Lymphoepithelial cyst of the pancreas. Report of a case diagnosed by fine needle aspiration biopsy.
Bolis GB. Farabi R. Liberati F. Maccio T.
Institute of Pathologic Anatomy and Histology, Perugia University, Terni Civic Hospital, Italy.
BACKGROUND: Lymphoepithelial cysts of the pancreas are very rare lesions. To the best of our knowledge, 24 cases are reported in the literature. CASE: A 64-year-old male presented with gastrointestinal complaints. A computed tomography scan of the abdomen disclosed a 55 x 30-mm, homogeneous mass anterior to and contiguous with the pancreas. Fine needle aspiration biopsy (FNAB) showed threads of tissue composed of stratified squamous epithelium with subepithelial lymphocytic infiltrate and keratinous material. CONCLUSION: This case illustrates that FNAB is a rapid and reliable technique that can be used as the first diagnostic step in cases of cystic lesions of the pancreas. To our knowledge, this is the third case reported of this entity diagnosed with FNAB.
Use of CD34 and factor VIII to diagnose hepatocellular carcinoma on fine needle aspirates.
Gottschalk-Sabag S. Ron N. Glick T.
Department of Pathology, Shaare Zedek Medical Center, Jerusalem, Israel.
OBJECTIVE: The immunohistochemical staining patterns characteristic of hepatocellular carcinoma (HCC) using CD34 and factor VIII antibodies were compared with those of other hepatic lesions to determine if these stainings can be used as a diagnostic criterion. STUDY DESIGN: We reviewed 44 fine needle aspirates from the liver to evaluate the immunoperoxidase staining patterns on cell block preparations using CD34 and factor VIII and to determine whether this could distinguish HCC from the other lesions. These included HCC (14 cases), metastatic tumor (14 cases) and nonneoplastic liver lesions (16 cases). RESULTS: This retrospective study showed that in the nine documented cases of HCC, staining for CD34 and/or factor VIII was positive. The pattern of staining was either peripheral, around small clusters of tumor cells, or linear, diffuse and sinusoidal. In all the documented cases (27) of metastatic carcinoma and nonneoplastic lesions staining for CD34 and factor VIII was negative. In addition, there were eight problematic cases. In 7 cases the cytologic diagnosis on Papanicolaou-stained smears was inconclusive about HCC or metastatic carcinoma. CD34 and factor VIII confirmed the final diagnosis on the cell blocks. Based on this staining, 4 were HCC, 2 were metastatic carcinoma and 1 was equivocal, most probably HCC. In one case the differential diagnosis between well-differentiated HCC and a nonneoplastic liver lesion could not be made on cytologic smears, and here, also, CD34 and factor VIII aided in the correct diagnosis of a nonneoplastic liver lesion. CONCLUSION: We suggest immunoperoxidase staining with CD34 and factor VIII be performed on the cell block sections from FNAs in any problematic hepatic case.
Preparation of heat-labile antigens on air-dried cytologic specimens for immunocytochemical analysis.
Baba N. Kawabata H. Kanno T. Ueno T. Makuuchi M. Morishita Y. Mori S. Sasaki J. Soejima K.
2nd Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
OBJECTIVE: To demonstrate the efficacy of Zamboni's solution and storage medium for immunocytochemistry of Ki-67, p53 tumor suppressor gene product and CD3 on long-preserved, air-dried cytologic specimens. STUDY DESIGN: Air-dried imprint cytologic specimens obtained from 13 lymphatic tissues and 13 colorectal cancers were fixed with Zamboni's solution and stored for various periods in storage medium including 50% glycerol at -10 to -20 degree C. Mouse monoclonal antibody PC, PAb 1801 and anti-Leu-4 were used for immunostaining. RESULTS: Immunocytochemical identification of Ki-67, p53 and CD3 was possible on specimens stored for 36, 32 and 16 weeks, respectively. CONCLUSION: Our method, using Zamboni's solution and storage medium, is feasible for immunocytochemistry on long-preserved, air-dried cytologic specimens using the three antibodies were employed.
Sarcomatous hepatocellular carcinoma with malignant ascites. A report of two cases.
Morishita Y. Etori F. Sawada K. Kachi H. Yamada T. Kawamori T. Tanaka T.
First Department of Pathology, Gifu University School of Medicine, Japan.
BACKGROUND: Although some cases of hepatocellular carcinoma (HCC) are known to possess a sarcomatous appearance, their cytologic characteristics in ascites have not been reported. CASES: Two Japanese males, aged 67 and 60 were admitted to the Gifu Municipal Hospital because of liver tumors. In the first case, although transcatheter arterial embolization (TAE) was performed, ascites with neoplastic cells continued to enlarge, and the patient died of liver failure. In the second case, although TAE, percutaneous ethanol injection therapy, chemotherapy and radiotherapy were performed, the patient died of tumor progression: expansion of the hepatic tumor, metastases to distal organs and increasing malignant ascites. Neoplastic cells in the ascites of both cases had nuclei that were shaped irregularly or were vesicular and contained conspicuous nucleoli. A number of multinucleated giant cells were also seen. Immunocytochemically, numerous neoplastic cells were positive for alpha-fetoprotein. These findings suggested sarcomatous HCC. Also, histologic findings of the liver tumors at autopsy showed the appearance of sarcomatous HCC. CONCLUSION: In both cases presented, HCC cells with sarcomatous change were observed in ascites. To our knowledge, this is the first report describing the cytologic diagnosis of sarcomatous HCC in ascites.
Microfilariae in a cytologic smear from cavernous hemangioma of the liver. A case report.
Agarwal R. Khanna D. Barthwal SP.
Department of Medicine, M.L.N. Medical College, Allahabad, India.
BACKGROUND: Wuchereria bancrofti has been found in almost every tissue except the liver. CASE: Microfilariae were found in a hemangioma of the liver on fine needle aspiration in a 40-year-old female with pyrexia associated with hepatomegaly and a peripheral blood smear negative for microfilariae. CONCLUSION: Absence of microfilariae in a peripheral blood smear does not exclude filarial infection.
Metastatic squamous cell carcinoma in a liver graft. Report of a case diagnosed by fine needle aspiration.
Lopez-Rios F. Alonso S. Lozano F. de Agustin PP.
Department of Pathology, 12 de Octubre, University Hospital, Madrid, Spain.
BACKGROUND: Fine needle aspiration is a well-established and safe method for the diagnosis of focal liver lesions, but it has played a limited role in the transplant setting. CASE: A case of metastatic squamous cell carcinoma in a liver graft was diagnosed by fine needle aspiration. The tumor developed in the right pyriform sinus five years after an orthotopic liver transplantation was performed. CONCLUSION: With the improvement of survival rates following liver transplantation, metastatic tumors should be considered in liver grafts with space-occupying lesions. Therefore, fine needle aspiration is adequate for diagnosis and is cost-effective and safe.
Fine needle aspiration cytology of hepatoblastoma. A report of two cases.
Ersoz C. Zorludemir U. Tanyeli A. Gumurdulu D. Celiktas M.
Department of Pathology, Medical Faculty, Cukurova University, Adana, Turkey.
BACKGROUND: Hepatoblastoma is the most common primary hepatic tumor in children. The literature contains few examples of fine needle aspiration (FNA) cytology of these tumors. CASES: A 5-month-old and 4-month-old underwent ultrasonography-guided FNA for the preoperative investigation of hepatic masses. The smears were stained with May-Grunwald-Giemsa and Papanicolaou stain. Alcohol-fixed smears were used for immunocytochemistry. All smears revealed cells with round/oval nuclei, prominent nucleoli and vacuolated cytoplasm, arranged in groups and acinar structures. The groups were embedded in a myxoid stroma. alpha-Fetoprotein was positive in all, and vimentin was positive in some tumor cells. The cytologic findings resembled the histologic counterpart in one case, and the other case agreed with the clinical/radiologic prediagnosis. Immunocytochemistry was supportive. CONCLUSION: FNA cytology can be diagnostic in many other childhood tumors as well as hepatoblastomas. Detailed descriptions of cytomorphologic features of hepatoblastoma will help FNA to be used confidently on these tumors.