Cultured anaplastic cell lines as immunocytochemistry controls: a comparison of ThinPrep-processed smears and conventional air-dried cytospins.

Cultured anaplastic cell lines with previously characterized phenotypes are considered to be the best positive controls for immunocytochemistry. We assessed the validity of using anaplastic cell line cytospins as positive controls for immunocytochemistry performed on ThinPrep-processed clinical samples. We compared ThinPrep-processed slides and air-dried cytospins from cultured anaplastic cell lines for intensity and pattern of staining. Also, antigen preservation was assessed over a 3-mo period, using a panel of 16 primary antibodies and 12 anaplastic cell lines. A three-step alkaline phosphatase procedure was used except when in a single instance the EnVision method was employed. If appropriately stored, both preparations showed excellent correlation with no decrease in antigenicity during the 3-mo testing period. ThinPrep-processed slides from clinical samples are ideal for immunocytochemistry, because internal negative controls can be performed for each test. We recommend the use of cytospins for positive controls because of the lower cost.

Large-cell neuroendocrine carcinoma of the lung: proposed criteria for cytologic diagnosis.

The category of large-cell neuroendocrine carcinoma (LCNEC) of the lung, proposed to expand the traditional scheme of typical carcinoid, atypical carcinoid (AC), and small-cell carcinoma (SCC), based on histologic features, has not been defined in cytology. We attempt to describe LCNEC cytologically. Cytologic features in 16 histologically confirmed LCNECs in fine-needle aspiration biopsies, cell blocks, bronchial brushes, washes, and sputum specimens stained with Diff-Quik, Papanicolaou, hematoxylin-eosin, chromogranin, and synaptophysin were analyzed. Three poorly differentiated nonsmall-cell carcinomas, 4 SCCs, and 2 atypical carcinoids were studied similarly. Twenty specimens from 16 histologically confirmed cases of LCNEC with original cytologic diagnoses including high-grade neuroendocrine carcinoma, large-cell carcinoma, nonsmall-cell carcinoma, poorly differentiated carcinoma, adenocarcinoma, and SCC, were examined. Features included flattened three-dimensional clusters with peripheral palisading, moderate to large single cells with scant (alcohol-fixed) or moderate (air-dried) cytoplasm; and large, oval, or polygonal nuclei with irregular contours, thickened nuclear membranes, and finely or coarsely granular chromatin, showing some molding and crush artifact. Nucleoli were generally present, and occasionally prominent. Mitosis and necrosis were apparent. Neuroendocrine stains were applied to all specimens, with at least one marker, commonly synaptophysin, positive in 18/20 specimens. LCNEC can be diagnosed in cytologic material, using morphology confirmed by immunocytochemistry. Treatment can be offered on the basis of cytologic examination.

Fine-needle aspiration biopsy of chromophobe renal cell carcinoma and oncocytoma: comparison of cytomorphologic features.

BACKGROUND: Chromophobe renal cell carcinoma (ChRCC) is a distinct tumor with a prognosis intermediate between renal oncocytoma (RO) and clear cell renal cell carcinoma. To our knowledge the cytologic features of only a limited number of ChRCC have been described to date. A retrospective review of the cytomorphologic features of ChRCC and a comparison with RO was performed. METHODS: Fine-needle aspiration biopsies (FNABs) of six cases of histopathologically proven ChRCC were reviewed. The material examined was comprised of smears, cytospins, Thin Prep Pap Test preparations, and cell block sections stained with Diff-Quik, Papanicolaou, and hematoxylin and eosin. Six FNABs of ROs were examined similarly. The cytomorphology of each tumor was studied and particular attention was paid to features differentiating the two entities. RESULTS: The characteristic cytomorphologic features of ChRCC (present in all cases) included round/oval, occasionally polygonal, moderately pleomorphic large cells present singly and in small clusters. The abundant cytoplasm was variegated, ranging from dense to flocculent to vacuolated, with prominent cytoplasmic membranes. The nuclei were large and hyperchromatic, with nuclear membrane irregularities and grooves present at least focally. Frequent binucleation was observed. Small nucleoli were present in many cells, but rarely prominent. In contrast, RO showed large cells with homogenous granular cytoplasm. The nuclei showed minimal to no nuclear membrane irregularities, tiny nucleoli, mild pleomorphism, and only an occasional large, more hyperchromatic nucleus was observed. CONCLUSIONS: ChRCC has a distinct combination of cytomorphologic features. Careful attention to cytoplasmic and nuclear features allows for the distinction between ChRCC and RO in cytologic preparations.

The accuracy of frozen-section diagnosis in metastatic breast and colorectal carcinoma to the adnexa.

OBJECTIVE: The objective of our study was to describe the accuracy of intraoperative frozen-section diagnosis of carcinoma metastatic to the adnexa in women with a history of breast or colorectal carcinoma. METHODS: We conducted a retrospective chart review of all patients with a history of breast or colorectal carcinoma who developed histologically proven pelvic or abdominal metastases between 1988 and 1995. In those patients whose final histologic review revealed carcinoma metastatic to the adnexa, the accuracy of the intraoperative frozen-section diagnosis of the adnexal tumor was compared to the final diagnosis. RESULTS: Forty-three patients were identified and in 36 patients the frozen section was obtained from the adnexa. Twenty-one patients (58.3%) had metastatic breast carcinoma and 15 (41.7%) had metastatic colorectal carcinoma to the adnexa. Carcinoma in the adnexa was correctly diagnosed by frozen section in 35 of 36 patients (97.2%). Metastatic carcinoma was identified at frozen section in 17 of 21 patients (81%) with metastatic breast cancer and 13 of 15 patients (86.7%) with metastatic colorectal cancer. In 3 of 21 patients (14.3%) with metastatic breast cancer and in 2 of 15 patients (13.3%) with metastatic colorectal cancer, the frozen-section diagnosis was carcinoma of uncertain origin. One patient had a false-negative frozen section because the small focus of metastatic breast cancer was not sampled at the time of frozen section. CONCLUSION: Intraoperative frozen-section evaluation correctly diagnosed carcinoma in the adnexa in 97% of patients, and in over 80% of cases, the carcinoma was diagnosed as being metastatic in origin.

Fine needle aspiration biopsy of pulmonary hamartomas. Radiologic, cytologic and immunocytochemical study of 15 cases.

OBJECTIVE: To review the radiographic, cytologic and immunocytochemical features of pulmonary hamartomas (PHs) diagnosed on fine needle aspiration biopsy (FNAB). STUDY DESIGN: Fifteen consecutive cases of PH, diagnosed on FNAB between January 1987 and February 1993 and confirmed by surgery or follow-up, were studied. In two additional cases PH was offered as a differential diagnosis and was excluded on follow-up. Clinical notes, radiographs, cytologic smears and cell block sections stained routinely and with antibody to S-100 protein, as well as histologic slides, were reviewed. RESULTS: All cases of PH showed common radiographic features, including peripheral location, round or oval shape, sharp edges and size < 3 cm. Cytologic diagnosis of PH was based on recognition of mesenchymal component, characterized by fibromyxoid stroma, present in 94% of FNABs. Chondroid material was present in 75% of aspirates. In all cases of proven PH, fibromyxoid material showed S-100 protein positivity, characterized by finely granular, brown staining of the stellate cells. In two cases proven not to be hamartomas, the material, suspected to be fibromyxoid or chondroid, failed to show S-100 protein positivity. CONCLUSION: These findings confirm the value of FNAB in the diagnosis of PH. Immunocytochemical staining with antibody to S-100 protein is a useful diagnostic tool in confirming the cartilaginous nature of PH. The cytologic findings should be correlated with radiologic and clinical findings before a definitive diagnosis of PH is rendered on FNAB material.

Surgery for cardiac tumours: the University of Ottawa Heart Institute experience (1980-91).

OBJECTIVE: To review the University of Ottawa Heart Institute's experience with surgery for cardiac tumours. Case series of all patients who had surgical exploration of cardiac tumours from 1980-91 inclusive. Hospital charts, surgical pathology reports, gross photographs and glass microscopic slides were reviewed in each case. SETTING: Tertiary care, specialized cardiac referral centre. PATIENTS: All patients were diagnosed and treated surgically for heart tumours at the University of Ottawa Heart Institute over the 11-year period. The group consisted of 29 adults (14 male, 15 female) aged 15 to 76 years (mean 48) and one male newborn (six days old). Follow-up was available in 24 of 30 cases and averaged three years and four months (range four days to seven years). RESULTS: Twenty-six patients had primary cardiac tumours; 24 were benign (18 myxomas and seven nonmyxomas [one patient with lipomatous hypertrophy had coexistent myxoma]) and two were malignant. Four patients had involvement of the heart by tumours elsewhere: one benign and three malignant. Twenty-two of 24 benign primary tumours were resected successfully with relief of symptoms; two tumours were not resectable. None of the resected benign tumours recurred. Both patients with malignant primary tumours died from their disease. Three of the four patients with tumours arising elsewhere died, while the patient with benign hepatic vein leiomyoma extending into the heart remains well. CONCLUSIONS: Therefore, surgical resection of benign cardiac tumours, whether primary or secondary, is safe and usually curative. Surgery for malignant tumours is diagnostic at best.