of 21 (95%) specimens. Conclusion: Cytology fluid alone is uncommonly used for diagnosis of HGSC prior to initiation of neoadjuvant chemotherapy at our institution, possibly due to morphologic overlap on fluid specimens and relatively new implementation of neoadjuvant chemotherapy guidelines. High-grade serous carcinoma is most often encountered in effusions post-therapy. Morphology is similar in all specimens, regardless of preparation method or therapy status.

Sertoli–Leydig cell tumors: an overview of key findings

Primary Uterine Angiosarcoma Presenting With Omental Metastasis, Lymph Node Involvement, and Demonstrating a Null p53 Mutational Staining Pattern

In this report, we present a 51-year-old woman with months of heavy vaginal discharge, pain, nausea, and vomiting. Magnetic resonance imaging showed a large necrotic mass expanding the uterus with extension through the myometrium. Initial biopsy showed a malignant spindle cell neoplasm with high mitotic activity and necrosis. Immunohistochemistry (IHC) suggested a high-grade sarcoma, and further surgical resection confirmed a diagnosis of primary uterine angiosarcoma with positive ERG and CD31. Whole exome and whole transcriptome sequencing revealed pathogenic variants for CDKN2A (p.W110*; c.330G > A) and TP53 (c.782 + 1G > T; c.782 + 1G > T). Unfortunately, despite aggressive surgical management, the patient experienced rapid progression and succumbed to her disease within 5 months. Primary uterine angiosarcomas are exceedingly rare and clinically aggressive mesenchymal malignancies, with fewer than 30 tumors reported in the English literature. This report highlights the diagnostic challenges posed by primary uterine angiosarcomas, particularly due to their nonspecific high-grade morphology and focal vascular features. A broad IHC panel and molecular analysis can aid in accurate diagnosis.

Cytology and histology of endocervical glandular lesions: a review with emphasis on recent developments

In recent years, there has been vast change in the field of cervical pathology, most notably in the classification and approach to cervical glandular lesions. The publication of the 5th edition of the World Health Organization Classification of Tumours of Female Reproductive Organs in 2020 signalled a paradigm shift away from morphology-based categorisation towards an aetiology-based system linked to lesional human papilloma virus (HPV) status. This includes several newly described entities such as HPV-associated micropapillary and stratified mucin-producing carcinomas, and gastric-type adenocarcinoma in situ and atypical lobular endocervical glandular hyperplasia, both regarded as precursors to HPV-independent carcinoma of gastric type. Simultaneously, cervical screening programs in resource-rich nations have undergone major renewal, with transition to more sensitive primary HPV-based molecular screening. Diagnostic methods have also been expanded in recent years, including the availability of sensitive, immunohistochemically based in situ hybridisation testing for HPV on tissue samples. The rate of change has been rapid, exposing pathologists to potential knowledge gaps. In this review, many of the key changes pertinent to reporting these lesions are addressed.