Nodular regenerative hyperplasia of the liver: diagnosis by liver biopsy.

Specimens of liver obtained by needle biopsy from two patients with rheumatoid arthritis showed features of nodular regenerative hyperplasia. In one patient the nodularity was apparent on gross examination of the specimen. Portal hypertension was present in the other patient. The cause and pathogenesis of the disorder are poorly understood.     

Measuring opening pressure in lumbar puncture--a new method]

Determination of the opening pressure (OP) during diagnostic lumbar puncture (LP) yields additional information that may impact on treatment and prognosis in disorders affecting the central nervous system (e.g. meningitis). Established methods contain systematic errors as well as risks to the patient. We therefore present a new procedure that allows measurement of the OP by timing the flow of cerebrospinal fluid through a capillary attached to an LP needle. A resistance located between needle and capillary slows down the flow of cerebrospinal fluid so that it becomes independent of the capillary forces acting on it. The time required for the fluid to travel between two marks on the capillary (defining a given volume) can be used to calculate the flow. Since the combined resistance of needle and resistance can be calibrated, the pressure driving the flow--in this case the opening pressure--can be calculated. A simple model was used to evaluate the impact of different resistances and different needles on OP determination. The effects of cellular elements and proteins in the CSF are discussed.     

Needle biopsy of the kidneys; studies of two cases of lower nephron nephrosis due to toxic solvents

In two cases of "lower nephron nephrosis" or acute renal failure, needle biopsies of the kidney were performed. The first case developed in a 46-year-old woman following inhalation of vapors from an insecticide spray and a cleaning fluid. The second case was due to ingestion of carbon tetrachloride. Histologic study of the human kidney during toxic nephrosis showed changes confined mainly to the epithelium of the proximal tubules, confirmed the diagnosis, and illuminated the clinical course. Needle biopsy of the kidney during acute renal failure did not influence the course of the disease unfavorably. It was easy, and entailed no complications. Needle biopsy of kidneys may prove as informative and valuable as needle biopsies of the liver by aiding in the prognosis as well as in the diagnosis of various renal diseases.     

Gaucher's disease in an infant diagnosed by fine needle aspiration of the liver and spleen. A case report.

A case of Gaucher's disease diagnosed by means of fine needle aspiration of the liver and spleen in a 12-month-old boy with hepatosplenomegaly is presented. The diagnosis was based on the finding of large, macrophagelike cells with abundant, pale, fibrillary cytoplasm and small nuclei. The patient had no family history of Gaucher's disease, and the diagnosis was not suspected clinically.     

Cirrhosis with atypia. A potential pitfall in the interpretation of liver aspirates

Needle aspirations of the liver yielding highly atypical hepatocytes present a diagnostic challenge, with the differential diagnosis lying between hepatocellular carcinoma and benign reactive atypia. A case of a healing liver abscess in a patient with cirrhosis, mistakenly diagnosed as an hepatocellular carcinoma, is presented. Criteria for the avoidance of false-positive diagnoses of hepatocellular carcinoma on needle aspirates are presented, and the concept of "liver cell dysplasia" as a cytodiagnostic entity is discussed.     

Intraabdominal hydatid cyst: a case report

BACKGROUND: Hydatid disease is caused by Echinococcus granulosus, endemic in cattle and sheep-raising regions of the world such as Central Europe, South America, Australia, New Zealand and South Africa. Although hydatid disease is more common in liver and lung, it also affects brain, kidney, spleen and muscle. We present a case of intraabdominal hydatid cyst, diagnosed by fine needle aspiration cytology, producing an indentation of the liver, which is uncommon. CASE: A male patient presented with right side abdominal pain. On ultrasonography an intraabdominal solid mass (right hypochondrial) was revealed, and subsequently FNA was done. Smears were diagnostic of hydatid cyst. CONCLUSION: FNAC is a sensitive and rapid technique in diagnosis of hydatid cysts. The present case is unusual, owing to its presentation as a solid abdominal mass seeding over the liver and mimicking malignancy radiologically.     

Fetal tissue sampling--indications,techniques, complications,and experience with sampling of fetal skin,liver, and muscle.

Invasive prenatal testing has become an important way to evaluate fetuses at increased risk for hereditary disorders. In utero sampling of fetal skin, liver, and muscle may be required to diagnose before-birth disorders that cannot be diagnosed by analysis using chorionic villi or amniotic fluid. In the next few years, many of these conditions will be detected by DNA analysis, and the need for these procedures may decrease dramatically. First performed by fetoscopy, fetal tissue sampling is now most frequently done by inserting a biopsy needle under continuous ultrasonographic guidance. We describe the indications, techniques, complications, and experience with obtaining fetal skin, liver, and muscle biopsy specimens.     

Eleven cases of nonfunctioning parathyroid cyst--significance of needle aspiration in diagnosis and management

Eleven cases of nonfunctioning parathyroid cyst are reported. Ultrasonography revealed the cystic nature of the asymptomatic lump in the neck. Clear watery fluid obtained by needle aspiration and the increased parathyroid hormone concentration in the fluid established the diagnosis. Five patients, in four of whom the cysts reappeared after one (3 cases) or seven (1 case) needle aspirations, underwent surgical resection of the cysts. Six other patients were followed conservatively after the aspiration maneuver. In four patients with enough follow-up time for evaluation, the cyst fluid has not reaccumulated 5, 2 and 2 years after only one aspiration, and 1 year after two aspirations. In one patient, the cyst reappeared 9 months after the initial aspiration. Simple percutaneous aspiration may be curative in some cases of nonfunctioning parathyroid cysts.     

ASPIRATION OF BREAST CYSTS

In 1,364 cases of breast cyst aspiration reported in the literature, there is no note of a missed diagnosis of carcinoma.The author carried out needle aspiration in 80 patients with a definite mass in the breast as a therapeutic or diagnostic procedure.A diagnosis must be established for every definite mass in the breast and needle aspiration is a logical diagnostic procedure. If the needle encounters a solid mass, the mass must be removed for biopsy. If the needle encounters a cyst containing fluid, the fluid should be removed completely. A biopsy specimen then should be taken from the mass if (a) the fluid is bloody, (b) the mass does not entirely disappear, or (c) the mass recurs promptly. Adherence to these rules will keep the examining physician from missing a carcinoma within the cyst.Aspiration of breast cysts is a simple and safe diagnostic and therapeutic procedure that saves the patient distress and money.     

Fatal septic shock after fine needle aspiration of a pancreatic pseudocyst

Fatal septic shock due to Streptococcus sanguis developed eight days after fine needle aspiration (FNA) of a pancreatic pseudocyst. The pseudocyst was adherent to the transverse colon (as is often the case with pseudocysts), and contamination of cyst fluid with colonic bacteria most likely initiated the infection. The patient had not received prophylactic antibiotics, even though the needle had been observed to pass through the bowel at the time of the CAT-scan-guided aspiration. Although the literature documents the safety and usefulness of FNA in the diagnosis of pancreatic tumors, this case suggests that prophylactic antibiotics be considered at the time of aspiration of pseudocysts or necrotic tumors.     

Fine needle aspiration cytology of cystic parathyroid lesions. A cytomorphologic overlap with cystic lesions of the thyroid

Three cases of palpable cystic parathyroid nodules examined by fine needle aspiration (FNA) cytology are reported. Two of the three aspirates were incorrectly identified as thyroid neoplasms due to the presence of papillary clusters or microfollicles and grossly golden-brown cyst fluid. Histologic examination of these two nodules revealed partially cystic parathyroid adenomas. Aspirated material from the third patient yielded clear watery fluid, which was correctly identified as consistent with a parathyroid cyst. The diagnostic difficulties in the differentiation of parathyroid adenoma from thyroid carcinoma or adenoma are discussed, as is the utilization of assays for parathyroid hormone in making the FNA diagnosis of parathyroid lesions.     

Haemorrhage as a Complication of Extracorporeal Pig Liver Perfusion: Studies on Mechanism and Prevention

The use of extracorporeal pig liver perfusion for temporary liver support has been followed not infrequently by major bleeding with a fall in coagulation factors and platelets, rather than a rise as hoped. In 18 experimental perfusions in which ¹²⁵I-labelled fibrinogen was used as a marker there was in every instance a significant loss of the fibrinogen into the fluid supporting the liver in the perfusion chamber. Further, in 11 of the perfusions there was an additional loss into liver substance, this being associated with a very rapid fall in ¹²⁵I fibrinogen and platelets content of the perfusion fluid. Damage to the sinusoids from ischaemic damage incurred during removal of the liver could explain both the direct loss of fibrinogen and, as a result of intravascular coagulation, the associated loss within the perfused liver. No correlation could be found with biochemical function, but it proved possible to assess haematological safety before connexion of the patient to the perfusion by a shortened ¹²⁵I fibrinogen test. This was done in three patients treated by five perfusions and in none was the thrombocytopenia or coagulation disturbance adversely affected.     

Cytology of extrapulmonary Pneumocystis carinii infection in the acquired immunodeficiency syndrome.

Rare cases of extrapulmonary Pneumocystis carinii (EPPC) have been seen in patients with acquired immunodeficiency syndrome (AIDS). We report seven such diagnoses of nonpulmonary P carinii (PC) from four AIDS patients between 1986 and 1989. The specimens included fine needle aspirate of liver, spleen, periarticular tissue and pleura as well as ankle fluid, pleural fluid and ascites. In some, but not all, cases the patients had concurrent or previous episodes of PC pneumonia. In all cases the typical granular, eosinophilic aggregates of PC cysts were noted on routine Papanicolaou staining, leading to the definitive detection of PC cysts with Grocott silver stain. In most cases, evidence for granulomalike and neovascularized tissue reaction was present in cytologic material. One specimen demonstrated concurrent acid fast bacilli. In the setting of AIDS, cytology of effusions and masses should include an evaluation for EPPC.     

Diagnostic pitfalls in fine needle aspiration of solitary pulmonary nodules: two cases with radio-cyto-histological correlation

Background

Fine needle aspiration is an important tool for diagnosis and preoperative evaluation of solitary nodules of the lung. It provides a definitive diagnosis in most patients at low cost with minimal trauma. However, because of the nature of the study and the presentation of the cells in a more distorted and incomplete tissue structure than a histological slide, false positive results can occur. Prior detailed clinical knowledge about the patient, procedures and methods of radiology in obtaining the aspirate specimen is extremely useful in the accurate interpretation of fine needle cytological specimens.

Case presentation

We report two cases of solitary pulmonary nodules in two elderly females, which were initially diagnosed as malignant by fine needle aspiration biopsy. Both cases subsequently underwent pulmonary lobectomy in which, one turned out to be a pulmonary hamartoma and the other appeared to be a middle lobe syndrome of the right lung with liver tissue contamination at the time of fine needle aspiration of the lung.

Conclusions

We are now strong believers that much care must be taken in the interpretation of fine needle aspiration of solitary nodules of the lung. Complete study of the entire specimen, including the cell block, is warranted, since what one interprets as malignant, could have different features in another part of the sample. Last but not the least, prior knowledge of the complete clinical history of the patient together with the salient radiological findings would greatly facilitate the cytopathologist to reach an accurate diagnosis.     

Endogenous phosphatase activity in tumor cells in a liver aspirate. A potential problem for immunocytodiagnosis using immunoalkaline phosphatase methods

Immunocytochemical studies were performed on fine needle aspirates of the liver in a patient with hepatocellular carcinoma. A panel of commercially available antibodies was used to study the aspirated cells by immunoalkaline phosphatase and immunoperoxidase methods. The malignant cells in the aspirates, which were positively stained by the immunoperoxidase method for alphafetoprotein and by both methods for epithelial membrane antigen, were most probably hepatocellular in origin. Some cells were shown by the immunoalkaline phosphatase method to possess leukocyte-common antigen (LCA) and antigens of colonic and ovarian tissues. These findings were further investigated, and it was found that the tumor cells indeed had LCA as well as levamisole-resistant alkaline phosphatase activity. Although the immunoalkaline phosphatase methods are useful immunodiagnostic techniques applicable to fine needle aspirates, the endogenous enzyme activity present in some nonhematopoietic tumor cells is a cause for caution in the use of these methods in aspirates from nonhematopoietic tumor tissues.     

Diagnosis of malignant granular cell tumor by fine needle aspiration cytology:.

BACKGROUND: Malignant granular cell tumors (GCT) are the rarest of all sarcomas, and the histologic differentiation from their benign counterpart may be extremely difficult or impossible unless metastatic disease is demonstrated. To our knowledge, this is the first report of a malignant GCT diagnosed by fine needle aspiration (FNA) cytology. CASE: A 70-year-old, Caucasian female presented with a progressively enlarging left supraclavicular mass. FNA of the mass revealed a metastatic tumor cytologically consistent with GCT. With this diagnosis, a search for other metastatic sites was initiated. Computed tomography (CT) scan revealed several tumor nodules in the lungs and liver. CT-guided FNA and tru-cut needle biopsy of a liver mass confirmed the diagnosis of metastatic GCT. In searching for a primary site, the patient revealed a clinical history of having had a tumor removed from her back two months before; it was reported to be an atypical GCT. Comparison of the three tumors revealed similar histologic, cytologic and immunohistochemical features. CONCLUSION: Evidence of mild to moderate cytologic atypia; increased mitotic activity; locally aggressive growth; increased proliferative activity as demonstrated by immunohistochemical evaluation of proliferation markers; and DNA ploidy analysis, as reported for this case, may be helpful in predicting malignant behavior of GCTs.     

Needle biopsy of the liver for the diagnosis of nonneoplastic liver diseases

The results of 209 liver biopsy needle washings were compared with the corresponding histologic findings. An effort was made to distinguish major categories of liver disease on the basis of cytologic findings. Pigment identification and fat quantitation were also evaluated. It was found that it was often possible to determine whether a liver needle washing was normal or abnormal; however, it was rarely possible to provide specific diagnoses. Pure fatty change and primary cholestasis could be reliably differentiated from the steatosis and bile plugging seen in other liver disorders. Cirrhosis could be suggested in a limited number of cases, although in most cases the findings were nonspecific. Cytology was found to be less reliable than biopsy in the discrimination between the major pigments. Finally, cytology was an acceptable method for detecting and quantitating fatty change.     

Measurement of subcutaneous tissue fluid pressure using a skin-cup method

We developed a new method for measuring tissue fluid pressure in subcutaneous tissue. Porous Teflon cylinders were permanently implanted subcutaneously into the inguinal area of 10 dogs, and after several weeks a skin concavity formed in the center of each of the cylinders. A small needle attached to a recording system was inserted into the free tissue fluid lining the concavity, and the tissue fluid pressure averaged -8.8 +/- 2.7 (SD) mmHg. Next, a hollow Plexiglas cup was placed over the concavity and glued to the skin. The air pressure in the skin cup was continually adjusted (using an electromechanical servo-control system) to pull the skin upward and to hold it perfectly flat across the upper ridge of the Teflon cylinder. The simultaneously recorded needle and cup pressures averaged -9.1 +/- 2.4 and -8.6 +/- 2.6 mmHg, respectively, during steady-state conditions with the skin in a flat position. Both pressures also responded appropriately to dynamic changes in tissue fluid pressure caused by increasing and decreasing the volume of the free tissue fluid. Because the skin was flat, the equivalences of pressures above and below the skin is consistent with the hypothesis that the skin was not tethered significantly to the underlying tissues and that cup pressure accurately estimates the tissue free fluid pressure.     

Radiofrequency ablation of hepatic tumors: simulation, planning, and contribution of virtual reality and haptics

For radiofrequency ablation (RFA) of liver tumors, evaluation of vascular architecture, post-RFA necrosis prediction, and the choice of a suitable needle placement strategy using conventional radiological techniques remain difficult. In an attempt to enhance the safety of RFA, a 3D simulator, treatment planning, and training tool, that simulates the insertion of the needle, the necrosis of the treated area, and proposes an optimal needle placement, has been developed. The 3D scenes are automatically reconstructed from enhanced spiral CT scans. The simulator takes into account the cooling effect of local vessels greater than 3 mm in diameter, making necrosis shapes more realistic. Optimal needle positioning can be automatically generated by the software to produce complete destruction of the tumor, with maximum respect of the healthy liver and of all major structures to avoid. We also studied how the use of virtual reality and haptic devices are valuable to make simulation and training realistic and effective.     

Studies on type II glycogenosis. Effects of cortisone derivatives on acid α-glucosidase

Cortisone causes a marked increase in the activity of liver acid alpha-glucosidase 2h after injection into male Wistar rats. Studies on rat liver tissue slices, isolated lysosomes and cultured skin fibroblasts have demonstrated similar elevations of acid alpha-glucosidase activity after incubation with cortisone. Cortisone-treated human liver tissue, obtained by needle biopsy, also shows an increase in acid alpha-glucosidase activity. Neutral alpha-glucosidase activity was not stimulated by cortisone in vivo or in liver slices.