Fetomaternal transfusion of blood lymphocytes and identification of the sex of the fetus

Karyotypes of blood lymphocytes were studied in 21 pregnant women. In 8 cases, 46,XY cells were found in the maternal blood and a boy was born in all cases. In 3 cases various chromosome rearrangements were seen. In 6 cases, no 46,XY cells were seen and a girl was born in each case. In 3 cases no 46,XY cell was observed (in 800 cells) and boys were born. In 3 other cases, a 46,XY cell was found and girls were born; all mothers had previously given birth to boys. In 1 case, 2 46,XY cells were observed, and a girl was born; the mother had had an induced abortion in the 3rd month of pregnancy 3 years earlier. It was concluded that the detection of a male fetus seems possible in pregnant women who have no previous male progeny. The persistence of cells from previous pregnancies appears to be a possibility, however.     

Transthoracic needle aspiration biopsy. Review of 233 cases

In 233 cases in which transthoracic needle aspiration was done at the Mayo Clinic from 1980 through 1983, the cytology slides, tissue fragments and patient histories were reviewed; the original and review diagnoses were compared and correlated with the subsequent clinical course. In most cases, the procedure was performed with an 18-gauge needle under fluoroscopic guidance, primarily in cases with suspected malignant masses that were considered to be not surgically resectable. In 70% of the cases, there was a history of malignancy, and 82% of the malignant lesions were of extrapulmonary origin. Correlation of the original diagnosis with the clinical course yielded 70% (164 cases) true positives, 6% (14 cases) true negatives, 16% (37 cases) false negatives, 0% false positives and 8% (18 cases) indeterminants. In none of the false-negative cases was the slide subsequently read as positive in a blind review. Of the true-positive cases, 12% had positive tissue fragments only, 37% had positive cytology smears only, and 51% had both positive smears and fragments. In 32% of the cases, there were radiologically demonstrable pneumothoraces, and in 12%, placement of a chest tube was required. Hemoptysis occurred in less than 5% of the cases. In summary, transthoracic needle biopsy provides an efficient way to accurately obtain diagnostic tissue, with acceptable minor complications.     

Obstetric accidents: a review of 64 cases.

OBJECTIVE--To identify the causes of obstetric accidents. DESIGN AND SETTING--Analysis of case records at the Medical Protection Society''s London office covering the five years 1982-6. SUBJECTS--Cases that had come to litigation which had resulted in stillbirth, perinatal or neonatal death, central nervous system damage to the baby, or maternal death and in which there was an opinion from a senior obstetrician consulted by the society. Of 147 cases reviewed, 64 met the criteria for the study. MAIN OUTCOME MEASURES--The principal findings of the expert reviewers. RESULTS--Three major topics of concern emerged common to most of the 64 cases. These were inadequate fetal heart monitoring, mismanagement of forceps, and inadequate supervision by senior staff. In 11 of the 64 cases cardiotocography was omitted, in 19 cases the trace was missing, in six cases the trace was unreadable, and in 14 of the remaining 28 cases signs of fetal distress went unnoticed or were ignored. In 31 cases forceps were used to aid delivery or were tried and abandoned in favour of caesarean section. In 16 cases two or more attempts to use forceps were made. Five infant deaths were directly attributed to mismanaged forceps. In 20 cases senior staff were criticised by the expert reviewer for failure to come to the labour ward. In many of these cases they may have given advice over the telephone, but the inadequacy of records made it impossible to tell. In these cases the labour and birth were managed by junior staff, usually a senior house officer. In six cases when senior staff did come they suggested that no action was needed. CONCLUSION--These few cases should not be dismissed as isolated incidents in obstetric practice in Britain. They reflect more general problems--namely, concerning the ability of junior doctors to interpret fetal heart traces accurately, their ability to use forceps, and the participation of senior staff in running a labour ward and delivery suite.     

Fine needle aspiration biopsy in the diagnosis of tuberculosis

Bacteriologic data and aspiration smears obtained by fine needle aspiration (FNA) biopsy for a series of 39 cases of tuberculosis were reviewed. Based on the morphologic features of the aspiration smears, the cases were divided into two groups: 18 cases in which distinct epithelioid granulomas were present and 21 in which no granulomas were found but large amounts of necrotic debris with variable numbers of polymorphonuclear cells, histiocytes and lymphocytes were present. Material from the FNA biopsy specimen was submitted for culture and fluorescence studies in 34 cases (15 with and 19 without granulomas). In the first group, auramine-rhodamine staining of smears was positive in 4 of 15 cases and Mycobacterium tuberculosis was isolated in 12 of 15 cases. In the second group, auramine-rhodamine staining was positive in 9 of 19 cases and culture was positive for M. tuberculosis in 16 of 19 cases. The results indicate that studying FNA smears by light microscopy and bacteriologic culture is an effective way of diagnosing tuberculosis.     

Chromosomal abnormalities and DNA image cytometry of haematological neoplasms in fine needle aspirates of lymph nodes

The current diagnostics of haematological neoplasms along with morphological analysis, immunophenotyping and molecular analysis inevitably includes cytogenetic analysis. In this work the possibility of cytomorphological subclassification of haematological neoplasms from lymph node fine needle aspirates was examined without depending upon the referential histological diagnosis and cytogenetic analysis. In addition, the feasibility of cytogenetic analysis of the material obtained by lymph node fine needle aspiration (FNA) was examined. By analysing the findings of cytogenetic analysis and DNA image cytometry, it was decided to examine the possibility of comparing the findings and supplementing diagnostic possibilities of these methods. In 15 cases cytological diagnoses and cytogenetic analysis of haematological neoplasms were performed on the material obtained by lymph node FNA. In 12 of 15 cases histological diagnosis was made separately. A good cytohistological correlation was available in 9 of 12 cases (75%). Cytomorphological diagnoses in 10 of 15 cases (76%) were confirmed by the finding of a specific chromosomal translocation. In two cases cytological diagnosis did not correlate with the histological diagnosis and was confirmed only with specific chromosomal translocations. The lymphocytes obtained by lymph node FNA were adequate material for cytogenetic analysis - in 15 of 18 (83%) cases mitoses in cell cultures were obtained. In 13 of 15 (87%) cases clonal chromosomal abnormalities were detected, whereas in 2 of 15 (13%) cases a normal karyotype was found. DNA image cytometry was performed on nine samples, whereas in six samples the material was not sufficient. Although a small number of samples was analysed in the cases with identical cytomorphological diagnoses, the analysed histograms regarding the DNA index values showed heterogeneity. In conclusion, a cell culture sampled by FNA of lymph nodes is an adequate method for the chromosomal analysis. The specific cytogenetic abnormality associated with cytological diagnosis provides an opportunity to make a definitive diagnosis and provides a powerful approach when reference diagnosis on biopsy material cannot be obtained.     

Cytomorphological spectrum in gynaecomastia: a study of 389 cases

Cytomorphological spectrum in gynaecomastia: a study of 389 cases The objective of this study was to document the spectrum of cytomorphological features in aspirates from gynaecomastia. During a 22-year period (July 1979 to June 2001) fine needle aspirations (FNA) were conducted on 651 males with a breast lesion. Fine needle aspirate slides from 529 benign cases were reviewed along with the histological sections of 54 cases where available. Of the 529 FNA, 140 were excluded (105 unsatisfactory, five cystic fluid aspirated, 30 inflammatory lesions). In 134 of 389 cases reviewed florid gynaecomastia was observed while the remainder showed benign ductal cells (BDC) in varying quantities from less than five to more than 25 groups. Of the 134 cases with florid gynaecomastia, 49 had a fibroadenoma-like picture (FLP), where a large number of BDC fragments with a staghorn configuration, prominent stromal fragments with contoured stroma and bare bipolar nuclei were seen abundantly in all cases. In 85 cases the features resembled fibroadenomatoid hyperplasia (FH), with only an occasional staghorn configuration of BDC seen in 82% of the cases. In 83% of cases stromal fragments of varying proportions were seen but a contoured stroma was seen in only 3.5% of cases. Both stromal and epithelial atypia were seen in 41% and 86% cases, respectively, of FLP, and in 7% and 69% cases of FH. Columnar cells, apocrine cells and foam cells were seen in approximately similar quantities in both the lesions. Vascularized stroma was seen in 22% of the cases with FLP but in only 4.5% of cases those with FH. Cytohistological correlation performed in 54 cases showed marked variation. Fine needle aspirates showed florid changes in 13 of the 41 cases of simple gynaecomastia and two of the eight cases with florid gynaecomastia on tissue sections. In conclusion, a wide spectrum of morphological features are encountered in FNA from benign male breast lesions. It is important to recognize these to avoid a false-positive diagnosis.     

Role of fine needle aspiration cytology in diagnosis of pleomorphic adenomas

Role of fine needle aspiration cytology in diagnosis of pleomorphic adenomas This retrospective study was carried out to review the cases diagnosed as pleomorphic adenoma in major or minor salivary glands and determine the difficulties encountered on typing this tumour on fine needle aspiration cytology (FNAC). Over a 19‐year period (1982–2000) 488 pleomorphic adenomas were diagnosed on FNAC from different sites (parotid – 372 cases, submandibular – 95 cases; oral cavity – 21 cases). Histology was available in 232 cases. Twenty‐nine cases where a histological diagnosis of pleomorphic adenoma was made but the cytological diagnosis was variable were also reviewed. In 216 of the 232 cases a good cytohistological correlation was available. On review only 4 of the 16 cases initially diagnosed as pleomorphic adenoma on FNAC where the histology revealed a different tumour were categorized as pleomorphic adenoma, while 3 each were classified as adenoid cystic carcinoma and benign tumour ?type, and 2 each were diagnosed to be muco‐epidermoid carcinoma, monomorphic adenoma and acinic cell carcinoma. On review of the FNAC smears from 29 cases where a histological diagnosis of pleomorphic adenoma was available while the cytological diagnosis was variable, only 11 (38%) were categorized as pleomorphic adenoma. In the majority of the remaining cases the cytological diagnosis did not alter markedly, 7 of 10 cases where the tumour could not be typed on cytology initially could not be typed even on review. In conclusion, FNAC is an ideal, fairly accurate preoperative procedure for the diagnosis of pleomorphic adenomas. Certain diagnostic problems occur in differentiating pleomorphic adenomas from adenoid cystic carcinoma, monomorphic adenoma and mucoepidermoid carcinoma. Carcinoma ex‐pleomorphic adenoma is difficult to identify on FNAC and in our series all 4 such cases on histology were considered benign on cytology.     

Stereotactic biopsy and cytological diagnosis of solid and cystic intracranial lesions

Cytological smears from 115 consecutive cases of stereotactic biopsies of intracranial lesions were reviewed. Ninety-five lesions were solid and 20 cystic. Material from 90 solid and 13 cystic lesions was sent both for cytological and histological examination. In 66 of the solid lesions, the cytological diagnosis was confirmed by histology (five were benign lesions and 61 malignant tumours: 56 primary brain tumours, three metastases and two lymphomas). In 24 cases with discrepant cytology and histology, the histology was inconclusive or insufficient in 14 cases, while cytology established the diagnosis of astrocytoma grade II (seven cases), metastases (two cases), gliosis (one case) and benign (four cases). Necrosis of tumour type was observed cytologically in six patients representing glioblastoma (two cases), anaplastic astrocytoma (one case), lymphoma (one case) and normal brain (two cases) histologically. Three cases reported cytologically as benign were primary brain tumour (two cases) and gliosis (one case). One smear of a glioblastoma was insufficient for cytological diagnosis. Cystic lesions were cytologically benign in 17 cases and malignant in three cases. Histology from the cyst wall confirmed the malignant diagnosis in three cases and showed tumour in six more cases, a benign process (two cases), changes induced by radiotherapy for arteriovenous malformation (one case) and insufficient material (one case). In conclusion, cytology from solid brain lesion allows an accurate diagnosis and subtyping of tumours in a majority of cases, and can thus be used to choose type of therapy. In cystic brain tumours, however, examination of the cystic fluid, is often inconclusive and a biopsy from the cyst wall should be performed if there is clinical or radiological suspicion of tumour.     

Prosthetic arteries; resection of the abdominal aorta and replacement with plastic materials

In seven cases, nine operations were done in which arterial replacements made of synthetic fabrics were used. In three cases the operation was entirely elective, and at last report the patients were doing well. In the four other cases there were acutely complicating factors, known before operation, and the patients died although so far as functioning of the prosthetic artery was concerned there was difficulty in only one case-a leak at one of the anastomotic seams. In one case in which the synthetic material was removed after it had been in place some time, the prosthesis showed little effect of foreign body reaction.     

Echographic findings and histological feature of the thyroid: a reverse relationship between the level of echo-amplitude and lymphocytic infiltration

In 43 patients with Graves' disease, 5 patients with painless thyroiditis and 30 patients with Hashimoto-thyroiditis ultrasonographical observations and histological examinations by needle biopsy of the thyroid were carried out simultaneously. In all cases the level of echo-amplitude was well correlated with the rate of lymphocytic infiltrations and fibrosis. In cases which exhibited marked lymphocytic infiltrations in the thyroidal biopsy specimen, no apparent echoes or very low amplitude echoes were observed in the whole thyroid and in cases in which replacement with lymphocytic infiltration was observed in almost a half part of the thyroid, several sonolucent regions were observed in the thyroid and in cases in which lymphocytic infiltration or fibrosis was observed sporadically, low-amplitude and uniform echoes were observed in the whole or several regions of the thyroid. In cases with no lymphocytic infiltration in the histological specimen, diffuse high-amplitude and uniform echoes were observed throughout the whole lobe of the thyroid. In patients with painless thyroiditis, the amplitude of echo was low when the level of lymphocytic infiltration was high and the echo-amplitude showed a tendency to increase along with the decrease in the rate of lymphocytic infiltration. From these observations it is concluded that echo-amplitude is well correlated with lymphocytic infiltration and fibrosis in patients with Hashimoto-thyroiditis, Hashitoxicosis and painless thyroiditis.     

Fluorescent antibody study of diseased, end-stage human kidneys.

Forty cases of diseased kidneys at end-stage were studied by fluorescent antibody technique in search for viral etiology of glomerulonephritis and other renal diseases. Among these 40 cases, 12 (30%) were ascribed to immune complex disease because of detection of immunoglobulins and complement in glomeruli of the same kidney specimen. In 8 cases (20%) only complement was detected in glomeruli. In the remaining 50% neither complement nor immunoglobulin deposit was found in glomeruli. The etiologies of the latter cases remain unknown. Of 12 cases of kidney disease of immune complex origin, hepatitis virus type B surface antigen was detected in 2 cases. In these 2 cases the magnitude of immune complex deposits with complement was greater than that of other cases. Other than hepatitis B virus antigen, no other viruses including Coxsackieviruses, ECHO viruses, and HSV-1 could be detected by indirect fluorescent antibody techniques. The proportion of complement deposit to the deposition of complement with immune complex in the diseased kidneys at end-stage was calculated and statistically analyzed.     

The diagnostic value of fine needle aspiration cytology (FNAC) in the assessment of palpable supraclavicular lymph nodes: a study of 218 cases

The aim of this study was to evaluate the diagnostic value of fine needle aspiration cytology (FNAC) in the assessment of palpable supraclavicular lymph nodes. The material was analysed in 218 cases with enlarged supraclavicular lymph nodes in which FNAC was performed by the conventional method. In all cases cytological examination was performed on-site after staining the smears by the Papanicolaou method. In addition, air-dried smears, fixed smears, filter preparations from needle washings and cell blocks were studied. The FNAC diagnosis was supported by examining cell blocks which added the reliability of histological architecture; further support was obtained by tissue biopsy and/or comparison with the primary tumour in some of the cases. Eleven cases were diagnosed as inflammatory lesions and 41 cases were unsatisfactory because of scanty/acellular samples (despite two to three repeat samplings). However, in five of these, malignant tumours were later found on biopsy, which was done for persistent enlargement of the supraclavicular lymph node(s). Fifty-three cases were diagnosed as negative for malignancy (normal cellular elements, n=15; reactive elements, n=38) and 12 cases were suspicious of malignancy. In 11 cases a diagnosis of lymphoma was made on histology and in 90 cases metastatic tumours were diagnosed. The overall sensitivity was 92.7%, specificity 98.5%, positive predictive value 97.3% and the negative predictive value was 94.8%. Based on our study we feel that FNAC of palpable supraclavicular lymph nodes as a first line of investigation is a cost-effective procedure and is not only useful in the diagnosis of various lesions but can also help in deciding on appropriate management. Furthermore, the histological architecture from cell blocks can be correlated with cytology, and such material can be used for appropriate histochemical and immunomarker studies, which can be useful in enhancing the diagnosis.     

Effect of Tetrabenazine on Extrapyramidal Movement Disorders

Thirty patients with various extrapyramidal movement disorders were treated for prolonged periods with 75 to 225 mg. daily of tetrabenazine. In patients with choreiform and hemiballistic motor activity the involuntary movements were diminished or abolished. In patients with cerebellar or Parkinsonian tremor the tremor was aggravated in moderately severe cases, but was uninfluenced in severe cases. In all cases the dyskinesia returned when- the drug was stopped.Side-effects were inconsiderable and disappeared on reducing the dose slightly. Hence the drug may be an important alternative to neurosurgical treatment of hyperkinesias and especially suitable for severely disabled patients.     

A high ratio of chromogranin A to synaptin/synaptophysin is a common feature of brains in Alzheimer and Pick disease

Chromogranin A and synaptin/synaptophysin were characterized by immunological methods in human autopsy brain tissue from patients with Alzheimer's and Pick's disease. In immunoblots there was no qualitative difference between the antigens in control and diseased brain, but significant quantitative differences were found. In all Alzheimer cases there was a significantly lower level of synaptin/synaptophysin, whereas chromogranin A was higher in 4 out of 5 cases and in all cases relative to synaptin/synaptophysin. An analogous finding was obtained for Pick's disease. Immunohistologically a consistent staining of neuritic plaques for chromogranin A, but not for secretogranin II was found in Alzheimer cases. In Pick's disease the characteristic Pick bodies showed an analogous specific immunostaining.     

Prostatectomy in private practice; a review of 589 cases in a five-year period

Prostatectomy was done in 589 cases in a five-year period. The operation was done transurethrally in 530 cases of benign disease and in 50 cases of malignant lesions. In six cases of malignant disease and three of benign, open procedures were used. Results of transurethral prostatectomy were considered good or excellent in 94.4 per cent of the cases of benign hypertrophy and in 92 per cent of the cases of carcinoma. It was felt that radical perineal prostatectomy was advisable for early operable cases of carcinoma, but that the transurethral procedure was more suitable in almost all cases of benign hypertrophy.     

Evaluation of Clinical and Laboratory Variables as Prognostic Indicators in Hospitalised Gastrointestinal Colic Horses

The present prospective study included 106 horses referred to the Department of Large Animal Sciences, The Norwegian School of Veterinary Science, as non-responders to the initial colic treatment in general practise. In 14 of these cases a required surgical treatment was not performed due to economical or other reasons and were excluded from the study. Clinical and laboratory data were obtained at the arrival in the hospital. The outcome for all analyses was survival/non-survival. A multivariable logistic regression was performed. The analyses were used in medically (46 horses) and surgically treated cases (46 horses) separately. The same analyses were also run for all 92 horses in a simulated "field" situation, where only clinical variables and D-dimer values were included. The fraction of survivors was 78% in the medical and 48% in the surgical cases. In total 63% of the horses survived. In the final multivariable logistic regression model packed cell volume (PCV) was the only important predictor for medically treated cases, and heart rate and presence of hyperaemic or cyanotic mucous membranes were the predictors in the surgically treated cases as well as in the simulated "field" situation. In conclusion, traditional variables as heart rate, mucous membranes and PCV were the important predictors for the outcome in hospitalised colic cases.     

急性右下肢深静脉血栓的临床治疗分析

目的:探讨右下肢深静脉血栓的临床治疗方法。方法:对我院2015年6月-2017年6月收治的63例右下肢深静脉血栓形成患者进行回顾性分析,从小腿周径差、彩超检查及造影3方面对疗效进行评价,并统计导管接触溶栓后患者复查肺部增强CT情况。结果:63例患者中,57例进行导管接触溶栓+下腔静脉滤器,6例进行导管接触溶栓+下腔静脉滤器+肺动脉碎栓、溶栓。治疗后,患者小腿周径差较治疗前明显降低,差异具有统计学意义(P0.05)。患者显效26例,有效28例,好转8例,无效1例,临床治愈率为85.7%。63例下腔静脉滤器,取出60例,3例留置为永久性滤器。新增肺栓塞12例,无致死性肺栓塞发生。结论:导管接触溶栓对右下肢深静脉血栓的治疗效果较好,但导管接溶栓时有较高肺栓塞发生率,应积极放置下腔静脉滤器。     

Spectrum of karyotypic aberrations in cultured human meningiomas

Twenty-two unselected cases of meningioma were initiated in tissue culture on an extracellular matrix derived from bovine corneal endothelial cells. The cultures were available for karyotypic analysis at passages 1 to 5, representing cultivation periods of up to two months. Histologically, the meningiomas were meningiotheliomatous (16 cases), fibrous (1 case), angiotheliomatous (1 case), microcystic (2 cases), and parenchymatous (2 cases). Two of the meningotheliomatous cases had histological signs of malignancy, another case showed increased signs of proliferation, and two cases were recurrences, one after a complete course of irradiation. In five cases no structural chromosome aberrations were found. Monosomy of chromosome 22 was found in six cases and was associated with other random aberrations. Clonal or random aberrations without monosomy 22 were present in 11 cases, including one case with trisomy 7 and another case with a stable translocation marker, t(4;7). In these latter two cases, EGF-receptor binding was not elevated, compared to other meningiomas. Our results illustrate that, in addition to the frequent involvement of chromosome 22, numerous other individual clonal karyotype aberrations exist in meningioma cell populations, reflecting the heterogeneity of biological and pathological findings.     

Origin of the v. portae and variability of its tributaries in laboratory animals. III. The laboratory rat (Rattus norvegicus var. alba)

The authors studied the origin of the v. portae and the variability of its tributaries in 30 adult laboratory rats (Rattus norvegicus v. alba) after injecting blue-dyed latex into the venous bed. In 21 cases (70.0%) the v. portae was formed from three tributaries. In 18 of these cases (60.0%) they were the v. mesenterica cranialis, v. lienalis and v. pancreaticoduodenalis cranialis. In eight cases the v. portae was formed from four or five tributaries and in only one case was it formed from two--the v. mesenterica cranialis and v. lienalis. In 21 cases (70.0%) the v. gastrica sinistra was a tributary of the v. lienalis. It collected blood from the anterior and posterior surface of the stomach and sometimes originated as far away as the curvatura major ventriculi. A v. cardiaca was present in all 30 cases (100%). As a rule (in 28 cases, i.e. 93.3%), it was a tributary of the v. gastrica sinistra. There was likewise a v. pylorica in every case; most frequently this united with the v. pancreaticoduodenalis cranialis, but was also connected with other veins in the vicinity. A v. pancreaticoduodenalis cranialis was always present. In 22 cases (73.3%) it was an independent tributary of the v. portae. In 11 cases (36.7%), there were no vv. gastroepiploicae or equivalent vessels and blood from the stomach was drained mainly by the v. gastrica sinistra. A v. gastroepiploica dextra was present in 11 cases (36.7%), mostly as a tributary of the v. lienalis; in two cases (6.7%) there was a v. gastroepiploica sinistra and in six cases (20%) the place of these veins was taken by vv. gastricae as tributaries of the v. lienalis. In 21 cases (70.0%) the v. lienalis was joined by the v. gastrica sinistra. In 22 cases (73.3%) inter-organ anastomoses between the spleen, stomach and pancreas were found. A v. pancreaticoduodenalis caudalis was always present and in 20 cases (66.7%) it was an independent tributary of the v. mesenterica cranialis. A comparison of the origin of the v. portae and the organization and variability of its tributaries in the rat, cat and guinea pig shows that, in agreement with their position in the zoological system and their mode of life, there was greater similarity between the rat and the guinea pig as regards practically all the veins examined.     

The cytopathologic diagnosis of esophageal adenocarcinoma

The diagnostic cytologic features were analyzed in 18 cases of histopathologically proven esophageal adenocarcinoma accessioned at the Johns Hopkins Hospital between 1975 and 1988 for which cytologic material was available. Primary esophageal adenocarcinoma was diagnosed in 15 of 18 cytologic specimens (83%); in 3 cases (17%), carcinoma was suspected, but the changes were nondiagnostic. The most consistent cytologic changes included both architectural features (loss of orientation and nuclear crowding) and criteria of malignancy (high nuclear/cytoplasmic ratios and prominent nucleoli). In the 15 diagnostic cases, the nucleoli were small in 8 and round in 11; in the majority of these cases, the nuclei contained one to three nucleoli. In addition, nuclear and cytoplasmic molding was seen in 9 of these 15 cases, hyperchromasia was present in 8, coarse chromatin clumps were seen in 5, and tissue fragments tended to be multilayered. Review of the three nondiagnostic cases showed that scant material was present in two; the third case had abundant material, but only nondiagnostic changes, suggesting a sampling error. Barrett mucosa was seen in 7 of the 18 cases. These cases show that esophageal adenocarcinoma can be reliably diagnosed on cytologic preparations, based on the consistent architectural features and the usual cellular criteria of malignancy.