Biomedical subjects

J L Finley

Publications and source records attributed to J L Finley.

At least 37 records · Page 2Linked to original sources

PubMed1989

Fine-needle aspiration cytology of breast masses in pregnant and lactating women.

Eleven pregnant women with breast masses that arose during pregnancy or in the postpartum period underwent fine-needle aspiration biopsies. Cytologic examination demonstrated a spectrum of morphologic features, including (1) a pattern of dissociated epithelial cells stripped of their cytoplasm along with small clusters of cells having a frayed secretory type of cytoplasm; (2) larger epithelial groups with nuclear pleomorphism, prominent irregular nucleoli, and abundant vacuolated cytoplasm; (3) cellular smears, often with an inflammatory background and proteinaceous debris; and (4) microtissue fragments showing features of lobular hyperplasia. This article illustrates the clinical utility of fine-needle aspiration biopsy in evaluating breast masses in pregnant and lactating women and discusses the potential hazards for a false-positive diagnosis of malignancy in these patients.

Adenofibroma↗

PubMed1989

Significance of giant cells in fine-needle aspiration biopsies of benign and malignant lesions of the pancreas.

The cytologic results of 44 consecutive fine-needle aspiration (FNA) biopsies of the pancreas are reported. The series consisted of 27 women and 17 men with an age range of 31-89 yr (mean, 61.5). Excluding insufficient cases, the sensitivity of the procedure was 88%, specificity was 100%, positive predicative value (PV) was 100%, negative PV was 69%, and efficiency of the test was 90%. There were 29 true-positive, four false-negative, and nine true-negative diagnoses. Two specimens were insufficient for diagnosis. Giant cells of varying types were seen in both the malignant and benign cases. Two of the benign cases demonstrated rare multinucleated foreign body-type giant cells, most likely representing the changes seen in pancreatitis. In 13 malignant cases, multinucleated tumor cells were present, while six additional cases had multinucleated benign histiocytes reflecting the associated pancreatitis. Two malignant cases each had tumor giant cells and benign multinucleated histiocytes. Three of the malignant cases had numerous multinucleated tumor giant cells arranged in a dissociative fashion with evidence of cytophagocytosis consistent with a pleomorphic giant-cell carcinoma of the pancreas. One additional case demonstrated numerous multinucleated osteoclastic-like cells consistent with an osteoclastic tumor of the pancreas. This article documents the accuracy of FNA biopsy of the pancreas and notes that giant cells of varying types can be found in pancreatic FNA biopsies. Appreciation of the various types of giant cells in pancreatic FNA biopsy is important for diagnostic accuracy and prognosis.

Adult↗

PubMed1989

Gastric ulcer healing after laser treatment in dogs.

Endoscopic laser photocoagulation of ulcers is increasingly used to produce hemostasis in patients who are actively bleeding or in patients with stigmata of recent hemorrhage. Little information is available describing ulcer healing rates after laser treatments. The aim of this study was to compare the healing rates of gastric ulcers treated with laser energy (Nd:YAG) with untreated ulcers in dogs. Two standard gastric ulcers (12-14 mm diameter) were created in each dog stomach using an ulcer maker (Quinton) under endoscopic guidance and one was randomly selected for laser treatment (L), while the other served as control (C). Ten laser spots were applied circumferentially around the ulcer crater with a mean energy of 595 J per ulcer. Ten dogs were studied; four of which were sacrificed after one week and six after two weeks. Healing of treated ulcers was compared with that of control ulcers and expressed as a percentage of the initial ulcer surface. Histologic injury and reepithelialization were scored by two pathologists unaware of the treatment. Laser-treated ulcers healed significantly slower than untreated ulcers at one week (53% L vs 94% C, P less than 0.05) and histologic injury was greater in ulcers treated with laser photocoagulation. At two weeks, only 82% of the laser-treated ulcer surface was healed in comparison with 94% (P less than 0.05) healing in untreated ulcers, although the mean histologic injury score was not different at two weeks. Reepithelialization was decreased both at one week (11% L vs 71% C, P less than 0.01) and at two weeks (75% L vs 100% C, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1988

Fine-needle aspiration cytology of pulmonary carcinosarcoma with immunocytochemical and ultrastructural observations.

The cytologic, immunocytochemical, and ultrastructural features of a pulmonary carcinosarcoma diagnosed by fine-needle aspiration biopsy are presented. Both malignant epithelial groups and bizarre spindle-shaped cells arranged in loose groups, microtissue fragments and in a dissociate fashion showed dual immunoperoxidase staining with cytokeratins and vimentin. Although the immunocytochemical staining pattern is typical of this neoplasm, it does not allow differentiation in all cases from the more common primary large-cell undifferentiated carcinoma, which can also show dual staining for cytokeratin and vimentin. However, the presence of poorly differentiated epithelial groupings associated with a malignant mesenchymal component set in a myxoid stroma should suggest the correct diagnosis. Cytologically, differentiating carcinosarcoma, a poorly differentiated malignancy showing dual staining for cytokeratin and vimentin, from a large-cell carcinoma is important, since the former may pursue a more indolent clinical course.

Biopsy, Needle↗

PubMed1988

Renal vascular smooth muscle proliferation in neurofibromatosis.

An unusual vascular lesion was seen in a 14-year-old white boy with renal vascular hypertension and neurofibromatosis. Microscopically, nodular intimal and medial proliferations of spindle-shaped cells involved arteries, arterioles, and veins of all caliber within the renal parenchyma. Immunoperoxidase studies indicated these cells to have characteristics of smooth muscle, and this finding was confirmed by ultrastructural examination. Despite the generalized nature of the process in the biopsy sample, the patient's hypertension responded well to surgical treatment.

Adolescent↗

PubMed1988

Fine-needle aspiration biopsy of pleomorphic (giant cell) carcinoma of the pancreas. Cytologic, immunocytochemical, and ultrastructural findings.

Four cases of pleomorphic (giant cell) carcinoma (PGC) of the pancreas, diagnosed by fine-needle aspiration biopsy, are presented. Ancillary immunocytochemical studies were also performed on the smears (four cases) and cell blocks (three cases), along with ultrastructural (electron microscopic) examination of the aspirated specimen (two cases). Three of the four patients were elderly (age range: 44-65 years), and all had large pancreatic masses. A spectrum of cytomorphologic features was encountered, including poorly cohesive bizarre mononuclear cells, many multinucleated tumor giant cells, and associated malignant spindle cells. Prominent cellular cannibalism and cytophagocytosis also were seen. Immunoperoxidase studies demonstrated dual staining of the malignant cells for cytokeratin and vimentin in two cases and exclusive staining for vimentin in the remaining two cases. Ultrastructural examination demonstrated epithelial features in both cases studied. One of the cases demonstrated intracytoplasmic whorled bundles of intermediate filaments, corresponding to pale eosinophilic globular material, appreciated both in the Diff-Quik- and Papanicolaou-stained smears and staining with positive results for vimentin. The immunocytochemical studies suggest that the coexpression of vimentin and cytokeratin within the cells is consistent with a pleomorphic malignancy of epithelial origin. It is speculated that the staining of two of the cases exclusively for vimentin can be seen in either epithelial malignancies with sarcomatoid transformation or, less likely, a pure sarcoma of the pancreas.

Adult↗

PubMed1986

The role of fine-needle aspiration biopsy in the rapid diagnosis and management of thyroid neoplasm.

This report describes our 5-year experience with fine-needle aspiration (FNA) biopsy of the thyroid in a 560-bed teaching hospital. Three hundred nine FNA biopsies were performed primarily by one endocrinologist and interpreted by several pathologists. Analysis of the data reveals the sensitivity of the procedure is 93%, specificity is 95.1%, and the positive and negative predictive values are 88.9% and 96.5%, respectively. This data confirms the diagnostic accuracy of FNA biopsy. Complications were seen in 6 of 309 cases (1.9%) and were relatively mild. Nearly 75% of the cases in the series were cytologically diagnosed as nonneoplastic. Fine-needle aspiration biopsy identified 19.4% of the cases needing surgery, of which 72% had neoplastic nodules, confirming the selection role of the procedure. The management of thyroid nodules is discussed and a selective review of the FNA literature is presented. The authors believe that our experience rebuts the argument that special referral centers are needed to interpret the cytologic material. Several well trained surgical pathologists can become proficient in interpreting the FNA biopsies without significant loss in accuracy, and thereby render a definite diagnosis in the vast majority of the cases. Accordingly, the authors recommend FNA of the thyroid as the initial diagnostic test in the evaluation of thyroid nodules.

Adenocarcinoma↗

PubMed1986

Chordoma: diagnosis by fine-needle aspiration biopsy with histologic, immunocytochemical, and ultrastructural confirmation.

Five cases of chordoma, diagnosed by fine-needle aspiration (FNA) biopsy, are presented. Four cases were histologically confirmed, and in one, immunocytochemical and ultrastructural studies were performed on both the aspirate and tissue specimen. Four cases presented as sacral masses, while in the fifth case, a destructive lesion of the clivus extended into the soft tissues of the lateral neck. A spectrum of cytomorphologic features was encountered including the presence of abundant microtissue fragments and cells in a dissociate pattern, often with abundant metachromatic extracellular matrix. Stellate and cuboidal cells often contained intracytoplasmic vacuoles of varying sizes. Intranuclear inclusions, mitotic figures, and anisonucleosis were prominent features of several cases. Immunoperoxidase studies on a single case demonstrated cytoplasmic staining for low- and high-molecular-weight cytokeratins, vimentin, and epithelial membrane antigen, while glial fibrillary acidic protein and carcinoembryonic antigen were negative. Ultrastructural features included the presence of mitochondrial endoplasmic reticulum complexes, occasional desmosome-like junctions, and abundant extracellular matrix adherent to the tumor cells. We believe the cytomorphologic findings are characteristic and, when taken in concert with immunocytochemical and ultrastructural studies, allow differentiation of chordoma from other primary or metastatic neoplasms occurring in bone. As demonstrated in our series, chordoma is often an unsuspected diagnosis. We believe that FNA biopsy of these lesions can lead to a correct preoperative diagnosis and may also be utilized to document recurrence and thus facilitate the evaluation and management of patients with these lesions.

Aged↗

PubMed1984

Port-wine stains. Morphologic variations and developmental lesions.

Studies have shown that port-wine stains (PWSs) probably represent a progressive ectasia of the superficial cutaneous vascular plexus. During examination of approximately 500 patients with PWSs, seven lesions were identified that could be categorized into two groups. In one group (two patients), the typical superficial PWS was accompanied by a proliferation and ectasia of thin-walled vessels in the deeper dermis, subcutaneous adipose tissue, and skeletal muscle (cavernous hemangioma). In the other group (five patients), single or multiple polypoid tumors arose that consisted of a proliferation of vessels with walls of varying thickness, and intervascular stroma (arteriovenous malformation). These tumors appear to arise in both young patients with flat lesions as well as the older patients with pronounced surface irregularities. Two patients were specifically chosen because they represented the typical PWS cobblestone pattern. This vascular abnormality represents a localized exaggeration of the ectasia process. We conclude that a small number of PWSs are associated with an underlying cavernous hemangioma. Furthermore, besides the surface irregularities that characterize the older PWS, de novo vascular tumors arise that can be categorized as arteriovenous malformations.

Adult↗

PubMed1984

Argon laser-port-wine stain interaction. Immediate effects.

Biopsy specimens from 11 patients with port-wine stains were examined by routine paraffin sections immediately after argon laser therapy, and the findings were correlated with those seen in 1-micron epoxy resin-embedded sections and with immunofluorescence microscopy studies localizing factor VIII-related antigen and type IV collagen. The histopathologic pattern was that of an arc-shaped injury to the papillary and upper reticular dermis, extending to a depth of 0.45 mm. Most of the abnormal vessels in the port-wine stain were encompassed in this zone and showed severe injury. Erythrocytes in these vessels displayed changes, ranging from near normal to complete fragmentation. Focally, vessels adjacent to the area of major injury contained clumped erythrocytes with tinctorial changes but intact walls. In two specimens, alterations in basement membrane and endothelial immunofluorescence staining patterns were present in the zones adjacent to the major cauterized areas, extending focally to a depth of 0.75 mm. This study suggests that, in addition to the major nonspecific destructive component of argon laser therapy, there is a smaller adjacent "specific" zone of damage in which collagenous stroma is maintained and chromophore content becomes important as a determinant of injury.

Adult↗

PubMed1982

Immunofluorescent staining with antibodies to factor VIII, fibronectin, and collagenous basement membrane protein in normal human skin and port wine stains.

Specific antibodies directed against three important components of the vessel wall (collagenous basement membrane protein-type IV collagen, fibronectin, and factor VIII) were used to study and compare the distribution of these proteins in normal skin and port wine stains. Collagenous basement membrane protein was localized to the basement membrane and basal lamina zones of blood vessels, appendages, arrector pili muscles, endoneurium and perineurium, and the dermoepidermal junction of both port wine stains and normal skin. Vessels of the port wine stain as well as those of normal skin showed a similar narrow uniform homogeneous line of fluorescence. Granular endothelial staining was seen in the blood vessels of both normal skin and port wine stains. The distribution of fibronectin was that of a low-intensity punctate pattern situated in the subendothelial region of both port wine stain and normal vessels and in the basement membrane zones of hair follicles, endoneurium and perineurium, and the dermoepidermal junction.

Adolescent↗

PubMed1981

Healing of port-wine stains after argon laser therapy.

Studies have shown port-wine stains (PWSs) probably represent an aneurysmal dilation and ectasia of the cutaneous vascular plexus. The abnormal vessels are largely included within a 0.6-mm subepidermal zone, which is within the argon laser destruction range. Twenty-eight patients with PWSs underwent biopsies prior to argon laser treatment and repeated biopsies 4 1/2 months later. Those lesions (23) that contained large ectatic blood-filled vessels responded well to argon laser therapy in contrast to those (five) in which the vessels were relatively small and erythrocyte free. A similar histologic pattern was seen in the repeated biopsy specimens of both groups: the mean vessel area, the fraction of dermis occupied by vessels, vascular erythrocyte content, and vessel wall thickness sharply decreased, while the number of vessels tripled. Since lesion color strongly correlates with and probably is largely determined by erythrocyte content, the reason for the PWS lightening, despite increased vessel number, is the relative lack of erythrocytes in the newly formed vessels.

Adolescent↗

PubMedDate not supplied

Psammoma bodies and optically clear nuclei in bronchiolo-alveolar cell carcinoma. Diagnosis by fine needle aspiration biopsy with histologic and ultrastructural confirmation.

The fine needle aspiration cytology of two cases of bronchiolo-alveolar cell carcinoma of the lung having unusual features is reported. One case demonstrated numerous psammoma bodies in the cytologic smears, whereas the other case showed an abundance of cells with optically clear nuclei. Both peripherally located tumors were resected and confirmed as primary bronchiolo-alveolar cell carcinoma by histologic and ultrastructural examination. We believe this to be the first report describing these unusual features of bronchiolo-alveolar cell carcinoma diagnosed by fine needle aspiration cytology. Presented is a discussion of psammoma bodies and optically clear nuclei seen in primary and metastatic tumors of the lung. This will aid in the diagnosis of these cases.

Adenocarcinoma, Bronchiolo-Alveolar↗

PubMedDate not supplied

Fine-needle aspiration versus large-needle biopsy or cutting biopsy in evaluation of thyroid nodules.

This report describes our experience with both fine-needle aspiration (FNA) biopsies and large-needle biopsies (LNB) or core biopsies (CB) performed at the same time on 23 patients out of a series of 309 patients examined by the FNA technique. There was no significant differences in diagnostic accuracy of tissue obtained with the FNA technique when compared with the LNB or CB biopsy technique. While FNA always yielded tissue adequate for diagnosis, the LNB, and/or CB technique yielded tissue insufficient for diagnosis in four of 26 biopsies (15.4%). We believe that the FNA is better able to sample a mass with fewer insufficient specimens. Using FNA, the diagnosis can be rendered more rapidly, at lower cost, and with decreased potential for complications. The adequacy of the FNA biopsies can be assessed immediately using a modified Wright stain (Diff-Quik). Repeat biopsies can be performed that better sample the lesions with increased patient acceptance.

Adenoma↗

PubMedDate not supplied

Malignant thymic neoplasms: diagnosis by fine-needle aspiration biopsy with histologic, immunocytochemical, and ultrastructural confirmation.

Two cases of malignant thymic neoplasms diagnosed by transthoracic fine-needle aspiration (FNA) biopsy under fluoroscopic and computerized axial tomography (CT) guidance with histologic, immunocytochemical, and ultrastructural confirmation are presented. The clinical and cytomorphologic features of the first case were typical of a malignant thymoma. A characteristic biphasic cell population of benign epithelial cells and mature lymphocytes was seen in Diff-Quik- and Papanicolaou-stained smears from the anterior mediastinal mass and the paravertebral metastasis and was confirmed by histologic examination. Immunoperoxidase studies for T and B cell subsets demonstrated lymphocytes with the thymic lymphocyte phenotype (Leu 6). Electron microscopic (EM) examination revealed epithelial cells with desmosomal attachments, tonofilaments, and extended cell processes along with mature lymphocytes. FNA biopsy of the second case demonstrated features of a thymic carcinoma. Individually scattered and loosely clustered small groups of markedly anaplastic and pleomorphic large cells were seen both in the Diff-Quik- and Papanicolaou-stained smears. EM performed on the FNA specimen demonstrated the poorly differentiated epithelial nature of the malignancy. The mediastinal mass was partially resected and demonstrated an undifferentiated carcinoma staining positively for low-molecular-weight cytokeratin. Ultrastructure demonstrated cell attachments and relationships consistent with carcinoma. The lack of a lung or other extrapulmonary primary tumor was consistent with a thymic carcinoma. These cases demonstrate the value of performing EM and immunocytochemistry on material obtained by fine-needle aspiration, which can aid in establishing the correct diagnosis and facilitate the clinical management of patients with malignant thymic neoplasms.

Adult↗

PubMedDate not supplied

Large-bore feeding tube occlusion by yeast colonies.

This is a first report of three patients with silicone feeding tubes (two with percutaneous endoscopic gastrostomies and one with a jejunostomy, all 20 French catheters) that have formed a thick yeast crust on the inner luminal surface causing tube occlusion in two cases. Candida species were isolated in all three tubes. The yeast crust could not be removed with a brush or with fungicidal drugs such as nystatin and amphotericin B. Histologic sections through these feeding tubes revealed yeast penetration through the silicone material, explaining the adherent nature of the crust. This complication may also explain the observed material deterioration with subsequent breakage.

Aged↗

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

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↗