Polymorphous low grade adenocarcinoma of the salivary gland. Diagnosis by fine needle aspiration cytology

OBJECTIVE: To describe the fine needle aspiration cytology findings of polymorphous low grade adenocarcinoma of the salivary gland. STUDY DESIGN: The authors reviewed the cytologic findings of 5 cases of polymorphous low grade adenocarcinoma. All cases were confirmed by histologic examination. RESULTS: All cases showed similar cytologic findings. The smears had high cellularity with a population of mixed epithelial and myoepithelial cells. These cells formed branching papillae, sheets and clusters. The epithelial cells were uniform, with round to ovoid nuclei; absent or inconspicuous nucleoli; and a moderate amount of dense cytoplasm. Occasionally the cells formed spherical structures containing hyaline globules. Myxoid matrix, either dispersed in the background or interspersed with the cellular elements, was also seen often. CONCLUSION: Polymorphous low grade adenocarcinoma should be cytologically differentiated from adenoid cystic carcinoma, monomorphic adenoma and pleomorphic adenoma. Recognition of subtle cytologic features. may be useful in the differential diagnosis.     

Adenocarcinoma of the uterine cervix metastatic from primary stomach cancer. Cytologic findings in six cases

The cytologic features of six cases of stomach cancer metastatic to the uterine cervix are presented. Atypical cells were found in cytology samples from four patients. Fewer atypical cells, larger cellular and nuclear areas, more discrete vacuoles, increased frequencies of thickening of the nuclear membrane and more coarsely granular chromatin patterns were the characteristic cytologic findings of metastatic cervical adenocarcinoma as compared with primary endocervical adenocarcinoma.     

Fine needle aspiration cytology of lactating adenoma of the breast. A comparative light microscopic and morphometric study

Six cases of lactating adenoma of the female breast diagnosed by fine needle aspiration (FNA) were reviewed. The FNA cytologic diagnostic features included a usually moderately cellular aspirate with an abundant foamy background material, intact epithelial lobules or acini and small groups and solitary epithelial cells that contained uniform nuclei, fine chromatin and prominent nucleoli. When present, the cytoplasm was finely vacuolated or wispy; many nuclei appeared stripped of their cytoplasm. These features were compared light microscopically with the cytopathologic features of six cases of invasive well-differentiated ductal adenocarcinoma, seven cases of invasive lobular carcinoma, one case of granulocytic sarcoma and one case of primary histiocytic lymphoma of the breast. In addition, cytomorphometric analysis demonstrated no statistically significant differences in the nuclear areas of lactating adenoma as compared with those of well-differentiated ductal carcinoma and lobular carcinoma.     

Diffuse alveolar damage. Morphologic features in bronchoalveolar lavage fluid

OBJECTIVE: To evaluate the overall cytologic characteristics of diffuse alveolar damage (DAD) in bronchoalveolar lavage (BAL) specimens in search of features that could be useful in cytologic diagnosis. STUDY DESIGN: We evaluated BAL samples from patients with DAD obtained simultaneously with transbronchial biopsies (n = 8) or open lung biopsies (n = 2) or within 24 hours of autopsy (n = 2). The material was processed routinely for cytologic and histologic evaluation. RESULTS: The smears were moderately to highly cellular. All cases had large numbers of alveolar macrophages and/or desquamated alveolar cells. The epithelial component displayed various degrees of nuclear atypia. Some epithelial clusters were three-dimensional, with peripheral cells showing clear cytoplasm, protruding outwards and resembling hobnails. Other aggregates appeared two-dimensional, as sheets of cells with flattened and dense cytoplasm (squamotized). Both types of cell clusters were often associated with dense, basophilic or amphophilic, amorphous extracellular material. Counterparts of all the cytologic features were observed in the histologic material, including atypia of the alveolar lining with hobnailing, squamotization, amorphous extracellular material and hyaline membranes. CONCLUSION: The cytologic features of BAL represent a constellation of alveolar cell injury. Based on these features, DAD can be correctly diagnosed or suggested in BAL samples in the appropriate clinical setting.     

Fine needle aspiration biopsy of hepatic focal fatty change. A report of two cases

BACKGROUND: In rare instances, hepatic steatosis produces a circumscribed, nodular lesion described as focal fatty liver change (FFLC). The ultrasonographic and computed tomographic patterns are those of an isointense or hyperechoic nodule, sometimes simultating metastasis. CASES: Fine needle aspiration biopsy was performed under ultrasonographic control in two men aged 65 and 67 years who had previously undergone emicolectomy and gastrectomy for adenocarcinoma. Routine hepatic ultrasound showed solitary nodules, of 3 and 4 cm in diameter. The microscopic patterns were similar and highly cellular in both cases. Cells were isolated or organized in sheets and characterized by large, intracytoplasmic, clear vacuoles that displaced nuclei to the periphery of the cells, flattening them against the cytoplasmic membrane and giving these cells a signet-ring appearance. Nuclei were generally round and nucleolated or dense and hyperchromatic when flattened onto the cytoplasmic membrane. Normal hepatocytes were interspersed in the background, and in some areas of the slides hepatocytes with one or more small intracytoplasmic vacuoles with cytologic features intermediate between those of vacuolated cells and normal hepatocytes were present. Digested periodic acid-Schiff staining, performed on destained, fixed smears, gave negative results. The cytologic diagnosis was FFLC. Clinical and echographic follow-up confirmed the cytologic diagnosis. CONCLUSION: The ultrasonographic and microscopic features of FFLC may mimic those of metastasis. A proper cytologic diagnosis may contribute to the diagnostic workup of these rare lesions.     

Cytologic findings with histologic correlation in 43 cases of mammary intraductal adenocarcinoma diagnosed by aspiration biopsy

OBJECTIVE: To review the cytologic and subsequent histologic findings in intraductal mammary adenocarcinoma (ductal adenocarcinoma in situ) (DCIS) to evaluate the role of aspiration biopsy (AB) in identifying and grading the disease. STUDY DESIGN: AB smears and tissue sections from 43 women with pure DCIS who underwent preoperative AB were reviewed. Smears were assessed for cellularity, cellular arrangement (including dissociation, nuclear size and pleomorphism), and presence of nucleoli and necrosis. RESULTS: Of the 43 cases, 22 were high grade (HG) DCIS, 7 cases were intermediate grade (IG), and 14 cases were low grade (LG). Cytologic findings of HG DCIS was as follows: high cellularity (22/22), clusters of pleomorphic cells with large nuclei and increased nuclear/cytoplasmic ratios (22/22), single cells (20/22), prominent nucleoli (22/22) and necrosis (diffuse in 15/22, focal in 7/22). All LG cases had moderately to highly cellular smears with cohesive, 3-dimensional sheets of uniform, small cells with inconspicuous nucleoli arranged around a central lumen, forming "punched-out" spaces. Single cells were prominent in 2 of 14 cases. IG DCIS showed intermediate features between LG and HG DCIS: 3-dimensional sheets with punched-out spaces, abundant single cells, moderate pleomorphism and focal necrosis. CONCLUSION: HG DCIS is easily identifiable on AB smears; however, distinction from invasive carcinoma may not be possible. The cytologic diagnosis of LG DCIS is difficult, and 50% of our cases were called atypical on AB. Recognition of cohesive cellular arrangements with crowding and punched-out spaces is crucial as single cells and prominent atypia are often lacking.     

Exfoliative sputum cytology in pulmonary embolism

In a prospective, double-blind, randomized study of cytologic changes found in pulmonary infarction, nine roentgenologically proven cases of pulmonary embolism were studied with sputum samples from the 1st to 26th postinfarction days. Maximum atypical cytologic changes were seen during the second and third postinfarction weeks. Specific cytologic features included three-dimensional clusters of glandular cells with enlarged nuclei and macronucleoli: they were malignant-appearing cells except for their inconsistent morphology, fewer numbers, transient appearance and lack of solitary atypical cells. A similar study in a canine model is discussed, and a case of pulmonary embolism with abnormal cytology and corresponding histology is presented.     

Fine needle aspiration cytology of primary pulmonary paraganglioma. A case report

BACKGROUND: Primary pulmonary paragangliomas are rare tumors. To our knowledge, there is no prior report on fine needle aspiration cytology (FNAC) in pulmonary paraganglioma. CASE: A 34-year-old man presented with an incidentally found solitary pulmonary mass. FNAC showed papillarylike clusters of epithelioid cells with round to oval nuclei, evenly dispersed chromatin, micronucleoli and occasional anisonucleosis. These cytologic features were suggestive of a sclerosing hemangioma or bronchioloalveolar carcinoma. A right lower lobectomy revealed a primary pulmonary paraganglioma. CONCLUSION: The possibility of pulmonary paraganglioma should be considered in the differential diagnosis of FNAC showing pseudopapillary clusters of epithelioid cells.     

Cytology of angiosarcoma in effusions

The cytologic and immunocytochemical findings in pleural effusions from three cases of angiosarcoma are presented. In two of the cases, the primary lesion was on the scalp; in the third case, an angiosarcoma of the small intestine developed after radiotherapy for Hodgkin's disease. Single malignant cells and small clusters of cells were seen in cytologic preparations from two cases while only single cells were seen in preparations from one case. The malignant cells had delicate, finely vacuolated cytoplasm with distinct borders. No specific morphologic features were noted. Immunoperoxidase studies revealed binding of Ulex europaeus and reactivity for vimentin in all three cases and expression of Factor VIII-related protein in two of the cases but no expression of epithelial markers. The clinical history and immunoperoxidase studies are necessary to distinguish angiosarcoma from metastatic adenocarcinoma and other malignancies in effusions.     

Cytomorphometry of large cell carcinoma of the lung

A computerized morphometry system was used to evaluate criteria for the cytologic diagnosis of large cell carcinoma (LCC) and poorly differentiated adenocarcinoma of the lung. There were 143 cells measured in six cases of LCC (five sputums and one bronchial washing) and 61 cells in four cases of adenocarcinoma (all sputum samples). Cellular and nuclear areas were significantly larger in adenocarcinoma whereas nucleolar area was greater in LCC, producing a higher nucleolar/nuclear area ratio in LCC. Cellular and nuclear form factors were smaller in LCC while the minor axis was longer in adenocarcinoma, resulting in a smaller axial ratio in adenocarcinoma. These data indicate that adenocarcinoma cells are larger and have a more rounded shape and less nucleolar material, as compared to the smaller, more ellipsoid and convoluted cells of LCC, which have more nucleolar area. A logistic regression identified cellular area, nucleolar/nuclear area ratio and cellular and nuclear form factors as significant contributors to the discrimination of LCC from adenocarcinoma, with a positive predictive value of 92%. Morphometry may therefore be helpful in the differential cytologic diagnosis of adenocarcinoma and LCC.     

Intraocular tumors. A cytopathologic study

The cytologic characteristics and histopathologic correlates of common ocular tumors were examined using (1) cytologic and histologic specimens prepared from enucleated eyes with retinoblastoma and melanoma, (2) cytologic specimens prepared from clinically obtained intraocular fluids from eyes with lymphoma, metastatic adenocarcinoma and retinoblastoma and (3) cytologic specimens prepared from orbital aspirates and cerebrospinal fluids from a patient in whom retinoblastoma had spread to the orbit and central nervous system. Retinoblastoma cells occurred singly and in clusters and were associated with abundant necrotic debris and portions of capillaries with perivascular tumor infiltrates. Melanoma cells frequently had prominent nucleoli and variable amounts of fine cytoplasmic pigmentation and were found individually and in groups. Lymphoma cells were noncohesive, with scant cytoplasm. Metastatic intraocular adenocarcinoma cells had well-defined borders, multiple nucleoli and vacuolated cytoplasm. In general, the cellular morphology in the cytologic and tissue preparations of the intraocular tumors correlated well with each other. The findings suggest that common primary and metastatic intraocular tumors can be differentiated in cytologic preparations.     

Microglandular hyperplasia of the uterine cervix. Cytologic diagnosis in cervical smears

OBJECTIVE: To identify cytomorphologic features specific to microglandular hyperplasia (MGH) in cervical cytologic smears. STUDY DESIGN: Twenty-four cervical smears from 24 patients obtained before the histologic diagnosis of MGH made on colposcopically directed biopsies during a period of two years (1995-1997) were evaluated. RESULTS: Of cases with MGH, 13/24 (54%) showed the presence of bidimensional or tridimensional cellular clusters made up of cubic or cylindrical glandular cells with vacuolated cytoplasm; cells with dense cytoplasm, basaloid in appearance, corresponding to immature squamous metaplasia; and subcylindrical reserve cells with small, round nuclei and scant cytoplasm. Clusters showed microlumina or fenestrated spaces, preserved polarity and absence of nuclear peripheral dispersion. In the control group these cellular clusters were found in 6/100 (6%). Statistical analysis (chi 2) showed a strong, highly significant association (P < 0.001) of the cytologic parameters selected and the histologic diagnosis of MGH. CONCLUSION: Until now, no specific cytologic parameters were described for MGH. This study underscored the value of cytomorphologic parameters described for typical cellular clusters showing microlumina or fenestrated spaces with shared party walls and an admixture of glandular cells, and immature squamous metaplastic and subcylindrical reserve cells in the cytologic diagnosis of MGH.     

Aspiration cytology of the oncocytic variant of papillary adenocarcinoma of the thyroid gland

OBJECTIVE: To study the cytologic features of the oncocytic variant of papillary adenocarcinoma of the thyroid gland to distinguish this subtype from other oncocytic lesions of the thyroid. STUDY DESIGN: We reviewed the smears from aspiration biopsies of 6 proven cases of oncocytic variant of papillary adenocarcinoma and compared their cytologic features with smears from 19 oncocytic follicular neoplasms (11 adenocarcinomas and 8 adenomas). Smears were stained with a modified Giemsa stain (Diff-Quik). RESULTS: All smears were cellular. Colloid was variable but more abundant in cases of the oncocytic variant of papillary adenocarcinoma. The cells in papillary adenocarcinoma had round to ovoid, overlapped nuclei; prominent intranuclear inclusions; and "grooves." Nucleoli were generally absent. In oncocytic follicular neoplasms, the cells had round nuclei and prominent nucleoli. Nuclear inclusions and grooves were seen but were not as prevalent as in papillary adenocarcinomas. CONCLUSION: The oncocytic variant of papillary adenocarcinoma of the thyroid gland can be distinguished from other oncocytic lesions by fine needle aspiration biopsy, whereas the absence of prominent nucleoli in oncocytes favors the diagnosis of an oncocytic papillary adenocarcinoma.     

磷酸丝氨酸氨基转移酶1介导肺腺癌细胞粘附及其机制探究

摘要 目的：探究丝氨酸生物合成途径（SSP）关键酶磷酸丝氨酸氨基转移酶1（PSAT1）与肺腺癌细胞粘附的关系，并初步探讨其作用机制。方法：使用siRNA抑制PSAT1蛋白表达，观察肺腺癌细胞形态以及粘附变化，同时过表达PSAT1，反向观察PSAT1对肺腺癌细胞粘附的影响。初步探究其作用机制，采用免疫共沉淀-蛋白质谱法寻找与PSAT1直接相互作用的蛋白，筛选差异蛋白，并在过表达细胞体系中验证。结合临床公共数据库分析互作蛋白与患者预后关系。结果：发现敲低PSAT1引起肺腺癌细胞形态改变；敲低PSAT1抑制肺腺癌PC9、HCC827细胞粘附；过表达PSAT1增强PC9及HCC827细胞粘附；免疫共沉淀-蛋白质谱检测到2560个可能与PSAT1结合的蛋白，进一步通过免疫共沉淀-免疫印迹法验证PSAT1过表达使细胞中与间皮素（MSLN）结合显著上升；通过临床样本数据观察PSAT1与MSLN共同高表达的肺腺癌患者，其预后更差。结论：本文首次报道PSAT1可能通过与MSLN等蛋白-蛋白相互作用影响肺腺癌细胞粘附的新机制，提示PSAT1有望成为潜在抗肿瘤靶点，靶向其相互作用蛋白能为小分子抑制剂设计及患者个体化治疗提供新思路。     

Fine needle aspiration of adenoid cystic carcinoma metastatic to the lung. Cytologic features and differential diagnosis

Two examples of adenoid cystic carcinoma metastatic to the lung, one from a Bartholin's gland and the other from a submandibular gland, were sampled by fine needle aspiration. Although the cytologic features of adenoid cystic carcinoma have been well described, it is easy to confuse adenoid cystic carcinoma with other more common primary small-cell neoplasms of the lung; to determine distinguishing features, we compared the cytomorphology of adenoid cystic carcinoma with well-differentiated adenocarcinoma, small-cell undifferentiated carcinoma and carcinoid tumor of the lung. The differential features distinguishing adenoid cystic carcinoma from these other neoplasms include: (1) tight, globular, honey-comb arrangements of cells lacking true nuclear molding; (2) acellular chunks of basal lamina material, which alone may suggest adenoid carcinoma; and (3) the extension of a solid core of basal lamina material beyond a sievelike cellular meshwork. The morphologic expression of metastatic adenoid cystic carcinoma is so distinctive as to permit a definite diagnosis.     

Fine needle aspiration cytology of sarcomas metastatic to the lung

A review was made of the morphologic features of cells aspirated from 17 sarcomas (5 malignant fibrous histiocytomas, 3 fibrosarcomas, 3 leiomyosarcomas, 3 endometrial stromal sarcomas, 1 osteosarcoma and 2 poorly differentiated sarcomas) metastatic to the lung, paying particular attention to the morphologic differences between the cells of sarcoma and carcinoma and between the cells of the different types of sarcoma. In general, sarcomas were characterized by loosely cohesive, rather flat, cellular aggregates and isolated cells. Three-dimensional cell balls or clusters were not present in any case. Cellular pleomorphism was a common, though not invariable, feature. Each type of sarcoma showed some morphologic distinctiveness; however, certain morphologic features were common to more than one type of sarcoma. By comparing the cytologic features of metastatic sarcomas in aspirates with the histologic features of the primary neoplasms, it should usually be possible to decide if a pulmonary lesion is a metastatic sarcoma.     

Epithelioid hemangioendothelioma of the lung diagnosed by transesophageal endoscopic ultrasound-guided fine needle aspiration: a case report

BACKGROUND: Epithelioid hemangioendothelioma is a rare vascular tumor of the lung and is also known as intravascular sclerosing bronchoalveolar tumor. Although it has relatively low malignant potential, extensive pulmonary involvement and systemic metastasis have been described. The cytologic features of these tumors are not very well defined, with only few case reports describing the cytologic findings of epithelioid hemangioendothelioma of the lung on fine needle aspiration. CASE: Endoscopic ultrasound-guided fine needle aspiration of a hilar mass was performed on a 25-year-old female. The cytology showed loosely cohesive sheets and clusters of epithelioid cells. The cellular features included large, irregular nuclei with nucleoli and a moderate amount of vacuolated cytoplasm. Rare cells had a suggestion of cytoplasmic lumen formation. Histologic examination of tissue fragments on the cell block revealed a tumor composed of rounded to spindled epithelioid cells in a background of light blue stroma. The endothelial differentiation was evidenced by cytoplasmic vacuoles and lumens, some of which contained erythrocytes. The endothelial nature of these cells was confirmed by positive staining with factor VIII and CD34. CONCLUSION: The cytomorphologic features of epithelioid hemangioendothelioma described in the literature and observed in our case are distinctive and can help with the interpretation of cytologic smears and prevent misdiagnosis.     

Significance of cytologic smears in the diagnosis of small cell carcinoma of the uterine cervix

OBJECTIVE: To provide improved identification of small cell carcinoma (SMCC) and reevaluate the significance of cervical cytologic smears in its diagnosis. STUDY DESIGN: Analyses of histocytologic morphology and clinical data were performed by reviewing clinical records, histopathology and cervical cytology smears from 18 SMCC cases of the uterine cervix (including one recurrent case and three SMCC cases with adenocarcinoma) between 1986 and 2001. RESULTS: Most cases showed minimal cytoplasm, finely stippled ("salt and pepper") chromatin, prominent nuclear molding and smearing effect. Cytologic smears diagnosed or suggested 79% of SMCC cases before histologic confirmation. Of the cases, 89% displayed moderate to high cellularity. The tumor cells were arranged mostly in clusters of varying sizes with no typical architectural pattern. In addition, the tumors often exhibited very pleomorphic cells and recognizable nucleoli. CONCLUSION: Cytologic features of SMCC cells are characteristics enough for specific diagnosis or at least an early indication of it. Timely detection by cervical cytologic smears will allow clinicians to initiate prompt treatment of these aggressive tumors.     

Diagnosing endometrial carcinoma with cervical involvement by cervical cytology

OBJECTIVE: To assess the relationship of a cervical cytologic diagnosis based on number, size and degeneration of malignant clusters and necrotic background to cervical involvement of endometrial carcinoma. STUDY DESIGN: Cervical smears of 53 women with endometrial carcinoma were evaluated for cervical involvement. The cytologic diagnosis was compared with actual involvement, and accuracy was calculated. Retrospectively, cytologic features, including number, size and degeneration of malignant clusters and necrotic background, were analyzed in involved and noninvolved cases. RESULTS: Cervical involvement was confirmed in 15 patients (28.3%). The number and size of malignant clusters in the involved cases were significantly larger than those in the noninvolved cases (P < .001 and < .01, respectively). The proportion of degenerated malignant cells and necrotic background in involved cases were significantly higher than those in noninvolved cases (P < .05). Cytologic diagnosis had a sensitivity and specificity of 62.5% and 86.8%, respectively. CONCLUSION: Cervical smears of involved cases revealed a large number and large size of malignant clusters. These findings support cytologic diagnosis based on number, size and degeneration of malignant cells and necrotic background. Cervical cytology is useful to exclude cervical involvement because of its high specificity and can help detect cervical involvement because of its moderately high sensitivity.     

Morphologic and immunocytochemical studies of bronchioloalveolar carcinoma at Duke University Medical Center, 1968-1986

Between 1968 and 1986, the tumor registries at Duke University Medical Center and Durham VA Medical Center accumulated a total of 193 patients with a diagnosis of bronchioloalveolar carcinoma (BAC). All available histologic sections of primary lung tumors and all available respiratory and pleural cytologic material were reviewed for 135 cases having an initial histologic diagnosis of BAC and no history of a primary nonpulmonary adenocarcinoma. Thirty-nine cases showed a pure BAC pattern in histologic sections; 76 showed a dominant BAC pattern with focal areas of fibrosis and acinar differentiation; 16 were carcinomas with a focal BAC pattern; and 4 were adenocarcinomas lacking a BAC pattern. Of the 115 cases with at least a dominant BAC pattern, 51 showed predominantly mucinous differentiation while 64 showed predominantly nonmucinous differentiation. Adequate cytologic material was available for review from 111 patients. For cases having at least a dominant BAC pattern, tumor cells were present in 77 of 172 adequate sputums (44.8%), 36 of 133 bronchoscopy specimens (27.1%), 15 of 18 needle aspirates (83.3%) and 14 of 15 pleural fluids (93.3%). Of all patients in this group, 60.2% had at least one specimen positive for malignancy. No cytologic features clearly distinguished adenocarcinomas having only focal bronchioloalveolar differentiation from those with a pure or dominant BAC pattern. A significant degree of overlap was observed in the cytologic features of mucinous and nonmucinous tumors. Histologic sections from 19 mucinous and 16 nonmucinous tumors were stained with monoclonal antibody B72.3: all showed some staining, with no significant difference in degree of staining between the two groups. This suggests that expression of the tumor-associated glycoprotein TAG-72 is independent of mucinous differentiation.