Fine needle aspiration biopsy of idiopathic retroperitoneal fibrosis.

OBJECTIVE: To report three cases of idiopathic retroperitoneal fibrosis (IRF) diagnosed by fine needle aspiration (FNA) biopsy and confirmed by histologic examination. To our knowledge, this is the first report on the FNA findings in IRF. STUDY DESIGN: Specimens were obtained under computed tomographic guidance using the standard technique. Half the smears were ethanol fixed and stained with Papanicolaou stain, and the other half were air dried and stained with Diff-Quik. A cell block was prepared in all cases. RESULTS: Similar findings were seen in all three cases. The predominant elements were fibrous tissue and inflammatory cells, which occasionally occurred together but often were separate. The inflammatory cells were predominantly small lymphocytes, with occasional plasma cells, histiocytes and neutrophils. Smears from one case showed the inflammatory component only, but the cell block in all three cases showed both elements. The diagnosis of IRF was suggested in two of the three cases. All patients underwent laparotomy for diagnostic confirmation, and two had therapeutic resection of the lesion. Histologic material reflected the FNA findings, showing hyalinized fibrous tissue and an inflammatory cell infiltrate consisting of lymphocytes, plasma cells, histiocytes and neutrophils. No infection, arteritis or malignancy was present. CONCLUSION: Although the FNA picture is nonspecific, in combination with clinical and radiologic findings it is highly suggestive of a diagnosis of IRF. A presumptive diagnosis allows a rational approach to further evaluation and therapy, which, in most cases, is an exploratory laparotomy with ureterolysis.

Fine needle aspiration diagnosis of ciliated hepatic foregut cysts: a report of three cases.

BACKGROUND: Ciliated hepatic foregut cysts, albeit rare, are important to consider in liver aspirates obtained for evaluation of possible neoplastic disease. CASES: In three cases, liver fine needle aspirates showed features consistent with ciliated hepatic foregut cysts. Two of these aspirates were obtained to evaluate possible metastatic disease prior to resection of primary tumors, one of the lung and one of the bladder. A third case had radiologic findings suggestive of a cystic neoplasm. The fine needle aspirate material from these cases revealed clusters of tall, columnar cells with basally oriented nuclei and prominent apical terminal plates with cilia. These features are consistent with ciliated hepatic foregut cysts. CONCLUSION: This entity, although originally described in the late 19th century, to our knowledge has not been reported to occur in fine needle aspirate material and should be included in the differential diagnosis of cystic lesions of the liver.

Primary diagnosis of disseminated fungal disease by fine-needle aspiration of soft-tissue lesions.

Two cases of disseminated fungal infections diagnosed by fine-needle aspiration of soft-tissue masses are presented. Both patients were initially treated on an outpatient basis for a presumed musculoskeletal disorder before the diagnostic biopsy was obtained. The first patient apparently contracted Coccidioides immitis infection while residing in Arizona, but the diagnosis was rendered on an aspirate of a buttock mass performed in Boston. The second patient, a non-insulin-dependent diabetic, was diagnosed with a cryptococcal abscess on an aspirate of a shoulder mass performed in the emergency room. The diagnosis of coccidioidomycosis was confirmed by culture and that of Cryptococcus by serology. Fungal infection was clinically unsuspected in both patients and the cytologic diagnosis facilitated rapid implementation of therapy.

Colonic cytology. A retrospective study with histopathologic correlation.

Three hundred sixty cytologic specimens obtained by colonoscopic brushing from 336 patients were compared with biopsy specimens simultaneously obtained for histologic examination. Of the cytologic specimens, 160 (44%) were positive for malignant cells, 37 (10%) contained suspicious cells, 54 (15%) had atypical glandular cells, 107 were cytologically negative, and 2 were considered unsatisfactory. Eight-four percent of the patients with cytologically positive smears and 54% of those with suspicious smears had malignant neoplasms in the simultaneously obtained tissue biopsies. Of the patients with follow-up, all with cytologically positive findings and nine with suspicious findings on the initial cytologic examination and simultaneous negative tissue biopsies, were subsequently found to have carcinoma of the colon. Cytology proved to have a sensitivity of 0.73 and a specificity of 1.00 while tissue biopsy showed a sensitivity of 0.81 and a specificity of 1.00. By combining the two methods, the sensitivity increased to 0.92. It is concluded that cytologic examination of colonic brushings is a highly accurate and reliable technique for the detection of malignant neoplasms of the colon and can preempt the use of biopsy forceps.

Changes in peripheral blood and bone marrow specimens during and after alpha 2b-interferon therapy for hairy cell leukemia.

We studied changes in peripheral blood and bone marrow biopsy specimens obtained before, during, and after recombinant alpha 2b-interferon (IFN-alpha 2b) therapy in 25 patients with hairy cell leukemia. During therapy, only 1 patient showed no improvement in at least one of the parameters monitored. Granulocytopenia, thrombocytopenia, and monocytopenia resolved in 19/20, 14/15, and 17/18 patients, respectively. In 18/21 patients with Hb less than 12g/dl before treatment, the anemia became less severe. Hairy cells disappeared or decreased in numbers in the peripheral blood in all patients. In the bone marrow, numbers of hairy cells decreased and numbers of granulocytic, erythroid, and megakaryocytic cells increased usually within 3-6 months after the start of therapy. In no patient were hairy cells ever completely absent from the bone marrow. After cessation of IFN-alpha, the median Hb value, WBC, and platelet counts changed little for up to 12 months, but the absolute neutrophil count and absolute monocyte count decreased. Hairy cells reappeared in the peripheral blood of three patients. In the bone marrow the percentage of hairy cells increased, whereas the percentage of granulocytic and erythroid cells decreased. Neutrophil alkaline phosphatase (NAP) scores were abnormally high in 18/18 patients studied prior to IFN-alpha, but became normal in 17 of these during therapy and were normal in seven first studied during therapy. The median NAP score doubled by 3 months after cessation of therapy and was abnormal in 17/19 patients followed for 6 months. NAP score may be useful in predicting changes in the bone marrow in patients treated with IFN-alpha. We did not find any parameter in the pretherapy specimens that would have allowed us to predict individual response.

Durability of responses to interferon alfa-2b in advanced hairy cell leukemia.

Previous studies have demonstrated that significant hematologic improvement occurs in the majority of patients with hairy cell leukemia (HCL) treated with partially purified or recombinant interferon (IFN). Fifty-three patients received IFN alfa-2b for at least 3 months in a dose of 2 X 10(6) U/m2 subcutaneously thrice weekly. Of the 49 patients evaluable for response (at least 6 months of IFN therapy), there were ten complete responses and 29 partial responses for a total response rate of 80%. The peripheral blood counts and bone marrow continued to improve over the course of a full year of therapy. IFN was well tolerated, with no patients discontinuing therapy because of toxicity. Transient myelosuppression occurred in most patients during the first 1 to 2 months of therapy, occasionally precipitating a transfusion requirement. After IFN treatment was discontinued, there was a marked decrease in normal marrow elements and a relative increase in marrow hairy cells. This was associated with a transient increase in normal elements in the peripheral blood. Only one of 24 patients followed after receiving IFN for a median of 8.5 months (range, 3 to 16 months) has required further therapy. We conclude that low-dose IFN alfa-2b is highly effective in advanced HCL; responding patients should be treated for at least 1 year. The decision to initiate a second course of IFN therapy should be based primarily on peripheral blood counts and the clinical status of the patient rather than on the bone marrow.

Changes in peripheral blood and bone marrow specimens following therapy with recombinant alpha 2 interferon for hairy cell leukemia.

The authors studied peripheral blood (PB) and bone marrow (BM) biopsy specimens from 12 patients treated with recombinant alpha 2 interferon (raIFN) for hairy cell leukemia (HCL), to assess changes caused by raIFN therapy. Specimens were obtained immediately before therapy and during follow-up periods for 6 months to 12 months. Before raIFN, 11 patients had hairy cells (HC) in the PB; 11 were granulocytopenic; 12, monocytopenic; and 6, thrombocytopenic. The median bone marrow hairy cell index (HCI = %HC X %BM cellularity/10,000), an indicator of HC packing in the BM, was 0.56 (range, 0.12-0.83). The myeloid:erythroid (M:E) ratio was below 1:1 in all patients. By the end of the study, HC in the PB had disappeared or decreased in numbers. Granulocytopenia, monocytopenia, and thrombocytopenia had resolved in 10 of the 11, 10 of the 12, and 5 of the 6 patients, respectively, in whom they were present before raIFN. The numbers of large granular lymphocytes (LGL) increased in 11 patients after raIFN, but often fluctuated, and in 3 patients fell to pre-raIFN values. In the BM, improvement was noted with median HCI of 0.12 (range, 0.03-0.4). In no case were HC completely absent from the BM. The BM showed increased percentages of granulocytic elements in 11 patients, of erythroid precursors in 12, and of megakaryocytes in 10. However, the M:E ratio was 1:1 or higher in only six patients at any time during the study. Marrow reticulin fibers remained increased. This study morphologically confirms the clinical improvement reported in patients with HCL who are treated with recombinant alpha 2 interferon.