Epithelial-myoepithelial carcinoma of the parotid. A case of ductal-predominant presentation with cytologic, histologic and ultrastructural correlations

BACKGROUND: The cytologic features of the usual type of epithelial-myoepithelial carcinoma (EMC) of the parotid, with myoepithelial cell predominance, is well described in the cytology literature. In contrast, the cytologic features of ductal-predominant-type EMC has not yet been reported. CASE: An 82-year-old male presented with a 2.7-cm parotid mass of two years' duration. Fine needle aspiration smears stained with Diff-Quik showed cohesive tissue fragments outlined by metachromatic fibrils scattered in abundant, smooth, bluish background material. Ultrafast Papanicolaou stain revealed sharply outlined, large ductal cells with smooth, round to oval nuclei, prominent nucleoli and abundant vacuolated cytoplasm; the cells were arranged tridimensionally in occasional follicles that contained thick secretions. Neoplastic myoepithelial cells were occasionally seen at the periphery of tissue fragments, most commonly hidden underneath the neoplastic ductal epithelium at a slightly different focal plane; the cells had small, oval, dark nuclei and inconspicuous cell borders. The nuclear area and cell size of the neoplastic ductal cells was two and three times, respectively, that of neoplastic myoepithelial cells. CONCLUSION: EMC, depending on the ratio of ductal to myoepithelial cell components, has different cytologic presentations. This case illustrates the ductal-predominant presentation of EMC.     

A case of Pneumocystis carinii in pleural fluid with cytologic, histologic and ultrastructural documentation

Pneumocystis carinii involvement of the pleural cavity in a patient with the acquired immune deficiency syndrome was documented by cytologic as well as scanning and transmission electron microscopic study of pleural fluids. Histologic examination of the pleura and the subpleural lung revealed vasculitis and infarctlike necrosis as well as P carinii in the tissue. Although a few cases of extrapulmonary P carinii infection have been reported, this appears to be the first time its presence in pleural fluid has been documented.     

Adenocarcinoma of the urinary bladder: histologic, cytologic and ultrastructural features in a case

A case of primary adenocarcinoma of the urinary bladder is presented, including the histologic, cytologic and ultrastructural studies. Cytologically, the diagnosis was substantiated by the presence of gland-like clusters of columnar epithelial cells and "signet-ring" cells. The neoplastic cells, whether single or in clusters, had large secretory vacuoles, hyperchromatic nuclei and prominent nucleoli. Ultrastructurally, the neoplastic cells appeared as rounded, distended structures, with markedly diminished surface microridges and plicae. In thin sections, the neoplastic cells showed a large cytoplasmic vacuole and an eccentric nucleus. An early diagnosis of primary bladder adenocarcinoma is of importance due to therapeutic and prognostic implications.     

Granular-cell tumor of the breast. A cytologic, immunohistochemical and ultrastructural study of two cases

Two primary granular-cell tumors of the breast are reported. Cytologically and histologically, these tumors had the classic features of small, eccentrically located nuclei and numerous periodic acid-Schiff-positive cytoplasmic granules. The characteristic cytologic features were best appreciated in touch imprints, not in frozen sections. Immunohistochemically, the tumors demonstrated diffuse cytoplasmic staining for S-100 protein but negative staining for myoglobin. The significance of these immunohistochemical staining characteristics, particularly in evaluating the possible histogenesis of these tumors, is discussed. The ultrastructural features of these two tumors are also presented and compared to findings reported by other investigators.     

Fine needle aspiration cytologic study of the solitary thyroid nodule. Profile of 308 cases with histologic correlation

The cytologic features and diagnoses of 308 solitary thyroid nodules subjected to fine needle aspiration (FNA) are presented and correlated with the histopathology. The findings reconfirmed the overall utility of FNA cytology in the differentiation of benign from neoplastic lesions and in the specific diagnosis of most types of thyroid lesions. The difficulty in the diagnosis of follicular carcinoma and in its differentiation from follicular adenoma is highlighted. Of note was the finding of Hürthle-cell populations in several types of lesions, which represents a potential diagnostic problem; this potential difficulty was lessened by sampling two or three areas within a nodule, thus obtaining a more truly representative specimen.     

Aspiration cytology of intramuscular myxoma. A comparative clinical, cytologic and histologic study of ten cases

Soft-tissue tumors are a fairly new area for aspiration cytology. As part of the correlation between the cytology and histology in these tumors, a retrospective study of ten intramuscular myxomas was conducted. All of the patients presented with a firm, painless intramuscular mass that was excised with different surgical margins; no recurrences were found at follow-up. The cytologic findings corresponded well with the histologic ones. Droplets of a highly viscous fluid typically characterized an aspirate from an intramuscular myxoma. The fluid was generally not very cellular. The cells had elongated cytoplasm and spindle-shaped nuclei. They varied in size and shape, and cellular atypia was minimal. Aspirates from low-grade myxofibrosarcoma and myxoid liposarcoma presented the main differential diagnostic problems.     

Malacoplakia of the uterine cervix. Histologic, cytologic and ultrastructural study of a case

A rare case of malacoplakia of the uterine cervix is described. The histologic, histochemical and ultrastructural findings in this case were typical of this entity. The typical Michaelis-Gutmann bodies were quite easily identified in the cervicovaginal smear with the use of the Von Kossa stain. This method can be an important diagnostic aid in cytologically differentiating this lesion from neoplastic or parasitic processes.     

Pulmonary oncocytoma. Report of a case with cytologic, histologic and electron microscopic study

The cytology of a pulmonary oncocytoma diagnosed by bronchial brushings is described along with the light and electron microscopic findings. Ultrastructurally, the tumor cells showed mitochondrial hyperplasia and an absence of neurosecretory granules. The possible histogenesis of pulmonary oncocytomas is discussed.     

Amiodarone pulmonary toxicity. Clinical, cytologic and ultrastructural findings

Amiodarone, a new antiarrhythmic drug, may produce severe and potentially lethal pulmonary toxicity. A case is presented of a patient on amiodarone therapy who presented with recurrent pleural effusions and subsequently developed pulmonary infiltrates. The diagnosis of lung toxicity was documented by the cytologic examination of the pleural effusions and the bronchial washings. It was further supported by the ultrastructural demonstration of the characteristic cytoplasmic osmiophilic lamellar inclusions in the foamy macrophages. We conclude that cytologic and ultrastructural examinations of bronchial lavage cells are extremely helpful in the diagnosis of amiodarone-induced pulmonary toxicity.     

Malignant angioendothelioma. Cytologic, histologic and ultrastructural findings

Cells of a malignant angioendothelioma in pleural fluid were studied by light and electron microscopy. They occurred singly and clustered, with peripheral, pleomorphic nuclei containing finely particulate chromatin and one or two nucleoli. The cytoplasm was pale and finely vacuolated. Ultrastructural findings were those of endothelial cells: cytoplasmic pseudopodia, tight junctional complexes, cytoplasmic filaments and pinocytotic vesicles.     

Morphology of adenocarcinoma in situ and microinvasive adenocarcinoma of the uterine cervix. A cytologic and ultrastructural study

Adenocarcinoma in situ (AIS) and microinvasive adenocarcinoma of the uterine cervix and normal endocervical columnar epithelium were studied by cytology, morphometry and electron microscopy to identify differentiating features and to ascertain the cellular origin of cervical adenocarcinoma. Smears from AIS showed the characteristic cytology, consisting of glandular rosettes, palisading and crowded sheets; most nuclei had a relatively uniform oval shape. Smears from microinvasive adenocarcinoma showed more crowded sheets, with enlarged, round and irregular-shaped nuclei and prominent oval nucleoli. These nuclear features were confirmed by the morphometric results. Ultrastructurally, reserve cells in the normal tissues contained tonofibers and secretory granules and showed squamous and adenomatous features. The ultrastructural features of microinvasive adenocarcinoma were similar to those of well-differentiated invasive adenocarcinoma. The cells from both contained tonofibers and secretory granules. These findings suggested that the reserve cell is the cell of origin for cervical adenocarcinoma.     

Storage granules of thyroid C cells in the dog: a cytochemical and ultrastructural study, in relation to the masked metachromasia reaction.

Masked metachromasia can be demonstrated in thyroid C cells, and other cells of the APUD series, by staining with a metachromatic basic dye after hydrolysis of suitably fixed tissue. The reaction is thought to be due to the presence of polypeptides with a high concentration of side-chain acidic groups. Since most APUD cells possess storage granules, presumed to contain a polypeptide hormone, it has been assumed that the masked metachromasia reaction gives information concerning the contents of these granules. However, there has been an increasing suspicion that the reaction might actually be due to the membrane bounding these granules, rather than to the contents. We have examined, cytochemically and ultrastructurally, dog thyroid tissue which has been subjected to fixation and hydrolysis as in the usual method for masked metachromasia. We found that the membrane surrounding the C cell granules is removed by hydrolysis, confirming the hypothesis that the reaction is due to the contents (hormone and/or matrix)rather than to the membrane. Tissues were fixed in an aqueous mixture containing glutaraldehyde (6 25% v/v), picric acid (three-quarters saturation) and sodium acetate (I% W/V)adjusted to PH 7 with sodium hydroxide. This was found to be a very satisfactory fixative for electron microscopy Some morphological details of C cells were noted, such as the richness of desmosomes between C cells in this species, and frequent direct contact with the colloid.     

Malignant teratoma of the thyroid with predominantly neuroepithelial differentiation. Fine needle aspiration cytologic, histologic and immunocytochemical features of a case

BACKGROUND: Teratoma of the thyroid in adults is extremely rare, and most are malignant. Only nine cases have been adequately documented in the English-language literature, and there are no reports detailing the fine needle aspiration (FNA) cytologic characteristics. CASE: A 32-year-old female presented with a left-sided nodular thyroid mass with left cervical lymphadenopathy. FNA cytology of the thyroid and lymph nodes was done. The cytologic and immunocytochemical features were that of a small round cell tumor with neuroepithelial (NE) differentiation, metastasizing to the cervical nodes. Microscopic study of the thyroidectomy specimen showed a tumor showing an NE pattern with occasional islands of squamous and cuboidal epithelium, leading to a diagnosis of malignant teratoma. CONCLUSION: Knowledge of FNA cytologic features of rare but highly malignant lesions like thyroid teratomas allow early recognition so that suitable and possibly aggressive treatment protocols can be adopted in the hope of prolonging survival.     

Elastofibroma dorsi. Cytologic, histologic, immunohistochemical and ultrastructural studies.

Cytologic, light and electron microscopic, and immunohistochemical studies were conducted on a case of elastofibroma. Aspiration cytology showed a characteristic "braidlike" or "fern leaf-like" structure. Immunohistochemically the accumulate was shown to be elastin. Transmission electron microscopy indicated electron-dense, granular aggregates surrounded by microfilaments and collagen, while scanning electron microscopy revealed balls with a ball-of-yarn-like structure consisting of small fibrils, probably of elastin. These structures are unique to this disease and useful for diagnosis.     

Follicular variant of papillary carcinoma of the thyroid. A cytologic study of 15 cases

OBJECTIVE: To study the cytologic findings of follicular variant of papillary thyroid carcinoma (FVPTC) and to compare them with the cytologic findings on other thyroid lesions. STUDY DESIGN: The study group consisted of aspirate smears from 15 cases of histologically proven FVPTC. The control group consisted of 152 cases, including adenomatous colloid goiter (70), usual papillary carcinoma (40), follicular adenoma (30), Hürthle cell neoplasm (7) and medullary carcinoma (5). RESULTS: The smears of FVPTC revealed numerous colloid balls in the background, multilayered microfollicles (rosettes), numerous nuclear grooves and inclusions in the monolayer sheets of follicular cells, very rare giant cells, absence of calcification and papillary clusters. Rosettelike microfollicles and numerous colloid balls were not seen in the control group. CONCLUSION: The combination of numerous colloid balls and rosettelike microfollicles was frequently seen in FVPTC. This combination was not observed in the control group.     

Comparative cytologic and histologic studies in oral leukoplakia.

Comparative analysis of cytologic and histologic results and clinical types of 201 oral leukoplakias has shown: 1) an agreement between cytologic and histologic results in 76.6% of all cases; 2) an occurrence of carcinoma in 32.9% of the erosive leukoplakias in 3.2% of the verrucous leukoplakias, and none in the leukoplakia simplex group; 3) a higher efficacy of cytology in detecting malignancy in the erosive leukoplakia group.