Alcoholic carbowax prefixation and formal alcohol fixation. A new technique for urine cytology.

OBJECTIVE: To compare the cellular yield and sensitivity of cancer detection by urine cytology using alcoholic carbowax as a prefixative and formal alcohol as a final fixative with the conventional centrifugation-and-smearing method. STUDY DESIGN: Four hundred seventeen voided urine specimens were examined. Each specimen was divided into two equal portions. One portion was centrifuged and wet fixed (CS). The other was treated with alcoholic carbowax as a prefixative and then fixed in formal alcohol (CW). The smears were studied for cellular yield, morphology, cancer detection rate and typing. RESULTS: The CW method yielded significantly more cells with excellent morphology. It detected 25 more abnormal cases out of a total of 86, including 5 more transitional cell carcinomas, as compared to the CS method. This finding was statistically significant (P < .0000003). CONCLUSION: The CW method is simple and enhances cellular yield and the cancer detection rate as compared to the conventional centrifuge-and-smear technique.

Sensitivity of sputum cytology after homogenization with dithiothreitol in lung cancer detection. Two years of experience.

OBJECTIVE: To compare the sensitivity of sputum cytology using the dithiothreitol homogenization method (DTT) with that of the standard pick-and-smear (PS) method in lung cancer detection. STUDY DESIGN: In a two-year period, 2,428 sputum specimens were examined. Standard PS smears were prepared as controls; the remainder of the specimens were homogenized with DTT before smears were prepared. The sensitivity of the two methods in detecting positive cases was compared. RESULTS: Among 260 positive cases, the DTT method detected 256, while the PS method detected only 212, representing a difference of 17%. The DTT method also detected 28 more suspicious cases and permitted definitive typing of the tumor in a further 11 cases. CONCLUSION: Homogenization of sputum with DTT is not only a simple and versatile method but also a more sensitive method as compared to the PS method in lung cancer detection.

Expression of muscle actins in diffuse mesotheliomas.

Ultrastructural examinations have shown myofibroblastoid differentiation in sarcomatoid/desmoplastic mesotheliomas, but immunohistochemical expression of muscle actins seldom has been documented. We examined 10 sarcomatoid, 12 epithelial, and five biphasic mesotheliomas immunohistochemically for the expression of muscle-specific actin (MSA) and smooth muscle actin (SMA) and compared it with that in 12 specimens of lung cancer. All of the sarcomatoid mesotheliomas were found to be positive for both MSA and SMA. The epithelial cells in nine epithelial and two biphasic mesotheliomas were positive for MSA, but SMA was only positive in one epithelial mesothelioma. Conversely, the lung cancers were negative for both MSA and SMA in the epithelial cells, except for one specimen that was weakly positive for MSA. The stromal cells in both the epithelial mesotheliomas and lung cancers were negative for cytokeratin but were positive for MSA and SMA, whereas the sarcomatoid and biphasic mesothelioma spindle cells were positive for all three antibodies. We concluded that sarcomatoid mesothelioma was positive for MSA and SMA, which is in support of its myofibroblastic differentiation, and that positivity for MSA in some epithelial mesotheliomas might be of diagnostic value in differentiation from lung cancers.

Maxillary giant cell tumour associated with Paget's disease of bone.

A case involving the rare occurrence of a maxillary giant cell tumour in association with Paget's disease is reported. Surgical treatment consisted of a combined intraoral and temporal approach for tumour resection with temporalis muscle flap reconstruction of the maxilla. The postoperative course was complicated by a recurrence.

Dithiothreitol homogenization of prefixed sputum for lung cancer detection.

The technique of chemical homogenization of sputum for cancer detection was revisited. The mucolytic agent dithiothreitol (DTT) had been used by the authors on fresh specimens. In this study, its effectiveness in homogenizing prefixed sputum was investigated. Fifty-seven positive samples were examined: 28 were prefixed with 2% carbowax in 60% ethanol and 29 in 3% carbowax in 60% ethanol. Each specimen was divided equally into three parts and homogenized immediately, 3 and 7 days later, respectively, with 0.2% (0.013 mol/L) DTT in the respective prefixative. Five samples were prefixed for 4 wk before homogenization. The homogenization time varied from 30 min to 48 hr. The cellular morphology was compared to directly smeared controls from the same samples. It was found that the cellular morphology was well preserved and best with the 3% carbowax in 60% ethanol. The specimen could be prefixed for up to 4 wk before homogenization and the homogenization process could last from 30 min to 48 hr without any damaging effect on morphology. Furthermore, screening was made easy with the mucus lysed and its obscuring effect removed and the cells concentrated and evenly distributed. The method was versatile and could be of value in enhancing the detection rate of cancer in sputum.

Homogenization of sputum with dithiothreitol for early diagnosis of pulmonary malignancies.

Homogenization of sputum with dithiothreitol (DTT) has not been used in cytology for the detection of malignant cells. We examined the efficacy of this method as compared to the conventional "pick and smear" (PS) method. Smears were prepared from sputum samples using the PS technique to act as the control. The remaining sputum was digested with an equal volume of 0.3% DTT in 70% ethanol at room temperature. The cells were washed with 35% ethanol and smears prepared. The DTT-treated specimens gave a much higher concentration of evenly distributed cells. The background was clear and the morphology comparable to that of the control. More positive cases were detected with the DTT than the conventional PS technique. Homogenization of sputum with DTT is a simple and effective method of screening for pulmonary malignancies.

Fine-needle aspiration of cystic nephroma (multilocular cyst of the kidney).

Cystic nephromas are rare tumors of the kidney most commonly affecting boys or adult females. The fine-needle aspiration cytomorphology has not yet been described. A renal cystic mass in a 56 year old female was aspirated under ultrasound guidance. Papanicolaou stained smears of the cyst fluid revealed markedly atypical cells forming papillary clusters. Subsequent nephrectomy showed a typical cystic nephroma with lining epithelium resembling that seen in the aspirate. The cytomorphology of cystic nephroma has been misdiagnosed as renal cell carcinoma in the literature. Low cellularity, absence of necrosis, and paucity of single cells are features that should raise the possibility of cystic nephroma in a cystic renal mass.

Fine-needle aspiration in hepatocellular carcinoma. Combined cytologic and histologic approach.

Cytologic features of fine-needle aspiration (FNA) of hepatocellular carcinoma (HCC) have not been well documented. Most previous reports described only the the morphologic features of the tumor cells without considering the sinusoidal stroma. Cytohistologic correlation on tissue from the same aspirate has rarely been done. This report describes the cytologic patterns of 50 cases of HCC in terms of histologic pattern observed in cell blocks prepared from the same aspiration specimen and classified according to the World Health Organization (WHO) classification. Tumors were classified according to the predominant pattern. Thirty-two cases gave the trabecular pattern. Smears could be subdivided into a central-sinusoidal pattern (23 cases) and a peripheral-sinusoidal pattern (nine cases). One case gave the pseudoglandular pattern. Seventeen cases gave the compact pattern with inconspicuous sinusoids. In all cases sinusoids were easily recognized in cell block sections. Other cytologic features such as intranuclear cytoplasmic inclusions, eosinophilic globules, and bile secretion could be seen in both smears and cell blocks. Mallory's hyalin and ground glass inclusions were only recognized in cell blocks. More attention should be paid to the sinusoidal stroma for diagnosis of HCC in FNA; cell blocks should be more widely utilized to this effect; cytologic patterns could be classified according to the WHO histologic classification.

Fine-needle aspiration of gastric leiomyoblastoma metastatic to the subcutis.

Leiomyoblastomas are rare tumors, and there have been few reports on their fine-needle aspiration (FNA) cytologic morphology. We herein describe the FNA features of a gastric leiomyoblastoma with subcutaneous metastasis. The cells had eosinophilic cytoplasm and oval eccentric nuclei, occasionally with intranuclear cytoplasmic inclusions. An organoid pattern was obvious in cell block sections. The tumor was positive for vimentin but negative for desmin, S-100 protein, and the common epithelial markers. The histogenesis is discussed, as are reasons why this tumor is better termed epithelioid mesenchymal tumor.

Polymorphic reticulosis and conventional lymphomas of the nose and upper aerodigestive tract: a clinicopathologic study of 70 cases, and immunophenotypic studies of 16 cases.

Seventy patients with malignant lymphomas, including the entity known as polymorphic reticulosis (PR), involving the nose, nasal sinuses, nasopharynx, oropharynx (excluding tonsil), and larynx were studied. There were 26 cases of PR, 19 cases of lymphoma with features of PR (ML[PR]) and 25 cases of conventional lymphomas. Fourteen of the 25 conventional lymphomas were due to dissemination from distant sites. For all histologic types of primary lymphoma, the presenting symptoms were similar, and the nasal cavity was more commonly involved than the nasopharynx. Patients with PR were younger, had a higher male:female ratio, and had a better overall survival rate than patients with conventional lymphomas. Cryostat section immunohistochemistry performed on 17 samples from 16 patients showed only one B lymphoma out of 11 primary lesions; the other 10 cases and three recurrent tumors at distant sites showed phenotypic markers of T lymphocytes and natural killer cells. All three secondary tumors were of B-cell type. Of eight patients with sequential biopsies, progression to a more malignant histopathologic type was found in six. In the PR and ML[PR] biopsies, angiocentricity was detected in 11%, and angioinvasion in 22%. We could not confirm identity of PR with other angiocentric immunoproliferative lesions.

Application of the immunoperoxidase technique to cell block preparations from fine needle aspirates.

Immunocytochemistry on fine needle aspiration (FNA) material has been mainly performed on cytologic preparations; there have been few reports on the use of FNA cell blocks. This study compared the intensity scores of immunoperoxidase staining on FNA cell block preparations from 21 breast, 12 thyroid and 10 lymph node aspirates with the scores on the corresponding surgically excised specimens. FNA materials for cell blocks were fixed in formalin and embedded in agar. Ten commercially available antibodies forming three panels were studied using standard peroxidase-antiperoxidase and avidin-biotin complex techniques. In general, the staining results on the FNA cell block sections agreed with those on the surgical specimens; in addition, there were fewer aberrant positive staining results and much less background staining in the cell block sections. These phenomena were most striking with the cytokeratin antibodies. It is concluded that immunoperoxidase staining on FNA cell block preparations is reliable; the advantages of the use of cell block sections as opposed to smears are discussed.

Kikuchi's histiocytic necrotizing lymphadenitis. Diagnosis by fine needle aspiration.

Two cases of Kikuchi's histiocytic necrotizing lymphadenitis diagnosed by fine needle aspiration (FNA) of enlarged lymph nodes are reported. The FNA smears contained randomly activated lymphoid cells, necrotic debris, karyorrhectic cells and prominent histiocytes, suggesting the presence of reactive lymph nodes. The true nature of the lesions was evident from the examination of cell block sections prepared from tissue fragments in the aspirates, which preserved the architectural relationships of the different cell types. The same patterns were found in retrospectively and subsequently examined excised lymph nodes from these cases. The differential diagnosis of this entity, which may simulate a malignant lymphoma because of the presence of large numbers of activated lymphoid cells, is discussed and the value of preparing FNA cell blocks is emphasized. Though this rare benign disease may be suspected clinically in the more typical cases, such as young women with cervical lymphadenopathy, fever, neutropenia and otherwise excellent condition, the diagnosis cannot be made without a lymph node biopsy, which FNA may be able to provide in some instances.

Distinction between colloid nodules and follicular neoplasms of the thyroid. Further observations on cell blocks.

The differentiation between colloid nodules and follicular neoplasms may be difficult in lesions yielding only microfollicles by fine needle aspiration (FNA). In a retrospective study of 35 follicular lesions, the FNA smears and cell blocks and the excised specimens were reviewed for possible distinguishing features. Columnar cells lining follicles and prominent sinusoidal stroma were seen only in follicular neoplasms; these were more easily appreciated in the cell blocks. Nuclear features and fibrosis were not helpful because they were found in both groups of lesions. Attention to the nuclear morphology was important, however, for the diagnosis of the follicular variant of papillary carcinoma. A repeat FNA might be helpful in obtaining hyperplastic papillae and fragments of dilated follicles for a diagnosis of colloid nodule in half of the cases. A few lesions with predominant microfollicular patterns were even problematic to diagnose on the excised specimens.

Epithelioid haemangioma (angiolymphoid hyperplasia with eosinophilia) and Kimura's disease in Chinese.

Although Kimura's disease has often been considered to be identical to angiolymphoid hyperplasia with eosinophilia (epithelioid haemangioma), recent studies suggest that they are different clinicopathological entities. In this study, we have made a detailed morphological comparison of 10 cases of epithelioid haemangioma and 40 cases of Kimura's disease occurring in the Chinese population. The epithelioid haemangiomas occurred in the subcutaneous tissue, skin and maxillary antrum, whereas Kimura's disease affected the subcutaneous tissue, major salivary glands and lymph nodes. Distinctive features of epithelioid haemangiomas were exuberant proliferation of vessels lined by cuboidal to hobnail endothelial cells with irregular nuclei and cytoplasmic vacuoles, fibromyxoid matrix, involvement of muscular coat of blood vessels and zonation of inflammatory infiltrate towards the peripheral portion of the lesion. Distinctive features of Kimura's disease were florid lymphoid infiltrate with prominent lymphoid follicles, vascularization of germinal centres, germinal centre necrosis, marked eosinophilia with or without eosinophil abscess formation, proliferation of high endothelial venules, and sclerosis. The histological features suggest that epithelioid haemangioma is a proliferation of atypical endothelial cells, possibly neoplastic, that is associated with a variable inflammatory infiltrate, whereas Kimura's disease is primarily an inflammatory condition in which high endothelial venules are usually found.

Soft tissue cysticercosis. Diagnosis by fine-needle aspiration.

Taenia solium infection is endemic in Asia and cysticercosis is not uncommon. The authors report a case of cysticercosis diagnosed by fine needle aspiration using a cell block. The authors believe it to be the first such case so diagnosed.