VAGINAL CYTOLOGY—Results in 3,000 Consecutive Women with “Normal” Cervices

Cytologic examination of 9,000 specimens of mucoid material taken from the cervices of 3,000 women who had no clinically observable vaginal abnormality was carried out. Sixteen of them had carcinoma, later proved by tissue examination. In 15 cases the lesion was epidermoid carcinoma of the cervix and in one was adenocarcinoma of the endometrium. Routine use of examination of mucoid specimens easily and painlessly obtained from the vagina should contribute substantially to a lower mortality from pelvic carcinoma.     

Adenoid cystic carcinoma metastatic to the lung. Report of a case diagnosed by fine needle aspiration biopsy cytology

Cytologic examination of a fine needle aspiration (FNA) biopsy specimen served to diagnose a lung metastasis in a patient with an adenoid cystic carcinoma primary in a minor salivary gland of the hard palate. The aspiration cytologic features of the metastatic adenoid cystic carcinoma were similar to those of primary adenoid cystic carcinoma, including uniform tumor cells with scant cytoplasm surrounding transparent, mucoid spherical bodies. FNA biopsy cytologic diagnosis of metastatic adenoid cystic carcinoma is accurate, particularly if mucoid spherical bodies are present.     

Papillary carcinoma of the common bile duct. Diagnosis by bile drainage cytology

A 54-year-old man with clinical and radiologic findings suggestive of pancreatic carcinoma had cytologic examination of bile drainage fluid specimens prepared by membrane filtration and cytocentrifugation. Examination showed clumps of malignant cells with features most consistent with a well-differentiated papillary neoplasm of bile duct origin, rather than a primary pancreatic carcinoma. Partial pancreatoduodenectomy with resection of the proximal common bile duct confirmed the presence of a small, well-differentiated but invasive papillary bile duct carcinoma. Pancreatic carcinoma and papillary carcinoma of the bile duct are anatomically and biologically different lesions that should be distinguished, when possible, by cytologic examination. In this case, surgical treatment was planned on the assumption that cytologic examination could distinguish a papillary carcinoma of the bile duct from the clinically suspected pancreatic adenocarcinoma.     

Cytomorphology of the variants of small-cell carcinoma of the lung

Cytologic classification of subtypes of small-cell carcinoma of the lung (SCCL) was retrospectively performed on respiratory material of 90 cases of lung carcinoma cytologically diagnosed as SCCL. Additionally, the cytologic material was reexamined for the presence of variants of SCCL in 68 cases of lung carcinoma whose types had not been conclusively defined by cytology. The type of lung cytology specimens reviewed were sputa, bronchial washings and brushings and fine needle aspirations. The study included review of pretreatment tumor histology, when present, and examination of the ultrastructure of the tumor in selected cases whose type had not been well defined by histology. Subtype recognition depended on the adequacy of the specimens rather than on the type of cytologic material examined. The cytologic subtyping was generally in agreement with the histologic subtyping of the tumor, except for cases in which SCCL was combined with other types of lung carcinoma, where certain discrepancies were noted.     

Cystoscopic biopsy supernate. A new cytologic approach for diagnosing urothelial carcinoma in situ

The examination of cystoscopic biopsy supernates is a new cytologic procedure that can aid the urologist in the differential diagnosis of urothelial carcinoma in situ (CIS) and cystitis. Within the past two years, the Cytodiagnostic Urinalysis Laboratory has received 79 cystoscopic biopsy supernate specimens from 29 patients; these were prepared using a membrane filtration technique and stained with a modified Papanicolaou method. Positive diagnoses were rendered on 17 (21.5%) specimens, including 7 (41%) CIS and 10 (59%) papillary neoplasms. An 87% cytohistologic correlation was seen. Of the 17 cases with biopsy specimens that were denuded and thus nondiagnostic, 11 had negative supernate cytologies and 6 had positive cytologic diagnoses. Half of these positive specimens were diagnosed as CIS. Because urothelial CIS is often a friable lesion that yields denuded bladder biopsies, the cytologic examination of cystoscopic biopsy supernates offers a valuable adjunctive method for diagnosing urothelial CIS on otherwise lost cellular material.     

Fine needle aspiration cytology of mucinous cystadenocarcinoma of the lung: report of a case with radiographic and histologic correlation

BACKGROUND: Mucinous cystadenocarcinoma of the lung is an uncommon tumor. Because it contains relatively few neoplastic cells relative to the amount of mucin produced, diagnosis of this entity, particularly on small specimens, is exceedingly difficult. CASE: The diagnosis of adenocarcinoma was made on transthoracic fine needle aspiration from a patient with a right upper lobe lung mass. Abundant mucoid material suggested a mucin-producing neoplasm. Histopathology revealed a mucinous cystadenocarcinoma with focal mucinous bronchoalveolar carcinoma. CONCLUSION: The presence of copious extracellular mucin in fine needle aspirates from the lung otherwise diagnostic of adenocarcinoma should raise the possibility of a mucinous tumor. In particular, the diagnosis of mucinous cystadenocarcinoma may be suggested in cases that have a cystic appearance on imaging studies.     

Colorectal cytology in chronic ulcerative colitis

During a period of ten years, 109 colorectal cytology specimens were obtained from 41 patients with chronic ulcerative colitis. There were 28 male and 13 female patients, whose average age was 45 years. All patients were symptomatic and had ulcerative colitis with repeated attacks of profuse diarrhea on the average for 12 years prior to their first cytologic examination. Eight cytology specimens were positive for malignant cells, 35 had atypia, 58 were negative and 8 were unsatisfactory. The malignant cells showed marked anisocytosis, pleomorphism and nuclear hyperchromasia and appeared in loosely cohesive clusters or in single forms in an inflammatory and necrotic background. Subsequent colectomy revealed invasive carcinoma in five patients and carcinoma in situ in two. Smears that were negative or showed atypia contained abundant chronic inflammatory cells. The atypical colonic epithelial cells contained prominent nuclei and formed cohesive clusters. Surgical biopsy and/or segmental resection revealed the presence of polyps, pseudopolyps, polypoid hyperplasia, mucosal atypia and crypt abscesses in patients with atypical and negative cytologic findings. It is concluded that cytologic examination of the colon can play an important role in the examination of patients with ulcerative colitis and allows for the detection of malignant transformation of the colonic mucosa.     

Mammary mucinous carcinoma with marked cytoplasmic hyalinization. A report of 2 cases with emphasis on fine needle aspiration cytologic findings

BACKGROUND: Cytoplasmic eosinophilia in breast tumors is due mainly to abundance of secretory granules, lysosomes and/or mitochondria. Diffuse cytoplasmic hyalinization caused by intermediate filaments has not been described before. CASES: Two cases of pure mammary mucinous carcinoma occurred with marked cytoplasmic hyalinization among 556 wide excision/mastectomy specimens of mammary ductal carcinoma, either in situ or invasive, encountered at Pamela Youde Nethersole Eastern Hospital, Hong Kong, during the period from 1994 to the end of 2001. Preoperative fine needle aspiration cytology was available in 1 case, showing cohesive clusters and micropapillae of tumor cells in abundant background mucin. The tumor cells had low mitotic activity and possessed round to oval nuclei, solitary macronucleoli; ample, eosinophilic cytoplasm and discrete cell borders. Cytoplasmic granularity, intracytoplasmic vacuoles or "cometlike" cells were not found. Histologic examination of the surgical specimens in both cases revealed pure mucinous carcinoma with diffuse and marked cytoplasmic hyalinization. There was no evidence of peritumoral lymphovascular permeation or regional lymph node metastasis. Ultrastructural examination showed minimal secretory activity, with abundant, loose aggregates of intermediate filaments in the cytoplasm. There was a relative paucity of other organelles. CONCLUSION: Diffuse cytoplasmic hyalinization is a peculiar morphologic change in mammary ductal carcinoma and apparently unique to pure mucinous carcinoma. Recognition of this phenomenon may help to avoid misdiagnosis of other types of ductal carcinoma with cytoplasmic eosinophilia, such as apocrine carcinoma and ductal carcinoma with neuroendocrine differentiation, which sometimes are also associated with pools of extracellular mucin.     

婴幼儿腹泻病原学及其快速诊断

目的探讨小儿腹泻标本病原学特点及流行病学特征,寻求小儿感染性腹泻的快速诊断方法。方法对我院2003年10月至2005年9月门诊及住院的1160例2个月-5岁腹泻患儿的腹泻标本进行细菌学检查及pH检测。结果(1)1160例患儿腹泻标本病原学阳性605例(52.16%),检出病原20种621株,外源性肠道病原菌、内源性肠道条件致病菌以及轮状病毒3种病原构成比依次为35.75%、32.69%、31.56%。主要病原:(1)轮状病毒196株(31.56%),志贺菌118株(19.00%),克雷伯菌86株(13.8%),枸橼酸杆菌67株(10.79%),致泻性大肠埃希菌60株(9.66%)。(2)1160例患儿腹泻标本6个月-2岁患儿占881例(69.91%)。轮状病毒腹泻多发于秋冬季、大便为水样、多见于2岁以内婴幼儿,志贺菌以夏秋季与脓血便检出率较高。(3)病原菌分离阳性腹泻标本pH>7占明显优势,轮状病毒阳性标本、病原检查阴性标本、健康体检对照标本pH<6占明显优势,前者pH与后三者pH统计学比较,差异有高度显著性(P<0.01)。结论引起小儿腹泻的病原种类繁多,轮状病毒居首位,内源性肠道条件致病菌在腹泻标本中的构成比已接近外源性肠道致病菌而成为腹泻的重要病原菌,大便pH可作为急性腹泻病早期简单、快速、准确、价廉的初步诊断及合理应用抗生素的重要指标。     

Basement membrane components of bronchial epithelium in humans suffering from chronic nonspecific lung diseases

Collagen IV and laminin are important constituents of the basement membrane (BM). By use of immunocytochemistry we examined the occurrence and distribution of these two components in the BM beneath normal, mucoid and metaplastic epithelium of large bronchi in 22 adults suffering from chronic nonspecific lung diseases. Both collagen IV and laminin were expressed as a thin and continuous layer beneath the epithelium in most tissue specimens with normal epithelium. In a few specimens the layer showed interruptions with a patchy distribution of the immunoreactivity. Three patterns of distribution of BM components were found under the metaplastic epithelium. Total absence of immunoreactive collagen IV and laminin was the most common variant. Weak and scarce staining for both proteins in the BM characterized the second pattern. The third variant showed strong collagen IV immunoreactivity but lack of laminin. The BM beneath the mucoid epithelium was characterized by irregular distribution of collagen IV and laminin. We suggest that the occurrence and distributional pattern of the BM components are related to the type of overlying epithelium and connected with an altered synthesis of these components.     

Cytology, immunohistochemistry and 3-dimensional reconstruction of adenoma malignum: a case report

BACKGROUND: Cytologic diagnosis of adenoma malignum is not easy. A case of adenoma malignum was diagnosed cytologically. CASE: A 45-year-old woman was suspected of having adenoma malignum. Her chief complaint was a mucoid cervical discharge. Transvaginal ultrasound examination showed multiple cervical cysts, and peculiar clusters of cervical columnar cells showing a channellike structure were observed cytologically. Cytologic analysis detected tumor cells with increased euchromatin and stretched nuclear membranes with distinct eosinophilic nucleoli. Intranuclear cytoplasmic inclusion bodies and lobate or budlike nuclei were also observed. Immunohistochemically, both HIK-1083 and carcinoembryonic antigen (CEA) were positive in the histologic specimens, although only a few glands were positive for CEA. On 3-dimensional reconstruction of normal cervical tissue, glands showing similar calibers and straight lines also had a "weeping willow-shaped" growing pattern. In the adenoma malignum there were large and small glands showing a cumuliform pattern, and cystic dilation with discontinuity and fusion of glands could be seen. CONCLUSION: The nuclear findings mentioned above were thought to be diagnostic characteristics of adenoma malignum. Three-dimensional reconstruction seems to be a method that can aid in the diagnosis of adenoma malignum.     

Colonic cytology. A retrospective study with histopathologic correlation

Three hundred sixty cytologic specimens obtained by colonoscopic brushing from 336 patients were compared with biopsy specimens simultaneously obtained for histologic examination. Of the cytologic specimens, 160 (44%) were positive for malignant cells, 37 (10%) contained suspicious cells, 54 (15%) had atypical glandular cells, 107 were cytologically negative, and 2 were considered unsatisfactory. Eight-four percent of the patients with cytologically positive smears and 54% of those with suspicious smears had malignant neoplasms in the simultaneously obtained tissue biopsies. Of the patients with follow-up, all with cytologically positive findings and nine with suspicious findings on the initial cytologic examination and simultaneous negative tissue biopsies, were subsequently found to have carcinoma of the colon. Cytology proved to have a sensitivity of 0.73 and a specificity of 1.00 while tissue biopsy showed a sensitivity of 0.81 and a specificity of 1.00. By combining the two methods, the sensitivity increased to 0.92. It is concluded that cytologic examination of colonic brushings is a highly accurate and reliable technique for the detection of malignant neoplasms of the colon and can preempt the use of biopsy forceps.     

The prognostic value of the aspiration biopsy smear in mammary carcinoma.

The prognostic significance of various morphologic factors (size of nuclei, nucleoli, mitotic frequency, naked carcinoma nuclei, nuclear:cytoplasmic ratio, size of cell clusters, necrotic matter, mucoid matter, and lymphocytes) was studied in aspiration biopsy smears from 494 carcinomas of the breast. A multivariate analysis of clinical and cytologic variables was performed with regard to five-and ten-year survival.     

Cytology of metastatic neuroendocrine (Merkel-cell) carcinoma in pleural fluid. A case report

A case of Merkel-cell (neuroendocrine) carcinoma of the skin with extensive metastases, including pleural effusion, occurring over 20 years after primary resection and treatment, is reported. The histologic appearance of the primary neoplasm was identical to that seen in the biopsy specimens of the metastatic carcinoma involving the great toe and inguinal lymph nodes and to that of the residual neoplasm tissue found at necropsy. Electron microscopic examination of a lymph node metastasis demonstrated cytoplasmic microfilaments and numerous dense-core, peripheral, neurosecretory granules, as previously described in Merkel-cell carcinoma. Cytologic examination of a pleural fluid specimen demonstrated numerous small malignant cells closely resembling the cells seen in the histopathologic sections from the surgical and necropsy tissues involved by metastatic carcinoma. This is the first report of the cytologic findings in a patient with Merkel-cell carcinoma metastatic to the pleural cavity.     

Urine cytology evaluation in cases of uretero-ileal cutaneous diversion

Cytological examination of urine from the ileal conduit in cases of bladder cancer treated by radical surgery can be an important and effective follow-up procedure. A total of 19 patients (18 males and one female) on whom radical cystectomy for cancer was performed were studied. Three urine specimens were examined in each case using routine cytological methods. Three cases of recurrent carcinoma (mainly of papillary type) were diagnosed cytologically before any clinical evidence of disease. the cytological examination of urine at 3-6 month intervals after cystectomy for bladder carcinoma is considered advisable in all cases, since the recurrence rate of transitional cell neoplasms in the upper urinary tract after cystectomy for transitional carcinoma is quite high.     

Effect of mucoid property on antibiotic susceptibility ofPseudomonas aeruginosa

Clinical isolates ofPseudomonas aeruginosa from patients with cystic fibrosis (CF) were examined for susceptibility to the antibiotics carbenicillin, ticarcillin, tobramycin, gentamicin, and tetracycline. Minimal inhibitory concentrations of the antibiotics were determined for mucoid and nonmucoid isolates from the same patient by a single-colony replica plating method. This method allows the rapid determination of antibiotic susceptibility of a single cell’s progeny and the individual screening of each colony against all antibiotics. Twenty of 34 (58%) cystic fibrosis patients had a mucoid isolate which was more susceptible to antibiotics than their nonmucoid isolate of the same serotype. Nonmucoid revertant segregants of mucoid strains isolated from 50% of the patients demonstrated greater resistance to at least one antibiotic than the original mucoid strain. Multiple isolates from 25 patients were serotyped by Difco (Liu) or Homma antiserum; only 2 patients harbored multiple strains with no common serotyping antigens. Serotypes of the nonmucoid revertants were the same as the original mucoid isolate even if the susceptibilities of the two strains were not similar.     

Cytologic diagnosis of lung tumors from bronchial brushings of Chinese patients in Hong Kong

In 1,156 single or multiple specimens obtained from fiberoptic bronchoscopy on 1,016 Chinese patients in Hong Kong, a positive diagnosis of malignancy was made on cytologic examination in 288 and a histologic type assigned. On histologic examination of tissue, malignant tumors were diagnosed in 284 cases. The total positive yield by cytology was 88%, and the overall cytologic accuracy in correlation with histology was 73%. Comparing cases typed by cytology and by histology, the diagnostic accuracy of cytology was 83% in squamous-cell carcinoma, 81% in small-cell carcinoma, 69% in adenocarcinoma and 46% in large-cell carcinoma. The detection rate of nonbronchogenic tumors was 50%. Bronchogenic tumors showed a low male:female ratio, 1.96:1, whereas 80% of squamous-cell carcinomas and 45% of adenocarcinomas occurred in males. All seven cases of bronchogenic carcinoma in patients under 40 years of age occurred in males.     

Cytologic diagnosis of the papillary variant of renal-cell carcinoma

The papillary variant of renal-cell carcinoma is characterized by distinctive histologic, clinical and angiographic features. A study was undertaken to delineate the cytologic features of this tumor as it is encountered in cellular samples. Cytologic specimens containing tumor cells from eight patients who underwent resection for papillary renal-cell carcinoma were examined and compared to corresponding cytologic samples obtained from ten other patients who had nonpapillary renal-cell carcinoma. The cytologic appearance of papillary renal-cell carcinoma, which is deceptively benign, is marked by distinctive papillary structures that often resemble branched chains. The cells are usually small and contain uniform nuclei; numerous macrophages with foamy cytoplasm are often found in the background. These cytologic features were not observed in the cellular specimens from the nonpapillary renal carcinomas. We conclude that papillary renal-cell carcinoma can be confidently recognized in cytologic specimens.     

Benign squamous cells with pleomorphic microvilli in urine or bladder washings

Exfoliated cells in catheterized urine or bladder washings from 40 patients were observed by light microscopy (LM) and by scanning electron microscopy (SEM). The specimens from seven of these patients (six postmenopausal females and one 85-year-old male) contained squamous cells with pleomorphic microvilli (PMV) on their surfaces. Four of these cases had no bladder lesions by cystoscopic examination. Three patients had recurrent papillary transitional-cell carcinoma of the bladder, and the cytologic specimens from two of them contained transitional cells with PMV. The distinction between squamous and transitional cell is readily made by SEM, based primarily on cell shape and thickness. The presence of PMV on otherwise-benign-appearing squamous cells in urine or bladder washing specimens may be a source of confusion in the interpretation of SEM findings. The presence of PMV on exfoliated squamous cells in cytologic material from the human urinary tract does not seem to have the same diagnostic and prognostic significance as the presence of PMV on transitional cells.     

The value of routine cytologic examination of breast cyst fluids

The results of the cytologic examination of 6,782 consecutive breast cyst fluids aspirated from 4,105 women during the period 1976 to 1983 were reviewed to assess the value of the routine cytologic study of such specimens. Cases in which cancer had been suspected by physical examination and/or mammography before aspiration of the cyst were excluded from the evaluation. Five clinically and radiologically inapparent intracystic papillomas were detected overall (0.1%). All cases of intracystic papilloma produced a blood-stained fluid and showed an intracystic mass at pneumocystography. Cytology was negative in two of these cases and falsely positive in one case while correctly identifying the papilloma in two cases. One incidental case of occult in situ lobular carcinoma was also detected. Routine cytologic examination of all breast fluids is thus not recommended as a cost-effective practice. Cytology should be used only when a blood-stained fluid is obtained (2% in the present series) since its indiscriminate application to all cyst fluids does not affect the rate of detection of intracystic lesions, most of which are suspected before the aspiration.