Nodal nevi and cutaneous melanomas.

Nevocytes in melanoma-draining lymph nodes can be mistaken for melanoma metastases and may possibly transform to melanoma. During the development of a new technique for managing high-risk primary melanomas, selective lymph node dissection, we examined 4,821 nodes from 208 melanoma patients by light microscopy and immunohistochemistry. Nodal nevi were identified in 49 of 226 lymphadenectomy specimens (22%), a frequency considerably higher than previously recorded (5-6%). Nevi occurred in 57 of 4,821 nodes (1.2%), in 84% of patients in one node, in 13% of patients in two nodes, and in 3% of patients in three nodes. Nevocytes were detected in hematoxylin and eosin-stained sections in 38 of 49 cases (78%) and exclusively by immunocytochemistry with an antibody to S-100 protein in 11 of 49 (22%). Nevi were in the peripheral capsule in 93% of cases and in internal trabecula in the remaining 7%. Nevocytes surrounded a small vessel in 33% of cases. Nevi were more frequent in axillary (37 of 140, 26%) and cervical nodes (seven of 40, 18%) than in inguinal nodes (five of 46, 11%). Nevi were more frequent in sentinel nodes, the first nodes on the lymphatics draining a primary melanoma (11 of 284, 3.9%), than in nonsentinel nodes (46 of 4,537, 1.01%; p < 0.0008). One of 1,071 nodes from 50 patients with breast cancer (0.1%) and none of 521 nodes from 50 patients with pelvic cancer contained nevocytes. That nodal nevi are selectively present in melanoma patients raises the possibility of their origin from nodal melanocytes influenced by tumor products. Alternatively, the association may indicate that the nevocytes of cutaneous nevi can be disrupted and displaced by the growth of an adjacent melanoma.

Bronchoalveolar lavage in a girl with Gaucher's disease. A case report.

A case of Gaucher's disease with pulmonary involvement occurred. Numerous Gaucher cells were seen in bronchoalveolar lavage (BAL) fluid on two occasions in a girl with Gaucher's disease and respiratory symptoms. The Gaucher cells resembled macrophages with eccentric, small, oval nuclei but were distinguished by their abundant cytoplasm with the characteristic "rumpled tissue paper" appearance. The Gaucher cells were in a cellular background composed mainly of macrophages. These cells stained strongly positive with periodic acid-Schiff stain. Electron microscopy revealed numerous intracytoplasmic, elongated, membrane-bound lysosomes containing the characteristic twisted tubular structures. Severe pulmonary involvement is seen infrequently in all types of Gaucher's disease, and it is especially rare in the adult and juvenile forms (types I and III). To our knowledge, Gaucher cells have never been found before in BAL fluid. This case shows that BAL can be a useful adjunct in diagnosing and following the progression of pulmonary involvement in patients with Gaucher's disease.

Pitfalls in the cytologic diagnosis of angiosarcoma of the breast by fine-needle aspiration: a case report.

This paper describes a case of angiosarcoma of the breast in a 26-yr-old female. The tumor, originally thought to be granulation tissue on fine-needle aspiration biopsy, was correctly identified as a malignant neoplasm of probable mesenchymal origin on a repeat FNA biopsy 4 mo later. A diagnosis of angiosarcoma was made on a subsequent excisional biopsy. Review of the cytologic features revealed findings that should suggest angiosarcoma, especially when correlated with the clinical history. The authors describe the cytological features seen in this case, and discuss an important pitfall in the diagnosis of angiosarcoma of the breast on FNA.