Posterior Segment Uveal Melanoma: An Analysis of Potential Prognostic Cellular Features

Abstracts were lymphoma. Of the 10 lymphoma cases 2 were diffuse large B cell lymphoma, 6 follicular lymphoma, and 2 marginal zone lymphoma. The overlap in cytomorphological features between low grade lymphoma and benign reactive lymphocytic lesions was the most challenging in the absence of flow cytometry studies, thus 2/6 follicular lymphomas included one non-diagnostic and the single false negative case which was misdiagnosed as a benign lymphoid process. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FNA of salivary glands for the diagnosis of lymphoma without ancillary studies in our study is 88%, 100%, 100%, 89%, and 94%, respectively. Conclusion: Our study demonstrates that even with the lack of on-site evaluation, and flow cytometry studies, a diagnosis of lymphoma based on FNA of a salivary gland can be rendered. However, the diagnostic accuracy is limited in cases of low grade lymphomas were the role of on-site evaluation and flow cytometry studies is most helpful. 128 Fine Needle Aspiration Cytology in Diagnosis of Spindle Cell Lesions of Salivary Glands Shiguang Liu, MD, PhD, Nihar Hotchandani, MD, Shobha Parajuli, MD, Xinmin Zhang, MD, Jasvir Khurana, MD, He Wang, MD, PhD. Temple University Hospital, Philadelphia, Pennsylvania Introduction: Fine needle aspiration (FNA) is an accurate and reliable procedure for an initial diagnosis of epithelial salivary gland lesions. Spindle cell lesions of the salivary glands are exceedingly rare, and the role of FNA in their diagnosis is less defined. Materials and Methods: We report our experience in which we reviewed 242 cases from 1999-2013, from amongst which we identified 26 cases that were primarily composed of spindle cells. Results: The cytology diagnoses were categorized into 4 groups: 1) six cases of inflammatory changes, which include five granulomatous inflammations (GMS and AFB stain were negative in all cases) and one subacute inflammation; 2) fifteen benign neoplasms, including eight pleomorphic adenomas, one angioleiomyoma, one granular cell tumor and five lipomas; 3) two malignant neoplasms, both were diagnosed as malignant myoepithlial carcinoma; 4) three other types of lesions, including two ectopic thyroid and one epidermal inclusion cyst. Nineteen out of the 26 FNA cases (73%) were followed up with tissue biopsy. Identical diagnosis between FNA and tissue biopsy were seen in 85% (16 out of 19 cases). One case was initially interpreted by FNA as an abscess, however subsequent histology showed a lipoma. An additional two cases which were inadequate by FNA revealed a granular cell tumor and angioleiomyoma by histology. Conclusions: In summary, spindle cell predominant salivary gland lesions are rarely encountered during FNA cytology. The differential diagnoses range from inflammatory changes to benign and malignant neoplasms. Other uncommon entities including ectopic thyroid, granular cell tumor and epidermal inclusion cyst should also be considered in the differential diagnosis. Immunohistochemical stains, as well as clinical and radiological findings helps to reach definitive diagnosis in some cases. 129 Posterior Segment Uveal Melanoma: An Analysis of Potential Prognostic Cellular Features Fatima Hamadeh, MD, Carlos Medina, MD, Arun Singh, MD, Jordan Reynolds, MD, Charles Biscotti, MD. Cleveland Clinic Foundation, Cleveland, Ohio Introduction: The management of uveal melanoma challenges oncologists. Iris lesions usually follow a benign course. In contrast, posterior segment uveal melanomas divide into two approximately equal groups. Local therapy cures one while the other metastasizes and proves lethal. Most experts agree that the dye is cast at presentation, even in the absence of detectable metastases. Monosomy 3 is an effective marker of aggressive disease. We analyzed a series of posterior segment uveal melanomas to

S63 determine if cellular features correlate with monosomy 3 status or metastases. Materials and Methods: 150 consecutive patients underwent uveal melanoma FNA for prognostic testing. 111 specimens met the study’s inclusion criteria. Following ThinPrep processing, samples were analyzed for cellular features including: cell type (pure spindle, pure epithelioid or mixed), nuclear grade (1, 2, or 3), tumor infiltrating lymphocytes, and the presence of necrosis and melanin. FISH analysis for monosomy 3 was performed on ThinPrep slides using a threshold of 20% monosomic cells per 200 melanoma cells. The association between cellular features, monosomy 3 and metastases was analyzed using Fisher’s exact test. Results: Table 1 summarizes clinical and cellular features. 56 (50%) tumors had monosomy 3. Monosomy 3 occurred significantly more often in tumors with grade 3 nuclei (79% vs 43%, pZ0.002). Tumors with grade 3 nuclei metastasized significantly more often (29% vs 8%, pZ 0.01). None of the 11 pure spindle cell tumors with grade 1 nuclei metastasized or had monosomy 3. Conclusions: Uveal melanoma’s relatively consistent cellular appearance, characterized by a mixed cell pattern and moderate nuclear atypia, limits prognostication using cellular features. However, cellular features are significantly associated with prognosis in the minority of tumors at the extremes of the morphologic spectrum. Specifically, spindle cell tumors with low grade nuclei have a favorable prognosis while high grade nuclear atypia associates with an adverse outcome. Table 1

Clinical and cellular features

Uveal melanoma cases (nZ111)

Number and (percentage)

Tumor Location

79 25 3 4 74 37 9 5 72 37 2 12 75 24 35 88 4

Treatment Follow up Tumor cell type

Nuclear grade

Other cellular features

Choroidal Ciliochoroidal Ciliary Iridociliary Radiation plaque Enucleation Dead of disease Alive with metastases Mixed Spindle Epithelioid 1 2 3 Tils Melanin Necrosis

(71%) (23%) (2.7%) (3.6%) (67%) (33%) (8%) (4.5%) (65%) (33%) (1.8%) (11%) (67%) (22%) (32%) (79%) (3.6%)

130 Cytomorphologic and Radiological Findings of Ectopic Thymic Tissue in Pediatric Fine Needle Aspirations Liron Pantanowitz, MD, Jennifer Picarsic, MD, Sabri Yilmaz, MD, Fernando Escobar, MD, Sara Monaco, MD. Children’s Hospital of Pittsburgh at University of Pennsylvania Medical Center, Pittsburgh, Pennsylvania Introduction: Given the embryological descent of the thymus, ectopic thymic tissue can arise and manifest as an asymptomatic neck mass, which may be detected clinically or radiologically. The aim of this study was to determine the incidence of ectopic thymic tissue in pediatric fine needle aspirations (FNAs) and to correlate clinical, radiological, and cytomorphologic findings. Materials and Methods: A search was done for FNA cases performed in pediatric patients with head and neck lesions from January 2012 to April 2014. Cases reporting thymic tissue were evaluated reviewing clinical, cytological, and radiological findings. Results: Of 145 pediatric head and neck FNAs identified, 5 specimens from 4 patients (2.8%) reported the presence of thymic tissue, including 4 (80%) neck masses and 1 (20%) thyroid lesion. All patients were male, ranging in age from 6 months to 13 years (mean 6 years). Lesion size ranged from 1.02.2 cm (mean 1.4 cm). One patient (20%) had a history of papillary thyroid carcinoma (PTC), 1 (20%) congenital absence of a thyroid lobe, and 2 (40%) were radiologically suspected to have PTC. Sonographic findings included solid lesions with punctate areas of increased echogenicity in 4