Fluorescence microscopy of mycobacteria in pleural effusions.

The diagnostic advantage of fluorescence microscopy (FM) of Papanicolaou-stained cytological specimens obtained by bronchoscopy has been described previously. This study was designed to evaluate the method's diagnostic benefit in cytological preparations of pleural effusions in cases of active pulmonary tuberculosis. In contrast to bronchial material there is no advantage in cytological evaluation of pleural effusions by FM.

Aspergillus in the Papanicolaou stain: morphology, fluorescence and diagnostic feasibility.

Aspergillus species exhibit a distinct and clear fluorescence in Papanicolaou-stained cytological samples. The Papanicolaou (PAP) stain enhances the autofluorescence of cultured aspergilli and allows better cytological recognition of the fungus by fluorescence microscopy when it is not easily discerned from its surroundings by light microscopy. Morphological properties can be better distinguished and facilitate the differentiation of aspergillus organisms from other filamentous fungi. Neither light nor fluorescence microscopy, the cytological quality nor the presence of phagocytosed hyphae in alveolar macrophages allow distinction between infection and contamination with Aspergillus species. Only the presence of eosinophilic inflammation permits a tentative diagnosis of an Aspergillus infection. In conclusion, PAP fluorescence reduces the need for special stains, is superior to and quicker than other investigative techniques and enhances the sensitivity and specificity of cytological investigation when a rapid and reliable identification of Aspergillus is needed.

Cytomorphologic findings in fine needle aspiration specimens of eosinophilic renal cell carcinoma.

The cytologic morphology of an eosinophilic renal cell carcinoma verified by histology is demonstrated. We describe the morphologic criteria for the differential diagnosis of the types of renal cell carcinoma in fine needle aspiration cytology and discuss the role of this procedure in the diagnosis of the entity.

Morphological study of bacteria of the respiratory system using fluorescence microscopy of Papanicolaou-stained smears with special regard to the identification of Mycobacteria sp.

In Papanicolaou-stained smears certain structures such as nucleoli, Pneumocystis carinii, Charcot-Leyden crystals, bacteria and fungi show a brilliant fluorescence. The morphological characteristics of microorganisms which can be detected by this system, especially mycobacteria, are described. This screening method offers the possibility of providing the clinician with a provisional diagnosis within hours. Proof of the nature of the organisms should be obtained by culture.

Cytology of pseudomyxoma peritonei.

The cytology of five cases of pseudomyxoma peritonei is described. It is characterized by large masses of mucinous material, some of which is wrapped up in a network of elongated fibroblast-like cells. Irregular clusters of flat branching vimentin-positive fibroblast-like cells may be found as the disease progresses. Goblet or tumour cells were not found in the cytology preparations, although they were seen in the histological sections of the one case which was biopsied. The appendiceal origin of pseudomyxoma peritonei could not be traced in three of four male patients, and the cause of the disease remained undetermined. Autopsy of the fourth case demonstrated a complete replacement of the appendix by mucus.

The cytologic diagnosis of Mycobacterium kansasi tuberculosis by fluorescence microscopy of Papanicolaou-stained specimens.

The sensitivities of (i) Papanicolaou fluorescence, (ii) auramine rhodamine fluorescence, and (iii) Ziehl-Neelsen staining were compared for their ability to detect the atypical mycobacterium Myco. kansasi in cytological samples. Ninety-two cases were investigated, and the sensitivities of the three methods of detection were found to be 36.9%, 12.0%, and 20.7% respectively. The control groups consisted of 30 specimens from cases of bronchial carcinoma and 30 of pneumonia. All cases were proved by microbiology. No false-positive results were recorded using Papanicolaou fluorescence. An important but coincidental finding arising from this study was that infection by the atypical mycobacterium Myco. kansasi causes cytological patterns corresponding to those normally associated with acute pneumonia and not to tuberculosis.

Fine needle aspiration (FNA)-induced necrosis of tumours of the thyroid.

Two cases of necrosis of thyroid oxyphilic tumours following FNA are reported. The first patient received surgery 4 weeks after FNA and histological examination revealed an encapsulated and totally necrotic tumour 2 cm in diameter. In the second patient surgery was performed after 25 days. Histological examination showed a 0.7 cm diameter tumour consisting mainly of fibrous tissue with residual oxyphilic tumour cells only in a small peripheral rim. In both patients no capsular or vascular invasion and no blood vessel thrombosis were present. A review of the literature revealed that oxyphilic tumours are susceptible to post-FNA necrosis, which might be due to the compromised vascular supply after FNA in conjunction with the intrinsic energy deficiency of oncocytic tumour cells.

The cytodiagnosis of meningeal involvement in familial haemophagocytic lymphohistiocytosis.

The cytological appearances of the cerebrospinal fluid (CSF) in two cases of familial haemophagocytic lymphohistiocytosis (FHL) are described. The presence of numerous lymphocytes and immature macrophages in the CSF, some of which showed lymphohistiocytosis, was indicative of meningeal involvement. The appearance of large numbers of immature macrophages indicated rapid deterioration and death within a few weeks. Furthermore, some CSF samples taken at times when the patients were asymptomatic contained suspicious cells, indicating asymptomatic persistence of the meningeal lesions. Thus, cytological examination of CSF can assist with the management of patients with this rare disease.

Detection of Charcot-Leyden crystals by fluorescence microscopy of Papanicolaou-stained smears of sputum, bronchoalveolar lavage fluid, and bronchial secretions.

Fluorescence microscopy was used to examine Papanicolaou-stained smears of sputum and other secretions from the respiratory tract. Under these conditions Charcot-Leyden crystals (CLC) appear as bright yellow-green fluorescing needles. The study was performed to determine the value of this approach for the diagnosis of allergic lung diseases. The time taken to detect the crystals was recorded and the sensitivity of fluorescence microscopy for the detection of CLC was compared with light microscopy of the same samples. The data show that fluorescence microscopy is superior to light microscopy for the detection of CLC. The characteristic needle-shaped crystal can be recognized easily and fragments of crystals could be easily identified. In doubtful cases of allergic lung diseases, fluorescence microscopy may be used to supplement light microscopy for the detection of Charcot-Leyden crystals.

[New aspects of effusion cytology in borderline ovarian cancer]. / Neue Aspekte der Ergusszytologie beim ovariellen Borderline-Karzinom.

The diagnosis of a case of ovarian borderline carcinoma with unspecific clinical and laboratory results finally made an explorative laparotomy necessary. The cytology of ascites and pleural effusion was in contrast to the "typical" findings of this entity, showing many single cells and small cloverleaf-like complexes. The morphological and immunological findings are discussed.

Identification of phagocytosed Pneumocystis carinii in human pulmonary alveolar macrophages.

Examination of Papanicolaou-stained bronchoalveolar lavage samples from cases with Pneumocystis carinii pneumonitis under ultra-violet light reveals alveolar macrophages packed with fluorescent inclusions. Immunoenzymatic staining of the alveolar macrophages with a monoclonal antibody specific for P. carinii (3F6) showed that these inclusions contain intact pneumocysts or their degradation products. Fluorescence microscopy of Papanicolaou-stained smears is advocated as a sensitive and specific method of diagnosing P. carinii infection.

Quantitative differences in phagocytosis and degradation of Pneumocystis carinii by alveolar macrophages in AIDS and non-HIV patients in vivo.

Bronchoalveolar lavage (BAL) specimens (n = 213) from AIDS and non-HIV immunosuppressed patients were investigated for the presence of Pneumocystis carinii infection by fluorescence microscopy of Papanicolaou-stained slides. Alveolar casts, extracellular pneumocysts and phagocytosed cysts and their degradation products in pulmonary alveolar macrophages were identified. The number of phagocytosed pneumocysts within human pulmonary alveolar macrophages was recorded and correlated with the number of extracellular cysts and alveolar casts, in both groups of patients. Both phagocytic and degradation capacity were depressed in AIDS patients. This observation may explain the large number of extracellular organisms found in BAL specimens of AIDS patients compared with non-HIV-positive immunocompromised individuals.

Monoclonal antibody Due ABC 3 directed against transitional cell carcinoma. II. Prospective trial on the diagnostic value of immunocytology using monoclonal antibody Due ABC 3.

Recently, the development of monoclonal antibody Due ABC 3 directed against transitional cell carcinoma has been reported. With this monoclonal antibody an in vitro test system for diagnosis and followup of patients with transitional cell carcinoma has been developed. The clinical value of this assay, designated as quantitative immunocytology, was evaluated in a prospective trial and compared to conventional cytology. We investigated 74 voided urine specimens obtained from patients with histologically proved transitional cell carcinoma and 60 specimens from donors without clinical evidence of transitional cell carcinoma. Sensitivity was 66% versus 47% for immunocytology and conventional cytology. Specificity of conventional cytology (92%) was higher compared to immunocytology (58%). Statistical analysis demonstrated a significantly higher sensitivity of the combined analysis of conventional cytology and immunocytology (p less than 0.001) compared to conventional cytology alone, without significant differences in specificity. The results obtained with immunocytology were impaired by the great number of nonevaluable specimens. Poor preservation of cells, severe pyuria or an insufficient number of urothelial cells prevented evaluation in 25% of the cases, while only 6% could not be evaluated by conventional cytology. The ability of immunocytology to improve the sensitivity of conventional cytology makes this technique a promising adjunct to the noninvasive diagnosis of transitional cell carcinoma.

Pressure induced hypertrophy in the hearts of growing dwarf pigs.

The left ventricles of 8 sibling dwarf pigs were stressed by banding the aorta ascendens for 7 to 49 days. There was no developmental retardation. Neither light nor electron microscopic controls showed signs of insufficiency. 3.7 X 10(7) Bq/kg (1 mCi/kg) body weight (3 H-)methyl thymidine had been applied as pulse at the end of the experiment. The 3 H-index (LI) of the left ventricular wall increases with the pressure registered (r = 0.95). At the same time the values for the right ventricular wall and the left atrium showed an inverse tendency corresponding to the fact that all indices decrease during normal growth. The relation of the indices is two to one for each atrium and its corresponding ventricle, as well as for the stressed left ventricular wall to the right one. The 3 H marked cells are found in groups with constant distances (75-85 microns). High LI are the consequences of the enlargement of these groups. There is no detectable relation to an anatomic structure. Some rare mitoses could be seen, especially in the left ventricular wall. Signs of a high biochemical activity are accumulations of mitochondria, high number of polysomes and large Golgi areas as well as laminas of ergastoplasm. The nuclei are extremely invaginated.

The cytological diagnosis of Pneumocystis carinii by fluorescence microscopy of Papanicolaou stained bronchoalveolar lavage specimens.

In a retrospective and prospective analysis fluorescence microscopy of Papanicolaou stained bronchoalveolar lavage specimens has been applied to the diagnosis of Pneumocystis carinii (PC) in routine cytology. The pneumocysts presented as circular structures of 5 microns in diameter and of brilliant green-yellow fluorescence surrounding two mirror image reniform structures. Fluorescent inclusions of 1-3 microns diameter within the alveolar macrophages could be identified as remnants of pneumocysts by a follow-up of all steps of degradation ending in very small irregular granules. By applying both criteria, i.e. pneumocysts with reniform bodies and degradation inclusions within macrophages, Pneumocystis carinii pneumonitis (PCP) could be detected in 100% of cases. Transbronchial biopsy permitted the correct diagnosis in only 65.2% of cases. Retrospective analysis of slides is possible after a long period as no significant loss of fluorescence occurs after 4 years. Thus fluorescence microscopy permits the diagnosis of Pneumocystis carinii without any additional staining or loss of time.

Well-differentiated papillary mesothelioma of the peritoneum: a borderline mesothelioma. Report of two cases and review of literature.

Well-differentiated papillary mesothelioma (WDPM) is considered to be a distinct subtype of peritoneal mesothelioma. Although the WDPM is usually qualified as benign, the natural history of this lesion has not been clearly established. This report relates to two WDPMs which were found incidentally. In a 51-year-old man the WDPM developed over a period of 5 years into a typically malignant diffuse mesothelioma. Thus, although the WDPM morphologically lacks signs of malignancy, it should be regarded as a borderline mesothelioma.

Case of cyclopia with an unbalanced karyotype attributable to a balanced 3/7 translocation.

This report presents a case of cyclopia attributable to an unbalanced karyotype in a family with a balanced, reciprocal 3/7 translocation. This case was the fifth recorded in three generations of this family. From this report it is possible that the simultaneous action of partial trisomy 3p and partial monosomy 7q may be one cause of holoprosencephaly.