Cell block preparation on residual ThinPrep sample.

The liquid-based cytology system ThinPrep has overcome many of the deficiencies of the conventional Pap test. However, the cytologic appearances of the cells in the liquid-based medium are different and staffs of laboratories adopting the new system have to be specially trained. Even after the training sessions provided by the vendor, the cytology staff still face a sharp learning curve initially. One way to recognize the different appearances of cells in the liquid-based system is to look at paired split-sample cases from the same patient in laboratories offering the test as an adjunct to the conventional Pap test. Laboratories offering direct-to-vial testing may be able to overcome the difficulties with some cases by performing cell block sections of residual materials in the samples. The protocol for making cell blocks and its application in resolving difficulties with high-grade squamous and glandular epithelial lesions is illustrated in this report. Diagn. Cytopathol. 1999; 21:427-431.

Fine-needle aspiration cytology of mucocelelike tumors of the breast.

Mucocelelike tumors of the breast encompass a spectrum of pathologic lesions, including benign tumor, atypical ductal hyperplasia, carcinoma in situ, and colloid carcinoma. Because the fine-needle aspiration (FNA) cytology of mucocelelike tumors covering this pathologic spectrum is not well defined, a study of 21 cases of mucocelelike tumors was conducted. Benign lesions are likely to be poorly cellular and to contain cohesive clusters of cytologically bland cells arranged in two dimensional sheets in the background of abundant mucoid material. Colloid carcinomas are usually highly cellular and contain loosely cohesive clusters and dissociated cells with nuclei showing minimal to mild atypia. The most discriminating feature between benign and malignant lesions appears to be the presence of many dissociated cells with intact cytoplasm. Cases with atypical ductal hyperplasia, with some bordering on carcinoma in situ as seen in 7 of the 12 benign cases, may be difficult to identify on FNA cytology, possibly because of sampling. As expected, some of the atypical cases have intermediate features of benign and malignant tumors. Because of overlapping features in borderline cases, we recommend excisional biopsy for all mucocelelike lesions. Myxoid fibroadenoma is more cellular than benign mucocelelike lesions and can be distinguished from carcinoma by the absence of dissociation and presence of numerous bare nuclei of bland morphology in the background. The mucoid material of myxoid fibroadenoma stained brightly pink rather than magenta as in mucocelelike tumors using the Diff Quik stain.

Nasal cerebral heterotopia: the so-called nasal glioma or sequestered encephalocele and its variants.

Twenty two nasal cerebral heterotopias were compared with 11 nasal encephaloceles. No histological feature was found that would allow a communication with the brain to be confidently identified or excluded. Even laminated cerebral cortex with neurones and ependymal canals, suggestive of encephalocele, were found in heterotopias. Distinction required radiological and surgical evidence. However, CT scan could be misleading, in one infant suggesting a cribriform plate defect when none was found at craniotomy. Three children had multiple extracranial glial lesions, two with both heterotopia and encephalocele in the same patient. In a few older children it was extremely difficult to identify brain tissue because of marked replacement by fibrous tissue (up to 95%), leading to one misdiagnosis as fibroma, and considerable fibrosis occurred also in five of six recurrences and in a longstanding small encephalocele. In two heterotopias, cellularity in places approached that of low-grade neoplastic glioma. One nasopharyngeal heterotopia contained multiple mesenchymal tissues suggestive of teratoma. Two midline nasopharyngeal encephaloceles showed adjacent epithelium, possibly vestiges of Rathke's pouch.

Combined renal and pancreatic dysplasia in the newborn.

A term female infant with early onset respiratory distress and pneumothorax died on day 20 with renal failure. Autopsy revealed dysplastic kidneys with occasional cortical cysts. The pancreas showed focal dysplasia with cysts and dilated ducts lying in primitive mesenchyme. A mild chronic inflammatory infiltrate was present in the dysplastic areas of kidneys and pancreas. The abnormalities in the affected organs were similar to those in two siblings described by Ivemark et al. in 1959 and designated "familial dysplasia of kidneys, liver and pancreas". Relationships to subsequently reported cases, including some with major congenital malformations, and the validity of this dysplastic triad as a disease entity are examined.