[Diagnosis of pancreatic lesions: possibilities of cytology]. / Diagnose von Läsionen des Pankreas: Möglichkeiten der Zytologie.

The pancreas is relatively inaccessible to conventional methods of study and is difficult to investigate because of its anatomic location. Different imaging techniques have made it possible to detect tumors with diameters in the range of 1 cm. Endoscopic methods (lavage and cytologic brush methods) never proved successful enough to obtain diagnostic material. Combination among aspiration cytology, different X-ray methods, and ultrasound scanning have been reported to give astonishingly accurate results: many reports indicate its value. The following paper describes our experiences with this method for examination of pancreatic lesions and presents our own results.

[Diagnosis of pathologic changes in the liver caused by fine needle puncture]. / Diagnose von pathologischen Veränderungen der Leber durch die Feinnadelpunktion.

Needle aspiration biopsy for cytologic detection of tumors and tumor-like lesions of the liver is widely recognized as a safe and highly sensitive method, especially since the introduction of imaging techniques for guidance of the aspirators needle. In the following paper we discuss indications and contraindications of the method; in the context of the articles about cytologic diagnosis of gastrointestinal lesions we write about our own observations and experiences in using this method of guided fine needle aspirations and cytologic examinations of liver lesions.

[Possibilities of cytodiagnosis in ascites]. / Möglichkeiten der Zytodiagnostik im Aszites.

The examination of ascitic fluid is an important part in the diagnosis and control of gastrointestinal diseases. Different etiological conditions and pathological ways help develop different types of ascitic fluid. Variation of protein content (transudates/exsudates), variation of cells lead to different diagnosis. The following paper describes methods, diagnosis and differential diagnosis and limits of the cytological ascitic fluid examination.

[Image-guided thin needle puncture of tumors of the gastrointestinal system. Puncture technique and handling of materials]. / Die bildgesteuerte Feinnadelpunktion von Tumoren aus dem Magen-Darm-Trakt. Technik der Punktion und der Materialverarbeitung.

The image-guided fine-needle aspiration biopsy in the diagnosis of gastro-intestinal tumors has reached a very high value out of other diagnostic tools. The results of this method depend directly on the technical performance (aspirator, technicians, cytologist) of the punction and processing of the obtained cytological material. The following paper is a brief communication on technical methods and experience in performing the image-guided fine-needle aspiration biopsy at the university hospital of Zurich.

[Ascites in metastatic neuroendocrine tumor of the intestine. Cytologic and immunocytochemistry diagnosis]. / Aszites bei metastasierenden neuroendokrinen Tumoren des Darms. Zytologische und immunzytochemische Diagnostik.

The presence of neuroendocrine tumor cells in ascites is extremely rare. Cytologic specimens of ascites of two patients suffering from this tumor disease were examined. The use of immunocytochemical staining allows to reach a correct diagnosis in cases in which the result of conventional diagnosis remains unsettled.

Pseudoepithelial pattern in smears prepared from fine needle aspirates of plasmacytomas.

A pseudoepithelial pattern was observed in smears prepared from fine needle aspirates (FNA) from three plasmacytomas. In one case cells displayed a markedly granular, 'oncocytic' cytoplasm. Granularity of the cytoplasm was due to a large number of mitochondria as shown by electron microscopy. B-lymphocytic origin of the neoplasms was confirmed by immunocytochemistry.

[Evaluation of fine needle puncture of the breast mass]. / Die Wertung der Feinnadelpunktion des Mammaknotens.

Fine-needle aspiration (FNA) biopsy for cytology is an established, widely accepted, safe and very accurate method permitting morphological investigation of nodules within the breast. It represents an important part of the preoperative "triple diagnostic" which includes clinical examination, mammography and FNA. In a palpable malignancy, FNA permits a definitive diagnosis of cancer in 90-95% of the cases. False-positive results should be extremely rare (about 0.2%), whereas false-negative results cannot always be prevented (5-10%). This high accuracy of cytologic method, however, can be realized only under ideal conditions. If any possible, FNA should be performed by the cytologist himself in the cytology laboratorium; the possibility of direct clinical and anamnestic information, the optimal handling of the aspirated material, by necessity the immediate control of cells amount and preservation by quick stain, the immediate repetition of an insufficient aspiration within the same session: this are very important factors for diagnostic efficiency of cytologic method. If aspiration has to be performed outside the cytology laboratory, a close contact between the cytologist and the physician who performs aspiration is indispensable. If both (these possibilities) cannot be realized, the open surgical biopsy is considered as the best alternative to FNA.

[The value of fine-needle biopsy under ultrasonic control in the diagnosis of kidney tumors]. / Die Wertigkeit der ultraschallgeleiteten Feinnadelpunktion in der Diagnostik von Nierentumoren.

127 fine-needle aspiration biopsies obtained under ultrasonographic control from circumscribed kidney lesions of 102 patients (with histologically examined lesions) were selected from a total of 867 fine-needle aspiration biopsies performed in the years between 1978 and 1986. The result of the cytological examination was compared with the histological diagnosis of the lesion. A correct diagnosis of the nature of the lesion (concerning dignity) was achieved in 90.2% of the cases under optimal circumstances. No mistakenly positive diagnosis was made. A total of 88% of the histologically malignant tumors or 80.2% of the kidney cancers were correctly diagnosed already on the basis of the cytological examination. The fine-needle aspiration can be repeated when the obtained material is insufficient: A kidney cancer was diagnosed in this way 13 times among 22 patients. The cytological examination permitted a more precise tumor-type differentiation in the large majority of cases. These results demonstrate the value of this diagnostic tool that carries only an irrelevant risk.

Fine needle aspiration of the liver. Significance of hepatocytic naked nuclei in the diagnosis of hepatocellular carcinoma.

Fine needle aspiration (FNA) smears from 60 cases of histologically (34) or clinically (26) confirmed hepatocellular carcinomas were reviewed. In about 90% of the cases, the cytologic preparations contained clusters of malignant cells with variable degrees of hepatocytic features and a distinctive type of naked nuclei. These naked nuclei had features similar to those of the malignant hepatocytes, but with more evident atypia. They were numerous in about 75% of the cases and less frequent in 15%; in three cases, they were practically absent. All three cases of well-differentiated hepatocellular carcinomas presented with numerous naked nuclei with slight atypia. Flowerlike-configured naked nuclei were especially found in poorly differentiated hepatocellular tumors. Hepatocytic naked nuclei were rarely found in FNA smears from normal liver, metastases, cysts or degenerative, regenerative and inflammatory liver processes; when seen in these cases, they showed no atypia. The presence of atypical hepatocytic naked nuclei appears to be a very useful criterion for the diagnosis of hepatocellular carcinoma.

[Cytological diagnosis of hepatocellular carcinoma based on ultrasonically guided fine needle biopsy]. / Die zytologische Diagnose des hepatozellulären Karzinoms anhand der ultraschallgesteuerten Feinnadelpunktion.

1902 ultrasonically guided fine needle aspirations of liver were examined in the Cytology Department of the Institute of Pathology, University Hospital of Zürich, in the period 1977 to March 1987. 75 of the patients had hepatocellular carcinoma which was confirmed by clinical follow-up, laboratory data and/or by histology. In 71 cases (94.6%) malignancy was diagnosed with certainty or was strongly suspected. There were no false positive diagnoses of malignancy. 2 cases of well differentiated hepatocellular carcinoma were interpreted as liver cell hyperplasia. Hepatocellular carcinoma was distinguished from metastatic tumors in 68 of 75 cases (= 83%). In 7 cases a metastatic process was misinterpreted as primary liver cell carcinoma. However, in 3 cases tumors diagnosed as metastases proved to be hepatocellular carcinomas. The efficacy and limits of the technique of ultrasonically guided fine needle aspiration in the diagnoses of liver pathology are discussed.

Cytologic presentation of malignant mesothelioma in pleural effusions.

1,601 pleural effusions were found to be malignant between 1976 and 1987. Among these were 26 (1.6% of the malignant effusions) mesothelioma. Only 2 cases showed pronounced cytologic features that made a definite diagnosis possible on cytologic criteria alone. In 20 cases diagnosis of mesothelioma was strongly suggested by the patient's history and cytology of the effusion was compatible with mesothelioma. In the other 4 cases special examinations (histo- and immunohistochemistry, electron microscopy) led to the final diagnosis. The cytologic features of mesothelioma and other examination techniques, needed to resolve the differential diagnosis of mesothelioma versus other neoplasm in pleural effusions, are discussed.

[Cytodiagnosis and marker determination in pleural effusion]. / Zytodiagnostik und Markerbestimmung im Pleuraerguss.

Malignant cells can be identified in 70-85% of all tumor-induced serous effusions by cytological examination. Carcinoma and malignant lymphoma can be frequently found in pleural fluids, while sarcoma is rare. In many cases, morphological criteria allow these tumors to be distinguished and may even lead to identification of the primary site of carcinoma. This may be of considerable therapeutic relevance. It may however be impossible to classify undifferentiated tumors on the basis of morphology alone. In these cases a diagnosis may be established by immunocytochemical typing. The most commonly employed markers and their applications are discussed.