By the end of the 19th century, exfoliated cancer cells had been described in all of the types of specimen in which we find them today. However, it was not until Drs. Papanicolaou and Traut published their account of the diagnosis of uterine cancer from exfoliated cells (1941 and 1943) that cytopathology acquired the momentum to develop into the powerful presence that it has in human medicine today. These and the subsequent publications by Papanicolaou stimulated the development and application of cytopathology worldwide, resulting in abundant literature on the subject and a galaxy of outstanding practitioners. The 1980s saw the development and widespread use of aspiration cytology. This was followed in the 1990s by the development of automated screening systems, marking the latest stage in the evolution of cytopathology. These and other events and achievements in cytopathology, from its meager beginnings in the early 20th century to its worldwide use and acceptance today, mark this century as the "century for cytopathology."

Cell Biology↗

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Cytologic diagnosis of two rarities. Granulocytic sarcoma and microsporidiosis.

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Animals↗

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Amyloid in cytologic specimens. Differential diagnosis and diagnostic pitfalls.

OBJECTIVE: To describe and illustrate the characteristic features of amyloid in cytologic preparations and point out its diagnostic pitfalls. STUDY DESIGN: Five fine needle aspirates and one bronchial washing that contained amyloid were retrospectively reviewed. The aspirates were obtained from each of the five following sites: lung, occipital lymph node, thyroid gland, proximal humerus and subcutaneous soft tissue. Smears of all of the aspirates were stained with Papanicolaou stain, and in two cases they were also stained with Diff-Quik. Cell block sections were stained with hematoxylin and eosin. Congo red, CD45 and CD20 were used on selected cases. RESULTS: Amyloid appears as either flocculent material or irregularly shaped fragments with scalloped and pointed edges. The amorphous fragments are acellular and frequently associated with connective tissue cells. They stain eosinophilic to cyanophilic with Papanicolaou stain and deep blue with Diff-Quik. In two cases an exuberant giant cell reaction almost obscured the amyloid. In the thyroid aspirate, the amyloid was misinterpreted as colloid. In bronchial washings and lung aspirates, amyloid has to be distinguished from mucus, alveolar proteinosis, chondroid material and corpora amylacea. When circumferentially surrounded by lymphocytes or plasma cells, flocculent amyloid deposits may simulate adenoid cystic carcinoma. CONCLUSION: Amyloid can be easily overlooked or mistaken for other entities with similar staining qualities. Congo red staining can help to confirm the diagnosis.

Aged↗

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Cyanophilic bodies in cervico-vaginal smears.

Thirty-six out of 171 (21%) cervico-vaginal smears that manifested pronounced squamous epithelial atrophy contained cyanophilic bodies about the size and shape of parabasal cells. These cyanophilic bodies have been misinterpreted as cancer cells. Patients whose smears contained cyanophilic bodies were likely to be elderly, at least ten years postmenopausal, and free of any gynecologic symptoms or abnormalities except those associated with previous surgery. Smears which contained cyanophilic bodies also contained numerous parabasal cells in various stages of degeneration, objects which closely resembled trichomonads, and a heavy background of granular material. A morphologic continuum existed between all of these elements. The conclusion, therefore, is that cyanophilic bodies, spurious trichomonads and the granular material are all derived from degenerating parabasal cells. It is suggested that cyanophilic bodies develop because of the diminished efflux of exfoliated epithelial cells and mucus associated with squamous epithelial atrophy. The ensuing stagnation of parabasal cells allows them to degenerate to an advanced degree. It appears that as some of the parabasal cells degenerative, their nuclear chromatin becomes widely dispersed throughout the cytoplasm, thereby forming cyanophilic bodies.

Cervix Uteri↗

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"Collagen balls" in peritoneal washings. Prevalence, morphology, origin and significance.

Peritoneal washings obtained at laparotomy from women undergoing surgery for neoplasms of the genital tract may contain "collagen balls," consisting of tissue fragments composed of collagen covered with mesothelial cells. Collagen balls were found in 19 (4.5%) of 418 peritoneal washings and were more prevalent in specimens labeled pelvic washings (17 of 294, or 5.8%) than in those labeled peritoneal washings (2 of 124, or 1.6%). In 15 of the 19 cases in which we found collagen balls, at least one ovary was available for microscopic examination. In 14 of the 15 cases minute nodular papillary stromal projections covered with mesothelium were found on the surface of the ovaries. We conclude that collagen balls, a nonspecific entity, most probably originate on the surface of the ovaries. Their significance lies in their being mistaken for mucin-distended cells exfoliated from a neoplasm or from detached fragments of a papillary ovarian neoplasm.

Adult↗

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Curschmann's spirals in pleural and peritoneal effusions.

Curschmann's spirals were found in smears and cell block preparations of five spontaneously occurring pleural and peritoneal fluids. The spirals were similar to those seen in the respiratory tract, although generally much smaller. In three of the five cases, the fluids also contained mucus-secreting adenocarcinoma cells; it is postulated that the spirals formed from mucus secreted by these cells. In the other two cases, there was evidence of serosal inflammation; it is suggested that the spirals in these cases developed from submesothelial connective tissue mucosubstances that entered the serosal cavity through a mesothelium of increased permeability due to the inflammation. No simple explanation can be accepted as to the exact mode of spiral formation, which is presumed to be a complex physical and biochemical phenomenon.

Adenocarcinoma↗

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The pathognomonic cytologic picture of rheumatoid pleuritis. The 1989 Maurice Goldblatt Cytology award lecture.

Patients with rheumatoid arthritis of any degree of severity or duration may develop necrotizing granulomatous pleuritis, a morphologic replica of the inflammatory reaction characteristic of rheumatoid synovitis and rheumatoid nodules. The ensuing pleural effusion may show a unique cytologic picture consisting of slender, elongated multinucleated macrophages, round giant multinucleated macrophages and necrotic background material. A review of 24 such cases from our laboratory as well as the relevant literature clearly demonstrated that not only is this cytologic picture unique, but that it is pathognomonic of rheumatoid disease, even in patients who have not yet developed arthritis.

Arthritis, Rheumatoid↗

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Fine needle aspiration biopsy of the breast. Influence of the number of passes and the sample size on the diagnostic yield.

The sensitivity of fine needle aspiration (FNA) biopsy of the breast as a function of the number of aspirations performed on any given lesion was investigated. Four separate aspirations each were performed on over 400 lesions of the breast, 93 of which yielded a cytologic diagnosis. The incremental diagnostic yields of each subsequent aspiration were tabulated. The first aspirate of the sequence gave the greatest yield, with smaller incremental yields on the second through the fourth aspirates. Benign and malignant lesions gave similar results, as did palpable and nonpalpable lesions (the latter being usually smaller in size). A mathematical extrapolation of the data indicates that three or four aspirations of any given lesion provide the optimal yield within the limits of practicality. This performance of multiple FNA biopsies is particularly important when the pathologist does not perform the biopsy, or is unable to assist in the immediate interpretation of the specimen to assess its adequacy.

Biopsy, Needle↗

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Charcot-Leyden crystals in pleural fluids.

Charcot-Leyden crystals have rarely been reported in serous fluids. We present eight examples of Charcot-Leyden crystals, all found in eosinophilic pleural effusions. The crystals were found in toluidine blue-stained wet films of pleural fluid after either the fluid or the wet film had stood for at least 24 hours at 4 C.

Adenocarcinoma↗

PubMedDate not supplied

Cells of squamous cell carcinoma in pleural, peritoneal and pericardial fluids. Origin and morphology.

The records of two cytopathology laboratories, covering an aggregate of 33 years, were searched for pleural, peritoneal and pericardial fluids reported as containing cells of squamous cell carcinoma (SCC). This search embraced 9,297 serous fluids from 7,389 patients. Cells of SCCs were found in the fluids from only 46 patients, illustrating the infrequency of such a finding, with most of the SCC cells originating in primary neoplasms of the lung (16), female genital tract (8) or larynx (6). All of the recognized types of SCC cells were found in these fluids. Even so, SCC cells may be mistaken for cells of other neoplasms, such as adenocarcinoma and malignant mesothelioma. SCC cells in serous fluids should be identifiable if careful attention is paid to the morphologic features characteristic of SCC.

Body Fluids↗