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PubMed2006

Endoscopic ultrasound-guided fine needle aspiration diagnosis of metastatic sex cord tumor with annular tubules: a case report.

The cytologic findings of a paratracheal metastasis from a malignant sex cord tumor with annular tubules (SCTATs) diagnosed by endoscopic ultrasound guided fine needle aspiration are described. Cytologic features of SCTATs include the presence of highly cellular aspirates forming simple and complex rosette-like structures around central rounded hyaline material, small nucleoli, and prominent nuclear grooves. These cytologic findings are clearly distinct from the poorly formed rosette-like structures of granulosa-cell tumors and are reminiscent of the low-power appearance of the cribriform variant of adenoid cystic carcinoma. The fine needle aspiration cytologic features of only two other cases have been previously described and, to the best of our knowledge, this is the first case reporting the cytologic diagnosis of a distant metastasis of a SCTATs by endoscopic ultrasound-guided fine needle aspiration. In this case, the distinctive and characteristic cytologic features have allowed the proper diagnosis of a distant metastasis of SCTATs.

Biopsy, Fine-Needle↗
PubMedDate not supplied

Prostatic aspirates. A cytomorphologic analysis with emphasis on well-differentiated carcinoma.

In this retrospective evaluation of 72 cases of fine needle aspiration biopsy of the prostate, 25 aspirates from well-differentiated carcinoma were compared with 27 aspirates from benign prostatic enlargement and 20 aspirates from moderately to poorly differentiated carcinoma. Each case was examined by a single observer (V.K.) for multiple parameters including cellularity, dyshesion, nuclear membrane irregularity, anisonucleosis, macronucleoli (major criteria of malignancy), cell and nuclear enlargement, and altered nuclear/cytoplasmic ratio. Cellularity was the most significant indicator, but all major and minor criteria of malignancy were consistently important for distinguishing well-differentiated carcinoma from benign lesions. Systematic use of these meaningful standards enhances diagnostic sensitivity.

Biopsy, Needle↗
PubMed1987

The reliability of fine-needle aspiration biopsy in the diagnosis of deep lesions of the lung and mediastinum: experience with 250 cases using a modified technique.

Two-hundred and fifty discrete lesions of the lung and mediastinum were sampled by a modified fine-needle aspiration biopsy (FNAB) technique. Aspirates were collected directly into 15 ml of Saccomanno's fixative, and all preparative work was carried out in the cytopathology laboratory. Only seven aspirates were "insufficient for diagnosis," giving a productivity rate of 97%. Five insufficient aspirates later proved to be neoplasms. Of the 243 cases with a primary FNAB diagnosis, 21 had insignificant disease, 29 had benign neoplasms or nonneoplastic disease, and 193 had malignant tumors. Most malignancies could be assigned to a specific histologic type by FNAB; those that proved difficult by FNAB were usually difficult on histopathologic examination. There were no false-positive diagnoses of malignancy and only eight false-negative results. Of 12 results interpreted as "suspicious," 10 proved to be malignant on follow-up. This modified method has proven to have a low complication rate and to be both highly productive and reliable in the diagnosis of malignant and nonmalignant disease.

Aged↗
PubMed1987

Fine-needle aspiration cytology of malignant lymphoma of the thyroid.

Our experience with fine-needle aspiration cytology in five cases of malignant lymphoma of the thyroid is reported. Only one case was correctly diagnosed as malignant lymphoma from the original cytologic reports. Three cases were misdiagnosed as anaplastic carcinoma of small-cell type and two of these three cases were subsequently revised as malignant lymphoma after a second aspiration. The final case was misdiagnosed as chronic thyroiditis at both the first and second aspirations; following a third aspiration, 8 mo later, it was correctly diagnosed as malignant lymphoma. Cytological findings of malignant lymphoma are as follows: many malignant cells are distributed as isolated cells and show monotonous features. Malignant cells are slightly larger than normal lymphocytes. Sometimes cleaved cells or large nucleoli are visible. The differential diagnosis of cytologic findings of malignant lymphoma and the other thyroid diseases is discussed in detail.

Aged↗
PubMed1988

Immunoperoxidase studies by monoclonal antibody B72.3 applied to breast aspirates: diagnostic considerations.

The purpose of this study was to determine the reactivity of monoclonal antibody (MAb) B72.3 when applied directly to aspiration biopsy cytology (ABC) of the breast in the following conditions: (1) infiltration lobular carcinoma; (2) fibrocystic disease; (3) fibroadenoma; and (4) apocrine cysts. Nine of ten aspirates from infiltrating lobular carcinoma were positive in these assays, while 21 of 22 benign cases reacted negatively. The single false-positive benign aspirate manifested a staining pattern characteristic of apocrine cells. This study demonstrates that the MAb B72.3 can be employed as a potentially valuable diagnostic adjunct. It can be used on stained aspirates to assist in the interpretation of ABC from breast lesions.

Antibodies, Monoclonal↗
PubMed1989

Aspiration biopsy cytology of mesothelioma.

From 1977 to 1986, 39 cases at our institution were diagnosed as "consistent with mesothelioma" by percutaneous fine-needle aspiration biopsy. All were verified clinically and/or histologically, with no false-positive results. All mesotheliomas except four tumors of peritoneal origin originated from the pleura. On the basis of their cytomorphologic features in correlation with histopathology, the tumors were classified into four types: benign, carcinomatous, sarcomatous, and undifferentiated. Of these 39 cases of mesothelioma diagnosed by aspiration biopsy, nine were benign type; 14, carcinomatous type; 13, sarcomatous type; and three, undifferentiated type. The cytomorphologic features and patterns of different types of mesotheliomas observed in aspirate preparations are presented, and the differential diagnosis is discussed. It appears feasible to investigate pleural- or peritoneal-based lesions with fine-needle aspiration biopsy, particularly in patients without effusions or with negative results in effusion examinations. It is also possible to make a definitive diagnosis of mesothelioma on the basis of cytologic findings coupled with special and immunoperoxidase staining in combination with roentgenographic findings and clinical history.

Biopsy, Needle↗
PubMed1989

Fine-needle aspiration of the liver: out of the ivory tower and into the community.

This study of 160 consecutive fine-needle aspirates of localized hepatic masses analyzed the efficacy of the technique when extended into a multicenter setting. The aspirates were processed and interpreted by a single cytology service, but they were performed, under radiographic imaging, in eight different hospitals by at least 20 radiologists, few of whom had had the opportunity to acquire long-term experience. Of 108 malignancies, 101 were correctly sampled (sensitivity, 93.5%), including 30 primary hepatocellular carcinomas, 70 metastatic tumors, and 1 lymphoma. Specific benign pathologic lesions in 12 cases were amenable to cytodiagnosis. The problem of the remaining 47 samples, which contained exclusively blood, necrotic material, or normal and reactive hepatic constituents, was addressed at length. These were considered "nondiagnostic" samples in the context of aspirating focal masses. The majority had benign lesions on further study, but tumors were found in seven, all of which had been sampling errors, resulting in a negative predictive value of 82.5%. Fine-needle sampling of localized lesions, particularly neoplasms, can thus perform well in transition from single-center studies to more widespread usage in daily practice. Confident reliance on the procedure can be maintained if appropriate radiologic and cytologic facilities exist, provided that the limitations of nonneoplastic aspirates are fully understood.

Adolescent↗
PubMed1989

Fine-needle biopsy: comparison of cellular yield with and without aspiration.

Fine-needle biopsies with and without aspiration were performed on 103 lesions, and the cellular yields obtained by the two techniques were compared. A scoring system was devised by which the amount of material obtained in each needle stick was estimated. The mean score/stick for fine-needle biopsy with aspiration was 2.7; for biopsy without aspiration, it was 2.9. The results of this study indicate that there is no significant difference in the amount of cellular material obtained by the two techniques. It is concluded that needle biopsy without aspiration may be performed routinely with good results.

Biopsy, Needle↗
PubMed1989

Fine-needle aspiration cytology of superficial lymph nodes.

A series of 244 enlarged superficial lymph nodes was examined by fine-needle aspiration cytology. Twenty-nine smears (11.9%) were inadequate for study. Of the remaining 215, 108 were negative, 13 suspicious for malignancy, and 94 positive. Forty-five excisional biopsies were performed correlating the cytologic and histologic findings. There were two cytologic false-negative results; both were patients who had been treated for carcinoma and whose aspirates were cytologically negative. Of the 13 samples reported as suspicious for malignancy, there were three epidermoid carcinomas, nine reactive hyperplasias, and one non-Hodgkin's lymphocytic lymphoma. Of the positive cases, 83 were metastatic tumors, and 11 were malignant lymphomas (two non-Hodgkin's lymphomas and nine Hodgkin's lymphomas). The criteria used in the interpretation of these aspirates and the problems of differential cytological diagnosis are discussed. In spite of the drawbacks of inadequate and false-negative smears, fine-needle aspiration cytology is valuable in preliminary diagnosis of diseased lymph nodes and subsequent management.

Adenocarcinoma↗
PubMed1989

Lymphocytic thyroiditis in fine-needle aspirates: differential diagnostic aspects.

This study assessed the morphological criteria for the diagnosis of various types of lymphocytic thyroiditis in fine-needle aspirates. Of 950 aspirates, 121 revealed lymphocytic thyroiditis, including Hashimoto's thyroiditis (partly confirmed by serological or histological examination) and focal thyroiditis adjacent to neoplasms. The diagnosis of Hashimoto's thyroiditis was easy when the aspirated material was adequate and contained oxyphilic cells; in the fibrous type, diagnosis was rather difficult. Focal thyroiditis may be confused with Hashimoto's thyroiditis, especially when adjacent to neoplasm. Surgical exploration should be performed in cases of severe lymphocytic thyroiditis revealed by fine-needle aspiration with repeatedly negative antibody titers in order to exclude neoplasm.

Biopsy, Needle↗
PubMed1989

Ductal carcinoma-in-situ of the breast: fine-needle aspiration cytology of 12 cases.

Aspiration specimens from 12 patients with histologically documented ductal carcinoma-in-situ (DCIS) of the breast (seven patients) or DCIS with minute foci of stromal invasion (five) were evaluated. Five patients presented with palpable masses, 1.5-4.0 cm, and four patients presented with localized thickening, associated with nipple erosion and discharge in two of them. One patient had nipple inversion, and one patient had bilateral nipple discharge. In one patient, no apparent abnormality of the breast was present. Mammography was either suspicious for or strongly suggestive of carcinoma in 10 patients and negative in two. Aspirates from all patients were composed of fragments of atypical ductal epithelium and numerous single epithelial cells. In nine cases, the smears were hypercellular and similar to aspirates of typical invasive ductal carcinoma. Calcifications were present in six cases. In four of these, associated tumor necrosis was evident. Cytologic features separating DCIS patients from those showing minimal stromal invasion or common types of invasive ductal carcinoma (IDC) were not identified. We conclude that fine-needle aspiration cytology of DCIS is identical to that of IDC. If preoperative radiotherapy or chemotherapy is considered in the management of invasive breast carcinoma, cutting-needle biopsy for confirmation of tumor invasion is necessary.

Adult↗
PubMed1989

Cytologic evaluation of Papanicolaou-stained bone marrow aspirates.

Aspirates obtained from bone marrow were prepared for routine Papanicolaou staining and screened by a cytologist. As a preliminary study, 100 consecutive bone marrow aspirations were examined. It was shown that metastatic carcinoma and primary bone marrow disorders (including leukemia, myelodysplastic syndromes, and multiple myeloma) can be recognized on Papanicolaou-stained marrow aspirates using the same cytologic criteria employed in the evaluation of cells from any site. Evaluation of bone marrow aspirates in the cytology laboratory is feasible and can be used to augment parallel services employing air-dried Wright-Giemsa-stained specimens in the hematology laboratory.

Biopsy, Needle↗
PubMed1990

Light and electron microscopic examination of fine-needle aspirates in the preoperative diagnosis of osteogenic tumors: a study of 21 osteosarcomas and two osteoblastomas.

Twenty-three patients with primary osteogenic tumors, two osteoblastomas and 21 osteosarcomas, underwent fine-needle aspiration biopsy in the preoperative investigation. The cytologic features in smears were compared with the light and electron microscopic findings of resin-embedded fine-needle aspirates (16 cases) and the histopathologic findings of the surgical specimens. Cytologic smears clearly indicated a primary bone malignancy in all 20 high-malignancy osteosarcomas. In the osteoblastic osteosarcomas, the diagnosis of osteosarcoma was strongly suggested by the osteoblastic appearance of the tumor cells and the presence of an osteoid-like fibrillar matrix in 6 of 11 cases in the May-Grünwald-Giemsa-stained smears. The distinction of chondroblastic osteosarcomas from high-grade chondrosarcomas and of polymorphic osteosarcomas from malignant fibrous histiocytomas is difficult in smears. Electron microscopic examination and immunocytochemistry indicating a positivity for vimentin but not for cytokeratin helped to exclude the possibility of a carcinoma in osteoblastic osteosarcomas where the tumor cells had epithelium-like features in the smears. The resin-embedding technique of fine-needle aspirates was useful for the typing since it gave additional light microscopic information about growth pattern, structure, and matrix production, as well as ultrastructural information about cell and tissue differentiation. The osteoid-like material seen in May-Grünwald-Giemsa-stained smears could be proven to represent osteoid with varying degrees of calcification at the ultrastructural examination. The fine-needle aspiration technique, especially when used for both smears and embedding, may play an important role in the preoperative investigation of bone tumors, provided that it is used with full knowledge of the clinical and radiographic findings.

Adolescent↗
PubMed1990

Fine-needle aspiration biopsy diagnosis of endodermal sinus tumor: histologic and ultrastructural correlations.

Fine-needle aspiration biopsies from five patients with endodermal sinus tumors (ESTs) were reviewed, and the findings were correlated with histologic and ultrastructural appearances. In the aspiration smears, two types of tumor cells were seen, forming clusters of variable sizes. Type A cells had distinct cell borders, and their cytoplasm contained only occasional vacuoles. Type B cells had ill-defined cell borders and formed syncytial clusters; their cytoplasm was characterized by large numbers of rounded vacuoles. The background contained patches of mucoid material and macrophages with foamy cytoplasm. Eosinophilic hyaline cytoplasmic bodies and irregular deposits of intercellular basement membrane-like material were recognized easily in aspiration smears. These features correlated well with histologic and ultrastructural appearances. The significance of these findings in the fine-needle aspiration biopsy diagnosis of EST and its distinction from other germ-cell and non-germ-cell tumors is discussed.

Adult↗
PubMed1990

Fine-needle aspiration cytology of hematopoietic lesions from multiple sites.

We reviewed 130 fine-needle aspiration (FNA) biopsies from 118 patients with a variety of benign and malignant hematopoietic lesions. There were 74 (57%) malignant, 45 (35%) benign, and 11 (8%) atypical diagnoses. Immunocytochemistry of the aspirated material was performed in 47 (36%) and electron microscopy in 4 (3%) of the cases. FNA cytology was utilized to make a primary hematopoietic malignant diagnosis in approximately half of the cases and to confirm recurrence in the remainder. The malignant cases included non-Hodgkin's lymphoma. Hodgkin's disease, medullary and extramedullary plasmacytoma, and granulocytic sarcoma. Forty-two malignant cases had either previous or follow-up surgical biopsy with no false-positive diagnoses. Of the 11 atypical cases, seven had surgical confirmation with five malignant and two benign diagnoses. The benign hematopoietic lesions correctly identified included acute and chronic lymphadenitis, granulomatous processes, and eosinophilic granuloma. Only 5 of the 45 benign FNA biopsies had surgical pathology follow-up, with no false-negative diagnoses. The most commonly aspirated sites were lymph nodes (71%), although hematopoietic lesions were correctly identified in a number of extranodal locations, including soft tissue (8%), abdominal viscera (6%), lungs (5%), mediastinum (2.5%), bone (3%), and thyroid, salivary gland, and breast (1.5% each). This study demonstrates the clinical utility and diagnostic accuracy of FNA cytology in the evaluation of benign and malignant hematopoietic disorders from multiple sites. Ancillary studies performed on the aspirated material aided in making a specific and accurate diagnosis.

Adolescent↗
PubMed1990

Fine-needle aspiration of lymph nodes in patients with acute infectious mononucleosis.

We studied lymph node fine-needle aspirations from 10 patients with primary Epstein-Barr virus (EBV) infections (infectious mononucleosis). There were five males and five females, aged 15-54 yr. The diagnoses were confirmed by blood morphology and heterophil antibody (HA) and EBV-specific serologic studies. Nine patients were HA-positive, nine were viral capsid antigen (VCA)-IgM-positive, and all 10 were VCA-IgG-positive and anti-EBV nuclear antigen (EBNA)-negative. Five patients were referred for fine-needle aspiration biopsies for clinically suspected malignant lymphoma (ML). Four of these patients had been tested for HA prior to fine-needle aspiration, with negative results in three cases. The heterophil-positive patient was referred for fine-needle aspiration due to very impressive unilateral cervical adenopathy. Cytologically, all cases showed atypia consisting of greater numbers of large immunoblastic lymphocytes than are usually seen in the reactive lymph node. Two cases were cytologically suspicious for malignant lymphoma but included a considerable background of polymorphic immunoblasts. We suggest that polymorphic immunoblastic proliferations in lymph node cytology are suggestive of infectious mononucleosis. Since several reactive and neoplastic processes mimic this pattern, cases not followed by both confirmatory serologic studies and resolution of adenopathy should be pursued by excisional lymph node biopsy.

Adolescent↗
PubMed1991

Carcinoembryonic antigen in fine-needle aspirate of liver: a diagnostic adjunct to cytology.

Carcinoembryonic antigen (CEA) was measured in 50 consecutive fine-needle aspirates of liver to determine whether elevated levels could predict the presence of carcinoma in cytologically negative aspirates. There were 44 malignant and 6 benign lesions. The highest mean CEA values (591-672 ng/ml) were obtained in metastatic adenocarcinoma of the colon, stomach, and pancreas; lower levels (13.5-151 ng/ml) were found in metastatic carcinoma from the breast and lung. Carcinoid, hepatoma, Hodgkin's disease, and benign liver aspirates had low (less than 5 ng/ml) CEA levels. Cytologic diagnosis of malignancy was 96% sensitive and 100% specific. Using 5 ng as a cutoff for malignancy, the overall sensitivity of CEA for detection of malignancy was 77%; for detection of adenocarcinoma alone, sensitivity was 85%. Specificity was 100%. The CEA content of fine-needle aspirates generally exceeded serum values by 10-100-fold. Although CEA content did not enhance the sensitivity of cytologic diagnosis, it may suggest metastatic carcinoma of the GI tract in patients presenting with adenocarcinoma of an unknown primary source.

Adenocarcinoma↗
PubMed1991

A case of neurilemoma (schwannoma) that mimicked a pleomorphic adenoma (an example of potential pitfall in aspiration cytodiagnosis).

Needle-aspiration cytology of a case of benign neurilemoma (Schwannoma) from the neck is presented. It was clinically diagnosed as an enlarged lymph node, while on aspiration cytology, it was diagnosed as a pleomorphic adenoma. An excision biopsy, however, was diagnostic of neurilemoma. A review of cytologic material was undertaken, and it was felt that the cytologic features in Papanicolaou stained preparations in the aspirate were present that initially should have enabled the correct cytodiagnosis and distinction from a pleomorphic adenoma. The findings presented in this study were considered to be an example of a potential pitfall in the aspiration cytodiagnosis of a neurilemoma.

Biopsy, Needle↗