Cystic nephroma: cytologic findings in fine-needle aspiration cytology.

This report presents the fine-needle aspiration cytology (FNAC) findings of a multicystic renal tumor found in a 3-year-old child. The smears contained benign epithelial cells isolated or arranged in sheets of uniform cells strongly suggesting the lining of the cysts. The combination of the imaging data with the FNAC findings favoured the diagnosis of cystic nephroma (CN), a benign renal tumor that is cured by surgery. Surgical pathology confirmed the diagnosis. CN should be added to the list of tumors of the kidney in infancy that appear to be diagnosable by FNAC/biopsy.     

Breast fine-needle aspiration. A comparison of ThinPrep and conventional smears

Fine-needle aspiration (FNA) of the breast has been used in our institution since 1969. In August 1993, ThinPrep (Cytyc Corp, Boxbotough, MA) processing of breast FNA biopsy specimens was introduced. Comparing conventionally prepared breast FNA specimens (21,193 cases) with ThinPrep processed material (7,903 cases) shows a decrease in the unsatisfactory rate with the ThinPrep processing (29.5% to 27.7%) with no significant change in sensitivity (84.4% vs 86.3%) or positive predictive value (96.5 vs 95.0%). However, there is a slight decrease in specificity (98.6% vs 96.5%) and negative predictive value (91.1% vs 88.0%) with the ThinPrep specimens. The results span 28 years, during which time the breast cancer population has changed, with a higher prevalence of malignancy in the last decade of our study. When the 4 most recent years of conventional cytology are compared with the 4 years of ThinPrep processing, there is no significant difference in diagnostic accuracy. The results of the present study show that the ThinPrep processing technique provides an effective method for preparing breast FNA. specimens.     

Role of cytologic examination of smears in vulvovaginal candidiasis

Cytological examination allows one to reveal various forms of the fungus vegetation in the host, the fungus-epitheliocyte interaction to evaluate morphological state of the epithelium. The method in combination with clinical symptoms allows one to establish a differential diagnosis of genital candidiasis in 87.8% cases and to have an opinion of the disease prognosis.     

Repeat thyroid nodule fine-needle aspiration in patients with initial benign cytologic results

Fine-needle aspiration (FNA) is the standard of care for the initial workup of thyroid nodules, but there is no consensus algorithm to manage patients with benign results. We examined performance characteristics of initial and repeat satisfactory FNAs for all 402 patients who underwent thyroid surgery during a recent 22-month period. Of these patients, 267 had at least 1 satisfactory FNA and 70 had 2 or more. After an initial benign FNA, 1 repeat FNA correctly identified an unsuspected malignancy in 2 of 70 patients and was indeterminate in 17; of these, 7 of 17 were identified as malignant in the final pathologic diagnosis. Overall, the use of 1 repeat FNA increased the sensitivity for malignancy from 81.7% to 90.4% and decreased the false-negative rate from 17.1% to 11.4%. With more than 1 repeat FNA, there was no improvement in performance characteristics. These data make a strong argument for 1 repeat FNA following an initial benign FNA diagnosis.     

Desmoplastic ameloblastoma: a case report with fine-needle aspiration cytologic findings

A case of desmoplastic ameloblastoma of the maxilla in a 25-yr-old woman is presented. Smears prepared from fine-needle aspiration cytology showed two populations of cellular elements: cohesive epithelial clusters with basaloid morphology present, mostly in bidimensional, irregularly outlined clusters with ill-formed palisading of nuclei at the periphery in some, and a mesenchymal component represented by 1) a sparse chunk of moderate-sized tissue fragments made up of spindle- or ovoid-shaped nuclei entrapped in mesenchymal matrix, and 2) many dissociated naked oval-to-spindle-shaped nuclei. The presence of epithelial and mesenchymal components and their benign nature lead us to consider the possibility of benign odontogenic tumors 1) of epithelial origin, such as ameloblastma with a stromal component, e.g., desmoplastic ameloblastoma; 2) of mesenchymal origin, such as odontogenic fibroma; and 3) of mixed epithelial and mesenchymal origin, such as ameloblastic fibroma. Excision and histopathological examination of this lesion confirmed the diagnosis of desmoplastic ameloblastoma. In the given clinical setting and radiological examination, the above cytological features suggest a benign odontogenic tumor, rather than precisely diagnosing any of the entities mentioned above. However, it is important to distinguish between these, since the treatment varies accordingly. The differential diagnosis is discussed.     

Cytopathology and AgNOR counts in fine-needle aspiration cytology smears of thyroid lesions

The object of the present work is to study the cytomorphological features and the value of silver colloidal staining method in distinguishing the non-neoplastic, benign, and malignant neoplasm in fine-needle aspiration cytology (FNAC) smears of thyroid nodules. One hundred forty histologically confirmed aspirated samples of thyroid lesions were studied and classified cytologically. These smears were stained for AgNOR counts. The number and location of AgNOR dots as well as clusters in nuclei were studied by two different observers independently. Lower AgNOR counts were recorded in cases of thyroiditis (1.375 ± 0.414), whereas follicular carcinoma had a higher number of AgNOR counts (5.04 ± 0.52). The clusters of AgNOR dots were centrally located in colloid goitre, but no cluster arrangement was observed in cases of carcinomas. Increased nuclear size, nucleoli, and chromocentres were helpful in the diagnosis of follicular carcinoma. AgNOR counting cannot be reliably used on an individual case basis to differentiate adenoma from carcinoma. Therefore, AgNOR study in thyroid lesions can be used as an additional diagnostic method with cytomorphological features to differentiate benign and malignant follicular neoplasms. Diagn. Cytopathol. 1998;19:238–243. © 1998 Wiley-Liss, Inc.     

Diagnosis of pulmonary blastoma by fine-needle aspiration biopsy: cytologic and immunocytochemical findings.

A preoperative diagnosis of pulmonary blastoma was established by fine-needle aspiration (FNA) cytology in a patient who presented with a pulmonary mass discovered incidentally on chest x-ray. At the time of computed tomography-guided FNA, an on-site preliminary diagnosis of poorly differentiated carcinoma was made after examination of a rapid hematoxylineosin (H&E)-stained smear. Malignant epithelial and stromal elements could be demonstrated on smears subsequently stained with the H&E, Papanicolaou, and Diff-Quik methods. The cell block preparation showed a distinctly biphasic malignant tumor with classic morphologic features of pulmonary blastoma. We present the clinical, cytologic, immunocytochemical, and histologic findings of this case and re-emphasize the valuable contribution of adequate cell block preparations to accurate diagnosis of fine-needle aspiration material.     

Kuttner tumor of the submandibular gland: fine-needle aspiration cytologic findings of seven cases.

Kuttner tumor or chronic sclerosing sialadenitis is a benign inflammatory condition of the submandibular gland that mimics a malignant neoplasm clinically because of presentation as a hard mass. This is an underrecognized entity in the surgical pathology and cytology literature. We describe thefine-needle aspiration cytologic findings of 7 cases with histologic correlation. The 6 men and 1 woman (age, 47-72 years) had unilateral (4 cases) or bilateral (3 cases) submandibular masses known to be present for 1 month to 6 years (mean, 15 months). The aspirates were paucicellular to moderately cellular. They were characterized by scattered tubular ductal structures often enveloped by collagen bundles or lymphoplasmacytic infiltrate, isolated fragments of fibrous stroma, a background rich in lymphoid cells, and paucity or absence of acini. Histologic examination of the excised submandibular glands revealed preserved lobular architecture, thickening of interlobular septa by sclerotic tissue, dense lymphoplasmacytic infiltrate, preservation of ducts with periductal fibrosis, and variable loss of acini. In combination with the clinical findings, the fine-needle aspiration cytologic findings can strongly suggest the diagnosis of Kuttner tumor and may obviate the need of surgical intervention.     

Cystic lesions of the salivary glands: cytologic features in fine-needle aspiration biopsies

A variety of neoplastic and nonneoplastic lesions of the salivary glands have a predominantly cystic architecture. Fine-needle aspirates of these lesions yield watery or mucoid material, frequently of low cellularity. Such aspirates may be obtained from mucus retention cysts, lymphoepithelial cysts, cystadenomas, Warthin's tumors, cystic pleomorphic adenomas, low-grade mucoepidermoid carcinomas, cystadenocarcinomas, and examples of polycystic disease of the parotid gland. The cellular component within the fluid obtained from these lesions may be exceedingly scant or absent, making cytologic diagnosis difficult and, at times, impossible. We studied a series of 56 cystic lesions of the salivary glands, including 38 Warthin's tumors, 6 benign cysts, 2 lymphoepithelial cysts, 5 low-grade mucoepidermoid carcinomas, 1 cystic pleomorphic adenoma, 2 cystadenomas, and 2 cystadenocarcinomas. Careful attention to the cellular elements present often allowed definitive cytologic diagnosis, with an overall accuracy rate of 84%. The presence of atypical squamous metaplasia in oncocytic lesions was a significant cause of false-positive diagnoses of carcinoma (4 cases, 7%). Aspirates of low-grade mucoepidermoid carcinoma may contain no epithelial cells and result in false-negative diagnoses (1 case, 2%).     

ThinPrep vs. conventional smear cytologic preparations in analyzing fine-needle aspiration specimens from palpable breast masses.

Limited data exist concerning the cellular features of the ThinPrep (Cytyc Corp., Boxborough, MA) technique in the analysis of breast fine-needle aspiration specimens. Therefore, we analyzed a series of 75 surgically excised palpable breast masses and compared ThinPrep and conventional smear fine-needle aspiration preparations. Each mass was aspirated twice. The first sample was used for two alcohol-fixed conventional smears, and the second sample was rinsed into CytoLyt (Cytyc Corp., Boxborough, MA) solution for processing into a ThinPrep slide. The paired slides were separated and independently analyzed for adequacy, overall cellularity, single epithelial cells (absent, rare, moderate, or numerous), epithelial architecture (sheets or three-dimensional clusters), myoepithelial cells and stripped bipolar nuclei (present or absent), and nuclear detail (poor, satisfactory, or excellent). Each sample was classified as negative, negative consistent with fibroadenoma, atypical favoring benign, atypical favoring malignant, or positive for malignant cells. The 75 breast masses included 32 carcinomas and 43 benign lesions. Four conventional smears and one ThinPrep were unsatisfactory. Significantly, more conventional smears were limited by drying artifact (9 vs. 0). ThinPrep aspirates of carcinomas had better nuclear detail (P = 0.03) and greater cellularity (P = 0.05). ThinPrep aspirates of benign masses had greater epithelial cellularity (P = 0.007) and better nuclear detail (P < 0.001), and more specimens had myoepithelial cells (P = 0.007). The ThinPrep interpretation classified 29 of 32 carcinomas (91%) as positive and three as atypical favoring malignant (sensitivity = 100%). The conventional smear interpretation classified 28 of 31 carcinomas (90%) as positive and three as atypical favoring malignant (sensitivity = 100%). The ThinPrep interpretation classified 42 benign lesions as negative (23 cases), negative consistent with fibroadenoma (8 cases), atypical favoring benign (10 cases), and atypical favoring malignant (1 case) (specificity = 74%). The conventional smear interpretation classified 40 benign lesions as negative (25 cases), negative consistent with fibroadenoma (12 cases), and atypical favoring benign (3 cases) (specificity = 93%). ThinPrep was less specific, but the difference was not statistically significant (P = 0.065). In summary, ThinPrep aspirates had greater cellularity and better nuclear detail than conventional smears, and were just as sensitive in identifying the carcinomas. The difference in specificity between the two techniques was not statistically significant (P = 0.065). Diagn. Cytopathol. 1999;21:137-141.     

Ultrafast papanicolaou stain is not limited to rapid assessments: Application to permanent fine-needle aspiration smears

Ultrafast Papanicolaou (Pap) stain, a 90-second preparation originally designed for the immediate assessment of fine-needle aspiration (FNA) smears (Yang and Alvarez, Acta Cytol 1995;39:55–60), can also be adapted for permanent FNA smears. It involves the addition of three simple steps prior to the conventional Pap procedure: the first step is to make the cells appear larger, thus increasing the resolution for analysis of cellular details; the second step is to hemolyse the background blood, thus unmasking tumor cells; and the third step is to bring out the vibrant colors in the cells and the nucleoli, which stain red. © 1995 Wiley-Liss, Inc.     

Commercial laboratory practice evaluation of air-dried/rehydrated cervicovaginal smears vs. traditionally-fixed smears

Air-drying artifacts remain a significant problem in the interpretation of cervicovaginal cytologic smears. One historical, and little-used, method to combat these artifacts is to have smears submitted solely air-dried, subsequently rehydrated, fixed, and then stained as usual. Reported here is a 1992–1993 retrospective matched provider study of 6,788 air-dried/rehydrated smears and 1,691 traditionally-fixed smears. No significant differences either in the percentage of abnormalities (8.6% vs. 8.2%) or the degree of abnormality (class II, 6.9%/6.9%; class III, 1.7%/1.3%; class IV, .01%/.06%; and class V, .01%/0%) were seen between the two techniques. Cytology-biopsy correlation remained in the 98–99% range for three large providers switching from air-dried to traditionally-fixed smears. These findings strengthen our belief that the air-dried/rehydrated technique is a viable alternative to combat the usual “air-dried” artifact problem. Diagn. Cytopathol. 16:174–176, 1997. © 1997 Wiley-Liss, Inc.     

Morphometric analysis of the homogeneity of lymphoid cell populations in fine-needle aspiration cytology smears

Quantitative morphometry was used to evaluate the homogeneity of lymphoid cell populations in fine-needle aspiration cytology smears of lymph nodes from eight non-Hodgkin's lymphomas and four benign lymphoid proliferations. Using the standard deviation of log-transformed nuclear areas as the measure of lymphoid cell homogeneity, diffuse small cell lymphomas were found to be significantly more homogeneous than diffuse large cell lymphomas or benign lymphoid proliferations, but there was no significant difference in the homogeneity of the latter two groups. Two of four large cell lymphomas showed a bimodal distribution of nuclear areas. Methodologic issues--including the random selection of cells, the number of cells that should be counted in each case, the significance of microscopic field-to-field variation in this setting, and the significance of drift in observations during the examination of individual cases--are discussed.     

Glomus tumor of the stomach: cytologic diagnosis by endoscopic ultrasound-guided fine-needle aspiration

The glomus tumor is usually a benign solitary neoplasm that arises from modified smooth muscle cells of the glomus body, a type of neuromyoarterial receptor that plays a role in the regulation of arterial blood flow. We report a case of gastric glomus tumor diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Smears exhibited groups of cohesive, uniform, small, round to polygonal cells with scant cytoplasm, indistinct cell borders, and round, hyperchromatic nuclei with homogeneous chromatin. The cell block contained fragments of cells with similar morphologic features and immunohistochemical staining exhibited positivity for smooth muscle actin and vimentin. The diagnosis was confirmed by the surgically resected specimen. Ultrastructural examination revealed prominent pinocytotic vesicles lining the plasmalemma. In this report, we discuss the differential diagnosis of gastric glomus tumor and compare the cytologic features of this case with two others reported in the literature.     

Atypical chondroma of the cricoid cartilage: fine-needle aspiration cytologic and histopathologic findings

Chondroma of the laryngeal skeleton is a rare, benign neoplasm manifested either as a neck mass or, if situated within the airway, as slowly progressive obstruction, hoarseness, or dyspnea. The most common site is the posterior plate of the cricoid cartilage. An atypical perichondrial chondroma arising from the anterior plate of the cricoid cartilage membrane as a neck mass in a young female is presented. The diagnosis was made on a fine-needle aspiration of the mass and subsequently confirmed by histologic examination of the excised mass. Although rare, cartilaginous tumors of the laryngeal skeleton can manifest as a neck mass, and the diagnosis can be made by fine-needle aspiration biopsy in combination with radiographic and clinical examinations. Therefore, the existence and inclusion of these tumors in the differential diagnosis of neck masses by aspiration biopsy should be considered by clinicians and pathologists, and especially cytopathologists, when cartilaginous components are encountered.     

Ciliated foregut cyst of pancreas: cytologic findings on endoscopic ultrasound-guided fine-needle aspiration

The cytologic findings of a ciliated foregut cyst of the pancreas diagnosed by endoscopic ultrasound-guided fine-needle aspiration (FNA) are described. Cytologic features of ciliated foregut cysts include the presence of ciliated columnar cells and detached ciliary tufts in a cystic fluid background with amorphous debris and rare macrophages. These cytologic findings are clearly distinct from those of cystic mucinous neoplasms and other pancreatic cysts with which the ciliated foregut cyst may be confused. To the best of our knowledge, this is the first case reporting the cytologic findings of a pancreatic ciliated foregut cyst sampled by endoscopic ultrasound-guided FNA. We believe that the distinctive and characteristic cytologic features can allow a preoperative cytologic diagnosis of this highly unusual pancreatic cystic lesion.     

Application of nucleolar organizer region staining technique to air-dried blood smears]

Silver staining of nucleolar organizer regions (NOR) was applied to air-dried peripheral and bone marrow smears of normal subjects and leukemic patients. Specimens were fixed in buffered acetone formalin. Even in smears kept for 2 years at room temperature, the stainability of Ag-NOR was well preserved. By dipping Giemsa-stained smears in 5% trichloracetic acid and then placing them in methanol for 5 minutes, the stain was leached out. After the dye had been removed, the smears were clearly stained by a Ag-NOR staining technique. The mean number of Ag-NOR per nucleus of mature granulocytes and mononuclear cells in normal peripheral bloods was 0.59 and 1.43 respectively. The mean number of Ag-NOR per nucleus of peripheral and bone marrow leukemic cells from patients with acute leukemia and chronic myelocytic leukemia in blastic crisis was 2.32 and 2.66 respectively. On the other hand, the mean number of Ag-NOR per nucleus of peripheral leukemic cells from patients with chronic lymphocytic leukemia was 1.48. These results suggest that acute leukemia cells possess a more active proliferating potential. The Ag-NOR staining technique is very simple and might be useful for investigation of hematologic cells.     

Nevus-cell aggregates in lymph nodes: fine-needle aspiration cytologic findings and resulting diagnostic difficulties

We report a case of nodal nevus present in enlarged lymph nodes with changes of dermatopathic lymphadenopathy sampled by fine-needle aspiration (FNA) cytology prior to clinical evaluation of the patient. This lymph node pathology was established later by lymph node excisional biopsy, by which along with a skin biopsy the dermatopathic lymphadenopathy was tentatively attributed to early mycosis fungoides. The FNA revealed fairly atypical melanotic tissue from the dermatopathic lymphadenopathy along with nodules of uniform melanocytic nevoid cells, the presence of which in combination with the dermatopathic atypical tissue provided a tentative diagnosis of metastatic melanoma of unknown primary, with the diagnosis of nodal nevus presented as a less likely possibility. This is to our knowledge the first cytologic report on FNA of nodal nevus, which besides presenting cytologic findings of this entity highlights some of the problems related to providing an accurate diagnosis, if this exceptionally unusual pathologic entity is encountered in lymph nodes sampled for enlargement from pathologies unrelated to this entity. The subject of nevus changes in lymph nodes is briefly discussed.