Background
To the authors' knowledge, the impact of the coronavirus disease 2019 (COVID‐19) pandemic on cytopathology practices worldwide has not been investigated formally. In the current study, ...data from 41 respondents from 23 countries were reported.
Methods
Data regarding the activity of each cytopathology laboratory during 4 weeks of COVID‐19 lockdown were collected and compared with those obtained during the corresponding period in 2019. The overall number and percentage of exfoliative and fine‐needle aspiration cytology samples from each anatomic site were recorded. Differences in the malignancy and suspicious rates between the 2 periods were analyzed using a meta‐analytical approach.
Results
Overall, the sample volume was lower compared with 2019 (104,319 samples vs 190,225 samples), with an average volume reduction of 45.3% (range, 0.1%‐98.0%). The percentage of samples from the cervicovaginal tract, thyroid, and anorectal region was significantly reduced (P < .05). Conversely, the percentage of samples from the urinary tract, serous cavities, breast, lymph nodes, respiratory tract, salivary glands, central nervous system, gastrointestinal tract, pancreas, liver, and biliary tract increased (P < .05). An overall increase of 5.56% (95% CI, 3.77%‐7.35%) in the malignancy rate in nongynecological samples during the COVID‐19 pandemic was observed. When the suspicious category was included, the overall increase was 6.95% (95% CI, 4.63%‐9.27%).
Conclusions
The COVID‐19 pandemic resulted in a drastic reduction in the total number of cytology specimens regardless of anatomic site or specimen type. The rate of malignancy increased, reflecting the prioritization of patients with cancer who were considered to be at high risk. Prospective monitoring of the effect of delays in access to health services during the lockdown period is warranted.
The coronavirus disease 2019 (COVID‐19) pandemic has resulted in a drastic reduction in the total number of cytology specimens obtained regardless of anatomic site or specimen type. The rate of malignancy has increased, reflecting the prioritization of patients with cancer who are considered to be at high risk. Prospective monitoring of the effect of delays on access to health services during the lockdown period is warranted.
Background & Aims
To analyse elastographic characteristics of focal liver lesions (FLL)s and diagnostic performance of real‐time two‐dimensional shear‐wave elastography (RT‐2D‐SWE) in order to ...differentiate benign and malignant FLLs.
Methods
Consecutive patients diagnosed with FLL by abdominal ultrasound (US) underwent RT‐2D‐SWE of FLL and non‐infiltrated liver by intercostal approach over the right liver lobe. The nature of FLL was determined by diagnostic work‐up, including at least one contrast‐enhanced imaging modality (MDCT/MRI), check‐up of target organs when metastatic disease was suspected and FLL biopsy in inconclusive cases.
Results
We analysed 196 patients (median age 60 range 50‐68, 50.5% males) with 259 FLLs (57 hepatocellular carcinomas, 17 cholangiocarcinomas, 94 metastases, 71 haemangiomas, 20 focal nodular hyperplasia) of which 70 (27%) were in cirrhotic liver. Malignant lesions were stiffer (P < .001) with higher variability in intralesional stiffness (P = .001). The best performing cut‐off of lesion stiffness was 22.3 kPa (sensitivity 83%; specificity 86%; positive predictive value PPV 91.5%; negative predictive value NPV 73%) for malignancy. Lesion stiffness <14 kPa had NPV of 96%, while values >32.5 kPa had PPV of 96% for malignancy. Lesion stiffness, lesion/liver stiffness ratio and lesion stiffness variability significantly predicted malignancy in stepwise logistic regression (P < .05), and were used to construct a new Liver Elastography Malignancy Prediction (LEMP) score with accuracy of 96.1% in validation cohort (online calculator available at http://bit.do/lemps).
Conclusion
The comprehensive approach demonstrated in this study enables correct differentiation of benign and malignant FLL in 96% of patients by using RT‐2D‐SWE.
Background
In a previous worldwide survey, the authors showed a drastic reduction in the number of cytological specimens processed during the coronavirus disease 2019 “lockdown” period along with an ...increase in malignancy rates. To assess the continued impact of the pandemic on cytological practices around the world, they undertook a second follow‐up worldwide survey collecting data from the post‐lockdown period (2020).
Methods
Participants were asked to provide data regarding their cytopathology activity during the first 12 weeks of their respective national post‐lockdown period (2020), which ranged from April 4 to October 31. Differences between the post‐lockdown period and the corresponding 2019 period were evaluated, and the authors specifically focused on rates of malignant diagnoses.
Results
A total of 29 respondents from 17 countries worldwide joined the survey. Overall, a lower number of cytological specimens (n = 236,352) were processed in comparison with the same period in 2019 (n = 321,466) for a relative reduction of 26.5%. The overall malignancy rate showed a statistically significant increase (12,442 5.26% vs 12,882 4.01%; P < .001) during the same time period. Similar results were obtained if both malignancy and suspicious for malignancy rates were considered together (15,759 6.58% vs 16,011 4.98%; P < .001).
Conclusions
The data showed a persistent reduction in the cytological specimen volume during the post‐lockdown period (2020). However, the relative increase in the cytological workload in the late part of the post‐lockdown is a promising finding of a slow return to normality.
A persistent reduction in the cytological specimen volume during the post‐lockdown period has been observed. The relative increase in the cytological workload in the late part of the post‐lockdown period is a promising finding of a slow return to normality.
We retrospectively investigated a cohort of 176 myelofibrosis patients (128 primary-PMF; 48 secondary-SMF) from five hematology centers. The presence of chronic kidney disease (CKD) was determined in ...addition to other clinical characteristics. CKD was present in 26.1% of MF patients and was significantly associated with older age (
P
< 0.001), higher WBC (
P
= 0.015), and its subsets (neutrophil, monocyte, and basophil counts), higher platelets (
P
= 0.001), lower albumin (
P
= 0.018), higher serum uric acid (
P
= 0.001), higher LDH (
P
= 0.022), and the presence of CV risk factors (
P
= 0.011). There was no significant association with driver mutations, degree of bone marrow fibrosis, PMF/SMF, or DIPSS risk categories (
P
> 0.05 for all analyses). The presence of CKD was significantly associated with shorter time to arterial (HR = 3.49;
P
= 0.041) and venous thrombosis (HR = 7.08;
P
= 0.030) as well as with shorter overall survival (HR 2.08;
P
= 0.009). In multivariate analyses, CKD (HR = 1.8;
P
= 0.014) was associated with shorter survival independently of the DIPSS (HR = 2.7;
P
< 0.001); its effect being more pronounced in lower (HR = 3.56;
P
= 0.036) than higher DIPSS categories (HR = 2.07;
P
= 0.023). MF patients with CKD should be candidates for active management aimed at the improvement of renal function. Prospective studies defining the optimal therapeutic approach are highly needed.
Merkel cell carcinoma (MCC) is uncommon cutaneous malignant neuroendocrine tumour of the elderly people with rapidly growing skin nodules found frequently on sun-exposed areas of the body. MCC is ...often an aggressive tumour with high tendency for local recurrence, lymph node involvement and distant metastases. This paper reports a case of metastatic MCC diagnosed by fine needle aspiration cytology (FNAC), flow cytometric deoxiribonucleated acid (DNA) analysis, pathohistology and electron microscopy. The cytological features in aspirate (stained with Papenheim and Papanicolaou staining) included increased cellularity, discohesive groups of small-to-medium size malignant cells with uniform, round-to-oval nuclei with moulding effect, fine chromatin, multiple micronucleoli and scanty cytoplasm. DNA flow cytometric analysis of the aspirate showed unexpected results for clinically aggressive behaviour of this tumour (the patient died after 21 months), and revealed that tumour contained diploid peak with DNA index of 1.1. The proliferation was high with elevated S-phase fraction (21%). The cytological diagnosis of possible metastatic MCC was confirmed by histological one as well as by electron microscopy presented the pathognomonic features for this tumour: dense-core neurosecretory granules with diameter of 100-250 nm surrounded by whorls of intermediate filaments. MCC provides an enormous challenge for the morphologist because of a wide range of differential diagnosis and for the clinician because this tumour has a highly malignant potential for local recurrence, nodal and distant spread and very often is combined with other tumours. Therefore it is important to perform FNAC of different lesions in the same patient because it can distinguish MCC from the other tumours.
The role of endoscopic ultrasound(EUS) in evaluating pancreatic pathology has been well documented from the beginning of its clinical use. High spatial resolution and the close proximity to the ...evaluated organs within the mediastinum and abdominal cavity allow detection of small focal lesions and precise tissue acquisition from suspected lesions within the reach of this method. Fine needle aspiration(FNA) is considered of additional value to EUS and is performed to obtain tissue diagnosis. Tissue acquisition from suspected lesions for cytological or histological analysis allows, not only the differentiation between malignant and non-malignant lesions, but, in most cases, also the accurate distinction between the various types of malignant lesions. It is well documented that the best results are achieved only if an adequate sample is obtained for further analysis, if the material is processed in an appropriate way, and if adequate ancillary methods are performed. This is a multi-step process and could be quite a challenge in some cases. In this article, we discuss the technical aspects of tissue acquisition by EUS-guided-FNA(EUS-FNA), as well as the role of an on-site cytopathologist, various means of specimen processing, and the selection of the appropriate ancillary method for providing an accurate tissue diagnosis and maximizing the yield of this method. The main goal of this review is to alert endosonographers, not only to the different possibilities of tissue acquisition, namely EUS-FNA, but also to bring to their attention the importance of proper sample processing in the evaluation of various lesions in the gastrointestinal tract and other accessible organs. All aspects of tissue acquisition(needles, suction, use of stylet, complications, etc.) have been well discussed lately. Adequate tissue samples enable comprehensive diagnoses, which answer the main clinical questions, thus enabling targeted therapy.
Two patients with features of multiple symmetric lipomatosis type 2 are presented. This particular disorder with a characteristic distribution of fat should be considered on differential diagnosis of ...obesity. Besides being rare, it may occasionally be unrecognized, especially in females. The etiology remains unknown; however, the association with high alcohol consumption is very strong. Several issues about the possible metabolic role of lipomatous adipose tissue have been discussed. Patients with multiple symmetric lipomatosis should be treated by liposuction or surgery instead of being submitted to diets.
Objectives: The recent availability of potent oral iron chelators is renewing an interest in the assessment of the possible impact of HFE genetics in MDS.
Methods: Thirty six newly diagnosed patients ...with MDS were studied for parameters of iron metabolism in addition to C282Y and H63D mutations of the HFE gene.
Results: Mutations were present in 11 out of 36 patients (31%), which were not different from our general population and were equally distributed among MDS subtypes. Mutated patients had higher ferritin levels (P = 0.039) and lower TIBC (P = 0.018). Ferritin was found to be higher for the untransfused mutated patients (P = 0.017), but not for transfusion-dependent patients in whom ferritin levels correlated significantly with the number of blood units received (P = 0.04). There was no difference in the number of blood units received between the mutated and wild type patients. A new observation made was that the mutated patients had a lower overall survival in addition to a poorer leukemia free survival (LFS) (P = 0.004 and P = 0.003, respectively).
Discussion: The HFE gene mutations are not more frequent in MDS patients. Iron overload in mutated patients was higher but there was no correlation found using supportive therapy for anemia. The effect of mutations on survival could be mediated by changes in iron metabolism.
Conclusion: The HFE genotype may predict MDS prognosis and there is a need for further studies. It remains a challenging question if HFE mutated MDS patients should be considered for potent iron chelation therapy.
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