Fine needle aspiration (FNA) biopsy of the adrenal gland is not a commonly performed technique that is usually limited to tertiary medical centers. It is a safe and effective diagnostic modality with reported high sensitivity, specificity, positive, and negative predictive values. 1 FNA is usually performed in patients with malignant disease who have suspected adrenal metastasis, but is also performed for patients with adrenal masses that are found incidentally during routine image studies performed for the investigation of other conditions. 2In recent years, several standardized "Bethesda-like" classification scheme for FNA diagnoses were proposed which provided implied risk of malignancy and follow-up clinical recommendations for each diagnostic category. [3][4][5][6] The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has been recently developed to standardize the terminology for reporting FNA cytology of salivary gland. The MSRSGC is a seven-tiered classification system including: non-diagnostic, non-neoplastic, atypia of undetermined significance, neoplasmbenign, salivary gland neoplasm of uncertain malignant potential, suspicious for malignancy, and malignant. 5,6 Similar to the salivary gland lesions, adrenal lesions also include non-neoplastic, benign, borderline and malignant primary tumors and metastatic tumors. In this current study, we adopt similar classification scheme to the MSRSGC and reclassify the cytologic diagnoses of the adrenal FNA into seven categories with calculations of the risk of malignancy (ROM) for each category.With regard to the FNA cytology of the adrenal gland, studies with large number of cases are lacking in the literature. In this study, we included 484 cases, which to our knowledge is the largest case series for FNA cytology of the adrenal gland. | MATERIALS AND METHODSThis study was approved by Indiana University Institutional Review Board. In a computerized search of databases at our institution, adrenal FNA cases were identified for a 20-year period from 1997 to 2017. We reviewed patients' demographics, clinical history, radiologic studies, cytologic diagnoses, and correlating histologic diagnoses. The FNA biopsies were procured percutaneously by a radiologist under CT or ultrasound guidance or through the gastrointestinal tract by a gastroenterologist under endoscopic ultrasound guidance. 20 to 25 gauge needles were used. On site evaluation was performed by either a cytopathologist or cytotechnologist for all cases. A pair of smears with alcohol-fixed Papanicolaou-stained and air-dried Diff-Quik stained were prepared from each pass. Two to five passes were usually obtained.Additional samples were obtained for cell block preparation and ancillary studies in selected cases.Each cytologic diagnosis was placed into one of seven categories similar to the MSRSGC: I, non-diagnostic; II, non-neoplastic; III, atypia of undetermined significance (AUS); IVA, neoplasm-benign (N-B); IVB, neoplasm of uncertain malignant potential (N-UMP); V, suspicious for malignancy (...

Background: Malignant effusions secondary to thyroid carcinomas are rare, and publications on this topic are limited. This study presents a large cohort of thyroid carcinomas involving effusion cytology. Methods: A 20-year computerized search for fluid cytology diagnosed with thyroid malignancy was performed. The following data were collected: patients' demographics, clinical findings, and histologic diagnoses. The cytology slides and ancillary tests were reviewed. Results: Among 47,593 specimens, 15 thyroid carcinomas involving the pleural fluid from 11 patients were found. There were six males and five females with a mean age of 72 years. Ten patients with available follow-up died of their disease. Papillary thyroid carcinoma (PTC) was the only histologic type. Ten cytology cases were available for review. The cytologic findings common to all cases were nonspecific (clusters/three-dimensional architecture, enlarged irregular nuclei, and scant to abundant to vacuolated cytoplasm). The classic PTC features were not present in all cases (fine/powdery chromatin [80%], micronucleoli [70%], nuclear grooves [50%], papillary-like architecture [40%], psammoma bodies [40%], and pseudo-nuclear inclusions [20%; present on the cell block only]). In 11 of the 15 cases, the diagnosis was rendered with immunohistochemical stains performed on the cell block (paired box 8, thyroid transcription factor 1, and thyroglobulin). In four of the 15 cases, the cytologic diagnosis was made after a comparison with prior surgical pathology or fluid cytology. Conclusions: PTC is the most common histologic type of thyroid malignancy involving pleural effusion. Because the cytologic findings are nonspecific and classic PTC features are not always present, the clinical history in conjunction with immunohistochemical stains is helpful in arriving at the correct diagnosis.

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Highlights Uterine arteriovenous malformations (AVMs) may be associated with leiomyomas. Uterine AVMs can lead to a high cardiac output state and cardiac dysfunction. Multidisciplinary management of uterine AVMs may prevent high output cardiac failure.