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This report details a fine-needle aspiration biopsy performed in the investigation of two right breast nodules in a patient with previous history of lumpectomy for infiltrating ductal carcinoma in the same breast 3 years before. Because the cytology was atypical for a mammary carcinoma and cells did not match the morphology of the previous breast carcinoma, a tissue biopsy was recommended, revealing the presence of metastasis from a previously silent primary renal-cell carcinoma. This report illustrates not only how metastatic lesions in the breast can masquerade clinically as a primary carcinoma but also the necessity for the cautious approach to interpreting the fine-needle aspiration biopsy of these lesions. Furthermore, essential guidelines necessary to distinguish primary from metastatic lesions in the breast are presented.

The Bethesda System categorizes atypical parakeratosis (APK) as "ASCUS or SIL depending on the degree of cellular abnormalities." APK, however, is not well-defined. We retrospectively reviewed 68 cervicovaginal specimens with follow-up material to identify specific criteria and clinical significance of APK. APK cells were small cells, 2-3 times the diameter of neutrophil, with dense, orangeophilic cytoplasm, high nuclear cytoplasmic ratio, dense, often uneven chromatin, and irregular nuclear contour. Of 62 cases with APK, 37 had accompanying dysplastic cells. Of 25 cases with APK alone, follow-up revealed 12 with squamous intraepithelial lesion (5 HSIL and 7 LSIL) and 13 with benign changes. A major diagnostic pitfall of APK was inflammation with degeneration. Abundant APK cells, minimal inflammation and degeneration, and previous history of dysplasia frequently were associated with follow-up SIL. The findings of this study identify APK as an important marker for dysplasia that warrants careful evaluation and follow-up.

Exfoliative cytologic studies directed toward atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) have been neglected in the rising postmenopausal population. This retrospective study from 60 cases, initially interpreted as ASCUS or LSIL, concentrates on these lesions and their associated diagnostic pitfalls. Cytologic reevaluation of the 60 patients revealed squamous-cell abnormalities in 45 (18 ASCUS and 27 LSIL) and cervicitis alone in 15 cases. Follow-up studies of the 18 ASCUS cases showed cervicitis in seven, persistent ASCUS in five, CIN I in five, and VAIN I-II in one. Follow-up of the 27 cases categorized as LSIL, showed ASCUS in two, CIN in 20 and VAIN in one, while four had cervicitis alone. Interestingly, two of these 45 patients had only vaginal dysplasia. By application of uniform diagnostic criteria, 15 of the 60 cases were reviewed as benign. Pitfalls included inflammatory and drying alterations, reactive metaplasia, and sampling problems. Thus, squamous-cell abnormalities in postmenopausal women can be significant when artifactual alterations are eliminated.

This is a retrospective review of 74 colonic brushings with a view to identify colonic adenomas and recognize the cytologic features of villous adenoma (VA) and tubular adenoma (TA). Smears were reviewed for overall field pattern as well as individual cellular changes. The results were tabulated and analyzed for differences and similarities. The most distinguishing feature of adenoma was the presence of isolated and clustered elongate "needle" and "fan" cells as first described by Thabet. These were more abundant and in papillary cluster formations in VA as opposed to clusters of more blunted configuration in TA. Another striking feature of VA was an abundance of elongated benign naked needle nuclei in the background. Smears from some cases of TA revealed isolated and clustered needle cells in low numbers but almost no naked nuclei. Tubulovillous adenoma (TVA) showed features of VA on brush cytology. A hemorrhagic diathesis was distinctly more prominent in VA than in TA. However, focally some red cells were noted in smears from TA. The patterns of TA and VA were otherwise essentially similar with regard to cellularity, individual cell sizes, N/C ratios, and nuclear appearance.

Urinary cytology is a well-accepted diagnostic procedure for bladder carcinomas but it is utilized less frequently for diagnosis of upper urinary tract tumors. Accurate diagnosis depends on a suitable specimen as well as knowledge of diagnostic traps. This review article with several case studies emphasizes the various techniques used to obtain optimal samples, correct interpretative criteria, and diagnostic pitfalls. Technological advances for objective grading and predicting the biological behavior of tumors are also discussed.

To evaluate the usefulness of transbronchial needle aspiration biopsy (TBNAB) in the primary diagnosis of lung cancer, we undertook a prospective study of this technique, assessing specimens from 124 patients over a 3-yr period. Cytologic and/or histologic material obtained by an alternate technique was available for 105 (84.7%) of the patients. The diagnostic sensitivity of TBNAB was comparable with that of other bronchoscopic techniques; with the addition of TBNAB, the overall sensitivity of bronchoscopy was increased from 54% to 72% (P less than 0.001). Because of its usefulness for diagnosis of submucosal tumors and its safety, we conclude that TBNAB is a useful addition to current methods for the diagnosis of suspicious pulmonary lesions.

In this retrospective evaluation of 72 cases of fine needle aspiration biopsy of the prostate, 25 aspirates from well-differentiated carcinoma were compared with 27 aspirates from benign prostatic enlargement and 20 aspirates from moderately to poorly differentiated carcinoma. Each case was examined by a single observer (V.K.) for multiple parameters including cellularity, dyshesion, nuclear membrane irregularity, anisonucleosis, macronucleoli (major criteria of malignancy), cell and nuclear enlargement, and altered nuclear/cytoplasmic ratio. Cellularity was the most significant indicator, but all major and minor criteria of malignancy were consistently important for distinguishing well-differentiated carcinoma from benign lesions. Systematic use of these meaningful standards enhances diagnostic sensitivity.

This work is based on 15 years experience with more than 9000 needle aspiration biopsies from the breast performed by a number of clinicians without syringe guns. From 1981 through 1983, 329 carcinomas were detected with a sensitivity of 90%. A positive or suspicious report was issued in 17 of the 32 minimal carcinomas. There were no false-positive diagnoses. A retrospective comparative study was made on the aspiration biopsy cytology specimens from 65 histologically verified carcinomas: 30 infiltrating ductal, 16 infiltrating lobular, 10 medullary, and 10 colloid carcinomas. Parameters included the pattern, major malignant criteria, and cell measurements by calibrated ocular micrometry. The classic features of each carcinoma and the differential cytomorphology are described.

Aspiration biopsy cytology by fine needle is becoming a popular diagnostic procedure for soft-tissue lesions; it also can be used successfully to diagnose some lesions from bone. The value of this procedure for making the initial diagnosis is illustrated by a case in which a malignant fibrous histiocytoma from a skull bone afflicted with Paget's disease was aspirated and interpreted as a sarcoma. This was later confirmed and subclassified by histology and electron microscopy from the tissue.