Fine needle aspiration cytology of lipid-secreting carcinoma of the breast. A case report

A renotropic factor was partially purified by sequential gel filtration and anion exchanger chromatography from plasma of human kidney transplantation donors and a renal cancer patient after uninephrectomy. This activity increased the rate of [3H]thymidine incorporation into DNA in rat cortical tubules, but not in rat liver cells, within the range of 100-200 ng/ml protein. The renotropic activity was detected between 7 and 12 days after uninephrectomy, and at least in 1 case decreased thereafter. This activity was undetected in gel-filtrated plasma of patients after a nonurological surgical procedure. The potency of this renotropic activity and its elution by gel filtration are similar to those displayed by a renal growth factor activity isolated from uninephrectomized rat plasma, as recently reported.     

Fine needle aspiration cytology of mycetoma

Models for the surface of cuticle cells in hair fibers consist of a monolayer of fatty acids covalently bound to the underlying protein membrane by thioester linkages. The most prominent of these fatty acids is 18-methyleicosanoic acid (C21a), the synthesis of which requires the oxidative decarboxylation of isoleucine. Maple syrup urine disease (MSUD) is caused by an inherited deficiency in the enzyme branched chain 2-oxo acid dehydrogenase, which leads to the accumulation of branched chain alpha-keto-acids derived from the amino acids, leucine, isoleucine, and valine. Transmission electron microscopy studies of developing hair fibers show a structural defect in the fiber shaft in hair from patients with MSUD. This defect is confined to the cuticle of the fiber, where the cuticle membrane directly apposes the intercellular material. Thus, the defect indicates that C21a is located exclusively on the upper surface of fiber cuticle cells. Lipid analysis of MSUD hairs has demonstrated significant changes in the relative abundance of the covalently bound fatty acids and an almost complete absence of C21a, whereas there was little difference in the amino acid composition compared with normal hair. These results provide further evidence for the existence of the surface lipid monolayer and its crucial role in cellular adhesion.     

Fine needle aspiration cytology of papillary neoplasms

This article covers the fine needle aspiration biopsy cytomorphology of papillary carcinomas of different organs, differential diagnoses, and clinical correlation. Diagnostic problems and helpful cytologic features are emphasized. The purpose is to have a concise source of information that helps the pathologist to evaluate these neoplasms.     

Fine needle aspiration cytology of orbital masses

OBJECTIVE: To review our experience with fine needle aspiration of orbital lesions. STUDY DESIGN: Over an eight-year period, 24 orbital fine needle aspiration (FNA) samples were recorded, 22 of them adequate for interpretation. RESULTS: There were two benign tumors. There were 14 malignant tumors, 5 primary, 8 metastatic and 1 malignant and originating in the nasal cavity, invading the orbit. In two cases the original tissue diagnosis was incorrect and was revised by the fine needle aspirate. There were six nonneoplastic cases. In one case an infectious agent was identified, and another showed atypical lymphoid cells. Of the two nondiagnostic cases, one was compatible clinically with an orbital pseudotumor, and the other had no available follow-up. A specific diagnosis was achieved in 18 of 24 instances, or 75% of the cases. CONCLUSION: FNA is useful in the workup of an orbital lesion, leading to prompt diagnosis and treatment.     

Fine needle aspiration cytology in parotid lumps

Over a period of two years, Fine Needle Aspiration Cytology (FNAC) was performed on 33 patients presenting with a parotid lump. Five patients were excluded as they were treated medically after FNAC report. The FNAC results of 28 cases were compared with histopathological diagnoses of surgically resected specimens. There were 8 true positive, 17 true negative, 1 false positive and 2 false negative cases. Sensitivity was 80%, specificity 94.4% and diagnostic accuracy 89.3%. FNAC is a simple quick, accurate and virtually complications free investigative modality. It is also helpful adjunct to assess preoperatively the suitability and extent of the surgical treatment.     

Fine needle aspiration cytology in a rural setting

OBJECTIVE: To compare, contrast and analyze the value and limitations of fine needle aspiration (FNA) cytology and core biopsy (CB) in a rural setting. STUDY DESIGN: Retrospective analysis of 100 FNA cytology and 100 CB results of mass lesions from 193 patients matched for age, sex and body organs, and referred for FNA or CB in rural New South Wales, Australia, between September 1990 and May 1996. RESULTS: FNA cytology and CB results from 193 patients were analyzed, based on anatomic location and cytologic criteria. Sites included lung, retroperitoneum, liver, breast, kidney, pancreas and ovary. The FNA group contained 6 inadequate, 14 benign, 3 atypical, 6 suspicious and 71 malignant cases, whereas the CB group had 1 inadequate, 24 benign and 75 malignant conditions. The inadequate samples in both groups were due to technical difficulty in obtaining representative material. The indeterminate (atypical and suspicious) group, which was the main pitfall of FNA, contained 4 low grade carcinomas, 3 low grade non-Hodgkin's lymphomas and 2 fibrocystic breast changes. The benign FNA group comprised 8 cysts, 5 inflammatory/reactive conditions and 1 benign tumor/hamartoma, whereas the benign CB group contained 11 cysts, 9 inflammatory/reactive conditions and 4 benign tumors. CONCLUSION: FNA was comparable to CB at most anatomic sites. CB occasionally offered additional information. This slight advantage was due to the availability of tissue from the first and often the only pass for assessment of architecture and performance of ancillary tests, which obviated the need for further sampling. On-site assessment of the core imprints at the time of the procedure by the highly skilled and experienced interventional cytopathologist was responsible for limiting the number of attempts to one core in most of the instances, therefore minimizing complications. Pathologists are encouraged to become more familiar with the criteria of aspiration cytology, which has proven its validity in the new cost-conscious environment. Despite the recent surge in the popularity of core biopsy, FNA cytology, when practiced in a multidisciplinary setting, with involvement of pathologists, radiologists and clinicians, is an extremely accurate test with very high sensitivity, which approaches that of surgical pathology, and specificity very similar to that of frozen section. FNA has a positive predictive value for a malignant diagnosis of almost 100%. FNA is a well-tolerated, relatively noninvasive test with a very low risk of complications.     

Fine needle aspiration biopsy of breast carcinoma in pregnancy and lactation

OBJECTIVE: To delineate the cytomorphologic features seen in cancer of the breast during pregnancy and lactation, to compare them to the cytomorphologic parameters in benign conditions and to determine the feasibility of differentiating features of malignant breast carcinoma from those of benign breast lesions during pregnancy. STUDY DESIGN: The study group consisted of pregnant or lactating women with breast carcinoma and with benign breast lesions who underwent fine needle aspiration (FNA) of the breast lesions. The findings of FNA were reviewed, analyzed, tabulated and correlated with the pathologic diagnosis of the breast biopsies. RESULTS: Eleven patients had malignant cytomorphologic changes, including increased cellularity, multilayering, enlarged and pleomorphic nuclei, single or multiple nucleoli, mitosis and numerous isolated tumor cells. Secretory changes were scanty. The background was foamy and necrotic. FNA of the benign lesions showed a biphasic cell pattern with cohesion; minimal nuclear pleomorphism; single, regular nucleoli; and naked nuclei in a granular background with foamy macrophages. Increased cellularity with nuclear atypia, single cells and a dirty background was seen in benign and malignant conditions. CONCLUSION: The main cytologic features that differentiate breast carcinoma from benign conditions during pregnancy and lactation are crowding and overlapping of nuclei, dyscohesion and enlarged, pleomorphic nuclei with irregular nuclear membranes, coarse nuclear chromatin and mitoses. Pregnancy-related hyperplastic changes with atypia can potentially result in a false positive diagnosis of carcinoma.     

Fine needle aspiration of the breast. A probabilistic approach to diagnosis of carcinoma

European signing policy favours uncontrolled intersections--a trend which is in marked contrast to the U.S.A. policy. European drivers must constantly keep in mind the general rule of priority at cross-roads which requires one to yield to a vehicle coming from the right, if not otherwise indicated. For a European driver, an uncontrolled junction means an obligation to yield to vehicles on the right while for U.S. drivers, adapted to the U.S.A. system with more frequent signing, an intersection unsigned from his direction suggests priority for him, particularly in an urban area. To demonstrate a safety problem which follows, three American subjects, visiting professors without previous experience of driving in Europe, were asked to drive a 1.8 km route six times with an instrumented car in the downtown area of Helsinki. All of them first showed unsafe driving practices at uncontrolled intersections with restricted visibility in comparison to a local control group, but changed their strategy, both in terms of speed control and visual search, after they had been informed of the European rule of crossroad priority. In spite of the same general rule at blind intersections in a similar urban environment, a different signing policy may cause safety problems for American drivers in Europe, and translate into more accidents at non-priority intersections. Varying rules and practices in different jurisdictions call for further efforts in presenting vital information to foreign motorists and striving towards worldwide uniform traffic control.     

Fine needle aspiration cytology of acinar cell carcinoma of the pancreas: a report of two cases

BACKGROUND: Fine needle aspiration in lieu of needle biopsy is widely used for the diagnosis of pancreatic neoplasms. The cytologic features of ductal carcinomas are well characterized, but the appearances of less common pancreatic neoplasms, such as acinar cell carcinoma (ACC), are not well described. CASES: We present the cytologic, histologic, immunocytochemical and ultrastructural features of two cases of ACC. The tumors occurred in a 36-year-old woman and 43-year-old man. The aspirate from one case contained neoplastic cells with smooth-contoured nuclei containing one or two prominent nucleoli. The aspirated material from the second case was necrotic, with numerous neutrophils and scattered nests of tumor cells similar to those present in the first case. Histologically, both tumors manifested solid and acinar patterns, and each contained some cells with periodic acid-Schiff-positive granules that were resistant to diastase. The neoplasms were immunochemically positive for trypsin and negative for neuroendocrine markers. Ultrastructurally, the aspirate from one case demonstrated apical microvilli, zymogenlike granules and abundant rough endoplasmic reticulum. CONCLUSION: Uncommon pancreatic neoplasms may be difficult to diagnose due to their cytologic and histologic subtleties. Supplemental studies including immunocytochemistry, cytochemistry and electron microscopy are important in facilitating their identification.     

Fine needle aspiration (FNA) cytology of Rosai Dorfman disease

In our laboratory, a semi-quantitative pattern classification (PC) for the distribution pattern of glomerular sclerotic lesions in biopsied renal specimens with IgA nephropathy has been utilized, and found to be quite beneficial for predicting the patient's prognosis. In the present study conducted to re-evaluate this classification, 503 patients with IgA nephropathy (male/female, 256/247; mean age: 32.1 +/- 13.5 yrs; follow-up: 9.3 +/- 4.5 yrs) were used. The patients had been divided originally into 5 groups based on a previous PC: minimal, mild, moderate, severe and advanced groups. Their glomerular lesions were classified as mild, moderate, severe and global sclerosis, and were given scores of 1-4 points. The mean glomerular score was then calculated for each patient, as a value of the calculated classification (CC), and all patients were then re-divided into 5 groups based on their scores. The renal survival curves in the CC were similar to those in PC, and no significant differences in the renal survival rates were found between the classifications in each group, thus suggesting that the CC has a similar predictive power for renal survival. Although 7 of 39 cases (18%) with global sclerosis in PC groups 4 and 5 shifted down to CC group 3, of 61 patients with global sclerosis in PC group 1 who had a good prognosis, 26 cases (43%) shifted up to the CC group 2 and 6 cases (8%) changed to the CC group 3. As a result, the predictive power in patients in the lower CC groups was lost for the renal survival rate. In conclusion, statistical comparison between the PC and CC groups revealed that global sclerosis presents in non/minimally affected glomeruli as a nonspecific alteration. Severely advanced cases also possess a high incidence of globally sclerotic glomeruli (87%), and therefore the occurrence of global sclerosis may involve two different pathogenic mechanisms.     

Fine needle aspiration of secretory breast carcinoma resembling lactational changes. A case report

The purpose of the study was to determine if exhaled nitric oxide levels in children varied according to their asthmatic and atopic status. Exhaled nitric oxide was measured in a sample of 93 children attending the North West Lung Centre, Manchester, United Kingdom, for the clinical evaluation of a respiratory questionnaire being developed as a screening tool in general practice. The clinical assessment included full lung function, skin prick testing, and exercise challenge. Children were said to be asthmatic either by consensus decision of three independent consultant pediatricians, who reviewed all the clinical results except the nitric oxide measurements, or by positive exercise test. Atopic asthmatic children had higher geometric mean exhaled nitric oxide levels (consensus decision, 12.5 ppb [parts per billion] 95% CI, 8.3 to 18. 8; positive exercise test, 12.2 ppb 95% CI, 7.6 to 19.7) than did nonatopic asthmatic children (3.2 ppb 95% CI, 2.3 to 4.6; 3.2 ppb 95% CI, 2.0 to 5.0), atopic nonasthmatic children (3.8 ppb 95% CI, 2. 7 to 5.5; 5.7 ppb 95% CI, 4.1 to 8.0), or nonatopic nonasthmatic children (3.4 ppb 95% CI, 2.8 to 4.1; 3.5 ppb 95% CI, 3.0 to 4.1). Thus, exhaled nitric oxide was raised in atopic asthmatics but not in nonatopic asthmatics, and these nonatopic asthmatics had levels of exhaled nitric oxide similar to those of the nonasthmatics whether atopic or not.     

Fine needle aspiration cytology of the thyroid osteosarcoma. Report of a case

The histologic changes in the white pulp of the spleens collected from thirty women died of widespread adenocarcinoma of the breast were assessed by using the standardized reporting system previously introduced. As a control material, the same number of age-matched women died of myocardial infarction or cerebrovascular accident without signs of any malignancy was used. Special attention was focused on the evaluation of the lymphocyte populations (T- and B-cells) responsible for immunological reactivity. Histological characteristics suggested to reflect the activity of both the cell-mediated and humoral immune reactions were found to be within normal range in the control patients, whereas in the cancer series both these elements seemed to be profoundly deranged. The significance of these observations was discussed with regard to the background of the previously demonstrated immunological reactivity against the cells of human breast carcinoma, and the conclusion was drawn that an impairment of both the humoral and cell-mediated immune responses must exist in women dying of widespread adenocarcinoma of the breast. The applicability of the standardized reporting system used in the assessment of spleen white pulp morphology was emphasized.     

Fine needle aspiration cytology of adenoma of the nipple. A case report

BACKGROUND: Adenoma (papillary adenoma, florid papillomatosis, subareolar duct papillomatosis, erosive adenomatosis) of the nipple is an uncommon lesion and can be mistaken clinically for Paget's disease and pathologically be misinterpreted as an adenocarcinoma. CASE: A case of adenoma of the nipple was studied by cytology and histopathology. CONCLUSION: Recognition of this benign lesion on cytology will prevent unnecessary radical surgery. Local excision alone suffices.     

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.     

Fine needle aspiration cytology of the kidney, renal pelvis, and adrenal

Fine needle aspiration biopsy for cytologic evaluation of mass lesions of the kidney, renal pelvis and adrenal is a safe economic and accurate diagnostic procedure. Tumors and inflammatory or degenerative lesions arising from these organs have characteristic cytologic features permitting their correct identification in the majority of cases.