Fine-needle aspiration cytology of metastatic nasopharyngeal carcinoma in cervical lymph nodes: comparison with metastatic squamous-cell carcinoma, and Hodgkin's and non-Hodgkin's lymphoma.

Our objective was to study the cytomorphological features of metastatic nasopharyngeal carcinoma (NPC) as compared to squamous-cell carcinoma (SCC) of nonnasopharyngeal origin, Hodgkin's lymphoma (HL), and non-Hodgkin's (NHL) lymphoma in the neck lymph nodes. The aim of this study was to find simple cytological criteria using routine stains that can help in differentiating between these entities. All fine-needle aspiration (FNA) smears of metastatic NPC, SCC, HL, and NHL from neck nodes available in our files were included in this study. Nodal disease was the first clinical manifestation in all cases of NPC, and all the lesions were of the nonkeratinizing type. The cytomorphological features of metastatic NPC, SCC, HL, and NHL have been described. Metastatic NPC and HL had a similar reactive lymphoid background, with eosinophils, plasma cells, and sometimes epithelioid-cell granulomas. The bizarre cells of NPC showed some resemblance to Reed-Sternberg cells of HL. However, the latter can be distinguished from the former on the basis of bulky, pale gray, vacuolated cytoplasm and vesicular nuclei with sharply demarcated prominent macronucleoli. In NPC, the neoplastic cells form distinct aggregates contrasting with the normal lymphoid cells in the background, which was different from the monotonous dispersed population of cells in NHL. Moreover, bizarre cells, prominent nucleoli, and the presence of plasma cells, eosinophils, and granulomas were not common features of NHL. The smears of metastatic SCC revealed keratinized malignant cells in all cases, while eosinophils and plasma cells were absent in the background. Plasma cells were seen intimately related to tumor cells in all cases of NPC. In conclusion, metastatic NPC can be differentiated from metastatic SCC of nonnasopharyngeal origin, HL, and NHL on the basis of simple nuclear and cytoplasmic features of malignant cells and their background. The presence of plasma cells intermingling with tumor-cell clusters is a good indicator of nasopharyngeal origin. On the other hand, a nasopharyngeal origin is unlikely in the presence of keratinized malignant cells.

Follicular thyroid lesions coexisting with Hashimoto's thyroiditis: incidence and possible sources of diagnostic errors.

Our objectives were to study the types and incidence of thyroid follicular lesions coexisting with Hashimoto's thyroiditis (HT), the pitfalls in their cytodiagnosis, and the effect on management. All cases of HT diagnosed by fine-needle aspiration (FNA) and/or histology over a 7-yr period were retrospectively studied. HT coexisted with follicular adenoma (FA) in 6 cases, follicular variant of papillary carcinoma (FVPC) in 1 case, and goitrous nodule (GN) in 2 cases. The overall incidence rates of thyroid neoplasm and goitrous nodules coexistent with HT were 15% and 3.5%, respectively. A preoperative FNA diagnosis was available in 10 histologically proven cases of HT. A false-positive diagnosis of follicular neoplasm (FN) that led to unnecessary thyroidectomies was given in 3 cases. In 2 of these, the cytological diagnosis was HT with the possibility of coexisting FN, and in the third case, the cytological finding of HT was misinterpreted as FN. The main causes of these diagnostic pitfalls were the presence of hyperplastic follicular cells with nuclear pleomorphism, a paucity of lymphoid cells in burned-out HT, and lack of ones exposure. Nuclear pleomorphism was observed in none of the follicular adenomas. FNA diagnosed accurately the coexisting lesions in 6 cases; 3 FA, 1 FVPC, and 2 GN, but it did not sample HT. In one case, FNA diagnosed correctly both HT and the coexisting FA. Therefore, the presence of a coexistent neoplasm or goitrous nodule reduced the chances of sampling HT by 85.7%, with no false-negative results. Indeed, aspiration on and around the thyroid nodule helps in sampling HT. However, HT may dominate the smear and obscure neoplasia. This can be avoided if the procedure is performed by the pathologist and the aspiration is done on the nodule only. The overlapping cytological features of FN and HT were the main causes of false-positive results. This can be reduced by avoiding the diagnosis of FN in the presence of follicular-cell pleomorphism and/or moderate to excessive numbers of lymphoid cells, provided proper aspiration technique is maintained.

Fine needle aspiration cytology of head and neck masses. Seven years' experience in a secondary care hospital.

OBJECTIVE: To study the value of fine needle aspiration (FNA) in the diagnosis of head and neck masses in a secondary care hospital. STUDY DESIGN: FNA from 225 patients with head and neck masses were reviewed. The results were analyzed, according to anatomic location, into 3 groups: inflammatory, congenital and neoplastic. FNA diagnoses were retrospectively correlated with available histologic findings or with the outcome of treatment. Accuracy, sensitivity, specificity, positive predictive value and negative predictive value in the diagnosis were computed. The numbers of lymph node biopsies performed before and after introduction of the procedure were compared. RESULTS: The most common diagnoses were reactive/nonspecific lymphadenitis and tuberculous (TB) lymphadenitis (33% and 21%, respectively). Sensitivity and negative predictive value for TB were 97% and 93%, respectively. The next most common masses were malignant neoplasms, cysts, benign neoplasms and sialadenitis, in 13%, 11%, 9% and 5%, respectively. Carcinomas metastatic to the lymph node were the most common type of cancer, followed by lymphoma and salivary gland carcinoma. The primary site of metastatic carcinomas were nasopharynx (44%) and thyroid (22%). The sensitivity and negative predictive values for the diagnosis of cancer were 95% and 96%, respectively, but reached 100% when lymphoma was excluded. The introduction of FNA reduced the number of lymph node biopsies performed in this hospital by 90%. CONCLUSION: FNA of head and neck masses proved to be a very useful diagnostic tool in separating inflammatory lesions (no surgical excision required) from cystic and neoplastic lesions. It enhanced surgical planning for malignant diseases, allowing rapid referral of lymphomas and cancer cases to tertiary care centers for management. FNA is simple, cost effective and suitable for developing countries and small, secondary care hospitals with limited resources. Skilled personnel and routine audits are the keys to success.

Mast cells in testicular lesions.

The study was performed on orchidectomized tissue and testicular biopsies sent for histopathological examination which included; 9 cases of orchitis, 6 pyocele, 9 haematocele, 13 seminomas, 5 embryonal cell carcinoma, 2 teratocarcinoma, 2 lymphoma, 4 yolk sac tumor, 17 infertility lesions and 6 normal. Toluidine blue stained sections were examined under high power magnification (hpm) and the number of mast cell present in 10 consecutive fields was counted. There was a considerable variation in the number and distribution of mast cells in various testicular lesions. Mast cells were observed mainly in the areas of inflammatory infiltrate, granulation tissue and immature fibrous tissue. In infertility, interstitium and tubular walls were the areas of predilection for the presence of mast cells. The highest number of mast cells was noted in infertility (23/hpm), compared to inflammatory/reactive lesions (19/hpm) and testicular neoplasms (2/hpm). The highest and the lowest mast cell concentration were observed in infertility and testicular tumours compared to inflammatory/reactive lesions, respectively. The role of mast cells in the pathogenesis of infertility and testicular tumourogenesis requires further investigation.

Breast diseases in the Northern region of Saudi Arabia.

OBJECTIVE: The incidence and pattern of breast diseases varies within countries. There is virtually no information on breast diseases found in the Northern region, Kingdom of Saudi Arabia (KSA). This study hopes to provide data in this area. METHODS: We reviewed the histological and clinical records of 708 patients who presented to General Surgery in Prince Abdul-Rahman Al-Sudairy Central Hospital, Sakaka, Al-Jouf, KSA, with breast complaints over an 8-year period (June 1994 and June 2002). Breast findings were categorized in terms of benign, inflammatory, malignant, congenital and functional. Benign diseases were also evaluated in terms of their proliferative status and cancer risk. RESULTS: The findings in order were benign breast disease in 245 (48.9%) were most common, inflammatory disease, 213 (42.5%), and finally cancer of the breast in 43 (8.6%). Fibroadenoma was the most common benign disease. Twenty-seven (5.4%) of benign breast disease were lesions with a cancer relative risk ranging from 1.6-4.4. Breast abscess was the most common inflammatory disease. Ductal carcinoma was the most common breast cancer. Breast cancer was bulky and presented late in mostly premenopausal women. CONCLUSION: Breast diseases are common among our patients. Although benign disease is the most common, some patients have lesions that have a small but definite cancer risk. Of concern is the pattern of advanced breast cancer, which presents mostly in young premenopausal women. A concerted educational program is needed to acquaint the patients with the significance of breast masses.

Pattern and incidence of cancer in Northern Saudi Arabia.

OBJECTIVE: To study the pattern and incidence of cancer in the Al-Jouf region of Saudi Arabia. METHODS: The record of all confirmed cancer cases were retrieved and studied from the files of the Histopathology and Cytology Department, Prince Abdulrahman Al-Sudairy Central Hospital, Al-Jouf, Kingdom of Saudi Arabia (KSA) during the period 1994 to 2001. The major types of cancer were ranked in order of relative frequency. The crude incidence rate and age standardized rate were then calculated. RESULTS: The age standardized rate in Al-Jouf was 38.5 per 100,000, a figure lower than the Saudi Arabian national average of 71.7 per 100,000 and lower than the lowest published international figure of 39.6 from Gambia. The most common cancers in the whole population irrespective of sex were carcinoma of the breast, lymphoma and leukemia combined and colorectal cancer. The most common cancers in females in Al Jouf were those of the breast, thyroid, and lymphomas and leukemia combined. Comparative findings for males were lymphomas and leukemias combined, colorectal and skin cancers. CONCLUSION: The incidence of cancer in Al Jouf region appears to be the lowest incidence published to date. The over all pattern of cancer is however similar to the findings in other regions of KSA. Carcinoma of breast, lymphomas and leukemias, and colorectal cancers are the leading cancers in the region.