Cytomorphology of tyrosine-rich crystalloids in fine needle aspirates of salivary gland adenomas

Comparison of Modified Ultrafast Giemsa Stain with the Standard May Grunwald Giemsa Stain in FNAC of Various Organs

Background

The May-Grünwald Giemsa Stain is one of the preferred Romanwsky stains in studying cell morphology of air-dried smears with respect to cellular and nuclear size details and metachromatic extracellular ground with an approximate staining time of 20-30 min. A reduction in staining time and possible application of an ultrafast stain for rapid onsite evaluation (ROSE) of cytological material is the need of the hour. With the application of the new modified ultrafast Giemsa (MUFG) technique, rapid staining can be achieved, thereby helping in triaging of samples and, most importantly, providing an early preliminary diagnosis.

Aims

The aim is to assess the quality index of the MUFG technique in FNAC of various organs in comparison with the standard MGG stain.

Materials and Methods

A total of 61 FNAC cases were studied by random sampling. Two smears were prepared for each case and stained by both. Scores were given based on five parameters, and the quality index was calculated.

Statistical Analysis

Results were analyzed using mean, median, standard deviation, "t" paired test, "P" value, and M-diff for statistical significance.

Results

The quality index of MUFG smears was comparable to the standard MGG stain in salivary gland, breast, and thyroid aspirates and low in lymph node and soft tissue aspirates. MUFG is a rapid cost-effective stain which can be applied in the setting of ROSE for a preliminary diagnosis.

Conclusion

MUFG is a reliable alternative and rapid technique for cytology diagnosis.

Crystals and crystalloids in cytopathology: Incidence and importance

Many crystals and crystal-like structures may be encountered in cytopathology practice and can represent both beautiful novelties and diagnostic aids. The authors present an organ-specific review of the published literature on crystals combined with personal experiences. The purpose is not only to serve as a reference guide by highlighting the clinical and morphologic features of crystals, crystalloids, and crystal-like structures but also to review their significance and to offer reporting strategies in cases that bear management implications.

Fine needle aspiration cytology of polymorphous adenocarcinoma of the salivary glands: A report of 11 patients and review of the literature

BACKGROUND

Polymorphous adenocarcinoma (PAC) is a rare malignant tumor of the minor salivary glands. It has an infiltrative growth, variable architectural patterns, neurotropism and cellular monomorphism. Approximately 75% of the cases show a specific mutation in the protein kinase D1 (PRKD1) gene. Reflecting the rarity of the tumor and intraoral location, the cytologic experience is limited with few reported series. In this study we analyze our cytologic experience to determine if a preoperative diagnosis is possible.

METHODS

A retrospective study of 11 patients with PAC in which a cytologic study was available. A review of the literature was also performed.

RESULTS

Our study shows that PAC has relatively constant cytological features. The analysis of the cytological literature although it shows some heterogeneity, also reveals repetitive cytological findings. Smears are cellular with irregular groups some showing pseudopapillary branching morphology. Monolayered clusters and small acinar structures are also present. Most cases have small metachromatic globules embedded within the groups determining a cylindromatous pattern. Tumoral cells are small and uniform with scarce to moderate cytoplasm. Nuclei are round and oval with occasional grooves and small nucleoli.

CONCLUSION

PAC has characteristic cytological features that together with its location in minor salivary gland must make us consider it preoperatively. It may resemble basal cell adenoma and epithelial-rich pleomorphic adenoma so we should be cautious in the final diagnosis. Whenever possible, the characteristic cytomorphology of PCA should make us evaluate the mutational status of PRKD1 gene since it may permit a more accurate diagnosis.

Diagnostic Approach to Fine Needle Aspirations of Cystic Lesions of the Salivary Gland

Fine needle aspiration (FNA) has diagnostic and therapeutic value in the management of salivary gland cysts. Rendering an accurate diagnosis from an aspirated salivary gland cyst is challenging because of the broad differential diagnosis, possibility of sampling error, frequent hypocellularity of specimens, morphologic heterogeneity, and overlapping cytomorphology of many cystic entities. To date, there have been no comprehensive review articles providing a practical diagnostic approach to FNA of cystic lesions of salivary glands. This article reviews the cytopathology of salivary gland cysts employing 2017 World Health Organization terminology, addresses the accuracy of FNA, and presents The Milan System approach for reporting in cystic salivary gland cases. The utility of separating FNA specimens from salivary gland cysts, based upon the presence of mucin and admixed lymphocytes in cyst fluid is demonstrated. A reliable approach to interpreting FNA specimens from patients with cystic salivary gland lesions is essential to accurately determine which of these patients may require subsequent surgery.

Rapid-air-dry papanicolaou stain in canine and feline tumor cytology: a quantitative comparison with the Giemsa stain

The Papanicolaou stain is a gold-standard staining method for tumor diagnosis in human cytology. However, it has not been used routinely in veterinary cytology, because of its complicated multistep procedure and requirement for wet fixation. Currently, a rapid Papanicolaou stain using air-dried smears is utilized in human cytology, but usefulness of this rapid-air-dry Papanicolaou (RAD-Pap) stain in the veterinary field has not been fully evaluated. The purpose of this study was to evaluate the usefulness of the RAD-Pap stain by using quantitative analysis. Air-dried impression smears were collected from tumor specimens and stained with RAD-Pap and Giemsa. Twelve parameters representing the criteria of malignancy were quantitated, and characteristics of the RAD-Pap were evaluated statistically. The RAD-Pap stain could be applied to all the smears, and images of nucleoli and chromatin patterns were clear and detailed. In quantitative analysis with the RAD-Pap stain, but not with the Giemsa stain, dispersion of nucleolus size and dispersion of nucleolus/nucleus ratio in malignant tumors were significantly higher than those in benign tumors. These findings demonstrated that the RAD-Pap stain was useful for obtaining detailed nuclear information, and the ability to differentiate benignity and malignancy by nucleolus findings was a principal advantage of this stain. This RAD-Pap stain could be routinely used as a supportive staining method in veterinary diagnostic cytology.

Application of modified ultrafast Papanicolaou stain in cytology of various organs

This prospective study was conducted to assess the use of modified ultrafast Papanicolaou (MUFP) stain for fine-needle aspiration cytology (FNAC) of various organs. In India, many reagents are not easily available. In this modification, Gill's haematoxylin, EA-36, and isopropanol substitute Richard-Allan haematoxylin, cytostain, and ethanol, respectively. Group I included 40 FNAC smears of various organs. In each case, three smears were prepared and stained by MUFP, Papanicolaou, and May-Grunwald Giemsa (MGG) stains. In group II, 10 intraoperative cytology smears of different organs were stained with MUFP and rapid haematoxylin-eosin (H&E). For assessment of MUFP stain, scores were given on four parameters: background of smears, overall staining pattern, cell morphology, and nuclear staining. Quality index was calculated from ratio of score achieved to maximum possible score. Diagnosis made by MUFP stain was compared with standard stains. It was observed that MUFP-stained smears had clear RBC free background, crisp nuclear chromatin, well-stained nucleoli, and transparent cytoplasm. The diagnosis made was correct except in three cases of metastatic squamous-cell carcinoma. Hence, it was concluded that MUFP stain is useful for rapid diagnosis by FNAC, but is not useful for squamous-cell lesions.

Quick aspiration cytology for thyroid nodules by modified Ultrafast Papanicolaou staining

Quick cytologic diagnosis by Ultrafast Papanicolaou stain (Ultrafast stain) is useful in various neoplastic diseases; however, it has a significant drawback in that the ground-glass appearance of nuclei is a preparation artifact in some specimens from thyroid aspirations. To eliminate this artifact, the nucleus was stained with Gill-5 Hematoxylin (modified Ultrafast stain) rather than with Richard-Allan Hematoxylin 2 in Ultrafast stain. The applicability of this modified Ultrafast stain for quick diagnosis of thyroid diseases was investigated. Two specimens from each of 251 thyroid aspirations (122 malignant and 131 benign) were prepared using the modified Ultrafast stain and the standard Papanicolaou stain. The sensitivities of cytologic diagnosis in specimens stained by the standard Papanicolaou method and the modified Ultrafast method were 95.0% and 93.3%, respectively, and the specificities were 99.2% and 97.7%, respectively. The modified Ultrafast stain is a reliable procedure for quick diagnosis in thyroid aspiration cytology.