Fine needle aspiration cytology compared with open biopsy histology for the diagnosis of azoospermia.

This was a comparative study to determine the diagnostic value of fine needle aspiration of the testis compared with open testicular biopsy in azoospermic men. A total of 34 infertile, azoospermic patients aged from 26-54 years underwent concurrent testicular fine needle aspiration (FNA) and biopsy. The testis was aspirated at three separated sites (upper, middle and lower pole) using a 20 ml syringe and 21-G butterfly needle. A testicular biopsy was taken from the same sites. Samples obtained from FNA were air-dried and stained with Romanowsky-May-Grunwald-Giemsa method. Sections obtained from testicular biopsy were stained with haematoxylin and eosin (H&E). The patient's history, semen analyses, hormonal profile and testicular volume were analysed, and in addition to the histological results azoospermia was classified into obstructive and non-obstructive. A good correlation between cytological smears and histological sections was found in 65 of 68 testes (95.6%). Normal spermatogenesis was diagnosed in seven patients (20.6%), hypospermatogenesis in nine (26.5%), late maturation arrest in five (14.7%), early maturation arrest in three (8.8%) and Sertoli only-cell in 10 (29.4%) patients. Discordance between cytology and histology was observed in three of 68 testes (4.4%) and was related to inadequacy of FNA. Testicular fine needle aspiration is a simple, minimally-invasive procedure that can diagnose accurately testicular function. In addition to the testicular volume and hormonal status, it can differentiate the obstructive from non-obstructive azoospermia. In cases of non-obstructive azoospermia, multiple passes with a fine needle can be performed instead of open testicular biopsy for sperm extraction if present.

Cytopathology of oncocytic carcinoid tumor of the lung mimicking granular cell tumor. A case report.

BACKGROUND: The cytopathologic features of oncocytic carcinoid tumor of the lung, a rare variant of carcinoid tumor that is composed exclusively of oncocytes, have not been described before in detail. CASE: The bronchial brush smears from an 80-year-old female with an endobronchial obstructive tumor showed single and loose clusters of tumor cells with abundant granular, eosinophilic cytoplasm. The differential diagnoses included oncocytic carcinoid tumor, granular cell tumor, other oncocytic tumors of bronchial origin and metastatic oncocytic tumors. Immunocytochemistry and electron microscopy confirmed the diagnosis of oncocytic carcinoid tumor. CONCLUSION: Oncocytic carcinoid tumor of the lung has cytopathologic features similar to those of granular cell tumor and pulmonary oncocytoma. Immunocytochemistry, electron microscope or both are necessary to distinguish these neoplasms.

Salivary gland tumors in Jordan: a retrospective study of 221 patients.

AIM: To evaluate the types and clinical outcome of salivary gland tumors in Jordan. METHODS: Hospital records of 221 patients (85 women and 136 men) with salivary gland tumors, diagnosed from January 1988 to December 1997 were reviewed. The patients were analyzed according to sex, age, histopathological type and site of the tumor. Survival curves for patients with malignant tumors were constructed using Kaplan-Meier's method. RESULTS: Of the total 221 salivary gland tumors, 155 (70.2%) were parotid tumors, 42 (19%) minor salivary gland tumors, 23 (10.4%) submandibular gland tumors, and a single (0.4%) sublingual gland tumor. Most of the tumors (151, or 68.4%) were classified as benign and 70 (31.6%) were malignant. Men to women ratio was 1.6:1, and the age of the patients ranged from 2 to 81 years. The overall 5 and 10 year-survival rates for the 70 malignant tumors were 67% and 53%, respectively, for all tumor stages. Mucoepidermoid carcinoma had the best, and squamous cell carcinoma the worst 10-year survival rate. Patients treated with surgery and subsequent radiation therapy had better survival rates than those treated with surgery or radiation therapy alone. CONCLUSION: The principal site for salivary gland tumors in Jordan population was the parotid, and the pleo- morphic adenoma the most common pathological finding. Tumor characteristics and survival data for the Jordanian population are comparable to those from western countries.

Relationship between the size and margin status of ductal carcinoma in situ of the breast and residual disease.

BACKGROUND: For women with ductal carcinoma in situ (DCIS) of the breast who have been treated with breastconserving surgery, the usefulness of size and surgical margin status (i.e., presence or absence of disease at the point of excision) as prognostic factors for predicting residual disease has not been well established. This study was conducted to determine more clearly the relationship between size and margin status of mammary DCIS to residual disease. METHODS: The pathology records of 232 consecutive patients with mammary DCIS who had been initially treated with lumpectomy at the University Hospitals of Cleveland were retrospectively reviewed. The size of the DCIS and the surgical margins of lumpectomy were analyzed. Residual disease was defined as the persistence of DCIS in the re-excision and/or mastectomy specimens. RESULTS: Residual disease was found in 15 of 101 patients with DCIS of less than 1.0 cm in longest dimension, in 27 of 96 patients with DCIS of 1.0-2.4 cm in size, and in 24 of 35 patients with DCIS of greater than or equal to 2.5 cm in size (P<.001). Residual disease was found in 30 of 77 patients with DCIS and positive margins, in 11 of 59 patients with DCIS and close margins (< or =1mm), and in 10 of 73 patients with DCIS and negative margins (>1 mm) (P =.001). In multivariate analysis, the occurrence of residual disease was associated with large tumor size (i.e., > or =2.5 cm) (odds ratio [OR] = 7.7; 95% confidence interval [CI] = 3.13-20.00; two-sided P = .0001) and with positive margin status (OR = 2.2; 95% CI = 1.02-4.55; two-sided P = .04). CONCLUSIONS: The size and margin status of DCIS each were found to be independent predictors of residual disease.

The results of intraoperative consultations in 181 ductal carcinomas in situ of the breast.

BACKGROUND: The utility of frozen section (FS) examination in the intraoperative management of breast lesions is well established. The accuracy of FS in the diagnosis of borderline noninvasive or preinvasive breast lesions is uncertain. METHODS: The authors retrospectively reviewed the results of intraoperative consultations/frozen section examinations of 181 ductal carcinomas in situ (DCIS) of the breast. Various clinical and pathologic factors were analyzed and correlated with FS diagnosis. RESULTS: FS examination was performed on 153 cases (85%) and only macroscopic examination on 28 cases (15%). FS diagnoses were as follows: DCIS in 76 cases (50%), atypical ductal hyperplasia/suspicious for DCIS in 8 cases (5%), benign in 55 cases (36%), deferred in 13 cases (8%), and invasive carcinoma in 1 case. FS accuracy, false-negative rate, and false-positive rate were 55%, 36%, and 0.6%, respectively. Sampling error was the main reason for the low detection rate, and technical inadequacy was a major factor contributing to interpretive problems. In multivariate regression analysis, FS accuracy was significantly associated with the clinical presentation of a palpable mass (odds ratio [OR] = 4.16, 95% confidence interval [CI]: 2.04-8.45), the macroscopic finding of a mass (OR = 3.03, 95% CI: 1.45-6.67), and necrosis (OR = 3.13, 95% CI: 1.4-6.67). CONCLUSIONS: The authors concluded that the accuracy of FS diagnosis of DCIS was low, mainly due to sampling error. In general, FS examination should not be performed when no lesion/mass is identified by macroscopic examination.

The spectrum of the "gray zone" in breast cytology. A review of 186 cases of atypical and suspicious cytology.

A "gray zone" exists in fine needle aspiration (FNA) cytology of breast; there an unequivocal diagnosis cannot be made. Previous studies have reported a gray zone incidence of 6.9-20%. We reviewed 2,197 fine needle aspirations (FNAs) of the breast performed at our institution to determine the incidence of the gray zone, analyze the sources of difficulty and establish guidelines to minimize the size of the gray zone. One hundred eighty-six (10%) of the total 2,197 FNAs were diagnosed as atypical (91) or suspicious for malignancy (95). The cytologic smears from all 186 equivocal cases and histopathologic sections from 156 of these patients who underwent a biopsy or mastectomy were reviewed. Clinical follow-up was obtained on the remaining 30 cases. Upon review, the causes of the equivocal diagnoses were divided into three categories: (1) technical, in which the smears were either markedly limited in cellularity or obscured by blood and/or drying artifact; (2) inexperience, which included cases that were reclassified by the reviewing cytopathologist as benign or malignant; and (3) the overlap of cytologic features of benign and malignant lesions due to the nature of the lesion, justifying a confirmational biopsy. Technical difficulties accounted for 103 equivocal diagnoses (4.5%); inexperience of the cytopathologist was responsible for 44 cases (2.4%). The third category, which represents the true gray zone in breast cytology, accounted for 39 cases (2%). Fibroadenomas constituted the largest single cause of equivocal diagnoses (17 cases). These fibroadenomas exhibited very cellular smears with marked discohesiveness and occasional nuclear atypia and prominent nucleoli. Other breast lesions in this category were intracystic papillary carcinoma, low grade apocrine carcinoma, solitary intraductal papilloma, and intraductal and atypical hyperplasia. The remaining lesions, and useful criteria of help with the differential diagnosis of the above categories, are discussed.

Intraductal papilloma of the male breast: an ultrastructural and immunohistochemical study.

A case of intraductal papilloma of the male breast was studied by electron microscopy and immunohistochemistry. The major components of this lesion were the epithelial and myoepithelial cells. Intermediate cells showing ultrastructural features of both cell types were also observed. Squamous metaplasia was noted in many areas. Numerous intranuclear helioid inclusions were seen in the tumor cells. The features of this lesion are similar to those of papillomas of the female breast.

Atypical bronchial carcinoid tumour with amyloid deposition.

The rare association of carcinoid tumors and amyloid deposition has previously been reported. A case of amyloid deposition associated with bronchial carcinoid tumor is presented. The clinical and histopathological findings are discussed.

Mucinous lesions of the breast. A pathological continuum.

Mucocele-like tumor and invasive mucinous carcinoma of the breast may represent the two ends of the pathological spectrum of mucinous lesions of the breast, respectively. Little data exists on mucinous lesions that may be considered intermediate between mucocele-like tumor and invasive mucinous carcinoma. We studied 23 consecutive cases of invasive mucinous carcinoma of the breast and observed the following associated intermediate mucinous lesions: mucin-filled ducts (MFD) with unremarkable epithelium in 15 cases (65%), MFD with typical ductal hyperplasia in 9 cases (39%), MFD with atypical ductal hyperplasia in 5 cases (22%), and MFD with intraductal carcinoma in 13 cases (57%; micropapillary or cribriform types). Eighteen cases (78%) contained MFD with one of these four lesions and five cases (22%) contained all four lesions. Twenty-three consecutive cases of infiltrating ductal carcinoma-not otherwise specified (IDC-NOS), 21 cases of intraductal carcinoma, and 50 consecutive cases of surgically-excised breast tissue with fibrocystic change (FC), were similarly reviewed. Only one case (4%) of IDC-NOS, 1 case of intraductal carcinoma, and two cases (4%) of FC, contained small foci of MFD with intraductal carcinoma, intraductal carcinoma, and unremarkable epithelium, respectively. Our findings suggest the presence of a spectrum of mucinous lesions of the breast which represents a pathological continuum.

Evaluation of breast masses and axillary lymph nodes with [F-18] 2-deoxy-2-fluoro-D-glucose PET.

Twenty-eight patients with a total of 35 suspect breast masses underwent positron emission tomography (PET) with [fluorine-18] 2-deoxy-2-fluoro-D-glucose (FDG) in order to study the utility of this technique in the evaluation of breast cancer. FDG PET allowed discrimination between eight benign and 27 malignant breast masses, with a sensitivity of 96% and specificity of 100%. Among the malignancies, there was a significant correlation between normalized FDG uptake and nuclear grade (P = .006). In addition, the results of PET imaging were compared with results of axillary node dissection in 20 cases of breast cancer. PET allowed correct categorization of 10 of 10 axillae as negative (specificity = 100%). PET results were equivocal in one axilla and positive in the remaining nine of 10 axillae with positive dissection results (sensitivity = 90%). The authors conclude that FDG PET may give useful information on breast masses and axillary node status prior to surgery.

Fine needle aspiration cytology of neuroendocrine tumors of the pancreas. A cytologic, immunocytochemical and electron microscopic study.

We report the fine needle aspiration cytology findings in six cases of neuroendocrine tumor of the pancreas. Three cases were from the pancreas, two from hepatic metastases and one from a peripancreatic lymph node metastasis. The cytologic features that permitted a preoperative diagnosis of pancreatic neuroendocrine tumor were: a cellular aspirate; numerous isolated cells and irregular, loose, dyshesive cellular aggregates; minimal nuclear pleomorphism; infrequent mitoses; fine, evenly dispersed nuclear chromatin with occasional inconspicuous nucleoli; a scant-moderate amount of granular, amphophilic, well-defined cytoplasm; clustering of tumor cells around segments of capillaries; and rosette formation. The differential diagnosis includes cells derived from normal pancreatic acini, islet cell hyperplasia, acinic cell carcinoma, well-differentiated pancreatic adenocarcinoma, metastatic small cell undifferentiated carcinoma of the lung, pancreatic small cell anaplastic carcinoma and malignant lymphoma. The application of immunocytochemistry to cytologic smears can be easily and reliably performed to confirm the neuroendocrine nature of the tumor and identify the specific type of polypeptide hormone or hormones produced by these tumors. Four aspirates showed immunoreactivity for chromogranin, and one was positive for gastrin. Cells of a lipid-rich neuroendocrine tumor were negative for chromogranin; however, the tissue section contained neuron specific enolase, and neurosecretory granules were demonstrated by electron microscopy.

Noninvasive grading of musculoskeletal tumors using PET.

Twenty-five patients with mass lesions involving the musculoskeletal system were studied with positron emission tomography (PET) in order to determine if a relationship exists between histologic grade and tumor uptake of [fluorine-18]2-deoxy-2-fluoro-D-glucose (FDG). There were 6 benign lesions and 19 malignant lesions of various grades. A high correlation (Rho = 0.83) was found between the normalized uptake of tracer and the NCl grade. The high-grade malignancies had significantly greater (p = 0.0091) uptake of FDG than the combination of benign lesions and low-grade malignancies. All lesions with a normalized uptake value of 1.6 or greater were high-grade, while all lesions less than 1.6 represented either benign tumors or low grade malignancies. This strong relationship between FDG uptake and grade among neoplasms from a wide variety of cell types within a single organ system suggests that the technique may be useful in predicting grade even when the cell type is unknown.

Fine-needle aspiration cytology of a renal cell adenocarcinoma with massive intracellular hemosiderin accumulation.

The cytologic findings of a fine-needle aspiration biopsy of a renal cell adenocarcinoma with massive intracellular hemosiderin accumulation are described. These findings have not been previously illustrated in the cytology literature. These features could also be observed in fine-needle aspiration biopsies of renal cell adenocarcinoma metastases.

Fine-needle aspiration cytology of a metastatic Merkel-cell carcinoma.

The cytologic features of Merkel-cell carcinoma metastatic to inguinal lymph nodes are described. The primary tumor was in the buttocks. The cytologic smears from the inguinal lymph node were highly cellular, with small to medium-sized cells in a predominantly discohesive or single-cell pattern, as well as large clusters surrounding segments of capillary-sized blood vessels. The nuclei were uniform, round to oval, with delicate nuclear membranes. The chromatin pattern was fine and "powdery" with multiple small micronucleoli. The cytoplasm was very scanty. Intermediate filament "buttons" were abundant. Rosette formation was very rare. Frequent mitotic figures and individual cell necrosis were observed. These features are helpful in the differential diagnosis from other small-cell tumors that may involve the skin.

Grading liposarcomas with PET using [18F]FDG.

Five patients with liposarcomas of the thigh were studied using positron emission tomography (PET) with [18F]2-deoxy-2-fluoroglucose (FDG). There were three low-grade tumors (all National Cancer Institute Grade 1 myxoid liposarcomas) and two high-grade tumors (both pleomorphic liposarcomas, Grades 2 and 3). The low-grade liposarcomas were easily identified with an average dose uptake ratio (DUR) of 1.38 +/- 0.045 (mean +/- SD). The high-grade lesions were more avid for FDG with a mean DUR of 2.45 +/- 0.24. There was a significant difference (p = 0.004) in the DUR for the two groups and the histological grade of malignancy was highly correlated with the DUR for FDG (Rho = 0.89). These findings suggest that FDG-PET may be useful for distinguishing between low-grade and high-grade liposarcomas.

Fine needle aspiration cytology of the pancreas.

A review is presented of 205 fine needle aspirations of the pancreas performed on 149 patients. Clinical follow-up was available for 134 patients (88%). Aspirates from 71 patients (53%) were correctly diagnosed as malignant while those from 43 patients (32%) were correctly diagnosed as negative. Ten patients (7%) were falsely diagnosed as negative, and ten patients (7%) were diagnosed as suspicious. There were no false-positive diagnoses. This resulted in a specificity of 100%, a sensitivity of 87%, a diagnostic efficiency of 92%, a predictive value of a positive test of 100% and a predictive value of a negative test of 80%. The cytologic criteria of malignancy can be easily recognized. The complications are very few. Comparisons with the results of needle and wedge pancreatic biopsies are presented.

Endoscopic and histologic correlates of intestinal ischemia in a canine model.

The purpose of this study was to correlate endoscopic, microscopic and gross changes in an isolated ischemic segment of canine jejunum. Three experiments were devised. The arterial and venous blood supply to a 20 cm segment of distal jejunum in mongrel dogs was isolated and the bowel divided. External and endoscopic photography and intestinal biopsies were obtained at 0, 5, 15, 30, 60, 120, 180 and 360 minutes after vascular occlusion. Arterial occlusion was characterized by initial blanching of the mucosa, hyperperistalsis, edema, spasm and serosal pallor within 5 minutes. Microscopically, capillaries became congested at 5 minutes; epithelial sloughing occurred in 1-2 hours; necrosis of the tips of the villi occurred at 4 hours; and necrosis of muscle fibers was observed at 18 hours. Venous occlusion was characterized by marked mucosal and edema and hemorrhages within 5 minutes. At 15 minutes serosal hemorrhages were observed. Mucosal sloughing with hemorrhage and infarction were observed at 3 hours. Microscopically, mucosal capillary congestion was severe at 5 minutes and widespread hemorrhages were seen at 15 minutes. Mucosal sloughing began at 30 minutes and was severe by 60 minutes. Complete mucosal necrosis occurred by 3 hours. Combined arterial and venous occlusion was similar to arterial occlusion alone except for the early appearance of punctate mucosal hemorrhages. Massive submucosal hemorrhages did not occur. Results demonstrate that arterial and venous occlusion can be differentiated endoscopically; venous occlusion appears to be more readily injurious; and endoscopy and biopsy are valuable in diagnosis and management.

Bronchial carcinoid tumor with amyloid stroma.

The histopathologic, immunohistochemical, and ultrastructural findings of a unique case of an atypical bronchial carcinoid tumor containing abundant stromal amyloid are presented. The differential diagnosis from other neuroendocrine tumors that can produce amyloid is discussed.

Plasmacytoma of the ileum complicating Crohn's disease: report of a case and review of the literature.

Portions of the gastrointestinal tract involved with Crohn's disease are at increased risk of undergoing neoplastic change. Most of these neoplasms are adenocarcinomas. We recently encountered the first reported patient with a solitary plasmacytoma of the ileum arising in an area of preexisting active Crohn's disease. This case is presented along with a review of the literature dealing with lymphoproliferative disorders in bowel affected with Crohn's disease.

Feline endotoxin shock: effects of methylprednisolone on kininogen-depletion, on the pulmonary circulation and on survival.

1 Escherichia coli endotoxin, administered intravenously in a dose of 2 mg/kg to pentobarbitone anaesthetized, artificially ventilated cats resulted in pulmonary hypertension, systemic hypotension and an immediate (1-2 min) 30-40% reduction in plasma kininogen, an effect which probably indicates a release of plasma kinins. 2 Methylprednisolone (30 mg/kg), when administered 30 min before endotoxin, did not influence the endotoxin-induced pulmonary hypertension or systemic hypotension but completely prevented the depletion of plasma kininogen. 3 In spontaneously breathing cats, methylprednisolone, administered 30 min after endotoxin, caused a rapid repletion of kininogen and prolonged survival (47% at 6 h compared to 10% in the endotoxinalone animals). Methylprednisolone did not appear to influence lactate production or the hyperventilation observed during the delayed endotoxin shock phase. 4 It is concluded t,at methylprednisolone does not prevent the release, by endotoxin, of a pulmonary vasoconstrictor prostaglandin, or its effects, but that perhaps by preventing kinin release it may reduce endotoxin-induced capillary leakage.