Microsatellite instability and MLH1 hypermethylation - incidence and significance in colorectal polyps in young patients.

OBJECTIVE: Microsatellite instability (MSI) is observed in most hereditary nonpolyposis colorectal cancer-related colorectal cancers (CRC). The original Bethesda criteria recommends MSI testing in patients

Cytodiagnosis of a meningeal fibrosarcoma metastatic to the thyroid gland.

A case of primary leptomeningeal fibrosarcoma metastatic to the thyroid gland, diagnosed by fine needle aspiration biopsy is described. The patient, a 39-year-old women was initially diagnosed with a leptomeningeal fibrosarcoma. Sections of the primary tumor studied by electron microscopy showed that the tumor cells have the ultrastructure features of a fibroblast. She underwent tumor resection, followed by chemotherapy and local radiotherapy. Four months later, she presented with dysphagia. Ultrasonography confirmed the presence of a 2-cm mass in the right lobe of thyroid. A fine needle aspiration biopsy was performed. Light microscopy showed interwoven bundles of neoplastic spindle cells similar to the primary tumor, consistent with a metastatic fibrosarcoma. To our knowledge, this is the first report of a primary meningeal fibrosarcoma that metastasized to the thyroid gland, which was diagnosed by a fine needle aspiration biopsy.

Pseudomembranous gastritis: a novel complication of Aspergillus infection in a patient with a bone marrow transplant and graft versus host disease.

A 36-year-old Hispanic man who had undergone allogeneic bone marrow transplantation, complicated by graft versus host disease, was admitted with acute gastrointestinal symptoms, including severe diarrhea and diffuse abdominal pain. He also had a persistent cough with sputum production. Blood cultures yielded Escherichia coli, and sputum cultures grew Apergillus species. The patient was treated with antifungal agents and broad-spectrum antibiotics. Despite aggressive medical therapy, the patient died 10 days after admission. Postmortem examination disclosed severe, bilateral confluent bronchopneumonia, with numerous septated branching hyphae consistent with Aspergillus species fungal organisms that involved the pulmonary parenchyma and tracheobronchial tree. Although the small and large bowels were only mildly congested, the entire gastric mucosa was covered with a 1.5-cm-thick pseudomembrane that contained numerous Aspergillus organisms. Our report represents the first description, to our knowledge, of a diffuse inflammatory pseudomembrane in the stomach, a complication that to date has only been associated with small and large bowel involvement.

Fine needle aspiration cytology of vaginal cuff lesions.

OBJECTIVE: To assess the usefulness of fine needle aspiration (FNA) of the vaginal cuff in various lesions in the female genital tract. STUDY DESIGN: Twenty-six FNAs of vaginal cuff lesions were performed at our institution from 1994 to 1998. All cases were reviewed. Data on clinical histories and follow-up, if available, were collected. Histologic material was reviewed. Fourteen gynecologic (cervicovaginal) smears performed on these patients within six months prior to the FNA were also reviewed. RESULTS: Two of twenty-six (7.7%) FNAs were non-diagnostic due to poor cellular yield. Four lesions were classified as benign (16.7%). The remaining 20 FNAs were classified as malignant (83%) and were consistent with the clinical history in all cases. CONCLUSION: The results show that FNA of the vaginal cuff appears to be a simple and accurate procedure for detecting benign and malignant lesions of the female genitourinary tract. Clinical indications, cytologic techniques and potential pitfalls are identical to those of FNAs at other sites.

Pancreatic masses: a multi-institutional study of 364 fine-needle aspiration biopsies with histopathologic correlation.

Only 15% of primary malignant tumors are confined to the gland at the time of presentation. Fine-needle aspiration (FNA) is valuable in confirming the malignant nature of these unresectable lesions. Benign pancreatic lesions and metastatic neoplasms can also be evaluated by fine-needle aspiration. We undertook a retrospective study to evaluate the efficacy of FNA in assessing pancreatic masses. Three hundred and sixty-four radiologically guided FNAs of the pancreas performed between 1986-1996 were reviewed. Surgical material was also evaluated when available and compared to the FNA material. There were 223 men and 141 women. Their ages ranged from 23-90, with a mean of 64 yr. Two hundred and twelve patients (58%) had primary malignant tumors, 183 had adenocarcinomas, 15 had mucinous cystadenocarcinomas, 12 had neuroendocrine tumors, and 2 had pleomorphic giant-cell carcinomas. Ninety-one (43%) had available surgical material which showed adenocarcinoma. Ninety-one patients (25%) had benign aspirates, including 53 showing benign ductal epithelium, 23 showing pancreatitis/inflammation. 10 showing pseudocysts, and 7 showing serous cystadenomas. Surgical material was available in 24 (26%) of these patients. Two of these showed adenocarcinoma. Sixteen aspirates (4%) were suspicious for malignancy, 13 (81%) of which showed adenocarcinoma on follow-up biopsies. Twenty-two aspirates (6%) showed metastatic neoplasms. Twenty-three (6%) had unsatisfactory specimens. Ten (43%) of these had follow-up biopsies, 3 of which were malignant. FNA of primary benign and malignant pancreatic masses is highly sensitive (98%) and specific (100%). Eighty-one percent of the suspicious lesions showed adenocarcinoma on follow-up biopsy. FNA of metastatic neoplasms to the pancreas is also very accurate. This technique can be useful in avoiding unnecessary surgery.

Fine needle aspiration cytology of the oxyphil variant of papillary carcinoma of the thyroid. A report of three cases.

BACKGROUND: A number of histologic variants of papillary carcinoma of the thyroid have been described, including an oxyphil cell subtype (OVPC). Few OVPC cases have been detailed cytologically. CASES: Smears prepared from aspiration biopsies, as well as the corresponding histologic sections and clinical histories, were reviewed for three cases. Two patients had asymptomatic thyroid tumors, and the third developed neck tumors after thyroid cancer surgery. All smears revealed scattered papillary groups and monolayered sheets. The large, neoplastic cells had abundant, granular cytoplasm and eccentrically placed nuclei. Nuclear grooves and intranuclear inclusions were variably present. Psammoma bodies and colloid were not identified. Histologically the tumors consisted predominantly of oxyphil cells arranged in papillary patterns and with nuclear features of usual papillary carcinoma (UPC). CONCLUSION: OVPC can be diagnosed in smears composed predominantly of large oxyphil cells but showing features associated with UPC and can be cytologically distinguished from follicular oxyphilic tumors and UPC.

Peritoneal implantation of meningeal melanosis via ventriculoperitoneal shunt: a case report and review of the literature.

Systemic spread of primary intracranial neoplasms is rare and may be due to ventriculoperitoneal shunt (VPS). The most common tumors to metastasize via VPS are germinoma of the pineal gland and medulloblastoma. We report a case of 16-yr-old girl with central nervous system malignant melanosis who developed subsequent peritoneal implants via VPS. To the best of our knowledge, this patient represents the third reported case of meningeal melanosis or melanoma which metastasized to the peritoneal cavity via VPS. The VPS should be considered as possible mode of systemic spread in patients with primary cranial malignancy.

Myxoid liposarcoma of the anterior mediastinum. Diagnosis by fine needle aspiration biopsy.

The mediastinum is an uncommon primary site of liposarcoma, which constitutes < 1% of tumors at that site. We report a case of myxoid liposarcoma evaluated with fine needle aspiration biopsy in a 66-year-old male who presented with cardiac tamponade, superior vena cava syndrome and radiologic evidence of a large anterior mediastinal mass. Cytologically the neoplastic cells were strikingly dyscohesive, with ovoid or spindle-shaped, hyperchromatic nuclei. The cytoplasm was abundant and often finely vacuolated with lipid. They were associated with a prominent myxoid, intercellular substance and distinct, arborized capillary structures. Survival is influenced by the tumor cell type and differentiation. The overall prognosis seems to be poorer than that of liposarcomas occurring in other areas. To the best of our knowledge, this is the first reported case of primary mediastinal liposarcoma diagnosed by fine needle aspiration biopsy.