Malpractice vs benepractice.
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Biopsy, Needle↗
Biomedical subjects
M W Stanley
Publications and source records attributed to M W Stanley.
Metastatic myxopapillary ependymoma: report of a case with fine-needle aspiration findings.
A case of recurrent and metastasizing myxopapillary ependymoma of the sacral region in a 35-yr-old man is reported. Fifteen years after the original diagnosis, he presented with an abdominal mass, subcutaneous nodules in the previous surgical excision line, and bilateral inguinal lymph node enlargement. FNA cytology of the inguinal lymph nodes showed a poorly cohesive, highly cellular smear pattern exhibiting papillary formations and rosette-like structures composed of slim columnar cells having cytoplasmic processes without evidence of atypia. Histologic and ultrastructural findings confirmed the diagnosis. Chromosomal analysis was also done.
Adult↗
Papillary neoplasms of the breast: fine-needle aspiration findings in cystic and solid cases.
Papillary neoplasms of the breast are uncommon; at the time of needle aspiration, the diagnostic yield from such lesions can be initially classified as cystic or solid. We describe the fine-needle aspiration findings in four cystic papillary neoplasms (three intracystic papillary carcinomas and one intracystic papilloma) and three solid masses (two sclerosing ductal lesions and one infiltrating ductal carcinoma with prominent papillary component). The smears were examined with respect to the following features: cellularity, architectural pattern in cell groups, cytologic pleomorphism, degree of cohesiveness, morphology and size of individual cells, anisonucleosis, nuclear-cytoplasmic ratio, irregularity of nuclear contour, chromatin texture, macronucleoli, the presence of bipolar nuclei, apocrine cells, and multinucleated giant cells. A combination of cytologic and clinical characteristics may be helpful in distinguishing benign from malignant papillary lesions.
Adenoma↗
Toxoplasma pneumonia: cytologic diagnosis by bronchoalveolar lavage.
Two cases of toxoplasma pneumonia in immunocompromised hosts are reported. The diagnoses were made by the identification of trophozoites in bronchoalveolar lavage material. The organisms were more readily identified in the air-dried Diff-Quik-stained smears. Cytologic findings and correlation with postmortem examination material in one case are described. A high index of suspicion for this pathogen, as well as screening cytologic preparations at medium to high magnification may increase the diagnostic rate for this uncommon but treatable disease.
AIDS-Related Opportunistic Infections↗
Skeletal structures that clinically simulate lymph nodes: encounters during fine-needle aspiration.
We report eight patients in whom bones of the cervical spine or cervical ribs were clinically mistaken for jugular chain or supraclavicular lymphadenopathy, respectively. Each was referred for fine-needle aspiration by an experienced surgeon, oncologist, rheumatologist, or otolaryngologist. In the neck, the bony nature of the pseudo-lymph nodes was apparent when the needle contacted bone. Bone was not contacted by the needle in the supraclavicular fossa. Aspiration smears showed normal soft tissues in all cases. Radiographs showed cervical ribs in both of the patients with supraclavicular pseudo-lymphadenopathy. One of these was surgically explored and no adenopathy was detected. Radiographically, one patient with jugular chain findings had unilateral enlargement of a transverse vertebral bone process, another showed scoliosis, and a third had a normal cervical spine study. During follow-up of 1-33 mo (median = 14 mo), no patient developed adenopathy at any additional site. All are alive and well.
Adult↗
Adenoid cystic carcinoma of the breast: diagnosis by fine-needle aspiration.
Adenoid cystic carcinoma rarely occurs as a primary breast malignancy. When seen in fine-needle aspiration (FNA) material, it is identical to its counterpart in the salivary glands. We report six cases diagnosed by aspiration in patients aged 32-82 yr. The smears were highly cellular and featured extracellular spheres of metachromatic material. These were surrounded by small, uniform cells with bland nuclei and very little cytoplasm. Numerous similar cells occurred singly in the background. The cytologic differential diagnosis of adenoid cystic carcinoma includes other entities that produce extracellular metachromatic spheres including collagenous spherulosis. We describe and illustrate similar material originating in inspissated secretions or stromal fragments from fibrocystic change and fibroadenoma, as well as infiltrating ductal carcinoma. Diagnostic criteria for adenoid cystic carcinoma and the clinical relevance of distinguishing this rare tumor from typical infiltrating ductal carcinoma are discussed.
Adult↗
Nodular fasciitis: spontaneous resolution following diagnosis by fine-needle aspiration.
Nodular fasciitis can be histologically mistaken for a sarcoma. Typical cases are less than 5 cm and enlarge rapidly over days or weeks before diagnosis. The natural history of nodular fasciitis is unknown, since the diagnosis is usually based on excised lesions. Fine-needle aspiration of nodular fasciitis has been described, and features benign-appearing spindle cells (singly and in groups), collagen, and myxoid material. We describe 11 cases in which nonsurgical observation led spontaneously to complete resolution. Our study includes 7 males and 4 females (24 to 73 years of age; median = 42). Lesions were located in the arm (4), thigh (3), temporal area (2), breast (1) and the parotid (1) and ranged from 0.5 to 5.0 cm. (median = 1.5). They had been present for from less than 1 to 4 weeks (median = 2). In 9 cases, spontaneous resolution occurred in from 3 to 8 weeks (median = 4). Two other patients were lost to follow-up for up to 11 months, after which resolution was noted. Small palpable masses in the subcutaneous soft tissues which evolve over a short period of time and show the cytologic features of nodular fasciitis should be managed nonsurgically. If resolution does not occur within a few weeks, surgery can then be performed.
Adult↗
Cytologic diagnosis of cytomegalovirus in cervical smears.
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Cervix Uteri↗
Cervical cytology findings in women infected with the human immunodeficiency virus.
It has been suggested that immunocompromised, HIV-infected patients are at risk of developing HPV infection and SIL. The well documented role of HPV and SIL in cervical carcinogenesis should lead to frequent, careful evaluation of HIV infected women. Forty-four cervical smears from 23 patients (20 HIV and 3 AIDS) were reviewed. While 11 of the 23 patients produced negative smears, 11 had abnormal cytological findings on at least one occasion. Sixteen smears (36 percent) from 10 patients (43%) showed evidence of HPV and/or SIL. Two smears (two patients) were assigned to the benign epithelial atypia category. (One of these showed keratosis which may indicate HPV infection.) Six smears (three patients) represented either a severe Trichomonas, fungal (Candida sp.), or Herpes infection. Three smears were deemed unsatisfactory for diagnosis due to severe acute inflammation or obscuring blood. Five biopsies were available. In four, histologic findings supported the original cytologic diagnosis. One patient with a negative smear had a biopsy showing condyloma. This study further supports an association of HPV and/or cervical dysplasia with HIV. Careful evaluation and follow-up of HIV-infected women is essential.
Female↗
Benign and malignant neoplasms of myoepithelial cells: cytologic findings.
We report two myoepithelial cell neoplasms; a salivary gland tumor was malignant and a breast neoplasm was benign. Both were studied histologically, immunohistochemically, cytologically, and ultrastructurally. The malignant myoepithelioma recurred twice and metastasized to one regional lymph node. This tumor was infiltrative with areas of necrosis and hemorrhage. It was composed of malignant-appearing spindle and plasmacytoid cells. Both types of cells were immunoreactive to muscle specific actin, S-100 protein, cytokeratin, vimentin, and neuron-specific enolase. Ultrastructurally, features of myoepithelial cells were seen. Fine-needle aspirate smears showed spindle and plasmacytoid cells, numerous mitoses, and malignant-appearing nuclei. Spindle-cell adenomyoepithelioma of the breast, a small well-circumscribed firm nodule, featured multiple lobules of spindle cells associated with clear-cell glands at the lobular periphery. Histologically and cytologically, the lesion was cellular but appeared benign. The differential diagnosis of myoepithelial neoplasms is discussed.
Adult↗
Atypia in breast fine-needle aspiration smears correlates poorly with the presence of a prognostically significant proliferative lesion of ductal epithelium.
Proliferative lesions of breast duct epithelium are associated with an increased risk of subsequent carcinoma. Fine-needle aspiration criteria for these lesions are poorly defined; most studies are retrospective and do not clearly use the classification of Page and Rogers. Suggested criteria for "atypia" include crowded, enlarged, overlapping nuclei in three-dimensional groups or sheets, loss of cohesion, occasional single cells, a homogeneous cell population, chromatin changes, and increased cellularity in older patients. Our prospective series of 1,925 aspirations included 717 breast cases, of which 25 (3.5%) were considered sufficiently atypical to possibly represent proliferative lesions, but were not suspicious for carcinoma. Fifteen patients with histologic follow-up formed the basis for this study. All had physical examinations and mammogram results consistent with fibrocystic change. Their ages ranged from 30 to 70 years (median age, 44 years). Cytologic changes of atypia were cataloged. Histologically, six cases (40%) showed prognostically significant lesions (moderate, florid, or atypical hyperplasia and one lobular carcinoma in situ). Many (60%) cytologically provocative lesions may originate in prognostically trivial lesions. At this time our limited understanding of the cytologic presentation of these lesions indicates that surgical excision is essential in all instances. Efforts to recognize and properly classify these proliferations in cytologic material should continue.
Adolescent↗
Processing of needle rinse material from fine-needle aspirations rarely detects malignancy not identified in smears.
When preparing FNA smears, we recover material left in the needle hub by forcefully striking the open hub against a slide. Material in the syringe tip is expressed by repeated forceful blasts of air (needle unattached). We investigated the utility of recovering additional material by rinsing the needle and syringe. Saline was used to flush the needle and syringe tip repeatedly. All material was processed by cytocentrifugation. We studied 159 needle rinse (NR) specimens from 152 patients (breast = 70, lymph node = 30, lung = 15, soft tissue = 14, salivary gland = 12, thyroid = 12, liver = 5, branchial cleft cyst = 1). Malignancy was identified in 21 FNAs (13%) from 21 patients (14%). All were diagnosed in smears (9 lung, 5 liver, 4 lymph node, 2 breast, 1 soft tissue). NR material identified 16 of these (76%). No case with benign smears (n = 138) showed malignancy in NR material. We conclude that if good technique is applied to preparation of smears and recovery of material from the needle hub and syringe tip, NR material will rarely identify additional malignancies. It thus represents an inefficient allocation of technical and human resources within the laboratory. However, NR may provide additional slides for special stains and may be useful for clinicians who do not always prepare high quality smears. Furthermore, the ease with which FNA of palpable masses can be repeated suggests that in the small number of cases requiring special stains, additional material can be readily obtained.(ABSTRACT TRUNCATED AT 250 WORDS)
Biopsy, Needle↗
Pulmonary mycetomas in immunocompetent patients: diagnosis by fine-needle aspiration.
Mycetomas usually grow within preexisting cavities and frequently lead to pulmonary hemorrhage. We describe four males, aged 38 to 72 years, in whom myceotomas were diagnosed by FNA. Preexisting cavitary lesions resulted from tuberculosis, anaerobic abscess, and bullous lung disease (two cases). Fine needle aspiration yielded tangled mats of fungal hyphae (large and grossly visible in three cases) and acute inflammatory cells. The atypical cells often seen in the walls of such lesions were not identified. Cultures showed Aspergillus (3 cases) Pseudoallescheria boydii (1 case). The diagnosis was surgically confirmed in two cases. Two patients were too ill for surgery and the fourth refused. At 7 and 10 months, the two remaining individuals have pulmonary hemorrhage but no evidence of progression or malignancy. In poor surgical candidates, conservative management of mycetomas diagnosed by fine needle aspiration is appropriate. Excluding mycetoma secondary to cavitary lung carcinoma requires careful correlation of historical, clinical, radiographic, cytologic, and follow-up data.
Adult↗
Pulmonary aspergillosis: an unusual cytologic presentation.
Cytologic identification of Aspergillus is usually based on recognition of hyphal elements; conidia are rarely seen. We report a case of autopsy-proven pulmonary Aspergillosis which was studied antemortem by bronchoalveolar lavage. This mass arose in the clinical setting of chronic necrotizing pulmonary aspergillosis. The specimen contained numerous conidia, some of which exhibited germination. No hyphae were seen. This unusual cytologic expression of clinically significant fungal disease could be easily overlooked. Distinction of Aspergillus conidia from contaminating pollen is discussed.
Aspergillosis↗
Hyperplasia of type II pneumocytes in acute lung injury. Cytologic findings of sequential bronchoalveolar lavage.
The organizing stage of acute lung injury syndrome is characterized, in part, by a reactive hyperplasia of type II pneumocytes. These cells may be recovered in large numbers and in an excellent state of preservation by bronchoalveolar lavage. It was noted recently that such cells in lavage samples may mimic adenocarcinoma. To examine the dynamics of type II pneumocyte shedding in acute lung injury, we studied 62 bronchoalveolar lavage samples from 38 patients with acute onset of the adult respiratory distress syndrome (median age, 54 years). A single lavage was performed in 25 patients, whereas from two to five studies were performed in 13 individuals. The timing of lavage ranged from 1 to 435 days after the onset of respiratory distress. Type II pneumocytes were present in 12 specimens as follows: 6 of 24 (25%) samples from days 1 to 3, 4 of 9 (44%) samples from days 4 to 10, and 2 of 11 (18%) samples from days 21 to 32. Specimens obtained after day 32 never contained such cells. Cytologically, type II pneumocytes may resemble the cells of acute radiation injury. Alternatively, they may be smaller, with an increased nuclear-cytoplasmic ratio, nuclear membrane irregularities, and prominent nucleoli, thus resembling the cells of adenocarcinoma. They may shed singly or in groups. A spectrum of changes from small cells to large, fully hyperplastic type II cells may be seen. Recognition of the morphologic features of type II pneumocytes and careful clinical correlation usually will suffice to prevent a false diagnosis of malignancy. Sequential lavage provides a means to study pulmonary epithelial changes after lung injury.
Acute Disease↗
Cellular follicular cyst of the ovary: fluid cytology mimicking malignancy.
We report three ovarian cysts studied by aspiration cytology. The fluids obtained were highly cellular, with numerous groups of atypical cells featuring a high nuclear-cytoplasmic ratio, nuclear hyperchromasia, and prominent nucleoli. In each case, these features were considered evidence of a low-grade malignant neoplasm. All three patients underwent oophorectomy, which revealed benign follicular cysts. Possible means of resolving the diagnostic dilemma posed by these cellular follicular cysts are discussed.
Adult↗
Granulomatous prostatitis: a spectrum including nonspecific, infectious, and spindle cell lesions.
Most granulomas of the prostate are nonspecific; infectious, post-operative, and allergic lesions are much less common. Fine-needle aspiration findings in the typical case are distinctive and easily recognized. Several series have been reported, but few have included histologic follow-up. We describe three cases of granulomatous prostatitis (GP) which showed a spectrum of findings confirmed by histologic sections. In all cases, carcinoma was suspected clinically. Case 1 represents typical nonspecific GP with epithelioid and multinucleated histiocytes. In case 2, aggregates of epithelioid histiocytes alternated with areas of necrosis and neutrophils. Histologically, the granulomas showed purulent centers. Silver stains revealed budding yeast in smears and sections. Cultures of FNA material subsequently revealed Cryptococcus. In case 3, the histiocytes were predominantly spindled and occurred singly and in groups. The differential diagnosis included reactive and neoplastic spindle cell lesions. Histologic sections showed GP with spindled histiocytes. Appreciation of the broad cytologic spectrum of GP will facilitate accurate cytologic diagnosis.
Aged↗
Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): diagnosis by fine-needle aspiration.
Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare idiopathic proliferative disorder of histiocytes with characteristic morphologic features. We describe a case of SHML occurring in a 14-yr-old black male, in whom the diagnosis was made by fine-needle aspiration of a cervical lymph node. Cytologic features included increased numbers of large histiocytes associated with a polymorphous, cellular background composed of benign lymphocytes, plasma cells, and polymorphonuclear leukocytes. Lymphophagocytosis was a prominent feature. Extranodal involvement of the larynx was documented by surgical biopsy; there was no other extranodal disease. One year after diagnosis, the patient is clinically well, with no residual lymphadenopathy.
Adolescent↗