Significance of epithelial membrane antigen in the work-up of problematic serous effusions.

Differentiation of reactive and/or atypical mesothelial cells from malignant epithelial cells in serous effusions remains a frequent diagnostic problem. Since epithelial membrane antigen (EMA) positive malignant cells in serous effusions have been reported in almost all adenocarcinomas and most malignant mesotheliomas, immunoreactivity for EMA is felt to be less useful than other antibodies in the workup of problematic serous effusions. However, immunostaining of reactive and/or atypical benign mesothelial cells for EMA has not been well studied, with only a few series reporting either weak or negative staining for EMA. This study was undertaken to evaluate how often reactive and/or atypical appearing mesothelial cells stain positively for EMA. One hundred eighty serous effusions (115 pleural, 55 peritoneal, and 10 pericardial) from 123 females and 57 males ages 20 to 89 yr were evaluated in which an antibody panel including EMA was performed on cell blocks (141 cases), cytospins (36 cases), or both (3 cases). Of the 100 cytologically positive cases, EMA immunoreactivity was present in 97/100 (97%) cases. One EMA negative case suspicious for a metastatic renal cell carcinoma was lost to follow-up and not included in the analysis. The remaining three negative cases consisted of malignancies not expected to have EMA positive cells (small cell carcinoma, neuroblastoma, and synovial sarcoma). Therefore, EMA was positive in virtually 100% of the remaining malignant cases. In the 78 cytologically negative cases, EMA positivity was present in 3/78 (3.8%) cases. Clinical follow-up of up to 14 mo in these three cases revealed no evidence of malignancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Effusion cytology in Burkitt's lymphoma.

The American form of Burkitt's lymphoma is a high-grade malignancy which usually involves the abdomen in children and young adults. There is only a limited literature which describes the cytologic features of Burkitt's lymphoma in serous effusions. We present three children with Burkitt's lymphoma initially diagnosed by effusion cytology. The first patient, an 11-yr-old boy, presented with bilateral pleural effusions, ascites, and abdominal masses and had diagnostic pleural fluid cytology without tissue confirmation (ultrastructural examination was performed on the effusion specimen). He died 7 months after the initial diagnosis. The second patient, a 9-yr-old boy, presented with ascites and abdominal masses and had diagnostic peritoneal fluid cytology with a subsequent confirmatory chest wall biopsy. The third patient, a 16-yr-old girl, presented with a 2-month history of irregular menses, a large pelvic mass, lymphadenopathy, and liver masses. Although an ovarian malignancy was clinically suspected, cytologic examination of her peritoneal fluid revealed Burkitt's lymphoma. Surgical exploration revealed involvement of her right ovary, cecum, and terminal ileum. The second and third patients are currently alive with no apparent disease following chemotherapy. In all three patients, effusion cytology revealed Burkitt's lymphoma, characterized by a uniform population of non-cohesive lymphoid cells with noncleaved nuclei, prominent multiple nucleoli, and scanty-to-moderate basophilic cytoplasm. Cytoplasmic and/or nuclear vacuoles were also seen, more prominent in Diff-Quik-stained, air-dried smears. These cases demonstrate the importance of recognizing the cytologic features of Burkitt's lymphoma, as serous fluid may be the initial diagnostic specimen.

Diagnosis of inflammatory myopathy by percutaneous needle biopsy with demonstration of the focal nature of myositis.

Inflammatory myopathies are a group of acquired disorders with histologic features of inflammation and nonspecific myopathic changes in the muscle fibers. Up to 25% of patients with clinical features of polymyositis reportedly have no inflammatory changes in their muscle biopsy specimens, but the absence of inflammatory infiltrates does not exclude an inflammatory myopathy. However, whether the lack of inflammation is caused by sampling variation or by a total lack of demonstrable inflammation in a particular patient has been unclear in the literature. The authors diagnosed polymyositis in six patients who underwent percutaneous muscle biopsy using a Bergstrom needle. Through one skin incision, the needle was inserted into different areas within the muscle compartment, obtaining three or four concurrent specimens from each patient. In all cases of needle biopsy, adequate tissue was obtained for histochemical and electron microscopic examination. All patients tolerated the procedure well and resumed normal daily activities the morning after biopsy. Although we saw inflammatory changes in at least one biopsy specimen from each patient, one or more of the remaining specimens contained no evidence of inflammation. This illustrates that inflammatory infiltrates can be focal in polymyositis. Because a specific diagnosis of inflammatory myopathy cannot be made in the absence of demonstrable inflammation, the diagnostic yield of multiple percutaneous needle biopsy specimen is potentially higher than that of the traditional single biopsy specimen obtained with the open surgical method.

Fine-needle aspiration cytology of metastatic basal cell carcinoma of the skin to the lung.

Metastatic basal cell carcinomas of the skin are rare. We present the cytologic features of a metastatic basal cell carcinoma to the lung diagnosed by fine-needle aspiration biopsy. Cytologic examination revealed syncytial groups of relatively small cells with hyperchromatic, oval to spindle-shaped nuclei having high nuclear to cytoplasmic ratios. Immunocytochemical studies performed on the cell block sections revealed the malignant cells to be positive for cytokeratin (AE1/3) and negative for neuroendocrine markers, [neuron specific enolase (NSE) and chromogranin (Phe-5)]. We reviewed the literature related to metastatic basal cell carcinoma of the skin and discuss risk factors and mechanisms of metastatic spread. In addition, a discussion of the other entities that can enter into the differential diagnosis is presented along with the role of ancillary studies. To the best of our knowledge, we believe this is the first case report of the fine-needle aspiration (FNA) cytology of a basal cell carcinoma metastatic to the lung.

Thermal model for the local microwave hyperthermia treatment of benign prostatic hyperplasia.

A system for the noninvasive localized, hyperthermia treatment of benign prostatic hyperplasia was investigated. The system uses a microwave transrectal antenna with a water cooled jacket to achieve localized hyperthermia. The purpose of this study is to model the temperature rise in the prostate and in the surrounding tissue during treatment. The SAR distribution for the transrectal probe is measured in a muscle tissue equivalent phantom. The SAR information is used with a finite element solution of the bioheat transfer equation to give the temperature rise during the treatment. Also the finite element solution is further used to determine the effect of the microwave power, the cooling fluid temperature and the blood perfusion on the tissue temperature rise. The results of the solution are compared to temperature measurements in a canine protocol. It was found that the maximum temperature rise in the tissue during treatment is 44 degrees C at a depth of 2 cm from the rectal mucosa.