Bernard Naylor

The Uterine Corpus

During the reproductive years, the size and weight of a normal uterus vary according to parity. Nulliparous uteri weigh 40 to 100 g and measure about 8 cm in length, 5 cm in width at the fundus, and 2.5 cm in anteroposterior thickness. Muciparous uteri weigh up to 250 g and measure 12 cm × 5–7 cm × 3.5 cm.

Pulmonary needle aspiration biopsy in the diagnosis of Pancoast tumors.

Twenty-seven patients with Pancoast tumors underwent fluoroscopically guided pulmonary needle aspiration biopsy, a diagnostic procedure which provided a cellular aspirate rather than a core of tissue. Diagnoses were made by cytologic rather than histologic techniques. A diagnosis of carcinoma was made in 26 of the 27 cases. The remaining tumor was a locally invasive pleural fibrous mesothelioma. Pulmonary needle aspiration biopsy gave diagnostic results far superior to those obtained by bronchoscopic biopsy, cytology of sputum or bronchial washings, or biopsy of scalene or supraclavicular lymph nodes.

Clinical outcome in aggressively treated meningeal gliomatosis

We reviewed 11 consecutive patients with an antemortem cytologic diagnosis of meningeal gliomatosis. In three patients, meningeal gliomatosis was diagnosed before surgical resection of the glioma. Three of five patients with anaplastic astrocytoma and one with oligodendroglioma improved with treatment. Patients with glioblastoma multiforme did not respond and had a median survival from the diagnosis of meningeal gliomatosis of only 8 weeks. Meningeal gliomatosis can be an early finding in gliomas. Treatment response is probably related to tumor histology and grade.

Aspiration biopsy of thoracic lesions

We have performed percutaneous needle aspiration biopsy of intrathoracic lesions under fluoroscopic control on 50 patients. Lesions as small as 1 to 1·5 cm. in diameter were aspirated. Thirty of the 36 cases of malignant neoplasm were diagnosed by this method. Of the 14 non-neoplastic cases, granuloma was diagnosed in two, and in eight of the remaining 12 the clinical diagnosis was supported by the nature of the aspirated material. Pneumothoraces are to be expected as a complication of the method. Most will be asymptomatic; a small proportion will require treatment. There will also be the occasional haemoptysis. The procedure can be quickly performed and it is well tolerated by the patient. It causes less discomfort than bronchoscopy or scalene lymph node biopsy. The interpretation of the cytological material presents no undue difficulty to the pathologist experienced in conventional pulmonary exfoliative cytology.

Amyloid in cytologic specimens: Differential diagnosis and diagnostic pitfalls

OBJECTIVE To describe and illustrate the characteristic features of amyloid in cytologic preparations and point out its diagnostic pitfalls. STUDY DESIGN Five fine needle aspirates and one bronchial washing that contained amyloid were retrospectively reviewed. The aspirates were obtained from each of the five following sites: lung, occipital lymph node, thyroid gland, proximal humerus and subcutaneous soft tissue. Smears of all of the aspirates were stained with Papanicolaou stain, and in two cases they were also stained with Diff-Quik. Cell block sections were stained with hematoxylin and eosin. Congo red, CD45 and CD20 were used on selected cases. RESULTS Amyloid appears as either flocculent material or irregularly shaped fragments with scalloped and pointed edges. The amorphous fragments are acellular and frequently associated with connective tissue cells. They stain eosinophilic to cyanophilic with Papanicolaou stain and deep blue with Diff-Quik. In two cases an exuberant giant cell reaction almost obscured the amyloid. In the thyroid aspirate, the amyloid was misinterpreted as colloid. In bronchial washings and lung aspirates, amyloid has to be distinguished from mucus, alveolar proteinosis, chondroid material and corpora amylacea. When circumferentially surrounded by lymphocytes or plasma cells, flocculent amyloid deposits may simulate adenoid cystic carcinoma. CONCLUSION Amyloid can be easily overlooked or mistaken for other entities with similar staining qualities. Congo red staining can help to confirm the diagnosis.

Multiple primary neoplasms of the ovary and uterus

Multiple primary neoplasms arising in the ovary and uterus were analyzed in 55 patients: 49 synchronous and 6, metachronous. When they occurred synchronously, 74.5% of the ovarian carcinomas and 93.6% of the uterine carcinomas were stage I lesions. The endometrial carcinomas were invariably well differentiated and superficial. It was the stage of the ovarian carcinomas that determined the prognosis of these patients. Ways of their identification as separate neoplasms are discussed. The potential to develop further neoplasms in the gastrointestinal tract and breasts should be borne in mind.

Acid mucopolysaccharide composition of serous effusions. Study of 100 patients with neoplastic and non-neoplastic conditions.

Serous effusions from 100 patients were examined for cancer cells and analyzed for acid mucopolysaccharides (AMPS) by both quantitative and qualitative methods. Strikingly high concentrations of hyaluronic acid were present not only in effusions from patients with mesotheliomas but also in effusions from many patients with other neoplasms. In 15 of 23 fluids analyzed in detail 20 to 90% of the AMPS was identified as a type of chondroitin sulfate.

Neoplasms of the Skin

The integument may give rise to a wide variety of neoplasms, partly because of the plethora of specialized structures that compose the organ. A complete exposition of these is far beyond the scope of this chapter, which will be devoted to the most common tumors, or to neoplasms that serve as examples of categories of these lesions.

An exfoliative cytologic study of intracranial fluids.

WHEREAS TWENTY YEARS AGO the use of diagnostic exfoliative cytology was exceptional, today in North America it is commonplace. This branch of pathology finds its most widespread application in investigation of the respiratory and female genital systems; utilization of the method in the diagnosis of lesions of the central nervous svstem has received relatively scant attention. However, a perusal of the literature shows that, since the beginning of this century, there have been about 60 publications which mention specific instances of finding tumor cells in either intracranial or intraspinal fluids. This does not take into account tumors of the malignant lvmphoma and leukemia groups. The great majority of authors have reported finding tumor cells in cerebrospinal fluid obtained by lumbar puncture; fewer mention finding tumor cells in fluids obtained directly from the cranial cavity. The impression given in many instances is that the identification of tumor cells in a fluid derived from the central nervous system has been a unique or most uncommon experience for the authors concerned. But one is also left with the impression that tumor cells would be found more frequently in these fluids if suitable technics were used to demonstrate them and if persons seeing them could, with assurance, recognize them for what they are. Intracranial fluids (usually ventricular fluids) are often withdrawn from patients who are obscure diagnostic problems, who are suspected of having brain tumor, or who are undergoing craniotomy. In many instances, the cerebrospinal fluid withdrawn from a lateral ventricle is the first specimen of such fluid obtained; this applies particularly to brain tumor suspects. In view of these facts and of the relatively few reports of finding tumor cells in intracranial fluid, a series of such fluids has been

Pneumocystis carinii pneumonia. Cytologic manifestations and rapid diagnosis in routinely prepared papanicolaou-stained preparations

In this study of 28 immunocompromised patients, it was found that Pneumocystis carinii pneumonia could be easily and reliably diagnosed by examination of routinely prepared, Papanicolaou-stained cellular samples obtained by bronchoalveolar lavage, bronchial brushing, and bronchial washing. The distinctive intra-alveolar exudate of pneumocystosis observed in lung biopsy specimens was readily discernible in all of the cellular samples that demonstrated P. carinii by special stains. The exudate was not present in any of the P. carinii-negative samples. Routinely prepared, Papanicolaou-stained cellular samples can be relied upon for the rapid diagnosis of P. carinii pneumonia.