A Retrospective Analysis of Serous Effusions Based on the Newly Proposed International System for Reporting Serous Fluid Cytopathology: A Report of 3633 Cases in an Oncological Center

Background: The International System for Reporting Serous Fluid Cytopathology (TIS) was recently proposed. We retrospectively applied TIS recommendations for reporting the cytological diagnosis of serous effusions and reported our experience.Methods: All the serous effusions from January 2018 to September 2021 were retrieved from the database. Recategorization was performed using the TIS classification, the risk of malignancy (ROM) was calculated for each TIS category, and the performance evaluation was carried out among different samples (pleural, peritoneal and pericardial effusions) and preparation methods (conventional smears, liquid-based preparations and cell-blocks). Results: A total of 3633 cases were studied, 17 (0.5%) were diagnosed as ND, 1100 (30.3%) as NFM, 101 (2.8%) as AUS, 677 (18.6%) as SFM, and 1738 (47.8%) as MAL. The ROM for the categories were found to be 38.5%, 28.6%, 52.1%, 99.4% and 100%, respectively. The ROM for SFM was significantly higher than that for AUS (P < 0.001), while the difference between the ROMs for the IVa and IVb was insignificant. The sensitivity, negative predictive value(NPV) and diagnostic accuracy of liquid-based preparations were all superior to conventional smears and cell-blocks in detecting abnormalities. Using three preparation methods simultaneously had the highest sensitivity, NPV and diagnostic accuracy.Conclusion: Serous effusion cytology has a high specificity and positive predictive value(PPV), and the TIS is a user-friendly reporting system. Liquid-based preparations could improve the sensitivity of diagnosis, and it is best to use three different preparation methods simultaneously for serous effusion cytologic examination.

A Study of Reproducibility of Papanicolaou Society of Cytopathology System of Reporting Respiratory Cytology-A Single Institutional Experience on Image Guided Aspiration Cytology

Background: Cytologic examination of specimens obtained from the respiratory tract is a primary and frequently the initial diagnostic technique performed in patients with pulmonary abnormalities. Fine needle aspiration (FNA) is extensively used for diagnosis of pulmonary lesions. The Papanicolaou Society of Cytopathology (PSC) issued a new classification for respiratory cytology and criteria, risk of malignancy, post-cytologic diagnosis management and follow-up. Methods: Respiratory FNA specimens obtained between January 2015 to March 2021 were reviewed and reclassified according to PSC guidelines. Cytologic category as per PSC system was assigned after reviewing by two pathologists. Risk of malignancy for each category was calculated for cases where biopsy was available for correlation. Results: Three eighty-four samples were classified as non-diagnostic (30.5%), negative for malignancy (13.3%), atypical (0.5%), neoplastic (benign/ low malignant potential) (0%), suspicious for malignancy (5.7%%) and malignancy (50%). Risk of malignancy for malignant category (Category V and Category VI) was 64.1% and for non-malignant (Category I to Category IV) cases was 35.9%. Overall, there was lesser incidence of atypical category and more specific diagnoses were possible on cytology in non-malignant category. Sensitivity and specificity for malignant cases was 99.33% and 100% respectively. Conclusion: Our study substantiates that use of PSC guidelines improves the overall reporting of respiratory cytology due to the use of standardized terminology.

Diagnosis and treatment of Candida glabrata proventriculitis in an eclectus parrot (Eclectus roratus)

CASE DESCRIPTION An 8-year-old sexually intact female eclectus parrot (Eclectus roratus) with a 4-day history of hyporexia and lethargy and a 1-day history of tenesmus was examined. CLINICAL FINDINGS Severe leukocytosis characterized by severe heterophilia and moderate monocytosis was present. Marked dilation of the proventriculus and ventriculus and ascites were identified by means of radiography, coelomic ultrasonography, and contrast-enhanced CT, with no clinically relevant motility noted on ultrasonography. Results of coelomic fluid analysis were consistent with pyogranulomatous effusion. Endoscopy of the upper gastrointestinal tract following proventricular and ventricular lavage showed a thick caseous plaque occupying 30% of the caudal proventricular mucosa. Abundant yeast organisms were evident during cytologic examination of a proventricular and ventricular wash sample, and fecal culture yielded Candida glabrata. TREATMENT AND OUTCOME The bird was treated with SC fluids, assisted feedings, nystatin, fluconazole, amoxicillin–clavulanic acid, enrofloxacin, gastroprotectants, maropitant, and analgesics and slowly improved during hospitalization. A marked decrease in proventricular dilation was evident on serial radiographs obtained over a 12-month period. One year after diagnosis, the bird was presented with a 1-week history of hyporexia and lethargy, and fecal culture grew C glabrata. Antifungal treatment was resumed for 3 months. The bird had no clinical signs of infection 16 months after this recurrence, and subsequent fecal cultures were negative for fungal growth. CLINICAL RELEVANCE Findings illustrate the importance of upper gastrointestinal endoscopy in diagnosing proventricular and ventricular dilation in birds and emphasize the need for long-term antifungal treatment and monitoring in birds with fungal infections.

Calcarea carbonica derivative complex (M8) as adjuvant treatment of inflammatory mammary carcinoma in a dog

Background: Inflammatory mammary carcinoma (IMC) is locally aggressive, fast growing, highly malignant tumor that affects humans and dogs. Affected dogs usually are presented with generalized edema, pain, erythema, and skin ulceration in mammary glands. Surgery is not recommended and an effective treatment has not been established [1]. Calcarea carbonica derivative complex (M8) has demonstrated anticancer properties in a murine model, by improving innate immune response against tumor cells [2,3]. M8 is a complex high diluted medication comprised of a 10%-20% concentration of Calcarea carbonica, Aconitum napellus, Arsenicum album, Asa foetida, Conium maculatum, Ipecacuanha, Phosphorus, Rhus tox, Silicea, Sulphur, and Thuya occidentalis, all in decimal dilutions of Hahnemann in distilled water and submitted to vigorous shaking. Aim: Describe an association of M8 and piroxicam (Non-steroidal anti-inflammatory drug) to treat a dog with IMC. Discussion: A 7 years old, mixed breed intact female dog was presented to the Federal University of Parana - Veterinary Hospital, Curitiba (HV-UFPR) for mammary glands examination. The owners related inflammation of mammary glands with clinical course of approximately 10 days, which was treated for mastitis (cephalexin and metergoline) without clinical improvement. Clinical examination revealed erythema, increased skin warmth, pain on palpation, and plaque involving the 4th and 5th right mammary glands. Abdominal ultrasound and serum biochemistry were unremarkable. Thoracic radiographs showed suspicious images of pulmonary metastasis. Fine needle biopsy was taken for cytologic examination. Cytological interpretation was a malignant epithelial neoplasm, probably a mammary carcinoma. Diagnosis of IMC was based on clinical signs and cytopathology. Dog was treated with oral (0.5 mL) and topical M8 twice a day for 15 days, and pyroxican, 0.3mg/kg, PO, q24h. Clinical improvement was observed 7 days after starting treatment. Until present date (70 treatment days with M8), dog has no clinical signs of IMC, and does not show signs of disease progression. Conclusion: The present report suggests that M8 associated with piroxicam contributes to improvement of IMC dog’s quality of life and survival rate. However, further clinical studies are needed to evaluate response to treatment in patients diagnosed with IMC.

Imaging diagnosis of paranasal sinus mucocele in a Yorkshire Terrier dog

An 8-year-old, neutered male Yorkshire Terrier dog presented with left ventromedial canthus swelling over a one-month period, refractory to pharmacological therapy. There was no history of trauma. On ultrasonography, the lesion had a cystic character filled with anechoic fluid and hyperechoic sedimenting debris. The computed tomography (CT) and CT-dacryocystography showed a cystic lesion protruding from the lacrimal sac fossa and occupying a defect in the orbital plate and an ethmoidal ectoturbinate surrounded by a bony structure with an intact nasolacrimal system. The dog underwent the surgical resection of the cyst and its fluid content was aspirated. Ethmoid mucocele was diagnosed based on the CT, cytologic examination, bacterial culture and histopathologic findings. This case describes the imaging characteristics of an ethmoid mucocele and highlights the importance of CT and CT-dacryocystography in dogs with ventromedial canthus swelling that had poor response to medical treatment.

Difficulty in Diagnosing Peritoneal Fluid Cytology in Ovarian Yolk Sac Tumor Cases

Objective : This article objective is to describe cytology diagnosis difficulties of yolk sac tumors of the ovary.Method : Case reports and literature review.Case : The author reports the case of a 24 year old woman who complained of an enlarged stomach. Serum AFP increased to 16,519.7 U/mL. Ultrasound examination revealed solid and irregular mass of ovarian, so the conclusion was suspect ovarian carcinoma. Conclusion of CT scan examination was a solid ovarian tumor. The working diagnosis was suspect ovarian carcinoma. Optimal debulking was performed, accompanied by taking a sample from the peritoneal rinse fluid. Microscopic examination of peritoneal fluid showed the distribution and group of cells with pleomorphic nuclei, partly hyperchromatic, partly vesicular with coarse chromatin and prominent nucleoli. There were also cells with polygonal nuclei, small nuclei, basophilic and vacuole cytoplasm with a mucoid background. These cells formed a solid arrangement. Conclusion from these features was carcinoma metastases to the peritoneal fluid. Microscopic examination from tumor tissue sample showed an ovarian yolk sac tumor appearance.Conclusion : Cytologic examination of peritoneal fluid in cases of ovarian yolk sac tumor is quite difficult to determine the diagnosis. This is due to the microscopic appearance of tumor cells which often looks like a carcinoma and limited literature about this tumors in the peritoneal fluid.Keywords: Yolk sac tumor, ovary,

Mammary gland condition in premenopausal women with endometrial hyperplasia

Introduction. Amidst a steady increase in hyperplastic processes in uterus and mammary glands, numerous studies have shown that women with dyshormonal pathology of mammary glands had a range of gynecological diseases: external or internal endometriosis, hyperplastic processes of the endometrium and myometrium, polyps, polycystic ovary syndrome (PCOS), etc.Objective. To assess the mammary gland condition in premenopausal women with endometrial hyperplasia during indole-3-car-binol (I3C) therapy.Materials and methods. A total of 42 premenopausal patients aged 45-52 years (48.54 ± 1.83) were enrolled in an open-label prospective study. All patients received I3C 400 mg a day for 12 months. The examination included clinical laboratory, ultrasound imaging and mammographic examination of the mammary glands, cytologic examination of a nipple discharge. The examinations were carried out at the baseline, 6 and 12 months after starting treatment. The study findings were evaluated using descriptive statistics. Differences were considered significant at p <0.05.Results and discussion. All patients were diagnosed as having mastalgia before starting treatment. Mammary gland ultrasound imaging showed that the frequency of BI-RADS 2 was 9.5 times higher than that of BI-RADS 1 (90.5% and 9.5%, respectively, p <0.05). Mammography revealed that the frequency of BI-RADS 2 was 9.26 times higher than that of BI-RADS 1 (88% and 9.5%, respectively, p <0.05). After 6-month therapy, 59.5% of patients reported the disappearance of pain syndrome, the number of patients with ONE1/16a-ONE1 deviations decreased by 22%, 7.1% of patients showed improvement of ultrasound picture in BI-RADS. After 12-month therapy, the number of patients with ONE1 / 16a-ONE1 deviations decreased by 92.86% compared with the figures before starting treatment, ultrasound imaging showed improvement in the BI-RADS picture in 19% of patients, mammography findings - in 28.5% of patients. I3C is an effective and safe method to treat benign breast diseases in premenopausal women.Conclusion. Indole-3-carbinol therapy can be assessed as the treatment having an influence on the general components of pathogenesis of endometrial hyperplasia and benign hyperplastic processes in mammary glands. It is advisable to consider the use of indole-3-carbinol combined with antioxidant resveratrol in clinical practice.

Follicular adenoma of the thyroid gland in children: a clinical spectrum

IntroductionThe aim of the study was to assess of clinical aspects of thyroid follicular adenoma in children and attempt to elaborate management algorithm useful in a clinical practice.Material and methodsClinical database of all children operated due to thyroid disease in years 1993-2018 at the university pediatric surgical centre was reviewed. The children in whom postoperative histology report showed follicular adenoma were selected and their medical files were analysed in detail. Clinical course of the disease, medical and family history, results of imaging studies, details of surgical management and final outcome were assessed in each case.ResultsAmong 183 children operated on for thyroid pathology in the study period there were 56 patients with follicular adenoma ( 30,6%). Their age ranged from 7 to 18 years. Seven patients were found hypothyroid and further seven showed hyperthyroid status initially. Ultrasound scan showed a solitary nodule in 37 children (66,1%). Multiple nodules in one lobe were detected in 5 patients, while further 14 children showed bilateral thyroid pathology. The result of preoperative cytologic examination was suspicious in 12 children (21,4%). All children were subjected to an operative management. Forty- two children (75%) underwent at least unilateral total lobectomy. No patient showed a recurrent thyroid disease.ConclusionsFollicular adenoma in children presents a wide clinical and morphological spectrum. High incidence of associated diseases of other systems and congenital anomalies of the thyroid gland may indicate on complex etiology of follicular adenoma with participation of yet unknown endogenic factors in children.