Carcinosarcoma of the uterus. Cytologic and ultrastructural features

A 56-year-old woman presented with a carcinosarcoma consisting of a small focus of adenocarcinoma and a larger endometrial stromal sarcoma component. Although a preoperative endometrial biopsy revealed only adenocarcinoma, an endometrial smear obtained with an endometrial brush sampler revealed many undifferentiated malignant cells and a smaller number of adenocarcinoma cells. These undifferentiated malignant cells were cytologically identical to the stromal sarcoma cells in an imprint smear from the surgically removed tumor. The cellular and ultrastructural features of the stromal sarcoma are described in detail.     

Adenoid cystic carcinoma of the uterine cervix. Cytologic features

A case of primary cervical adenoid cystic carcinoma in a 75-year-old woman is reported. Two cervical smears taken at the time of initial presentation for vaginal spotting were negative; a third smear, taken a year later prior to laparotomy, was diagnosed as positive. The cytologic findings in the positive cervical smear are described and illustrated. The differential diagnosis of the cytologic findings is discussed, and the literature on this lesion is briefly reviewed. The results in this case and others suggest that the diagnosis of cervical adenoid cystic carcinoma in an asymptomatic patient may be missed by routine smear examination.     

Ultrastructural organization of the hamster renal pelvis.

The renal pelvis of the hamster has been studied by light microscopy (epoxy resin sections), transmission electron microscopy, and morphometric analysis of electron micrographs. Three morphologically distinct epithelia line the pelvis, and each covers a different zone of the kidney. A thin epithelium covering the outer medulla (OM) consists of two cell types: (1) granular cells are most numerous and have apically positioned granules which stain intensely with toluidine blue, are membrane-bound, and contain a fine particulate matter that stains light grey to black in electron micrographs. (2) Basal cells do not have granules, are confined to the basal lamina region, and do not reach the mucosal epithelial surface. The inner medulla (IM) is covered by a pelvic epithelium morphologically similar to collecting duct epithelium of IM. Some cells in this portion of the pelvic epithelium (IM) stain intensely dark with toluidine blue, osmium tetroxide, lead, and uranyl acetate. Transitional epithelium, which separates cortex (C) from pelvic urine, has an asymmetric luminal plasma membrane and discoid vesicles, each of which is similar to those previously observed in mammalian ureter and urinary bladder epithelia. Based on morphological comparisons with other epithelia, the IM and OM pelvic epithelia would appear permeable to solutes and/or water, while the transitional epithelium covering the C appears relatively impermeable. It would also appear that the exchange of solutes and water between pelvic urine and OM would involve capillaries, primarily, since morphometric analysis showed that both fenestrated and continuous capillaries of the OM were extremely abundant (greater than 60% of OM pelvic surface area) just under the thin pelvic epithelium.     

Pseudosarcomatous fasciitis of the breast. Cytologic and histologic features

A rare case of pseudosarcomatous fasciitis of the breast is presented. Both the clinical examination and the mammographic findings led us to expect a malignant lesion. Fine needle aspiration biopsy cytology, however, was negative, with the cells observed indicating a benign lesion. The benignity was proven by histologic examination of the extirpated nodule. The usefulness of aspiration cytology in the diagnosis of this entity and the need for a combined methodology in the diagnosis of breast tumors are emphasized.     

Anatomy of the renal pelvis in the hamster.

The hamster renal pelvis has been studied by means of low-power light microscopy, scanning electron microscopy and morphometric analyses. The results of this study are highly suggestive that the contact of pelvic urine with the other medulla as well as with the inner medulla may be an important aspect of final urine formation. The outer medulla constituted nearly 50% of the total pelvic surface area, with the inner stripe of the outer medulla more than twice the pelvic surface area of the outer stripe of the outer medulla. The large outer medullary pelvic surface area was accounted for by the elaboration of the upper pelvic walls into peripelvic columns, opercula ("secondary pyramids"), fornices and secondary pouches. A thin simple-squamous to low cuboidal pelvic epithelium separated pelvic urine from outer medullary parenchyma. The inner medulla which constituted about one quarter of the total pelvic surface area was covered by a cuboidal to columnar pelvic epithelium which appeared morphologically similar to the papillary collecting duct epithelium. Tubules and capillaries of the inner medulla did not appear as closely juxtaposed to the pelvic epithelium as did those of the outer medulla. Cortical tissue comprised only 11.7% of the total pelvic surface area and was covered by transitional epithelium similar to that of ureter and bladder. The previously reported impermeability of this epithelium suggests that pelvic urine contact with the cortex is unimportant in final urine formation. The rich layer of smooth muscle under the transitional epithelium probably functions to move urine into and out of the pelvis during pelvic peristalsis, which has been observed in vivo.     

Cytologic features of secretory meningioma

OBJECTIVE: To describe the cytologic features of secretory meningioma on crush preparations. STUDY DESIGN: In five cases, the diagnosis of secretory meningioma was made and crush preparations were available. In each case, crush preparations were made at the time of intraoperative consultation from an open biopsy specimen or stereotactic biopsy. RESULTS: Hematoxylin and eosin-stained crushes showed the presence of clusters of cohesive cells containing variable numbers of inclusions among less cohesive typical meningothelial cells. In two cases, the inclusions were especially prominent. Inclusions varied in size from 3 to 40 microns, had a well-defined rim and contained finely granular or hyaline material and a central core. CONCLUSION: Secretory meningiomas demonstrate distinct cytologic features on crush preparations. Recognition of these inclusions is important since their prominence in some stereotactic smear preparations may lead to diagnostic problems.     

Cytologic features of islet-cell tumors

Although a number of reports have demonstrated the accuracy of fine needle aspiration (FNA) in the diagnosis of nonendocrine pancreatic carcinomas, the cytomorphology of islet-cell tumors (pancreatic endocrine tumors) is not well defined. This paper describes the cytologic features of three histologically confirmed cases of islet-cell tumors. The three tumors occurred in one man and two women, who were 63, 64 and 70 years of age, respectively. Each patient underwent FNA of pancreatic mass with computed body tomography guidance. The aspirates contained large numbers of tumor cells in two cases and a smaller number in one case. The cells, distributed singly and in small groups, were small and round or polygonal, with scant to more often abundant, dense or granular cytoplasm. The nuclei were often located eccentrically and were round to oval, with smooth nuclear borders and finely stippled chromatin. Many nuclei contained a single nucleolus. Multinucleated cells were present and generally contained two or three nuclei. Although the diagnosis of islet-cell tumors in fine needle aspirates is difficult, the cytomorphologic features of these tumors are sufficiently distinctive to suggest the diagnosis, especially when a relatively monomorphic population composed predominantly of single cells is present.     

Cytologic features of chordoid meningioma. A case report

BACKGROUND: Chordoid meningioma is a rare subtype of meningioma characterized by myxoid matrices deposited among epithelioid or vacuolated tumor cells and infiltrates of inflammatory cells, and its cytologic features have rarely been reported. CASE: A 57-year-old man with a history of headache and visual disturbance presented with a tumor in the suprasellar region. Intraoperative touch smear cytology of the tumor disclosed a cord-like arrangement of polygonal tumor cells occasionally containing intranuclear inclusions. Furthermore, periodic acid-Schiff-positive, mucinous matrices were deposited among the tumor cells. Also, infiltrates of lymphocytes and plasma cells were noted. Histologic, immunohistochemical and ultrastructural examination confirmed the diagnosis of chordoid meningioma. CONCLUSION: Intraoperative smear cytology in a case of chordoid meningioma showed distinctive cytologic features suggestive of the histologic patterns. The cytologic features, together with a histologic examination, are useful for its diagnosis.     

Recurrent carcinosarcoma of the renal pelvis. Case report

Carcinosarcoma is a malignancy that occurs very rarely in the renal pelvis; thus, only a very limited number of cases has been documented. These tumors are composed of both carcinomatous and sarcomatous elements. We report here a case of a carcinosarcoma composed of well-differentiated, keratinizing, squamous carcinoma cells and high-grade sarcoma cells. Differently from the cases described so far, this carcinosarcoma of the renal pelvis was characterized by the quick recurrence, following complete surgical resection, as a highly disseminated high-grade sarcoma.     

Metastatic spindle-cell carcinoma. Cytologic features and differential diagnosis

Fine needle aspiration biopsies of tumors can yield a variety of spindle cells derived from several types of neoplasms. Among these is a rare lesion known as a "spindle-cell carcinoma" or "pseudosarcoma," which may represent a transformation of a preexisting squamous-cell carcinoma that has been subjected to radiotherapy or solar damage. The cytologic, histologic and ultrastructural features of a case of metastatic spindle-cell carcinoma of the rib subjected to fine needle aspiration are presented, and other spindle-cell tumors that should be considered in the differential diagnosis are discussed.     

Cytologic features of nonfatal herpesvirus tracheobronchitis

Herpesvirus infections of the lower respiratory tract have most commonly been reported in patients with severe burns, immunosuppression or malignancies. Two patients without any of these underlying conditions developed severe herpetic tracheobronchitis, diagnosed by cytologic examination and confirmed by serologic studies. Serial examination of sputum, bronchial brushings and bronchial washings permitted observation of the evolution and progression of cellular changes found in herpesvirus infection of the lower respiratory tract. both patients recovered without specific antiviral therapy, but both developed superinfection with gram-negative organisms, requiring intensive antibiotic therapy. The distinctive features of herpesvirus infection in the tracheobronchial tree are similar to those recognized elsewhere in the body. Early findings include a variety of nonspecific changes in nuclear chromatin configurations; multinucleated cells may be common but do not often contain the central intranuclear inclusion bodies seen in later stages. These distinctive central intranuclear inclusions disappear in a few days, leaving only reparative changes in the surface epithelium. Herpesviruses are increasingly being reported in the literature as an etiologic agent of acute tracheobronchitis in otherwise healthy individuals.