Fine-needle aspiration cytology of granulocytic sarcoma and myeloid metaplasia

The fine-needle aspiration (FNA) cytology of two cases of granulocytic sarcoma involving the breast is reported along with the FNA cytology of one case of myeloid metaplasia (extramedullary hematopoiesis) involving an axillary lymph node. Two patients had known myeloproliferative disorders, while granulocytic sarcoma of the breast was the initial presentation of an unsuspected acute granulocytic leukemia in the other patient. Diff-Quik-stained preparations aided in the diagnosis of all three cases. Immunoperoxidase stains for factor VIII-related antigen helped confirm the megakaryocytic differentiation of the cells in the FNA cytology of myeloid metaplasia. Electron microscopic (EM) examination performed on the aspirated material also showed megakaryocytic differentiation of the bizarre cells. FNA cytology can make a specific diagnosis of granulocytic sarcoma and myeloid metaplasia. The workup of these unusual extramedullary myeloproliferative masses was aided when immunocytochemistry and EM were performed on the aspirated material.

Utility of peanut agglutinin (PNA) in the diagnosis of squamous cell carcinoma and keratoacanthoma

Lectins are glycoproteins that bind to specific carbohydrate groups on cell surfaces. Peanut lectin (PNA) binds to carbohydrates on the membranes of normal keratinocytes. Recently, some authors have proposed that PNA may be a useful marker to help differentiate keratoacanthomas from well-differentiated squamous cell carcinomas of the skin. We studied a total of 34 skin biopsy specimens, including 11 keratoacanthomas, 15 well-differentiated squamous cell carcinomas, and 8 poorly differentiated squamous cell carcinomas, using peanut lectin with the avidin-biotin complex (ABC) peroxidase technique. All keratoacanthomas demonstrated uniform positive membrane staining of keratinocytes, which was identical to PNA staining in normal skin. Keratinocytes in 80% of the well-differentiated squamous cell carcinomas and keratinocytes in all the poorly differentiated squamous cell carcinomas did not stain. With prior digestion by neuraminidase, however, positive membrane staining for PNA was demonstrated in the squamous cells of all well-differentiated squamous cell carcinomas and all but one case of the poorly differentiated squamous cell carcinomas. Our results support the efficacy of PNA in most cases as a marker to aid in the often difficult histologic differentiation of keratoacanthoma from well-differentiated squamous cell carcinoma. Our findings also support those of previous authors who suggested that the negative PNA stain of malignant squamous cells is not the result of a lack of PNA receptors, but is due instead to a masking of receptor sites by terminal sialic acid residues.

Fine-needle aspiration cytology of hematopoietic lesions from multiple sites

We reviewed 130 fine-needle aspiration (FNA) biopsies from 118 patients with a variety of benign and malignant hematopoietic lesions. There were 74 (57%) malignant, 45 (35%) benign, and 11 (8%) atypical diagnoses. Immunocytochemistry of the aspirated material was performed in 47 (36%) and electron microscopy in 4 (3%) of the cases. FNA cytology was utilized to make a primary hematopoietic malignant diagnosis in approximately half of the cases and to confirm recurrence in the remainder. The malignant cases included non-Hodgkin's lymphoma. Hodgkin's disease, medullary and extramedullary plasmacytoma, and granulocytic sarcoma. Forty-two malignant cases had either previous or follow-up surgical biopsy with no false-positive diagnoses. Of the 11 atypical cases, seven had surgical confirmation with five malignant and two benign diagnoses. The benign hematopoietic lesions correctly identified included acute and chronic lymphadenitis, granulomatous processes, and eosinophilic granuloma. Only 5 of the 45 benign FNA biopsies had surgical pathology follow-up, with no false-negative diagnoses. The most commonly aspirated sites were lymph nodes (71%), although hematopoietic lesions were correctly identified in a number of extranodal locations, including soft tissue (8%), abdominal viscera (6%), lungs (5%), mediastinum (2.5%), bone (3%), and thyroid, salivary gland, and breast (1.5% each). This study demonstrates the clinical utility and diagnostic accuracy of FNA cytology in the evaluation of benign and malignant hematopoietic disorders from multiple sites. Ancillary studies performed on the aspirated material aided in making a specific and accurate diagnosis.

Polarization characteristics of wire mesh at 119 microm

Polarization characteristics of the transmitted beam through the various sizes of metal wire grid meshes are examined experimentally at 118.8 microm. When these results were compared to Chen's waveguide theory, we obtained excellent agreement. In particular, when the incident beam polarization is neither parallel (TM) nor perpendicular (TE) to the wire grid axis, a linearly polarized incident beam can be made elliptic due to the phase difference between the TE and TM modes.

Diagnostic accuracy and role of immediate interpretation of fine needle aspiration biopsy specimens from various sites

A statistical analysis of the accuracy of the immediate interpretation of 425 fine needle aspiration (FNA) biopsies from various sites was performed. Preliminary interpretation of Diff-Quik-stained smears was rendered within a few minutes after performing the FNA biopsy, using diagnostic terminology similar to that of a surgical pathology report. The immediate assessment was documented in the formal cytology report and compared to the final diagnosis. For the entire series, the immediate interpretation had a sensitivity of 96%, a specificity of 97%, a positive predictive value (PV) of 98%, a negative PV of 95% and an efficiency of the test of 96%. There were 14 false-negative or falsely insufficient immediate interpretations and one false-positive immediate diagnosis. The diagnostic accuracy of the immediate interpretation of FNA biopsies from specific sites was also calculated; FNA biopsies of the pancreas were the least accurate procedure, having a sensitivity of 60% but a specificity of 100%. The role of the immediate interpretation of FNA biopsies is similar to the use of frozen sections in surgical pathology. An immediate assessment can (1) determine whether an adequate specimen is present, (2) render a specific preliminary diagnosis, (3) guide further clinical investigations or treatment, and (4) determine whether ancillary studies are needed to make a more accurate or specific diagnosis from the FNA specimen. Our results indicate that the immediate interpretation of FNA biopsies is an accurate procedure that should be routinely employed.

Dual far infrared laser diagnostic of magnetized plasmas

A dual far infrared laser has been constructed and its properties have been exploited to probe tokamaklike discharges in the CDX toroidal device. Thermal variation of the difference frequency between the two far infrared cavities is slow, although the cavities lack thermal stabilization, simply because their assembly on the same chassis exposes them to virtually identical temperature changes. The optical arrangement beyond the laser permits conversion within minutes between interferometry and density fluctuation observation, and within an hour between different operating wavelengths. Line average densities of 2 x 10(13) cm(-3) and coherent fluctuations in the neighborhood of 20 kHz have been measured with this diagnostic.

Malignant rhabdoid skin tumor: an uncommon primary skin neoplasm. Ultrastructural and immunohistochemical analysis

Rhabdomyosarcomatoid renal tumors were initially described as a subset of tumors in the National Wilms Tumor Study that had light microscopic features similar to rhabdomyosarcomas. Subsequent studies failed to reveal evidence of muscle differentiation, thus the genesis of the term "rhabdoid" tumor. Such renal tumors are rapidly lethal. Recent reports suggest the occurrence of tumors with similar morphology in other anatomic sites. We wish to report a primary malignant rhabdoid tumor of the facial skin with detailed immunohistochemical and ultrastructural studies. Vimentin was expressed in the tumor cells, but there was no immunoreactivity for cytokeratins, neurofilaments, muscle actin, synaptophysin, S-100, melanoma antigen HMB-45, epithelial membrane antigen, neuron specific enolase, Leu-7, leucocyte common antigen or lysozyme/alpha-1-antitrypsin. Ultrastructure revealed typical whorled cytoplasmic aggregates of intermediate filaments. These studies along with a literature review reveal the heterogeneous immunohistochemical profiles of these tumors with common morphologic features. While the histogenesis of these tumors remain uncertain, it is necessary to recognize that these aggressive neoplasms may occur primarily in the skin.

Multichannel far-infrared laser interferometer for electron density measurements on the tokamak fusion test reactor

A ten-channel far-infrared laser interferometer which is routinely used to measure the spatial and temporal behavior of the electron density profile on the tokamak fusion test reactor is described, and representative results are presented. This system has been designed for remote operation in the very hostile environment of a fusion reactor. The possible expansion of the system to include polarimetric measurements is briefly outlined.

Recurrent melanocytic nevi: clinical and histologic review of 175 cases

Pigmented nevi, if excised incompletely, often recur and occasionally cause concern to the patient and the physician. In this study of 175 recurrent nevi from 173 patients, the clinical, gross, and microscopic features of recurrent nevi are described and criteria for diagnosis are developed. Rarely, recurrent nevi have atypical features that suggest malignant melanoma. The differential diagnosis entails clinical and histologic criteria that are presented.

Histologic and endoscopic studies before and after gastric bypass surgery

The purposes of this study were to establish a standardized multiparameter analysis system for histologic grading of gastritis and to compare histologic changes with endoscopic findings in the proximal and distal bypassed stomach in obese patients undergoing gastric bypass surgery. Three groups, comprising a total of 91 patients, were studied: a preoperative group (34 patients), a postoperative group at one year (33 patients), and a postoperative group at two years (24 patients). the biopsy specimens from the proximal and distal bypassed stomach were compared in all groups. Seventeen histologic variables were evaluated by three observers to classify the severity of gastritis. Forty percent of the patients in the postoperative group demonstrated histologic evidence of nonerosive, superficial gastritis, slightly more in the proximal stomach. Endoscopy showed significantly more bile reflux and inflammation in the distal stomach than the proximal stomach in nearly all patients. Our study demonstrates a significant discrepancy between bile reflux observed endoscopically and the histologic findings after gastric bypass surgery. No metaplastic or dysplastic changes were found up to two years postoperatively, but further studies are needed to determine the long-term endoscopic and histologic endoscopic and histologic sequelae of gastric bypass surgery.

Erythema chronicum migrans of Lyme disease: diagnosis by monoclonal antibodies

We demonstrated spirochetes from a skin lesion of the erythema chronicum migrans in a patient with Lyme disease by the murine monoclonal antibody (H9724). Frozen skin biopsy specimens reacted with murine monoclonal antibodies (H5332, H9724, and H4825) and were examined by indirect immunofluorescence assay. The spirochetes stained with monoclonal antibody H9724 and fluorescein isothiocyanate-conjugated second antibody (goat antimouse IgG). The antibody H9724 is specific for the periplasmic flagellae (axial filaments) of several Borrelia species, including Ixodes dammini spirochete (Borrelia burgdorferi). No immunofluorescence staining was demonstrated with either monoclonal antibody H5332, specific for an outer membrane protein of North American strains of B. burgdorferi, or the antibody H4825, specific for an outer membrane protein of B. hermsii.

Enhanced inflammatory response with histiocytes and epithelioid cells in rabbits to the intradermal injection of supernatants of cultured cutaneous sarcoidal granulomas

This study was designed to examine the inflammatory response in rabbits to intradermal injections of lymphokine-containing supernatants from cultured cutaneous sarcoidal granulomas (sarcoidal supernatant). Cell-free sarcoidal supernatants and concurrently incubated culture medium controls, alone or mixed with heat-inactivated K-S antigen or BLB, were injected intradermally into rabbits. These were, compared to control results, increased inflammatory reactions with histiocytes and epithelioid cells at the injection sites in 9 out of 11 experiments using sarcoidal supernatants mixed with K-S antigen and in 8 out of 10 experiments with these supernatants mixed with BLB. Sarcoidal supernatant alone, control medium, or normal saline solution produced no inflammatory response. Supernatants from cultured normal skin tissues obtained from sarcoid patients and those obtained from surgical patients free of sarcoidosis, when mixed with K-S antigen or BLB, showed variable inflammatory responses similar to the response seen with sarcoidal supernatants, but these were not significantly different from those of their own controls. It was concluded that lymphokines released locally may initiate and maintain the formation of sarcoidal granulomata.

Dynamics and mechanism of the sarcoidal granuloma. Detecting T cell subsets, non-T cells, and immunoglobulins in biopsies at varying intervals of Kveim-Siltzbach test sites

Punch biopsies of K-S test sites were studied by the use of monoclonal antibodies for the presence of T cells, T cell subsets, B cells, IgG, IgM, IgA, and kappa and lambda chains by an indirect and direct immunoperoxidase technique. A total of 10 biopsies were performed at intervals ranging from 6 hr to 34 days. Results revealed that at 6 hr there was an influx of T cells, predominantly helper cells, at the injection site, followed by an infiltration of monocytes, an infiltration that was maximal at 48 hr. By day 7 there was a marked increase in the number of T lymphocytes, predominantly helper cells, and a few persistent monocytes were seen. By day 12 there was evidence of granuloma formation with the appearance of some epithelioid cells and a few giant cells. These cells, along with helper T cells, were seen to have progressively increased in number when the confluent granulomas on the day 34 biopsies were studied. Epithelioid cells, however, did not show any reactivity with Leu-M3 monoclonal antibody, which stained the majority of peripheral blood monocytes. B cells were rarely present; immunoglobulins were absent in all biopsies. It was concluded that the evolution of the sarcoidal granuloma in response to K-S antigen is a purely cell-mediated phenomenon. Helper-inducer T cells appear to play a dominant role in its evolution and maintenance. Lack of reactivity of epithelioid and giant cells with Leu-M3 monoclonal antibody indicates either a different lineage from monocytes or a change in their phenotype.

The role of fine-needle aspiration biopsy in the rapid diagnosis and management of thyroid neoplasm

This report describes our 5-year experience with fine-needle aspiration (FNA) biopsy of the thyroid in a 560-bed teaching hospital. Three hundred nine FNA biopsies were performed primarily by one endocrinologist and interpreted by several pathologists. Analysis of the data reveals the sensitivity of the procedure is 93%, specificity is 95.1%, and the positive and negative predictive values are 88.9% and 96.5%, respectively. This data confirms the diagnostic accuracy of FNA biopsy. Complications were seen in 6 of 309 cases (1.9%) and were relatively mild. Nearly 75% of the cases in the series were cytologically diagnosed as nonneoplastic. Fine-needle aspiration biopsy identified 19.4% of the cases needing surgery, of which 72% had neoplastic nodules, confirming the selection role of the procedure. The management of thyroid nodules is discussed and a selective review of the FNA literature is presented. The authors believe that our experience rebuts the argument that special referral centers are needed to interpret the cytologic material. Several well trained surgical pathologists can become proficient in interpreting the FNA biopsies without significant loss in accuracy, and thereby render a definite diagnosis in the vast majority of the cases. Accordingly, the authors recommend FNA of the thyroid as the initial diagnostic test in the evaluation of thyroid nodules.

Fine-needle aspiration versus large-needle biopsy or cutting biopsy in evaluation of thyroid nodules

This report describes our experience with both fine-needle aspiration (FNA) biopsies and large-needle biopsies (LNB) or core biopsies (CB) performed at the same time on 23 patients out of a series of 309 patients examined by the FNA technique. There was no significant differences in diagnostic accuracy of tissue obtained with the FNA technique when compared with the LNB or CB biopsy technique. While FNA always yielded tissue adequate for diagnosis, the LNB, and/or CB technique yielded tissue insufficient for diagnosis in four of 26 biopsies (15.4%). We believe that the FNA is better able to sample a mass with fewer insufficient specimens. Using FNA, the diagnosis can be rendered more rapidly, at lower cost, and with decreased potential for complications. The adequacy of the FNA biopsies can be assessed immediately using a modified Wright stain (Diff-Quik). Repeat biopsies can be performed that better sample the lesions with increased patient acceptance.

Fine needle aspiration cytology of bronchioloalveolar-cell carcinoma of the lung

The fine needle aspiration cytology features of twelve peripherally located bronchioloalveolar cell carcinomas of the lung diagnosed by fine needle aspiration biopsy are described. A spectrum of cytomorphologic changes was appreciated, including classic groups showing uniform malignant cells having prominent depth of focus with a lack of significant nuclear molding. Other cells showed features of atypical alveolar macrophages and bronchial-lining cells. The smears demonstrated malignant cells arranged along alveolar septae and possessing hobnail-shaped nuclei. Two cases had associated psammoma bodies, and one case demonstrated optically clear nuclei in the malignant cells. This series stresses the fine needle aspiration features that aid in the recognition of this specific lung neoplasm and its differentiation from benign reactive pulmonary lesions, other primary lung cancers and metastatic tumors.

Psammoma bodies and optically clear nuclei in bronchiolo-alveolar cell carcinoma. Diagnosis by fine needle aspiration biopsy with histologic and ultrastructural confirmation

The fine needle aspiration cytology of two cases of bronchiolo-alveolar cell carcinoma of the lung having unusual features is reported. One case demonstrated numerous psammoma bodies in the cytologic smears, whereas the other case showed an abundance of cells with optically clear nuclei. Both peripherally located tumors were resected and confirmed as primary bronchiolo-alveolar cell carcinoma by histologic and ultrastructural examination. We believe this to be the first report describing these unusual features of bronchiolo-alveolar cell carcinoma diagnosed by fine needle aspiration cytology. Presented is a discussion of psammoma bodies and optically clear nuclei seen in primary and metastatic tumors of the lung. This will aid in the diagnosis of these cases.

Retrograde endoscopy of the bypassed stomach segment after gastric bypass surgery: unexpected lesions

Surgical measures for the treatment of morbid obesity include gastric bypass of the stomach and duodenum. We endoscopically evaluated the bypassed segments in 51 patients three to 24 months after a standard gastric bypass procedure. Retrograde endoscopy was successful in 33 of the patients (65%). There was significantly more gastritis by endoscopic grading in the distal bypassed segment than in the proximal part of the stomach. The gastritis in the bypassed segment was associated with pooled bile in 97% of the patients. The severity of gastritis did not appear to be related to the time after surgery and was as severe three months after surgery as it was at 24 months. Histologically, the gastritis was nonconfluent, and often the histologic and endoscopic findings were at variance. There was intestinal metaplasia in biopsy specimens from the distal pouch in four of the 33 patients. The mechanism for the high incidence of gastritis is unknown, but may be related to decreased antral motility due to distention of the proximal pouch with food. These patients require close observation for changes in the bypassed segment of stomach that may occur as a consequence of chronic inflammation.

Aspiration biopsy cytology of malignant schwannoma metastatic to the lung

The aspiration biopsy cytologic features of a malignant schwannoma metastatic to the lung in a 39-year-old black female with von Recklinghausen's disease are reported. Cytologic features of malignant sarcomas having a spindle-cell pattern are described along with a discussion of the cytologic differential diagnosis. This is believed to be the first reported case of a malignant schwannoma involving the lung diagnosed by aspiration cytology and demonstrates the usefulness of the technique in evaluating patients with metastatic sarcomas.

The bypassed stomach

Retrograde duodenogastroscopy solves the problem of postoperative evaluation of the gastric bypass patient. The stomach may be bypassed to treat morbid obesity, but it no longer need be inaccessible. Endoscopic gastritis is rare in the proximal gastric pouch but common in the distal gastric segment and may be related to the presence of bile. Although the gastric mucosa is histologically normal in half of the gastric bypass patients, acute and chronic gastritis, regenerative changes, and intestinal metaplasia may develop in either or both segments. The causes and implications of these endoscopic and histologic findings are unknown.