Peripheral primitive neuroectodermal tumor of the vulva: report of a case with imprint cytology.

BACKGROUND: Peripheral primitive neuroectodermal tumor (PNET) of the vulva is an extremely rare disease, and, to our knowledge, only two cases have been previously reported. CASE: A 45-year-old woman presented with a mass in the right labium major. Three years after removal of the tumor, she noticed a new lesion in the same place and underwent a partial vulvectomy. The imprint cytology of the recurrent tumor showed a monomorphic appearance, composed of small round cells with scant cytoplasm against a hemorrhagic background. These tumor cells were loosely connective, but rosettelike structures were observed focally. On pathologic examination, the neoplasm was composed of small round tumor cells showing sinusoidal, diffuse or micropapillary growth. Immunohistochemically, the neoplastic cells stained positively for neuron-specific enolase, vimentin and HBA 71 and negatively for cytokeratin, HBA 45 and muscle-specific actin. The morphologic characteristics of the disease were well expressed in the imprint cytology, and this influenced the selection of immunohistochemical studies. CONCLUSION: Cytologic examination for vulvar tumors, even imprint cytology, can be a useful tool in obtaining an accurate pathologic diagnosis of a rare disease, such as peripheral PNET.

Identification of a high-risk subgroup in cytology-positive stage IIIA endometrial cancer.

OBJECTIVE: To identify a high-risk subgroup among patients with cytology-positive stage IIIA endometrial cancer. STUDY DESIGN: Fifty-four stage IIIA endometrial cancer patients who were positive only on peritoneal cytology were divided into two groups based on the cytologic pattern of their peritoneal smears. In group A, malignant cell clusters had well-defined edges, while the tumor cell clusters had scalloped edges in group B. The prognostic significance of these findings was investigated. RESULTS: The five-year disease-free survival rate was 97.5% in group A (n=40) versus 50% in group B (n = 14). Multivariate analysis confirmed that the cytologic pattern had an independent influence on survival. CONCLUSION: Positive peritoneal cytology composed of malignant cell clusters with well-defined edges has no impact on survival. Only endometrial cancer patients who show tumor cell clusters with scalloped edges in peritoneal smears are worth considering for upstaging.

Müllerian adenosarcoma of the uterus: report of a case with imprint cytology.

BACKGROUND: Müllerian adenosarcoma is a rare morphologic variant of uterine sarcoma that, although well described histologically, is scarcely mentioned in the cytologic literature. CASE: A 75-year-old female was suspected of having atypical endometrial hyperplasia on an endometrial smear. However, subsequent imaging techniques revealed the presence of a bulky, polypoid mass filling the uterine cavity. On pathologic examination of the hysterectomy specimen, the polypoid tumor was diagnosed as mullerian adenosarcoma, homologous, with sarcomatous overgrowth, in which the sarcomatous component was compatible with high grade endometrial stromal sarcoma. Imprint smears of the tumor consisted of two morphologic patterns, sarcomatous and glandular. The sarcomatous tumor cells, with coarse chromatin and relatively scant cytoplasm, formed small aggregates or appeared alone. These cells were semiround or oval and had conspicuous nucleoli. In addition to these observations, small and large clusters of glandular cells with mild atypism were interspersed with the sarcomatous cells. CONCLUSION: Cytologic examination of müllerian adenosarcoma well reflects its pathologic features.

Respiratory jugular venodilation: its anatomic rationale as a landmark for right internal jugular vein puncture as determined by ultrasonography.

OBJECTIVE: To reveal anatomic factors that determine the visibility of respiratory jugular venodilation, a landmark for right internal jugular vein puncture, in ventilated patients. DESIGN: Prospective observational study. SETTING: Single community hospital. PARTICIPANTS: Adult patients undergoing general endotracheal anesthesia. INTERVENTIONS: Anatomy of the right neck, including the carotid artery and internal jugular vein, was evaluated in a blind manner using 7.5-MHz ultrasonography in patients simulating the position for internal jugular vein puncture. Anatomic variables correlated with the visibility of respiratory jugular venodilation were analyzed. MEASUREMENTS AND MAIN RESULTS: Of 124 patients, respiratory jugular venodilation was observed in 94 patients (75.8%). Satisfactory quality of ultrasound image was obtained for all patients. The visibility of venodilation correlated with the extent of change of the vein size during a respiratory cycle but not with the end-expiratory or end-inspiratory vein diameter. These results indicated that there was no correlation between the vessel size and the visibility of venodilation, suggesting that it is rational to attribute the increased success rate of the respiratory jugular venodilation-guided puncture to accurate vein localization rather than to a larger target size. Among the demographic variables examined, body weight and obesity correlated with the visibility of venodilation, but age, gender, and height did not correlate. In obese patients, the respiratory change of the vein diameter was smaller, and the vein was deeper. CONCLUSIONS: The visibility of respiratory jugular venodilation does not correlate with the vein size but with the extent of its dynamic change during a respiratory cycle.

Respiratory jugular venodilation: a new landmark for right internal jugular vein puncture in ventilated patients.

OBJECTIVE: To report a new technique for right internal jugular vein puncture using respiratory jugular venodilation as a landmark for vein location. DESIGN: Prospective observational study. SETTING: Single community hospital. PARTICIPANTS: Two hundred patients undergoing right internal jugular vein cannulation under general anesthesia. INTERVENTIONS: Catheter placement was attempted using respiratory jugular venodilation as the primary landmark. When it was not applicable, an alternative technique using the carotid pulse as a landmark was used. MEASUREMENTS AND MAIN RESULTS: Visibility of the venodilation, the number of needle passes, the success rate, and the incidence of arterial puncture were analyzed. Respiratory jugular venodilation was observed in 158 patients (79%). In this group of patients, the jugular vein was cannulated at the first attempt in 83.5% of patients, and arterial puncture occurred in one patient (0.6%). In the remaining 42 patients (21%) lacking the visible venodilation, catheter placement was accomplished at the first attempt in 42.9% of patients (p<0.01 v. the venodilation-visible group), and 4 patients (9.5%) suffered arterial puncture (p<0.01). The overall incidence of arterial puncture was 2.5%. The success rate of cannulation (within four needle passes and no arterial puncture) was 98.1% in the venodilation-visible patients and 73.8% in the others (p<0.01), with the overall success rate of 93%. CONCLUSIONS: Respiratory jugular venodilation can be identified in a large proportion of ventilated patients. This experience suggests that respiratory jugular venodilation could be favorably used as the primary landmark for right internal jugular vein puncture in anesthetized patients.

Morphologic analyses of positive peritoneal cytology in endometrial carcinoma.

OBJECTIVE: To investigate the relationship between the morphologic features of endometrial adenocarcinoma cells in peritoneal fluids (effusions and washings) and macroscopic intraabdominal adenocarcinoma at laparotomy as well as prognosis. STUDY DESIGN: Seventy-one patients with endometrial adenocarcinoma who showed positive peritoneal cytology at laparotomy were clinically divided into three groups: 25 patients with macroscopic neoplastic seeding in the peritoneal cavity (type 1), 38 patients without macroscopic peritoneal metastasis who survived with no evidence of disease (type 2) and 8 patients without macroscopic peritoneal metastasis who later developed recurrence of adenocarcinoma (type 3). Morphologic features of the adenocarcinoma cells in smears of peritoneal fluids were examined. RESULTS: Most of the smears from type 1 patients showed moderate to high cellularity, scalloped edges of cell clusters and isolated adenocarcinoma cells, whereas these features were seldom observed in type 2 patients. Although not all type 3 patients demonstrated these three features, patients in the series whose specimens exhibited none of the three features did not show any peritoneal lesions or have a recurrence of their disease. CONCLUSION: The finding of endometrial adenocarcinoma cells exhibiting high cellularity, scalloped edge of cell clusters and isolated cells in smears of peritoneal fluid is associated with the presence of intraabdominal macroscopic metastatic lesions and could be regarded as a risk factor for intraabdominal recurrence of carcinoma.

Papillary carcinoma of the thyroid occurring during pregnancy. Report of a case diagnosed by fine needle aspiration cytology.

A case of papillary carcinoma of the thyroid gland occurring during pregnancy in a 29-year-old woman is described. The enlarged thyroid nodule was first detected at 10 weeks of gestation; fine needle aspiration (FNA) of the nodule showed no cytologic evidence of malignancy. Repeat FNA at 30 weeks of gestation produced inadequate material for diagnosis. A final FNA at 38 weeks of gestation showed classic cytologic features of papillary carcinoma, including papillary structures, grooved nuclei and intranuclear cytoplasmic inclusions. After delivery, the patient was treated with total thyroidectomy and cervical lymph node dissection. The enlargement of the nodule in this case during the course of the pregnancy suggests a relationship between pregnancy and the malignant development of thyroid nodules; this is discussed along with the utility of FNA cytology for diagnosing thyroid cancers during pregnancy.

[Early invasive squamous cell carcinoma of the tongue--report of a case].

A 65-year-old woman with early invasive squamous cell carcinoma of the tongue is reported. Atypical but not definitely malignant epithelium was detected by cytology, although the gross appearance of the glossal lesion looked like early invasive squamous cell carcinoma. On the surgical material, the basal and para-basal cell layers were occupied by cancer, but the upper portion of the epidermis from the prickle cell layer through the surface of the mucosa was histologically benign. In such cases, to obtain the correct diagnosis on cytology, repeated examinations as well as using a sharp instrument like a curatte are necessary.