MALT lymphoma of the floor of the mouth: a case report.

MALT (mucosa-associated lymphoid tissue) lymphomas are low-grade extranodal B-cell lymphomas that may involve various sites in the head and neck including the thyroid, salivary, and lacrimal glands. Development of MALT lymphoma in the head and neck is often associated with autoimmune diseases such as Sjögren syndrome or Hashimoto thyroiditis. Here we report a case of a MALT lymphoma of the floor of the mouth that likely arose in the sublingual gland. The patient was successfully treated with external-beam radiation therapy and remained disease-free at the 4-year follow-up.

Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations.

BACKGROUND: The Papanicolaou Society of Cytopathology recently proposed 6 diagnostic categories for the classification of thyroid fine-needle aspiration (FNA) cytology. Using these categories, the experience with FNA from 2 institutions was studied with emphasis on cytologic-histologic correlation, source of errors, and clinical management. METHODS: Patient cytology data were retrieved by a retrospective search of thyroid FNA in the institutional databases. Cytologic diagnoses were classified as unsatisfactory, benign, atypical cellular lesion (ACL), follicular neoplasm (FN), suspicious for malignancy, and positive for malignancy. Samples with a histologic discrepancy were re-evaluated, and clinical follow-up information was recorded. RESULTS: Of 4703 FNA samples, 10.4% were classified as unsatisfactory, 64.6% were classified as benign, 3.2% were classified as ACL, 11.6% were classified as FN, 2.6% were classified as suspicious, and 7.6% were classified as malignant. Five hundred twelve patients had at least 1 repeat FNA, mainly for results in the unsatisfactory and ACL categories. One thousand fifty-two patients had surgical follow-up, including 14.9% of patients with unsatisfactory FNA results, 9.8% of patients with benign results, 40.6% of patients with ACL results, 63.1% of patients with FN results, 86.1% of patients with suspicious results, and 79.3% of patients with malignant results. The rates for histologically confirmed malignancy in these categories were 10.9%, 7.3%, 13.5%, 32.2%, 64.7%, and 98.6%, respectively. The cytologic-histologic diagnostic discrepancy rate was 15.3%. Sources of errors included diagnoses on inadequate specimens, sample errors, and overlapping cytologic features between hyperplastic nodules and follicular adenoma. The sensitivity and specificity of thyroid FNA for the diagnosis of malignancy were 94% and 98.5%, respectively. CONCLUSIONS: The current results indicated that FNA provides an accurate diagnosis of thyroid malignancy. The 6 diagnostic categories were beneficial for triaging patients for either clinical follow-up or surgical management.

Role of FNA cytology and immunochemistry in the diagnosis and management of medullary thyroid carcinoma: report of six cases and review of the literature.

Medullary thyroid carcinoma (MTC) is a rare neuroendocrine thyroid malignancy. This study retrospectively reviewed 10 fine-needle aspiration samples from six MTC patients. Aspirated specimens were from thyroid (3), cervical lymph nodes (5), left lung (1), and anterior chest wall (1). Cytomorphology consisted predominantly of plasmacytoid cells (3 cases), spindle cells (2 cases), and epithelioid cells (1 case). However, all specimens had a mixture of other cell types and "salt and pepper" chromatin. Only one specimen showed Congo-red-positive amyloid. Calcitonin was expressed in 7/7 specimens. Four patients underwent surgical excision and MTC was confirmed in all four. Follow-up studies included serum calcitonin (3/6 cases) and imaging (2/6 cases). One patient had MTC associated with multiple endocrine neoplasia IIA syndrome and one had familial MTC with a history of MTC in mother. In conclusion, the cytomorphology of MTC is typical and calcitonin immunostain is a reliable method for confirming primary or metastatic MTC. Early cytological diagnosis of MTC positively impacted patient management. Follow-up with serum calcitonin and imaging is helpful in the early detection of recurrences.

The role of endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration in distinguishing pancreatic cystic lesions.

Distinguishing mucinous from nonmucinous cystic lesions of the pancreas often constitutes a diagnostic dilemma. The clinical management differs between such lesions; therefore it is important to make an accurate preoperative diagnosis. Various centers have reported conflicting results regarding their ability to detect mucin-producing neoplastic cells and appropriately reach a diagnosis based on endoscopic ultrasound (EUS) guided FNA. The aim of this study is to assess the ability of EUS-FNA cytology to diagnose and differentiate mucinous from nonmucinous pancreatic cystic lesions. We reviewed records of patients who underwent EUS of pancreatic cystic lesions. If FNA was performed and mucinous neoplasm was suspected, aspirate was evaluated for cytomorphology and presence of mucin. FNA results were compared to final histologic diagnosis if surgery was performed. Cytologic diagnosis was provided for 28/30 (93%). By comparing EUS-FNA diagnoses with final surgical pathology, FNA accurately diagnosed in 10/11 cases with sensitivity and specificity for detection of malignancy of 100 and 89, respectively, while the accuracy for identification of mucinous cystic neoplasms was 100%. Our results indicate that in the appropriate clinical and imaging setting, EUS-FNA cytology with analysis for mucin production by tumor cells is an important test in distinguishing pancreatic cystic lesions and guiding further management.

Imaging, morphologic, and immunohistochemical correlation in gastrointestinal stromal tumors.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) recently have been distinguished morphologically, immunohistochemically, and genetically from other gastrointestinal-tract spindle cell neoplasms. The objective of this study was to correlate clinical and imaging findings with morphology and immunohistochemistry to diagnose GISTs and to differentiate them from other spindle cell lesions in the gastrointestinal tract. METHODS: The authors reviewed 9 patients who had tumors that were diagnosed as GIST by image-guided and endosonographic-guided fine-needle aspiration (FNA) with or without core biopsy (7 stomach tumors and 2 intraabdominal tumors). The male:female ratio was 3:6, and the patients ranged in age from 38 years to 80 years. Onsite evaluation, preliminary cytologic evaluation, and immunohistochemistry were provided for 6 patients. Immunostains were performed, depending on sample size, on aspirates and/or core biopsies. RESULTS: On imaging studies, most tumors were smooth and homogenous, consistent with GIST. Tumors ranged in size from 1.8 cm to 22 cm. The largest neoplasm showed solid/cystic and necrotic components. Aspirates consisted of spindle cell, neoplastic proliferation arranged in fascicles that exhibited focal, nuclear palisading; indistinct, cytoplasmic borders; and no significant atypia or mitosis. Focal epithelioid changes or cytologic atypia and mitoses were observed in 2 tumors. Immunostains revealed tumor expression of CD117 and/or CD34 in 5 of 6 tumors, expression of actin in 3 of 6 tumors, and expression of desmin in 1 of 6 tumors. All tumors were diagnosed as GIST (or consistent with GIST for tumors that lacked immunochemical analysis). Five patients underwent surgical excision, and the GIST diagnosis was confirmed in 3 patients, whereas 1 tumor proved to be neurofibroma, and another tumor was leiomyoma. No surgical follow-up was available for the remaining 4 patients, who had imaging and morphologic findings consistent with GIST. CONCLUSIONS: In the setting of consistent clinical and radiologic findings, the combined use of cytomorphology and immunohistochemistry on FNA and/or core biopsy in most instances provides a reliable pathologic diagnosis of GIST. The need of sufficient material for performing ancillary studies and the usual impossibility of excluding malignancy are limitations of FNA cytology of GIST.

Activation of the hedgehog pathway in a subset of lung cancers.

Activation of the hedgehog pathway is reported in lung cancer, but its frequency remains unknown. We examine activation of this pathway in lung cancers by in situ hybridization and immunohistochemstry, and find that less than 10% of the tumors have elevated hedgehog target gene expression. We further identify a cell line NCI-H209 and two primary tumors with no detectable Su(Fu), a negative regulator of the pathway. Ectopic expression of Su(Fu) in NCI-H209 cells down-regulates hedgehog target gene expression and leads to inhibition of cell proliferation. These data indicate that activation of the hedgehog pathway is activated through Shh over-expression or Su(Fu) inactivation in only a subset of lung cancers.

Primer: cytopathology for the clinician--how to interpret the results of aspiration cytology.

The practice of clinical cytopathology is characterized by the daily challenges of trying to establish pathological diagnoses on the basis of microscopic evaluation of small cellular samples, from both deep-seated and superficial anatomic sites. The diagnostic work-up of mass lesions involves a collaborative effort between clinicians and pathologists, and relies on the pathologist's ability to establish a reliable diagnosis; that is, one that convincingly explains the mass and its underlying neoplastic or non-neoplastic nature. Arriving at a conclusive pathological diagnosis is not always easy and additional ancillary tests, such as special stains, microbiologic cultures and flow cytometry, are often required. To ensure that clinicians can make appropriate management decisions, it is essential that pathologists use conventionally accepted diagnostic nomenclature and communicate effectively with their clinical colleagues. Clinicians should also ensure that the pathologist is provided with all relevant clinical information, preferably at the time of submission of the specimen. Clinicians should consult with the pathologist before the biopsy procedure, and inform them of the clinical differential diagnoses, to ensure that the proper ancillary tests are obtained for definite diagnosis.

Endoscopic ultrasound-guided fine-needle aspiration cytology for diagnosis above and below the diaphragm.

Endosonography ultrasound (EUS) is a minimally invasive technology using a high-frequency ultrasound transducer that is incorporated into the tip of a conventional endoscope. This technique permits high-resolution imaging of the gastrointestinal wall and structures in its vicinity, as well as real-time endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA). This is a review of the literature on EUS-guided FNA of the mediastinal and abdominal lymph nodes, the pancreas, intramural gastrointestinal masses, and other miscellaneous organs and body cavities. EUS-guided FNA is a recently developed procedure that has established itself as a safe, highly accurate, and clinically useful modality.

Synergistic interaction of hyperthermia and Gemcitabine in lung cancer.

Hyperthermia increases cytotoxicity of various antineoplastic agents. We investigated the cytotoxic effects of Gemcitabine and/or hyperthermia on BZR-T33 (human non-small-cell lung cancer cells) in vitro and in immune-suppressed athymic nude mice. Isobologram analysis of monolayer cell cultures for cytotoxicity demonstrates a synergistic interaction between hyperthermia and Gemcitabine. Clonogenic results show significant reductions in surviving fractions and colony size for both therapies; greatest reduction was for the combined therapy group. Using cell cycle analysis, hyperthermia enhanced Gemcitabine-induced G2-M arrest resulting in destruction of 3.5 log cells. Apoptotic studies (Annexin-V FITC staining) showed that hyperthermia augmented Gemcitabine-induced apoptosis. Transmission electron microscopy demonstrated pathology observed in cultures exposed to either therapy present in cultures exposed to both therapies. Studies in nude mice show that the combination therapy group had both an initial decrease in tumor size, and a significantly delayed rate of growth. Additionally, using tumor material harvested from nude mice two days after end to treatment reveals a significantly greater apoptotic index and significantly smaller mitotic index for the combined therapy group. Western blots of the same tumor material, showed that heat shock protein 70 was not significantly increased, however, caspase-3 activity of was significantly increased because of the combined therapy. In conclusion, the combined therapy is synergistic in effect because of hyperthermia enhancing Gemcitabine-induced apoptosis.

Phenotypic diversity of intrahepatic and extrahepatic cholangiocarcinoma on aspiration cytology and core needle biopsy: case series and review of the literature.

BACKGROUND: Cholangiocarcinoma (CC) represents approximately 10% of primary liver malignancies and can mimic metastatic adenocarcinoma. METHODS: The authors retrospectively reviewed the cytopathology files at the University of Texas Medical Branch to identify patients who were diagnosed with intrahepatic or extrahepatic CC by aspiration cytology between 1995 and 2004. Brush cytology specimens of extrahepatic CC were excluded. All diagnoses were confirmed as CC by clinical, imaging, and histopathologic findings and by chart review. RESULTS: Cytopathology files from 13 patients with CC diagnosed by FNA were retrieved. The male:female ratio was 5:8, and the patients ranged in age from 29 years to 74 years (mean age, 59 years). In 12 of 13 patients, aspirates were obtained by ultrasound guidance; and, in 1 patient, computed tomography guidance was used. Three patients had aspirates only, 10 patients also had core biopsies, and 1 patient had cell block preparations. The phenotypic distribution of CC according to the World Health Organization (WHO) histologic classification was 9 adenocarcinoma (intrahepatic), not otherwise specified (NOS) (69%); 2 gastric foveolar type (extrahepatic) CCs (15%); 1 intestinal type (extrahepatic) CC (8%); and 1 sarcomatous/spindle cell type (intrahepatic) CC (8%). One adenocarcinoma, NOS was well differentiated CC with bland tubular architecture, and one was pleomorphic. Ancillary histochemical and immunochemical stains were performed on 5 of 13 specimens, which included 4 core biopsies and 1 aspirate with Mucicarmine positivity (3 specimens), carcinoembryonic antigen positivity (3 specimens), and a cytokeratin 7 (CK7)-positive/CK20-negative pattern (2 specimens). The 1 sarcomatous/spindle cell type CC was chromogranin-negative and low molecular weight keratin (cell adhesion molecule 5.2)-positive, which excluded metastatic carcinoid. CONCLUSIONS: Classification of intrahepatic and extrahepatic CC in aspiration cytology specimens was achieved in a reliable manner concordant with the WHO histologic classification. Special types of CC with bland nuclear features posed a diagnostic challenge on cytologic evaluation, particularly the well differentiated CC with tubular architecture and the gastric foveolar type CC with mucin-producing tumor cells. The addition of core biopsy and/or ancillary studies, such as histochemical and immunochemical stains, were helpful in reaching the correct diagnosis.

Clinical, imaging, and cytopathological features of solid pseudopapillary tumor of the pancreas: a clinicopathologic study of three cases and review of the literature.

Solid pseudopapillary tumors are rare pancreatic neoplasms of uncertain pathogenesis that rarely metastasize and usually occur in young women. We describe the clinical, imaging, and cytopathological features of solid pseudopapillary tumor of the pancreas. We reviewed the clinical presentation, imaging, morphologic/immunochemical features, and follow-up of three women (age range 26-44). Cases 1, 2, and 3 presented with abdominal wall abscess, multiple endocrine neoplasia, and solid/cystic mass in the pancreatic head, respectively, and computed tomography of abdomen revealed solid/cystic masses with heterogeneous enhancement in body, tail and head of the pancreas, respectively. Case 2 also exhibited a left adrenal mass. Case 3 underwent endoscopic ultrasound of the pancreas, which showed a complex solid/cystic mass with septations. Sampling consisted of fine-needle aspiration (percutaneous or endosonography-guided), and additionally, core biopsy of the pancreatic mass and adrenal lesion in case 2. Aspirates and core biopsy revealed vascular structures with attached monotonous neoplastic cells in papillary-like arrays. Tumor cells had bland nuclear features with grooves, cytoplasmic periodic acid Schiff-positive hyaline globules, and associated myxoid/stromal fragments. Immunochemistry expressed alpha-1-antitrypsin, alpha-1-antichymotrypsin, vimentin, and focal neuron-specific enolase. Cases 1 and 3 underwent pancreatectomy with follow-up consisting of yearly imaging and no recurrences. Case 2 proved metastatic disease to adrenal gland and no follow-up was available. In the setting of typical clinical and imaging findings, an accurate preoperative diagnosis of pancreatic solid pseudopapillary tumor can be established by aspiration cytology and immunochemistry with or without concomitant core biopsy, on the basis of which clinicians decide treatment. This tumor can behave in a malignant fashion.

Regulation of lung cancer cell growth and invasiveness by beta-TRCP.

Beta-transducin-repeat-containing protein (beta-TRCP) serves as a substrate-recognition subunit of Skp1/Cullin/F-box (SCF)(beta-TRCP) E3 ligases, involved in regulation of several important signaling molecules. SCF(beta-TRCP) E3 ligases play a critical role in cell mitosis as well as in various signaling pathways. Here, we provide evidence to support that beta-TRCP negatively regulates cell growth and motility of lung cancer cells. With specific antibodies, we detect loss of beta-TRCP1 protein in several lung cancer cell lines. One cell line contains an inactivated mutation of the beta-TRCP1 gene. Loss of beta-TRCP1 protein is also found in subsets of lung cancer specimens. We observe that retrovirus-mediated stable expression of beta-TRCP1 in beta-TRCP1 negative cells inhibits cell growth in soft-agar and tumor formation in nude mice. Furthermore, expression of beta-TRCP1 alters cell motility, as indicated by morphological changes and a reduced level of active matrix metalloproteinase (MMP)11. Conversely, inactivation of beta-TRCP1 by specific siRNA accelerates cell invasion. Of the 10 known substrates of SCF(beta-TRCP) E3 ligases, the protein level of cell division cycle 25 (CDC25)A is clearly affected in these lung cancer cells. Cells treated with CDC25A inhibitors become less invasive. Thus, loss of beta-TRCP1 may promote both growth and cell motility of lung cancer cells, possibly through regulation of CDC25A and the MMP11 level.

Reporting the presence of significant epithelial atypia in pancreaticobiliary brush cytology specimens lacking evidence of obvious carcinoma: impact on performance measures.

OBJECTIVE: To assess the clinical impact of recognizing and reporting the presence of significant atypia in brush cytology specimens from the biliary and pancreatic ducts lacking obvious features of carcinoma. STUDY DESIGN: Analysis of 120 pancreaticobiliary brushings from 99 patients over a 4-year period. There were 114 bile duct and 6 pancreatic duct specimens obtained via endoscopic retrograde cholangiopancreatography at a tertiary care center. RESULTS: Overall sensitivity, specificity, accuracy, and positive and negative predictive values for carcinoma were 47%, 99%, 79%, 95% and 76%, respectively. When the presence of "significant epithelial abnormalities," cancer or cellular atypia less than carcinoma, was reported, the overall sensitivity, specificity, accuracy, and positive and negative predictive values were 62%, 93%, 82%, 85% and 80%, respectively. CONCLUSION: Recognizing and reporting the presence of significant epithelial abnormalities in pancreaticobiliary specimens lacking obvious features of malignancy in brush cytology specimens led to a modest improvement in sensitivity for "significant epithelial abnormalities" and cancer, along with a slight decrease in specificity and positive predictive value and slightly increased accuracy and negative predictive value. Maintaining high specificity is essential to avoiding false positive diagnoses on pancreaticobiliary brush cytology.

Endoscopic sonographically guided fine-needle aspiration yield in submucosal tumors of the gastrointestinal tract.

OBJECTIVE: To study the yield of endoscopic ultrasonographically guided fine-needle aspiration cytologic examination in the diagnosis of submucosal masses. METHODS: From 1999 to 2003, 10 patients underwent ultrasonographically guided fine-needle aspiration for the cytologic diagnosis of submucosal masses in our institution. The endoscopic ultrasonography records and the cytology database were consulted, and the reports were analyzed, as were slide material and the technical aspects related to these procedures. All procedures were performed under conscious sedation and cardiorespiratory monitoring on an outpatient basis. Ten patients (4 men and 6 women; mean age, 60.8 years) were studied. RESULTS: Eight lesions were located in the stomach, and 2 were located in the esophagus, with a mean diameter of 3.3 cm. An experienced cytopathologist was present on-site during all procedures for assessment of adequacy and preliminary cytologic examination. Cytologic diagnoses were obtained in 8 cases as follows: 6 gastrointestinal stromal tumors, 1 organizing submucosal hematoma, and 1 low-grade mucosa-associated lymphoid tissue-associated lymphoma. Two cases consisted of scant gastric epithelium only and were considered nondiagnostic. The cytologic diagnoses guided further clinical treatment. CONCLUSIONS: Ultrasonographically guided fine-needle aspiration with cytopathologic analysis has a high accuracy rate (80%) for diagnosing submucosal lesions. These findings potentially affect clinical decision making.

Recent advances in cell biology, diagnosis, and therapy of gastrointestinal stromal tumor (GIST).

The understanding of mesenchymal neoplasms of the gastrointestinal tract has evolved dramatically over the last two decades since gastrointestinal stromal tumor (GIST) was described as the most common stromal tumor arising anywhere from the esophagus to the ano-rectum. Although morphologically similar to other benign and malignant smooth muscle and neural stromal neoplasms, GIST constitutes a distinct group of rare gastrointestinal tract tumors that originate from the interstitial cells of Cajal, regulators of gut peristalsis that normally express CD117, which is the product of the c-KIT proto-oncogene that encodes a tyrosine kinase receptor that regulates cellular proliferation in GISTs. Virtually all GISTs occur from mutations of the c-KIT oncogene and exhibit consistent expression of c-KIT (CD117), which is considered the most specific criterion for a diagnosis of GIST. Gastrointestinal stromal tumors vary in their behavior and several features have to be considered to assess their malignant potential. The advent of sophisticated imaging techniques for the evaluation and sampling of stromal tumors of the gastrointestinal tract has resulted in improved detection of GISTs. The identification of a novel tumor-specific target in c-KIT resulted in the development of a tyrosine kinase-inhibitor (imatinib mesylate) that provides an encouraging option for treating GISTs. This article reviews recent advances in the understanding of the cell biology, diagnosis, and therapy of GISTS.

Primary pulmonary adenoid cystic carcinoma: report of a case diagnosed by fine-needle aspiration cytology.

Adenoid cystic carcinoma of the lower respiratory tract is an uncommon tumor that can arise in the mainstem bronchus and often presents as an endobronchial mass lesion causing bronchial obstruction with post obstructive atelectasis and pneumonia. Exfoliative cytology is seldom useful in the diagnosis of primary bronchial adenoid cystic carcinoma, because these neoplasms usually have a submucosal location with often intact mucosa. Since most endobronchial adenoid cystic carcinomas are endoscopically visible, bronchoscope-guided fine-needle aspiration constitutes an excellent approach to establish a pathologic diagnosis. The fine-needle aspiration cytology of primary pulmonary adenoid cystic carcinoma has been rarely described. We report a case of primary adenoid cystic carcinoma of the lung having characteristic cytologic features and correlate with computed tomography, bronchoscopic, and histological findings. Bronchoscope-guided aspiration cytology provided a conclusive diagnosis of adenoid cystic carcinoma, which was further corroborated by histology in the pneumonectomy specimen. Diagn. Cytopathol. 2004;30:51-56.

Clinical impact of on-site cytopathology interpretation on endoscopic ultrasound-guided fine needle aspiration.

OBJECTIVES: Endoscopic ultrasound-guided fine needle aspiration (EUS-guided FNA) is becoming a preferred modality for diagnosing and staging GI and mediastinal malignancies. Although experts advocate on-site cytopathology assessment for tissue sample adequacy, there are few data to support this claim. Our goal was to determine whether on-site cytopathology interpretation improves the diagnostic yield of EUS-guided FNA. METHODS: EUS-guided FNA results from two university hospital centers were reviewed and compared. At center 1, where EUS-guided FNA was performed with a cytopathologist on site, the results of 108 consecutive patients were evaluated. At center 2, where a cytopathologist is unavailable, the results of 87 consecutive patients were reviewed. One endoscopist performed all procedures at both institutions. Cytologic diagnoses were categorized as positive or negative for malignancy, suspicious for malignancy, atypical/indeterminate, or unsatisfactory. The number of repeat procedures, needle passes, medication use, target site, age, and sex were compared between the two sites. RESULTS: Patients at center 2 were older (p = 0.04) and predominantly female (p = 0.03). Pancreas was the most common target site at center 2, whereas thoraco-abdominal nodes were the most common at center 1 (p = 0.0001). Patients at center 1 had a diagnosis of positive or negative for malignancy more frequently (p = 0.001) and were less likely to have an unsatisfactory specimen (p = 0.035) or repeat procedure, although the latter was not significant (p = 0.156). CONCLUSION: On-site cytopathology interpretation improves the diagnostic yield of EUS-guided FNA. EUS centers should allocate resources to cover for on-site cytopathology evaluation.

Enhancing recovery of endocervical component on gynecologic cytology specimens processed by thin-layer technology.

OBJECTIVE: To address the causes and report the corrective measures required for resolving the initial problem of high rates of cervical vaginal cytology specimens reported as having no endocervical component on SurePath (AutoCyte, Inc., Burlington, North Carolina, U.S.A.) liquid-based, thin-layer technology at an academic center cytology laboratory. STUDY DESIGN: Analysis of 511 cases lacking endocervical/transformation zone component out of 9,221 SurePath thin-layer gynecologic specimens processed in a one-year period. The study encompassed a review of sample collection techniques by physicians and nurses, specimen processing, cytologic features of endocervical/squamous metaplastic cells processed by the SurePath method and statistical analysis of endocervical cell recovery rates after implementation of corrective measures. RESULTS: Absence of endocervical/transformation zone component varied from an initial 18% in the first month to an average of 5.3% after corrective actions were implemented. Current rates of SurePath thin-layer specimens having no endocervical component are lower than those for conventional smears. CONCLUSION: Since SurePath was only recently introduced to the market, there are no previously published data addressing how to optimize the recovery of endocervical component on liquid-based, thin-layer specimens processed by this methodology.

Fine needle aspiration cytology of hepatobiliary cystadenoma with mesenchymal stroma.

BACKGROUND: Hepatobiliary cystadenomas (HBCs) with mesenchymal stroma (MS) are rare cystic neoplasms occurring exclusively in women. Hepatobiliary cystadenoma consists of a mucin-producing cyst lining epithelium underlined by a dense MS cell layer. In the current study, the authors review the fine needle aspiration cytology of HBC with MS and identify characteristic cytologic features that suggest such an uncommon neoplasm on aspirates. METHODS: A search of the histopathology files at the University of Texas Medical Branch at Galveston for the interval of January 1992 through December 2000 yielded four cases of HBC having both cytologic and histologic specimens. The cytologic features of the aspirates were reviewed and correlated with the clinical history, radiologic findings, and the histopathology of the excised specimens. RESULTS: All four patients were middle-aged women (mean age, 48.5 years) who presented with epigastric pain radiating to the back, due to large cystic lesions in the right liver lobe (three patients) or the left liver lobe (one patient). Aspiration cytology revealed chronic inflammatory exudate in all cases, along with occasional aggregates of bland, cuboidal-columnar epithelial cells (in three cases), which rarely arranged in papillary clusters. No significant atypia, evidence of malignancy, or MS cells were identified on the aspirates. HBC with MS was confirmed histologically on the excised specimens in all cases. CONCLUSIONS: By ensuring adequate sampling and correlating with consistent clinical and radiologic findings, a diagnosis of HBC or cystic hepatobiliary neoplasm can be suggested on the basis of aspiration cytology.