bluuebunny/crossref_metadata_2025 huggingface dataset:
High grade squamous cervical lesions following negative papanicolaou smears: False‐negative cervical cytology or rapid progression
Authors: Hatem Fadi , Wilbur David C.
Published: February 2007

The cervical cytologic finding of a high grade squamous intraepithelial lesion (HGSIL) or carcinoma shortly following a negative smear is unusual. to determine if such cases are due to screening errors, inadequate sampling, or rapidly progressive lesions, a review of negative smears (immediately preceding a diagnosis of HGSIL or carcinoma by at most 2 yr) was performed on 17 patients (all such patients in our 1990–92 files, representing 6% (17/290) of such diagnoses). the time between negative smear and positive result averaged 9.3 mo. Eighty‐eight percent of these patients had prior histories of a cytologic abnormality.

Upon review, 16 of 17 “negative” smears contained a cytologic abnormality. Atypical immature squamous metaplastic type cells (AISMTs) were found in 11 of 16 cases, atypical squamous cells or slight dysplasia were found in 5 of 16, HGSIL was found in 5 of 16, and atypical cells of undetermined type and origin were noted in 1 of 16. Combinations of the above diagnoses were present in 6 of 16 cases. the number of abnormal cells per slide was estimated, with < 10 cells in 1 case, <50 in 4 cases, 50–100 in 7 cases, 100–200 in 3 cases, and > 200 in 1 case.

In this study, screening and/or evaluation errors were the dominant cause of false‐negative cytologic diagnoses, with AISMTs accounting for the most commonly missed or misinterpreted cells. These cells are small and have hyperchromatic nuclei with elevated nucleus to cytoplasmic ratio and nuclear irregularities. They may occur singly or in small groups, and may be interpreted as small histiocytes or missed entirely on screening. A careful search for such cells is warranted, and in their presence, colposcopy and biopsy should be undertaken. © 1995 Wiley‐ Liss, Inc.
Comparison of immunoreactivity of neu oncoprotein in fine‐needle aspirates and paraffin‐embedded materials
Authors: Linder James , Martin Alvin W. , Davey Diane D.
Published: February 2007

Expression of the neu oncogene has been extensively examined in frozen and paraffin section breast cancers; however, very few studies examine neu oncoprotein expression in fine‐needle aspirates. to this effect, we compared the expression of neu oncoprotein in formalin‐fixed paraffin‐embedded breast cancers and the corresponding fine‐needle aspirates of these cancers. There was 100% correlation between the expression of neu oncoprotein in the paraffin‐embedded breast cancers and the fine‐needle aspirates, indicating the suitability of fine‐needle aspirates for the expression of neu oncoprotein in breast cancers. © 1995 Wiley‐ Liss, Inc.
Role of AgNOR in diagnosis of thyroid follicular neoplasms on fine‐needle aspiration smears
Authors: Karmakar T. , Dey P.
Published: February 2007

This is a retrospective study to examine the role of AgNOR in differentiating thyroid follicular carcinoma and adenoma preoperatively on fine‐needle aspiration (FNA) smears. Nineteen histopathology‐proven cases of follicular adenoma and carcinoma were selected for this study. May‐Grünwald‐Giemsa—stained smears were destined and AgNOR staining technique was employed. Significant differences of AgNOR values were observed among follicular carcinoma versus adenoma (P < .05) and follicular carcinoma versus control cases (P < .01). Thereby the AgNOR technique may have some role in differentiating between benign and malignant follicular neoplasms of thyroid. Diagn Cytopathol 1995;12:148–151. © 1995 Wiley‐ Liss, Inc.
Primary lymphoma of bone: Diagnosis by fine‐needle aspiration biopsy in a pediatric patient
Authors: Niemann Theodore H. , Thomas Patricia A.
Published: February 2007

We present an unusual case of a child with an isolated lytic lesion in the L3 vertebral body. Fine‐needle aspiration biopsy showed a small, blue‐cell neoplasm raising the differential diagnosis of Ewing's sarcoma and lymphoblastic lymphoma. Through a combination of morphologic and immunofluorescent findings we established a diagnosis of lymphoblastic lymphoma. This case further documents the utility of fine‐needle aspiration biopsy in the diagnosis of pediatric tumors. © 1995 Wiley‐ Liss, Inc.
Cytodiagnostic pitfalls in pulmonary coccidioidomycosis
Authors: Chen Karl T. K.
Published: February 2007

Two cases of pulmonary coccidioidomycosis which were initially misdiagnosed as carcinoma in cytologic examinations of material obtained by bronchoscopy or fine‐needle aspiration are reported. the cytodiagnostic pitfalls of misinterpreting reactive bronchial epithelial cells as carcinoma cells and of failing to recognize fungal organisms are discussed. © 1995 Wiley‐ Liss, Inc.
Comparison of conventional and thinprep preparations of mucoid cytology samples
Authors: Hees K. , Lebeau P. B.
Published: February 2007

Cytological specimens containing large amounts of mucus and/or blood are often a considerable problem as far as preparation and especially screening are concerned. the ThinPrep™ ‐method, which uses a mucolytic and hemolysing solution and prepares slides automatically, eliminates difficulties in both areas. Comparing ThinPreps to conventionally prepared samples reveals equivalent or even superior cellular preservation. Cells are spread in a thin layer, mostly with only a minimal amount of residual mucus or blood. Screening is consequently much easier and faster. the time‐saving effect does not compromise the diagnostic accuracy, as we could demonstrate with an 92% overall agreement in both procedures. the difference of 8% could possibly be attributed to inadequate splitting of the samples. © 1995 Wiley‐ Liss, Inc.
Fine‐needle aspiration biopsy and imprint cytology of small non‐cleaved cell (Burkitt's) lymphoma
Authors: Stastny Janet F. , Almeida Margarida M. , Wakely Paul E. , Kornstein Michael J. , Frable William J.
Published: February 2007

We reviewed 13 cases of small non‐cleaved cell (Burkitt's) lymphoma diagnosed by fine‐needle aspiration biopsy (FNAB) and four cases where that diagnosis was made from touch imprints from surgical biopsy specimens. the most common site was intraabdominal. Histologic confirmation was present in 14/17 cases. General microscopic features on smears included high cellularity and an individual cell pattern. Extracellular lymphoglandular bodies were abundant and tingible body macrophages were prominent. Nuclei were intermediate in size and round with a finely dispersed chromatin pattern on May‐Grünwald‐Giemsa stained smears. Cytoplasm was basophilic and scant with prominent vacuoles. Extracellular vacuoles and vacuoles within lymphoglandular bodies occurred in all patients. Immunocytochemistry performed on 16/17 cases demonstrated a B cell phenotype in 15. Nine cases were kappa light chain positive and six were lambda light chain positive. Flow cytometry performed in five cases demonstrated diploid cells with a high S phase. We conclude that Burkitt's lymphoma can be diagnosed using combined FNAB and immunophenotyping. © Wiley‐Liss, Inc.
Cytokeratin positivity in fine‐needle aspirates of melanomas and sarcomas
Authors: Banks Evelyn R. , Jansen John F. , Oberle Elaine , Davey Diane D.
Published: February 2007

Cytokeratin (CK) positivity has been considered a specific marker for epithelial differentiation in cytologic specimens. After observing CK reactivity in fine‐needle aspirate (FNA) specimens of melanoma and sarcoma, a retrospective study of melanomas and sarcomas was undertaken to investigate the frequency of anomalous CK staining in these neoplasms. Cell block sections and/or restained smears from 36 melanomas and sarcomas were retrospectively stained for CK. An appropriate internal positive control (HMB‐45, S100 protein, or vimentin) was also used to insure antigen preservation. of the smears from 19 melanomas, five revealed focal strong CK positivity of neoplastic cells, two cases showed faint or equivocal staining, 11 cases were negative for CK, and one could not be interpreted due to inadequate controls. of the smears from 14 sarcomas, two showed positivity for CK (one fibrosarcoma and one condrosarcoma), 11 were negative, and one had inadequate controls. the number of CK positive cells was less than that observed with the appropriate internal positive control antibodies. Destained Papanicolaou smears were superior to Diff‐Quik smears for retrospective immunocytochemical stains. Cell block sections from four of the melanomas and one sarcoma demonstrated no aberrant staining. Since Cytokeratin positivity occasionally is seen in nonepithelial neoplasms, its presence alone cannot be used to make a definitive diagnosis of carcinoma. Therefore, a panel of immunocytochemical stains should be utilized in diagnosis of FNA specimens. © Wiley‐Liss, Inc.
Fine‐needle aspiration diagnosis of extrapulmonary Pneumocystis carinii lymphadenitis in a human immunodeficiency virus positive patient
Authors: Ellison E. , Yuen S. Y. , Lawson L. , Chan N. H. L.
Published: February 2007

Extrapulmonary Pneumocystis carinii is an uncommon and probably underdiagnosed complication of pulmonary P. carinii infections. We report the cytologic diagnosis of a case of P. carinii lymphadenitis which presented, without concurrent or historical pneumonitis, in a human immunodeficiency virus (HIV) positive patient who was taking aerosolized pentamidine. the diagnosis was suggested by abundant granular exudate on the cell block. Only scant, fragmented, irregular‐shaped granular exudate was present on the direct smears and the Millipore filter preparation. the diagnosis was confirmed by special stains on the cell block. © Wiley‐Liss, Inc.
Cytopathological features of undifferentiated carcinoma of the ovary
Authors: Kuwashima Yoshio , Uehara Toshitaka , Kishi Kiyozo , Era Hideto , Sano Yusaku , Shiromizu Kenji , Matsuzawa Masumi , Takayama Shojiro
Published: February 2007

Cytopathological characteristics of undifferentiated carcinoma of the ovary were examined and reviewed. Seven cases of undifferentiated carcinoma were encountered among 202 malignant ovarian neoplasms in the Saitama Cancer Center. Histologically, two cases contained a minor component of usual Müllerian carcinoma and five others were purely of solid architecture without differentiation. Nevertheless, six cases, four of which were totally undifferentiated histologically, showed cytological features characteristic of adenocarcinoma. the results indicate that even carcinomas histologically diagnosed as undifferentiated may have cytological features of glandular differentiation, which may be Müllerian in origin. © Wiley‐Liss, Inc.
Aspiration cytodiagnosis of metastatic merkel‐cell carcinoma
Authors: Gupta Raj K. , Teague Clinton A.
Published: February 2007

A case of metastatic Merkel‐cell carcinoma to lymph nodes on the left side of the neck and left parotid is described. the primary was at the left side of the cheek and bridge of the nose. the cytologic features in needle aspirates of metastases included increased cellularity, discohesive or loose groups of small‐to‐medium size malignant cells with uniform, round‐to‐oval nuclei, delicate nuclear membranes, fine chromatin, multiple micronucleoli, and scanty cytoplasm. Additionally, rare intermediate filament “buttons” and frequent mitotic figures were found. the primary tumour showed similar features. On immunostaining, although a positivity for chromogranin was noted in the primary tumour, it was found to be negative in the cytologic material. All other histochemical and immunostains were found to be negative in both the primary and metastatic neoplasm. the problems in differential diagnosis from other small cell tumours and the features of this unique tumour that may be helpful in the diagnosis are discussed. © Wiley‐Liss, Inc.
Endometrial cells of the “Lower uterine segment” (LUS) in cervical smears obtained by endocervical brushings: A source of potential diagnostic pitfall
Authors: Gupta Prabodh , De Peralta‐Venturino Mariza N. , Jane Purslow M. , Kini Sudha R.
Published: February 2007

The use of endocervical brushes has led to a generous sampling of both endocervical and “lower uterine segment” (LUS) cells. to an unfamiliar eye, the large fragments of endometrial tissue from the LUS may lead to misinterpretation as endometriosis or glandular malignancy, as happened in our institution when the use of endocervical brush and recognition of LUS cells in cervical smears were limited. Eight cases, cytologically interpreted as such, were proven to be benign following cervical biopsy or endometrial curettage. the nature of LUS cells was recognized only on retrospective review of this cytologic material. However, in recent years, routine use of the endocervical brush resulted in an influx of similar cases referred by the cytotechnologists to the pathologist as glandular atypia. Thus, to get familiarized with the cytomorphology of LUS cells and its diagnostic pitfalls, a prospective study was undertaken. This entailed a review of 62,187 consecutive cervicovaginal smears (women of post‐hysterectomy status were excluded) received within a 12‐mo period (July 1, 1992‐June 30, 1993). A total of 344 smears (0.55%) showed large tissue fragments of branching tubular endometrial glands with and without surrounding stroma. Patients ranged from 14–82 yr of age. History of cervical cone biopsy was noted in nine patients (2.6%). Repeat cervical smear or concurrent endometrial or endocervical biopsy available in 84 patients (24.4%) were negative. LUS cells may be mistaken for endometriosis, epithelial glandular atypia, as well as carcinoma of both endocervical and endometrial origin. in addition to glandular abnormality, LUS cells may also be misinterpreted as that of squamous intraepithelial lesion. the characteristic presentation of LUS cells with long tubular branching glands embedded in a loose monomorphic stromal cells containing delicate capillaries is best appreciated at low power magnification. Familiarity with the cytomorphologic features of LUS and awareness of the diagnostic pitfalls may avoid interpretative errors and unnecessary surgical procedures. © Wiley‐Liss, Inc.
Unsatisfactory aspirates from fine‐needle aspiration biopsies: A review
Authors: Carson Henry J. , Saint Martin Gaston A. , Castelli Melanie J. , Gattuso Paolo
Published: February 2007

While there is much evidence that fine‐needle aspiration biopsy (FNAB) is sensitive and specific, there is little information comparing the proportions of unsatisfactory aspirates obtained by clinicians or pathologists. We reviewed 2,199 FNAB reports of superficial lesions. Cases were grouped by organ/site and according to who performed the biopsy. the proportions of unsatisfactory aspirates were computed for clinicians and pathologists. Both groups performed approximately equal numbers of procedures. Overall, 9% of aspirates obtained were unsatisfactory (n = 191). Pathologists had lower proportions of unsatisfactory aspirates in all sites. of aspirates obtained by clinicians, 14% were unsatisfactory, compared to 3% of those obtained by pathologists (P < .00001). the proportion of unsatisfactory aspirates appears to decrease as physician experience increases, and pathologists may have more experience with FNAB than do clinicians. Other advantages pathologists may have include technique and working with tissue regularly. Both clinicians and pathologists can expect to decrease their proportions of unsatisfactory aspirates by performing FNABs frequently. © Wiley‐Liss, Inc.
Leu‐7 immunoreactivity in cytologic specimens of thyroid lesions, with emphasis on follicular neoplasms
Authors: Ostrowski Mary L. , Brown Richard W. , Wheeler Thomas M. , Green Linda K. , Schaffner David L.
Published: February 2007

Anti‐Leu‐7 (HNK‐1, CD 57) antibody, a marker for natural killer lymphocytes, was employed by Ghali et al. (Hum Pathol 1992;23:21–25) to study surgically resected formalin‐fixed, paraffin‐embedded thyroid lesions. They demonstrated strong immunoreactivity of this antibody with thyroid carcinomas, both follicular and papillary, and only occasional weak immunoreactivity with colloid goiters and follicular adenomas. We studied cytologic specimens (primarily fine‐needle aspiration biopsy specimens) from 44 thyroid lesions, including 10 follicular carcinomas, 14 follicular adenomas, seven adenomatous nodules, six papillary carcinomas, and seven cases of Hashimoto's thyroiditis. All follicular carcinomas exhibited immunoreactivity to anti‐Leu‐7 antibody, usually of a moderate to strong degree (9/10); however, six of 14 follicular adenomas yielded similar results. the patterns of immunoreactivity in the other lesions were similar to those previously described (Ghali et al., Hum Pathol 1992;23:21–25). It does not appear that anti‐Leu‐7 antibody can be used as a specific marker of malignancy in the cytologic assessment of follicular neoplasms of the thyroid.
Utility of cytokeratin 20 in identifying the origin of metastatic carcinomas in effusions
Authors: Ascoli Valeria , Taccogna Silvia , Scalzo Caterina Carnovale , Nardi Francesco
Published: February 2007

Using a commercially available monoclonal antibody (Ks20.1) and the avidin‐biotin peroxidase method on cytospins and cell blocks, we analyzed cytokeratin (CK) 20 expression in 169 serous effusions. Cytoplasmic staining was observed in 44/151 malignant fluids. Colon, gastric, and pancreatic adenocarcinomas and mucinous ovarian tumors were most frequently positive. Single cases of transitional‐cell and squamous cell carcinomas were reactive as well. Lung and breast cancers were mostly negative. Nonmucinous ovarian tumors were invariably unlabeled as were mesotheliomas and normal mesothelial cells. the study shows that CK 20 is valuable in distinguishing tumor cell origin in effusions. in particular, it identifies a set of carcinomas with the majority arising from the gastrointestinal tract, and represents a highly characteristic marker for colorectal cancer. © 1995 Wiley‐ Liss, Inc.
Cytologic diagnosis of papillary cystic neoplasm of the pancreas
Authors: Granter Scott R. , Dinisco Sheryl , Granados Rosario
Published: February 2007

The diagnosis of papillary cystic neoplasm of the pancreas (PCNP) on cytologic material allows important therapeutic decisions to be made before surgery. We report two cases in which PCNP was diagnosed preoperatively by fine‐needle aspiration biopsy, and review the cytologic features of PCNP previously reported in the literature.

The distinctive cytologic features of this tumor included papillary structures composed of tumor cells surrounding myxoid material with delicate central vascular cores, and globoid structures composed of amorphous myxoid material.

The cytologic characteristics of PCNP are reviewed here. Definitive diagnosis of PCNP can be reliably achieved by fine‐needle aspiration cytology.© 1995 Willey‐ Liss, Inc.
Single‐slide versus double‐slide Pap smear: A comparative study
Authors: Saitas Vasiliki L. , Hawthorne Clementine , Cater Jacqueline , Bibbo Marluce
Published: February 2007

Comparison of the single‐slide versus double‐slide Pap smear method was performed using ectocervical and endocervical samples taken with the Ayre spatula and Cytobrush and placed together on one slide or on two separate slides. Eight hundred cases were collected by four different physicians in a gynecologic clinic (100 consecutive cases per doctor per method). All samples were evaluated at the Thomas Jefferson University Hospital. Parameters evaluated were: specimen adequacy, quality and detection of disease. Results for the double‐slide method were: 352/400 (88%) satisfactory, 48/400 (12%) satisfactory, but limited, and 0% unsatisfactory cases. Results for the single‐slide method were: 347/400 (86.7%) satisfactory, 50/400 (12.5%) satisfactory, but limited, and 3/400 (0.75%) unsatisfactory cases. Results regarding detection of disease were 16/400 (4%) CIN 1/400 (0.25%) carcinomas with the double‐slide method as compared to 13/400 (3.25%) CIN and no carcinomas with the single‐slide method. No statistically significant differences were found regarding specimen adequacy ( P= 0.31), quality ( P= 1.00), and detection of disease [CIN ( P= 0.71) and carcinomas ( P= 1.0)]. These preliminary findings suggest that the single‐slide method is as efficacious as the double‐slide method, although a larger group of patients with a longer follow‐up need to be evaluated.© 1995 Willey‐ Liss, Inc.
Diagnostic value of gonadal steroid hormones and gonadotropins in ovarian cystic lesions
Authors: Mulvany Nick , Pickel Helmuth , Schneeweiss Dieter , Pürstner Peter
Published: February 2007

During a 12‐mo period the fluid aspirated from 32 ovarian cystic lesions was assayed for 17β‐estradiol (E2), progesterone (P), testosterone (T), follicle‐stimulating hormone (FSH), and luteinizing hormone (LH). All cysts were subsequently subjected to histologic or cytologic examination.

In 84.6% (11/13) of the proven follicular cysts, the E2 content was greater than 100 pg/ml, in 76.9% (10/13) the P content was greater than 13 ng/ml, and in 69% (9/13) the T content was greater than 0.5 ng/ml. in 94.7% (18/19) of the ovarian cysts of other types, the E2 content was less than 100 pg/ml and the P content was less than 13 ng/ml. the FSH and LH contents of both types of cysts were variable, and no consistent pattern was discerned. in contrast, cytologic examination identified 69.2% (9/13) of the follicular cysts.

In conclusion, consideration of the E2 and P contents with cytologic examination allowed the identification of all follicular cysts. Accordingly we recommend the estimation of E2 and P as part of the assessment of all ovarian cyst aspirates obtained from premenopausal patients.© 1995 Willey‐ Liss, Inc.
Fine‐needle aspiration cytology of seminoma: A review of 16 cases
Authors: Caraway Nancy P. , Fanning Christina V. , Amato Robert J. , Sneige Nour
Published: February 2007

We report the cytomorphologic features of 16 fine‐needle aspiration (FNA) biopsies of seminoma obtained from 16 male patients. the aspirates included two primary gonadal tumors (one occurring in a cryptorchid testis), two primary mediastinal tumors, and 12 metastases (two with unknown primaries). Analysis of the aspirates revealed a primarily dispersed cell population of large cells with scant to moderately abundant cytoplasm. the nuclei were round to slightly irregular, had finely granular chromatin, and had either one central prominent nucleolus or two to three smaller nucleoli. Variable numbers of lymphocytes and plasma cells were intermingled with the tumor cells. Only a few cases had epithelioid histiocytes or the characteristic “tigroid” background. the cytologic features of the metastases were distinctive and were considered diagnostic for therapeutic management. in six cases, an initial diagnosis of seminoma by FNA biopsy identified the neoplasm as germ cell in origin rather than other neoplasms in the differential diagnosis, thereby expediting therapeutic management. © 1995 Willey‐ Liss, Inc.
Fine‐needle aspiration cytology of carcinosarcoma of the parotid gland: Cytohistological and immunohistochemical findings
Authors: De La Torre Manuel , Larsson Erik
Published: February 2007

Carcinosarcoma or true malignant mixed tumor of salivary glands is a very rare neoplasm which shows malignant features of the epithelial and mesenchymal components. We hereby present cytological, pathological, and immunohistochemical findings of one such case, first examined by fine‐needle aspiration cytology.

The aspirate was cell‐rich and consisted of large cell clusters which at low magnification showed an arrangement reminiscent of a jigsaw puzzle. An amorphous substance was observed in the middle of some of these clusters. There were also numerous dissociated cells which often displayed marked atypia. Histology showed a tumor with malignant epithelial and mesenchymal components. the carcinomatous areas consisted of cells arranged in solid nests or glandular structures. the sarcomatous areas showed osteosarcoma, low‐grade chondrosarcoma, and undifferentiated components. On immunohistochemistry, the tumor coexpressed epithelial and mesenchymal markers. Cytokeratin, keratin, and epithelial membrane antigen were mainly localized to the carcinomatous portion, whereas vimentin and neuron‐specific enolase were restricted to the sarcomatous areas. S‐100 protein was positive in both. Our findings support previous views that this tumor may be related to pleomorphic adenoma. © 1995 Willey‐ Liss, Inc.
Differential diagnostic dilemmas in malignant fine‐needle aspirates of liver: A practical approach to final diagnosis
Authors: Gupta Prabodh , Pisharodi Latha R. , Lavoie Ross , Bedrossian Carlos W. M.
Published: February 2007

We retrospectively reviewed two hundred malignant fine‐needle aspirates of liver. of these 49.5% were metastatic neoplasms, 32% were hepatocellular carcinomas, and 18.5% presented with diagnostic dilemmas. in less than half of these diagnostic challenges, differential diagnosis was between hepatocellular carcinoma and metastatic adenocarcinoma. the remainder of cases involved a variety of metastatic neoplasms. Cytomorphology in association with immunocytochemistry resolved the diagnostic problems in about half of the problematic cases. Three cases were undifferentiated and remained unclassifiable. We conclude that approximately 80% of malignant lesions of liver can be correctly diagnosed by thorough cytomorphologic analysis and good clinical correlation, and 20% pose differential diagnostic dilemmas. © 1995 Willey‐ Liss, Inc.
Communication and cytopathology—part IV: Cytohistologic correlation and patient care
Authors: Davey Diane D. , Tritz Denise M.
Published: February 2007

“The laboratory … must compare all pre‐malignant and malignant gynecological (cytology) reports with the histopathology report, if available, in the laboratory (either on site or in storage) and determine the causes of any discrepancies.” [CLIA '88 493.1257(d)(2)]1.
Significance of epithelial membrane antigen in the work‐up of problematic serous effusions
Authors: Singh Harsharan K. , Silverman Jan F. , Berns Lisa , Haddad Michel G. , Park H. Kim
Published: February 2007

Differentiation of reactive and/or atypical mesothelial cells from malignant epithelial cells in serous effusions remains a frequent diagnostic problem. Since epithelial membrane antigen (EMA) positive malignant cells in serous effusions have been reported in almost all adenocarcinomas and most malignant mesotheliomas, immunoreactivity for EMA is felt to be less useful than other antibodies in the workup of problematic serous effusions. However, immunostaining of reactive and/or atypical benign mesothelial cells for EMA has not been well studied, with only a few series reporting either weak or negative staining for EMA. This study was undertaken to evaluate how often reactive and/or atypical appearing mesothelial cells stain positively for EMA. One hundred eighty serous effusions (115 pleural, 55 peritoneal, and 10 pericardial) from 123 females and 57 males ages 20 to 89 yr were evaluated in which an antibody panel including EMA was performed on cell blocks (141 cases), cytospins (36 cases), or both (3 cases). Of the 100 cytologically positive cases, EMA immunoreactivity was present in 97/100 (97%) cases. One EMA negative case suspicious for a metastatic renal cell carcinoma was lost to follow‐up and not included in the analysis. The remaining three negative cases consisted of malignancies not expected to have EMA positive cells (small cell carcinoma, neuroblastoma, and synovial sarcoma). Therefore, EMA was positive in virtually 100% of the remaining malignant cases. In the 78 cytologically negative cases, EMA positivity was present in 3/78 (3.8%) cases. Clinical follow‐up of up to 14 mo in these three cases revealed no evidence of malignancy. One cytologically negative case with EMA positive cells was lost to follow‐up and therefore not included in the analysis. This study demonstrates that only a low percentage of cytologically negative serous effusions will have EMA positive reactive and/or atypical mesothelial cells. Although not discriminatory between adenocarcinoma and malignant mesothelioma, EMA is a useful antibody for separating reactive and/or atypical mesothelial cells from malignant epithelial and mesothelial cells and should be included as part of an antibody panel in the workup of problematic effusions. © 1995 Wiley‐Liss, Inc.
HPV detection in cytological cases with condylomatous or dysplastic changes: A study with PCR and in situ hybridization on cytological material
Authors: Skyldberg Barbro , Hagmar Björn , Johansson Bo , Kalantari Mina , Moberger Birgitta , Walaas Lisa , Wärleby Bengt
Published: February 2007

Cytobrush samples of 80 patients, who previously had a cytological or histopathological diagnosis of condyloma and/or dysplasia were investigated for human papillomavirus infection (HPV) by polymerase chain reaction (PCR) and in situ DNA hybridization technique (ISH). The results were compared with concomitantly obtained cytological Pap‐stained smears or, in some cases, histological sections. The time between the diagnosis of the original and the concomitant cytology/histopathology was less than 1 yr. Six additional patients had similar morphological diagnoses 2–4 yr before. Five more cases were included on clinical diagnosis of HPV.

Compared with the original morphological diagnoses, 70% of the cases were positive by PCR and/or ISH. The concomitant morphology was not diagnostic of HPV in 44 out of 80 cases (55%), showing a relatively high percentage of cases morphologically normalized in the interval since the first specimen was taken. After detection with PCR, 30 cases (37.5%) were negative for HPV. Only one of the patients with a previous disease 2–4 yr before was HPV positive by PCR and two out of five patients with a clinical diagnosis of HPV.

ISH could be performed on 67/80 cases, 43 of which were positive for HPV. There was a good agreement between the results of ISH and PCR, but there were six cases positive by ISH and negative by PCR. In these cases, few infected cells may have escaped detection by PCR. Both methods seem to be able to detect silent HPV infections and comparison with concomitant cytology/histopathology shows that morphology alone is insufficient for HPV detection in these cases. © 1995 Wiley‐Liss, Inc.
“Cercariform” cells: A clue to the cytodiagnosis of transitional cell origin of metastatic neoplasms?
Authors: Powers Celeste N. , Elbadawi Ahmad
Published: February 2007

The “cercariform” cell is described as a distinct cytomorphologic clue that may be helpful in the diagnosis of metastatic transitional cell neoplasms, particularly low grade. This cell has a nucleated globular body and a cytoplasmic process with a nontapering, flattened, bulbous or fishtail‐like end. The cercariform cell corresponds to intermediate cells in histologic and ultrastructural preparations of normal urothelium. The cercariform appearance is the result of pseudostratification of both normal and low‐grade neoplastic urothelium. The unique features of cercariform cells make them readily distinguishable from neoplastic squamous cells as well as spindle cells of mesenchymal origin. © 1995 Wiley‐Liss, Inc.
Neovaginal cytology after total pelvic exenteration for gynecological malignancies
Authors: Selvaggi Suzanne M. , Haefner Hope K. , Lelle Ralph J. , Pearl Michael L. , Roberts James A.
Published: February 2007

Vaginal reconstruction has become an established method to re‐store sexual function in women who have undergone ultraradical surgery and/or irradiation for the treatment of gynecologic malignancies. Cytologic evaluation of the neovagina serves a major role in the detection of recurrent disease. The purpose of this retrospective 6‐yr study (January 1987–December 1993) was to evaluate the cytologic features of vaginal smear specimens from neovaginas constructed utilizing split‐thickness skin grafts. Thirty‐four vaginal smears were obtained at regular intervals from nine women (mean age: 51 yr) who underwent total pelvic exenteration with vaginal reconstruction for recurrent malignancies of the vagina and the cervix. Anucleated, keratinizing squames were a constant finding in each smear. Over a 4‐mo‐6‐yr postoperative period, superficial and intermediate squamous cells were present in the majority of the smears and the maturation index showed a shift to the right. In two cases, a squamous cell carcinoma of the cervix recurred within the neovagina. Knowledge of the cytologic features associated with neovaginas is important in order to distinguish normal changes from neoplastic lesions. © 1995 Wiley‐Liss, Inc.
Cytopathology of undifferentiated (embryonal) sarcoma of the liver
Authors: Sola‐Pérez Joaquín , Pérez‐Guillermo Miguel , Giménez‐Bascuñana Alberto , Garre‐Sánchez Carmen
Published: February 2007

We have studied one undifferentiated (embryonal) sarcoma of the liver (USL) by fine‐needle aspiration cytology (FNAC) and have correlated the cytologic findings with those seen in the histologic sections.

The main cytologic and immunocytochemical features were: cellular aspirates, mesenchymal clusters, disparity in individual cell size (small round cells, and multinucleated giant cells, sometimes bizarre), absence of biliary pigment, AFP‐negative and vimentin‐negative tumor cells, AFP‐negative and PAS‐positive hyaline globules, and apoptotic cells.

Only immunostaining for alpha‐1‐antitrypsin, alpha‐1‐anti‐chymotrypsin, and carcinoembryonic antigen were positive in tumor cells in histologic sections.

The differential diagnosis should be carried out with rhabdomyosarcomas, hepatoblastomas, malignant fibrous histiocytomas, and poorly differentiated hepatocarcinomas.

We think that the cytologic features observed in this case, evaluated both in the appropriate clinical context and in the light of the laboratory findings, may permit the correct diagnosis of this infrequent liver tumor. Nevertheless, more cases need to be studied to assess the reliability of our findings. © 1995 Wiley‐Liss, Inc.
Paracoccidioidomycosis: Diagnosis by fine‐needle aspiration cytology
Authors: Drut Ricardo
Published: February 2007

A 4‐yr‐old girl presented with constitutional symptoms, abdominal swelling, ascites, and cervical lymphadenopathy. Fine‐needle aspirate smears of a cervical lymph node revealed numerous round yeasts, many of them with several peripheral buds fitting the pattern of Paracoccidiodes brasilensis. This appears to be the first case in which the diagnosis of this deep mycosis was achieved by FNAC. The procedure may prove useful for rapid diagnosis in cases like the present one which represents the so‐called acute disseminated form which affects mainly children and immunosupressed patients and can be rapidly fatal. © 1995 Wiley‐Liss, Inc.
Epithelioid hemangioendothelioma of the lung: Pleural effusion cytology, ultrastructure, and brief literature review
Authors: Buggage Ronald R. , Soudi Nael , Olson Jean L. , Busseniers Anne E.
Published: February 2007

Epithelioid hemangioendothelioma (EHE) of the lung is a low‐grade malignant tumor of vascular origin initially described under the name intravascular bronchioloalveolar tumor (IVBAT). We present a case of a 44‐yr‐old Caucasian female with severe radiating back pain, shortness of breath, recurrent malignant pleural effusions, and a negative malignancy workup. Cytopathologic examination of the four pleural fluid specimens revealed large undifferentiated plasmacytoid malignant cells with abundant pink and finely granular cytoplasm, round nuclei, and prominent nucleoli. The differential diagnosis based on the cytologic findings included hepatocellular, adrenal, and renal carcinomas, melanoma, mesothelioma, and neuroendocrine tumors. Electron microscopy performed on a pleural fluid specimen and subsequent histologic examination of pleural and lung biopsies established the diagnosis of EHE. © 1995 Wiley‐Liss, Inc.
Cytologic diagnosis of cat scratch disease (CSD) by fine‐needle aspiration
Authors: Donnelly Amber , Hendricks Gary , Martens Susan , Strovers Cindy , Wiemerslage Sara , Thomas Patricia A.
Published: February 2007

Cat scratch disease (CSD) is usually a benign, self‐limited lymphadenitis, characterized by suppurative granulomas. It can, however, produce a wide spectrum of clinical symptoms and cytologic changes and be the source of diagnostic dilemmas. Identification of pleomorphic bacilli (PB) with silver impregnation stains aids in the diagnosis, but this has not been well documented in cytologic preparations or in cases without the classic morphologic changes. We reviewed 13 aspirations from eight patients (aged 13–36 yr) occurring over a 15 mo time period, all clinically or cytologically suspicious for CSD. Sites included: axilla (6), parotid (3), epitrochlear (1), neck (1), submental (1), and intraclavicular (1) nodes. Neoplasia was initially suspected clinically in 38% of the cases. All but two patients had cat exposure on subsequent interview. The cytologic differential included bacterial abscess and lymphoproliferative disorders in 31%. Neither granulomas nor suppurative inflammation were seen in all cases. Changes included: granulomas (77%), PMNs (62%), dispersed epithelioid histiocytes (46%), and suppurative granulomas (38%). A modified silver stain (Modified Steiner, Sigma Diagnostics, St. Louis, MO) was performed on all specimens. Silver positive organisms were seen in 69% of cases and were not limited to those preparations with suppurative granulomas. Fine‐needle aspiration biopsy (FNAB) is an effective method for diagnosing CSD despite its heterogeneous appearance; and, when combined with clinical information and silver staining, may obviate the need for excision. © 1995 Wiley‐Liss, Inc.
Value of image guided fine‐needle aspiration cytology in the diagnosis of pancreatic malignancies
Authors: Gupta Raj K.
Published: February 2007

In the period between 1981–1993, 93 image guided fine‐needle aspiration cytology (FNAC) of the pancreas were performed on 63 patients suspected of having a pancreatic carcinoma. From these, 42 patients were subsequently confirmed to have had a pancreatic malignancy by a tissue biopsy. However, FNAC was positive in 29 cases (69.04%) while seven cases (16.66%) were classified as suspicious. In six cases of malignancy (14.28%), cytologically diagnostic material was not sampled using FNAC; hence it was considered that FNAC evaluation gave false negative results in these cases. As a result of this study it was felt that while a cautious approach is necessary in view of certain false negative results, on the whole FNAC was a valuable investigation in the diagnosis of pancreatic carcinoma with no serious complications in this series. Also, FNAC under imaging assistance is a fairly reliable and safe procedure and the false negative results may be reduced by repeat aspirations especially in cases when insufficient diagnostic material is obtained in a patient clinically suspected of a pancreatic carcinoma. © 1995 Wiley‐Liss, Inc.
Serosal balls detected immunocytochemically in peritoneal lavage obtained during surgery
Authors: Sasaki Masaomi , Wakasa Kenichi , Sakurai Masami , Iwa Nobuzo
Published: February 2007

Using the immunoperoxidase technique, we studied “serosal balls,” which have features resembling those of cells from primary and metastatic tumors, and may thus complicate cytodiagnosis. Serosal balls were detected in 32 (18%) of 174 peritoneal washings. The balls consisted of oval clusters of cells in solid masses surrounded by flattened cells. The interior of the serosal balls was stained green with Papanicolaou method, showing the presence of homogeneous amorphous material, sometimes stained in a filamentous pattern. Almost all serosal balls were stained immunocytochemically for both keratin and vimentin. The interior was stained with antibodies against collagen types I and III. Therefore, these balls were fragments of serous membrane, and contained fibrous tissue and mesothelial cells. © 1995 Wiley‐Liss, Inc.
p53 protein expression in fine‐needle aspirates of breast cancer: An immunocytochemical assay for identifying high‐grade ductal carcinomas
Authors: Colecchia Maurizio , Frigo Barbara , Zucchi Alberto , Leopardi Orazio
Published: February 2007

The expression of the p53 gene product was investigated immunocytochemically in a series of 51 fine‐needle aspiration (FNA) samples of breast carcinomas. Results were compared with those obtained by immunocytochemistry on paraffin embedded tissue sections of the corresponding surgical specimens. Cytological samples showed a variable degree of p53 immunoreactivity in 14 tumors (27.6%), all of ductal type, while p53 immunoreactive tumor cells were present in tissue sections from 15 carcinomas (29.4%). The only discordant case was a signet‐ring cell carcinoma.

Abnormal p53 expression was significantly associated with high nuclear grade in ductal carcinomas. No association was seen with tumor size, lymph node status, and age of the patient. Detection of p53 altered expression in FNA samples of breast carcinoma may play a role in the assessment of tumoral grading and is predictive of p53 immunoreactivity in histological specimens. © 1995 Wiley‐Liss, Inc.
Aspiration biopsy cytology of intranodal myofibroblastoma: Case report with immunocytochemical analysis
Authors: Dei Tos Angelo P. , Libera Duilio Della , Bittesini Lucia
Published: February 2007

Intranodal myofibroblastoma (IM) is a recently delineated clinicopathologic entity represented by a myofibroblastic proliferation of the lymph node. It usually occurs at the groin and presents clinically as a single enlarged lymph node. Its clinical behavior is entirely benign and local excision is curative. The authors herein report a case of IM diagnosed by aspiration biopsy cytology (ABC). The main diagnostic clues to the cytologic diagnosis of this entity as well as the differential diagnosis are presented. © 1995 Wiley‐Liss, Inc.
Primary hepatic lymphoma: Report of two cases diagnosed by fine‐needle aspiration
Authors: Rappaport Karen M. , Digiuseppe Joseph A. , Busseniers Anne E.
Published: February 2007

Primary hepatic lymphoma (PHL) is a rare disease which tends to progress slowly in the absence of other disorders and remains confined to the liver until late in its course. We report two patients with PHL diagnosed by fine‐needle aspiration (FNA). Histopathologically, PHL can be misdiagnosed as poorly differentiated carcinoma or hepatocellular carcinoma. On FNA, cellular smears with artifactual grouping of malignant cells may result in similar errors. Since PHL has an excellent prognosis and is not usually the working diagnosis in patients who present with a solitary liver mass, a high index of suspicion is necessary to make the diagnosis. We report two cases of PHL in which the diagnosis of lymphoma was rendered on FNA. In one patient, who carried a clinical diagnosis of cavernous hemangioma for 18 mo, FNA showed large‐cell lymphoma, B‐cell type. Subsequent extensive workup did not reveal extrahepatic disese. The other patient, followed for sclerosing cholangitis, was clinically thought to have developed cholangiocarcinoma. FNA revealed high grade lymphoma, B‐cell type. We present the clinical, radiologic, and pathologic findings and differential diagnoses of PHL as well as the various clinical settings in which PHL has been described. © 1995 Wiley‐Liss, Inc.
Exfoliative cytology of adenoma malignum (minimal deviation adenocarcinoma) of the uterine cervix
Authors: Vogelsang Philip J. , Nguyen Gia‐Khanh , Honoré Louis H.
Published: February 2007

Cervical scraping smears from two cases of histologically confirmed adenoma malignum of the uterine cervix were reviewed. In one case, several irregular sheets of benign‐appearing glandular cells with slightly enlarged nuclei, conspicuous nucleoli, and clear cytoplasm were found. In the other case, in addition to sheets of benign‐appearing glandular cells, there were clustered malignant glandular cells with prominent nucleoli. The sheets of benign‐appearing glandular cells in both cases displayed wispy cytoplasmic extensions or “tails.” Cytologic differential diagnosis with other glandular lesions of the cervix such as clear cell carcinoma, microglandular hyperplasia, diffuse laminar glandular hyperplasia, tubal metaplasia, and well‐differentiated invasive or in situ adenocarcinoma is briefly discussed. © 1995 Wiley‐Liss, Inc.
Unusual small bone metastases from epithelial malignancies: Diagnosis by fine‐needle aspiration cytology with histologic confirmation
Authors: Singh Harsharan K. , Silverman Jan F. , Ballance William A. , Park H. Kim
Published: February 2007

Although epithelial malignancies can have bone metastases, involvement of small bones is exceedingly rare, representing either first manifestation of an occult carcinoma or late disseminated disease. Small bone metastases may mimic primary skeletal diseases leading to misdiagnosis and delayed treatment. We report three cases of metastatic epithelial malignancies diagnosed by computed tomography (CT)‐guided fine‐needle aspiration (FNA) biopsy in two patients with lytic calcaneal lesions and a patellar lesion in a third patient; all with histologic confirmation. Case 1, a 63‐yr‐old female, presented with heel pain. FNA and tissue biopsy of the calcaneus revealed a clear cell malignancy consistent with a renal primary. Follow‐up abdominal CT scan revealed a renal lesion consistent with renal cell carcinoma. Case 2, a 37‐yr‐old male with squamous cell carcinoma of the esophagus, presented with foot pain. FNA and tissue biopsy of the calcaneus revealed metastatic squamous cell carcinoma. Case 3, a 52‐yr‐old male with a history of squamous cell carcinoma of floor of mouth, presented with knee pain and swelling. FNA and tissue biopsy of the patella revealed metastatic squamous cell carcinoma. To the best of our knowledge, this is the first complete FNA cytology report with histologic confirmation of unusual small bone metastases of the feet and patella from epithelial malignancies and shows the value of FNA cytology in establishing a correct diagnosis, and excluding primary skeletal diseases. © 1995 Wiley‐Liss, Inc.
Lobular carcinoma of the breast: Cytological features supporting the diagnosis of lobular cancer
Authors: Robinson I. A. , McKee G. , Jackson P. A. , Cook M. G. , Kissin M. W.
Published: February 2007

Lobular carcinomas have a distinct natural history with a better response to endocrine therapy and a higher incidence of local recurrence and are more often bilateral. The cytological diagnosis of lobulur carcinoma permits a discriminating therapeutic approach with pre‐operative Tamoxifen, more generous resection margins, and assessment of the contralateral breast. The cytological features of lobular cancer however are not well defined and the low cell yield from such neoplasms can result in a high false negative rate.

To determine whether we could improve the pre‐operative diagnosis, we reviewed the cytological features of 112 lobular carcinomas. They had small uniform sized nuclei with irregular outlines and inconspicuous nucleoli. The degree of dissociation was similar to duct carcinomas and the incidence of inadequate aspirates was no higher. We found no features that confidently diagnosed lobular cancer or its sub‐types. However, using a combination of features, typing of lobular cancer on aspirated material is possible and should be attempted. © 1995 Wiley‐Liss, Inc.
Role of fine‐needle biopsy in the diagnosis of hydatid cyst
Authors: Saenz‐Santamaria Javier , Moreno‐Casado Jose , Nuñez Carlos
Published: February 2007

The cytopathologic findings in 17 patients with hydatid cyst are reported. All patients but one were referred for evaluation of a tumor mass. In 13 patients the aspirated material was diagnostic of hydatid cyst. In four patients only acellular laminated membranes were present in the aspirate and a presumptive cytopathologic diagnosis of hydatid cyst was made. Subsequent histologic studies confirmed the diagnosis of hydatidosis in all patients. No complications were encountered. Fine‐needle biopsy appears a safe diagnostic approach in the evaluation of suspected hydatid disease. The presence of acellular laminated membranes confirm the diagnosis of hydatid cyst. © 1995 Wiley‐Liss, Inc.