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J F Silverman

Publications and source records attributed to J F Silverman.

At least 73 records · Page 4Linked to original sources
PubMed1995

Significance of epithelial membrane antigen in the work-up of problematic serous effusions.

Differentiation of reactive and/or atypical mesothelial cells from malignant epithelial cells in serous effusions remains a frequent diagnostic problem. Since epithelial membrane antigen (EMA) positive malignant cells in serous effusions have been reported in almost all adenocarcinomas and most malignant mesotheliomas, immunoreactivity for EMA is felt to be less useful than other antibodies in the workup of problematic serous effusions. However, immunostaining of reactive and/or atypical benign mesothelial cells for EMA has not been well studied, with only a few series reporting either weak or negative staining for EMA. This study was undertaken to evaluate how often reactive and/or atypical appearing mesothelial cells stain positively for EMA. One hundred eighty serous effusions (115 pleural, 55 peritoneal, and 10 pericardial) from 123 females and 57 males ages 20 to 89 yr were evaluated in which an antibody panel including EMA was performed on cell blocks (141 cases), cytospins (36 cases), or both (3 cases). Of the 100 cytologically positive cases, EMA immunoreactivity was present in 97/100 (97%) cases. One EMA negative case suspicious for a metastatic renal cell carcinoma was lost to follow-up and not included in the analysis. The remaining three negative cases consisted of malignancies not expected to have EMA positive cells (small cell carcinoma, neuroblastoma, and synovial sarcoma). Therefore, EMA was positive in virtually 100% of the remaining malignant cases. In the 78 cytologically negative cases, EMA positivity was present in 3/78 (3.8%) cases. Clinical follow-up of up to 14 mo in these three cases revealed no evidence of malignancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Unusual small bone metastases from epithelial malignancies: diagnosis by fine-needle aspiration cytology with histologic confirmation.

Although epithelial malignancies can have bone metastases, involvement of small bones is exceedingly rare, representing either first manifestation of an occult carcinoma or late disseminated disease. Small bone metastases may mimic primary skeletal diseases leading to misdiagnosis and delayed treatment. We report three cases of metastatic epithelial malignancies diagnosed by computed tomography (CT)-guided fine-needle aspiration (FNA) biopsy in two patients with lytic calcaneal lesions and a patellar lesion in a third patient; all with histologic confirmation. Case 1, a 63-year-old female, presented with heel pain. FNA and tissue biopsy of the calcaneus revealed a clear cell malignancy consistent with a renal primary. Follow-up abdominal CT scan revealed a renal lesion consistent with renal cell carcinoma. Case 2, a 37-yr-old male with squamous cell carcinoma of the esophagus, presented with foot pain. FNA and tissue biopsy of the calcaneous revealed metastatic squamous cell carcinoma. Case 3, a 52-yr-old male with a history of squamous cell carcinoma of floor of mouth, presented with knee pain and swelling. FNA and tissue biopsy of the patella revealed metastastic squamous cell carcinoma. To the best of our knowledge, this is the first complete FNA cytology report with histologic confirmation of unusual small bone metastases of the feet and patella from epithelial malignancies and shows the value of FNA cytology in establishing a correct diagnosis, and excluding primary skeletal diseases.

Adolescent↗
PubMed1995

Endoscopically removed malignant colorectal polyps: clinicopathologic correlations.

BACKGROUND/AIMS: Treatment options for patients with endoscopically removed malignant colorectal polyps are polypectomy alone vs. polypectomy followed by surgery. The aim of this study was to define histopathologic parameters that can be used for clinically relevant treatment decisions. METHODS: Five pathologists evaluated 140 polyps for the presence or absence of unfavorable histology. Unfavorable histology was tumor at or near (< or = 1.0 mm) the margin and/or grade III and/or lymphatic and/or venous invasion. Adverse outcome was recurrent and/or local cancer and/or lymph node metastasis. RESULTS: Adverse outcome was 19.7% (14 of 71), 8.6% (2 of 23), and 0% (0 of 46) when unfavorable histology was present, indefinite (lack of agreement), and absent, respectively (P < 0.0005, present vs. absent). Four patients with cancer > 1.0 mm from the margin had an adverse outcome (2 with lymphatic invasion and 2 indefinite for lymphatic invasion). Four patients with negative resections later developed distant metastases. Eight patients (6.3%) died of disease, and 2 of 69 without unfavorable histology (both indefinite for lymphatic invasion) had an adverse outcome. Interobserver strength of agreement was substantial to almost perfect for margin, grade, and venous invasion and fair to substantial for lymphatic invasion. CONCLUSIONS: This system is usable clinically. Patients with unfavorable histology are probably best managed by resection postpolypectomy, whereas in the absence of unfavorable histology, they probably can be treated by polypectomy only.

Colonic Polyps↗
PubMed1995

Virchow's node revisited. Analysis with clinicopathologic correlation of 152 fine-needle aspiration biopsies of supraclavicular lymph nodes.

OBJECTIVE: The left supraclavicular lymph node (Virchow's node) may be involved by metastatic malignancies, including those of abdominal or pelvic origin. Almost all previous studies have been based on examination of surgically sampled tissue or postmortem examination. To our knowledge, there has not been a study for nearly 40 years addressing the metastatic pattern to the left supraclavicular lymph node. Furthermore, there has been no study comparing left with right supraclavicular lymph node metastasis or the utilization of fine-needle aspiration biopsy to samples these sites. DESIGN: A retrospective review of 152 fine-needle aspiration biopsies of supraclavicular lymph nodes was performed, and the neoplasms were grouped into six diagnostic categories from five primary regions. RESULTS: The patients ranged in age from 2 years to 94 years (average, 55 years) and consisted of 66 males and 83 females. Three patients were biopsied twice. Of the 152 fine-needle aspirations, 87 (57.2%) were of the left supraclavicular lymph node and 65 (42.8%) of the right supraclavicular lymph node. Of the 96 biopsies positive for malignancy, 58 (60.4%) were biopsies of the left and 38 (39.6%) were of the right supraclavicular lymph nodes. Sixteen of 19 pelvic tumors and all six primary abdominal malignancies metastasized to the left supraclavicular lymph node. Thorax, breast, and head and neck malignancies showed no differences in metastatic patterns to the right and left supraclavicular lymph nodes. Ten patients (10.4% of positive nodes) had a diagnosis of non-Hodgkin's lymphoma, leukemia, or Hodgkin's disease. Six patients (7.1% of positive nodes) had a metastasis of unknown primary site, and 19 cases (19.8%) had acute or chronic inflammation; seven of the latter cases demonstrated acid-fast bacilli in the aspirated smears. CONCLUSIONS: Fine-needle aspiration biopsy is an excellent initial procedure in the workup of an enlarged supraclavicular lymph node. Our study confirmed that malignancies originating in the pelvis or abdomen were significantly more likely to metastasize to the left supraclavicular lymph node and that the primary site and types of malignancies that involved the left supraclavicular lymph node were different from those involving the right supraclavicular lymph node.

Abdominal Neoplasms↗
PubMed1995

Fine-needle aspiration and surgical pathology of infectious lesions. Morphologic features and the role of the clinical microbiology laboratory for rapid diagnosis.

There has been a renewed interest in the use of imprint smears at the time of frozen section in surgical pathology and FNA biopsy for the diagnosis of infectious disease because of the increasing need for rapid diagnosis of opportunistic infections in immunocompromised patients. Moreover, the use of FNA biopsy for the evaluation of superficial and deep masses has become more widespread. The critical step in the FNA biopsy and in evaluation of imprint smears from surgical specimens is immediate interpretation of the slides that have been stained by rapid methods as the Diff-Quik technique. This quick interpretation can identify as infectious case that may need ancillary studies such as a separate pass or more tissue for microbiologic examination and special stains on the aspirated smears, sections, or cell block. An infectious case may be suspected when the basic cytologic inflammatory patterns are identified including acute inflammation, chronic inflammation, granulomatous inflammation, or necrosis. There have been numerous reports describing the cytomorphologic features of several organisms seen in FNA and tissue specimens. The pathologist also needs to be aware of the potential for a false-negative diagnosis of neoplasms in those lesions having a prominent inflammatory component as well as the potential for false-positive diagnosis of malignancy when inflammatory atypia and a repair reaction is present. The interaction of anatomic pathologists and clinical microbiologists is essential for appropriate workup of specimens with an infectious disease etiology. Thus, pathologists need to be well versed in both the anatomic and clinical pathology features of infectious diseases. Finally, those involved with FNA biopsy and handling of surgical pathology specimens should use universal precautions, since all patients are potentially infectious with the HIV virus and other communicable agents.

AIDS-Related Opportunistic Infections↗
PubMed1995

Pediatric thyroid nodules: disease demographics and clinical management as determined by fine needle aspiration biopsy.

OBJECTIVE: The prevalence of thyroid nodularity in children has been estimated to be 1.8%. The reported prevalence of specific diseases which comprise these nodules is conflicting as evidenced by a reported range of malignancy of 2 to 50% in solitary nodules. In order to better classify pediatric (< 18 years old) thyroid disease and evaluate the utility of fine needle aspiration biopsy (FNAB) in this patient population, we retrospectively reviewed 66 FNABs from 64 thyroid nodules and 2 perithyroid lymph nodes from 57 patients. METHODOLOGY PATIENTS: The study was composed of 8 males and 49 females who ranged in age from 1 to 18 years old (mean = 13.1). DESIGN: Surgical and/or clinical follow-up was obtained in all patients. The 66 FNAB diagnoses were initially classified into specific diseases. However, for the purpose of this review, the cases were classified as: 3 insufficient, 51 benign, 8 suspicious, and 4 malignant. RESULTS: There were no "false positives" and one "false negative" (a papillary carcinoma was misdiagnosed as a benign nodule). Overall, 10 patients (18%) had malignant thyroid lesions, including 8 papillary carcinomas and 2 follicular carcinomas. Benign diagnoses included benign nodule, cyst, lymphocytic thyroiditis, granulomatous thyroiditis, hyperplasia, and abscess. CONCLUSIONS: The prevalence of malignancy in pediatric patients with thyroid nodules was 18%. We conclude that, because of its high diagnostic accuracy and minimal invasiveness, FNAB is useful in the management of pediatric thyroid nodules.

Adolescent↗
PubMed1994

Fine-needle aspiration cytology of metastatic basal cell carcinoma of the skin to the lung.

Metastatic basal cell carcinomas of the skin are rare. We present the cytologic features of a metastatic basal cell carcinoma to the lung diagnosed by fine-needle aspiration biopsy. Cytologic examination revealed syncytial groups of relatively small cells with hyperchromatic, oval to spindle-shaped nuclei having high nuclear to cytoplasmic ratios. Immunocytochemical studies performed on the cell block sections revealed the malignant cells to be positive for cytokeratin (AE1/3) and negative for neuroendocrine markers, [neuron specific enolase (NSE) and chromogranin (Phe-5)]. We reviewed the literature related to metastatic basal cell carcinoma of the skin and discuss risk factors and mechanisms of metastatic spread. In addition, a discussion of the other entities that can enter into the differential diagnosis is presented along with the role of ancillary studies. To the best of our knowledge, we believe this is the first case report of the fine-needle aspiration (FNA) cytology of a basal cell carcinoma metastatic to the lung.

Biopsy, Needle↗
PubMed1994

Prognostic factors from the fine-needle aspirate: breast carcinoma nuclear grade.

Two of the most important microscopically derived morphologic prognostic factors for breast carcinoma patients are histologic type of tumor and nuclear grade. The recent literature stresses the importance of including these parameters in the surgical pathology report, yet there is little information in the cytology literature regarding the reporting of the nuclear grade of breast carcinomas from fine-needle aspirate biopsies (FNAB). In this retrospective study, we examined 104 ductal carcinomas of the breast in order to determine whether the FNAB derived nuclear grade and morphologic aspects of histological grading such as tubule formation and mitoses could accurately correlate with the same parameters on the tissue specimens. There was a correlation of 87% between the nuclear grade assigned by FNAB and the nuclear grade assigned to the tissue sample. Both the Diff-Quik and the Papanicolaou staining methods were assessed in this study and both gave comparable nuclear grade results. Tubule formation was difficult to assess on the cytologic samples and mitoses showed no correlation between cytologic and tissue specimens. The FNAB sample was not representative of the tissue nuclear grade in only 4.8% of the cases. Nuclear grade is especially important in patients treated with chemotherapy prior to definitive therapy for breast carcinoma. We conclude that the nuclear grading of breast carcinomas is performed with ease, correlates well with tissue nuclear grade, and, as a fundamental cytologic parameter, should be included in the fine-needle aspirate biopsy report whenever possible.

Biopsy, Needle↗
PubMed1994

FNA biopsy of small round cell tumors of childhood: cytomorphologic features and the role of ancillary studies.

Pediatric tumors which are conventionally considered to be small round cell tumors (SRCTs) include the prototypical neuroblastoma as well as rhabdomyosarcoma (RMS), Ewing's sarcoma (ES), malignant lymphoma, and primitive neuroectodermal tumor (PNET). Other malignancies may be considered in the differential diagnosis such as small-cell osteogenic sarcoma, undifferentiated (anaplastic) hepatoblastoma, granulocytic sarcoma, blastemal type Wilms' tumor, and desmoplastic small-cell tumor of the peritoneum. The cytomorphologic features of conventional SRCTs is presented as well as the utility of ancillary studies performed on the aspirated material in making a specific and correct diagnosis. The role of the immediate cytologic assessment of the aspirate is stress, since this is a critical step in formulating an initial diagnostic impression that should prompt the need for additional material for pertinent ancillary studies. Although challenging, FNA cytology of SRCTs of childhood can be diagnostic in the majority of cases, allowing specific therapy to be given to patients with unresectable SRCTs without a tissue biopsy as well as documenting recurrent and/or metastatic disease.

Adolescent↗
PubMed1994

Fine-needle aspiration cytology of hepatic leiomyosarcoma.

Hepatic leiomyosarcoma is a rare malignancy to involve the liver, occurring as a primary liver sarcoma in patients without an underlying medical disorder, as a metastatic malignancy, and with increasing incidence, as a primary tumor in AIDS patients. A series of hepatic leiomyosarcomas diagnosed by FNA biopsy, including the first reported case in an adult AIDS patient, were reviewed with respect to cytomorphologic features. The series consisted of five men and two women ranging from 24 to 72 years of age. One case was a primary hepatic lesion in a 24-yr-old man with AIDS and six were metastatic from a number of sites (stomach, small bowel, retroperitoneum, vena cava, and seminal vesicle). Two cytologic patterns were identified. Aspirates of spindle-cell leiomyosarcomas (six cases) generally produced hypocellular smears composed primarily of small irregular clusters of cells with blunt-ended, uniform, overlapping nuclei. The differential diagnosis included benign reactive processes and other benign and malignant spindle-cell neoplasms. The aspirate of an epithelioid leiomyosarcoma (one case) revealed a second pattern characterized by highly cellular smears with many single polygonal cells having eccentric, malignant nuclei and a characteristic clear quality to the cytoplasm in Papanicolaou-stained material. This epithelial appearance generated a differential diagnosis that included hepatocellular carcinoma, metastatic carcinoma, and melanoma. Careful integration of clinical information, cytomorphologic features, and ancillary studies will allow specific FNA diagnosis of hepatic leiomyosarcoma in most cases.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Pathology of neuroblastic tumors.

Histogenesis, basic histologic features, nomenclature, and criteria for diagnosis and prognostic classifications based on morphological features of neuroblastic tumors (NTs) are described. NTs that arise from neuroectodermal cells of the adrenal medulla and sympathetic ganglia recapitulate the development of sympathetic ganglion. The following three basic types of NTs are recognized: neuroblastoma (NBs) and ganglioneuroblastomas (GNBs) and ganglioneuromas (GNs). NBs can be undifferentiated, poorly differentiated or differentiating; GNBs have the following three subtypes. (1) nodular, (2) intermixed, and (3) borderline. The conventional and recommended terminology and Shimada terminology of NTs are described (Tables 1 and 2). There are three basic pathologic components of NTs, neuroblastomatous, ganglioneuromatous, and intermediate components (Figs 3, 5, and 7). There are two major prognostic classifications based on morphological features of NTs, Shimada classification and histologic grading (Tables 3 and 4).

Adrenal Gland Neoplasms↗
PubMed1993

Correlation between morphologic and other prognostic markers of neuroblastoma. A study of histologic grade, DNA index, N-myc gene copy number, and lactic dehydrogenase in patients in the Pediatric Oncology Group.

BACKGROUND: Histologic grades (HG), N-myc (NM) gene copy number, DNA index (DI), and serum lactic dehydrogenase (LDH) have been shown to be related to prognosis in neuroblastoma. The relationship between HG and nonmorphologic prognostic markers has not been investigated previously. METHODS: Each prognostic marker was determined independently and without the knowledge of clinical features and outcome by different investigators in 275 (HG), 96 of 275 (DI), 94 of 275 (NM), and 224 of 275 patients (LDH) with neuroblastoma by methods described previously. Patients younger than 2 years of age were included in the analysis for DI. Patients of all ages were included in the analysis of HG, NM, and LDH. RESULTS: A statistically significant association of low HG (1 and 2) was found with DI of more than 1 (hyperdiploid), single copy of NM gene per haploid genome, and an LDH of less than 1500 IU/l (P value for each, < 0.001), factors that are associated with better prognosis. High HG was associated with DI of 1 (diploidy), amplified NM gene, and an LDH of 1500 or more, factors that are associated with aggressive behavior. CONCLUSION: The value of HG is strengthened by its statistically significant association with features that reflect tumor cell biology of neuroblastoma. In view of the tissue sample size required for determination of HG, consideration should be given to obtaining such a sample in as many patients as is feasible if there is no contraindication to surgery. Nonmorphologic prognostic markers, when used in concert with HG, would provide a basis for individualized risk-specific therapy of this disease.

Adolescent↗
PubMed1993

Fine-needle aspiration cytology of primary large-cell lymphoma of the mediastinum: cytomorphologic findings with potential pitfalls in diagnosis.

We report the fine-needle aspiration (FNA) cytomorphologic features of six cases of primary mediastinal large-cell lymphoma with sclerosis. The series consisted of three men and three women with a median age of 36 yr. All the patients presented with a large anterior or superior mediastinal mass with no evidence of peripheral lymphadenopathy or hepatosplenomegaly. Two of the cases showed typical findings of lymphoma, characterized by hypercellular specimens with numerous individually scattered markedly atypical lymphoid cells present, demonstrating nuclear irregularity with the presence of nucleoli and surrounding scant to slight amount of cytoplasm. Numerous lymphoglandular bodies were seen in the background. Both cases were correctly diagnosed as representing non-Hodgkin's large-cell lymphomas. Two other cases had slight cellularity with the presence of a few scattered atypical lymphoid cells. Although a definite diagnosis was not rendered in either case, the possibility of malignant lymphoma was considered. Two other cases consisted predominantly of microtissue fragments with some associated scattered individual atypical cells. Within the microtissue fragments, the cells were distorted with a tendency to elongate and spindle in a prominent fibrous matrix. Our experience demonstrates that FNA cytology of primary mediastinal diffuse large cell lymphoma with sclerosis can be challenging, with a potential for a false-negative diagnosis due to limited cellularity secondary to the sclerosis or a misdiagnosis as a spindle cell neoplasm due to distortion of these cells by the fibrous matrix. To the best of our knowledge, we believe this is the first FNA series of primary mediastinal diffuse large cell lymphoma with sclerosis.

Adult↗
PubMed1993

Cytomorphology of familial hemophagocytic syndrome.

Familial hemophagocytic syndrome (FHS) is a rare, fatal disorder of childhood demonstrating failure to thrive, fever, hepatosplenomegaly (HSM), recurrent infections, pancytopenia, and histologically, the infiltration of reticuloendothelial organs by benign-appearing histiocytes demonstrating hemophagocytosis. We report two fatal cases of FHS including a 3 year-old female who underwent fine-needle aspiration (FNA) biopsy of the liver in the initial workup of the disease (case 1) and an 8 month-old boy with ascites and HSM having peritoneal fluid cytology submitted as the first specimen for morphologic examination (case 2). In case 1, the FNA cytologic findings included benign hepatocytes and scattered mature and reactive lymphocytes and histiocytes. The histiocytes demonstrated fine to coarse cytoplasmic vacuoles and erythrophagocytosis. The diagnosis was confirmed at autopsy which revealed extensive lymphohistiocytic infiltrates in various organs including the central nervous system. In case 2, the peritoneal fluid cytology specimen contained numerous atypical and degenerating mononuclear lymphoreticular cells which were dispersed as a single cell suspension admixed with infrequent mesothelial elements; hemophagocytosis was not appreciated. Subsequent liver biopsy revealed portal tracts and sinusoids infiltrated by benign but atypical histiocytes with hemophagocytosis. Bone marrow examination and then autopsy confirmed the diagnosis of FHS. A panel of immunocytochemical studies was performed in the first case which was an aid in confirming the diagnosis of FHS and ultrastructural examination of the second case revealed well-developed erythrophagocytosis. Both patients had siblings who died of FHS. Although not diagnostic, cytomorphology may suggest FHS.

Ascitic Fluid↗
PubMed1993

Fine-needle aspiration cytology of extramedullary hematopoiesis (myeloid metaplasia).

Myeloproliferative disease may be associated with extramedullary hematopoiesis (EH). Clinically, however, the differential diagnosis of solid masses in these patients includes not only EH but also inflammatory lesions and malignant neoplasms, including granulocytic sarcoma. We report the fine-needle aspiration (FNA) cytology of extramedullary hematopoiesis in five patients with a history of myeloproliferative disease. All of the masses developed subsequent to the diagnosis of myeloproliferative disease. Two of the patients had chronic myelogenous leukemia, one had essential thrombocythemia, and two had an unspecified chronic myeloproliferative disorder. The patients ranged in age from 50 to 88 years, and all presented with solid masses involving the kidney (two aspirates), liver (one aspirate), and lymph nodes (three aspirates). One of the lymph node aspirates was from a paratracheal lymph node. Cytologically, the lesions were composed of varying numbers of hematopoietic cells from all three hematologic cell lines. The Diff-Quik stain was especially helpful in the recognition of the hematopoietic cells such as granulocytic precursors, eosinophils, and megakaryocytes. In several cases, the megakaryocytic component was particularly prominent. In one case, the Factor VIII immunoperoxidase stain was used to confirm the megakaryocytic lineage of the multinucleated cells. The cytologic differential diagnosis, which includes granulocytic sarcoma, inflammatory disorders, and other lesions containing multinucleated giant cells, is discussed.

Aged↗