While fine needle aspiration (FNA) is certainly not a new biopsy technique, recent developments in advanced imaging techniques, molecular testing, and targeted therapies have coincided with a rapid increase in the number of FNA procedures being performed. Concurrently, the demand for on-site evaluation of adequacy (OSEA) has also increased, outstripping the capacity of available cytopathologists at some institutions. Among the several alternatives to cytopathologist-performed OSEA, cytotechnologist-attended OSEA stands out because it preserves the representation of the pathology service at the time of the procedure. Herein, we review the current literature about OSEA and the necessity of cytotechnologists to expand access of this useful pathology service to a broader patient population. We also examine how cytotechnologists are likely to fit into the emerging practice of telecytology.
Biopsy ; Biopsy, Fine-Needle ; Humans ; Telepathology

BACKGROUND: The pancreas is surrounded by soft tissue known as the peripancreatic space (PPS). Pathologic lesions of the PPS are infrequent and have only rarely been reported in the cytopathology literature. METHODS: A retrospective review of cytopathology files at two large institutions revealed 42 cases of PPS lesions obtained by transabdominal fine needle aspiration (FNA) or endoscopic ultrasound-guided FNA over a 16-year period. Clinicoradiologic findings and follow-up information were also reviewed. RESULTS: Patients ranged in age from 23-83 years (mean, 60 years) with an equal gender distribution. The major clinical presentations included pain, jaundice, nausea/vomiting, and abnormal liver enzymes. Radiographic characteristics included lymphadenopathy and cystic/solid soft tissue masses with a size range of 1.5 to 8 cm. Cytologically, 4 (9.5%) cases were nondiagnostic, 9 (21.5%) were diagnosed as benign, 4 (9.5%) were atypical or suspicious for cancer, and 25 (59.5%) were malignant. Six of 25 (24%) patients had metastasis of a prior known malignancy. CONCLUSIONS: FNA of PPS masses is a rare occurrence. The majority of lesions are metastatic carcinomas from a variety of primary sites. Flow cytometry and immunoperoxidase studies are useful adjuncts to determine the tumor origin. The sensitivity of PPS aspiration for a malignant diagnosis is 90% with a positive predictive value of 100%.
Adenocarcinoma ; Biopsy, Fine-Needle ; Flow Cytometry ; Follow-Up Studies ; Humans ; Jaundice ; Liver ; Lymphatic Diseases ; Neoplasm Metastasis ; Pancreas ; Retrospective Studies

Acinar cell carcinoma is a rare malignant epithelial neoplasm with predominantly exocrine acinar differentiation and is seen primarily in older men (mean age, 62 years). The presenting symptoms are usually non-specific, and jaundice is often not present. Symptoms relating to the overproduction and release of lipase into the circulation are present in 10-15% of patients. Characteristic cytomorphologic features include a population of cells with minimal pleomorphism, eccentrically placed nuclei with a single prominent nucleoli and moderate hyperchromasia. The cytoplasm is finely granular, and the background may contain granular debris secondary to cytolysis. A significant proportion of the cases also have a minor neuroendocrine component or scattered neuroendocrine cells. Approximately 50% of patients have metastatic disease at presentation, often restricted to the regional lymph nodes and liver. The prognosis is poor, only slightly better than that of pancreatic ductal adenocarcinoma.
Acinar Cells ; Adenocarcinoma ; Carcinoma ; Carcinoma, Acinar Cell ; Cytoplasm ; Humans ; Jaundice ; Lipase ; Liver ; Lymph Nodes ; Male ; Neuroendocrine Cells ; Pancreas ; Pancreatic Ducts ; Prognosis

Primary intraosseous squamous cell carcinoma is a rare malignant central jaw tumor derived from odontogenic epithelial remnants. Predominantly, it affects mandible, although both jaw bones may be involved. This report describes a 60-year-old man who was initially misdiagnosed with a periapical infection related to the right lower wisdom tooth. After four months, the patient presented to a private dental clinic with a massive swelling at the right side of the mandible. Panoramic radiographs and advanced imaging revealed a lesion with complete erosion of the right ramus, which extended to the orbital floor. A biopsy from the mandibular angle revealed large pleomorphic atypical squamous cells, which is the primary microscopic feature of a poorly differentiated squamous cell carcinoma.
Atypical Squamous Cells of the Cervix ; Biopsy ; Carcinoma, Squamous Cell ; Delayed Diagnosis ; Dental Clinics ; Epithelial Cells ; Humans ; Jaw ; Magnetic Resonance Imaging ; Mandible ; Middle Aged ; Molar, Third ; Orbit ; Tomography, X-Ray Computed

Herein, we report and discuss the detection of fossa navicularis magna, a close radiographic anatomic variant of canalis basilaris medianus of the basiocciput, as an incidental finding in cone-beam computed tomography (CBCT) imaging. The CBCT data of the patients in question were referred for the evaluation of implant sites and to rule out pathology in the maxilla and mandible. CBCT analysis showed osseous, notch-like defects on the inferior aspect of the clivus in all four cases. The appearance of fossa navicularis magna varied among the cases. In some, it was completely within the basiocciput and mimicked a small rounded, corticated, lytic defect, whereas it appeared as a notch in others. Fossa navicularis magna is an anatomical variant that occurs on the inferior aspect of the clivus. The pertinent literature on the anatomical variations occurring in this region was reviewed.
Cone-Beam Computed Tomography* ; Cranial Fossa, Posterior ; Humans ; Incidental Findings ; Mandible ; Maxilla ; Multidetector Computed Tomography ; Pathology ; Skull Base

The incidental finding of an enlarged mastoid foramen on the right posterior mastoid region of temporal bone is reported, together with a discussion of its clinical significance. A 67-year-old female underwent the pre-implant assessment of a maxillary left edentulous region. A cone-beam computed tomographic (CBCT) image was acquired and referred for consultation. Axial CBCT slices revealed a unilateral, well-defined, noncorticated, low-attenuation, transosseous defect posterior to the mastoid air cells in the right temporal bone. The borders of the osseous defect were smooth and continuous. No other radiographic signs suggestive of erosion or sclerosis were noted in the vicinity. The density within the defect was homogenous and consistent with a foramen and/or soft tissue. The patient's history and physical examination revealed no significant medical issues, and she was referred to a neuroradiologist for a second opinion. The diagnosis of an enlarged mastoid foramen was made and the patient was reassured.
Aged ; Cone-Beam Computed Tomography* ; Diagnosis ; Female ; Humans ; Incidental Findings ; Mastoid* ; Physical Examination ; Referral and Consultation ; Sclerosis ; Temporal Bone

The aim of this report is to present two cases of canalis basilaris medianus as identified on cone-beam computed tomography (CBCT) in the base of the skull. The CBCT data sets were sent for radiographic consultation. In both cases, multi-planar views revealed an osseous defect in the base of the skull in the clivus region, the sagittal view showed a unilateral, well-defined, non-corticated, track-like low-attenuation osseous defect in the clivus. The appearance of the defect was highly reminiscent of a fracture of the clivus. The borders of osseous defect were smooth, and no other radiographic signs suggestive of osteolytic destructive processes were noted. Based on the overall radiographic examination, a radiographic impression of canalis basilaris medianus was made. Canalis basilaris medianus is a rare anatomical variant and is generally observed on the clivus. Due to its potential association with meningitis, it should be recognized and reported to avoid potential complications.
Cone-Beam Computed Tomography* ; Cranial Fossa, Posterior ; Dataset ; Meningitis ; Skull ; Skull Base

Rhinoliths are foreign bodies composed of mineralised deposits in the nasal cavity that are rarely encountered in routine dental practice. The current report presents a case of a 77-year-old female patient who visited a dental treatment centre for a routine dental check-up and prophylaxis. On the clinical examination, the patient did not report any breathing difficulty, nasal obstruction, or any form of discharge. Panoramic radiography showed a horizontally magnified radiopaque structure in the right nasal fossa region. Cone-beam computed tomography (CBCT) revealed a hyperdense entity with a laminated presentation in the right nasal fossa. The hyperdense entity was diagnosed as a rhinolith based on the radiographic findings. Although the patient was asymptomatic, a referral was made to an ear, nose, and throat surgeon for a further evaluation. This report highlights the importance ofCBCT imaging in the diagnosis of soft-tissue calcifications.

Purpose: An oroantral communication (OAC) is an abnormal space between the maxillary sinus and oral cavity. The causes, complications, treatment, and radiographic features of OAC in 2-dimensional and 3-dimensional imaging modalities are discussed. Materials and Methods: This pictorial review presents a broad spectrum of imaging findings of OAC. Representative radiographs depicting OAC were chosen from our database. PubMed was used to conduct a comprehensive literature search of OAC. Results: Characteristic features of OAC include discontinuity of the maxillary sinus floor, thickening of the maxillary sinus mucosa, or a combination of both. Two-dimensional imaging modalities are the method of choice for identifying discontinuities in the maxillary sinus floor. However, 3-dimensional imaging modalities are also essential for determining the status of soft tissue in the maxillary sinus. Conclusion The integration of 2-dimensional and 3-dimensional imaging modalities is crucial for the correct diagnosis and comprehensive treatment of OAC. However, the diagnosis of OAC must be confirmed clinically to prevent unnecessary mental and financial burdens to patients

Soft tissue calcification is a pathological condition in which calcium and phosphate salts are deposited in the soft tissue organic matrix. This study presents an unusual calcification noted in the cartilaginous portion of the Eustachian tube. A 67-year-old woman presented for dental treatment, specifically for implant placement, and cone-beam computed tomography (CBCT) was performed. The CBCT scan was reviewed by a board-certified oral and maxillofacial radiologist and revealed incidental findings of 2 distinct calcifications in the cartilaginous portion of the Eustachian tube. To the authors' knowledge, no previous study has reported the diagnosis of Eustachian tube calcification using CBCT. This report describes an uncommon variant of Eustachian tube calcification, which has a significant didactic value because such cases are seldom illustrated either in textbooks or in the literature. This case once again underscores the importance of having CBCT scans evaluated by a board-certified oral and maxillofacial radiologist.
Aged ; Calcinosis ; Calcium ; Cone-Beam Computed Tomography* ; Diagnosis ; Eustachian Tube* ; Female ; Humans ; Incidental Findings ; Radiography ; Salts