Blastic variant of mantle cell lymphoma following interfollicular Hodgkin's lymphoma.

Infrequently, patients are diagnosed with Hodgkin's lymphoma and a morphologically distinct lymphoma. While specific subtypes of lymphomas (including Hodgkin's lymphoma) may present diagnostic difficulties, fine needle aspiration biopsy (FNAB) is sometimes useful in the evaluation and classification of these lymphoproliferative processes. We report a case of the blastic variant of mantle cell lymphoma following Hodgkin's lymphoma, interfollicular variant. A 66-year-old woman with a history of Hodgkin's lymphoma presented with increasing contralateral cervical adenopathy three years after receiving chemotherapy. FNAB with ancillary immunophenotypic characterization identified mantle cell lymphoma, blastic variant. Subsequent excisional biopsy confirmed this diagnosis and also aided in the exclusion of recurrent Hodgkin's lymphoma. In addition to identifying the previously unreported combination of blastic variant of mantle cell lymphoma and Hodgkin's lymphoma, this case emphasizes the utility of FNAB in evaluation of new masses in patient's with a previous diagnosis of Hodgkin's lymphoma.

Positron emission tomography scanning in the evaluation of hepatocellular carcinoma.

BACKGROUND/AIMS: 18F-fluorodeoxyglucose uptake allows estimation of glucose metabolism by tumor cells using positron emission tomography (PET). We evaluated the role of PET imaging in the diagnosis of hepatocellular carcinoma. METHODS: PET images were collected after intravenous injection of 8-12 mCi of 18F-FDG in 20 patients with hepatocellular carcinoma (HCC). PET tumor activity level was assessed on a scale of 1 to 4 compared to normal liver tissue. The PET score was compared with abdominal computerized tomography (CT) scan results and between tumors of different grades and differentiation. RESULTS: Of the 20 patients studied, 11 (55%) had positive PET scans (PET score: 3 or 4) while nine (45%) were negative (PET score: 1 or 2). CT scan was positive in 18 patients (90%) and negative in two (10%). PET, however, revealed metastases in three patients that were not seen on CT. On pathological review, well-differentiated and low-grade tumors had lower PET scores. Comparison of the well-differentiated with the moderately- and poorly-differentiated tumors revealed a statistically significant difference. No statistical significance was observed between the moderately- and poorly-differentiated tumors or between different tumor grades and PET scores. CONCLUSIONS: The sensitivity of PET in diagnosis of HCC was 55% compared to 90% for CT scanning, although only PET detected some tumors (including distant metastases). Well-differentiated and low tumor grades had lower activity on PET and correspondingly lower PET scores. PET imaging may help assess tumor differentiation and may be useful in the diagnosis and staging and prognostication of HCC as an adjunct to CT.

Mechanical deformation induces proliferation of human colorectal carcinoma cells.

The cell biology of intravascular tumor cells is clinically important but the many important variables of this environment have proved difficult to model. We studied the effects of repetitive mechanical deformation, a phenomenon affecting all intravascular cells, on human colon cancer cell line HCT 116 in vitro. Cell proliferation, assessed by [3H]-thymidine incorporation and cell count, increased by about 30% at two days in cells subjected to deformation at 30 cycles/min as compared to controls; levels of the nuclear proliferation antigen detected by monoclonal antibody MIB-1 were also increased. Deformation increased transforming growth factor beta1 (TGF-beta1) and plasminogen activator inhibitor-1 gene expression sevenfold at two days, but mannose-6-phosphate did not affect cell proliferation, indicating that endogenous TGF-beta is not involved in the proliferative response. HCT 116 cells lack TGF-beta type II receptors, but stable transfection of TGF-beta type II receptor cDNA did not alter the cellular response to mechanical deformation, as assessed by cell proliferation, morphology, or gene expression. Mechanical deformation affects several important aspects of HCT 116 cell biology, suggesting that the intravascular environment may regulate tumor cell biology in general. Endogenous TGF-beta and TGF-beta receptor-mediated signaling are not responsible for the deformation-induced proliferative response in HCT 116.

Surveillance for recurrent head and neck cancer using positron emission tomography.

PURPOSE: Earlier detection of head and neck cancer recurrence may improve survival. We evaluated the ability of [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) to detect recurrence in a prospective trial using sequential PET scans. PATIENTS AND METHODS: Serial posttherapy FDG-PET was prospectively performed in 44 patients with stage III or IV head and neck cancer. PET was performed twice during the first posttreatment year (at 2 and 10 months after therapy) and thereafter as needed. After therapy, patients were grouped, based on tissue biopsies, into those who achieved a complete response (CR) and those who had residual disease (RD). Patients who achieved a CR were further grouped into those without evidence of disease and those who had recurrence by 1 year after completion of therapy. Disease status as determined by physical examination (PE), PET, and correlative imaging was compared. RESULTS: Eight patients were lost to follow-up and six had RD after therapy. Of the remaining 30 patients with a CR, 16 had recurrence in the first year after therapy. Five of these 16 patients had recurrence detected by PET only, four by PET and correlative imaging only, five by PE and PET only, and two by PE, correlative imaging, and PET. Only PET detected all recurrences in the first year. PET performed better than correlative imaging (P =.013) or PE (P =.002) in the detection of recurrence. CONCLUSION: PET can detect head and neck tumor recurrence when it may be undetectable by other clinical methods. FDG-PET permits highly accurate detection of head and neck cancer recurrence in the posttherapy period.

Initial evaluation of pulmonary abnormalities: CT-guided fine-needle aspiration biopsy and fluoride-18 fluorodeoxyglucose positron emission tomography correlation.

Fluoride-18 fluorodeoxyglucose positron emission tomography (FDG-PET) can evaluate patients with new pulmonary lesions. CT-guided fine-needle aspiration (FNA) biopsy is a well-described method in the diagnosis of pulmonary lesions. In order to correlate results from these testing modalities, retrospective findings from FNA biopsies of pulmonary lesions are compared to concurrent FDG-PET scans. Files of the Saint Louis University Hospital were retrospectively searched for patients with CT-guided FNA biopsies of the lung during a consecutive 3-yr period. Patients were collected, and corresponding FDG-PET scans were identified. Only new pulmonary lesions presenting for initial evaluation were included. Findings were correlated. Forty patients with a total number of 41 CT-guided FNA biopsies of the lung and thoracic cavity had corresponding FDG-PET scans. The combined positivity of the two testing modalities, i.e., cases where both FNA and FDG-PET scan were positive, yielded a sensitivity of 100% (37/37). Four patients had infectious/inflammatory processes by CT-guided FNA biopsy that were FDG-PET-positive for malignancy. CT-guided FNA biopsies with FDG-PET scans of pulmonary lesions are important, complementary diagnostic tools which can contribute significantly to the management and treatment of pulmonary disease. Diagn. Cytopathol. 2000;22:92-96.

DNA polymerase chain reaction using fine needle aspiration biopsy smears to evaluate non-Hodgkin's lymphoma.

OBJECTIVE: To apply polymerase chain reaction (PCR) analysis to the fine needle aspiration biopsy (FNAB) evaluation of lymphoid proliferations. STUDY DESIGN: We analyzed 37 consecutive archived FNAB malignant lymphoma specimens. Immunophenotypic data from the fine needle aspiration biopsy and excisional biopsy material was available for all specimens. PCR to identify monoclonal rearrangements of the immunoglobulin heavy chain gene, T-cell receptor and translocations involving the bcl-1 and bcl-2 genes was performed. RESULTS: Seventy-eight percent of cases were detected by at least one of these assays. Where DNA analysis was performed on excisional biopsy material, 70% of the cases had identical results; no discordant results for the immunoglobulin heavy chain gene or T-cell receptor were found. In 23% of cases, after review of all available data, a discordant result was thought to be a consequence of a false negative result in DNA analysis of excisional biopsy material. CONCLUSION: These findings indicate that PCR analysis of archived FNAB material, when necessary, provides useful information for diagnosis and staging of malignant non-Hodgkin's lymphomas.

Correlation of CT-guided fine-needle aspiration biopsy of the liver with fluoride-18 fluorodeoxyglucose positron emission tomography in the assessment of metastatic hepatic abnormalities.

Imaging studies using the fluoride-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scan have recently become available for patient neoplasia evaluation. Fine-needle aspiration (FNA) biopsy is a well-described diagnostic method for hepatic lesion evaluation. Correlation of these testing modalities in hepatic abnormalities has not been previously reported. Pathology files of Saint Louis University Hospital were retrospectively searched for patients with FNA biopsy of the liver. Thirty-one patients with a total of 32 FNA biopsies of the liver with corresponding FDG-PET scans were identified. Twenty-five patients had 25 cases of metastatic malignant neoplasia diagnosed by FNA biopsy. Of these cases, all but one had an FDG-PET scan positive for malignancy, yielding a sensitivity of 96% (24/25) for the FDG-PET scan. Combined positivity of the two testing modalities yielded a sensitivity of 100% (24/24). Seven patients did not demonstrate neoplasia by FNA biopsy, and the FDG-PET scan was negative in 6 of these 7 cases. The FDG-PET scan is an important imaging technique and, combined with FNA biopsy, can provide reliable diagnostic results and assist in the guidance of oncologic patient management.

Fine needle aspiration biopsy of well-differentiated liposarcoma of the neck in a young female. A case report.

BACKGROUND: Well-differentiated liposarcomas are low grade, nonmetastasizing, malignant neoplasms composed primarily of mature adipose tissue. They are uncommon in the head and neck. CASE: A 24-year-old female presented to the ears, nose and throat clinic for evaluation of a recent, rapidly growing neck mass on the right side. Fine needle aspiration (FNA) biopsy of the mass showed that the smears had fragments of connective tissue with a mixture of mature-appearing fat traversed by bands of fibrous collagen and vessels. Nuclei within the fat and fibrous bands were mildly irregular, hyperchromatic and enlarged, with one or two small nucleoli. Infrequently present but readily identified, lipoblasts were scattered throughout the aspirate smears. A diagnosis of "atypical lipomatous neoplasm" was rendered. Subsequently, the mass was surgically removed. On histologic examination, the tumor was a well-differentiated liposarcoma. CONCLUSION: FNA biopsy of well-differentiated liposarcomas in the head and neck can present difficulties in the classification and diagnosis of this neoplasm.

Correlation of fine needle aspiration biopsy and dynamic contrast-enhanced 3D magnetic resonance imaging of the breast.

OBJECTIVE: To correlate and assess the utility of dynamic contrast-enhanced three-dimensional gadolinium-enhanced magnetic resonance imaging (Gd-3DMRI) and fine needle aspiration biopsy (FNAB) findings in patients with suspected breast disease. STUDY DESIGN: Beginning in 1993, all patients who underwent percutaneous FNAB of the breast and had concurrent Gd-3DMRI evaluation of the breast were selected for this study. Findings for FNAB and Gd-3DMRI were stratified into two categories, positive and negative. Subsequent clinical management decisions, which included surgical intervention and/or clinical follow-up, were recorded for all patients. RESULTS: There were 69 FNABs in 59 patients with corresponding Gd-3DMRI evaluation. A positive result by both FNAB and Gd-3DMRI was found in 15 of 18 malignant cases. FNAB missed one case, and Gd-3DMRI missed two, and each of these was thought to be technical. Combining the methods yielded 100% sensitivity. False positive results on Gd-3DMRI (17 cases) were all confirmed to be benign by FNAB and subsequent tissue evaluation. All 32 cases with combined negative results by FNAB and Gd-3DMRI demonstrated a benign process, yielding a specificity of 100% (32/32). CONCLUSION: Our combined testing modalities showed a high degree of specificity and good sensitivity. FNAB used with dynamic contrast-enhanced Gd-3DMRI can contribute valuable information for physicians treating patients with suspected breast abnormalities.

Correlation of fine needle aspiration biopsy and fluoride-18 fluorodeoxyglucose positron emission tomography in the assessment of locally recurrent and metastatic head and neck neoplasia.

OBJECTIVE: Patients with primary head and neck neoplasia can present during follow-up with suspected recurrence, and both fine needle aspiration biopsy (FNAB) and fluoride-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scan are available methodologies for evaluating these patients. Our objective was to retrospectively correlate patients who underwent both FNAB and FDG-PET scan in order to assess the possibility of recurrent neoplasia. STUDY DESIGN: The cytopathology files at Saint Louis University Health Sciences Center were retrospectively searched for patients with known primary head and neck malignancies beginning in 1995. Suspected recurrence and local metastases evaluated by both FNAB and FDG-PET scan were correlated. RESULTS: Twenty-eight patients received a combined total of 37 FNABs with concurrent FDG-PET scans. The majority of patients had primary oropharyngeal squamous cell carcinoma with intermixed, single cases of other primary head and neck neoplasms. Thirty of the 32 aspirates with recurrent or locally metastatic disease had combined positive findings by both FNAB and FDG-PET scan, yielding a sensitivity of 94%. One nonspecific and one negative FDG-PET scan came from a patient who had disease confirmed by FNAB. Five patients had negative findings by both methods that were supported by the subsequent clinical course. CONCLUSION: FNAB can provide confirmatory evidence of disease in a clinically suspicious abnormality with nonspecific FDG-PET results. FNAB and FDG-PET are highly sensitive for tumors in cases of clinically suspected recurrence and locally metastatic disease.

Fine needle aspiration cytology of penile tumors.

OBJECTIVE: Penile tumors are unusual and can represent neoplastic or inflammatory processes. We report a series of penile tumors diagnosed by fine needle aspiration (FNA) cytology. STUDY DESIGN: Files from the Division of Clinical Cytology, Karolinska Hospital, were searched, and cases of FNA cytology of the penis selected. Clinical information and cytologic diagnoses were recorded and observations from aspiration smears made. RESULTS: Eleven patients had presented to Karolinska Hospital for FNA cytology of the penis. They ranged from 46 to 89 years of age; all were uncircumcised. Tumors were present in various locations, including the glans and shaft. Five patients had squamous cell carcinoma (SCCA) of the penis; three were primary, one locally recurrent and one metastatic from primary lung SCCA. There were three carcinomas metastatic from primary colon, prostate and bladder tumors. There was one each of locally recurrent malignant melanoma, locally metastatic testicular mesothelioma and Peyronie's disease. Discomfort associated with the procedure was tolerable, there were no complications, and each biopsy provided sufficient material for a cytologic diagnosis. CONCLUSION: FNA cytology of penile tumors is a successful, well-tolerated procedure capable of providing a cytologic diagnosis and useful information for patient management.

Fine-needle aspiration biopsy of metastatic Ewing's sarcoma with MIC2 (CD99) immunocytochemistry.

The use of fine-needle aspiration biopsy (FNAB) has been infrequently described as a diagnostic modality for Ewing's sarcoma (ES) patient follow-up and management. The purpose of this study is to examine the use and accuracy of FNAB combined with MIC2 immunocytochemistry for evaluating metastases in patients with ES. Records from Saint Louis University Health Sciences Center and Indiana University Medical Centers identified patients with known ES who had undergone FNAB for evaluation of potential metastases. Immunocytochemical analysis for MIC2 (CD99) was performed retrospectively on cell blocks and direct aspirate smears. FNABs from nine patients were procured either percutaneously or under radiologic guidance and in all cases a definitive cytologic diagnosis of metastatic ES was rendered. Aspirates were cellular with many single discohesive small round cells and occasional loosely cohesive clusters. The nuclei were round with a fine chromatin pattern and small nucleoli. The cytoplasm was scanty and the nuclear-cytoplasmic ratio was high. Six of six cases showed strongly positive immunocytochemical labeling for MIC2. Immunocytochemistry with MIC2 in FNAB aspirate smears can provide supportive evidence of ES in patients with known disease.

Combined fine needle aspiration biopsy, and immunophenotypic and genotypic approach to posttransplantation lymphoproliferative disorders.

OBJECTIVE: To report our experience with a combined approach to posttransplant lymphoproliferative disorders (PT-LPDs) that utilizes fine needle aspiration biopsy. STUDY DESIGN: A review of the files in the Department of Pathology, Saint Louis University Health Sciences Center; from 1988 to 1996 identified six patients with a diagnosis of PT-LPD who underwent either percutaneous or radiologically guided fine needle aspiration biopsy (FNAB). In all cases, material was collected for cytomorphology, flow cytometric analysis and, in selected cases, DNA polymerase chain reaction (PCR). Subsequent evaluations and clinical outcomes were obtained from the medical record. RESULTS: The six transplant recipients (4 men and 2 women; 3 cardiac, 2 renal and 1 hepatic transplant) had an age range of 16-65 years. The aspirate material on these six patients had a polymorphic pattern of lymphoid cells with varying sizes. By flow cytometry, two were monoclonal, while four had a polyclonal pattern. DNA PCR analysis on two FNABs demonstrated a monoclonal rearrangement of the immunoglobulin heavy chain gene. CONCLUSION: FNAB provides cytomorphologic characterization of PT-LPDs in transplantation patients and sufficient material for successful use of flow cytometry immunophenotyping and DNA PCR analysis. FNAB, therefore, has an important role in the evaluation of organ transplantation patients and is a valuable tool for assessing and diagnosing PT-LPD.

Lymphocyte-depleted Hodgkin's disease: diagnostic challenges by fine-needle aspiration.

The diagnosis of Hodgkin's disease by fine-needle aspiration (FNA) can be problematic. A case of Hodgkin's disease, lymphocyte depleted subtype, sample by FNA biopsy is presented. We describe the cytomorphologic features present in this unusual subtype of Hodgkin's disease and discuss the differential diagnosis. Immunohistochemical and morphologic findings of a subsequent biopsy specimen supported the diagnosis. Although FNA is an increasingly used diagnostic modality to evaluate tumors including malignant lymphomas, Hodgkin's disease remains, as in this case, a difficult diagnosis by FNA.