[Determination of infiltrative ductal breast carcinoma differentiation grade in biopsy imprints].

BACKGROUND/AIM: In patients with breast carcinoma there are many risk factors for assessment of breast carcinoma maturity and prognosis. Besides histological type of differentiation, cytologic criteria for the evaluation grade of the differentiation of infiltrative ductal breast carcinomas are very important for prognosis. The aim of this study was to define cytologic criteria for grading of infiltrative ductal carcinomas of the breast. METHODS: . The imprints of intraoperative biopsies from 124 patients were studied. They were air-dried and stained by May-Grünwald Giemsa method. The features assessed were: the degree and type of cell clustering, nuclear diameter and pleomorphism, chromatin structure, number and features of nucleoli, the aspect of cytoplasm, noncellular background and the variability of cells and nuclei. According to these morphologic features the infiltrative ductal carcinomas of the breast could be classified into three grades of differentiation. RESULTS: Cytologic and histologic differentation grade revealed disagreement among 34.6% of the imprints. In 9 of total 23 histologicaly well differentiated carcinomas, cytological differentation grade was moderately differentiated. In 63 carcinomas with histologic differentiation grade II, cytologic differentation grade was good in 12 and poor in 16 carcinomas. CONCLUSION: Cytologic and histologic grading were not identical in 34.6% of the imprints what points out the need to further definition of diagnostic criteria, especially for grade II of differentiation.

[Detection of free cancer cells in peritoneal cavity in patients surgically treated for gastric adenocarcinoma].

BACKGROUND/AIM: Peritoneal metastasis is a leading cause of therapeutic failure after an operative treatment of patients with gastric adenocarcinoma. Free cancer cells might induce or indicate an early peritoneal seeding with a subsequent peritoneal metastasis. The aim of this study was to determine the frequency of the presence of free cancer cells in the peritoneal cavity in the patients surgically treated for gastric adenocarcinoma, and its relation to certain clinical, operative and pathohistological paramethers. METHODS: Inside a period from April 2000, and April 2004, the total of 100 patients underwent intraoperative peritoneal lavage for cytological examination. Immediately after the laparotomy, 200 ml physiologic saline, heated to 37 degrees C, was introduced into the abdominal cavity, mannualy dispersed and collected from the region around the gastric tumor and the pouch of Douglas. The nucleated cell layer was smeared on four glass slides for every patient and dyed with May-Grünwald-Giemsa stain. The cytological findings were defined as positive or negative according to the presence of cancer cells. The frequency of positive cytological findings was compared to the location and the diameter of the cancer, pathohistological type of carcinoma, pathohistological stage of the disease, lymph node and the liver and/or peritoneal metastases and the type of surgical procedure. RESULTS: Free cancer cells were found in 24 (24%) of the patients, while in 76 (76%) of them cytological findings were negative. A statistically highly significant difference (p < or = 0.001) in the frequency of positive cytological finding was found between the groups of patients with and without cancer invasion of serosa, with cancer diameters > 5 cm and < or = 5 cm, in the stage of disease I, II and III, IV, with macroscopically present and without metastases, with re section and D2 lymphadenectomy and palliative procedure. Free cancer cells were statistically more frequently (p < or = 0.05) detected in the patients with lymph nodes metastases comparing to the patients with out lymph nodes involvement. The results of the univariate analysis showed that the cancer diameter > 5 cm, tumor invasion of serosa, pathohistological stage of the disease III and IV and macroscopically visible metastases were the most important risk factors for the free cancer cells detection. CONCLUSION: Peritoneal lavage cytology was shown to be a useful tool for the detection of the group of patients with greatest risk of peritoneal dissemination. The frequency of positive cytological findings was highly associated with the diameter of the tumor and the cancer invasion of serosa. Cytological examination of peritoneal lavage fluid improved the accuracy of staging and selection of patients who might have benefit from neoadjuvant chemotherapy.

[Umbilical metastasis (Sister Mary Joseph's nodule) diagnosed by fine-needle aspiration]. / Umbilikusna metastaza--cvor sestre Meri Dzozef dijagnostikovana aspiracijom tankom iglom.

Sister Mary Joseph's nodule is the eponym for metastatic involvement of the umbilicus. This less common entity is the sign of disseminated malignant disease, mainly of digestive and gynecologic origin, and is associated with a poor prognosis. A case of Sister Mary Joseph's nodule in a 76-year-old woman in whom the umbilical metastasis was the first sign of malignant disease in presented. The diagnosis of metastatic adenocarcinoma was established by fine needle aspiration cytology of the umbilical nodule. Radiological and ultrasonographic investigation disclosed carcinoma of the gallbladder with pancreas, stomach, and colon invasion as well as peritoneal dissemination. The diagnosis was confirmed by exploratory laparatomy and histological examination of the excised umbilical nodule.

[Diagnosis of multiple myeloma based on the material obtained by fine needle aspiration biopsy of the lungs]. / Dijagnoza multiplog mijeloma na osnovu materijala dobijenog perkutanom iglenom biopsijom pluca.

The patient presented in this paper was admitted to the hospital for the evaluation of radiologically revealed shadow in both lungs. In the course of diagnostic procedures, fine needle aspiration biopsy of the intrathoracic mass was performed. Cytologic analysis of the smear was performed because of clinical suspicion of plasma cell proliferative disease that was confirmed by bone marrow aspiration. Thus, the cytologic finding of intrathoracic lesion preceded the diagnosis of multiple myeloma.

[Potential role of cholesterol in distinguishing malignant from benign pleural effusion]. / Moguci znacaj holesterola u razlikovanju malignog od nemalignog pleurnog izliva.

Cholesterol and carcinoembryonic antigen (CEA) levels in pleural effusion and sera, were measured in 199 patients with pleural effusions of various origins. Malignant cause was found in 93, and nonmalignant in 106 patients. Mean cholesterol level in sera of patient with malignant disease was 5.0 +/- 0.93 mmol/L, and in nonmalignant group 4.34 +/- 1.32 mmol/L. The difference was not statistically significant. Mean cholesterol level in nonmalignant pleural effusions was higher thAn those in malignant (2.51 +/- 1.23 mmol/L; and 2.28 +/- 1.06 mmol/L), but the difference was also not significant. Average pleural fluid/serum cholesterol ratio (Holl/S) in nonmalignant group was 0.61 +/- 0.32 and in malignant group 0.46 +/- 0.22. The difference between those mean values was significant. Higher ratio, at the cut off value of 0.5 was found in 79/106 and in 25/93 malignant patients. Calculated sensitivity was 75%, specificity 73%, positive predictive value 76%, negative predictive value 65% and accuracy 69%. Significant negative correlation between Holi/S and pleural fluid CEA was found (p < 0.05). It was assumed that pleural fluid/serum cholesterol ratio lower than 0.5 could be of great benefit, as an additional test in the differentiation of malignant from benign pleural effusion.

[Importance of cytologic examination of urine in the diagnosis of renal transplant function disorders]. / Znacaj citoloskog pregleda urina u dijagnostici poremecaja funkcije transplantovanog bubrega.

BACKGROUND: This paper presents our experience with cytologic examination of urine in diagnosing renal allograft dysfunction. METHODS: The study group included 23 patients with renal allograft dysfunction, selected from 56 patients who underwent renal transplantation. Etiologic diagnosis was made according to the clinical picture, histological findings during allograft biopsy, and cytologic examination of urine. Urine sediment was obtained in cytocentrifuge and was air dried and stained with May Grunwald Giemsa. RESULTS: Out of 23 patients with allograft dysfunction in 18 (78.3%) patient it was caused by acute rejection, and in 5 (8.9%) patients by allograft infarction, cyclosporine nephrotoxicity, acute tubular necrosis and chronic nephropathy. In eighteen patients (78.3%) cytologic examination of urine was pathologic, while in 16 (70%) clinical and histology findings coincided with urine cytology findings. Out of 18 patients with acute allograft rejection in 15 patients cytologic examination of urine coincided with acute rejection. Out of 7 patients with expressed cyclosporine nephrotoxicity, in 5 cytologic examination of urine confirmed the cause of allograft dysfunction, as well as in one of 2 patients with acute tubular necrosis. Cytologic examination of urine indicated parenchymal damage in 2 patients with recurrent disease (membranoproliferative and focal sclerosing glomerulonephritis). In 4 of 5 patients suffering from chronic rejection in a year's monitoring period, urine sediment periodically consisted of lymphocytes, neutrophilic leucocytes, monocyte/macrophages, tubular cells and cylindres, without the predominance of any cell type. In 3 patients allograft dysfunction was caused by infective agents (bacteria, fungus, cytomegalovirus). CONCLUSION: Cytologic examination of urine might be an alternative to histological in diagnosing acute allograft rejection and acute tubular necrosis or nephrototoxicity. Also it might indicate parenchymal disease while the importance of urine cytology in chronic allograft nephropathy needs to be investigated further.

[Phonation bronchoscopy]. / Fluorescencijska bronhoskopija.

BACKGROUND: Fluorescence bronchoscopy is one of the methods of the early detection of lung cancer that involves the large airways. The method is based on the detection of the altered autofluorescence of malignantly transformed tissue, and confirmed by biopsy and histopathologic examination. METHOD: Fluorescence bronchoscopy was performed in 18 patients, mean age of 51.2 years (male n = 12, female n = 6) due to the suspected lung cancer. Fluorescence bronchoscopy was performed using the Xillix LIFE-Lung System, Vancouver, Canada. After conventional white-light bronchoscopy, the tracheobronchial tree was illuminated by blue light (442 nm) using helium-cadmium laser, and the results of autofluorescence were classified into three classes. Normal mucosa was of green fluorescence (Class I), abnormal mucosa was red or dark brown fluorescence (Class II and II), which was the indication for performing biopsy. RESULTS: Normal endoscopy findings were established in 15 patients by conventional bronchoscopy. In the same group, by fluorescence bronchoscopy, Class I of fluorescence (normal finding) was found in 9 patients, while Class II changes occurred in 6 patients. Histopathologic analysis of bronchial mucosa with Class II changes was performed detecting planocellular carcinoma in situ in one patient. Tumor-like changes were detected in 3 patients by conventional bronchoscopy, and were determined as Class III changes by fluorescence bronchoscopy. By the biopsy of these chages carcinoma was documented in 2 patients while in one patient metaplasia of epithelium and granulation tissue around aspirated foreign body was detected. CONCLUSION: Fluorescence bronchoscopy is one of the methods for detecting metaplasia, carcinoma in situ and cancerous changes of bronchial epithelium in the large airways. However, the high rate of falsely positive findings represents a limitation of this method.

[Value of urinary cytology findings in the diagnosis of acute renal graft rejection]. / Vrednost nalaza citoloskog pregleda urina u dijagnozi akutnog odbacivanja transplantovanog bubrega.

BACKGROUND: Acute rejection of allograft is one of the most serious complications of renal transplantation that requires fast and precise diagnostic approach. In this paper our experience in cytologic urinalysis as a diagnostic method of the acute renal allograft rejection was reviewed. METHODS: The study group included 20 of 56 patients with transplanted kidneys who were assumed for the acute allograft rejection according to allograft dysfunction and/or urine cytology findings. Histological findings confirmed allograft rejection in 4 patients. Urine sediment obtained in cytocentrifuge was air-dried and stained with May-Grunwald-Giemsa. Acute allograft rejection was suspected if in 10 fields under high magnification 15 or more lymphocytes with renal tubular cells were found. RESULTS: Acute transplant rejection occurred in 32.1% patients. In 15 patients clinical findings of the acute renal allograft rejection corresponded with cytological and histological findings (in the cases in which it was performed). Three patients with clinical signs of the acute allograft rejection were without cytological confirmation, and in 2 patients cytological findings pointed to the acute rejection, but allograft dysfunction was of different etiology (acute tubular necrosis, cyclosporine nephrotoxicity). In patients with clinical, cytological and histological findings of the acute allograft rejection urine finding consisted of 58% lymphocytes, 34% neutrophilic leucocytes and 8% monocytes/macrophages on the average. The accuracy of cytologic urinalysis related to clinical and histological finding was 75%. CONCLUSION: Urine cytology as the reliable, noninvasive, fast and simple method is appropriate as the a first diagnostic line of renal allograft dysfunction, as well as for monitoring of the graft function.

[Cytologic features of ameloblastoma]. / Citoloska slika ameloblastoma.

Ameloblastoma is a rare tumor of the jaw arising from odontogenic epithelium. There are sparse reports in the literature concerning cytologic features of this tumor. This paper presents two cases of ameloblastoma, diagnosed by imprint cytology and confirmed histopathologically. The imprints were hypercellular, with single cells and the groups of basaloid and polygonal squamous cells with huge vacuoles in cytoplasm. Stellate and fusiform cells were found in the background of the preparation. These morphologic parameters were sufficient for the cytologic diagnosis of ameloblastoma.

[Value of cytologic diagnosis in rapid intraoperative diagnosis of mediastinal lymphadenopathy and tumors of the lung and mediastinum]. / Vrednost citoloske dijagnostike u brzoj intraoperativnoj dijagnozi medijastinalne limfadenopatije i tumora pluca i medijastinuma.

Extemporary (EXT) analysis is unavoidable in establishing the tumor diagnosis, operability and the extent of the operation. Alternative approach is cytologic analisis which, because of its simple methodology, provides results even faster. In this paper, the results of cytologic imprints (CI) and EXT finding were compared with definite histopathologic diagnosis (HDP) to determine the value of both methods. A total of 109 samples obtained during 55 thoracotomies were analyzed. Eighty eight specimens were analyzed simultaneously by CI Method and in frozen sections. Twenty-one sample was analyzed only by cytologic methods and the results of standard CI were compared with definite HDP. After being processed for EXT diagnosis, intraoperative specimens were imprinted on glass slides, air-dried and stained by May-Grünwald--Giemsa Method. In cytologic analysis there were no false negative results, but there were 7 false positives. The overall diagnostic accuracy was 93.6%, sensitivity and negative predictive value was 100%, specificity was 91.1% and positive predictive value was 81.8%. Diagnostic accuracy of frozen sections was 98.8% also without false negatives and with one false positive finding with sensitivity and negative predictive value of 100%, specificity of 98.4% and positive predictive value of 95%. These results corresponded to the results of other studies and confirmed the efficacy of CI method, which could be used either simultaneously with EXT diagnosis as a complementary or as an alternative method in the hospitals where EXT analysis is not used. However, imprint cytology demands an experienced cytologist and could be used only in hospitals with well organized cytologic service.

Intrathecal synthesis of complement components C3c and C4 in the central nervous system infections with signs of the acute serous meningitis syndrome.

Two hundred and ten patients with meningismus and the infections of the central nervous system (CNS) with the clinical symptoms and signs of the acute serous meningitis syndrome, were divided in to groups according to etiology (enterovirus meningitis-ENTERO, serous meningitis various etiology-SM and tuberculous meningitis-TBC). Intrathecal synthesis (ITS) of C3c and C4 complement components and IgG were determined by the method of cerebrospinal indexes (I), to examine their role in differential diagnosis of this syndrome. Correlative study between the CSF/serum ratio (Q) for albumin (Alb) and QC3c and QC4 in patients with no proven ITS of this two complement proteins, and the comparative study of the increased value of C3cI and C4I (and IgGI) between the examined groups of the patients was done. Highly significant correlations were found between QAlb and QC3c (r = 0.89, p < 0.001) and QC4 (r = 0.85, p < 0.001). In 22.4% of the examined patients ITS of C3c and C4 were found. There was no difference in frequency of ITS of the two complement proteins between the examined groups, nor inside any particular group. TBC group had significantly lower (p < 0.05) intensity of ITS of C3c and C4 than MNG and ENTERO, and significantly higher intensity of ITS of IgG (p < 0.05) than the other tested groups. CSF index was confirmed as a valid method to detect intrathecal C3c and C4 production. Determination of ITS C3c and C4 could not be of great help in differential diagnosis in the acute serous meningitis syndrome. The intensity of ITS of C3c and C4, related to the intensity of ITS of IgG, could be of help in the determination of the duration of the disease.

[Epithelioid vascular tumor]. / Epiteloidni vaskularni tumor.

Epithelioid vascular tumors are neoplasms formed by endothelial cells, morphologically similar to epithelial cells. Morphological shape of the cells in this tumors varies from benign to malignant forms, causing the diverse biological potential of the tumors. This case-report presents immunophenotypically interesting epithelioid vascular tumor of the upper vena cava manifested in thrombotic complications. It is characterized by solid growth of tumor cells and the attempt of forming vascular channels. According to immunophenotype, tumor cells corresponded to endothelial cells with low proliferative potential and vasoformative capability of forming intracellular lumina. For that reason this tumor manifested similarity with epithelioid hemangioendothelioma. However, it differentiated from the hemangioendothelioma by benign cytomorphological characteristics of tumor cells, absence of pathological mitoses, more intensive inflammatory infiltrate with eosinophylia and good tissue control, of tumor growth because of the presence of pericites. According to histological features and histochemical analyses the diagnosis of this tumor was established as an intravascular, solid, epithelioid hemangioma.