Pemphigus vulgaris of the uterine cervix revisited: case report and review of the literature.

Pemphigus vulgaris is an autoimmune disease characterized by acantholytic blisters and erosions involving the oral mucosa, skin, and less frequently other mucosal surfaces. Although the cytology of scrapings from the cutaneous and oral lesions has been well-documented, there are relatively few reports in the literature of the cytologic appearance of pemphigus on cervicovaginal smears. This report documents a case of pemphigus involving the cervix, in which the diagnosis was not known at the time of the cervical smear and biopsy. The cytologic features of this case and those in the literature are described in detail, highlighting the necessity of awareness of the disease and its presentation on cervicovaginal smears, in preventing an overdiagnosis of neoplasia.

Thin-layer cytology meets viral hybrid capture.

This commentary addresses the benefits of liquid-based thin-layer cervical cytology, and the applicability of residual samples for human papilloma virus assay. The potential for use of this technology in wide-scale screening as well as the many unanswered issues, in particular cost-benefit ratio and financing, are also discussed.

The cytomorphology of papillary serous carcinoma of the endometrium in cervical smears.

BACKGROUND: An investigation into the determination of cytomorphologic criteria that may distinguish papillary serous carcinoma of the endometrium (PSC) from typical endometrioid carcinoma (TEC) in cervical smears was undertaken. Preoperative identification of this poor prognostic variant of endometrial carcinoma may influence the surgical management of these cases and the choice of adjuvant therapy. METHODS: The cervical smears of 12 cases of histologically confirmed PSC; 12 cases of TEC, including 2 villoglandular/papillary variants, and 6 cases of mixed PSC and papillary endometrioid carcinoma were reviewed. In all cases an initial diagnosis of malignancy had been made on the cervical smears. Twenty-seven criteria were evaluated and the relation between the cytologic characteristics and the type of adenocarcinoma, the degree of association, and the intergroup homogeneity were tested. RESULTS: Features strongly associated with PSC were hypercellular smears with a background tumor diathesis, papillae, bare nuclei, and cells with large pleomorphic nuclei and bulky dense cytoplasm. In contrast, TEC showed a relatively monomorphic population of cells with moderately enlarged oval nuclei and delicate cytoplasm. In the mixed tumors, the features were similar to those of PSC, suggesting preferential exfoliation of the PSC component of the tumor. CONCLUSIONS: Assessment of the cytomorphology of PSC and TEC of the endometrium in Papanicolaou stained cervical smears is possible using statistically significant diagnostic criteria.

Natural killer cell lymphoma in cytology: breaking all the rules--a case report.

A testicular mass aspirate was received from a 22-yr-old patient with known non-Hodgkin's lymphoma. The cells were large and pleomorphic, occurring in syncytial fragments and demonstrating abundant cytoplasm. No lymphoglandular bodies were seen. As characteristic lymphoma criteria were not present, a cytodiagnosis of germ-cell tumor was suggested, and testicular biopsy advised. The final histopathology report, however, was of a CD 56-positive (large-cell) T-natural killer cell lymphoma, of which this appears to be the first example described and illustrated cytologically.

Cytopathology of follicular dendritic cell tumors.

Follicular dendritic cell tumors are rarely described entities, arising from antigen-presenting immune accessory cells, found within B-lymphocyte follicles in nodal and extranodal sites. We report two cases, one associated with Castleman's disease, in whom fine-needle aspiration biopsy was performed followed by surgical biopsy. The diagnosis was confirmed using immunoreactivity with CD21 and CD35 antibodies and by ultrastructural demonstration of interdigitating cell processes with desmosomes. Both the cytologic and histologic findings are presented, and the differential diagnoses are discussed. Awareness of this entity and recognition of the pathologic features may lead to a presumptive diagnosis which must be confirmed using imunohistochemistry and/or electron microscopy.

Exuberant fibroadenomatoid proliferation in a pulmonary mesenchymoma (hamartoma): report of a lesion mimicking a sclerosing pneumocytoma.

We report the cytologic and histopathologic features of an unusual peripheral primary lung tumor in a 61-year-old female. The central portion showed features of typical pulmonary chondroid hamartoma (mesenchymoma). Arising from the peripheral margin of this tumor, however, was an exuberant proliferation of papillary mesenchymal structures lined by type 2 pneumocates, mimicking papillary sclerosing hemangioma (pneumocytoma). This extreme example of fibroadenomatoid proliferation shares histologic features with other pulmonary neoplasms characterized by mesenchymal cores lined by type 2 pneumocytes. We propose that such lesions be unified under the term "alveolar mixed tumor".

Simulation of primary cervical cancer screening by the PAPNET system in an unscreened, high-risk community.

OBJECTIVE: To evaluate the performance of the PAPNET system as a primary cervical cancer screening modality in an unscreened population with a high prevalence of cervical cancer and its precursor lesions. STUDY DESIGN: Consecutive cervical smears from 3,106 women, screened and reported in the usual manner, were submitted for analysis by the PAPNET system. The original manual screening diagnoses were compared with those obtained by PAPNET analysis. By inclusion of normal and abnormal smears, this evaluation not only provided quality assurance for the laboratory but also simulated primary screening by automation. RESULTS: Comparison of the two methods of screening showed statistically significant superiority of the PAPNET over conventional screening (89.6% vs. 63.8%, respectively) in low grade lesions, including atypical squamous and atypical glandular cells of uncertain significance (ASCUS and AGUS, respectively) and low grade squamous intraepithelial lesion. Conversely, there was no significant difference between PAPNET and manual detection (87.5% vs. 94.6%) for more significant abnormalities, including high grade squamous intraepithelial lesions and invasive carcinoma. CONCLUSION: The PAPNET system, which would probably not be affordable as a quality assurance modality only in the public health sector of this country, was shown to be more than sufficiently effective as a primary screening method for the large numbers of women likely to undergo cervical cancer screening in anticipated mass population programs.

Metastases to the thyroid gland: diagnosis by aspiration cytology.

The purpose of this study was to document the incidence, nature and source of neoplasms metastatic to the thyroid gland, which were diagnosed by fine needle aspiration (FNA) cytology. In the seven year period from 1986 to 1992, 21 cases were identified with metastatic malignancies in FNA specimens from the thyroid. This represented 7.5% of neoplastic thyroid lesions aspirated in this unit. All patients presented clinically with thyromegaly or discrete nodules. Only five patients were known to have malignancies of other sites prior to FNA. The majority of metastatic nodules were bronchogenic in origin (nine). The gastrointestinal tract (five) and melanomas (two) were the next most frequent sources in the series. Single cases arose in the prostate, larynx, kidney (all carcinomas), and uterus (a leiomyosarcoma). One patient had a thyroid deposit of acute myeloblastic leukemia. This large study demonstrated that tumors of many histological types may involve the thyroid gland, and furthermore, may masquerade as primary thyroid malignancies. Recognition of an alien cell type not only prevents inappropriate thyroid surgery, but may also direct the search for the unsuspected or unknown primary. Metastases to the thyroid gland occur more frequently than is generally appreciated. FNA is the procedure of choice for evaluation of thyroid nodules in general, and thyroid metastases in particular.

Pseudomyxoma peritonei associated with ovarian mucinous tumors. Cytologic appearance in five cases.

The cytologic findings in five cases of pseudomyxoma peritonei associated with ovarian mucinous tumors are reported. The evidence suggests that if mucinous or gelatinous ascitic fluid is received in the laboratory and is shown to contain a dual cell population of round cells of mesothelial origin and spindle-shaped cells of fibroblastic origin together with lakes of fibrillar mucin, a cytologic diagnosis of pseudomyxoma peritonei can be made with confidence. It will usually indicate mucinous neoplasia of the appendix or ovary. In the case of ovarian neoplasia, the tumor is most likely to be a low-malignant-potential mucinous tumor. The patient's prognosis, however, will be that of mucinous carcinoma rather than of usual borderline tumors of the ovary.

Fine needle cytodiagnosis of renal tuberculosis.

A total of 8 patients in whom renal tuberculosis was suspected on clinical or radiological grounds but in whom confirmation could not be achieved by urine culture underwent renal fine needle aspiration. Immediate cytodiagnosis was accomplished in 7 of 8 patients by the finding of Langhans' giant histiocytes, epithelioid histiocytes and necrotic debris. Later confirmation was obtained in all 8 cases by radiometric culture of aspiration material or saline rinses of the fine needles. This experience introduces fine needle aspiration cytology as a diagnostic modality in renal tuberculosis.

The prevalence and age distribution of peripheral pulmonary hamartomas in adult males. An autopsy-based study.

This autopsy-based study defined the prevalence and age distribution of peripheral pulmonary hamartomas in 47,635 southern African miners examined between 1975 and 1988. The prevalence rate for white miners was 7.5/1,000 and for black miners 1.1/1,000. When directly standardised to the white men in the general population, the rates for white and black miners were 7.2 and 5.5/1,000, respectively. The prevalence of peripheral pulmonary hamartomas in both groups increased with age, from 0.8/1,000 in the third decade to 12.0/1,000 in the eighth decade. The study showed a much higher prevalence of peripheral pulmonary hamartomas for whites than previously reported. Furthermore, it documented the occurrence of these benign lung tumours in blacks, a fact that has previously been questioned. There appeared to be no significant difference in prevalence and age distribution between white and black miners, although the database for the black group was deficient for the later decades of life.

Asbestos bodies in fine needle aspirates of lung masses. Markers of underlying pathology.

Analysis of 52 transthoracic-mass aspirates that contained asbestos bodies (ABs) showed the mass to be due to pathology other than (or superimposed upon) asbestosis in every case. Malignancy accounted for 30 masses, all of which were carcinomas except for one mesothelioma. The remaining 22 lesions were benign, with tuberculosis or lung abscesses accounting for the majority. Fine needle aspiration (FNA) detection of the pathology (benign or malignant) associated with ABs was diminished, probably due to asbestos-induced fibrosis. Other diagnostic methods, including bronchial studies, mediastinoscopy and even exploratory thoracotomy, were required to document 20% of the neoplasms and 50% of the benign lesions. The results of this series support the view that ABs in FNA specimens from localized or dominant parenchymal lung masses are significant markers of underlying pathology, whether or not cellular evidence of that pathology is observed in the aspirated material.

Audit of fine needle aspiration cytology of 120 renal lesions.

Solid renal masses in 120 patients were assessed by percutaneous fine needle aspiration cytology, performed under radiographic guidance. Follow-up was obtained in all but seven cases. Diagnostic sensitivity for 83 tumours in the series was 91.6%, while two false positive reports resulted in a specificity of 93.8%. Positive and negative predictive values were 97.4% and 81.1% respectively. One advantage of the procedure was the ability to cell type neoplasms accurately, which enabled administration of pre-operative chemotherapy in childhood tumours, and selection of appropriate surgical procedures in adults. The technique offered a non-surgical means of confirming primary renal tumours in patients presenting initially with distant metastases, and documenting renal secondaries in cases with malignancy at other sites. The diagnosis of benign or inflammatory lesions permitted institution of definitive therapy.

Benign neurilemmoma (schwannoma) masquerading as a pleomorphic adenoma of the submandibular salivary gland.

A case of solitary benign neurilemmoma (schwannoma) arising in the submandibular region is presented. The tumor was mistaken clinically for an enlarged submandibular salivary gland. Fine needle aspiration cytology made an erroneous diagnosis of a pleomorphic adenoma, predominantly stromal in composition. Histology of the resection specimen resulted in the correct diagnosis of a benign schwannoma. Review of the needle aspirate demonstrated cytologic features that should enable both the correct diagnosis of this neoplasm and its distinction from pleomorphic adenoma, which it mimicked in this location.

Transthoracic fine-needle aspiration cytology. An analysis of 500 cases.

Existing cytological and radiological services enabled the introduction of transthoracic fine-needle aspiration (FNA) in Johannesburg in 1983. The results achieved in the first 500 patients subjected to this procedure are presented, together with histological and clinical correlation. Of a total of 330 malignant tumours in this series, 306 were successfully sampled by FNA. Sensitivity of the technique in malignant disease was 92.7%, with 98.8% specificity. Positive and negative predictive values were 99.4% and 85% respectively. FNA was less accurate in the assessment of 24 benign thoracic tumours, only 75% of which were adequately sampled. Similarly, definitive cytological diagnosis of specific non-neoplastic pulmonary lesions, including granulomatous disease, was possible in only 78.6% of cases. The problem of aspirates in which no cellular abnormality (benign or malignant) was observed is discussed in relation to accuracy of needle placement. The special advantages of this technique included non-surgical verification of malignancy in radiologically or clinically inoperable cases; documentation of metastases; and detection of those tumour types (small-cell undifferentiated carcinoma and lymphoma) more appropriately treated by chemotherapy than by surgery. Pneumothorax requiring intercostal drain insertion occurred in 24 patients (4.8%). The advantages of rapid, accurate, inexpensive, non-operative diagnosis of thoracic masses was felt to outweight this single major complication.