The Immunocytochemical Detection of P53 Protein In Cytological Specimens: Technical Considerations

The p53 gene encodes a 393 amino acid nuclear phosphoprotein that appears to act as a cell cycle checkpoint, possibly by transactivating other target genes. Abnormalities of the p53 gene are common in a wide range of human tumours and are associated in many cases with immunologically detectable p53 protein. Detection of p53 immunoreactivity is uncommon in normal cells, but is frequently seen in neoplasia. Here we define the optimum conditions for the detection of p53 immunoreactivity in cytological material, including fixation and storage. Immersion in acetone-methanol for 10 min is optimal, and after air drying, smears or cytospin preparations can be stored at - 70°C for at least 6 months. We describe the range of controls necessary, including the use of positive control cell lines with known mutations of the p53 gene and defined abnormalities of p53 protein. Negative controls should include cell lines (or strains) with no p53 abnormality as well as the conventional negative immunological controls. It is only with these technical caveats and controls that p53 immunoreactivity can be performed reliably on cytological specimens. Le géne p53 code pour une phosphoprotéine nucléaire de 393 acides aminés qui semble jouer en rôle dans la régulation du cycle cellulaire, probablement par transactivation d'autres gènes cibles. Les anomalies du gène p53 sont présentes dans un large éventail de tumeurs humaines et sont associées a la présence d'une protéine p53 détectable immunologiquement. La détection d'une immunoréactivité anti p53 est rare dans les cellules normales alors qu'elle est fréquente dans les tumeurs. Nous avons défini dans ce travail les conditions optimales pour la détection de l'immunoréactivité anti p53 sur matériel cytologique, y compris les conditions de fixation et de conservation. L'immersion dans l'acétone-méthanol pendant 10 minutes est optimale. Aprés séchage à l'air, les frottis ou les préparations par cytocentrifugation peuvent être stockés à—70°C pendant au moins 6 mois. Nous décrivons aussi l'éventail des contrôles nécessaires incluant I'utilisation, comme contrôle positif, de lignées cellulaires avec des mutations connues du gène p53 et des anomalies définies de la protéine p53. Les contrôles négatifs doivent comporter des lignées cellulaires (ou des espèces) sans anomalie de p53 ainsi que les contrôles immunologiques négatifs convrentionnels. C'est seulement lorsque ces précautions techniques et ces contrôles sont respectés que l'immunoréactivité anti p53 peut être étudiée valablement sur les prélèvements cytologiques. Das p53 kodiert ein aus 393 Aminosären bestehendes Phosphoprotein, das offensichtlich den Zellzyklus blockiert, möglicherweise durch Aktivierung anderer Gene. Veränderungen des p53-Gens wurden in zahlreichen menschlischen Tumoren nachgewiesen, sodaß eine positive Reaktion in Neoplasien häufig, in Normalzellen jedoch ungewöhnlich ist. Die optimalen Bedingungen für den p53-Nachweis in cytologischem Material werden hinsichtlich Fixation und Lagerung untersucht. Eine 10minütige Aceton-Methanol-Fixierung mit anschlies-sender Lufttrocknung erlaubt die Lagerung von Ausstrichen und Cytozentrifugen-präparaten bei - 70°C für mindestens 6 Monate. Die erforderlichen Kontrollen einschließlich positiver Zellinien mit bekannten Mutationen des p53-Gens und definierten Anomalien des Proteins werden beschrieben. Negativkontrollen sollten Zellinien ohne p53-Anomalie ebenso umfassen wie die üblichen negativen immunologischen Kontrollen. Nur unter diesen Bedingungen ist ein zuverlässiger Nachweis von p53 mögloch.     

The varied presentation of metastatic melanoma in fine needle aspiration cytology of the breast

D. L. Ribu, P. W. Shield and J. F. Bligh
The varied presentation of metastatic melanoma in fine needle aspiration cytology of the breast Objective: To identify cytomorphological patterns of metastatic melanoma (MM) in breast fine needle aspiration (FNA) specimens and highlight the differential diagnoses and features most useful in identifying MM. Methods: The clinical, radiological and FNA findings of 16 cases were reviewed. Cytological features evaluated related to cell arrangement, size and shape of cells, nuclear and cytoplasmic features, and the presence or absence of necrosis. Results: The series consisted of 14 females and two males, ranging in age from 24 to 83 years (mean = 50 years). A previous history of melanoma was available in 12/16 (75%) cases at the time of FNA reporting; however the clinical/radiological impression in 4/16 cases was of a breast cyst. The cases were classified into six morphological variants: classical (8/16), pseudopapillary (3/16), spindle‐cell (1/16), melanin‐rich (1/16), pleomorphic (2/16) and lymphoma‐like (1/16). The varying patterns raised a wide range of differential diagnoses; however, discohesion, binucleation and granular cytoplasm were the major features seen in 94% of all cases. In 14/16 cases (88%), plasmacytoid cells, prominent nucleoli and cytoplasmic vacuolation were identified. Melanin and multinucleation were detected in 44% of cases and intranuclear cytoplasmic invaginations in 63%. Necrosis was present in more than half of the cases (56%). Conclusion: MM should be considered in the differential diagnosis of breast FNA specimens when atypical cells are seen that present as plasmacytoid cells in a dispersed or pseudopapillary pattern, or as spindle, pleomorphic or pigmented cells. These features, combined with clinical history and immunocytochemistry, may assist in correctly identifying MM and directing optimal treatment.     

Fine needle aspiration biopsy of three cases of squamous cell carcinoma presenting as a thyroid mass: cytological findings and differential diagnosis

M. Rosa and K. Toronczyk Fine needle aspiration biopsy of three cases of squamous cell carcinoma presenting as a thyroid mass: cytological findings and differential diagnosis Objective: Primary squamous cell carcinomas of the thyroid gland are extremely rare, comprising about 1% of thyroid malignancies. Although squamous cell carcinomas are readily identified as such on aspiration cytology in the majority of cases, the differentiation of primary versus metastatic tumour might not always be easy. Herein, we report three cases of squamous cell carcinomas involving the thyroid gland. Methods: Fine needle aspiration cytology (FNAC) was performed in three patients with a thyroid mass using standard guidelines. Smears were stained with Diff‐Quik and Papanicolaou stains. Results: Two patients were male and one was female, aged 59, 45 and 35 years, respectively. In all three patients a thyroid mass was present. FNAC smears in all cases showed cytological features of squamous cell carcinoma including keratinization and necrosis. After clinical and cytological correlation, one case appeared to be primary, one case metastatic, and in the third case no additional clinical information or biopsy follow‐up was available for further characterization. Conclusions: Because primary squamous cell carcinoma of the thyroid is a rare finding, metastatic squamous cell carcinoma should always be excluded first. Metastatic disease usually presents in the setting of widespread malignancy, therefore a dedicated clinical and radiological investigation is necessary in these cases. In both clinical scenarios the patient’s prognosis is poor.     

Diagnostic accuracy of fine-needle aspiration cytology in histological grade 1 breast carcinomas: are we good enough?

Background: Fine-needle aspiration cytology (FNAC) of both palpable and non-palpable breast carcinomas has a high accuracy and sensitivity in dedicated centres. It is generally thought that low-grade carcinomas have a distinctly lower sensitivity due to discrete cellular atypia that may be difficult to appreciate. Grade 1 carcinomas make up about 45% of screening-detected breast carcinomas and about 20% of symptomatic breast cancers. The aim of this study was to evaluate the diagnostic sensitivity of grade 1 carcinomas and identify the critical features in the cytological diagnostic work-up of these tumours. Methods: There were FNAC smears from 494 histologically confirmed grade 1 carcinomas diagnosed during 1996–2004. The cytological diagnoses were compared with the histology. Results: A definitive malignant diagnosis (absolute sensitivity) was given in 382 cases (77.3%). Equivocal or suspicious diagnoses were given in 75 (15.2%), benign or probably benign (false negative) in 24 (4.8%). Thirteen cases (2.6%) were unsatisfactory. Complete sensitivity was 92.7%. Invasive ductal carcinomas comprised 81.3% of all cases; absolute sensitivity for these was 80.9%. Invasive lobular and tubular carcinomas comprised 7.3% and 5.9% of cases, respectively; absolute sensitivity for these diagnosis was 50.0% and 57.1%, respectively, significantly lower than for other subtypes (P ≤ 0.0001) whereas the difference for complete sensitivity was less but still significant (P = 0.017). Absolute and complete sensitivities were lower for tumours less than 1 cm size compared with more than 1 cm (P ≤ 0.00001). Conclusion: Preoperative FNAC diagnosis of grade 1 breast carcinoma has a high sensitivity, especially in ductal carcinomas. Invasive lobular and tubular carcinomas were less likely to receive a definite preoperative diagnosis. The main reason for not reaching a definitive malignant diagnosis was sampling error due to small tumours less than 1 cm in diameter, irrespective of tumour subtype.     

Diagnostic associations of p53 immunostaining in fine needle aspiration cytology of the breast

Duplicate cytospin preparations were made from 46 symptomatic breast fine needle aspirates. One of each pair was assigned to benign or malignant categories by one experienced observer as part of the 'triple approach'patient assessment. the other was immunostained with DO7, a monoclonal antibody to recombinant p53 protein, and rated by another observer as positive or negative for nuclear staining, unaware of the cytodiagnosis. Positive controls included carcinomas known to have mutant p53, while negative controls were of the reagent substitution type. of the 26 aspirates with a benign cytodiagnosis (verified by the triple approach), 23 were p53 protein-negative and three positive. of the 20 with a malignant cytodiagnosis (histologically confirmed), six were p53 protein-negative and 14 positive (exact P <0.0001). As a diagnostic test this would give 70% sensitivity and 88% specificity.     

Fine needle aspiration (FNA) of synovial sarcoma—a comparative histological–cytological study of 15 cases, including immunohistochemical, electron microscopic and cytogenetic examination and DNA‐ploidy analysis

A retrospective study of 25 FNAs (11 aspirates from primary tumours and 14 from recurrencies and metastases) from 15 synovial sarcomas was performed. The cytological findings were correlated with the histopathology and the value of immunohistochemical and electron microscopic examination as well as DNA‐ploidy and cytogenetic analysis for diagnosis were assessed. A reproducible cellular pattern with a reliable diagnosis of spindle cell sarcoma was possible provided that the aspirates were cell rich. However, a true biphasic pattern indicative of synovial sarcoma was only seen in one of the 25 specimens. Electron microscopic examination of the aspirates was a valuable adjunctive diagnostic method, whereas immunocytochemistry and DNA‐ploidy analysis were not. Immunohistochemical, electron microscopic and cytogenetic analysis were all valuable ancillary methods when performed on surgical specimens. Malignant haemangiopericytoma and fibrosarcoma were the most important differential diagnoses in the FNA specimens.