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Mikou P, Chantziantoniou N. The Kymi Odyssey Honorary Ceremony celebrated the life and career of Dr. George N. Papanicolaou; and the future, dedicated museum. Cytopathology 2024; 35:324-325. [PMID: 38111137 DOI: 10.1111/cyt.13349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/30/2023] [Indexed: 12/20/2023]
Affiliation(s)
- Panagiota Mikou
- Head of Cytopathology Department, Laiko Hospital, Athens, Greece
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Chantziantoniou N. The Kymi Odyssey Honorary Ceremony and the Future G.N. Papanicolaou Museum: A Personal Appeal for Support, Enrichment, and Visitation. Acta Cytol 2023; 68:6-12. [PMID: 37989108 DOI: 10.1159/000535394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 11/23/2023]
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Chantziantoniou N. BestCyte® primary screening of 500 ThinPrep Pap Test thin-layers: 3 Cytologists' Interobserver diagnostic concordance with predicate manual microscopy relative to Truth Reference diagnoses defining NILM, ASCUS+, LSIL+, and ASCH+ thresholds for specificity, sensitivity, and equivalency grading. J Pathol Inform 2023; 14:100182. [PMID: 36747889 PMCID: PMC9898738 DOI: 10.1016/j.jpi.2022.100182] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/08/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Background The BestCyte® Cell Sorter Imaging System (BestCyte) facilitates algorithmic discrimination of clinically relevant cells in Pap test cytopathology by classifying and projecting images of cells in galleries based on cytomorphology. Warranted is awareness of potential BestCyte advantages as measured through 3 cytologists' interobserver diagnostic concordance, specificity and sensitivity differentials, and equivalency grading relative to manual microscopy (MM). Objectives Using 500 MM-reported ThinPrep thin-layers, analyze: (1) cytologists' blinded BestCyte screening to raise Bethesda diagnoses; (2) correlate BestCyte and MM diagnoses (i.e., predicate) to establish Truth Reference Diagnoses (TRDx) from concordance between 4 possible diagnoses; (3) analyze cytologists' and MM predicate diagnoses through 4 diagnostic thresholds defined by TRDx: NILM (Negative) for specificity, and ASCUS+, LSIL+, and ASCH+ (Positive) for graded sensitivity (with abnormal cells decreasing in size with increasing dysplasia); and, (4) statistically determine cytologists' equivalency grading to MM using 95% Confidence Interval (CI) ranges. Results 500 TRDx breakdown (n/%): NILM (241/48.2), ASCUS (79/15.8), ASCH (9/1.80), AGUS (2/0.40), LSIL (86/17.2), HSIL (68/13.6), CA (2/0.40), UNSAT (13/2.60). TRDx breakdown (n/%) per 4 of 4, 3 of 4, 2 of 4 diagnostic concordances: 264 (52.8%), 182 (36.4%), 54 (10.8%), respectively. No cases of discordant diagnoses were recorded. HSIL TRDx were established from 66.2% of 4 of 4 concordances, followed by NILM (59.3%), LSIL (46.5%), ASCUS (41.8%); antithetically, from 4.40% of 2 of 4 concordances. Specificity for MM predicate (NILM): 67.08%; for Cytologists 1, 2, and 3: 89.71%, 82.30%, 97.53%, respectively. For NILM threshold, cytologists revealed Significantly Superior equivalency to MM. Sensitivity for ASCUS+, LSIL+, and ASCH+ thresholds: MM (91.36%, 86.67%, 74.36%); Cytologist 1 (95.88%, 96.97%, 94.87%); Cytologist 2 (95.47%, 95.76%, 93.59%), Cytologist 3 (94.65%, 95.15%, 98.72%), respectively. Cytologists revealed Significantly Superior equivalency to MM for graded Positive thresholds; with Cytologist 3 for ASCUS+ being: Superior. Conclusions BestCyte detects and efficiently displays abnormal cells in strategic galleries standardizing objectivity by systematizing mosaics of cell-types for cytologists' consideration. BestCyte fosters consistent, enhanced cytologists' sensitivity values for the ASCUS+, LSIL+, and ASCH+ Positive thresholds relative to MM. Also, BestCyte facilitates improved specificity and superior equivalency grading to MM reflecting efficient screening, and reduced labor. Confident interpretations of small dysplastic epithelial cells characteristic of HSIL led to exceptional interobserver diagnostic concordance inferring BestCyte is primed for effective cervical cancer screening practice.
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Elgert PA, Chantziantoniou N. Biography of George N. Papanicolaou, MD, PhD: Historical Variations of the Reported Wedding Date. Acta Cytol 2022; 67:102-104. [PMID: 36404718 DOI: 10.1159/000527068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Paul A Elgert
- Retired from Cytopathology, NYU Grossman School of Medicine at NYC Health & Hospitals
- Bellevue, New York, New York, USA
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Chantziantoniou N. BestCyte® Cell Sorter Imaging System: Primary and Adjudicative Whole Slide Image Rescreening Review Times of 500 ThinPrep Pap Test Thin-layers - An Intra-observer, Time-Surrogate Analysis of Diagnostic Confidence Potentialities. J Pathol Inform 2022; 13:100095. [PMID: 36268084 PMCID: PMC9576977 DOI: 10.1016/j.jpi.2022.100095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background The novel Artificial Intelligence-driven BestCyte® Cell Sorter Imaging System (BestCyte) enables hybrid digital screening through classification and sorting of tiles depicting cells in 8 galleries or whole slide image (WSI) reviews. Objectives (1) Analyze expenditures of time (minutes) for primary BestCyte cell sorter screening and adjudicative WSI rescreening of 500 blinded, randomized ThinPrep thin-layers to determine review times per Bethesda nomenclature; (2) Analyze review times for NILM qualifier diagnoses reflecting increasing interpretive complexity (i.e., Inflammation, Reactive/Repair, Bacterial cytolysis, Bacterial vaginosis, Atrophy, and Atrophic vaginitis); (3) Challenge accuracy of primary diagnoses (Downgraded, Upheld, and Upgraded) following adjudicative WSI rescreening to assess correlated review times as surrogate indicators of diagnostic confidence in BestCyte functionality (i.e., learning curve); and (4) Correlate primary and adjudicative diagnoses to calculate intra-observer reproducibility Kappa coefficients per Bethesda nomenclature. Results Of 500 thin-layers, the mean [primary/adjudicative rescreening review times (minutes)] were: Overall study [1.38/3.94], NILM [1.23/3.02], ASCUS [1.18/2.53], ASC-H [1.73/4.86], AGUS [1.84/6.34], LSIL [1.49/4.16], HSIL [1.52/4.10], CA [0.65/2.57]. Of 500 primary Bethesda diagnoses: 2 (0.40%) downgraded; 483 (96.6%) upheld; 15 (3.00%) upgraded after adjudicative WSI rescreening. Of 354 NILM diagnoses: 0 downgraded; 344 (97.2%) upheld; 10 (2.82%) upgraded. Of 34 ASCUS diagnoses: 2 (5.88%) downgraded; 28 (82.4%) upheld; 4 (11.8%) upgraded. Of 17 ASC-H diagnoses: 0 downgraded; 16 (94.1%) upheld; 1 (5.88%) upgraded. Of AGUS (n=1), LSIL (n=24), HSIL (n=52), CA (n=1), UNSAT (n=17): 100% upheld. Kappa coefficients with 95% (Confidence Intervals): Overall study 0.9305 (0.8983–0.9627), NILM 0.9429 (0.9110–0.9748), ASCUS 0.8378 (0.7393–0.9363), ASC-H 0.9112 (0.8113–0.9999), AGUS 1.0 (1.0–1.0), LSIL 0.9189 (0.8400–0.9978), HSIL 0.9894 (0.9685–0.9999), CA 1.0 (1.0–1.0), UNSAT 1.0 (1.0–1.0). Primary BestCyte cell image review time trends for NILM, ASCUS, LSIL, and HSIL, revealed plateaus relative to decreasing respective adjudicative WSI rescreening times. Conclusions Given innovative robustness, BestCyte accommodates interpretive fundamentals, enabling shorter ThinPrep thin-layer review times with optimal intra-observer concordance per Bethesda nomenclature through classifying, ranking, sorting, and displaying clinically relevant cells efficiently in galleries. BestCyte fosters continuously optimizing diagnostic confidence learning curves; may supplant manual microscopy for primary screening.
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Chantziantoniou N. Back from the Future: Rational Accountabilities for Cytopathology in Pap Test Cervical Cancer Screening Arising from Covid19. Acta Cytol 2022; 66:165-170. [PMID: 35093950 PMCID: PMC9059046 DOI: 10.1159/000521911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/24/2021] [Indexed: 12/04/2022]
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Ahmad M, Thomas M, Hameed M, Alabbas A, Al-Tikrity MAY, Najim Najim MS, Chantziantoniou N, Abdulsattar H, Ali M. ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSBRONCHIAL NEEDLE ASPIRATION (EBUS-TBNA) THROUGH RAPID ON SITE EVALUATION (ROSE) TINTED GLASSES. Chest 2019. [DOI: 10.1016/j.chest.2019.08.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Mukherjee M, Donnelly A, Rose B, Warren DE, Lyden E, Chantziantoniou N, Dimmitt B, Varley K, Pantanowitz L. Eye tracking in cytotechnology education: "visualizing" students becoming experts. J Am Soc Cytopathol 2019; 9:76-83. [PMID: 31401035 DOI: 10.1016/j.jasc.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/03/2019] [Accepted: 07/07/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION This study reports the potential of eye-tracking technology in determining screening skills of cytotechnology (CT) students while examining digital images (DI). MATERIALS AND METHODS Twenty-five static DI of gynecologic cytology specimens were serially displayed on a computer monitor for evaluation by 16 CT students and 3 cytotechnologists at 3 locations. During evaluation, participant's eye movements were monitored with a Mirametrix S2 eye tracker (iMotions, Boston, MA) and EyeWorks software (Eyetracking, Solana Beach, CA). Students completed the protocol at: Period1 (P1)-4 months, Period2 (P2)-7 months, Period3 (P3)-11 months during their 1-year training; and the cytotechnologists only once. A general linear mixed model was used to analyze the results. RESULTS The proportion of agreement on interpretations for cytotechnologists, students during P1, and students during P3 were 0.83, 0.62, and 0.70 respectively. The mean task duration in seconds for cytotechnologists, students during P1, and students during P3 were 21.1, 34.6, and 24.9 respectively. The mean number of fixation points for cytotechnologists, students during P1, and students during P3 were 14.5, 52.2, and 35.3, respectively. The mean number of gaze observations of cytotechnologists, students during P1, and students during P3 on region of interest (ROI) 1 were 77.93, 181.12, and 123.83, respectively; and, ROI 2 were 38.90, 142.79, and 92.46, respectively. CONCLUSIONS This study demonstrated that students had decreased time, number of fixation points, gaze observations on ROI, and increased agreement with the reference interpretations at the end of the training program, indicating that their screening skills were progressing towards the level of practicing cytotechnologists.
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Affiliation(s)
- Maheswari Mukherjee
- Cytotechnology Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Amber Donnelly
- Cytotechnology Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska
| | - Blake Rose
- Department of Pathology and Microbiology, Nebraska Medicine, Omaha, Nebraska
| | - David E Warren
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth Lyden
- Department of Biostatistics, College of Public Health, Omaha, Nebraska
| | | | - Brian Dimmitt
- Department of Anatomic Pathology, Carle Foundation Hospital, Urbana, Illinois
| | - Karyn Varley
- Department of Pathology, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Chantziantoniou N, Mukherjee M, Donnelly AD, Pantanowitz L, Austin RM. Digital Applications in Cytopathology: Problems, Rationalizations, and Alternative Approaches. Acta Cytol 2017; 62:68-76. [PMID: 29183021 DOI: 10.1159/000484434] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/19/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this work was to raise awareness of problems using digital applications for examining, teaching, and applying telecytology at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia; University of Nebraska Medical Center (UNMC), Omaha, NE, USA; and University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA. The objective was to rationalize problems and propose alternative digital approaches. STUDY DESIGN We sought to identify solutions to improve the following: (a) interpretive examination scores at KAMC for complex cytological templates (i.e., high-grade squamous intraepithelial lesions [HSIL]) when using static digital images (SDI) of cells in regions of interest (ROI); (b) visualization of cells in 3D clusters when teaching at UNMC using 2D and 3D whole-slide imaging (WSI); and (c) visualization of cells through streaming telecytology at UPMC. RESULTS Composite SDI (CSDI) improved test scores for complex interpretations (i.e., HSIL) by converging diagnostic criteria from multiple ROI. Multiplane focusing through z-stacked WSI facilitated the teaching of cytological entities characterized by 3D cell clusters and consultative telecytology through robotic cell analysis. CONCLUSIONS Adequately visualized cytomorphology and multiplane focusing are essential for virtual cytopathology examinations, teaching, or consultative telecytology. Visualization of diagnostic criteria through 2D or 3D imaging is critical. Panoptiq panoramic WSI with integrated z-stacked video clips enables optimal applied telecytology.
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Chantziantoniou N, Donnelly AD, Mukherjee M, Boon ME, Austin RM. Inception and Development of the Papanicolaou Stain Method. Acta Cytol 2017; 61:266-280. [PMID: 28384641 DOI: 10.1159/000457827] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/24/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cytodiagnoses of specific malignancies are enabled through analyses of abnormal nuclear chromatin and cytoplasmic features in stained cells. AIM The objective of this work was to explore the inception, development, and chemistry of the Pap stain method introduced in 1942 by Dr. G.N. Papanicolaou. STUDY DESIGN To achieve this, we carried out a review of the English literature. RESULTS Between 1914 and 1933, Papanicolaou first analyzed vaginal squamous cells in guinea pigs and later in human vaginal fluid samples using hematoxylin and eosin with limited color reactions, correlating the cell-type morphology with endocrinology and histology. The 5-dye Pap stain method evolved through 2 salient phases. The first, between 1933 and 1942, saw the introduction of alcohol-ether fixation and aqueous waterblue staining to enhance cellular transparency, aiding the distinction of cervical cancer cells from benign cells, with quantitative and qualitative assessment of squamous cell maturity. The second phase, between 1942 and 1960, saw the introduction and refinement of various alcoholic cytoplasmic counterstaining schemes with orange G and EA (light green, Bismarck brown, eosin) and phosphotungstic acid, allowing wider ranges of polychromasia and further enhancing cellular visualization, facilitating the distinction of cell types and improving diagnostic confidence. CONCLUSIONS Development of the Pap stain method followed specific historical and scientific events. The staining method evolved following incremental improvements in cellular transparency achieved through tailored cellular fixation and cytoplasmic staining using variable dye and pH combinations.
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Affiliation(s)
- Nikolaos Chantziantoniou
- Division of Anatomic Pathology, Department of Pathology, Sidra Medical and Research Center, Qatar Foundation, Doha, Qatar
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Chantziantoniou N, Joudeh AA, Hamed RMA, Al-Abbadi MA. Significance, cytomorphology of decoy cells in polyomavirus-associated nephropathy: Review of clinical, histopathological, and virological correlates with commentary. J Am Soc Cytopathol 2016; 5:71-85. [PMID: 31042494 DOI: 10.1016/j.jasc.2015.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 10/28/2015] [Accepted: 11/03/2015] [Indexed: 01/23/2023]
Abstract
Human polyomaviruses (PyV) are ubiquitous, remaining predominantly inactive hence asymptomatic in the healthy, immunocompetent population. BK and JC PyV potentially infect pan-urinary tract epithelial cells. With reactivation, PyV disrupt cell cycling mechanisms, facilitating viral replication leading to cell necrosis, exfoliation, and, infrequently, carcinogenesis. Exfoliated PyV-infected cells pose diagnostic pitfalls, hence they are termed "decoy cells" as they may mimic high-grade urothelial carcinoma cells. BK polyomavirus-associated-nephropathy (BKVAN) is an inflammatory disease causing interstitial fibrosis with tubular atrophy in renal transplant recipients, increasing risk of graft loss. BKVAN is confirmed by renal biopsy, and managed by immunosuppression modulation. As voided urine may provide pan-reno-urinary tract sampling, cytopathology may serve a critical diagnostic purpose coupled with decoy cell quantification and indirect BK PyV load gauging. Thus, identification of decoy cells and differentiation from high-grade urothelial carcinoma cells, and degenerated, benign urothelial cells, is clinically essential. PyV virology and pathobiology in the context of renal transplantation, immuno-suppression and BKVAN, and, decoy cell cytomorphology and cytopreparation with commentary are highlighted. Decoy cell overall characteristics: variable degeneration; cytomegaly; comet-like shapes; angular cytoplasmic extensions; eccentric, polar nuclear placements; moderate anisocytosis; typically single cells with high N:C ratios. Cytoplasmic features: moderate-abundance; granular, blue-gray monochromatism. Nuclear features: karyomegaly; haphazardly-scattered chromatin densities; smudged, homogeneous, basophilic ground glass masses displacing chromatin alongside inner periphery of regular, symmetrical nuclear envelopes. Background features: granular cellular debris; inflammatory cells; intact and lyzed erythrocytes. Decoy cells lack coarse chromatin as in high-grade urothelial carcinoma cells. Benign urothelial cells exhibit low N:C ratios with fine chromatin distribution and euchromasia.
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Affiliation(s)
| | - Amani A Joudeh
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Radi M A Hamed
- Department of Pediatrics, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mousa A Al-Abbadi
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Chantziantoniou N. Lady Andromache (Mary) Papanicolaou: The Soul of Gynecological Cytopathology. J Am Soc Cytopathol 2014; 3:319-326. [PMID: 31051722 DOI: 10.1016/j.jasc.2014.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 08/20/2014] [Accepted: 08/20/2014] [Indexed: 10/24/2022]
Abstract
This commentary serves to impress the astonishing and selfless contributions that Andromache (Mary) Papanicolaou made toward the scientific development of the Papanicolaou (Pap) test; for she alone was, and remains, the hidden soul of gynecological cytopathology. The odyssey assumes even greater significance as 2014 marks 100 years since the beginning of this saga at Cornell Medical College. An awareness of the background historical details and events is important and relevant to this commentary. Her kindness, thoughtfulness, and devotion to her husband, Dr. George N. Papanicolaou, and his work, shall survive her indefinitely through the Pap test and through the women surviving cervical cancer globally as a result of their combined revolutionary scientific work.
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Affiliation(s)
- Nikolaos Chantziantoniou
- Cytology Section, Department of Pathology, Sidra Medical and Research Center, Qatar Foundation, P.O. Box 26999, Doha, Qatar.
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Affiliation(s)
- Nikolaos Chantziantoniou
- Cytology Section, Department of Pathology, Sidra Medical and Research Center, Qatar Foundation, P.O. Box 26999, Doha, Qatar.
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Abstract
Quantitative image cell analysis for DNA ploidy was performed on cytologic smears from a series of 19 histologically proven cases of renal parenchymal tumors. These cases included chromophobe-cell carcinoma (n = 5), oncocytoma (n = 5), papillary carcinoma (n = 2), and conventional renal-cell carcinoma (n = 7). All chromophobe renal-cell carcinomas were composed predominantly of hypodiploid cells, while the five oncocytomas were virtually entirely composed of diploid cells. The papillary and conventional renal-cell carcinomas, on the other hand, showed a variety of ploidy profiles. Scatterplots generated by plotting nuclear DNA mass against nuclear area produced patterns that correlated with the morphologic type of the neoplasms. These findings indicate that quantitative image cell analysis for DNA ploidy may provide valuable clues that could be helpful in arriving at a precise diagnosis of renal parenchymal tumors. Diagn. Cytopathol. 1999;21:223-229.
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Affiliation(s)
- M Akhtar
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Abstract
Flow cytometry and quantitative image cell analyses were performed on a series of 31 chromophobe cell carcinoma and the findings were compared with those from 14 clear cell carcinomas. Thirty of 31 chromophobe cell carcinomas had significant hypodiploid cell clones with both techniques. By contrast, none of the 14 clear cell carcinomas was hypodiploid. Using quantitative image cell analyses, four groups of nuclei with hypodiploid, diploid, hyperdiploid, and tetraploid/hypertetraploid DNA patterns were identified, and their relative proportions were compared. In most of the chromophobe cell carcinomas, the predominant nuclear pattern was hypodiploid, and in clear cell carcinoma, diploid nuclei were most frequent. The number of binucleated cells in chromophobe cell carcinomas varied from 1.40% to 23% (mean, 10.8%) whereas, in clear cell carcinoma, these varied from 0.4% to 9.2% (mean, 2.5%). Evaluation of DNA content of double hypodiploid nuclei in chromophobe cell carcinomas showed that their combined DNA content was essentially similar to that of single hyperdiploid nuclei, thus suggesting polyploidy resulting from the fusion of these nuclei. Polyploidy may indeed be the basis for nuclear heterogeneity in chromophobe cell carcinoma. Scatterplots generated by plotting nuclear DNA mass against nuclear area produced patterns that were distinctive for the two types of carcinoma. We believe that the comparative findings in this study provide a comprehensive understanding of the ploidy status of chromophobe carcinoma and that these findings may be used as supportive evidence for establishing the diagnosis of chromophobe cell carcinoma.
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Affiliation(s)
- M Akhtar
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Abstract
BACKGROUND Adenoid cystic carcinoma of the cervix is a rare, aggressive neoplasm generally found in postmenopausal women. CASE A cervical cytology specimen was obtained by endocervical brush from an 80-year-old woman with histologically confirmed primary adenoid cystic carcinoma of the cervix. Both small cells arranged in a cribriform (cylindromatous) pattern and moderately dysplastic squamous cells (high grade squamous intraepithelial lesion) were evident. CONCLUSION Although the endocervical brush technique may yield well-preserved cells and tissue fragments morphologically characteristic of adenoid cystic carcinoma of the cervix, confusion with more common tumors, such as endometrial adenocarcinoma, still may create cytologic diagnostic difficulties.
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Affiliation(s)
- E Ravinsky
- Department of Pathology, Health Sciences Centre, Winnipeg, Manitoba, Canada
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Abstract
Pneumocystis carinii (PC) pneumonia in the immunocopromised patient requires prompt therapeutic intervention; therefore, rapid identification of PC organisms in cytopathologic specimen is essential. Conclusive diagnoses of PC are achievable using Grocott's methenamine silver (GMS), the "gold-standard" stain for PC cyst visualization. However, non-budding Candida sp. yeasts can simulate PC cysts with GMS and thus pose significant diagnostic challenges. After qualitative and semi-quantitative analysis of 49 cytopulmonary cases, this study aimed to establish morphologic criteria that differentiate these organisms using GMS. The results showed that spherical/demilune PC cysts (4 to 7 microns in diameter) are monomorphic and mainly transparent, with intracyst densities being commonly evident. Demilune cysts typically display wall wrinkling with longitudinal clefts. Relative to cysts, Candida sp. yeasts reveal increased argyrophilia, range 4 to 10 microns in diameter, are mainly oval and budding, polymorphic, and exhibit wall deformation with variable internal structure. Differentiating criteria are (a) budding; (b) cyst transparency, demilune shape; (c) longitudinal cyst clefts; (d) paired comma-like intracyst densities; (e) cyst monomorphism ; (f) alveolar cast formations; (g) overall cytomorphologic presentation; and (h) relative argyrophilia.
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Affiliation(s)
- N Chantziantoniou
- Department of Pathology and Laboratory Medicine, Cytology Section, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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