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  1. Article ; Online: Cytologic features of gynecologic germ cell tumors and carcinomas exhibiting germ cell tumor differentiation.

    Hodgson, Anjelica / Kim, Veronica / Murali, Rajmohan

    Cancer cytopathology

    2022  Volume 131, Issue 4, Page(s) 254–261

    Abstract: Background: In this study, the authors sought to describe the cytologic features of primary gynecologic germ cell tumors and carcinomas exhibiting germ cell differentiation because little information currently exists.: Methods: An institutional ... ...

    Abstract Background: In this study, the authors sought to describe the cytologic features of primary gynecologic germ cell tumors and carcinomas exhibiting germ cell differentiation because little information currently exists.
    Methods: An institutional database search was performed to identify histologically confirmed gynecologic germ cell tumors and carcinomas with germ cell tumor differentiation. Available cytologic material was reviewed by three observers, and morphologic features were recorded in addition to patient age at original diagnosis, primary tumor site, site(s) from which the examined cytologic material was obtained, and the type of examined cytologic preparations.
    Results: In total, 15 cytologic specimens from 12 women (aged 19-82 years) were identified and included touch preparations of core biopsies from various sites (n = 6), fine-needle biopsies (n = 2), pelvic washings (n = 1), ascitic fluids (n = 4), pelvic cyst fluid (n = 1), and endometrial aspirate (n = 1). Of the 12 patients, seven had primary gynecologic germ cell tumors, four had gynecologic (ovarian and endometrial) tumors exhibiting somatic yolk sac tumor-like differentiation, and the remaining patient had an intestinal-type adenocarcinoma arising within an ovarian teratoma. There was morphologic overlap among many of the cases, although cytoplasmic vacuolation/granular cytoplasm was seen in 75% of primary yolk sac tumors or carcinomas with yolk sac tumor differentiation, and dense/squamoid cytoplasm was seen in 100% of teratomatous elements that were sampled.
    Conclusions: Germ cell tumors and somatic neoplasms exhibiting germ cell tumor differentiation occurring in adult women share some cytologic features and may be difficult to distinguish from one another, although some tumor types showed characteristic cytomorphologic findings.
    MeSH term(s) Adult ; Humans ; Female ; Endodermal Sinus Tumor/pathology ; Neoplasms, Germ Cell and Embryonal/diagnosis ; Teratoma/pathology ; Ovarian Neoplasms/diagnosis ; Adenocarcinoma/pathology
    Language English
    Publishing date 2022-12-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2594979-2
    ISSN 1934-6638 ; 1934-662X
    ISSN (online) 1934-6638
    ISSN 1934-662X
    DOI 10.1002/cncy.22673
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Cytopathologic features of epithelioid hemangioendothelioma including touch imprints for rapid on-site evaluation.

    Lahori, Mega / Dehghani, Amir / Wilson, Christina / Law, Wyanne / Agaram, Narasimhan / Murali, Rajmohan / Sigel, Carlie

    CytoJournal

    2023  Volume 20, Page(s) 29

    Abstract: Objectives: Epithelioid hemangioendothelioma (EHE) is a vascular tumor of intermediate malignant potential, which presents as infiltrative lesions involving multiple organs. We reviewed our institutional experience with the cytologic diagnosis of this ... ...

    Abstract Objectives: Epithelioid hemangioendothelioma (EHE) is a vascular tumor of intermediate malignant potential, which presents as infiltrative lesions involving multiple organs. We reviewed our institutional experience with the cytologic diagnosis of this neoplasm including the performance of rapid on-site evaluation (ROSE).
    Material and methods: From our institutional database, we identified 29 cytology specimens, obtained between 2012 and 2020, from 21 patients with biopsy confirmation of EHE. ROSE and final diagnosis were compared. All cytology slides were reviewed, and selected cytologic features were recorded.
    Results: The cohort included 29 specimens comprising 17 (59%) from liver, 6 (21%) from lung, 2 (7%) from lymph node, and 4 (14%) from other sites. At ROSE, 8/27 (30%) were reported inadequate, yet on review, all cases contained scattered cells typical of EHE in the touch imprint air-dried slides including two cases reported with a final diagnosis of non-diagnostic. All cases contained epithelioid and plasmacytoid cells with ovoid nuclei, fine chromatin, delicate (or biphasic) cytoplasm, and scattered cells with delicate, elongated cytoplasmic tails. The majority 26/29 (90%) of cases had multi-nucleated and multi-lobated nuclei. Intracytoplasmic lumens/blister cells were in 17/29 (59%), and a subset had erythrocytes therein (4/29, 14%). Metachromatic fibromyxoid or fibrotic stroma fragments were commonly seen (23/29, 79%). Mitoses and necrosis were absent in all cases. Of 11 tested cases,
    Conclusion: EHE has distinctive cytologic features which are often under-recognized during ROSE.
    Language English
    Publishing date 2023-09-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2158838-7
    ISSN 1742-6413 ; 0974-5963
    ISSN (online) 1742-6413
    ISSN 0974-5963
    DOI 10.25259/Cytojournal_57_2022
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Cytologic features of sex cord-stromal tumors in women.

    Edmund, Liz N / Salama, Abeer M / Murali, Rajmohan

    Cancer cytopathology

    2021  Volume 130, Issue 1, Page(s) 55–71

    Abstract: Background: Gynecologic sex cord-stromal tumors (SCSTs) arise from sex cords of the embryonic gonad and may display malignant behavior. We describe the cytomorphologic features of SCSTs in females, including adult and juvenile granulosa cell tumors ( ... ...

    Abstract Background: Gynecologic sex cord-stromal tumors (SCSTs) arise from sex cords of the embryonic gonad and may display malignant behavior. We describe the cytomorphologic features of SCSTs in females, including adult and juvenile granulosa cell tumors (AGCTs and JGCTs), Sertoli-Leydig cell tumors (SLCTs), and steroid cell tumors (SCTs).
    Methods: We retrieved available cytology slides from females with a histologic diagnosis of sex cord-stromal tumor between 2009 and 2020 from institutional archives and reviewed their cytoarchitectural features.
    Results: There were 25, 2, 2, and 1 cytology specimens from 19, 2, 2, and 1 patients (aged 7-90 years, median 57 years) with AGCT, JGCT, SLCT, and SCT, respectively. Features common to all SCSTs included 3-dimensional groups, rosettes, rare papillary fragments, abundant single cells and naked nuclei. Rosettes and a streaming appearance of cell groups were only seen in AGCTs, which also rarely featured eosinophilic hyaline globules and metachromatic stroma. AGCTs exhibited high nuclear:cytoplasmic (N:C) ratios, with mild nuclear pleomorphism, uniform nuclei with finely granular chromatin, nuclear grooves and small nucleoli; in contrast, other SCSTs lacked rosettes and nuclear grooves and had generally lower N:C ratios, greater nuclear pleomorphism, coarse chromatin and more abundant cytoplasm. Mitotic figures, necrosis, and inflammation were rarely identified.
    Conclusions: AGCTs show cytomorphologic features that are distinct from those of other SCSTs. Careful evaluation of the cytological features and ancillary studies (eg, immunochemistry for FOXL2, inhibin and calretinin, or sequencing for FOXL2 mutations) can aid in the accurate diagnosis of these tumors.
    MeSH term(s) Adult ; Chromatin ; Female ; Granulosa Cell Tumor/diagnosis ; Granulosa Cell Tumor/genetics ; Granulosa Cell Tumor/pathology ; Humans ; Mutation ; Ovarian Neoplasms/pathology ; Sex Cord-Gonadal Stromal Tumors/diagnosis ; Sex Cord-Gonadal Stromal Tumors/genetics ; Sex Cord-Gonadal Stromal Tumors/pathology
    Chemical Substances Chromatin
    Language English
    Publishing date 2021-08-19
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2594979-2
    ISSN 1934-6638 ; 1934-662X
    ISSN (online) 1934-6638
    ISSN 1934-662X
    DOI 10.1002/cncy.22502
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Interobserver Reproducibility in Assessing Eosinophilic Cells in Ovarian Serous Borderline Tumors to Predict BRAF Mutational Status.

    Chui, M Herman / Murali, Rajmohan / Soslow, Robert A / Matrai, Cathleen / Xing, Deyin / Vang, Russell

    International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists

    2023  Volume 42, Issue 5, Page(s) 472–481

    Abstract: Ovarian serous borderline tumors (SBTs) harboring the BRAFV600E mutation are associated with decreased risk of progression to low-grade serous carcinoma, and often prominently feature tumor cells with abundant eosinophilic cytoplasm. Since eosinophilic ... ...

    Abstract Ovarian serous borderline tumors (SBTs) harboring the BRAFV600E mutation are associated with decreased risk of progression to low-grade serous carcinoma, and often prominently feature tumor cells with abundant eosinophilic cytoplasm. Since eosinophilic cells (ECs) may be a marker of the underlying genetic driver, we proposed morphologic criteria and evaluated the interobserver reproducibility for assessing this histologic feature. Following the completion of an online training module, representative tumor slides from 40 SBTs ( BRAFV600E -mutated, n=18, BRAF -wildtype, n=22) were independently reviewed by 5 pathologists. For each case, reviewers provided a semiquantitative assessment of the extent of ECs (0: absent, 1: <10%, 2: 10%-50%, or 3: >50%, of tumor area). Interobserver reproducibility for estimating the extent of ECs was moderate (κ=0.41). Applying a cut-off score of ≥2, the median sensitivity and specificity for predicting BRAFV600E mutation were 67% and 95%, respectively. With a cut-off score of ≥1, median sensitivity and specificity were 100% and 82%, respectively. Morphologic mimics of ECs, including tumor cells with tufting or hobnail change and detached cell clusters in micropapillary SBTs, were possible contributing factors for discordant interobserver interpretations. BRAFV600E immunohistochemistry showed diffuse staining in BRAF -mutated tumors, including those with few ECs. In conclusion, the finding of extensive ECs in SBT is highly specific for BRAFV600E mutation. However, in some BRAF -mutated SBTs, ECs may be focal and/or difficult to distinguish from other tumor cells with overlapping cytologic features. The morphologic finding of definitive ECs, even when scarce, should therefore prompt consideration for BRAFV 600E mutation testing.
    MeSH term(s) Female ; Humans ; Proto-Oncogene Proteins B-raf/genetics ; Reproducibility of Results ; Mutation ; Cystadenocarcinoma, Serous/diagnosis ; Cystadenocarcinoma, Serous/genetics ; Cystadenocarcinoma, Serous/pathology ; Cystadenoma, Serous/genetics ; Ovarian Neoplasms/diagnosis ; Ovarian Neoplasms/genetics ; Ovarian Neoplasms/pathology ; Precancerous Conditions
    Chemical Substances Proto-Oncogene Proteins B-raf (EC 2.7.11.1) ; BRAF protein, human (EC 2.7.11.1)
    Language English
    Publishing date 2023-01-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604859-6
    ISSN 1538-7151 ; 0277-1691
    ISSN (online) 1538-7151
    ISSN 0277-1691
    DOI 10.1097/PGP.0000000000000933
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: A pragmatic approach to carcinomas concurrently involving the endometrium and ovary.

    Murali, Rajmohan / Soslow, Robert A

    Gynecologic oncology reports

    2018  Volume 27, Page(s) 74

    Language English
    Publishing date 2018-12-30
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2818505-5
    ISSN 2352-5789
    ISSN 2352-5789
    DOI 10.1016/j.gore.2018.12.010
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  6. Article ; Online: Evaluation of Women With a Positive Urine Cytology and no Demonstrable Disease in the Urinary Tract.

    Donat, Sherri M / Sonoda, Yukio / Al-Ahmadie, Hikmat / Murali, Rajmohan / Ng, Dianna L / Funt, Samuel A / Park, Kay J

    Urology

    2023  Volume 173, Page(s) 10–16

    Abstract: Urinary cytology is indispensable both for the evaluation of gross hematuria and surveillance of patients with urothelial neoplasms. A positive urine cytology usually indicates the presence of urothelial carcinoma somewhere in the urinary tract. However, ...

    Abstract Urinary cytology is indispensable both for the evaluation of gross hematuria and surveillance of patients with urothelial neoplasms. A positive urine cytology usually indicates the presence of urothelial carcinoma somewhere in the urinary tract. However, in women, it may also signal urothelial carcinoma involvement of the lower gynecologic tract or be the presenting sign for a primary cancer of the lower gynecologic tract or rectum. Guidelines for the evaluation of women with a positive cytology and normal urinary tract are lacking. We present a review of the current literature with case scenarios to bring clinicians attention to this diagnostic dilemma.
    MeSH term(s) Humans ; Female ; Carcinoma, Transitional Cell/diagnosis ; Carcinoma, Transitional Cell/pathology ; Urinary Bladder Neoplasms/pathology ; Cytology ; Urinary Tract/pathology ; Urologic Neoplasms/diagnosis ; Urine
    Language English
    Publishing date 2023-01-06
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, N.I.H., Extramural
    ZDB-ID 192062-5
    ISSN 1527-9995 ; 0090-4295
    ISSN (online) 1527-9995
    ISSN 0090-4295
    DOI 10.1016/j.urology.2022.12.032
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: A guided tour of selected issues pertaining to metastatic carcinomas involving or originating from the gynecologic tract.

    Soslow, Robert A / Murali, Rajmohan

    Seminars in diagnostic pathology

    2017  Volume 35, Issue 2, Page(s) 95–107

    MeSH term(s) Carcinoma/pathology ; Female ; Genital Neoplasms, Female/pathology ; Humans ; Neoplasm Metastasis/pathology
    Language English
    Publishing date 2017-11-20
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 605834-6
    ISSN 1930-1111 ; 0740-2570
    ISSN (online) 1930-1111
    ISSN 0740-2570
    DOI 10.1053/j.semdp.2017.11.007
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Cytologic features of undifferentiated and dedifferentiated carcinomas of the endometrium.

    Akbari, Amir-Hossein / Wang, Lu / Soslow, Robert A / Murali, Rajmohan

    Cancer cytopathology

    2020  Volume 129, Issue 2, Page(s) 121–131

    Abstract: Background: Undifferentiated carcinoma (UC) is a rare, aggressive subtype of endometrial carcinoma. Dedifferentiated carcinomas (DCs) are UCs associated with a component of well differentiated endometrioid carcinoma. The authors sought to describe the ... ...

    Abstract Background: Undifferentiated carcinoma (UC) is a rare, aggressive subtype of endometrial carcinoma. Dedifferentiated carcinomas (DCs) are UCs associated with a component of well differentiated endometrioid carcinoma. The authors sought to describe the morphologic features of UCs and DCs in cytologic specimens.
    Methods: Cytologic specimens from 23 women (aged 46-86 years; median age, 59 years) were reviewed, including cervicovaginal specimens (n = 7), peritoneal washings (n = 5), touch preparations of core biopsies from various sites (n = 5), fine-needle biopsies of lymph nodes (n = 3), ascitic fluid (n = 1), pleural fluid (n = 1), and intrauterine fluid (n = 1).
    Results: There were 10 UCs (43%) and 13 DCs (57%). Tumor cells were arranged as single cells (9 UCs, 90%; 12 DCs, 92%) and 3-dimensional groups (8 UCs, 80%; 11 DCs, 85%). Most cases showed high nuclear-to-cytoplasmic ratios. Nuclear molding was observed in 3 UCs (30%) and in 5 DCs (38%). Nuclear chromatin was often coarsely granular 6 UCs, 60%; 9 DCs, 69%). Nucleoli were inconspicuous in some cases (6 UCs, 60%; 8 DCs, 62%) but were appreciable in others. Necrosis was observed in 5 UCs (50%) and in 5 DCs (38%). Most cases exhibited clean backgrounds, and a few showed acute inflammation. Comparison of the cytologic features of UCs and DCs did not reveal any statistically significant differences.
    Conclusions: UCs and DCs have a spectrum of cytomorphologic appearances that are not pathognomonic, but the presence of some of these (relatively uniform population of predominantly singly dispersed cells with high nuclear-to-cytoplasmic ratios and variably conspicuous nucleoli) should prompt consideration of UC and DC in the differential diagnosis.
    MeSH term(s) Aged ; Aged, 80 and over ; Biopsy, Fine-Needle ; Carcinoma/pathology ; Cell Differentiation ; Diagnosis, Differential ; Endometrial Neoplasms/pathology ; Female ; Humans ; Middle Aged
    Language English
    Publishing date 2020-09-16
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2594979-2
    ISSN 1934-6638 ; 1934-662X
    ISSN (online) 1934-6638
    ISSN 1934-662X
    DOI 10.1002/cncy.22351
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: The roles of pathology in targeted therapy of women with gynecologic cancers.

    Murali, Rajmohan / Grisham, Rachel N / Soslow, Robert A

    Gynecologic oncology

    2017  Volume 148, Issue 1, Page(s) 213–221

    Abstract: The role of the pathologist in the multidisciplinary management of women with gynecologic cancer has evolved substantially over the past decade. Pathologists' evaluation of parameters such as pathologic stage, histologic subtype, grade and microsatellite ...

    Abstract The role of the pathologist in the multidisciplinary management of women with gynecologic cancer has evolved substantially over the past decade. Pathologists' evaluation of parameters such as pathologic stage, histologic subtype, grade and microsatellite instability, and their identification of patients at risk for Lynch syndrome have become essential components of diagnosis, prognostic assessment and determination of optimal treatment of affected women. Despite the use of multimodality treatment and combination cytotoxic chemotherapy, the prognosis of women with advanced-stage gynecologic cancer is often poor. Therefore, expanding the arsenal of available systemic therapies with targeted therapeutic agents is appealing. Anti-angiogenic therapies, immunotherapy and poly ADP ribose polymerase (PARP) inhibitors are now routinely used for the treatment of advanced gynecologic cancer, and many more are under investigation. Pathologists remain important in the clinical management of patients with targeted therapy, by identifying potentially targetable tumors on the basis of their pathologic phenotype, by assessing biomarkers that are predictive of response to targeted therapy (e.g. microsatellite instability, PD1/PDL1 expression), and by monitoring treatment response and resistance. Pathologists are also vital to research efforts exploring novel targeted therapies by identifying homogenous subsets of tumors for more reliable and meaningful analyses, and by confirming expression in tumor tissues of novel targets identified in genomic, epigenetic or other screening studies. In the era of precision gynecologic oncology, the roles of pathologists in the discovery, development and implementation of targeted therapeutic strategies remain as central as they are for traditional (surgery-chemotherapy-radiotherapy) management of women with gynecologic cancers.
    MeSH term(s) Female ; Genital Neoplasms, Female/pathology ; Genital Neoplasms, Female/therapy ; Humans ; Molecular Targeted Therapy ; Precision Medicine
    Language English
    Publishing date 2017-11-23
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 801461-9
    ISSN 1095-6859 ; 0090-8258
    ISSN (online) 1095-6859
    ISSN 0090-8258
    DOI 10.1016/j.ygyno.2017.11.020
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  10. Article ; Online: Landscape of chromatin remodeling gene alterations in endometrial carcinoma.

    Momeni-Boroujeni, Amir / Vanderbilt, Chad / Yousefi, Elham / Abu-Rustum, Nadeem R / Aghajanian, Carol / Soslow, Robert A / Ellenson, Lora H / Weigelt, Britta / Murali, Rajmohan

    Gynecologic oncology

    2023  Volume 172, Page(s) 54–64

    Abstract: Objective: Chromatin remodeling genes (CRGs) encode components of epigenetic regulatory mechanisms and alterations in these genes have been identified in several tumor types, including gynecologic cancers. In this study, we sought to investigate the ... ...

    Abstract Objective: Chromatin remodeling genes (CRGs) encode components of epigenetic regulatory mechanisms and alterations in these genes have been identified in several tumor types, including gynecologic cancers. In this study, we sought to investigate the prevalence and clinicopathological associations of CRG alterations in endometrial carcinoma (EC).
    Methods: We performed a retrospective analysis of 660 ECs sequenced using a clinical massively parallel sequencing assay targeting up to 468 genes, including 25 CRGs, and defined the presence of somatic CRG alterations. Clinicopathologic features were obtained for all cases. Immunohistochemical interrogation of ARID1A and PTEN proteins was performed in a subset of samples.
    Results: Of the 660 ECs sequenced, 438 (66.4%) harbored CRG alterations covered by our panel. The most commonly altered CRG was ARID1A (46%), followed by CTCF (21%), KMT2D (18%), KMT2B (17%), BCOR (16%), ARID1B (12%) and SMARCA4 (11%). We found that ARID1A genetic alterations were preferentially bi-allelic and often corresponded to altered ARID1A protein expression in ECs. We further observed that ARID1A alterations were often subclonal when compared to PTEN alterations, which were primarily clonal in ECs harboring both mutations. Finally, CRG alterations were associated with an increased likelihood of myometrial and lymphovascular invasion in endometrioid ECs.
    Conclusion: CRG alterations are common in EC and are associated with clinicopathologic features and likely play a crucial role in EC.
    MeSH term(s) Humans ; Female ; Chromatin ; Retrospective Studies ; Chromatin Assembly and Disassembly/genetics ; Endometrial Neoplasms/pathology ; Mutation ; DNA Helicases/genetics ; Nuclear Proteins/genetics ; Nuclear Proteins/metabolism ; Transcription Factors/genetics ; Transcription Factors/metabolism
    Chemical Substances Chromatin ; SMARCA4 protein, human (EC 3.6.1.-) ; DNA Helicases (EC 3.6.4.-) ; Nuclear Proteins ; Transcription Factors
    Language English
    Publishing date 2023-03-21
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 801461-9
    ISSN 1095-6859 ; 0090-8258
    ISSN (online) 1095-6859
    ISSN 0090-8258
    DOI 10.1016/j.ygyno.2023.03.010
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