Abstracts S27

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Lower Endoscopic Ultrasound-Guided Fine-Needle Aspiration:A Useful Diagnostic Tool for Perirectal and Intraluminal Lesions:A Large Series in a Single Tertiary Referral Hospital

Roula Albadine, MD, Geneviève Soucy Soucy, MD,Anand Sahai, MD, MSc(EPID), FRCPC, Gilles Gariépy, Bich Nguyen, MD,Sarto Paquin, MD, FRCPC. University of Montreal Center, Montreal,Canada

Introduction: Lower Endoscopic Ultrasound-Guided Fine-Needle Aspira-tion (LEUS-FNA) of perirectal lesions is a safe, minimally invasive, andwell tolerated procedure that provides valuable information which affectspatient management. Herein, we presented our experience of LEUS -FNAto evaluate perirectal lesions.Materials and Methods: LEUS-FNAs were retrieved from the cytopathol-ogy archives of our University Hospital, from 2001- February, 2014. Thecytopathology reports, corresponding histology, immunohistochemistrywhen available, and clinical data were collected. The sensitivity andspecificity of EUS-FNA were calculated in a subset of patients withavailable surgical pathology.Results: 114 specimens were retrieved. Masses measured 5e100 mm(mean: 27.5 mm) in diameter. Recurrent cancer was clinically suspected in46% of cases (nZ53). For 37 cases histopatholgic material was available.The aspirated material showed malignant (n Z 48), benign (n Z 41),atypical/suspicious (nZ6) and nondiagnostic cytology (nZ 19). Malignantcases were adenocarcinoma (24), neuroendocrine tumor (3), squamous cellcarcinoma (5), urothelial carcinoma (2), positive for malignant cells (12),gastrointestinal stromal tumor (1) and non Hodgkin lymphoma (1). Theprimary site of the tumors included colorectal, anal, urinary bladder,prostate, pancreas, ovary, and female lower genital tract. The benigncytology cases were negative for malignant cells (32), schwannoma (1), and8 non neoplastic lesions including: abscess (3), endometriosis (2),hematoma (1), malacoplakia (1) and mucinous cyst (1). Histologyconfirmed 11/12 negative cytology; one false negative cytology of lymphnode. Statistical analysis for LEUS-FNA showed 91% sensitivity, 100%specificity, diagnostic accuracy of 95%, and a positive predictive value of

100% and a negative predictive value of 88%. Discrepancies were likelydue to cytology sampling errors.Conclusion: Lower EUS-FNA allows cytological examination and ancillarystudies (immunohistochemistry, flow cytometry) of suspicious pelviclesions in the gut wall and surrounding tissues. LEUS-FNA can detectlocal recurrences and also improve the staging accuracy of colorectaladenocarcinoma by proving nodal metastasis.

GENITOURINARY40

Performance Characteristics of Voided Urine Cytology forPolyomavirus Detection as Compared to Plasma Viremia

Dina Kokh, MD, Jennifer Collins, DO, MPH, Cinthia Drachenberg, MD,Paul Staats, MD. University of Maryland Medical Center, Baltimore,Maryland

Introduction: Polyomavirus re-activation or infection is common in renaltransplant patients, and causes renal graft injury. Urine cytology and/or serologycan be utilized in screening and monitoring of polyoma virus in these patients.Materials and Methods: We evaluated 138 consecutive cases over a two-year period in which urine cytology and plasma BK viremia (plasma BKV)assay were performed concurrently. We counted the number of decoy cells,recorded volume of urine submitted and plasma viremia for each case.Standard statistical methods were employed.Results: Of 138 cases, 17 (12%) were positive for polyoma virus by both(cytology and plasma BKV assay), 14 (9%) were positive by plasma BKV assayonly, 10 (4%) were positive by urine cytology only, and 97 (70%) were negativeby both tests. The number of urine decoy cells per unit specimen volume wascorrelated with BK viremia by linear regression (R2 Z0.67; Graph1). Comparedto plasma viremia the sensitivity of urine cytology was 55%, specificity was 91%,PPV was 63% and NPV was 87%. Of false negative cytology cases, the medianspecimen volume was 5 mL (range 1-15 mL, with only 1 case>7mL), versus 10mL (range 2-80 mL) among positive cases. Median viremia was Graph 1.<1500copies/mL (range<1500-21,000 copies/mL) in false negative cases, compared to47,000 copies/mL (range<1500-800,000 copies/mL) in the double positive cases.Of the 10 urine positive, plasma negative cases, the median number of decoy cellswas 2 (range 1-5); median specimen volume was 30 mL (range 2-60 mL).

Graph 1.

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Significance, Cytomorphology of Decoy Polyomavirocytes in RenalTransplant Urinary Cytology with Clinical, Histopathological andVirological Correlates - Literature Review and commentary

Nikolaos Chantziantoniou, BSc ART(CSMLS)CFIAC1,Amani Joudeh, MD1, Radi Hamed, MD1,Khaled Alsaad, MBBS, FRCPC, FCAP, FRCPath2,Mousa Al-Abbadi, MD, FCAP, FIAC2. 1King Fahad Specialist Hospital,

S28 Abstracts

Dammam, Saudi Arabia; 2King Abdulaziz Medical City, Riyadh, SaudiArabia

Introduction: Human Polyomaviruses are ubiquitous, generally acquired inchildhood, target urothelia (renal tubules through to bladder), and remainlatent in 80% of the immuno-competent population. However Polyomavi-ruses may reactivate with immuno-suppression, replicate, and becomepathogenic by disrupting cell-cycle mechanisms; causing epithelial cellnecrosis and exfoliation. Suspended Polyomavirus-affected cells (Poly-omavirocytes) in urinary cytology specimens reveal viral involvement, andtermed ‘decoy’ cells as they may mimic high-grade urothelial carcinomacells. While BK and JC Polyomaviruses are linked to hemorrhagic cystitisand ureteral stenosis, BK Polyomavirus-associated-nephropathy (BKVAN)is a tubulo-interstitial inflammatory disease, and critical consideration inrenal transplant patients for possible renal graft failure. Undetected orunmanaged BKVAN may result in interstitial fibrosis with tubular atrophyin 2-10% of renal transplant recipients, with 40% risk of graft loss. WhereasBKVAN is managed by reduced immuno-suppression, graft rejectionrequires increased, potent immuno-suppression. Identified early, BKVANmay be reversible. Therefore accurate cytologic differentiation of decoycells from degenerated urothelial cells or high-grade carcinoma cells isessential.Materials and Methods: Literature review and commentary to raiseawareness of decoy cells overall; with update of Polyomavirocytesignificance, differential cytomorphology, virology, laboratory diagnosis,with histopathological and clinical correlates.Results: Decoy cell cytomorphologic features: (a) cytomegaly; (b) round/elongated comet-shapes; (c) abundant basophilic cytoplasm, high N/C ratio;(d) smudged chromatin patterns from viral particles forming homogeneous,basophilic ground-glass appearance; (e) chromatin margination (beading) inperiphery of thin, regular nuclear membranes; (f) background of cellulardebris, inflammatory cells, and occasionally renal tubular casts, and (g)‘stellate’ chromatin condensation.Conclusion: Cytologic urinary decoy cell analysis is a representative, non-invasive, simple diagnostic tool; recent literature documents efficacy giventhe potentially-positive correlation between Polyomavirocyte quantificationand viral load. Cytology may support detection and indirect grading ofBKVAN, particularly as antiviral therapy is lacking; ultimately minimizingthe likelihood of limitations arising from renal biopsies.

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Urine Cytology Screening Among Renal Transplant Recipients forPresence of Atypical Changes

Emanuel Siddig, BSc, MB, BS, LIBMS. University of Khartoum, Khartoum,Sudan

Introduction: Renal transplantation has markedly increased over the years.The two major factors for successful renal transplantation are better controlof rejection and better prevention and treatment of infection. Infectiouscomplications are frequent in renal transplant recipients. The termopportunistic infections are applied to an infection occurring in animmunocompromized host with impaired defense mechanisms. Suchinfections have been on the increase for a variety of reasons. Newimmunosuppressive drugs can foster the genesis of new opportunisticinfections. The aim of this study was to screen transplant patients for thepresence of inflammatory and atypical cytological changes, and to correlatecytological findings with demographic, clinical data and type of immuno-suppressive drug in use.Materials and Methods: A total of 300 voided urine samples were collectedfrom patients, 242 male and 58 female, the ages range from 11 to 71 witha mean age of 41 years. All patients were using immunosuppressive drugsincluding cyclosporine, Tacrolimus, mycophenolate motifel, with highestratio of patients taking tacrolimus (38.6%), and the least taking cyclo-sporine (13%). The average period of transplant was 8.4 years, with thehighest group (64.3%) 0 e 4.2 years.Results: 300 cases were identified, including 262 (87.34%) reported withnormal cytology, the remainder 38 (12.6%) were inflammatory, in which 6

(2%) have a nonspecific inflammation, 17 (5.67%) from viral infections thatinclude (3 BKV, 2 CMV and 12 HPV), 10 (3.34%) bacterial infections, 3(1%) candida albicans fungal infections and 2 mixed bacterial and fungalinfections.Conclusion: The study concluded that urine cytology is an excellent tool forroutine follow-up of renal transplant recipients to detect a variety ofinflammatory and infectious agents, and need to be a widely recognizedamong physicians.

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PAX8 Staining in Urine Specimens of Patients with NephrogenicAdenoma

Zulfia McCroskey, MD, Mohanad Shaar, MD, Eva Wojcik, MD, MIAC,Guliz Barkan, MD. Loyola University Medical Center, Maywood, Illinois

Introduction: Nephrogenic adenoma (NA) is a rare benign lesion thatdevelops as result of traumatic injury and implantation of exfoliated renal