Nasopharyngeal lipoma--a rare clinico-pathological entity.

A lipoma situated within the posterior wall of the nasopharynx is reported. Only three lipomas of the nasopharynx in adults have previously been reported. The value of CT scan and cytology in making the preoperative diagnosis of a lipoma at this location is discussed.

The significance of nuclear grooves and phagocytosis in the diagnosis of metastatic papillary carcinoma of the thyroid.

A 57-year-old patient presented with a lesion of the iliac bone. Cytological smears prepared from material aspirated from the lesion revealed cells with longitudinal nuclear grooves and haemosiderin within their cytoplasm. These observations led to a diagnosis of metastatic thyroid papillary carcinoma which was confirmed by histological examination.

Primary oesophageal rhabdomyosarcoma.

A case is presented of a rhabdomyosarcoma of the oesophagus with a description of the cytology, light microscopy, and immunocytochemical findings and a discussion of spindle cell tumours occurring at this site. Cytologically, large bizarre shaped pleomorphic cells were seen in which desmin was demonstrated in order to confirm the diagnosis after destaining a Papanicolaou stained slide and restaining it with antibody to desmin.

The changing incidence of cervical intra-epithelial neoplasia.

In order to determine whether the incidence of cervical intraepithelial neoplasia (CIN) was changing, statistics were obtained from the annual reports of the cytopathology laboratory at Groote Schuur Hospital, Cape Town, for the years 1979-1988 inclusive, and from the computerised records of the laboratory during 1987 and 1988. Analysis of 642,574 smears during the 10-year period showed an increase in incidence of human papillomavirus infection was noted. The follow-up of patients with CIN 3 was good. The peak incidence of CIN was in the 29-39 year age group. A high pick-up rate of CIN was noted in pregnant patients--10% had CIN 3. Smears from teenage patients, 78% of whom were pregnant, showed an alarmingly high incidence of atypical findings. The incidence of CIN is also high in the geriatric group of patients. These findings indicate that traditional teaching concerning cervical intra-epithelial neoplasia needs to be reviewed.

Giant cell hepatocellular carcinoma.

A terminal case of giant cell hepatocellular carcinoma, subsequent to Hepatitis B-associated macronodular cirrhosis is presented, illustrated and discussed. The uncommon finding of malignant ascites, in itself atypical of hepatocellular carcinoma, with an almost exclusive content of giant cells as the cellular component, was a feature of this unusual variant of hepatocellular carcinoma.

Helminths and protozoa as an incidental finding in cytology specimens.

This is a description of some helminths and protozoa found incidentally in routine cytology specimens submitted to this laboratory. Eight different organisms are described together with the case history for each patient. All the specimens were stained with Papanicolaou technique.

Fine-needle aspiration biopsy cytology of the breast. A review of the Groote Schuur Hospital experience.

The results of the first 1,500 cytological diagnoses of fine-needle breast aspirates performed at Groote Schuur Hospital Breast Clinic are compared with the histological diagnoses of Tru-cut and excision biopsies of the same lesions. A cytological diagnosis of malignant disease was made in 358 cases, 349 of which were confirmed histologically. The 10 false-positive and 1 false-negative diagnoses are discussed. The reliability of diagnosis in the first 500 cases is compared with that in the second and third 500 cases. There were no false-positive diagnoses in the last 500 cases, and only 3 in the second 500 cases compared with 7 in the first 500 cases. Similarly, the 1 false-negative diagnosis was made in the first 500 cases. The results confirm the reliability of fine-needle aspiration biopsy cytology as a diagnostic technique. The number of incorrect diagnoses decreases as experience with the technique increases.

Case for conservative management of selected fibro-adenomas of the breast.

To assess the safety of a conservative approach to fibro-adenoma of the breast we prospectively studied 321 women with this clinical diagnosis, and performed aspiration cytology and excision biopsy. There was histological confirmation of fibro-adenoma in 217 (68 per cent), the remainder having various benign conditions and 4 (1.3 per cent) had carcinoma. Aspiration cytology had a sensitivity of 87 per cent and a specificity of 76 per cent for fibro-adenoma. Three cases of carcinoma were identified cytologically and the fourth was regarded as suspicious. To estimate the risk of missing carcinoma we compared the annual frequency of carcinoma with fibro-adenoma in young women and found a ratio of 1:470 between 15 and 19 years, 1:133 between 20 and 24 years and 1:9 in the 25-29 age group. To assess patients' views on non-operative treatment of benign breast masses we asked 124 women, 10 days postoperatively, whether they preferred a conservative approach for a cytologically benign lump: 26 (21 per cent) opted for conservative management in the future and 8 (7 per cent) would have preferred conservatism rather than their recent excision. A conservative approach is safe for clinically and cytologically benign breast lumps in women under 25 years, but very few will accept it.

Surgical staging of gastric carcinoma: sources and consequences of error.

Macroscopic 'TNM' staging was performed during 78 consecutive operations for gastric carcinoma and compared with subsequent pathological staging. Surgical assessment was correct for tumour (T) in 60 per cent when depth of invasion was assessed, for nodes (N) in 61 per cent, for liver metastases (M) in 92 per cent but for all aspects in only 21 per cent. Curability (conservatively defined as T1-3, N0-1, M0) was correct in 8 of 18 patients thus assessed at surgery and incurability was pathologically correct in 58 of 60 patients. Despite inaccurate surgical staging, no patient was denied a resection although 10 patients had unduly radical procedures for their stage and 2 had inappropriately conservative procedures for their stage (but without evidence of residual disease). Staging errors did not jeopardize conventional surgical management substantially and use of intra-operative microscopic sampling of nodes would have improved surgical treatment only minimally.

Papillary and cystic neoplasm of the pancreas--an acinar cell tumour?

Two cases of papillary and cystic neoplasm of the pancreas (PCN) occurring in 17 and 21 year old women are reported with ultrastructural and immunohistochemical findings. A review of the English literature shows that although potentially malignant, PCN, which occurs mainly in young women, is amenable to surgical cure. The significance of large PAS positive and alpha-1-antitrypsin positive tumour granules; the lack of specificity of alpha-1-antitrypsin for pancreatic acinar cells; the possibility of acinar differentiation of PCN; and its separation from pancreaticoblastoma are discussed.

Acute acalculous cholecystitis complicating systemic lupus erythematosus: case report and review.

A case of acalculous cholecystitis presented as an acute abdominal emergency in a 22 year old woman with severe systemic lupus erythematosus. At the time of presentation the patient was receiving high doses of prednisone and cyclophosphamide to control her underlying disease. Histological examination of the biopsy specimen from the gall bladder showed lupus vasculitis. This complication of systemic lupus erythematosus has not been reported before. Laboratory studies and changes in lupus activity may fail to predict the onset of cholecystitis.