Carlos W. Bedrossian

Intraoperative consultation in ovarian lesions: A comparison between cytology and frozen section

Little information is available on the relative value of intraoperative cytology (IOC) and frozen section (FS) in evaluation of ovarian lesions. We compared the two methods in 63 histologically proven cases of resected ovaries studied by imprints (40 cases), FNAs (38 cases), and scrapes (5 cases). Diagnoses were: 10 non‐neoplastic cysts, 46 neoplasms (benign, 19; borderline, 8; and malignant, 19) and 7 tumors comprised of small blue cells (SBC): granulosa cell (3), lymphoma (1), small cell carcinoma (1), and sarcoma (2). There were no false‐positive diagnoses by IOC or FS among the benign and borderline conditions. Five benign lesions, however, had FS deferred because of architectural complexity, this in contrast to only one case reported as atypical by IOC. Borderline tumors were recognized as such in 3 cases examined by FS, but no such diagnosis was possible by IOC due to the inability to assess invasion. The diagnosis in borderline neoplasms of surface epithelial origin was deferred in 4 cases by FS and reported as atypical in 5 cases examined by IOC due to the spectrum of architectural and nuclear atypia in borderline tumors. Of the 19 malignant cases, five were deferred because of uncertainty of invasion by FS, whereas two were called atypical by IOC. Five of 7 SBC tumors were recognized as such by FS and 6 of 7 by IOC, but none could be unequivocally subclassified by either method. Intraoperative FNAs and scrapes were superior to imprints, which tended to be bloodier and thicker. In contrast to FNAs, scrapes were easier to direct and yielded greater cellularity, although both methods were comparable in diagnostic accuracy. Even though the diagnostic yield of IOC was only slightly better than that of FS, it provided much better cytologic detail, and afforded a more representative sampling. Diagn Cytopathol 1996;15:387–394.

Fine-needle aspirate of primary lymphoma of bone

Primary lymphoma of bone (PLB) is a rare bone tumor. Fine‐needle aspirates (FNA) were done on large destructive bone tumors from 2 elderly men, and both were initially read as inconclusive for malignancy because of scant cellularity. On retrospective study of the FNA slides after examining tissue histology, low numbers of diagnostic cells for lymphoma were recognized on the smears. There was extensive crush artifact, and most intact cells were stripped of their cytoplasm. In neither case was enough material harvested to make cell blocks or to perform special studies. Tissue histology disclosed abundant fibroconnective tissue stroma which probably made it difficult to acquire adequate FNA specimens. Another FNA done on a postoperative PLB tissue specimen disclosed similar features. Our experience in the 3 cases is consistent with the view that even though smears show scant cellularity, the diagnosis of PLB can at least be suggested by FNA. It is therefore important not to undercall the specimen because of low cellularity, and recommendation for tissue diagnosis can be given. This process is facilitated by a high index of suspicion based on clinical and radiographic findings. Diagn Cytopathol 1996;15:421–426.

Principles and practice for biopsy diagnosis and management of musculoskeletal lesions

INTRODUCTION TO THE DIAGNOSIS OF MUSCULOSKELETAL LESIONS Fine needle aspiration and core biopsy are used at some oncology centers as the initial technique to obtain a tissue diagnosis for mass lesions occurring within the musculoskeletal system. A majority of such lesions are in actuality metastatic deposits from a primary malignancy arising elsewhere. Metastatic neoplasms usually present little difficulty in diagnosis. Primary lesions of the musculoskeletal system are a significantly greater diagnostic challenge and many authorities in histopathology of bone and soft tissue tumors have recommended against the use of small biopsy techniques for the diagnosis of these lesions. The resistance to the use of small volume specimens, especially fine needle aspiration (FNA), results from a combination of factors including the relative rarity of these lesions, the potential for radical deforming surgery and the young age of the patients in which many of these lesions occur. Musculoskeletal sarcomas account for less than 1% of all malignant neoplasms. The infrequency of these tumors results in limited experience with their morphologic appearances among surgical pathologists and cytopathologists except for those practicing at orthopedic oncology centers. Contributing to this reduction in the utilization of small biopsy procedures is the relatively high percentage of benign proliferations (pseudosarcomas) closely resembling true sarcomas. An additional issue which has slowed the implementation of FNA for the investigation of musculoskeletal neoplasms is concern that the technique may not procure sufficient sample to obtain reliable results with a variety of ancillary techniques including immunohistochemistry and molecular diagnostics.