Washed-biopsy cytology of abdominal lesions.

The accuracy of an alternative method of preparing cytologic smears from material collected under laparoscopic examination was studied. "Washed-biopsy" cytology was performed by saline solution lavage of the fragments using a cytocentrifuge. Rich and well-preserved cellularity was obtained. Among 51 cases, cytology revealed 12 benign, 3 suspicious and 36 malignant cases, including 9 true negatives, 3 false negatives and 36 true positives. Suspicious cases were excluded from the analysis. The sensitivity, specificity, positive and negative predictive values, and efficiency, when comparing the cytologic to the definitive diagnoses, were, respectively, 92.3%, 100.0%, 100.0%, 75.0% and 93.7%. We recommend the routine use of the washed-biopsy method in laparoscopic examinations to improve the accuracy of cytologic investigations.

Cytologic diagnosis of melanoma in serous effusions. A morphologic and immunocytochemical study.

The diversity of melanoma patterns greatly impairs the interpretation of malignant cells in effusion samples. The presence of melanin pigments greatly helps determine the histogenetic origin of the tumor, but unfortunately many cases do not exhibit this feature. We reviewed cases with a definitive diagnosis of melanoma in order to identify some useful characteristics of the morphologic examination of effusions. We also subjected the effusions to the HMB45 immunoreaction to determine the diagnostic usefulness of this monoclonal antibody. The study was performed on 21 effusion samples containing malignant cells, and the main cytologic findings were similar to those on other neoplasms except for the presence of melanin pigment. The HMB45 immunoreaction was very sensitive, confirming the diagnosis in 14 of 18 cases (77.8%). Melanin pigments seem to be useful markers for melanoma in effusions, and HMB45 can be used as an ancillary method in the differential diagnosis.

Adenocarcinoma in females detected in serous effusions. Cytomorphologic aspects and immunocytochemical reactivity to cytokeratins 7 and 20.

OBJECTIVE: To investigate the usefulness of assessing the immunoreactivity of cytokeratins 7 (CK7) and 20 (CK20) as well as several cytomorphologic parameters in effusions with metastatic adenocarcinomas in the search for the primary site of the tumor. STUDY DESIGN: From the files of the Pathology Department, A. C. Camargo Hospital, we studied cytologic smears from 73 metastatic adenocarcinomas originally from the breast, 63 from the ovary, 40 from the lung and 32 from the stomach, looking for morphologic parameters that could have discriminant potential in suggesting the primary site in a routine situation, including intranuclear inclusions, prominent nucleoli, mitosis, signet-ring cells, psammoma bodies, nuclear crease, binucleation and multinucleation, papillary features, acinar profile (including ball cells) and single cells. Immunoreactions were performed with monoclonal antibodies to CK7 (OV-TL 12/30) and CK20 (Ks 20.8) and included morphologic analysis. Both analyses were studied in a blind fashion regarding the primary site of the tumors. RESULTS: Positivity ratios for breast, ovary, stomach and lung cases were 67.6%, 63.5%, 29.7% and 45.5%, respectively, for CK7 and 17.2%, 15.8%, 13.5% and 32.2%, respectively, for CK20. Discriminant analysis of morphologic and immunocytochemical parameters had an error rate of 42.9% in recognizing the primary site and a Wilk's lambda of .7290. CONCLUSION: The more efficient parameter with discriminant function was the papillary appearance showed by CK7, which should be used in further studies with a similar scope. The set of parameters used in this study were insufficient to discriminate the primary site of female adenocarcinomas in effusions with significant accuracy.

Cytomorphologic evidence of human papillomavirus infection in smears from the irradiated uterine cervix.

OBJECTIVE: To report the cytomorphologic evidence of human papillomavirus (HPV) infection in cervical smears from women treated with radiotherapy for carcinoma of the uterine cervix. STUDY DESIGN: From January 1986 to December 1993, 32 cervical cytologic smears (CCSs) from women who had received radiotherapy (Rtx) for squamous cell cervical carcinoma at A.C. Camargo Cancer Hospital were selected for study due to the presence of signs of HPV infection. Review of the files of these patients showed 22 additional samples, which we included in this study. The avidinbiotin-immunoperoxidase technique was performed on previously stained slides using polyclonal rabbit antibovine papillomavirus type 1 to confirm the HPV infection. RESULTS: Positive reactions were found in 18 cases (27 samples), mainly in cells with classic koilocytotic features, but also in epithelial cells that lacked cytopathic effects. Only one case, a biopsy from a verrucous lesion observed after Rtx, was found to be positive for HPV 6/11 DNA by in situ hybridization. CONCLUSION: Cytologic and immunohistochemical positivity for HPV, as well as the reaction with a HPV 6/11 DNA probe, strongly suggested that HPV infection was acquired or expressed after radiotherapy. Further studies are needed to assess the mechanisms responsible for such an association.

[Frequency of adenocarcinomas in serous effusions]. / Freqüência de adenocarcinomas em derrames cavitários.

BACKGROUND: Metastatic adenocarcinomas in effusions are frequently observed. Cytologic diagnosis of adenocarcinoma is often precise; unfortunately, the classification of the primary site is not possible in a great number of cases. The scope of this study was to report the frequency of adenocarcinomas in effusions according to the primary site. MATERIAL: We studied 2317 sequential cases: 1146 pleural effusions (943 women and 203 men), 1168 ascitic (727 women and 441 men), and 3 pericardial (2 women and 1 men). METHOD: Retrospective analysis of the records of the patients and correlations of the data of clinical follow up and morphological findings. RESULTS: The primary sites more frequently seen in pleural cavity were: breast (N = 586--51.1%), lung (N = 185--16.1%: 102 men and 83 women), and ovary (N = 124--10.8%); in ascites: stomach (N = 473--40.5%: 300 men and 173 women), ovary (N = 306--26.2%) and breast (N = 83--7.1%). Regarding only the samples of malignant effusions we observed 555 in pleural cavity: breast (N = 288--51.9%), lung (N = 92, 16.6%: 45 men and 47 women) and ovary (N = 54, 9.7%). In ascites we reported: ovary (N = 205--37.9%), stomach (N = 202--37.3%: 119 men and 83 women) and breast (N = 31--6.8%). In 47 pleural effusions (8.5%) and 37 ascites (6.8%), the original site of the neoplasia remained undetermined. CONCLUSION: The knowledge of the relative frequencies, associated with clinical information, can be helpful in the selection of further investigation for the metastatic adenocarcinomas.

Cytological diagnosis of serous effusions in a cancer hospital in Brazil.

The performance of cytological diagnosis in serous effusions was evaluated through a historical large series study which was carried out at Department of Surgical Pathology of Hospital A.C. Camargo. Files from the period of 1966 to 1990 were reviewed. Out of 4297 serous effusions samples (from 3379 patients), 2520 were pleural, 1763 ascitic and 14 pericardiac, with cytological report of malignancy in 917, 688 and 4 cases, respectively. Cytological diagnoses were confirmed true or false after correlation with the final diagnosis of the patients (clinical follow-up and/or histological evaluation). The results observed were 1982 false-negative, 21 false-positive, 1588 true-positive and 468 true-negative cases. Suspicious (161 or 3.75%) and inconclusive (77 or 1.79%) cases were not considered for statistical evaluation. Sensitivity, specificity, efficiency, as well as positive and negative predictive values were 44.5%, 95.7%, 50.1%, 98.7% and 20%, respectively. These values in pleural and ascitic effusions, separately showed similar performance, which was not observed in pericardiac samples due to small casistics. These data show low sensitivity and negative predictive values which contrast with the high specificity and positive predictive values that can be partially explained by the methodological limitations and invasive features of neoplasias.

[Urinary cytodiagnosis in urothelial neoplasms. A study of 678 cases]. / Citodiagnóstico urinário nas neoplasias uroteliais: estudo de 678 casos.

Reliability of urinary cytology was studied in 678 cases in the pathology department of the A.C. Camargo Hospital from 1966 to 1988. Cytologic diagnosis was compared to the final diagnosis of the patients (histopathologic diagnoses, cystoscopy, and clinical data). The rate of sensitivity, specificity, predictive value (positive and negative), and efficiency was obtained. Patients ranged from 2 months to 88 years, mean age being 59.9, among 446 men and 180 women. Cytologic diagnoses produced 139 positive cases (20.5%), 459 negative (67.7%), 21 "suspected" (3.0%), and 59 unsatisfactory cases (8.8%). There were 306 true negative cases (58.4%), 88 false-negative (16.8%), 126 true-positive (24.0%), and only 4 false-positive (.76%). The authors did not prepare a statistical correlation for the "suspected" and unsatisfactory cases; in 74 cases there was not information enough to perform the necessary comparison. The rate of sensitivity was 59.0%, specificity 98.7%, predictive positive value 96.9%, predictive negative value 77.6%, and efficiency 82.4%.

Frequência de adenocarcinomas em derrames cavitários / Frequency of adenocarcinomas in serious effusions

Objetivo. Identificação de freqüência de adenocarcinomas de diferentes sítios primários em derrames cavitários. Material e Métodos. Foram estudados 2.317 casos: 1.146 de derrame pleural (943 mulheres e 203 homens), 1.168 de ascite (727 mulheres e 441 homens) e três pericárdio (duas mulheres e um homem) e realizada análise retrospectiva dos prontuários dos pacientes e correlação dos achados clínico-laboratoriais. Resultados. Os sítios primários mais freqüentes em derrames pleurais foram: mama (N=586 - 51,1 por cento), pulmão (N=185 - 16,1 por cento: 102 homens e 83 mulheres), ovário (N=124 - 10,8 por cento); em ascites: estômago (N=473 - 40,5 por cento: 300 homens e 173 mulheres), ovário (N=306 - 26,2 por cento) e mama (N=83 - 7,1 por cento). Desses, 555 casos foram citologicamente positivos para malignidade em derrames pleurais, 541 em ascite e dois em pericárdio. Os sítios primários mais freqüentes em derrames pleurais citologicamente positivos foram: mama (N=288 - 51,9 por cento), pulmão (N=92, 16,6 por cento: 45 homens e 47 mulheres) e ovário (N=54, 9,7 por cento); e, em ascites: ovário (N=205 - 37,9 por cento), estômago (N=202, 37,3 por cento: 119 homens e 83 mulheres) e mama (N=31 - 6,8 por cento). Em 47 derrames pleurais (8,5 por cento) e 37 ascites (6,8 por cento), a origem dos adenocarcinomas persistiu indeterminada. Conclusão. As freqüências estabelecidas poderão, em associação e dados clínicos, orientar a investigação dos sítios primários de adenocarcinomas metastáticos.