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During the years 1975-1988, twenty lung cancer patients with symptomatic pericardial effusion were treated conservatively at our center. Echocardiography demonstrated small pericardial effusion in 2 patients, medium size effusion in 3 patients and large amount of fluid in 15 patients. Fifteen patients developed cardiac tamponade; in three of these patients, this was the presenting manifestation of lung cancer. Pericardiocentesis resulted in prompt, though temporary, symptomatic relief in all patients. Fluid cytology demonstrated suspected malignant cells in 2 patients and malignant cells in 13 patients. Based on cytology, the diagnosis of adenocarcinoma was established in six patients, small cell carcinoma in three patients, and epidermoid carcinoma in one patient. All patients were dead within 9 months from the time of diagnosis of pericardial effusion; 17 died within less than 3 months. It is concluded that pericardial effusion in lung cancer is indicative of rapid tumor progression and short survival. Fluid cytology provides an immediate and accurate means of diagnosis.

The aim of the present study was to determine the diagnostic accuracy of ultrasonically guided fine-needle aspiration for liver lesions detected by ultrasound scan. A total of 142 aspirations were carried out in 129 patients with unifocal or multifocal liver lesions suspected of malignancy. The aspiration was made with a 22-gauge needle, guided by ultrasound. Based on histological, cytological, and clinical findings, final diagnoses were reached in 123 patients, 96 of whom had malignant liver disease and 27 benign liver disease. Among the 96 patients with malignant liver disease, the cytological findings revealed malignancy in 78 patients (81.3%) and suspected malignancy in five patients (5.1%), but failed to demonstrate malignancy in 13 patients (13.3%). Among 27 patients with benign liver disease, all the cytological findings indicated benignancy. The overall sensitivity, specificity, and positive and negative predictive values for cytological findings were 86.5%, 100%, 100%, and 76.9%, respectively. The diagnostic accuracy of ultrasonically guided fine-needle aspiration was 89.4%. In one patient with incipient chronic disseminated intravascular coagulation, a fatal intraperitoneal bleeding complicated the procedure. We conclude that ultrasonically guided FNA for cytologic diagnosis of liver lesions is highly accurate and is only rarely associated with fatal complication.

The aim of the present study was to describe our experience from 1976 through 1988 with fine needle aspiration (FNA) cytology of pancreatic lesions in 90 patients. Fine needle aspirations were performed preoperatively under ultrasound guidance (USG) in 46 patients, under computed tomographic guidance (CTG) in seven patients, and intraoperatively in 37 patients. Based on histologic, cytologic, and clinical findings, final diagnoses were reached in 80 patients, of whom 62 had malignant pancreatic disease (MPD) and 18 had benign pancreatic disease (BPD). The accuracy of cytologic diagnoses was verified by histologic, cytologic, and clinical findings. In 62 patients with MPD, the cytologic findings suggested malignancy in 54 patients, suspected malignancy in five, and did not reveal malignancy in three patients. Among 18 patients with BPD, all of the cytologic findings were reported as benign. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for intraoperative FNA cytologic results were 96%, 100%, 100%, 91%, and 97%, respectively, and for USG FNA cytologic results were 94%, 100%, 100%, 78%, and 95%, respectively. No complications followed the procedure.Both transabdominal percutaneous imaging-guided and intraoperative FNA cytology of pancreatic lesions are simple, safe, and highly accurate methods in differentiation of benign from malignant pancreatic lesions.

We report a 63-year-old woman who presented with anemia and a left kidney mass. Guided fine-needle aspiration of the mass revealed extramedullary hematopoiesis and enabled avoiding an unnecessary operation. Subsequent bone marrow biopsy demonstrated myelofibrosis. Twenty-four months later the mass remained stable.

Histologic and cytologic preparations from the saline rinsings of the Menghini biopsy were obtained from 193 patients with a variety of liver diseases. The results were analyzed to determine the sensitivity, specificity, and overall accuracy of the histologic, cytologic, and of the two combined methods. Thirty-four patients had malignant liver disease (MLD), whereas 159 patients had no evidence of MLD. Malignant neoplasms were detected by cytology alone in five patients, by histology alone in 15 patients, and by both histologic and cytologic findings in six patients. Liver cancer was not diagnosed by both methods in eight patients. The sensitivity of the cytologic, histologic, and combined cytologic and histologic results for detecting malignancy were 32.4%, 61.8%, and 79.4%, respectively, whereas the specificity was 100% for all methods. The overall accuracy was 88.1%, 93.2%, and 95.5%, respectively. This study demonstrates that cytologic examination of the fluid obtained by liver needle biopsy (LNB) has a high specificity and low sensitivity that increased the diagnostic yield of histology alone for detecting MLD by 14.7%.

A patient with epithelial ovarian carcinoma, who developed meningeal carcinomatosis, is hereby presented. A review of the literature revealed that only a few cases of this entity have been reported. With the prolonged survival of ovarian cancer patients treated by combination chemotherapy, it is expected that meningeal involvement will be found more often.

In a pilot study, 21 patients underwent transbronchial fine needle aspiration (TBFNA) using a 45 cm-22 gauge needle guided by means of a semi-rigid metal sleeve, which was introduced through a standard rigid bronchoscope. A total of 33 aspirations were performed from main carina (15), paratracheal (five), and lobar carinal (13) foci. Six aspirations yielded malignant cellular samples, 22 aspirations presented only normal cells, and in five no adequate cellular sample was obtained. Fifteen patients underwent surgical exploration (mediastinoscopy with or without thoracotomy). Four of the cytologically malignant cases were explored and in three the aspiration site was confirmed histologically. In the remaining patients where the site of aspiration was explored, no tumour was demonstrated in the cytologically negative or cytologically inadequate cases. There were no complications from TBFNA. We suggest that TBFNA is useful in determining mediastinal malignant involvement rapidly and with lesser invasion than with current techniques.

A case of intraorbital adenocystic carcinoma, which was diagnosed preoperatively by means of fine needle aspiration, is described and discussed.

Four initially misdiagnosed cases of thyroid cancer or purported thyroideal malignancy are described. In each, aspirative cytology was instrumental in establishing the true nature of the lesion.

Solcoderm, a liquid preparation developed in the USSR, is recommended for topical treatment of benign and malignant skin tumors. We present 5 out of 25 patients treated in our department over the past 2 years who had been treated with Solcoderm for malignant skin tumors. The preparation appeared to have affected only the superficial layers of the tumor and had not penetrated in depth. Cellular remnants tended to spread far beyond the confines of the original tumor and seemed to become much more aggressive. To be effective, the technique of applying the drug would have to be much more complicated than originally specified. Both the functional and esthetic results are much worse than expected.

While examining fine needle aspirates of lesions, it became evident that preovulatory aspirates differed from postovulatory ones. Proliferation activity was noted in cells and in fragments aspirated during the luteal phase. In order to verify this observation, pairs of smears obtained during different phases of the menstrual cycle from eight fertile women were studied by computer image analysis. Using discriminant analysis based on nuclear features extracted from the digitized cell images, 84.87% of all cells were correctly classified as preovulatory or postovulatory, according to the smear of origin. When the classification was restricted to only the cells from each woman, a 100% correct identification of cell types was obtained, which supports the visual observation that there are cellular changes in the mammary epithelium correlated to the menstrual cycle. Since some proliferative changes may mimic atypia or malignancy, these findings suggest that it is advisable to perform needle aspirations of breast lesions during the preovulatory phase of the cycle.

Our existing cytologic and radiologic service enabled us to introduce transthoracic fine needle aspiration cytology (FNAC). The results of 301 aspirations on 221 patients during the first three years and the histologic, hematologic or clinical correlations are presented. Cytologically, 127 cases were reported positive for malignancy. No false-positive diagnosis was made. Most cases reported as suspicious for or suggestive of malignancy were also found to be malignant. In 23 cases (18%), the cytologic diagnosis of malignancy was made only upon repeated aspiration. Half of the cases reported as "insufficient" or "negative" on the first aspiration attempt were subjected to repeat aspirations, yielding representive samples in 57% of theses cases. FNAC helped to isolate cases of small-cell undifferentiated carcinoma and lymphoma as well as metastases from a group of patients presenting radiologic and clinical symptoms of malignancy and thus was instrumental in establishing proper treatment and preventing contraindicated surgery. It is suggested that in cases considered inoperable, where exfoliative cytology has failed, transthoracic FNAC, rather than bronchoscopy, mediastinoscopy or thoracotomy, should be applied.

A comparative cytologic-histologic study of 107 lesions clinically suspected of being basal-cell carcinomas was conducted. Good correlation was found in 94.3% of the cases. This study indicated that needle aspiration cytology could be utilized for the preoperative and follow-up diagnosis of skin lesions clinically suspected of being basal-cell carcinoma. Cellular as well as structural diagnostic criteria are suggested.

Hematopoietic elements were found in breast aspirates from nine women. A complete hematologic work-up did not disclose any hematologic disorder. It was concluded that these findings represent microfoci of extramedullary hematopoiesis without any pathologic significance.

In 170 of 244 fine needle aspiration biopsies of suspicious supraclavicular lymph nodes performed over the course of a decade, the medical records were available for study. In 67 cases aspirations were by the staff of the Cytological Department, while 103 were by the ward and clinic physicians. Among the former about 6% were nonrepresentative, and among the latter 32%. In all cases in which a cytological diagnosis of malignancy was made, it corresponded either to the available histological diagnosis or to the final diagnosis. In all cases with a benign cytological diagnosis, either the available histological diagnosis or the long term follow-up was in accord. The malignant lymph nodes aspirated drained regional as well as distant tumors. 82% (23/28) of the malignant nodes draining distant tumors were on the left side.

The case of a 50-year-old patient is presented, suffering from multiple penetrating basal cell carcinomas of the forehead, left orbit, auricle and scalp. He was first irradiated 25 years ago and since which time the patient has undergone repeated excisions. The orbital lesion which has penetrated deeply has caused blindness of the left eye, necessitating exenteration. Two years ago the patient developed metastases to the hilus of both lungs, which were diagnosed by means of fine needle aspiration. These lesions are spreading notwithstanding radiotherapy.

Auto and homo transplantation of the uterus and ovaries was studied in 40 bitches divided into four groups. Group A served as a control. In group B the omentopexy technique of auto-transplantation was used. This method did not prove very rewarding and all 12 grafts were found to have degenerated and were non-functioning when relaparotomy was performed, 3 months after transplantation. In group C, auto transplantation with vascular anastomosis was performed in 12 dogs, yielding satisfactory results including one successful pregnancy and the delivery of 3 healthy puppies. In group D homotransplantation of the internal genital organs was performed in two sets of twin dogs. No immunosuppressive treatment was used. These grafts survived for a limited period as proved by the functional tests and X-ray examination but after 3 months were found to be necrotic and degenerated. Graft function and viability was established by: X-ray examination, cytology of vaginal smears, the effect of gonadotropins on the grafted ovaries and finally relaparotomy undertaken after 3 weeks and 3 months.

In seven patients with orbital lesions, fine-needle aspiration (FNA) was performed. No complications were seen in performing this procedure. FNA proved to be an important adjuvant method in the diagnosis of orbital lesions, especially in their pre-operative cytologic definition.

During an 18-mo period, 760 palpable mammary lesions were examined and aspirated. When indicated, mammography was performed in addition. Three separate aspirations were performed in each lesion utilizing 23 gauge (0.6 mm) needles. Biopsies were performed following aspiration in 206 lesions; and 470 of the cases in whom biopsies were not performed were followed up clinically for periods of 10 to 26 mo (mean period 15 mo). Accuracy and sensitivity of the cytological examination were found to be far higher than that of clinical evaluation or mammography. Aspiration cytology resulted in only 1.5% false negative, no false positive, and only 1.65% inconclusive reports. On the other hand, clinical evaluation and mammography yielded 35 and 29% false negative, 0.3 and 0.8% false positive, and 6.75 and 8.8% inconclusive findings, respectively. Eleven malignant cases that were considered to be benign both clinically and mammographically, were correctly diagnosed cytologically. Aspiration cytology was found to be the most accurate of the preoperative diagnostic methods.

Fine needle aspiration is emerging as a useful diagnostic tool in the evaluation of tumor masses. This technique provides high diagnostic yield associated with only minimal side effects. Of 500 transabdominal aspirations conducted in our hospital over an 8-year period we have experienced four cases of unusual complications after this procedure. These included bile peritonitis, localized peritonitis and infection, perforation of small bowel, and pneumothorax. The last three cases have not yet been described in the literature as complications of transabdominal aspiration. Analysis of these complications illustrate the importance of careful patient selection and meticulous attention to the proper procedure.

Cytological findings of 100 fine-needle aspirations from thyroid nodules of 83 patients were reviewed and correlated with histological or clinical diagnoses. Diagnostic accuracy of inflammatory lesions, papillary carcinomas and nonfollicular tumors was very high and did not alter significantly after reexamination. The diagnostic accuracy of proliferative follicular lesions improved considerably with experience. There was some overlap in the diagnosis of follicular adenomas and goiters; we did not differentiate between follicular adenomas and carcinomas, both of which were reported as follicular tumors, but all cases of follicular carcinoma were diagnosed as follicular tumors, thus warranting biopsy.

Among 7,650 patients who attended the oral surgery clinic in the Royal Victoria Hospital, Bathurst, Gambia, between February 1964 and March 1965, were 50 young children between the ages of 1 to 6 years who suffered from acute oral necrotizing diseases.These disease processes started with necrosis and ulceration of interdental papillae and often continued to the most severe stage of fulminating necrosis, frequently associated with death. The disease intensity was inversely related to the child's age. A search for oral factors contributing to this condition was made in a survey of the entire child population of 4 Gambian villages. 361 children, 1 week to 5 1/2 years old were examined. Poor oral hygiene and gingivitis were found to be common in these children. Food debris in various amounts were found in 71 per cent of the children over 18 months of age. Periodontal diseases were already found in 9 per cent of the 18 month-old children. In the 3 to 4 year age group, 61 per cent of the children suffered from periodontal diseases which often were of a chronic nature. Bacterial smears showed a high incidence of Vincent's organisms. Systemic factors apparently predisposing to the acute oral necrosis were improper nutrition, debilitation and lowered resistance brought about by endemic infectious diseases.