Hepatic angiosarcoma: aspiration biopsy cytology and immunocytochemical contribution.
Saleh HA. Tao LC.
Department of Pathology, Grace Hospital, Detroit, MI 48235, USA.
In the absence of previously documented sarcoma, the initial diagnosis of angiosarcoma (AS) on fine-needle aspiration (FNA) biopsy of the liver is difficult. However, awareness of its occurrence and the assistance of immunocytochemical stains may aid in arriving at the correct diagnosis. In this paper, a 59-yr-old smoker and alcoholic woman presented after a syncopal episode and was found to have a palpable right abdominal mass. An abdominal CT scan confirmed multiple centrally necrotic liver masses, from which an FNA biopsy was obtained. The smears were bloody with groups of relatively dishesive and singly dispersed spindle cells in a somewhat necrotic background. The nuclei were elongated to ovoid-round with small nucleoli. The cytoplasm was ample and ill-defined. The cells were reactive for factor VIII-related antigen and CD31 but negative for cytokeratin immunocytochemical stains, and a diagnosis of "suspicious for angiosarcoma" was entertained. The patient declined further studies or treatment but presented 4 mo later with light-headedness and hypoglycemia. Laparoscopic tissue biopsies of the liver/abdominal masses were obtained and revealed AS. Rarely, liver masses may represent AS. Pathologists should be aware of their cytomorphology and characteristic immunostaining to avoid their misinterpretation.
Ultrasound-guided fine-needle aspiration cytology diagnosis of gallbladder lesions: a study of 82 cases.
Das DK. Tripathi RP. Bhambhani S. Chachra KL. Sodhani P. Malhotra V.
Institute of Cytology and Preventive Oncology, New Delhi, India.
Carcinoma of the gallbladder (GB) is among the five most common forms of cancers and tops the list of gastrointestinal malignancies in females of the Delhi region. Lack of specific signs and symptoms prevents early detection of GB carcinoma. However, in recent years ultrasonographically (US)-guided fine-needle aspiration (FNA) cytology has been found to be a reliable procedure for its diagnosis. The present study was carried out during a period of 5 yr (1986-1990) in 64 female and 18 male patients to find out the diagnostic utility of US-guided FNA cytology in gallbladder lesions. Ultrasonography in these 82 cases revealed a mass in the gallbladder/GB area in 74 (90.2%), a mass in the GB/pancreas in 1 (1.2%), gallstones in 32 (39.0%), and miscellaneous gallbladder lesions in 4 (4.9%). The other findings included space-occupying lesions in liver in 18 (22.0%), portal lymphadenopathy in 12 (14.6%), and infiltration in other organs in 7 (8.5%). The initial cytodiagnosis was malignancy in 48 cases, inflammatory in 12, and inadequate in 22. Following review of the smears by one of the investigators (D.K.D.), the number of malignant cases remained 48 (58.5%). There were 10 (12.2%) inflammatory and 24 (29.3%) inadequate cases. Adenocarcinoma was the most common malignancy (83.3%), followed by squamous-cell and adenosquamous carcinoma (12.5%) and small round cell tumors (4.2%). The 10 inflammatory lesions showed slight (+) to excessive (+3) neutrophilic infiltration and included one case each of xanthogranulomatous cholecystitis and a necrotizing granulomatous lesion likely to be of tuberculous etiology.
Metastatic papillary oncocytic carcinoma of the pancreas to the liver diagnosed by fine-needle aspiration.
Thompson K. Castelli MJ. Gattuso P.
Loyola University Medical Center, Maywood, Illinois, USA.
A 37-year-old white male with a large pancreatic mass was referred to our institution with a hypodense liver lesion detected on CT scan. A fine-needle aspiration (FNA) was performed on the liver lesion. Diff-Quik smears demonstrated scattered papillary structures and single neoplastic cells with abundant well-defined dense granular cytoplasm. Eccentrically located nuclei were noted with single prominent nucleoli. Cell block preparations showed papillary structures lined by cells with abundant pink granular cytoplasm, hyperchromatic nuclei, and prominent single nucleoli. Electron microscopic examination displayed numerous but poorly preserved mitochondria. The diagnosis of papillary carcinoma with oncocytic features was made. Only two previous cases of pancreatic oncocytic tumors diagnosed by FNA have been reported in the literature. We present an additional case, notable in that the diagnosis was made in a metastatic liver nodule.
Is the cytologic diagnosis of esophageal glandular dysplasia feasible?
Hughes JH. Cohen MB.
University of Iowa Hospitals and Clinics, Iowa City 52242-1009, USA. email@example.com
Barrett's esophagus is a premalignant condition in which the normal stratified squamous epithelium of the esophagus is replaced by metaplastic glandular epithelium. Patients with Barrett's esophagus are at increased risk for the development of esophageal adenocarcinoma. Because dysplasia precedes the development of frank adenocarcinoma, the cytologic detection of esophageal glandular dysplasia represents a potentially inexpensive and efficient means of monitoring disease progression to adenocarcinoma and identifying high-risk patients. This article discusses the current status of exfoliative cytology as a screening test for glandular dysplasia of the esophagus.
Detection of apoptotic cells in cytology specimens: an application of TdT-mediated dUTP-biotin nick end labeling to cell smears.
Sasano H. Yamaki H. Nagura H.
Department of Pathology, Tohoku University School of Medicine, Sendai, Japan.
We applied TdT-mediated deoxyuridine triphosphate (dUTP)-biotin nick end labeling (TUNEL) to cytologic smears in order to detect the cells undergoing apoptosis. These smears were obtained by scraping the cut surface of 9 cases of carcinoma, including renal-cell carcinoma (3 cases), esophageal squamous-cell carcinoma (3 cases), and gastric adenocarcinoma (3 cases), and were fixed and prepared by different methods. The results were also compared with those of tissue sections. TUNEL in smears was generally associated with higher background nuclear stain than in tissue sections. Smears that were fixed in 4% or 8% paraformaldehyde or absolute methanol exhibited results comparable with those of tissue sections, with minimum background in all cases examined. There were no significant differences in TUNEL labeling index among tissue sections and smears fixed in 4% or 8% paraformaldehyde or in absolute methanol. Smears treated in Carnoy's fixative (3:1 methanol:acetic acid) and air-dried smears demonstrated a higher background. TUNEL positivity could not be detected in slides decolorized from May-Grunwald-Giemsa stain. Markedly high background, which may occur as a result of artifactural DNA breaks, was also observed in slides decolorized from Papanicolaou stain, in which TUNEL-positive cells could be evaluated only in 3/8 cases. Application of the TUNEL method to cytology specimens has disadvantages or limitations compared to its application to histological sections, but the method is considered the most suitable one for detecting cells undergoing apoptosis in cytology materials.
Infiltrating carcinoma arising in intraductal papillary-mucinous tumor of the pancreas.
Tomaszewska R. Popiela T. Karcz D. Nowak K. Stachura J.
Department of Clinical and Experimental Pathomorphology, Jagiellonian University Medical College, Krakow, Poland.
A case of an infiltrating carcinoma arising in an intraductal papillary mucinous tumor (IPMT) of the pancreas was reported in a 60-yr-old man. Preoperative diagnosis of the carcinoma was established on the basis of fine-needle aspiration biopsy.
Role of touch imprint and core biopsy for detection of tumor metastases in bone marrow.
Kjurkchiev G. Valkov I.
Department of Pathology and Cytopathology, Medical University, Sofia, Bulgaria.
A total number of 248 bone marrow trephine biopsies were reviewed and 21 paired biopsy and touch imprints were identified to estimate the role of these two diagnostic methods for detection of tumor metastases from nonhematologic malignancies in the bone marrow. The study period ran between January 1, 1993, and June 1, 1996. Eight histology sections and eight touch imprints were prepared from every case and were reviewed by two pathologists independently. In 20 cases, tumor cells were present without a doubt both on cytologic and histologic preparations. In one touch imprint, single cells were suspicious for malignancy, and the final pathology report was prepared after examination of the histologic sections. There was no positive biopsy in which the imprint was negative for tumor cells, and no positive touch imprint in which the biopsy was negative for such cells. The results from our study show that every one of these approaches has advantages and disadvantages and that they have a complementary role for identification of solid malignancies in the bone marrow.
Congenital toxoplasmosis: diagnosis by exfoliative cytology.
Nicol KK. Geisinger KR.
Department of Pathology, Wake Forest University Medical Center, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27157-1072, USA.
Toxoplasmosis, caused by the intracellular protozoan Toxoplasma gondii, has as its major routes of acquisition either ingestion (of the cyst or oocyte) or transplacental infection (by trophozoites). Transplacental transmission occurs to the fetus in utero or to the newborn at vaginal delivery. Maternally acquired infections can infect the embryo as early as the 7th week of gestation. It has been estimated that 15-17% of maternal infections acquired between the 7th and 14th weeks of gestation are transmitted to the embryo (Lynfield R, Eaton RB., Teratology 1995;52:176-180.). We present a 7-wk-old white male, delivered at 38 wk of gestation, who shortly after birth was found to have hepatosplenomegaly and anemia; he developed liver failure and ascites with persistent anemia during the first week of life. After an extensive, but nondiagnostic, work-up, a paracentesis was performed which led to a diagnosis of congenital toxoplasmosis. This case demonstrates the utility of exfoliative cytology in determining the cause of neonatal ascites, especially of an infectious etiology. To our knowledge, this represents the first reported case of Toxoplasma gondii diagnosed by exfoliative cytology in a pediatric patient.