Inflammatory myofibroblastic tumour of the breast: report of a case with giant vacuolated cells.

Inflammatory myofibroblastic tumours (IMTs) or inflammatory pseudo-tumours are uncommon lesions of unknown aetiology. The majority of the cases are reported in the lungs of young patients. Extra-pulmonary anatomic locations include the abdomen and pelvis, but rare cases have been described in the breast. We describe an IMT in an 86-year-old female, presenting as a well-circumscribed palpable mass in the left breast. Histologically the remarkable feature was the presence of giant vacuolated cells intermixed with spindle cells and a prominent plasma cell infiltrate immersed in a fibrous hyalinized stroma. Immunohistochemical and electron microscopy studies demonstrated the myofibroblastic nature of the giant vacuolated cells and the spindle cells, and the polyclonal nature of the plasma cells. The morphologic and immunohistochemical findings supported the diagnosis of IMT. The biological behaviour of IMT in this age group is unknown and surgical excision with close mammographic follow-up is considered to be appropriate treatment for this lesion in the breast.

Lymphoglandular bodies in fine-needle aspiration cytology smears.

Lymphoglandular bodies (hyaline bodies or lymphoid globules), when found in cytology smears from fine-needle aspirates, have long been accepted as being diagnostic of lymphoid tissue. To investigate the validity of this association as it relates to malignant tumors, we examined cytologic smears from 132 fine-needle aspirates of malignant neoplasms. Three experienced observers independently scored Diff-Quik-stained smears as to cellularity and number and size of lymphoglandular bodies. Discrepancies were resolved by consensus. Results of the fine-needle aspiration biopsies revealed 6 of 104 nonlymphoid malignancies with easily identifiable lymphoglandular bodies (defined as > 2 lymphoglandular bodies per high-power field) and 3 with numerous lymphoglandular bodies (> 10 per high-power field). These tumors consisted of two cases of small-cell carcinoma, four non-small-cell carcinomas, one ganglioneuroblastoma, one melanoma, and one seminoma. The tumors had few, if any, lymphocytes. Of the 28 lymphomas, 5 had easily identifiable lymphoglandular bodies and 19 had numerous lymphoglandular bodies. Although lymphoglandular bodies in the background of cytologic smears taken from malignant tumors are useful in alerting the pathologist to the possibility of lymphoma, there are exceptions.

Dendritic reticulum cells and immunophenotype in aspiration biopsies of lymph nodes. Value in the subclassification of non-Hodgkin's lymphomas.

Twenty-seven lymph node aspirates were identified for which histologic confirmation of non-Hodgkin's lymphoma was subsequently obtained. Fifteen aspirates interpreted as reactive hyperplasia were also examined. All aspirates were studied by immunoperoxidase on cytospin preparations with the use of antibodies DRC1, kappa, lambda, CD3, CD5, and CD20. The follicular lymphomas could not be identified reliably by morphologic examination of aspirate smears. Clusters of DRC1-positive (DRC1+) cells were present in seven of seven follicular lymphomas, one of one mantle zone lymphoma, and one of seven small lymphocytic lymphomas. Rare DRC1+ cells were present in one of one diffuse mixed and one of seven large cell lymphomas. One lymphoblastic, one Burkitt's, and two diffuse small cleaved cell lymphomas had no DRC1+ cells. None of the seven follicular lymphomas was CD5 positive (CD5+), whereas five of the seven small lymphocytic lymphomas were CD5+. Conversely, all seven follicular lymphomas were CD20-positive (CD20+), but only one of seven small lymphocytic lymphomas was CD20+. Nineteen of the lymphomas, including all 7 of the follicular lymphomas, were either kappa or lambda positive. The other eight lymphomas were T-cell (1), B-cell (1), true histiocytic (1), or "null" cell (5). The reactive aspirates had both kappa- and lambda-positive B-cells. Seven of the 15 had clusters of DRC1+ cells. To further evaluate these antibodies, the authors studied 29 additional, surgically biopsied, non-Hodgkin's lymphomas that had not been aspirated. Similar results were obtained, except that three of five diffuse small cleaved cell lymphomas had DRC1+ cells. DRC1, in conjunction with antibodies to CD5, CD20, kappa, and lambda, helps to distinguish follicular lymphoma from small lymphocytic lymphoma. DRC1 is not useful in separating reactive hyperplasia from follicular lymphoma.

Fine needle aspiration biopsy in the management of children and young adults with peripheral lymphadenopathy.

To determine the effectiveness of fine needle aspiration (FNA) of the lymph node in the management of young patients with peripheral lymphadenopathy, all patients 30 years of age and under who had a lymph node aspirate and who then had subsequent excisional biopsy, autopsy, or clinical follow-up for a minimum of one year were examined. One hundred twenty-seven aspirates from one hundred twenty-six patients fulfilled the criteria of the study. Diagnoses of eighty-three benign and thirty-seven malignant lymphadenopathies were confirmed. There were three false negative and four false positive diagnoses. Sensitivity, specificity, and positive and negative predictive values were 0.93, 0.95, 0.90, and 0.97%, respectively. Of the one hundred twenty-six patients, twenty-five had a previous history of malignancy. Results of aspiration biopsy in this group were examined to determine FNA ability to predict recurrent disease. In this group the sensitivity, specificity and positive and negative predictive values were 0.95, 0.80, 0.95, and 0.80 respectively. Finally, the group of patients with clinically suspicious primary lymphadenopathy without an antecedent history of malignancy were examined to determine the effectiveness of the technique for selecting patients for surgical biopsy. This group included a total of one hundred two patients. Sensitivity, specificity, and positive and negative predictive values were 0.93, 0.96, 0.90, and 0.97, respectively. Based on the data from this retrospective study, we conclude that fine needle aspiration provides a useful tool in the management of young patients with peripheral lymphadenopathy, both in monitoring recurrent disease and in triaging patients with clinically suspicious primary lymphadenopathy to determined the next appropriate step in management.

Application of fine needle aspiration biopsy to pediatrics.

Fine needle aspiration (FNA) biopsy cytology is a technique rarely used in children, although it is increasingly used in a routine fashion for the evaluation of masses in adults. We reviewed our experience with FNA in patients 16 years of age and younger from the period 1973 to 1987. FNA diagnoses were confirmed either by subsequent surgical biopsy, autopsy, or clinical follow-up for a minimum period of 1 year. One-hundred twelve FNA procedures were performed in 107 patients. Patient age distribution was as follows: newborn to 5 years of age, 37 aspirates; 6 to 11 years of age, 39 aspirates; and 12 to 16 years of age, 36 aspirates. Fifty-five patients were female. Of the 112 aspirates, 70 were diagnosed as benign disorders, 39 were diagnosed as malignant, one was diagnosed as unsatisfactory, and two were considered suspicious for malignancy. The most common sites of involvement for benign lesions were lymph node (31 sites), soft tissue (13 sites), and thyroid (12 sites). The most common sites for malignancies were lymph node (12 sites), bone (eight sites), and soft tissue (eight sites). Of the malignant aspirates, 20 were from primary neoplasms, three were from locally recurrent neoplasms, and 16 were from metastatic neoplasms. Two false-positive and one false-negative diagnoses yielded sensitivity and specificity rates of 97%, and a predictive value of a positive FNA of 95%. Our experience indicates that selective application of FNA is a useful and important step in the evaluation and management of mass lesions throughout the entire age range of infancy and childhood.

Cytology and immunocytology of infectious mononucleosis in fine needle aspirates of lymph nodes.

Two cases of infectious mononucleosis with atypical clinical presentations were initially diagnosed by fine needle aspiration (FNA) of lymph nodes and subsequently confirmed by serologic studies. The cytologic features that allowed recognition included a high percentage of cells with relatively abundant cytoplasm that stained pale to deep blue using a Giemsa-type stain. Many of the cells had plasmacytoid features. The cells ranged in size from small lymphocytes to large immunoblastic forms. Other features included mitotic figures and occasional binucleated forms. Immunologic studies showed a mixture of B and T cells, with many of the cells having a cytotoxic/suppressor phenotype. The features seem to be relatively characteristic and distinct from those of malignant processes that could be aspirated in lymph nodes. Recognition of infectious mononucleosis by FNA in these cases allowed for confirmation by serologic studies, thereby avoiding the need for an excisional biopsy. These cases show that FNA of lymph nodes may shed light on the nature of the process underlying the lymphadenopathy in selected cases of clinically atypical infectious mononucleosis.

Fine needle aspiration biopsy. Applications in the diagnosis of lymphoproliferative diseases.

A review of fine needle aspiration biopsies of lymph nodes was performed to determine accuracy and reproducibility among observers for the diagnosis of malignant lymphomas and lymphoproliferative diseases and to identify problem areas in the diagnosis of lymphomas and lymphoproliferative diseases by this biopsy method. Not including cases of carcinoma, 85% of the lymphomas and lymphoproliferative processes were correctly identified by seven of eight observations from a blind review without clinical information. Four problem areas in diagnosis from aspirates were identified: (a) distinction of lymphoid hyperplasia from non-Hodgkin's lymphoma by relying significantly on polymorphism versus monomorphism of the smear pattern; (b) separating undifferentiated carcinoma from large cell lymphoma; (c) overinterpreting extensive lymphoid polymorphism as Hodgkin's disease; and (d) diagnosing some aspirates of granulomatous lymphadenopathy, viral infection, or nodes with extensive necrosis as Hodgkin's disease. From the analysis of this series, a programmed approach was developed for diagnosing lymph node aspirates. History, physical examination, correct performance of the aspiration biopsy, and proper handling of the specimen are the four basic elements. Microscopic evaluation includes assessment of overall cellularity, pattern of cell arrangement, identification of predominant cell type, and background elements.

Fine-needle aspiration biopsy of lymphoblastic lymphoma and leukemia. A clinical, cytologic, and immunologic study.

Six cases of lymphoblastic lymphoma or leukemia are reviewed in which fine needle aspiration (FNA) biopsy was used to either initially diagnose or to document relapse of the condition. Accuracy of diagnosis was confirmed by surgical or autopsy material or by subsequent clinical course. Cytologically, aspirates were characterized by numerous blast cells with frequent mitoses. Immunologic confirmation utilizing aspirate material was obtained in all cases. Adequate material for extensive immunologic studies was obtained in five of six cases. The impact of FNA on patient management included; primary diagnosis in three cases; documentation of recurrence in two cases; avoidance of surgical biopsy in a patient considered a poor surgical candidate in three cases; correct subtyping of a lymphoma in which material obtained by surgical biopsy was unclassifiable in one case; and correct subtyping of a lymphoma inaccurately subtyped by surgical biopsy in one case.

Hodgkin's disease: diagnosis by fine-needle aspiration biopsy. Analysis of cytologic criteria from a selected series.

Two hundred thirteen cases in which a lymph node aspirate and subsequent surgical biopsy had been performed were studied independently by four observers. Each observer attempted to discriminate involvement by Hodgkin's disease from involvement by other processes. The material included 18 cases of histologically confirmed Hodgkin's disease. The remaining 195 cases included a wide range of pathologic processes. All four observers were able to distinguish Hodgkin's disease from other processes in the great majority of cases. Two observers reviewed the aspirate material from the 18 cases of Hodgkin's disease to determine the presence and significance of elements known to characterize this disease, i.e., multinuclear and mononuclear Reed-Sternberg cells, polyploidal cells, granulomatous elements, metachromatic material, necrosis, eosinophils, neutrophils, and plasma cells. Reed-Sternberg cells were present in most but not all cases. Reed-Sternberg-like cells also were occasionally encountered in other processes. Polyploidal cells were invariably present and were useful in recognizing the disease. Granulomatous elements, metachromatic material, necrosis, eosinophils, and neutrophils were frequently present and, while not specific for the process, helped to draw attention to or substantiate the diagnosis of Hodgkin's disease.