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Biomedical subjects

J F Silverman

Publications and source records attributed to J F Silverman.

At least 217 records · Page 12Linked to original sources
PubMedDate not supplied

Alveolar cell carcinoma presenting as malignant pericardial effusion: diagnosis by electron microscopy.

The cytologic, immunocytochemical, and ultrastructural findings in a 68-year-old man who presented with a malignant pericardial effusion are reported. Radiologic studies failed to identify a primary neoplasm over the next 6 months. Ultrastructural examination of a repeat pericardiocentesis fluid specimen revealed cells with intranuclear tubular inclusions and cytoplasmic lamellar bodies typical of alveolar cell carcinoma. Review of the chest radiographs showed nonresolving patchy infiltrates in the upper lobe of the left lung clinically thought to represent pneumonia; in retrospect, however, these were consistent with the pneumonic form of alveolar cell carcinoma.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMedDate not supplied

Fine needle aspiration cytology of primitive neuroectodermal tumors. A report of these cases.

Primitive neuroectodermal tumor (PNET) is a small round cell malignancy arising in soft tissue and bone, predominantly in older children and adolescents. We report the cytomorphologic features and findings of ancillary studies of eight fine needle aspiration (FNA) biopsies from three patients (7-year-old male, 12-year-old female, 9-year-old female). Two of the biopsies suggested the initial diagnosis of PNET of the chest wall, while the remaining six documented recurrent or metastatic disease. In one of these cases the primary diagnosis made by FNA biopsy enabled the pediatric oncologists to give specific therapy for the unresectable tumor and achieve remission. Local recurrences included the chest wall (two cases), pleura (one case) and pericardium (one case), while metastatic disease involved the supraclavicular lymph node and breast. All the cases consisted of small malignant cells with a high nuclear/cytoplasmic ratio and hyperchromatic nuclei without prominent nucleoli. Homer Wright rosettes were seen in only two of the aspirates, and neuropil and ganglion cells were not present. Ancillary studies, including electron microscopy (two cases), immunocytochemistry (four aspirates from two cases) and cytogenetics (11/22 translocation, one case) performed on the aspirated material were aids in making a specific diagnosis and excluded other small round cell tumors of childhood, such as malignant lymphoma, rhabdomyosarcoma and Ewing's sarcoma. The differential diagnosis between PNET and neuroblastoma can be difficult on the basis of an FNA biopsy alone, although light microscopic morphologic differences exist. Clinical features (e.g., age, primary site, metastatic patterns), catecholamine levels, electron microscopy and cytogenetics are necessary in establishing the correct diagnosis.

Biopsy, Needle↗
PubMedDate not supplied

Fine needle aspiration of metastatic and hematologic malignancies clinically mimicking pancreatic carcinoma.

The fine needle aspiration (FNA) cytology findings in 19 cases of hematopoietic and metastatic neoplasms that radiographically mimicked primary pancreatic carcinoma are reported. These cases represented 11% of 176 malignant diagnoses in a series of 304 pancreatic FNAs. The cytologic diagnoses included 7 non-Hodgkin's lymphomas, 2 Hodgkin's lymphomas, 6 small cell carcinomas (4 lung, 1 gallbladder, 1 skin), 3 squamous cell carcinomas (2 cervix, 1 esophagus) and 1 hepatocellular carcinoma. In six cases the pancreatic lesion was the initial presentation of malignant disease. These included five lymphomas, which probably involved peripancreatic lymph nodes, and a metastatic small cell carcinoma of pulmonary origin. Recognition of unusual morphologic features of pancreatic carcinoma raised the possibility of extrapancreatic malignancies. Electron microscopy and immunocytochemistry performed on FNA specimens were helpful in selected cases. The FNA diagnosis of hematopoietic and metastatic neoplasms that clinically mimic pancreatic carcinoma prompts appropriate clinical studies and treatment and eliminates the need for open pancreatic biopsy and/or resection.

Adult↗
PubMedDate not supplied

Fine needle aspiration cytology of renal infarcts. Cytomorphologic findings and potential diagnostic pitfalls in two cases.

The fine needle aspiration (FNA) cytologic features of two cases of renal infarction are presented. Both patients did not have a classic clinical history for infarction, and the radiologic findings were suggestive of neoplasia. In one of our cases, necrotic glomeruli and tubules were present, which suggested the correct diagnosis of renal infarction and permitted appropriate early treatment. In the other case, groups of atypical renal tubular cells undergoing repair secondary to the infarction was misinterpreted as renal cell carcinoma. This case illustrates that renal infarction, like pulmonary infarction, can be a potential pitfall for a false-positive cytologic diagnosis of malignancy in FNA biopsy. A conservative approach is warranted when there is scanty cellularity and atypical cells having features of a repairlike reaction are present.

Adult↗
PubMedDate not supplied

Fine needle aspiration cytology of desmoplastic malignant melanoma. A case report.

The cytologic features of a recurrent desmoplastic malignant melanoma (DMM) examined by fine needle aspiration biopsy are reported. Cytologic examination revealed multiple microtissue fragments as well as smaller, dissociative aggregates composed predominantly of spindle-shaped neoplastic cells with hyperchromatic nuclei, small but prominent nucleoli and no cytoplasmic pigment or intranuclear pseudoinclusions. The tumor cells exhibited weak cytoplasmic staining for S-100 protein. To the best of our knowledge, this is the first reported case report describing the cytologic findings of DMM. Problems in differential diagnosis are discussed.

Biopsy, Needle↗
PubMedDate not supplied

Fine needle aspiration cytology of pancreatoblastoma with immunocytochemical and ultrastructural studies.

The cytologic features of a pancreatoblastoma (infantile adenocarcinoma), a rare pancreatic neoplasm of childhood, are described. Fine needle aspiration (FNA) under ultrasound guidance produced a hypercellular specimen consisting of numerous oval-to-cuboidal cells that had a moderate amount of granular cytoplasm. Spindle-shaped, elongated and triangular-shaped epithelial cells were also seen, along with smaller cells that had a higher nuclear/cytoplasmic ratio and a denser cytoplasm. In addition, there were abundant fragments of stroma present, including some surrounded by epithelial cells. Immunoperoxidase studies performed on the aspirated material revealed positive staining of the epithelial cells for cytokeratin (AE1/3), including high and low molecular weight cytokeratin, carcinoembryonic antigen, neuron-specific enolase and alpha-1-antitrypsin. Ultrastructural examination demonstrated epithelial cells containing either large electron-dense zymogen granules in the range of 400 nm to 600 nm or small dense neuroendocrine granules measuring from 100 nm to 200 nm. This finding, in concert with the immunocytochemical studies, supported a "blastemal" cell origin with bidirectional differentiation for this unusual pancreatic neoplasm and enabled a specific preoperative diagnosis of pancreatoblastoma to be made. The differential diagnosis of pancreatoblastoma from other pediatric neoplasms involving the pancreas, including neuroendocrine tumors and neoplasms of acinar cell derivation, is presented. We believe that the FNA cytologic findings can lead to a correct diagnosis of pancreatoblastoma, especially when coupled with immunocytochemical and ultrastructural studies performed on the aspirated material.

Adenocarcinoma↗
PubMedDate not supplied

Selective use of electron microscopy in fine needle aspiration cytology.

The utility of electron microscopy (EM) applied to fine needle aspiration (FNA) biopsy specimens was analyzed in order to determine the role and the diagnostic contribution of the EM examination. A rapid stain (Diff-Quik) was used to obtain a preliminary diagnostic impression and to assure the adequacy of the EM specimen for problematic cases. Our experience suggests that EM is being relied upon with greater frequency in the study of FNA specimens because it is an accurate and cost-effective diagnostic procedure. The use of a rapid interpretation (Diff-Quik stain) enhances the quality of the EM specimen and, as in surgical pathology, the EM examination increases the accuracy and specificity of the FNA biopsy diagnosis.

Biopsy, Needle↗
PubMedDate not supplied

Cytopathology of neoplasms of the central nervous system in specimens obtained by the Cavitron Ultrasonic Surgical Aspirator.

The Cavitron Ultrasonic Surgical Aspirator (CUSA) is a dissecting system that removes tissue by vibration, irrigation and suction; fluid and particulate matter from tumors are aspirated and subsquently deposited in a canister. The CUSA permits the neurosurgeon to remove large tumors by debulking them quickly and effectively, without traction or manipulation and with minimal transmission of movement to adjacent normal tissues. The cytomorphologic appearances of 22 central nervous system tumors in CUSA samples were evaluated and compared with the findings in biopsy or resection specimens. Papanicolaou-stained and Diff-Quik-stained Cytospin preparations were prepared from the saline irrigation fluid along with a cell block in every case. Three specimens (13.6%) were insufficient for interpretation. Of the materials from seven astrocytic neoplasms examined, two were insufficient for diagnosis. The other insufficient case was tissue obtained from an ependymoma. All 11 meningiomas had diagnostic material in the slides and cell blocks. In general, the cytologic smears and cell block preparations were best preserved in meningiomas and schwannomas. Varying degrees of degeneration were noted in the glial neoplasms. Since tissue obtained from the CUSA may represent the bulk of the specimen, the examination of cytologic smears and especially cell blocks from the tissue that "went down the sucker" and were previously discarded may be quite useful.

Adenocarcinoma↗
PubMedDate not supplied

Fine needle aspiration cytology of granulomatous cryptococcosis of the lung.

A cryptococcal infection was diagnosed in a patient with a history of immunoblastic non-Hodgkin's lymphoma by fine needle aspiration (FNA) cytology of a pulmonary nodule. This case illustrates that granulomatous inflammation can be appreciated by FNA cytology and, when seen, should result in a search for the specific organism. This case also reemphasizes the value of FNA cytology in the management and follow-up of patients with malignancy or those being treated with chemotherapy.

Aged↗
PubMedDate not supplied

Fine needle aspiration cytology of pulmonary infarct.

The cytologic features of a pulmonary infarct diagnosed by fine needle aspiration (FNA) cytology are reported in a 54-year-old white man with a prior history of renal transplant surgery. Although the diagnosis of pulmonary embolus was unsuspected, FNA cytology suggested the correct diagnosis, which was confirmed by subsequent radiologic studies. This is believed to be the first reported case of pulmonary infarct diagnosed by FNA cytology. Cytologic features of the entity are discussed along with potential sources for a false-positive diagnosis of malignancy.

Biopsy, Needle↗
PubMedDate not supplied

Diagnostic accuracy and role of immediate interpretation of fine needle aspiration biopsy specimens from various sites.

A statistical analysis of the accuracy of the immediate interpretation of 425 fine needle aspiration (FNA) biopsies from various sites was performed. Preliminary interpretation of Diff-Quik-stained smears was rendered within a few minutes after performing the FNA biopsy, using diagnostic terminology similar to that of a surgical pathology report. The immediate assessment was documented in the formal cytology report and compared to the final diagnosis. For the entire series, the immediate interpretation had a sensitivity of 96%, a specificity of 97%, a positive predictive value (PV) of 98%, a negative PV of 95% and an efficiency of the test of 96%. There were 14 false-negative or falsely insufficient immediate interpretations and one false-positive immediate diagnosis. The diagnostic accuracy of the immediate interpretation of FNA biopsies from specific sites was also calculated; FNA biopsies of the pancreas were the least accurate procedure, having a sensitivity of 60% but a specificity of 100%. The role of the immediate interpretation of FNA biopsies is similar to the use of frozen sections in surgical pathology. An immediate assessment can (1) determine whether an adequate specimen is present, (2) render a specific preliminary diagnosis, (3) guide further clinical investigations or treatment, and (4) determine whether ancillary studies are needed to make a more accurate or specific diagnosis from the FNA specimen. Our results indicate that the immediate interpretation of FNA biopsies is an accurate procedure that should be routinely employed.

Biopsy, Needle↗
PubMedDate not supplied

Fine needle aspiration cytology of adenosis tumor of the breast. With immunocytochemical and ultrastructural observations.

The fine needle aspiration (FNA) findings of multinodular sclerosing adenosis forming a discrete lesion (so-called "adenosis tumor") of the breast are presented. The findings in this case and a review of the literature indicate that adenosis tumor is an unusual breast lesion that can clinically and histologically be confused with breast carcinoma, especially at the time of frozen section. FNA biopsy demonstrated uniform groups of ductal cells, stromal fragments and many stripped bipolar nuclei, which led to a correct diagnosis of a benign proliferative breast lesion, but not to a specific diagnosis of adenosis tumor. Immunoperoxidase staining for muscle actin demonstrated positive staining of many bipolar spindle-shaped cells, indicative of myoepithelial cells. Immunohistochemical studies on the resected specimen demonstrated actin positivity of myoepithelial cells and intact linear staining of type IV collagen around the ductules. Ultrastructural examination demonstrated ductal cells with surrounding myoepithelial cells resting on a delicate basal lamina, with surrounding bundles of collagen in the interstitial space. This appears to be the first FNA cytologic description of this unusual breast tumor and the first immunohistochemical and ultrastructural characterization of this lesion. FNA cytologic examination may more clearly identify the benign nature of the breast mass than frozen section.

Adult↗
PubMedDate not supplied

Fine needle aspiration cytology of bronchioloalveolar-cell carcinoma of the lung.

The fine needle aspiration cytology features of twelve peripherally located bronchioloalveolar cell carcinomas of the lung diagnosed by fine needle aspiration biopsy are described. A spectrum of cytomorphologic changes was appreciated, including classic groups showing uniform malignant cells having prominent depth of focus with a lack of significant nuclear molding. Other cells showed features of atypical alveolar macrophages and bronchial-lining cells. The smears demonstrated malignant cells arranged along alveolar septae and possessing hobnail-shaped nuclei. Two cases had associated psammoma bodies, and one case demonstrated optically clear nuclei in the malignant cells. This series stresses the fine needle aspiration features that aid in the recognition of this specific lung neoplasm and its differentiation from benign reactive pulmonary lesions, other primary lung cancers and metastatic tumors.

Adenocarcinoma↗
PubMedDate not supplied

Fine needle aspiration cytology of neuroblastoma, including peripheral neuroectodermal tumor, with immunocytochemical and ultrastructural confirmation.

Eleven fine needle aspiration (FNA) biopsies were performed on seven children with neuroblastoma, including one patient with a congenital neuroblastoma and another with a peripheral neuroblastoma of the thoracopulmonary region. FNA cytology made the primary diagnosis of neuroblastoma in four of the seven cases. The other biopsies documented local recurrences and metastases to liver, lymph nodes, orbit and breast. The cytologic features included varying numbers of small primitive cells with scanty cytoplasm, poorly to well-formed pseudorosettes, cell processes, a fibrillary matrix and multinucleated ganglion cells. Five of the seven patients had electron microscopic (EM) examination of the FNA specimen, which in all cases confirmed the diagnosis. Batteries of immunoperoxidase stains were performed on all 11 aspirates with variable results. Staining for neuron-specific enolase was positive in four of the five neoplasms tested, although strongly positive in only three of the cases. Staining for neurofilament markers was positive in only two of five tumors. Studies for cytokeratin markers (AE1/3), low-molecular-weight cytokeratin (35BH11), hematopoietic markers (T29/33), immunoglobulin light chains and myoglobin were negative. One case was positive for vimentin. This study attests to the value of FNA cytology in suggesting a correct diagnosis of either primary, recurrent or metastatic neuroblastoma in children. Selective use of immunoperoxidase stains and EM on the aspirates may be of value.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

The triage role of fine needle aspiration biopsy of palpable breast masses. Diagnostic accuracy and cost-effectiveness.

A total of 219 fine needle aspiration (FNA) biopsies of the breast were performed during the period 1983 to 1985 at a tertiary medical center. The series consisted of 215 women (98.2%) and 4 men (1.8%), with an are range of 14 to 90 years (mean of 46.5 years). Histologic confirmation (93 cases) or clinical follow-up for up to two years was obtained. The sensitivity of the FNA procedure was 82.2%, its specificity was 98.8%, and the overall efficiency of the test was 95.4%. The false-negative rate was 4.4%, with no false-positive diagnoses for the primary diagnosis of breast carcinoma. We have found that one of the major advantages of FNA biopsy is that it lowers costs by allowing the surgeon to triage which patients should have an outpatient excisional biopsy under local anesthesia and which patients should have a one-stage inpatient procedure with frozen section confirmation. For this triage role, suspicious diagnoses (3.2%) were included in the positive group and atypical (1.8%) and insufficient diagnoses (6.8%) in the negative group. Taking into account the FNA biopsy cost of $75, the procedure resulted in a savings per case of $262 over the cost that would have occurred if all cases had had routine inpatient biopsy and $154 per case over the cost that would have occurred with routine outpatient biopsy of all cases. Our results indicate that FNA breast biopsy is a diagnostically accurate and economical triage procedure, even when followed by an excisional or frozen-section biopsy for confirmation. The use of FNA biopsy could be expanded to a greater number of medical centers and decrease the potential for false-positive diagnoses by combining FNA biopsy with frozen-section confirmation.

Adolescent↗