bluuebunny/crossref_metadata_2025 huggingface dataset:
Cytopathology of malignant mesothelioma: A stepwise logistic regression analysis
Authors: Stevens Mark W. , Leong Anthony S‐Y. , Fazzalari Nicola L. , Dowling Kaylene D. , Henderson Douglas W.
Published: February 2007

Twenty‐four cytologic features, previously reported to be useful in the distinction of malignant mesothelioma, adenocarcinoma, and benign mesothelial proliferation in serous effusions were assessed. Forty‐four cases of malignant mesotheliomas, 46 cases of metastatic adenocarcinomas, and 30 cases of benign mesothelial proliferations were examined for these parameters. When these cytologic features were subjected to a stepwise logistic regression analysis, five features were selected to distinguish malignant mesothelioma from adenocarcinoma. These were true papillary aggregates, multinucleation with atypia, cell‐to‐cell apposition, acinus‐like structures, and balloon‐like vacuolation, the latter two features being characteristic of adenocarcinoma. The four variables selected to distinguish malignant mesothelioma from benign mesothelial proliferations were nuclear pleomorphism, macronucleoli, cell‐in‐cell engulfment, and monolayer cell groups, the latter being a feature of benign proliferations. Using these selected variables, the logistic model correctly predicted 95.4% of cases of malignant mesothelioma versus 100% of adenocarcinoma and 100% of malignant mesotheliomas versus 90% of benign mesothelial proliferations. The results of regression analysis suggest that many of the previously described cytologic features are not important diagnostic discriminators. © 1992 Wiley‐Liss, Inc.
Aspiration cytodiagnosis of breast carcinoma in pregnancy and lactation with immunohistochemical and electron microscopic study of an unusual mammary malignancy with pleomorphic giant cells
Authors: Gupta Raj K. , Wakefield St John , Lallu Sharda , Fauck Robert , Simpson John , Dowle Carl S.
Published: February 2007

We have reviewed our experience with 8,706 needle aspiration cytology (NAC) of the breast which were done from January 1983 to June 1991, During our study we diagnosed four cases of breast carcinomas (three ductal type and one with pleomorphic giant cells) in pregnant or lactating women; in all of these the cytologic findings corresponded with the subsequent tissue diagnosis and cell block preparations. Considering that carcinoma of breast during pregnancy and lactation is rare and is second only to cervical cancer, it was felt that its diagnosis by NAC was useful for timely management. In the case in which pleomorphic giant cells were present as an integral component of the tumour, immunohistochemical and electron microscopic study was done. This is discussed in view of our recent experience with this unusual tumour.
Malignant rhabdoid tumor of soft tissues: A cytopathological and immunohistochemical study
Authors: Sola Pérez J. , Pérez‐Guillermo M. , Bas Bernal A. , Manzanera López T. , Caro López F.
Published: February 2007

We describe the cytopathological and immunohistochemical features of a primary malignant rhaboid tumor (MRT) located in the left forehead region of an 8‐mo‐old female. The cardinal characteristics are hyaline cytoplasmic inclusions, rounded or bean‐shaped nucleus, vesicular chromatin, central prominent nucleolus, and poorly defined cytoplasmic profile. Both the cytoplasm and the hyaline inclusion are vimentin and keratin positive, but negative with desmin, S‐100 protein, neuron‐specific enolase, (NSE) myoglobin, leukocyte common antigen (LCA), and alpha‐1‐antichymotrypsin. This immunohistochemical pattern, although not exclusive to MRT, is fairly typical of MRT, and when it is assessed in conjunction with cytopathological findings and clinical data permits a confident diagnosis of MRT. We emphasize the utility of immunohistochemical techniques in making the differential diagnosis of MRT against other childhood round‐Cell tumors. © 1992 Wiley‐Liss, Inc.
Needle aspiration cytology, immunocytochemistry, and electron microscopy in a rare case of secretory carcinoma of the breast in an elderly woman
Authors: Gupta Raj K. , Lallu Sharda D. , Fauck Robert , Simpson John S. , Wakefield St John
Published: February 2007

Needle aspiration was performed on a breast mass in a 91‐year‐old woman. The cytologic features in the aspirate were a diffuse, prominent, intracytoplasmic vacuolization and secretion in malignant cells and occasional signet ring‐like forms. This was confirmed in a subsequent cell block which was made from the aspirate. Immunocytochemical studies showed a positivity for mucin by alcian blue stain in the vacuolated cells which was periodic acid‐Schiff positive and resistant to diastase digestion. Oil‐red‐O staining was negative and on Colloidal iron stain the tumour cells were positive. Immunopositivity to carcinoembryonic antigen, cytokeratin, and epithelial membrane antigen was found in the malignant cells, while on electron microscopy the tumour cells contained a significant amount of intracytoplasmic secretory material. Secretory carcinoma of the breast is a rare tumour and can be diagnosed and differentiated from other breast carcinomas in view of its characteristic cytologic features. © 1992 Wiley‐Liss, Inc.
Evaluation of cytocentrifuge apparatus with special reference to the cellular recovery rate
Authors: Kobayashi Tadao K. , Ueda Masami , Yamaki Tarumi , Yakushiji Michiaki
Published: February 2007

Two types of commercially available cytocentrifuge apparatus (type A and type B apparatus) using disposable funnels were compared for percentage of cell recovery and degree of cell preservation. The cellularity of each cell suspension was determined using a Sysmex micro cell counter for blood analysis, and the cell recovery was obtained by counting cells in the total smeared area on the May‐Grünwald Giemsa (MGG)‐stained slide. Overall recovery rate by the type A apparatus was between 54.3% and 74.9% with a mean of 63.0%, whereas, the recovery rate for type B apparatus was between 30.6% and 51.8%, with a mean of 42.5%, indicating that the type A apparatus was significantly better. In the type A apparatus, a higher yield of all cells was obtained (69.7‐74.9%) in the group of low cell counts (350 cells/ 0.5 ml), which was run for 10 minutes at 2,000 rpm. On the other hand, in the type B apparatus a higher yield of all cells was obtained (38.6‐42.6%) in the group of low cell counts which was run for 10 minutes at 2,000 rpm. Cellular structure was better preserved on the slides in the type A apparatus. However, the percentage of ghost cells was somewhat higher in the type B apparatus. The cytocentrifugation of the type A apparatus consistently recovered a higher percentage of cells than with the type B apparatus.

Using the type A apparatus, a high rate of cellular recovery, which is extremely important, such as for accurate morphological evaluation of cerebrospinal fluid, can be consistently obtained.
Fine‐needle aspiration cytology of localized fibrous tumor of pleura
Authors: Dusenbery David , Grimes Margaret M. , Frable William J.
Published: February 2007

Fine‐needle aspiration (FNA) biopsy findings are presented in three cases of localized fibrous tumor of pleura (LFTP). Clinically, two of the tumors behaved benignly, although one showed frequent mitoses and foci of necrosis. The third tumor exhibited local aggressiveness as evidenced by rib destruction. Cytologically, these tumors exhibited a wide range of cellularity, composed mainly of small, bland oval to spindle cells with moderate numbers of stripped nuclei. Small bits of collagen were seen in the smears. In all cases, cell blocks were instrumental in making the diagnosis. Previous cytologic descriptions of the tumor are briefly reviewed and the cytologic differential diagnosis is discussed. The peripheral location of this uncommon tumor makes it an ideal target for FNA biopsy. © 1992 Wiley‐Liss, Inc.
Role of fine‐needle aspiration cytology in the management of thyroid nodules: Review of experience with 1,925 cases
Authors: Bisi Hélio , De Camargo Rosalinda Y. Asato , Filho Adhemar Longatto
Published: February 2007

In this review article, the authors present their experience with the management of thyroid nodules using fine‐needle aspiration cytology as the primary method of investigation. © 1992 Wiley‐Liss, Inc.
Needle aspiration cytology, immunocytochemistry, and electron microscopic study of unusual pancreatic carcinoma with pleomorphic giant cells
Authors: Gupta Raj K. , Wakefield St John
Published: February 2007

Needle aspiration cytology, immunocytochemistry, and electronmicroscopic findings are presented in three cases of an unusual pancreatic carcinoma in which pleomorphic giant cells formed an integral part of the tumour. All three patients were elderly males (age range 66–83 years) and had pancreatic masses. Notable cytologic features in all cases were the presence of bizarre mononucleated and multinucleated, poorly cohesive tumour giant cells, rare spindle cells, with occasional cannibalism and cytophagocytosis. Immunocytochemical study of aspirated material showed diffuse staining of cytokeratin and EMA within the tumour cells, while B 72.3 was seen as focal trace stain. Electron microscopy of aspirated material demonstrated epithelial features and these were characterised by the presence of tonofilaments and surface microvilli. Based on our findings, it is felt that the bizarre giant cells in this unusual variant of pancreatic carcinoma are of epithelial origin. The differential diagnosis of other tumours that may be associated with predominant giant cells in pancreatic aspirates is appropriately discussed. © 1992 Wiley‐Liss, Inc.
Fine‐needle aspiration cytology of malignant nerve sheath tumors
Authors: Vendraminelli R. , Cavazzana A. O. , Poletti A. , Galligioni A. , Pennelli N.
Published: February 2007

Precise preoperative diagnosis of three malignant nerve sheath tumors (MNST) was based on their remarkably uniform and highly characteristic cytologic appearance. The differential diagnosis with benign nerve sheath tumors and other spindle cell sarcomas is addressed, and the possibility of achieving confident diagnosis on cytologic material from at least some soft‐tissue sarcomas is confirmed. © 1992 Wiley‐Liss, Inc.
Comparative features of comedo and noncomedo ductal carcinoma in situ of the breast on fine‐needle aspiration biopsy
Authors: Malamud Yasmin R. , Ducatman Barbara S. , Wang Helen H.
Published: February 2007

To determine whether fine‐needle aspiration biopsy (FNAB) can differentiate between comedo (C‐DCIS) and noncomedo ductal carcinoma in situ (NC‐DCIS), we reviewed retrospectively the preoperative FNAB and surgical biopsy slides of 13 cases of DCIS with adequate cytologic material. Eight were NC‐DCIS and 5 were C‐DCIS. Three (60 percent) of the C‐DCIS and 7 (88%) of the NC‐DCIS were nonpalpable lesions biopsied under conventional mammographic guidance. Three (60%) of the C‐DCIS but only 2 (25%) of the NC‐DCIS were considered either suspicious or positive for malignancy on FNAB, the remainder in both groups being atypical. A statistically significant difference in marked nuclear pleomorphism (60% of C‐DCIS vs. 0% of NC‐DCIS, P=0.04) and large nucleoli (60% of C‐DCIS vs. 0% of NC‐DCIS, P=0.04) was observed between these 2 groups. DCIS is morphologically diverse, and it appears that the cytologic features of individual cells on FNAB may distinguish C‐DCIS from NC‐DCIS. Diagn Cytopalhol 1992;8:571‐576. © 1992 Wiley‐Liss, Inc.
Sinus histiocytosis with massive lymphadenopathy (Rosai‐Dorfman disease): Cytomorphologic analysis on fine‐needle aspirates
Authors: Schmitt Fernando C.
Published: February 2007

Cytomorphologic characteristics of smears from fine‐needle aspirates (FNA) of three cases of sinus histiocytosis with massive lymphadenopathy (SHML) (Rosai‐Dorfman disease) are described. All aspirates showed mature lymphocytes, plasma cells, and large pale histiocytes with well‐preserved lymphocytes within the cytoplasm (lymphocytophagocytosis). The cases were confirmed by surgical biopsy, and the immunohistochemical findings suggested a macrophage origin for this lesion. The value of FNA analysis as an aid to diagnosis of SHML is discussed.
Fine‐needle aspiration cytology of an endometrioid‐like variant of yolk sac tumor
Authors: Wade Strong J. , Frederick Worsham G. , Baker Angus S. , Hawk J. C. , Marshall Austin R.
Published: February 2007

A 36‐year‐old male with a history of immature teratoma and embryonal carcinoma of the test is was admitted to the hospital for abdominal pain and fever. A CT scan revealed a large right abdominal mass. The patient's serum alpha‐fetoprotein (AFP) was 46.8 ng/ml (reference <25 ng/ml). Fine‐needle aspiration (FNA) of the mass revealed malignant glandular cells. Chemotherapy was instituted, followed by resection of the large abdominal mass. The tumor was grossly encapsulated, consisting of large areas of necrotic, hemorrhagic tissue surrounded by smaller, multiloculated cysts. Microscopically, the tumor had a villoglandular pattern and variably stratified tall columnar cells. A prominent feature of the columnar cells was supranuclear and subnuclear racuolization. Intracytoplasmic PAS‐positive, diastase‐resistant hyaline globules were occasionally present. AFP by immunoperoxidase was prominent within the tumor. This recurrence of the previously diagnosed testicular teratoma with embryonal carcinoma represents a yolk sac tumor with components strongly resembling endometrioid carcinoma, a variant only recently described in eight cases of ovarian origin (Clement et al: Am J Surg Pathol 1987;11(10):767‐778). We believe this is the first reported case of an endometrioid‐like variant of testicular yolk sac tumor and also the first report of the FNA cytology findings in this variant. © 1992 Wiley‐Liss, Inc.
Fine‐needle aspiration of a periurethral teflon‐filled cyst following radical prostatectomy
Authors: Hanau Cheryl A. , Chancellor Michael B. , Alexander Archibald , Rishi Mazhar , Jordan Andrea G.
Published: February 2007

Periurethral Teflon injections are being used increasingly for the treatment of urinary incontinence after radical prostatectomy. We report a case of a man who developed increasing obstructive urinary symptoms and stress incontinence following radical retropubic prostatectomy. Six months earlier, he had undergone periurethral Teflon injections. On transrectal ultrasound and magnetic resonance imaging, a 3.2‐cm cystic lesion was noted at the prostatic bed near the bladder neck where the Teflon had been injected. Ultrasound‐guided transperineal fine‐needle aspiration of the cyst yielded a specimen with numerous birefringent crystalline Teflon particles. Although previous reports have described granulomatous tissue reaction, no multinucleated giant cells were present to suggest granuloma formation. To our knowledge, this is the first reported case of Teflon cyst formation following periurethral Teflon injections. The patient's history, imaging studies, cytopathology, and review of the literature are presented in this report. © 1992 Wiley‐Liss, Inc.
Infantile cutaneous rhabdomyosarcoma (Li‐Fraumeni syndrome): Cytological presentation of fine‐needle aspirate biopsy, report of a case
Authors: Pérez‐Guillermo M. , Bonmatí‐Limorte C. , García‐Rojo B. , Hernández‐Gil A.
Published: February 2007

We describe the cytopathological picture of a cutaneous rhabdomyosarcoma located in the left nasal furrow of a 4‐mo‐old girl, some of whose close relatives have died or suffered from different types of neoplasias (Li‐Fraumeni syndrome). We believe that the cytological picture is highly characteristic and rules out other round cell tumours of childhood. We underline the usefulness of FNAC in dermatology and strongly advocate the introduction of this technique into the diagnostic armoury of every dermatologist.
Detection of numerical chromosomal abnormalities in malignant cells on body fluids by fluorescence in situ hybridization of interphase cell nuclei with chromosome‐specific probes
Authors: Cajulis Ricardo S. , Frias‐Hidvegi Denise
Published: February 2007

To detect numerical chromosomal abnormalities (NCA) in malignant cells on body fluids, Fluorescence in situ hybridization (FISH) technique was tested in clinical specimens from patients with metastatic disease. Directly labeled DNA probes specific for chromosomes 8, 12, X, and Y (Imagenetics, Naperville, IL) were used for in situ hybridization to interphase cell nuclei. Fifteen body fluids (BF) from various sites were studied. Based initially on the Papanicolaou‐stained slides, there were seven malignant and eight benign samples. Blind analysis (200 cells/sample) showed that all benign samples had a normal number of chromosomes, whereas six of seven malignant samples showed different NCA comprising 5‐60% of the cell population ranging from three to 10 chromosome signals per cell. We conclude that interphase cytogenetic cell analysis of BF by FISH is: (1) feasible and gives superior signals for detection of NCA, (2) helpful in detecting malignant cells, (3) relatively simple with a turnaround time of less than 24 hr. This method may have diagnostic and prognostic application in the study of the biologic behavior of malignant neoplasms. © 1992 Wiley‐Liss, Inc.
Fibroadenoma of the breast: Diagnostic pitfalls of fine‐needle aspiration
Authors: Benoit Janine L , Kara Rosemin , Elizabeth McGregor S. , Duggan Máire A.
Published: February 2007

On fine‐needle aspiration (FNA), fibroadenomas have a characteristic cytological appearance, although occasional cases are misinterpreted as carcinomas and vice versa. In a review of 521 breast aspirates correlated with the subsequent histology, six of 87 fibroadenomas (7%) were malignant or suspicious of malignancy on FNA (false positives). Following cytological review, four were still suspicious of malignancy because of cellular dyscohesion and prominent nucleoli, while two were fibroadenomas. On FNA, four of 145 carcinomas (3%) were diagnosed as fibroadenomas (false negatives). On review, three were malignant or suspicious of malignancy, while one was consistent with a fibroadenoma. Three false negative diagnoses were due to underappreciation of single malignant cells present between epithelial groupings typical of a fibroadenoma, while one was due to undersampling of the carcinoma. Cytologically, some fibroadenomas are sufficiently atypical that histological confirmation is necessary to exclude a malignancy. Misinterpreting carcinomas as fibroadenomas could be avoided by careful study of the morphology of isolated cells.
Diagnosis of eosinophilic granuloma of bone by fine‐needle aspiration with concurrent institution of therapy: A cytologic, histologic, clinical, and radiologic study of 27 cases
Authors: Shabb Nina , Fanning Christina V. , Carrasco Cesar H. , Guo Shan Q. , Katz Ruth L , Ayala Alberto G. , Raymond A. Kevin , Cangir Ayten
Published: February 2007

Twenty‐seven patients with eosinophilic granuloma (EG) of bone seen at our institution between 1979 and 1991 underwent fine‐needle aspiration (FNA) with or without concurrent Tru‐Cut biopsy. The 16 males and 11 females ranged in age from 2 1/2 to 61 years (median, 10 yr). Twenty‐four patients had monostotic lesions. The clinicoradiologic differential diagnosis included osteomyelitis and Ewing's sarcoma (young patients) and primary and metastatic malignancies (older patients). Twenty‐four of 28 FNAs (one patient had two FNAs) were diagnostic of EG, and 10 cases were diagnosed by FNA alone. Smears in these cases showed histiocytes, often with grooved or infolded nuclei, and abundant eosinophils. Multinucleated giant cells, foamy histiocytes, neutrophils, lymphocytes, and plasma cells were present in variable numbers. Four FNAs were misdiagnosed: two as osteomyelitis where smears contained abundant neutrophils, sparse eosinophils, and histiocytes misinterpreted as foamy histiocytes, and two as metastatic carcinoma (in adults) where histiocytes in a scant specimen (one case) and skin appendageal structures without lesional tissue (one case) were misinterpreted. These cases were correctly diagnosed on repeat FNA (one case), Tru‐Cut (two cases), or excisional biopsy (one case); however, three cases diagnosed by FNA had nondiagnostic concurrent Tru‐Cut biopsies. Treatment consisted of intralesional injection of 125 mg of methylprednisolone (22 cases). Progressive or complete healing of alt lesions occurred. FNA is a rapid and useful technique for the immediate diagnosis of EG that allows concurrent institution of therapy.
Eight cases of sister mary joseph's nodule diagnosed by fine‐needle aspiration
Authors: Fleming Marian V. , Oertel Yolanda C.
Published: February 2007

We report eight cases of umbilical metastases (Sister Mary Joseph's nodules) diagnosed by fine‐needle aspiration. The primary carcinoma was below the diaphragm in seven patients. There was one false‐negative diagnosis. We advocate the use of fine needle aspiration as the initial diagnostic test. It is a simple, fast, accurate, and relatively inexpensive means of making the definitive diagnosis. It can spare patients invasive procedures that are not clearly of benefit.
Objective comparison of cellular yield in fine‐needle biopsy of lymph nodes with and without aspiration
Authors: Cajulis Ricardo S. , Sneige Nour
Published: February 2007

Recent reports have indicated that needle biopsy without aspiration obtained adequate material for diagnosis. To determine objectively the adequacy of cell yield both for diagnosis and for special studies (e.g., flow cytometry, markers), we prospectively studied 20 superficial lymph nodes in 20 patients with a history of lymphoma. In each case, the cytology materials were obtained by fine‐needle biopsy techniques with (FNAB) and without (FNB) aspiration. Two needle passes for each method were placed in separate tubes of RPMI medium. With FNAB, the cell counts (determined by a Coulter counter) ranged from 1,55 to 70 million (M) per tube, mean = 19.12 M, whereas with FNB, the cell counts ranged from 1.58 M to 40 M, mean = 15.48 M (P=0.4555). Although FNAB provided more cells in 12 cases (60%), FNB provided more cells in the remaining 8 cases (40%) (P=0.9392). Both techniques provided adequate numbers of cells for special studies in all cases. We conclude that FNB can provide an adequate number of cells both for diagnosis and for special studies.
Chondromyxoid fibroma: A fine‐needle aspiration diagnosis
Authors: Gupta S. , Dev G. , Marya S.
Published: February 2007

A 25‐yr‐old female presented with a slowly progressive swelling, occurring over an 8‐yr period, in the right lower leg. The swelling was tender and fixed to the underlying bone. Clinical and radiological diagnosis was giant cell tumor (GCT) of the bone. Aspiration cytology smears were cellular showing an admixture of chondroid, stellate, and fibrocytic cells against a chondroid background. On cytomorphology, a diagnosis of chondromyxoid fibroma (CMF) was made. It was confirmed on histologic examination.
Fine‐needle aspiration of dermoid cyst of the pancreas: A case report
Authors: Markovsky Valentina , Russin Victoria L.
Published: February 2007

A 53‐yr‐old woman presented with a left upper quadrant abdominal mass attached to the body of the pancreas. Fine‐needle aspiration (FNA) yielded cyst fluid containing numerous benign, mature squamous cells, keratin debris, and inflammatory cells. The diagnosis of dermoid cyst was subsequently rendered on the resected specimen. The cytologic and histologic features are presented. FNA cytology proves to be a valuable diagnostic adjunct in the preoperative evaluation of a patient with dermoid cyst of the pancreas.
Microglandular adenosis of the breast: Fine‐needle aspiration biopsy of two cases
Authors: Gherardi Giorgio , Bernardi Cinzia , Marveggio Cristina
Published: February 2007

Microglandular adenosis (MGA) recognizes a benign proliferative lesion of the breast that can mimic adenocarcinoma histologically. We describe the fine‐needle aspiration (FNA) biopsy cytology of MGA in two female patients. Smears were characterized by sparse cellularity, and the harvest consisted of a monotonous population of medium‐sized cells, with vacuolated clear cytoplasm and round and uniform nuclei with small nucleoli. Clear cells appeared isolated or clustered with spindly fibroblasts. No naked nuclei of myoepithelial origin were present in the background. The differential diagnostic considerations included several breast lesions composed of clear cells. Subsequent surgical histology of lumpectomy revealed MGA. Further studies are needed to determine whether these cytologic features permit the specific identification of MGA, but our observations show that FNA is a sensitive method in recognizing the benign nature of the lesion.
Cytology of allergic bronchopulmonary aspergillosis
Authors: Chen Karl T. K.
Published: February 2007

The cytologic features of a case of allergic bronchopulmonary aspergillosis (ABPA) are reported and the literature reviewed. The bronchial brushing smears in this case showed mucus that contained laminated aggregates of eosinophils with scattered Charcot‐Leyden crystals and fungal hyphae. These cytologic findings, overlooked by the initial examining pathologist, reflected the “mucoid impaction of bronchi” component of ABPA and are therefore diagnostic of ABPA. A cytologic diagnosis of a clinically unsuspected ABPA would lead to the correct treatment and prevent unnecessary surgery.
Skeletal structures that clinically simulate lymph nodes: Encounters during fine‐needle aspiration
Authors: Stanley Michael W. , Knoedler John P.
Published: February 2007

We report eight patients in whom bones of the cervical spine or cervical ribs were clinically mistaken for jugular chain or supra‐clavicular lymphadenopathy, respectively. Each was referred for fine‐needle aspiration by an experienced surgeon, oncologist, rheumatologist, or otolaryngologist. In the neck, the bony nature of the pseudo‐lymph nodes was apparent when the needle contacted bone. Bone was not contacted by the needle in the supra‐clavicular fossa. Aspiration smears showed normal soft tissues in all cases. Radiographs showed cervical ribs in both of the patients with supraclavicular pseudo‐lymphadenopathy. One of these was surgically explored and no adenopathy was detected. Radiographically, one patient with jugular chain findings had unilateral enlargement of a transverse vertebral bone process, another showed scoliosis, and a third had a normal cervical spine study. During follow‐up of 1‐33 mo (median = 14 mo), no patient developed adenopathy at any additional site. All are alive and well.
Respiratory cytology: A review of non‐neoplastic mimics of malignancy
Authors: Naryshkin Sonya , Young Nancy A.
Published: February 2007

Respiratory cytology has its share of pitfalls. Some, such as vegetable cell contaminants, pose problems for only inexperienced observers, while others, such as reactive bronchoalveolar cells from pneumonia, can lead even experienced cytopathologists to make a misdiagnosis of malignancy. This review illustrates and analyzes those benign conditions or entities known to mimic malignancy in exfoliative respiratory cytology and fine‐needle aspiration biopsy of the lung. Entities are grouped by the type of malignancy they mimic, and guidelines are presented for avoiding specific pitfalls.
Fine‐needle aspiration of the breast: A review of 1,995 cases with emphasis on diagnostic pitfalls
Authors: Sneige Nour
Published: February 2007

Between 1985 to 1989, 1, 95 fine‐needle aspirations of palpable breast lesions were performed at our institution. In all cases, the aspirates were procured by cytopathologists using 22‐ or 23‐gauge needles. Direct smears were immediately stained with Diff‐Quik and Papanicolaou and assessed for specimen adequacy (criteria as followed in this institution). Tissue follow‐up was available in 1,117 cases. The cytologic diagnoses rendered in these cases were: malignant, 690 cases (60.2%); suspicious for carcinoma, 49 cases (4.3%); benign, 343 cases (29.9%), and insufficient specimen, 35 cases (3.1%). There were 28 false‐negative and 2 false‐positive results. Considering only cases definitively diagnosed as benign or malignant, the sensitivity was 96%, specificity 99%, positive predictive value 99%, negative predictive value 94%, and overall efficiency 97%. Of those specimens considered suspicious, only 11 cases (22%) were proved not to be malignant after excisional biopsy. These were three fibroadenomas, three ductal hyperplasias, two adenosis tumors, two mucocele‐like lesions, and one nipple adenoma. The two lesions that resulted in true false‐positive diagnoses were an apocrine cyst with atypia and sclerosing adenosis with radial scar. The clinical and cytologic features of the benign conditions that resulted in false suspicious and positive diagnoses and those features that distinguish them from carcinoma are presented.
Cytobrush sampling in conjunctival cytology
Authors: Anagnostopoulou‐Fotinopoulou Irene , Rammou‐Kinia Rea
Published: February 2007

The cervical cytobrush was used to obtain samples from the temporal bulbar conjunctiva of normal and nonnormal eyes in 54 cases after application of local anesthesia. The cotton swab was also used. All samples were smeared on glass slides, fixed immediately and then stained by a routine Papanicolaou method. On microscopic examination plenty of well preserved cells were present in all smears sampled by the cervical cytobrush. On the contrary, all samples obtained by the cotton swab contained few cells, most of which showed degeneration. The cervical cytobrush is very useful to conjunctival cytology because it provides abundant cellular material and good cell preservation, using standard and simple preparatory methods.
Thyroid tumors: Cytomorphology of hürthle cell tumors, including an uncommon papillary variant
Authors: Kaur Arvind , Jayaram Gita
Published: February 2007

Of 2,012 fine‐needle aspirations (FNA) performed by us between 1984 and 1988, we present a detailed cytomorphologic analysis of 95 cases that were diagnosed as neoplastic on histology and/or cytology and those that received an equivocal cytodiagnosis. Discussed are eight tumors, which include three classic and five variant forms of Hürthle cell carcinoma. The latter showed a papillary tumor populated wholly by Hürthle cells, which we have morphologically designated as papillary Hürthle cell carcinoma. All three Hürthle cell carcinomas (PHC) were diagnosed on FNA as papillary Hürthle cell neoplasms (PHN). One was a false negative cytodiagnosis.
Quality‐assurance study of simultaneously sampled, non‐correlating cervical cytology and biopsies
Authors: Dodd Leslie G. , Sneige Nour , Villarreal Yolanda , Fanning Christina V. , Staerkel Gregg A. , Caraway Nancy P. , Silva Elvio G. , Katz Ruth L.
Published: February 2007

As part of a quality assurance study, we reviewed 223 cases of simultaneously sampled cervical smears and biopsies that showed a significant lack of correlation for squamous dysplasia or carcinoma. In 153 of the 223 cases (68.6%), the cytology was negative and the biopsy positive. After review of the specimens, errors in this group were found to be of the following types: sampling 64%, interpretive 29%, and combined sampling and interpretive 7%. In the remaining 70 cases (31.4%), the biopsy was negative and the Papanicolaou smear positive. In these cases, the following types of errors occurred: sampling 54%, interpretive 33%, and combination 13%. Twenty‐nine of these 70 patients showed dysplasia on follow‐up material. These findings indicate there are a significant number of false‐negative Papanicolaou smears, mostly because of sampling problems. There are few false‐positives. In cases of positive Papanicolaou and negative biopsy, dysplasia is likely to be present in subsequent samples.
Transplant aspirative cytology: Analysis of morphological and immunocytochemical parameters in renal allograft dysfunction
Authors: Castro C. Garcia , Gonzalez‐Posada J. M. , Lopez‐Tarruella V. Castro , Ruiz E. C. Salido
Published: February 2007

We have analyzed 245 transplant aspirative cytologies (TACs) from 96 renal allograft patients. TACs were divided in two chronological groups: Early (TACs performed during the first 3‐mo post‐transplantation) and late (TACs performed after the third month post‐transplantation), in order to assess the effect of allograft tolerance on TAC features. Both morphological and immunocytochemical aspects were evaluated, including CD4, CD8, IL2‐R, and HLA‐DR immunolabeling. A final diagnosis for each case of allograft dysfunction was achieved by other independent diagnostic means. Four diagnostic groups were considered in the present study: acute rejection (AR), chronic rejection (CR), acute tubular necrosis (ATN), and Cyclosporin A toxicity (CsA‐T). In addition, a control group (C) was established from patients with stable allograft function. We found that immunocytochemical analysis of TACs is particularly helpful in the diagnosis of late allograft dysfunction, a time period when the simple cytological study of renal infiltrate is not informative enough to help take therapeutic decisions.
Adenomyoepithelioma of the breast: Fine‐needle sampling with histologic, immunohistologic, and electron microscopic analysis
Authors: Vielh Philippe , Thiery Jean Paul , Validire Pierre , Maublanc Marie Annick , Woto Gisèle
Published: February 2007

Fine‐needle sampling was performed in a woman with a subareolar breast mass. The cytologic diagnosis was consistent with a benign sweat gland‐type tumor. Cytologic features included epithelial cells and spindle‐shaped cells lying free or in fibrillary myxoid ground substance. Histologic study revealed the biphasic appearance of this tumor composed of proliferating myoepithelial cells and glandular epithelial cells as supported by immunohistologic and electron microscopic analyses. Epithelial cells were strongly positive for cytokeratins, and spindle cells were positive for actin, S‐100 protein, and keratin and showed ultrastructurally typical features of myoepithelial cells.
Chondrosarcoma of bone as second tumor after diffuse anaplastic wilms' tumor:
Authors: Drut Ricardo , Pollono Daniel
Published: February 2007

A 6‐yr‐old boy already treated (surgery and chemotherapy) for a diffuse anaplastic Wilms' tumor discovered at the age of 10 mo, presented with a large tumor in the left femur. This proved to be a chondrosarcoma after fine‐needle aspiration cytology, a diagnosis later confirmed by histology of the tumor. The patient was treated with marginal excision and prothetic replacement but died 1 yr after this operation with lung metastasis. It is proposed that this case may represent a new association of unusual types of tumors.
Immunophenotyping of cytologic specimens by flow cytometry
Authors: Moriarty Ann T. , Wiersema Lisa , Snyder Will , Kotylo Patricia K. , McCloskey Donald W.
Published: February 2007

Immunophenotyping by flow cytometry is well established as an ancillary technique in the diagnosis of hematopoietic neoplasms. However, flow cytometry is rarely performed on cytologic specimens because most cytologists are more comfortable with direct microscopy and believe that there is inadequate cellularity for analysis. Paradoxically, cytologic material is usually cell suspensions making it ideal for flow cytometry. In order to evaluate the usefulness of immunophenotyping cytologic specimens by flow cytometry, we retrospectively reviewed all cytologic specimens submitted to our flow cytometry unit from 1988 to 1991. Thirty‐one cerebrospinal fluid specimens were analyzed. There were inadequate cells for analysis in 15 cases. Five showed a monoclonal proliferation; 11 were nondiagnostic. A range (r) of one to six cell surface markers were performed. Thirty‐two body cavity fluids were analyzed: 7 peritoneal, 19 pleural, 2 pericardial, and 4 bronchoalveolar lavage. There were cells to analyze in all cases. Seven had a monoclonal proliferation; 25 were nondiagnostic (r = 4‐21 markers performed). One hundred eighteen fine needle aspirates (FNA) were reviewed; 58 FNA were radiologically guided, 60 were superficial lesions. There were inadequate cells for analysis in two cases. Sixty‐one demonstrated a monoclonal proliferation; 55 were nondiagnostic (r = 1‐22 markers performed). We conclude that immunophenotyping by flow cytometry is of limited value for cerebrospinal fluid analysis and that knowledge of previous immunophenotyping studies is essential for correct analysis; analysis of body cavity fluids is easily performed but less often demonstrates a monoclonal proliferation. Immunophenotyping by flow cytometry is a valuable adjunctive technique for FNA and yields adequate cells for analysis.
Comparison of two techniques (flow cytometry and alkaline immunophosphatase) in the evaluation of alveolar macrophage immunophenotype
Authors: Pérez‐Arellano J. L. , Losa‐Garcia J. E. , Orfao‐Matos A. , González M. , De La Cruz J. L. , Jiménez A. , de Castro S.
Published: February 2007

The alveolar macrophage (AM) plays an essential role in the pathogenesis of interstitial lung diseases. The expression of specific membrane antigens is related to the functional or madurative status of the cells of mononuclear phagocyte system. The aim of this study was to analyze the expression of several markers (HLA‐DR, CD11b, CD16, CD14) in AM obtained by bronchoalveolar lavage from control patients (n = 6), patients with sarcoidosis (n = 6), diffuse neoplastic infiltration of the lung (n = 7), pulmonary fibrosis (n = 4), and hypersensitivity pneumonitis (n = 3) by two evaluation techniques (flow cytometry and alkaline immunophosphatase). In the light of the results we can conclude that in the immunophenotypical study of the alveolar macrophage, flow cytometry (with semiquantitative evaluation to avoid the problem of autofluorescence) is a useful tool in the evaluation of those antigens that are only weakly or moderately expressed on AM (CD11b or CD14), whereas the alkaline immunophosphatase technique is of great interest in the evaluation of those that are strongly expressed (i.e., HLA DR). Additionally, the variable expression of the different antigens in the different alveolar‐interstitial pathological states is patent in some diseases.
Cytology of pericardial effusions in aids patients
Authors: Zakowski Maureen F. , Lanuale‐Shanerman Angela
Published: February 2007

Pericardial effusions in patients with the acquired immunodeficiency syndrome (AIDS) can be due to a variety of causes and are often large enough to be sampled for cytologic examination. Over a period of 46 months, 15 cytologic specimens from 14 patients with AIDS were examined. Thirteen patients were male, one was female; the age range was 26 to 43 years. All male patients were homosexual or intravenous drug abusers, and the female patient was the spouse of an intravenous drug abuser. In general, the cytology specimens were moderately cellular with inflammatory cells seen in all cases. Atypical or reactive mesothelial cells were found in 12 cases (80%), and the atypia in one of these 12 was so marked that carcinoma was suspected; cells suspicious for malignant lymphoma were found in 2 cases (13%); degenerated mesothelial cells were present in one case. No infections were identified in this series. Ten patients (66%) had subsequent pericardial biopsies. Marked cellularity and nuclear pleomorphism in lymphoid cells with an altered nuclear cytoplasmic ratio were the dominant findings in the two suspected lymphoma cases. Both patients had known lymphoma elsewhere; in one, involvement by lymphoma was also found on pericardial biopsy. Mesothelial proliferations showing papillary formations with psammoma bodies were seen in three cases; in one of these, histoplasmosis was later diagnosed by pericardial biopsy. To our knowledge this is the first series to describe cytologically the marked mesothelial atypia seen in pericardial fluid in AIDS patients. We contrast this atypia with that seen in malignant effusions and caution against overinterpretation of pericardial fluids from AIDS patients.
Spindling artifact of urothelial cells in post‐laser treatment urinary cytology
Authors: Fanning Christina V. , Staerkel Gregg A. , Sneige Nour , Thomsen Sharon , Myhre Michael J. , von Eschenbach Andrew C.
Published: February 2007

We reviewed 22 post‐laser (Nd:YAG laser) coagulation bladder washes collected immediately after treatment. All washes demonstrated a striking artifact of cellular spindling. These spindled cells occurred singly, in loose clusters, and in lamellar stacks and had elongated nuclei with dense chromatin and bipolar cytoplasm that was fused in the stacks. Concurrent biopsies demonstrated similar cytologic changes. The spindling is a nonspecific epithelial response to heat. Conventionally electrocauterized epithelia show this artifact in biopsies, but since only the base of the lesion and surrounding urothelium are subjected to heat with electrocautery, the relatively few spindled epithelial cells created presumably go undetected in cytology specimens. With laser treatment, however, the whole urothelial surface of the lesion is coagulated, producing a much greater number of spindled cells. It is important to avoid misinterpreting the spindled cells as cells from a mesenchymal neoplasm or a sarcomatoid carcinoma, mistakes that were made in some of our initial cases. Malignancy cannot be evaluated when cells exhibit spindling artifact; this judgement should be made on undistorted cells. Thus, pre‐laser and post‐laser washes should be submitted for evaluation of malignancy.
Salivary monomorphic adenomas of dermal analogue type: Report of two cases
Authors: Sparrow Susan A. , Frost Felicity A.
Published: February 2007

Two cases of monomorphic adenoma, dermal analogue type, are presented illustrating fine‐needle aspiration cytology and subsequent histopathology. Aspiration findings were similar in both cases, demonstrating aggregates of mildly disorganised small regular epithelial cells bordered by a thick rim of basement membrane material. In the first case seen, there was a prominent lymphoid component which gave rise to the false suspicion that the lesion was lymphoepithelial in nature. The cytological features of this tumour are characteristic, however, and their recognition is important to enable distinction from malignancy (e.g., adenoid cystic carcinoma), other benign neoplasms (e.g., pleomorphic adenoma), and non‐neoplastic conditions.
Fine‐needle aspiration cytology of sclerosing hemangioma of the lung: Case report with immunohistochemical study
Authors: Wojcik Eva M. , Sneige Nour , Lawrence David D. , Ordóñez Nelson G.
Published: February 2007

Sclerosing hemangioma of the lung (SHL) is a rare benign neoplasm, usually found incidentally on a routine chest X‐ray. We present a case of SHL initially diagnosed by fine‐needle aspiration cytology. Cytomorphologic characteristics were confirmed by a cell block examination and immunohistochemical findings. The differential diagnoses of the fine‐needle aspiration are discussed.
Malignant cystic epithelial‐stromal tumor of the prostate
Authors: Hessel R. Glenn , Reyes Cesar V. , Jensen Joanne , Bayer Robert , Chinoy Mumtaz , Bhoophalam Nirmala
Published: February 2007

A huge cystic tumor in the pelvis of a 62‐year old man, cytologically by fine needle aspiration biopsy, was composed of malignant spindle cells and transitional as well as glandular epithelial cells. Histochemical, immunostaining, and ultrastructural studies of the aspirated specimens and on the radically resected tumor indicated that the neoplastic cells are of prostatic fibroleiomyomatous stromal and epithelial origin. The lesion did not extend to the urothelium of the urinary bladder. This tumor resembles the rare cystadenoleiomyofibroma of the prostate, yet the cytologic abnormalities suggest a malignant potential. Long‐term follow‐up and recognition of additional cases are necessary to define the biologic behavior of this neoplasm.
Negative images of mycobacteria in aspiration biopsy smears from the lymph node of a patient with acquired immunodeficiency syndrome (AIDS): Report of a case and a review of the literature
Authors: Ang Grace A. T. , Janda William M. , Novak Richard M. , Gerardo Leo
Published: February 2007

Negative images of acid‐fast bacilli were observed in Diff‐Quik‐stained smears of lymph node aspirates from a patient with acquired immunodeficiency syndrome (AIDS) and disseminated Mycobacterium avium‐intracellulare infection. The significance of this finding in relation to the diagnosis and treatment of this infection is discussed and the literature pertaining to this observation is reviewed.
Cytomorphology of familial hemophagocytic syndrome
Authors: Silverman Jan F. , Singh Harsharan K. , Joshi Vijay V. , Holbrook C. Tate , Chauvenet Allen R. , Harris Lawrence S. , Geisinger Kim R.
Published: February 2007

Familial hemophagocytic syndrome (FHS) is a rare, fatal disorder of childhood demonstrating failure to thrive, fever, hepatosplenomegaly (HSM), recurrent infections, pancytopenia, and histologically, the infiltration of reticuloendothelial organs by benign‐appearing histiocytes demonstrating hemophagocytosis. We report two fatal cases of FHS including a 3 year‐old female who underwent fine‐needle aspiration (FNA) biopsy of the liver in the initial workup of the disease (case 1) and an 8 month‐old boy with ascites and HSM having peritoneal fluid cytology submitted as the first specimen for morphologic examination (case 2). In case 1, the FNA cytologic findings included benign hepatocytes and scattered mature and reactive lymphocytes and histiocytes. The histiocytes demonstrated fine to coarse cytoplasmic vacuoles and erythrophagocytosis. The diagnosis was confirmed at autopsy which revealed extensive lymphohistiocytic infiltrates in various organs including the central nervous system. In case 2, the peritoneal fluid cytology specimen contained numerous atypical and degenerating mononuclear lymphoreticular cells which were dispersed as a single cell suspension admixed with infrequent mesothelial elements; hemophagocytosis was not appreciated. Subsequent liver biopsy revealed portal tracts and sinusoids infiltrated by benign but atypical histiocytes with hemophagocytosis. Bone marrow examination and then autopsy confirmed the diagnosis of FHS. A panel of immunocytochemical studies was performed in the first case which was an aid in confirming the diagnosis of FHS and ultrastructural examination of the second case revealed well‐developed erythrophagocytosis. Both patients had siblings who died of FHS. Although not diagnostic, cytomorphology may suggest FHS.
Neural network processing can provide means to catch errors that slip through human screening of pap smears
Authors: Boon Mathilde E. , Kok L. P. , Under James
Published: February 2007

The problem of the false‐negative smear deserves the attention of the cytologic community. We found that by using the PAPNET system, equipped with neural network programming, cancer cells can be detected in repeatedly misdiagnosed Pap smears. The correct diagnosis of these false‐negative smears depended on the skills of the diagnostician to recognize the cells on one or more of the 128 tiles of the video display as abnormal, and to make the proper decision when to turn to light microscopy. In 8 of the 10 tested false‐negative smears, the cancer cells were found exclusively in epithelial fragments; in two cases there were no more than five abnormal cells in the smear (which were detected by PAPNET). This study gave us insight into the nature of the false‐negative problem and showed us that the application of neural network processing can provide means to catch errors that slip through human screening of Pap smears.