Papillary-cystic variant of acinic cell carcinoma of the salivary gland diagnosed by fine needle aspiration biopsy. A case report.

BACKGROUND: Fine needle aspiration (FNA) biopsy is reliably used to classify most conditions involving the salivary glands. It is useful for establishing, or at least suggesting, the diagnosis in unusual cases or narrowing the differential diagnosis. CASE: A 25-year-old male presented with a slowly enlarging mass of the left parotid. FNA biopsy of the parotid gland was performed, and a diagnosis of papillary-cystic variant of acinic cell carcinoma was suggested. The patient underwent incomplete resection of the lesion, which was interpreted as acinic cell carcinoma. CONCLUSION: Papillary-cystic variant of acinic cell carcinoma is rarely seen, especially in young people. FNA biopsy is a useful diagnostic procedure that can help diagnose this relatively uncommon type of salivary gland neoplasm and guide its management.

Fine-needle aspiration of 154 parotid masses with histologic correlation: ten-year experience at the University of Texas M. D. Anderson Cancer Center.

BACKGROUND: Clinical and radiologic assessment of parotid masses cannot distinguish reliably between benign and malignant lesions. The utility of fine-needle aspiration (FNA) of parotid masses at a cancer referral center (where clinicians may be especially adept at diagnosing parotid gland malignancies) remains controversial. METHODS: Between January 1986 and June 1996, 482 parotid glands were resected at the University of Texas, M. D. Anderson Cancer Center (MDACC). A preoperative FNA result was available for 147 of these resections (30%), (corresponding to 154 preoperative FNAs). The results of 154 consecutive preoperative FNAs were compared with the corresponding histopathologic diagnoses. RESULTS: Histologic evaluation revealed 76 malignant tumors and 78 benign lesions (67 neoplastic and 11 nonneoplastic). The FNA smear was nondiagnostic in two benign and two malignant cases. The cytologic diagnosis was true-positive in 61 cases (82% sensitivity), and true-negative in 65 cases (86% specificity). There were 11 false-positive results. Eight of these cases were classified as false-positive because they were suspicious for malignancy; five of the eight were outside cases. In addition, there were 13 false-negative results (6 metastatic lesions, 3 low grade mucoepidermoid carcinomas, 2 acinic cell carcinomas, and 2 carcinoma ex pleomorphic adenomas) (9%). Fifty-one of the malignant lesions (84%) and 60 of the benign lesions (92%), including 93% of the benign tumors, were classified accurately. Ten of ten lymphoma cases in this series were identified correctly. CONCLUSIONS: FNA of parotid masses at a major referral cancer center has a sensitivity of 82%, a specificity of 86%, and an overall diagnostic accuracy of 84%. FNA plays an important role in the preoperative and postoperative assessment of parotid masses by aiding in the evaluation of tumors in poor surgical candidates and unresectable tumors, and by identifying metastases from other sites, reticuloendothelial tumors, and nonneoplastic inflammatory conditions.

Microautoradiographic quantitation of vascular endothelial growth factor mRNA levels in human prostate specimens containing normal and neoplastic epithelium.

Human prostate specimens commonly contain a spectrum of epithelial changes, including normal acinar and ductal structures, hyperplasia, intraepithelial neoplasia (dysplasia), and carcinoma. Since vascular endothelial growth factor (VEGF) expression is dependent on cell type and tissue microenvironment, meaningful quantitation of the levels of this mRNA in pathological specimens requires analysis at the microscopic level. Phosphorimage analysis of the binding of radiolabeled cRNA probes to tissue sections allows quantitation of mRNA levels, but the resolution is limited. Alternatively, emulsion autoradiography allows visualization of mRNA levels at cellular resolution, but quantitation is difficult. We have developed a method of quantitating steady state mRNA levels in tissue sections at the microscopic level, using autoradiography and quantitative image analysis. In this study, we describe the method and apply it to quantitation of VEGF mRNA in human prostate specimens. The VEGF mRNA level was low in nonepithelial stromal tissue (0.8 dpm/mm2), high in normal and benign hyperplastic epithelium (17-18 dpm/mm2), and significantly decreased in intraepithelial neoplasia (6.4 dpm/mm2) and in microacinar carcinoma that had invaded the stroma (3.5 dpm/mm2). Immunohistochemical staining detected VEGF protein in epithelial and stromal cells, with highest levels on the luminal surface of normal epithelium and in stromal cells, and lower levels in benign hyperplasia, intraepithelial neoplasia, and carcinoma. No correlation between VEGF expression in epithelium and nearby vessel density was observed. The results indicate a decrease in the steady state level of VEGF mRNA when prostate epithelial cells become transformed, escape the confines of glandular structure and invade the stroma, and suggest that the progression of prostatic carcinoma through the stages examined in this study is not associated with increased VEGF expression, in contrast to the elevated VEGF expression associated with progression of several other tumor types.

Desmoplastic fibroma of the temporal bone.

BACKGROUND: Desmoplastic fibroma is a benign, locally aggressive, intraosseous neoplasm with a propensity for local recurrence. Desmoplastic fibroma most commonly originates within the mandible (70% of cases), and long bones with rare lesions reported in the maxillary, frontal, and parietal bones. We report two patients with desmoplastic fibroma arising within the temporal bone. STUDY DESIGN: Case report and literature review. PATIENTS: Two patients with desmoplastic fibroma with intracranial and extra cranial growth patterns are presented. Both were young females with aural fullness and decreased hearing. INTERVENTIONS: Diagnostic and therapeutic. RESULTS: Both tumors were surgically extirpated and the patients have remained disease free for 18-48 months. Neither tumor expressed estrogen or progesterone receptors. CONCLUSION: Desmoplastic fibroma is a highly invasive local destructive lesion which is best treated by nondestructive surgical intervention. Immunohistochemical analysis may demonstrate hormonal receptors, in which case Tamoxifen may reduce recurrence.

Relationship between cytomegalovirus cells and survival in acquired immunodeficiency syndrome patients.

OBJECTIVE: To determine whether cytopathic changes due to cytomegalovirus (CMV) in human immunodeficiency virus-infected patients are prognostic. STUDY DESIGN: Three-month mortality was compared in three groups: 36 patients with positive CMV cytology, 38 with negative cytology but culture positive, and 40 with no evidence of CMV. Bronchoalveolar lavage, Papanicolaou-stained cytocentrifuge smears were quantitated using an average of two slides per case. Additionally, coinfection with Pneumocystis carinii and Cryptococcus neoformans was evaluated. RESULTS: There was a statistically significant increase in mortality at three months in CMV cytology-positive patients versus those with no evidence of CMV. Ten patients had quantitative CMV counts of less than 2, with a median survival of 3.0 months (range, 0.3-13.0); seven patients had counts of 2 or 3, with a median survival of 5.5 months (0.4-13.5); and 11 patients had CMV counts greater than 3, with a median survival of 7.2 months (0.3-14.0). There was no significant difference between the groups. Coinfection was P Carinii (12) or C neoformans (2) showed no difference from patients without coinfection (chi2 = 0.81). CONCLUSION: The presence of CMV cytopathic changes is associated with poorer survival, but an increased number of CMV-infected cells is not related to higher mortality.

Alterations of the retinoblastoma gene in human prostate adenocarcinoma.

The loss or mutational inactivation of the RB1 tumor suppressor gene has been implicated in the development of a diverse group of human malignancies. However, the contribution of the RB1 gene alteration to human prostatic carcinogenesis has been poorly understood. Thus far, deletion of the promoter sequence and exon 21 from one primary tumor specimen and the alterations found in the cell line DU-145, are the only cases of RB1 mutations reported in human carcinoma of the prostate. This study was designed to determine whether alterations in the structure or expression of the RB1 gene occur in human prostate carcinoma, and to determine the nature of these changes and the frequency with which they occur. One hundred twelve primary prostate tumor tissues and four metastatic lesions were obtained immediately after surgical resection. The RB1 gene was characterized in 68 tumor DNA samples using Southern analysis and the PG3.8M or H3-8 probes. Band profiles were analyzed by scanning densitometry. Sixty-three tumor DNA samples were analyzed for defects in the RB1 promoter using polymerase chain reaction (PCR) and heteroduplex analysis. Alterations in the expression of exons 1-27 were analyzed in 79 primary and four metastatic tumor RNAs using RT-PCR. Three of 68 tumors were identified to have gross rearrangement of the RB1 gene or deletion of one allele. One of four stage D tumor specimens showed truncated RT-PCR products indicating an internal deletion of RB1 transcripts. In all, 14 of 83 (17%) specimens displayed abnormally low levels of RB1 mRNA expression. Furthermore, these alterations of RB1 expression showed a correlation with increasing tumor stage and grade. These results suggest alterations of RB1 mRNA expression occur more frequently in higher stages and grades of prostate cancer and, thus, may be contributing to the malignant progression of a subset of human prostate cancer.

Dysplastic tubular epithelium in "normal" kidney associated with renal cell carcinoma.

Intratubular epithelial dysplasia (IED) of the renal tubules has not been fully described in human renal cell carcinoma (RCC). This lesion has been found in male Syrian hamsters exposed to estrogens. One article reports IED in human kidney showing nephrosclerosis and RCC. We examined "normal" kidney tissue adjacent to 110 cases of RCC in an attempt to identify possible precursor lesions. There were 73 male and 37 female patients (M/F = 2:1). The ages ranged from 27 to 86 years (median 64 years). IED was identified in 30 cases. The lesions consisted of foci of crowded tubular epithelium with large, vesicular nuclei two to three times the size of nuclei of benign tubular cells with eosinophilic macronucleoli. The tubules were occasionally filled with dysplastic cells mimicking carcinoma in situ. The lesions were predominantly cortical and periglomerular. They either were subtle and focal or, less commonly, involved tubules diffusely. Eighteen of the 73 male patients (24%) had these lesions compared with 12 of 37 female patients (32%). They were more usually seen in the clear cell (21 of 66) and sarcomatoid (three of four) variants of RCC than in the oncocytic/granular cell (four of 25) or tubulopapillary (two of 14) variants. One case of collecting duct RCC showed no evidence of IED. Immunohistochemical assessment of 20 dysplastic and 20 nondysplastic lesions with their adjacent RCC for cytokeratin, vimentin, cathepsin-D, and epidermal growth factor receptors was inconclusive. Our findings suggest that IED associated with RCC might represent previously unrecognized precursor lesions along the spectrum ranging from dysplasia to frank carcinoma. The biological significance of these lesions, their preponderance in women, and the phenotypic and genotypic characteristics require further investigation.

Fine needle aspiration cytology of lymphoepitheliomalike carcinoma of the parotid gland. A case report.

Lymphoepitheliomalike carcinoma is a rare primary neoplasm of the salivary gland that has also been reported to occur in other primary sites. In this report we document the clinical, cytomorphologic and histologic findings of a case affecting the parotid gland. The patient was a 48-year-old, white woman with a two-month history of a swelling on the left side of the face and associated pain. Physical examination and computed tomography revealed a left parotid mass with spread to the superior cervical lymph nodes. Fine needle aspiration (FNA) of the parotid and upper cervical nodes revealed multiple, irregular aggregates of epithelial cells with a high nuclear/cytoplasmic ratio and finely granular chromatin. Prominent, single, round nucleoli were present. Multiple chromocenters were also noted. These aggregates were found in a background of abundant, benign, small and large lymphocytes. The patient underwent parotidectomy with radical neck dissection. Histopathologic examination of the parotid showed a poorly differentiated carcinoma in a benign lymphoid background consistent with lymphoepitheliomalike carcinoma, with metastatic tumor involving two lymph nodes of the parotid compartment. To our knowledge, this is the first reported case of FNA biopsy of this unusual entity. The cytomorphologic features of these neoplasms when aspirated from the salivary gland are sufficiently distinctive to allow a specific diagnosis of lymphoepitheliomalike carcinoma.

Leukemic infiltration of the esophagus.

BACKGROUND: Leukemic infiltrates of the esophagus have been described occasionally in autopsy series, but there are no reports of antemortem diagnosis. METHODS: Case reports are presented for three patients with acute myeloid leukemia in whom leukemic infiltration of the esophageal mucosa was diagnosed histologically and cytologically by endoscopic examination. Autopsies of patients with leukemia from 1976-1988 were reviewed. RESULTS: The autopsy review of 207 patients with leukemia showed evidence of leukemic infiltration in the esophagus in 7.2% of cases. The only clinical factor identified to be significantly associated with esophageal involvement by leukemic cells was a high initial leukocyte count. Esophageal involvement was associated with leukemic infiltration of other soft tissues and organs. CONCLUSIONS: Although the etiology of dysphagia in patients with acute leukemia is usually related to infection, reflux, chemotherapy toxicity, or benign strictures, the frequency of esophageal leukemic infiltration in this autopsy series suggests that this diagnosis must be considered. Esophageal leukemia is usually associated with widely disseminated soft tissue and visceral infiltrates.

The incidence of unexpected pathological findings in an image-guided biopsy series: a review of 100 consecutive cases.

Despite the widespread availability of image-guided stereotactic biopsy, the need for such procedures in patients with "clear-cut" clinical and radiographic diagnoses is still frequently discussed. In an attempt to ascertain the incidence of unexpected pathological findings, 100 consecutive stereotactic biopsies have been reviewed. Twelve patients were found to have diagnoses of pathological conditions that preoperatively were considered unlikely, or not considered at all. The details of these "diagnostically discordant" cases are discussed.

Splenic rupture as a cause of sudden death in undiagnosed chronic myelogenous leukemia.

A 35-year-old man died suddenly in a clinic waiting area after repeated visits for flu-like symptoms. At autopsy, hemoperitoneum, splenic capsular rupture, and splenomegaly were found. Microscopic examination, special stains, and immunoperoxidase studies revealed findings consistent with chronic myelogenous leukemia. Spontaneous splenic rupture is an unusual presenting feature of chronic myelogenous leukemia. The symptoms of leukemia may mimic those of other "benign" disorders and misdiagnosis may lead to catastrophic consequences in some instances.