Fine needle aspiration cytology of vaginal cuff lesions.

OBJECTIVE: To assess the usefulness of fine needle aspiration (FNA) of the vaginal cuff in various lesions in the female genital tract. STUDY DESIGN: Twenty-six FNAs of vaginal cuff lesions were performed at our institution from 1994 to 1998. All cases were reviewed. Data on clinical histories and follow-up, if available, were collected. Histologic material was reviewed. Fourteen gynecologic (cervicovaginal) smears performed on these patients within six months prior to the FNA were also reviewed. RESULTS: Two of twenty-six (7.7%) FNAs were non-diagnostic due to poor cellular yield. Four lesions were classified as benign (16.7%). The remaining 20 FNAs were classified as malignant (83%) and were consistent with the clinical history in all cases. CONCLUSION: The results show that FNA of the vaginal cuff appears to be a simple and accurate procedure for detecting benign and malignant lesions of the female genitourinary tract. Clinical indications, cytologic techniques and potential pitfalls are identical to those of FNAs at other sites.

Benign glandular and squamous metaplastic-like cells seen in vaginal Pap smears of post hysterectomy patients: incidence and patient profile.

We have observed benign glandular cells and squamous metaplastic-like cells in vaginal Pap smears of post hysterectomy patients (PHP). Vaginal Pap smears from 1,547 PHP were retrieved. In 2% of these smears (Group A) glandular cells were observed, with the majority of the smears revealing squamous metaplastic-like cells (47%). Mucinous endocervical columnar-like cells were seen in 9% of the cases, glandular cells not resembling endocervical cells in 13%, and a combination of the former two categories in 31%. Group A patients were compared with other PHP without these cells in their vaginal smears (Group B). Several clinical and surgical parameters were evaluated. A distinctive clinical profile was not identified for either group of patients (A or B). Of patients in group A 49.8% had a history of a previous gynecologic malignancy (Group B: 19%). Based on our study, we postulate that in the absence of a clinically identifiable source of these cells, the most likely source of origin is probably vaginal adenosis not associated with DES exposure in utero or a metaplastic phenomenon perhaps related to therapy. These cells do not seem to be related to imminent neoplasia or dysplasia.

Diagnostic accuracy and clinical utility of endoscopic bile duct brushing in the evaluation of biliary strictures.

Pathologic evidence of malignancy in biliary strictures is useful in the preoperative setting because it helps define therapeutic planning and prognosis. The purpose of this study was to assess the diagnostic accuracy and clinical utility of endoscopic bile duct brushings in the evaluation of bile duct strictures. We retrospectively evaluated 34 endoscopic biliary brushings derived from 31 patients with bile duct strictures. Relevant clinical and follow-up data were collected. Histologic specimens were reviewed in patients undergoing subsequent biopsies. Patients included 18 men and 13 women with an age range of 25 to 79 years (mean, 52 years). All patients had histologic and/or clinical follow-up. Cytologic diagnosis included cholangiocarcinoma (14.7%), suspicious for cholangiocarcinoma (5.9%), atypical hyperplasia (17.6%), and negative for malignancy (61.7%). All positive diagnoses were confirmed by histologic testing (false-positive rate, 0%). The cases that were suspicious for cholangiocarcinoma and the 5 atypical hyperplasia cases were also subsequently diagnosed as cholangiocarcinoma by biopsy. One atypical case was diagnosed as pancreatic carcinoma. All 21 negative cases were confirmed by biopsies (15) and clinical follow-up (6) (false-negative rate, 20%). Endoscopic bile duct brushing is diagnostically accurate and hence clinically useful in the management of patients with bile duct strictures. Atypical hyperplasias may contribute to diagnostic pitfalls leading to false-positive and false-negative diagnoses.

The role of fine-needle aspiration biopsy in the management of thyroid nodules in children, adolescents, and young adults: a multi-institutional study.

Thyroid nodules in children are extremely uncommon and in most cases present as asymptomatic neck masses. The significance of a thyroid nodule in a child involves the underlying risk of malignancy. The purpose of this study was to assess the validity of results of fine-needle aspiration biopsy (FNAB) of thyroid nodules in the pediatric population and its usefulness in pediatric patient management. FNAB was performed on a total of 57 thyroid nodules from 57 patients between 1992 and 1997. The patients included 46 females and 11 males ranging in age from 9 to 20 years (average 16.5 years). Surgical and/or clinical follow up was available in all patients. FNAB diagnoses included papillary thyroid carcinoma (PTC) (12.3% [7/57]), follicular neoplasm (FN) (15.8% [9/57]), atypical cytology (8.8% [5/57]) and nonneoplastic thyroid (63.2% [36/57]). Surgical follow-up available in all patients with cytological diagnoses of PTC, FN, and atypical cytology revealed malignancy in 13 cases. Of the 36 patients with nonneoplastic cytological diagnosis, surgical excision was performed in 3 patients and the rest were followed up clinically. Surgical excision in these 3 patients revealed follicular carcinoma (FC) (1 case) and multinodular goiter (2 cases). Overall, 14 patients (24.6%) had malignant thyroid lesions, including 11 PTC and 3 FC. In conclusion, the majority of pediatric thyroid nodules are benign. The prevalence of malignancy in pediatric patients with thyroid nodules in our series was 24.6%. High diagnostic accuracy of thyroid FNAB improves selection of pediatric patients requiring surgery.

Cytological, histological, and clinical correlations in intravesical Bacillus Calmette-Guerin immunotherapy.

Bacillus Calmette-Guerin (BCG), an attenuated form of mycobacterium, has been used extensively for the immunotherapy of bladder carcinoma. BCG induces a granulomatous response in the bladder wall. The cytological features induced by BCG-immunotherapy in urines and bladder washes have been described in only rare articles. We evaluated cytologic specimens from 50 patients who received intravesical BCG for bladder carcinoma. Forty-three patients received BCG therapy in a single course, averaging to 6.3 weeks per patient, whereas seven patients received an average of 9 weeks therapy with 2 to 3 interruptions. A total of 93 voided urines (avg, 1.9/patient), 57 bladder washes (avg, 1.1/patient) and 64 biopsies (avg, 1.3/patient) were obtained in the 2-year and 8-month retrospective review from these 50 patients. There were 30 responders and 20 nonresponders to BCG therapy. Positive cytology was predictive of recurrence: (cytologic-histologic correlation, 85%). Nine of 64 (14%) tissue biopsies revealed granulomatous inflammation, whereas only 2 of 150 cytological specimens (1.3%) exhibited specific inflammatory cells and epithelioid cells diagnostic of granulomas. Decoy cells appeared on the surface of the urothelium in four biopsies and in two cytological specimens. Based on this study, cytology appears to be adequate for the follow-up of BCG-treated patients for assessment of recurrence of carcinoma. Diagnostic features of granulomas were detected only in a smaller percentage of urine specimens, compared with biopsies. The presence of decoy cells in the urine and biopsies is an intriguing phenomenon that requires further investigation, especially in regard to the source of these cells and whether they are apoptotic in nature or whether they result from necrosis.

Diagnosis and differential diagnosis of small-cell lesions of the liver.

The objective of this study was to evaluate the cytologic spectrum of small cell lesions of liver as diagnosed by fine-needle aspiration (FNA). Of 304 FNAs of liver that were performed in our institution between 1990 and 1994, 29 were classified as small-cell lesions. The final diagnoses were as follows: small-cell undifferentiated carcinoma (10), neuroendocrine carcinoma (9), cloacogenic carcinoma (1), Merkel-cell carcinoma (1), cholangiocarcinoma (1), metastatic adenocarcinoma (4), small-cell sarcoma (1), lymphoma (2). Relevant clinical history and immunocytochemistry were helpful in making the final diagnosis in some cases. The diagnosis and differential diagnosis of small cell lesions of the liver are discussed in detail in this report.

Low grade papillary adenocarcinoma of minor salivary gland origin. Diagnosis by fine needle aspiration cytology.

OBJECTIVE: To describe the diagnostic cytologic features of low grade papillary adenocarcinomas of minor salivary gland origin (LPA) along with its pertinent differential diagnostic entities. STUDY DESIGN: The study was based on a histologically confirmed case of LPA that recurred after multiple excisions. Fine needle aspiration (FNA) was performed during the most recent recurrence. RESULTS: Low-power examination showed geographic sheets and papillary groups of epithelial cells. Individual cells were medium sized, with scant cytoplasm, finely clumped chromatin and occasional prominent nucleoli. Pleomorphism was conspicuously absent. Differential diagnosis included cellular mixed tumor, basal cell adenoma, basal cell adenocarcinoma, low grade mucoepidermoid carcinoma and metastatic papillary carcinoma. CONCLUSION: LPA can be accurately diagnosed by FNA biopsy. However, the cytopathologist must entertain and exclude various differential diagnostic entities.

False-negative diagnosis in fine-needle aspirations of squamous-cell carcinoma of head and neck.

Squamous-cell carcinoma (SCC) is the most common malignancy encountered in the head and neck area. Fine-needle aspiration (FNA) is routinely performed in the diagnosis of primary, recurrent, and metastatic SCC. This paper describes several diagnostic problems and pitfalls that might be seen in FNAs of SCC. These include cystic changes, well-differentiated SCC, spindles SCC, and SCC with foreign-body giant cells, keratin plaques, and ghost cells. Recognition of these patterns along with clinical correlation enables the pathologist to prevent a false-negative diagnosis.

Cytopathology of serous neoplasia of the ovary and the peritoneum: differential diagnosis from mesothelial proliferations.

Serous neoplasia of the ovary ranges from benign adenomas through serous borderline tumors to invasive serous adenocarcinoma. This spectrum of neoplasia is at least partially reflected in the cytomorphologic features of the lesions. The objective of this study is to review the cytopathology of serous neoplasia of the ovary. In addition, cytologic features of serous surface papillary carcinoma and its distinction from peritoneal mesothelial proliferations are discussed.

Cytologic diagnosis of pseudomyxoma peritonei: common and uncommon causes.

Pseudomyxoma peritonei (PP) refers to accumulation of mucus in the peritoneal cavity, regardless of cause or pathogenesis. We have reviewed 8 cases of PP diagnosed in our institution over the past 5 years. Pertinent cytologic features include a mucinous background with mesothelial cells and histiocytes. Two cases contained rare clusters of neoplastic epithelial cells, with low-grade nuclear features of malignancy. The origin and nature of the parent neoplasms were variable, with no reflection of the cytologic features of PP.

Spectrum of cytologic changes in pregnancy. A review of 100 abnormal cervicovaginal smears, with emphasis on diagnostic pitfalls.

OBJECTIVE: To review pregnancy-related changes in cervicovaginal smears and to distinguish them from neoplasia and dysplasia. STUDY DESIGN: One hundred consecutive abnormal cervicovaginal smears from pregnant women obtained during 1992-1993 were reviewed. Corresponding biopsies that were available were also reviewed for cytologic correlation. RESULTS: Sixty-one percent of cases showed inflammation changes, 21% contained low grade squamous intraepithelial lesion, and 9% had high grade squamous intraepithelial lesion. Diagnostic problems were encountered with decidual cells, Arias-Stella reaction and trophoblastic cells. CONCLUSION: Both the clinician and pathologist must be aware of diagnostic pitfalls and false positive diagnoses in pregnancy. Hence, it is extremely important that the clinician notify the pathologist about the pregnancy status of the patient.

Differential diagnostic dilemmas in malignant fine-needle aspirates of liver: a practical approach to final diagnosis.

We retrospectively reviewed two hundred malignant fine-needle aspirates of liver. Of these 49.5% were metastatic neoplasms, 32% were hepatocellular carcinomas, and 18.5% presented with diagnostic dilemmas. In less than half of these diagnostic challenges, differential diagnosis was between hepatocellular carcinoma and metastatic adenocarcinoma. The remainder of cases involved a variety of metastatic neoplasms. Cytomorphology in association with immunocytochemistry resolved the diagnostic problems in about half of the problematic cases. Three cases were undifferentiated and remained unclassifiable. We conclude that approximately 80% of malignant lesions of liver can be correctly diagnosed by thorough cytomorphologic analysis and good clinical correlation, and 20% pose differential diagnostic dilemmas.

Basal cell adenocarcinoma of the salivary gland. Diagnosis by fine-needle aspiration cytology.

Basal cell adenocarcinoma of salivary gland is a relatively recently described neoplasm. Histopathologic features of these tumors have been published in the literature mainly in the form of case reports. This paper elaborates and describes the diagnostic fine-needle aspiration cytomorphology of two cases of basal cell adenocarcinoma of parotid gland, which, to the author's knowledge, has not been previously reported in the English literature. Fine-needle aspiration specimens in both cases contained cohesive, focally papillary, and filiform groups of neoplastic cells, which were highly reminiscent of basal cell adenoma on low power examination. Higher power, however, revealed significant cytologic atypia and mitotic activity. Differential diagnoses included basal cell adenoma, epithelial rich pleomorphic adenoma, myoepithelial lesions, small cell undifferentiated carcinoma, and metastatic carcinoma among others.

Elastofibroma dorsi: diagnostic problems and pitfalls.

The diagnostic cytomorphologic findings in a case of elastofibroma dorsi are described in this report. The correct diagnosis was initially overlooked on fine-needle aspiration, and was subsequently made by open biopsy. Review of the FNA material, however, demonstrated scanty but diagnostic material. Cytologic examination revealed a mixture of fibroblasts, adipose tissue, and swollen lightly staining cyanophilic elastic fibers in a background of collagenous matrix. Cross sections of the elastic fibers had the typical serrated and globular appearance. These fibers stained positive with elastin stains. The cytomorphology of elastofibroma dorsi with diagnostic pitfalls and differential diagnostic dilemmas are discussed in this article.