Carcinoembryonic antigen in fine-needle aspirate of liver: A diagnostic adjunct to cytology

Carcinoembryonic antigen (CEA) was measured in 50 consecutive fine-needle aspirates of liver to determine whether elevated levels could predict the presence of carcinoma in cytologically negative aspirates. There were 44 malignant and 6 benign lesions. The highest mean CEA values (591–672 ng/ml) were obtained in metastatic adenocarcinoma of the colon, stomach, and pancreas; lower levels (13.5–151 ng/ml) were found in metastatic carcinoma from the breast and lung. Carcinoid, hepatoma, Hodgkin's disease, and benign liver aspirates had low (<5 ng/ml) CEA levels. Cytologic diagnosis of malignancy was 96% sensitive and 100% specific. Using 5 ng as a cutoff for malignancy, the overall sensitivity of CEA for detection of malignancy was 77%; for detection of adenocarcinoma alone, sensitivity was 85%. Specificity was 100%. The CEA content of fine-needle aspirates generally exceeded serum values by 10–100-fold. Although CEA content did not enhance the sensitivity of cytologic diagnosis, it may suggest metastatic carcinoma of the GI tract in patients presenting with adenocarcinoma of an unknown primary source.     

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. © 1995 Willey- Liss, Inc.     

Nodular pulmonary amyloidosis: Diagnosis by fine-needle aspiration cytology and a review of the literature

Solitary nodular pulmonary amyloid tumor is an uncommon benign lesion which is seldom diagnosed prior to surgical extirpation. We present a case of unsuspected nodular pulmonary amyloid tumor diagnosed by fine needle aspiration cytology. A 52-yr-old-black woman presented with a 3-cm right middle lobe mass. Percutaneous fine-needle aspiration cytology (FNA) of the mass revealed waxy amorphous material that demonstrated apple green birefringence on Congo Red Stain. Thoracotomy for diagnosis may be avoided by using FNA to diagnose these unusual lesions.     

Significance of endothelium in the fine-needle aspiration biopsy diagnosis of hepatocellular carcinoma

We reviewed fine-needle aspiration biopsies (FNAB) of hepatocellular carcinoma (HCC) (n = 35), benign hepatic processes (n = 35), cholangiocarcinoma (CC) (n = 6), and metastatic tumors (n = 100) to evaluate the significance of endothelium present either peripherally-wrapping around groups of cells, (peripheral endothelium (PE)), or transgressing sheets of cells (transgressing endothelium (TE)), in distinguishing these lesions. These patterns were assessed as absent, focal, or prominent. Thirty-three of 35 (94%) HCCs contained either focal or prominent PE or TE, compared to only 3 of 35 (9%) benign hepatocytic lesions. Only one benign lesion contained a prominent endothelial component (TE only). Two cases of HCC failed to contain endothelium, one fibrolamellar variant and one well-differentiated HCC. These differences were statistically significant (P < 10^–5, sensitivity 94%, specificity 91%, and positive predictive value [PPV] 92%). Neither pattern of endothelium was present in any CC or metastatic tumor. These differences were also statistically significant (P < 10^–5, sensitivity 94%, and specificity and PVP 100%). We conclude that the presence of endothelium, at least focally in either one or both distinctive patterns, is highly sensitive and specific for HCC and aides in distinguishing it from benign hepatocytic lesions, CC, and metastases. © Wiley-Liss, Inc.     

Solitary pleural amyloid nodules occurring as coin lesions diagnosed by fine-needle aspiration biopsy

Solitary pleural amyloid nodule is rare and radiologically can mimic neoplastic lesions. This report describes two cases of this entity diagnosed by fine-needle aspiration biopsy in patients without systemic amyloid deposits. The histologic, ultrastructural, and cytologic features are described.     

Diagnosis of metastatic appendiceal adenocarcinoid in liver by fine-needle aspiration cytology

A 70-yr-old woman presented with symptoms clinically attributed to acute appendicitis. An adenocarcinoid tumor of the appendix was resected, followed by right hemicolectomy with negative lymph nodes. Seven years later, a fine-needle aspiration biopsy was performed on one of multiple hepatic nodules, revealing metastatic adenocarcinoid. the cytopathologic features of the metastatic tumor are described.     

Cytologic diagnosis of cavernous hemangioma of the liver with fine-needle biopsy.

We present the cytopathologic findings in seven cases of cavernous hemangiomas of the liver diagnosed by direct "squash" smears made on tissue obtained through image-guided fine-needle biopsy. The diagnosis in each case was confirmed histologically. Utilizing this simple cytologic technique, the morphologic findings in these common hepatic lesions are as accurate and diagnostic as histologic examination.     

Histochemical analysis of senile plaque amyloid and amyloid angiopathy

Summary Histochemical methods were used to obtain information on the chemical constituents of brain amyloid in senile dementia of the Alzheimer type. The staining properties of brain amyloid (senile plaque and amyloid angiopathy) were compared with those of extraneural amyloidosis and endocrine amyloid. We found no histochemical differences between amyloid in senile plaques and in amyloid angiopathy. The content of aromatic amino acids was higher in amyloid of plaques and in amyloid angiopathy than in endocrine amyloid. Furthermore, we found persistent birefringence and affinity of brain amyloid for Congo red after exposure to potassium permanganate, suggesting that AA amyloid is not a major constituent of cerebral amyloid.     

Classification of amyloid deposits in diagnostic cardiac specimens by immunofluorescence

BackgroundAt least 12 distinct forms of amyloidosis are known to involve the heart or great vessels. Patient treatment regimens require proper subtyping of amyloid deposits in small diagnostic cardiac specimens. A growing lack of confidence in immunohistochemical staining for subtyping amyloid has arisen primarily as a result of studies utilizing immunoperoxidase staining of formalin-fixed paraffin-embedded tissue. Immunofluorescence staining on fresh frozen tissue is generally considered superior to immunoperoxidase staining for subtyping amyloid; however, this technique has not previously been reported in a series of cardiac specimens.MethodsAmyloid deposits were subtyped in 17 cardiac specimens and 23 renal specimens using an immunofluorescence panel.ResultsAmyloid deposits were successfully subtyped as AL, AH, or AA amyloid by immunofluorescence in 82% of cardiac specimens and 87% of renal specimens. In all cases, the amyloid classification was in good agreement with available clinical and laboratory assessments. A cross-study analysis of 163 cases of AL amyloidosis reveals probable systemic misdiagnosis of cardiac AL amyloidosis by the immunoperoxidase technique, but not by the immunofluorescence technique.ConclusionsAmyloid deposits can be reliably subtyped in small diagnostic cardiac specimens using immunofluorescence. The practical aspects of implementing an immunofluorescence approach are compared with those of other approaches for subtyping amyloid in the clinical setting.     

Ultrasonically guided fine-needle aspiration biopsy of portal vein thrombosis: A cytomorphological study of 14 patients

Portal vein tumor thrombosis is an important and consistent prognostic indicator in hepatocellular carcinoma. We reviewed 14 cases of ultrasonically guided fine-needle aspiration biopsy (FNAB) of the portal vein. All the patients had clinical evidence of portal vein thrombosis (PVT). Twelve of these patients had a preliminary diagnosis of hepatocellular carcinoma while the remaining two, initially, had a clinical diagnosis of end-stage liver disease. The mean age of the patients was 60 years. An average of 1.7 passes per case was made. No clinical complications were encountered. The cytomorphologic features of the aspirated materials were reviewed. Twelve of the 14 cases (85.7%) were judged neoplastic or thought to have probable neoplastic involvement of the portal vein while two were clearly benign. The cell block was found to be the most useful in diagnosis. We conclude that FNAB of the portal vein is a feasible method in evaluating PVT, especially in patients already known to have hepatocellular carcinoma. Diagn Cytopathol 1994; 11:281–285. © 1994 Wiley-Liss, Inc.     

Quality assurance in a fine-needle aspiration biopsy service.

Fine-needle aspiration biopsy (FNAB) is an increasingly popular tool for the evaluation of a variety of palpable and nonpalpable masses. Its acceptance has been based on its simplicity, safety, and accuracy. It is its accuracy that is crucial and that requires careful clinical and/or histologic follow-up. In order to satisfy our own department's quality assurance requirements, we developed a computer-based searching program that effectively identifies FNAB cases in which there was histologic follow-up and retrieves the necessary information to produce a meaningful quality assurance report.     

Diagnosis of the type of amyloid in paraffin wax embedded tissue sections using antisera against human and animal amyloid proteins

Summary Different histochemical techniques were compared on paraffin wax embedded tissue sections for routine classification of amyloid; the following methods were used: potassium permanganate, the indirect immunoperoxidase method using polyclonal anti-human amyloid antisera (anti-AA, anti-A, anti-A and anti-AF) and the peroxidase-antiperoxidase (PAP) method using antisera against human, bovine, hamster and canine AA amyloid. Anti-human AA antiserum appeared to be a useful tool in this respect. Polyclonal anti-AL antisera may be helpful in diagnosing AL amyloid, but were of less value than anti-AA serum.Strong cross reactivity between anti-bovine AA antiserum and human AA amyloid deposits was found. This indicates that animal amyloid AA antisera can also be used for the diagnosis of AA amyloid in human tissues.This study was funded by the Division of Rheumatology, A.Z.U., the Netherlands League against Rheumatism and Sonderforschungsbereich 0207 (Project C6), München     

Cytopathology of fine-needle aspiration biopsy of the brain and spinal cord

The cytomorphologic findings of 37 intraoperative fine-needle aspiration (FNA) biopsies are presented. Thirty-two of the biopsies were performed at the time of craniotomy, and five were performed through a burr-hole. All cases used direct smear preparations stained with Papanicolaou and modified Wright stain (Diff-Quik). Immediate evaluation of the Diff-Quik-stained smears was performed for assessment of the adequacy of the specimen, and in most cases, a rapid preliminary diagnosis (similar to a frozen-section report) was rendered in the operating room. Cytopathologic features of anaplastic astrocytomas, glioblastoma multiforme, pituitary adenoma, meningioma, metastatic carcinoma, epidermoid cyst, herniated disc, hemangioblastoma, cerebral hemorrhage, and malignant lymphoma are described and illustrated. The cytologic preparation demonstrated superior cellular detail, which served as a considerable aid for diagnosis, and lacked the artifactural distortion often seen in the frozen-section preparations. Reliance on the fine-needle aspiration biopsy specimen enabled better triage of the small amount of tissue often available for permanent sections and special studies including electron microscopy and immunohistochemistry. Although not meant to replace tissue biopsy, FNA of the central nervous system though burr holes under radiologic guidance can be advantageous in selective cases.     

Seminal vesicle amyloid: the first example of exocrine cell origin of an amyloid fibril precursor.

Amyloid fibrils have been extracted from seminal vesicles, and a dominant 14 kD amyloid fibril protein has been identified. An antiserum to this protein reacted both with amyloid and with epithelial cells in some normal seminal vesicles. These reactions were blocked with seminal vesicle secretion and seminal vesicle amyloid fibril protein, but not by degraded amyloid fibrils or fibril protein from other types of amyloid. It is concluded that seminal vesicle amyloid is derived from secretory proteins of the seminal vesicles. As such, it is the first amyloid described which appears to be the product of an exocrine secretory cell.     

Incidence and characterization of age related amyloid deposits in the human anterior pituitary gland

Summary To identify amyloid deposits in the anterior pituitary gland, we have immunohistochemical, histochemical and alkaline Congo red staining. The anti-human P component reacted positively with these amyloid deposits, while antisera against prealbumin, AA type amyloid fibril protein and various anterior pituitary hormones were negative. A combination of Congo red and anti-human P component staining was most sensitive and reliable for detection of amyloid in the anterior pituitary glands of 300 randomly autopsied patients. Amyloid deposits increased in parallel with the age of the patients, however, they appeared earlier and more frequently than heretofore reported. Deposition of amyloid was seen initially in the 3rd decade and the positivity rate of amyloid deposits was 73% in the 5th decade. The histochemical characteristics of these pituitary amyloid deposits differed from those of cerebral and systemic deposits, particularly those found in the amyloid of senile systemic amyloidosis.This study was supported in part by a grant from the Fundation for Advancement of Clinical Medicine and Ministry of Health and Welfare of Japan     

Prognostic factors from the fine-needle aspirate: Breast carcinoma nuclear grade

Two of the most important microscopically derived morphologic prognostic factors for breast carcinoma patients are histologic type of tumor and nuclear grade. The recent literature stresses the importance of including these parameters in the surgical pathology report, yet there is little information in the cytology literature regarding the reporting of the nuclear grade of breast carcinomas from fine-needle aspirate biopsies (FNAB). In this retrospective study, we examined 104 ductal carcinomas of the breast in order to determine whether the FNAB derived nuclear grade and morphologic aspects of histological grading such as tubule formation and mitoses could accurately correlate with the same parameters on the tissue specimens. There was a correlation of 87% between the nuclear grade assigned by FNAB and the nuclear grade assigned to the tissue sample. Both the Diff-Quik and the Papanicolaou staining methods were assessed in this study and both gave comparable nuclear grade results. Tubule formation was difficult to assess on the cytologic samples and mitoses showed no correlation between cytologic and tissue specimens. The FNAB sample was not representative of the tissue nuclear grade in only 4.8% of the cases. Nuclear grade is especially important in patients treated with chemotherapy prior to definitive therapy for breast carcinoma. We conclude that the nuclear grading of breast carcinomas is performed with ease, correlates well with tissue nuclear grade, and, as a fundamental cytologic parameter, should be included in the fine-needle aspirate biopsy report whenever possible. © 1994 Wiley-Liss, Inc.     

Significance of giant cells in fine-needle aspiration biopsies of benign and malignant lesions of the pancreas

The cytologic results of 44 consecutive fine-needle aspiration (FNA) biopsies of the pancreas are reported. The series consisted of 27 women and 17 men with an age range of 31-89 yr (mean, 61.5). Excluding insufficient cases, the sensitivity of the procedure was 88%, specificity was 100%, positive predicative value (PV) was 100%, negative PV was 69%, and efficiency of the test was 90%. There were 29 true-positive, four false-negative, and nine true-negative diagnoses. Two specimens were insufficient for diagnosis. Giant cells of varying types were seen in both the malignant and benign cases. Two of the benign cases demonstrated rare multinucleated foreign body-type giant cells, most likely representing the changes seen in pancreatitis. In 13 malignant cases, multinucleated tumor cells were present, while six additional cases had multinucleated benign histiocytes reflecting the associated pancreatitis. Two malignant cases each had tumor giant cells and benign multinucleated histiocytes. Three of the malignant cases had numerous multinucleated tumor giant cells arranged in a dissociative fashion with evidence of cytophagocytosis consistent with a pleomorphic giant-cell carcinoma of the pancreas. One additional case demonstrated numerous multinucleated osteoclastic-like cells consistent with an osteoclastic tumor of the pancreas. This article documents the accuracy of FNA biopsy of the pancreas and notes that giant cells of varying types can be found in pancreatic FNA biopsies. Appreciation of the various types of giant cells in pancreatic FNA biopsy is important for diagnostic accuracy and prognosis.     

乳腺癌细针穿刺标本中端粒酶检测的诊断意义

目的 检测乳腺癌细针穿刺细胞标本中的端粒酶,探讨其在乳腺癌辅助诊断中的临床意义。方法 采用聚合酶链反应－端粒末端重复序列技术检测９９例乳腺细针穿刺标本（８３例乳腺癌、１２例乳腺良性病变和４例乳腺炎）中的端粒酶。