Adenoma of the nipple. An unusual diagnosis in aspiration cytology

The cytology of adenoma of the nipple in a fine needle aspirate has so far not been reported. Such a case is described, and the very important cytologic distinction of this lesion from Paget's disease is emphasized.     

Papillary adenoma of the nipple.

Papillary adenoma of the nipple is a benign condition of the nipple that can be confused clinically with adenocarcinoma metastatic to the skin or Paget's disease. Deep biopsy of the nipple is necessary to make a histologic diagnosis. Complete excision of the nipple and the subareolar tissue is sufficient to effect a cure.     

Efficacy of fine needle capillary sampling in the diagnosis of stage III and IV cervical carcinoma

OBJECTIVE: To test the sensitivity of fine needle capillary sampling (FNCS) as compared to scrape cytology in cervical carcinoma, stage III and IV, and to study the quality of material obtained by FNCS. STUDY DESIGN: Prospective. In 48 cases of cervical carcinoma, clinically stage III and IV, FNCS was done along with scrape cytology. The results were compared, considering histopathology as the gold standard. The quality of material obtained by both methods was compared using the parameters background, cellularity and cellular preservation. RESULTS: FNCS had a sensitivity of 87.5% as against 62.5% for scrape cytology. Material obtained by FNCS had a cleaner background and better cellularity and morphologic preservation. CONCLUSION: FNCS is superior to scrape cytology for the diagnosis of stage III and IV cervical carcinoma.     

Cytology of secondary vulvar Paget's disease of urothelial origin: a case report

BACKGROUND: Primary cutaneous Paget's disease of the vulva is an intraepithelial adenocarcinoma most likely arising from a cutaneous stem cell with sweat gland epithelial differentiation or can be of sweat gland origin. Primary vulvar Paget's disease, however, can be mimicked by an internal noncutaneous neoplasm htat has extended to secondarily involve the vulva. Most commonly, this is due to an anal or rectal adenocarcinoma or a urothelial carcinoma. These malignancies may be detected in a vaginal or vulvar cytologic smear. CASE: An 81-year-old woman with a past history of urothelial carcinoma in situ of the bladder presented severalyears subsequent to treatment for bladder cancer with extensive vulvar and vaginal disease, clinically interpreted as primary vulvar Paget's disease involving the vagina. Vaginal cytology showed a high grade malignancy. The patient subsequently underwent radical (total deep) vulvectomy and vaginal excision. Subsequent investigation of her bladder showed recurrent urothelial carcinoma in situ with extensive spread to the vagina and vulva, simulating primary cutaneous vulvar Paget's disease. CONCLUSION: It is important to recognize secondary vulvar Paget's disease, although uncommon, because of the difference in therapy for primary and secondary vulvar Paget's disease. Certain cytologic characteristics in a vaginal or vulvar smear in a patient with suspected vulvar Paget's disease may aid in distinguishing them.     

Adenoma of the nipple. Cytopathologic features

The cytologic appearances of two examples of adenoma of the nipple are described. The cellular samples from both lesions contained large numbers of epithelial cells, which were present both singly and in numerous clusters. The uniform nuclei contained finely distributed chromatin and inconspicuous nucleoli. Some of the cells varied in size and shape; a few had hyperchromatic nuclei. Small amounts of cellular debris, inflammatory cells and hemosiderophages were also present. Adenoma of the nipple can usually be distinguished cytologically from other lesions that may involve the nipple, such as Paget's disease, adenocarcinoma, fibrocystic disease, mammary duct ectasia, intraductal papilloma and chronic subareolar abscess; the cellular features of fibroadenoma, however, overlap those of adenoma and may cause diagnostic confusion. The increasing use of cellular samples obtained from breast lesions underscores the importance of recognizing this uncommon neoplasm and its cytologic manifestations. Adenoma of the nipple can be treated successfully by limited resection, and preoperative recognition will obviate unnecessary extensive surgery.     

Fine needle aspiration cytology diagnosis of cutaneous leishmaniasis in a 6-month-old child: a case report.

BACKGROUND: Skin biopsy and scrape smear examination are the two most commonly employed investigatory techniques in the diagnosis of cutaneous leishmaniasis. Although cases Leishmania lymphadenitis are reliably diagnosed with fine needle aspiration (FNA) cytology, it has not attained popularity in the diagnosis of cutaneous leishmaniasis, and only a few reports are available. CASE: A 6-month-old Kuwaiti child presented with a skin lesion on her left forearm of five months' duration. Both scrape smears and FNA were performed from the lesion. FNA cytology smears showed a rich population of inflammatory cells predominating in lymphocytes and histiocytes and epithelioid cell granulomas. The amastigote forms of Leishmania were noted on the smears. The scrape smears were nondiagnostic. CONCLUSION: FNA cytology can be reliably used in the diagnosis of cutaneous leishmaniasis, especially in dry lesions, where scrape smears are likely to be nondiagnostic.     

Immunocytochemistry on scrape cytology in breast cancer: will it unearth the weaker positives?

OBJECTIVE: To standardize the technique of immunocytochemical (ICC) assessment of estrogen (ER) and progesterone receptor (PR) status in breast cancer by scrape cytology and to compare the results with immunohistochemistry on paraffin blocks. STUDY DESIGN: ICC assessment for ER and PR was done on scrape smears from tissue samples in 200 cases of primary breast cancer. The results were compared to those obtained from immunohistochemical (IHC) evaluation of formalin-fixed paraffin same tissue samples. RESULTS: ER/PR positivity rates as well as staining scores were compared between the scrape smears and tissue sections. The concordance between cytology and histology was 84% for ER and 90% for PR. Both the positivity rates and the staining intensity scores were higher for cytochemistry than for histochemistry. CONCLUSION: The ICC method on scrape smears is a simple test with rapid turnaround time. The sample required is small, and antigen loss due to fixation and processing is minimal. This new method gives a higher yield of hormone receptor positivity and, when used in conjunction with the IHC method, may improve the pickup rate of ER-positive cases, thereby playing an important role in risk stratification and therapeutic decision making in patients with breast cancer.     

The specific features of diagnosis of breast diseases accompanied by the retracted nipple syndrome

By examining 201 patents by currently available radiation (X-ray, ultrasound, and radionuclide) and pathomorphological techniques, the authors consider that benign diseases (nonspecific mastitis, focal fibrosclerosis, pathological secretion appearing as ductal cysts or papillomas, fibroadenomas, gynecomastia, oleogranulomas) and different histological forms of breast cancer (Paget's disease, infiltrating ductal carcinoma, infiltrating and non-infiltrating lobular carcinoma) result in the retracted nipple syndrome. The sensitivity, accuracy, and specificity of various diagnostic techniques used alone or in combination have been calculated. A monitoring system and indications for surgical treatment have been developed. The pathomorphological mechanisms of nipple retraction have been defined.     

Paget's disease of the breast.

Criteria of the morphological diagnosis as well as the histogenesis of the lesions in Paget's disease are presented; the authors claim that the initial lesion occurs in the lactiferous ducts, the skin being secondarily involved. Likewise, the dyskeratotic lesions are considered as secondary to the neoplastic process, either by neoplastic induction or by mobilization and proliferation of cancerous cells from lactiferous ducts. The utility of biopsies in all cases of nipple eczema, and of the histologic investigation of the profound tissues is pointed out. In this way the canalicular starting point in the vicinity of the nipple can be noticed.     

Cytology of abnormal nipple discharge: a cyto-histological correlation

Spontaneous or expressible nipple discharge may occur in palpable and nonpalpable breast lesions. The aim of the study was to evaluate the sensitivity and specificity of nipple discharge cytology in palpable and nonpalpable breast lesions. One hundred and seventy-four nipple discharge specimens were reviewed, of which 82 had corresponding surgical pathology, including 34 palpable breast lesions and 48 nonpalpable breast lesions. There was good correlation between nipple discharge cytology and concomitant fine needle aspiration (FNA) cytology. Nipple discharge cytology is as specific as concomitant FNA cytology but is slightly less sensitive in detecting papillomas or malignant lesions. The sensitivity and specificity of the nonpalpable and palpable breast lesions were similar. Nipple discharge cytology is very helpful in detecting an underlying breast lesion even if the case has no palpable mass in the breast.     

Scrape cytology assessment of margins of lumpectomy specimens in breast cancer

In cases of breast carcinoma in which only lumpectomy is performed, it is necessary to ascertain that the surgical margins were adequate, i.e., free of tumor. Since the histologic methods used for this purpose are either unreliable or very cumbersome, scrape cytology was evaluated as a method for the examination of lumpectomy margins. In 30 cases examined both cytologically and histologically, a very good correlation was found between the two methods. The scrape cytology method has the advantage of being much easier and quicker and is thus recommended for routine use.     

Cytological diagnosis of basal cell carcinoma and actinic keratosis, using Papanicolaou and May–Grünwald–Giemsa stained cutaneous tissue smear

Objective:  Cytology may become the diagnostic method of choice with the advent of new non-invasive treatments for non-melanoma skin cancer, as the sampling technique for cytology entails little tissue disfiguration. The aim of this study was to compare and evaluate the diagnostic performance of scrape cytology using two different cytological staining techniques, and to evaluate additional touch imprint cytology, with that of histopathology of basal cell carcinoma (BCC) and actinic keratosis (AK).
Methods:  We investigated 50 BCC and 28 AK histologically verified lesions, from 41 and 25 patients, respectively. Two separate skin scrape samples and one touch imprint sample were taken from each lesion. The smears were stained with Papanicolaou (Pap) or May–Grünwald–Giemsa (MGG) stains. All cytological specimens were examined in random order by pathologists without knowledge of the histology. Cytodiagnostic results were compared with the histopathological report.
Results:  Scrape cytodiagnosis agreed with histopathology in 48 (Pap) and 47 (MGG) of the 50 BCC cases, and in 26 of 28 (Pap) and 21 of 26 (MGG) AK cases, yielding sensitivities of 96%, 94%, 93% and 81%, respectively. No significant difference in sensitivity between the two staining methods was found but a trend towards higher Pap sensitivity for AK was noted ( P  =   0.10). Touch imprint cytology confirmed histopathology in 38 of the 77 cases of BCC and AK.
Conclusion:  Cytological diagnosis with either Pap or MGG stain for BCC and AK is reliable, and differentiates well between BCC and AK. Imprint cytology proved to be non-diagnostic in half of the examined cases.     

Vulvar Paget's disease. Cytologic and immunohistologic diagnosis of a case

An exfoliative smear from the vagina in a case of vulvar Paget's disease extending into the vagina and urethra was cytologically diagnosed as showing a large cell carcinoma. The malignant cells proved to be Paget cells by comparison of the cytologic specimen with subsequent biopsy specimens and by immunohistochemical studies using antibodies for glandular cytokeratin, epithelial membrane antigen, carcinoembryonic antigen and gross cystic disease fluid protein. These studies demonstrated that the Paget cell is probably of apocrine derivation. Exfoliative cytology and immunohistochemistry of exudative vulvar lesions may be helpful in the identification of Paget cells.     

Conjunctival dysplasia in soldiers exposed to mustard gas during the Iraq-Iran war: scrape cytology.

OBJECTIVE: To describe the conjunctival scrape cytology findings in Iraq-Iran war veterans exposed to mustard gas and to detect malignant transformation at an early stage. STUDY DESIGN: Twenty-two male war veterans (29-54 years old) who were exposed to chemical bombing about 14 years earlier, formed the base of this study. All of them had chronic eye problems, such as dryness, conjunctival scarring and decreased visual acuity. Conjunctival scrape cytology was performed for cytologic study. RESULTS: Among 22 cases of conjunctival scarring, 9 were diagnosed as dysplasia. Mild inflammation and squamous metaplasia were also noted. Squamous cell carcinoma was not identified. CONCLUSION: Conjunctival scraping cytology is useful for the diagnosis of dysplasia in soldiers exposed to mustard gas during of the Iraq-Iran war. This method is also effective for follow-up study.     

Primary malignant melanoma of uterine cervix: a rare entity diagnosed on fine needle aspiration cytology – report of a case

Primary malignant melanoma of uterine cervix is a rare neoplasm. Its diagnosis on cervical fine needle aspiration cytology, a first of its kind in the literature, has been reported. Although cervix is a rare site for melanoma, cytopathologists should be familiar with it and be able to diagnose this entity on cervical cytology when pigment containing tumour cells are present. In a patient with visible growth on cervix, fine needle aspiration cytology may prove to be a useful diagnostic tool, especially when cervical smear/scrape cytology is non-diagnostic.     

Pain in Paget's disease: a retrospective study of treatment efficacy

The authors addressed the role and the management of pain in Paget's disease by a retrospective study. The objectives were: to assess the presence of pain in Paget's disease; to look for a relationship between pain and the levels of total alkaline phosphatase (total ALP); to verify if the most commonly used drugs in Paget's disease, calcitonin and bisphosphonates, were able to reduce the pain and the levels of total ALP. The study analyzed 107 Italian patients with Paget's disease who were hospitalized at the same Institute between 1970 and 2010; all patients affected by severe arthritis were excluded. From the analysis of the clinical records it emerged that as many as 85% of patients had pain and that total ALP was also increased in most of the patients with pain in comparison with patients without pain. The clinical and metabolic effects of different therapies were then assessed: many patients had not received any specific therapy (58%), others had been treated with calcitonin (25%) and others with bisphosphonates (17%). In fact, the patients treated with bisphosphonates had significantly lower levels both of pain and total ALP. The authors hypothesize that the pain in Paget's disease has a primary origin and is correlated to the degree of bone metabolic hyperactivity. Finally, treatment with bisphosphonates appeared to be the most appropriate treatment, having been able to control both the pain and the metabolic hyperactivity.     

Diagnostic imaging and histologic background of nipple discharge -- our experience with 40 patients

The authors present the diverse etiology of nipple discharge, which background may be a tumor. They discuss the checkup ways of nipple discharge and review in detail the galactographic technique and evaluation. The examination of pathologic nipple discharge is essentially based on contact cytology, x-ray-, and ultrasound mammography. Consequently, galactography is applied by filling the ducts with contrast material. The final diagnosis is rendered by histologic examination, following the operation. The authors demonstrate the application and role of galactography through various cases.