Aspiration and Brushing Cytology in tumors and tumor-like conditions of the tongue: A Study of 27 Cases.

BACKGROUND: Lesions of the tongue have a broad differential diagnosis ranging from benign idiopathic processes to infections, cancers, and infiltrative disorders. An important thing to remember is that most tongue lesions will resolve spontaneously or with simple therapy within a week, if not, they should be biopsied or evaluated further for a definitive diagnosis of a potentially serious disorder. Some tongue lesions may be clues to other underlying illnesses which require further evaluation Tongue lesions are traditionally evaluated by surgical biopsy. Most of them, however, are easily accessible by fine-needle aspiration (FNA) or brushing. STUDY DESIGN: Fifteen males and twelve females aged from 15 to 72 were examined in our institution over a period of 15 years and 27 lesions, were evaluated by fine-needle aspiration cytology (FNAC) or brushing cytology. RESULTS: The lesions were located at the mobile aspect of the tongue.10 malignant tumors were diagnosed: 9 cases of squamous cell carcinoma (SCC), and 1 non-Hodgkin lymphoma (NHL). In addition, 13 benign tumors (7 cases of papillomas / fibromas, 3 cases of hemangiomas, 2 cases lymphangiomas, and 1 case of lipoma), and 4 nonneoplastic benign conditions (3 traumatic ulcers and 1 hematoma) were found. There were no false-positive diagnoses. There were no clinical complications resulting from FNA or brushing. CONCLUSION: Cytologic examination is rapid, safe, accurate, inexpensive, and patient-friendly for establishing preoperative diagnosis in tumors and tumor-like conditions of the tongue, and we recommend this method as the first diagnostic step in the evaluation of these lesions.

CD30 (Ber-H2) expression by thymocytes and thymic epithelial cells during the late first and second trimester of gestation: an immunohistochemical and in situ hybridization (ISH) study.

BACKGROUND: The exact biological function of CD30 in the thymus during development has been only partially elucidated, although data indicate it may be involved in negative selection. This study was prompted by the observation of a positive reaction of thymic epithelial cells (TECs), Hassall's corpuscles, and thymocytes with the monoclonal antibody CD30 during the late first and second trimester. MATERIAL/METHODS: Twenty paraffin-embedded fetal thymus specimens at the late first and second trimester were investigated by conventional histology and immunohistology for CD30 expression. To provide additional information on the nature and localization of CD30+ thymocytes and CD30+ TECs, in situ hybridization (ISH) was performed on the specimens. RESULTS: 1) In the medulla, a statistically significant difference between CD30+ thymocytes from the late first trimester and those from the second trimester (p<0.0001, t-test) was demonstrated. No significant difference was found concerning CD30+ thymocytes in the cortex. 2) Many medullary TECs and Hassall's corpuscles showed high expression of CD30 during the second trimester, whereas small numbers of CD30+ TECs were found during the late first trimester. No statistically significant difference was found concerning CD30+ TECs in the cortex. CD30 was expressed by ISH in many cells in the medulla and along the septa, whereas the cortex showed little if any expression. Accordingly, a higher CD30 expression was found in medullary than in cortical thymocytes. CONCLUSIONS: Comparison of CD30 expression by TECs and thymocytes during the late first trimester and second trimester suggests an important role for CD30 in thymic selection.

An unusual case of posttransplant peritoneal primary effusion lymphoma with T-cell phenotype in a HIV-negative female, not associated with HHV-8.

Primary effusion lymphoma (PEL) is a recently individualized form of non-Hodgkin's lymphoma (WHO classification) that mainly develops in HIV infected males, more frequently in homosexuals and advanced stages of the disease (total CD4+ lymphocyte count below 100-200/microL). Occasionally, it appears in other immunodepressive states (such as solid organs transplant period) and even, although very rarely, in immunocompetent patients. From a pathogenetic point of view, PEL has been related to Kaposi's sarcoma associated herpes virus (also named human herpesvirus 8, HHV-8), an etiological factor of Kaposi's sarcoma. The relative infrequency of this disease, the absence of wide casuistics allowing a better characterization, and its unfavorable outcome support the need of a deeper knowledge. We present here the clinical-biological findings of a patient, HIV seronegative, who was diagnosed with peritoneal PEL of T-cell origin, and not HHV-8-associated, five years after renal transplantation.

Fine needle aspiration cytology diagnosis of gastrointestinal stromal tumors utilizing scanning electron microscopy.

BACKGROUND: Digestive stromal neoplasms are the most frequent undifferentiated mesenchymal tumors. The outcome of these malignancies is difficult to predict and the histogenesis is still controversial. However, the frequent and specific expression of CD117 (c-kit) by these tumors could imply an origin from interstitial cells of Cajal. Our objective was to analyze the role of fine needle aspiration cytology, cell block preparation, and immunocytochemistry in the interpretation of gastrointestinal stromal tumors, and to establish scanning electron microscopy as a useful research aid for pathologic changes of the surface cells of gastrointestinal stromal tumors, not totally appreciated by light microscopy. MATERIAL AND METHODS: Twelve cases of gastrointestinal stromal tumors were included in this study, in which fine needle aspiration cytology was performed. RESULTS: On aspirated material, the tumor cells formed closely packed cohesive tissue fragments with high cellular density often in bloody background, or fascicles with parallel side-by-side arrangements of the nuclei. On cell block biopsy material, gastrointestinal stromal tumors were highly cellular spindle or epithelioid tumors with basophilic appearance. Immunocytochemically, they were CD117 positive in all twelve cases, CD34 positive in nine, weakly smooth muscle actin-positive in five, and S-100 and GFAP-negative in all cases. The scanning electron microscopy study showed a strong correlation with the cytomorphological profile. CONCLUSIONS: Gastrointestinal stromal tumors show a broad morphologic variety, but nuclear pleomorphism by cytology alone, rarely correlates with malignant potential. In the appropriate clinical and radiological setting, a confident diagnosis of gastrointestinal stromal tumors can be documented by fine needle aspiration cytology, cell block, immunocytochemical, and scanning electron microscopy results.

Human decidual cells activity in women with spontaneous abortions of probable CMV aetiology during the first trimester of gestation. An immunohistochemical study with CMV-associated antigen.

AIM: To determine the expression of CMV-associated antigen in the human decidual endometrial stromal cells in spontaneous abortions with no evidence of maternal relapse during the first trimester of gestation. EXPERIMENTAL DESIGN: We examined 15 placentas resulting from intrauterine fetal death after spontaneous abortion during the 8th, 10th, and 12th week of gestation respectively, and in which CMV reactivation was ruled out from serological evaluation of the pregnant women at admission, versus equal controls after voluntary abortion following well-documented maternal viral recurrence. In addition, a panel of monoclonal antibodies for the identification of leukocytes (CD45/LCA), B-lymphocytes (CD20/L-26), and T-lymphocytes (CD45RO/UCHL1), was performed. All women received hormonal medication to support gestation, in the cases of spontaneous abortions. RESULTS: Immunohistochemical examination using a specific antibody against cytomegalovirus showed large multinucleated infected cells with intranuclear inclusions, located primarily in the decidual stroma within a lymphoplasmacytic infiltrate in the cases of spontaneous abortions. No evidence of infection was observed in the chorionic villi. In the cases of voluntary abortions same findings were observed in the relevant areas, and a strong evidence of infection was observed in the chorionic villi. CONCLUSION: This study demonstrates 1) that the decidual endometrial stromal cells can express the CMV-associated antigen prior to serological manifestation of the viral replication, 2) the expression of the antigen is higher in cases of hormonal administration to support gestation. In these cases a mild mononuclear infiltrate of UCHL1 (T marker) positive cells, accompanies the CMV-associated antigen positive cells.

Altered intrahepatic hematopoiesis in neonates from women with pregnancy induced hypertension/pre-eclampsia.

AIM: To detect whether preeclampsia influences neonatal intrahepatic hematopoiesis, given that an activation of fetal neutrophils and monocytes during the course of this disorder occurs. EXPERIMENTAL DESIGN: We examined liver samples from 10 neonates of hypertensive/preeclamptic women at 27 to 28 weeks of gestation delivered by a cessarian section. All neonates were placed in incubators but they all died within 24 hours due to immaturity. The control group comprised 10 fetuses of the same gestational age, after voluntary abortion due to a neural defect. Specific antibodies against CD34, glycophorin C, hemoglobins A and F, myeloperoxidase, CD61, CD68, terminal desoxynucleotidyl transferase and the pax-5/B-cell specific activator protein, were used in each sample. RESULTS: Neonates from hypertensive/preeclamptic women, in comparison with controls, showed: a statistically significant reduction of erythropoiesis by 25% (p=0.015); a statistically significant increase of granulopoiesis (p=0.019); a statistically significant increase in the expression of CD68 positive cells of the monocytic lineage (p=0.017); a statistically significant increase in the expression of CD34 progenitor/stem positive cells (p=0.021). No statistically significant differences were observed in both examined groups, concerning megakaryopoiesis and B lymphopoiesis. CONCLUSIONS: Preeclampsia of pregnancy has an impact on neonatal intrahepatic hematopoiesis by increasing granulopoiesis, reducing erythropoiesis and triggering endothelial and stem cell activation. We suggest that these findings reflect a state of persistent inflammation and a loss of red blood cell production possibly contributing to the neonatal morbidity related to this disorder.

Prevalence of CD8/CD4 ratio in the fetal thymic parenchyme in Down's syndrome.

AIM: The maturation of most T-lymphocyte precursors takes place within the meshwork of thymic epithelial cells. Different steps of this process can be defined by immunologic phenotyping. The prothymocytes are positive for the terminal deoxynucleotidyl transferase (TdT) and give rise to cortical thymocytes, which express CD1, CD2, CD3, CD5, and both CD4 and CD8. These CD4 and CD8 double-positive cortical thymocytes differentiate into two lineages: CD4+ or CD8+ lymphocytes of the thymic medulla, by the tenth week of gestation. Our study points towards the determination of the CD8 cytotoxic/suppressor capacity of the fetal thymus in Down's syndrome. EXPERIMENTAL DESIGN: A quantitative comparison of T-lymphocytes (CD3, CD4, and CD8) in the thymic parenchyme in embryos after voluntary abortion during 2nd trimester of gestation and embryos with Down's syndrome, respectively, was performed. RESULTS: Our results showed: 1) A statistically significant depletion in the total number of T-cells (CD3 positive) in the cases of embryos with Down's syndrome over those after voluntary abortion, during the second trimester of gestation (p<0.0001, t-test). 2) A significant difference in the CD8/CD4 ratio in the cases of embryos with Down's syndrome, during the second trimester of gestation which was numerically stronger with the progress of fetal development (20th week: p<0.025; 24th week: p<0.01, chi-square). CONCLUSIONS: The occurrence of increased CD8/CD4 ratio in the cases with Down's syndrome, in the second trimester of gestation, underlines the cytotoxic/suppressor property of the thymus in the affected fetuses.