Cytopathology of neoplasms of the central nervous system in specimens obtained by the Cavitron Ultrasonic Surgical Aspirator.

The Cavitron Ultrasonic Surgical Aspirator (CUSA) is a dissecting system that removes tissue by vibration, irrigation and suction; fluid and particulate matter from tumors are aspirated and subsquently deposited in a canister. The CUSA permits the neurosurgeon to remove large tumors by debulking them quickly and effectively, without traction or manipulation and with minimal transmission of movement to adjacent normal tissues. The cytomorphologic appearances of 22 central nervous system tumors in CUSA samples were evaluated and compared with the findings in biopsy or resection specimens. Papanicolaou-stained and Diff-Quik-stained Cytospin preparations were prepared from the saline irrigation fluid along with a cell block in every case. Three specimens (13.6%) were insufficient for interpretation. Of the materials from seven astrocytic neoplasms examined, two were insufficient for diagnosis. The other insufficient case was tissue obtained from an ependymoma. All 11 meningiomas had diagnostic material in the slides and cell blocks. In general, the cytologic smears and cell block preparations were best preserved in meningiomas and schwannomas. Varying degrees of degeneration were noted in the glial neoplasms. Since tissue obtained from the CUSA may represent the bulk of the specimen, the examination of cytologic smears and especially cell blocks from the tissue that "went down the sucker" and were previously discarded may be quite useful.

Significance of giant cells in fine-needle aspiration biopsies of benign and malignant lesions of the pancreas.

The cytologic results of 44 consecutive fine-needle aspiration (FNA) biopsies of the pancreas are reported. The series consisted of 27 women and 17 men with an age range of 31-89 yr (mean, 61.5). Excluding insufficient cases, the sensitivity of the procedure was 88%, specificity was 100%, positive predicative value (PV) was 100%, negative PV was 69%, and efficiency of the test was 90%. There were 29 true-positive, four false-negative, and nine true-negative diagnoses. Two specimens were insufficient for diagnosis. Giant cells of varying types were seen in both the malignant and benign cases. Two of the benign cases demonstrated rare multinucleated foreign body-type giant cells, most likely representing the changes seen in pancreatitis. In 13 malignant cases, multinucleated tumor cells were present, while six additional cases had multinucleated benign histiocytes reflecting the associated pancreatitis. Two malignant cases each had tumor giant cells and benign multinucleated histiocytes. Three of the malignant cases had numerous multinucleated tumor giant cells arranged in a dissociative fashion with evidence of cytophagocytosis consistent with a pleomorphic giant-cell carcinoma of the pancreas. One additional case demonstrated numerous multinucleated osteoclastic-like cells consistent with an osteoclastic tumor of the pancreas. This article documents the accuracy of FNA biopsy of the pancreas and notes that giant cells of varying types can be found in pancreatic FNA biopsies. Appreciation of the various types of giant cells in pancreatic FNA biopsy is important for diagnostic accuracy and prognosis.

Fine needle aspiration cytology of subareolar abscess of the breast. Spectrum of cytomorphologic findings and potential diagnostic pitfalls.

The cytomorphologic findings of eight cases of subareolar abscess of the breast diagnosed by fine needle aspiration (FNA) biopsy are presented. A spectrum of cytologic findings was appreciated, including diagnostic anucleated squames associated with numerous neutrophils, keratinous debris, cholesterol crystals, parakeratosis and strips of squamous epithelium. A foreign-body reaction, with sheets of histiocytes and multinucleated foreign-body-type giant cells, was noted in some of the cases. Potential pitfalls for a false-positive diagnosis of malignancy included the presence of groups of atypical ductal cells, squamous atypia and fragments of exuberant granulation tissue. Seven of the eight cases had complete surgical excision of the lesion, which demonstrated the characteristic findings of dilated lactiferous ducts undergoing squamous metaplasia with rupture and surrounding extensive acute and chronic inflammation with foreign-body reaction. With recognition of the FNA cytologic findings of subareolar abscess of the breast, a specific diagnosis can be rendered, which then allows different treatment modalities depending on the stage of the lesion. Appreciation of the spectrum of cytologic features will enable the pathologist to make the correct diagnosis and thereby avoid potential pitfalls that can possibly lead to a false-positive diagnosis of malignancy.

Fine needle aspiration cytology of bronchioloalveolar-cell carcinoma of the lung.

The fine needle aspiration cytology features of twelve peripherally located bronchioloalveolar cell carcinomas of the lung diagnosed by fine needle aspiration biopsy are described. A spectrum of cytomorphologic changes was appreciated, including classic groups showing uniform malignant cells having prominent depth of focus with a lack of significant nuclear molding. Other cells showed features of atypical alveolar macrophages and bronchial-lining cells. The smears demonstrated malignant cells arranged along alveolar septae and possessing hobnail-shaped nuclei. Two cases had associated psammoma bodies, and one case demonstrated optically clear nuclei in the malignant cells. This series stresses the fine needle aspiration features that aid in the recognition of this specific lung neoplasm and its differentiation from benign reactive pulmonary lesions, other primary lung cancers and metastatic tumors.