Denise Hidvegi

The efficacy of image-guided stereotactic brain biopsy in neurologically symptomatic acquired immunodeficiency syndrome patients.

A prospective series of 50 neurologically symptomatic human immunodeficiency infected patients with intracranial lesions who underwent image-guided stereotactic brain biopsy is presented. Patients were diagnosed with primary central nervous system lymphoma (14 patients), progressive multifocal leukoencephalopathy (14 patients), toxoplasmosis (13 patients), human immunodeficiency virus encephalitis (3 patients), infarction (2 patients), and 1 patient each with metastatic adenocarcinoma, metastatic melanoma, cryptococcoma, and atypical mycobacterial infection. Two of the patients with toxoplasmosis had a second intracranial abnormality. Two biopsies resulted in either descriptive diagnosis only or were nondiagnostic; the definitive diagnostic efficacy of image-guided stereotactic biopsy was thus 96%. No deaths were incurred as a result of biopsy. Four intraoperative or postoperative hemorrhages occurred; in only 1 patient was there a residual neurological deficit related to the surgery. Image-guided stereotactic biopsy may thus be considered both safe and effective in this patient population.

Olfactory neuroblastoma. An ultrastructural study

The ultrastructural features of two olfactory neuroblastomas are reported. By means of light microscopy, one was well differentiated while the other was a poorly differentiated, small cell neoplasm. The latter case required ultrastructural examination to establish the diagnosis. Electron microscopy of human tumors for diagnostic purposes may be particularly helpful in deciphering small, round cell tumors. Catecholamines were not biochemically detected in a portion of recurrent tumor from Case 2. The significance of this is equivocal in view of the limited previous biochemical studies of this neoplasm. However, by both light and electron microscopy, the morphology of olfactory and sympathetic neuroblastomas are strikingly similar.

Metaplastic squamous cell carcinoma of bronchus simulating giant cell tumor of bone.

A 57‐year‐old man underwent a right pneumonectomy for a bronchogenic carcinoma following bronchoscopy and bronchial biopsy. The tumor was a polypoid mass arising from the lower lobe bronchus. Microscopically it was characterized by mononuclear cells mixed with randomly distributed multinucleated giant cells similar to those seen in giant‐cell tumor of bone. Also found were portions showing typical squamous cell and spindle cell carcinoma. Based on the light and electron microscopic findings, we suggest that the current case represents a metaplastic squamous carcinoma showing mesenchymal cell differentiation. A hypothesis on the histogenesis of pleomorphic carcinomas was presented. The problems of histological diagnosis generated by such a tumor should be emphasized.

Natural history and significance of esophageal squamous cell dysplasia

Balloon‐mesh cytologic screening for esophageal cancer done in 255 asymptomatic high‐risk United States veterans (age > 40 years, ethanol abuse for > 20 years, and cigarette smoking > 20 pack years} identified 37 patients with squamous cell dysplasia. Of the 37 patients with dysplasia, 28 were re‐evaluated prospectively at 6‐month intervals for up to 36 months by balloon‐mesh cytology, esophagoscopy with vital staining and biopsies, chest radiographs, oropharyngeal examination, and indirect laryngoscopy. During prospective follow‐up evaluation, cytology specimens were repetitively normal in 16 patients (57%), showed inflammatory changes in eight patients (29%), persisted as dysplasia in two patients (7%) (both had endoscopic and histologic evidence of esophagitis), and progressed to carcinoma in two patients (7%) (one esophageal, one laryngeal). Although histologic findings concurred with the resolution of dysplasia, biopsy specimens were characterized by a similar difficulty in distinguishing dysplasia from inflammation. Erroneous histologic diagnoses of carcinoma in situ were made in two patients with reflux esophagitis evident endoscopically and confirmed during the course of a 24‐36 month follow‐up period. The authors conclude that squamous cell dysplasia detected by balloon‐mesh cytology is seldom a precursor of esophageal cancer in the high‐risk U.S. population but, rather, is often related to esophagitis. Thus, balloon‐mesh cytology has limited use as a screening method for the early detection of esophageal cancer in the United States.

Computed Tomography of Retroperitoneal Castleman Disease (plasma Cell Type) with Sonographic and Angiographic Correlation

The CT and sonographic appearances of a case of retroperitoneal Castleman disease of the plasma cell type are reported along with angiographic correlation. In this case CT demonstrated a minimally calcified homogeneously enhancing retroperitoneal mass. Sonography showed the mass to be hypoechoic with good through transmission. The lesion was hypervascular with prominent early venous drainage on inferior mesenteric arteriography.

Reliability of balloon-mesh cytology in detecting esophageal carcinoma in a population of US veterans

A catheter, equipped with a terminal ballon covered with nylon mesh, was developed to study the reliability of abrasive cytology for the diagnosis of esophageal carcinoma. Eighty‐seven balloon cytology analyses were attempted in 82 subjects. Four patients were unable to swallow the balloon. In the 78 successful attempts, the initial diagnoses were: esophagitis (34) and esophageal carcinoma (13), established by endoscopic examination and histologic sampling; and normal esophagus (31) confirmed histologically in 25. The remaining 6 controls were younger than 40 years old, without any significant history of smoking, drinking and esophageal symptoms. For esophageal carcinoma, the sensitivity of balloon cytology was 91% and the specificity was 94% with four false‐positives. Balloon cytology was generally well‐tolerated and easily performed. This method is now being tested for screening high‐risk patients for esophageal carcinoma.

The Mechanical Spread of Viable Tumor during Surgery

The “mechanical” spread of tumor is that which occurs through physical trauma, such as during surgical resection. There has been a waxing and waning of interest in this concept over the past 70 years. We have collected the blood that comes off the surgical field during major head and neck resections and separated and plated all nucleated cells in the tumor stem cell assay of Hamburger and Salmon. In one of six such preparations, we demonstrated the presence of viable, colony-forming tumor cells. Two were contaminated and three did not grow. We demonstrated, therefore, that the blood that bathes the raw open surgical field contains tumor cells that are viable and potentially capable of producing new foci of tumor.

Touch preparation cytological evaluation of radical prostatectomy specimens

The failure of current histological techniques to predict local failure and disease progression after radical prostatectomy is supported by substantial evidence. Moreover, the characterization of histological findings is hampered by the lack of uniform interpretation. We report a prospective study of 92 patients undergoing radical prostatectomy for clinical stages A and B prostate cancer in which the technique of touch preparation cytological analysis of surgical margins is compared to the standard histological approach. We evaluated 47 pathological stage B, 43 stage C and 2 stage D specimens. Specimens initially assigned to pathological stage B were upstaged to stage C on review by 1 blinded pathologist in 19 of 65 cases (29%). Overall, 15 of 47 histological stage B specimens (32%), 20 of 43 histological stage C specimens (47%) and 2 of 2 histological stage D specimens (100%) had malignant cells identified on the margins by touch preparation cytology. Postoperative mean followup of 7 months (range 0.4 to 26) revealed that 7 of 14 nonstage D cancer patients (50%) with elevated serum prostate specific antigen levels had positive cytology results, including 1 with histologically confirmed organ-confined disease. Among the stage C specimens cytology was more likely to be positive if there was concomitant seminal vesicle invasion. Correlation of this information with eventual patient course during the long term will be necessary to assess its role in patient management.

Modified interphase cytogenetics technique as an adjunct in the analysis of atypical cells in body fluids

Our objective was to determine the value of modified interphase cytogenetics technique (MICT) by fluorescence in situ hybridization (FISH) in the study of atypical cells in body fluids in previously stained slides, allowing a direct morphologic‐cytogenetic correlation. Thirty‐five cases (29 bladder washes, four pleural fluids, two ascitic fluids) initially diagnosed as “atypical” with subsequent histologic confirmation were included. Histologically, there were 25 malignant, four dysplastic, and six benign lesions. Previously Papanicolaou or Diff‐Quick‐stained slides were marked to determine the location of the cells of interest prior to FISH analysis. A pretreatment modification using pepsin digestion was utilized. Chromosome‐specific probe 8 (Vysis) was used to detect numerical chromosomal abnormalities (NCA) involving chromosome 8. Various NCA (aneuploid) were detected in the atypical cells of histologically proven malignant cases but not in the benign cases. Using histology as a “gold standard.” FISH has a sensitivity of 83% and a specificity of 100%. In conclusion this study shows that a MICT by FISH on previously stained slides can serve as an adjunct in the study of atypical cells in body fluids. This technique allows a direct morphologic‐cytogenetic correlation which in the future may aid in the better understanding of carcinogenesis. Diagn. Cytopathol. 16:331–335, 1997.

Cytomorphology of progressive multifocal leukoencephalopathy (PML): review of sixteen cases occurring in HIV-positive patients.

Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disorder of the central nervous system (CNS) resulting from infection of oligodendrocytes by JC virus. Although all patients immunocompromised by any congenital, acquired, or iatrogenic condition are at risk, the population which currently accounts for the majority of new cases is that infected with the human immunodeficiency virus (HIV). Though the clinical/radiologic presentation is characteristic, biopsy confirmation is necessary, as these patients are at risk for other primary CNS disorders which may produce similar clinical findings. Immediate assessment of tissue adequacy by cytologic smear is generally preferred in these specimens due to its relative reduced risk of disease transmission when compared to conventional frozen section. We report here the cytologic findings seen in touch imprints and squash preparations of 16 cases of PML, all occurring in HIV‐positive patients and obtained by stereotactic guided needle biopsy. Typical cytomorphologic findings are described and correlated with histologic sections. In addition, features useful in the exclusion of other differential diagnostic possibilities are discussed. Diagn Cytopathol 1996;14:4–9.