Fine needle aspiration cytology of granulomatous mastitis. Report of a case and review of the literature.

A case of granulomatous mastitis diagnosed by fine needle aspiration (FNA) cytology alone is reported. A 24-year-old pregnant woman presented with a six-week history of a rapidly enlarging breast mass, considered clinically to be malignant. The FNA smears contained numerous aggregates of epithelioid histiocytes admixed with Langhans' and foreign-body giant cells, lymphocytes, neutrophilic leukocytes and apoptotic debris, leading to a diagnosis of granulomatous mastitis. The features of granulomatous mastitis and its differential diagnoses are discussed.

The cytologic diagnosis of adenocarcinoma in situ of the cervix uteri and related lesions. II. Microinvasive adenocarcinoma.

Criteria for the cytologic diagnosis of microinvasive adenocarcinoma of the cervix have not been previously established. Such cytologic criteria were evolved through the detailed analysis of cervical smears from 40 histologically confirmed cases. The cellular features of cervical adenocarcinoma in situ (AIS) were always associated with microinvasion. Syncytia of glandular cells, small cells in very crowded sheets and papillary groupings of cells, when seen in conjunction with AIS, were suggestive of microinvasion. Dissociation of cells was common. Nuclear pleomorphism with an irregular chromatin pattern and inconspicuous-to-prominent nucleoli was frequently present. In some cases, a tumor diathesis was seen in the smear background. Using these criteria, our predictive accuracy for diagnosing microinvasive cervical adenocarcinoma is improving steadily and now approaches 50%. Ongoing investigation of these cases must include a diagnostic come biopsy to further improve the predictive accuracy for this lesion.

The cytologic diagnosis of adenocarcinoma in situ of the cervix uteri and related lesions. III. Pitfalls in diagnosis.

Potential pitfalls in the cytologic diagnosis of adenocarcinoma in situ (AIS) of the cervix are illustrated by the presentation of three cases of benign cervical lesions initially diagnosed as AIS: cervical endometriosis, tubal metaplasia of the endocervix and changes due to a previous biopsy. The differential diagnosis of endocervical glandular abnormalities is discussed.

The cytologic diagnosis of adenocarcinoma in situ of the cervix uteri and related lesions. I. Adenocarcinoma in situ.

Seventy cases of histologically confirmed adenocarcinoma in situ (AIS) of the cervix uteri have been predicted in this laboratory using cytologic criteria, which are illustrated in this paper. The architectural features that were of primary diagnostic importance included an exfoliation pattern consisting of sheets of cells and tissue fragments in the form of cellular strips and rosettes. Nuclear criteria allowed the distinction of AIS into well-differentiated and poorly differentiated types. The former showed nuclear enlargement, an oval nuclear shape, hyperchromasia and moderate-to-coarse granularity as usual features. In the latter, nuclear enlargement was even greater, with an oval-to-round shape, prominent nucleoli and chromatin that was usually only finely granular. Variant patterns of AIS included endocervical, endometrioid and intestinal subtypes, each with characteristic cytologic appearances that correspond closely with their histologic appearances. The evolution of the description of AIS reveals a range of precursor lesions that may match the range of invasive adenocarcinomas originating in the cervix. This suggests that invasive adenocarcinoma of the cervix uteri could be preventable as is its more common squamous counterpart.

Cytogenetic diagnosis of cancer from body fluids.

Serous effusions from 50 patients suspected of having cancer were subjected to cytogenetic analysis by the use of a simple direct technique. Within 24 hours the specimens were reported as unsatisfactory or as positive or negative for malignancy, according to specific chromosomal criteria, which included hypodiploidy. Reports were sent directly to referring clinicians, who also received independently derived findings from routine cytologic study. The value of cytogenetic analysis was clearly shown in this situation, in which the chromosomal findings took the form of an independent second opinion in clinical assessment. There were no false-positive results in any of the 16 cases diagnosed by cytogenetic analysis. Furthermore, in six of these, the initial cytologic report was equivocal, and the repeat sample from three of these failed to yield material suitable for a definite cytologic diagnosis of malignancy. Negative cytogenetic findings also supported the use of cytogenetic analysis as an adjunct to cytologic examination: 23 of the 24 negative cytogenetic reports proved to be accurate, whereas in 8 of these cases the first cytologic report was equivocal. There was one cytogenetic false negative, in which, after retrospective analysis, chromosomal criteria of malignancy were found.

Expanded cytologic criteria for the diagnosis of adenocarcinoma in situ of the cervix and related lesions.

Fifty-two cases of adenocarcinoma in situ (AIS) of the cervix uteri, or lesions closely related to AIS, have been reported by this laboratory over a five-year period. Whereas this lesion has commonly been considered a rare and usually incidental histologic finding, the large majority of these cases involved glandular atypia only and were prospectively diagnosed. Comparison of the findings from this larger series with the 11 cases of AIS described by us previously has led to a shift in emphasis from cell size to sheet architecture as the primary cytologic criterion for diagnosis of this lesion. The structure of AIS sheets was consistent with respect tothe cytologic appearances described here, even when the cells were poorly preserved. Retrospective studies of Papanicolaous smears of other cases from this laboratory that were confirmed histologically as endocervical dysplasia, microinvasive or early invasive adenocarcinoma or deeply invasive adenocarcinoma indicate that these entitites can be distinguished from AIS primarily on the basis of the architecture of the sheets of cells. Cellular groups comprising small, crowded nuclei were a feature of several undercalled deeply invasive adenocarcinomas, and the diagnostic significance of this material is discussed.