Search PubMed⌕ Search

Biomedical subjects

J F Silverman

Publications and source records attributed to J F Silverman.

233 records · Page 13Linked to original sources
PubMedDate not supplied

Ascitic fluid cytology in a case of metastatic malignant mixed mesodermal tumor of the ovary.

The cytologic features of the abdominal fluid from a patient with a malignant mixed mesodermal tumor (MMMT) of the ovary are presented. Both malignant epithelial and stromal elements were cytologically appreciated and confirmed by histologic examination. Other ovarian neoplasms that can present with malignant sarcomatous elements or mixed epithelial and sarcomatous elements are discussed; this case documents the importance of recognizing these features when staging patients with unusual ovarian neoplasms. To our knowledge, this is the first complete report of the ascitic fluid cytology of an MMMT of either ovarian or uterine origin.

Aged↗
PubMedDate not supplied

Fine needle aspiration cytology of hemangioblastoma of the spinal cord. Report of a case with immunocytochemical and ultrastructural studies.

The cytologic features of a hemangioblastoma of the spinal cord diagnosed by an intraoperative fine needle aspiration (FNA) biopsy are reported in a 66-year-old man with a long-standing history of Charcot-Marie-Tooth disease. A dual population of delicate branching vascular channels associated with nearby coarsely vacuolated stromal cells was appreciated in the smears. Histologic, immunocytochemical and ultrastructural studies demonstrated three cell types comprising the tumor: endothelial cells, pericytes and stromal cells. Factor VIII-related antigen positivity, vimentin positivity and glial fibrillary acid protein negativity support the contention that all three types of tumor cells may arise from a common angiogenic mesenchymal ancestry. A discussion of the expected aspiration cytologic findings of other tumors of the spinal cord is also presented. FNA biopsy of suspected hemangioblastoma should be performed with utmost caution due to the possibility of extensive intraoperative bleeding, such as we experienced following sampling of this tumor.

Aged↗
PubMedDate not supplied

Fine needle aspiration cytology of subareolar abscess of the breast. Spectrum of cytomorphologic findings and potential diagnostic pitfalls.

The cytomorphologic findings of eight cases of subareolar abscess of the breast diagnosed by fine needle aspiration (FNA) biopsy are presented. A spectrum of cytologic findings was appreciated, including diagnostic anucleated squames associated with numerous neutrophils, keratinous debris, cholesterol crystals, parakeratosis and strips of squamous epithelium. A foreign-body reaction, with sheets of histiocytes and multinucleated foreign-body-type giant cells, was noted in some of the cases. Potential pitfalls for a false-positive diagnosis of malignancy included the presence of groups of atypical ductal cells, squamous atypia and fragments of exuberant granulation tissue. Seven of the eight cases had complete surgical excision of the lesion, which demonstrated the characteristic findings of dilated lactiferous ducts undergoing squamous metaplasia with rupture and surrounding extensive acute and chronic inflammation with foreign-body reaction. With recognition of the FNA cytologic findings of subareolar abscess of the breast, a specific diagnosis can be rendered, which then allows different treatment modalities depending on the stage of the lesion. Appreciation of the spectrum of cytologic features will enable the pathologist to make the correct diagnosis and thereby avoid potential pitfalls that can possibly lead to a false-positive diagnosis of malignancy.

Abscess↗
PubMedDate not supplied

Fine needle aspiration cytology of tuberculosis of the lumbar vertebrae (Pott's disease).

The cytomorphologic features of tuberculosis of the lumbar vertebra having a granulomatous pattern diagnosed by fine needle aspiration (FNA) biopsy are reported in a 72-year-old woman with a prior history of malignant lymphoma treated by chemotherapy. Cytologic examination revealed microtissue fragments of cohesive cells, including epithelioid histiocytes and scattered, multinucleated Langhans-type giant cells. This is believed to be the first reported case of vertebral tuberculosis (Pott's disease) diagnosed by FNA cytology and confirmed by culture of the aspirate material. This case illustrates the value of FNA cytology in the diagnosis of nonneoplastic skeletal lesions and confirms the value of FNA biopsy the early detection of infectious processes in patients with malignancy.

Aged↗
PubMedDate not supplied

Fine needle aspiration cytology of neoplasms metastatic to the breast.

The fine needle aspiration (FNA) cytologic findings in 18 cases of metastatic neoplasms of the breast are reported. The cases were encountered in a combined series of 2,529 FNA breast biopsies, of which 666 were malignant; the metastatic neoplasms of the breast thus constituted 2.7% of all the malignant breast tumors. The series consists of 15 women and 3 men, with a mean age of 48 years (range of 11 to 73 years). Sixteen biopsies confirmed metastatic malignancy in patients with known extramammary primaries; the prebiopsy clinical diagnoses in six of the patients were benign breast lesions. In eight patients, the clinical differential diagnosis was either a benign or malignant primary breast lesion versus a metastatic malignancy. In two additional patients, the FNA biopsy identified metastatic neoplasms from unsuspected extramammary primaries. The metastatic neoplasms included three small-cell carcinomas of the lung, one squamous-cell carcinoma of the lung, two malignant melanomas, three ovarian malignancies, including a dysgerminoma, and one each of carcinoma of the fallopian tube, endometrial carcinoma, transitional-cell carcinoma of the urinary bladder, prostatic carcinoma, acute granulocytic leukemia, lymphoma, mycosis fungoides, hepatoma and neuroblastoma of the retroperitoneum. Recognition of unusual cytologic patterns raised the suspicion of, or confirmed the diagnosis of, malignancy in all cases, with no false-negative diagnoses. None of the cases were cytologically interpreted as a primary breast malignancy. Ancillary studies performed on the FNA material, including immunocytochemistry, contributed to a definitive diagnosis in three cases. FNA diagnosis of metastatic malignancy of the breast is essential in order to avoid unnecessary mastectomy and to ensure appropriate chemotherapy and/or irradiation treatment.

Adult↗
PubMedDate not supplied

ASA-dipyridamole prophylaxis in elective total hip replacement.

A prospective, double-blind clinical study was performed to evaluate the combination of dipyridamole 225 mg/day and acetylsalicylic acid 1 gm/day prophylaxis of postoperative venous thromboembolism in elective total hip replacement. Patients were stratified according to age, and randomly assigned to receive drug or placebo. All patients were followed with 125I-labeled fibrinogen scanning for one week postoperatively, or until fully mobile. Venography was performed in 79/132 patients; in 36 patients the venogram was obtained to confirm a positive fibrinogen scan, in 43 patients an elective venogram was obtained on the seventh postoperative day to evaluate the operated thigh (a blind area for scanning). Thrombosis (by scan or venogram) was found in 17/68 (25%) in the control group, and in 23/64 (36%) in the treated group. Overall incidence was 40/132 (30%). Correlation of scan with venography was 90%. There were no clinically significant pulmonary emboli in either group. The combination of acetylsalicylic acid (ASA) and dipyridamole as given in this study is not effective prophylaxis in elective total hip replacement.

Administration, Oral↗
PubMedDate not supplied

Fine needle aspiration cytology of granulomatous diseases of the lung, including nontuberculous Mycobacterium infection.

The spectrum of cytomorphologic changes of pulmonary granulomas diagnosed by fine needle aspiration (FNA) biopsy is reported, with a review of the pertinent literature concerning the cytologic diagnosis of granulomatous disease. In our cases, organisms were not seen in the Papanicolaou-stained smears. Recognition of the granulomatous cellular pattern, however, resulted in a thorough search for organisms by special stains, and an etiologic diagnosis was made in each case. These cases emphasize the need for routine staining and culture of FNA material when an initial diagnosis of malignancy is not made. One of the cases appears to be the first report of a nontuberculous Mycobacterium infection diagnosed by fine needle aspiration biopsy.

Adult↗
PubMedDate not supplied

Fine needle aspiration cytology of cat scratch disease.

The cytologic features of cat scratch disease diagnosed by fine needle aspiration cytology of a right inguinal lymph node in a 23-year-old woman are reported. Characteristic granulomas, with peripherally palisading epithelioid histiocytes and centrally located neutrophils, and an associated polymorphic cell population were observed. The cytologic pattern closely parallels the expected histopathologic findings and therefore can suggest the diagnosis in unsuspected cases or can confirm the clinical impression. The cytologic differential diagnosis and a discussion of other granulomatous lymphadenitis are presented.

Adult↗
PubMedDate not supplied

Fine needle aspiration cytology of primary epidermoid cyst of the brain.

The cytologic features of a primary epidermoid cyst of the brain diagnosed by intraoperative fine needle aspiration cytology are reported. The cytomorphologic findings included numerous anucleated squames, polarizable cholesterol crystals and a few squamous cells with keratohyaline granules. This case demonstrated the efficacy of using both the Diff-Quik and Papanicolaou stains in evaluation of cystic lesions of the brain. A discussion of the expected aspiration cytologic findings of other cystic cerebral lesions is also presented.

Adult↗
PubMedDate not supplied

Aspiration biopsy cytology of malignant schwannoma metastatic to the lung.

The aspiration biopsy cytologic features of a malignant schwannoma metastatic to the lung in a 39-year-old black female with von Recklinghausen's disease are reported. Cytologic features of malignant sarcomas having a spindle-cell pattern are described along with a discussion of the cytologic differential diagnosis. This is believed to be the first reported case of a malignant schwannoma involving the lung diagnosed by aspiration cytology and demonstrates the usefulness of the technique in evaluating patients with metastatic sarcomas.

Adult↗
PubMedDate not supplied

Fine needle aspiration cytology of renal and retroperitoneal angiomyolipoma. Report of two cases with cytologic findings and clinicopathologic pitfalls in diagnosis.

BACKGROUND: Angiomyolipoma is a benign soft tissue neoplasm that usually arises in the kidney, although rare extrarenal examples have been documented. CASES: Two cases of the neoplasm occurred in which fine needle aspiration (FNA) biopsies were performed. The first patient was a 73-year-old female with a history of breast carcinoma who presented with a large retroperitoneal mass. Transabdominal FNA biopsy revealed multiple fragments of spindle-shaped mesenchymal cells, a few of which showed marked cellular atypia with occasional cells containing fat vacuoles, producing a lipoblastlike appearance. However, the atypical spindle cells were immunohistochemically reactive for actin, raising the possibility of a smooth muscle tumor rather than a liposarcoma. The surgically resected specimen revealed an extrarenal, retroperitoneal angiomyolipoma. The second patient was a 71-year-old female who presented with a right renal mass and hepatomegaly. Computed tomography showed a mass in the upper pole of the kidney and multiple enhancing lesions in the liver. FNA biopsy was diagnostic of angiomyolipoma, which was confirmed histologically. CONCLUSION: Angiomyolipoma should be considered in aspirates of both renal and extrarenal masses when an admixture of blood vessels, fat and smooth muscle cells is encountered. Pitfalls leading to an incorrect diagnosis include aspiration at unusual sites for angiomyolipoma and/or the presence of atypical spindle cells and lipoblastlike cells, which can be mistaken for leiomyosarcoma or liposarcoma cells. Ancillary studies, such as immunocytochemistry for smooth muscle markers, may be helpful in making the correct diagnosis.

Aged↗
PubMedDate not supplied

Collagenous spherulosis. Report of a case with diagnosis by fine needle aspiration biopsy with immunocytochemical and ultrastructural observations.

Collagenous spherulosis (CS) is a benign breast lesion usually seen in association with other benign proliferative processes in the breast. To the best of our knowledge, this is the second fine needle aspiration (FNA) cytologic report of CS and the first with corresponding immunocytochemical and ultrastructural studies performed on the subsequent biopsy material. Cytologically, the aspirate consisted of scattered, metachromatically staining hyaline globules seen best with Diff-Quik stain in intimate association with numerous groups of benign ductal cells some of which had a papillary configuration. The globules exhibited periodic acid-Schiff positivity. A subsequent excisional biopsy confirmed the cytologic impression and revealed a multifocal process of ductal papillomas and papillomatosis containing numerous eosinophilic spherules with morphologic features and histochemical staining reactions typical of CS. Electron microscopic and immunoperoxidase studies suggest the spherules to be composed predominantly of basement membrane proteins, specifically type IV collagen, laminin and fibronectin, and to be derived principally from myoepithelial cells. Although CS has been found primarily in benign breast lesions, it can be found in other organs and in association with both benign and malignant processes. The differential diagnosis of other breast lesions that can be confused with CS on FNA biopsy is presented.

Adult↗
PubMedDate not supplied

Fine needle aspiration cytology of pleomorphic lobular carcinoma of the breast. Duct carcinoma as a diagnostic pitfall.

Pleomorphic lobular carcinoma (PLC) of the breast is a subtype of lobular carcinoma of the breast that is well recognized in the surgical pathology literature. Fine needle aspiration (FNA) recognition of this subtype is important, for the subtype characteristically pursues an aggressive clinical course as compared to the classic lobular carcinoma of the breast. The cytologic literature on this entity is nonexistent. We describe the FNA findings in a series of four cases of PLC diagnosed retrospectively, discuss the cytologic features that are useful in the recognition of this entity and the diagnostic pitfalls, and propose classifying these tumors as a high (poor) nuclear grade variant of lobular carcinoma, analogous to the grading scheme in use for aggressive ductal carcinomas.

Biopsy, Needle↗
PubMedDate not supplied

Value of ancillary studies in fine needle aspiration cytology of the lung.

The importance of ancillary studies in surgical pathology of the lung is well documented. Less well established is the utility of these methods in fine needle aspiration (FNA) cytology of the lung. We reviewed our experience over a two-year period (1990-1991) with the use of ancillary studies in addition to routine light microscopy in FNA of the lung. Three hundred forty-five percutaneous aspirations were performed under radiologic guidance during this period. A diagnosis of malignancy was made in 233 (68%) cases. Thirty-two aspirates provided specific benign inflammatory or infectious diagnoses of mass lesions. Approximately one-half the cases required no additional studies (181/345, 52%). Immunocytochemistry was performed in 50 cases (14.5%), electron microscopy (EM) in 28 cases (8%), microbiologic staining in 42 cases (12%), mucin staining in 72 cases (21%) and cell blocks in 77 cases (22%). Immunocytochemistry and EM were generally used to classify poorly differentiated neoplasms, confirm the diagnosis of bronchioloalveolar cell carcinoma, determine neuroendocrine differentiation and establish primary sites for suspected metastatic malignancies. Immunocytochemistry provided significant additional information in 20 (40%) of the cases in which it was attempted and confirmed the light microscopic impression in an additional 18 cases (36%). Similarly, EM provided significant additional information in 10 cases (67%) and confirmed the light microscopic impression in an additional 4 cases (27%). Microbiologic staining was performed when an infectious etiology was suspected clinically or an inflammatory (especially granulomatous) background was present in the smears. In 11 cases (27%) the staining was positive for organisms. Mucin staining was performed in an attempt to better classify poorly differentiated non-small cell malignancies and was contributory in 68% of the cases. In conclusion, ancillary studies are helpful in confirming the cytologic impression and making a more specific diagnosis in FNA of the lung.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMedDate not supplied

Fine needle aspiration biopsy of the spleen in the evaluation of neoplastic disorders.

Splenic fine needle aspiration (FNA) biopsy has been used mainly in Europe to diagnose nonneoplastic systemic diseases. A few reports have described FNA biopsy of the spleen for the diagnosis of lymphoma. There is a definite paucity of North American reports concerning FNA biopsy for metastatic disease involving the spleen; that probably is a reflection of both the relative infrequency of splenic metastases and concern about potential hemorrhagic complications of the procedure. We report a series of 11 FNA biopsies of the spleen in patients with known carcinoma or hematologic malignancies. The FNA biopsies were performed on eight males and three females with a median age of 45 years and a range of 6-77 years. Six patients had a known hematopoietic malignancy at the time of aspiration (five non-Hodgkin's lymphoma, one acute myelogenous leukemia [AML]). The one patient with Hodgkin's disease had an FNA biopsy of the spleen as part of the initial workup; cytologic impression was atypical lymphoid cells with granulomas suggestive of Hodgkin's disease, which was confirmed by splenectomy. Four patients with carcinoma (two testicular, one lung, one ovarian) had FNA biopsies for the evaluation of splenic nodules; FNA biopsy confirmed metastatic carcinoma in three of these patients. In the entire series splenic FNA biopsy documented malignancy in 6 of the 11 patients. The one patient with AML had Aspergillus identified in the splenic aspirate, while granulomatous inflammation with yeast consistent with Candida was seen in a patient with non-Hodgkin's lymphoma. One aspirate demonstrated abscesses without recognizable organisms, and another showed extensive necrosis in a patient with testicular choriocarcinoma. Only one hemorrhagic complication was noted following splenic biopsy. Our experience demonstrates that FNA biopsy of the spleen is a useful and safe procedure in evaluating infectious and neoplastic splenic masses in patients with hematopoietic malignancies and carcinoma.

Adolescent↗
PubMedDate not supplied

Fine needle aspiration biopsy of fibromatoses.

Fibromatoses form a spectrum of clinicopathologic entities characterized by the infiltrative proliferation of fibroblasts that lack malignant cytologic features. Fibromatoses present as nodular soft tissue masses almost anywhere in the body and thus are often amenable to fine needle aspiration (FNA). This report describes the FNA cytologic findings of fibromatosis in six patients ranging in age from 7 1/2 weeks to 36 years. Two of the lesions arose in the abdominal wall (musculoaponeurotic fibromatosis or extra-abdominal desmoid), and one each involved the plantar surface (Ledderhose's disease), the shoulder and the sternocleidomastoid muscle (Fibromatosis coli). The FNA of the shoulder was initially interpreted as nodular fasciitis due to the clinical presentation of a rapidly growing mass; an aspirate from the deep musculoaponeurotic region was believed to reveal a low grade sarcoma. The FNA diagnosis of musculoaponeurotic fibromatosis in a patient with familial polyposis coli suggested the diagnosis of Gardner's syndrome. Cytologically the aspirates consisted of groups of loosely cohesive, bland-appearing, spindle-shaped cells having oval to elongated nuclei and cytoplasmic tags. Individual spindle cells and rare inflammatory cells were also present. The aspirate of fibromatosis coli also contained degenerating skeletal muscle cells. Tissue confirmation was obtained in four cases. We believe that FNA is a useful procedure for the initial and recurrent diagnosis of fibromatoses and in the separation of fibromatoses from other benign and malignant soft tissue lesions. A discussion of other entities that enter into the cytologic differential diagnosis, such as mesenchymal repair, fasciitis and spindle cell types of sarcoma, is presented. From our experience we believe that the clinicopathologic features can suggest the diagnosis of fibromatosis, but histologic confirmation is recommended.

Adult↗