不能手术切除的非小细胞肺癌集束电极射频治疗的初步探讨

目的：探讨应用集束电极射频(radiofrequency ablation；RFA)治疗不能手术切除的非小细胞肺癌的可行性和近期疗效。方法：在CT引导下经皮肺穿刺或术中直视下RFA治疗不能手术切除的非小细胞肺癌，随访观察治疗近期效果、中位生存期、1年生存率、2年生存率及围手术期并发症。结果：86例患共92个肿瘤病灶用RFA治疗，术后并发气胸16例，随访5～36个月。治疗后1个月41．86％的KPS评分改善。16例出现局部复发，其中9例患再次RFA。中位生存时问为14个月，1年生存率为78．15％，2年生存率为46．88％。结论：RFA治疗不能手术的非小细胞肺癌创伤小，可重复治疗，安全可靠．局部治疗效果较好。     

Retroperitoneal germ cell tumor diagnosed by endoscopic ultrasound-guided fine needle aspiration

Isolated extragonadal germ cell tumors can be primary in nature or metastatic from a burned out testicular cancer. Accurate diagnosis is critical as appropriate therapy can be highly curative. We present the case of an isolated extragonadal germ cell tumor in the retroperitoneum diagnosed by endoscopic ultrasound-guided fine needle aspiration. This case underscores the importance of considering germ cell tumors in the differential diagnosis of an unexplained retroperitoneal mass, particularly since immunophenotypic staining may be necessary to establish the diagnosis.     

The Merkel cell carcinoma challenge

Merkel cell carcinoma (MCC) is a highly aggressive neuroendocrine carcinoma of the skin that occurs primarily in elderly or immunocompromised patients. For this report, the authors reviewed the diagnostic challenges associated with MCC encountered on their fine‐needle aspiration (FNA) service and also conducted an in‐depth review of the literature on MCC. A computer search for patients who were diagnosed with MCC by FNA at the authors' institution from 2006 to 2010 was conducted, and 5 patients were selected for cytologic and immunochemical analyses based on their varied and diagnostically challenging clinical presentations. The 5 selected patients had clinical findings commonly associated with MCC, including advanced age (4 of the 5 patients were ages 75‐85 years) and a history of previous malignancies (3 of the 5 patients had a history of previous malignancy), and 1 patient was diagnosed with a concomitant low‐grade lymphoma. The patients and their disease illustrated the protean clinical presentation of MCC and the clinical and cytologic challenges associated with this neoplasm. The current findings indicate the need for cytopathologists to be aware of the deceptive presentation of this neoplasm and its cytologic and immunochemical features to correctly diagnose this insidious neoplasm. Cancer (Cancer Cytopathol) 2013;121:179–188. © 2012 American Cancer Society.     

Granular cell tumor of the breast diagnosed by core needle biopsy: a case report

Granular cell tumor rarely occurs in the breast. We report a 69-year-old woman with a right breast mass that simulated carcinoma on palpation, mammography, and ultrasonography. Aspiration biopsy cytology showed no malignant atypical cells. Core needle biopsy was performed to obtain an accurate diagnosis. The lesion was histologically confirmed to be a granular cell tumor. Immunostaining was positive for S-100 protein and vimentin, and negative for keratin, carcinoembryonic antigen, estrogen receptor and gross cystic disease fluid protein-15. The tumor was treated by wide local excision. Surgeons should be aware that granular cell tumor can resemble breast cancer in order to avoid performing a needless radical mastectomy.     

Cytology of desmoplastic small round‐cell tumor

BACKGROUND.

Desmoplastic small round‐cell tumor (DSRCT) is an aggressive malignancy of young adults, which is amenable to fine‐needle aspiration biopsy (FNAB). As this entity is increasingly recognized and biopsied, cytopathologists are compelled to become familiar with the range of cytologic features of DSRCT. In addition, postchemotherapy tumors may be sampled to confirm disease recurrence before planning additional therapy. This study was designed to compare prechemotherapy and postchemotherapy cytomorphology of DSRCT and to evaluate for distinct chemotherapy‐induced changes.

METHODS.

The authors searched their respective institutional databases for all DSRCT cases with an associated FNAB. FNAB slides, immunocytochemistry, and cytogenetic results were reviewed.

RESULTS.

Six aspirates from 5 patients were identified, 3 of which were postchemotherapy. The postchemotherapy cases demonstrated cytologic findings not typically described in DSRCTs, including prominent and conspicuous nucleoli, discohesive single‐cell architecture, and slightly larger cell size.

CONCLUSIONS.

Cytomorphologic variability was prominent in prechemotherapy cases, and no case could be classified as DSRCT on cytology alone; immunohistochemistry was necessary for definitive diagnosis. Chemotherapy increased the spectrum of cytologic features. The most notable difference between the 2 groups was a predominantly discohesive single‐cell pattern with conspicuous nucleoli in the postchemotherapy group, instead of the clustering pattern of medium‐sized cells with inconspicuous nucleoli typically attributed to de novo cases reported in the literature. Cancer (Cancer Cytopathol) 2006 © 2006 American Cancer Society.     

Analysis of ThinPrep cytology in establishing the diagnosis of small cell carcinoma of lung

BACKGROUND:

ThinPrep liquid‐based cytology (TP) preparations are being used increasingly in nongynecologic specimens. To the authors' knowledge, few studies to date have evaluated TP cytology in the setting of small cell carcinoma of the lung (SCCL). Accurately differentiating SCCL from other lung tumors has important clinical and therapeutic implications. Herein, the authors evaluated the diagnostic utility and cytomorphology of TP in the setting of SCCL.

METHODS:

All cases of SCCL with prior or concurrent TP cytologic specimens were identified via computer search. The cytodiagnoses were tabulated. When available, cytologic material was reviewed. Performance parameters of the various cytologic modalities processed with TP were calculated.

RESULTS:

In 121 patients with SCCL, 261 TP specimens were identified. The cytodiagnoses were: SCCL (119 specimens), suspicious for SCCL (45 specimens), atypical cells‐not otherwise specified (22 specimens), negative/nondiagnostic (63 specimens), and nonsmall cell carcinoma (4 specimens). During the same period of time, 3 cases of false‐positive diagnoses of SCCL were identified. The positive predictive value for a cytodiagnosis of SCCL on TP was 97.5%, and the sensitivity was 62.8%. Bronchial brush was the most sensitive cytologic modality (78.3%). Immunostaining was found to be contributory to the diagnosis in 10 of the 11 cases in which it was attempted.

CONCLUSIONS:

TP is a sound alternative to conventional preparations for the cytodiagnosis of SCCL. Cytomorphology of SCCL is altered in TP with less molding, less cell fragility, more discohesion, and tumor cell shrinkage artifact. Immunohistochemical staining of cellblocks is a useful adjunct in challenging cases. A positive cytodiagnosis of SCCL on TP can be used to initiate definitive therapy when biopsy is not possible. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.     

Fine-needle cytology of cutaneous juvenile xanthogranuloma and langerhans cell histiocytosis

BACKGROUND:

In pediatric patients, a cutaneous nodule is usually diagnosed by performing an excisional biopsy, but fine‐needle cytology (FNC) is a safer and noninvasive diagnostic method widely used to obtain diagnostic specimens with little stress to the patient. The authors compared the ability of FNC and biopsy to differentiate Langerhans cell histiocytosis (LCH) from juvenile xanthogranuloma (JXG).

METHODS:

Correlating cytological results with histological findings, the authors reviewed 27 patients (15 males and 12 females; mean age, 37 months; range, 1 month to 14 years) admitted to the University of Padua Department of Pediatrics from 1998 to 2010.

RESULTS:

Cytology smears were adequate in all 27 (100%) patients: 14 (52%) were classified as having JXG, 12 (44%) as having LCH, and 1 (4%) as having a doubtful finding. A biopsy was also performed in 20 of these patients, and in all but 1, the 2 methods were completely concordant.

CONCLUSIONS:

FNC is safe and useful in the diagnostic workup of pediatric patients with cutaneous nodules and has no contraindications to its use as the initial diagnostic procedure. Cancer (Cancer Cytopathol) 2011;. © 2010 American Cancer Society.     

Fine‐needle aspiration cytology of large cell neuroendocrine carcinoma of the lung

BACKGROUND.

The classification of pulmonary neuroendocrine neoplasms is particularly controversial. Large cell neuroendocrine carcinoma (LCNEC) has emerged as a separate entity among pulmonary endocrine neoplasms and the criteria for its histologic diagnosis are now well‐described. However, cytologic diagnosis presents more difficulties and to the authors' knowledge, few cytologic studies concerning the entity have been published to date. The objective of the current study was to describe the cytologic features of LCNEC in an attempt to distinguish it from other pulmonary carcinomas.

METHODS.

A cytohistologic study of 11 surgical lobectomy specimens classified as LCNEC was performed. In all these cases, preoperative fine‐needle aspiration cytology (FNAC) material was available for review.

RESULTS.

The cytologic features of the cases were rather similar, resulting in a repetitive pattern. The majority of smears were hypercellular with numerous single, medium‐to‐large cells. Naked nuclei were abundant but a variable subset of cells demonstrated evident cytoplasm. Groups were 3‐dimensional and of variable size, some of them large. Nuclear pleomorphism, molding, and mitosis were common findings. A necrotic background was evident in 6 cases. In 6 cases, neoplastic groups demonstrated peripheral nuclear palisading. Rosette‐like structures were present in samples from 5 patients. In 4 cases, immunocytochemistry for the detection of synaptophysin was performed, with positive results.

CONCLUSIONS.

The authors' experience with 11 FNAC cases of LCNEC, has led them to believe that the cytologic image of LCNEC is peculiar and recognizable in many cases. Nevertheless, it is a difficult diagnosis to make and immunocytochemistry plays a critical diagnostic role. Cancer (Cancer Cytopathol) 2008. © 2008 American Cancer Society.     

基于人工神经网络的诊断模型对针吸细胞学诊断小细胞型乳腺癌的应用研究

目的探讨人工神经网络（ANN）诊断模型对小细胞型乳腺癌的针吸细胞学诊断价值。方法利用MPIAS-2000系统对60例乳腺癌及30例乳腺良性病变针吸细胞的29项形态定量参数进行定量分析，建立人工神经网络诊断模型，对19例小细胞型乳腺癌进行人工神经网络诊断模型的判别分析。结果人工神经网络诊断模型对小细胞乳腺癌及良性病变的诊断特异性为100％，敏感性为84．2％。结论利用乳腺癌针吸细胞形态定量的人工神经网络诊断模型，对辅助针吸细胞学诊断小细胞型乳腺癌具有重要的参考价值。     

Diagnostic challenges of metastatic spindle cell melanoma on fine‐needle aspiration specimens

BACKGROUND

Spindle cell melanoma is a morphologic variant of melanoma that can be difficult to diagnose on specimens obtained via fine‐needle aspiration (FNA). Published cytology studies concerning this entity were based for the most part on small series. In the current study, a large series of metastatic spindle cell melanoma is described and the diagnostic pitfalls present in FNA samples addressed.

METHODS

The authors retrospectively reviewed the cytologic features of 81 metastatic spindle cell melanoma specimens obtained from 67 patients. Corresponding primary tumors or metastatic tumors taken elsewhere from the same patient were also evaluated.

RESULTS

The cytologic smears were mostly cellular and comprised of predominantly spindle tumor cells that frequently formed cohesive fascicles or whorls intermingled with scattered epithelioid tumor cells. The classic cytologic characteristics of conventional melanoma (predominantly dyshesive cellular distribution, cytoplasmic melanin pigments, intranuclear pseudoinclusions, macronucleoli, and binucleation or multinucleation) were noted infrequently or, if present, were more readily found in coexisting epithelioid cells. Remarkably, 9% of the cases failed to demonstrate any of the above classic characteristics. In addition, spindle cells demonstrated a wide range of cytologic atypia, from deceptively bland cells resembling reactive fibroblasts to those indistinguishable from pleomorphic high‐grade sarcomatous neoplasms. When the morphologic features were compared with those of the primary tumor or metastatic melanoma taken elsewhere from the same patient, cell type discrepancy was found in 20% of the cases in that the previous counterparts demonstrated the epithelioid cell type. Spindle cells also tended to lose immunoexpression of melanoma markers.

CONCLUSIONS

Spindle cell melanoma infrequently demonstrates the diagnostic cytologic features and immunoreactivity of conventional melanoma. Varying degrees of cytologic atypia and possible cell type differences from the primary counterpart or metastatic melanoma occurring elsewhere are additional sources of diagnostic challenges, especially in the metastatic setting. Familiarity with cytologic features, combined with clinical and immunoperoxidase findings, is required to avoid misinterpretation. Cancer (Cancer Cytopathol) 2008. © 2008 American Cancer Society.     

Comparing core needle to surgical biopsies in breast cancer for cell kinetic and ploidy studies

The evaluability and reliability of proliferative activity (expressed as³H-thymidine labeling index,³H-TdR LI) and ploidy determinations on core needle biopsies were compared with those obtained on surgical material from the same breast cancers. The evaluability of³H-TdR LI on core needle biopsies was markedly lower than that on surgical material (53% vs 100%), and the association between³H-TdR LI values in the 16 cases with both evaluable determinations was poor (r_s=0.45). Conversely, determinations of ploidy on core needle biopsy and surgical material provided superimposable results, in terms of evaluability (91% vs 100%) and reliability (r_s=0.99). Further efforts are needed to improve sampling procedures for a reliable assessment of biological markers.     

Prevention of tumour cell dissemination in diagnostic needle procedures

Background:

A side effect of diagnostic needle biopsies is the possibility to disseminate tumour cells into the needle track, which may cause concern in certain malignant tumour types.

Methods:

In order to prevent tumour cell dissemination we developed a technology that uses radiofrequency (RF) pulses to sterilise the needle track and denaturate tumour cells. To determine feasibility, we applied this technology to fine needle aspiration biopsy (FNAB) and used breast cancer as a model tumour. Routine FNAB was performed in 88 patients with adenocarcinoma and blood droplets passing the skin orifice were cytomorphologically analysed for the presence of tumour cells.

Results:

The analysis showed the presence of tumour cells in 65/88 cases (74%). When using an experimental anti-seeding device in a subset of patients viable tumour cells were found in 0/31 cases (P<0.001). In all 31 patients blood passing the skin orifice was sparse. No degrading effect on the cytological sample inside the needle was detected and pain caused by the RF pulses was comparable to that of the biopsy procedure itself.

Conclusion:

The herein presented method has the potential to prevent the dissemination of viable tumour cells in the needle track and minimize bleeding without additional pain or degradation of the aspirate.     

Epidermal growth factor receptor mutations in needle biopsy/aspiration samples predict response to gefitinib therapy and survival of patients with advanced nonsmall cell lung cancer

Recently, mutations in the epidermal growth factor receptor (EGFR) gene in nonsmall cell lung cancer (NSCLC) patients were reported to correlate with gefitinib response. Less than 30% of NSCLC patients are surgically resectable; however, molecular analysis has to rely on nonsurgical diagnostic tissue samples. The objective of this study is to investigate EGFR mutation analysis on needle biopsy/aspiration samples and its correlations with gefitinib response and patients' survival. EGFR mutation was assessed from DNA of 63 paraffin-embedded small needle biopsy/aspiration specimens from 62 patients with NSCLC treated with gefitinib. The peripheral blood lymphocyte DNA of the patients was sequenced to verify the EGFR mutation. EGFR mutations were found in 47% of 62 patients (60% of 20 CT-guided biopsies, 44% of 18 ultrasound-guided biopsies, 31% of 16 endoscopic biopsies and 44% of 9 effusion cell blocks). EGFR mutations were frequently present in females (p = 0.006) and never smokers (p = 0.04). Patients with EGFR mutations had a significantly better response rate compared to that of the nonmutation group (p < 0.001). Multivariate analysis showed that EGFR mutation (p < 0.001) and PS 0-1 (p = 0.02) were independently associated with a better response rate. Cox regression analysis showed that EGFR mutation was the independent prognostic factor for progression-free survival (p = 0.008) and overall survival (p = 0.03). In conclusion, EGFR mutation analysis is feasible in needle biopsy/aspiration paraffin-fixed specimens. EGFR mutation is an independent predictor of gefitinib response and survival in patients of advanced NSCLC treated by gefitinib.