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.

Introduction/Objective Spillage of gallstones in the peritoneal cavity during laparoscopic cholecystectomy is a known intraoperative complication which could cause peritoneal irritation/abscess and occasionally present as ovarian cholelithiasis and pelvic mass. Our aim is to present the clinicopathologic findings of pelvic cholelithiasis in our institution. Methods/Case Report A one year computerized natural language search for “Halls, bile, pigment, crystals” in surgical final diagnosis and comment was performed. The patients’ demographic, clinical presentation & history of cholecystectomy were collected from the medical records. The pathologic findings were reviewed. Results (if a Case Study enter NA) We identified 4 women with an age range of 45-52 (mean=50). Three patients presented with abnormal uterine bleeding and one patient was admitted for sterilization. The time interval from cholecystectomy was 3-26 years (mean=18).Intra-operative findings were as follows: Case 1: blue-black 5 mm lesion located in the right ovary, Case 2: yellow-surface nodularity of left ovary and <1 cm white lesion in posterior cul- de sac, Case 3 two left ovarian cysts (0.8 and 1.5 cm), and Case 4 for sterilization showed a 0.3 cm. brown peritoneal lesion and unremarkable fallopian tubes. The histologic findings revealed bile pigment/crystals overlying the surfaces of the ovaries (3) peritoneum (1), & pelvis (1) with fibrosis and foreign-body giant cell reaction. The pathologic diagnosis was made in conjunction with prior history of cholecystectomy. Halls bilirubin stain was positive in 2/2 cases. Conclusion Pelvic cholelithiasis is an incidental finding in pre and post-menopausal women often involving the ovaries, peritoneum and pelvis. Intra-operatively, it could mimic endometriosis and pelvic mass. Histologic findings show bile pigment/crystals on serosal surface with fibrosis and foreign-body giant cell reaction. Familiarity with the histologic findings in conjunction with history of cholecystectomy is helpful in arriving at the correct diagnosis.