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Items 1-17 of 17 |
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One page. |
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Computed tomography-guided fine needle aspiration of peripheral lung opacities. An initial diagnostic procedure?
Gouliamos AD, Giannopoulos DH, Panagi GM, Fletoridis NK, Deligeorgi-Politi HA, Vlahos LJ.
Department of Radiology, Aretaeion Hospital, Athens University Medical School, Greece. [email protected]
OBJECTIVE: To evaluate the results of computed tomography (CT)-guided fine needle aspiration (FNA) cytology following negative fiberoptic bronchoscopy and sputum cytology. STUDY DESIGN: Retrospective study of 64 patients who underwent CT-guided needle aspiration of lung opacities over one year. Following a review of the CT studies, patients were selected according to image characteristics of a primary neoplasm and pleural effusion in cases with pleural lesions. The lesions were classified into three categories--intrapulmonary and peripheral pulmonary, pleuropulmonary and pleural--and were localized and aspirated under CT using a fine needle (22-23 gauge) for obtaining cellular material. Lesions diagnosed as benign on FNA cytology were followed by serial CT scans for a period of two years at six-month intervals. RESULTS: Thirty-nine of 64 (61%) lesions were diagnosed as malignant on FNA cytology and 25 of 64 (39%) as benign. There was one false negative case. There were no serious complications from the procedure. CONCLUSION: FNA under CT guidance may be applied as the initial procedure in the diagnosis of peripheral malignant pulmonary lesions, rendering a high diagnostic yield.
PMID: 10833989 [PubMed - indexed for MEDLINE]
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Mixed small cell/large cell carcinoma of the lung. Report of a case with cytologic features and ultrastructural correlation.
Yang GC.
Department of Pathology, New York Hospital-Cornell Medical Center, New York, USA.
BACKGROUND: Mixed small cell/large cell carcinoma of the lung, a chemotherapy- and radiation-resistant subtype of small cell lung cancer, constitutes 4-6% of small cell lung cancer but has been described rarely in the cytopathology literature. CASE: A 64-year-old man presented with a left hilar mass. A concurrent transbronchial biopsy and postbiopsy bronchial washing were performed. The latter presented as loosely cohesive cells, scattered singly, in small clusters, in monolayer sheets and in a perivascular arrangement. The tumor exhibited a wide spectrum of cytomorphology: small cells with pyknotic nuclei and scanty cytoplasm were admixed with larger cells with vesicular nuclei, prominent nucleoli and abundant cytoplasm. Nuclear shape included oval, spindle and peg. Nuclear size was also highly variable. The tumor was retrieved from the transbronchial biopsy and processed for ultrastructural study. CONCLUSION: Based on cytologic-ultrastructural correlations. the seemingly "mixed" morphology may have resulted from the rapid degeneration of a single clone of tumor cells: the viable tumor cells were the "large" cells, and the dying cells were the "small" cells. A novel ultrastructural observation is that the perivascular tumor cells developed peculiar, fingerlike cytoplasmic processes abutting an undulating basement membrane along the thin-walled blood vessel.
PMID: 7483994 [PubMed - indexed for MEDLINE]
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Cytologic characterization of bronchial epithelial changes in small cell carcinoma of the lung.
Boucher LD, Yoneda K.
Pathology and Laboratory Medicine Service, Veterans Affairs Medical Center, Lexington, Kentucky 40511-1093.
Cytologic specimens obtained by fiberoptic bronchoscopy were examined in 111 cases; the diagnosis of small cell carcinoma of the lung was established with this procedure. The findings of cytologic examination were compared to those of histologic examination of the biopsy specimens obtained simultaneously. Our aim was to evaluate other cell components in the specimen besides small cell carcinoma. The majority of the cases showed morphologic changes in the bronchial epithelium, which ranged from benign squamous metaplasia (59%) to atypical squamous metaplasia (8%) and squamous cell carcinoma (8%). In 6% of cases a large cell carcinoma component was found in addition to the small cell carcinoma. The findings show a good correlation with those of histologic examination of the biopsy specimens, indicating that cytologic examination is an excellent procedure for detecting concomitant changes in the bronchial epithelium in the setting of small cell carcinoma of the lung.
PMID: 7847011 [PubMed - indexed for MEDLINE]
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Percutaneous fine needle aspiration biopsy cytology of the liver for staging small cell lung carcinoma. Comparison with other methods.
Miralles TG, Gosabez F, de Lera J, Gonzalez LO, Penin C.
Department of Pathology, Hospital Central de Asturias, Hospital Universitario, Oviedo, Spain.
Fine needle aspiration biopsy (FNAB) is used routinely in the diagnosis of primary, benign, malignant and metastatic hepatic tumors. At our hospital, the staging protocol for small cell lung carcinomas and lymphomas requires biochemical determination of liver function, hepatic radionuclide analysis with 99Tc and abdominal echography (used also for FNAB guidance). We analyzed the effectiveness of these methods in 16 patients with a previous diagnosis of small cell lung carcinoma. They represented 22.5% of 71 patients on whom 142 FNABs of the liver were performed. Biochemistry was normal in 1 case of tumor and abnormal in 19 others in which all other determinations were normal. Echography was positive in 12 of the 16 cases; gammagraphy was abnormal in 11. FNAB of the liver therefore increased the sensitivity of the other procedures.
PMID: 8392252 [PubMed - indexed for MEDLINE]
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Immunocytologic diagnosis of small-cell lung cancer in imprint smears.
Tome Y, Hirohashi S, Noguchi M, Matsuno Y, Kishi K, Uei Y, Shimosato Y.
Clinical Laboratory Division, National Cancer Center Hospital, Tokyo, Japan.
Imprints of histologic or autopsy specimens from 12 small-cell lung cancers (SCLCs), 82 non-SCLCs (50 adenocarcinomas, 25 squamous-cell carcinomas, 1 adenosquamous carcinoma and 6 large-cell carcinomas), 2 carcinoid tumors, 1 malignant lymphoma and 8 metastatic carcinomas were examined immunocytologically for the presence of cluster 1 SCLC antigen (neural-cell adhesion molecule: N-CAM), chromogranin A, Leu-7, neuron-specific enolase (NSE) and gastrin-releasing peptide (GRP). The monoclonal antibodies NCC-LU-243 and NCC-LU-246, which are reactive with cluster 1 SCLC antigen/N-CAM, diffusely stained the cell membranes of all SCLCs and carcinoid tumors (100%) and diffusely and focally stained those of two of the large-cell carcinomas, two of the adenocarcinomas, two of the squamous-cell carcinomas and the one adenosquamous carcinoma. Malignant lymphoma and metastatic carcinoma were negative for this antigen. A few cases of large-cell carcinoma, adenocarcinoma, squamous-cell carcinoma and adenosquamous carcinoma were also stained with these antibodies, which may indicate a neuroendocrine differentiation. However, these tumors were different from SCLCs in that their positive tumor cell population was definitely smaller than that in SCLC, in which almost all tumor cells were positive. This confirmed the usefulness of antibodies against cluster 1 SCLC antigen for the immunocytologic diagnosis of SCLC and carcinoid tumor in imprint smears. Chromogranin A, GRP, NSE and Leu-7 were not useful in immunocytologically differentiating the imprints from these cases since only a few tumor cells were reactive with these antibodies. The antibodies against cluster 1 SCLC antigen/N-CAM can also be applied to cytologic preparations of sputum, pleural fluid and fine needle aspirates stained routinely by the Papanicolaou method since the antigen is preserved in such alcohol-fixed smears.
PMID: 1656682 [PubMed - indexed for MEDLINE]
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Diagnostic value of crush artifact in cytologic specimens. Occurrence in small cell carcinoma of the lung.
Davenport RD.
Department of Pathology, University of Michigan, Ann Arbor.
The occurrence of nuclear crush artifact (NCA) in cytologic specimens of small cell undifferentiated carcinoma (SCUC) and other carcinomas of the lung, lymphoma and benign lymphoid proliferations was studied to determine its diagnostic usefulness. NCA was found to be a common and morphologically distinct feature in SCUC, depending on how the specimen was prepared; it was present in aspirates, washings, brushings and sputum, but not in pleural or cerebrospinal fluids. It was absent in other types of cancer and could be distinguished from other similar-appearing artifacts. These results demonstrate that NCA is a diagnostically useful feature in pulmonary SCUC.
PMID: 2165345 [PubMed - indexed for MEDLINE]
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Malignant pleural effusions due to small cell carcinoma of the lung. An immunocytochemical cell-surface analysis of lymphocytes and tumor cells.
Guzman J, Bross KJ, Costabel U.
Department of Pathology, University of Freiburg, Federal Republic of Germany.
Thirteen malignant pleural effusions due to small cell carcinoma (SCC) of the lung were immunocytochemically studied using the peroxidase-antiperoxidase adhesive slide assay for the determination of cell surface antigens. A panel of monoclonal antibodies (MAbs) was used to determine the lymphocyte subpopulations and the reactivity of the tumor cells. Of the lymphocytes, 87 +/- 1% were CD3+ T cells, with 72 +/- 10% CD4+ helper/inducer T cells and 20 +/- 5% CD8+ suppressor/cytotoxic T cells. Only a minority of T lymphocytes were activated in terms of expressing the surface markers CD38 and HLA-DR. The distribution of the lymphocyte subpopulations was not significantly different from the distribution in other malignant and nonmalignant pleural diseases previously studied, indicating that the reaction pattern of the lymphocytes in the pleural cavity is similar in different diseases. The tumor cells from all cases were positive for LeuM1, CD16 and HLA-DR; 10 of 11 cases were positive for HEA-125, Sam 2 and Sam 10. Positivity for epithelial membrane antigen was observed in 11 cases, for OKT9 in 8 cases and for carcinoembryonic antigen in 6 cases. A total or partial loss of the reactivity with HLA-1 was found in nine cases. The reactivity pattern of the tumor cells with the MAbs used in this study is not specific for SCC of the lung because other carcinoma cells also reacted with these markers. Additional morphologic criteria, such as cell size and cell configuration, are needed to recognize the immunocytochemically positive-reacting cells as tumor cells from SCC of the lung. However, the immunostaining allows a better identification of the tumor cells, especially in cases with a small quantity of tumor cells.
PMID: 2165344 [PubMed - indexed for MEDLINE]
Cytomorphology of small-cell (neuroendocrine) carcinoma on ThinPrep cytology as compared to conventional smears.
Ciesla MC, Guidos BJ, Selvaggi SM.
Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA.
Small-cell (neuroendocrine) carcinoma of the female genital tract is an uncommon, aggressive neoplasm that occurs most commonly in the cervix and rarely in the vagina. Although the cytologic findings have been reported on conventional smears, the cytologic diagnosis of primary vaginal small-cell carcinoma on ThinPrep material has not been previously reported. We present a case of a 46-yr-old woman who underwent cervical/vaginal biopsies as a result of abnormal cells seen on the ThinPrep Pap Test. Small to medium-sized cells with scant cytoplasm were present singly and in loose, cohesive clusters. Nuclear molding was noted in a few cellular groups. The differential diagnosis included a high-grade squamous intraepithelial lesion, small-cell (neuroendocrine) carcinoma, endometrial adenocarcinoma, and lymphoma. Subsequent tissue biopsies with immunohistochemical staining confirmed a diagnosis of small-cell carcinoma of the vagina. The cytologic features of small-cell (neuroendocrine) carcinoma on slides prepared by the ThinPrep Pap Test are discussed and compared to those on conventional cervicovaginal smears.
PMID: 11135469 [PubMed - indexed for MEDLINE]
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Cytodiagnosis of bronchogenic carcinoma and neuroendocrine tumor of the lung by transthoracic fine-needle aspiration.
Nguyen GK, Gray JA, Wong EY, Crocket JA, McNamee C.
Department of Laboratory Medicine and Pathology, University of Alberta Hospitals, Edmonton, Alberta, Canada. [email protected]
To evaluate our experience with the cytodiagnosis of primary lung cancers by transthoracic fine-needle aspiration (TFNA), 106 bronchogenic carcinomas (BC) and 6 neuroendocrine tumors of the lung (NTL) with adequate needle aspirates were reviewed. The cytodiagnostic accuracy rates of BCs were 75.5%, 72%, 100%, 53%, and 50% for bronchogenic adenocarcinomas, squamous-cell carcinomas, small-cell carcinomas, large-cell carcinomas, and mixed carcinomas, respectively. Of the 6 NTLs, 4 typical carcinoid tumors (CT) were correctly diagnosed, 1 atypical CT was wrongly identified as small-cell carcinoma, and 1 large-cell NTL was mistaken for an adenocarcinoma. Copyright 2000 Wiley-Liss, Inc.
Publication Types:
PMID: 11074654 [PubMed - indexed for MEDLINE]
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Fine-needle aspiration biopsy of metastatic small cell carcinoma from extrapulmonary sites.
Shin HJ, Caraway NP.
Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Like a pulmonary counterpart, extrapulmonary small cell carcinoma (SCC) is an aggressive tumor with a high rate of metastasis. Forty-nine fine-needle aspiration biopsies (FNABs) (36 patients) of various primary sites other than the lung diagnosed as metastatic SCC (including Merkel cell carcinoma) were reviewed. FNABs were derived from lymph nodes (20), liver (7), bone (2), breast (1), pancreas (1), and skin/soft tissue (18). Primary tumor sites included the prostate (14), skin (11; Merkel cell carcinoma), cervix (5), urinary bladder (3), urethra (1), ovary (1), and parotid (1). Aspirates revealed predominantly dispersed single tumor cells with occasional clustering. Tumor cells were small with scant cytoplasm, fine powdery chromatin, and inconspicuous nucleoli. Nuclear molding, mitotic figures, and apoptotic bodies were frequently observed. In four cases, findings from the FNABs were used to render the initial diagnosis of SCC. FNAB is useful for determining whether metastases contain a SCC component, a finding that may alter clinical management. Cytologically, SCC from different primary sites cannot be differentiated, and its distinction requires clinical and radiographic correlation.
PMID: 9740990 [PubMed - indexed for MEDLINE]
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Diagnosis and differential diagnosis of small-cell lesions of the liver.
Pisharodi LR, Bedrossian C.
Department of Pathology, Detroit Medical Center, Wayne State University, Michigan 48201, USA.
The objective of this study was to evaluate the cytologic spectrum of small cell lesions of liver as diagnosed by fine-needle aspiration (FNA). Of 304 FNAs of liver that were performed in our institution between 1990 and 1994, 29 were classified as small-cell lesions. The final diagnoses were as follows: small-cell undifferentiated carcinoma (10), neuroendocrine carcinoma (9), cloacogenic carcinoma (1), Merkel-cell carcinoma (1), cholangiocarcinoma (1), metastatic adenocarcinoma (4), small-cell sarcoma (1), lymphoma (2). Relevant clinical history and immunocytochemistry were helpful in making the final diagnosis in some cases. The diagnosis and differential diagnosis of small cell lesions of the liver are discussed in detail in this report.
PMID: 9664180 [PubMed - indexed for MEDLINE]
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Diagnostic pitfalls in fine-needle aspiration biopsy of the mediastinum.
Singh HK, Silverman JF, Powers CN, Geisinger KR, Frable WJ.
Department of Pathology and Laboratory Medicine, East Carolina University School of Medicine, Greenville, North Carolina 27858-4354, USA.
A retrospective review of 189 fine-needle aspiration (FNA) biopsies of the mediastinum from four university medical centers was performed. Review of Diff-Quick- and Papanicolaou-stained direct smears was performed from a series of 189 FNA biopsies along with surgical pathology correlation obtained in 42% of the cases. There were 28 (14.8%) nondiagnostic or unsatisfactory for diagnosis cases. Of the satisfactory FNA specimens with histologic correlation, 12 cases (6%) were discordant. These errors primarily involve subclassification of small-cell malignancies involving the mediastinum, including a misdiagnosis of small-cell carcinoma for lymphoma. Large-cell lesions that were problematic included the accurate diagnosis of Hodgkin's lymphoma including the separation from non-Hodgkin's lymphoma. Large-cell lymphoma with sclerosis was misinterpreted in two cases due to distortion of cells by the mesenchymal tissue and sparsely cellular smears. In two cases classification of primary germ-cell tumors and separation from metastatic carcinoma was a problem. In general, FNA of the mediastinum is an accurate procedure, but can be challenging in a minority of cases due to sparse cellularity of the lesions and accurate classification of a variety of neoplasms that occur in this region. These 12 discordant cases serve as the basis of our report.
PMID: 9258619 [PubMed - indexed for MEDLINE]
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Paranuclear blue inclusions in small cell undifferentiated carcinoma: a diagnostically useful finding demonstrated in fine-needle aspiration biopsy smears.
Walker WP, Wittchow RJ, Bottles K, Layfield LJ, Hirschowitz S, Cohen MB.
Department of Pathology, University of Iowa, Iowa City 52242-1009.
In a study of bone marrow aspiration smears, Wittchow et al. (Mod Pathol 1992;5:555-558) described a highly characteristic finding, paranuclear blue inclusions (PBIs), found almost exclusively in cases of metastatic small cell undifferentiated carcinoma (SCUC). PBIs are 1-4 microns, light blue, cytoplasmic inclusions best visualized with Romanowsky-type stains. These inclusions are most easily found indenting the nuclei within clusters of closely opposed tumor cells. In the current study air-dried fine-needle aspiration biopsy (FNAB) smears from 146 primary and metastatic small cell and non-small cell adult and childhood malignancies were reviewed. PBIs were found in 28/32 (88%) of SCUC but were observed in only 4/44 (9%) non-small cell carcinomas, 2/21 (9.5%) lymphomas, 1/8 (12.5%) melanomas, 0/14 sarcomas, and 6/27 (22%) small round cell neoplasms. These results suggest that the presence of PBIs in air-dried FNAB smears of adult neoplasms, while not pathognamonic of SCUC, are a diagnostically useful finding. PBIs may be seen in a variety of different childhood small round cell neoplasms which limits their utility in this setting. The recognition of PBIs is most important to the cytologist who may not have access to ancillary studies, such as immunohistochemistry and electron microscopy.
PMID: 8050327 [PubMed - indexed for MEDLINE]
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Paranuclear blue inclusions: an aid in the cytopathologic diagnosis of primary and metastatic pulmonary small-cell carcinoma.
Mullins RK, Thompson SK, Coogan PS, Shurbaji MS.
Pathology and Laboratory Medicine Service, Veterans Affairs Medical Center, Johnson City, TN.
Accurate diagnosis of small-cell carcinoma of the lung (SCLC) is clinically important because of the therapeutic implications. SCLC must be distinguished from non-small-cell carcinoma (NSCLC) and lymphoma. Paranuclear blue inclusions (PBIs) were recently described as a feature of metastatic SCLC on air-dried Wright-stained bone marrow aspirate smears. To determine the utility of PBIs in distinguishing SCLC from NSCLC and lymphoma, we evaluated air-dried Diff-Quik-stained smears from 103 fine-needle aspiration (FNA) specimens and 14 touch imprint specimens. PBIs were identified in 24 (89%) of 27 cases of SCLC, in 6 (9%) of 64 non-small-cell carcinomas (P < 0.00001), and in two (8%) of the 26 lymphoma cases (P \ 0.00001). No PBIs were seen on any of the alcohol-fixed Papanicolaou or hematoxylin-eosin (H&E) stained smears examined. In conclusion, PBIs appear to be a feature of SCLC on air-dried cytologic material stained with Romanowsky type stains. In the presence of cytologic features of SCLC, the identification of PBIs provides a useful diagnostic feature for differentiating between SCLC and NSCLC carcinomas, and between SCLC and lymphomas in FNA specimens and touch imprints from surgical specimens.
PMID: 7523050 [PubMed - indexed for MEDLINE]
Comment in:
- Diagn Cytopathol. 1989;5(1):113-4
Carcinoids, atypical carcinoids, and small-cell carcinomas of the lung: differential diagnosis of fine-needle aspiration biopsy specimens.
Szyfelbein WM, Ross JS.
Department of Pathology, Harvard Medical School, Boston, MA.
The acceptance of fine-needle aspiration biopsy in the diagnostic work-up of pulmonary masses has resulted in an increased number of neuroendocrine tumors of the lung first encountered as aspiration cytology specimens. The accurate cytologic identification of these neuroendocrine neoplasms is important in that they have relatively specific clinical and prognostic features in contrast to nonneuroendocrine neoplasms. We report on the cytologic features of 46 primary pulmonary neuroendocrine neoplasms initially encountered on fine-needle aspiration biopsies. The neoplasms are separated into three distinct cytologic groups, including the typical carcinoid (13 cases), the atypical carcinoid (3 cases), and small-cell carcinomas (30 cases). The clinical features of all cases--and histologic findings when they were available--are also considered. Finally, a detailed cytologic description of the three groups of neuroendocrine neoplasms is presented with emphasis on differential diagnosis including nonneuroendocrine pulmonary neoplasms.
PMID: 2837371 [PubMed - indexed for MEDLINE]
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The diagnosis of pulmonary small-cell anaplastic carcinoma by cytologic means: a 13-year experience.
Caya JG, Wollenberg NJ, Clowry LJ, Tieu TM.
Department of Pathology, Medical College of Wisconsin, Milwaukee 53226.
This article reports on a series of 432 patients with positive respiratory (sputum and bronchial) cytology and proven malignant respiratory tract disease as corroborated by detailed verification criteria; 54 of these patients were diagnosed as having small-cell anaplastic carcinoma (SCAC). None of the 31 patients with autopsy-and/or biopsy-proven disease had false-positive results for SCAC. Typing accuracy for SCAC versus non-SCAC was 97.7% in the 263 patients with histologic confirmation of their respiratory tract disease. Twenty-three of the 54 patients (42.6%) were treated for SCAC solely on the basis of positive cytology in the context of compatible clinical data. This finding underscores the great importance of proper specimen preparation, quality control procedures, and diligent clinical follow-up in an era of heightened cost-containment awareness when many patients with pulmonary SCAC will be treated on the basis of positive cytology not immediately confirmed by histologic methods.
Publication Types:
- Review
- Review of Reported Cases
PMID: 2855509 [PubMed - indexed for MEDLINE]
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Carcinoid tumors of the lung: cytologic differential diagnosis in fine-needle aspirates.
Kim K, Mah C, Dominquez J.
Pulmonary carcinoid tumors presenting as peripheral or coin lesions are rare and radiologically may resemble other primary or metastatic neoplasms in the lung. This study consisted of the cytologic evaluation of fine-needle aspirates from five peripheral carcinoid tumors of the lung with particular reference to the differences between the cytologic manifestations of this neoplasm and of small-cell carcinoma and well-differentiated adenocarcinoma. Aspirates of typical carcinoid tumors are characterized by isolated cells and loose aggregates of cells; spindle- and oval-shaped cells of uniform size with scanty, pale eosinophilic cytoplasm; and nuclei with evenly dispersed finely granular chromatin and usually prominent single micronucleoli with occasional macronucleoli. In contrast, the cells of small-cell carcinoma are pleomorphic and arranged in noncohesive loose aggregates, their cytoplasm is scanty, and they show nuclear molding. Their nuclei are hyperchromatic with fine to coarsely granular chromatin. The cells of well-differentiated adenocarcinoma are arranged in three-dimensional clusters or loose aggregates of relatively uniform cells with a columnar configuration. The nuclei are uniformly round and hyperchromatic with finely granular chromatin. Macronucleoli are usually prominent. This study demonstrates that cytologic analysis of fine-needle aspirates can play a significant role in the evaluation and management of peripheral lung tumors.
PMID: 3024938 [PubMed - indexed for MEDLINE]
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Items 1-17 of 17 |
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One page. |
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