Fine-needle aspiration of Merkel cell carcinoma of the skin with cytomorphology and immunocytochemical correlation.

Merkel cell carcinoma (MCC) of the skin is a rare, primary malignant skin neoplasm which can present as a cutaneous nodule. These neoplasms are seen primarily in the elderly and located in the head and neck area or extremities. Twenty-nine aspirates from primary and metastatic lesions obtained by percutaneous fine-needle aspiration in 19 patients have been studied. The cytomorphologic features, clinical information, and immunocytochemical (ICC) findings are detailed. Aspirate smears demonstrated small-to-intermediate-sized cells with a loosely cohesive pattern. Nuclei were round with finely granular chromatin and multiple, small nucleoli. Cells possessed a thin rim of cytoplasm, and infrequent pseudorosette formations were noted in cell groups. ICC results were universally positive for cytokeratin, which showed a paranuclear "dot-like" pattern. Neuron-specific enolase, epithelial membrane antigen, and S-100 protein were positive in varying degrees. Leukocyte common antigen was universally negative. The diagnosis of MCC of the skin by FNA can be made by applying cytologic features in addition to ancillary studies and clinical information.

Thyroid peroxidase immunodetection as a tool to assist diagnosis of thyroid nodules on fine-needle aspiration biopsy.

In a previous work we have reported the presence in 96.9% of malignant and 4.2% of benign thyroid tumors of an immunological abnormality of the enzyme thyroid peroxidase, impeding the fixation of the anti-thyroid peroxidase monoclonal antibody termed "MoAb47". The present study has been designed to establish the ability of thyroid peroxidase immunodetection to assist the diagnosis of malignancy in fine-needle aspiration of thyroid nodules. The fixation of anti-thyroid peroxidase monoclonal antibody was investigated by immunohistochemistry on fine-needle aspirates of 150 surgically removed thyroid nodules (20 papillary carcinomas, five follicular carcinomas, 90 colloid adenomas, nine fetal adenoma, 13 atypical adenomas, five oncocytic adenomas, six Hashimoto's thyroiditis and two Graves' disease). The percentage of positive cells has been compared to the final histological diagnosis. In samples from 113/125 benign nodules 80-100% cells presented a positive immunoreaction, whereas all samples from malignant tumors yielded less than 80% positive cells. Benign nodules exhibiting less than 80% positive cells corresponded to three degenerative colloid nodules, five atypical follicular adenomas, two oncocytomas and two thyroiditis. According to results obtained in this series, with the value of 80% as the limit for discrimination between benign and high-risk nodules, the sensitivity of thyroid peroxidase staining for diagnosis of malignancy would be 100%, its specificity 90% and its overall accuracy 92%. Thyroid peroxidase staining with monoclonal antibody MoAb47 on fine-needle aspirates is a useful adjunct to conventional cytology for the investigation of patients with thyroid nodules.

Nodular fasciitis: spontaneous resolution following diagnosis by fine-needle aspiration.

Nodular fasciitis can be histologically mistaken for a sarcoma. Typical cases are less than 5 cm and enlarge rapidly over days or weeks before diagnosis. The natural history of nodular fasciitis is unknown, since the diagnosis is usually based on excised lesions. Fine-needle aspiration of nodular fasciitis has been described, and features benign-appearing spindle cells (singly and in groups), collagen, and myxoid material. We describe 11 cases in which nonsurgical observation led spontaneously to complete resolution. Our study includes 7 males and 4 females (24 to 73 years of age; median = 42). Lesions were located in the arm (4), thigh (3), temporal area (2), breast (1) and the parotid (1) and ranged from 0.5 to 5.0 cm. (median = 1.5). They had been present for from less than 1 to 4 weeks (median = 2). In 9 cases, spontaneous resolution occurred in from 3 to 8 weeks (median = 4). Two other patients were lost to follow-up for up to 11 months, after which resolution was noted. Small palpable masses in the subcutaneous soft tissues which evolve over a short period of time and show the cytologic features of nodular fasciitis should be managed nonsurgically. If resolution does not occur within a few weeks, surgery can then be performed.

Adenoid cystic carcinoma of the breast: diagnosis by fine-needle aspiration.

Adenoid cystic carcinoma rarely occurs as a primary breast malignancy. When seen in fine-needle aspiration (FNA) material, it is identical to its counterpart in the salivary glands. We report six cases diagnosed by aspiration in patients aged 32-82 yr. The smears were highly cellular and featured extracellular spheres of metachromatic material. These were surrounded by small, uniform cells with bland nuclei and very little cytoplasm. Numerous similar cells occurred singly in the background. The cytologic differential diagnosis of adenoid cystic carcinoma includes other entities that produce extracellular metachromatic spheres including collagenous spherulosis. We describe and illustrate similar material originating in inspissated secretions or stromal fragments from fibrocystic change and fibroadenoma, as well as infiltrating ductal carcinoma. Diagnostic criteria for adenoid cystic carcinoma and the clinical relevance of distinguishing this rare tumor from typical infiltrating ductal carcinoma are discussed.

[Simulation in the teaching of the cardiorespiratory system: a report of innovative experience]. / Simulação no ensino do sistema cardiorrespiratório: relato de uma experiência inovadora.

The nurse teachers in charge of the Auxiliary Nursing Course at the Heart Institute (InCor-FMUSP) propose simulation as an innovative teaching strategy and describe its application to the Cardiorespiratory System. By doing this, they make their students participate actively in their classes, thus improving the teaching-learning process.

Fine-needle aspiration of fibroadenomas of the breast with atypia: a spectrum including cases that cytologically mimic carcinoma.

We herein report the cytologic and histologic findings in 11 cases of cytologically atypical fibroadenoma (FA). These ranged from cases recognizable as FA but showing epithelial atypia to cases that, even on review, completely mimicked the needle aspiration picture of ductal breast carcinoma. A retrospective review of 45 cases of previously excised FA showed that focal atypia is common (27%). Possible physiologic explanations for atypia in FA, along with strategies for avoiding false diagnoses of malignancy in aspiration smears, are discussed.

Metaplastic carcinoma of the breast: fine-needle aspiration cytology of seven cases.

We describe the cytomorphology of seven cases of metaplastic carcinoma of the breast studied by fine-needle aspiration cytology and by histology. All seven cases contained foci of ductual adenocarcinoma. This finding was combined with heterologous mesenchymal elements in four cases, a spindle-cell pattern of growth in one case, and extensive squamous-cell metaplasia in two cases. Both carcinomatous and metaplastic components were present on smears in four cases (57%). Thus in three cases (43%), the diagnosis was not possible on smear material alone. Differential diagnostic considerations are discussed.

Cystosarcoma phyllodes of the breast: a cytologic and clinicopathologic study of 23 cases.

Twenty-three cases of cystosarcoma phyllodes of the breast were studied clinically and by fine-needle aspiration (FNA) cytology as well as by tumor histology. The median patient age was 52 yr. The total actuarial survival at 5 yr was 90%, and the recurrence-free survival was 70%. A combination of stromal elements (tissue fragments and/or single spindle cells) and epithelial tissue was required to make the diagnosis on smear material. In FNA smears, stromal elements were absent in two cases, and ductal elements were not seen in three. Thus, the dimorphic pattern essential to this diagnosis was not present in five (22%) cases. An evaluation of tumor factors reported to be of prognostic significance was performed on histologic sections of resected tumors. Comparison of these data with FNA results indicates that little prognostic information can be obtained from FNA alone in most cases.

Mucinous breast carcinoma and mixed mucinous-infiltrating ductal carcinoma: a comparative cytologic study.

In its pure form, mucinous breast carcinoma (MC) has a much better prognosis than infiltrating ductal carcinoma (IDC). Mixed MC-IDC has the prognosis of IDC. We compared the fine-needle aspiration (FNA) cytology and histology of nine cases of pure MC with 13 cases of mixed MC-IDC. While typical of pure MC, abundant mucin (3+/3+) was noted in smears from three cases of mixed tumor and is thus necessary but not sufficient for a diagnosis of pure MC. Cellular pleomorphism has been said not to be a feature of MC; however, we found occasional large cells markedly different from the typical small uniform cells of MC in four pure and seven mixed tumors. Cytologic features indicative of a mixed tumor include one or more smears totally without mucin, scantly amounts of mucin, or necrosis. A combination of features indicative of pure mucinous carcinoma in FNA included abundant mucin on all smears, no pleomorphism, and no necrosis. Many cases will have smear patterns that are not typical of either profile and should probably be designated as carcinoma with a mucinous component.

Immunocytochemical detection of estrogen receptors in mammary Paget cells.

Immunocytochemistry was used to analyze the estrogen receptor (ER) content in mammary Paget cells obtained by scraping the nipples of six patients. The Paget cells in the smears were ER positive in four cases and ER negative in two cases. Five of the patients underwent a modified radical mastectomy; histologic study of the excision specimens showed three invasive ductal carcinomas and two intraductal carcinomas. Analysis of the ER status of the three invasive tumors, analyzed both by immunohistochemistry and by the radioligand technique, showed that the ER content in the Paget cells reflected that in the tumor in the breast parenchyma. This finding lends support to the hypothesis that Paget cells originate from an epidermotropic cancer in the parenchyma of the breast.

Fine needle aspiration cytology presentation of bilateral mammary fibromatosis. Report of a case.

A case of bilateral fibromatosis of the breast occurring in a 22-year-old woman is described. The cytologic findings in fine needle aspirates included numerous stromal cells of the fibroblastic type, without atypia, in a background of granular amorphous material. Small fragments of collagen were present. Clusters of benign epithelial cells were occasionally observed.

Immunocytochemical analysis and cytomorphologic diagnosis on fine needle aspirates of lymphoproliferative disease.

Fine needle aspirates were used for the cytologic and immunologic analysis of 21 cases of lymphoproliferative disorders. Immunocytochemical studies performed on Cytospin preparations confirmed the cytomorphologic diagnosis in 19 cases. In one case, the morphology of both aspirates and surgically obtained material showed a reactive pattern while immunologic analyses were inconclusive on both types of material. Immunocytochemistry on tumor material obtained by fine needle aspirations was in agreement with immunohistochemistry on surgical biopsies in 15 of 16 patients with malignant lymphomas. We conclude that immunocytochemical studies performed on Cytospin material in conjunction with the cytologic diagnosis will lead to an increase in diagnostic accuracy as well as providing a means for subclassification of neoplastic lymphoid cells. Moreover, this technique appears to give results comparable to those obtained by histopathologic and immunohistochemical analysis on surgically removed lymph nodes.

Primary spindle-cell sarcomas of the breast: diagnosis by fine-needle aspiration.

Primary breast sarcomas (excluding cytosarcoma phyllodes and its sarcomatous recurrences) are rare neoplasms. Few have been described in the aspiration cytology literature. We report the cytologic features of two cases of stromal sarcoma (both with the pattern of malignant fibrous histiocytoma) and two cases of angiosarcoma. The dominant cytologic features included individual atypical spindle cells and fragments of collagenous stroma. Tumor giant cells were present in one stromal sarcoma. Features of possible significance in the diagnosis of angiosarcoma include obvious vessel formation by atypical spindle cells, bridging of adjacent tumor fragments by spindle cells, and microacinar structures lined by atypical spindle cells. The differential diagnostic considerations in spindle-cell breast aspirations are discussed.

Clinical utility of fine-needle aspiration cytology of the thyroid.

Fine-needle aspiration cytology (FNAC) of the thyroid has radically changed the management of patients with thyroid disease. It is an inexpensive, safe, and rapid procedure that usually gives a definitive morphological diagnosis. It frequently eliminates the need for diagnostic surgery. FNAC should be the initial diagnostic test to evaluate any palpable thyroid lesion. This direct approach reduces the need for other time-consuming and expensive investigations. FNAC can also determine whether patients with hyper- or hypothyroidism have underlying thyroiditis.

Experimental pulmonary paracoccidioidomycosis in the Syrian hamster: morphology and correlation of lesions with the immune response.

A model for pulmonary paracoccidioidomycosis in the hamster is described. The disease was induced by intratracheal inoculation of 1.7 x 10(5) viable yeast forms of P. brasiliensis. Lung histopathology, dissemination lesions and humoral and cellular immune responses were investigated at intervals up to 24 weeks after infection. Humoral immunity was studied by immunodiffusion and complement fixation tests. Cell-mediated immunity was evaluated in vitro by the macrophage migration inhibition test in the presence of phytohaemagglutinin and P. brasiliensis soluble antigen, and in vivo by the paracoccidioidin test. Thirty out of 35 infected animals (85.7%) developed pulmonary paracoccidioidomycosis. Dissemination lesions were observed in regional lymph nodes (82.8%), liver (8.5%) and spleen (5.7%). Lung involvement was mainly around bronchi and vessels. Regional lymph nodes were severely involved from the fourth week on, acquiring a pseudotumoral aspect at later stages. Specific antibodies were detected from the fourth week on, with titres increasing progressively. The cellular immune response to phytohaemagglutinin was intact throughout the experiment and the response to P. brasiliensis antigen was already detectable by the second week and remained positive to the end of the experiment. The skin test became positive from the fourth week on. Inoculation by the intratracheal route represents a highly effective way of infecting hamsters with P. brasiliensis, with the induction of localized disease, good antibody production and intact cell immunity.

Pulmonary cytology in tuberculosis.

A review was made of 138 sputa, 4 bronchial washings and 4 bronchial aspirates from 64 patients with pulmonary tuberculosis. The cytologic findings that may indicate granulomatous involvement were epithelioid cells, giant cells, lymphocytes and a necrotic background. Cell-block preparations stained by the Ziehl-Neelsen technique gave a positivity for acid-fast bacilli similar to that of bacterioscopy. This study emphasizes the potential diagnostic value of inflammatory alterations, even when the main objective of pulmonary cytology is the diagnosis of neoplasia; the finding of epithelioid cells and giant cells in a necrotic background may indicate a specific granulomatous involvement.

Lesöes histológicas da mucosa vesical em 91 autópsias / Histological lesions of the vesical mucosa in 91 autopsies

As bexigas de 91 autópsias foram estudadas histologicamente para se avaliar a freqüência e a distribuiçäo anatômica de alteraçöes uroteliais proliferativas. Sessenta e sete (74%) dos casos apresentaram pelo menos uma das lesöes estudadas, sendo os ninhos de Brünn a lesäo mais freqüente (60%), seguida de "cistite" glandular (45%) e metaplasia escamosa (24%). Todas as lesöes foram mais freqüentes no trígono vesical. Ninhos de Brünn e "cistite" glandular ocorreram em todas as faixas etárias e indiferentemente nos dois sexos, sendo mais freqüentes acima dos 15 anos de idade, quando ocorreram no sexo masculino. A metaplasia escamosa foi alteraçäo observada só acima dos 15 anos de idade, em 70 a 100% das mulheres e somente em 3 a 12% dos homens. frente à baixa freqüência do carcinoma de bexiga em nosso meio, näo há razäo para considerar estas alteraçöes epiteliais täo ubíquas como lesöes pré-neoplásicas