In recent years, technological innovation have emerged to standardize pathology laboratory processes and reduce the handling of diagnostic samples. Among them is an automatic tissue embedding system that eliminates the need for manual activity in tissue paraffin embedding, thereby improving sample preservation. Unfortunately, this system cannot be used for cytological specimens due to the lack of an effective holder to support the procedure steps. In this study, we evaluated the performance of a commercial polymer matrix to enable and standardize the automatic paraffin embedding of cytological material from different organs and sources. Cytological samples from 40 patients were collected on the matrices and submitted for fully automatic workflow preparation, from formalin fixation until paraffin block, using the Sakura embedding system. Our results demonstrated the feasibility of the automated procedure, from loading cytological sample onto the matrix to obtaining the paraffin cellblock, thereby avoiding manual manipulation of cellular material. All samples resulted adequately processed and paraffin-embedded showing satisfactory tissue permeation by processing reagents, optimal preservation of cytoplasmic and nuclear details, and good quality of staining results on paraffin sections. Automated embedding of cytological samples eliminates the risk of lost specimens, reduces laboratory burden, standardizes procedures, increases diagnostic yield, and ultimately improves patients\' management.

BACKGROUND: Fine needle aspiration cytology (FNAC) sampling is a minimally invasive procedure done to identify the pathology behind superficial and deep-seated lesions. Rapid on-site evaluation (ROSE) can be an adjunct to the FNACs. Our study aimed to identify the role of ROSE in diagnostic adequacy and to check the benefit of cell block (CB)/cell buttons prepared from the ROSE samples.
METHODS: A prospective study was conducted where all patients referred for FNAC were included. ROSE using 1% aqueous toluidine blue stain and CB/cell button preparations were done for the identification of various cytological lesions.
RESULTS: Among 600 cases included in the study most common age group was third and fourth decades with a mean age of 41.6 years and M: F ratio of 1:1.7. Ultrasound-guided procedures were done in 20% of cases. CB preparation was available in 14% of cases. Most CBs were from the cases wherein ROSE was performed 81% (77 out of 86), with CB helping in making an accurate diagnosis in 17% of cases. Lymph nodes 26%, and thyroid 23% were the most common sites for sampling with the highest number of repeat procedures from non-ROSE cases (14%). The non-diagnostic rate for non-ROSE cases was 7.7% (23/300) even after the repeat procedures as compared to 1.3% (4/300) for ROSE. Three slides on average were consumed in ROSE-performed procedures, as compared to an average of 5 slides in non-ROSE. The average turnaround time was 1.7 days for non-ROSE cases and 1.05 for ROSE cases respectively. Cyto-histopathological correlation was available in 40% of cases with a sensitivity of 98.1%, specificity of 96.7%, positive predictive value of 90%, negative predictive value of 99.4%, and diagnostic accuracy of 97%. The correlation of CB, number of slides consumed, and turnaround time among the 2 groups were statistically significant (P value < 0.001).
CONCLUSIONS: ROSE is a method used to assess material aspirated at the time of FNAC procedures to determine the adequacy and to an extent to identify whether the lesion is neoplastic or non-neoplastic. CBs have helped in increasing diagnostic accuracy apart from the fact that the paraffin-embedded tissue material can be used for further studies.

Pap smears play a role in detecting extrauterine serous tumours in asymptomatic women. Certain cytopathologic and histopathologic findings combined with relevant clinical and radiologic findings indicate the possibility of primary peritoneal serous tumours. Cellblock immunohistochemistry is a valuable confirmatory diagnostic tool.

Epithelial pearls and Keratin pearls are pathognomonic of squamous cell carcinoma. However, their histogenesis is not well understood. Only a handful of studies have been conducted in the past in this regard. This brief communication aims to understand the formation of these pearls with a few of our own experiences.

UNASSIGNED: Cellblock (CB) with immunohistochemistry (IHC) is practically indispensable in the diagnostic workup of serous effusions; however, CB requires a minimum of 15-20 h for routine histopathological processing. A reduction in processing time can expedite a faster diagnosis.
UNASSIGNED: This study was undertaken to evaluate the utility of the heat-induced CB (HICB) technique.
UNASSIGNED: Two sets of agar-embedded CBs were processed from 50 effusion samples. CBs were further processed by conventional and rapid methods. Conventional CBs (CCB) were processed in a histoprocessor, whereas rapid CB was processed in a heated water bath with an agitation facility. For HICB processing, dehydration and clearing were performed at 50°C followed by paraffin wax impregnation at 65°C temperature. From both CBs, sections of 5 um thickness were cut and stained with hematoxylin and eosin (H and E). Cell morphology, cost, and time were compared between the two methods. The feasibility of IHC was attempted in a few cases.
UNASSIGNED: HICB was completed within 4.30 h compared with CCB. Diagnoses on both CBs were concordant in all the cases. Incomplete dehydration was noted in six (12%) cases, but the diagnosis was not compromised. No additional cost was involved in HICB. On IHC, both HICB and CCB exhibited equivalent expression.
UNASSIGNED: HICB is a rapid, innovative, simple, and cost-effective technique and expedites faster diagnosis. It does not require any advanced equipment.

UNASSIGNED: Rapid on-site evaluation (ROSE) is an essential component of thyroid cytopathology, particularly important in thyroid lymphoma, anaplastic carcinoma, metastasis to avoid unnecessary surgery. Follicular epithelial neoplasms are the most common tumors arising from the thyroid, whereas primary thyroid lymphomas are uncommon, accounting for less than 5% of all thyroid malignancies.
UNASSIGNED: A 45-year-old male patient presented to our ENT outpatient department with swelling in the anterior neck for 3 years duration. Non-aspirational needling was done along with rapid on-site evaluation using 1% aq. toluidine blue and was reported as Malignant thyroid neoplasm- possibility of Non-Hodgkin lymphoma (NHL). Cellblock sample also confirmed as B-cell NHL followed by Immunohistochemistry.
UNASSIGNED: Primary thyroid lymphomas (PTL) are uncommon malignant neoplasms. They represent < 5% of all thyroid malignancies and 1-2% of all extra-nodal lymphomas. If diagnosed cytologically, unnecessary surgery can be avoided in thyroid lymphoma. ROSE helps in the rapid diagnosis and sample adequacy. Cellblock can avoid the biopsy procedure used for confirmation and subtyping of lymphoma.

UNASSIGNED: The neck is a common site of both primary and secondary malignancies. Many tumors from the head and neck (oral cavity, larynx, and pharynx), lung, and gastrointestinal tract metastasize to cervical lymph nodes. At most times, tumors are diagnosed by morphology, sometimes it is difficult to diagnose an unknown primary presenting as metastatic lymphadenopathy solely on the basis of morphology. Specific histological cell types can be confirmed by the use of immunohistochemistry.
UNASSIGNED: The present study evaluated the utility of cell block over fine-needle aspiration cytology (FNAC) and immunohistochemical expression of CK5/6, CK7, and CK20 in metastatic cervical lymphadenopathy.
UNASSIGNED: This prospective study design was used on a total of 50 cases. FNAC smears and cell blocks were made in all the cases. All the cell blocks were compared with FNAC findings and further subjected to immunohistochemical (IHC) analysis. The necessary statistical analysis was done.
UNASSIGNED: Our study showed that the combined use of the cell block technique and FNAC was more useful and sensitive in diagnosing the metastatic cervical lymph nodes and the accuracy can be further improved by the use of IHC on the cell blocks. The combined use of CK5/6, CK7, and CK20 in metastatic cervical lymphadenopathy is helpful in diagnosing squamous cell carcinoma and adenocarcinoma with known/unknown primary sites.

UNASSIGNED: Diagnosis of pancreatic lesions remains a clinical challenge. Early and accurate diagnosis is extremely important for improving the therapeutic usefulness of pancreatic cancers and Endoscopic ultrasonography - fine needle aspiration (EUS-FNA) cytology has come up with this advantage. For current study the authors evaluated the diagnostic accuracy of EUS-FNAC by applying PSC system for reporting pancreaticobiliary cytology and Calculated the malignancy risk associated with the diagnostic categories.
UNASSIGNED: A retrospective study over the period of 2.5 years (April 2017 to Oct 2019) 60 patients in our cohort EUS-FNAC guided unstained fixed and unfixed slides received of pancreatic lesion and were stained with Papanicolau and Giemsa using standard technique and immunocytochemistry, where required Application of Papanicolaou Society of Cytopathology system for reporting pancreaticobiliary cytology Histopathological and clinical follow-up were retrieved.
UNASSIGNED: Our study has comparable results with sensitivity, specificity, PPV, and NPV of 92.8%, 100%, 100%, and 92.59%, respectively. Fuurthermore, a diagnostic accuracy of 96.2%. Risk of malignancy is lower for benign and indeterminate category whereas it is higher for suspicious and malignant categories.
UNASSIGNED: The application of the new proposed terminology for pancreaticobiliary cytology brings standardization. Final diagnosis can be reached by the multidisciplinary approach of EUS-FNA cytology, cell block preparation, immunocytochemistry, and immunohistochemistry; if required, can be adopted as an alternative approach to biopsy. The present study showed high sensitivity and specificity for EUS-FNA in the diagnosis of pancreatic carcinoma, which may influence the treatment plans of both surgeons and oncologists.

BACKGROUND: Thyroid nodules are common in the general population. The current diagnostic method for nodules is the ultrasound guided fine needle aspiration (US-FNA). The aim of the study was to evaluate the usefulness of cellblock preparation in addition to routine US-FNA in the diagnosis of thyroid nodules.
METHODS: A retrospective study of patients with thyroid nodules submitted to US-FNA, with collection of material using both smears and cellblock preparation. Two air-dried smears were prepared for each nodule. After centrifugation, the residual aspirate in the syringe and needle was processed as a standard histology specimen (cellblock). Then a pathologist reviewed the smears and cellblock slides of each case.
RESULTS: A total of 12.360 thyroid nodules were submitted to US-FNA. Cellblock preparation was performed in 153 (1.2%) in addition to smears. Among the satisfactory cellblocks (80.5%, 120), 31.7% (38) provided additional morphological information in comparison with smears alone. No significant differences were found between the smear and the combined smear and cellblock evaluation concerning the number of unsatisfactory (12.1% vs. 11.4%, p = .85) and indeterminate (27.5% vs. 24.2%, p = .52) results. Overall, 10 samples (6.7%) had their diagnosis changed after cellblock evaluation, nine of them due to immunohistochemical studies. Immunohistochemistry confirmed parathyroid origin of the nodule in six cases.
CONCLUSIONS: Cellblocks did not contribute to increase cellularity of the samples or to reduce indetermined results of FNA of thyroid nodules. Immunohistochemistry was essential to characterize rare cases without follicular histogenesis. Cellblock must only be prepared when considering performing immunohistochemistry.

Serous effusions occur in a small group of patients with classic Hodgkin lymphoma (cHL). Most effusions are benign inflammatory fluids. Malignant effusions predominantly in patients with treated relapsed diseases or rarely as a primary manifestation are diagnostically challenging to cytopathologists. Established cases of cHL with effusions were retrieved. Cytology slides were screened looking for Reed-Sternberg-Hodgkin (RSH) cells and patterns of background inflammatory cells. Cellblocks and their corresponding immunocytochemistry (ICC) slides were examined. The cytologic findings were correlated with nodal biopsy histopathologic and immunohistochemical features. We found six cases of benign and malignant pleural and pericardial effusions in patients with mediastinal nodular sclerosis-type cHL. Various cytomorphologic patterns were observed. Slides revealed sparsely scattered either isolated or aggregated mononuclear, binucleated and multinucleated RSH-like cells. Some may have been either disregarded as reactive mesothelial or histiocytic cells, or confused with other RSH-like malignant cells. The background varied between characteristic mixed inflammatory milieu, predominantly small lymphocytic or lymphohistiocytic with or without reactive mesothelial cells. Cytologic examination showed three positive cases (two cases with RSH cells confirmed by cellblock section ICC, one case with a mixed inflammatory infiltrate), and three benign effusions (one case with atypical RSH-like reactive mesothelial cells confirmed by ICC). Effusions associated with cHL exhibit different cytologic patterns. A high level of vigilance with utility of ICC has an important role in suspecting primary cases and confirming recurrences in known cases. The various cytologic patterns of cHL-associated benign and malignant effusions might reflect parallel pathophysiologic mechanisms.