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The Role of Pelvic Washings in the Diagnosis of Endometriosis
Abstracts
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washings, and none of these patients were deemed surgical candidates. 68/75 patients (90%) had negative peritoneal washings. Of these fluid negative patients, 22/68 (32%) underwent surgical resection, while 44/68 (65%) were classified as unresectable based on imaging and/or pre-op staging laparoscopy, and 2/68 (3%) had no follow-up. Conclusions: Previous studies have suggested significantly higher overall survival rates in patients with pancreatic adenocarcinoma and negative PWs. Our findings confirm that patients with positive peritoneal washings are unlikely to be surgical candidates. Pancreatic cancers are clinically categorized as resectable or unresectable based on involvement of nearby structures and/or by presence of metastases. While negative washing results may indicate a better prognosis and may contribute to disease management for individual patients, such results do not correlate with overall resectability in our cohort (p Z 0.0941, Fisher’s exact test, GraphPad).
adenocarcinoma, one ovarian mucinous adenocarcinoma, one ovarian mucinous borderline tumor). Two had salpingoophorectomies for nonneoplastic reasons, and one had oophorectomy for serous cystadenoma. Four had endometriosis confirmed on surgical pathology. Liquid-based cytology was diagnostic of endometriosis in 7/9 patients, including 5 with glandular cells and HLMs and 2 with all three components (glandular cells, HLMs, and stromal cells). CB was diagnostic in 8/9 patients, including 4 with intact fragments of endometrial glands and stroma (Image 1). Three showed glandular cells and HLMs, while one showed separate fragments of glandular cells and stromal cells. Conclusions: PW increased the diagnostic yield for endometriosis at the time of gynecologic surgery, as only 4/9 cases had endometriosis diagnosed on surgical pathology. CB in particular aids in the diagnosis, as 4/9 cases had intact glandular and stromal fragments.
PST25
PST26
The Role of Pelvic Washings in the Diagnosis of Endometriosis
Molecular Alterations in Patients with Pulmonary Adenocarcinoma Presenting with Malignant Pleural Effusion at First Diagnosis
Lorene Yoxtheimer, MD, Stacy Molnar, BS, SCT(ASCP), CT(IAC), Richard Cantley, MD. University of Toledo, Toledo, OH Introduction: Endometriosis, the presence of endometrial tissue outside the uterine corpus, is a common finding in reproductive age women. It is classically diagnosed based on the presence of at least two of the following: endometrial glands, endometrial stroma, and hemosiderinladen macrophages (HLMs). Although a common finding in surgical pathology specimens, there is little literature on the role of pelvic washings in diagnosing endometriosis. Our study aims to examine the characteristics of endometriosis in pelvic washings (PW) at the time of gynecologic surgery. Materials and Methods: Our anatomic pathology archives were searched for cases of endometriosis diagnosed on PW from 1/1/2010-12/31/2016. Patient age, clinical history, findings on cytology and cell block (CB), and concurrent surgical specimen diagnoses were recorded. Cytology material was re-reviewed. Results: Nine cases of endometriosis were diagnosed on PW. The average patient age was 37 (range 19-56). Two had a previous history of endometriosis. Three patients underwent total abdominal hysterectomy and bilateral salpingoophorectomy (TAHBSO) for benign processes; three had TAHBSO for neoplasms (one endometrial endometrioid
Maryam Shabihkhani, MD1, Jamal Carter, MD2, Zahra Maleki, MD1, Erika Rodriguez, MD, PhD1. 1Johns Hopkins University, Baltimore, MD; 2 Washington University School of Medicine, St. Louis, MO Introduction: In Lung cancer, the presence of malignant pleural effusion is considered stage IV disease in the tumor-node metastasis (TNM) staging classification. Approximately 15% of non-small cell lung cancer patients have pleural effusions at the time of diagnosis, adenocarcinoma representing the main histologic subtype in half of the cases. Herein we report our experience with pulmonary adenocarcinoma patients presenting with malignant pleural effusion at first diagnosis, and the correlation with specific molecular alterations. Materials and Methods: We searched our pathology database for the last 5 years for patients who had cytopathologic diagnosis conclusive for lung adenocarcinoma for the first time on their pleural fluid specimen, and molecular testing done on pleural effusions or pleural biopsies. Age, gender, smoking history, molecular profile and survival were recorded. Results: We identified 18 cases (9M, 9F). The mean age at diagnosis was 69.6 years (range 55-81y). Patients included non-smokers nZ7, smoker/former smoker nZ9, and unknown smoking history nZ 2. Two patients had history of asbestos exposure and 3 patients had previous malignancies in other organs. All patients had molecular tests performed on pleural effusion (nZ16,) or pleural biopsy (nZ2). In total, 55% of the cases (nZ 10) had known mutations in EGFR (nZ6, 60%), KRAS (nZ3, 30%) or ALK translocation (nZ1, 10%). No mutations were identified in BRAF, AKT, ERBB2, NRAS, and PIK3CA in the 7 patients tested for these genes. Patients with known mutations had better overall survival than patients without known mutations (mean survival 18 months vs. 8 months respectively, pZ0.03, Wilcoxon). Conclusions: In pulmonary adenocarcinoma patients presenting with malignant effusion in our series, alterations in EGFR was the most frequent identifiable molecular change. Patients with known mutations as a group had a better overall survival than those without known mutations, a finding that deserves further study. PST27 Cytomorphology, Clinicopathologic and Cytogenetics Correlation of Myelomatous Effusion of Serous Cavities: A Retrospective Review Aparna Harbhajanka, MD, Vijaya Reddy, MD, MBA, Ji-Weon Park, MD, Pincas Bitterman, MD, Paolo Gattuso, MD, Arlen Brickman, MD. Rush University Medical Center, Chicago, IL Introduction: Myelomatous effusions (ME) of the serous cavities are rare. Identification of the atypical plasma cells in the
Image 1
CB with intact endometrial tissue (H&E, 200x)
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washings, and none of these patients were deemed surgical candidates. 68/75 patients (90%) had negative peritoneal washings. Of these fluid negative patients, 22/68 (32%) underwent surgical resection, while 44/68 (65%) were classified as unresectable based on imaging and/or pre-op staging laparoscopy, and 2/68 (3%) had no follow-up. Conclusions: Previous studies have suggested significantly higher overall survival rates in patients with pancreatic adenocarcinoma and negative PWs. Our findings confirm that patients with positive peritoneal washings are unlikely to be surgical candidates. Pancreatic cancers are clinically categorized as resectable or unresectable based on involvement of nearby structures and/or by presence of metastases. While negative washing results may indicate a better prognosis and may contribute to disease management for individual patients, such results do not correlate with overall resectability in our cohort (p Z 0.0941, Fisher’s exact test, GraphPad).
adenocarcinoma, one ovarian mucinous adenocarcinoma, one ovarian mucinous borderline tumor). Two had salpingoophorectomies for nonneoplastic reasons, and one had oophorectomy for serous cystadenoma. Four had endometriosis confirmed on surgical pathology. Liquid-based cytology was diagnostic of endometriosis in 7/9 patients, including 5 with glandular cells and HLMs and 2 with all three components (glandular cells, HLMs, and stromal cells). CB was diagnostic in 8/9 patients, including 4 with intact fragments of endometrial glands and stroma (Image 1). Three showed glandular cells and HLMs, while one showed separate fragments of glandular cells and stromal cells. Conclusions: PW increased the diagnostic yield for endometriosis at the time of gynecologic surgery, as only 4/9 cases had endometriosis diagnosed on surgical pathology. CB in particular aids in the diagnosis, as 4/9 cases had intact glandular and stromal fragments.
PST25
PST26
The Role of Pelvic Washings in the Diagnosis of Endometriosis
Molecular Alterations in Patients with Pulmonary Adenocarcinoma Presenting with Malignant Pleural Effusion at First Diagnosis
Lorene Yoxtheimer, MD, Stacy Molnar, BS, SCT(ASCP), CT(IAC), Richard Cantley, MD. University of Toledo, Toledo, OH Introduction: Endometriosis, the presence of endometrial tissue outside the uterine corpus, is a common finding in reproductive age women. It is classically diagnosed based on the presence of at least two of the following: endometrial glands, endometrial stroma, and hemosiderinladen macrophages (HLMs). Although a common finding in surgical pathology specimens, there is little literature on the role of pelvic washings in diagnosing endometriosis. Our study aims to examine the characteristics of endometriosis in pelvic washings (PW) at the time of gynecologic surgery. Materials and Methods: Our anatomic pathology archives were searched for cases of endometriosis diagnosed on PW from 1/1/2010-12/31/2016. Patient age, clinical history, findings on cytology and cell block (CB), and concurrent surgical specimen diagnoses were recorded. Cytology material was re-reviewed. Results: Nine cases of endometriosis were diagnosed on PW. The average patient age was 37 (range 19-56). Two had a previous history of endometriosis. Three patients underwent total abdominal hysterectomy and bilateral salpingoophorectomy (TAHBSO) for benign processes; three had TAHBSO for neoplasms (one endometrial endometrioid
Maryam Shabihkhani, MD1, Jamal Carter, MD2, Zahra Maleki, MD1, Erika Rodriguez, MD, PhD1. 1Johns Hopkins University, Baltimore, MD; 2 Washington University School of Medicine, St. Louis, MO Introduction: In Lung cancer, the presence of malignant pleural effusion is considered stage IV disease in the tumor-node metastasis (TNM) staging classification. Approximately 15% of non-small cell lung cancer patients have pleural effusions at the time of diagnosis, adenocarcinoma representing the main histologic subtype in half of the cases. Herein we report our experience with pulmonary adenocarcinoma patients presenting with malignant pleural effusion at first diagnosis, and the correlation with specific molecular alterations. Materials and Methods: We searched our pathology database for the last 5 years for patients who had cytopathologic diagnosis conclusive for lung adenocarcinoma for the first time on their pleural fluid specimen, and molecular testing done on pleural effusions or pleural biopsies. Age, gender, smoking history, molecular profile and survival were recorded. Results: We identified 18 cases (9M, 9F). The mean age at diagnosis was 69.6 years (range 55-81y). Patients included non-smokers nZ7, smoker/former smoker nZ9, and unknown smoking history nZ 2. Two patients had history of asbestos exposure and 3 patients had previous malignancies in other organs. All patients had molecular tests performed on pleural effusion (nZ16,) or pleural biopsy (nZ2). In total, 55% of the cases (nZ 10) had known mutations in EGFR (nZ6, 60%), KRAS (nZ3, 30%) or ALK translocation (nZ1, 10%). No mutations were identified in BRAF, AKT, ERBB2, NRAS, and PIK3CA in the 7 patients tested for these genes. Patients with known mutations had better overall survival than patients without known mutations (mean survival 18 months vs. 8 months respectively, pZ0.03, Wilcoxon). Conclusions: In pulmonary adenocarcinoma patients presenting with malignant effusion in our series, alterations in EGFR was the most frequent identifiable molecular change. Patients with known mutations as a group had a better overall survival than those without known mutations, a finding that deserves further study. PST27 Cytomorphology, Clinicopathologic and Cytogenetics Correlation of Myelomatous Effusion of Serous Cavities: A Retrospective Review Aparna Harbhajanka, MD, Vijaya Reddy, MD, MBA, Ji-Weon Park, MD, Pincas Bitterman, MD, Paolo Gattuso, MD, Arlen Brickman, MD. Rush University Medical Center, Chicago, IL Introduction: Myelomatous effusions (ME) of the serous cavities are rare. Identification of the atypical plasma cells in the
Image 1
CB with intact endometrial tissue (H&E, 200x)