Cytopreparation, Instrumentation, and Automated Screening in Gynecologic Cytology

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1 Table of Contents PART 1: GYNECOLOGIC CYTOPATHOLOGY SECTION I: OVERVIEW Pap Test: History and Reporting Terminology Cytopreparation, Instrumentation, and Automated Screening in Gynecologic Cytology Specimen Adequacy in Cervicovaginal Cytology SECTION II: BENIGN AND INFECTIOUS CONDITIONS Normal Pap Test Infectious and Other Organisms in Pap Tests Benign/Other Nonneoplastic Findings Other Benign Mimics and Artifacts SECTION III: SQUAMOUS CELL ABNORMALITIES AND MIMICS Low-Grade Squamous Intraepithelial Lesion and Mimics High-Grade Squamous Intraepithelial Lesion and Mimics Atypical Squamous Cells of Undetermined Significance Atypical Squamous Cells, Cannot Rule Out High-Grade Squamous Intraepithelial Lesion Squamous Cell Carcinoma of Cervix, Variants and Mimics SECTION IV: GLANDULAR CELL ABNORMALITIES AND MIMICS Endocervical Adenocarcinoma In Situ, Variants and Mimics Endocervical Adenocarcinoma, Variants and Mimics Adenocarcinoma, Minimal Deviation Endometrial Cancers: Usual Types, Variants, and Mimics Atypical Glandular Cells: Endocervicals, Endometrials, and Glandulars, NOS Endometrial Cells in Pap Test and Glandular Cells Status Post Hysterectomy SECTION V: EXTRAUTERINE CARCINOMAS AND OTHER MALIGNANCIES OF FEMALE GENITAL TR Extrauterine Carcinomas and Presentations in Cervicovaginal Cytology

2 Small Cell Neuroendocrine Carcinoma of Cervix Other Uncommon Malignancies in Cervicovaginal Cytology SECTION VI: MOLECULAR TESTING IN GYNECOLOGIC CYTOLOGY HPV and Other Molecular Testing in Gynecologic Cytology SECTION VII: DIRECTLY SAMPLED ENDOMETRIAL CYTOLOGY Directly Sampled Endometrial Cytology SECTION VIII: ANAL CYTOLOGY Anal Cytology PART 2: EXFOLIATIVE CYTOPATHOLOGY SECTION I: RESPIRATORY TRACT INCLUDING LUNG FNAS Specimen Types in Respiratory Cytology and Adequacy Criteria Benign and Reactive Changes Pneumocystis Pneumonia and Mimics Fungal Organisms in Respiratory Cytology Parasitic Organisms in Respiratory Cytology Viral Infections (Cytomegalovirus, Herpesvirus, and Others) Mycobacteria and Other Bacterial Infections Sarcoidosis and Other Immune-Related Conditions Pulmonary Alveolar Proteinosis and Mimics Miscellaneous Findings Including Contaminants Adenocarcinoma Squamous Cell Carcinoma Small Cell Carcinoma Large Cell Neuroendocrine Carcinoma Carcinoid and Atypical Carcinoid

3 Rare Benign and Low Malignant Potential Tumors Rare Malignant Tumors Pulmonary Lymphoma Pulmonary Metastasis SECTION II: GASTROINTESTINAL TRACT Specimen Types in Gastrointestinal Cytology and Normal Cellular Components Parasitic Infections Viral Infections Esophagitis and Barrett Esophagus Esophageal Adenocarcinoma Esophageal Squamous Cell Carcinoma Gastritis and Intestinal Metaplasia Gastric Adenocarcinoma Gastric Lymphoma Ampulla/Bile Duct/Pancreatic Duct Reactive Changes Ampulla/Bile Duct/Pancreatic Duct Adenocarcinoma Colorectal Adenoma/Carcinoma Neuroendocrine Tumor/Carcinoma SECTION III: CEREBROSPINAL FLUID Normal Cerebrospinal Fluid and Contamination by Normal Elements Infectious Meningitis Aseptic and Mollaret Meningitis Subarachnoid Hemorrhage Neurodegenerative Diseases Primary Brain Tumors Leukemia and Lymphoma

4 Metastasis in CSF SECTION IV: PLERUAL, PERITONEAL, PERICARDIAL, AND PELVIC FLUID AND WASHINGS Normal Cellular Components and Reactive Mesothelial Proliferations Infectious Conditions Autoimmune Diseases Malignant Effusion, Mesothelioma Malignant Effusion, Carcinomas Malignant Effusion, Sarcomas Lymphoid Effusions and Lymphomas Primary Effusion Lymphoma Endometriosis and Endosalpingiosis Ovarian Neoplasms Immunocytochemistry, Histochemistry, and Other Ancillary Techniques SECTION V: URINARY CYTOLOGY Normal Urinary Cytology and Specimen Types Ileal Conduit Specimens Noninfectious Benign Conditions Infectious Benign Conditions Reactive Urothelial Changes Low-Grade Urothelial Lesions High-Grade Urothelial Dysplasia/Carcinoma/Carcinoma In Situ Squamous Cell Carcinoma of Urinary Bladder Adenocarcinoma of Urinary Bladder Other Malignancies in Urinary Cytology Renal Pelvic Cytology Ancillary Testing, UroVysion, and Others

5 PART 3: FINE-NEEDLE ASPIRATION, SUPERFICIAL SECTION I: OVERVIEW Superficial Aspiration Technique SECTION II: THYROID GLAND Ultrasound-Guided Thyroid Fine-Needle Aspiration Thyroid Fine-Needle Aspiration Reporting Terminology and Specimen Adequacy Adenomatous Nodule Chronic Lymphocytic/Hashimoto Thyroiditis Granulomatous Thyroiditis Graves Disease/Diffuse Toxic Goiter Pigmented Thyroid Lesions and Crystals Atypical (Follicular) Cells of Undetermined Significance Suspicious for Follicular Neoplasm Suspicious for Hürthle Cell Neoplasm Papillary Thyroid Carcinoma Papillary Thyroid Carcinoma Variants Medullary Thyroid Carcinoma Poorly Differentiated Thyroid Carcinoma Anaplastic Thyroid Carcinoma Thyroid Lymphoma Metastatic Carcinoma to Thyroid Other Nonneoplastic and Neoplastic Thyroid Lesions Encountered on Thyroid FNA SECTION III: PARATHYROID GLAND Parathyroid Cyst, Adenoma, and Carcinoma SECTION IV: LYMPH NODES

6 Indications for Aspiration and Techniques FNA Sample Prep and Triage in Evaluating Suspected Lymphoma Benign, Infectious, and Reactive Hyperplasia Inflammatory and Reactive Lymphoid Hyperplasia Granulomatous Lymphadenitis, Infectious and Sarcoid Rosai-Dorfman Disease Metastatic Malignancies Metastatic Malignancies (Carcinoma, Melanoma) HPV-Related Head and Neck Squamous Cell Carcinoma Nodal B-Cell Lymphoma Small Lymphocytic Lymphoma Lymphoplasmacytic Lymphoma Mantle Cell Lymphoma Nodal Marginal Zone Lymphoma Follicular Lymphoma Burkitt Lymphoma Large B-Cell Lymphoma Extranodal B-Cell Lymphoma Plasmacytoma Mediastinal Large B-Cell Lymphoma Plasmablastic Lymphoma T-Cell Lymphoma Peripheral T-Cell Lymphoma Mycosis Fungoides Angioimmunoblastic Lymphoma ALK(+) Anaplastic Large Cell Lymphoma

7 T-Cell Lymphoblastic Lymphoma Hodgkin Lymphoma Nodular Lymphocyte-Predominant Hodgkin Lymphoma Classical Hodgkin Lymphoma SECTION V: SALIVARY GLAND Approach to Interpretation of Salivary Gland Aspiration Biopsies Benign Lesions Normal Salivary Gland and Sialadenitis on Aspiration Cysts Pleomorphic Adenoma Warthin Tumor Other Benign Neoplasms Malignant Neoplasms Adenoid Cystic Carcinoma Acinic Cell Carcinoma Mucoepidermoid Carcinoma Basaloid Neoplasms, Benign and Malignant Carcinoma Ex Pleomorphic Adenoma Adenocarcinoma, Not Otherwise Specified Polymorphous Low-Grade Adenocarcinoma Salivary Duct Carcinoma Metastatic Carcinoma Primary and Metastatic Nonepithelial Tumors SECTION VI: BREAST

8 Role of Fine-Needle Aspiration of Breast,Techniques and Triple Test Benign Breast Lesions Inflammatory and Granulomatous Conditions Fat Necrosis Nonproliferative and Proliferative Changes in Breast Radial Scar/Complex Sclerosing Lesion Gynecomastia Mucocele-Like Lesion Benign Neoplasms Fibroadenoma Granular Cell Tumor of Breast Papillary Neoplasms Myofibroblastoma Malignant Neoplasms Ductal Carcinoma and Variants of Invasive Mammary Carcinoma Lobular Carcinoma Phyllodes Tumor Angiosarcoma and Other Sarcomas Lymphomas and Metastatic Tumors Nipple Discharge Cytology Specimens for Risk Assessment of Breast Cancer PART 4: FINE-NEEDLE ASPIRATION, DEEP ORGANS AND TISSUES SECTION I: OVERVIEW Techniques and Modalities of Deep Aspiration Biopsies SECTION II: MEDIASTINUM

9 Anatomic Compartments and Constituent Tumors Nonneoplastic Lesions Mediastinal Cysts and Inflammatory Lesions Neoplasms Thymoma Thymic Carcinoma Germ Cell Tumors Neurogenic Tumors Metastatic Tumors SECTION III: LIVER Cytology of Normal Liver Inflammatory and Infectious Conditions of Liver Benign Hepatic Neoplasms Hepatocellular Adenoma Focal Nodular Hyperplasia Hemangioma Malignant Neoplasms Hepatocellular Carcinoma Hepatoblastoma Liver Metastasis SECTION IV: KIDNEY Cytology of Normal Kidney Nonneoplastic Lesions

10 Renal Cysts Xanthogranulomatous Pyelonephritis/Malakoplakia Benign Neoplasms Angiomyolipoma Oncocytoma Metanephric Adenoma Metanephric Stromal Tumor Malignant Neoplasms Clear Cell Renal Cell Carcinoma Papillary Renal Cell Carcinoma Chromophobe Renal Cell Carcinoma Collecting Duct Carcinoma Mucinous Tubular and Spindle Cell Carcinoma of Kidney Renal Medullary Carcinoma Metastatic Tumors to Kidney Renal Lymphomas Primary Renal Sarcomas in Adults Nephroblastoma (Wilms Tumor) Clear Cell Sarcoma of Kidney Rhabdoid Tumor of Kidney Congenital Mesoblastic Nephroma Carcinoid Tumor Tumors of Renal Pelvis Urothelial Carcinoma SECTION V: ADRENAL GLAND

11 Cytology of Normal Adrenal Gland Adrenal Cortical Lesions Adrenal Cortical Adenoma Adrenal Cortical Carcinoma Metastatic Tumors to Adrenal Gland Adrenal Medullary Lesions Pheochromocytoma SECTION VI: PANCREAS Cytology of Normal Pancreas Pancreatic Cytology Reporting Terminology and Other Nonneoplastic Entities Nonneoplastic Lesions Pancreatitis Neoplasms Serous Microcystic Adenoma Mucinous Cystic Neoplasm Intraductal Papillary Mucinous Neoplasm Solid Pseudopapillary Neoplasm Pancreatic Endocrine Tumor Pancreatic Ductal Adenocarcinoma Unusual Variants of Ductal Carcinoma Acinar Cell Carcinoma Lymphoma and Secondary Tumors of Pancreas SECTION VII: BONE Approach to Cytologic/Small Biopsy Diagnosis of Primary Bone Tumors

12 Neoplasms Langerhans Cell Histiocytosis Osteoblastoma Osteosarcoma Chondromas of Bone and Soft Tissue Chondroblastoma Chondrosarcoma Ewing Sarcoma/Primitive Neuroectodermal Tumor Adamantinoma Chordoma Giant Cell Tumor Bone Lymphoma Metastatic Tumors SECTION VIII: SOFT TISSUE Approach to Cytologic/Small Biopsy Diagnosis of Primary Soft Tissue Lesions Adipocytic Tumors Benign Adipose Tissue Tumors Liposarcoma Fibroblastic/Myofibroblastic Lesions Fibrosarcoma Myofibroblastoma Myofibroblastic Sarcoma Fibrohistiocytic Tumors Giant Cell Tumor of Tendon Sheath Fibrohistiocytic Tumors

13 Tumors of Muscle Origin Smooth Muscle Tumors Skeletal Muscle Tumors Vascular Tumors Hemangioma Epithelioid Hemangioendothelioma Angiosarcoma Other Tumors Other Reactive and Neoplastic Soft Tissue Entities, Including GIST Cutaneous and Adnexal Cytology Intramuscular Myxoma Synovial Sarcoma Epithelioid Sarcoma Alveolar Soft Part Sarcoma Clear Cell Sarcoma of Soft Tissue Desmoplastic Small Round Cell Tumor SECTION IX: OPTHALAMIC AND NEUROPATHOLOGY Approach to Ophthalmic Cytology Ophthalmic Cytopathology, Infectious Ophthalmic Cytopathology, Neoplastic Neuropathology Squash Preparations, Infectious Neuropathology Squash Preparations, Glial Neoplasms Neuropathology Squash Preparations, Nonglial Neoplasms PART 5: MANAGEMENT AND ANCILLARY TESTING SECTION I: CYTOPREPERATORY AND QUALITY MANAGEMENT

14 Cytopreparatory Techniques and Instrumentation in Nongynecologic Cytology Quality Improvement and Risk Reduction in Cytopathology SECTION II: ANCILLARY TESTING Immunocytochemistry Molecular Techniques

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