Serial studies were done on cerebrospinal fluid (CSF) from a patient with sarcoidosis involving the meninges. Initially when the disease was active, the CSF protein was increased and glucose decreased. The number of cells in the CSF was moderately increased, and many mononuclear cells were present. Cytologic studies of the CSF showed many normal and some atypical lymphocytes. Immunochemical studies showed that most of these lymphocytes were T cells, with T-helper cells predominating over T-suppressor cells by a ratio of 3.92; B-lymphocytes were polyclonal. Subsequent studies of the CSF over the following three and one-half years showed that the protein and glucose content and the cell counts in the fluid did not correlate well with the activity of the disease. The number of atypical lymphocytes seemed to be a more useful marker of disease activity in the patient. Cytologic studies, when interpreted within the context of other CSF and clinical findings, are useful for the assessment of patients with sarcoidosis involving the meninges.

Central Nervous System Diseases↗

PubMedDate not supplied

Cytodiagnosis of extrapleural tumors in multiple myeloma by fine needle aspiration. A report of three cases.

Cytologic and immunocytochemical studies were done on fine needle aspirates of extrapleural tumors from three patients with multiple myeloma. In the first case the cytologic findings were consistent with myeloma, but the immunochemical studies were done improperly and were not interpretable. In the second case the cytologic findings were those of acute inflammation despite the strong clinical suspicion of the thoracic lesion's malignancy. In the third case both the cytologic and immunocytochemical findings were diagnostic of plasmacytoma. Our experience with these cases suggests that an assessment of the nature of the extrapleural tumor is indicated even in patients with known myeloma, that fine needle aspiration (FNA) is the diagnostic procedure of choice under the circumstances and that immunocytochemical studies can enhance the diagnostic accuracy of FNA for plasmacytoma. The best results for assessment of the cytologic FNA findings in extrapleural tumor in myeloma can be achieved by proper execution of both the FNA procedure and immunochemical studies and by interpretation of the cytologic findings within the context of the clinical findings.

Aged↗

PubMedDate not supplied

Blast transformation in chronic myeloid leukemia with synovial involvement.

In a patient with chronic myeloid leukemia in blastic transformation, the blast cells in a knee joint effusion were identical morphologically to those in the marrow. Cytochemical and immunocytochemical studies showed that these blasts were primitive erythroblasts and not granulocytic or monocytic precursors. The combined use of cytologic, cytochemical and immunocytochemical techniques will help to accurately identify cells in joint effusions and to elucidate the mechanism of synovial involvement by hematologic disorders.

Aged↗

PubMedDate not supplied

Myeloma with involvement of the serous cavities. Cytologic and immunochemical diagnosis and literature review.

The significance of serous cavity involvement by myeloma was evaluated in two patients with pleural involvement and two with peritoneal involvement. The involvement occurred at presentation in two patients and after the diagnosis of myeloma in two. The effusions were bloody exudates containing numerous atypical plasma cells. The diagnosis of cavitary involvement was made by morphologic examination of air-dried smears of the effusions, supplemented by the immunocytochemical demonstration of monoclonal proliferation of the plasma cells. In all four cases, these cells contained cytoplasmic kappa light chain immunoglobulins; many of them also stained positively for epithelial membrane antigen. It was best to interpret these immunocytochemical findings with those of the morphologic and additional immunocytochemical studies; the best results for studies for cytoplasmic immunoglobulins were obtained only if the cells in the effusions were washed before they were used for smear preparations and staining. The four patients responded poorly to treatment, dying 12 days, 16 months, 1 month and 10 days after cavitary involvement was recognized. Review of the literature confirmed that the findings in these cases were similar to those in other cases. Cavitary involvement by myeloma carries an ominous prognosis; an accurate recognition of the plasma cells by morphologic and immunocytochemical studies provides the best method of diagnosing cavitary involvement of myeloma and of predicting the poor outcome in such patients.

Aged↗

PubMedDate not supplied

Immunocytochemistry of fine needle aspirates. A tactical approach.

To maximize the potential of immunocytodiagnosis for fine needle aspiration (FNA) samples, it is necessary to be aware of the pitfalls and limitations of these techniques and to formulate a strategy to deal with the many variables involved. Five cases are presented to illustrate some of these variables, which include determining the adequacy of the FNA specimen, selecting tactics for cytologic and immunocytochemical studies, selecting methods for processing the FNA sample, preparing smears to enrich and preserve cells of interest, selecting enzyme labeling methods to optimize sensitivity and specificity, selecting monoclonal antibodies to make the study efficient and pertinent and interpreting the study results. The adequacy of the FNA specimen could be determined by an immediate cytologic assessment of the aspirate as it was obtained. Alcohol-fixed smears and formalin-fixed tissue sections prepared from the aspirate were used for diagnosis; the immunocytochemical studies were used as a diagnostic adjunct for accurate cell identification. Immunocytochemical studies were done on air-dried cytocentrifuge smears of pre-washed cells. While both immunoperoxidase and immunoalkaline phosphatase methods were suitable, we recommend the immunoperoxidase method for the study of aspirates from nonhemopoietic tissues and the immunoalkaline phosphatase method for the study of aspirates with many blood cells present. The proper selection of monoclonal antibodies and the interpretation of the results are best made in the context of the cytologic characteristics of the FNA sample and the clinical features of the patient.

Adult↗

PubMedDate not supplied

Endogenous phosphatase activity in tumor cells in a liver aspirate. A potential problem for immunocytodiagnosis using immunoalkaline phosphatase methods.

Immunocytochemical studies were performed on fine needle aspirates of the liver in a patient with hepatocellular carcinoma. A panel of commercially available antibodies was used to study the aspirated cells by immunoalkaline phosphatase and immunoperoxidase methods. The malignant cells in the aspirates, which were positively stained by the immunoperoxidase method for alphafetoprotein and by both methods for epithelial membrane antigen, were most probably hepatocellular in origin. Some cells were shown by the immunoalkaline phosphatase method to possess leukocyte-common antigen (LCA) and antigens of colonic and ovarian tissues. These findings were further investigated, and it was found that the tumor cells indeed had LCA as well as levamisole-resistant alkaline phosphatase activity. Although the immunoalkaline phosphatase methods are useful immunodiagnostic techniques applicable to fine needle aspirates, the endogenous enzyme activity present in some nonhematopoietic tumor cells is a cause for caution in the use of these methods in aspirates from nonhematopoietic tumor tissues.

Alkaline Phosphatase↗

PubMedDate not supplied

Diagnostic accuracy of the immunocytochemical study of body fluids.

The diagnostic accuracy of the immunocytochemical characterization of body fluids was evaluated in 100 specimens (35 pleural, 40 peritoneal, 7 pericardial and 18 cerebrospinal [CSF] fluids) in comparison with routine morphologic examination. The immunochemical markers used for all specimens were common-leukocyte antigen, epithelial membrane antigen, epithelial keratin and desmin. Additional immunocytochemical studies for neurofilaments, glial fibrillary acidic protein, vimentin and melanoma-associated antigen were performed on the CSF specimens. The study confirmed the accuracy of the immunocytochemical characterization of cells in body fluids using a panel of immunocytochemical stains. These methods are recommended as an adjunct to improve the accuracy of the cytologic diagnosis of body fluids, especially in cases with diagnostically difficult morphologic features.

Antibodies, Monoclonal↗

PubMedDate not supplied

Immunocytochemistry of cerebrospinal fluid.

In order to determine how best to study cells in cerebrospinal fluid (CSF) by immunocytochemical techniques, several crucial technical variables and five immunocytochemical methods were examined. Immunocytochemical studies could be performed on either cell suspensions or smears. The method using cell suspensions was more sensitive, producing less background staining, but requiring more cells than that using smears. Among the five methods examined, indirect immunoperoxidase (IP) and indirect immunoalkaline phosphatase (IAP) were comparable in sensitivity. The peroxidase-antiperoxidase (PAP), alkaline phosphatase-antialkaline phosphatase (APAAP) and avidin-biotin complex-immunoalkaline phosphatase (ABC-AP) methods were comparable in sensitivity and were more sensitive than either the IP or IAP technique. The peroxidase methods were plagued with problems related to endogenous enzyme activity and the ABC-AP method may exhibit undesirable background staining. Therefore, the IAP method should be used for cell suspensions and the APAAP for cells on smears. In CSF specimens with a small number of cells, immunocytochemical studies should be done on smears by the APAAP method. These conclusions are supported by our experience with CSF specimens from patients with reactive and neoplastic lymphocytoses.

Adult↗

PubMedDate not supplied

Immunocytodiagnosis of carcinocythemia in disseminated breast cancer.

A small number of large, malignant mononuclear cells were found in the blood of a patient with disseminated breast carcinoma. The detection of these scarce cells was facilitated by examining leukocyte concentrates. Cytochemical and immunochemical studies showed that these were epithelial cells, not hemopoietic cells. These findings, when correlated with the clinical features and the cytologic findings in blood and marrow, suggested that the malignant mononuclear cells in the blood were breast carcinoma cells. This study demonstrates the technical feasibility of accurately identifying cells in blood, which may stimulate interest in the study of cancer cells in the circulating blood. The method may also be applied to other cytologic specimens, such as fine needle aspirates, that contain only a few neoplastic cells.

Antigens, Neoplasm↗

PubMedDate not supplied

Crystalline deposits in ascites in a case of cryoglobulinemia.

Crystalline inclusions were observed on routine cytologic studies of ascitic fluid from a patient with exudative ascites of undetermined cause. These inclusions were polymorphic, but frequently appeared as slender needles. They were seen most often in histiocytes and, less frequently, in mesothelial cells and plasma cells. Extracellular crystals were also seen. The crystals were also present in biopsy specimens of peritoneum, liver and bone marrow. Special studies by polarizing light microscopy, cytochemistry, electron microscopy and immunocytochemistry suggested that the crystals were most probably immunoglobulins synthesized by plasma cells. Some were excreted extracellularly and phagocytized by histiocytes. Further studies indicated that the patient had an indolent plasma-cell dyscrasia, resulting in excessive production of a monoclonal immunoglobulin. The immunoglobulin may have crystallized and become deposited in tissues, inciting chronic inflammatory changes. Massive deposits of crystals in the peritoneum, with the resultant inflammatory reaction, was possibly the cause of the formation of ascites.

Aged↗

PubMedDate not supplied

Granulocytic sarcoma with pleural involvement. Identification of neoplastic cells with cytochemistry.

Malignant cells were detected in the pleural effusion of a patient with three separate primary malignancies. These cells were judged by conventional morphologic studies to be poorly differentiated cells, but cytochemical studies showed them to be granulocytic precursor cells. The use of cytochemical or immunochemical techniques may be most practical for the cytodiagnosis of malignant cells in serous effusions.

Biopsy↗

PubMedDate not supplied

Immunocytochemical diagnosis of acute leukemia with pleural involvement.

Cytologic examination of the pleural effusion from a patient with acute leukemia, leukocytosis and bleeding revealed the presence of many leukemic cells, "lymphocytes" and erythrocytes. The significance of these cellular changes was investigated by simultaneous study of blood and effusion leukocytes by morphologic, cytochemical and immunochemical methods. Both the leukemic blasts and the "lymphocytes" in the effusion and the blood were found to be neoplastic and contained antigens characteristic of both myeloid cells (OKM-1) and lymphoblasts (C-ALLA, common acute lymphoblastic leukemia antigen). These results, when analyzed in the context of the clinical findings, were indicative of acute leukemia with pleural involvement. Such a clinically oriented approach may further enhance the potential of cytodiagnosis in patients with serous effusions.

Acute Disease↗

PubMedDate not supplied

Immunocytochemical diagnosis of lymphoma in serous effusions.

An immunoalkaline phosphatase technique was used to examine the lymphoid cells in serous effusions from five patients with malignant lymphoma. The results were interpreted along with the morphologic studies and retrospective assessments of the clinical conditions of the patients. Two patients had no involvement of the serous cavities, and two had proven involvement. The fifth patient was studied while his lymphoma was evolving from inapparent to disseminated disease. In the two patients without involvement of the serous cavities, the effusion lymphocytes were predominantly monoclonal T cells, comparable to those in six patients with diseases other than lymphoma. In those with involvement of the serous cavities, the effusion lymphocytes were predominantly monoclonal B cells. In the patient with lymphoma in evolution, immunocytochemical studies accurately reflected the progression of disease. We conclude that immunocytochemical studies of the lymphocytes in serous effusions help not only to differentiate reactive from neoplastic lymphoproliferation but also to assess the status of lymphomatous involvement of the serous cavities. The immunocytochemical studies are most effective when correlated with clinical and cytologic studies.

Adult↗

PubMedDate not supplied

Immunocytochemical diagnosis of lymphoma from urine sediment.

Cytologic studies were done on the urine sediment of a patient with an indolent lymphoma of 20 years' duration. The patient had localized disease in his groins and developed marked swelling in his penis and scrotum and pedal edema shortly after radiotherapy was instituted to the inguinal areas. The urine specimen obtained after chemotherapy showed many large mononucleated malignant cells. These cells were extremely fragile and were best demonstrated by supravital staining of wet preparations. Although morphologic examination could not confidently indicate the origin of these malignant cells, cytochemical and immunocytochemical studies showed them to be monoclonal B lymphocytes. This study suggests that, even under unusually difficult circumstances, a combined cytologic, cytochemical and immunocytochemical approach can be successfully applied for cytodiagnosis.

Humans↗