RESUMO
We present a case of a false-positive 131I scan in the follow-up of a patient with papillary thyroid carcinoma, which developed 24 yr after radiation therapy for Hodgkin's disease. In the primary evaluation of a neck mass, histology was typical for a papillary thyroid carcinoma and thyroglobulin staining was positive. After total thyroidectomy, 131I uptake was seen in the hilum and right lung. The initial interpretation of these foci as metastatic disease was not supported by the progressive clinical course despite radioiodine treatment. Hence, repeated bronchial brushings and cytology of the pleural effusion were obtained. These specimens were negative in thyroglobulin staining and positive for synoptophysin, a marker for small-cell bronchial carcinoma. Thereby a small to medium cell undifferentiated bronchial carcinoma was demonstrated, which apparently was actively taking up iodine. In conclusion, an atypical clinical course of a suspected metastatic thyroid carcinoma should lead to a reevaluation of the initial diagnosis to prevent an inappropriate therapeutic regimen.
Assuntos
Carcinoma Broncogênico/etiologia , Carcinoma Papilar/etiologia , Doença de Hodgkin/radioterapia , Neoplasias Pulmonares/etiologia , Neoplasias Induzidas por Radiação/etiologia , Segunda Neoplasia Primária/etiologia , Neoplasias da Glândula Tireoide/etiologia , Carcinoma Broncogênico/diagnóstico por imagem , Carcinoma Broncogênico/epidemiologia , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/epidemiologia , Diagnóstico Diferencial , Seguimentos , Doença de Hodgkin/epidemiologia , Humanos , Radioisótopos do Iodo , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/epidemiologia , Masculino , Neoplasias Induzidas por Radiação/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Cintilografia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/epidemiologiaRESUMO
Fine needle aspiration (FNA) smears from 60 cases of histologically (34) or clinically (26) confirmed hepatocellular carcinomas were reviewed. In about 90% of the cases, the cytologic preparations contained clusters of malignant cells with variable degrees of hepatocytic features and a distinctive type of naked nuclei. These naked nuclei had features similar to those of the malignant hepatocytes, but with more evident atypia. They were numerous in about 75% of the cases and less frequent in 15%; in three cases, they were practically absent. All three cases of well-differentiated hepatocellular carcinomas presented with numerous naked nuclei with slight atypia. Flowerlike-configured naked nuclei were especially found in poorly differentiated hepatocellular tumors. Hepatocytic naked nuclei were rarely found in FNA smears from normal liver, metastases, cysts or degenerative, regenerative and inflammatory liver processes; when seen in these cases, they showed no atypia. The presence of atypical hepatocytic naked nuclei appears to be a very useful criterion for the diagnosis of hepatocellular carcinoma.
Assuntos
Biópsia por Agulha , Carcinoma Hepatocelular/patologia , Núcleo Celular/patologia , Neoplasias Hepáticas/patologia , Fígado/patologia , Adenoma de Ducto Biliar/patologia , Humanos , Neoplasias Hepáticas/secundário , Regeneração HepáticaRESUMO
The dose-response relations of the cytotoxic drugs taxol and cisplatin and their combination were analyzed in an ovarian cancer cell line (BG-1). The chemosensitivity profiles were obtained with 5 concentrations using the ATP cell viability assay (ATP-CVA). Furthermore, the cytomorphologic changes were analyzed. Our findings demonstrate that the ATP-CVA is able to determine the fraction of surviving cells and has proved to be an effective tool to measure cytotoxicity. At the same time we were able to analyze the cytomorphologic changes. The implications of these results for the practice of gynecologic oncology are discussed.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Cisplatino/farmacologia , Neoplasias Ovarianas/patologia , Paclitaxel/farmacologia , Células Tumorais Cultivadas/efeitos dos fármacos , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Relação Dose-Resposta a Droga , Feminino , Humanos , Células Tumorais Cultivadas/patologiaRESUMO
A 65-year-old patient was referred to hospital with suspected myocardial infarction because of left-sided thoracic pain. A paresis of the left recurrent nerve of unknown etiology has been known for three years. Because of shock with anemia, upper gastrointestinal endoscopy was performed. A diverticulum-like lesion in the proximal esophagus was found to be the source of the bleeding. A contrast X-ray examination showed a cavity of approximately 2 x 2 cm originating from the proximal esophagus. Computerized tomography revealed a large mediastinal mass reaching from the thyroid to the diaphragm. An ultrasound-guided fine-needle puncture of this tumor, together with the endoscopical snare biopsies of the esophageal lesion, allowed the diagnosis of an anaplastic thyroid carcinoma with erosion of the esophagus. The patient responded well to palliative radiotherapy. The defect in the proximal esophagus refilled quickly. Nine months after radiotherapy the patient is doing well.
Assuntos
Dor no Peito/etiologia , Fístula Esofágica/complicações , Hemorragia Gastrointestinal/etiologia , Idoso , Carcinoma/complicações , Carcinoma/radioterapia , Divertículo Esofágico/complicações , Divertículo Esofágico/diagnóstico por imagem , Divertículo Esofágico/cirurgia , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/etiologia , Humanos , Masculino , Radiografia , Choque Hemorrágico/etiologia , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/radioterapiaAssuntos
Adenoma Pleomorfo/secundário , Neoplasias Pulmonares/secundário , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias das Glândulas Salivares/diagnóstico , Adenoma Pleomorfo/diagnóstico , Adenoma Pleomorfo/patologia , Idoso , Biópsia por Agulha , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Masculino , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias das Glândulas Salivares/patologiaRESUMO
1902 ultrasonically guided fine needle aspirations of liver were examined in the Cytology Department of the Institute of Pathology, University Hospital of Zürich, in the period 1977 to March 1987. 75 of the patients had hepatocellular carcinoma which was confirmed by clinical follow-up, laboratory data and/or by histology. In 71 cases (94.6%) malignancy was diagnosed with certainty or was strongly suspected. There were no false positive diagnoses of malignancy. 2 cases of well differentiated hepatocellular carcinoma were interpreted as liver cell hyperplasia. Hepatocellular carcinoma was distinguished from metastatic tumors in 68 of 75 cases (= 83%). In 7 cases a metastatic process was misinterpreted as primary liver cell carcinoma. However, in 3 cases tumors diagnosed as metastases proved to be hepatocellular carcinomas. The efficacy and limits of the technique of ultrasonically guided fine needle aspiration in the diagnoses of liver pathology are discussed.
Assuntos
Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Idoso , Biópsia por Agulha/métodos , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Hepáticas/secundário , Masculino , UltrassonografiaRESUMO
Needle aspiration biopsy for cytologic detection of tumors and tumor-like lesions of the liver is widely recognized as a safe and highly sensitive method, especially since the introduction of imaging techniques for guidance of the aspirators needle. In the following paper we discuss indications and contraindications of the method; in the context of the articles about cytologic diagnosis of gastrointestinal lesions we write about our own observations and experiences in using this method of guided fine needle aspirations and cytologic examinations of liver lesions.
Assuntos
Biópsia por Agulha , Hepatopatias/patologia , Neoplasias Hepáticas/patologia , Biópsia por Agulha/instrumentação , Carcinoma Hepatocelular/patologia , Contraindicações , Humanos , Hiperplasia/patologia , Fígado/patologia , Neoplasias Hepáticas/secundárioRESUMO
The examination of ascitic fluid is an important part in the diagnosis and control of gastrointestinal diseases. Different etiological conditions and pathological ways help develop different types of ascitic fluid. Variation of protein content (transudates/exsudates), variation of cells lead to different diagnosis. The following paper describes methods, diagnosis and differential diagnosis and limits of the cytological ascitic fluid examination.
Assuntos
Líquido Ascítico/citologia , Gastroenteropatias/diagnóstico , Neoplasias Gastrointestinais/diagnóstico , Neoplasias Peritoneais/diagnóstico , Peritonite/diagnóstico , Diagnóstico Diferencial , Gastroenteropatias/patologia , Neoplasias Gastrointestinais/patologia , Humanos , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/secundário , Peritonite/patologiaRESUMO
The image-guided fine-needle aspiration biopsy in the diagnosis of gastro-intestinal tumors has reached a very high value out of other diagnostic tools. The results of this method depend directly on the technical performance (aspirator, technicians, cytologist) of the punction and processing of the obtained cytological material. The following paper is a brief communication on technical methods and experience in performing the image-guided fine-needle aspiration biopsy at the university hospital of Zurich.
Assuntos
Biópsia por Agulha/métodos , Citodiagnóstico , Neoplasias Gastrointestinais/diagnóstico , Ultrassonografia , Adenoma/diagnóstico , Adenoma/patologia , Biópsia por Agulha/efeitos adversos , Diagnóstico Diferencial , Neoplasias Gastrointestinais/diagnóstico por imagem , Neoplasias Gastrointestinais/patologia , Técnicas Histológicas , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/patologiaRESUMO
The presence of neuroendocrine tumor cells in ascites is extremely rare. Cytologic specimens of ascites of two patients suffering from this tumor disease were examined. The use of immunocytochemical staining allows to reach a correct diagnosis in cases in which the result of conventional diagnosis remains unsettled.
Assuntos
Adenocarcinoma/secundário , Tumor Carcinoide/secundário , Neoplasias do Colo/patologia , Neoplasias Intestinais/patologia , Neoplasias Hepáticas/secundário , Neoplasias Primárias Múltiplas/patologia , Adenocarcinoma/patologia , Adulto , Idoso , Ascite/patologia , Biomarcadores Tumorais/análise , Tumor Carcinoide/patologia , Humanos , Imuno-Histoquímica , Intestino Delgado/patologia , Fígado/patologia , Neoplasias Hepáticas/patologia , Masculino , Síndrome do Carcinoide Maligno/patologia , Proteínas de Membrana/análise , SinaptofisinaRESUMO
A pseudoepithelial pattern was observed in smears prepared from fine needle aspirates (FNA) from three plasmacytomas. In one case cells displayed a markedly granular, 'oncocytic' cytoplasm. Granularity of the cytoplasm was due to a large number of mitochondria as shown by electron microscopy. B-lymphocytic origin of the neoplasms was confirmed by immunocytochemistry.
Assuntos
Neoplasias Ósseas/patologia , Ílio/patologia , Vértebras Lombares/patologia , Plasmocitoma/patologia , Costelas/patologia , Neoplasias da Coluna Vertebral/patologia , Idoso , Linfócitos B/patologia , Biomarcadores Tumorais/análise , Biópsia por Agulha , Neoplasias da Mama , Feminino , Humanos , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade , Mitocôndrias/patologia , Neoplasias Primárias Múltiplas , Osteólise/etiologiaRESUMO
The rare form of retinal metastasis with infiltration of the vitreous is presented in terms of a 47-year-old female patient suffering from an oat cell bronchogenic carcinoma with remote metastasis. Clinical appearance, differential diagnosis, diagnostic evaluation, histology and evolution are discussed.
Assuntos
Carcinoma de Células Pequenas/secundário , Neoplasias Oculares/secundário , Neoplasias Pulmonares/patologia , Retina/patologia , Doenças Retinianas/patologia , Corpo Vítreo/patologia , Carcinoma de Células Pequenas/patologia , Neoplasias Oculares/patologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
The leading symptom of proliferative myositis is a rapidly growing hard tumor in the muscle. The disease is rare and therefore widely unknown. We observed a case of proliferative myositis in a 54-year-old female. We initially interpreted the hard tumor in the left musculus sternocleidomastoideus and its rapid growth as a malignant disease. The histological findings finally led to the correct diagnosis. In the light of the literature of 78 reported cases, a presumptive diagnosis can already be suspected from the clinical examination. The addition of CT scan and fine needle aspiration is highly diagnostic.
Assuntos
Miosite/patologia , Músculos do Pescoço/ultraestrutura , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Microscopia Eletrônica , Pessoa de Meia-Idade , Doenças Musculares/diagnóstico por imagem , Doenças Musculares/patologia , Miosite/diagnóstico por imagem , Músculos do Pescoço/patologia , Tomografia Computadorizada por Raios XRESUMO
A 29-year-old man who had been abroad for several years (mainly Mexico) fell ill with fever (up to 39.8 degrees C), night sweats, weight loss of 10 kg in 6 months (height 181 cm, weight 50.5 kg) and abdominal pain. Computed tomography of the abdomen revealed many enlarged abdominal lymph nodes. Serological tests were positive for HIV antibodies. Fine-needle biopsy of one of the enlarged lymph nodes revealed numerous macrophages with round inclusions, typical for Histoplasma capsulatum. Disseminated histoplasmosis was confirmed by direct antigen demonstration in serum and urine. The patient's serious clinical condition clearly improved and lymph node enlargement regressed after starting specific i.v. treatment with amphotericin B (initially 20 mg/dl, then 50 mg/dl). Although complete cure of the histoplasmosis in connection with the HIV infection is not to be expected, the patient has remained without symptoms for four months on 50 mg weekly of amphotericin B i.v., later changed to imidazole derivatives (400 mg ketoconazole or 200 mg itraconazole, respectively.