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PubMedDate not supplied

Myeloid metaplasia in aspirates from enlarged spleens: a clue in the absence of peripheral blood findings characteristic of myelofibrosis.

OBJECTIVE: To assess the significance of finding myeloid metaplasia in splenic aspirates from patients presenting with mild to moderate firm splenomegaly, in the absence of characteristic peripheral blood findings, in diagnosing idiopathic myelofibrosis. STUDY DESIGN: Archival records pertaining to 14 patients diagnosed as having myeloid metaplasia on splenic aspirates performed between September 2000 and April 2004 were analyzed. RESULTS: The relevant findings in these 9 women and 5 men were: splenic enlargement 17-21 cm with homogeneous echotexture on ultrasonography, hemoglobin 4-10 g/dL, variable pattern of anemia, total leukocyte count 6,300-28,800/ mm3 with neutrophilia and a few late myeloid precursors on the differential count, normal platelet counts, dry bone marrow tap in 10 patients and cellular marrow aspirate with prominence of megakaryocytes dispersed in a maturing cell population of myeloid and erythroid series in 4 patients. Splenic aspirates yielded foci of trilineage hematopoiesis suggestive of myeloid metaplasia, possibly due to myelofibrosis of idiopathic type, as confirmed on trephine biopsy in all cases. CONCLUSION: Splenic aspirates may be a useful tool for detecting myeloid metaplasia suggesting myelofibrosis when peripheral blood findings are not yet characteristic of the same. The procedure was not associated with any complications.

Adult↗
PubMedDate not supplied

Preoperative diagnosis of suspicious parathyroid adenomas by RT-PCR using mRNA extracted from leftover cells in a needle used for ultrasonically guided fine needle aspiration cytology.

OBJECTIVE: To determine the usefulness of reverse transcriptase-polymerase chain reaction (RT-PCR) detection of parathormone (PTH) gene mRNA in needle aspirates to confirm the parathyroid nature of suspicious cervical lesions in patients with hyperparathyroidism. STUDY DESIGN: Ultrasound-guided fine needle aspiration cytology (FNAC) was performed on 12 patients with suspected parathyroid adenomas. The aspirates were subjected to cytologic and chromogranin A examination. Messenger RNA was isolated from left-over cells within the needle, and RT-PCR was used to amplify mRNA encoding PTH. RESULTS: The 12 aspirates were positive by PTH RT-PCR, and molecular diagnosis was confirmed by histologic examination. The lower sensitivity of cytologic and immunocytochemical methods was demonstrated, respectively, by 67% and 50% of positive results. Sensitivity assays demonstrated that with our system, PTH RT-PCR products are obtained from as few as 10 pg of parathyroid mRNA. CONCLUSION: The present study showed that RT-PCR-based analysis of PTH gene transcripts in aspirates, obtained by US-guided FNAC of cervical lesions suspicious for parathyroid adenoma, is a feasible, sensitive and specific method for preoperative diagnosis of parathyroid adenomas.

Adenoma↗
PubMedDate not supplied

Fine needle aspiration cytology of bursal cyst.

OBJECTIVE: To evaluate the cytomorphology of bursal cyst and assess the efficacy of aspiration cytology in its diagnosis and treatment. STUDY DESIGN: Nineteen cases of bursal cyst seen over four years were studied. Material was obtained by fine needle aspiration. The smears were stained with May-Grünwald-Giemsa stain and hematoxylin and eosin. RESULTS: Eight cysts were in the popliteal fossa, 4 on the elbow, 3 on the knee, 2 on the shoulder and 2 in the calf. Gelatinous material was aspirated in all the cases. In some cases the cyst collapsed after aspiration. The key diagnostic features were hypocellular smears in a mucoid background. Histiocytelike (synovial) cells were seen lying in all cases and as pseudopapillary structures in two. CONCLUSION: The presence of a cyst at a classic location with aspiration of gelatinous material and the presence of singly occurring histiocytelike cells in a mucoid background in smears is diagnostic of bursal cyst. The procedure is therapeutic in some cases.

Biopsy, Needle↗
PubMedDate not supplied

Spermatogenesis in azoospermic, formerly cryptorchid men. Use of needle aspiration techniques.

OBJECTIVE: To assess the use of testicular needle aspiration techniques to evaluate fertility potential in azoospermic, formerly cryptorchid men. STUDY DESIGN: Fifteen consecutive adult azoospermic, formerly cryptorchid patients (eight unilateral and seven bilateral) were examined by needle aspiration techniques, fine (FNA) and large needle (LNAB) testicular aspiration biopsy, for cytologic and histologic analysis. Five of the 15 subsequently underwent surgical biopsy for attempted assisted fertilization. RESULTS: Spermatozoa or spermatids were detected by FNA cytology or LNAB histology in one or both testicles in 87.5% of the unilateral and 28.6% of the bilaterally affected, formerly cryptorchid patients (P = .041, Fisher's exact test). The addition of LNAB to FNA identified spermatids in one patient with unilateral cryptorchidism and only Sertoli cells on FNA cytology. Furthermore, LNAB differentiated testicles with the cytologic finding of only Sertoli cells into those with or without diffuse fibrosis. In the five patients in whom assisted fertilization was attempted, the needle aspiration techniques predicted the presence or absence of spermatozoa in the subsequent surgical biopsy. CONCLUSION: The two needle aspiration techniques can be used to assess the fertility potential of azoospermic, formerly cryptorchid men and to select patients for assisted fertilization.

Adult↗
PubMedDate not supplied

Fine needle aspiration cytology of adenocarcinoma of the rectovaginal septum. A case report.

BACKGROUND: Adenocarcinoma arising in the rectovaginal septum is exceedingly rare and is difficult to diagnose by pathologic examination prior to surgery because of the anatomic position of the tumor. CASE: A 42-year-old woman presumed to have adenocarcinoma of the rectovaginal septum underwent fine needle aspiration for diagnosis. Although a previously performed biopsy from the posterior vaginal fornix was unsuccessful, fine needle aspiration cytology via the posterior vaginal wall detected adenocarcinoma cells. The cell clusters were composed of cells with enlarged and hyperchromatic nuclei. The nuclei themselves demonstrated round and/or irregular morphologic patterns, with high nuclear/cytoplasmic ratios, and often contained an enlarged, round nucleolus and sometimes multiple ones in a single nucleus. Aniso-nucleosis was severe, and the chromatin patterns ranged from coarse to finely granular. The cytoplasm was narrow and lightly stained. Following fine needle aspiration, the patient underwent posterior exenteration on the basis of the cytologic diagnosis. CONCLUSION: Fine needle aspiration cytology was useful in establishing the preoperative diagnosis of adenocarcinoma of the rectovaginal septum, and curative exenterative surgery could be then performed. To our knowledge, this is the first report of fine needle aspiration cytology of adenocarcinoma at this location.

Adenocarcinoma↗
PubMedDate not supplied

Usefulness of endometrial aspiration cytology for the preoperative diagnosis of ovarian carcinoma.

OBJECTIVE: To evaluate the usefulness of endometrial aspiration cytology for the preoperative diagnosis of ovarian carcinoma. STUDY DESIGN: A total of 210 patients with ovarian carcinoma were investigated by endometrial aspiration cytology. RESULTS: Fifty-five of 210 patients (26.2%) had positive endometrial aspiration cytology. The positive rates of endometrial cytology were 3.9% in stage I, 23.8% in stage II, 36.5% in stage III and 53.3% in stage IV. When classified by histologic type, the positive rates of endometrial cytology in patients with serous adenocarcinoma, mucinous adenocarcinoma, clear cell adenocarcinoma, undifferentiated carcinoma and yolk sac tumor were 38.9%, 11.8%, 21.1%, 16.7% and 16.7%, respectively. One hundred twenty-eight of 210 patients (61.0%) were positive on peritoneal cytology, and 54 of these 128 cases (42.2%) were also positive on endometrial cytology. The positive rates of endometrial cytology were especially high in patients with serous adenocarcinoma (51.2%) and those with clear cell adenocarcinoma (40.0%) among those who were positive on peritoneal cytology. Of 74 patients who were negative on peritoneal cytology, only one (1.4%) with mucinous adenocarcinoma had positive endometrial cytology. Hysterectomy was performed on 130 patients, and the positive rate of endometrial cytology was 100% in 4 patients with endometrial invasion and 15.9% in 126 cases without invasion. CONCLUSION: Endometrial aspiration cytology can detect ovarian carcinoma cells not only in patients with endometrial involvement but also in patients with positive peritoneal cytology. Endometrial aspiration cytology appears to be useful for the preoperative diagnosis of ovarian carcinoma.

Adenocarcinoma, Clear Cell↗
PubMedDate not supplied

Fine needle aspiration cytodiagnosis of sialadenitis with crystalloids.

OBJECTIVE: To assess the utility of fine needle aspiration cytology in the diagnosis of sialadenitis with crystalloid formation in four patients that presented with a swelling of the parotid gland. STUDY DESIGN: The swelling was aspirated in all the cases using a 22-gauge needle, and aspirates were submitted as needle and syringe washings in a cytology fixative (30% ethyl alcohol in physiologic saline). From these washings filter preparations were made on Sartorius or Gelman filters (pore size, 3 microns) and stained by the Papanicolaou method. Additionally, cell block preparations were made from the aspirate. After processing, sections were cut and stained by hematoxylin-eosin, Prussian blue, alcian blue, mucicarmine, and Von Kossa and congo red stain. No air-dried smears were made, and no electron microscopic studies were done. RESULTS: Stained cytologic preparations and cell blocks showed numerous nonbirefringent crystalloids of varying sizes and shapes appearing as rectangles, needles, squares and rods mixed with neutrophils and rare multinucleated giant cells. No salivary gland components were seen, and all special staining was negative. CONCLUSION: Fine needle aspiration cytology not only provided an accurate diagnosis of sialadenitis with crystalloids but also resulted in adopting conservative management and avoiding unnecessary surgery.

Adolescent↗
PubMedDate not supplied

Fine needle aspiration biopsy of Hashimoto's thyroiditis. Sources of diagnostic error.

OBJECTIVE: To determine the accuracy of cytologic interpretation in the diagnosis of Hashimoto's thyroiditis (HT). STUDY DESIGN: At Ottawa Hospital from 1987 to 1994, 1,638 fine needle aspiration biopsies (FNABs) from thyroid were performed. HT was suggested in 184 FNAB samples taken from 157 patients. Of the 184 aspirates diagnosed with HT, 39 had corresponding surgical specimens taken from 31 patients. A retrospective review of these FNABs and surgical pathology slides formed the basis of this study. RESULTS: In 27 (69%) aspirates, HT was diagnosed on both the FNAB and surgical specimens. In 10 of 27 FNABs an associated lesion was not sampled by FNAB. In four of these 10 aspirates some of the cellular features of HT were misinterpreted, and the possibility of an associated neoplasm could not be ruled out. This resulted in four false positive diagnoses. In 12 (31%) FNABs from nine patients, the cytologic diagnosis of HT was not confirmed histologically. These cases included five Hürthle cell adenomas and one case each of follicular adenoma, nodular goiter, macrofollicular adenoma and malignant lymphoma. This resulted in five false negative diagnoses. CONCLUSION: These results support the value of FNAB in the diagnosis of HT. The presence of hyperplastic follicular cells on FNAB samples from HT may mimic a follicular neoplasm and result in a false positive interpretation. Adequate sampling of the thyroid is important, particularly when there is an associated lesion. The diagnosis of lymphocytic thyroiditis should not be made when only a few lymphocytes are present. Finally, pleomorphic Hürthle cells may be present in aspirates from Hürthle cell neoplasms and underdiagnosed as HT, especially when they are associated with a few lymphocytes.

Adult↗
PubMedDate not supplied

Cytomorphologic features of angiosarcoma on fine needle aspiration biopsy.

OBJECTIVE: To present the cytomorphologic features of angiosarcomas identified on fine needle aspiration biopsy, review the literature, and discuss the differential diagnosis and pitfalls involved in such cases. STUDY DESIGN: Fine needle aspirate smears from 11 cases (1 hepatic, 3 breast and 7 subcutaneous/soft tissue lesions of angiosarcomas from eight patients were reviewed. All cases had histologic confirmation of angiosarcoma. RESULTS: All aspirates were hypocellular, with predominantly single cells in a background of moderate to abundant amounts of blood. Nine cases had scattered inflammatory cells, primarily neutrophils, in the background. Six of the cases had rare small clusters of cells. The cells were oval, round or spindled, with eccentric, round to spindle-shaped nuclei and moderate to abundant amounts of pale blue-gray, vacuolated cytoplasm. The cells ranged from two to nine times the size of the background red blood cells. In four cases, malignant cells demonstrated intracytoplasmic hemosiderin deposits. Small nucleoli were identified in five cases, large nucleoli in one case and hyperchromasia in seven cases. Mitotic figures, erythrophagocytosis, acinarlike or vascular structures, and necrosis were not identified in any of the studied cases. In four cases, a definitive diagnosis of angiosarcoma was rendered on the fine needle aspiration specimen. In three other cases, the differential diagnosis remained between angiosarcoma and radiation change. CONCLUSION: The presence of scarce single pleomorphic cells in a bloody background should raise the diagnostic possibility of angiosarcoma. A definitive diagnosis of angiosarcoma is often difficult to render due to the paucity of diagnostic cells unless intracytoplasmic hemosiderin deposits can be identified. Multiple aspirations are often needed in order to obtain diagnostic material. In the setting of radiotherapy, it may be impossible to distinguish angiosarcoma from radiation change, and biopsy should be recommended.

Aged↗
PubMedDate not supplied

C cells in normal thyroid aspirates.

OBJECTIVE: To quantify C cells in normal thyroid aspirates. STUDY DESIGN: Smears of 18 glands from patients with no thyroid disease, 8 women and 10 men aged on average 52.8 years, were analyzed. Five samples were aspirated from the upper, middle and lower thirds of each lateral lobe and from the isthmus. Smears were stained with anticalcitonin monoclonal antibody. RESULTS: C cells were detected in all specimens, ranging in number from 3 to 19 per gland, with 53.4% of the cells in the right lobe, 42.8% in the left lobe and 3.7% in the isthmus. The aspirates from the right lobe had 0-13 cells in the upper third, 0-9 in the middle third and 0-3 in the lower third. In the left lobe aspirates there were 0-7 cells in the upper third, 0-6 in the middle third and 0-2 in the lower third. One to two C cells were observed in the isthmus in only four cases. CONCLUSION: It is possible to determine the presence of C cells in normal thyroids and confirm studies conducted on histologic material; the cells were more frequently detected in the middle and upper third and mainly on the right side. They were rare in the isthmus. The search for C cells in thyroid aspirates is of great importance because it permits one to confirm rapidly, precisely and minimally invasively cases suspected of C cell hyperplasia, a preneoplastic condition that precedes the development of medullary carcinoma. In addition, the method shows numerical changes in these cells in such conditions as Hashimoto's thyroiditis and colloid goiter, in which the present results could serve as a control.

Adolescent↗
PubMedDate not supplied

Fine needle aspiration of mucinous (colloid) breast carcinoma. Nuclear grading and mammographic and cytologic findings.

OBJECTIVE: The clinical, mammographic and low grade cytologic features of mucinous carcinoma can make it difficult to diagnose by fine needle aspiration (FNA). Fine needle aspirates of mucinous carcinoma were reviewed with the mammographic findings to improve the diagnostic criteria and specificity for FNA. STUDY DESIGN: All aspirates were reviewed for cytologic criteria and cellularity, atypia and single epithelial cells (SEC). A nuclear grade was assigned to each aspirate. The mammographic findings were correlated with the FNA diagnoses. RESULTS: Forty-five patients with an aspirate and confirmed diagnosis of mucinous carcinoma were identified. The clinical impressions were: benign tissue (5), fibroadenoma (6) and cancer (32). The initial cytologic diagnoses were: adenocarcinoma (32), atypical/suspicious for cancer (11), insufficient (1) and negative (1). The cytologic findings showed smears with increased cellularity (35/45 cases) and minimal atypia. SEC with eccentrically located nuclei and eosinophilic cytoplasm were numerous. The assigned nuclear grade was as follows: grade 1, 16 cases; grade 2, 20 cases; and grade 3, 6 cases. Abundant mucin was present in Papanicolaou-stained slides in 23 cases; focal mucin was observed in 14 cases. The mammograms showed a smoothly outlined to lobulated mass with only slight irregularities identified. CONCLUSION: Mucinous carcinoma has a cytologic pattern that includes increased cellularity, with numerous single cells and abundant mucin. Although the mammographic findings may mimic a benign lesion, in the most patients a specific diagnosis of mucinous carcinoma can be made by FNA.

Adenocarcinoma, Mucinous↗
PubMedDate not supplied

Breast cancer diagnosis by fine needle aspiration and excisional biopsy. Recurrence and survival.

OBJECTIVE: To determine whether fine needle aspiration of palpable breast cancers increases the risk of local or distant recurrence. STUDY DESIGN: The study group consisted of 58 patients with palpable breast cancers who were treated with breast conservation following diagnosis by fine needle aspiration. The control group consisted of 308 patients with palpable cancers treated in the same way following diagnosis by excisional biopsy. All patients were followed for five years. RESULTS: The 58 cases diagnosed by fine needle aspiration were significantly younger than the 308 patients diagnosed by excisional biopsy (55 vs. 63, P < .0001). Otherwise, pathology, tumor size, differentiation, progesterone and estrogen receptor content, nodal involvement, stage and treatment were comparable for both groups. Five-year local and distant disease-free survivals were 94% and 86% for cases diagnosed by fine needle aspiration and 86% and 85% for cases diagnosed by excisional biopsy. In multivariate analysis, no single variable was significantly predictive of local recurrence. Tumor size and nodal involvement were significantly predictive of distant disease. Mode of diagnosis, whether by needle or excisional biopsy, was not predictive of local (P = .921) or distant (P = .831) recurrence. CONCLUSION: This study found no evidence that fine needle aspiration for diagnosis of breast cancer adversely affects outcome.

Adult↗
PubMedDate not supplied

Fine needle aspiration of pleomorphic adenoma and adenoid cystic carcinoma of salivary gland origin.

OBJECTIVE: To determine the cytologic similarities, distinctive features and diagnostic problems on fine needle aspiration in patients with pleomorphic adenoma (PA) and adenoid cystic carcinoma (ACC) of salivary gland origin. STUDY DESIGN: We reviewed the preoperative cytology and histologic sections in 22 patients in whom the resected specimens were diagnosed as PA (17 cases) or ACC (5 cases) of salivary gland. RESULTS: Concordant results were noted between cytologic and histologic diagnoses in 20 cases (91%) and discordant results in 2 cases (9%). Both discordant aspirates had been diagnosed as PA; however, their resected specimens were diagnostic of ACC. Although there were cytologic features common to both tumors, each had a unique relationship of epithelial cells to stroma. Aspirates in PA showed cell clusters with a "sunburst" appearance caused by peripheral spindled cells streaming into a fibrillar myxoid stroma. In ACC well-delineated, tightly cohesive, basaloid cells surrounded mucoid/hyaline globules or clear spaces in a honeycomb pattern. CONCLUSION: The cytologic distinction between PA and ACC in most cases was easily made on adequately cellular aspirates. In the two aspirates with discordant results, diagnostic difficulty resulted when the distinctive relationship between epithelial cells and extracellular matrix was not recognized in sparsely cellular specimens, in part due to lack of observer familiarity with the different patterns.

Adenoma, Pleomorphic↗
PubMedDate not supplied

Aspiration cytology of echinococcus oligarthrus. A case report.

BACKGROUND: Fine needle aspiration cytology is a useful technique in the diagnosis of several parasitic infections. The present case highlights the aspiration cytology findings in a case of Echinococcus oligarthrus infection, a rare variant of the Echinococcus species affecting humans. To the best of our knowledge, this is the first case report on the cytology of E oligarthrus in English. CASE: A submandibular swelling developed in a 14-year-old male. A mistaken diagnosis of Cysticercus cellulosae was made on the first aspirate and of a hydatid cyst (Echinococcus granulosus) on the second aspirate. A diagnosis of E oligarthrus was made on subsequent histopathologic examination of the excised lesion. CONCLUSION: This seems to be the first case report in English of the cytomorphology of E oligarthrus on fine needle aspiration cytology with histopathologic confirmation.

Adolescent↗
PubMedDate not supplied

Fine needle aspiration biopsy findings in lymphoepithelial carcinoma of salivary gland.

OBJECTIVE: To study the fine needle aspiration cytology of lymphoepithelial carcinoma of salivary gland (LECSG). STUDY DESIGN: Needle aspirates from five primary and two metastatic LECSGs were reviewed. RESULTS: Three aspirates showed very scant cellularity with rare tumor cells originally misinterpreted as lymphohistiocytic cells. Six fine needle aspiration biopsies (FNABs) contained medium to large polygonal and spindled cells with one or more prominent nucleoli. Five aspirates also displayed a heterogeneous population of lymphoid cells, while a sixth had much necrotic debris and only a few lymphocytes admixed with tumor cells. CONCLUSION: In the clinical setting of an Inuit or Chinese patient with a salivary gland mass, an FNAB with these features should suggest the possibility of LECSG.

Adult↗
PubMedDate not supplied

Fine needle aspiration diagnosis of ciliated hepatic foregut cysts: a report of three cases.

BACKGROUND: Ciliated hepatic foregut cysts, albeit rare, are important to consider in liver aspirates obtained for evaluation of possible neoplastic disease. CASES: In three cases, liver fine needle aspirates showed features consistent with ciliated hepatic foregut cysts. Two of these aspirates were obtained to evaluate possible metastatic disease prior to resection of primary tumors, one of the lung and one of the bladder. A third case had radiologic findings suggestive of a cystic neoplasm. The fine needle aspirate material from these cases revealed clusters of tall, columnar cells with basally oriented nuclei and prominent apical terminal plates with cilia. These features are consistent with ciliated hepatic foregut cysts. CONCLUSION: This entity, although originally described in the late 19th century, to our knowledge has not been reported to occur in fine needle aspirate material and should be included in the differential diagnosis of cystic lesions of the liver.

Adult↗
PubMedDate not supplied

Fine needle aspiration cytology in pancreatic pathology.

OBJECTIVE: To assess the sensitivity and specificity of pancreatic fine needle aspiration. STUDY DESIGN: Two hundred five fine needle aspirates were obtained from 149 patients over seven years. After excluding 40 patients lacking biopsy or follow-up, 125 aspirates from 109 patients were selected to analyze the accuracy of this method. (male:female ratio, 1.4:1; age range 43-79 years). RESULTS: The cytologic diagnosis was true positive in 50 studies (45.9%), false positive in 0, true negative in 25 (22.9%), false negative in 19 (17.4%) and suspicious for malignancy in 17 (15.6%); 14 aspirations (12.8%) yielded material unsatisfactory for a diagnosis. Of the 17 suspicious studies, 15 were from patients in whom a malignancy was confirmed later. The other two patients had chronic pancreatitis. CONCLUSION: The efficiency was 79.8%, sensitivity 72.5%, and specificity and predictive value of a positive result 100%. Cell blocks provided sufficient material in 96.8% of cases and smears in 90.4%. No major complications were reported after fine needle aspiration.

Adult↗
PubMed1983

The value and role of percutaneous pelvic lymph node aspiration biopsy in definitive staging of prostatic and bladder carcinoma.

Percutaneous fluoroscopy-guided aspiration biopsy of the pelvic nodes was performed for staging in 136 nodal chains of 26 patients with clinically localized carcinoma of the prostate and in 14 patients with bladder cancer. The fine-needle aspiration biopsy had an overall accuracy of 97.5%, sensitivity of 94.11% and specificity of 100%. In the management of prostatic cancer, the positive aspiration biopsy may be considered a definitive diagnostic means for determining tumor stage. The negative aspirations may be accepted as definitive diagnostic staging procedure too, since the sensitivity of the method is of 93.3% in patients with prostatic carcinoma. As the presence or absence of nodal metastasis cannot be predicted accurately on the basis of the T or P category of the primary tumor in patients with bladder carcinoma, the fine-needle aspiration biopsy may have a prominent role in accurate clinical stage determination, for a rational application of the treatment.

Biopsy, Needle↗