Cytology: Diagnostic Principles and Clinical Correlates

Cytology
Copyright
Dedication
Contributors
Preface
Acknowledgments
1 - Cervical and Vaginal Cytology
	The History of the Pap Test and Its Current Practice
		Screening Guidelines
		Guidelines for Managing Women with Abnormal Pap Results
		HPV Vaccination
	Sampling and Preparation Methods
		Smears
		Liquid-Based Cytologic Study
			ThinPrep Pap Test
			SurePath Pap Test
	Automated Screening
		Historical Overview
		ThinPrep Imaging System
			BD FocalPoint Slide Profiler and Guided Screening Imaging System
	Accuracy and Reproducibility
	Diagnostic Terminology and Reporting Systems
	The Bethesda System
		Specimen Adequacy
		General Categorization
		Interpretation and Results
	The Normal Pap
		Squamous Cells
		Endocervical Cells
		Exfoliated Endometrial Cells
		Abraded Endometrial Cells and Lower Uterine Segment
		Trophoblastic Cells and Decidual Cells
		Inflammatory Cells
		Lactobacilli
		Artifacts and Contaminants
	Organisms and Infections
		Shift in Flora Suggestive of Bacterial Vaginosis
		Trichomonas Vaginalis
		Candida
		Actinomyces
		Herpes Simplex Virus
		Cytomegalovirus
		Chlamydia Trachomatis
		Rare Infections
	Benign and Reactive Changes
		Benign Squamous Changes
		Benign Endocervical Changes
		Repair
		Radiation Changes
		Cellular Changes Associated with Intrauterine Devices
		Glandular Cells Status Post Hysterectomy
		Other Benign Changes
	Vaginal Specimens in “Des Daughters”
	Squamous Abnormalities
		Squamous Intraepithelial Lesions
			Grading Squamous Intraepithelial Lesions
			Low-Grade Squamous Intraepithelial Lesion
				Management
			High-Grade Squamous Intraepithelial Lesion
				Management
			Problems in the Diagnosis of Squamous Intraepithelial Lesions
				Avoiding Overdiagnosis of LSIL
				Distinguishing LSIL from HSIL
				Distinguishing HSIL from Invasive Carcinoma
		Squamous Cell Carcinoma
		Atypical Squamous Cells
			Atypical Squamous Cells of Undetermined Significance
				Management
			Atypical Squamous Cells, Cannot Exclude Hsil
				Management
	Glandular Abnormalities
		Endocervical Adenocarcinoma in Situ
		Adenocarcinoma
			Endocervical Adenocarcinoma
			Endometrial Adenocarcinoma
			Differential Diagnosis of Adenocarcinoma
		Atypical Glandular Cells
		Atypical Endocervical Cells
		Atypical Endometrial Cells
	Other Malignant Neoplasms
		Small Cell Neuroendocrine Carcinoma
		Malignant Melanoma
		Malignant Lymphoma
		Carcinosarcoma
		Metastatic Tumors
	Endometrial Cells in Women ≥45 Years of Age
	References
2 - Respiratory Tract and Mediastinum
	Normal Anatomy, Histology, and Cytology of the Respiratory Tract
	Sampling Techniques, Preparation Methods, Reporting Terminology, and Accuracy
		Sputum
		Bronchial Specimens
			Bronchial aspirations and washings
			Bronchial brushings
			Bronchoalveolar lavage
		Transbronchial FNA (“Wang Needle”)
		Endobronchial Ultrasound-Guided (EBUS) FNA
		Transesophageal FNA
		Percutaneous FNA
	Benign Cellular Changes
		Reactive Squamous Cell Changes
		Reactive Bronchial Cell Changes
		Bronchial Reserve Cell Hyperplasia
		Repair
		Type II Pneumocyte Hyperplasia
	Noncellular Elements and Specimen Contaminants
	Infections
		Viral Infections
			Herpes Simplex
			Cytomegalovirus
			Measles Virus and Respiratory Syncytial Virus
			Adenovirus
		Bacterial Pneumonias
		Tuberculosis
		Pulmonary Fungal Infections
			Cryptococcosis
			Histoplasmosis
			Blastomycosis
			Coccidioidomycosis
			Paracoccidioidomycosis
			Sporotrichosis
			Invasive Fungi
				Aspergillosis
				Zygomycosis
				Candidiasis
			Pneumocystis Jirovecii
		Parasitic Infections
			Strongyloidiasis
			Dirofilariasis
			Echinococcosis (Hydatid Disease)
	Nonneoplastic, Noninfectious Pulmonary Diseases
		Sarcoidosis
		Granulomatosis with Polyangiitis
		Pulmonary Amyloidosis
		Pulmonary Alveolar Proteinosis
		Common Inflammatory Processes, Including Organizing Pneumonia
	Benign Neoplasms of the Lung
		Pulmonary Hamartoma
		Langerhans Cell Histiocytosis
		Sclerosing Pneumocytoma
		Papillomas and Related Lesions
		Inflammatory Myofibroblastic Tumor
		Endobronchial Granular Cell Tumor
	Precursor Lesions of the Respiratory Epithelium
	Lung Cancer
		Molecular Testing of Lung Cancers
			EGFR
			MET
			ERBB-2 (HER2)
			ALK
			ROS1
			RET
			BRAF
			PIK3CA
			KRAS
			PD-L1
		Squamous Cell Carcinoma
		Adenocarcinoma
		Large Cell Carcinoma
		Sarcomatoid Carcinoma
		Neuroendocrine Tumors
			Typical Carcinoid Tumor
			Atypical Carcinoid Tumor
			Large Cell Neuroendocrine Carcinoma
			Small Cell Carcinoma
	Uncommon Pulmonary Tumors
		Lymphoepithelioma-Like Carcinoma
		Adenoid Cystic Carcinoma and Other Bronchial Gland Tumors
		PEComa (“Clear Cell Tumor,” “Sugar Tumor”)
		Sarcomas
		Lymphomas and Leukemias
	Metastatic Cancers to the Lung
	Tumors of the Mediastinum
		Thymoma
		Thymic Carcinoma
		Mediastinal Lymphomas
		Germ Cell Tumors
		NUT Carcinoma
		References
3 - Urine and Bladder Washings
	Indications
	Specimen Collection
		Voided Urine
		Catheterized Urine
		Bladder Washings
		Upper Tract Washings and Brushings
		Ileal Conduits
	Sample Processing
	Adequacy Criteria
	Reporting Terminology
		Accuracy
	Normal Elements
	Benign Lesions
		Infections
		Noninfectious Findings and Conditions
			Crystals
			Casts
			Nonspecific reactive urothelial cell changes
			Effects of radiation and chemotherapy
			Urothelial atypia associated with urinary calculi
	Other Benign Lesions
		Nephrogenic adenoma
		Müllerianosis
	Urothelial Neoplasms
		High-Grade Urothelial Carcinoma and Carcinoma in Situ
		Atypical Urothelial Cells
	Other Malignant Lesions
		Other Primary Cancers of the Urinary Tract
			Squamous cell carcinoma
			Adenocarcinoma
			Clear cell carcinoma
			Small cell carcinoma
			Melanoma
			Paraganglioma
			Sarcoma
		Metastatic Cancers
			Renal cell carcinoma
			Prostatic carcinoma
			Colonic carcinoma
			Other metastatic tumors
	Ancillary Techniques
	Summary
	References
4 - Pleural, Pericardial, and Peritoneal Fluids
	Specimen Collection, Preparation, and Reporting Terminology
	Accuracy
	Benign Elements
	Nonneoplastic Conditions
		Acute Serositis
		Eosinophilic Effusions
		Lymphocytic Effusions
		Rheumatoid Pleuritis
		Lupus Pleuritis
		Other Nonneoplastic Conditions
	Malignant Effusions
		Primary Tumors
			Diffuse Malignant Mesothelioma
				Mesothelioma versus Reactive Mesothelial Cells
				Mesothelioma versus Adenocarcinoma
				Mesothelioma versus Squamous Cell Carcinoma
				Mesothelioma versus Vascular Tumors
			Primary Effusion Lymphoma
		Metastatic Tumors
			Adenocarcinoma
				Immunohistochemistry for ER, PR, and HER2
				Molecular Testing of Effusions with Metastatic Lung Cancer
			Squamous Cell Carcinoma
			Small Cell Carcinoma
			Melanoma
			Non-Hodgkin Lymphoma
			Hodgkin Lymphoma
			Multiple Myeloma
			Acute and Chronic Leukemias
			Myeloproliferative Neoplasms
			Sarcomas
			Germ Cell Tumors
			References
5 - Peritoneal Washings
	Specimen Collection, Preparation, and Reporting Terminology
	Accuracy
	The Normal Peritoneal Washing
	Benign Conditions
		Endosalpingiosis and Similar Benign Proliferations
		Endometriosis
	Malignant Tumors
		Ovarian and Fallopian Tube Cancers
		Endometrial Cancer
		Cervical Cancer
		Pancreatic and Gastrointestinal Malignancies
			Pancreatic Cancer
			Gastric Cancer
			Colorectal Cancer
	Monitoring Response to Treatment (“Second-Look Procedures”)
	References
6 - Cerebrospinal Fluid
	Anatomy and Physiology
	Obtaining and Preparing the Specimen
	Reporting Terminology
	Accuracy
	Normal Elements
	Abnormal Inflammatory Cells
	Nonneoplastic Disorders
		Acute Bacterial Meningitis
		Aseptic Meningitis
		Cryptococcal Meningitis
		Toxoplasmosis
		Cysticercosis
		Angiostrongyliasis
		Primary Amebic Meningoencephalitis
	Neoplasms
		Metastatic Solid Tumors
			Carcinoma of the lung
			Carcinoma of the breast
			Melanoma
		Leukemia
			Acute lymphoblastic leukemia
			Acute myeloid leukemia
			Chronic lymphocytic leukemia
		Myeloproliferative Neoplasms
		Malignant Lymphoma
		Primary CNS Tumors
			Primary central nervous system lymphoma
			Medulloblastoma
				Anchor 513
			Astrocytomas and oligodendroglial tumors
			Ependymoma
			Atypical teratoid/rhabdoid tumor
			Choroid plexus tumors
			Pineal tumors
			Germ cell tumors
			Other tumors of the central nervous system
			References
7 - Gastrointestinal Tract
	Clinical Indications
		Sampling a Wider Area and Reaching Deep Organs
		Better Recognition of Lymphoid Cells
		Less Invasive
		Shorter Turnaround Time
	Sample Collection and Processing
		Sample Collection
		Processing the Sample
	Accuracy
	Review of Morphologic Findings
	Esophagus
		Infections
		Epithelial Repair and Reactive Changes
		Barrett’s Esophagus
		Dysplasia in Barrett’s Esophagus
		Adenocarcinoma
		Squamous cell carcinoma
		Uncommon Tumors of the Esophagus
	Stomach
		Infections
		Epithelial Repair
		Dysplasia and Gastric Adenomas
		Adenocarcinoma
		Neuroendocrine Neoplasms
		Non-Hodgkin Lymphoma
		Gastrointestinal Stromal Tumor
	Duodenum
		Infections
		Adenoma and Adenocarcinoma
	Colon
	The Anal Pap Test
	References
8 - Fine Needle Aspiration Biopsy Technique and Specimen Handling
	Introduction
	Materials and Supplies
	Procedure for Performing FNA of a Palpable Mass
		Determining Whether FNA Is Warranted
		Obtaining Patient Consent
		Sample Explanation of the Procedure
		Readying the Equipment
		Positioning the Patient and Immobilizing the Lesion
		Sampling the Lesion
		“Feeling With the Needle”
	Preparing the Sample
		Making Smears
			The “one-smear” method (Fig. 8.2A–D)
			The “two-smear” method (Fig. 8.3A–C)
		Splitting Material for Multiple Smears
			Method 1 (Fig. 8.4A–F)
			Method 2
		Fixing the Smears
		Handling Cystic Masses
		Retrieving Material from the Needle Hub
		Rinsing the Needle and Reserving Material for Ancillary Studies
		Making a Cell Block from a Smear
	Postprocedure Information for the Patient
	Variations on Biopsy Technique
	Ultrasound-Guided Techniques
		Perpendicular Technique
		Parallel Technique
	Complications
	Management of Adverse and Unexpected Events
	Acknowledgments
	References
9 - Breast
	Specimen Types
		Fine-Needle Aspiration
		Nipple Discharge
	Sample Preparation
	Reporting Terminology
	Evaluation of the Specimen
	The Normal Breast
	Benign Conditions
		Cysts
		Fibrocystic Changes
			Nonproliferative Fibrocystic Changes
			Proliferative Fibrocystic Changes
		Fibroadenoma
		Pregnancy and Lactational Changes
		Fat Necrosis
		Radiation Change
		Mastitis
		Subareolar Abscess
		Gynecomastia
	Papillary Neoplasms
	Phyllodes Tumor
	Breast Cancer
		Invasive Ductal Carcinoma
		Invasive Lobular Carcinoma
		Medullary Carcinoma
		Mucinous (Colloid) Carcinoma
		Tubular Carcinoma
		Metaplastic Carcinoma
	Uncommon Breast Tumors
		Microglandular Adenosis
		Apocrine Carcinoma
		Adenoid Cystic Carcinoma
		Non-Hodgkin Lymphoma
		Peri-implant Seroma and Anaplastic Large Cell Lymphoma
		Sarcoma
	Metastatic Tumors
	References
10 - Thyroid
	Aspiration Technique and Slide Preparation
	Terminology for Reporting Results
		Nondiagnostic (ND) or Unsatisfactory
			Benign
			The “Indeterminate” Categories
			Malignant
	Accuracy
	Molecular Testing
	Evaluation of the Specimen
	Benign Conditions
		Benign Follicular Nodules
		Chronic Lymphocytic (Hashimoto) Thyroiditis
		Subacute (de Quervain) Thyroiditis
		Riedel Disease
		Amyloid Goiter
		Black Thyroid
		Radiation Changes
	Suspicious for a Follicular Neoplasm or Follicular Neoplasm
	Suspicious for a Follicular Neoplasm, Hürthle Cell Type
	Malignant
		Papillary Thyroid Carcinoma
			Management
		Poorly Differentiated Thyroid Carcinoma
		Anaplastic Thyroid Carcinoma
		Squamous Cell Carcinoma
		Medullary Thyroid Carcinoma
			Management
		Primary Thyroid Lymphoma
		Rare Primary Thyroid Tumors
		Metastatic Tumors
	Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance
	Parathyroid Tumors
	References
11 - Salivary Gland
	Rationale, Indications, and Technical Considerations
	Classification
	Diagnostic Overview
	The Normal Aspirate
	Nonneoplastic Conditions
		Acute and Chronic Sialadenitis
		Granulomatous Sialadenitis
		Sialadenosis
		Lymphoepithelial Sialadenitis
		Non-neoplastic Cysts
			Squamous-Lined Cysts
			Mucin-Containing Cysts
		Amyloidosis
	Benign Neoplasms
		Pleomorphic Adenoma
			Pitfalls Associated with Pleomorphic Adenomas
				Sparse or Absent Matrix
				Adenoid Cystic-Like Matrix
				Cytologic Atypia
				Metaplastic Changes
		Myoepithelioma
		Basal Cell Adenoma
		Warthin tumor
		Oncocytoma
	Carcinomas of Salivary Gland Origin
		Mucoepidermoid Carcinoma
		Acinic Cell Carcinoma
		Adenoid Cystic Carcinoma
		Carcinoma Ex Pleomorphic Adenoma
		Salivary Duct Carcinoma
		Secretory Carcinoma
		Polymorphous Adenocarcinoma
	Rare Malignant Neoplasms
		Basal Cell Adenocarcinoma
		Epithelial-Myoepithelial Carcinoma
		Clear Cell Carcinoma
		Primary Small Cell Carcinoma
		Lymphoepithelial Carcinoma
		Adenocarcinoma, Not Otherwise Specified
	Other Malignancies
		Squamous Cell Carcinoma
		Lymphoma Involving the Salivary Gland
	Miscellaneous
		Summary of Salivary Gland FNA
		References
12 - Lymph Nodes
	Technical Aspects
	Reporting Terminology and Accuracy
	Ancillary Studies
		Flow Cytometry
		Immunocytochemistry
		Molecular Genetic Studies
	Nonneoplastic Lesions
		Reactive Hyperplasia (Without Specific Etiology)
		Benign Lymphadenopathies with Specific Etiology but without Characteristic Fine-Needle Aspiration Findings
		Inflammatory/Infectious Conditions with Characteristic Fine-Needle Aspiration Findings
			Sarcoidosis
			Bacterial and Fungal Lymphadenitis
			Cat Scratch Disease
			Mycobacterial Lymphadenitis
			Rosai–Dorfman Disease (Sinus Histiocytosis with Massive Lymphadenopathy)
			Kikuchi Lymphadenitis
			Infectious Mononucleosis
			HIV-Associated Lymphadenopathy
			Dermatopathic Lymphadenitis
			Silicone Lymphadenitis
	Neoplasms
		Hodgkin Lymphoma
		Non-Hodgkin Lymphoma
			Lymphomas of Small Cells
				Follicular Lymphoma
				Marginal Zone Lymphoma
				Small Lymphocytic Lymphoma
				Mantle Cell Lymphoma
				Differential Diagnosis: Small Cell Lymphomas
			Lymphomas of Large Cells
				Diffuse Large B-cell Lymphoma
				Variants of Diffuse Large B-Cell Lymphoma
				High-Grade B-Cell Lymphoma
				Burkitt Lymphoma
				Plasmablastic Lymphoma
				T-Cell Lymphomas
					. Peripheral T-cell lymphoma of unspecified type (PTCL, NOS) is much more common in Asia than Europe or North America. In the Un...
					. Anaplastic large cell lymphoma (ALCL) is a subtype of non-Hodgkin lymphoma that was recognized after the discovery of the CD30...
					. AITL is a typically an advanced stage lymphoma of T cells with a T follicular helper immunophenotype (e.g., expressing PD1, CD...
					. Mycosis fungoides is a primary cutaneous T-cell lymphoma, but in advanced stages lymph nodes and viscera may be involved. Such...
					. Adult T-cell leukemia/lymphoma is a disease of adult patients in endemic regions (including the Caribbean islands in the Weste...
					. Lymphoblastic lymphoma is an aggressive lymphoma that comprises almost one-half of childhood non-Hodgkin lymphoma, is more com...
				Posttransplant Lymphoproliferative Disorders
				Differential Diagnosis: Large Cell Lymphomas
		Nonlymphoid Neoplasms
			Carcinomas
			Malignant Melanoma
			Seminoma/Germinoma
			Sarcomas
			References
13 - Liver
	Normal Liver
	Infections
		Hepatic Abscess
		Echinococcal Cyst (Hydatid Cyst)
		Other Infections
	Benign Lesions
		Solitary Cysts
		Cirrhosis
		Focal Nodular Hyperplasia
		Hepatic Adenoma
		Bile Duct Hamartoma and Adenoma
		Hemangioma
		Angiomyolipoma
	Malignant Tumors
		Hepatocellular Carcinoma
		Cholangiocarcinoma
		Hepatoblastoma
		Angiosarcoma
		Epithelioid Hemangioendothelioma
		Metastatic Tumors
		References
14 - Pancreas and Biliary Tree
	Indications
	Sampling Techniques
	Complications
	Rapid On-Site Evaluation
	Sample Preparation and Cyst Fluid Analysis
	Accuracy and Limitations
	Reporting Terminology
	Normal Pancreas and Bile Duct
	Pancreatitis and Reactive Changes
	Pancreatic Intraepithelial Neoplasia
	Ductal Adenocarcinoma
	Variants of Ductal Adenocarcinoma
	Neuroendocrine Neoplasms
	Acinar Cell Carcinoma
	Solid-Pseudopapillary Neoplasm
	Pancreatoblastoma
	Pancreatic Cysts
		Pseudocyst
		Serous Cystadenoma
		Lymphoepithelial Cyst
		Mucinous Cysts: Mucinous Cystic Neoplasm and Intraductal Papillary Mucinous Neoplasm
	Secondary Pancreatic Neoplasms and Ectopic Splenic Tissue
	References
15 - Kidney and Adrenal Gland
	The Kidney
		Indications and Sampling Methods
	Specimen Collection and Preparation
	Accuracy
	Adequacy
	Normal Elements
		Glomeruli and Tubular Cells
	Benign Lesions
		Oncocytoma
		Papillary Adenoma
		Angiomyolipoma
		Metanephric Adenoma
		Mixed Epithelial and Stromal Tumor
		Renal Abscess
		Tuberculosis
		Xanthogranulomatous Pyelonephritis
		Renal Infarct
		Renal Cysts
		Other Benign Lesions
	Renal Cell Carcinoma
		Clear Cell Renal Cell Carcinoma
		Papillary Renal Cell Carcinoma
		Oncocytic Papillary Renal Cell Carcinoma
		Chromophobe Renal Cell Carcinoma
		Clear Cell Papillary Renal Cell Carcinoma
		Tubulocystic Renal Cell Carcinoma
		Renal Medullary Carcinoma
		Collecting Duct Carcinoma (Bellini Tumor)
		MiT Family Translocation Renal Cell Carcinoma
		Mucinous Tubular and Spindle Cell Carcinoma
	Urothelial Carcinoma
	Lymphoma
	Metastatic Tumors
	Pediatric Tumors
	Rare Entities
	The Adrenal Gland
	Specimen Collection, Preparation, and Accuracy
	Myelolipoma
	Adrenal Cortical Neoplasms
	Pheochromocytoma
	Metastatic Tumors
	References
16 - Ovary
	Obtaining the Specimen
	Preparing the Specimen and Reporting Results
	Accuracy
	Benign Tumor-Like Lesions of the Ovary
		Nonneoplastic Cysts
			Cystic Follicle and Follicle Cyst
			Corpus Luteum Cyst
			Endometriotic Cyst
			Simple Ovarian, Paraovarian, and Paratubal Cysts
		Hydrosalpinx
		Tuboovarian Abscess
	Benign Surface Epithelial–Stromal Tumors
		Benign Serous Tumors
		Benign Mucinous Tumors
		Benign Brenner Tumor
	Malignant Surface Epithelial-Stromal Tumors
		Serous Borderline Tumor and Serous Carcinoma
		Mucinous Borderline Tumor and Mucinous Carcinoma
		Endometrioid Carcinoma
		Clear Cell Carcinoma
	Germ Cell Tumors
		Teratoma
			Mature Teratoma
			Immature Teratoma
			Carcinoid Tumor
		Dysgerminoma
		Embryonal Carcinoma and Other Malignant Germ Cell Tumors
	Sex Cord–Stromal Tumors
		Granulosa Cell Tumors
			Adult Granulosa Cell Tumor
			Juvenile Granulosa Cell Tumor
		Thecoma
		Fibroma
	Uncommon Primary Ovarian Tumors
	Metastatic Tumors
	References
17 - Soft Tissue
	Specimen Collection and Preparation
	Ancillary Studies
	Reporting Terminology
	Adipocytic and Lipogenic Neoplasms
		Lipoma
		Hibernoma
		Spindle Cell/Pleomorphic Lipoma
		Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma
		Pleomorphic Liposarcoma
	Myxoid Neoplasms
		Intramuscular Myxoma
		Soft Tissue Perineurioma
		Myxofibrosarcoma
		Low-Grade Fibromyxoid Sarcoma
		Myxoid Liposarcoma
		Lipoblastoma
		Myxofibrosarcoma-Like Dedifferentiated Liposarcoma
		Myxoinflammatory Fibroblastic Sarcoma
		Extraskeletal Myxoid Chondrosarcoma
	Spindle Cell Neoplasms
		Leiomyosarcoma
		Schwannoma
		Malignant Peripheral Nerve Sheath Tumor
		Synovial Sarcoma
		Solitary Fibrous Tumor
		Desmoid (Deep) Fibromatosis
		Nodular Fasciitis
		Dermatofibrosarcoma Protuberans
		Inflammatory Myofibroblastic Tumor
		Adult Fibrosarcoma
	Fibrohistiocytoid Neoplasms
		Tenosynovial Giant Cell Tumor, Localized and Diffuse Types
		Giant Cell Tumor of Soft Tissue
		Angiomatoid Fibrous Histiocytoma
	Round Cell Neoplasms
		Neuroblastoma
		Ewing Sarcoma
		Desmoplastic Small Round Cell Tumor
		Embryonal Rhabdomyosarcoma
		Alveolar Rhabdomyosarcoma
		Undifferentiated Round Cell Sarcomas, including CIC-Rearranged Sarcoma
	Epithelioid Neoplasms
		Epithelioid Sarcoma
		Clear Cell Sarcoma of Soft Tissue
		Alveolar Soft Part Sarcoma
		Epithelioid Hemangioendothelioma
		Pseudomyogenic Hemangioendothelioma
		Epithelioid Angiosarcoma
		Granular Cell Tumor
	Pleomorphic Neoplasms
		Undifferentiated Pleomorphic Sarcoma
		Pleomorphic Rhabdomyosarcoma
	Dedifferentiated Sarcomas
	Nonneoplastic Soft Tissue Lesions
		Idiopathic Retroperitoneal Fibrosis
		Elastofibroma
		Amyloidoma (Tumoral Amyloidosis)
		References
18 - Bone
	Introduction
	Cartilaginous Tumors
		Chondroblastoma
		Chondromyxoid Fibroma
		Enchondroma
		Chondrosarcoma and Chondrosarcoma Variants
	Giant Cell–Rich Tumors
		Giant Cell Tumor of Bone
		Aneurysmal Bone Cyst
	Osteogenic Tumors
		Osteoblastoma
		Conventional Osteosarcoma and Osteosarcoma Variants
		Low-Grade Osteosarsarcoma
	Notochordal Tumors
		Benign Notochodal Cell Tumor
		Chordoma
	Tumors of Other Lineages
		Adamantinoma
		Vascular Tumors
	Hematopoietic and Histiocytic Neoplasms
		Plasmacytoma/Myeloma and Non-Hodgkin Lymphoma
		Langerhans Cell Histiocytosis
	Nonneoplastic Bone Lesions
	Metastasis
	References
19 - Laboratory Management
	Agencies and Organizations
		Centers for Medicare and Medicaid Services
		The Joint Commission
		College of American Pathologists
		Commission on Accreditation of Allied Health Education Programs
		Occupational Safety and Health Administration
		National Fire Protection Association
	Regulations
		Clinical Laboratory Improvement Amendments of 1988
		Health Insurance Portability and Accountability Act of 1996 (HIPAA)
	Laboratory Personnel
		Laboratory Director
		Technical Supervisor
		General Supervisor
		Cytotechnologist
	Policy and Procedure Manuals
	Workflow
	Billing
		Procedure Codes
			. This is the most widely used in pathology. It denotes that only the physician professional component of the service is being b...
				. This modifier denotes a reduced service from the customary procedure. In cytology, a good example is the manual review of a sl...
					. Modifier 59 denotes a “separate procedure,” such as a different specimen (e.g., washing vs brushing) or anatomic site. Payers ...
					. Teaching physicians must append modifier GC to CPT and HCPCS codes on Medicare claims when a resident or fellow actively parti...
					. These modifiers are applied to Pap test HCPCS codes when billing Medicare. They clarify the laboratory’s right (or lack thereo...
					. This modifier denotes the facility technical component of the service being billed, and thus is the counterpart of the CPT 26 ...
		International Classification of Diseases (ICD)-10-CM Codes
		Coding Pap Tests
			The Screening (Routine) Pap Test
			The Screening (High-Risk) Pap Test
			The Diagnostic Pap Test
		Coding Nongynecologic, Non-Fine-Needle Aspiration Cases
		Coding Fine-Needle Aspirates
		Coding Consultation Cases
	Quality Control and Quality Assurance
		Prospective 10% Rescreen
		Retrospective Rescreen (“5-Year Lookback”)
		Cytologic-Histologic Correlation
		Annual Statistics
		Workload Records
	Competency Assessment
	Proficiency Testing
		General Description of Cytology PT
		Scoring
		Results
	Performance Evaluation
		Measures of Cytotechnologist Performance
			Screening Skills
				. Inevitably, when enough cases interpreted as negative by one CT are rescreened by another, abnormal cells are identified in so...
					. The abnormal rate is the percentage of abnormal cases (ASC, AGC, SIL, and carcinoma) diagnosed by a CT divided by the total nu...
			Interpretive Skills
				. CLIA 88 requires that the performance of a CT be based, in part, on an evaluation of the cases submitted to the pathologist fo...
					. The unsatisfactory rate is the proportion of all Pap test results that are interpreted as unsatisfactory by a CT. A low unsati...
		Measures of Cytopathologist Performance
			Atypical Squamous Cells-to-Squamous Intraepithelial Lesion Ratio
			High-Risk Human Papillomavirus Positivity Rates for Atypical Squamous Cells of Undetermined Significance
			Cytology/Biopsy Correlation
	Safety
		OSHA Bloodborne Pathogens Standard
			Exposure Control
			Hepatitis B Vaccination
			Communication of Hazards to Employees
			Recordkeeping
		OSHA Laboratory Standard
		National Fire Protection Association Standard for Health Care Facilities
		NFPA Standard on Fire Protection for Laboratories Using Chemicals
		References
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