A number of immunological markers and chromosomal abnormalities are described to aid in the diagnosis, prognosis and management of soft tissue sarcomas. Although the chromosomal abnormalities may be specific in some cases, they have only been reported in small series or single cases and their significance has not yet been established. None of the immunological markers described is either entirely specific or sensitive for a particular tumor type, and virtually none of these immunological reagents is currently approved for diagnostic use despite their widespread applications in pathology. They function in a supporting role to conventional tissue pathology, grading, and pathological and clinical staging of soft tissue sarcomas. Antibodies employed as an aid in diagnosis of soft tissue tumors should always be run in panels and never as single tests. New immunological markers and chromosomal abnormalities in soft tissue sarcomas should be carefully evaluated for their specificity and sensitivity and their usefulness in diagnosis and prognosis.

Actins↗

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Competency assessment and proficiency testing.

Competency assessment is an ongoing, continuous process of monitoring individuals' abilities to perform their specific job functions. A variety of methods are useful in monitoring cytology competency, including rescreening studies, descriptive monitors (abnormality rates), discrepancy rates, workload patterns, competency-based educational programs and programs using unknown slide challenges. The goal of proficiency testing (PT) is to ascertain and assess the ability of individuals beyond the particular items or challenges presented. However, cytology PT faces many challenges for implementation as it cannot duplicate normal working conditions, and there is often no gold standard to define the truth. PT is just one measure of performance and should be considered in conjunction with other quality assessment monitors. There is no consensus on the value or validity of a large-scale regulatory PT program. Any regulatory PT program should be field tested prior to implementation, and the grading system should be scientifically defensible. Scoring of performance on PT should occur in a timely fashion, and there should be an opportunity for educational feedback. The ultimate aim of both competency assessment and PT is to positively affect laboratory procedures and improve the cervical cancer screening process.

Cell Biology↗

PubMedDate not supplied

ASCUS and AGUS criteria. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.

ISSUES: The conference participants addressed the following issues: (1) reporting of equivocal diagnoses, (2) strategies to minimize the use of such diagnoses, (3) morphologic criteria, and (4) management of women with equivocal diagnoses. CONSENSUS POSITION: Equivocal diagnoses should be minimized, to the extent possible, by emphasizing cytologist education and training, improved specimen collection and quality assurance monitoring of individual and laboratory diagnosis rates. Cases fulfilling criteria for other diagnostic entities should not be included in the equivocal category. Regardless of the term utilized, an equivocal diagnosis should be qualified in some manner to indicate that the diagnosis defines a patient at increased risk of a lesion, particularly for those cases which raise concern about a possible high grade lesion. Qualification of an equivocal diagnosis can also be accomplished by appending laboratory statistics of the likelihood of various clinical outcomes or recommendations for patient follow-up. In contrast to favoring a reactive process versus squamous intraepithelial lesion (SIL), a more rationale approach to qualification of atypical squamous cells of undetermined significance may be to separate cases equivocal for low grade SIL from those suspicious for high grade SIL. With regard to glandular lesions, the conference participants expressed unanimous support for the separation of adenocarcinoma in situ (AIS) from atypical endocervical cells of undetermined significance when sufficient criteria are present. However, the diagnosis of a precursor lesion to AIS, endocervical glandular dysplasia, was controversial. The majority of conference participants discourage the use of such terms as mild glandular dysplasia and low grade glandular dysplasia for cytologic diagnoses. ONGOING ISSUES: Conference participants agreed that a term reflecting diagnostic uncertainty is necessary to communicate findings that are equivocal. However, participants could not agree on the wording of such a term. Opinions differed as to: (1) use of atypical, abnormal or morphologic changes to describe cell changes, (2) whether the diagnosis should indicate a squamous or glandular origin of the cells in question when this determination can be made, and (3) the value of defining morphologic criteria for such a diagnosis. The debate over terminology, as well as morphologic criteria, is ongoing, and the readership is invited to communicate opinions to Acta Cytologica. Management of women with equivocal diagnoses varies widely from locale to locale and may differ based on how the equivocal diagnosis is qualified. Findings insufficient for the diagnosis of a high grade lesion may warrant more aggressive follow-up than cases equivocal for a low grade lesion. Where sensitivity of detection of lesions is of paramount importance, follow-up will generally consist of more frequent cytology screening or colposcopy and biopsy. However, in some countries it is considered unethical to have a high percentage of false positive diagnoses, which result in overtreatment and an unnecessary burden for women participating in cervical screening. Future studies may provide a morphologic, or perhaps molecular, basis for distinguishing true precursors of neoplasia from minor lesions of no significant clinical import; this would allow a more coherent and rational approach to diagnosis and management of women with equivocal cytologic findings.

Adenocarcinoma↗

PubMedDate not supplied

Medicolegal affairs. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.

ISSUES: Increasing litigation over alleged false negative cervical cytologic (CC) smears threatens the viability of this test for cervical cancer detection. The problem appears to be largely American but is beginning to appear in some other countries. In the vast majority of cases there is either a settlement or jury verdict for the plaintiff based largely on the testimony of expert witnesses. Cases are judged on an individual basis without significant consideration of the general performance of the CC smear in laboratories operating in compliance with a wide array of laboratory regulations and with documented and comprehensive quality control practices in place. It is acknowledged that there are problem laboratories and cytology practitioners. There is an emerging issue of automated preparation and screening devices and issues of informed patient consent. CONSENSUS POSITION: Cytology professionals have done an extraordinary and commendable job of educating the public about the benefits of the CC smear. We have been less successful and conscientious about explaining and defining the limitations of the CC test. There is a need for public and professional education as to the benefits and limitations of the CC smear for cervical cancer detection. The process suggested is to work with women's groups, public health agencies, government agencies, and state and national legislatures and to coordinate professional committees working on liability issues. Contextual information could be included with the CC smear report to indicate that a negative report confers a low probability of developing cervical cancer. It is suggested that appropriate language and a menu of statements be developed. Increased efforts should be directed to physician education with respect to informed consent concerning the benefits and limitations of CC smear testing and the application of new technology to improve smear accuracy. The process should include development of appropriate statements on the use of alternative technology. The profession should develop "process guidelines" for review of CC smears in the context of possible litigation, including standardized methods for blind slide review of smears that reduce or eliminate context and outcome bias. It is suggested that review panels be anonymous, that the process be standardized and that there be limitations on liability for participating organizations. Professional cytopathology and pathology societies should formulate acceptable guidelines for expert witnesses. The standards should be applicable to both defendant and plaintiff experts. All materials to the extent practical, including consultant opinions, should be available for peer review. Professional cytopathology and pathology societies should monitor expert testimony for objectivity and scientific accuracy. ONGOING ISSUES: For the near future, litigation will continue to focus on false negative CC smears on a case-by-case basis. Laboratories and individuals can reduce the risk of malpractice liability by directing their attention to proactive quality control and quality assurance methods. In the final analysis, consumer education about the benefits and limitations of the test is key to limiting malpractice claims. To stem the tide of continued medicolegal challenges to the integrity of cytology practice, the cytology community has now focused its efforts on developing and utilizing standards that convey to patients, attorneys and cytologists the contemporary status of and reasonable expectations for the practice of cytology. Guidelines such as those for uniform reporting terminology and clinical management of cervical abnormalities form the basis of cytology practice standards on which legal standards of practice can be based. Consensus conference reports, clinical management trials and scientifically valid studies of false negative rates that analyze the type, frequency and cause of missed cases represent sounder methods of establishing defensible

Cell Biology↗

PubMedDate not supplied

Primary lymphoma of the endometrium. A report of two cases diagnosed on cervicovaginal smears.

BACKGROUND: Primary lymphomas of the endometrium are extremely rare. Diagnosis is difficult, especially when the neoplasm is originally evaluated on a cervicovaginal smear. When lymphomas involve the endometrium, the cervix is three times more likely to be the primary site rather than the endometrium. Two of the symptoms of primary lymphoma of the endometrium are abnormal vaginal bleeding and an abdominal or pelvic mass. CASES: Case 1 was a 36-year-old, obese, black female with an abdominal mass and recent onset of ascites. The second case was a 31-year-old, obese, black female with a history of menometrorrhagia. The cytologic findings in both cases revealed an individual cell population, high nuclear/cytoplasmic ratio, small nucleoli and coarsely granular chromatin with some chromatin clearing. Endometrial currettings showed a histologic pattern of malignant non-Hodgkin's lymphoma, diffuse, large cell type. Immunoperoxidase staining was positive for leukocyte common antigen. CONCLUSION: Two cases of lymphoma of the endometrium were diagnosed first by a cervical cytologic smear, supported by a positive body cavity fluid in one case and histology in both. The differential diagnoses included various inflammatory lesions, small cell carcinoma, endometrial stromal sarcoma and granulocytic sarcoma.

Adult↗

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Rhabdoid cells in peritoneal fluid. A case report.

BACKGROUND: Rhabdoid tumor is an aggressive, malignant renal neoplasm of infants. Many extrarenal sites have been documented. CASE: A poorly differentiated carcinoma of the ovary with rhabdoid features occurred in a 36-year-old woman. The peritoneal fluid contained numerous malignant cells with rhabdoid features. Electron microscopy and immunocytochemistry corroborated the rhabdoid nature of the cells. CONCLUSION: Rhabdoid cells can be distinguished from other neoplasms with similar cytologic features by ancillary studies and clinical history.

Adult↗

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Fine needle aspiration cytology of phyllodes tumor. Potential diagnostic pitfalls.

We reviewed the fine needle aspiration cytologic findings in six cases of phyllodes tumor (PT). The average age of the patients at the time of the diagnosis was 47 years. Two cases were correctly diagnosed cytologically; both were malignant histologically. Of the histologically benign tumors, two were misdiagnosed as carcinoma, and a third was considered suspicious for carcinoma. The remaining case was diagnosed descriptively as "benign duct epithelium." Possible reasons for overdiagnosis include high cellularity of the smears, the presence of atypical ductal hyperplasia, paucity of the stromal component in the aspirates and occasional dissociation of epithelial cells. Recommendations are offered to prevent misdiagnosis. The cytologic differential diagnosis between fibroadenoma and PT is discussed briefly, and the considerable cytologic overlap that can occur is emphasized. The specific cytologic diagnosis of PT is not possible in many cases, but the presence of certain cytologic features in the correct clinical setting allows the diagnosis to be suggested.

Adult↗

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Tubal metaplasia. A frequent potential pitfall in the cytologic diagnosis of endocervical glandular dysplasia on cervical smears.

The detection of endocervical glandular abnormalities has risen in recent years due to the increased clinical use of improved endocervical canal sampling instruments, such as Cytobrushes. From January 1987 through August 1989, a diagnosis of endocervical glandular dysplasia was initially suggested on cervical smears from 50 women for whom histologic follow-up information was available. Retrospective review of the cytologic smears and histologic slides from these patients revealed tubal metaplasia in 19 of 29 (66%) cases evaluated by cervical conization and/or hysterectomy and in 19 of 21 (90%) cases confirmed by cervical biopsy and/or endocervical curettage. Cytologic criteria for the diagnosis of tubal metaplasia on cervical smears are discussed. Inasmuch as adenocarcinoma in situ of the cervix and endocervical glandular dysplasia are not readily discernible by colposcopy, the responsibility for the diagnosis of these lesions lies with surgical pathologists and cytopathologists. Familiarity with the cytologic features of adenocarcinoma in situ and endocervical glandular dysplasia that distinguish these lesions from tubal metaplasia and other potential mimics is essential.

Adenocarcinoma↗

PubMedDate not supplied

Adenoid cystic carcinoma of Bartholin's gland diagnosis by aspiration biopsy.

Explore the source record for details and available documents.

Bartholin's Glands↗

PubMedDate not supplied

Fine needle aspiration of benign and malignant breast masses associated with pregnancy.

Of 1,612 fine needle aspirates (FNA) of breast lesions performed over a seven-year period, 25 cases (1.5%) were identified as breast masses associated with pregnancy. Patients ranged in age from 16 to 46 years, with a mean of 27. Gestational age at the time of FNA ranged from three months to three months postpartum or following breast-feeding. Cytologic diagnoses of these pregnancy-associated breast masses were: galactocele (5 cases, 20%), lactating adenoma (9 cases, 36%), fibroadenoma with lactational change (7 cases, 28%), juvenile fibroadenoma with lactational change (1 case, 4%), atypical reactive duct cells with lactational change (1 case, 4%) and infiltrating duct carcinoma (2 cases, 8%). The degree of lactational change varied proportionately with gestational age. None of the 22 patients with benign cytologic diagnoses of galactocele, lactating adenoma or fibroadenoma subsequently developed carcinoma. The mean clinical follow-up for these 22 patients was 27 months. Three cases of fibroadenoma and the case of juvenile fibroadenoma were confirmed by surgical excision. Biopsy of the lesion cytologically diagnosed as atypical reactive duct cells with lactational change revealed infiltrating duct carcinoma (IDC). All three patients with IDC had involvement of multiple axillary lymph nodes, and 1 patient had widely metastatic disease. In two cases of IDC the background lactational breast epithelium exhibited marked cytologic atypia that closely resembled the IDC. Pregnancy-related cellular atypia potentially results in a false-positive diagnosis of breast carcinoma on FNA. FNA is useful in distinguishing benign breast masses of pregnancy from those with marked cytologic atypia requiring surgical biopsy and may minimize the delayed diagnosis of carcinoma associated with pregnancy.

Adenofibroma↗

PubMedDate not supplied

Virus infections of the respiratory tract cytopathologic and clinical analysis.

Thirty-three cases of respiratory tract virus infections diagnosed cytologically are reviewed. The clinical and demographic data are presented and correlated with an analysis of the cytologic findings. Herpes virus was the most common infection. It occurred in patients with other severe medical problems and had little apparent effect on the clinical outcome of any particular case. Quantitative and qualitative cytologic findings did not correlate with the severity of the herpetic infection. The virus was isolated in culture in only one of 21 cases of Herpes virus infection. Cases in the later part of the study indicate an increasing incidence or recognition of the infection in the respiratory tract. In this series there was a clustering of Herpes virus cases in relation to date of admission and hospitalization in respiratory intensive care. Cytomegalovirus infection was recognized in four cases. This infection occurs in the immune suppressed patient and can be made reliably from cytologic findings. Smears must be screened thoroughly and carefully as the characteristic inclusion is seen in only a rare cell. Bronchial brushing specimens are the most useful. The disease should not be fatal if the level of immune suppression can be manipulated and the patients basic medical problem is not too severe. Cytologic findings contribute little information to tjor medical problems and the adenovirus infection was incidental. Thy cytologic findings in some cases may be non-specific since antibody studies and culteral confirmation are lacking in these cases.

Adenoviridae Infections↗

PubMedDate not supplied

Fine needle aspiration of breast lesions in women aged 30 and under.

Fine needle aspiration (FNA) biopsies of 1,598 breast masses were performed between 1983 and 1989, and of them, 48 were from women aged 30 and under for whom a cytologic diagnosis was made by FNA and histologic follow-up was available. In 37 (77%) of the cases, both the cytologic and histologic diagnoses were benign. Fibroadenoma (20/37) and fibrocystic changes (14/37) were the most common benign lesions aspirated. Eight (17%) FNAs showed cytologic atypia. Four of these atypical lesions proved to be benign (two fibroadenomas, two fibrocystic changes). Epithelial proliferation in fibroadenomas and fibrocystic changes and cellular stroma in a fibroadenoma mimicking phylloides tumor were the causes of atypia in these biopsies. Four of the eight atypical lesions were shown to be carcinoma at biopsy (three infiltrating duct, one atypical medullary). Low cellularity, epithelial cohesiveness mimicking a fibroadenoma and background lactational changes in a pregnant patient were the causes of the atypical, rather than unequivocally malignant, diagnoses in these cases. In three patients (6%), a diagnosis of carcinoma was made by FNA and confirmed histologically (all were infiltrating duct carcinoma). Although most breast masses in women aged 30 and under are benign, cytologic atypia in a breast fine needle aspirate in this age group warrants a surgical biopsy. Clinical follow-up alone may be appropriate for young women with clinically nonsuspicious breast masses without cytologic atypia.

Adolescent↗

PubMedDate not supplied

Herpesvirus infection of the respiratory tract electronmicroscopic observation of the virus in cells obtained from a sputum cytology.

A case of herpesvirus infection of the respiratory tract in which the virus was seen ultrastructurally in cells obtained from a routine sputum collected for cytology studies, is presented. The method described would seem feasible for additonal studies at the ultrastructural level of cells obtained during collection of material for routine cytology of the respiratory tract. In the present case the virus particles were easily seen and characterized.

Cell Nucleus↗