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Cytologic results of preoperative fine-needle sampling (FNS) of 15 salivary basal-cell tumors are presented, described, and compared with histologic results. Eleven of the FNAS showed individual and clusters of homogeneous basaloid cells with scanty cytoplasm, occasional peripheral palisading, and naked nuclei and were diagnosed as basal-cell adenoma. Four samples showed, in addition, three-dimensional cell clusters with mild cytonuclear atypia, occasional mitosis, and/or focal necrosis and were diagnosed as basal-cell adenocarcinoma. Basal-cell tumors must be diagnostically differentiated from adenoid cystic carcinoma and metastatic basal-cell carcinoma. Although the adenomas diagnosed by cytologic examination and four suspected carcinomas in our series were verified by histologic testing, the bland cytologic features of basal-cell adenocarcinoma may not always allow diagnosis on cytologic examination.

Fine-needle samplings (FNS) of 21 salivary duct carcinomas, histologically correlated, including 19 primaries, one local recurrence, and one lymph node metastasis from 19 patients, are reported. Cytologic diagnosis of high-grade adenocarcinoma was established in 15 (71%). Five (24%) cases were misclassified as high-grade mucoepidermoid carcinomas and one (5%) as squamous-cell carcinoma. The histologic evaluation in all cases showed cytomorphologic features resembling mammary duct carcinoma with marked cytonuclear atypia and occasional oncocytic appearance. Our cytohistologic correlations indicate that irregular clusters of high-grade adenocarcinoma cells with necrotic background and oncocytic features suggest a cytologic diagnosis of either primary salivary duct carcinoma or metastatic mammary carcinoma.

We retrospectively compared fine-needle samplings (FNS) from two recently individualized low-grade papillary salivary carcinomas, polymorphous low-grade adenocarcinoma (PLGAC) and papillary cystadenocarcinoma (PCAC), to define the cytologic criteria allowing the correct diagnosis. Twelve PLGACs in 10 patients and 5 PCACs in 4 patients were investigated by FNS preoperatively. In both entities, smears contained variable proportions of malignant cells, occasionally arranged in pseudopapillary formations. In contrast to PCAC, PLGAC showed stromal fragments and hyaline globules resembling pleomorphic adenoma or adenoid cystic carcinoma. Cytologic diagnoses of malignancy were established in 10 (83.3%) PLGACs and in 4 (80%) PCACs. Two (16.7%) PLGACs were misdiagnosed as pleomorphic adenoma, and 1 (20%) PCAC as a salivary cyst.

BACKGROUND. The early diagnosis of nonpalpable breast lesions is a medical challenge because of the low specificity of different radiologic modalities. Fine-needle aspiration cytology (FNAC) assisted by a stereotactic guidance is an adjunctive diagnostic approach in the management of these lesions. The primary purpose of this article was to assess the diagnostic accuracy of FNAC in patients with nonpalpable breast lesions. METHODS. Three hundred and seventy-one lesions from 357 patients (all female) underwent FNAC using the stereotactically guided technique. Of these cases, 243 lesions from 238 patients subsequently were acquired by surgical excisional biopsies and formed the basis of this study. Statistical analyses of the cytologic and the histologic diagnoses of these cases were performed. RESULTS. Histologically, 107 lesions (44%) were benign and 136 lesions (56%) were malignant. Of the 136 malignant lesions, cytology was concordant in 73 lesions (53.7%), suspicious in 15 lesions (11.0%), false-negative in 12 lesions (8.8%) (benign), and unsatisfactory in 36 lesions (26.5%). Among the 107 benign lesions, cytology was concordant with histology in 75 lesions (70.1%), whereas 4 lesions (3.7%) and 28 lesions (26.2%) were cytologically suspicious and unsatisfactory, respectively. No false-positive cytologies were found in the current series. CONCLUSIONS. The current prospective study indicates that mammography combined with FNAC provides an accurate and practical diagnostic approach for the majority of nonpalpable lesions. Patients with unsatisfactory and false-negative lesions should undergo excisional biopsy. Cancer (Cancer Cytopathol) 1998;84:77-83.

Purpose : Prospective investigation of spontaneous and in vitro radiation-induced apoptosis to predict early response to palliative radiotherapy in patients with non-Hodgkin's lymphomas. Patients and methods : Fine-needle sampling was performed in 28 tumor sites (26 patients) and yielded adequate cell numbers in 27 cases. Apoptotic cells were counted by fluorescence microscopy immediately after sampling and after 24-h culture (spontaneous apoptosis) and 24 h after 2- and 10-Gy in vitro irradiation (radiation-induced apoptosis). Early response to low-dose in vivo radiotherapy (mostly 4 Gy in two fractions over 3 days) was evaluated 15 days after treatment. Results : The tumor response rates at 15 days were 11 (39%) complete responses, nine (32%) responses of greater than 50% reduction in volume, six (21%) responses of less than 50% reduction in volume and two (7%) cases of no response. Tumors achieving complete or major response after in vivo irradiation had higher percentages of apoptotic cells after in vitro irradiation, while no significant differences in terms of spontaneous apoptosis were observed between responders and non-responders. Conclusion : Spontaneous and in vitro radiation-induced apoptosis can be easily and quickly assessed on cells obtained by fine-needle sampling of non-Hodgkin's lymphoma lesions. The present results suggest that in vitro radiation-induced apoptosis could be used as a predictive assay of early response to low-dose in vivo irradiation in patients with non-Hodgkin's lymphomas.

Fine-needle sampling (FNS) of 75 adenoid cystic carcinomas, including 44 primary tumors, 18 local recurrences, 10 lymph node, and 3 distant metastases, was performed in 66 patients. Concordant cytologic diagnoses were established in 68 tumors (90.7%), whereas 4 (5.4%) were classified as malignant (adenocarcinoma), 1 (1.3%) as suspicious, and 1 (1.3%) as pleomorphic adenoma. The material was insufficient for cytologic evaluation in 1 (1.3%) tumor. Adenoid cystic carcinoma is, in our opinion, easy to diagnose using the FNS technique.

Fine-needle sampling (FNS) of 71 Warthin's tumors was performed preoperatively in 70 patients. Cytologic diagnoses were concordant with histology in 50 (70.4%) tumors, whereas 14 (19.7%) cases were cytologically misclassified as benign lesions. Material for cytologic evaluation was unsatisfactory in seven (9.9%) cases, and no suspicious or false-positive diagnoses were observed. FNS is therefore a reliable preoperative technique for assessment of Warthin's tumor with a concordant/benign diagnostic rate of 90.1%.

The diagnosis of a case of childhood orbital granulocytic sarcoma, initially classified as a poorly-differentiated malignant tumor, was finally considered at the time of relapse following primary treatment with chemotherapy and local irradiation. At this time, systematic cerebrospinal fluid examination showed numerous blast cells with Auer rods, consistent with the diagnosis of meningeal acute myeloid leukemia of M2 type, and concomitant biopsy of the tumor indicated the diagnosis of chloroma. Reevaluation of the primary biopsy confirmed this diagnosis.

Fine-needle sampling was performed in a woman with a left breast lump. The cytologic diagnosis was consistent with a poorly-differentiated carcinoma. Cytologic features included medium-to-large, round, and spindle-shaped cells with scanty cytoplasm, nuclear molding, and rosette-like structures. Histology revealed an endocrine pattern. Immunohistochemical staining was positive for epithelial and neuroendocrine markers, and electron microscopy showed many small membrane-bound electron-dense granules, confirming the diagnosis of breast carcinoma with neuroendocrine differentiation. DNA flow cytometry and cytogenetic analyses revealed a near-tetraploid tumor.

Background. Quantification of tumor vascularization recently has been shown to a parameter of potential clinical significance. Several basic and clinical studies have demonstrated that tumor growth correlates significantly with angiogenesis. Methods. To determine the utility of quantification of tumor vascularization and mitotic index for the pathobiologic assessment of head and neck squamous cell carcinoma, a prospective study of 114 consecutively recruited primary neoplasms was performed. Tumors were also studied for differentiation, keratinization, nuclear atypia, growth pattern, inflammation, desmoplasia, vascular tumor emboli, and DNA content. Results. In this cohort, tumor vascularization was correlated with mitotic index (P < 0.001), nuclear grade (P = 0.03), presence of tumor emboli in the peripheral microvessels (P = 0.05), and lymph nodal status (P = 0.03). A strong relationship between poor differentiation and high N classification (P < 0.001), differentiation and keratinization (P < 0.001) and tumor cell emboli and clinically involved lymph nodes (P = 0.01) was also observed. Emboli were more rare in laryngeal and oropharynx/oral cavity tumors than in hypopharynx/epilarynx (P = 0.02). Conclusions. This study indicates that tumor vascularization, differentiation, and tumor emboli in peripheral microvessel network are important histologic parameters in the assessment of squamous cell carcinoma of the head and neck. Cancer 1995;75:1649-56.

• Basaloid squamous carcinoma (BSC) is a rare distinct variant of squamous cell carcinoma of the head and neck region. This entity may commonly pose diagnostic difficulties, especially on small biopsy material. We report the clinicopathological characteristics of 12 new cases and compare their immunohistochemical features with those of solid adenoid cystic carcinomas and conventional squamous cell carcinomas. Our results show that neoplastic BSCs and squamous cell carcinomas do not react to vimentin and S100 protein, while adenoid cystic carcinomas manifest both. The BSCs, however, are S100 protein—positive in intratumoral dendritic Langerhans' cells that are lacking in squamous cell and adenoid cystic carcinomas. Our findings indicate that the immunohistochemical differences between BSC and adenoid cystic carcinoma could assist in their differential diagnosis. ( Arch Otolaryngol Head Neck Surg. 1993;119:887-890)

Afin de determiner si le statut du ganglion sentinelle (GS) axillaire dependait du phenotype des cancers du sein, nous avons analyse une serie de 318 cas consecutifs de carcinome canalaire infiltrant (CCI) et 52 cas de carcinome lobulaire infiltrant (CLI). Le GS a ete classe comme metastatique si des cellules carcinomateuses etaient detectees par l’examen des preparations histologiques standard, et comme porteur d’une metastase occulte lorsque les cellules tumorales etaient detectees seulement apres etude immuno-histochimique (IHC) de sections histologiques seriees. Nous avons compare l’etat du ganglion sentinelle avec le type histologique, la taille de tumeur et le grade histologique. Le taux des GS metastatiques etait de 28 % (89 sur 318) pour les CCI, et 19 % (10 sur 52) pour les CLI. Par contre le taux de metastases occultes etait de 6 % (18 sur 318) pour les CCI et 21 % pour les CLI (P a 15 mm (P = 2,10-3). Par contre, le taux de taux de metastase occulte etait independant de la taille tumoral : 9 %, 6 % et 9 % dans ces groupes, respectivement. De la meme facon, le taux de GS metastatique etait dependant du grade histologique (19 % (37 sur 200) dans grade I, 32 % (41 sur 128) dans les grades II et de 53 % (21 sur 40) grade III) (P = 5,10-3) alors que le taux de metastases occultes etait sans difference significative dans ces groupes (7 %, 10 % et 3 % respectivement). Notre etude montre que l’incidence des metastases occultes des GS axillaires ne depend pas de la taille ni du grade du carcinome mammaire. Ceci suggere que l’extension metastatique des cancers invasifs debute precocement. Par ailleurs, l’IHC est recommandee pour definir le statut des GS en aval des CLI etant donne le taux eleve (20 %) de metastases occultes dans ce type de cancer.

Our study assessed the diagnostic performance of ultrasound (US)-guided fine needle aspiration (USFNA) in non- palpable breast lesions (NPBLs) and correlations between ultrasound, cytological and histological presentations of underscored (i.e malignant BI-RADS 3) and overscored (i.e benign BIRADS 4C and 5) NPBLs. Between 2003 and 2007, 3865 consecutive USFNA of NPBLs were performed and recorded at the Institut Curie. Clinical data, breast-ultrasound, cytology and pathology records for each NPBL were retrieved and analyzed. USFNA's sensitivity, specificity were respectively 0.93 (95% CI =[0.91,0.94) and 0.97 (95% CI = [0.96,0.98]). The best diagnostic performance was found in under50-year old patients and low BI-RADS categories.High-grade invasive carcinomas and specific types of carcinomas, represented most underscored NPBLs and were easily diagnosed at USFNA: in these cases USFNA alone can suffice to establish a diagnosis. Performance was lowest in cancers with very low mitotic counts, and among over-scored NPBLs, in epithelial and fibrous proliferations, intraepithelial proliferations, papillomas and benign tumors. These categories represented most over-scored NPBLs.These presented specific US features of shape, ultrasound pattern and posterior US-beam transmission to identify them. We therefore suggest using USFNA and core-needle biopsy in conjunction in higher BI-RADS categories, especially when such specific findings are found before biopsy.; Notre étude évaluait la performance diagnostique de la cytoponction mammaire échoguidée (CME) dans les lésions mammaires non-palpables (LMNP) et les corrélations échographiques, cytologiques et histologiques des LMNP sous-estimées(BI-RADS 3 malignes) et sur-estimées (BI-RADS 4C et 5 bénignes). Entre 2003 et 2007, 3865 CME consécutives étaient réalisées sur des LMNP à l’Institut Curie. Les données cliniques, d’imagerie, de cytologie et d’histologie ont été revues et analysées. La sensibilité et la spécificité de la CME étaient de 0.93 (IC95%=[0.91,0.94) et 0.97 (IC95%=[0.96,0.98]) respectivement. La performance était meilleure pour les patientes avant 50 ans et les catégories BI-RADS faibles. Les carcinomes invasifs de haut grade et certains types histologiques spécifiques représentaient la plupart des LMNP sous-estimées et étaient facilement diagnostiquées en cytologie : dans ces cas la CME peut suffire au diagnostic. La performance était moins bonne pour les carcinomes à très faible index mitotique et, parmi les LMNP sur-estimées, pour les proliférations épithéliales et fibreuses, les proliférations intra-épithéliales, les papillomes et les tumeurs bénignes. Ces typeshistologiques étaient majoritaires parmi les LMNP sur-estimées et présentaient des caractéristiques de forme, échogénicité et transmission postérieure des ultrasons spécifiques. Nous suggérons d’utiliser la CME association avec la microbiopsie dansle prélèvement des LMNP classées dans les catégories BI-RADS élevées, surtout si elles présentent une des caractéristiques spécifiques des lésions surestimées.