Vitrectomy

Fifty vitreous specimens obtained by routine pars plana vitrectomies were examined using Millipore filter processing and Papanicolaou staining technique. Cytological findings comprised of macrophages (melanophages, siderophages) and inflammatory cells, mainly lymphocytes. In a few cases, pigmented an nonpigmented epithelial cells of the ciliary body were encountered, retinal sensory cells only in one case. Fibroblasts and fragments of granulation tissue occurred in four of the 14 diabetic cases, in four of the 21 posttraumatic cases, in one case of chronic uveitis as well as in one case of retrolental fibroplasia. Fragments of ciliary body were in three specimens from injured eyes. In one case of chronic uveitis slight suspicion of ciliary body melanoma was aroused on the basis of distinct cellular atypia. There was agreement between clinical and cytological diagnosis in most cases, but particularly in posttraumatic and inflammatory diseases cytologic examination offered new diagnostic data. This is a new method of microscopical verification of the condition in the vitreous body in various diseases. Our experiences are preliminary but we feel that this method has proven its availability.     

Fine Needle Aspiration Compared with Scintigraphy for Detection of Liver Neoplasia

ABSTRACT The diagnostic accuracy of fine needle aspiration and scintigraphy was compared prospectively in a series of cases of suspected liver neoplasm. The results of both techniques showed a close correlation to final diagnosis. Biopsy, easily and rapidly performed with simple equipments, is a cost-saving procedure with as good a sensitivity as scintigraphy. Furthermore, the possible finding of specific cytological pictures of primary liver carcinoma or tumours of the amino precursor uptake decarboxylating cell series lend further weight to the biopsy technique.     

Mycobacterial autofluorescence in Papanicolaou‐stained lymph node aspirates: A glimmer in the dark?

This study was undertaken to determine the value of incorporating fluorescence into cytopathological evaluation of lymph node fine-needle aspiration (FNA) specimens suspected of harboring mycobacterial species. The study population consisted of 1,044 HIV-positive and -negative patients referred for FNA to the cytopathology unit of a South African medical school located in a very high HIV prevalence region. Each aspirate was assessed on routine Papanicolaou-stained slides for morphologic characteristics of mycobacterial infection. The same glass slides were then viewed under fluorescent microscopy to determine the presence or absence of mycobacterial autofluorescence. Using multivariate analysis, results of both cytology and fluorescence were compared with mycobacterial culture as the final arbiter of the presence of organisms. In this large clinical study, compared with culture, cytomorphology showed sensitivity of 84.9%, but low specificity of only 50.9%. Fluorescence demonstrated lower sensitivity of 65.9%, but improved specificity of 73.0%. Taken together, positivity of both cytology and fluorescence improved specificity to 81.8%. Fluorescent microscopy is rapid, inexpensive, and cost-effective; neither radioactive materials nor further staining are required. It is felt that this methodology would be of diagnostic benefit if used on morphologically suspicious samples in areas with a high prevalence of HIV and mycobacterial infections. Appropriate therapy could be commenced within hours of FNA, with reduction in the current number of patients lost to follow-up while awaiting results of culture. The technique is readily extended to other FNA types such as deep organ aspirates. Autofluorescence of organisms specifically requires usage of Papanicolaou staining; the technique cannot be used in histopathologic specimens stained with hematoxylin-eosin.     

颈部淋巴结细针穿刺细胞学检查的临床应用

目的:探讨颈部淋巴结细针穿刺的临床应用价值。方法:回顾性分析我院2002年3月1日～2005年4月1日931例颈部淋巴结细针穿刺涂片细胞学检查与术后病理切片结果对比的临床资料。结果:931例颈部肿大淋巴结的细针穿刺诊断敏感度(总符合率)为82.5%。细针抽吸诊断良性病变350例(37.6%),恶性病变491例(52.8%),可疑恶性20例(2.1%),诊断不明70例(7.5%)。本组细针穿刺良性病变诊断敏感度85.3%,总准确率为91.4%;恶性病变诊断敏感度94.4%,总准确率为96.0%;恶性淋巴瘤诊断敏感度为64%,总准确率为94.7%;转移癌诊断敏感度为92.6%,总准确率95.7%。结论:针吸细胞学检查是一种可靠的、准确率较高的颈部淋巴结病理诊断检查方法,值得临床推广使用。     

宫颈管细胞学检查在诊断子宫内膜癌中的价值

应用瑞典欧立宫颈管毛刷获取宫颈管细胞 ,对 1 0 93例需进行分段诊刮术的病人进行细胞学检查 ,并与以分段诊刮术或子宫全切术获得的子宫内膜组织的病理结果进行比较。结果 :宫颈管毛刷和宫颈管搔刮术取材满意率分别为 82 .5 %和 1 7.0 %。 60例子宫内膜癌病人中 48例接受了分期手术 ,其中 1 4例宫颈受累。在判断宫颈是否受累方面 ,宫颈管细胞学的敏感性为 71 .4% ,特异性为 82 .4% ;宫颈管搔刮术的敏感性为 5 0 .0 % ,特异性为 79.4%。提示 :宫颈管细胞学检查阳性不一定代表宫颈管受累 ,但对术前决定分期、术式和判断预后有一定的参考价值     

急性白血病的细胞化学和免疫分型

对52例急性白血病进行多种细胞化学染色和单克隆抗体免疫分型,并与以FAB为基础的形态学分型比较.结果表明,氯醋酸酯酶在鉴别粒细胞系统、α-醋酸萘酯加氯化钠抑制试验在鉴别单核细胞系有重要作用.其中2例形态学、细胞化学不能分型的白血病,显示髓系单克隆抗体阳体,并发现5例混合白血病同时表达粒系和淋巴系的抗原标志.提示细胞化学和免疫学分型能明显提高急性白血病形态学诊断的正确率.     

口服灌洗法脱落细胞学检查对大肠癌的诊断价值

目的：探讨口服肠道灌洗液进行的脱落细胞学检查对诊断大肠癌的可靠性及可行性。方法：26例可疑大肠癌患者（后经病理学证实14例为腺癌,12例未见肿瘤）内镜检查前口服平衡盐液3～4L,收集水样粪便,分离\浓缩其中的脱落细胞,细胞涂片、巴氏染色。结果：14例腺癌病人中12例细胞学检查结果为阳性或可疑阳性,2例呈阴性,敏感性为85．7％;12例对照组中11例为阴性,1例呈可疑阳性,特异性为91．7％。结论：该方法简便、易行、可靠,有可能作为大肠癌的筛选检查方法。     

Cytodiagnosis of amelanotic metastatic malignant melanoma: An immunocytochemical study

Malignant melanomas are known to present diverse patterns and this can result in considerable difficulties for an interpretation of malignancy type from cytohistologic material. Such difficulties are further compounded, if melanin pigment cannot be demonstrated by conventional histochemical stains; unfortunately many cases do exhibit this feature, especially in its metastases. This study was designed to review cases of amelanotic metastatic malignant melanomas in a variety of cytologic samples which were received from 40 patients with a known history of malignant melanoma. Cytomorphologically, the cases were classified as classical, carcinoma-like, spindle cell type, lymphoma-like, and undifferentiated type (Table I). While in 36 of the cases, the diagnosis of metastases from a melanoma was confirmed based on an immunopositivity to a variety of melanoma markers (Table III), in four of the cases, the immunostaining indicated metastases from another primary source, which was subsequently found. Based on our study, we are of the opinion that an immunologic characterization is useful to conclusively diagnose the majority of cases of metastatic amelanotic malignant melanomas. Furthermore, we feel that a reliance on a single melanoma marker is not justified, and a panel of antibodies should be used to distinguish a metastatic amelanotic malignant melanoma from other metastatic neoplasms. Diagn. Cytopathol. 16:238–241, 1997. © 1997 Wiley-Liss, Inc.     

细针吸取细胞诊断涎腺肿瘤

用细针吸取细胞诊断涎腺肿瘤154例，均经病理诊断对照，其中良性肿瘤占124例，恶性肿瘤30例，总符合率为94.2%，细胞学与病理诊断完全一致占81.2%，定性正确而组织学类型不一致占13%，良，恶性质误诊占5.8%。重点叙述了较多见的涎腺肿瘤细胞学诊断特征，并分析了误诊原因。     

Aetiology of non‐diagnostic renal fine‐needle aspiration cytologies in a contemporary series

OBJECTIVES

To determine the aetiology of non‐diagnostic renal fine‐needle aspiration cytologies (FNACs) in a contemporary series.

PATIENTS AND METHODS

We retrospectively reviewed our institutional database of renal FNACs performed between 1995 and 2005. There were 118 patients with renal lesions that underwent FNAC. Indications for FNAC were indeterminate complex renal cysts, significant medical comorbidities, previous history of malignancy, multiple bilateral renal lesions, and suspected metastatic disease. A cytotechnologist was present during the FNA procedure to perform Diff‐Quik staining and ensure an adequate sample of cells were obtained. Except for seven (six open, one ultrasound‐guided), all of the FNACs were performed with CT guidance.

RESULTS

The median (range) number of passes for each FNAC session was 2.7 (1–6). Of the 16 FNACs performed for indeterminate complex renal cysts, nine (56%) were adequate with the cytodiagnosis of benign cysts. Of the seven inadequate specimens, three had benign cysts and another three were non‐diagnostic due to acellularity. Therefore, the technical failure rate was 19% (3/16) for indeterminate complex renal cysts. The last patient had a cytodiagnosis of benign cyst and the final histological diagnosis of renal cell carcinoma (RCC; papilllary, grade III). Therefore, this represents a sampling error (false negative rate) of 0.8% (1/118). For the 102 solid renal masses, 22 (22%) had inadequate specimen by Diff‐Quik staining. The technical failure rate (inability to obtain sufficient epithelial cells) was 16% (16). In 18 patients, immunocytochemistry (ICC) was used to differentiate primary renal parenchymal tumours from others such as transitional cell carcinoma (TCC), lymphoproliferative, colon, and lung. There were two FNACs with misdiagnosis (2%), where ICC was not used. In both, the cytodiagnosis was TCC and the final histological diagnosis was RCC in one and atypical urothelium in another.

CONCLUSIONS

Non‐diagnostic renal FNACs can be attributed to misdiagnosis (2%), sampling error (0.8%) and technical failure (16%).