Papillary carcinoma of the breast. Cytologic study of nine cases

OBJECTIVE

To study the cytologic findings of papillary breast carcinoma by fine needle aspiration.

STUDY DESIGN

The study group consisted of fine needle aspiration (FNA) specimens of breast tumors from nine patients performed during the period 1988-1997. Eight were female, and one was male. The FNA results were compared with the final histologic diagnosis.

RESULTS

The tumor sizes were 4-6.5 cm. The aspirations yielded a good amount of bloody material. The smears revealed high cellularity, papillary clusters, isolated low-to-tall columnar cells, mild to moderate atypia, hemorrhagic background, foam and hemosiderin-laden macrophages, calcification, rare mitoses, palisading row of cells and bipolar cytoplasmic eosinophilic granules. The smears were diagnosed as either suspicious or suggestive of papillary carcinoma. The histologic examination revealed invasive papillary carcinoma.

CONCLUSION

Papillary carcinoma of the breast can be diagnosed by using a panel of cytologic findings that includes hypercellularity, papillary clusters, hemorrhagic background, palisading rows of tall columnar cells, cellular atypia and calcification. The interesting finding in this study was the presence of eosinophilic bipolar cytoplasmic granules, which has not been reported before.

Primary squamous cell carcinoma of the thyroid diagnosed by fine needle aspiration cytology. A report of two cases

BACKGROUND

Primary squamous cell carcinoma of the thyroid is a rare malignant tumor that needs to be distinguished from other neoplasms.

CASES

Two males aged 65 and 68 years presented with an enlarged right lobe of the thyroid. Thyroid scintigraphy revealed a cold nodule. Clinically malignancy was suspected. Fine needle aspiration (FNA) revealed numerous clusters and isolated malignant cells, dyskeratotic cells and deposits of eosinophilic granular keratin material. Subtotal thyroidectomy was performed. Histologic findings confirmed the cytologic diagnosis of squamous cell carcinoma.

CONCLUSION

Primary squamous cell carcinoma of the thyroid is a rare tumor. FNA findings of this tumor were not reported before. FNA study cannot help to differentiate primary from metastatic squamous cell carcinoma of the thyroid.

Modulatory potential of Spirulina fusiformis on carcinogen metabolizing enzymes in Swiss albino mice

The modulatory potential of Spirulina fusiformis was observed on the hepatic and extrahepatic carcinogen metabolizing enzymes in Swiss albino mice at a dose of 800 mg/kg b.w. given orally. A significant reduction in the hepatic cytochrome P-450 content was observed in the group treated with Spirulina in comparison with the control group. The hepatic glutathione S-transferase activity was induced significantly by Spirulina treatment. There was no change in the extrahepatic glutathione S-transferase activity after the animals were fed with Spirulina.

Follicular variant of papillary carcinoma of the thyroid. A cytologic study of 15 cases

OBJECTIVE

To study the cytologic findings of follicular variant of papillary thyroid carcinoma (FVPTC) and to compare them with the cytologic findings on other thyroid lesions.

STUDY DESIGN

The study group consisted of aspirate smears from 15 cases of histologically proven FVPTC. The control group consisted of 152 cases, including adenomatous colloid goiter (70), usual papillary carcinoma (40), follicular adenoma (30), Hürthle cell neoplasm (7) and medullary carcinoma (5).

RESULTS

The smears of FVPTC revealed numerous colloid balls in the background, multilayered microfollicles (rosettes), numerous nuclear grooves and inclusions in the monolayer sheets of follicular cells, very rare giant cells, absence of calcification and papillary clusters. Rosettelike microfollicles and numerous colloid balls were not seen in the control group.

CONCLUSION

The combination of numerous colloid balls and rosettelike microfollicles was frequently seen in FVPTC. This combination was not observed in the control group.

Papillary Hürthle cell carcinoma (Warthin-like tumor) of the thyroid. Report of a case with fine needle aspiration findings

BACKGROUND

Papillary Hürthle cell carcinoma with lymphoplasmacytic stroma is a newly recognized variant of papillary carcinoma of the thyroid gland. Fine needle aspiration findings reveal some points that have not been reported previously.

CASE

A 50-year-old female presented with a left lobe thyroid mass. Fine needle aspiration of the nodule yielded cellular smears, mostly in large and small papillary clusters of Hürthle cells, with nuclear grooves and rare nuclear inclusions in a lymphoplasmacytic background. Isolated Hürthle cell and multinucleated giant cells were also seen. Histopathologic examination of the 3-cm-diameter nodule showed papillary Hürthle cell carcinoma with lymphocytic stroma, or "Warthin-like tumor" of the thyroid, with capsular invasion.

CONCLUSION

The presence of papillary clusters with nuclear features of papillary carcinoma and oxyphilic cytoplasm in a lymphoplasmacytic background should raise the diagnosis of Warthin-like tumor of the thyroid.

Post-kala-azar dermal leishmaniasis

Post-kala-azar dermal leishmaniasis is a dermatosis which was described during the first quarter of this century. Most cases reported are from the Indian subcontinent and certain parts of Africa. The disease generally follows an attack of kala-azar, usually a few months to several years after the visceral disease has healed. The clinical picture is variable. In this report, we present a case of post-kala-azar dermal leishmaniasis in a 5-year-old Iranian boy who presented with multiple, asymptomatic, erythematous papules on his trunk and extremities and a brownish, figurate discoloration on his lower extremities, 4 years after an attack of kala-azar which was completely cured. Histopathological examination of one of the biopsied papules revealed multiple Leishman bodies. The patient was successfully treated with a pentavalent antimonial compound.

Testicular leukemia relapse. Fine needle aspiration findings

OBJECTIVE

To study the role of testicular fine needle aspiration (FNA) in the diagnosis of leukemia relapse.

STUDY DESIGN

The study group consisted of 32 leukemia patients in complete remission for one to five years. Their ages ranged from 8 to 63 years. Twenty-five of them had bilateral testicular enlargement, and seven had unilateral enlargement. Hematologic workup and bone marrow studies of all of the patients showed no evidence of leukemia (full remission). FNA smears were obtained by using 22-gauge needles fitted to 20-mL syringes.

RESULTS

The smears revealed 13 cases of acute lymphoblastic leukemia L2 (ALL-L2), 8 of ALL-L3, 5 of acute monoblastic leukemia M5 (AML-M5), 1 of acute promyelocytic leukemia (APL-M3), 1 of AML-M1; 1 of erythroleukemia, AML-M6, 1 of chronic lymphocytic leukemia, 1 of chronic myelogenous leukemia and 1 of plasma cell leukemia.

CONCLUSION

FNA study of the testis is safe, time saving, rapid and easy to perform for the diagnosis of testicular leukemia relapse, obviating the need for biopsy.

Safety of thrombolytic therapy following acute myocardial infarction in patients above 65 years

The safety of thrombolytic therapy for acute myocardial infarction in the elderly population has not been clearly established. In a retrospective study we evaluated the efficacy and complications of thrombolytic therapy in the elderly as compared to younger patients. Consecutive 588 patients who received thrombolytic therapy were studied. Clinical data in 136 patients aged above 65 years were compared with 85 patients below 40 years. Cigarette smoking was a common risk factor in the young (46 vs 13; p < 0.0001). Coexistent systemic diseases and conduction system disturbances (28 vs 9; p < 0.05) were common in the older patients, but the incidence of bleeding complications to thrombolytic therapy (6 vs 1; p = NS) was not found to be higher. Ninety percent of the elderly who had cardiogenic shock died. There was no significant difference between the two groups in reinfarction rate (12 vs 15; p = NS) and post-infarct angina (20 vs 20; p = NS). Coronary angiography revealed a higher incidence of multivessel disease in the elderly. To conclude, thrombolytic therapy is safe and effective even in older individuals.

Nuclear grooves in ependymoma. Cytologic study of 21 cases

OBJECTIVE

To study the efficacy of crush preparation smears in the diagnosis of ependymomas.

STUDY DESIGN

The study group consisted of 21 patients aged 7-61 years. All were admitted to Shiraz University hospitals (Nemazi and Beheshti) with intramedullary tumors. Fourteen were ventricular (fourth ventricle), 1 was in the parietal lobe, 5 were in the lumbosacral region and 1 was in the cauda equina. Intraoperative crush preparation smears were obtained from tissue, which was sent for frozen section and diagnosed cytologically. The control group consisted of 123 intracranial tumors (meningiomas, schwannomas, astrocytomas, oligodendrogliomas, medulloblastomas, pituitary adenomas, choroid plexus papilloma, craniopharyngioma and metastatic tumors).

RESULTS

The smears in 11 cases revealed perivascular pseudorosettes, and the smears in 21 cases revealed ependymal rosettes. Papillary clusters, calcification and intranuclear inclusions were seen in two cases. Acinar structures were seen in seven cases. Myxomatous material was seen in one case. Nuclear grooves were seen in 15 cases. All cases were diagnosed as ependymomas. Biopsy specimens confirmed the cytologic diagnosis. The tumors in the control group showed no evidence of nuclear grooves.

CONCLUSION

Fifteen cases of ependymoma showed a substantial number of nuclear grooves. Intraoperative crush preparation smears were very useful in the diagnosis of ependymomas and helped with the rapid interpretation of frozen sections.

Osteoclastomalike anaplastic carcinoma of the thyroid gland diagnosed by fine needle aspiration cytology. Report of two cases

BACKGROUND

Thyroid diseases are common among the female population in Iran; the main one is endemic colloid goiter. Thyromegaly can be due to neoplastic and nonneoplastic disorders. The clinical distinction between benign and malignant tumors of the thyroid gland is sometimes difficult. Fine needle aspiration (FNA) study can be used as a preliminary step for identifying such lesions.

CASES

Two female patients aged 54 and 62 years were admitted to Nemazi Hospital, Shiraz, Iran, with the chief complaint of weight loss, rapid enlargement of the thyroid gland for the last few months and pressure symptoms in the neck. Clinically these cases were diagnosed as malignant thyroid lesions. However, for further diagnosis the tumors were aspirated. The smears revealed numerous osteoclastlike giant cells with intranuclear inclusions and numerous, isolated oval to spindle-shaped malignant cells. The smears were diagnosed as osteoclastlike anaplastic carcinoma of the thyroid.

CONCLUSION

FNA is useful in the diagnosis of osteoclastomalike anaplastic carcinoma of the thyroid.

Primary T-cell lymphoma of the breast with lymphoepithelial lesion. A case report

Fine-needle aspiration, histomorphologic and immunologic findings in a case of primary T-cell lymphoma of the breast are reported. The tumor cells were diagnosed as large cell lymphoma with lymphoepithelial lesion and no nuclear multilobulation. No serologic evidence of HTLV-1 infection was detected. After simple mastectomy, lymph node dissection and chemotherapy, the patient is now doing well, having been followed for 30 months. To our knowledge, this is the first case report of primary T-cell lymphoma of the breast with prominent lymphoepithelial lesion, no nuclear lobularity, and an indolent clinical course.

Leukemia cutis. Fine needle aspiration findings

OBJECTIVE

To aspirate, for cytologic study, skin nodules from known cases of leukemia during full remission.

STUDY DESIGN

The study group consisted of nine leukemia patients in full remission who developed skin nodules on the head, face, chest and upper extremities.

RESULTS

The size of the nodules ranged between 1 and 3.5 cm. The nodules were aspirated with 21-gauge needle. Four were diagnosed as acute lymphoblastic leukemia, 1 as chronic lymphocytic leukemia, 1 as acute myeloblastic leukemia, 2 as acute monocytic leukemia and 1 as acute promyelocytic leukemia. Histologic sections were diagnosed as lymphoma-leukemia. The patients developed leukemia again three to four months after excision of the skin nodules.

CONCLUSION

Fine needle aspiration cytology is useful in the diagnosis of leukemia cutis.

Extramedullary plasmacytoma. Fine needle aspiration findings

OBJECTIVE

To determine the role of fine needle aspiration cytology in the diagnosis of extramedullary plasmacytoma.

STUDY DESIGN

The study group consisted of 13 patients with palpable masses at various sites. The tumors were aspirated for cytologic study.

RESULTS

The smears revealed groups of mature and immature plasma cells at various stages of maturation. Mature plasma cells showed an eccentric nucleus and abundant, deep, basophilic cytoplasm with a paranuclear halo. Plasmablasts (immature plasma cells) showed a prominent, eccentric nucleus with single, large nucleolus and abundant, deep, basophilic cytoplasm with no paranuclear halo. Binucleate and multinucleate forms were also seen quite often. The tumors were excised, and the histologic sections confirmed the cytologic diagnosis. All the patients received radiotherapy. One patient (18 years old) developed recurrence and died due to extensive infiltration into the maxilla and mandible. Two patients (57 and 62 years) developed multiple myeloma one to two years after the excision of tumors, and both died two to three months later. The remaining 10 patients were alive and well at this writing.

CONCLUSION

The smears from all 13 patients were diagnosed as extramedullary plasmacytomas by fine needle aspiration cytology.

Tuberculous orchitis diagnosed by fine needle aspiration cytology

OBJECTIVE

To study the role of the fine needle aspiration cytology (FNAC) in the diagnosis of testicular lesions.

STUDY DESIGN

Seven adult males (55-68 years) presented to the clinic with unilateral enlargement of the testis for the previous few months. Clinically, a malignant tumor was suspected. Fine needle aspiration was performed for rapid diagnosis.

RESULTS

The smears revealed many groups of epithelioid histiocytes, giant cells, a few plasma cells and occasional spindle-shaped fibroblasts. Acid-fast stain revealed a few acid-fast bacilli. The cases were diagnosed as tuberculosis and treated with orchiectomy and antituberculous drugs. The patients did well. Histologic sections confirmed the cytologic diagnosis.

CONCLUSION

FNAC is useful in the diagnosis of tuberculous orchitis.

Intestinal neuronal dysplasia as a cause of surgical failure in Hirschsprung's disease: a new modality for surgical management

Two hundred fifteen cases of Hirschsprung's disease (HD) had follow-up after definitive surgical treatment, which had been performed between September 1983 and August 1994. Of these, 20 (9.3%) had recurrence of obstructive symptoms that was unresponsive to conservative treatment. Nine cases were improved by posterior anorectal myectomy (PARM). The other 11 patients, who did not have improvement after PARM, had a re-pull-through. Reoperation consisted of excision of the descending and left transverse colon with pull-through of the right colon, regardless of the histology of the colon. The blood supply was based on the ileocolic vessels, with or without division of the right colic artery. To provide a smooth course for these blood vessels, without kinking, and to obtain adequate length of the right colon with less dissection, the entire bowel was derotated clockwise. Re-pull-through was then performed from the left side of the abdomen. The excised bowel from both operations was examined, using H&E staining, for possible evidence of intestinal neuronal dysplasia (IND) or acquired aganglionosis. All had ganglion cells in the remaining colon and at the distal limit of the pull-through. Histological signs of IND were present in all patients in the previously pulled-through colon. Apart from one mentally retarded child, all had satisfactory bowel movement in a 10 to 54-month follow-up period. IND should be considered a cause of surgical failure in HD. Subtotal colectomy and pull-through of the right colon after clockwise derotation of the entire bowel appears to be effective when symptoms persist after conservative therapy or PARM.

Kala-azar: liver fine needle aspiration findings in 23 cases presenting with a fever of unknown origin

OBJECTIVE

To study the role of liver fine needle aspiration (FNA) in the diagnosis of kala-azar with an atypical presentation.

STUDY DESIGN

The study group consisted of 23 patients (aged 18-37). All were admitted to Shiraz University Hospitals for the investigation of fever of unknown origin. The immunofluorescent antibody titer for kala-azar was positive (> 1:256 dilution). However, routine abdominal sonography revealed multiple small, hypoechoic lesions in the liver, more suggestive of metastatic tumor or miliary tuberculosis. The lesions were aspirated for cytologic diagnosis.

RESULTS

The smears revealed many atypical hepatocytes, groups of epithelioid histiocytes and, in 15 patients, macrophages containing few to many Leishman bodies, allowing a diagnosis of kala-azar. The liver needle biopsy specimens confirmed the cytologic diagnosis of kala-azar and liver cell atypia. The patients were given glucantime therapy, and 21 recovered; 1 patient was lost to follow-up, and 1 died during treatment.

CONCLUSION

Liver FNA is a useful procedure for the diagnosis of kala-azar, particularly in cases with atypical clinical presentations.

Splenic hamartoma. A diagnostic problem on fine needle aspiration cytology

Between 1980 and 1992, four splenic hamartomas from three patients were aspirated for cytologic diagnosis. Two patients were female and one male, with two lesions. All were seen because of hematologic problems, such as anemia and pancytopenia. Routine bone marrow study revealed normal to hypercellular marrow. Abdominal sonography revealed hypoechoic masses in the spleen. In all cases the clinical diagnosis of a malignant lymphoma was established. The smears of aspirated material showed many small and large clusters composed of large, abnormal cells that were diagnosed as metastatic tumors. Since no primary tumor sites were detected, the patients underwent splenectomy for a definitive diagnosis. Histologically the splenic masses were diagnosed as hamartomas. The source of the abnormal cells could have been endothelial cells or hematologic precursor cells, such as erythroblasts or atypical lymphocytes. The hematologic abnormalities disappeared after removal of the spleen.

Fine needle aspiration cytologic findings in malignant small cell tumor of the thoracopulmonary region (Askin tumor)

From 1980 to 1992, five cases of Askin tumor were diagnosed by fine needle aspiration cytology at the Shiraz University Hospitals, Namazi, Faghihi and Beheshti, Iran. All patients were female, their ages ranging between 15 and 22 years. Three of them had a mass on the right side and two on the left side of the chest. Chest roentgenography revealed no bone involvement. Two tumors involved the lungs and pleura. Urinary catecholamine levels were within normal limits. The fine needle aspiration smears revealed many small, round malignant cells with indistinct cytoplasm, a high nuclear/cytoplasmic ratio and prominent, multiple nucleoli. Homer-Wright rosettes were seen frequently. The cells were often arranged in rows simulating rouleaux formation. They were positively stained by periodic acid-Schiff stain. The histologic sections confirmed the cytologic diagnosis of Askin tumor. Four of the patients died within 7-11 months after treatment began.