bluuebunny/crossref_metadata_2025 huggingface dataset:
Toxoplasma pneumonia: Cytologic diagnosis by bronchoalveolar lavage
Authors: Wheeler Rebecca R. , Bardales Ricardo H. , North Paula E. , Vesole David H. , Tricot Guido , Stanley Michael W.
Published: February 2007

Two cases of toxoplasma pneumonia in immunocompromised hosts are reported. The diagnoses were made by the identification of trophozoites in bronchoaheolar lavage material. The organisms were more readily identified in the air‐dried Diff‐Quik‐stained smears. Cytologic findings and correlation with postmortem examination material in one case are described. A high index of suspicion for this pathogen, as well as screening cytologic preparations at medium to high magnification may increase the diagnostic rate for this uncommon but treatable disease. Diagn Cytopathol 1994; 11:52–55. © 1994 Wiley‐Liss, Inc.
Fine‐needle aspiration of anaplastic thyroid carcinoma with varied cytologic and histologic patterns: A case report
Authors: Brooke P. K. , Hameed Meera , Zakowski Maureen F.
Published: February 2007

Anaplastic carcinoma of the thyroid (ACT) is a rare subtype of thyroid neoplasm. This tumor represents approximately 5–10% of all thyroid malignancies and its poor prognosis has not changed in 25 years. ACT often arises in a long‐standing thyroid nodule and has been documented to be associated with a variety of more well‐differentiated thyroid carcinomas. We describe the cytologic features of a case in which the patient had a 10‐yr history of a thyroid nodule. The ACT in this case had a cytologic and histologic appearance of several different subtypes of thyroid carcinomas. Diagn Cytopathol 1994;11:60–63. © 1994 Wiley‐Liss, Inc.
Metastatic epithelioid hemangioendothelioma in a pleural effusion: Diagnosis by cytology
Authors: Abati Andrea , Cajigas Agustin , Hijazi Yasmine M.
Published: February 2007

Epithelioid hemangioendothelioma (EH) is a vascular neoplasm of uncertain malignant potential. We report a 22‐yr‐old female with a primary malignant EH of the iliac bone with adjacent soft tissue involvement which, during its metastatic course, presented as a pleural effusion. The effusion was cellular with tumor cells present both singly and in clusters. Distinguishing cytologic features included cytoplasmic vacuolization consistent with primitive intracytoplasmic lumen formation, variability in cell size, biphasic cytoplasmic staining with Diff‐Quik stain, multinucleation, cell in cell engulfment, and multiple prominent nucleoli. Differential diagnosis based on morphology included malignant mesothelioma and adenocarcinoma. Immunocytochemical stains on the neoplastic cells were positive for Ulex Europaeus, Factor VIII‐related antigen, and CD34, reflecting vascular differentiation and confirming the diagnosis of metastatic EH to the pleural cavity. Diagn Cytopathol 1994;11:64–67. © 1994 Wiley‐Liss, Inc.

This article is US government work and, as such, is in the public domain in the United States of America

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p53 immunolocalization in cytology specimens: A study in human esophageal carcinoma
Authors: Goukon Yuji , Sasano Hironobu , Nishihira Tetsuro , Mori Shozo , Nagura Hiroshi
Published: February 2007

Immunohistochemical analysis of p53 has become an established method of detecting mutated p53. Immunolocalization of p53 has been extensively studied in tissue sections of many human neoplasms, but not in cytology specimens. Therefore, we performed Immunolocalization of p53 in both cytology and tissue preparations obtained from the same specimens in 19 cases of human esophageal squamous‐cell carcinoma. Three different antibodies, PAb1801, DO‐7, and CM‐1, were employed. Positive p53 nuclear immunoreactivity was observed in carcinoma cells, but not in noncarcinomatous cells, in both tissue and cytology preparations. The incidence of p53 positivity was 53% (10/19) in cytology and 42% (8/19) in tissue, and the coincident rate of both results was 89% (17/19). We conclude that immunohistochemistry of p53 in cytology is a useful method for detecting p53 mutations, and may contribute to the diagnosis of malignancy, because it is a simple, easy, and rapid technique. Diagn Cytopathol 1994; 11:113–118. © 1994 Wiley‐Liss, Inc.
Simplified nuclear grading of fine‐needle aspirates of breast carcinoma: Concordance with corresponding histologic nuclear grading and flow cytometric data
Authors: Cajulis Ricardo S. , Hessel R. Glenn , Hwang Shyn , Haines Kenneth , Frias‐Hidvegi Denise , O'Gorman Maurice
Published: February 2007

Although histologic grading of breast carcinoma is widely practiced by most pathologists, cytologic grading of fine‐needle aspirates (FNA) of this neoplasm is not commonly done. This study addresses the issue of the accuracy of a new classification system, a simplified Nuclear Grading (NG) system based on the criteria proposed by Black et al. (Surg Gynecol Obstet 1955; 100:543) in FNA of breast carcinoma. We reviewed 100 cases of breast carcinoma, initially diagnosed by fine‐needle aspiration biopsy (FNAB) with subsequent histologic confirmation, consisting of 94 ductal, five lobular, and one medullary carcinoma. NG of Papanicolaou's stained materials were reviewed twice independently by two pathologists and then were compared to the original histologic NG. The concordance rate with histology ranged from 80–90%. Intraobserver reproducibility was 86 and 88%, while interobserver reproducibility ranged from 84–88%. Of the 88 cases with corresponding flow cytometic (FCM) data, there were 35 diploid and 53 aneuploid cases. Fifty‐nine (95%) of histologic high NG were aneuploid or diploid with high S‐phase fraction (SPF), while 20 (77%) of histologic low NG were diploid with low SPF. This study confirms that nuclear grading of FNA of breast carcinoma using a simplified NG system has a high concordance with histology, has high intraobserver and interobserver reproducibility, and that this grading system correlates well with FCM analysis when tumors are simply divided based on NG as high or low grade. Diagn Cytopathol 1994; 11:124–130. © 1994 Wiley‐Liss, Inc.
Hashimoto's thyroiditis: Fine‐needle aspirations of 50 asymptomatic cases
Authors: Poropatich Cary , Marcus Devra , Oertel Yolanda C.
Published: February 2007

The cytologic findings from 50 cases of asymptomatic Hashimoto's thyroiditis diagnosed by fine‐needle aspiration are reviewed. All patients were referred for fine‐needle aspiration by the same physician: 48 because of thyroid enlargement and the clinical suspicion of Hashimoto's thyroiditis, two because of a small thyroid nodule. Positive antimicrosomal (antithyroid peroxidase) and/or antithyroglobulin antibody tilers (performed by the same laboratory using the same technique) were present in only 25 of 48 patients evaluated. Cytologic findings included a predominantly lymphocytic process in 92% of the cases and a predominantly oxyphilic (Askanazy/Hürthle) cell process in 8% of the cases. It is likely that all patients were in an early stage of the autoimmune process. Our data indicate that the incidence of Hashimoto's thyroiditis is considerably higher than when recognized only by serologic tests for antibodies. Diagn Cytopathol 1994; 11:141–145. © 1994 Wiley‐Liss, Inc.
Aspiration biopsy cytology of tubular carcinoma of the breast
Authors: Tos Angelo P. Dei , Giustina Dino Della , De Martin Vallì , Libera Duilio Della , Bittesini Lucia
Published: February 2007

Tubular carcinoma represents a rare, well‐differentiated type of breast malignancy, characterized by relatively unaggressive clinical behavior. Cytologic diagnosis of this subgroup of tumors is considered difficult as cell population usually presents in tightly cohesive clusters and shows minimal atypia. Cytomorphologic features of 15 examples of histologically proven pure tubular carcinomas of the breast are herein reported. If a constellation of morphologic criteria is critically evaluated, tubular carcinoma may be diagnosed on cytologic specimens.

Aspiration biopsy cytology represents an optimal diagnostic tool in the preoperative diagnosis of breast masses. Its application to the detection of this special type of breast carcinoma permits better planning of therapeutic procedures. Diagn Cytopathol 1994; 11:146–150. © 1994 Wiley‐Liss, Inc.
Pulmonary carcinoid with papillary structure: Report of a case with fine‐needle aspiration cytology
Authors: Evans Hilary , Blaney Ronald
Published: February 2007

Fine‐needle aspiration biopsy of a peripheral lung mass in a 44‐yr‐old man revealed a papillary tumor. Histologic examination of the mass, removed by lobectomy, demonstrated a pulmonary carcinoid tumor with papillary structure. Most papillary tumors of the lung are malignant. Pulmonary carcinoid and pulmonary sclerosing hemangioma—benign tumors—have papillary variants. Both have been described in fine‐needle aspiration specimens and should be included in the differential diagnosis of papillary lung tumors. The cytologic features of pulmonary carcinoid are described. Diagn Cytopathol 1994;11:178–181. © 1994 Wiley‐Liss, Inc.
Cytologic patterns of metastatic thymoma: Diagnosis by fine‐needle aspiration biopsy
Authors: Reddy Vijaya B. , Reyes Cesar , Wang Helena , Walloch Jami , Doria Manuel , Castelli Melanie , Gattuso Paolo
Published: February 2007

Thymomas are the most frequent primary tumors of the anterior mediastinum. These lesions are slow growing and can be locally invasive, but extrathoracic metastases are rare, occurring in less than 2% of cases. Fine‐needle aspiration biopsy (FNAB) may be helpful in making the diagnosis of metastatic thymoma, with or without a clinical history of primary mediastinal thymoma. We report three cases of metastatic thymoma diagnosed by FNAB. Each case illustrates a distinctive cytologic pattern. While two of the patients had a history of histologically confirmed thymoma 11 and 13 years previously, a third patient presented with an enlarged supraclavicular lymph node and pulmonary nodules, and no prior diagnosis of thymoma. These cases demonstrate that based on distinctive cytologic patterns and features, a diagnosis of metastatic thymoma can be made with FNAB. Ancillary studies will often confirm the diagnosis. Diagn Cytopathol 1994;11:182–187. © 1994 Wiley‐Liss, Inc.
Quality assurance programs to meet CLIA requirements
Authors: Inhorn Stanley L. , Shalkham John E. , Mueller Gail B.
Published: February 2007

CLIA '88 delineates specific quality assurance (QA) practices for cytology laboratories in the United States. In addition, there are general requirements that all types of clinical laboratories must meet to satisfy the CLIA law and regulations. This paper describes the origins and objectives of CLIA and it outlines the major sections of the legislation. To satisfy the regulations, every laboratory must develop its own quality assurance plan that addresses each of the specific conditions and standards. Furthermore, the laboratory must monitor its performance and document that, indeed, the QA systems are operating effectively. The article then describes the quality assurance plan of the Cytology Department of the Wisconsin State Laboratory of Hygiene. The department uses 28 monitors to determine compliance with the criteria and standards and to prevent problems in its day‐to‐day operation. When standards are not met or are exceeded, action steps are specified. Diagn Cytopathol 1994;11:195–200. © 1994 Wiley‐Liss, Inc.
Postmenopausal squamous‐cell atypias: A diagnostic challenge
Authors: Saminathan Thamarai , Lahoti Chitra , Kannan Vaidehi , Kline Tilde S.
Published: February 2007

Exfoliative cytologic studies directed toward atypical squamous cells of undetermined significance (ASCUS) and low‐grade squamous intraepithelial lesions (LSIL) have been neglected in the rising postmenopausal population. This retrospective study from 60 cases, initially interpreted as ASCUS or LSIL, concentrates on these lesions and their associated diagnostic pitfalls.

Cytologic revaluation of the 60 patients revealed squamouscell abnormalities in 45 (18 ASCUS and 27 LSIL) and cervicitis alone in 15 cases. Follow‐up studies of the 18 ASCUS cases showed cervicitis in seven, persistent ASCUS in five, CIN I in five, and VAIN I‐II in one. Follow‐up of the 27 cases categorized as LSIL, showed ASCUS in two, CIN in 20 and VAIN in one, while four had cervicitis alone. Interestingly, two of these 45 patients had only vaginal dysplasia. By application of uniform diagnostic criteria, 15 of the 60 cases were reviewed as benign. Pitfalls included inflammatory and drying alterations, reactive metaplasia, and sampling problems. Thus, squamous‐cell abnormalities in postmenopausal women can be significant when artifactual alterations are eliminated. Diagn Cytopathol 1994; 11:226–230. © 1994 Wiley‐Liss, Inc.
Fine‐needle aspiration biopsy of childhood rhabdomyosarcoma: Reevaluation of the cytologic criteria for diagnosis
Authors: De Almeida Margarida , Stastny Janet F. , Wakely Paul E. , Frable William J.
Published: February 2007

The distinction between rhabdomyosarcoma (RMS) and the other small round blue cell tumors of childhood has therapeutic implications which stress the importance of a correct diagnosis. In attempts to reevaluate the cytologic criteria of this entity, we reviewed a series of 17 fine‐needle aspiration biopsies and three touch imprints from soft tissue masses. All cases had been histologically confirmed except for two cases that only had immunocytochemical and ultrastructural confirmation. The features occurring most commonly include a uniform population of tumor cells arranged as single cells and cohesive aggregates. The cells were predominantly round/polygonal, with uniform nuclei and scant to moderate amounts of cytoplasm. The nuclear chromatin was most often finely granular and hyperchromatic, while nucleoli were inconspicuous. Binucleated and multinucleated cells were found in 17 of the 20 smears. Intracytoplasmic vacuoles were present in 17 cases, ranging from occasional in one case, a few in 10 cases, and very numerous in six cases. We conclude that the presence of bi/multinucleated cells is an important clue for the diagnosis of RMS on fine‐needle aspiration biopsy. Diagn Cytopathol 1994;11:231–236. © 1994 Wiley‐Liss, Inc.
Application of impression cytology to the diagnosis of conjunctival neoplasms
Authors: Nolan Glenda R. , Hirst Lawrence W. , Wright R. Gordon , Bancroft B. Josephine
Published: February 2007

Conjunctival impression cytology using cellulose acetate filter paper was employed to obtain multiple samples of conjunctival epithelium from 192 normal and abnormal eyes. Modifications of an established technique were used and the impressions were stained by the Papanicolaou method and mounted on glass slides. The impressions were examined for their effectiveness in demonstrating the morphological characteristics of normal epithelium and the features of the more common conjunctival neoplasms. The technique was found to be successful at both removing cells and preserving cytologic features. It also had several advantages over other collection techniques. Overlapping cells were not a detrimental feature of the preparations from this study. Diagn Cytopathol 1994;11:246–249. © 1994 Wiley‐Liss, Inc.
Fine‐needle aspiration biopsy diagnosis of extrarenal malignant rhabdoid tumor
Authors: Akhtar Mohammed , Kfoury Hala , Haider Abdulrazzaq , Sackey Kwesi , Ali M. Ashraf
Published: February 2007

Two cases of extrarenal malignant rhabdoid tumors are presented in which diagnosis was suggested by fine‐needle aspiration biopsy and confirmed by histologic and electron microscopic examination. Fine‐needle aspiration smears in both cases revealed round to polygonal cells with vesicular nuclei and prominent nucleoli. Several tumor cells contained cytoplasmic inclusions composed of intermediate filaments. A majority of the tumor cells stained strongly for vimentin and cytokeratin. Electron microscopic examination revealed many cells with large aggregates of intermediate filaments corresponding to the cytoplasmic inclusions. Fine‐needle aspiration biopsy may be used for diagnosing malignant rhabdoid tumor. The diagnosis may be further confirmed by immunohistochemistry and electron microscopy. Diagn Cytopathol 1994;11:271–276. © 1994 Wiley‐Liss, Inc.
Pitfalls in the cytologic diagnosis of angiosarcoma of the breast by fine‐needle aspiration: A case report
Authors: Carson Karen F. , Hirschowitz Sharon L. , Nieberg Roberta K. , Sadeghi Shala
Published: February 2007

This paper describes a case of angiosarcoma of the breast in a 26‐yr‐old female. The tumor, originally thought to be granulation tissue on fine‐needle aspiration biopsy, was correctly identified as a malignant neoplasm of probable mesenchymal origin on a repeat FNA biopsy 4 mo later. A diagnosis of angiosarcoma was made on a subsequent excisional biopsy. Review of the cytologic features revealed findings that should suggest angiosarcoma, especially when correlated with the clinical history. The authors describe the cytological features seen in this case, and discuss an important pitfall in the diagnosis of angiosarcoma of the breast on FNA. Diagn Cytopathol 1994; 11:297–300. © 1994 Wiley‐Liss, Inc.
Retrospective analysis of non‐correlating cervical smears and colposcopically directed biopsies
Authors: Sidawy Mary K. , Siriaunkgul Sumalee , Frost Andra R.
Published: February 2007

The purpose of this study is to evaluate the cause of discrepancies between non‐correlating cytologic and histologic cervical samples. The biopsy results of 433 women examined colposcopically were compared to their referral cervical smears (RS). There was a discrepancy between the RS and the subsequent biopsy in 120 women (28%). One hundred of these 120 RS were available for review; and in each case, a reason for the discrepancy was established and classified as RS overcall, RS undercall, RS sampling error, or biopsy sampling error. Fifty‐one discrepant RS were overcalled. They were reported initially as condyloma (19), mild dysplasia (22), and moderate dysplasia (10). One RS was undercalled. Nine RS were not diagnostic of the biopsy‐proven lesion due to smear sampling error. The discrepancies in the remaining 39 cases were due to biopsy sampling error. Twenty‐one of these 39 cases had additional biopsies or smears that confirmed the presence of condyloma/dysplasia, and 18 had negative follow‐up. In summary, discrepancies were a result of pathologists' interpretative error, predominantly overcalls, in 52% of non‐correlating cases, and smear or biopsy sampling error in the remaining 48%. Diagn Cytopathol 1994;11:343–347. © 1994 Wiley‐Liss, Inc.
Fine‐needle aspiration biopsy of vertebral body lesions: Cytologic, pathologic, and clinical correlations of 57 cases
Authors: Carson Henry J. , Castelli Melanie J. , Reyes Cesar V. , Gattuso Paolo
Published: February 2007

We reviewed 57 cases of fine‐needle aspiration biopsy (FNAB) specimens of vertebral body lesions at our institutions and sought correlations between clinical histories, aspirates, and tissue specimens. Patients'ages ranged from 10–86 yr (mean 62 yr). Previous clinical histories included malignancy (n = 33), osteomyelitis or systemic infection (n = 18), and nonspecific (n = 6). FNAB diagnoses were rendered in 81% of cases (n = 46) and were correlated with previous clinical history (P < 0.004). Tissue diagnoses were also correlated with previous clinical history (P < 0.02). In 19% of cases (n = 11), FNAB was unsatisfactory; of these, tissue specimens were diagnostic for five cases. In 19% of cases (n = 11), both aspirates and tissue specimens were available, and the diagnoses coincided in all cases; tissue specimens did not enhance the results of aspirates which produced positive results. Aspirates which showed normal bone marrow elements appeared to effectively rule‐out metastatic malignancy based on clinical follow‐up (mean 3.7 yr). Diagn Cytopathol 1994;11:348–351. © 1994 Wiley‐Liss, Inc.
Extraskeletal myxoid chondrosarcoma: Fine‐needle aspiration biopsy findings
Authors: Niemann Theodore H. , Bottles Kent , Cohen Michael B.
Published: February 2007

Extraskeletal myxoid chondrosarcoma (EMC) is a malignant soft tissue tumor which typically presents as an enlarging mass in an extremity. In this location it is amenable to sampling and diagnosis by fine‐needle aspiration biopsy. We present our experience with three cases of EMC and discuss the differential diagnosis of myxoid soft tissue tumors. Diagn Cytopathol 1994; 11:363–366. © 1994 Wiley‐Liss, Inc.
Epithelioid sarcoma in FNAB smears
Authors: Pohar‐Marinšek Živa , Zidar Andreja
Published: February 2007

FNAB smears of eleven epithelioid sarcomas were reviewed and analysed. Ten cases had a very similar cytomorphologic picture composed predominantly of dissociated epithelioid‐like cells with eccentrically placed nuclei. These tumors were clearly malignant but difficult to differentiate morphologically from melanoma, epithelioid leiomiosarcoma, and Schwannoma or adenocarcinoma. One case was composed of spindle cells and was reminiscent of a fibrohistiocytic tumor. Immunocytochemical reactions to vimentin and cytokeratin were performed in six cases on the Papanicolaou stained smears. The reactions to both antigens were positive in all six cases. Ultrastructural characteristics of eight of the tumors are also described.

It seems that epithelioid sarcoma has a rather distinct cytomorphologic picture. Taking into consideration clinical data and using also immunocytochemistry, a definitive diagnosis of epitheliold sarcoma can probably be given from FNAB smears. Diagn Cytopathol 1994; 11:367–372. © 1994 Wiley‐Liss, Inc.
Nodular lepromatous leprosy: Report of a case diagnosed by FNA
Authors: Singh Navjeevan , Arora Vinod Kumar , Ramam M.
Published: February 2007

Lepromatous leprosy can present with skin nodules which can be misdiagnosed as soft tissue tumors or infected cysts. FNA can be diagnostic of unstained, refractile, intracellular mycobacteria are recognized on Romanowsky stained smears. File stain for Mycobacterium leprae confirms the diagnosis. Awareness of the differential diagnosis of skin nodules yielding foamy histiocytes on FNA, briefly discussed, should help avoid error. Diagn Cytopathol 1994; 11:373–375. © 1994 Wiley‐Liss, Inc.
Oncocytic carcinoma of parotid gland: Fine‐needle aspiration and histologic findings
Authors: Laforga J. B. , Aranda F. I.
Published: February 2007

A parotid gland mass in an eldery man was diagnosed as an oncocytic neoplasm with cellular pleomorphism and cytologic atypia by fine‐needle aspiration. The histologic features showed a primary parotid malignant oncocytoma with metastasis in regional lymph nodes. Diagn Cytopathol 1994; 11:376–379. © 1994 Wiley‐Liss, Inc.
Diagnostic difficulties in the interpretation of needle aspiration material from large renal cysts
Authors: Horwitz Charles A. , Manivel J. Carlos , Inampudi Subbarao , Kaye Keith , Jensen Chris S. , Cohen Michael B.
Published: February 2007

In recent years, fine‐needle‐aspiration biopsies (FNA) have been widely used in the evaluation of renal masses, with false‐positive FNA data being very uncommon. We present a case report of a 76‐yr‐old man with a 16‐cm renal cyst and what was interpreted as an isolated calcified mural nodule. Following drainage of the main cyst fluid, FNA biopsy showed atypical cell clusters thought to be positive for malignancy. Subsequent surgery failed to disclose either a residual mural nodule or evidence of malignancy. Immunoperoxidase studies performed on both the cell block and actual cyst wall suggested that the abnormal cells were histiocytes. The diagnostic pitfalls of this case, along with a review of pertinent literature, are discussed. Diagn Cytopathol 1994; 11:380–384. © 1994 Wiley‐Liss, Inc.
Focal fatty change of the liver: Cytologic findings in a radiographic mimic of metastases
Authors: Layfield Lester J. , Frias‐Hidvegi Denise
Published: February 2007

Fine‐needle aspiration (FNA) is being increasingly utilized for the workup of patients with suspected metastatic disease. In the course of these biopsies, cytologists are being confronted by a variety of nonneoplastic lesions which radiographically simulate metastatic deposits. Some of these lesions will predominately reveal hepatocytes. One of these cytologically poorly characterized lesions is focal fatty change. Aspirates show a population of benign hepatocytes with single or multiple clear cytoplasmic vacuoles. Recognition of the entity along with accurate needle placement in the nodule can establish the diagnosis of focal fatty infiltration and negate the need for further biopsies. Diagn Cytopathol 1994; 11:385–389. © 1994 Wiley‐Liss, Inc.
Atypical squamous cells of undetermined significance: Interlaboratory comparison and quality assurance monitors
Authors: Davey Diane D. , Naryshkin Sonya , Nielsen Mary L. , Kline Tilde S.
Published: February 2007

The Bethesda System recognizes “Atypical Squamous Cells of Undetermined Significance” (ASCUS) as a category of epithelial cell abnormality. Neither the acceptable rate of ASCUS nor the clinical follow‐up are well defined. This study focused on interlaboratory comparison and quality assurance methods for evaluating the rate and outcome of ASCUS. Data was collected from questionnaire surveys from the College of American Pathologists Interlaboratory PAP Program and the four authors' laboratories. Most PAP laboratories (82.5%) limit the use of “atypia” terminology to abnormalities of undetermined significance. According to PAP data, the median rate of ASCUS in 1992 was 2.9%, with 10% of laboratories reporting rates greater than 9.0%. The median squamous intraepithelial lesion (SIL) rate was 2.2%, with a median ASCUS/SIL ratio of 1.3. The authors' laboratories (university, independent, and hospital) revealed ASCUS rates of 1.6–9.0%, while SIL rates were 2.1–9.0%. The ASCUS/SIL ratio was less variable, 0.8–2.7. Follow‐up of ASCUS patients in the authors' laboratories showed 10.3–43% with SIL, but less than 6% with high grade SIL. The ratio ASCUS/SIL may serve as a useful laboratory monitor. Peer review and follow‐up studies of ASCUS serve to validate laboratory criteria and consequent clinical follow‐up. Communication with clinicians is vital in ensuring optimal patient care. Diagn Cytopathol 1994; 11:390–396. © 1994 Wiley‐Liss, Inc.
Effusion cytology in burkitt's lymphoma
Authors: Haddad Michael G. , Silverman Jan F. , Joshi Vijay V. , Geisinger Kim R.
Published: February 2007

The American form of Burkitt's lymphoma is a high‐grade malignancy which usually involves the abdomen in children and young adults. There is only a limited literature which describes the cytologic features of Burkitt's lymphoma in serous effusions. We present three children with Burkitt's lymphoma initially diagnosed by effusion cytology. the first patient, an 11‐yr‐old boy, presented with bilateral pleural effusions, ascites, and abdominal masses and had diagnostic pleural fluid cytology without tissue confirmation (ultrastructural examination was performed on the effusion specimen). He died 7 months after the initial diagnosis. the second patient, a 9‐yr‐old boy, presented with ascites and abdominal masses and had diagnostic peritoneal fluid cytology with a subsequent confirmatory chest wall biopsy. the third patient, a 16‐yr‐old girl, presented with a 2‐month history of irregular menses, a large pelvic mass, lymphadenopathy, and liver masses. Although an ovarian malignancy was clinically suspected, cytologic examination of her peritoneal fluid revealed Burkitt's lymphoma. Surgical exploration revealed involvement of her right ovary, cecum, and terminal ileum. the second and third patients are currently alive with no apparent disease following chemotherapy. in all three patients, effusion cytology revealed Burkitt's lymphoma, characterized by a uniform population of noncohesive lymphoid cells with noncleaved nuclei, prominent multiple nucleoli, and scanty‐to‐moderate basophilic cytoplasm. Cytoplasmic and/or nuclear vacuoles were also seen, more prominent in Diff‐Quik—stained, air‐dried smears. These cases demonstrate the importance of recognizing the cytologic features of Burkitt's lymphoma, as serous fluid may be the initial diagnostic specimen.
Utilization of fine‐needle aspiration biopsy in the diagnosis of metastatic tumors to the pancreas
Authors: Carson Henry J. , Green Linda K. , Castelli Melanie J. , Reyes Cesar V. , Prinz Richard A. , Gattuso Paolo
Published: February 2007

There is relatively little information concerning the use of fine‐needle aspiration biopsy (FNAB) to diagnose a mass in the pancreas that is secondary to metastatic tumor. This study reviews the incidence and types of neoplasms which metastasize to the pancreas and assesses the contribution FNAB can make in their diagnosis. of 117 radiologically guided FNABs of the pancreas, 11% (n = 13) showed metastatic malignancy. Nine patients had a previous history of malignancy while four patients presented with a pancreatic mass and were subsequently found to have widespread malignant disease. the majority of metastatic lesions were epithelial (77%, n = 10). Patient outcomes were generally poor (mean survival 2.8 mo). Metastases to the pancreas occur from a variety of primary sites and should be considered in patients with a pancreatic mass and a history of prior malignancy. FNAB is useful in diagnosing these metastases and this is clinically important because of their poor prognosis.
Diagnosis of lymphoma, leukemia, and metastatic tumor involvement of the cerebrospinal fluid by cytology and immunocytochemistry
Authors: Tani Edneia , Costa Isabel , Svedmyr Erik , Skoog Lambert
Published: February 2007

Fifty‐five cerebrospinal fluid (CSF) specimens from 42 patients with suspected meningeal tumor involvement were reviewed. Cytology in conjunction with immunocytochemistry identified 26 CSF specimens as malignant. There were fifteen cases of lymphoma, four cases of leukemia, two cases of carcinoma, and two cases of melanoma. A monoclonal light chain expression was demonstrated in nine out of eleven B cell lymphomas. the three T‐cell lymphomas all expressed pan T markers (CD 3) and two the T‐helper antigen (CD 4). One patient had meningeal involvement of a true histiocytic lymphoma which was indentified by its large atypical cells which were positive for α‐1‐anti‐trypsin and muramidase. in four patients with a primary diagnosis of acute lymphoblastic leukemia, CSF involvement was confirmed by the demonstration of blasts with CD 10 (cALLA) or light chain restriction. Epithelial or melanocytic markers were demonstrated on the tumor cells in CSF from the remaining four patients.

In 29 CSF specimens a diagnosis of reactive lymphocytosis was made using cytomorphology which mostly was characterized by macrophages mixed with small mature lymphoid cells. Immunologic evaluation showed that these mature cells were CD 10 negative T‐cells and only few specimens contained polyclonal B‐cells. the subsequent clinical course of these patients showed no evidence of CNS malignancy.

It is concluded that cytology should be used in conjunction with immunocytochemistry to accurately evaluate CSF specimens from patients with possible malignant meningitis.
Tuberculous lymphadenitis: Extended cytomorphologic features
Authors: Pandit Ajita Avinash , Khilnani Pushpa Hiranand , Prayag Arunakumari S.
Published: February 2007

In tuberculous lymphadenitis, FNAC smears sometimes reveal only caseous necrosis without epithelioid cell granuloma. They pose a diagnostic problem, if AFB staining is negative. the diagnostic clue noticed in these cases was presence of multiple pink, homogenous structures with irregular shape and well‐defined margins: “eosinophilic structures” (ES). the purpose of the present study is to find out the nature of ES and their role in the diagnosis of tuberculosis.

Seventy FNAC smears from documented cases of tuberculous lymphadenitis were classified according to their cytomorphological features. the association and relation of ES with other morphological criteria was noted. Immunoperoxidase staining was performed to find out the reactivity of ES to tuberculous antigen. Its intensity of positivity was compared with epithelioid cell granuloma and degenerating granuloma. It was concluded that ES are degenerated granuloma and thus form an extended diagnostic criterion. Diagn Cytopathol 1995;12:23‐27.
Predictors of human papilloma virus in patients with keratinization
Authors: Hudock Jude , Hanau Cheryl A. , Hawthorne Clementine , Jordan Andrea G.
Published: February 2007

Given the prevalence of human papilloma virus (HPV) infection, an attempt was made to determine whether certain factors such as keratinization and/or squamous atypia are associated with its development. Review of our gynecologic cytology files from 1989 yielded 1,615 specimens showing parakeratosis and/or hyperkeratosis, without cytologic evidence of HPV. Concomitant diagnoses included no atypia [keratinization only (KO)], inflammatory squamous atypia (ISA), and squamous atypia (SA).

Morphologic follow‐up including repeat cytology or biopsy was available for 916 cases, 92 (10.0%) of which possessed changes of HPV. For any case with both cytologic and biopsy evidence of HPV, only the biopsy result was tabulated.

HPV on follow‐up examination was detected in 52 (6.7%) of the 764 cases with KO; in 20 (20.8%) of the 96 cases with keratinization and ISA (KISA); and in 20 (35.7%) of the 56 cases with keratinization and SA (KSA).

The definitive diagnosis of HPV was based on previously described features (Gupta, In: Comprehensive Cytopathology, Philadelphia: WB Saunders, 1991:133‐140) including nuclear enlargement with nuclear membrane irregularities in combination with sharply demarcated paranuclear cytoplasmic clearing. Affected cells have rounded borders. Binucleated cells are not uncommon.

The increasing percentage of HPV from KO to KISA to KSA is not necessarily surprising. However, mathematical analysis revealed statistically significant differences in the development of HPV in each of the 3 groups: KISA vs. KO (P < 0.001), KSA vs. KO (P < 0.001), and KSA vs. KISA (P < 0.05). Therefore, a cytologic diagnosis of keratinization with ISA or especially SA should warrant closer follow‐up than that of KO.
Pulmonary lymphoma in cardiac transplant patients treated with okt3 for rejection: Diagnosis by fine‐needle aspiration
Authors: Reyes Cesar V. , Jensen Joanne , Chinoy Mumtaz
Published: February 2007

At Hines VA Hospital, three out of 38 cardiac transplant patients, who were 9, 10, and 14 mo post‐surgery and treated with immunosuppressive drugs, including OKT3 prophylaxis for acute rejection, developed a solitary pulmonary nodule.

Fine‐needle aspiration biopsy of the nodules in these three patients revealed a hypercellular, monotonous population of large lymphoid cells. These abnormal cells were isolated, with small aggregates occasionally seen. the nuclear membranes were irregular, the chromatin was finely granular, nucleoli were prominent, and mitotic figures were frequently noted.

The cells were immunoreactive to leukocyte common antigen and B‐lymphocyte. Lambda light chain immunoglobulin was positive in one case, kappa in the second case, and neither light chains in the third patient. By electron microscopy in one case, the cells were large immature lymphoid cells with immunoblastic features. Subsequent tissue studies, complemented by frozen section immunostaining, flow cytometry, and phenotyping, reaffirmed the diagnosis of malignant lymphoma.

It appears that OKT3 therapy increases several fold the risk of lymphoma's developing in cardiac transplant patients. Preliminary published reports have also recommended close surveillance of patients receiving OKT3 for early indications of lymphoproliferative disorder and a reevaluation of the risk vs. benefit for the prophylatic use of OKT3.
Antigen expression of alveolar macrophages in smokers and patients with lung diseases
Authors: Athanassiadou Pauline P. , Athanassiades Peter H. , Kostopoulos Charalambos , Kyrkou Kalliopi , Petrakakou Efthalia , Veroni Sofia
Published: February 2007

Alveolar macrophage function was studied immunocytochemically using three monoclonal antibodies—macrophage CD 68 KP 1 (M), protein CD 11C (P), and anti‐elastin (EL)—and three polyclonal antibodies—lysozyme (LZ), alpha‐1‐antitrypsin (AAT), and alpha‐1‐antichymotrypsin (AACT). the material for study was smears obtained from bronchial washings from 15 healthy persons and 60 patients with respiratory infections or primary or secondary malignant lung infiltration. Eight of the healthy group and 40 of the patient group were smokers (SM). the percentage of cells obtained from the washings which were macrophages was also measured.

The intensity of staining reactions for each of the six antigens was noted and in general more intense staining was noted in smokers than in non‐smokers. More intense staining was observed in patients with pulmonary infections (group II PI) and metastatic pulmonary infiltrations (group IV MP Ca) than in controls (group IC), while patients with primary lung cancer (group III PP Ca) had highly reduced staining reactions. the number of macrophages was similarly increased in all groups in comparison with the IC group for non‐smokers and in all groups except III PP Ca for smokers. It is concluded that smoking, pulmonary infections, and metastatic infiltration of the lung are associated with an increase in the number and activity of alveolar macrophages, while patients with primary lung cancer have an increase in the number of macrophages which are functionally incompetent.
Confocal microscopy of false‐negative breast aspirates
Authors: Boon M. E. , Schut J. J. , Suurmeijer A. J. H. , Benita E. M. , Hut P. K. H. , Kok L. P.
Published: February 2007

Even when using a novel optimized FNA‐21® for breast fineneedle aspiration biopsy, our series of 163 breast lesions with consecutive histology, including 110 carcinomas, contained eight cancer cases with a negative cytologic diagnosis. Two consisted exclusively of thick, undiagnosable epithelial fragments and were devoid of detached malignant cells on which the proper diagnosis could have been made. Optical sectioning of the original smears by the confocal microscope allowed us to reclaim from these epithelial fragments the diagnostic abnormal chromatin patterns, even in the air‐dried smears. in the thin optical sections the cancerous tubular or cribriform growing pattern was visualized. the high spatial resolution of the confocal microscope can be further exploited with the application visualization system (AVS). the AVS three‐dimensional reconstructions allow us to see the surface of these malignant cells in a detail approaching that of scanning electron microscopy. Furthermore, the internal aspects of the malignant nuclei can be visualized with these techniques.
Mycoses of the breast: Diagnosis by fine‐needle aspiration
Authors: Farmer Charles , Stanley Michael W. , Bardales Ricardo H. , Korourian Sohelia , Shah Hememdra , Bradsher Robert , Klimberg Vicki S.
Published: February 2007

Fungal infections of the breast are unusual and may clinically mimic carcinoma. When studied by fine‐needle aspiration (FNA), such masses may yield necrosis, granulomatous inflammation, reactive histiocytes, and atypical epithelial cells. Cohesive groups of atypical epithelial cells featured nuclear enlargement and overlapping, as well as prominent nucleoli. the organisms may be widely scattered, so that careful evaluation was required for their identification. in concert with provocative clinical findings, these features may lead to an erroneous diagnosis of malignancy. We describe three women with mycotic masses of the breast initially studied by FNA. the first patient presented at age 31 with a large, firm breast mass, chest wall extension, and radiographic evidence of vertebral bone involvement. FNA was requested to confirm the clinical diagnosis of advanced breast carcinoma. in addition to the atypia described above, the smears showed yeast forms indicative of blastomycosis surrounded by neutrophils. She remains well, following antifungal treatment. the second case of Blastomycosis was diagnosed by FNA of a breast mass in a 64‐yr‐old woman, who also responded to treatment. the third patient's preoperative needle aspiration showed granulomas, but no organisms were identified, even with special stains; silver stains of surgically excised tissue showed histoplasmosis.
Glycogen‐rich clear cell carcinoma of the breast: Report of a case with fine‐needle aspiration cytology and immunocytochemical and ultrastructural studies
Authors: Alexiev Borislav A.
Published: February 2007

Fine‐needle aspiration cytology, immunocytochemistry, and electron microscopic findings are described in a case of glycogen‐rich clear cell carcinoma of the breast. the aspirate contained many small and large papillary cell groups and numerous single tall columnar cells with apical cytoplasmic projections and mild to moderate degree of nuclear pleomorphism. Cytochemical localisation of glycogen and immunostaining on air‐dried smears with CEA and actin monoclonal antibodies permitted the correct identification and differential diagnosis of the tumor. Electron microscopic examination of the resected specimen confirmed the diagnosis of glycogen‐rich clear cell carcinoma. the differential diagnosis and potential diagnostic pitfalls are discussed, and recommendation are offered to prevent misdiagnosis.
Sialadenitis with crystalloid formation: A report of six cases diagnosed by fine‐needle aspiration
Authors: Johnson Frank B. , Oertel Yolanda C. , Ammann Kathleen
Published: February 2007

Six cases of sialadenitis diagnosed by fine‐needle aspiration contained large numbers of crystalloids. Light microscopy, ultrastructure, and chemical analysis suggest that the crystalloids represent crystallized salivary α‐amylase.

The inflammatory swelling may mimic benign and/or malignant neoplasms of the salivary glands. Drainage and/or antibiotic therapy may allow surgery to be avoided in these patients.
Fine‐needle aspiration cytopathology of soft tissue: Chondromyxoid and myxoid lesions
Authors: Wakely Paul E. , Geisinger Kim R. , Cappellari James O. , Silverman Jan F. , Frable William J.
Published: February 2007

Soft‐tissue lesions pose an intimidating challenge to diagnostic interpretation by fine‐needle aspiration cytology. to better characterize such aspirates, we investigated a subgroup of lesions which yielded a large amount of chondromyxoid and myxoid stroma (CMS). Thirty‐three cases (22 malignant lesions, 11 benign lesions) in which CMS was a prominent feature of the smears were studied. the most common malignant neoplasms were extraskeletal chondrosarcoma (6 cases), myxoid liposarcoma (6), and malignant fibrous histiocytoma (5). the benign entities consisted of ganglion cyst (4), myxoma (3), and neurofibroma (2). of the aspirates from 22 malignant neoplasms, 15 (68%) contained opaque stroma, and in 18 (81%) the stroma was distributed as discrete clumps or fragments; all extraskeletal chondrosarcomas and chordomas contained these features. Additionally, in five of six chondrosarcomas the matrix exhibited cells within lacunae. Except for a tracheal chondroma which extended into the adjacent soft tissue, no benign aspirates had all three of these cytologic features. Twenty‐three aspirates (70%) were moderately or highly cellular; all but two of these were malignant. Moderate to marked nuclear atypia occurred in 13/22 (59%) malignant and 1/11 (9.0%) benign aspirates. With a few exceptions, aspiration smears of benign lesions with abundant CMS were characterized by low cellularity, semitransparent amorphous stroma, and lack of nuclear irregularity. Recognition of variations in the character of the background material in addition to traditional cytologic criteria can aid in the diagnosis of benign and malignant chondromyxoid and myxoid aspirates of soft tissue. © 1995 Wiley‐ Liss, Inc.
Mucinous cystic tumor of the pancreas: An analysis of fna characteristics with an emphasis on the spectrum of malignancy associated features
Authors: Dodd Leslie G. , Farrell T. A. , Layfield Lester J.
Published: February 2007

Previously, pancreatic mucinous cystic tumors were classified as either benign (cystadenoma) or malignant (cystadenocarcinoma). Descriptions of the fine‐needle aspiration (FNA) findings of these neoplasms have heretofore emphasized malignant cytologic characteristics. in the following, we present a summary of a study of FNA characteristics from ten patients with cystic mucinous neoplasms, four of whom have correlating histologic material. in this study, we found a spectrum of cytologic features ranging from completely benign appearing to obviously malignant. We discuss cystic mucinous pancreatic tumors and the associated FNA findings helpful in diagnosis and categorization of these neoplasms. Also, we suggest the inclusion of a new entity in the mucinous neoplasm category. © 1995 Wiley‐ Liss, Inc.
Comparative cytologic findings of in situ and invasive adenocarcinoma of the uterine cervix
Authors: Keyhani‐Rofagha S. , Brewer J. , Prokorym Patricia
Published: February 2007

The cytologic findings in 13 cases of cervical adenocarcinoma in situ (mean age 33.9 yr) were compared with those in 9 cases of cervical invasive adenocarcinoma (mean age 45.7 yr). All diagnoses were confirmed by biopsy. the major differences found were that a necrotic background (66% invasive vs. 0% in situ) and macronucleoli (77% invasive vs. 0% in situ) were more common in invasive cases, whereas associated squamous‐cell dysplasia (69% in situ vs. 0% invasive) was more common in in situ cases. Other differences included syncytial tissue fragments with irregular cell borders, frequent cell drop‐off, and markedly atypical single columnar cells (or markedly atypical naked nuclei) seen more commonly in invasive cases, whereas monolayer sheets and/or syncytial tissue fragments with smooth borders and rare cell drop‐off were more common in in situ cases. Although none of these features is diagnostic individually, in combination they are helpful in distinguishing between in situ and invasive adenocarcinoma.

Nine of 13 of the in situ cases showed associated squamous‐cell dysplasia. in all nine of these cases, the glandular dysplasia was overlooked or underestimated in severity on original cytologic diagnosis. This suggests that the presence of a squamous lesion may lead to decreased detection of glandular lesions, perhaps because the features of squamous lesions are more well known; thus they are more easily recognized, at the expense of glandular lesions. All invasive adenocarcinomas were identified as carcinoma in the original diagnosis with seven specified as invasive adenocarcinomas. © 1995 Wiley‐ Liss, Inc.
Subcutaneous masses of the scalp and forehead: Diagnosis by fine‐needle aspiration
Authors: Bardales Ricardo H. , Stanley Michael W.
Published: February 2007

We report our cytologic findings and clinical correlations in benign (N = 2) and malignant (N = 16) subcutaneous masses of the scalp (N = 15) and forehead (N = 3), studied by fine‐needle aspiration (FNA). Diagnoses were divided in 3 groups: (1) Scalp plasmacytoma (as a manifestation of multiple myeloma) (6 cases) was the most frequent diagnosis. in one patient it was the presenting manifestation of the disease. (2) Miscellaneous malignancies included 8 carcinomas, 1 melanoma, and 1 malignant lymphoma. the scalp or forehead mass was the initial presentation and FNA was the initial diagnostic approach in five patients. (3) A single case each of pilar‐type keratinous cyst and hematoma were the only benign masses encountered. in conclusion, a significant number of subcutaneous masses of the scalp or forehead represent metastatic or systemic malignancies, and they may be the initial manifestation of the disease. Rapid and accurate diagnosis by FNA provides guidelines for appropriate therapy, especially in those patients who present with advanced disease. © 1995 Wiley‐ Liss, Inc.