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K R Geisinger

Publications and source records attributed to K R Geisinger.

At least 55 records · Page 3Linked to original sources
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

Differential diagnostic considerations and potential pitfalls in fine-needle aspiration biopsies of the mediastinum.

The mediastinum is the host for a number of relatively unusual primary neoplasms, as well as a frequent recipient of metastatic tumors. From the perspective of fine-needle aspiration cytomorphology, several distinct patterns are yielded. The polygonal (or epithelial-like) cell pattern may be seen with benign and malignant thymomas, germinomas, embryonal carcinoma, and many metastatic carcinomas. An intimate admixture of small lymphocytes with these epithelial cells may occur in this category. The small cell pattern may be produced by malignant non-Hodgkin's lymphomas, neuroblastoma, carcinoid tumors, and metastatic oat cell carcinoma. Uncommon morphologic forms of thymoma and carcinoid tumors, as well as benign mesenchymal lesions, may yield a picture of a spindle-cell proliferation. In addition to cytomorphology, the cytologist needs to integrate clinical, radiographic, immunocytochemical, and ultrastructural data to formulate a final diagnosis.

Biopsy, Needle↗
PubMed1995

Aspiration cytopathology of malignant melanoma in children. A morphologic spectrum.

Malignant melanoma (MM) is an uncommon neoplasm in the practice of pediatric cytopathology. The clinical and morphologic features of three white children with this neoplasm diagnosed by fine needle aspiration biopsy are described. All cytologic diagnoses were subsequently confirmed histologically. Two children were 16 years old and one was 9 years old. Two patients had metastatic MM to head and neck lymph nodes. In one of these children, a prior diagnosis of MM was known, whereas in the other it was unsuspected. A primary melanoma of the iris developed in the third child. The cytopathology of these children are similar to that described in adults. With the cytologic similarities, some striking differences were seen. Principal among these was the abundance of melanin in one case, its uneveness in another, and its absence in a third. The variation in individual cell morphology among the three cases is also described. Malignant melanoma is a rare neoplasm of children that can be recognized by fine-needle aspiration cytopathology.

Adolescent↗
PubMed1995

Endoscopic biopsies and cytologic brushings of the esophagus are diagnostically complementary.

It is traditionally taught that concurrently obtained endoscopic tissue biopsies and cytologic brushings from the esophagus are diagnostically complementary. This contention is supported mostly by studies that involve only a small subset of patients (ie, those clinically thought to have an upper gastrointestinal neoplasm). Only a few investigations have examined the role of these paired specimens in the general patient population. Two hundred twenty-two consecutive esophageal biopsies and brushings obtained during the same endoscopic session were retrospectively reviewed. The same or a similar diagnosis was made for both specimen types in 166 (74.8%) of the specimen pairs. Among these pairs with diagnostic agreement, the most frequent diagnosis included Barrett's metaplasia (46), Candida esophagitis (37), and morphologically nonspecific inflammation (47). Nine squamous cell carcinomas and six adenocarcinomas were also detected in this subset. Diagnostic differences existed among 56 (25.2%) of the pairs. The most common diagnosis in this subset was Candida esophagitis. This fungus was present in 27 brushings, but not in the concurrently obtained biopsies. Two squamous cell carcinomas and one adenocarcinoma were diagnosed by cytology but not by biopsy. One squamous cell carcinoma was found only in the biopsy specimen. In the esophagus, brushings and biopsies are truly complementary for the detection of both neoplastic and inflammatory conditions.

Adenocarcinoma↗
PubMed1995

Identification of male epithelial cells in routine postcoital cervicovaginal smears using fluorescence in situ hybridization. Application in sexual assault and molestation.

In a prospective blinded controlled study, the efficacy of fluorescence in situ hybridization (FISH) to detect non-sperm male cells verifying sexual contact was examined. Cervicovaginal smears (CVS) from 40 women with reported post-coital intervals were examined for sperm by cytology and for sperm and non-sperm male cells by FISH using X and Y chromosome specific DNA probes. Fluorescence in situ hybridization identified sperm and/or non-sperm male cells in all specimens from women with positive coital histories, including when the partner had a vasectomy. Male cells were also detectable by FISH in CVS up to 3 weeks after coitus. In comparison, cytology identified sperm in 41% of the positive coital history cases, and none beyond 2 weeks. Fluorescence in situ hybridization is highly sensitive and specific in detecting male cells, and can be performed rapidly on routine CVS. Application of this technique can provide new and additional evidence of sexual contact when current tests are inconclusive.

Coitus↗
PubMed1995

Positron emission tomography in the evaluation of laryngeal carcinoma.

Positron emission tomography (PET) is a relatively new radiologic imaging technique based on glucose analog uptake and metabolism in tumor tissue. In this study, PET was used in evaluating 38 patients with laryngeal cancer. Twenty-five patients were examined with PET prior to treatment to study the reliability of PET in identifying the primary tumor and assessing regional nodal status; 13 patients who had previously received irradiation with curative intent and who represented differential diagnostic problems were imaged to differentiate between irradiation effects and recurrent or residual cancer. Findings for both groups were compared to results of clinical evaluation and those of computed tomography (CT) and magnetic resonance imaging (MRI). The PET results were essentially identical to those of CT, MRI, and clinical evaluation in identifying metastatic lesions (82% correct), and were as reliable as CT and MRI for correctly identifying primary tumors (88%). Positron emission tomography was most helpful in differentiating recurrent tumor from postirradiation tissue sequelae. However, its lack of anatomic detail made PET less valuable for primary staging and therapeutic planning. It may enhance the diagnostic accuracy of CT and MRI where anatomic distortions occur or where diagnostic criteria for CT and MRI are ambiguous.

Carcinoma↗
PubMed1995

A comparative diagnostic study of head and neck nodal metastases using positron emission tomography.

A prospective study was conducted to compare the accuracy of clinical examination, computed tomography (CT), and positron emission tomography (PET) in identifying head and neck squamous cell carcinoma metastatic to cervical lymph nodes. The findings in the necks of 49 patients evaluated by clinical examination and CT were compared to the findings in the same necks by PET, a newly available metabolic imaging modality. Pathology specimens were available for 45 of the necks. The findings of PET and CT correlated in 84% of cases. In the cases that did not correlate, CT proved correct in four of five cases. PET (82%) and CT (84%) were comparable and were both better than clinical examination (71%) in correctly identifying the presence or absence of metastatic disease.

Carcinoma, Squamous Cell↗
PubMed1995

Gender identification of dried human bloodstains using fluorescence in situ hybridization.

Identification of the gender of an individual(s) from whom a bloodstain is derived represents important evidence in medicolegal cases. The efficacy of fluorescence in situ hybridization (FISH) using chromosome X and Y centromeric probes was tested to determine its ability to identify correctly the gender of extracted dried bloodstains. In this preliminary study, FISH correctly identified the gender of 2-week-old dried bloodstains in prepared mixtures of male-to-female blood as low as 1%. The technique is accurate, rapid, sensitive, easily performed and readily available. This application of FISH as a forensic laboratory technique holds great promise.

Blood Stains↗
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

The cytologic evaluation of lipid-laden alveolar macrophages as an indicator of aspiration pneumonia in young children.

Gastroesophageal reflux with aspiration of feedings in infants and young children may be involved in the development of chronic lung damage. Our laboratory has utilized tracheal aspirates stained with oil red O to identify and quantitate lipid-laden alveolar macrophages as a marker of such aspiration. During the last 10 years, we have evaluated 244 tracheal aspiration smears in children. Although a few patients were up to 3 years old, the vast majority were infants. The cytologist looked for the presence of and the number of oil red O-positive macrophages on tracheal aspirate smears. The specimens were easily assigned grades of absent (grade = 0), low positive (grade 1: 1-25 lipid-laden macrophages), moderate positive (grade 2: 26-50 lipid-laden macrophages), and high positive (grade 3: > 50 lipid-laden macrophages). The grade was then correlated with the positive or negative clinical diagnosis of gastroesophageal reflux with aspiration. We believe the cytologic evaluation and grading of oil red O-stained tracheal aspirates for lipid-laden macrophages is valuable in identifying these patients with gastroesophageal reflux and aspiration.

Azo Compounds↗
PubMed1994

Relationship of DNA ploidy to histology and prognosis in rhabdomyosarcoma. Comparison of flow cytometry and image analysis.

BACKGROUND: Although DNA ploidy correlates with prognosis in certain childhood cancers, e.g., neuroblastoma, its significance in rhabdomyosarcoma (RMS) is unclear and controversial. METHODS: Ploidy by flow cytometry (FCM) and image analysis (IA) in 26 of 27 children with RMS (17 embryonal, 3 mixed embryonal/alveolar, 5 alveolar, 1 anaplastic, 1 ectomesenchymoma) and 4 adults with pleomorphic RMS were evaluated. Statistical comparisons were analyzed between DNA content and gender, age, localization, Intergroup Rhabdomyosarcoma Study (IRS) group, and histopathologic subtype. Survival analyses were performed by the Kaplan-Meier test using the approximate chi-square statistic for the log rank test. RESULTS: The concordance rate between FCM and IA was 26 of 30 (87%); FCM was not performed in one tumor. Image analysis was more sensitive than FCM in detecting aneuploidy. Furthermore, DNA content was associated significantly with histologic subtype (P = 0.031); embryonal histology commonly was hyperdiploid (mean, 1.44; median, 1.27), whereas alveolar histology usually was near-tetraploid (mean, 1.83; median, 1.95). All four adult patients with pleomorphic RMS were aneuploid, with one showing multiple DNA peaks. No correlation between DNA content and survival was observed in the children with RMS. However, IRS group (P = 0.011) and patient age (P = 0.036) were independent prognostic indicators significantly related to survival. All adult patients died of their disease. CONCLUSIONS: Although ploidy correlates with histologic subtype, DNA content is not significantly predictive of prognosis in patients with RMS. Age at diagnosis and IRS group are independent predictors of clinical outcome in children with RMS.

Adolescent↗
PubMed1994

Positron emission tomography of patients with head and neck carcinoma before and after high dose irradiation.

BACKGROUND: Positron emission tomography (PET) with labeled fluorodeoxyglucose (FDG) demonstrates increased tracer uptake in many neoplasms. This study was undertaken to define the patterns of FDG uptake in head and neck neoplasms before and after high dose irradiation. METHODS: Twenty-five patients were evaluated prospectively with PET and standard clinical and radiographic techniques before and after irradiation. RESULTS: Twenty-seven primary sites were confirmed pathologically in 23 patients and included the nasopharynx (four lesions), oropharynx (14 lesions), larynx (five lesions), oral cavity (two lesions), and paranasal sinuses (two lesions). Two patients had unknown primary sites. Twenty-four of 27 primary sites correlated with areas of increased tracer uptake on PET scans. Five patients had increased uptake in cervical lymph nodes that were uninvolved by radiographic or clinical criteria. Positron emission tomography seemed to be able to differentiate tumor activity from fluid-filled sinuses in two patients with paranasal sinus tumors. In two patients with unknown primary sites, increased uptake in the base of tongue after PET suggested occult primary sites. Positron emission tomography scans obtained 1 month after high dose irradiation (RT) indicated decreased levels of FDG uptake in all patients' tumors. However, these scans did not accurately reflect the status of disease in these patients. Scans obtained 4 months after RT were believed to assess more accurately the presence of malignancy. CONCLUSIONS: Positron emission tomography is a new modality that may be useful in defining tumor activity in clinically negative areas. Appropriately timed posttreatment PET may be useful in predicting outcome after definitive RT and in distinguishing viable tumors from normal tissue changes after RT in patients with head and neck carcinomas.

Carcinoma↗
PubMed1994

Distinguishing tumor recurrence from irradiation sequelae with positron emission tomography in patients treated for larynx cancer.

PURPOSE: Distinguishing persistent or recurrent tumor from postradiation edema, or soft tissue/cartilage necrosis in patients treated for carcinoma of the larynx can be difficult. Because recurrent tumor is often submucosal, multiple deep biopsies may be necessary before a diagnosis can be established. Positron emission tomography with 18F-2fluoro-2deoxyglucose (FDG) was studied for its ability to aid in this problem. METHODS AND MATERIALS: Positron emission tomography (18FDG) scans were performed on 11 patients who were suspected of having persistent or recurrent tumor after radiation treatment for carcinoma of the larynx. Patients underwent thorough history and physical examinations, scans with computerized tomography, and pathologic evaluation when indicated. Standard uptake values were used to quantitate the FDG uptake in the larynx. RESULTS: The time between completion of radiation treatment and positron emission tomography examination ranged from 2 to 26 months with a median of 6 months. Ten patients underwent computed tomography (CT) of the larynx, which revealed edema of the larynx (six patients), glottic mass (four patients), and cervical nodes (one patient). Positron emission tomography scans revealed increased FDG uptake in the larynx in five patients and laryngectomy confirmed the presence of carcinoma in these patients. Five patients had positron emission tomography results consistent with normal tissue changes in the larynx, and one patient had increased FDG uptake in neck nodes. This patient underwent laryngectomy, and no cancer was found in the primary site, but nodes were pathologically positive. One patient had slightly elevated FDG uptake and negative biopsy results. The remaining patients have been followed for 11 to 14 months since their positron emission studies and their examinations have remained stable. In patients without tumor, average standard uptake values of the larynx ranged from 2.4 to 4.7, and in patients with tumor, the range was 4.9 to 10.7. CONCLUSION: Positron emission tomography with labeled FDG appears to be useful in distinguishing benign from malignant changes in the larynx after radiation treatment. This noninvasive technique may be preferable to biopsy, which could traumatize radiation-damaged tissues and precipitate necrosis.

Deoxyglucose↗
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↗