Biomedical subjects
Publications and source records attributed to W J Frable.
A case of cryptococcal endophthalmitis diagnosed by vitreous aspiration membrane filtration cytology is presented. Interest lies in its being the first such diagnosis reported by vitreous aspiration. This case also illustrates the usefulness of combining membrane filtration cytology with the mucicarmine stain for identification of the cryptococcal capsular mucin.
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Between November 1972 and December 1981, 1303 fine needle aspiration biopsies were performed on patients with head and neck masses at the Medical College of Virginia, Virginia Commonwealth University. The results of 649 lymph node, 227 salivary gland, 286 thyroid, and 41 miscellaneous aspiration biopsies are reviewed. No radical treatment resulted from false positive diagnoses and no patient delay in treatment occurred because of false negative results. Techniques for performing the procedure are briefly reviewed. Cost containment is stressed, particularly the savings that occur when the diagnosis is not neoplastic. Future developments and uses of the procedure are discussed.
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Between 1973 and December 1978, the authors performed 133 thin needle aspiration biopsies of the thyroid gland. Thin needle aspiration biopsy has proved valuable in this series and may save some patients the necessity of thyroid surgery. The procedure, performed quickly, results in a diagnosis usually available minutes later, and a definite patient disposition can be made promptly. At a time of medical cost containment, this procedure will become more important in patient care. Review of our aspirations through 1977 revealed three false negative biopsies and two false positive reports. Important differential characteristics between follicular neoplasm and nodular or adenomatous goiter will be discussed. Neoplasms appear to represent a smaller percentage of cold thyroid nodules than reported elsewhere.
Investigations were performed in eight young women to determine if the findings of secondary amenorrhea and high follicle-stimulating hormone levels were due to primary ovarian follicular atresia or to other causes. Karyotypes were determined from both peripheral leukocytes and ovarian tissue; one woman had XXX/XX/XO mosaicism. Another woman had normal ovarian histology and probably had the "gonadotropin-resistant ovary syndrome." No autoimmune antibodies were detected, but one woman with myasthenia gravis also had ovarian histology that demonstrated primary ova and a developing follicle. Only five of eight women had primary ovarian follicular atresia, and two of the other three women had conditions theoretically compatible with subsequent pregnancy.
Results of 567 thin-needle aspiration biopsies of head and neck lesions are reviewed. Cases included lymph nodes, salivary glands, thyroid, soft tissue and bone lesions. For the entire series, 17 patients had unsatisfactory aspirations. There were 12 false negative reports and 4 false positive reports, rates of 2.1% and 0.7%, respectively. No radical treatment resulted from false positive diagnoses and no patient delay in treatment occurred because of false negative reports. In the case of benign and malignant tumors, reports were histologically specific in more than 98% of the cases. This technique is simple to perform and saves time and hospital costs. Thin-needle aspiration biopsy can be effectively used in the management and diagnosis of head and neck tumor patients where close cooperation of the clinician and cytopathologist exists.
Actinomycosis was diagnosed in three cases by the use of thin-needle aspiration biopsy technic. Aspiration was utilized for morphologic studies and collection of material for microbiologic isolation. The critical histologic features of sulfur granules remain intact with aspiration technic. Thin-needle aspiration biopsy is a safe, simple, and rapid technic employed in the diagnosis of neoplastic disease. The use of this technic in the diagnosis of actinomycosis is demonstrated in this report.
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Primary adenocarcinoma of the cervix and endocervix is an unusual lesion. It is cytologically evasive, diagnostically challenging, histologically variable, and therapeutically perplexing. During the period 1954 through 1971, 53 cases were diagnosed at the Medical College of Virginia, representing 3% of all invasive cervical carcinomas. Clinical material, therapy, and five-year survival statistics have been complied for each histologic type of adenocarcinoma. The average age of the patients was 53.8 years, and the most frequent complaint was abnormal uterine bleeding. Histologically, the majority had adenocarcinomas of the endocervical type. Others, in order of descending frequency, had endometrioid, clear cell, colloid, and adenoid cystic carcinomas. Patients treated for endometrioid carcinomas had the best five-year survival rates. Standardization of the diagnostic process and the use of modern radiation therapy have significantly improved survival. All patients having radiation plus operation or operation alone lived five years or more.
Cytological examination of specimens obtained from the tracheobronchial tree has become an integral part of the evaluation of pulmonary lesions. Cytological criteria for the diagnosis of carcinoma exist and are well defined. Certain benign processes, however, may possess features strongly suggestive of carcinoma of the lung. We report 3 patients in whom a positive cytological diagnosis of carcinoma of the lung was made by an experienced cytopathologist. At operation each patient was found to have pulmonary infarct and no evidence of carcinoma. Review of this experience has disclosed cytological and clinical features that should alert the clinician to the possibility that the cytological diagnosis of lung cancer may be misleading in certain nonmalignant diseases.
The eighth documented case of leimoyomatosis peritonealis disseminata (LPD) is presented. Histologic evidence for concomitant intravenous leiomyomatosis and early development of a leiomyoma in a vessel wal was noted in the present case. Electronmicroscopic studies proved the smooth muscle origin of the tumors in this case. Intriguing features of this disease are its grossly malignant appearance, relatively benign histology, and generally favorable clinical behavior. Because women of reproductive age, especially in the fourth decade, are affected, hormones may play a role in the etiology of LPD. Intraoperative diagnosis requires frozen-section examination and treatment has included extirpation of involved tissues, wherever possible. Also advocated is surgical castration which may remove the hormonal stimulus for the growth of any residual tumor. Since LPD bears a close resemblance to genital leiomyosarcoma, it warrants proper recognition and management.
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The thin-needle aspiration biopsy technic was used in 469 cases to diagnose benign and malignant tumors. The success of the technic depends upon careful examination of the lesion to be biopsied and attention to the details outlined in procuring the aspiration material and preparing the smears. The most important technical consideration is creating a simulated tissue pattern in the preparation of the smears. Routine Papanicolaou, May-Grünwald-Giemsa, metachrome B, and hematoxylin and eosin stains are all useful. Special stains may provide additional evidence for specific diagnoses. Lymph nodes were the most common tissue examined by aspiration biopsy in this series. It was possible to identify the primary tumor site from the aspiration smear in most of the cases. Forty-seven breast cancers were identified from 127 aspiration biopsies of breast lumps. Breast aspirations are the most difficult to interpret, and no deviation from classic malignant smears should be attempted. The false-negative rate for breast aspirations was 7.0%. No delay in treatment occurred because of a false-negative report. Patient acceptance of the procedure was excellent.
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