Cytologic and histologic correlation in primary lung cancer. A study of 154 cases with resectable tumors

The accuracy of cytologic diagnosis and typing was examined in 154 patients, 113 males and 41 females, who underwent radical surgery during the past six years. There were 42 central and 112 peripheral lesions: 6 adenocarcinomas and 28 squamous-cell carcinomas were centrally located and 69 adenocarcinomas and 27 squamous-cell carcinomas were peripherally located. Repetition of sputum sampling at least three times was preferred, especially in central lesions, which were detected in 57% to 64% of the cases by either three-day-pooled or aerosol-induced specimens. Peripheral lesions required brushing to enhance the accuracy. The overall typing accuracy was 64.3%, ranging from 83.6% in squamous-cell carcinoma to 25.0% in large-cell carcinoma. Cytologic positivity correlated well with the finding of tumors more than 3 cm in diameter. Adenocarcinoma and squamous-cell carcinoma showed no significant difference in frequency of regional lymph nodal metastases. The value of judging the accuracy of cytologic diagnosis and typing on the histologic evaluation of the entire resected lesion, rather than on biopsy specimens, is emphasized.     

Lymphoepithelial cyst with crystalloid formation. Cytologic features of two cases

BACKGROUND: The presence of amylase crystalloids (AC) in cystic lesions of the parotid gland is a rare occurrence and has been diagnosed to date as sialadenitis. We report the first two cases of parotid lymphoepithelial cyst (LC) containing this type of crystalloid. CASES: Case 1, a 56-year-old male, presented with a 3-cm parotid cyst. Fine needle aspiration (FNA) was performed on the mass. Smears showed numerous crystalloids identical to those described as crystallized amylase. Case 2, a 36-year-old female, had a 2-cm parotid mass. FNA smears exhibited the same features as did case 1. The two patients were treated with superficial parotidectomy, and an LC containing AC was diagnosed in both cases. CONCLUSION: When the above findings are present on FNA of parotid gland, the diagnosis of LC must be considered.     

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.     

Dysgerminoma of the ovary. Cytologic, histologic and electron microscopic study of a case.

A case of ovarian dysgerminoma is reported. Both histology and cytology showed cells with distinctive anisokaryosis and large, sometimes bizarre, nucleoli as the most striking feature. A lymphocytic infiltration was present. Electron microscopy showed large convoluted nucleoli, structures resembling so-called "annulated lamellae" and glycogen particles, features that are typical of a germ-cell tumor. The cytologic, histologic and ultrastructural investigations revealed a dysgerminoma; that diagnosis was not certain on the frozen sections.     

Quality assurance in pathology. Cytologic and histologic correlation.

In this study we used a computerized program to compare the cytologic and histologic diagnoses made in a three-year period with the aim of evaluating the data obtained as an index of the diagnostic accuracy of cytology in a pathology quality assurance program. Concordance between the cytologic and histologic diagnoses was observed in 83.2% of the cases. In 1.2% the cytologic diagnosis was suspected malignancy, and 78.4% of these cases were positive for tumor at histologic examination. Analysis of the data must be performed in accordance with the anatomic site involved, and discordance must be investigated by a pathologist, especially in view of the different modalities of cytologic and histologic sampling. Analytic data on the breast, bladder and lung are presented.     

Intraocular lymphoma. Cytologic diagnosis and the role of immunologic markers

We retrospectively reviewed the cytology and immunohistochemistry of vitreous cells from 14 patients with benign or malignant intraocular diseases. Nine patients had intraocular lymphoma and five had benign forms of diffuse uveitis. The most useful cytologic criteria for lymphoma included an irregular nuclear outline, a coarse chromatin pattern and prominent nucleoli. In several cases, it was necessary to obtain more than one specimen to establish the diagnosis of lymphoma. When vitreous fluid was mixed with a balanced salt solution prior to processing, a resulting artifact interfered with interpretation of the specimen. A diagnosis of lymphoma was established by cytology in all nine patients; immunohistochemical techniques were less sensitive than was cytology.     

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.     

Adult rhabdomyoma in fine needle aspirates. A report of two cases

BACKGROUND: Adult rhabdomyoma (ARh) is a rare, benign tumor arising most frequently in the head and neck region and sometimes mimicking malignant tumors clinically. Correct preoperative evaluation of this tumor is of crucial importance as its treatment is complete excision only and not radical surgery. CASES: Two patients with ARh, one tumor presenting near the submandibular gland and the other in the thyroid area, are reported. The first tumor was correctly diagnosed by fine needle aspiration cytology. The second, clinically suspected to be a colloid goiter, was preoperatively diagnosed as such cytologically as well. After the tumor was excised, reexamination of the cytologic specimen disclosed follicle cells admixed with single cells from ARh; these had been interpreted as colloid fragments at the time of primary evaluation. CONCLUSION: Fine needle aspiration evaluation of ARh may be problematic due to the rarity of the tumor and to the similarity of the tumor cells to normal striated muscle and to other tumors in which cells with abundant granular cytoplasm are characteristic. With an awareness of the cytologic features of this uncommon tumor, cytopathologists can render a correct diagnosis.     

Papillary carcinoma of the breast. Cytologic study of nine cases.

OBJECTIVE: To study the cytologic findings of papillary breast carcinoma by fine needle aspiration. STUDY DESIGN: The study group consisted of fine needle aspiration (FNA) specimens of breast tumors from nine patients performed during the period 1988-1997. Eight were female, and one was male. The FNA results were compared with the final histologic diagnosis. RESULTS: The tumor sizes were 4-6.5 cm. The aspirations yielded a good amount of bloody material. The smears revealed high cellularity, papillary clusters, isolated low-to-tall columnar cells, mild to moderate atypia, hemorrhagic background, foam and hemosiderin-laden macrophages, calcification, rare mitoses, palisading row of cells and bipolar cytoplasmic eosinophilic granules. The smears were diagnosed as either suspicious or suggestive of papillary carcinoma. The histologic examination revealed invasive papillary carcinoma. CONCLUSION: Papillary carcinoma of the breast can be diagnosed by using a panel of cytologic findings that includes hypercellularity, papillary clusters, hemorrhagic background, palisading rows of tall columnar cells, cellular atypia and calcification. The interesting finding in this study was the presence of eosinophilic bipolar cytoplasmic granules, which has not been reported before.     

Cytologic findings in progressive multifocal leukoencephalopathy. Report of two cases

Cytologic preparations from two cases of progressive multifocal leukoencephalopathy (PML) were obtained by stereotactically guided needle biopsies using computerized tomograms of the brain. Case 1 was a 32-year-old man with an acquired immunodeficiency syndrome-related complex. Case 2 was a 71-year-old man with chronic lymphocytic leukemia. Smears showed moderate cellularity, consisting of moderately to markedly atypical cells with enlarged hyperchromatic nuclei. The chromatin pattern showed smudging, with or without clumping, similar in pattern to the human polyomavirus-infected "decoy" cells seen in urine cytology. Nuclei were predominantly round to oval, smoothly contoured and often stripped of cytoplasm. Occasional bizarre lobulated or multinucleated forms were seen. Some atypical cells had abundant cytoplasm exhibiting stellate projections. Histologic sections of the biopsy material confirmed the diagnosis in each case. In both cases, electron microscopy demonstrated intranuclear polyoma-type virus particles. The present findings suggest that PML should be considered in the differential diagnosis of marked cytologic atypia in brain aspirates from immunocompromised patients.     

Pseudotumoral tuberculosis of the uterine cervix. Cytologic presentation

The cytologic presentation of a case of pseudotumoral tuberculosis of the uterine cervix is described. The presence in cervicovaginal smears of epithelioid cells arranged in clusters mixed with Langhans' giant cells was highly suggestive of tuberculosis. This diagnosis was confirmed by the detection of acid-fast bacilli in histologic preparations and cultures from biopsy specimens.     

Hemangioendothelioma. Cytologic appearances in two cases presenting with multiple soft tissue and bone lesions

Two cases of hemangioendothelioma were detected by fine needle aspiration cytology in two women presenting with multiple soft tissue and bone lesions. The aspirates were hemorrhagic, and the smears showed mostly dissociated and predominantly monomorphic tumor cells. Focal rosettelike clustering of tumor cells was also present. A prominent cytologic feature of these two cases of hemangioendothelioma was the close association of tumor cells with endothelium-lined vascular structures, a pattern that can be seen in other sarcomas and sometimes in malignant epithelial tumors.     

Cytologic findings with histologic correlation in 43 cases of mammary intraductal adenocarcinoma diagnosed by aspiration biopsy

OBJECTIVE: To review the cytologic and subsequent histologic findings in intraductal mammary adenocarcinoma (ductal adenocarcinoma in situ) (DCIS) to evaluate the role of aspiration biopsy (AB) in identifying and grading the disease. STUDY DESIGN: AB smears and tissue sections from 43 women with pure DCIS who underwent preoperative AB were reviewed. Smears were assessed for cellularity, cellular arrangement (including dissociation, nuclear size and pleomorphism), and presence of nucleoli and necrosis. RESULTS: Of the 43 cases, 22 were high grade (HG) DCIS, 7 cases were intermediate grade (IG), and 14 cases were low grade (LG). Cytologic findings of HG DCIS was as follows: high cellularity (22/22), clusters of pleomorphic cells with large nuclei and increased nuclear/cytoplasmic ratios (22/22), single cells (20/22), prominent nucleoli (22/22) and necrosis (diffuse in 15/22, focal in 7/22). All LG cases had moderately to highly cellular smears with cohesive, 3-dimensional sheets of uniform, small cells with inconspicuous nucleoli arranged around a central lumen, forming "punched-out" spaces. Single cells were prominent in 2 of 14 cases. IG DCIS showed intermediate features between LG and HG DCIS: 3-dimensional sheets with punched-out spaces, abundant single cells, moderate pleomorphism and focal necrosis. CONCLUSION: HG DCIS is easily identifiable on AB smears; however, distinction from invasive carcinoma may not be possible. The cytologic diagnosis of LG DCIS is difficult, and 50% of our cases were called atypical on AB. Recognition of cohesive cellular arrangements with crowding and punched-out spaces is crucial as single cells and prominent atypia are often lacking.     

Oncocytoid adenocarcinoma of the parotid gland. Cytologic, histologic and ultrastructural findings

An oncocytoid adenocarcinoma of the parotid gland, diagnosed by fine needle aspiration cytology, is reported. The neoplasm, seen in a 66-year-old man, metastasized to 33 of 46 resected cervical lymph nodes; the patient is currently free of disease 17 months after surgery. Cytologically, the neoplastic cells occurred singly and in small clusters. They had abundant granular cytoplasm with occasional vacuoles, large nuclei and prominent nucleoli. Ultrastructurally, the tumor cells had copious cytoplasm, with moderately increased numbers of mitochondria, dilated endoplasmic reticulum, mucin droplets and intracytoplasmic lumina. The clinical importance of distinguishing this neoplasm from true malignant oncocytoma is, at present, unknown.     

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.     

Ewing's sarcoma. Cytologic features in fine needle aspirates in two cases

The cytologic findings of two cases of Ewing's sarcoma in fine needle aspiration biopsies are presented in relation to the subsequent histologic findings. The malignant cells were arranged in monocellular layers, pseudorosettes and in perivascular palisades in a fibrillar background. The nuclei were monomorphous with small nucleoli and finely granular chromatin. These features may be helpful in distinguishing this tumor from other small-cell neoplasms; the differential diagnosis between Ewing's sarcoma and such tumors is discussed.     

Cytologic demonstration of Entamoeba histolytica using immunoperoxidase techniques. Report of two cases

An indirect immunoperoxidase technique to detect Entamoeba histolytica in cell samples from patients suspected to have amebiasis is described. Using a rat antiserum specific for E. histolytica, the organism was clearly identified both in smears and in cell blocks. This immunoperoxidase technique seems to offer great possibilities for a specific, accurate and rapid identification of amebic infestation in diagnostic cytology.