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Biomedical subjects

F Rilke

Publications and source records attributed to F Rilke.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

Percutaneous intraductal sampling for cyto-histologic diagnosis of biliary duct strictures.

BACKGROUND: Percutaneous transhepatic biliary drainage (PTBD) allows ductal material to be collected for cyto-histologic examination. We evaluated the data from a large series of patients with a PTBD in whom endobiliary cyto-histologic sampling techniques were employed in order to define a strategy for their use in the diagnostic work-up. PATIENTS AND METHODS: Ductal samples for cyto-histologic examination were obtained from 409 consecutive patients with a PTBD for stenosing lesions of the biliary tree. Bile aspirate cytology was performed for all patients and ductal biopsy specimens were obtained, generally after negative cytology, from 49 of them (11.9%), all candidates for a therapeutic procedure. The cyto-histologic results of intraductal sampling were compared with pathologic surgical data in 210 patients and with clinical-radiologic follow-up in 199. RESULTS: Overall, 22 out of the 409 patients had a final diagnosis of benign stenosis and 177 had samples positive for neoplastic disease. The sensitivity of bile cytology was 43.8% while ductal biopsies showed a sensitivity of 60.4%. The combination of the two sampling techniques achieved a sensitivity of 65.1%. For both sampling methods the specificity was 100%. Hilar metastases from neoplastic lesions of the GI tract and primary lesions of the biliary ducts showed the highest sensitivity. CONCLUSION: Cyto-histologic assessment of stenosing lesions of the biliary ducts is mandatory when highly sophisticated interventions (e.g. wide hepatic resection or liver transplantation) or non-surgical treatments are envisaged. The collection of cyto-histologic samples from bile ducts, in patients with a percutaneous bile drainage, is an easy, safe and valuable method to obtain the diagnosis. In view of the absence of false positive results in our series and in others, intraductal biopsy serves no purpose when positive exfoliative cytology is positive for malignancy. In the presence of negative cytology it is felt that an intraductal biopsy should be mandatory when the choice of a therapeutic program depends on the result of the cyto-histologic diagnosis.

Adolescent↗
PubMedDate not supplied

Immunocytochemical detection and characterization of intrahepatic human pancreatic islets after combined liver-islet allotransplantation.

The unique availability of an explanted liver-islet allograft, removed for primary nonfunction of the liver, led us to evaluate distribution and phenotype of exocrine and endocrine components of the pancreatic graft. Immunocytochemistry was used to map patterns of gene products for islet hormones, proprotein processing enzymes, panneuroendocrine markers, and pancreatic exocrine markers. When compared with age-matched control pancreases, insulin-, glucagon-, somatostatin-, and pancreatic polypeptide-producing cells were similarly represented and distributed within the grafted islet. We also demonstrate that the intrahepatic transplanted islets retained the enzyme machinery able to process the hormone precursors into bioactive fragments. In the clinical setting, this resulted in an immediate functioning of the graft and insulin-independence of the patient one month after transplantation. The purity in islets, as assessed by immunocytochemistry with antibodies to tissue constituents of endocrine and exocrine lineages, was around 40%. Despite the massive intraportal presence of pancreatic acinar tissue, no signs or symptoms attributable to ectopic hypersecretion of exocrine enzymes occurred. In fact, when tested with antibodies to such enzymes, low levels of immunoreactivity were observed in the grafted acinar cells.

Biomarkers↗
PubMedDate not supplied

[Cytological diagnosis and cytohistological correlations of malignant epithelial tumors of the rhinopharynx].

Nasopharyngeal carcinoma frequently has as its first manifestation cervical lymph node metastases before local symptoms appear. In the Instituto Nazionale per lo Studio e la Cura del Tumori of Milan, routine nasopharyngeal cytology has been carried out on these patients. Positive cytology in 55 cases of undifferentiated carcinoma (83.6%) and positive cytology of biopsies was obtained in 87.3%. The combination of cytology and histology gave a yield of 98.2% positive cases. For squamous carcinomas positive cytology was less frequently obtained, the same as for malignant lymphomas. The cytology of undifferentiated carcinoma has such marked morphological characters that it is very easy to diagnose it in a very high percentage of cases. In the differential diagnosis cytologically it is necessary to bear in mind other neoplasias, in particular some of the malignant lymphomas.

Biopsy↗
PubMedDate not supplied

The cytologic diagnosis of gastric carcinoma related to the histologic type.

In gastric smears obtained by direct vision fiberoptic brush technique from 78 patients with carcinoma of the stomach, an attempt was made to recognize cytologically the histologic type of the tumor with reference to Lauren's classification. The cytologic diagnosis of intestinal type carcinoma was made in 36/45 positive cases on the basis of an abundant cellularity and the presence of rather large pleomorphic cohesive cells often arranged in sheets with a moderately increased N/C ratio. One case of intramucous and two of "early" invasive carcinoma revealed malignant cells which did not differ from those of the advanced cases. In these cases as well as in some of the advanced ones, atypical epithelial cells were found in addition to the malignant ones; these cells could have derived from the histologic areas of atypical hyperplasia of the gastric mucosa surrounding the carcinoma. 14/15 cases of advanced diffuse carcinoma of the stomach could be cytologically identified on the basis of a scanty cellularity and the presence of rather small, monomorphic poorly differentiated cells with a high N/C ratio. The cytologic diagnosis of the mixed-type carcinoma was made in 2/5 positive cases on the basis of the presence of an admixture of both cell types described above. In two cases of the mixed-type carcinoma, only intestinal type cells were found. In the smears of nine cases of intestinal type carcinoma, one of which was intramucous, and of one case of mixed-type carcinoma, the tumor cells could not be specified. 13/78 cases (16.7%) showed negative cytology. The overall accuracy rate was 83.3 per cent. The statistical analysis of a number of cytologic parameters indicated that morphologic differences between Type I and Type D carcinomas of the stomach do exist and that they can be evaluated for differential diagnostic purposes.

Aged↗
PubMedDate not supplied

Cytology of non-Hodgkin's malignant lymphomas involving the stomach.

An attempt was made to diagnose cytologically non-Hodgkin's malignant lymphomas (ML) of the stomach on gastric smears in terms of the Kiel classification. This classification represents a more advanced approach for the identification of ML with regard to the cell type specificity, with some functional connotations as compared with previous classifications. The endoscopic brushing cell film studies, when compared with histology of endoscopic biopsies and/or surgical specimens, indicated a high accuracy of cell type identification. Sampling may represent problems in relation to the type of gross lesion. Specific cell types could be recognized in 20 of 25 cases of gastric involvement of ML. Six of nine cases of lymphoplasmacytoid ML revealed diagnostic cells, such as lymphoplasmacytoid cells, plasma cells, lymphocytes, and occasional immunoblasts. Six of seven cases of centrocytic ML had a large number of small cells with indented nuclei, and seven of eight centroblastic-centrocytic ML yielded a mixture of large centroblasts and small centrocytes. In addition to these 24 low-grade ML, one case of unclassifiable high-grade ML was diagnosed. Differential diagnostic problems within ML subtypes and with benign lesions, such as pseudolymphoma of the stomach, as well as malignant tumors and especially diffuse type gastric carcinoma, are taken into consideration.

Adult↗
PubMedDate not supplied

Conclusive diagnosis of hepatic and pancreatic malignancies by fine needle aspiration.

A study of the diagnosis of hepatic and pancreatic malignancies by fine needle aspiration (FNA) was made, based on 221 aspirates obtained from 209 patients with histologic or clinical confirmation: 159 with hepatic and 50 with pancreatic lesions. The values of sensitivity, specificity and predictivity for positive FNA results were, respectively, 0.84, 0.96 and 1.0 for the liver and 0.76, 1.0 and 1.0 for the pancreas. The composition of the case material showed an incidence of malignant tumors of the liver and pancreas of 84% and 60%, respectively (among which the primary malignancies were 39% and 48%), while nonneoplastic lesions had incidences of 14% and 40%. However, conclusive FNA diagnoses of the histologic type of the primary and the site of origin of metastatic tumors were made in 60% of the hepatic lesions but in only 9% of the pancreatic lesions. Primary hepatocellular carcinoma was diagnosed by FNA of the liver in 95% of the cases; FNA specifically diagnosed 42% of intrahepatic bile duct carcinomas and 40% of hepatic metastases. These findings correlate with the unique cytologic features of primary hepatocellular carcinoma of intrahepatic rather nonspecific morphology of carcinoma of intrahepatic and extrahepatic origin, as well as of pancreatic ductal origin.

Adenoma, Bile Duct↗
PubMedDate not supplied

The role of fine needle aspiration in the assessment of renal masses.

An investigation of the role of fine needle aspiration in the assessment of renal masses was carried out on 132 consecutive patients, 11 of whom were children. Selection was based on the presence of a solid or mixed solid and cystic renal mass that could not be defined by radiology, either in symptomatic patients or in patients to be submitted to embolization of the renal artery and at high surgical risk. Histologic and clinical data showed 49% of the cases to have a malignant, predominantly (45%) primary disease of the kidney and the remainder to have a nonneoplastic lesion. In five cases, the primary lesion was in the adrenal gland (three neuroblastomas and two pheochromocytomas). Sensitivity, specificity and predictive values for positive results were, respectively, 0.93, 0.96 and 0.935 because of a false-positive diagnosis in a case of multilocular cystic nephroma. Furthermore, in 43 of 65 cases (66%), consisting of 33 renal cell carcinomas, 1 transitional cell carcinoma, 3 Wilm's tumors, 1 neuroblastoma, 2 pheochromocytomas and 3 metastatic lesions, the histologic type could be ascertained on the tissue yielded by the fine needle aspiration. The findings stress the usefulness of this method for the clarification of radiologically not unequivocal space-occupying lesions of the renal area, especially when, in addition to the smears, histologic sections of paraffin-embedded tissues are available. Ultrastructural and immunohistochemical studies are cost-effective mainly in pediatric patients.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Pulmonary carcinoid with glandular features. Report of two cases with positive fine needle aspiration biopsy cytology.

A detailed description is given of two challenging cases of pulmonary carcinoid with glandular features that were diagnosed cytologically on fine needle aspiration biopsy material. The histologic type in the first case was identified on the aspirated material obtained from the tumor at the time of its radiologic discovery; for the second case, after a prior diagnosis of adenocarcinoma, the correct diagnosis was made upon review of the material; the diagnosis was warranted by the indolent clinical course. The cytologic diagnoses were unequivocally confirmed by the histology of the surgical specimen in the first case and by an ultrastructural investigation of the second.

Aged↗
PubMedDate not supplied

Sputum cytology for the diagnosis of carcinoma of the lung.

Of 400 consecutive patients with histologically proven carcinoma of the lung, one to six sputum samples (mean, 2.8) were examined cytologically; 60% also had histologic examination of paraffin-embedded material. The overall sensitivity of sputum cytology was 0.58. The sensitivity increased from 0.37 to 0.57 when three samples rather than one were examined; it increased by only another 0.01 when four to six samples were studied. The examination of paraffin-embedded material yielded another 0.075 increase in sensitivity. A multiparametric study, including diameter, cavitation, site and histologic type of the pulmonary tumors, showed that sputum cytology was particularly significant for neoplasms of the left upper lobe and that the sensitivity related to the histologic type was not independent of the site, diameter and cavitation. The overall cytologic typing accuracy was 0.77, with a range from 0.20 to 0.96. The majority of the diagnoses at variance with histology and the unclassified malignant epithelial tumor cells were found to be associated predominantly with carcinoma of the large-cell type and with poorly differentiated adenocarcinomas.

Adenocarcinoma↗
PubMedDate not supplied

Cytologic diagnosis of pulmonary carcinoma on bronchoscopic brushing material.

The material obtained by brushing procedures under visual control from 370 consecutive patients with histologically confirmed primary carcinoma of the lung who underwent bronchoscopy was examined cytologically. The sputum of 276 of these patients was also investigated. The overall sensitivity of the bronchoscopically obtained cytology was 0.67; however, the values were 0.78 and 0.28, respectively, for the cases with and without visible lesions of the bronchi. Sputum examination enhanced the sensitivity to 0.79 overall and to 0.84 and 0.61, respectively, for the two groups, with a greater benefit for the group with negative bronchoscopy. The overall cytologic typing accuracy for 252 cases was 0.66, with a range of 0.19 to 0.86, depending on the histologic type. Typing failures were essentially related to adenocarcinomas and large-cell carcinomas.

Adenocarcinoma↗
PubMedDate not supplied

Transthoracic fine needle aspiration biopsy in pulmonary lesions. Updated results.

An investigation was carried out on 271 patients who underwent transthoracic fine needle aspiration biopsy ( FNAB ) for suspected pulmonary lesions in a four-year period; 80% of them had a malignant tumor. The histologic control of the cytologic diagnoses made on the transthoracic FNAB was possible in over 50% of the cases. The sensitivity and predictive value for positive results were, respectively, 0.890 and 0.995, whereas the typing accuracy verified in 58 cases on the surgical specimen was 0.76. The comparison of the data obtained from the most recent case material with that of early observations confirmed the high sensitivity of transthoracic FNAB in the detection and characterization of malignant lesions in the lungs. The sensitivity was almost identical for primary tumors, 0.90, and metastatic disease, 0.88. Furthermore, over the years the data showed an improvement in the results due to the experience gained, the combined use of cytology and histology and the application of histochemical methods. More sophisticated methods, such as immunocytochemistry and electron microscopy, were essential to the final diagnosis in only a few cases.

Biopsy, Needle↗