Search

We have studied 25 serous effusions containing definitive morphologic evidence of adenocarcinoma to evaluate the ability of two mucin stains (Mayer's mucicarmine, D-PAS) to detect intracytoplasmic mucin in both cytologic (cytospin) and corresponding histological (cell block) preparations. Mucicarmine stain was positive in six of 25 (24%) cytospins and 13 of 25 (52%) cell blocks. D-PAS was positive in 19 of 25 (76%) cytospins and 20 of 25 (80%) cell blocks. Eight cases were identified which showed mucicarmine positivity in the cell block but not the corresponding cytospin; prolonging incubation time resulted in a positive mucicarmine in cytospin preparations for seven of these cases. We conclude that: (i) D-PAS is a more sensitive stain for the detection of intracytoplasmic mucin in all preparations; (ii) mucicarmine shows preferential staining for cell blocks; (iii) alterations in the staining protocol may permit mucin detection by mucicarmine staining in cytologic preparations in a significant number of cases.

The use of membrane filters to concentrate cytology specimens was first described by Seal (Cancer 1956; 9:866-868). We report on a technique in which a portion of Papanicolaou-stained Millipore filter (Millipore Corp, Bedford, MA) preparation can be converted into a paraffin block for hematoxylin-eosin (HE) preparations and immunocytochemical analysis (ICC). Seven cases with moderate cellularity and no cell block preparation were retrieved from our cytopathology files. The specimens included: 4 pleural effusions with metastatic adenocarcinoma, and 3 FNA specimens (1 metastatic melanoma, 1 metastatic adenocarcinoma, and 1 thyroid/papillary carcinoma). The filter was removed from the slide, cut in half, and subjected to paraffin embedding in the usual fashion (postfixed in 10% neutral-buffered formalin). Four-micron-thick sections were cut onto Probe-On (Fisher Scientific, Pittsburgh, Pa) slides. ICC was performed using the avidin-biotin-peroxidase complex technique and capillary gap technology. Antibodies included CAM5.2, AE1/AE3, CEA, CD15, LCA, PanCK, S100, HMB45, and thyroglobulin. All cases showed excellent preservation of cellular morphology on HE. ICC performed on Millipore filter cell block preparations showed specific antibody staining patterns with preservation of cellular details. All antibodies showed their specific staining patterns with clean background and lack of nonspecific staining. This technique has the following advantages: 1) offers an alternative to cell blocks in moderately cellular specimens; 2) clean background; 3) preservation of cytology specimens for future studies.

OBJECTIVE: To determine whether preparation of cell blocks from fluid-based cervicovaginal specimens can add to the diagnostic accuracy of monolayer preparations from the same specimens. STUDY DESIGN: Cell block preparations were made from 100 cervicovaginal, fluid-based ThinPrep Pap test specimens. These specimens were collected in a fluid-based solution with a Papette or cytology brush and a scraper. After a monolayer slide was made, a determination was made if a cell block preparation was needed based on the morphologic findings on the slide. RESULTS: Cell block results aided the ThinPrep Pap diagnosis in 20% of specimens and were critical to the diagnosis in 5%. The cell block preparation was most useful in lesions where architecture and morphology were important, such as immature squamous metaplasia versus high grade squamous intraepithelial lesion, repair versus squamous carcinoma and tubal metaplasia versus atypical glandular cells of undetermined significance. It was also found that the presence of tissue fragments rather than single cells on the slide was an indication of the possibility that a cell block was productive. CONCLUSION: Cell block preparation in selected cases can be a valuable adjunct to monolayer slide preparations in the diagnosis of cervicovaginal lesions.

ÖZET Bu çalışmamızda Uludağ Üniversitesi Tıp Fakültesi Patoloji Anabilim Dalı'nda peritoneal ve plevral sitolojisi pozitif 31 olgu incelendi. Olgularda Giemsa boyaması yanısıra immunositokimyasal boyamalardan CA 125, CA 19-9 ve CA 15-3 kullanıldı. Her üç boyanın malign hücreler deki lokalizasyonu ve pozitivitesi değerlendirildi. Histopatolojik tanıları ile olan ilişkileri incelendi. 19 ovarian tümörlü (18 tanesi seröz tümör, 1 tanesi germ hücreli tümör) olgunun tamamında CA 125 antikor yanıtı pozitif bulundu. Seröz tümörlerde CA 125 pozitifliğine eşlik eden CA 15-3 pozitifliği tespit edildi. Ovarian seröz tümörlerde malign hücrelerdeki antikor lokalizasyonu ge nellikle apikal+stoplazmikti ve sadece apikal boyanma hiçbir olguda göz lenmedi. Gastrik tümörlerde CA 19-9 pozitifliği anlamlı idi. Malign hücrelerde CA 19-9 lokalizasyonu çoğunlukla apikal+stoplazmik bulundu. Olgu sayısı azlığından dolayı bronşial tümörlerde CA 125, CA 15-3 ve CA 19-9 ile anlamlı boyanma izlenmedi. Çalışmadaki bir meme tümörlü 43 ^o VHKSFKÖĞP.tfl j.C. tÜKSEMföolguda CA 1 5-3 ve CA 1 9-9 pozitif bulundu. Kolorektal karsinomlu iki ol guda da boyanma saptanmadı. Sonuç olarak ovarian seröz tümörler için CA 125'in, gastrik tümörler için CA 19-9'un, meme tümörleri için CA 15-3'ün immunositokimyasal ça lışmalarda kullanılmasının uygun olduğu görüşüne vardık. 44KAYNAKLAR 1. Old LJ.: immunotherapy for cancer. Sci. Am. Vol: 13: 136-143. 1996. 2. Motoo Y., Watanabe H., Sawabu N.: Sensitivity and specificity of tumor markers in cancer diagnosis. Nippon Rinsho. Vol 54: 1587-1591. 1996. 3. Vargas FS, Teixeira LR.: Pleural malignancies. Curr. Opin Pulm. Med. Vol 2: 335-340, 1996. 4. Sahn SA.: Malignancy metastatic to the plevra. Clin. Chest. Med. Vol 19:351-361. 1998. 5. Gammon R.-, Hameed A., Keyhani-Rofagha S.: Peritoneal washing in borderleine epithelial ovarian tumors in women under 25: the use of cell block preparations. Diag. Cytopathol. Vol 18: 212-214. 1998. 6. Van Den Bosch RP., Van Eijck CHJ.: Serum CA 19-9 determination in the management of pancreatic cancer. Hepato-Gastroenterology. Vol 43: 710-713. 1996. 7. Lo S.S.T., Cheng D.K.L.: Prognostic significance of Tumor Markers in Endometrial Cancer. Tumor Biol. Vol 18: 241-249. 1997. 45 54

Acquisition of saliva for biologic, immunologic and chemical analyses has been extremely difficult in infants and young children due to lack of cooperation and motor skills necessary for expectorating adequately. The purpose of this study was to investigate a technique for obtaining satisfactory quantities of whole, unstimulated saliva in the typical dental operatory setting for cytologic, microbiologic and viral evaluation, while requiring minimal cooperation and motor skills from pediatric patients. A low vacuum-assisted aspiration device was utilized to obtain samples from infants and children who were at risk for vertically acquired HIV-infection (age-range 6 mos to 8 yrs). Adequate saliva samples were collected in 175 of 196 (89 percent) attempts in 88 of 89 (99 percent) children (2.3 samples/child). Saliva was not obtained in twenty-one attempts primarily due to xerostomia (62.5 percent). Saliva sample volume obtained was variable, ranging from 1.2 to 3.6 mls with a collection time of approximately three to five minutes. Cell block preparations were made from the saliva, which allowed for cytologic evaluation of sloughed superficial squamous cells, evaluation of oral flora, and detection of yeast and hyphal fungal forms. Adequate volumes of supernate were also available for microbiologic and viral cultures, immunologic studies and PCR study for various viral agents shed in the saliva. Use of a vacuum-assisted collection device for whole unstimulated saliva in infants and young children in the dental operatory setting provides adequate saliva for multiple analyses, which may provide information regarding HIV disease status and early diagnosis of opportunistic infections.

OBJECTIVE: The immunohistochemical staining patterns characteristic of hepatocellular carcinoma (HCC) using CD34 and factor VIII antibodies were compared with those of other hepatic lesions to determine if these stainings can be used as a diagnostic criterion. STUDY DESIGN: We reviewed 44 fine needle aspirates from the liver to evaluate the immunoperoxidase staining patterns on cell block preparations using CD34 and factor VIII and to determine whether this could distinguish HCC from the other lesions. These included HCC (14 cases), metastatic tumor (14 cases) and nonneoplastic liver lesions (16 cases). RESULTS: This retrospective study showed that in the nine documented cases of HCC, staining for CD34 and/or factor VIII was positive. The pattern of staining was either peripheral, around small clusters of tumor cells, or linear, diffuse and sinusoidal. In all the documented cases (27) of metastatic carcinoma and nonneoplastic lesions staining for CD34 and factor VIII was negative. In addition, there were eight problematic cases. In 7 cases the cytologic diagnosis on Papanicolaou-stained smears was inconclusive about HCC or metastatic carcinoma. CD34 and factor VIII confirmed the final diagnosis on the cell blocks. Based on this staining, 4 were HCC, 2 were metastatic carcinoma and 1 was equivocal, most probably HCC. In one case the differential diagnosis between well-differentiated HCC and a nonneoplastic liver lesion could not be made on cytologic smears, and here, also, CD34 and factor VIII aided in the correct diagnosis of a nonneoplastic liver lesion. CONCLUSION: We suggest immunoperoxidase staining with CD34 and factor VIII be performed on the cell block sections from FNAs in any problematic hepatic case.

A 37-year-old white male with a large pancreatic mass was referred to our institution with a hypodense liver lesion detected on CT scan. A fine-needle aspiration (FNA) was performed on the liver lesion. Diff-Quik smears demonstrated scattered papillary structures and single neoplastic cells with abundant well-defined dense granular cytoplasm. Eccentrically located nuclei were noted with single prominent nucleoli. Cell block preparations showed papillary structures lined by cells with abundant pink granular cytoplasm, hyperchromatic nuclei, and prominent single nucleoli. Electron microscopic examination displayed numerous but poorly preserved mitochondria. The diagnosis of papillary carcinoma with oncocytic features was made. Only two previous cases of pancreatic oncocytic tumors diagnosed by FNA have been reported in the literature. We present an additional case, notable in that the diagnosis was made in a metastatic liver nodule.

Overlapping morphologic patterns that may be observed in goiter, follicular adenoma, and papillary carcinoma can limit the cytologic evaluation of the thyroid gland. In an attempt to develop a useful adjunctive test, the immunocytochemical reactivity of HBME-1, carcinoma antigen 19-9 (CA 19-9), and CD-15 (Leu-M1) was tested on 59 cell block preparations from fine-needle aspirations of the thyroid gland. HBME-1 monoclonal antibody was reactive in all 21 papillary carcinomas, in 4 of 18 adenomas, and in 5 of 20 goiters. CA 19-9 was identified in 13 of 21 carcinomas, 1 goiter, but none of the adenomas. CD-15 was present in 15 of 21 carcinomas, 1 goiter, and 1 adenoma. We conclude that HBME-1 is a sensitive marker of papillary thyroid carcinoma. CD-15 and CA 19-9 are less sensitive but more specific. This panel can be useful to help classify morphologically equivocal lesions. As with all immunocytochemical testing, caution must be exercised in the interpretation of results, and correlation made with morphologic and clinical data.

To evaluate the efficacy of Ber-EP4 in distinguishing epithelial cells from mesothelial cells in routine cytologic preparations.Paraffin-embedded cell blocks of serous effusions from 32 patients (11 metastatic adenocarcinomas, 16 reactive mesothelial proliferations and 5 malignant mesotheliomas) were immunostained with Ber-EP4. For comparison, cell block preparations of adenocarcinomas and mesotheliomas were also immunostained with the most commonly applied markers of adenocarcinoma: carcinoembryonic antigen (CEA), B72.3 and Leu-M1. In addition, cytocentrifuge preparations of 14 reactive effusions and 2 metastatic adenocarcinomas were stained prospectively with Ber-EP4.All adenocarcinomas showed intense membrane staining, while all mesothelial proliferations, both benign and malignant, were negative. The Ber-EP4-positive immunostaining was remarkably clean, with very minimal nonspecific staining. CEA stained 11/11 adenocarcinomas, B72.3 stained 10/11, and Leu-M1 stained 8/11; mesotheliomas were negative with all three antibodies.Ber-EP4 is at least as useful as CEA, B72.3 and Leu-M1 in the diagnosis of serous effusions. It has the advantage of high sensitivity and ease of interpretation because of the high percentage of tumor cells stained, characteristic membranous staining and lack of cross-reaction with background inflammatory cells.

Myoepithelial cells play an important role in the interpretation of breast fine-needle aspiration biopsy, since these cells are believed to be a component of a benign process in breast lesions. Myoepithelial cells are usually easy to recognize, however, other cells can morphologically simulate myoepithelial cells and make the distinction difficult. To assess the feasibility of immunostaining as an adjunct to identify myoepithelial cells, we have used immunocytochemistry using monoclonal antibody against muscle specific actin (MSA) in our breast fine-needle aspirates. Herein, we report our experience in immunocytochemical detection of myoepithelial cells using labeled Streptavidin Biotin Detection System on destained Papanicolaou stained smears and cell block preparations obtained from breast aspirates.

Intrathoracic sarcoidosis is often diagnosed by transbronchial lung parenchymal biopsy (TBBx), however, recent studies suggest endobronchial ultrasound-guided transbronchial fine needle aspiration of mediastinal lymph node (EBUS-FNA) is safer with superior diagnostic yield. We report our experience from 2008 to 2010 with combined EBUS-FNA and TBBx in 61 consecutive patients with clinical suspicion of sarcoidosis. One to three mediastinal lymph nodes (LN) in various locations were sampled using 21/22-gauge needles with on-site interpretation. Additional one to two specimens per site were collected in Normosol® for cell block preparations. A definitive diagnosis of sarcoidosis was made in 51 patients (84%) by EBUS-FNA/TBBx studies (46) and clinical information (5); alternative diagnoses were established in 8 patients (13 %); the last 2 patients remained suspicious for sarcoidosis without confirmatory tissue diagnosis. Of the 46 biopsy (EBUS-FNA and/or TBBx) confirmed cases, 37 (80.0%) were diagnosed by EBUS-FNA. Cell blocks prepared from all 37 patients contained diagnostic material, 10 (27.0%) were interpreted as such by on-site evaluations. The diagnostic yield of LNs at different locations varied, being 100, 68, 50 and 20% in R12, subcarinal, R4, and R11, respectively. A total of 36 patients had both EBUS-FNA and TBBx performed during the same visit. Diagnoses were identical in 15 patients (42 %). TBBx independently identified 9 cases of sarcoidosis. This study indicates that cell block preparation is valuable for EBUS-FNA diagnosis of sarcoidosis. EBUS-FNA and TBBx are effective and complimentary tools for intrathoracic sarcoidosis diagnosis. [N A J Med Sci. 2012;5(4):198-202.]

Background: Differentiation between reactive, but morphologically atypical, mesothelial cells and adenocarcinoma in effusions can be problematic. Elaborate immunohistochemical panels have been devised. Techniques like DNA analysis, flow/image cytometry, and K-ras mutation analysis are research oriented and difficult to perform in routine, especially in resource-poor centers. We evaluated the efficacy of a limited two-antibody panel comprising calretinin and Ber-EP4 on cytospin and cell block preparations, in 100 effusion samples. Materials and Methods: Fifty cases of reactive mesothelial hyperplasia and 50 cases of adenocarcinoma diagnosed by cytomorphology in ascitic/pleural fluid specimens over a 2-year period were assessed. The diagnoses were confirmed by clinical/histopathologic correlation. Cytospin smears were made in all. Cell blocks were prepared, wherever adequate fluid was available. Immunocytochemistry (ICC) for calretinin and Ber-EP4 was performed. Results: Forty-five of the reactive effusion cases (90%) were calretinin reactive and Ber-EP4 negative. Among the adenocarcinoma cases, 49 (98%) were calretinin negative but Ber-EP4 positive. Thus, both calretinin and Ber-EP4 had a high sensitivity (90% and 98%, respectively), as well as a high specificity (100% and 86%, respectively). In the 21 reactive mesothelial cases, whose cell blocks were made, results were comparable to those on cytospin. However, of the 19 adenocarcinoma cases in which cell blocks were prepared, all were Ber-EP4 immunopositive except for three, which were positive on cytospin, implying false-negative results on cell blocks. Conclusions: A limited panel of two monoclonal antibodies, calretinin and Ber-EP4, may be useful in cytology, as a “primary antibody panel”, for accurate diagnosis and patient management. Additionally, ICC can be performed easily on cytospin preparations, which gave results comparable to cell blocks in our study.

Pericellular lacunae are reported to be characteristic of adenocarcinoma cell clusters in cell block preparations of serous effusions. We examined the incidence of lacunae in cell blocks from 24 benign and 31 malignant effusions. The cases were classified as follows: group A with no pericellular lacunae, group B with50% of cell clusters in lacunae, and group C with50% of cell clusters in lacunae. Of the malignant effusions, 5% were in group A, 67% were in group B and 29% were in group C. Of the benign effusions, 50% were in group A, 50% were in group B, and 0% were in group C. The pericellular lacuna by itself is not a reliable diagnostic criterion. It could assist, however, in the overall evidence when evaluating a case, particularly if either there are no lacunae seen or the majority of cells are in lacunae. Furthermore, since lacunae are easily visible at low magnification, their recognition may help in screening cell blocks, using their presence to locate cell groups worthy of special attention.

While cell blocks of bronchial washings are often routinely prepared, their usefulness as adjuncts to the diagnosis of pulmonary neoplasms has not been evaluated. Bronchial washings obtained from 111 patients in whom clinical or radiographic evidence raised the suspicion of a pulmonary neoplasm were reviewed. The smears and cell block preparations were studied independently of each other without knowledge of the original diagnoses. Discrepancies between the smear and cell block diagnoses were noted in 17 cases. Smears detected more neoplasms (52) than cell blocks (43). However, four cell blocks were positive, while the corresponding smears were negative. According to these results, the use of cell blocks increased the diagnostic yield from 52 to 56 cases, for an increase of 9%. Cell blocks will increase the diagnostic yield of bronchial washings, albeit for a small number of patients. However, a positive result will have an obvious influence on patient management and will obviate incremental costs and risks attendant to more invasive diagnostic procedures.

A case of malignant neuroectodermal tumor of the ovary (monodermal teratoma) with a predominant ependymal component in the peritoneal washings of a 27-year-old woman obtained on second-look laparotomy is presented and discussed. The smear and cell block preparations showed sheets and clusters of cells containing oval nuclei with finely granular chromatin and small nucleoli. The cell nuclear/cytoplasmic ratio was within normal limits, and minimal cytologic atypia was observed. The clusters were rimmed by columnar-oriented cells lined by cilia. This is the first reported case of this rare ovarian neoplasm present on fluid cytology. Its bland cytologic appearance could be confused with endosalpingiosis.

The differential diagnoses of malignant mesothelioma in serous effusions include adenocarcinoma and reactive mesothelial cells. While several cytologic features are of predictive value in separating these entities, immunostaining and ultrastructural examination are important adjuncts that increase the diagnostic yield. Many of the cytomorphologic features can be correlated with immunohistochemical and ultrastructural findings. Most important among these is the ultrastructural demonstration of long, often branching microvillous processes in malignant mesothelial cells. Corresponding microvilli can be visualized by immunostaining for epithelial membrane antigen in both cell block preparations from effusions and biopsy specimens, allowing the identification of malignant mesothelioma. In addition, the circumferential distribution of these immunostained microvilli in cells dispersed in stromal connective tissue identifies them as malignant mesothelial cells, corresponding to the ultrastructural appearance of aberrant microvilli, which project through deficiencies in the basal lamina. These microvilli show interdigitation with stromal collagen fibers, a phenomena not observed in adenocarcinoma.

Hepatocellular carcinoma (HCC) may uncommonly present with distant metastasis in the absence of a documented neoplasm in the liver. The authors herein describe the case of a 60-year-old man with cirrhosis who developed unilateral enlargement of the breast and a subareolar mass. This problem was clinically thought to represent gynecomastia, but a mammary fine-needle aspiration biopsy demonstrated a malignant epithelial neoplasm composed of large granular amphophilic cells. Bile pigment was visualized in the tumor on aspirate smears and cell block preparations; immunostains showed reactivity for cytokeratin and alpha-fetoprotein, but there was no positivity for epithelial membrane antigen, gross cystic disease fluid protein-15, vimentin, estrogen receptors, progesterone receptors, or S100 protein. These results indicated a diagnosis of metastatic HCC, which was subsequently confirmed by computed tomography of the abdomen. © 1992 wiley-Liss, Inc.

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.

A preoperative diagnosis of pulmonary blastoma was established by fine-needle aspiration (FNA) cytology in a patient who presented with a pulmonary mass discovered incidentally on chest x-ray. At the time of computed tomography-guided FNA, an on-site preliminary diagnosis of poorly differentiated carcinoma was made after examination of a rapid hematoxylineosin (H a E)-stained smear. Malignant epithelial and stromal elements could be demonstrated on smears subsequently stained with the H&E, Papanicolaou, and Diff-Quik methods. The cell block preparation showed a distinctly biphasic malignant tumor with classic morphologic features of pulmonary blastoma. We present the clinical, cytologic, immunocytochemical, and histologic findings of this case and re-emphasize the valuable contribution of adequate cell block preparations to accurate diagnosis of fine-needle aspiration material.

Curschmann's spirals were found in smears and cell block preparations of five spontaneously occurring pleural and peritoneal fluids. The spirals were similar to those seen in the respiratory tract, although generally much smaller. In three of the five cases, the fluids also contained mucus-secreting adenocarcinoma cells; it is postulated that the spirals formed from mucus secreted by these cells. In the other two cases, there was evidence of serosal inflammation; it is suggested that the spirals in these cases developed from submesothelial connective tissue mucosubstances that entered the serosal cavity through a mesothelium of increased permeability due to the inflammation. No simple explanation can be accepted as to the exact mode of spiral formation, which is presumed to be a complex physical and biochemical phenomenon.

Percutaneous needle aspiration biopsies of the lung from five patients with Wegener's granulomatosis were reviewed. Three of the patients presented with the generalized form of the disease while two presented with the limited pulmonary form; one of the latter subsequently developed disseminated disease. The morphologic findings in the pulmonary aspirates were similar in all cases. The cytologic preparations contained neutrophils entrapped within necrotic debris plus scattered but prominent histiocytic giant cells, which often had nuclei arranged in rings or horseshoes, in a background of lymphocytes, epithelioid histiocytes and reactive pneumocytes. Cell block preparations showed discrete areas of necrosis containing a neutrophilic infiltrate and focally palisaded by epithelioid histiocytes. The intervening viable tissue contained prominent histiocytic giant cells and chronic inflammatory cells enmeshed in a fibrous matrix. One cell block contained a small artery with a small focus of possible granulomatous arteritis. While an open lung biopsy is generally required for a definitive diagnosis, the pathologist may encounter unsuspected Wegener's granulomatosis in a needle aspirate. Recognition of the findings observed in these cases should alert the pathologist to the possibility of Wegener's granulomatosis so that an open lung biopsy can be performed if clinically indicated and cytotoxic therapy can be promptly instituted if the diagnosis of this entity is confirmed.

A primary mediastinal endodermal sinus tumor in a young man was diagnosed by cytologic examination of a pleural effusion. Subsequent evaluation revealed a greatly elevated serum alphafetoprotein (AFP); computed tomographic scan of the chest showed a large anterior mediastinal mass. Routine examination of the smears and cell block preparations revealed clusters of tumor cells with a few intracytoplasmic hyaline droplets. Immunohistochemical stains for AFP, alpha-1-antitrypsin and cytokeratin were positive in the tumor cells while stains for carcinoembryonic antigen and the beta subunit of human chorionic gonadotropin were negative. This supported the diagnosis of endodermal sinus tumor, a rare primary tumor within the mediastinum.

Dear Dr. Bedrossian: I would like to offer an explanation as to how the nodules of so-called nodular histiocytic hyperplasia (NHH) form in some specimens of pleural, peritoneal, and pericardial fluid. Such nodules were well-illustrated by Drs. Choi and Song in their recently published article in Diagnostic Cytopathology.1 They demonstrated that these nodules are composed of compact aggregates of histiocytes, which may contain the occasional mesothelial cell. In cell block preparations, these tightly packed aggregates (nodules) of histiocytes are always bounded by a band of fibrin. The bands may be thin and scarcely visible as in Figure 4 of Drs. Choi and Song, or they may be thick, as in their Figure 3.1 Obviously, fluid manifesting NHH has to contain numerous histiocytes, and it must also contain fibrin, which may have formed spontaneously before or after the fluid was aspirated. In smears of serous fluids, histiocytes are often seen in irregularly shaped, loose aggregates, presumably because of their long microvilli. Such aggregates become enmeshed by fibrin in the fluid, which contracts around them to create densely packed, well-circumscribed nodules. Smear preparations do not exhibit the well-defined nodules of NHH, presumably because any histiocytic aggregates become disrupted by the smearing technique. In cell blocks, the dense and smoothly contoured aggregates of histiocytes may be mistaken for fragments of carcinoma. A superb example of this is featured in the chapter on cytology of serous fluids in both editions of Bibbo’s Comprehensive Cytopathology. The patient, a young woman, was referred to our hospital with a diagnosis of metastatic adenocarcinoma in her pleural effusion. And recently I reviewed a specimen in litigation that had been misdiagnosed as metastatic adenocarcinoma in pleural fluid; again, it was an example of NHH. Obviously, this morphologic entity is a most important pitfall of cytodiagnosis of serous fluids.

The endometrial jet washing technique of Gravlee is a satisfactory method of screening for endometrial carcinoma. The uterine cavity can be irrigated with an unlimited amount of fluid under a negative pressure. Cell block preparations of the tissue samples have proved adequate to establish a diagnosis of endometrial adenocarcinoma for 5 of 287 screened patients. Subsequent curettage demonstrated that no endometrial cancers were overlooked.

A review was made of 138 sputa, 4 bronchial washings and 4 bronchial aspirates from 64 patients with pulmonary tuberculosis. The cytologic findings that may indicate granulomatous involvement were epithelioid cells, giant cells, lymphocytes and a necrotic background. Cell-block preparations stained by the Ziehl-Neelsen technique gave a positivity for acid-fast bacilli similar to that of bacterioscopy. This study emphasizes the potential diagnostic value of inflammatory alterations, even when the main objective of pulmonary cytology is the diagnosis of neoplasia; the finding of epithelioid cells and giant cells in a necrotic background may indicate a specific granulomatous involvement.

To determine the efficacy of the uterine jet washing technique (Gravlee 1964) in endometrial cancer testing the Cytology Laboratory at Pittsburghs Magee-Womens Hospital analyzed the results of 230 washings obtained from 211 patients from May 1971 to March 1973. Average patient age was 46 years. In 125 cases a corresponding histologic specimen was available (through endometrial biopsy hysterectomy or dilatation and carettage) as a correlative sample. The uterine jet washings were evaluated in concentrated monolayers indirect smears and cell block preparations. Histologic diagnoses were possible in 150 of 230 cases (65.2%) cytologic diagnoses only were possible in 72 cases (31.3%) and 8 specimens were unsatisfactory (3.5%). 125 jet washing diagnoses were consistent with correlated surgical specimen interpretations and no false positive diagnoses were made. Data suggest that the endometrial jet washing technique is a reliable diagnostic office procedure which could prove superior to endometrial biopsy because in addition to obtaining microbiopsies it can recover desquamated fragments and cellular samples from the endometrial cavity. The technique is neither a routine procedure nor a replacement for the conventional cervical and vaginal smear method for mass screening of asymptomatic patients but serves as a valuable aid to better detection of suspected endometrial lesions and can provide a means for follow-up observation of a treated or untreated lesion when dilatation and curettage is undesirable.

The results of fine needle aspiration (FNA) cytology in 19 cases of malignant mesothelioma are presented. Adequate material for a diagnosis of malignancy was obtained in 17 cases, and in 8 cases a specific diagnosis of mesothelioma could be made. In four other cases, the findings were either consistent with or suggestive of mesothelioma; in four, accurate distinction from other neoplasms was not possible, and in two cases, adenocarcinoma was suggested. The spectrum of cytologic findings ranged from neoplasms of purely epithelial appearance through more pleomorphic biphasic neoplasms to anaplastic tumors. A combination of epithelial-like cell clusters, pavement-like sheets of epithelial cells with well-defined cell borders and prominent cell separation, dispersed angular cells with dense cytoplasm and some spindle-cell forms was the most specific cytologic pattern for mesothelioma. In four neoplasms, ultrastructural examination of aspirated material provided the additional evidence for a definitive diagnosis. The identification of hyaluronic acid within intracytoplasmic vacuoles, either in smears or in cell blocks, confirmed the diagnosis in three tumors. Only in one case, with a strong clinical background suggesting mesothelioma, was the cytologic preparation sufficient for diagnosis without ancillary diagnostic methods. FNA is of particular value in the diagnosis of pleural mesothelioma in patients who do not present with a pleural effusion. Obtaining material for cell block preparations, cytochemistry or ultrastructural study is generally necessary for definitive tumor typing.

The Cavitron Ultrasonic Surgical Aspirator (CUSA) is a dissecting system that removes tissue by vibration, irrigation and suction; fluid and particulate matter from tumors are aspirated and subsquently deposited in a canister. The CUSA permits the neurosurgeon to remove large tumors by debulking them quickly and effectively, without traction or manipulation and with minimal transmission of movement to adjacent normal tissues. The cytomorphologic appearances of 22 central nervous system tumors in CUSA samples were evaluated and compared with the findings in biopsy or resection specimens. Papanicolaou-stained and Diff-Quik-stained Cytospin preparations were prepared from the saline irrigation fluid along with a cell block in every case. Three specimens (13.6%) were insufficient for interpretation. Of the materials from seven astrocytic neoplasms examined, two were insufficient for diagnosis. The other insufficient case was tissue obtained from an ependymoma. All 11 meningiomas had diagnostic material in the slides and cell blocks. In general, the cytologic smears and cell block preparations were best preserved in meningiomas and schwannomas. Varying degrees of degeneration were noted in the glial neoplasms. Since tissue obtained from the CUSA may represent the bulk of the specimen, the examination of cytologic smears and especially cell blocks from the tissue that "went down the sucker" and were previously discarded may be quite useful.

From 1978 to 1982, 620 pleural fluid cytology specimens were examined, of which 80 were positive in 64 patients. Of these 64, three (0.5%) specimens had false-positive results. Adenocarcinoma of the lung was the most frequent (25 of 61) primary site, followed by breast (12 of 61), ovary (six of 61), and pancreas (five of 61). Comparing cytology with pleural core needle biopsy specimens in 26 patients, the cytology results were positive in 96%, while the needle biopsy specimens alone were positive in only 69%. Following the diagnoses of malignant pleural effusions, the patients receiving combined chemotherapy and radiotherapy had a mean survival of 328 days, compared with only 79 days for those who received no therapy. In conclusion, cytologic examination of Papanicolaou-stained smears yielded a greater percentage of positive diagnoses than either cell block preparations or pleural needle biopsy specimens. Over the past 25 years, the mean survival after the diagnosis of malignant pleural effusions has shown no improvement.

Cytotechnologists usually assist in smear preparation during radiologic fine needle aspiration (FNA) procedures. An alternative technique is presented that requires neither cytotechnologist participation nor immediate processing. In 111 consecutive patients undergoing FNA procedures, the aspirate was immediately fixed in 50% ethanol. The specimen was refrigerated and later processed in the laboratory as cell block preparations, which often maintained the original histologic architecture, and smears, which demonstrated good nuclear detail without air-drying artifacts. In our patients, this technique was 95% sensitive and 100% specific for the diagnosis of malignancy.

The authors report on the cytologic features of six cases of poorly differentiated "insular" carcinoma (IC) of the thyroid, a recently described variety of thyroid tumor intermediate between well-differentiated and anaplastic neoplasms. It is characterized by trabecular and/or alveolar growth patterns, merging with follicular areas, and by the absence of pleomorphism in the tumor cells. Fine-needle aspiration biopsy (FNAB) materials (both smears and cell-block preparations) from six patients were reviewed after the diagnosis of IC was confirmed on the surgical specimen. The following cytologic features were consistently found: high cellularity and necrotic background; low grade of atypia; trabeculae and/or clusters, possibly associated with microfollicles, of cells with poorly defined cytoplasm; and cytoplasmic vacuoles containing thyroglobulin. Nuclear inclusions and grooving of the nuclear surface were additional features. Preoperative diagnosis suggestive of IC might be of value for planning surgical treatment and subsequent therapy.

In order to further evaluate the utility of fine needle aspiration biopsy (FNAB) cytology for the diagnosis of hepatocellular carcinoma (HCC), we analyzed 39 cytologic features in a series of 102 FNABs from HCC and compared them with 28 FNABs from nonneoplastic conditions. Thirteen features were significantly associated with HCC; from them a stepwise logistic regression analysis selected the three most predictive: irregular arrangement, irregular chromatin pattern and uniformly smaller cytoplasm, the last two found only in HCC. Using different specific combinations of significant cytologic features, the highest sensitivity obtained was 84.3%, with 100% specificity. Sixteen HCC cases could not be diagnosed specifically using the criteria defined in this study, probably due to their well-differentiated nature or to sampling error. Although the use of additional techniques, such as cell block preparations, would improve the results in well-differentiated tumors, we recommend basing the early diagnosis of small HCC on a multidisciplinary approach.

Made available in DSpace on 2022-04-29T08:42:17Z (GMT). No. of bitstreams: 0 Previous issue date: 1987-11-03 A review was made of 138 sputa, 4 bronchial washings and 4 bronchial aspirates from 64 patients with pulmonary tuberculosis. The cytologic findings that may indicate granulomatous involvement were epithelioid cells, giant cells, lymphocytes and a necrotic background. Cell-block preparations stained by the Ziehl-Neelsen technique gave a positivity for acid-fast bacilli similar to that of bacterioscopy. This study emphasizes the potential diagnostic value of inflammatory alterations, even when the main objective of pulmonary cytology is the diagnosis of neoplasia; the finding of epithelioid cells and giant cells in a necrotic background may indicate a specific granulomatous involvement. Department of Pathology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, Sao Paulo 18600

From 1978 to 1982, 620 pleural fluid cytology specimens were examined, of which 80 were positive in 64 patients. Of these 64, three (0.5%) specimens had false-positive results. Adenocarcinoma of the lung was the most frequent (25 of 61) primary site, followed by breast (12 of 61), ovary (six of 61), and pancreas (five of 61). Comparing cytology with pleural core needle biopsy specimens in 26 patients, the cytology results were positive in 96%, while the needle biopsy specimens alone were positive in only 69%. Following the diagnoses of malignant pleural effusions, the patients receiving combined chemotherapy and radiotherapy had a mean survival of 328 days, compared with only 79 days for those who received no therapy. In conclusion, cytologic examination of Papanicolaou-stained smears yielded a greater percentage of positive diagnoses than either cell block preparations or pleural needle biopsy specimens. Over the past 25 years, the mean survival after the diagnosis of malignant pleural effusions has shown no improvement.