bluuebunny/crossref_metadata_2025 huggingface dataset:
HIV infection‐associated lymphoepithelial lesions of the parotid gland: Aspiration biopsy cytology, histology, and pathogenesis
Authors: Tao Liang‐Che , Gullane Patrick J.
Published: February 2007

Two homosexual men with parotid swellings were shown to be human immunodeficiency virus (HIV)‐positive. They initially presented with a painless solitary parotid mass accompanied by diffuse cervical lymphadenopathy. In case I, the patient further developed bilateral multiple cystic lesions. Aspirate preparations from the cystic lesions contained numerous anucleate squames, and superficial and intermediate squamous cells intermingled with various follicular center cells and lymphocytes. Immunoblasts and active phagocytosis of nuclear debris were also noted. Histologically, the parotid cystic lesions showed squamous epithelium‐lined clefts surrounded by abundant hyperplastic lymphoid tissue with prominent germinal centers. The cystic lesions did not involve submandibular and sublingual glands. The combination of bilateral multiple lymphoepithelial lesions of the parotid glands and diffuse cervical lymphadenopathy represents a new condition in patients who are likely to be HIV‐positive. At the early stage of the disease, when the lesion is confined to a unilateral parotid gland, the cytologic findings of the parotid mass, in combination with a computed tomographic appearance of multiple cystic lesions, are distinctly different from findings in other neck and facial lesions. The patient should be tested for antibodies to the HIV virus to confirm this diagnosis, so that the appropriate precautions and treatment can be initiated.
Malignant lymphoma of the thyroid: A report of two cases diagnosed by fine‐needle aspiration
Authors: Detweiler Rosemary E. , Katz Ruth L. , Alapat Christina , El‐Naggar Adel , Ordóñez Nelson
Published: February 2007

Two cases of primary malignant lymphoma of the thyroid were diagnosed by fine‐needle aspiration biopsy. In addition to morphologic evaluation performed on direct smears, immunophenotyping, flow cytometry, and molecular studies were performed on the aspirated material. These additional studies made a clear distinction between lymphoma and Hashimoto's thyroiditis, which may present a similar cytologic picture.
Extrarenal primitive malignant tumor with rhabdoid features: Fine‐needle aspiration cytology, lmmunocytochemistry, and electron microscopy of a case
Authors: Pettinato Guido , Manivel J. Carlos , d'Amore Emanuele S. G. , Petrella Giuseppe
Published: February 2007

We describe a malignant pelvic tumor with rhabdoid‐like features that arose in the sacroiliac region of a 15‐year‐old girl. Fine‐needle aspiration (FNA) cytology showed large cells with glassy cytoplasm, globular hyaline cytoplasmic inclusions, and prominent nucleoli. Immunocytochemical methods applied to FNA material revealed immunoreactivity for cytokeratin, epithelial membrane antigen, and vimentin; the cellsfailed to react with antibodies to desmin. This distinct appearance and phenotype was most consistent with a diagnosis of extrarenal malignant rhabdoid tumor. Electron microscopy confirmed this interpretation, showing whorled Jlamentous aggregates in the cytoplasm of the tumor cells.
Fine‐needle aspiration cytology of a metastatic merkel‐cell carcinoma
Authors: Al‐Kaisi Nadia K.
Published: February 2007

The cytologic features of Merkel‐cell carcinoma metastatic to inguinal lymph nodes are described. The primary tumor was in the buttocks. The cytologic smears from the inguinal lymph node were highly cellular, with small to medium‐sized cells in a predominantly discohesive or single‐cell pattern, as well as large clusters surrounding segments of capillary‐sized blood vessels. The nuclei were uniform, round to oval, with delicate nuclear membranes. The chromatin pattern was fine and “powdery” with multiple small micronucleoli. The cytoplasm was very scanty. Intermediate filament “buttons” were abundant. Rosette formation was very rare. Frequent mitotic figures and individual cell necrosis were observed. These features are helpful in the differential diagnosis from other small‐cell tumors that may involve the skin.
Fine‐needle aspiration cytology of ovarian follicle cysts with cellular atypia from reproductive‐age patients
Authors: Selvaggi Suzanne M.
Published: February 2007

The cytologic features of four luteinized ovarian follicle cysts with cellular atypia, obtained by fine‐needle aspiration, are presented and discussed. The threepatients, ages 31, 32, and 34, underwent laparoscopy for workup of unilateral or bilateral ovarian cysts. In each case, the aspirates were cellular and composed of atypical cells arranged in glandular clusters and papillary configurations. The cells showed an increased nuclear/cytoplasmic ratio and contained nuclei with prominent chromocenters, granular chromatin, and prominent nucleoli, some irregular in shape. Cell borders were indistinct, and the cytoplasm was finely vacuolated. In each case, the smears were interpreted by the cytotechnologist as showing cellular features compatible with malignancy. In addition to the atypical cells, the cytopathologist noted a few sheets of well‐ preserved small granulosa cells. A thorough review of the clinical histories revealed the patients to be 8, 6, and 6 mo postpartum, respectively, at the time of needle aspiration. In conjunction with the clinical histories, the cytologic findings supported a diagnosis of follicle cysts containing atypical luteinized granulosa cells. It is postulated that hormonal stimulation may have played a role in the development of the cellular atypiapresent within the luteinized cells. When analyzing ovarian cyst fluid from reproductive‐age patients, this entity should be considered so as not to make an erroneous diagnosis of malignancy.
Papillary renal‐cell carcinoma: Fine‐needle aspiration of 15 cases
Authors: Dekmezian R. , Sneige N. , Shabb N.
Published: February 2007

Although papillary carcinoma of the kidney is a distinct clinical and pathological entity, there are few descriptions of its cytologic features in the literature. We describe the cytologic features of aspirates from 1.5 papillary carcinomas of the kidney. The smears showed abundant papillary clusters with vascular cores and relatively few single cells. Tumor cells contained moderate to scant cytoplasm, nuclei were usually small and uniform, mild to moderate hyperchromasia was routine, nucleoli were single and small, and nuclear grooves were often prominent. Histiocytes and psammoma bodies were present in only four cases. Hemosiderin pigment within tumor cells was also present in four cases. Differential diagnosis should consider low‐grade transitional‐cell carcinoma, metastatic adenocarcinoma, normal renal tubular epithelium, mesothelial cells, and, occasionally, Wilms' tumor. Cytologically recognizing the distinct entity of papillary carcinoma is important in the workup of primary renal neoplasms and metastatic papillary neoplasms of unknown origin.
Diagnosis of cytomegalovirus pneumonitis on bronchoalveolar lavage fluid: Comparison of cytology, immunofluorescence, and in situ hybridization with viral isolation
Authors: Weiss Ronald L. , Snow Gail W. , Schumann G. Berry , Hammond M. Elizabeth
Published: February 2007

Forty‐three bronchoalveolar lavage (BAL) specimens from 40 immunocompromised patients were studied for the presence of cytomegalovirus (CMV) by rapid diagnostic methods. DNA in situ hybridization, cytology, and immunofluorescence were compared to conventional cell culture. Eleven (25%) of the 43 BAL samples grew CMV in culture. In situ hybridization detected 6 of these 11 for sensitivity, specificity, and predictive values of positive and negative of 55%, 94%, 75%, and 86%, respectively. Cytology had a sensitivity of 73% and specificity of 100%. Six Papanicolaoustained cytospins were screened cytologically versus one hybridization cytospin, and the higher sensitivity of cytology may reflect this extensive sampling. The immunofluorescent method had a sensitivity equal to that of cytology (73%); however, the specificity (72%) was significantly less than that of either the probe or cytology. These data suggest that although in situ hybridization can be a rapid, useful method for detecting CMV in BAL specimens, cytology appears to be a more sensitive method.
Intracytoplasmic vacuoles in cervical smears: Relationship to chlamydial inclusions–morphology, mucin histochemistry, and immunocytochemistry
Authors: Waters Susan A. , Sterrett Gregory F.
Published: February 2007

Cytomorphology, mucin stains, and immunocytochemistry were used to determine the characteristics of intracytoplasmic vacuoles in cervical smears and their relationship to chlamydial infections. Three study groups were examined: A) cervical smears containing intracytoplasmic vacuoles suggesting chlamydial infection; B) cervical smears from patients known to be either culture positive or culture negative for chlamydia; and C) control smears of chlamydia‐infected McCoy cell cultures. Forty‐nine smears containing vacuoles suspected of being chlamydial inclusions were studied. In 21 of 31 smears the vacuoles were shown by histochemistry to contain mucin. Immunoperoxidase staining performed on the remaining 18 smears revealed only two vacuoles to be chlamydial inclusions. Of 38 smears from chlamydia‐culture‐positive patients, only 4 showed chlamydial inclusions by immunoperoxidase methods. Of 30 smears from chlamydia‐culture‐negative patients, none were positive by immunoperoxidase staining. The “nebular body” of Shiina appears to be the most specific cytomorphologic evidence of chlamydial infection in cervical smears, but distinction from mucin vacuoles and other nonspecific vacuoles is difficult. The immunoperoxidase technique is unlikely to be useful in diagnosis in cervical smears unless samples are specifically obtained from the endocervical canal by endocervical brushing.
Fine‐needle aspiration cytology of langerhans' cell histiocytosis (Eosinophilic Granuloma) of Bone in Children
Authors: Elsheikh Tarik , Silverman Jan F. , Wakely Paul E. , Holbrook C. Tate , Joshi Vijay V.
Published: February 2007

Fine‐needle aspiration (FNA) cytology of three cases of Langerham' cell histiocytosis (eosinophilic granuloma [EG]) of bone in children (mean age–8.3 yr; range 5‐11 yr) is presented. Two patients presented with vertebral lesions and the third had a femoral mass. Cytomorphologic features of EG were seen in all cases, including Langerhans' cell histiocytes having oval to reniform shape nuclei with nuclear grooving and abundant pale cytoplasm. The background showed a polymorphic population of cells including neutrophils, lymphocytes, foamy histiocytes, and osteoclasts. Moderate numbers of eosinophils were seen in two cases, while eosinophils were sparse in the third case. Ancillary imrnunocytochemical (ICC) studies performed on the aspirated material demonstrated positive staining for S‐100 protein (all three cases) and T‐6 antigen (one case). Ultrastructural examination (EM) performed in one case demonstrated characteristic Birbeck granules in the histiocytes. A specific cytologic diagnosis was made in all cases, enabling proper chemotherapy in one case, surgical excision in another and spontaneous resolution in the third case. Our experience demonstrates that FNA cytology can make a definitive diagnosis of EG, especially when coupled with ancillary studies such as ICC and EM on the aspirated material.
Clear‐cell change in follicular adenoma mimicking hurthle‐cell tumor on thyroid aspiration biopsy cytology
Authors: Orlando Christine A. , Salman Karl , Miller Jeffrey L. , Naryshkin Sonya
Published: February 2007

We present a case of follicular adenoma with clear‐cell change, which on fine‐needle aspiration biopsy mimicked a Hürthle‐cell tumor. Papanicolaou‐stained smears revealed a monomorphic pattern of loosely cohesive groups of cells with abundant cytoplasm and centrally placed round nuclei with single prominent nucleoli. The cytoplasm was granular or finely vacuolated with occasional intracytoplasmic brown pigment. Subsequent surgical histology of the partial thyroidectomy specimen revealed a follicular adenoma composed of macro‐ and microfollicles. The microfollicular areas showed clear‐cell change; these cells appeared identical to those seen on cytology. No Hürthle‐cell change was present in the surgical specimen. Follicular cells with clear‐cell change of the granular type must be added to the list of differential diagnoses when cells with Hürthle‐like features are seen on aspiration biopsy of the thyroid.
Extracranial metastasis of an astrocytoma detected by fine‐needle aspiration: A case report
Authors: Sunita  , Kapila Kusum , Singhal R. M. , Verma Kusum
Published: February 2007

Extracranial metastasis of gliomas is rare, and the documented cases of extracranial metastasis are based on histological material. A case of metastatic astrocytoma to the soft tissue of the neck and back detected by fine‐needle aspiration is reported. Demonstration of glial fibrillary acidic protein by immunoperoxides technique on aspirated material helped to confirm the diagnosis.
Sampling accuracy of the modified ayre spatula/zelsmyr cytobrush versus the modified ayre spatula/bulb aspirator in the collection of cells from the uterine cervix
Authors: Selvaggi Suzanne M. , Malviya Vinay
Published: February 2007

An 8‐mo (August 1988 through April 1989) study was performed to evaluate the efficacy of the modified Ayre spatula/Zelsmyr Cytobrush versus the modified Ayre spatula/bulb aspirator in the collection of cells, both normal and abnormal, from the uterine cervix. The majority (78%) of the 192 patients, ranging in age from 18 to 82 yr, were referred to the gynecologic/oncologic clinic for follow‐up of an atypical Papanicolaou smear or of a previously diagnosed and treated cervical, vulvar, or endometrial lesion. Of the 192 patients, 149 were premenopausal (15 of whom were pregnant), 12 were perimenopausal, and 31 were postmenopausal. Patients were randomized into one of two groups based on the collection of samples for their cervical smears: 1) modified Ayre spatula (exocervix) plus Zelsmyr Cytobrush (endocervix; 90 cases) and 2) modified Ayre spatula (exocervix) plus bulb aspirator (endocervix; 102 cases). Of the smears prepared with the spatula/Cytobrush (90 cases), only 2 (2.2%) lacked endocervical cells. Within this group, the smears of 5 of 5 pregnantpatients (100%) and 13 of 13 postmenopausal patients (100%) contained endocervical cells. Cytologic abnormalities were present in 15 of these cases: koilocytosis in 4, cervical intraepithelial neoplasia (CIN)‐I in 5, CIN‐II in 4, and CIN‐III in 2. Five of the 15 cytologically positive cases had histologic verification; the cytologic findings were predictive of the histologic findings in all. Of the smears prepared using the spatula/bulb aspirator (102 cases), 26 (25.5%) lacked endocervical cells. Within this group, the smears of only 4 of 10 pregnant patients (40%) and 14 of 18 postmenopausal patients (78%) contained endocervical cells. Cytologic abnormalities were diagnosed in 23 of these 102 cases: koilocytosis in 6, CIN‐I in 12, CIN‐II in 3, and CIN‐III in 2. Fourteen of the 23 cytologically positive cases had histologic verification; cytologic underestimation of the severity of the lesion occurred in 5 cases (4 in CIN‐III and I in CIN‐II lesions). The results of this study indicate that the modified Ayre spatula/Zelsmyr Cytobrush technique is more effective than the modified Ayre spatula/bulb aspirator technique in obtaining an adequate cervical cell sample containing endocervical cells, particularly in pregnant and postmenopausal patients, and in may aid in predicting the histologic severity of the cervical lesion.
Pancreatic adenocarcinoma: Regression analysis to identify improved cytologic criteria
Authors: Cohen Michael B. , Egerter Daniel P. , Holly Elizabeth A. , Ahn David K. , Miller Theodore R.
Published: February 2007

The incidence of pancreatic adenocarcinoma is increasing and it is usually unresectable at the time of diagnosis. Consequently, fine‐needle aspiration biopsy (FNAB) is being used more frequently for diagnosis. The reported sensitivity of diagnosing pancreatic adenocarcinoma by FNAB has varied between 50% and 100%. In an attempt to increase the diagnostic sensitivity, we retrospectively reviewed a series of pancreatic FNABs. Fifteen cytologic criteria were evaluated in 78 patients who had pancreatic FNABs. Of these patients, 49 had primary adenocarcinomas and 29 had benign, non‐neoplastic lesions. Using a stepwise logistic regression analysis we identifed three key cytologic criteria for this diagnosis. Our study identifed anisonucleosis (P = 0.001). large nuclei (P = .007), and nuclear molding (P = .03) as the significant cytologic features for diagnosing pancreatic adenocarcinoma. In combination, these three criteria had a sensitivity of 98% and a specificity of 100%.
Cervical carcinogenesis and contraception
Authors: Misra Jata S. , Engineer Amy D. , Das Kalyani , Tandon Prabha
Published: February 2007

Cytologic evaluation of cervical smears has been carried out in 3,374 women who used different modes of contraception (Lippes loop, copper T200, copper T220, copper devices containing higher copper content than the copper T200, Cu T380 Ag, levonorgestrel IUD, injections of noresthisterone oenanthate, and subdermal implants of levonorgestrel) under the Contraceptive Testing Programme of Indian Council of Medical Research for periods ranging from 6 months to 15 yr. While no case of severe dysplasia or malignancy was noticed with any type of contraceptive, 113 dysplastic smears (99 mild and 14 moderate) were encountered on follow‐up, giving an incidence of 3.3%, which was statistically insignificant compared with the pretreatment incidence of 1.4% (47 of 3,374). The highest incidence of dysplasia was seen with devices containing a high copper content (9.2%), followed by CuT200 (6.1%) and levonorgestrel implants (4.2%), and was lowest with Lippes loop (1.8%), injection of noresthisterone oenanthate (1.7%), and CuT380 Ag (1.5%), but statistics higher than the pretreatment incidence of 1.4% were seen only with CuT200 and devices containing high copper content. Retrogression of dysplasia was seen in 85 of the 94 posttreatment dysplasia cases and in all 47 pretreatment dysplasia cases, whereas in the remaining nine posttreatment cases of dysplasia the lesion persisted for 6‐12 mo, necessitating discontinuation of contraception.

The accumulated follow‐up data indicate that the CuT380 Ag device is a promising IUD for the future in view of its low incidence of dysplasia determined during its use up to 5 yr. However, more prolonged follow‐up in larger numbers of subjects is required to confirm its innocuosness on long‐term retention.
Pulmonary cytology in lung transplant recipients: Recent trends in laboratory utilization
Authors: Walts Ann E. , Marchevsky Alberto M. , Morgan Margie
Published: February 2007

The value of bronchoscopy for the diagnosis of rejection and opportunistic injection in lung transplant recipients is controversial. We review our experience with pulmonary cytology obtained from 10 lung transplant recipients during the first 15 mos of the transplantation program at Cedars‐Sinai Medical Center and compare the efficacy of pulmonary cytology for the diagnosis of opportunistic infectious agents with that of histology and microbiology. Our study encompasses 1,465 post‐transplant days during which 70 bronchoscopies were performed yielding 94 cytologic specimens (44 bronchial washes, 25 bronchial brushings, and 25 bronchoalveolar lavages) and 55 transbronchial biopsies. The major advantages of cytology in this setting are short turn around time and high specificity for nonbacterial agents. All of the patients experienced episodes of bacterial pneumonia as well as fungal and viral infections. None developed Pneumocystis carinii infection during the study period. Simultaneous and concurrent infections were diagnosed. The initial diagnosis of bacterial pneumonia and herpes simplex virus preceded the diagnosis of cytomegalovirus; the former infections tended to persist and/or recur. Cytology was more effective than histology in establishing the diagnosis of Candida sp. and herpes simplex virus, while histology was more effective in establishing the diagnosis of cytomegalovirus. Increased numbers of polymorphonuclear cells did not constitute a consistent finding in cytologic or histologic samples during episodes of bacterial infection; cultures were most sensitive for detection of bacterial infection. Histochemical and immunohistochemical stains as well as in situ hybridization studies confirmed diagnoses rendered on routine Papanicolaou and hematoxylin and eosin stained material but did not provide additional diagnoses. No lymphocytosis was observed in bronchoalveolar lavages or bronchial washes that accompanied the 14 transbronchial biopsies diagnosed as mild rejection.
Changing utilization of cytopathology versus histopathology in the diagnosis of lung cancer
Authors: Fraire Armando E. , McLarty Jerry W. , Greenberg S. Donald
Published: February 2007

We studied the utilization rates of 1) cytopathology procedures [sputum, fine‐needle aspirates (FNA), bronchial washings and brushings] versus 2) histopathology procedures (bronchial biopsies, lymph node biopsies, lobectomies, pneumonectomies) in the diagnosis of lung cancer, over two time periods (1967/1987). Comparisons were made in the utilization rates of these two diagnostic procedures in two groups of 100 patients each. Statistically significant changes included 1) an increase of cytopathology procedures, as the sole means of diagnosis; 2) an increase in FNAs; 3) an increased percentage of positive cytopathologic diagnosis: and 4) a decrease of major surgical procedures (lobectomy, pneumonectomy), as means of initial pathologic diagnosis. This study provides data supporting the trend of decreasing surgical procedures for initial diagnosis of lung cancer, with greater, more efective utilization of cytopathologic (particularly FNA) procedures.
Review of the central nervous system cytopathology in human immunodeficiency virus infection
Authors: Strigle Stephen M. , Gal Anthony A.
Published: February 2007

The human immunodeficiency virus (HIV) is a neurotropic retrovirus capable of producing a wide spectrum of central nervous system changes. Nearly 40% of HIV‐infected patients demonstrate neuropathy ranging from dementia to the opportunistic infections and neoplasia seen in the acquired immunodeficiency syndrome (AIDS). Dramatic increases in the numbers of AIDS cases have allowed for the cytotechnologist and cytopathologist to become acquainted with the various pathologic manifestations of HIV infection. In this review, we are reporting the HIV‐related diseases in the central nervous system and the role of diagnostic cytology.
Eosinophilic granuloma of lymph node: Case report with cytohistologic, immunohistochemical, and flow cytometric observations
Authors: Granger John K. , Houn Houn‐Yee
Published: February 2007

A case study of eosinophilic granuloma (Langerhans cell histiocytosis) of lymph node in a 32‐year‐old white man is presented. Clinical, cytologic, histologic, immunohistochemical, and flow cytometric findings are reported. Intraoperative cytologic findings can serve as valuable adjuncts to the frozen section, in this case serving as the sole method for diagnosis. This case is presented in light of the rarity of node‐based eosinophilic granuloma and the absence of flow cytometric immunophenotypic findings in the literature.
Fine‐needle aspiration cytology of pulmonary adenocarcinoma of fetal type: Report of a case with lmmunohistochemical and ultrastructural studies
Authors: Lee Kwang Gil , Cho Nam Hoon
Published: February 2007

This report describes the fine‐needle aspiration (FNA) cytology of a case of adenocarcinoma resembling fetal lung in a 53‐yr‐old male, a very uncommon malignant tumor of the lung that is similar to an early stage of lung differentiation. FNA smears revealed relatively small, fairly uniform tumor cells appearing as cohesive cell groups and scattered, isolated cells, some of them showing a rosette or acinus pattern. In addition, clusters of larger cells with eosinophilic cytoplasm and prominent nucleoli existed contiguously with the small cells or separately. The possibilities of an unusual type of adenocarcinoma, carcinoid tumor, and pulmonary blastoma were suggested by the cytologic findings. Immunohistochemical studies performed on a resected tumor tissue showed irnmunoreactivity for α‐fetoprotein, neuron‐specific enolase, and somatostatin, and endocrine‐type granules were found ultrastructurally. This type of adenocarcinoma is considered to have a histogenesis similar to that of pulmonary blastoma. To our knowledge this is the first reported case in the cytologic literature.
Needle aspiration cytology of an oncocytic carcinoma of the parotid gland
Authors: Abdul‐Karim Fadi W. , Weaver Michael G.
Published: February 2007

A needle aspirate biopsy of a parotid neoplasm yielded uniform benign oncocytic cells consistent with oncocytoma. The subsequent surgical specimen demonstrated an oncocytic carcinoma with vascular and perineural invasion. These findings are analogous to those of oxyphilic tumors of the thyroid gland where cytologic features often do not allow for distinction between benign and malignant lesions.
Malignant mixed tumor (carcinosarcoma) of parotid gland diagnosed by fine‐needle aspiration biopsy
Authors: Granger John K. , Houn Houn‐Yee
Published: February 2007

True malignant mixed tumor (carcinosarcoma) of salivary gland is a very rare neoplasm. Only one brief account of the Fine‐Needle Aspiration Biopsy (FNAB) cytologic findings of this tumor was found in the literature. The authors report a case of malignant mixed tumor (chondrosarcoma and epidermoid carcinoma) arising from the left parotid gland in an 84‐yr‐old man, which was definitely diagnosed by FNAB. The cytologic findings and differential diagnosis are discussed.
Cytological detection of epithelial dysplasia in the oral mucosa using feulgen‐DNA‐image cytometry
Authors: Schulte E. K. W. , Joos U. , Kasper M. , Eckert H. M.
Published: February 2007

Cytological scrape material of the oral mucosa from 114 patients with epithelial dysplasia and with oral cancer was stained with the Feulgen‐reaction and investigated with an image analyzer. The size and the integrated optical density of cell nuclei, and four chromatin texture features were measured. All tumor slides contained cell nuclei with DNA > 5c, 16% of the slides had cell nuclei with DNA > 8c. A total of 14.5% of the tumor patients showed significantly increased DNA values in nuclei distant from the tumor. Two smears with severe epithelial dysplasia showed nuclei with DNA > 5c both in the tumor material and far from the tumor. Texture analysis allowed discrimination between benign, dysplastic and malignant smears. No correlation was found between DNA content and tumor staging.

Image cytometry was a reliable method for detecting tumor cells. Epithelial dysplasia in areas distant from the tumor isprobably due to “Feld canceration” of the epithelium.
Thyroid tumors: Cytomorphology of papillary carcinoma
Authors: Kaur Arvind , Jayaram Gita
Published: February 2007

Of 2,012 fine‐needle aspirations (FNA) of the thyroid performed by the authors between the years 1984 and 1988, a detailed cytomorphologic analysis of 9.5 cases diagnosed as neoplastic on histology and/or cytology and those that received an equivocal cytodiagnosis is presented. Discussed are papillary carcinomas (28 correctly diagnosed on FNA and two false positives).

In most of the cases of papillary carcinoma, the cytologic features were characteristic enough to enable accurate tumor typing. Follicular cells with dense cytoplasm, well defined cell margins, and presence of papillary clusters were the most consistent features obsewed. Intranuclear cytoplasmic inclusions, though characteristic, were found in only 66.6% of cases.

In cystic papillary carcinomas (seven cases) study of the cyst wall as well as the cyst contents enabled an accurate cytodiagnosis. Two cases of multinodular goiter with papillary hyperplasia could not be distinguished with certainty from papillary carcinoma on cytologic grounds.
Thyroid tumors: Cytomorphology of follicular neoplasms
Authors: Kaur Arvind , Jayaram Gita
Published: February 2007

From 2,012 fine‐needle aspirations (FNA), performed by us between the years 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 37 lesions that have been diagnosed on cytology and/or histopathology as follicular neoplasms.

In this group, there were 22 cases of histologically proven follicular carcinoma and 11 follicular adenomas. Three cases of multinodular goiter and one case of Hashimoto's thyroiditis with marked follicular hyperplasia have also been included because they received either a neoplastic or an equivocal cytodiagnosis.

Of 22 follicular carcinomas, 12 were diagnosed on FNA as follicular neoplasms, eight as follicular carcinoma, one was a false‐negative benign cytodiagnosis, and one was equivocal.

Of 11 follicular adenomas, seven were diagnosed as follicular neoplasms and four were cytologically equivocal. Three cases of multinodular goiter and one Hashimoto's thyroiditis had been diagnosed on FNA as either follicular neoplasm or equivocal.
Multiple peritoneal cytologies collected during laparotomy for gynecologic malignancy
Authors: Jacques Suzanne M. , Selvaggi Suzanne M.
Published: February 2007

Review of an 18‐mo experience with peritoneal cytology specimens showed that 760 peritoneal washings and 177 diaphragmatic smears were collected during 300 laparotomies on patients known to have or suspected of having gynecologic malignancy. One hundred three patients were eventually shown to have benign gynecologic disease. The remaining 197 procedures were done on patients undergoing primary operations for gynecologic malignancy or Iaparotomies for previously treated gynecologic malignancy. Of the 197 laparotomies for gynecologic malignancies, 168 had washings separately collected from multiple intra‐abdominal sites, and these fluids were interpreted as either all positive or all negative in all but seven (4%) patients. The location and extent of the gross or microscopic disease did not correlate with the site of positive washings. Only three of the 177 diaphragmatic smears were positive for malignant cells; these were collected from three patients undergoingprimary treatment of ovarian carcinoma, two of whom had extensive peritoneal involvement by carcinoma. Only 3.5 of the 197 patients with gynecologic malignancy had positive peritoneal cytologies; 32 of these patients had gross or microscopic peritoneal involvement by malignancy, and one additionalpatient had metastatic carcinoma in pelvic lymph nodes. The analysis of multiple peritoneal washings separately collected from various intra‐abdominal sites and the analysis of diaphragmatic smears collected in the absence of gross diaphragmatic disease appear to be of benejt in few cases.
FNA cytodiagnosis of non‐Hodgkin's lymphoma and its subtyping under working formulation of 175 cases
Authors: Das Dilip K. , Gupta Subhash K. , Datta Bhoopendra N. , Sharma Suresh C.
Published: February 2007

One hundred thirty‐two cases diagnosed as non‐Hodgkin's lymphoma (NHL) by fine‐needle aspiration cytology (FNAC) and histology, and 43 cases in which there were minor or major discrepancies between cytology and histology for diagnosis of NHL, were reviewed. The diagnostic accuracy of FNAC for NHL was 86.3% at the initial diagnosis. Following review, all the 132 cases initially diagnosed as NHL by cytology and histology remained so with minor changes in subtypes in a few cases. Of the 43 discrepant cases, 28 turned out to be NHL and 6 as Hodgkin's disease (HD); 3 were anaplastic carcinoma; and in 6 cases the discrepancy still persisted. Diagnostic accuracy of FNA for NHL improved to 98.0% following review. Categorization of histologically diagnosed NHL cases under working formulation showed that 10.4%, 21.5%. and 57.7%. respectively, were low, intermediate, and highgrade lymphomas. The corresponding figures were 16.6%, 18.4%. and 60. 1%, respectively, in cytology. The diagnostic accuracy of cytology for subtyping was found to be 67.5%.
Sinus histiocytosis with massive lymphadenopathy (rosai‐dorfman disease): Diagnosis by fine‐needle aspiration
Authors: Trautman Bruce C. , Stanley Michael W. , Goding George S. , Rosai Juan
Published: February 2007

Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare idiopathic proliferative disorder of histiocytes with characteristic morphologic features. We describe a case of SHML occurring in a 14‐yr‐old black male, in whom the diagnosis was made by fine‐needle aspiration of a cervical lymph node. Cytologic features included increased numbers of large histiocytes associated with a polymorphous, cellular background composed of benign lymphocytes, plasma cells, and polymorphonuclear leukocytes. Lymphophagocytosis was a prominent feature. Extranodal involvement of the larynx was documented by surgical biopsy; there was no other extranodal disease. One year after diagnosis, the patient is clinically well, with no residual lymphadenopathy.
Primary angiosarcoma of the cuboidal bone: A case report
Authors: Khiyami Amer , Green Linda K. , Gyorkey Ferenc , Landon Glen
Published: February 2007

Primary angiosarcorna of bone is a rare neoplasm. The unique cytomorphologic and ultrastructural aspects of a primary angiosarcoma of the cuboid bone diagnosed by fine‐needle aspiration are presented. Smears and cell block preparations revealed single and clustered large, pleomorphic, and spindle‐shaped cells with a markedly hemorrhagic background. Electron microscopy revealed characteristic features of endothelial cells including rare Weibel‐Palade bodies. The clinical, cytologic, histologic, and ultrastructural aspects of the case are discussed.
Primary diagnosis of disseminated fungal disease by fine‐needle aspiration of soft‐tissue lesions
Authors: Sherman Mark E. , Orr James E. , Balogh Karoly , Bardawil Ronald G.
Published: February 2007

Two cases of disseminated fungal infections diagnosed by fine‐needle aspiration of soft‐tissue masses are presented. Both patients were initially treated on an outpatient basis for a presumed musculoskeletal disorder before the diagnostic biopsy was obtained. The first patient apparently contracted Coccidioides immitis infection while residing in Arizona, but the diagnosis was rendered on an aspirate of a buttock mass performed in Boston. The second patient, a non‐insulin‐dependent diabetic, was diagnosed with a cryptococcal abscess on an aspirate of a shoulder mass performed in the emergency room. The diagnosis of coccidioidomycosis was confirmed by culture and that of Cryptococcus by serology. Fungal infection was clinically unsuspected in both patients and the cytologic diagnosis facilitated rapid implementation of therapy.
Metastatic nasopharyngeal carcinoma: Cytologic features of 18 cases
Authors: Grenko Ronald T. , Shabb Nina S.
Published: February 2007

The cytologic features of 18 fine‐needle aspirates (FNAs) of metastatic nasopharyngeal carcinoma from 17 patients were examined. The 12 males and 5 females had a median age of 45 years (range 17‐75 years). Six were white, five Oriental, four Hispanic, and two black. All patients had mid‐ or upper‐cervical lymphadenopathy (14 bilateral, 3 unilateral). Seven developed widespread metastasis (bone, 5; lung, 2; liver, 1; adrenal, 1; soji tissue, 1). The FNAs were from cervical lymph nodes (15), liver (1), adrenal (1). and soft tissue (1). Most aspirates showed similar cytologic features. Tumor cells were present singly and in syncytial groups with overlapping moderately pleomorphic oval to spindle‐shaped nuclei with thin, slightly irregular nuclear contours, moderately hyperchromatic chromatin, and usually one or two prominent nucleoli. The cytoplasm was scant and pale with ill‐defined borders. Mitoses were frequent. Mature lymphocytes were common in the background of lymph node aspirates. Electron microscopy and immunocytochemistry confirmed the epithelial nature of the tumor in four cases. Although the cytologic features of metastatic nasopharyngeal carcinoma (NPC) are characteristic, other poorly differentiated neoplasms need to be considered. Clinical and radiologic data are helpful in supporting the cytologic diagnosis.
The determination of papanicolaou smear adequacy using a semiquantitative method to evaluate cellularity
Authors: Valente Philip T. , Schantz H. Daniel , Trabal Jose F.
Published: February 2007

To examine the influence of sample cellularity and the presence of endocervical columnar cells on the detection of cervical dysplasia, Papanicolaou (Pap) smears taken from patients with biopsyproven CIN II and III were analyzed retrospectively. Adequacy was semiquantitated by dividing each smear into 15 equal areas using a lined template and assigning an adequacy index (AI) of 0 to 15. The total false‐negative (FN) rate was 15.8 percent, with 6.1% representing interpretive error and 9.7% representing sampling error. For FN slides truly lacking abnormal cells, the average AI was significantly lower than that of true positives (TP), even when endocervical columnar cells were present. The entire group was then blindly re‐evaluated using a subjective application of the Bethesda System, classifying slides as satisfactory, less than optimal, and unsatisfactory. Although correlation of AI with the rapid Bethesda System categorization was imperfect, the exclusion of less than optimal and unsatisfactory smears also lowered the FN rate, but less effectively. An AI scoring technique, therefore, may be useful in the routine evaluation of Pap smear adequacy.
Cytologic differentiation between proliferative and nonproliferative breast disease in mammographically guided fine‐needle aspirates
Authors: Masood Shahla , Frykberg Eric R. , McLellan Garey L. , Dee Supranee , Bullard J. Britt
Published: February 2007

Fine‐needle aspiration biopsy (FNAB) is considered a valid diagnostic procedure in management of patients with breast lesions. It is also important to differentiate benign nonproliferative change from proliferative breast changes, since the risk of development of breast carcinoma in patients with atypical hyperplasia is 4–5 times that of general population. Therefore, the recognition of proliferative breast disease with atypia significantly impacts on the patient's subsequent management. To assess the feasibility of a cytologic grading system to further characterize benign breast lesions, cytologic preparation of 87 mammographically guided FNABs were studied. Cellular aspirates were evaluated for the cellular arrangement, the degree of cellular pleomorphism and anisonucleosis, presence of myoepithelial cells and nucleoli, and the status of the chromatin pattern. Values ranging from 1 to 4 were assigned to each cytologic criterion, and a score based on the sum of the individual values was calculated for each case. The minimum score attainable was thus 6. In our chosen criteria, cytologic diagnosis of nonproliferative disease was entertained when the total score ranged from 6 to 10. Proliferative disease without atypia was diagnosed with a total score ranging from 11 to 14. Atypical hyperplasia was reported when the total score ranged from 15 to 18. A cytologic diagnosis of malignancy was entertained when the total score ranged from 19 to 24. The cytologic diagnosis was then compared to the reported histologic diagnosis from the excisional biopsies and the data were statistically analyzed. A high degree of concordance was found between the cytologic jndings and the histologic diagnosis. This study suggests that it is possible to apply a cytologic grading system to further subclassify benign breast disease and distinguish these forms from neoplastic lesions.
A case of neurilemoma (Schwannoma) that mimicked a pleomorphic adenoma (an example of potential pitfall in aspiration cytodiagnosis)
Authors: Gupta Raj K. , Dowle Carl S.
Published: February 2007

Needle‐aspiration cytology of a case of benign neurilemoma (Schwannoma) from the neck is presented. It was clinically diagnosed as an enlarged lymph node, while on aspiration cytology, it was diagnosed as a pleomorphic adenoma. An excision biopsy, however, was diagnostic of neurilemoma. A review of cytologic material was undertaken, and it was felt that the cytologic features in Papanicolaou stained preparations in the aspirate were present that initially should have enabled the correct cytodiagnosis and distinction from a pleomorphic adenoma. The findings presented in this study were considered to be an example of a potential pitfall in the aspiration cytodiagnosis of a neurilemoma.
Cytomegalovirus endocervicitis diagnosed by cervical smear
Authors: Gideon Kent , Zaharopoulos Paul
Published: February 2007

Cytomegalovirus (CMV) cytologic changes were found in a routine cervical smear of a 21‐yr‐old HIV‐negative woman, 4 wk post partum. The CMV changes were associated with columnar cervical epithelium. The case is reported because of the rarity of such an occurrence in cervical smears.
Cytologic diagnosis of cavernous hemangioma of the liver with fine‐needle biopsy
Authors: Kaw Yao Tek , Esparza Alfredo R.
Published: February 2007

We present the cytopathologic findings in seven cases of cavernous hemangiomas of the liver diagnosed by direct “squash” smears made on tissue obtained through image‐guided fine‐needle biopsy. The diagnosis in each case was confirmed histologically. Utilizing this simple cytologic technique, the morphologic findings in these common hepatic lesions are as accurate and diagnostic as histologic examination.
Extrapulmonary inflammatory myofibroblastic pseudotumor: A potential cytologic trap in childhood
Authors: Macleod Carla B. , Wakely Paul E. , Frable William J.
Published: February 2007

A previously healthy 20‐mo‐old infant presented with a right leg limp and was discovered to have a palpable intra‐abdominal mass. Radiographic studies showed the mass arising from the right psoas muscle. Preoperative clinical diagnosis was probable sarcoma. Percutaneous fine‐needle aspiration biopsy of the mass was interpreted as a sarcoma based on the abundant cellularity of spindled shaped mesenchymal cells. Exploratory laparotomy showed the mass to be unresectable. Histologic and ultrastructural examination of biopsy fragments, however, revealed an inflammatory myofibroblastic pseudotumor. Radiographic follow‐up showed a gradual disappearance of the mass. The infant was clinically well at a clinic visit one year following surgery. This case serves to illustrate the aspiration cytology of an uncommon benign tumor‐like proliferation that, when located in an unusual anatomic site, has the potential to mislead the cytopathologist into a malignant interpretation.
The diagnostic impact of needle aspiration cytology of the breast on clinical decision making with an emphasis on the aspiration cytodiagnosis of male breast masses
Authors: Gupta Raj K. , Naran Sarla , Dowle Carl S. , Simpson John S.
Published: February 2007

Our experience with a total of 7,231 needle aspirates of the breast was reviewed. Ninety‐nine cases from the total of 7,231 aspirates studied were from male patients. While an aspiration cytodiagnosis of gynecomastia was made in most of these cases, carcinoma was diagnosed in four cases. Although a clinical distinction between male breast cancer and gynecomastia is often difficult, we found needle aspiration cytology a very useful initial investigation for making this distinction.
Black thyroid: A pitfall for aspiration cytology
Authors: Keyhani‐Rofagha Sedigheh , Kooner Dilbagh S. , Landas Steven K. , Keyhani Manucher
Published: February 2007

Black thyroid discoloration following long‐standing use of minocycline has been reported. Morphologic findings of aspiration cytology of these lesions was first reported from The Ohio State University. This abstract describes a second case of black thyroid that was preceded by aspiration cytology. In both cases, thyroidectomies were performed based on “indeterminate” fine‐needle aspiration cytology (FNAC). Degenerative changes in follicular epithelial cells in black thyroid causes nuclear hyperchromasia and chromatin clumping, which may be mistaken for neoplasia. Pigment present in follicular epithelial cells and macrophages may be obscured by pigments with similar microscopic appearances, such as hemosiderin. A clinical history of the chronic use of a tetracycline derivative should alert the pathologist to the possibility of black thyroid. Diagnosis may be made by applying special stains on the cell block. The pigment stains with Melanin stain (Fontana) and bleaches with potassium permanganate. In the light of increasing use of FNAC of the thyroid gland and the large number of patients who received tetracycline therapy in the last two decades, it is likely that some practicing cytopathologists may experience this pitfall.
A simple time‐saving device for urine specimen preparation
Authors: Gribaudi Giovanna , Pittelli Maria , Sangiovanni Monica
Published: February 2007

A technique is described for quick urine specimen preparation with the use of a simple device to save time and laboratory material.
Accuracy of bronchial aspiration cytology in typing operable (stage I‐II) pulmonary carcinomas
Authors: Barbazza Renzo , Toniolo Lamberto , Pinarello Antonella , Scapinello Antonio , Falconieri Giovanni , Bonito Luigi Di
Published: February 2007

The accuracy of bronchial aspiration cytology in typing resectable (stage I‐II) lung cancer has been investigated in 100 cases, comparing preoperative cytologic features with pulmonary tumor histology seen at surgery. The accuracy has been 100% for small‐cell carcinoma (two cases), 98.8% for squamous‐cell carcinoma (86 cases), and 91.6% for adenocarcinoma (12 cases). The overall accuracy rate has been 98%. No case of undifferentiated large‐cell carcinoma has been identified. It is suggested that the high accuracy in cytologic typing of operable lung cancer is basically related to adequate preservation of differentiation features, thus allowing for correct identification of most non‐small‐cell carcinoma. Moreover, the absence in this study of any large‐cell carcinoma, compared with its frequency in advanced stage series, would indicate that such a histotype reflects excessive dedifferentiation of an original squamous or glandular form.
A logistic model for thyroid lesions
Authors: Basu D. , Jayaram G.
Published: February 2007

A stepwise logistic regression analysis was performed in 27 cases of papillary carcinoma thyroid (PC), 20 follicular neoplasms (FN), 30 cases of Grave's disease (GD), and 40 cases of colloid adenomatous goitre (CAG). The three most important variables in predicting PC were papillary clusters, dense cytoplasm, and intranuclear cytoplasmic inclusions, whereas the predictors of FN were high cellularity combined with a prominent acinar pattern. A few cases of GD and CAG showed a cytologic overlap with PC and FN, respectively. Regression analysis established high cellularity, fire flare appearance, and epitheloid granulomas as reliable predictors of GD, whereas abundant colloid with or without foam cells and follicles associated with colloid (FAC) were important variables in CAG.
Medullary carcinoma of the thyroid: A cytological, immunocytochemical, and ultrastructural study
Authors: Bose Shika , Kapila Kusum , Verma Kusum
Published: February 2007

The cytomorphological features of 38 cases of medullary carcinoma of the thyroid on FNAC were studied. These cases were retrieved from the files of the cytopathology laboratory. In addition, staining for calcitonin (19 cases), thyroglobulin (5 cases), neurone specific enolase (7 cases), and carcinoembryonic antigen (8 cases) was done. Electron microscopy was done in two cases. On morphology, the presence of amyloid together with cytoplasmic granules was found to be diagnostic. The plasmacytoid cell type and the mixed cell populations were most commonly observed. Pseudonuclear inclusions were seen in 58% of cases. Calcitonin was present in 74% of cases. NSE was noncontributory, whereas CEA was positive in one of the calcitonin negative cases.