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Biomedical subjects

A T Moriarty

Publications and source records attributed to A T Moriarty.

At least 19 recordsLinked to original sources
PubMed1995

Molluscum contagiosum presenting as cellulitis in an AIDS patient: cytologic and ultrastructural features.

This report describes the cytologic features of molluscum contagiosum presenting clinically as a left thigh abscess in a 29-yr-old male with AIDS. The fine-needle aspiration findings are correlated with the histologic and ultrastructural findings. Molluscum contagiosum's clinical presentation, natural course, and induction of host immune responses in immunocompetent and immunosuppressed individuals as identified by light microscopy, immunocytochemically and ultrastructurally are reviewed. Molluscum contagiosum presenting clinically and cytologically as an abscess is unusual. In this report, we emphasize the inclusion of molluscum contagiosum in a differential diagnosis of an abscess, particularly in immunosuppressed patients, and discuss the cytologic differential diagnoses.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Fine-needle biopsy techniques of aspiration versus capillary in head and neck masses.

Fine-needle aspiration and fine-needle capillary biopsy techniques were compared, and the number of samples necessary to assure a diagnostic specimen was determined. In this study, each mass served as its own control, since both aspiration and capillary fine-needle biopsy were performed randomly on each mass. The study found the number of "superior" slides to be evenly distributed between the two biopsy techniques, but a different preference, based on tumor type, was noted for one or the other technique. The "best" slides were obtained from one of the first four samples 92% of the time. The authors concluded that both fine-needle aspiration and capillary biopsy should be used and that three to four samples should be obtained to increase the likelihood of a diagnostic biopsy.

Biopsy, Needle↗
PubMed1993

Immunophenotyping of cytologic specimens by flow cytometry.

Immunophenotyping by flow cytometry is well established as an ancillary technique in the diagnosis of hematopoietic neoplasms. However, flow cytometry is rarely performed on cytologic specimens because most cytologist are more comfortable with direct microscopy and believe that there is inadequate cellularity for analysis. Paradoxically, cytologic material is usually cell suspensions making it ideal for flow cytometry. In order to evaluate the usefulness of immunophenotyping cytologic specimens by flow cytometry, we retrospectively reviewed all cytologic specimens submitted to our flow cytometry unit from 1988 to 1991. Thirty-one cerebrospinal fluid specimens were analyzed. There were inadequate cells for analysis in 15 cases. Five showed a monoclonal proliferation; 11 were nondiagnostic. A range (r) of one to six cell surface markers were performed. Thirty-two body cavity fluids were analyzed: 7 peritoneal, 19 pleural, 2 pericardial, and 4 bronchoalveolar lavage. There were cells to analyze in all cases. Seven had a monoclonal proliferation; 25 were nondiagnostic (r = 4-21 markers performed). One hundred eighteen fine needle aspirates (FNA) were reviewed; 58 FNA were radiologically guided, 60 were superficial lesions. There were inadequate cells for analysis in two cases. Sixty-one demonstrated a monoclonal proliferation; 55 were nondiagnostic (r = 1-22 markers performed). We conclude that immunophenotyping by flow cytometry is of limited value for cerebrospinal fluid analysis and that knowledge of previous immunophenotyping studies is essential for correct analysis; analysis of body cavity fluids is easily performed but less often demonstrates a monoclonal proliferation. Immunophenotyping by flow cytometry is a valuable adjunctive technique for FNA and yields adequate cells for analysis.

Antigens, Surface↗
PubMed1993

Localized primary amyloid tumor associated with osseous metaplasia presenting as bilateral breast masses: cytologic and radiologic features.

This report details the cytologic features of primary localized amyloid tumor of the breast presenting as bilateral breast masses in a 72-yr-old woman. Clinically and radiographically, the masses simulated metastatic or multifocal carcinoma. Fine-needle aspiration revealed irregular globules of acellular amorphous material and numerous multinucleated giant cells resembling granulomatous inflammation. Histology confirmed amyloid tumors with a foreign-body giant cell reaction in response to amyloid and foci of osseous metaplasia. Subsequent clinical workup included a serum electrophoresis and immunofixation which showed a small IgG kappa monoclonal protein. Urine immunofixation was negative for Bence Jones protein. Bone marrow examination revealed no evidence of a plasma cell dyscrasia. To date the patient has not developed clinical or laboratory evidence of systemic amyloidosis or multiple myeloma. Amyloidosis involving the breast and specifically localized primary amyloid tumors of the breast are rare and infrequently reported entities. To our knowledge, osseous metaplasia within isolated primary amyloid tumors of the breast has not been reported. We present this unusual case to illustrate the intratumoral calcification patterns mimicking carcinoma and to characterize the cytologic features. Emphasis is placed on the inclusion of amyloidosis in the differential diagnosis of breast masses.

Aged↗
PubMed1992

Fine-needle aspiration biopsy of small round blue cell tumors of childhood.

One hundred twenty-eight palpable and deep-seated fine-needle aspiration biopsies (FNAB) were done on pediatric patients at James Whitcomb Riley Hospital for Children and Indiana University Hospital between 1985 and 1988. During that 4-year period, 71 (56%) benign and 49 (38%) malignant diagnoses were made. Only eight (6%) of the FNAB were considered inadequate. Thirty-nine (80%) of the malignant aspirates were small round blue cell tumors of childhood (SRBCT). The SRBCT consisted of 21 (54%) lymphomas, 7 (18%) Ewing's sarcomas, 3 (8.5%) neuroblastomas, 3 (8.5%) rhabdomyosarcomas, 2 (5.0%) medulloblastomas, 2 (5.0%) Wilms' tumors, 1 (3.0%) retinoblastoma, and 1 (3%) granulocytic sarcoma. Fifteen (38%) of the SRBCT aspirates were obtained to render a primary diagnosis and 24 (62%) documented recurrence. Various combinations of electron microscopy, immunocytochemistry, and other special stains were used to confirm the diagnosis in 11 (28%) cases. These cases consisted of five lymphomas, two rhabdomyosarcomas, two Ewing's sarcomas, one neuroblastoma, and one granulocytic sarcoma. The technique of FNAB is a successful diagnostic tool for documenting primary and recurrent SRBCT in a pediatric population.

Biopsy, Needle↗
PubMed1992

Diagnosis of metastatic thymoma using flow cytometry.

Thymomas are cytologically benign epithelial neoplasms of the thymus gland. They compose 10% of mediastinal tumors, and are most common in the anterosuperior compartment. Seven to 36% of thymomas are malignant, as determined by tissue invasion, yet they metastasize in less than 3% of cases. Distinguishing lymphoma from lymphocyte-predominant thymoma is imprecise due to their histologic similarities. We present a 45-year-old man with intracranial metastatic thymoma. The lesion was interpreted radiographically as meningioma, and as possible lymphoma by frozen section. Flow cytometry proved this neoplasma to be a metastatic thymoma. Sixteen monoclonal antibodies were used to immunophenotype the CD45+ component of this tumor. Coexpression of CD4 and CD8 along with CD1 demonstrated lymphocytes of late cortical thymocyte origin; a second component was cytokeratin positive. This is the first reported case of extrathoracic metastases of thymoma diagnosed using flow cytometry. We propose this method as an invaluable technique to diagnose these histologically difficult neoplasms.

Aneuploidy↗
PubMed1990

Processing surgically removed lymph nodes.

Delicate lymph nodal tissue must be processed accurately and evaluated for proper patient management. In more than 125 cases at Methodist Hospital of Indiana, we devised a procedure that has allowed accurate diagnosis in 98% of cases. The pathologist's approach and the variety of studies necessary to confirm the diagnosis are presented, as well as important procedural considerations.

Diagnosis↗
PubMed1989

Cytologic criteria for subclassification of Hodgkin's disease using fine-needle aspiration.

Hodgkin's disease (HD) is increasingly being evaluated by fine-needle aspiration (FNA); however, criteria to subclassify HD into its four subtypes--nodular sclerosis (NS), mixed-cellularity (MC), lymphocyte-depleted (LD), and lymphocyte-predominant (LP)--has not been established. In order to evaluate criteria for subclassification, all FNA cases of HD obtained over a 5-yr period at Indiana University Medical Center that had confirmatory surgical biopsies were reviewed. The number of Reed-Sternberg (RS) cells was quantitated in each cytologic case and statistically analyzed by subgroup, using analysis of variance (ANOVA). LD had the highest mean (means) number of RS cells (means = 51) with NS and MC having similar means (means = 7 and 6, respectively). Only one case of LP was identified and therefore could not be analyzed statistically. Fibrosis and the presence of RS variants were qualitatively assessed and were not helpful in distinguishing the subtypes of HD. Although the quantitation of RS cells may be used to identify LD types of Hodgkin's disease, MC and NS cannot be separated reliably on this criterion alone. Although FNA can be used to diagnose HD, stage a patient, or assess efficacy of chemotherapy, subtyping of HD should still be done on histologic sections of excised lymph nodes.

Biopsy, Needle↗
PubMed1988

Fine-needle aspiration of metastatic atrial myxoma.

Atrial myxoma is the most common primary neoplasm of the heart, but "metastatic" or embolic phenomena are rare. The first reported case of "metastatic" atrial myxoma diagnosed by fine-needle aspiration biopsy is presented. It occurred in a 54-yr-old woman with multiple metastatic lesions. The cytologic and histologic findings of the fine-needle aspiration biopsy and subsequent surgical excision are presented as is a discussion of the incidence, origin, and clinical findings of atrial myxoma and the characteristics of its emboli.

Biopsy, Needle↗
PubMed1986

Etiology of pure tricuspid regurgitation based on anular circumference and leaflet area: analysis of 45 necropsy patients with clinical and morphologic evidence of pure tricuspid regurgitation.

Despite recent renewed interest in the detection of tricuspid valve regurgitation by echocardiographic and Doppler techniques, little morphologic information is available on dysfunctioning tricuspid valves. This report describes 45 necropsy patients with clinical and morphologic evidence of pure (no element of stenosis) tricuspid regurgitation and provides morphometric observations (anular circumference, leaflet area) of the tricuspid valve useful in determining the etiology of pure tricuspid regurgitation. Of 45 patients, 24 (53%) had pure tricuspid regurgitation resulting from an anatomically abnormal valve (prolapse in 7, papillary muscle dysfunction in 6, rheumatic disease in 5, Ebstein's anomaly in 3, infective endocarditis in 2, carcinoid tumor in 1), and 21 (47%) had an anatomically normal valve with systolic pulmonary artery hypertension (cor pulmonale in 12, mitral stenosis in 9). Anular circumference was dilated (greater than 12 cm) in patients with various causes of pulmonary hypertension, floppy valve and Ebstein's tricuspid anomaly. Leaflet area was increased in floppy valve and Ebstein's anomaly. Of the 45 patients, 24 had pulmonary systolic artery pressure measurements available for correlation with tricuspid valve morphology. Pulmonary artery pressures accurately predicted morphologically normal from abnormal valves in 16 patients (89%). Morphologic overlap occurred in six patients with pulmonary pressures of 41 to 54 mm Hg. Of these six, the additional knowledge of normal or dilated anular circumference correctly separated valves with normal and abnormal leaflets.

Adolescent↗
PubMedDate not supplied

Hodgkin's disease variant of Richter's syndrome. Report of a case with diagnosis by fine needle biopsy.

BACKGROUND: Chronic lymphocytic leukemia (CLL) with transformation into large cell lymphoma (Richter's syndrome) is a well-documented phenomenon. Only rarely does CLL terminate in Hodgkin's disease (HD) as Richter's syndrome. Reports of Hodgkin's variant of Richter's syndrome proven by histologic and immunohistologic evaluation have been published, but no cytologic reports of this entity exist. Distinguishing between large cell lymphoma and HD as variants of Richter's syndrome is essential because of recent reports of improved prognosis in HD. CASE: We report a case of a 65-year-old male previously diagnosed with CLL who subsequently developed fever, fatigue, an intraabdominal mass and enlarged periaortic lymph nodes. Fine needle biopsy (FNB) and immunophenotyping by flow cytometry of the mass revealed cytologic and immunophenotypical cells of CLL admixed with binucleate and multinucleate cells with prominant eosinophilic nucleoli consistent with Reed-Sternberg cells. CONCLUSION: This is the first reported case of HD variant of Richter's syndrome diagnosed by FNB. As FNB becomes more common in the follow-up of lymphoreticular diseases, cytologists should be aware of this unusual HD variant of Richter's syndrome.

Aged↗
PubMedDate not supplied

Fine needle aspiration of rhabdomyosarcoma of the heart. Light and electron microscopic findings and histologic correlation.

Fine needle aspiration (FNA) biopsy was performed on a 12-year-old child with intractable cardiac arrhythmias and a mediastinal mass. The cytologic, immunocytochemical and electron microscopic findings on the aspirated material established an initial diagnosis of cardiac rhabdomyosarcoma. Subsequent histologic material confirmed the cytologic diagnosis. The findings are presented, and the use of FNA to definitively establish a preoperative diagnosis of cardiac rhabdomyosarcoma is discussed.

Antibodies, Monoclonal↗
PubMedDate not supplied

The cytology of malignant histiocytosis (sinusoidal hematolymphoid malignancy).

Malignant histiocytosis (MH: sinusoidal hematolymphoid malignancy) is a rare lymphoreticular disorder characterized by an aggressive clinical course in younger patients with weight loss, hepatosplenomegaly, generalized lymphadenopathy and pancytopenia. Five cases of MH were identified over a five-year period (1982 to 1987) at Indiana University Medical Center. The patients' ages were 12, 16, 20, 30 and 57 years; all presented with classic clinical symptoms. Four cases were diagnosed by fine needle aspiration biopsy; one case was diagnosed by the examination of ascitic fluid. All patients had confirmatory surgical biopsies. The salient cytologic features of MH included (1) a lack of background lymphoglandular bodies, (2) a population of variably sized dyscohesive cells, (3) a component of large bizarre cells with abundant eccentric, deep-blue cytoplasm on Wright-Giemsa-stained preparations, (4) prominent cytoplasmic vacuolization and (5) inconspicuous erythrophagocytosis occurring in the most benign-appearing histiocytic cells. Ancillary studies on cytologic and histologic material (immunostaining for alpha-1-antichymotrypsin and alpha-1-antitrypsin and staining for nonspecific esterases) confirmed the histiocytic nature of the malignant cells. Recognition of the distinctive morphology of MH and the performance of ancillary studies on cytologic preparations should facilitate the rapid diagnosis and early treatment of this aggressive disease.

Adolescent↗
PubMedDate not supplied

The role of fine needle aspiration cytology in the management of gynecologic malignancies.

Between 1978 and 1983, 317 diagnostic fine needle aspirations (FNA) were procured at Indiana University by the Cytology, Radiology or Gynecology services for initial evaluation or follow-up of proven gynecologic malignancies. The primary sites of the neoplasms included the cervix, uterus, ovary, vagina and vulva. Totals of 199 samples were procured from superficial sites, including parametrium, vagina, subcutaneous tissue and superficial lymph nodes, and 118 were obtained from deep soft tissues, abdominal organs, pelvis and deep lymph nodes. Of the FNA specimens, 146 (46%) were cytologically diagnosed as malignant and 171 (54%) were reported as benign. Of the specimens initially given negative diagnoses, 35 (11%) were inadequate samples. No complications occurred as a result of FNA biopsy. All cases were reclassified using strict criteria for an inadequate specimen. After review, 79 biopsies were considered either scant (22%) or inappropriate (0.03%) for the target lesion. Scant specimens were obtained more often in superficial than in deep sites. No significant differences were found in the false-negative rate between superficial and deep sites; all false positives were from superficial sites. The use of strict criteria for adequacy of a sample (two groups of appropriate cells on two separate slides) yielded a specificity of 95%, an increased sensitivity from 73% to 91%, a predictive value for a positive result of 98% and a predictive value for a negative result of 84%. Use of strict criteria for specimen adequacy served to reemphasize two points regarding negative FNA results: that rebiopsy should be suggested and that on-site assessment of the specimen adequacy should be made during the aspiration.

Biopsy, Needle↗