Cytologic presentation of primary leptomeningeal sarcomatosis.

The cytologic findings in the cerebrospinal fluid of a 25-year-old male who presented with a diffuse neurologic disease clinically diagnosed as meningoencephalitis are described. Primary leptomeningeal sarcomatosis was subsequently diagnosed at postmortem examination. The potential value of cerebrospinal fluid cytology as a primary diagnostic tool in this rare and unusual tumor is discussed.

Cellules grumelées: old terminology revisited. Regarding the cytologic diagnosis of chronic lymphocytic leukemia and well-differentiated lymphocytic lymphoma in pleural effusions.

Distinguishing chronic lymphocytic leukemia (CLL) or well-differentiated lymphocytic lymphoma (WDLL) from a benign chronic inflammatory process involving the serous cavities is often a difficult task for the cytopathologist faced with a lymphocyte-rich effusion fluid. Spriggs and Boddington decribed characteristic heavy chromatin clumping (cellules grumelées) of the lymphocytic nuclei in effusions as diagnostic of chronic lymphocytic leukemia. A study of 23 cases of lymphocyte-rich pleural effusions in our laboratory showed that, while this cytomorphologic feature is a function of cytopreparatory technique and fixation, it was observed only in cases of CLL or WDLL and not in benign inflammatory processes.

Cartilaginous tumors of the larynx. A report of two cases with definitive diagnosis by fine needle aspiration and computed tomography.

BACKGROUND: Cartilaginous tumors of the larynx are rate tumors with an indolent course. In the past they were diagnosed by radiographic or computed tomographic imaging and laryngoscopic or surgical biopsy. The literature contains few examples of fine needle aspiration biopsy of these tumors. CASES: Smears of the fine needle aspirates from two cases of cartilaginous tumors of the larynx consisted of a mucinous background containing chondroid fragments of benign-appearing lacunar cells. Cytomorphologic and architectural features of smears and cell block preparations correlated well with histologic sections for subsequent surgical specimens. Both tumors were classified by cytology and histology as low grade cartilaginous tumors. CONCLUSION: Fine needle aspiration biopsy, together with typical computed tomographic images, is adequate for diagnosis, cost-effective and safe and can be performed in an outpatient setting.

Needle muscle biopsy.

We review our experience with needle muscle biopsy, including technique, results, complications, and outcome. We have collected data from 40 consecutive patients undergoing needle muscle biopsy of the quadriceps muscle. All biopsies were performed by the same operator and 98% were performed in the outpatient clinic. Specimens were sent to pathology for processing, staining, and interpretation. Follow-up clinical information was obtained by chart review. The ages of the patients ranged from 9 to 84 years, including three children. Of the 27 patients with a prebiopsy suspicion of idiopathic inflammatory myopathy (polymyositis, dermatomyositis, or inclusion body myositis) 13 had biopsies with consistent pathologic changes. Seven patients in this group had no pathologic diagnosis - none of these patients subsequently developed active myositis. Other conditions seen included mitochondrial myopathy, neuropathy, and type II fiber atrophy. Biopsies were very well tolerated, and no significant complications were seen. Therapeutic decisions were influenced most by needle muscle biopsy results obtained from patients suspected of having idiopathic inflammatory myopathy. Needle muscle biopsy charges were approximately 40% lower than those for open biopsies performed during the same interval. Needle muscle biopsy is a safe, care-effective, and cost-effective alternative to open muscle biopsy in the evaluation of a variety of myopathies.

Fibroma of tendon sheath in the hand.

Seven cases of fibroma of tendon sheath in the hand are reviewed. These tumors are common enough to be considered in the differential diagnosis of a soft tissue tumor in the hand, as they comprised 7 of our series of 208 soft tissue hand tumors excised over a 15-year period. A marginal excision was performed in each case, and no tumor recurred after a mean follow-up interval of 8 years. The fibromas were adherent to tendons, tendon sheaths, and neurovascular structures, and thus were more difficult to excise without morbidity than other soft tissue hand tumors.