Citopatología de los carcinomas de mama / Cytopathology of the breast carcinomas

La principal indicación de la PAAF de mama es la existencia de una masa palpable y valorada conjuntamente con la exploración clínica y mamográfica (Triple test); su precisión diagnóstica es de un 99 por ciento. Los criterios citológicos que permiten establecer un diagnóstico de malignidad son: celularidad abundante (celularidad tumoral), grupos celulares tridimensionales y poco cohesivos, pleomorfismo celular, células aisladas con citoplasma, ausencia de núcleos bipolares desnudos y presencia de fondo sucio Aunque la mayoría de los carcinomas mamarios son de tipo ductal, existen parámetros citológicos que, aunque no siempre, permiten identificar subtipos específicos. El material obtenido con la PAAF permite la valoración de factores pronósticos, ya sea realizando técnicas inmunocitoquímicos para receptores hormonales o aplicando criterios que permiten valorar el grado nuclear. La PAAF de mama en las lesiones malignas aporta una sensibilidad del 93 por ciento y una especificidad del 94 por ciento (AU)

On the utility of fine-needle aspiration in the diagnosis of primary scalp lesions.

A study of the clinico-cytologic findings of 62 primary palpable lesions located in the scalp is reported. Trichilemmal cyst (16 cases) followed by lipoma (8 cases) and benign melanocytic proliferation (4 cases) were the most frequent benign conditions (n = 45); basal-cell carcinoma (6 cases) and squamous-cell carcinoma (5 cases) were the most frequently aspirated malignant tumors (n = 17). In the cytologic category of benign lesions (n = 45), cytohistologic correlation was carried out in 19 cases and the cytohistologic agreement was 100%, except for the three actinic keratosis cases that were diagnosed as atypical epidermal lesions. Cytohistologic agreement was 100% in the 16 malignant lesions in which excisional biopsy was performed. Based on the findings reported here, fine-needle aspiration is indicated as the first-choice technique for the clinical evaluation of primary scalp lesions. Experience with cutaneous cytopathology is essential in order to be able to carry out this task.

On the utility and limitations of fine-needle aspiration of palpable lesions located in the hand.

Various types of superficial and deep-seated lesions may occur in the hand, causing concern to the patient and posing diagnostic dilemmas to the clinician. A study was undertaken to evaluate the utility of fine-needle aspiration (FNA) or scraping for the diagnosis of palpable lesions located in the hand. From a clinico-cytologic point of view, lesions were classified as superficial (n = 41) or deep-seated (n = 66), and aspirates were categorized into five groups: benign without specific cytohistologic diagnosis, benign with specific cytohistologic diagnosis, atypical, malignant without specific cytohistologic diagnosis, and malignant with specific cytohistologic diagnosis. Out of 107 cases with aspirates adequate for cytologic evaluation, 85 had histologic correlation; in 22 cases, histologic confirmation was deemed unnecessary because of unequivocal cytologic findings and/or clinical workup. Sensitivity was 90.9%, specificity 100%, and efficacy 98%. Based on these findings, we believe that FNA or scraping may help in the clinical workup of patients with either superficial or deep-seated lesions located in this anatomic region.

Punción aspiración con aguja fina de nódulos cutáneos y subcutáneos metastásicos / Fien neddle aspiration of metastatic cutaneous and subcutaneous nodules

Hemos estudiado los hallazgos clinicocitológicos de 142 nódulos cutáneos y subcutáneos metastásicos pertenecientes a 142 pacientes, por medio de punción aspiración con aguja fina (PAAF); de estos, 76 tenían antecedentes de neoplasia primaria. En 120 pacientes se dispuso de la histología del tumor primario. Las localizaciones más frecuentes de los nódulos cutáneos y subcutáneos metastásicos fueron el torax y el abdomen (61,9 por ciento), y de los tumores primarios, el pulmón (25,3 por ciento) y la piel (16,2 por ciento). con base en el patrón citoarquitectural dominante los aspirados fueron clasificados en seis categorías: adonocarcinoma (n=75), carcinoma escamoso (n=34), linfoma (n=6), melanoma (n=18), célula pequeña (n=8) y sarcoma (n=1). El patrón citoarquitectural más frecuente fue el de adenocarcinoma (52,8 por ciento). En los 120 casos en los cuales se efectuó correlación entre los hallazgos citológicos de los aspirados de los nódulos cutáneos y subcutáneos metastásicos y la histología del tumor primario la sensibilidad fue del 100 por ciento y el valor predictivo de un resultado positivo, también del 100 por ciento. De acuerdo con nuestras observaciones, la PAAF de los nódulos cutáneos y subcutáneos metastásicos es una técnica útil por su gran sensibilidad, rapidez de diagnóstico y bajo coste, y sirve de ayuda al clínico en el tratamiento de los pacientes con cáncer (AU)

Utility of fine-needle aspiration in the diagnosis of granulomatous lesions of the breast.

Fourteen cases of granulomatous mastitis (GM) studied by fine-needle aspiration (FNA) are reviewed and nine cytologic features (necrosis, neutrophil granulocytes, foamy cells, plasma cells, granulomas, epitheloid cells, multinucleated giant cells of foreign body type and Langhans' type, duct cells, and the presence of acid-fast bacilli) are reappraised in a semiquantitative manner. The main objective of this study was to find out if one or more of these features would permit the various granulomatous entities identified in surgical pathology to be separated cytologically. The results suggest that FNA does not permit the various granulomatous lesions identified in surgical pathology to be differentiated, since in this series different entities share a common cytologic pattern. Only the presence of acid fast bacilli in smears would enable a tuberculous etiology to be diagnosed. The opinion is put forward that the term GM should be avoided in the cytologic report and substituted by the noncommitted term "granulomatous lesion of the breast.

Fine-needle aspiration of subacute granulomatous thyroiditis (De Quervain's thyroiditis): a clinico-cytologic review of 36 cases.

Although subacute granulomatous thyroiditis (SGT) is usually diagnose clinically, there are other thyroid conditions that must be ruled out. This task is achieved by means of fine-needle aspiration (FNA). In retrospect, the clinical and cytologic findings seen in 36 SGT cases are reassessed with a view to deciding which findings are most reliable for reaching a confident cytologic diagnosis. These are: the simultaneous presence in the same aspirate of the following cells: 1) follicular cells with intravacuolar granules and/or plump transformed follicular cells; 2) epithelioid granulomas; 3) multinucleated giant cells; 4) an acute and chronic inflammatory dirty background; 5) the absence of the following cells: fire-flare cells, hypertrophic follicular cells, oncocytic cells, and transformed lymphocytes. The absence of one or more of these requirements does not exclude SGT but does increase the number of thyroid conditions that come into the differential diagnosis. In these cases, it is essential to review clinical data carefully and to submit the patient to a close clinical and FNA follow-up.

Follicular variant of papillary carcinoma of the thyroid: to what extent is fine-needle aspiration reliable?

We have reappraised the fine-needle aspirates (FNAs) of 5 cases of the follicular variant of papillary carcinoma of the thyroid (FVPCT). Three of these had been performed on cold thyroid nodules and had been diagnosed as follicular proliferations. The remaining 2 had been performed on cervical lymphadenopathies and had been diagnosed as metastatic papillary carcinoma, probably of thyroid origin. Careful reassessment of the slides did not allow any change of the original diagnoses. We found two constant cytologic features present in all cases studied: syncytial clusters without acinar formation, and monolayered sheets. Nonconstant findings included: follicular pattern, ropy colloid, multinucleated giant cells (MGCs), and nucleoli in FNAs performed on thyroid nodules, and papillae, pseudonuclear inclusions, nuclear grooves, MGCs, and nucleoli in FNAs performed on cervical lymphadenopathies. Our findings suggest that the cytologic diagnosis of FVPCT is very difficult if based solely on the cytologic features seen in FNAs, and that it is necessary to resort to the study of surgical specimens if a definitive diagnosis is to be achieved. We are also of the opinion that more weight should be given to the aforementioned nonconstant findings when faced by a thyroid aspirate with cell richness, syncytial clusters without acinar formation, and monolayered sheets.

Mimics of pilomatrixomas in fine-needle aspirates.

This is a review of the fine-needle aspirates (FNAs) of nine pilomatrixomas (PMs) found in a series of 1,500 FNAs performed on skin nodules. The objective is to determine and list the cytologic findings that might mislead the less-experienced cytopathologist and to give him advice on how to avoid such errors. The following recommendations are made: 1) The FNAs should be carried out and the smears interpreted by the same person. 2) Clinical data, particularly age and location, are of paramount importance. 3) Shadow cells are pathognomonic of PMs. 4) Basaloid nuclei with prominent nucleoli should not be overdiagnosed. 5) Use both Papanicolaou and Diff-Quik stains. 6) Think of PM when performing and interpreting aspirations from subcutaneous growths located in the head and neck of young persons.

Hepatic and blood lead levels in patients with chronic liver disease.

OBJECTIVE: To investigate the relationship between lead levels in the liver and blood, liver function indices and other biological variables in patients with liver disease. DESIGN: Prospective study. METHOD: The levels of lead in blood and hepatic tissue was measured in 92 patients with different liver diseases and in a control group (n = 100). Lead levels were analysed by electrothermic atomic absorption spectrophotometry. RESULTS: For controls, the mean lead level in blood was 175 +/- 87 micrograms/l. Blood lead levels were significantly linked with alcohol intake. They were raised in patients with alcoholic liver disease, including both those with cirrhosis (230 +/- 65 micrograms/l) and those with chronic non-cirrhotic liver disease (247 +/- 82 micrograms/l). The differences between these subgroups, the control group, and the patients with non-alcoholic liver disease were statistically significant. The mean hepatic lead level for patients was 2.30 +/- 1.40 micrograms/g dry weight (d.w.), and 2.15 +/- 1.71 micrograms/g d.w. for controls (not significant). Patients with alcoholic cirrhosis had higher hepatic lead levels than non-alcoholic patients (2.62 +/- 1.48 micrograms/g d.w. versus 2.07 +/- 1.14 micrograms/g d.w., respectively), although the difference was not statistically significant. There was no relationship between blood and hepatic lead levels (r = 0.27; not significant). Blood lead levels correlated with phosphorus (r = -0.36; P < 0.001), and alcohol intake (g/day; r = 0.32; P < 0.001). Blood and hepatic lead levels in patients with cirrhosis were similar for patients with Child-Pugh class A, B and C disease. CONCLUSIONS: Increased levels of lead were found in the blood of patients who consumed alcohol and those with alcoholic liver disease. Our data suggest that both blood and hepatic lead levels are not influenced by changes in liver function.

[Follicular bronchiolitis: an infrequent cause of interstitial pneumopathy]. / Bronquiolitis folicular: una causa infrecuente de neumopatía intersticial.

A 63-year-old woman with follicular bronchiolitis presenting as diffuse interstitial pneumopathy is described. Diagnosis was made by open lung biopsy and the patient was treated in our department until death. The course of disease and response to treatment was similar to that observed in cases of idiopathic pulmonary fibrosis. No associated collagen disease was found. This report reviews the histological and clinical signs of this disease, as well as treatment.

[Cytomorphologic characteristics of esophageal carcinosarcoma (pseudosarcoma)]. / Aspectos citomorfológicos del carcinosarcoma (seudosarcoma) esofágico.

We report a case of carcinosarcoma or pseudosarcoma of the esophagus, diagnosed through biopsy and endoscopic brush. We also describe several histogenetics hypothesis about this infrequent neoplasm and the difficulty of its diagnosis by means of endoscopy. We emphasize the endoscopic brush positivity and the description of its cytologic characteristics.

[Pulmonary tumorlets in POEMS syndrome]. / Tumorlets pulmonares en el síndrome POEMS.

POEMS syndrome is a systemic disease characterized by severe chronic polyneuropathy, organomegaly (adenopathy, and liver enlargement) endocrinopathy, monoclonal peak, sclerotic bone lesions and skin changes. We report on a case of complete POEMS syndrome with peripheral arterial thrombosis and multiple lung tumorlets. No antibodies were found against human nervous tissues or Rhesus monkey on patient serum. This case is the first association described of POEMS syndrome and lung tumorlets.