Spread through air spaces (STAS) represents an independent prognostic factor for poor overall survival (OS) in patients with colorectal carcinoma who underwent pulmonary metastasectomy. This study aims to evaluate the prognostic impact of STAS and explore its associations with histopathologic features and KRAS mutation status/subtypes.We retrospectively analyzed 61 consecutive patients with colorectal cancer (CRC) who underwent pulmonary metastasectomy at a single tertiary center (May 2016 - July 2024). Histopathologic review assessed STAS and other histopathologic features. KRAS mutations were tested using a real-time polymerase chain reaction assay detecting 19 variants (codons 12, 13, 59, 61, 117, 146). Spread through air spaces was present in 37/61 cases (60.7%). Median OS was 1702 days (95% CI: 1495-NA) in STAS-negative and 1288 days (95% CI: 523-NA) in STAS-positive patients (log-rank p = 0.041). In univariable analysis, STAS remained an independent predictor of poorer OS in multivariable modeling (hazard ratio: 2.37; 95% CI: 1.17-4.80; p = 0.017). KRAS mutations (present in 44.3% of tested cases; common subtypes G12V and G12D) showed no significant association with STAS (p = 0.34) or with OS. Spread through air spaces is an independent poor prognostic factor in resected CRC pulmonary metastases, whereas KRAS mutation status and subtypes were not prognostic in this cohort.

Abstract Background  Mediastinal lymphadenopathies with high 18-fluorodeoxyglucose uptake in patients previously operated on for lung cancer are alarming for recurrence and necessitate invasive diagnostic procedures. Peroperative placement of oxidized cellulose to control minor bleeding may lead to a metastasis-like image through a foreign body reaction within the dissected mediastinal lymph node field at postoperative examinations. In this study, we investigated clinicopathological features and the frequency of foreign body reaction mimicking mediastinal lymph node metastasis. Methods  Patients who underwent surgery for lung cancer between January 2016 and August 2021 and who were subsequently evaluated for mediastinal recurrence with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) were included. Patients were grouped according to the results of EBUS-TBNA as metastasis, foreign body, and reactive. Clinicopathological features of these patients were compared and characteristics of patients in the foreign body group were scrutinized. Results  EBUS-TBNA was performed on a total of 34 patients during their postoperative follow-up due to suspicion of mediastinal recurrence. EBUS-TBNA pathological workup revealed metastasis in 18 (52.9%), foreign body reaction in 10 (29.4%) and reactive lymph nodes in 6 (17.6%) patients. Mean maximum standardized uptake value (SUVMax) for metastasis group and foreign body group were 9.39 ± 4.69 and 5.48 ± 2.54, respectively ( p  = 0.022). Time interval between the operation and EBUS-TBNA for the metastasis group was 23.72 ± 10.48 months, while it was 14.90 ± 12.51 months in the foreign body group ( p  = 0.015). Conclusion  Foreign body reaction mimicking mediastinal lymph node metastasis is not uncommon. Iatrogenic cause of mediastinal lymphadenopathy is related to earlier presentation and lower SUVMax compared with metastatic lymphadenopathy.

OBJECTIVE:Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is increasingly used to sample mediastinal lymph nodes and lesions. However, the methodological details of an optimal preparation technique for aspirated material have not yet been clearly determined. This study was an evaluation of the effect of 2 preparation techniques on the adequacy of aspirated specimens.MATERIAL AND METHOD:A retrospective analysis was performed of EBUS-TBNA samples obtained at the institution over a total of 36 months. Two periods were examined. Almost all of the aspirated material was smeared onto slides and fixed with 95% alcohol in the first period of the study. Subsequently, to improve diagnostic ability, a pair of slides was prepared from each needle pass: the first was air-dried, and the second was fixed in 95% alcohol. The remainder of the aspirate was kept for cell block analysis.RESULTS:In total, 462 samples were obtained from 260 patients. The overall sampling adequacy was 74% in the first and 81.1% in the second period (p < 0.05). Approximately 14% of the specimens included a sufficient number of cells for immunohistochemical cell block evaluation in the first period and 42% in the second period (p < 0.001). Histological subtyping of non-small cell lung carcinoma was determined in 18 (56.3%) and the primary origin of a tumor was determined based on morphological and immunohistochemical properties in 32 (84.2%) of the patients in the first and second periods, respectively.CONCLUSION:The access to a sufficient EBUS-TBNA sample and the ability to perform the appropriate preparation can impact the specific diagnosis and treatment of patient with a single procedure.

BackgroundThis study aims to evaluate the factors influencing the adequacy of endobronchial ultrasound-guided transbronchial fine needle aspiration specimens.MethodsA retrospective analysis of 1,700 endobronchial ultrasound-guided transbronchial fine needle aspiration samples obtained from 822 patients (500 males, 322 females; mean age 56±13 years; range 16 to 83 years) was performed between March 2011 and March 2014 at our center. Variables potentially associated with sampling adequacy, such as all cytological materials and procedure notes (lymph node and/or lesion size, localization, needle pass number, and slide number) were examined.ResultsThe overall specimen adequacy was 79.8%. The specimen adequacy was associated with needle pass number (p≤0.001). Adequacy rate was 66.9% for one needle pass and 85.8% for three needle passes. According to the sampling regions, adequacy rates showed a difference [69.2%-85.8%; (p≤0.005)]. In the multivariate logistic regression analysis of subcarinal (7) lymph node station, patient age (odds ratio, 0.983; 95% confidence interval, 0.966-1.000; p=0.049) and number of slides (odds ratio, 1.240; 95% confidence interval, 1.062-1.448; p=0.006) were independent determining factors of specimen adequacy. While independent determinants of specimen adequacy for the right paratracheal (4R) region were lymph node size (odds ratio, 1.486; 95% confidence interval, 0.973-2.268; p=0.067) and number of slides (odds ratio, 1.418; 95% confidence interval, 1.146-1.756; p=0.001), they were lymph node size (odds ratio, 1.594; 95% confidence interval, 0.960-2.645; p=0.071) and number of needle passes (odds ratio, 2.277; 95% confidence interval, 1.360-3.811; p=0.002) for the right interlobar (11R) region. Independent determinant of specimen adequacy for the left paratracheal (4L) lymph node station was the number of needle passes (odds ratio, 1.656; 95% confidence interval, 0.955-2.869; p=0.072).ConclusionDuring endobronchial ultrasound-guided transbronchial fine needle aspirations, particularly when rapid on site evaluation cannot be applied, consideration of factors affecting adequacy according to lymph node localizations may increase the chance for obtaining materials with suitable quality for cytologic evaluation.

ÖZETAmaç: Meme başı akıntı sitolojisi klinik yararı hâlâ tartışmalı, patoloji rutininde sık karşılaşmadığımız ve deneyimin sınırlı olduğu alanlardan biridir.Bu çalışmada, meme başı akıntı örneği papiller lezyon açısından kuşkulu bulunan hastalarda sitolojik özellikler ile histopatolojik tanıların karşılaştırılması ve tanıda yönlendirici morfolojik

INTRODUCTION[|]As a result of recent advances in therapies, the subtyping of non-small cell lung carcinomas (NSCLC) has become more important. This study was an evaluation of the use of cytomorphological characteristics and immunohistochemical markers to predict the subtype of NSCLC in fine-needle aspiration (FNA) material.[¤]METHODS[|]Records of 73 cases of surgically resected NSCLC that had been preoperatively diagnosed with FNA biopsy were reviewed. Cytology specimens were reviewed for cytomorphological features of squamous cell carcinoma (SCC) and adenocarcinoma (AC), and the contribution of immunohistochemistry to histological subtyping was evaluated.[¤]RESULTS[|]The sensitivity, specificity, and positive predictive values for keratinized lamellar cytoplasm and dense chromatin in SCC, and for flat sheets and nucleocytoplasmic polarity in AC were more than 60%. Immunohistochemical analysis revealed 60% sensitivity and 93% specificity for thyroid transcription factor 1 in AC. P63 and cytokeratin 5/6 had 73% and 64% sensitivity and 78% and 96% specificity, respectively, in SCC. The immunohistochemistry results of the cell blocks and the resection material demonstrated 94% conformity.[¤]DISCUSSION AND CONCLUSION[|]Immunohistochemistry is helpful in subtyping NSCLC, including poorly differentiated tumors. The cell block method of representing the immune profile of the tumors was found to be reliable.[¤]

The presence of more than 1 distinct lung cancer in the same patient, or multiple primary lung cancer (MPLC) is a rarely seen condition. Multiple lung cancers are classified as synchronous when more than 1 type of lung cancer is detected at the same time, and as metachronous tumors if the second tumor is detected some months after the first lesion. Synchronous tumors are more rare and the treatment and prognosis differs from that observed in metastatic lung cancers. In recent years, thanks to the development of radiological modalities, such as multislice computed tomography and positron emission tomography-computed tomography, as well as invasive diagnostic methods, such as endobronchial ultrasound, transthoracic needle aspiration biopsy, and transbronchial needle aspiration biopsy, the detection rate of synchronous tumors has increased.

In many cancers, mast cell density (MCD) in the tumor microenvironment is associated with tumor progression and, to a greater extent, angiogenesis. Our study was designed to investigate the correlation between MCD, tumor lymphangiogenesis, and several well-established prognostic parameters in breast cancer. One hundred and four cases of invasive breast carcinoma diagnosed in our clinic between 2007 and 2011 were included. Mast cells and lymphatic vessels were stained with toluidine blue and D2-40, respectively, and their densities were calculated in various areas of tumors and lymph nodes. The variables of MCD and lymphatic vessel density (LVD) were compared using prognostic parameters as well as with each other. As tumor size and volume increased, MCD increased comparably in metastatic lymph nodes; intratumoral and peritumoral LVD also increased. Lymphovascular invasion, lymphatic invasion, perineural invasion, and estrogen receptor positivity were positively related to intratumoral MCD. The relationship between peritumoral MCD and nontumoral breast tissue MCD was statistically significant. Stage was correlated with MCD in metastatic lymph nodes. Metastatic lymph node MCD and intratumoral MCD were also significantly related. Stage, lymphatic invasion, perineural invasion, lymphovascular invasion, and metastatic lymph node MCD were all correlated with intratumoral and/or peritumoral LVD. As nuclear grade increased, intratumoral LVD became higher. In breast carcinoma, MCD, depending on its location, was related to several prognostic parameters. Notably, mast cells may have at least some effect on lymphangiogenesis, which appears to be a predictor of tumor progression.

Objective: This study has been conducted so as to contribute to health statistics of hydatid cyst by the data obtained from our clinic, and to discuss hydatid cysts in unusual locations.Material and Method: Cases diagnosed as hydatid cyst at Dr. Lutfi Kirdar Kartal Research and Education Hospital Pathology Clinic between 2007 and 2015 have been evaluated based on criteria such as age, sex and location.Results: A total of 364 cases, 209 females and 155 males, have been included in the study. The subjects in the cases are aged between 4 and 81 (mean: 38.84). Regarding the sites, 254 (69.8%) of the cases are located in liver, and 53 (14.6%) in the lung. Fifty-seven cases (15.6%) have been detected in unusual sites other than the lung or liver. The rate of isolated organ involvement, other than the lung and liver, has been found to be 10.3%.Conclusion: Since hydatid cyst can be found in all the body sites, it should be taken into account in the differential diagnosis of all cystic lesions.

Mini‐AbstractA 53‐year‐old male patient with a history of rheumatoid arthritis presented with exertional dyspnea, abdominal distension, and pleuritic chest pain for approximately one month. Transthoracic echocardiography revealed a large, hyperechogenic, and circumferential pericardial effusion. The computer tomography revealed circumferential hyperdense fluid image around the heart. After that findings, we aspirated approximately 900 mL yellow fluid with gold paint by emergency pericardial tapping with transthoracic echocardiographic guidance. Cytopathologic examination of the pericardial effusion showed the presence of multinucleated giant cells. The pathological images revealed rare crystals of cholesterol which were engulfed by multinucleated giant cells. The gold‐paint appearance, high cholesterol content, and cytopathologic characteristics of the pericardial effusion supported the diagnosis of cholesterol pericarditis.

The aim of this study evaluation of diagnostic accuracy of preoperative FNAC in salivary gland lesions.

Aim: The aim of this study was to investigate the factors influencing to obtain material that does not reflect the lymph node(inadequate material). Methods: Files of EBUS-TBNA performed patients between July 2013-November 2014 in our clinic were examined retrospectively.Demographic data of patients,the stations,short axis and morphological characteristics of EBUS-TBNA performed LNs,number of punctures from each LN and needle type used in EBUS-TBNA were recorded.The absence or limited number of lymphocytes in the smear (with 40xmagnification,<40 lymphocytes) were used as criteria of non-diagnostic material.Mann-Whitney U,Chi-square,and logistic regression analysis were used on the determination of risk factors for inadequate material.p value <0.05 was considered significant. Results: 331 patients included in the study.A total of 1655 punctures(2.56±0.74/LN) were performed from 644 LNs in 331 patients.The average short axis of LNs was 1.75±1.05 cm.There was no statistically significant relationship between age and gender of the patients,short diameter,echogenicity and edge features of the LNs with obtaining inadequate material.The number of LN puncteres were 307 and 337 with M(Medi-GlobeGmbH) type and O(Olympus) type needles respectively and the ratio of obtaining inadequate material with them were were 15.3% and 13.1% respectively(p> 0.05).However a highly significant inverse relation between obtaining inadequate material with puncture number for each LN was revealed(p <0.0001).The ratio of obtaining inadequate material with 1,2,3, and ≥4 punctures were 31.3%,17.9%,11.2%, and 0, respectively. Conclusion: Three or more puncture from each LN should be performed in order to increase the diagnostic value of EBUS-TBNA.

AIM: Without on-side pathology it is difficult to decide about the adequacy of the EBUS-TBNA material. But often assistan staff makes a comment about the qualification of material. The aim of the study is to investigate the predictability of qualification of material from the macroscopic appearence of smear material obtained by EBUS-TBNA. METHOD: Smear preperations of EBUS-TBNA materials were given points according to the macroscopic appearances from 0 to 5 by the same assitant staff in December 2013. 0 to 2 was accepted as inadequate material whereas 3 to5 was adequate material. All smears for every aspiration was sent to pathology department with different numbers. The same cytopathologist was eximined the smears without knowledge of macroscopic scores. Macroscopic evaluation of smears was compared with cytopathological results. The data obtained was eximined with SPSS 17.0 program and chi-square test. RESULTS: 110 smears obtained by different aspirations by EBUS included in study. 23(20.9%) of them were accepted macroscopically as inadequate, 87(79.1%)were adequate.There was a statistically signifficance between microscopic evaluation and lymph node reflection of the smear cytopathologically(p=0.01). CONCLUSION: With experience and good training, from the macroscopic appearence of smears obtained from EBUS-TBNA it can be estimated if the lymph node is sampled adequately. Nevertheless more studies whith larger series are necessary in this issue.

Background: In this study, we aimed to identify the sensitivity, specificity and diagnostic accuracy of integrated positron emission tomography-computed tomography (PET-CT) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of malignant mediastinal/hilar lymph nodes and to compare with each other.Methods: Records of 131 patients (96 males, 35 females; mean age 58.3 +/- 8.4 years; range 42 to 75 years) with known primary or suspected malignancy who had enlarged and hypermetabolic hilar/mediastinal lymph nodes detected by thoracic CT and at PET-CT and in whom EBUS-TBNA performed for cytologic confirmation of the malignancy between October 2008 and April 2011 were retrospectively analyzed. More invasive procedures including mediastinoscopy/video-assisted thoracoscopic surgery (VATS) were performed in patients who did not receive definite diagnosis using EBUS-TBNA. The maximum standardised uptake value (SUVmax) cut-off level of PET-CT was considered >= 3.0. The sensitivity, specificity, diagnostic accuracy, and negative and positive predictive values of PET-CT and EBUS-TBNA in diagnosis of malignant hilar/mediastinal lymph nodes were calculated. The results were compared with each other.Results: A total of 191 lymph node stations of 131 patients were aspirated from the LN stations. Of the 142 lymph nodes, 134 were diagnosed with malignancy using EBUS-TBNA, while SUVmax value was >= 3.0 in 127 by PET-CT. The sensitivity, spesificity, diagnostic accuracy, and negative and positive predictive values of EBUS-TBNA and PET-CT were 94.3%, 100%, 95.8%, 85.9%. 100% and 89.4%. 18.3%, 71.2%, 37.5%. 76.0%, respectively. With combined use of EBUS-TBNA and PET-CT, the sensitivity increased to 100%.Conclusion: The sensitivity, specificity, diagnostic accuracy, and negative predictive value and positive predictive value of EBUS-TBNA is higher than PET-CT. Based on conventional data, histological confirmation of PET-CT is necessary in mediastinal staging, due to high level of false positivity of PET-CT. EBUS-TBNA is an effective, reliable and minimally invasive method for histologic confirmation of PET-CT-positive malignant mediastinal/hilar lymph nodes.