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J F Silverman

Publications and source records attributed to J F Silverman.

At least 55 records · Page 3Linked to original sources
PubMed1997

Spindle-cell lesions of the mediastinum: diagnosis by fine-needle aspiration biopsy.

Spindle cells seen in fine-needle aspiration biopsy (FNAB) of the mediastinal lesions can be a component of a wide variety of benign and malignant conditions. Few of these conditions, however, are described in the FNA cytopathology literature. This review discusses the cytopathologic features, differential diagnoses, and potential pitfalls of a variety of lesions with a significant component of spindle cells encountered in mediastinal FNAB. The cytopathology files from four institutions were searched for cases of mediastinal FNAB containing a spindle-cell component that was a key or predominant cytologic feature of the diagnostic specimen. The cytomorphologic features of these cases were analyzed, and their differential features are discussed. Of 196 mediastinal FNABs, 22 (11%) were lesions with significant spindle-cell component: granulomatous inflammation (four); benign nerve sheath tumor (four); thymic cyst (two); spindle-cell thymoma (two); large-cell non-Hodgkin's lymphoma with sclerosis (two); nodular sclerosing Hodgkin's disease (two); liposarcoma (two); spindle-cell squamous carcinoma possibly arising in a teratoma (one); unspecified high-grade sarcoma (one); spindle-cell malignant melanoma (one); and nonspecific fibrous tissue (one). The cytologic features of each lesion were analyzed as an aid for accurate classification. These findings were correlated with radiologic and clinical information when available. The value of ancillary studies performed on aspirated material in selected cases was also reviewed. FNA of mediastinal lesions with significant spindle-cell morphology represents an infrequent and heterogeneous group of entities that may pose significant diagnostic challenges. This review presents the salient cytopathologic features of various spindle-cell lesions of the mediastinum with particular emphasis on differential diagnosis and pitfalls. The pathologist must use caution when interpreting these lesions and ancillary studies may be of significant value in selected cases.

Adolescent↗
PubMed1997

Fine-needle aspiration cytomorphology of clear-cell hepatocellular carcinoma.

The clear-cell type of hepatocellular carcinoma is an uncommon variant of hepatoma that can be confused with other clear-cell malignancies. We report on 4 cases of clear-cell hepatocellular carcinoma diagnosed by computed tomography (CT)-guided fine-needle aspiration (FNA) biopsy. All 4 patients were men with a median age of 71 yr (age range 66-76 yr). Three patients presented with a solitary liver mass and no known extrahepatic primary malignancies. The fourth patient, previously diagnosed with non-A, non-B posttransfusion hepatitis, presented with an irregular firm liver and abnormal serum liver function tests. Cytologically, all cases were characterized by hypercellular smears consisting of loosely cohesive groups and individually scattered malignant cells demonstrating anisonucleosis, nuclear hyperchromasia and irregularity, prominent nucleoli, and abundant finely vacuolated to clear cytoplasm. Immunocytochemical staining in three cases revealed focal positivity of the malignant cells for cytokeratin (AE1/3) and alpha-fetoprotein in one case. Electron microscopy (EM) was performed in all cases and revealed ultrastructural features consistent with hepatocellular differentiation. The cytologic differentiation of clear-cell hepatocellular carcinoma from metastatic clear-cell malignancies of renal, ovarian, and adrenal origin, among others, is presented. In addition, EM and immunocytochemistry study of the aspirated material can aid in establishing the correct diagnosis, thereby facilitating appropriate clinical management.

Adenocarcinoma, Clear Cell↗
PubMed1997

KRAS oncogene mutations suggest a common histogenetic origin for pleomorphic giant cell tumor of the pancreas, osteoclastoma of the pancreas, and pancreatic duct adenocarcinoma.

Giant cell neoplasms of the pancreas are rare tumors of uncertain histogenesis. Mutation of the KRAS oncogene is common in typical pancreatic duct adenocarcinoma. We have analyzed DNA from five pancreatic tumors with giant cells for mutations in the KRAS oncogene and found alterations of the second position of codon 12 in each case (four G > A transitions and one G > C transversion). The common mutation pattern in tumors with giant cells and duct adenocarcinoma suggests a common route to malignant transformation and may indicate a shared histogenesis. We also tested 11 cases of malignant fibrous histiocytoma, a histological mimic of pleomorphic giant cell tumor, for mutations in the KRAS oncogene. The absence of KAS mutations in each of the malignant fibrous histiocytomas (MFHs) and in other histologically similar tumors may provide assistance in the differential diagnosis of pleomorphic pancreatic tumors.

Adenocarcinoma↗
PubMed1997

Sensitivity and cost-effectiveness of fine-needle aspiration with immunocytochemistry in the evaluation of patients with a pulmonary malignancy and a history of cancer.

OBJECTIVE: To determine the sensitivity and cost-effectiveness of transthoracic fine-needle aspiration in the separation of primary from metastatic malignancy. MATERIALS AND METHODS: Eighty-nine malignant pulmonary fine-needle aspirations in patients with a history of cancer were classified retrospectively by light microscopy, comparison with previous material, and immunocytochemistry. Decision analysis compared the cost-effectiveness of fine-needle aspiration, bronchoscopy, and thoracoscopy. RESULTS: Fine-needle aspiration classified 87% of the malignancies as primary (n = 7) or metastatic (n = 70) and 13% as indeterminate. By immunocytochemistry alone, 14 of 18 malignancies were subclassified. Decision analysis showed that pulmonary fine-needle aspiration with select use of thoracoscopy was more cost-effective than either bronchoscopy or thoracoscopy alone in many common clinical scenarios. CONCLUSIONS: Pulmonary fine-needle aspiration with immunocytochemistry is sensitive and cost-effective in subclassifying malignancies in patients with a history of cancer.

Adult↗
PubMed1996

Fine-needle aspiration of chondroblastic osteosarcoma of the skull: report of a case in an 11-year-old girl.

We describe an unusual case of chondroblastic osteosarcoma of the skull in an 11-yr-old girl in whom a preoperative diagnosis was made by fine-needle aspiration (FNA) biopsy, followed by histologic confirmation of tissue biopsy and the surgically resected specimen. FNA cytology revealed pleomorphic oval cells with prominent nucleoli along with spindle cells, tumor giant cells, and a chondromyxoid background. The cell block of the aspirated material showed osteoid associated with the malignant cells. Immunocytochemical stains revealed S-100 and vimentin positivity; actin, myoglobin, and cytokeratin stains were negative. Electron microscopy revealed neoplastic cells with chondrocytic differentiation. This case demonstrates the value of FNA biopsy combined with immunocytochemical and ultrastructural studies performed on the aspirated material in diagnosing osteosarcoma from an unusual location such as the base of the skull.

Biopsy, Needle↗
PubMed1996

Cytologic diagnosis of bile peritonitis.

Bile peritonitis (BP) is a rare but acute and serious condition that may be associated with high mortality. BP results from generalized or localized leakage of bile into the peritoneal cavity. At best, radiologic studies may be suggestive of BP. We observed a spectrum of cytologic findings in aspirated peritoneal fluids (PF) from 3 patients with BP. Occasional bile pigment-laden macrophages, extracellular lakes of green stringy material admixed with variable numbers of histiocytes, mesothelial cells, and acute and chronic inflammatory cells, were seen. Numerous candida were present in one case. To the best of our knowledge, this is the first report describing the cytologic features of BP. Cytology is a simple, rapid, and cost-effective means of examining PF, and can therefore play a significant role in establishing the diagnosis of BP. Early recognition of BP can result in rapid, therapeutic intervention that may prevent significant morbidity and mortality.

Adult↗
PubMed1996

Role of immunocytochemistry, electron microscopy, and DNA analysis in fine-needle aspiration biopsy diagnosis of Wilms' tumor.

We reviewed the cytologic features and results of ancillary studies in eight fine-needle aspiration biopsies (FNAB) performed by posterior approach in 8 patients with unresectable Wilms' tumor (WT). Chemotherapy was given following the FNAB diagnosis of WT, which was confirmed subsequently by histologic examination of surgically resected specimens. Indications for FNAB included: unresectable tumor, bilateral disease, initial presentation with metastatic disease, uncertainty regarding tumor site, and documentation of recurrence. Cytologic examination revealed blastemal cells (8/8 aspirates), spindle cells (3/8 aspirates), and epithelial differentiation or tubules (3/8 aspirates). There was no cytologic evidence of anaplasia in any of the cases. Immunocytochemical studies on cell blocks and/or smears showed cytokeratin positivity in 5/8 and vimentin positivity in 5/5 of the aspirates in which these studies were performed. Focal positivity for neuron-specific enolase (NSE) was seen in 3/3 aspirates. Stains for actin and leukocyte-common antigen were negative (0/3 and 0/2 aspirates, respectively). DNA ploidy analysis of the aspiration material by flow cytometry revealed near-diploid populations in three aspirates. Electron microscopic findings helpful for diagnosis included: cell junctions, microvilli, flocculent basement membrane-like material, cilia, autophagolysosomes, and lack of neuroectodermal differentiation. Diagnostic morphologic pitfalls for an incorrect diagnosis of neuroblastoma included nuclear molding (all aspirates), pseudorosette formation (one aspirate), and focal NSE positivity (3/3 aspirates). None of the tumors showed anaplasia on histologic examination. Cytologic recognition of the triphasic cellular components of WT (blastemal cells, spindle cells, and epithelial cells) can be helpful for a correct diagnosis; however, in 5/8 aspirates in this study, only the blastemal component was present. In these cases, immunocytochemical stains and electron microscopy proved useful in arriving at a correct FNAB diagnosis of WT. However, NSE positivity can be a pitfall for a diagnosis of neuroblastoma if the radiologic, clinical, and other cytologic features are not clearly delineated. Presence of cytokeratin and vimentin positivity would be helpful in the diagnosis of WT in such instances.

Biopsy, Needle↗
PubMed1996

Detection of Trichomonas vaginalis in endocervical and ectocervical smears.

The objective of this study was to determine the relative sensitivity of detecting Trichomonas vaginalis in endocervical as compared to ectocervical Papanicolaou-stained smears. The average number of organisms in 10 (200x) high-power fields (hpf) per smear was used for comparing the presence of trichomonads in the two smear types. In every pair of ectocervical-endocervical smears, there were always more trichomonads in the ectocervical smear. Fifty percent of cases showed at least 25 more trichomonads per 200x hpf in the ectocervical smear than in the endocervical smear. In 20 of 50 cases (40%), trichomonads were present only in the ectocervical smear. The organisms were found only in the endocervical smears of women with a heavier ectocervical trichomonad burden. In conclusion, trichomonads are detected in the Papanicolaou-stained ectocervical smear more often than in the endocervical smear; therefore, examination of an adequate ectocervical smear has greater utility than the endocervical smear for the diagnosis of trichomoniasis.

Animals↗
PubMed1996

Fine-needle aspiration cytology of metastatic small cell carcinoma of the colon: a report of three cases.

Small cell carcinoma of the large intestine is a rare, extremely aggressive malignancy often associated with an overlying adenoma. We report three cases of metastatic small cell carcinoma of the colon diagnosed by fine-needle aspiration (FNA) biopsy. Two of the patients were women (ages 33 and 46 yr old) and one was a man (69 yr old). FNA biopsy established the diagnosis of metastatic small cell carcinoma involving the liver (2 cases) and soft tissue of the scapular region (1 case). In one patient, the FNA diagnosis of hepatic metastases preceded identification of the primary site. Subsequently, the patient was found to have a small cell carcinoma subadjacent to a colonic villous adenoma, illustrating the importance of investigating villous lesions of the colon in patients with metastatic small cell carcinoma of unknown primary origin (especially in non-smokers). All three cases showed the characteristic cytologic features of small cell carcinoma. Ancillary studies performed on aspirated material confirmed the diagnosis of small cell carcinoma in one case. Immunocytochemical studies revealed punctate cytokeratin and diffuse neuron-specific enolase (NSE) positivity of the malignant cells. Ultrastructurally neurosecretory granules were evident. To the best of our knowledge, this is the first FNA cytologic report of metastatic small cell carcinoma of the large intestine. This FNA report also demonstrates when a small cell carcinoma is detected in a metastatic site in a patient lacking a lung primary, a likely primary site could be adjacent or beneath a polypoid lesion of the colon.

Adult↗
PubMed1996

Fine-needle aspiration biopsy of the mediastinum. A multi-institutional analysis.

The combined experience of four university medical centers with fine-needle aspiration biopsy (FNAB) of the mediastinum is reviewed. This series includes 189 cases, with 100 males and 89 females, 6 months to 86 years of age. The majority (71%) of diagnoses were neoplastic with the remainder equally distributed between nondiagnostic/unsatisfactory and nonneoplastic lesions. Malignant lymphoma and thymoma were the most frequent primary malignancies. Metastatic tumors represented the majority (60%) of neoplasms identified by FNAB. In 16% of these cases, the primary tumor was not identified. The majority (67%) of metastases were from the lung and were predominantly small cell type (52%). Sixty-six ancillary tests were performed on 51 cases (27%). Histologic correlation was available in 78 of 189 (41%) cases, with a diagnostic sensitivity and specificity of 87% to 88% for the detection of neoplasm and 82% to 83% for distinguishing benign from malignant disease. The positive predictive value for the presence of neoplasm was 97% with three cytologic false positives identified. This series is the largest to date on the utility of FNAB for lesions of the mediastinum.

Adolescent↗
PubMed1996

Bronchoalveolar lavage cytology in pulmonary alveolar proteinosis.

Pulmonary alveolar proteinosis (PAP) is an uncommon disease in which alveoli are progressively filled with surfactant-related material. Although a definitive diagnosis is usually made by an open lung biopsy, bronchoalveolar lavage (BAL) cytology may play a decisive role in the clinical work-up of these patients, and, in some cases, may spare a patient a more invasive diagnostic procedure. The authors present three patients in whom BAL cytology specimens contained the characteristic (although not specific) globules of amorphous proteinaceous PAS-positive material accompanied by only rare background macrophages and inflammatory cells. The patients include a 40-year-old man with an 8-year history of fever of unknown origin, a 30-year-old man with a chronic nonproductive cough, and a 6-year-old boy diagnosed at 5 months of age with osteopetrosis and hypogammaglobulinemia who subsequently developed a disseminated Mycobacterium avium-intracellulare infection. All specimens stained with Gomori methenamine silver (3) and Ziehl-Neelsen (2) were negative for microbial organisms, Ultrastructural examination of two specimens revealed the characteristic lamellar structures of surfactant, increasing diagnostic specificity. Lung biopsies and/or autopsy subsequently confirmed the diagnosis in all three cases. The characteristic cytologic and ultrastructural features of PAP in BAL specimens are presented along with the morphologic differential features of other entities which potentially could be confused with PAP.

Adult↗
PubMed1995

Effusion cytology in Burkitt's lymphoma.

The American form of Burkitt's lymphoma is a high-grade malignancy which usually involves the abdomen in children and young adults. There is only a limited literature which describes the cytologic features of Burkitt's lymphoma in serous effusions. We present three children with Burkitt's lymphoma initially diagnosed by effusion cytology. The first patient, an 11-yr-old boy, presented with bilateral pleural effusions, ascites, and abdominal masses and had diagnostic pleural fluid cytology without tissue confirmation (ultrastructural examination was performed on the effusion specimen). He died 7 months after the initial diagnosis. The second patient, a 9-yr-old boy, presented with ascites and abdominal masses and had diagnostic peritoneal fluid cytology with a subsequent confirmatory chest wall biopsy. The third patient, a 16-yr-old girl, presented with a 2-month history of irregular menses, a large pelvic mass, lymphadenopathy, and liver masses. Although an ovarian malignancy was clinically suspected, cytologic examination of her peritoneal fluid revealed Burkitt's lymphoma. Surgical exploration revealed involvement of her right ovary, cecum, and terminal ileum. The second and third patients are currently alive with no apparent disease following chemotherapy. In all three patients, effusion cytology revealed Burkitt's lymphoma, characterized by a uniform population of non-cohesive lymphoid cells with noncleaved nuclei, prominent multiple nucleoli, and scanty-to-moderate basophilic cytoplasm. Cytoplasmic and/or nuclear vacuoles were also seen, more prominent in Diff-Quik-stained, air-dried smears. These cases demonstrate the importance of recognizing the cytologic features of Burkitt's lymphoma, as serous fluid may be the initial diagnostic specimen.

Adolescent↗
PubMed1995

Fine-needle aspiration cytopathology of soft tissue: chondromyxoid and myxoid lesions.

Soft-tissue lesions pose an intimidating challenge to diagnostic interpretation by fine-needle aspiration cytology. To better characterize such aspirates, we investigated a subgroup of lesions which yielded a large amount of chondromyxoid and myxoid stroma (CMS). Thirty-three cases (22 malignant lesions, 11 benign lesions) in which CMS was a prominent feature of the smears were studied. The most common malignant neoplasms were extraskeletal chondrosarcoma (6 cases), myxoid liposarcoma (6), and malignant fibrous histiocytoma (5). The benign entities consisted of ganglion cyst (4), myxoma (3), and neurofibroma (2). Of the aspirates from 22 malignant neoplasms, 15 (68%) contained opaque stroma, and in 18 (81%) the stroma was distributed as discrete clumps or fragments; all extraskeletal chondrosarcomas and chordomas contained these features. Additionally, in five of six chondrosarcomas the matrix exhibited cells within lacunae. Except for a tracheal chondroma which extended into the adjacent soft tissue, no benign aspirates had all three of these cytologic features. Twenty-three aspirates (70%) were moderately or highly cellular; all but two of these were malignant. Moderate to marked nuclear atypia occurred in 13/22 (59%) malignant and 1/11 (9.0%) benign aspirates. With a few exceptions, aspiration smears of benign lesions with abundant CMS were characterized by low cellularity, semitransparent amorphous stroma, and lack of nuclear irregularity. Recognition of variations in the character of the background material in addition to traditional cytologic criteria can aid in the diagnosis of benign and malignant chondromyxoid and myxoid aspirates of soft tissue.

Adolescent↗
PubMed1995

Extragonadal germ cell tumors: a fine-needle aspiration biopsy study.

Germ cell tumors (GCT) are neoplasms that originate predominately in the ovary and testis. Tumors of germ cell origin only very uncommonly arise in extragonadal sites. We have diagnosed ten primary malignant extragonadal GCT arising in the mediastinum, retroperitoneum, liver, and sacrococcygeal region by fine-needle aspiration biopsy (FNAB). Patient ages ranged from 1 to 54 years; the majority were males. Our series included three seminomas, three yolk sac tumors (YST), one choriocarcinoma, one embryonal carcinoma, and two mixed, poorly differentiated GCT. In aspirates, seminomatous elements are dissociated with uniform mononucleate cells having large vesicular nuclei and prominent nucleoli. A tigroid background is produced with Diff-Quik-stained smears. YST yields cohesive clusters of cells with large nuclei, vacuolated cytoplasm, and extracellular hyaline matrix (spheres or hyaline globules). Giant multinucleate tumor cells are seen in choriocarcinoma. Embryonal carcinoma yields cellular smears of hyperchromatic cells with scant cytoplasm arranged predominantly in glandular or papillary formations. Ultrastructural (four cases) and immunocytochemical (seven cases) studies of aspirated material corroborated our cytologic interpretations. Aneuploid tumor cells were found by flow cytometry in aspirated material from a YST. Subsequent histologic examinations were performed on eight, and all were confirmatory. Although extragonadal GCT are relatively uncommon, they need to be considered in FNAB material from midline mass lesions. Ancillary studies were useful in confirming their diagnosis.

Adult↗
PubMed1995

Serous effusion cytology in gynecologic malignant mixed müllerian tumors.

We reviewed 51 serous effusions (50 peritoneal/one pleural) from 38 patients with uterine (30 cases) and ovarian (eight cases) malignant mixed Müllerian tumors (MMMT). There were 16 patients (42%) with positive effusion cytology specimens; 13 cases (81%) were diagnosed as adenocarcinoma with three cases (19%) interpreted as having a sarcomatous component. Eight of 16 positive effusion specimens had cell block material available for immunoperoxidase (IP) study that included cytokeratin (AE1/3), vimentin, muscle specific actin (HHF) and S-100 protein to determine if unsuspected mesenchymal components were present in the cases originally diagnosed as carcinoma (six cases), or sarcomas (two cases). In the six cases originally interpreted as carcinoma, three were diagnosed as adenocarcinoma and three as poorly differentiated carcinoma. All three of the cases considered adenocarcinoma and two of those diagnosed as poorly differentiated carcinoma reacted only with AE1/3 and vimentin. The remaining case, considered a poorly differentiated carcinoma, stained only with vimentin. In the two cases having cell blocks interpreted as having a sarcomatous component, only vimentin was positive in one while AE1/3, vimentin, HHF, and S-100 were positive in the other. The case where all immunohistochemical stains were reactive contained both carcinomatous and sarcomatous components. In the three cases considered sarcomatous, the cytomorphologic features helpful in the recognition of a mesenchymal component included a dissociated smear pattern of pleomorphic round to oval cells and/or spindle cells. In retrospect, the IP stains did not alter any of the original diagnoses.(ABSTRACT TRUNCATED AT 250 WORDS)

Ascitic Fluid↗