Eoghan E. Mooney

Assessment of Tissue Estrogen and Progesterone Receptor Levels: A Survey of Current Practice, Techniques, and Quantitation Methods

Abstract: The assessment of steroid hormone receptors in resected breast carcinoma tissue is currently the standard of practice. The traditional method for assessment of receptor status is the ligand binding assay. More recently, immunohistochemistry (IHC) has become a popular method for such testing. Despite the widespread use of IHC and the availability of many antibodies, standardization of quantitative IHC for assessment of estrogen and progesterone receptors has not been achieved. While the College of American Pathologists (CAP) offers a Quality Assurance (QA) program for IHC quantitation of estrogen receptor (ER) and progesterone receptor (PgR), no universal standard is currently recognized in assessment of ER and PgR by IHC. We surveyed 300 laboratories within the United States for their current practices regarding the assessment of ER and PgR status in breast cancer tissue specimens. Eighty usable responses were received. Forty‐nine (61%) laboratories performed the assay in‐house, while the remainder sent the material out for assay. All responding laboratories performing their steroid receptor analysis in‐house used the IHC technique. Forty‐three (80%) laboratories answering the question on material accepted for analysis performed the assay only on paraffin‐embedded material, three (6%) used either paraffin block or frozen material, and two (4%) used only frozen material. Eighty‐eight percent of laboratories performing steroid receptor analysis in‐house used a manual quantitation technique. Four (8%) used computer‐assisted image analysis, and a single laboratory used laser scanning cytometry. Eight different antibodies were used among the 44 laboratories documenting the antibody supplier, and for any given commercially prepared antibody a wide variety of dilutions were used, with the exception of the standard solution used with the Ventana antibody. Of the laboratories using manual estimation techniques, 61% simply estimated the percentage of positive cells, 29% evaluated both the intensity of staining and percentage of nuclei staining, 6% used formal H‐score analysis, 2% evaluated only intensity of nuclear staining, and 2% mainly counted the percentage of nuclei staining for ER but used a formal H score in the assessment of PgR. Cutoff points for the separation of positive and negative results varied widely, with some laboratories assessing any demonstrable positivity as a positive result, while others required as many as 19% of the nuclei to stain before a specimen was declared positive. Standardization techniques differed considerably among laboratories. Eighty‐six percent used the CAP program for QA. While all laboratories utilized some form of intralaboratory control for assessment of ER and PgR, the nature of that control varied from laboratory to laboratory. Our survey indicates that a majority of laboratories perform their steroid hormone receptor analysis in‐house using IHC. There is considerable variability in the antibodies utilized, the dilutions applied, and the quantitation method and level of expression used to dichotomize specimens into positive and negative groups. Finally, no universal control for interlaboratory standardization appears to exist.

Middle ear carcinoid: An indolent tumor with metastatic potential

Neuroendocrine tumors of the head and neck region may present problems in diagnosis. Middle ear carcinoid is a rare, recently recognized tumor, which to date has not been reported to metastasize.

Fine-needle aspiration of neural lesions.

The cytomorphologic features of 13 neural lesions sampled by fine‐needle aspiration (FNA) are reviewed. The frequencies at which various architectural features including Verocay bodies, filamentous background, and vascular arcades were present was recorded, along with the frequencies of cytologic findings including the presence of spindle cells, wavy nuclei, intranuclear inclusions, fishhook nuclei, nuclear pleomorphism, filamentous cytoplasm, and mitotic figures. Verocay bodies were a rare finding, present in only 1 of 11 cases. Vascular arcades were similarly infrequent (1/11 cases). Spindle‐shaped cells along with wavy nuclei were the most frequent findings, with fishhook‐shaped nuclei and a filamentous background of high frequency (9/11 cases). Our study indicates that some of the characteristic features recorded in the literature are rarely seen in needle aspiration smears, but features such as spindle‐shaped cells, wavy and fishhook‐shaped nuclei, and a filamentous background are relatively frequent findings. Diagn. Cytopathol. 1999;20:1–5.

Not by blood alone: Diagnosis of hemangiomas by fine‐needle aspiration

Hemangiomas are common vascular neoplasms which are being radiographically detected and biopsied with increasing frequency during the workup of patients with malignant disease. The increasing confidence of radiologists in biopsying these lesions is in contrast to the reluctance of pathologists to make a specific diagnosis of hemangioma. Eleven cases of hemangioma, from both hepatic and superficial sites, were reviewed and the fine‐needle aspirate findings discussed and illustrated. Three‐dimensional arcades composed of bland elongated spindle cells or compact dense coils of spindle cells associated with scattered spindle‐shaped cells were identified in 10 of 11 cases. In conclusion, recognition of the cellular pattern of hemangiomas combined with the radiologic information can enable a positive diagnosis of hemangioma to be made. Diagn. Cytopathol. 1998;19:250–254.

Squamous cells in fine‐needle aspiration biopsies of salivary gland lesions: Potential pitfalls in cytologic diagnosis

A spectrum of neoplastic and non‐neoplastic lesions of the salivary glands may contain squamous cells. These include chronic sialadenitis, lymphoepithelial cyst, pleomorphic adenoma, Warthins tumor, mucoepidermoid carcinoma, and squamous cell carcinoma. The squamous cells may be a defining feature of the lesion, or an occasional and thus unexpected finding, with a consequent potential for misdiagnosis. Clinical management of these lesions differs significantly, and careful evaluation of the squamous elements, along with attention to other cellular and background components, facilitates accurate diagnosis. Diagn Cytopathol 1996;15:447–452.

Heterotopic Epithelium in an Intramammary Lymph Node

Abstract: Heterotopic squamous‐lined cysts and ductal epithelium occurring in an intramammary lymph node from a 23‐year‐old woman are described. The lesion presented as a 3 cm × 2 cm well‐circumscribed mass lying anterior to the left anterior axillary line. Careful examination of the breast revealed no other clinically apparent lesions. The nodule was thought to represent a benign neoplasm and excisional biopsy was performed. Pathologic examination revealed a lymph node whose architecture was distorted by multiple squamous‐lined cysts. The squamous epithelium demonstrated a prominent granular cell layer. No evidence of nuclear atypia was found within the squamous lining. Only rare cases of epithelial inclusions within axillary lymph nodes have been described. The majority have been unrelated to a breast malignancy and have followed a benign clinical course. Because these inclusions may lead to significant axillary or intramammary lymphadenopathy, they may be mistaken clinically for metastatic carcinoma. Disclosure of intranodal epithelial deposits on pathologic examination may result in an incorrect diagnosis of metastatic disease. However, careful evaluation of the epithelial nests will establish their benign character. Benign epithelial deposits within intramammary and axillary lymph nodes must be added to the list of heterotopic benign epithelial structures found in lymph nodes.

Placental Pathology in Patients Using Cocaine: An Observational Study

Objective Although retroplacental hemorrhage is a major cause of fetal death, its etiology often remains obscure. In some reports, cocaine use by pregnant women has been associated with retroplacental hemorrhage and clinical abruptio placentae. This study was designed to assess the occurrence of chorionic villus hemorrhage, an entity shown recently to be associated with retroplacental hemorrhage, in the placentas of cocaine users. Methods Twenty-nine placentas from cocaine users and 15 placentas from drug-free controls, as determined by questionnaire and urine toxicology screen, were examined prospectively, and pathological findings documented. The prevalence of retroplacental hemorrhage, chorionic villus hemorrhage, edema, chorioamnionitis, funisitis, infarction, fetal vessel thrombosis, and intervillus hemorrhage was examined in the two groups. Results Chorioamnionitis was the most frequent finding in both groups (58% of cocaine users, 66% of controls). Edema of moderate severity or greater was found only in the cocaine-using group (17%). The prevalence of chorionic villus hemorrhage among women using cocaine also was 17%. Conclusion Cocaine use during pregnancy may be associated with chorionic villus hemorrhage and villus edema, even in the absence of clinical abruptio placentae. The relationship between abnormal placental morphology and adverse perinatal outcomes remains to be determined.

Reporting fine-needle aspirates of breast : A survey of preferences among surgeons

The optimal format for reporting results of breast fine‐needle aspiration cytology is controversial, with some experts favoring a five‐category system and others recommending a four‐category format.

Cytomegalovirus-induced cutaneous vasculopathy and perianal ulceration

(peripheral) in our patient rather than midbrain (central) denervation. Arnaud Duval, MD, Nassos Kalempokas, MD, Anne Penicaud-V edrine, MD, Anne GuiochonMantel, MD, PhD, and Claude Bachmeyer, MD Service de Dermatologie, CHU Saint-Louis (APHP), Paris; Explorations Fonctionnelles, CHU Tenon (AP-HP), Paris; Laboratoire de G en etique Mol eculaire, Pharmacog en etique et Hormonologie, CHU Bic etre (AP-HP), Le Kr emlin-Bic etre; and Service de M edecine Interne, CHU Tenon (AP-HP), Paris, France

Granulomatous leg ulcers : an unusual presentation of Crohn's disease in a young man

Crohns disease is a granulomatous disease of the bowel in which several extraintestinal manifestations have been described. Some cutaneous manifestations bear a close histologic resemblance to the bowel disease as noncaseating granulomas are present within the skin. When found in skin distant from the bowel, this has been termed metastatic Crohns disease. We report the case of a young man with Crohns disease who came to us for treatment of fungating leg ulcers.