Concomitant papillary thyroid carcinoma and Hashimoto's thyroiditis.

An association between papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT) is well recognized. Both entities may often display overlapping morphologic features. The aim of this study was to evaluate the accuracy of fine needle aspiration (FNA) of concomitant PTC and HT. Twenty nine thyroid FNAs with a diagnosis of concomitant PTC and HT on follow-up surgical material were retrospectively reviewed (11% of all HT cases diagnosed in the same period of time). The cytologic specimens were evaluated for the presence of diagnostic features of PTC and HT. In 16 of 29 cases, the diagnosis of PTC was made or suggested; however, only in 3 cases were both entities recognized on the FNA material. The review of the remaining cases (13 cases) showed diagnostic features of PTC in 2 cases (interpretation errors), some features of PTC in 8 cases (insufficient diagnostic features), features of only HT in 2 cases, and 1 case was acellular (sampling errors). Originally, 10 cases with features of PTC were diagnosed as either follicular neoplasm or colloid nodule with or without HT. Histologically, 1 of 13 cases was a cystic variant and 7 of 13 cases were follicular variants of papillary carcinoma. It is important to be aware of the coexistence of PTC and HT. Deliberate search for evidences of PTC in every case of HT may be necessary to improve diagnostic accuracy of the FNA. However, the cytologic diagnosis of follicular variant of PTC coexisting with HT can be challenging. The sampling error may also cause false negative results.

Transthoracic fine-needle aspiration cytology of inflammatory pseudotumor, fibrohistiocytic type: a case report with immunohistochemical studies.

Inflammatory pseudotumor, fibrohistiocytic type, also called benign fibrous histiocytoma, is a rare reactive entity usually found incidentally on routine chest roentgenography. We present a case of inflammatory pseudotumor, fibrohistiocytic type, initially diagnosed by fine-needle aspiration (FNA) cytology in a 39-yr-old woman with a history of breast carcinoma. Cytomorphologic characteristics were confirmed by a cell block examination and immunohistochemical findings. The differential diagnoses of the fine-needle aspiration cytology of this type of inflammatory pseudotumor are discussed.

Fine-needle aspiration cytology of extraskeletal Ewing's sarcoma.

Extraskeletal Ewing's sarcoma (EES) is a round-cell malignancy that manifests most commonly in the paravertebral and intercostal regions. It occurs predominantly in adolescents and young adults, between the ages of 10 and 30 yr, and follows an aggressive course with a high recurrence rate. Distant metastasis is also common. The tumor is often confused with other round, small-cell neoplasms, including primitive neuroectodermal tumor, neuroblastoma, embryonal rhabdomyosarcoma, and lymphoma. This report pertains to a fine-needle aspiration cytologic diagnosis of EES, supported by clinicopathologic and fine structural correlations in a 56-yr-old man who presented with a rapidly growing, massive, right groin mass. The smears showed a diffuse cellular population of malignant round cells composed of two types: one group of larger cell exhibiting a thin-rim, pale cytoplasm, less hyperchromatic nuclei, nucleoli, and diffusely dispersed chromatinic nuclear details; and the second group of smaller and darker cells with highly hyperchromatic and almost smudged nuclei. These are chief cells and dark cells, respectively. Special studies revealed significant intracytoplasmic glycogen and positive vimentin and HBA-71 immunostaining. Cytogenetic findings of chromosomal 11;22 translocation is also supportive of the diagnosis of EES.

Evaluation of cellular residue in the ThinPrep PreservCyt vial.

The ThinPrep Pap Testtrade mark is a fluid-based method used for the collection and preparation of cervicovaginal samples. The collection device(s) is/are rinsed in Cytyc's ThinPrep PreservCyt medium and a thin-layer slide is prepared using the ThinPrep 2000 automated processor. The purpose of this study was to determine the detection rates for cervical lesions utilizing an additional ThinPrep slide. Fifty-four cervical samples processed by the ThinPrep method were reviewed. An additional thin-layer slide was obtained from the cellular residue for each case utilizing a new filter. Case selection criteria included cases with a few equivocal cells, a few diagnostic cells, or several low-grade dysplastic cells seen on the original ThinPrep slide. The original slides and repeat slides were reviewed by two cytopathologists and two cytopathology fellows. Fifty-four patients were included in the study, mean age 35 years (range: 16-76). The original diagnoses included: 17 negative cases, 22 atypical squamous cells of undetermined significance (ASCUS), 10 low-grade squamous intraepithelial lesions (LGSILs), four high-grade squamous intraepithelial lesions (HGSILs), and one case of atypical glandular cells of undetermined significance (AGUS). On the repeat slides the diagnosis remained the same in 42 (77.8%) cases, diagnostic cells were not present in 10 (18.5%) cases, fungal elements consistent with candida were detected on the repeat smear in one case (1.8%), and higher grade dysplastic cells were found in two cases (3.7%). Our study showed that the ThinPrep method provides a representative, diagnostic sample on the slide. Repeat processing adds little to the overall diagnosis.

Comparative analysis of DNA flow cytometry and cytology of bladder washings: review of discordant cases.

DNA analysis is becoming an important diagnostic and prognostic adjunct test in urinary cytology. The aim of this study was to compare the results of DNA flow cytometry (FCM) with the cytologic diagnosis of bladder washings (BW). DNA ploidy was evaluated in 251 BW. In 65 cases, follow-up surgical biopsies were available. Cytology results were classified as positive and negative, and FCM results were categorized as diploid and aneuploid. Both tests were evaluated independently. Cases were defined as discordant if the cytology was negative and FCM was aneuploid, or if the cytology was positive and FCM was diploid. All discordant cases were reviewed, and positive predictive values (PPV) for FCM and cytology were calculated for cases with follow-up biopsy results. Cytologic evaluation classified 181 cases as negative, with 175 of them diploid and 6 aneuploid; and 70 as positive, with 53 of them diploid and 17 aneuploid. Overall, there were 59 discordant cases (23.5%, with a confidence limit of 18.2-28.8%). Of 6 aneuploid/cytology-negative cases, biopsies were available in 4 cases and showed one grade 1, two grade 2, and one grade 3 urothelial carcinoma (UC). Reanalysis of these 6 cytology specimens showed 1 case that should have been interpreted as positive (false negative), 4 true negatives, and 1 polyoma virus infection. Out of 53 diploid/cytology-positive cases, biopsies were available in 45 cases and showed nine grade 1, 14 grade 2, three grade 3 UCs, 11 UCs in situ, and eight negative biopsies. The PPV for cytology was 85%, and the PPV for FCM was 95%. We concluded that FCM, which requires a large number of cells, often cannot detect small aneuploid populations, which are present particularly in cases of UC in situ.

Fine-needle aspiration of the thyroid: rate and causes of cytohistopathologic discordance.

Fine-needle aspiration (FNA) of the thyroid gland is a widely utilized, sensitive, specific, and cost-effective method for the evaluation of thyroid nodules. The purpose of this study was to evaluate the accuracy of thyroid FNA and causes of cytohistological discordance in our institution. Six hundred twenty-five thyroid FNAs obtained from 503 females (mean age, 54) and 122 males (mean age, 51) in whom histopathologic follow-up material was available for review, were analyzed. FNAs were classified as: nondiagnostic, negative, intermediate, and positive for malignancy, and the histopathologic material was categorized as benign or malignant. The review revealed 93% sensitivity and 96% specificity for the FNA diagnoses. The FNA results were diagnostic in 87%, indeterminate in 6%, and nondiagnostic in 7% of the cases. Cytohistologic correlation was achieved in 88% of the cases. The false-negative rate was 4% and the false-positive rate was 8%. The most common pitfalls for false-negative diagnoses consisted of suboptimal material and underdiagnosis of papillary carcinoma due to cystic degeneration. The most common pitfall for false-positive cases was overdiagnosis of follicular neoplasms. Our study confirmed that FNA of thyroid nodules can be performed with high sensitivity and specificity by experienced clinicians or pathologists. The application of strict specimen adequacy rules for FNA interpretation is likely to decrease the rate of false-negative and false-positive diagnoses.

Fine needle aspiration biopsy of calcinosis cutis. A case report.

BACKGROUND: Metastatic calcifications are currently an uncommon complication in patients with end-stage renal disease due to improvements in management of these patients. When present, however, calcifications may mimic neoplastic growth and can undergo fine needle aspiration biopsy (FNAB). CASE: A case of calcinosis cutis was diagnosed by FNAB in a 50-year-old male with a history of end-stage renal disease who presented with a subcutaneous nodule in the right side of his neck. CONCLUSION: The presence of histiocytes, foreign body-type giant cells and refractile material (calcium crystals) in FNAB material is diagnostic of calcinosis cutis in the proper clinical setting.

[Complications of single chamber pacemakers (pacemaker syndrome). Short-term and long-term follow-up of 278 patients]. / Complications de la stimulation cardiaque monochambre (syndrome de pacemaker). Suivi de 278 patients à moyen et long terme.

OBJECTIVES: To assess complications of single chamber pacemaker VVI. MATERIALS AND METHODS: We reviewed the medical files of 278 patients implanted with VVI pacemaker at Saint Joseph Hospital, Bawchrieh, Lebanon, between 1978 and 1988. We looked for complications that have been reported by the patients. We compared these complications to different factors: age, indication, retrograde conduction ECG aspect before implant. RESULTS: 36 patients (12.9%) reported at least once one of these complications: fatigue, headache, neck pain, palpitations, confusion, dyspnea, angina, chest pain, pulmonary oedema, pedal oedema, atrial fibrillation, cerebrovascular accident. These complications were more frequent when the indication was an atrial disease compared to AV Block. The retrograde conduction was frequent in patient with complications. Heart failure was aggravated by stimulation, but not induced by it. CONCLUSIONS: The single chamber VVI is complicated by symptoms which could be minor, moderate and major. VVI is an acceptable mode of stimulation when the indication is AV block. The dual chamber pacemaker should consider the cost-effectiveness.

Pulmonary alveolar proteinosis: an unusual association with Mycobacterium avium-intracellulare infection and lymphocytic interstitial pneumonia.

Pulmonary alveolar proteinosis is a nonspecific alveolar response to various forms of injuries. Many cases have been associated with hematologic malignancies. The most commonly reported complication of pulmonary alveolar proteinosis is superinfection with fungal, bacterial, and viral infections. We report a case of a 33-year-old man with alveolar proteinosis complicated by Mycobacterium avium-intracellulare complex infection. The additional presence of diffuse lymphocytic interstitial pneumonitis is an association that has not been previously reported.

Renal cell carcinoma with metastasis to the thyroid gland.

Cancers that metastasize to the thyroid gland are uncommon. Metastasis to the thyroid gland has been reported in renal cell carcinoma (RCC), breast cancer, lung cancer, gastrointestinal malignancies, malignant melanoma, sarcoma, hematologic malignancies, and other genitourinary cancers. A computer search of the records of the department of pathology at Loyola University Medical Center was done to determine the number of thyroidectomies performed between 1988 and 1998. A detailed review of the clinical records of patients with metastasis to the thyroid gland from RCC was done. A total of 941 thyroidectomies were performed between 1988 and 1998. Metastasis to the thyroid gland was seen in six cases (0.64%). Three of these six cases had metastasis from RCC. The interval between the diagnosis of the primary RCC and the thyroid metastasis was 2 to 10 years. Two of these three patients had an adenomatous thyroid gland. Metastases to the thyroid, though relatively rarely diagnosed clinically as a cause of thyroid nodule, must be considered in the differential diagnosis of thyroid nodule, particularly in patients who have a history of RCC.