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Two cases of histologically, immunohistochemically, and ultrastructurally confirmed collecting duct carcinoma of the kidney (CDCK) with positive urine cytology are reported. The patients' urine sediments showed malignant glandular cells in sheets with defined, variable, granular cytoplasm and oval, hyperchromatic nuclei containing micro- or macronucleoli. The cytologic differential diagnosis of CDCK is briefly discussed.

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 Papanicolaou-stained 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.

An exploratory analysis of sputum cytology was conducted to determine the extent and nature of cytomorphologic differences between smokers and nonsmokers. Specifically, alveolar macrophages, pigmentation of macrophages, neutrophils, mucus, mucous spirals, columnar cells, metaplastic cells, and dysplastic cells were analyzed and compared in 349 smokers and 93 nonsmokers. Results indicate that smokers have significantly higher scores on all components than do nonsmokers. Pigmentation of macrophages, alveolar macrophages, and mucous spirals were the major components discriminating between smokers and nonsmokers. A comparison of the nonsmoking sample with a different group of smokers (n = 466) revealed similar findings. Using the cytomorphologic parameters as the basis for classification, discriminant function analysis was able to classify correctly 94 percent of the nonsmokers and 91% of the smokers, a finding confirmed in the second group of smokers. These data indicate that smokers differ reliably from nonsmokers with respect to their cytomorphologic profile.

A small-cell undifferentiated tumor of the bladder in a 69-yr-old man with asymptomatic hematuria is described. Urine cytology showed abundant, small, round-to-oval hyperchromatic cells with coarse chromatin, nuclear molding, and high nuclear/cytoplasmic ratios. A primary cytodiagnosis of small-cell undifferentiated cancer with associated severe urothelial atypia was made. Immunohistochemical stains were negative for neuron-specific enolase, leukocyte common antigen, chromogranin, epithelial membrane antigen, prostatic acid phosphatase, and prostate-specific phosphatase. The diagnosis was confirmed histologically by studies performed on cystoscopic bladder biopsy material.

During the past two years, our laboratory has introduced a semiquantitative membrane filter approach to cerebrospinal fluid (CSF) cytology. Five hundred and thirty-five CSF specimens, averaging 3 ml in volume, were placed over 25-mm diameter Milliporer filters (5-μ pore size) and stained using a modified Papankolaou method. Each microscopic evaluation consisted of a cell count per milliliter, a 100-cell differential, and a diagnostic or interpretive statement. Seventy-four (13.8%) positive, 17 (3.2%) atypical, 439 (82%) negative, and 4(1%) unsatisfactory specimens were evaluated. Seventy-four percent of the positive or atypical CSF specimens had mononuclear cell counts within the medically accepted normal range of five mononuclear cells per cubic millimeter (chamber count method) or 5,000 cells per milliter (cytologic method). The small-filter technique offered advantages because it maximized cell retrieval, localized cells, and shortened the time required for microscopic evaluation. Diagn Cytopathol 1986;2:194-197.

Quality assurance is defined in this article as a comprehensive program aimed at preventing and controlling errors from the time a test is ordered until test results are reported and utilized in the care of the patient. Quality control is only one facet of a total quality assurance program. Recently, the general public, professional organizations, and regulatory agencies have scrutinized the standards and practice of Papanicolaou smear testing. The components of quality assurance for gynecologic cytology are reviewed, and the chain of events in performing effective cytologic testing is described. The impact of various events on the outcome of Papanicolaou smear testing is thoroughly discussed.

Central nervous system (CNS) involvement in Hodgkin's disease is rare, but when the tumor extends into the CNS the route of tumor spread is similar to that seen in non-Hodgkin's lymphoma. Reed-Sternberg cells were identified in the cerebrospinal fluid (CSF) of a patient with Hodgkin's disease involving the CNS. Sequential cytologic examination of the CSF proved valuable in evaluating the efficacy of therapy. The ability to identify Reed-Sternberg cells in the CSF makes CSF cytology a useful adjunct in the management of patients with established or suspected CNS involvement of Hodgkin's disease. Diagn Cytopathol 1987;3:323-5.