Nonalcoholic fatty liver disease was defined recently as another symptom of insulin resistance. Continuous therapy with valproate can result in increased body weight and insulin resistance, but no data are yet available on a possible relationship between valproate and nonalcoholic fatty liver disease. We here demonstrate in abdominal ultrasound investigations that characteristics of fatty liver disease were present in 61% of valproate‐treated patients as compared with 23% receiving carbamazepine therapy. Ann Neurol 2004

BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has emerged as the diagnostic modality of choice for mass lesions in the pancreas. The objective of the current study was to determine the accuracy and pitfalls of EUS-FNA in the diagnosis of pancreatic lesions in cases that involved follow-up surgical resection. METHODS: Cases of EUS-FNA of pancreatic lesions performed from 2007 to mid-2012 for which subsequent surgical resection was performed were retrieved from the department's database. The accuracy of the cytologic diagnosis was assessed using the histological diagnosis as the gold standard. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. "Neoplastic," "suspicious," and "malignant" were classified as a positive cytologic diagnosis. In one calculation method, "atypical" was also included as a positive cytologic diagnosis whereas in another it was not considered to be a positive cytological result. The cases with a cytologic-histological discrepancy were reviewed to identify sources of errors.RESULTS: A total of 1212 cases from 1104 patients (518 women and 586 men; age range, 18-94 years [average age, 63.5 years]) were identified. Cytologic diagnoses included 52 unsatisfactory, 224 benign, 129 atypical, 140 neoplasm, 35 suspicious, and 632 malignant diagnoses. Of these cases, 397 patients had histological follow-up information available. The sensitivity, specificity, positive predictive value, and negative predictive value were 83.2%, 85.9%, 95.9%, and 56.1%, respectively, with atypical cases excluded from the analysis. When atypical cases were included as a positive cytologic diagnosis, the sensitivity, specificity, positive predictive value, and negative predictive value were 86.7%, 67.9%, 90.7%, and 58.5%, respectively, and were 73.7%, 87.7%, 95.6%, and 48.0%, respectively, when atypical cases were included as a negative cytologic diagnosis. The major difficulty in EUS-FNA cytology was to differentiate pancreatic mucinous neoplasms from contaminants of gastric mucosa. Other pitfalls included differentiating mucinous neoplasm from extensive pancreatic intraepithelial neoplasia, and endocrine tumor from nesidioblastosis versus acinar cell carcinoma or intrapancreatic spleen.CONCLUSIONS: EUS-FNA is a valuable tool for the diagnosis of pancreatic lesions, especially solid malignant tumors.Cytologic-radiological correlation is essential in differentiating pancreatic mucinous neoplasms from gastric mucosa, because the former usually are found to have characteristic features on imaging. Pathologists should be aware of the pitfalls in the cytologic diagnosis of pancreatic lesions that may significantly change the clinical management of the patients.Cancer (Cancer Cytopathol) 2015;123:98-107.

Background Urine cytology has been used for screening of bladder cancer but has been limited by its low sensitivity. UroVysion is a FISH assay that detects common chromosome abnormalities in bladder cancers. The present study evaluates the effectiveness of UroVysion and urine cytology in detecting urothelial cell carcinoma (UCC) in same urine sample. Methods 1,835 cases with the following criteria were selected: valid results of both UroVysion and cytology from same urine sample; histological and/or cystoscopic follow up within 4 months of the original tests, or at least 3 year clinical follow up information. The results of the UroVysion and cytology were correlated with clinical outcome that was derived from combination of histological, cystoscopic and clinical follow up information. Results Of 1,835 cases, 1,045 cases were for surveillance of recurrent UCC, 790 cases were for hematuria. Overall sensitivity, specificity, PPV and NPV in detecting UCC were 61.9%, 89.7%, 53.9% and 92.4%, respectively for UroVysion, and 29.1%, 96.9%, 64.4% and 87.5%, respectively for cytology. The performance of both UroVysion and cytology was generally better in the surveillance population and in samples with high grade UCC. In 95 of 296 cases with atypical cytology that were proven to have UCC, 61 cases, mostly high grade UCC, were positive for UroVysion. Conclusions UroVysion was more sensitive than cytology in detecting UCC, but produced more false positive result. Our data suggest that the use of UroVysion as a reflex test following an equivocal cytological diagnosis may play an effective role for UCC detection.

BACKGROUND: Fine-needle aspiration (FNA) is a screening and diagnostic tool used in the evaluation of thyroid nodules.Its use has resulted in an increase in the ratio of malignant versus benign thyroid nodules undergoing surgical excision.However, the FNA procedure produces some histological and cytologic alterations, which may lead to misinterpretation on repeat FNA. The goal of the current study was to characterize FNA-induced morphological alterations and their potential influence on interpretations in repeat FNA specimens. METHOD: Thyroidectomy specimens that had benign histological diagnoses and for which previous FNA specimens were available were retrieved. The FNA-induced histological alterations were evaluated and grouped based on the interval between the FNA procedure and surgical excision. Repeat thyroid FNA specimens with a cytologic diagnosis of ''atypical cells/follicular lesion'' were reviewed. Worrisome cytologic features that might occur after the previous FNA procedure were discussed. RESULTS: Needle tracts were identified in 68 of the 96 thyroidectomy specimens studied. FNA-induced histological alterations included hemorrhage, granulation, exu-

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