Correlation of ascitic fluid cytology with histologic findings before and after treatment of ovarian cancer.

One hundred thirteen specimens of ascitic fluid from 97 patients with primary, persistent, or recurrent ovarian cancer were examined cytologically. Advanced stage of disease, involvement of the ovarian surface, a moderate or large volume of fluid, and nonbloody serous ascites were factors that correlated with a high rate of positive findings in ascites in these patients. Other factors influencing the positive rate appeared to be the invasive as opposed to borderline malignant histology of the tumor. Involved external surface and volume of ascites were influencing factors only in advanced cases. Therefore, the most important factor influencing the positive rate of ascites cytology was the proportion of cases in advanced stages to total cases.

Peritoneal fluid cytology in patients with ovarian cancer.

Peritoneal fluid was examined for the presence of tumor cells in 94 patients with ovarian cancer. The findings were correlated with the type, grade, and stage of the tumor. Fluids that were positive for malignant cells were associated with serous and endometrioid carcinomas more often than with carcinomas of other types. Patients with high-stage tumors of all types had positive fluids more often than those with low-stage tumors. The presence of tumor cells in the fluid indicated a worse prognosis at 2 years. Analysis of other factors that influence prognosis, however, revealed that this difference was related more specifically to the stage of the disease. Since the presence of tumor cells in abdominal fluid is a factor in the subclassification of Stage I and Stage II ovarian cancer, analysis of a larger group of patients with tumors in these stages is needed to establish the prognostic significance of positive cytological findings independent of other prognostic factors.

Bile cytology. A routine addition to percutaneous biliary drainage.

Exfoliative cytology of bile aspirated from percutaneously placed combined external/internal biliary drainage catheters yielded positive results in 34% of 100 cases. There were no false-positive results. Bile cytology is a simple, inexpensive, and useful method which can establish a diagnosis of malignant biliary obstruction after catheter decompression.

Quantitative cytocentrifugation in the evaluation of cerebrospinal fluid.

Five hundred sixteen samples of cerebrospinal fluid (CSF) were subjected to cytocentrifugation to determine whether this technique is reliable in quantifying the cells present while simultaneously allowing precise cytologic identification of the types of malignant and atypical cells present. Cell counts obtained by the cytocentrifuge method were comparable to those obtained by the standard hemocytometer method. Because of the larger volume of fluid used in cytocentrifugation, cells (0.2/cu mm) were found in 264 specimens that would have been considered devoid of cells by hemocytometry. Six of these samples contained malignant cells. The Wright's-stained cytocentrifuged specimens also allowed precise identification of hematopoietic cell types. CSF cytocentrifugation offers the advantages of (1) a simple and rapid method of quantifying the number of cells present, (2) use of larger volumes than the hemocytometer method, thereby minimizing the possibility that the specimen will be classified as acellular, and (3) improved morphology of hematopoietic cell types by use of the Wright's stain. We conclude that the cytocentrifugation method is useful in the routine quantification and diagnosis of CSF specimens.

Dysplasia and cytologic findings in 4,589 young women enrolled in diethylstilbestrol-adenosis (DESAD) project.

This report presents the cytologic findings and the rates of dysplasia for 4,589 young women enrolled in the National Cooperative Diethylstilbestrol-Adenosis (DESAD) Project. Mucinous columnar cells and/or metaplastic squamous cells with or without mucinous droplets were encountered in 22% of vaginal scrape smears from all diethylstilbestrol (DES)-exposed participants identified by review of prenatal records and in 43% of women in whom vaginal epithelial changes (VEC) were observed by colposcopy or by iodine staining. The frequency of cellular findings in the vaginal scrape smears was closely related to the timing of the administration of the DES to the mother. With increasing age of the daughters, the overall frequencies of both the mucinous and metaplastic cells decreased; relative to each other, an increasing proportion was metaplastic squamous cells. These data suggest that, as the women grow older, vaginal adenosis regresses by the process of squamous metaplasia. Endometrial type cells were found in 2% of vaginal scrape smears. Their cyclical occurrence during the menstrual cycle and lack of correlation with the presence of VEC indicated an origin from the uterine corpus rather than the tuboendometrial type of adenosis. Squamous cell dysplasia of the vagina and cervix was detected by biopsy or scrape smear specimens in 1.8% of DES-exposed women in the record review group. The rate of unexposed women was twice as high. In general, the rates of dysplasia were higher in the cervix than vagina, and the more severe degrees of dysplasia were encountered only in those women who were referred to the DESAD Project or who themselves requested entry. Four patients who were referred or who themselves requested entry were found to have clear cell adenocarcinoma of the vagina. The vaginal smear provided the first clue to the presence of an abnormality in three of them.

PIP: This report presents the cytologic findings and the rates of dysplasia for 4,589 young women enrolled in the National Cooperative (DESAD) Diethylstilbestrol-Adenosis Project. Mucinous columnar cells and/or metaplastic squamous cells with or without mucinous droplets were encountered in 22% of vaginal scrape smears from all (DES) diethylstilbestrol-exposed participants identified by review of prenatal records and in 43% of women in whom (VEC) vaginal epithelial changes were observed by colposcopy or by iodine staining. The frequency of cellular findings in the vaginal scrape smears was closely related to the timing of the administration of the DES to the mother. With increasing age of the daughters, the overall frequencies of both the mucinous and metaplastic cells decreased; relative to each other, an increasing proportion was metaplastic squamous cells. These data suggest that, as the women grow older, vaginal adenosis regresses by the process of squamous metaplasia. Endometrial type cells were found in 2% of vaginal scrape smears. Their cyclical occurrence during the menstrual cycle and lack of correlation with the presence of VEC indicated an origin from the uterine corpus rather than the tuboendometrial type of adenosis. Squamous cell dysplasia of the vagina and cervix was detected by biopsy or scrape smear specimens in 1.8% of DES-exposed women in the record review group. The rate in unexposed women was twice as high. In general, the rates of dysplasia were higher in the cervix than vagina, and the more severe degrees of dysplasia were encountered only in those women who were referred to the DESAD Project or who themselves requested entry. 4 patients who were referred or who themselves requested entry were found to have clear cell adenocarcinoma of the vagina. The vaginal smear provided the 1st clue to the presence of an abnormality in 3 of them.

Diagnosis of abdominal malignancy by radiologic fine-needle aspiration biopsy.

Fine needle aspiration biopsy in 100 consecutive patients with suspected abdominal malignancy yielded a positive diagnosis in 69 (82%) of 84 patients in cases ultimately proven to have cancer in the area sampled. Of 21 pancreatic cancers, 18 (86%) were detected; 24 (83%) of 29 liver lesions, usually metastases, were identifed; and 16 (78%) of 22 retroperiteonal masses, most frequently metastatic lymph nodes, were correctly diagnosed. Overall success rate for epithelial malignancy was 67 (85%) of 79 and far exceeded the yield in lymphomatous masses where two (40%) of five cases were detected. Several radiologic guidance methods were used including computed body tomography in 41%, ultrasonography in 45%, and fluoroscopy with or without conventional contrast agents in 14%. Complications were negligible. In a subgroup of 20 patients in whom a positive diagnosis was obtained, separate analysis of the cytologic specimen revealed that the first needle pass contained definitive material in 15 (75%) of 20 cases. The results confirm the effectiveness, safety, and wide applicability of fine-needle aspiration biopsy for nonsurgical confirmation of advanced or unresectable intraabdominal malignancy.

Cytologic diagnosis of intraventricular hemorrhage in a neonate.

A neonate with autoimmune thrombocytopenia presented with megacephaly and hydrocephalus. The cause remained obscure until hemosiderin-laden macrophages were found in the ventricular cerebrospinal fluid (CSF), indicating prenatal intracranial hemorrhage. The literature on the diagnosis of intraventricular hemorrhage by the cytologic examination of CSF is reviewed and discussed. The cytologic evaluation of CSF may be helpful in cases of central nervous system dysfunction when the cause is obscure.

A study of variability in cytologic diagnoses based on pulmonary aspiration specimens.

Reproducibility of cytologic diagnoses of malignancy and accuracy and variability of diagnoses of malignant cell types were assessed in a study of pulmonary aspirates from 100 patients. Original cytologic diagnoses were positive for 60 of the 80 patients who had malignancy (true-positive rate 75%). No false-positive diagnosis was made. Original cytologic diagnoses were negative for 15 of the remaining 20 patients (true-negative rate 75%). In "blindly" reviewing the slides, the pathologist who had made the original diagnoses (Observer A) and another pathologist (Observer B) confirmed the 60 original positive diagnoses. Observer A added four cases, Observer B 11 cases to the positive category. Cell types of original positive cytologic diagnoses and those of subsequent histologic diagnoses agreed for 23 of 33 malignancies (70%). Although two observers increased the proportion of positive cytologic diagnoses, the percentages of agreement with respect to histologic malignant cell types remained similar. For cytologic specimens, intraobserver agreement as to malignant cell types was 83% (50 of 60); interobserver agreement was 80% (48 of 60).

Flow cytofluorimetry in routine diagnostic cytology. A pilot study.

A simple procedure for disrupting cell clumps may aid in the automation of gynecologic cytology by flow cytofluorimetry. Such a procedure, using enzymatic digestion and fluorescent staining, was applied to aliquots of 264 gynecologic exfoliative specimens. Results were compared with cytopathologic diagnoses. A fluorimetric criterion of hypertetraploidy was used to detect abnormality. One quarter of the specimens fulfilled this criterion, including 15 of 17 specimens rated cytologically as premalignant. Two thirds of the falsely abnormal results were attributable to aggregated microorganisms, glandular clumps, and pusbound clumps.

Squamous cell dysplasia and carcinoma in situ of the cervix and vagina after prenatal exposure to diethylstilbestrol.

Squamous cell abnormalities of the vagina and cervix were evaluated in 1424 women exposed to diethylstilbestrol (DES) in utero. The prevalence of dysplasia was 2.1% and the incidence 0.85/100 person-years of followup. The dysplastic epithelial changes were almost always mild in women with no prior history of dysplasia and was slightly more frequent in the cervix than the vagina. Severe dysplasia and carcinoma in situ (CIS) were encountered only in those subjects specifically referred because of those abnormalities. The most common problem in the diagnosis of these squamous cell changes was the misinterpretation of mature and immature metaplastic cells for dysplastic squamous cells. Discordance between biopsy and cytology was common-place in the detection and followup of dysplasia, especially when it was mild. There were no instances in the study where cytology and biopsy samples from the vagina were both abnormal concurrently. Colposcopically directed biopsies did not increase the frequency of confirmation of cytologic findings. These data suggest that both cytology and biopsy of abnormal segments of the vagina and cervix remain an integral part of the examination of the DES-exposed female during long-term follow-up studies.

Cytology of 575 young women with prenatal exposure to diethylstilbestrol.

The vaginal and cervical cellular changes encountered in 575 postpubertal females exposed prenatally to diethylstilbestrol (DES) were compared with those of an unexposed population with particular reference to the role of cytology in the detection of vaginal adenosis and cervical ectropion (erosion). Several methods of obtaining specimens were utilized, the most effcacious of which was scraping of the vagina, especially the fornices, and the portio vaginalis of the cervix. With this technic, columnar cells of the mucinous type and metaplastic squamous cells were observed in 34% of the vaginal scrapes and 54% of the scrapes of the cervical portio. A higher incidence was apparent among those patients in whom iodine staining of the vaginal mucosa was abnormal or vaginal adenosis was proven by biopsy. Moderate to severe dysplasia of the squamous cells or atypical glandular cells were found in 1% of the exposed subjects. This study indicates that the presence of mucinous columnar or metaplastic squamous cells in vaginal scrapes is suggestive of vaginal adenosis but that vaginal cytology cannot be considered a uniformly reliable screening technic for detecting the presence of this disorder.

Glassy cell carcinoma of the cervix.

A clinicopathologic analysis of 13 cases of glassy cell carcinoma of the uterine cervix is presented. The glassy cell carcinoma is considered to be a poorly differentiated mixed adenosquamous carcinoma. Its histologic appearance is distinctive, being characterized by cells with a moderate amount of cytoplasm having a ground glass or finely granular appearance, a distinct cell wall that stains with eosin and PAS, and enlarged nuclei with prominent nucleoli. In the present study this tumor was associated with extrapelvic spread in 6/13 cases at diagnosis. Results were poor with either surgery and/or radiotherapy. Only four of 13 patients survived 5 years. The glassy cell carcinoma appears to be a distinct clinicopathologic entity which warrants a place in the classification of carcinoma of the cervix.

Nuclear chromatin determination in amniotic fluid cells for prenatal sex prediction in the macaque.

Amniotic fluid cells obtained after the ninetieth day of gestation in the macaque were analyzed for nuclear chromatin. The technique proved reliable for the prediction of fetal sex.

Carcinocythemia (carcinoma cell leukemia). An acute leukemia-like picture due to metastatic carcinoma cells.

Observation of a unique population of cells on a Wright-stained blood smear of a patient with metastatic breast carcinoma prompted a study to determine their origin. The primary carcinoma contained a marker, the presence of "signet cells." These were demonstrated in direct peripheral smears and buffy coat preparation of peripheral blood and confirmed histochemically by showing positive periodic acid-Schiff, alpha-napthol and beta-glucuronidase reactions. "Carcinocythemia" is suggested as a name for this unusual process observed over a six month period. Studies of the patient's immunocompetence, of circulating cell surface immunoglobulins and karyotype analysis were made. Postmortem examination revealed retroperitoneal fibrosis, splenic atrophy and extensive metastatic carcinoma but no evidence of leukemia. The cells will be contrasted to those seen in a second patient who appeared to have acute myelocytic leukemia complicating extensive cancer involving the bone marrow. The observations suggest that a leukemia-like blood picture due to circulating cancer cells may occur during the course of metastatic breast carcinoma.

Pulmonary metastases from intracerebral meningioma. Diagnosis by percutaneous needle aspiration biopsy.

A case of metastatic meningioma to the lung is reported and the recent literature reviewed. This case was diagnosed solely by cytologic examination of fine needle aspiration biopsy. Pulmonary metastases are relatively rare and the diagnosis by this method has not previously been reported.