Estudio del bloque celular en el diagnóstico de adenopatías mediastínicas mediante ecobroncoscopia / Study of the cell block as a dignostic technic of mediastinal lymphadenopathies in ecobronchoscopy obtained samples

Introducción. La introducción de nuevas técnicas diagnósticas hace que la necesidad de muestras de tejidos de alta calidad sea cada vez mayor. El bloque celular (BC) es una técnica útil para este fin, pero no es aun ampliamente usada en ecobroncoscopia (EBUS) y existe poca información en cuanto a su valor diagnóstico adicional. Pacientes y métodos. Estudio prospectivo y descriptivo que analiza el aporte diagnóstico del BC a la citología convencional (CC) en pacientes con adenopatías mediastínicas mediante EBUS. Sobre las muestras obtenidas se realizaron estudios de microscopia óptica, inmunohistoquímica y biología molecular. Resultados. Se realizaron 47 EBUS obteniendo 42 muestras representativas (89,4%) y resultados patológicos en 24 casos (57,1%). Los principales diagnósticos fueron metástasis de carcinoma broncogénico (66,7%) y metástasis de carcinoma extrapulmonar (20,8%). El 23% de los casos se diagnosticaron solo por BC, y no hubiera podido diagnosticarse de no haber sido realizado el BC. Conclusiones. El proceso del BC en muestras de adenopatías obtenidas mediante EBUS es un procedimiento sencillo que puede realizarse en la mayoría de los casos. En esta serie ha aportado información diagnóstica y pronóstica adicional clínicamente relevante en casi una cuarta parte de los casos en los que se ha realizado (AU)

Introduction. The introduction of new diagnostic techniques requires high quality samples. Cell block (CB) is a useful tool in this respect, although it is still not widely used in ecobronchoscopy (EBUS) and there is little available data regarding its diagnostic value. Methods. A prospective and descriptive study was carried out to analyze the contribution of Cell Block processing to the conventional smears (CS) in samples of mediastinal lymphadenopathies obtained with ecobronchoscopy CB and CS were processed and diagnostic techniques of optical microscopy, immunohistochemistry and molecular biology were compared. Results. 24 pathology samples were obtained, mainly lung cancer (66.7%) and extrapulmonary cancer metastases (20.8%). In 26% of cases CS was insufficient for staining techniques and a diagnosis could only be made with CB. CB diagnosed 25% of the samples not-diagnosed with CS. Conclusion. Processing of CB additionally to CS in samples obtained with EBUS in this series has contributed with clinically relevant diagnostic and prognostic information in a quarter of all cases (AU)

Primary papillary serous carcinoma of the peritoneum: report of a case with diagnosis by fine needle aspiration and immunocytochemistry.

BACKGROUND: Primary papillary serous carcinoma (PPSC) of the peritoneum is a rare neoplasm, histologically indistinguishable from papillary serous carcinoma of the ovary, which diffusely involves the peritoneum but spares or minimally invades the ovaries. To the best of our knowledge, the preoperative and the fine needle aspiration diagnosis of this disorder have not been reported before. CASE: A woman developed an extensive peritoneal neoplasm 4 years after hysterectomy and bilateral salpingo-oophorectomy for benign disease. Fine needle aspiration of the tumor was performed, and the cytologic and immunocytochemical findings were consistent with papillary serous carcinoma. A diagnosis of PPSC of the peritoneum was rendered because review of all slides from previous surgical specimens showed no evidence of carcinoma and no other primary tumors were found elsewhere. CONCLUSION: Fine needle aspiration cytology coupled with immunocytochemical and clinical data allows an unequivocal preoperative diagnosis of papillary serous carcinoma (primary peritoneal or with an ovarian origin). The sole limitation to establish a primary peritoneal origin before surgery is the requirement to histologically study the ovaries. Based on this fact, the preoperative fine needle aspiration cytology diagnosis of PSCP should be restricted to oophorectomized patients.

Cutaneous metastasis of occult hepatocellular carcinoma: a case report.

BACKGROUND: Skin metastases from hepatocellular carcinoma (HCC) represented only 0.8% of all known cutaneous metastases in a recent large series. The most frequent site appears to be the head, but this fact has received little attention. An accurate cytologic diagnosis is extremely difficult in patients with unknown liver dysfunction. We report the cytologic features of a face metastasis from occult HCC. CASE: A 65-year-old woman presented with a mass in the right preauricular region of 2 months' duration. Her past medical history was noncontributory. Fine needle aspiration cytology was performed. Following the cytologic diagnosis, computed tomography revealed a 6-cm mass in the right lobe of the liver, portal vein thrombosis and involvement of the superior vena cava. The smears were very cellular. The most frequent pattern was trabecular with transmural endothelization. The cells had an epithelial appearance and polyhedral shape, exhibiting distinct borders. The nuclei were centrally placed, with a prominent nucleolus. The cytoplasm was granular. There were numerous atypical bare nuclei. Subsequent staining with antihepatocyte showed positivity in most tumor cells. The final diagnosis was metastatic HCC. CONCLUSION: HCCs should be considered in the differential diagnosis of carcinomas metastatic to the face, even in the absence of liver symptoms.

Fine needle aspiration of chromophobe renal cell carcinoma.

OBJECTIVE: To describe the cytomorphologic findings of chromophobe renal cell carcinoma (CRCC) in order to preoperatively distinguish this rare neoplasm from other primary or secondary tumors arising from the kidney or presenting as retroperitoneal masses. STUDY DESIGN: Clinical data, fine needle aspiration (FNA) and follow-up surgical specimens from 4 patients with CRCC (3 primaries and 1 metastatic to the liver) were reviewed. Electron microscopy was available for 2 histologic specimens. RESULTS: Two tumors (1 primary and 1 metastatic case) were readily identified as CRCC on FNA. The 2 remaining cases were diagnosed as renal cell carcinoma (RCC) consistent with CRCC. All tumors showed aspirates with moderate to high cellularity, with the cells arranged in small clusters and single cells. Neoplastic cells had abundant heterogeneous cytoplasm, a thickened cell membrane, nuclear hyperchromasia, nuclear outline irregularity, significant nuclear size variation, intranuclear inclusions and frequent binucleation. Histology of the 4 renal tumors was characteristic of CRCC, with positivity for Hale's colloidal iron in all cases. Ultrastructurally, characteristic cytoplasmic microvesicles were observed in the 2 cases that we studied. CONCLUSION: In the adequate clinicoradiologic setting, CRCC has distinctive cytologic features that may allow an accurate preoperative FNA diagnosis.

Fine-needle aspiration biopsy of the retroperitoneum: a series of 111 cases not including specific organs.

We report on our experience in fine-needle aspiration (FNA) biopsy of the retroperitoneum: 111 FNA biopsies performed on 99 patients. Cytologic diagnoses were divided into four groups: nondiagnostic (unsatisfactory samples because of a low cellularity and/or improperly prepared smears) aspirates (20%), benign (16%), suspicious for malignancy (13%), and malignant (50%). There were no known false-positive samples. We had two false-negative diagnoses due to sampling errors. Among diagnostic smears, the procedure showed a sensitivity of 97% and a specificity of 100%. The predictive value of a positive result was 100% and the predictive value of a negative result was 90%. The overall accuracy was 98%. Metastatic carcinomas accounted for the largest number of lesions in the group of malignant tumors. A primary tumor site was known for the majority of the cases before the aspiration was performed. In the remaining cases we were unable to suggest an origin. It is therefore important to emphasize the role of ancillary studies in patients that are at the first assessment of the disease or when a second intercurrent malignancy is suspected. In our limited experience, a suggestion of the correct subtype of retroperitoneal sarcoma was not possible. As in the rest of cytopathology, a multidisciplinary approach is mandatory in this setting to improve patient management.