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S S Raab

Publications and source records attributed to S S Raab.

88 records · Page 5Linked to original sources
PubMed1993

Fine-needle aspiration biopsy of pulmonary coccidiodomycosis. Spectrum of cytologic findings in 73 patients.

Coccidioides immitis, the causal agent of coccidiodomycosis, is endemic in the arid desert regions of Mexico and the southwestern United States. Individuals may acquire the disease through the inhalation of conidia. The majority of infected patients are asymptomatic or exhibit flu-like symptoms. Two percent of infected individuals ultimately demonstrate a solitary pulmonary nodule that may be radiographically indistinguishable from neoplasms or other infectious lesions. This report describes the spectrum of cytologic findings in 73 patients who were diagnosed with pulmonary coccidiodomycosis by fine-needle aspiration (FNA) biopsy. The patients ranged in age from 30 to 92 years. Ten had a previous history of malignancy. The smears were characterized by a large amount of granular, eosinophilic debris with a paucity of acute or chronic inflammation. Granulomatous inflammation was present in only three cases. The diagnosis was confirmed by the cytologic observation of C. immitis spherules that ranged in size from approximately 20 to 200 microns. Many of these spherules had a crushed or fractured appearance, and occasional calcified forms were seen. Endospores were observed in intact spherules and were rarely observed outside these spherules. Mycelial elements occasionally were present. C. immitis were cultured in 9 of 44 cases in which fungal cultures were obtained. The cytologic differential diagnosis, which includes contaminant, other infectious diseases and malignancies, is discussed.

Adult↗
PubMed1985

Evidence for the role of class I and class II HLA antigens in the lytic function of a cloned line of human natural killer cells.

Monoclonal antibodies with specificity for HLA class I and class II antigens were generated which either inhibit or enhance the lytic activity of a cloned line of human NK cells. These antibodies were obtained from a fusion with spleen cells from mice immunized with NK clone 3.3. They affect the lytic function of that clone at the level of the killer cell; additional evidence suggests that the effect takes place during an early stage of lysis. Immunoprecipitation and cross-clearing experiments using MHC antibodies of known specificity demonstrate the reactivity of mAbs 131 and 164 with HLA class I antigens and mAbs 210 and 273 with HLA class II antigens. Binding studies indicate that these antibodies are probably recognizing nonpolymorphic MHC determinants. Although these antibodies bind to other NK effector cells tested, they have no effect on the lytic function of these bulk NK populations. Preliminary studies, however, indicate that they do affect the NK activity of a proportion of the clones within these bulk populations. To further assess the potential role of HLA gene products in the lytic function of NK3.3, several well-defined anti-MHC antibodies were tested for their effects on NK3.3 function. The anti-HLA class I and class II antibodies could each be grouped into functional categories based on their ability to enhance, inhibit, or not affect the lysis of NK-sensitive targets K562 and MOLT-4 by NK clone 3.3. These results demonstrate, for the first time, a potential involvement of MHC molecules with NK function.

Animals↗
PubMed1984

Inhibition of cell-mediated lympholysis by cloned and uncloned lines of natural killer cells and cytotoxic T lymphocytes with sugars and lectins.

This study was designed to further understand the nature of the interaction between natural killer (NK) cells and their susceptible targets. To do this, a panel of sugars and two lectins was tested for the ability to inhibit the lysis of NK-sensitive targets by cloned and uncloned lines of human NK cells. Six of these sugars (beta-gentiobiose, sucrose, alpha-lactose, beta-lactose, N-acetylglucosamine, and N-acetylgalactosamine) and one lectin, wheat germ agglutinin (WGA), proved to be potent inhibitors of the lytic activity of NK cells as well as of cytotoxic T lymphocytes activated in mixed lymphocyte cultures. Both beta-gentiobiose and WGA were shown to inhibit lysis at the level of the killer cell. Finally, the inhibitory effect of WGA could be reversed by addition of its sugar ligand, N-acetylglucosamine, which is itself an inhibitor of lytic function. From these findings it is concluded that these inhibitors probably do not act at the recognition stage of lysis since all of the NK and CTL lines tested, regardless of specificity, were inhibited by the same panel of sugars and lectins. Instead, it appears more likely that these inhibitors block some postrecognition stage of the lytic mechanism. The common inhibition profile by these sugars on NK and CTL activity further suggests that these two cell types may share, at least partially, a common lytic mechanism.

Acetylglucosamine↗
PubMedDate not supplied

Cost-effectiveness studies on cervical cancer.

Cost-effectiveness analyses are an important source of information for the design and evaluation of policies to reduce cervical cancer. This paper describes the recommendations of a panel on cost-effectiveness studies convened as part of the International Consensus Conference on the Fight Against Cervical Cancer. Recommendations for cost-effectiveness studies include: (1) the use of reference case methods to support comparisons across studies, (2) the use of a consistent standard of evidence on the clinical effectiveness of different screening strategies, (3)further research into the costs and effectiveness of different screening and treatment strategies for cervical cancer, (4) further research into screening and treatment strategies in a wide range of countries, (5) easily accessible and detailed descriptions of the methods and supplementary analyses underlying published studies, (6) greater use of newly developed models of cervical cancer, and (7) greater revelation of potential conflict of interest by researchers.

Conflict of Interest↗
PubMedDate not supplied

Interobserver and intraobserver variability in the cytologic diagnosis of normal and abnormal metaplastic squamous cells in pap smears.

OBJECTIVE: Interoberver variability has important implications for patient care, diagnostic error and medical litigation. In the management of any cervical epithelial abnormality, its biologic significance as well as diagnostic reproducibility is very important. Interobserver variability has not been measured adequately for metaplastic squamous lesions. We analyzed interobserver and intraobserver variability and diagnostic accuracy in the diagnosis of dysplastic metaplastic cells. STUDY DESIGN: Sixty Pap smears from patients with abnormalities of metaplastic squamous cells of varying severity were selected from the files of Lankenau Hospital, Wynnewood, Pennsylvania, U.S.A., diagnosed between 1990 and 1996. These were reviewed by four observers with different levels of cytology experience. Each of the observers blindly and independently reviewed all Pap smears. Tabulated results were analyzed to determine interobserver and intraobserver variability and diagnostic accuracy. RESULTS: Statistically significant interobserver reproducibility was found between both inexperienced observers as well as between observers 1 (experienced) and 3 (inexperienced) and between observers 2 (experienced) and 4 (inexperienced). The observed degree of agreement between both experienced observers (1 and 2) reflected random rating rather than reproducibility. There was no difference in interobserver reproducibility in low vs. high grade lesions. Intraobserver reproducibility had no significant correlation with experience of the observer. The sensitivity ranged from 0.69 to 0.97 (mean, 0.79), while the specificity ranged from 0.09 to 0.46 (mean, 0.30). Mean diagnostic accuracy was better in benign and low grade squamous intraepithelial lesions in comparison to high grade squamous intraepithelial lesions. CONCLUSION: There was good interobserver agreement in classifying squamous metaplastic lesions. The agreement did not correlate with grade of dysplasia or experience of the cytopathologists. These findings should be considered in making treatment, quality assurance and legal decisions. A larger study is indicated to study interobserver and intraobserver variability and define cytologic criteria for lesions of metaplastic squamous cells.

Adult↗
PubMedDate not supplied

Quality assurance and risk reduction guidelines.

Cervical cancer continues to be a major cause of death in women worldwide. The major problem facing most women is the unavailability of screening Pap tests in poor and underdeveloped countries. While rates of cancer deaths have decreased 60-80% in developed countries since the Pap test became available, the accuracy of Paps was challenged recently. In order to instill public confidence and promote optimal patient care, measures to improve the quality of the entire screening process should be undertaken. Continuous quality improvement processes are more appropriate than traditional quality assurance monitors. Although no standards can be defined that are applicable to all laboratory settings and nations, this document provides current views on universal quality procedures and risk reduction. Procedure/policy manuals, workload assessment, hierarchic/peer review, discrepancy analysis, rescreening studies and cytohistologic correlation are examples of universally applicable quality tools. The variability in practices in different parts of the world is also discussed.

Female↗
PubMedDate not supplied

Fine needle aspiration biopsy findings in congenital hepatic fibrosis. A case report.

BACKGROUND: Congenital hepatic fibrosis is an uncommon disease of undetermined etiology that may present clinically with portal hypertension or cholangitis. Histologically the liver is characterized by portal fibrosis and an increase in portal ductal structures. CASE: A 46-year-old male with a history of congenital hepatic fibrosis presented with abdominal pain and was found to have a 2 x 3-cm liver nodule. Fine needle aspiration biopsy showed hepatocytes and abundant bile duct epithelium. CONCLUSION: This report expands the spectrum of nonneoplastic diseases that have been sampled by fine needle aspiration biopsy.

Bile Ducts↗
PubMedDate not supplied

Fine needle aspiration biopsy of metastatic malignant melanoma with "rhabdoid" features. Frequency, cytologic features, pitfalls and ancillary studies.

OBJECTIVE: To characterize the cytopathology of metastatic malignant melanoma (MM) with "rhabdoid" features, a recently described, rare morphologic variant of MM that can be incorrectly diagnosed in fine needle aspiration (FNA) biopsy. STUDY DESIGN: A retrospective review of all FNA biopsy material with the diagnosis of metastatic MM was performed at two institutions. Only cases with a predominant composition of cells that met criteria defined as "rhabdoid" morphology were selected for study. The cytomorphologic features, immunocytochemistry and clinical features of these cases were reviewed. RESULTS: Of 88 FNA cases previously diagnosed as metastatic MM, 4 (4.6%) had a predominance of cells with rhabdoid features. These cases consisted of scattered atypical cells having enlarged, eccentrically placed nuclei; prominent nucleoli; and a moderate amount of cytoplasm possessing round, globular inclusions in Papanicolaou- and Diff-Quik-stained smears. Immunochemistry showed strong S-100, HMB-45 and vimentin staining in two of four cases. CONCLUSIONS: Metastatic MM may present in FNA biopsy as a poorly differentiated malignancy with rhabdoid features, potentially leading to an incorrect cytologic diagnosis. MM must be considered when evaluating neoplasms with a rhabdoid phenotype. Correlation of the cytologic finding with the clinical history and immunohistochemical studies can help in diagnosing this morphologic variant.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Fine needle aspiration biopsy of hepatic lymphomas: cytomorphology and ancillary studies.

OBJECTIVE: The utility of fine needle aspiration biopsy (FNAB) for the diagnosis of epithelial hepatic neoplasms is now widely recognized. The liver may also play host to malignant nonepithelial stromal and lymphoreticular neoplasms, both metastatic and rarely primary. The cytomorphology of these hepatic tumors in aspiration smears is much less well known. In the current study, we examined FNAB material from hepatic lymphomas, including ancillary studies. STUDY DESIGN: We collected 16 cases of lymphoma involving the liver and diagnosed by FNAB. The patients included seven women and nine men, with ages ranging from 34 to 84 years. Nine patients did not have a diagnosis of lymphoma prior to FNAB. In all cases, aspiration smears were stained by both Diff-Quik and Papanicolaou stain. RESULTS: Dispersed, monomorphic lymphoid cells were usually numerous, whereas benign hepatocytes were scanty. In addition to the lymphoid appearances of individual cells, helpful clues included the presence of lymphoglandular bodies and the absence of true intercellular cohesion. There were 6 large cell, 3 immunoblastic, 2 small cell, 1 small cell cleaved, 2 mixed cell and 2 unclassified lymphomas in our FNAB series. Immunocytochemical studies were performed on 9 aspirated specimens, flow cytometry on 4 and gene rearrangement on 1. All these ancillary studies supported the cytomorphologic diagnosis of lymphoma, with approximately 90% classified as of B-cell lineage. All seven subsequent histologic examinations were confirmatory. CONCLUSION: Other entities that must be considered in the FNAB differential diagnosis of hepatic lesions are nonlymphoreticular small cell neoplasms, inflammatory processes and sinusoidal hematopoietic cells. FNAB with ancillary studies can successfully establish the diagnosis of involvement of the liver by lymphoma.

Adult↗
PubMedDate not supplied

Cytopathology in the Socialist Republic of Vietnam.

OBJECTIVE: To determine the differences and similarities between cytopathology practice in Vietnam and North America. STUDY DESIGN: Through the sponsorship of Friendship Bridge, we traveled to Hanoi and Ho Chi Minh City, Vietnam, in January 1994. By visiting hospitals and medical centers in each city, we observed how economic, demographic and social factors affected cytopathology practice. RESULTS: In Vietnam, the resources of the medical system, cytopathology in particular, are devoted to diagnosis rather than prevention. Consequently, screening tests, such as the Papanicolaou smear for the detection of cervical-vaginal lesions, are not performed on a routine basis. There are regional differences in Vietnam in the employment of common techniques, such as fine needle aspiration biopsy. CONCLUSION: Although limited in funds, cytopathology is widely practiced and serves an important role in the medical system of Vietnam.

Biopsy, Needle↗
PubMedDate not supplied

The utility and cost-effectiveness of Pap test rescreening.

Although most laboratories practice 10% manual rescreening of negative Pap tests, the cost-effectiveness of this and other rescreening strategies rarely has been evaluated. A decision model was created in which rescreening strategies were compared with nonrescreening strategies in terms of the number of false negative and positive diagnoses, cancers, life expectancy, and cost-effectiveness. The 10% rescreening with a repeat Pap test strategy yielded almost no gain in life expectancy in comparison to an equivalent strategy with no rescreening. A 100% rescreening strategy generally was more cost-effective than a no-rescreening strategy at costs of rescreening varying from $2 to $10 per patient. We conclude that if the rescreening cost is low, 100% rescreening strategies are more cost-effective than nonrescreening strategies.

Adult↗
PubMedDate not supplied

Fine needle aspiration cytology of renal and retroperitoneal angiomyolipoma. Report of two cases with cytologic findings and clinicopathologic pitfalls in diagnosis.

BACKGROUND: Angiomyolipoma is a benign soft tissue neoplasm that usually arises in the kidney, although rare extrarenal examples have been documented. CASES: Two cases of the neoplasm occurred in which fine needle aspiration (FNA) biopsies were performed. The first patient was a 73-year-old female with a history of breast carcinoma who presented with a large retroperitoneal mass. Transabdominal FNA biopsy revealed multiple fragments of spindle-shaped mesenchymal cells, a few of which showed marked cellular atypia with occasional cells containing fat vacuoles, producing a lipoblastlike appearance. However, the atypical spindle cells were immunohistochemically reactive for actin, raising the possibility of a smooth muscle tumor rather than a liposarcoma. The surgically resected specimen revealed an extrarenal, retroperitoneal angiomyolipoma. The second patient was a 71-year-old female who presented with a right renal mass and hepatomegaly. Computed tomography showed a mass in the upper pole of the kidney and multiple enhancing lesions in the liver. FNA biopsy was diagnostic of angiomyolipoma, which was confirmed histologically. CONCLUSION: Angiomyolipoma should be considered in aspirates of both renal and extrarenal masses when an admixture of blood vessels, fat and smooth muscle cells is encountered. Pitfalls leading to an incorrect diagnosis include aspiration at unusual sites for angiomyolipoma and/or the presence of atypical spindle cells and lipoblastlike cells, which can be mistaken for leiomyosarcoma or liposarcoma cells. Ancillary studies, such as immunocytochemistry for smooth muscle markers, may be helpful in making the correct diagnosis.

Aged↗
PubMedDate not supplied

Fine needle aspiration biopsy of the spleen in the evaluation of neoplastic disorders.

Splenic fine needle aspiration (FNA) biopsy has been used mainly in Europe to diagnose nonneoplastic systemic diseases. A few reports have described FNA biopsy of the spleen for the diagnosis of lymphoma. There is a definite paucity of North American reports concerning FNA biopsy for metastatic disease involving the spleen; that probably is a reflection of both the relative infrequency of splenic metastases and concern about potential hemorrhagic complications of the procedure. We report a series of 11 FNA biopsies of the spleen in patients with known carcinoma or hematologic malignancies. The FNA biopsies were performed on eight males and three females with a median age of 45 years and a range of 6-77 years. Six patients had a known hematopoietic malignancy at the time of aspiration (five non-Hodgkin's lymphoma, one acute myelogenous leukemia [AML]). The one patient with Hodgkin's disease had an FNA biopsy of the spleen as part of the initial workup; cytologic impression was atypical lymphoid cells with granulomas suggestive of Hodgkin's disease, which was confirmed by splenectomy. Four patients with carcinoma (two testicular, one lung, one ovarian) had FNA biopsies for the evaluation of splenic nodules; FNA biopsy confirmed metastatic carcinoma in three of these patients. In the entire series splenic FNA biopsy documented malignancy in 6 of the 11 patients. The one patient with AML had Aspergillus identified in the splenic aspirate, while granulomatous inflammation with yeast consistent with Candida was seen in a patient with non-Hodgkin's lymphoma. One aspirate demonstrated abscesses without recognizable organisms, and another showed extensive necrosis in a patient with testicular choriocarcinoma. Only one hemorrhagic complication was noted following splenic biopsy. Our experience demonstrates that FNA biopsy of the spleen is a useful and safe procedure in evaluating infectious and neoplastic splenic masses in patients with hematopoietic malignancies and carcinoma.

Adolescent↗
PubMedDate not supplied

Fine needle aspiration biopsy of fibromatoses.

Fibromatoses form a spectrum of clinicopathologic entities characterized by the infiltrative proliferation of fibroblasts that lack malignant cytologic features. Fibromatoses present as nodular soft tissue masses almost anywhere in the body and thus are often amenable to fine needle aspiration (FNA). This report describes the FNA cytologic findings of fibromatosis in six patients ranging in age from 7 1/2 weeks to 36 years. Two of the lesions arose in the abdominal wall (musculoaponeurotic fibromatosis or extra-abdominal desmoid), and one each involved the plantar surface (Ledderhose's disease), the shoulder and the sternocleidomastoid muscle (Fibromatosis coli). The FNA of the shoulder was initially interpreted as nodular fasciitis due to the clinical presentation of a rapidly growing mass; an aspirate from the deep musculoaponeurotic region was believed to reveal a low grade sarcoma. The FNA diagnosis of musculoaponeurotic fibromatosis in a patient with familial polyposis coli suggested the diagnosis of Gardner's syndrome. Cytologically the aspirates consisted of groups of loosely cohesive, bland-appearing, spindle-shaped cells having oval to elongated nuclei and cytoplasmic tags. Individual spindle cells and rare inflammatory cells were also present. The aspirate of fibromatosis coli also contained degenerating skeletal muscle cells. Tissue confirmation was obtained in four cases. We believe that FNA is a useful procedure for the initial and recurrent diagnosis of fibromatoses and in the separation of fibromatoses from other benign and malignant soft tissue lesions. A discussion of other entities that enter into the cytologic differential diagnosis, such as mesenchymal repair, fasciitis and spindle cell types of sarcoma, is presented. From our experience we believe that the clinicopathologic features can suggest the diagnosis of fibromatosis, but histologic confirmation is recommended.

Adult↗
PubMedDate not supplied

Growth fraction determination in pulmonary hypoplasia using Ki-67 (MIB-1) antibody.

Pulmonary hypoplasia (PH) is a developmental abnormality that is typically assessed using lung/body weight ratios, radial alveolar counts, or lung volume measurements. Although it is often assumed that PH results from failure of growth and development, analysis of the proliferative index in PH has not been extensively described. We examined the lungs of 12 fetuses and newborn infants with pulmonary hypoplasia and those of 8 gestational age-matched controls using Ki-67 immunohistochemistry. Formalin-fixed, paraffin-embedded tissues were utilized. Growth fractions (GFs) were determined for peripheral lung parenchyma and bronchioles. The ratio of GFs for parenchyma and bronchioles was compared. There was no significant difference in the GF ratios obtained between control and hypoplastic lungs when gestational age was < 24 weeks. However, for gestational age > 24 weeks the GF ratio of mean values for controls was approximately four times the ratio of the mean values for the hypoplastic lungs. GF did not vary according to the presumed cause of PH, and at gestational ages < 24 weeks rates were the same as or greater than those of controls. These findings suggest that proliferative potential exists at < 24 weeks and that the growth of the lung parenchyma in relation to the conducting airways is significantly reduced or ceases after this point in gestation. Clinical interventions at or before 24 weeks of gestation might result in improved survival of infants with a propensity for pulmonary hypoplasia.

Abortion, Spontaneous↗