Clinical Focus

  • Anatomic and Clinical Pathology

Academic Appointments

  • Clinical Professor, Pathology

Professional Education

  • Board Certification: American Osteopathic Board of Pathology, Anatomic Pathology (2003)
  • Residency: Brigham and Women's Hospital (2002) MA
  • Fellowship: Brigham and Women's Hospital Dept of Pathology (2004) MA
  • Board Certification: American Board of Pathology, Cytopathology (2003)
  • Fellowship: Brigham and Women's Hospital Dept of Pathology (2003) MA
  • Medical Education: Shanghai Medical University (1988) China

All Publications

  • Pitfalls in soft tissue cytopathology. Cytopathology : official journal of the British Society for Clinical Cytology Rekhi, B., Qian, X., Domanski, H. A., Klijanienko, J., Field, A. 2023


    Fine needle aspiration biopsy (FNAB) is a diagnostic modality for the evaluation of suspicious soft tissue masses. Despite its reasonable sensitivity, specificity and positive predictive value in differentiating benign from malignant neoplasms, the exact subtyping of the primary soft tissue tumours can be challenging. Certain tumours constitute "pitfalls" and add to the diagnostic challenge. This review provides a detailed account of the diagnostic challenges in soft tissue cytopathology, including pitfalls and, more importantly, the ways to overcome these challenges by integrating clinical details, key cytomorphological features and judicious application of ancillary techniques.

    View details for DOI 10.1111/cyt.13282

    View details for PubMedID 37548096

  • The roles of the SWI/SNF complex in cancer CANCER CYTOPATHOLOGY Schaefer, I., Qian, X. 2023

    View details for DOI 10.1002/cncy.22691

    View details for Web of Science ID 000962646600001

    View details for PubMedID 37016486

  • Fine Needle Aspiration with Rapid on-site Evaluation in Diagnosing Retroperitoneal Masses: A Clinicopathological Analysis of 63 Cases Liu, Y., Lowe, A., Qian, X. ELSEVIER SCIENCE INC. 2023: S331
  • Molecular catastrophe, the peritoneal cavity and ovarian cancer prevention. The Journal of pathology Yoon, J. Y., Chapel, D., Goebel, E., Qian, X., Mito, J., Horowitz, N., Miron, A., Soong, T. R., Xian, W., Crum, C. P. 2022


    The current theory of carcinogenesis for the deadliest of "ovarian" cancers - high-grade serous carcinoma (HGSC) - holds that the malignancy develops first in the fallopian tube and spreads to the ovaries, peritoneum and/or regional lymph nodes. This is based primarily on the observation of early forms of serous neoplasia (serous tubular intraepithelial lesions (STILs), and serous tubular intraepithelial carcinomas (STICS)) in the fimbria of women undergoing risk reduction surgery. However, these lesions are uncommon in the general population, confer a low risk (5%) of HGSC following their removal in at-risk women with germ-line BRCA1/2 mutations and require 4 or more years to recur as intraperitoneal HGSC. These features suggest that isolated STILs and STICs behave as precursors with uncertain cancer risk rather than carcinomas. Their evolution to HGSC after escape from the tube could proceed step-wise with multiple biologic events; however, it is unclear whether immediately adjacent HGSCs in the setting of advanced disease evolved in the same fashion. The latter scenario could also be explained by a "catastrophic" model in which STICs suddenly develop with invasive and metastatic potential, overwhelming or obscuring the site of origin. Moreover, a similar model might explain the sudden emergence of HGSC in the peritoneal cavity following escape of precursor cells years before. Long term follow-up data from opportunistic or prophylactic salpingectomy should shed light on where malignant transformation occurs, as well as the time-line from precursor to metastatic HGSC. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1002/path.5891

    View details for PubMedID 35238033

  • Fine-needle aspiration of soft tissue perineurioma: A comparative analysis of cytomorphology and immunohistochemistry with benign and malignant mimics CANCER CYTOPATHOLOGY Yang, E. J., Hornick, J. L., Qian, X. 2016; 124 (9): 651-658


    Soft tissue perineurioma (STP) is a benign peripheral nerve sheath tumor demonstrating uniform perineurial cell differentiation. To the authors' knowledge, the cytomorphologic features of STP remain incompletely characterized, and the distinction between STP and its benign (intramuscular/cellular myxoma) and malignant (low-grade fibromyxoid sarcoma [LGFMS]) mimics is challenging.Fine-needle aspiration (FNA)/core needle biopsies of 25 low-grade myxoid spindle cell neoplasm cases including STP (5 cases), intramuscular/cellular myxoma (16 cases), and LGFMS (4 cases) were reviewed retrospectively for cytomorphologic and immunophenotypic comparison.FNA smears of STP were hypocellular with scattered clusters of spindle cells with bland, slender nuclei; bipolar cytoplasmic processes; and scant myxoid to collagenous matrix. STP commonly lacked the abundant granular myxoid matrix material present in intramuscular/cellular myxoma (20% in STP vs 75% in intramuscular/cellular myxoma; P <.05), but these tumors were otherwise remarkably found to be similar on FNA smears. All STP and intramuscular/cellular myxoma cases lacked cytologic atypia, whereas 50% of LGFMS cases demonstrated mild nuclear atypia. EMA was positive in all STPs, but also was found to be at least focally positive in 60% of intramuscular/cellular myxoma cases (9 of 15 cases) and 75% of LGFMS cases (3 of 4 cases). MUC4 was found to be negative in all 15 intramuscular/cellular myxoma and 5 STP cases, but was positive in all 4 LGFMS cases.STP, intramuscular/cellular myxoma, and LGFMS have significant cytomorphologic overlap. Immunohistochemical staining with EMA is not beneficial due to a lack of specificity. Negative MUC4 staining reliably excludes LGFMS. Therefore, a clinically meaningful approach to the FNA biopsy evaluation of a low-grade myxoid spindle cell neoplasm is to provide a differential diagnosis and to exclude a low-grade sarcoma. Cancer Cytopathol 2016;124:651-8. © 2016 American Cancer Society.

    View details for DOI 10.1002/cncy.21725

    View details for Web of Science ID 000383685600008

    View details for PubMedID 27159449