Fine needle aspiration cytology of the thyroid: a comparison of 5469 cytological and final histological diagnoses.

OBJECTIVE: We evaluated the efficacy of fine needle aspiration cytology (FNAC) of the thyroid in a series of 5469 lesions with histological control and studied the causes of, and the possibility of reducing the limitations of the method. METHODS: FNAC was always performed by a pathologist under the guidance of a clinician, using a 22-gauge needle. Generally two aspirations were carried out, and usually four slides were obtained for each nodule; they were then stained with May-Grünwald-Giemsa and with Papanicolaou. The cytological diagnoses were classified in four groups: inadequate, benign, suspicious and malignant. RESULTS: We obtained a complete sensitivity of 93.4%, a positive predictive value of malignancy of 98.6%, and a specificity of 74.9%. At histological control, the cytological diagnosis of Hurthle cell neoplasm corresponded to a significantly higher incidence of malignant neoplasms than the diagnosis of non-Hurthle cell follicular neoplasm (32.1% versus 15.5%). There were 66 false-negative findings, the main cause of diagnostic error (24 cases) being failure to recognize the follicular variant of papillary carcinoma. The number of inadequate FNACs was low (4.2%). CONCLUSION: Our study confirmed the great efficacy of thyroid FNAC. A cytological diagnosis of Hurthle cell neoplasm should be considered an indicator of high risk. Awareness that failure to recognize the follicular variant of papillary carcinoma was the main problem in the interpretation of thyroid FNAC should lead to a decrease of false-negative diagnoses. The inadequate rate was very low, as it was the pathologist personally who performed the needle aspiration.

Fine needle aspiration cytology of primary lymphoma of the thyroid: a report of 17 cases.

Between 1980 and 1998, 4272 thyroid surgical specimens with a preoperative fine needle aspirate were sent to our Anatomical Pathology Department. Among these cases there were 17 primary thyroid lymphomas, which constituted 0.3% of all the thyroid lesions and 2.3% of the thyroid malignancies. Seven cases were diffuse large B-cell (DLBC) lymphomas and 10 were MALT lymphomas. Of the DLBC lymphomas six were correctly diagnosed by fine needle aspiration cytology (FNAC) and one was diagnosed as positive for malignancy, and among MALT lymphomas four were diagnosed as lymphoma, four as suspicious for lymphoma, and three as Hashimoto's thyroiditis (HT). Our data indicate that the diagnosis of primary thyroid lymphoma of high grade is easy, and immunocytochemistry (ICC) can confirm suspicious cases. The diagnosis of MALT lymphoma is more difficult; ICC can confirm suspicious cases, and false-negative results seem to be caused by sampling error, because HT usually coexists with MALT lymphoma.

Unusual prostatic adenocarcinoma with endocrine basophilic FSH-immunoreactive cells.

We report an unusual variant of prostatic adenocarcinoma with marked endocrine differentiation (mixed endocrine-exocrine adenocarcinoma). Endocrine cells accounted for 60% of the tumour cells, were positive with silver impregnation and for chromogranin A, synaptophysin, and neuron-specific enolase, and coexpressed the exocrine antigens prostatic acid phosphatase and prostatic-specific antigen. Most of the endocrine cells were basophilic with haematoxylin-eosin and proved immunoreactive for alpha subunit of human chorionic gonadotropin and follicle-stimulating hormone. The remaining endocrine cells were represented by eosinophilic cells positive for serotonin, and by calcitonin and serotonin-immunoreactive cells not identifiable in haematoxylin-eosin-stained sections. On ultrastructural analysis, two types of endocrine cells were identified. The most frequent cell type showed abundant cytoplasmic round, electron-dense neurosecretory granules, either small (212+/-44 nm) or large (471+/-114 nm), resembling those of gonadotropic pituitary cells. The second type of endocrine cells contained irregular electron-dense granules similar to those of serotonin-storing enterochromaffin cells.

Spindle and giant cell carcinoma of the urinary bladder: a clinicopathological light microscopic and immunohistochemical study.

OBJECTIVE: To evaluate the cellular nature and biological behaviour of spindle and giant cell carcinoma (SGCC) of the urinary bladder. The clinicopathological, light microscopic and immunohistochemical features of seven patients are reported. PATIENTS AND METHODS: Paraffin-embedded tissue was available from each patient for microscopic and immunohistochemical studies. There were five men and two women, ranging in age from 48 to 79 years. Clinical histories and follow-up information were obtained by review of the patients' charts. The clinical outcome was compared with that of transitional cell carcinoma (TCC) and small cell carcinoma (SCC). RESULTS: The tumours were large, polypoid and frequently ulcerated. They diffusely permeated the bladder musculature or the perivesical fat. On microscopic examination five tumours were composed mainly of interlacing sheets of spindle cells and occasional giant cells; two comprised giant cells only. Foci of identifiable TCC (papillary or in situ) were present in four tumours. Immunohistochemistry demonstrated that SGCCs exhibit a phenotype indicative of an epithelial nature. CONCLUSIONS: The median survival (11 months) of the seven patients indicates that SGCCs have a poor prognosis and they are more aggressive than TCCs of the same stage. The unfavourable clinical course is similar to the rapidly fatal outcome of small cell carcinomas of the bladder. The prolonged survival periods of three patients who received additional chemotherapy suggest that this treatment may be profitable.

Scarff-bloom-richardson histoprognostic grading correlates with the immunohistochemical expressions of genomic alterations in infiltrating ductal carcinomas (nos) of the breast.

The Scarff-Bloom-Richardson (SBR) multiparametric histological grading has been correlated with the immunohistochemical expression of EGF-R, c-erbB-2 and p53 oncoproteins, with the growth fraction (Ki67 antibody) and with the receptor status (ER, PgR) in 365 infiltrating ductal carcinomas of the breast (IDC-NOS). Specimens of carcinomas after surgery were sectioned and a section of each lesion was formalin-fixed and paraffin-embedded, and stained by hematoxylin-eosin in order to classify and grade cases. Another section was liquid nitrogen frozen, cryostatcut and immunostained using monoclonal antibodies against EGF-R (455 and 528 clones), c-erbB-2 (3B5 clone), p53 (Pab 1801 clone) and Ki67 antigen. An ABC-peroxidase was used after incubation with biotinylated antimouse antibody. Colour was developed using a DAB solution. ER-ICA and PgR-ICA Kits (Abbott) served to detect the hormonal receptor status. A significant direct correlation between SBR and the immuno-histochemical markers (EGF-R, c-erbB-2, p53, Ki67 growth fraction) was found. An inverse relationship of grade to ER and a weaker one to PgR was evident. An increasing histological grade was found parallel with the progressive appearance of one, two or three immunohistochemical markers in the same tumour.

Epidermal growth factor receptor immunohistochemistry in different histological types of infiltrating breast carcinoma.

AIMS: To determine the immunohistochemical expression of epidermal growth factor receptor (EGF-R) in high grade, intermediate, and low grade tumours. METHODS: Specimens from 931 breast carcinomas were partly formalin fixed and paraffin wax embedded, to classify cases, and partly frozen in liquid nitrogen, cryostat sectioned, and immunostained using two monoclonal antibodies from clone 455 and 528 to demonstrate EGF-R positive cells. An avidin-biotin complex and peroxidase method was used after incubation with biotinylated anti-mouse antibody; colour was developed using a diaiminobenzidine solution. RESULTS: Low grade carcinomas seldom expressed EGF-R (n = 3) compared with 106 high grade infiltrating ductal carcinomas: EGF-R positive cases were much less common in infiltrating lobular than in infiltrating ductal carcinoma. Medullary carcinomas did not differ from infiltrating ductal carcinomas. CONCLUSIONS: The very low incidence of EGF-R positive cases in the "special type" group of breast carcinomas with a good prognosis is in line with the absence of the homologous c-erbB-2 and p53 oncoproteins, and the rarity of highly proliferating and oestrogen/progesterone negative cases. EGF-R expression in infiltrating lobular carcinoma was in keeping with the intermediate behaviour of this kind of tumour. EGF-R expression in cases of pure medullary carcinoma is the same as that of high grade tumours.

Relationships between epidermal growth factor receptor (EGF-R) and other predictors of prognosis in breast carcinomas. An immunohistochemical study.

The importance of epidermal growth factor receptor (EGF-R) as an immunohistochemical factor of prognosis has been investigated in 820 cases of breast carcinoma irrespective of subtyping. An immunohistochemical membrane positivity for EGF-R (Ab1, clone 455 and Ab2, clone 528, Oncogene Science Manhasset NY, USA, ABC-peroxidase method) has been observed in neoplastic cells of 131/820 breast carcinomas (15.9%); the percentage is lower than those of the majority of reported series, but the total number of cases is higher. A significant inverse relationship between EGF-R and estrogen/progesterone receptors has been found (ER-ICA, PgR-ICA, Abbott, PAP-method). Highly proliferating Ki67 positive (> = 20% stained nuclei-Dakopatts Denmark) and oncoprotein p53 (Pab 1801 clone, Oncogene Science) positive carcinomas are more frequently EGF-R positive (p < 0.001). No relationship exists between EGF-R expression, c-erbB-2 (3B5 clone, Oncogene Science) expression, tumor size and lymph node status. The detection of EGF-R may be a useful addition to other immunohistochemical prognosticators, but it must be related with clinical outcome in further studies.

Relationship between p53 expression and other prognostic factors in human breast carcinoma. An immunohistochemical study.

Among 843 cases of breast cancer, p53 oncoprotein was detected by the monoclonal antibody (MoAb) Pab-1801 in only 13%. Low-grade carcinomas (tubular, mucinous, papillary, and invasive cribriform types) did not express p53 protein, but it was observed in 4.2% of infiltrating lobular carcinomas (6 of 140 cases) and 50% of pure medullary carcinomas (5 of 10 cases). In intermediate-grade neoplasms, no correlation was seen between p53 status and other putative determinants of a poor prognosis. The latter included high tumor stage, lymph nodal involvement, high growth fraction (as determined by labeling with the MoAb Ki-67), negative results for estrogen receptor (ER) and progesterone receptor (PR) proteins, and amplification of the c-erbB-2 oncogene product in the neoplastic cells. Ninety-nine of 640 (15.5%) cases of high-grade, invasive, ductal breast carcinoma, however, showed an inverse relationship between expression of p53 protein and positive results for ER/PR proteins and a direct correlation with large tumor size, Ki-67-determined growth fraction, and amplification of c-erbB-2 oncopeptide. All of the latter associations were highly significant statistically. The authors conclude that mutant p53 protein may serve a prognostic role in a subset of cases of invasive ductal mammary carcinoma.

Low, intermediate and high grade breast carcinomas as determined by histotyping, immunohistochemical prognosticators and histological grading.

Low grade breast cancers i.e. mucinous (17 cases--3.2%), tubular (7 cases--1.3%) and invasive cribriform carcinomas (3 cases--0.5%) have been identified within a series of 524 breast cancers only by histotyping in hematoxylin-eosin stained sections: the reactivities of immunohistochemical prognosticators as estrogen/progesterone receptors (ER, PgR), growth fraction (GF: Ki67), p53 and c-erbB-2 oncoproteins are in agreement with clinical behaviours. Invasive papillary carcinomas (9 cases--1.6%) are not to be considered low grade carcinomas. Intermediate grade cancers are also determined by histotyping. Medullary carcinoma (13 cases--3.4%) has a paradoxical behaviour displaying a favourable clinical prognosis together with high grading and GF, absence of ER, PgR, high p53 and c-erbB-2 values, as compared with invasive ductal carcinomas: an extensive tissue immune response as suggested by a heavy lymphocyte infiltration may explain this behaviour. Invasive lobular carcinoma (62--11.6%) shows an intermediate immunohistochemical pattern, paralleling an intermediate prognosis, when compared with low and high grade carcinomas: ER, PgR and GF positivities are nearly the same as in ductal carcinomas whereas grading, p53 and c-erbB-2 are less expressed. These data are confirmed both for lobular carcinomas as a whole and for all variants of this kind of tumors. Invasive ductal carcinomas (413 cases--79%) may be stratified on three prognostic classes corresponding to histological grading (G1, G2, G3). Significant relationships of grading with all the immunohistochemical prognosticators studied has been observed. It may be concluded that grading is a parameter of paramount importance in this group of tumors.

[Malignant schwannoma of the mesentery. Presentation of a clinical case and clinical and histopathological considerations]. / Schwannoma maligno del mesentere. Presentazione di un caso clinico e considerazioni cliniche ed istopatologiche.

A case of malignant schwannoma of the mesentery is described which was treated with radical surgery. The natural history, diagnosis and therapy of neoplasias of the mesentery are discussed.

Prenatal diagnosis of a partial 8p trisomy.

The index patient is a female fetus in which prenatal diagnosis of 8p trisomy was established after amniocentesis at 16 weeks of gestation. This fetus was the unbalanced product of a maternal translocation of 5q/8p (karyotype: 46,XX,t(5;8)(q35;p11). Internal malformations include an anomalous lobature of the right lung, a little and high atrio-ventricular communication, and an anomaly in the number and shape of the aortic semilunar valves. The possible relationship between the phenotype and the chromosomal abnormality is briefly discussed.

Immunohistochemical distribution of mucinous-like carcinoma associated antigen (MCA) in breast and non-breast cancer: comparison with other biological parameters.

The present study reports the immunohistochemical reactivity of the monoclonal antibody b-12 (MAb b-12) with malignant human tissues. 173 neoplastic tissues were tested: MAb b-12 stained all breast carcinomas independently of their histology, with different patterns within the various type of cancer. Some other carcinomas (stomach, bowel, ovary, lung, endometrium), were also reactive even if the fraction of positive cells was lower. A comparison between the histological localization of MCA and that of CEA was performed; anti-CEA antibodies stained the cancer tissues with different reactivity and showed different percentages of positivity. MCA expression was also compared with other biological parameters such as the presence of estrogen receptors (ER), progesterone receptors (PgR), epithelial growth factor receptors (EGF-R), and oncoprotein p-53 which is encoded by the oncogene N-myc. The proliferative activity was also evaluated by measuring the growth fraction (GF) using the antibody Ki67. Any correlation was demonstrated between MCA and these parameters except for growth fraction as revealed by Ki67 antibody.

In utero ultrasonographic features of campomelic dysplasia.

A prenatal diagnosis of campomelic dysplasia in a primigravida is described. First level fetal ultrasonography demonstrated bowing and shortening of lower limbs. Second level examination allowed the correct diagnosis by demonstrating several skeletal anomalies pathognomonic of campomelic dysplasia.

[Mixed ovarian germinal neoplasia: adult embryonal carcinoma and dysgerminoma with trophoblasts]. / Neoplasia germinale ovarica complessa: carcinoma embrionale adulto e disgerminoma con trofoblasto.

Malignant mixed germ cell tumor of the ovary: embryonal carcinoma and dysgerminoma with trophoblastic cells. A case of ovarian neoplasia in a 19-years-old woman is described showing mixed germ cell tumor patterns. The main component is a solid embryonal carcinoma with mainly syncytial-like, highly anaplastic cells, displaying diffuse CK-immunoreactivities and scattered PLAP-positive cells. Many CK- and beta-HCG-positive syncytiotrophoblastic and intermediate trophoblastic cells are present. A second component is a dysgerminoma with lymphoid stroma and diffuse PLAP-cytomembrane immunoreactivities: rare cells, to be identified as intermediate trophoblast cells, are CK- and strongly beta-HCG-positive. Many syncytiotrophoblastic cells with a brisk CK- and beta-HCG-positivities are also noted. The embryonal carcinoma component is metastasized to the controlateral ovary, uterus and omentum. A complete immunohistochemical analysis is recommended to properly diagnose germ cell neoplasias of the ovary both for descriptive and prognostic-therapeutic purposes. The very rare presence in the same ovarian tumor of mixed patterns as adult embryonal carcinoma and dysgerminoma with trophoblastic cells, is stressed.

[Angioimmunoblastic lymphadenopathy. 2 case reports]. / Linfoadenopatia angioimmunoblastica. Osservazioni su due casi.

Of the two cases of angioimmunoblastic lymphadenopathy described, one had arisen after infection by a non-A non-B hepatitis virus and HIV. The possible cause of the immunological changes that triggered the disease are discussed as are its clinical picture, course and treatment. In the first case a 6 month remission period was obtained after a short cycle of cortisone treatment, a second remission followed treatment with CVP. Unfortunately the bronchial pneumonia that followed the second cycle proved fatal. The second case featured recurring infections of the middle ear and respiratory tract causing the patient's death about a year after the onset of the disease.

Cytology of malignant mixed mesodermal tumour of the uterus: experience of 10 cases.

The value of cytology as a diagnostic tool in uterine MMMT has been tested in order to reach an earlier diagnosis. From 10 endocervical scrapings we were able to obtain 7 positive smears, two of them diagnostic for mixed tumour at first examination, 1 detected upon revision. In one case the positive smear was obtained from a direct scraping of the neoplasia protruding through the cervical os.

Prenatal diagnosis of a rare heteropagus.

The prenatal diagnosis by ultrasound of an unusual case of supernumerary head is reported. The problems of differential diagnosis, the pathological findings after voluntary interruption of the pregnancy, and the problems of obstetric management are presented.

First trimester prenatal diagnosis of Sanfilippo disease (MPSIII) type B.

Two pregnancies of a family at risk for Sanfilippo disease type B were monitored in the first trimester. In one case an affected fetus was diagnosed on chorionic villi by the assay of N-acetyl-alpha-D-glucosaminidase and confirmed on cultured fibroblasts from the aborted fetus. Pathological findings are also reported and compared with changes observed later in life. The disease was excluded in the second pregnancy.