Testicular fine needle aspiration cytology as a diagnostic tool in dog infertility

The results of testicular aspirate cytology taken from clinical patients with a history of infertility were compared with the clinical and histological findings. Azoospermia was the most common and the most rewarding indication for the examination. Samples were also taken from cases with suspected testicular tumours, orchitis, epididymitis, severe oligo- and teratozoospermia, lack of libido and unilateral testicular atrophy. Histological and cytological findings were found to correlate well. Identification of cell types from normal germinal epithelium was relatively easy. No immediate adverse effects of aspiration were noted. Five normospermic dogs were monitored for two to six months after aspiration, and there were no marked deleterious effects on testicular consistency, testicular histology or semen characteristics. Testicular cytology obtained by fine needle aspiration may, at least to some extent, be used to assist clinical diagnosis, especially in azoospermic dogs and dogs with palpable changes of testicular tissue.     

Usefulness of fine needle aspiration cytology in the diagnosis of prostate cancer

The efficacy of aspiration cytology, using Franzen method and echo-guided aspiration for prostate cancer was examined to 102 patients under saddle-block anesthesia in urological clinic of Chiba University Hospital. Between 1990 and 1993, 77 cases out of 102 patients were diagnosed histologically as prostate cancer by needle biopsy and 90% of them were coincidental with findings of aspiration cytology. Looking at histological grades, well differenciated cancer was shown to yield low positivity compared with moderately and poorly differentiated cancer. Positive rate showed similar when grade of specimens from needle biopsy was classified with Gleason pattern. Neither T category nor method of aspiration between Franzen and echo-guided methods influenced positive rate of aspiration cytology. On aspiration cytology, its grading revealed 60% of coincidence with that obtained by histological method. When counting more than 300 scattered cells, 90% of coincidence was achieved with histological grading. It is concluded that aspiration cytology is efficient for diagnosis of prostate cancer.     

Ultrasound guided fine needle aspiration cytology in abdominal tuberculosis

Although barium studies and CT are useful in assessing abdominal pathology in tuberculosis, imaging findings are not always specific and a histopathological or bacteriological confirmation is often required. The aim of the present study was to evaluate the role of ultrasound (US) guided fine needle aspiration cytology (FNAC) in the diagnosis of abdominal tuberculosis in patients with non-palpable lesions detected on US/CT. FNAC was performed on 31 sites in 30 patients. The sites included enlarged lymph nodes (n = 14), focal lesions in liver (n = 2) and spleen (n = 8), and thickened bowel in the ileocaecal region (n = 7). The results were classified cytomorphologically into four groups: (1) definite evidence of tuberculosis; (2) presumptive evidence of tuberculosis; (3) suggestive of tuberculosis; and (4) negative for tuberculosis. 18 of the 31 FNACs (58%) revealed a positive diagnosis of tuberculosis (definite evidence in nine patients and presumptive evidence in nine patients). 13 of the 31 FNACs (42%) showed either necrosis alone (n = 4) or negative results (n = 9). Zeihl-Neelson staining for acid-fast bacilli on direct smear was positive in only nine patients (29%). Splenic and lymph nodal FNAC had a high sensitivity (87.5% and 78.6%, respectively) in the diagnosis of tuberculosis. None of the bowel and liver FNACs was diagnostic. No complications were encountered. US guided FNAC offers a safe and accurate method of achieving a diagnosis in patients with suspected abdominal tuberculosis who present with radiologically demonstrable but non-palpable lesions, especially those involving lymph nodes and spleen.     

Tuberculous pseudotumor causing biliary obstruction. Report of a case with diagnosis by fine needle aspiration biopsy and bile cytology

Hepatobiliary tuberculosis is a rare but distinct clinical entity. We report an unusual case of biliary tract obstruction due to localized hepatic tuberculosis with periportal tuberculous adenitis. The lesion mimicked a malignancy clinically and radiologically. Fine needle aspiration biopsy revealed granulomas, epithelioid histiocytes and Langhans' giant cells. The cytodiagnosis was confirmed by identification of acid-fast bacilli in the bile cytology and isolation of Mycobacterium tuberculosis by culture. The patient responded to antituberculosis therapy. The usefulness of bile cytology in the diagnostic management of biliary tract obstruction is illustrated.     

Immediate assessment of fine needle aspiration cytology of lung

BACKGROUND AND OBJECTIVE: To report five cases of vitreous opacification in phacolytic glaucoma (PG). PATIENTS AND METHODS: The records of patients with PG were retrospectively reviewed. A total of 135 eyes with PG were studied to determine the presence of vitreous opacification. RESULTS: Five eyes with PG demonstrated opacification of the vitreous, which was first noted at surgery and confirmed postoperatively. All patients had had symptoms of PG for 7 days or more (mean +/- SD, 10.6 +/- 2.4 days) before they sought medical attention. Three eyes had a hypopyon on preoperative examination; two of these eyes showed refractile crystals in the anterior chamber. The opacities resolved spontaneously in all five eyes over a period of 12 weeks and interfered with visual activity only in the immediate postoperative period. CONCLUSION: Vitreous opacification in PG is a self-limited process that may not require surgical intervention unless more rapid visual rehabilitation is desired. The vitreous opacification probably results from an exaggeration of the process causing the anterior chamber reaction.     

Ultrasound-guided fine needle aspiration biopsy in the diagnosis of breast cancer recurrence after mastectomy

PURPOSE: To define the accuracy and clinical impact of fine needle aspiration biopsy (FNAB) in diagnosing recurrent breast cancer after mastectomy. MATERIAL AND METHODS: The results of ultrasonography (US) and US-guided FNAB of 175 lesions located at the mastectomy site or in the ipsilateral axilla were reviewed. The final diagnosis was recurrent cancer in 77 cases and benign lesion in 98 cases, as verified by histological examination (n = 77) or follow-up (n = 98). RESULTS: FNAB yielded a representative aspirate in 92.6% of cases. The sensitivity, specificity and overall accuracy of FNAB cytology were 96.1%, 89.8% and 92.6% respectively. US and FNAB cytology were complementary methods in recurrent cancer diagnosis. The cytologic examination increased the specificity of US. The only recurrent tumor which appeared benign both sonographically and cytologically was removed because of a suspicious finding at palpation. FNAB cytologic diagnosis was found to have a clinical impact in 92.2% of the recurrent cases. CONCLUSION: US-guided FNAB provided an accurate adjunct to clinical examination and mammography for diagnosing and excluding breast cancer recurrence after mastectomy.     

CT-guided transthoracic needle biopsy: a comparison between automated biopsy gun and fine needle aspiration

AIMS: We retrospectively investigated the diagnostic accuracy and complication rate of transthoracic core biopsy using an automated biopsy gun and compared the findings with those of aspiration needle biopsy. PATIENTS AND METHODS: Seventy-three patients underwent 74 core biopsy procedures and 50 patients underwent 52 aspiration biopsy procedures. Of these, a final diagnosis was obtained in 107 lesions with surgery or clinical course. Fifteen patients in which a final diagnosis was not obtained were excluded from the study on diagnostic accuracy. Thus, in the study of diagnostic accuracy, 63 core biopsy procedures for 62 lesions are included. Core biopsy was performed with an 18 G cutting needle using an automated biopsy gun. Aspiration biopsy was performed with a 20 G aspiration needle. RESULTS: Core biopsy yielded sufficient material in 57/63 procedures (90.5%). A correct diagnosis was obtained in 36 procedures (85.7%) for malignant leisons and a specific benign diagnosis was obtained in 11 procedures (52.4%). Aspiration biopsy yielded a correct diagnosis in 26 procedures (81.3%) for malignant leisons and in seven (46.7%) for benign lesions. The overall correct diagnosis were 75.8% and 71.7% with core biopsy and aspiration biopsy, respectively. Core biopsy gave a higher predictive rate than that of aspiration biopsy for both benign and malignant lessons (P < 0.02). Pneumothorax occurred in 18/74 (24.3%) patients with core biopsy and in 18/45 (40.0%) patients with aspiration biopsy. Of these, three with core biopsy and two with aspiration biopsy needed tube drainage. The other complication was haemoptysis, which occurred in six patients following core biopsy and in three after aspiration biopsy. All nine cases subsided spontaneously. There were no fatal complications. CONCLUSIONS: Core biopsy with a biopsy gun increase the diagnostic accuracy with a higher histologic predictive rate and no obvious additional risk of complications.     

Diagnostic pitfalls of fine needle aspiration cytology for breast disease

We analysed 1500 consecutive fine needle aspiration cytology (FNAC) specimens to ascertain the reasons for diagnostic failure. Of 221 tumours proven malignant following open biopsy, 184 (83%) were correctly diagnosed on FNAC. Of 1082 aspirates classified 'benign', 787 (73%) underwent open biopsy and of these 33 (4%) were diagnosed malignant. All three cases of ductal carcinoma in-situ (DCIS) and eight of 16 lobular carcinomas in this study were missed using FNAC alone. Twelve of the 22 patients with invasive carcinoma not diagnosed on cytology had tumours measuring less than 1 cm diameter. Six of 1500 FNAC reports (0.4%) gave false positive diagnoses, five were classified as 'suspicious of malignancy; and one as 'frankly malignant'. The overall sensitivity was 84%, specificity 99% and positive predictive value 97%. Though these results confirm the value of FNAC as a rapid means of diagnosing most breast cancers, it it unreliable in patients with invasive carcinomas less than 1 cm in diameter and for the detection of lobular and in-situ carcinoma.     

Thymic carcinoid. Report of a case with diagnosis by fine needle aspiration biopsy

BACKGROUND: Fine needle aspiration biopsy (FNAB) affords a less expensive, less morbid approach to masses within the complex anatomy of the mediastinum as opposed to surgical biopsy. Given the current state of computed tomography guidance and the available cell block preparations and ancillary studies, definitive diagnosis of mediastinal tumors is possible. CASE: A 19-year-old male presented with weight loss and muscle weakness. Computed tomography revealed an anterior superior mediastinal mass with attachment to the posterior sternum and anterior aorta. FNAB yielded hyperchromatic cells with densely clumped chromatin and prominent nucleoli. These were present as single cells and clusters. Cell block preparations were studied with immunoperoxidase methods and were strongly positive for chromogranin and glucagon, supporting the diagnosis of carcinoid tumor. Surgical excision yielded a 7-cm, unencapsulated, red-brown tumor with medium-sized cells with oval to round nuclei, scant and granular cytoplasm and coarse "salt and pepper" chromatin with prominent nucleoli. The cells were arranged in islands and bands and were associated with prominent capillaries and dense, collagenous septae. Immunoperoxidase and electron microscopy demonstrated numerous intracytoplasmic, nonspecific neurosecretory granules and positivity for somatostatin, synaptophysin, cytokeratin and chromogranin. CONCLUSION: FNAB affords an accurate and timely diagnosis of an anterior mediastinal tumor without the necessity for open biopsy and also offers accurate surgical planning and decreased morbidity.     

The clinical use of fine needle aspiration cytology for diagnosis and management of children with neuroblastic tumours

Thirty-seven ankles in twenty-four patients were treated at our institution between July 1, 1974, and December 31, 1996, for atraumatic osteonecrosis of the talus. This group represents 2 per cent of the 1056 patients who were managed for osteonecrosis during this period. There were twenty-one women and three men, and their mean age was forty years (range, twenty-six to sixty-two years) at the time of the diagnosis. Thirteen (54 per cent) of the twenty-four patients had bilateral involvement. Sixteen patients (67 per cent) had a disease that affects the immune system, including systemic lupus erythematosus (thirteen patients), scleroderma (one), insulin-dependent diabetes mellitus (one), and multiple sclerosis (one). Four patients had a history of regular alcohol use, and four patients had a history of moderate smoking. One patient had a protein-S deficiency, one patient had had a renal transplant, and one patient had a history of asthma. Two patients had no identifiable risk factors for osteonecrosis [corrected]. Fifteen patients (63 per cent) had involvement of other large joints. The mean duration of symptoms before the patients were seen was 5.4 months (range, two months to two years). The mean ankle score at the time of presentation was 34 points (range, 2 to 75 points), according to the system of Mazur et al. A radiographic review revealed that, according to the system of Ficat and Arlet, eight ankles had stage-III or IV disease of the talus at presentation. The remaining twenty-nine ankles had stage-II disease. The osteonecrosis was seen in the posterolateral aspect of the talar dome (zones III and IV on the sagittal images and zones II, III, and IV on the coronal images) in twenty-two of the twenty-three ankles for which magnetic resonance images were available. The osteonecrosis was seen in the anteromedial aspect of the talar dome (zones I and II on the sagittal images and zone I on the coronal images) in the remaining ankle. Bone scans, which were available for eleven ankles, revealed increased uptake in the talus. All patients were initially managed non-operatively with restricted weight-bearing, an ankle-foot orthosis, and use of analgesics; two ankles responded to this regimen. Thirty-two ankles that remained severely symptomatic were treated with core decompression, which was useful in the treatment of precollapse (stage-II) disease. Twenty-nine of these ankles had a fair-to-excellent clinical outcome a mean of seven years (range, two to fifteen years) postoperatively; the remaining three ankles had an arthrodesis after the core decompression failed. Three ankles were treated initially with an arthrodesis for postcollapse (stage-III or IV) disease. All six of the ankles that had an arthrodesis fused, at a mean of seven months (range, five to nine months) postoperatively. When patients who have a history of osteonecrosis are seen because of pain in the ankle, the diagnosis of osteonecrosis of the talus should be considered. Early detection may allow the ankle to be treated non-operatively or with core decompression and thus reduce the need for arthrodesis. We also believe that when a patient has osteonecrosis of the talus, the hips should be screened with use of standard radiography or magnetic resonance imaging, or both.     

Preparation of fine needle aspiration biopsy samples for flow cytometric analysis

In order to improve the quality of flow cytometric (FCM) DNA histograms, a new preparatory method was tested on samples obtained by fine needle aspiration biopsy (FNAB) of breast tumors. Twenty-four samples were obtained in vivo (group 1), and 20 were obtained from surgically resected specimens (group 2). Tumors from both groups were aspirated twice each. The first sample was injected directly into 70% ethanol, whereas the second sample was pretreated with a mixture of Tween-20 and citric acid solution (Tween-20 CA) before ethanol fixation. The coefficient of variation (CV) of G0-G1 peaks of Tween 20 CA-pretreated samples varied from 1.85 to 5.10 (mean, 3.3) in group 1 and from 1.87 to 3.72 (mean, 2.77) in group 2. The CV of G0-G1 peaks of ethanol-preserved samples ranged from 2.28 to 7.22 (mean, 5.23) in group 1 and from 1.78 to 4.04 (mean, 3.48) in group 2. The CV values of histograms obtained by the new protocol were significantly lower (group 1, P < .05; group 2, P < .01).     

Histocytological correlation in fine needle aspiration biopsy of the thyroid gland]

Monoclonal antibodies are useful probes for analyzing cells at the molecular level at various developmental stages. Although identification of the genes encoding tissue- and stage-specific antigens could be informative for further molecular analysis, gene cloning is usually a time-consuming step, particularly when a monoclonal antibody is the only probe available. We describe here an immunocytochemical method for preliminary and immediate analysis of the regulation of antigen-coding genes. mRNAs purified from stage 27 and 38 Xenopus tadpoles were fractionated by size and injected into newt oocytes, from which frozen sections were prepared for immunostaining with tissue-specific monoclonal antibodies. Both of the antigens we tested, which are early markers for differentiating epidermal cells of Xenopus tadpoles, were detected in mRNA injected oocytes, but not in control oocytes. Immunostaining for each of the antigens showed that their relative levels in stage 27 and 38 tadpole tissue were reflected in those oocytes injected with mRNA purified from tadpoles of the respective stages. We suggest that this oocyte translation system combined with immunostaining provides for rapid analysis of changes in levels of antigen coding mRNAs throughout development.     

Use of fine needle aspiration cytology for investigating lymphadenopathy in HIV positive patients

The cytological diagnoses of 27 lymph node aspirates were compared with the histological diagnoses or clinical outcome in 23 HIV positive patients. There was agreement between the cytological and histological diagnoses in 14 of the 16 surgically biopsied cases. The clinical outcome in the remaining 11 cases was consistent with the cytodiagnosis. Fine needle aspiration (FNA) is a reliable, minimally traumatic, cost effective method with high specificity. It is suitable for an initial rapid diagnosis in HIV positive patients with lymphadenopathy.     

Myxoid neurofibroma of the male breast: fine needle aspiration cytodiagnosis

The use of colloid agents to achieve hypervolemia in the prevention and treatment of postsubarachnoid hemorrhage (post-SAH) vasospasm is included in the standard of care at many institutions. Risk profiles are necessary to ensure appropriate use of these agents. In a series of 85 patients with recent aneurysmal SAH, 26 developed clinical symptoms of vasospasm. Fourteen of the 26 were treated with hetastarch for volume expansion while the other 12 received plasma protein fraction (PPF). Clinically significant bleeding pathologies were noted in six patients who received hetastarch as a continuous intravenous infusion. Hetastarch increased partial thromboplastin time from a mean of 23.9 seconds to a mean of 33.1 seconds (p < 0.001) in all patients who received infusions of this agent, while no effect was noted in the 12 patients who received PPF infusions. No other coagulation parameters were altered. This study shows an increase in coagulopathy with the use of hetastarch as compared with the use of PPF for the treatment of postaneurysmal vasospasm.     

The use of fine needle aspiration biopsy in the management of thyroid disease

Fine needle aspiration biopsy is now a first line investigation in thyroid disease. The purpose of this study was to evaluate the results of this technique in comparison with routine histopathology. A total of 593 aspirations over a four year period were included. There were 390 (65.7%) solitary nodules, 124 (20.9%) multinodular goiters, 66 (11.1%) diffuse goitres and 13 (2.2%) recurrent post thyroidectomy nodules. Radioisotope scanning in 386 cases showed 325 (84.2%) cold nodules, 54 (14.0%) warm nodules and 7 (1.8%) hot nodules. There were 458 (77.2%) colloid goitres and cysts, 14 cases of thyroiditis (2.2%) and 30 malignancies diagnosed on fine needle aspiration biopsy. In 19 cases (3.2%) a diagnosis of follicular neoplasm and in 29 cases (4.9%) a diagnosis of suspicious aspirate was made. Histological results were available in 176 cases. In 108 cases findings of histology and FNAB were compared with radioisotope scanning. A sensitivity of 92.8% and 42.8%, a specificity of 90.1% and 98.7% and accuracy index of 90.3% and 94.3% was found, when considering suspicious cases alternatively as positives and negatives. Surgery was recommended in all suspicious cases to prevent reduction in sensitivity of the technique. Fine needle aspiration biopsy was found to be a highly effective procedure which can obviate a lot of unnecessary surgery in thyroid lesions.