Rhabdomyosarcoma presenting as a parotid gland mass in pediatric patients: fine-needle aspiration biopsy findings.

BACKGROUND: The head and neck region is one of the most common locations of rhabdomyosarcoma. Salivary gland involvement is usually secondary to advanced disease, and presentation as a primary salivary gland tumor is very rare. METHODS: Three cases of rhabdomyosarcoma presenting as parotid masses, in 2 boys (ages 3 and 7 years) and a girl (age 5 years), were retrieved from the files of 2 institutions. RESULTS: The three patients presented with parotid gland enlargement. Clinically, the enlargements appeared to be inflammatory, and they were treated unsuccessfully with antibiotics. Fine-needle aspiration biopsy (FNAB) was performed on all three patients. The cytologic features varied from one case to another; one case had features of a small round cell tumor, another was composed of a monomorphic population of spindle cells in a metachromatic stroma, and the third case was composed mostly of spindle cells with moderate cellular pleomorphism. Immunohistochemical studies performed in two of the cases confirmed the diagnosis of rhabdomyosarcoma, and ultrastructural studies were confirmatory in the other case. The patients are alive; 2 of them have had no evidence of disease after 6 and 9 years of follow-up, and the third, the most recent patient, has just finished adjuvant chemotherapy. CONCLUSIONS: With the increased use of FNAB for the evaluation of salivary gland masses in children, the authors believe that it is important to recognize the occurrence of rhabdomyosarcoma in this location. Immunohistochemical studies have proved helpful in differentiating rhabdomyosarcoma from other parotid gland tumors and can be readily done on cytologic preparations.

The utility of parotid gland and level I and II neck fine-needle aspiration.

OBJECTIVE: Although fine-needle aspiration (FNA) commonly is used in the diagnostic workup of parotid gland and level I and II neck lesions, the effect of an FNA service on patient care has not been definitively established. METHODS: Follow-up was obtained in 158 patients who underwent FNA. The value of FNA was analyzed by determining the proportions of cases in which management was altered by the information obtained. RESULT: The percentage of lesions classified by FNA as benign, nonneoplastic; benign, neoplastic; atypical or suspicious; malignant; and insufficient was 42%, 28%, 16%, 41%, and 7%, respectively. By using FNA, an operation was avoided in 70% and 79% of patients with a nonneoplastic lesion and a metastasis, respectively. CONCLUSIONS: Although definitive subclassification of some lesion types was poor, FNA was useful in patient triage.

Quantification of surgical margin shrinkage in the oral cavity.

BACKGROUND: Obtaining adequate surgical margins, free of tumor, is crucial for success in oncologic surgery. The head and neck surgeon often finds that the tumor-free margin reported from histopathologic measurement is significantly smaller than the margin measured in-situ. It was the purpose of this study to quantify the change in size of mucosal and muscle surgical margins following excision, formalin fixation, and slide preparation of tongue and labiobuccal tissue in a canine model. METHODS: Ten mongrel dogs under general anesthesia for a concurrent project were used in this study. Changes in mucosal and muscle dimensions around custom-made brass disks, one with a needle depth gauge, were measured immediately following excision after formalin fixation and after slide preparation. RESULTS: The mean shrinkage from initial resection to final microscopic assessment of the lingual surface mucosal margins was 30.7% (p < 0.0001). The deep tongue margin shrank 34.5% (p < 0.0001). The mean shrinkage of the labiobuccal mucosal margin was 47.3% (p < 0.0001). In all cases, the greatest proportion of shrinkage occurred immediately upon resection. CONCLUSIONS: From the in-situ measurement by the surgeon to final pathologic evaluation on the microscope slide, the measured dimensions of oral cavity mucosal and tongue muscle margins shrink significantly. To obtain 5 mm of pathologically clear margin an in-situ margin of resection of at least 8 to 10 mm needs to be taken. Studies reporting clinical correlation of recurrence and survival information with surgical margin status should include a detailed description of the technique used to determine the reported surgical margin status.

Telepathologic review: utility, diagnostic accuracy, and interobserver variability on a difficult case consultation service.

The diagnostic accuracy of telepathologic analysis has not been compared to that of conventional light microscopic review on a difficult case consultation service. The anatomic pathology consultation files of the University of Iowa were retrospectively examined, and 105 difficult cases from a variety of organs were chosen for real-time telepathologic and light microscopic review. The telepathologic and light microscopic crude agreement of five pathologists were compared, with use of the original consultation diagnosis as the "gold standard." Cases were scored as correct, partially correct, or incorrect. After making a video diagnosis, the pathologists reported whether they wanted to review the case with use of a light microscope. The pathologists performed significantly better with the light microscope, even after excluding cases in areas of inexpertise (P = .005). The mean percentage of cases that the pathologists wanted to review with the light microscope was 64%, and the major reason for review was diagnostic uncertainty. Cases incorrectly diagnosed with use of the video monitor were almost always requested for review. We conclude that, on a difficult case consultation service, pathologists perform significantly better with use of light microscopic than with telepathologic analysis; rarely make an incorrect diagnosis and do not request that case for light microscopic review; and exhibit high telepathologic diagnostic accuracy in areas of expertise.

Atypical glandular cells of undetermined significance. Diagnostic accuracy and interobserver variability using select cytologic criteria.

Histologic follow-up of patients with the Bethesda system cervical-vaginal diagnosis of atypical glandular cells of undetermined significance (AGUS), "favor endocervical origin", or "not otherwise specified" (NOS) shows a high percentage of clinically significant (neoplastic or preneoplastic) lesions. Using the criteria of atypical single cells, irregular nuclear membranes, and decreased cytoplasm, eight observers retrospectively reclassified 88 AGUS, "favor endocervical", or NOS smears using a probabilistic scheme. Follow-up showed 46 clinically significant and 42 benign lesions. The mean accuracy for all observers and the experienced observers was 65% and 72%, respectively. For the experienced observers, the mean specificity of a "favor clinically significant" category was 72%; the mean sensitivity of a "favor benign" category was 90%. For the less experienced observers, subclassification had poor predictive value. We conclude that experienced observers may use specific criteria to correctly subclassify AGUS lesions, and this may aid in patient management.

Intravascular malignant lymphomatosis: amelioration of neurological symptoms with plasmapheresis.

Intravascular malignant lymphomatosis is a rare disease that is uniformly fatal when disseminated. Chemotherapeutic and radiation therapy regimens have provided short-term amelioration of symptoms but have not affected overall survival. We describe a patient with diffuse neurological symptoms who responded transiently but dramatically to plasmapheresis. This marked response warrants further evaluation of this therapy in intravascular malignant lymphomatosis.