Lymphadenoma: a report of three cases of an uncommon salivary gland neoplasm.

AIMS: Lymphadenoma of the salivary gland is a rare neoplasm that has not been properly characterized. This study describes the clinicopathological features of three cases. METHODS AND RESULTS: All three patients were males, ranging in age from 13 to 57 years. Two presented with a parotid mass, and one a preauricular mass. The tumours were well circumscribed, comprising anastomosing trabeculae, solid tubules, glands or basaloid islands of epithelium with or without cyst formation, accompanied by a prominent lymphoid stroma lacking sinuses. Large reactive lymphoid follicles were found in two cases. The epithelial cells were bland-looking to mildly atypical. Immunostaining demonstrated dual luminal cell and abluminal basal cell differentiation, with the former being often subtle and highlighted only by immunostaining for epithelium membrane antigen or CAM 5.2, and the latter being highlighted by p63 immunostain. CONCLUSIONS: Although there is some variation in the histological pattern from case to case, lymphadenoma is a morphologically recognizable salivary gland adenoma characterized by a dense lymphoid infiltrate. Lack of familiarity with this tumour may lead to misdiagnosis as myoepithelial sialadenitis, lymphoma, metastatic carcinoma in lymph node or lymphoepithelial carcinoma.

False-positive reports in fine needle biopsy of breast lesions.

A review of the literature reveals considerable variations in the diagnostic accuracy of fine needle biopsy (FNB) of breast lesions between series, partly due to different methods of calculation, different definitions, and insufficient numbers of cases with adequate follow-up to provide reliable statistics. The best larger series have a false-positive rate between 0.2 and 0.3%, slightly higher for non-palpable than for palpable lesions. The cytological patterns of a range of benign lesions which may cause diagnostic difficulties and may be misdiagnosed as malignant by FNB are described, and guidelines to reduce the risk of false-positive diagnoses are proposed.

Broadsheet number 57: problems in fine needle biopsy of the thyroid.

The role of fine needle biopsy and cytological diagnosis in the preoperative evaluation of thyroid nodules is reviewed on the basis of the current literature as well as the authors' personal experience. Technical aspects and guidelines for reporting thyroid samples are discussed in some detail. The main emphasis is on diagnostic pitfalls, those which may lead to a false-negative diagnosis, to a false-positive diagnosis or to an erroneous typing of the lesion, and their cytological patterns are described.

Radial scar/complex sclerosing lesion--a problem in the diagnostic work-up of screen-detected breast lesions.

During the first 7.5 years of breast cancer screening in South Australia, 88 radial scar/complex sclerosing lesions were among the mammographically detected abnormalities. A false-positive cytological diagnosis by fine needle biopsy was given in three of 69 such cases with satisfactory smears, a false-positive rate of 4.3% in this particular group. A review of the smears suggested that the false-positive diagnoses could have been avoided if a total or near total absence of a benign epithelial component had been included among the criteria for a malignant diagnosis. However, even after review, atypia was considered sufficiently worrying to be reported as a suspicion of malignancy in 7% of cases.

Diagnostic difficulties in the interpretation of fine needle aspirates of salivary gland lesions: the problem revisited.

Cases of salivary gland lesions (n = 325), mainly neoplastic but including a small number of non-neoplastic lesions, investigated by fine needle aspiration (FNA) and with histological correlation, are reviewed. The review identified a number of differential diagnostic problems which are discussed in some detail. One false-positive and eight false-negative diagnoses had been made resulting in a 99.5% specificity and a 85.5% sensitivity. If type-specific diagnoses are made only when all defined diagnostic criteria are present and if any uncertainty is clearly conveyed to the clinician, FNA is a safe and accurate tool in the investigation of salivary gland lesions.

Rapid method for detecting monoclonality in B cell lymphoma in lymph node aspirates using the polymerase chain reaction.

AIMS: To use the polymerase chain reaction to detect monoclonality at the immunoglobulin heavy chain gene locus in cells derived from lymph node aspirates. METHODS: A nested two-stage polymerase chain reaction (PCR) for the VDJ region of the immunoglobulin heavy chain gene was used to detect monoclonality. The total number of cells available for diagnosis by PCR in lymph node aspirates was between 10(4) and 10(5). RESULTS: A monoclonal band was detected in 21 of 25 malignant B-lymphomas. The other four specimens gave polyclonal bands. Specimens from reactive lymph nodes produced polyclonal bands in 14 cases, no product in two cases, and one specimen gave two monoclonal bands. Polyclonal bands were obtained for three Hodgkin's lymphoma samples and five metastatic carcinomas. Four metastatic carcinoma samples gave no amplification. CONCLUSIONS: Detection of monoclonality in a cell population is strongly suggestive of malignant disease. The simple PCR method presented here should complement conventional cytological and immunological methods for diagnosis of malignancy by lymph node aspirates.

Immunocytochemical assay for oestrogen receptor in fine needle aspirates of breast cancer by video image analysis.

Assessment of heterogeneity in oestrogen receptor (ER) expression aims to improve prediction of prognosis and treatment assignment in breast cancer. Current assessments are performed manually and are subjective. Automated image analysis as described here objectively quantitates ER in breast cancer nuclei obtained by needle aspiration. ER was visualised by ERICA with diaminobenzidine (DAB) substrate. Various indices of ER positivity were derived from the integrated density and average density measurements of nuclear DAB. Each index was compensated for background staining by non-specific antibody binding and endogenous peroxidase activity. Total nuclear ER content (integrated optical density of stain) was strongly associated with the biopsy ER concentration determined by saturation analysis of radioligand binding (DCC), P less than 0.005. Nuclear ER concentration by image analysis (mean optical density of stain) was not associated with the DCC measurement of ER concentration, P greater than 0.05. This was attributed to technical artefacts of cytocentrifugation. Using threshold values of 5% positive cells and 10 fmol mg-1 concordance of assignment of ER status by image analysis with the DCC assay was 91%, sensitivity was 89% and specificity 100%. It was concluded that image analysis is an appropriate, easy and economic method for determining the nuclear ER status of aspirated cancer cells. Image analysis has the potential to become a powerful diagnostic tool in the assessment of hormone receptor status of breast cancer patients.

Fine needle aspiration in the diagnosis of salivary gland lesions.

Fine needle aspiration biopsy (FNAB) of salivary glands was performed in 187 patients. In 106 patients with satisfactory FNAB smears who proceeded to surgery, the original cytologic diagnosis was compared with subsequent histopathology. There were 74 benign tumours and 25 malignant tumours. Nineteen of the latter were primary malignant neoplasms of the salivary glands, and 6 were metastatic. The cytologic diagnosis by FNAB correlated exactly with the histologic diagnosis in 95% of benign neoplasms and in 68% of malignant neoplasms, with an overall accuracy of 88%. A false negative diagnosis for malignancy was made in five cases and a false positive diagnosis in one case. Hence the sensitivity for malignancy was 80% and the specificity was 99%. The most frequently misdiagnosed lesions were pleomorphic adenoma and muco-epidermoid carcinoma. FNAB of salivary gland lesions is easy to perform and free of complications, but the cytologic patterns may be difficult to interpret, and considerable experience is necessary in order to achieve a high diagnostic accuracy.

Fine needle aspiration biopsy of salivary gland tumours. Problems and pitfalls.

A review of all fine needle aspiration biopsies of salivary gland lesions performed at the Flinders Medical Centre during a 9-year period revealed a number of cases in which there was a discrepancy between the initial cytology report and the definitive diagnosis by histology examination. The most common problem was that of atypical features in pleomorphic adenoma, raising a suspicion of a low-grade malignant tumour in 4 cases. One mucoepidermoid carcinoma and one acinic cell carcinoma had been wrongly diagnosed as Warthin's tumours on the basis of the presence of sheets of bland epithelial cells with oncocyte-like cytoplasm. One trabecular monomorphic adenoma was misdiagnosed as adenoid cystic carcinoma, and one adenoid cystic carcinoma as pleomorphic adenoma. The cytologic patterns of these cases are presented and discussed.

Relationship between ploidy and steroid hormone receptors in primary invasive breast cancer.

The relationship between ploidy, as measured by flow cytometry, and the presence of oestrogen and progesterone receptors was investigated in 145 primary invasive breast cancers. The tumours were considered as an integral group, and as subgroups of lobular and ductal carcinomas. An association was found between the presence of aneuploid stemlines and an absence of oestrogen receptors (ER), for the total tumour population (P less than 0.02), and for the ductal carcinoma group (P less than 0.05). An association between aneuploidy and an absence of progesterone receptors (PR) was observed for the total tumour group (P less than 0.05). Evaluation of a combined oestrogen and progesterone receptor status indicated that the association between aneuploidy and an absence of both receptors was highly significant. The probability of such an association was P less than 0.001 for the total tumour population, and P less than 0.01 for the ductal tumour group. Assessment of progesterone receptor expression by breast cancers containing oestrogen receptors indicated that aneuploid tumours were as likely to express PR as were diploid tumours. Hence, the biological activity of oestrogen receptors appears unmodified by the presence of aneuploid nuclei.

Fine needle aspiration cytology in the diagnosis of solid renal and adrenal masses.

In the eight-year period 1977-1984, 83 renal and adrenal mass lesions which were not clearly simple cysts by ultrasonographic examination (US) were investigated by percutaneous fine needle aspiration (FNA) biopsy. Initially, biopsy was often guided by fluoroscopy, later US was by far the most commonly used modality. There were 77 renal and 6 adrenal masses; 69 lesions were malignant and 14 were benign. A positive cytological diagnosis of malignancy was given in 62 cases, a diagnostic sensitivity of 90%. One false positive diagnosis occurred, an angiomyolipoma was misinterpreted as a low grade renal cell tumour. One significant complication was recorded, post biopsy haemorrhage into a large, extensively necrotic renal adenocarcinoma causing severe pain. The place of FNA in the preoperative investigation of solid renal tumours is discussed on the basis of this experience and results reported in the literature.

Evaluation of cytodiagnosis of cutaneous basal cell carcinoma.

Cytologic and histopathologic diagnoses were assessed independently without clinical details in 150 lesions from 112 consecutive patients. Nine of the lesions (6%) could not be evaluated cytologically because of unsatisfactory smears. Correct cytodiagnosis was obtained in 125 of 141 (89%) evaluable lesions. A solar keratosis with prominent basal cell hyperplasia was incorrectly assessed as a basal cell carcinoma (BCC). Five BCCs were misdiagnosed as squamous atypia, either because the smears were not representative or from inability to distinguish between pleomorphic BCC and severe squamous atypia. An incorrect cytologic diagnosis was thus made in 4% of lesions. Smears from ten lesions (7%) were reported as nondiagnostic for the same reasons. Cytologic diagnosis is simple, rapid, and accurate and is of value in the management of suspected cutaneous BCC.

The diagnosis and local staging of renal cancer--an appraisal.

The standard pattern of investigation for renal masses usually involves excretion urography, ultrasonography and angiography. This study was undertaken to determine whether computed tomography (CT) and fine needle aspiration cytology could provide information that might allow this pattern to be modified. Diagnostic information was obtained by needle aspiration cytology in 25 patients who were shown at operation to have a neoplasm. The diagnosis was correct in 22 cases (88%). By comparison, arteriography was accurate in 22 out of 24 (92%), and computed tomography provided the correct diagnosis in 19 out of 21 (90%). Staging was performed surgically and histologically in 21 patients, and when this was compared with the results of CT staging there was complete agreement in 13 cases (62%). A literature review revealed an average staging accuracy for CT of 81% while arteriography was accurate in only 57%. Thus CT appears to be as good as arteriography for diagnosis and potentially better for local staging. It is also less invasive, rapid and cost effective and could supersede arteriography as the primary diagnostic and staging investigation in patients with a solid renal mass.

Oncofetal antigens as tumor markers in the cytologic diagnosis of effusions.

To test the value of oncofetal antigens in the cytologic diagnosis of effusions, immunoperoxidase staining with antisera to carcinoembryonic antigen (CEA), alpha fetoprotein (AFP), pregnancy-specific beta 1-glycoprotein (SP1) and placental alkaline phosphatase (PLAP) was carried out on pleural and peritoneal fluids from 72 cases. Sections of formalin-fixed, paraffin-embedded cell blocks were used in most cases; cytocentrifuge preparations were used in some. Reactions were negative with all antisera in 23 of 24 nonmalignant effusions as well as in all 7 cases of malignant mesothelioma and 4 cases of malignant lymphoma. In 24 of 36 confirmed carcinomatous effusions, staining was positive with one or more antisera, including anti-CEA positivity in 23 of the 24 cases. In 5 of the 24 cases with positive staining, a confident diagnosis of malignancy had not been made on routine cytologic preparations. Immunoperoxidase staining for CEA appears to be of supportive value in the cytologic diagnosis of malignancy in effusions.

The typing of non-Hodgkins lymphomas using fine needle aspiration cytology.

Fine needle aspiration cytology smears and histology sections from 53 cases of non-Hodgkin's lymphoma (NHL) were reviewed blindly and independently to determine the accuracy of cytological subtyping of NHL. It was decided to use the Kiel classification as it is based on cytological criteria. There was full agreement between the cytological and the histological classification in 44 of 53 cases. The cases were correctly assigned to a good or bad prognostic group in 48 of 49 instances in which a cytological diagnosis was made. It is felt that fine needle aspiration biopsy for cytology is sufficiently accurate to be of practical value in the following circumstances. 1. As a sole morphological diagnosis so as to avoid major surgery in cases of advanced disease without superficial node involvement. 2. To assess the extent of node involvement following histological diagnosis without further surgery. 3. In the selection of a representative node for surgical biopsy. 4. In the investigation of recurrent disease.