Esther Ravinsky

Cytodiagnosis of lymphoid proliferations by fine needle aspiration biopsy. Adjunctive value of flow cytometry.

OBJECTIVE To determine the accuracy of fine needle aspiration biopsy (FNAB) complemented by flow cytometry (FC) for the diagnosis of reactive and neoplastic lymphoid proliferations and subclassification of malignant lymphomas. STUDY DESIGN Forty-one FNABs of lymphoid lesions on which FC had been performed were evaluated retrospectively. All cases were correlated with histology or clinical follow-up. RESULTS Twelve FNABs were diagnosed as reactive. Eleven of the 12 were confirmed as reactive on follow-up. One was a case of posttransplant lymphoproliferative disorder. Twenty-five FNABs diagnosed as lymphoma were confirmed by histology. In 22 of these 25 cases, there was 100% correlation between the subclassification given on FNAB with FC and that given on histology. Two of the remaining cases, which were correctly called follicular center cell lymphoma, showed discrepancies in grading. One case called Hodgkins disease on FNAB was T-cell lymphoma on histology. Of four FNABs given an inconclusive diagnosis, two were lymphoma on follow-up, and two were reactive. CONCLUSION FNAB examination, when it includes immunophenotyping by FC, is a useful technique for distinguishing reactive lymphoid proliferations from malignant lymphomas and for the subclassification of lymphomas.

Diagnosis of lymphoma by image-guided needle biopsies: Fine needle aspiration biopsy, core biopsy or both?

OBJECTIVE To determine whether or not concurrent core biopsy adds to results obtained from image-guided fine needle aspiration biopsy (FNAB) in cases of lymphoma. STUDY DESIGN Twenty-eight FNABs of lymphomas with adjuvant flow cytometry (FC) and concurrent core biopsy were evaluated retrospectively. In each case, completeness of diagnosis by FNAB, including phenotyping and grading, where appropriate, was reviewed. The contribution of core biopsy to the diagnosis in cases where FNAB did not render a complete diagnosis was assessed. Prognostic information not available from the FNAB but obtained from the core biopsy was also evaluated. RESULTS FNAB with adjuvant FC gave a complete diagnosis, including phenotype and grade, where applicable, in 23 of 28 cases (82%). Core biopsy added to the diagnosis in 3 cases. In 1 case, large B-cell lymphoma was diagnosed on core biopsy when FNAB was unsatisfactory. In the other 2 cases, grade of follicle center cell lymphoma was higher on core biopsy than on FNAB. The addition of the information obtained by core biopsy to that obtained by FNAB raised the diagnostic accuracy to 93%. Core biopsy was used to assess nodularity, which could not be determined on FNAB. Core biopsy was also used to assess prognostic markers by immunohistochemistry (Ki-67 and p53); they were not available with FC. This was done in 11 cases when requested by the oncologist. CONCLUSION FNAB with adjuvant FC is a useful technique for diagnosing and subtyping lymphomas. However, diagnosis and subclassification are often insufficient. Core biopsy material provides opportunity for obtaining additional diagnostic and prognostic information that may not be easily derived from the FNAB. This allows optimal treatment planning in patients for whom excisional biopsy is contraindicated.

Fine Needle Aspiration Biopsy Findings in Lymphoepithelial Carcinoma of Salivary Gland

OBJECTIVE To study the fine needle aspiration cytology of lymphoepithelial carcinoma of salivary gland (LECSG). STUDY DESIGN Needle aspirates from five primary and two metastatic LECSGs were reviewed. RESULTS Three aspirates showed very scant cellularity with rare tumor cells originally misinterpreted as lymphohistiocytic cells. Six fine needle aspiration biopsies (FNABs) contained medium to large polygonal and spindled cells with one or more prominent nucleoli. Five aspirates also displayed a heterogeneous population of lymphoid cells, while a sixth had much necrotic debris and only a few lymphocytes admixed with tumor cells. CONCLUSION In the clinical setting of an Inuit or Chinese patient with a salivary gland mass, an FNAB with these features should suggest the possibility of LECSG.

Cytologic features of primary adenoid cystic carcinoma of the uterine cervix. A case report.

BACKGROUND Adenoid cystic carcinoma of the cervix is a rare, aggressive neoplasm generally found in postmenopausal women. CASE A cervical cytology specimen was obtained by endocervical brush from an 80-year-old woman with histologically confirmed primary adenoid cystic carcinoma of the cervix. Both small cells arranged in a cribriform (cylindromatous) pattern and moderately dysplastic squamous cells (high grade squamous intraepithelial lesion) were evident. CONCLUSION Although the endocervical brush technique may yield well-preserved cells and tissue fragments morphologically characteristic of adenoid cystic carcinoma of the cervix, confusion with more common tumors, such as endometrial adenocarcinoma, still may create cytologic diagnostic difficulties.

Fine needle aspiration biopsy of a small round cell tumor exhibiting both neural and myogenic differentiation. A case report.

BACKGROUND Divergent differentiation may not be detected in the limited material available in a fine needle aspiration biopsy (FNAB). CASE A small round cell malignancy showed neural features ultrastructurally on FNAB, in keeping with primitive neuroectodermal tumor, but desmin and actin positivity on surgical biopsy, suggesting rhabdomyosarcoma. CONCLUSION Accurate classification of small round cell tumors by FNAB is more likely to occur when both electron microscopy and immunocytochemistry are employed since these tumors may express divergent differentiation.

Fixation techniques for fine needle aspiration biopsy smears prepared off site.

OBJECTIVE To identify a simple, cost-effective, reliable fixation method for fine needle aspiration biopsy (FNAB) yielding a specimen suitable for mail transport. STUDY DESIGN Smears prepared from 59 FNABs of surgical specimens were fixed by continuous fixation in 95% ethanol, spray fixation, air drying, ethanol fixation for either 5 minutes or 4 hours followed by spray fixation, or fixation in 95% ethanol for either 30 minutes or 4 hours followed by air drying. Fixation was graded as unsatisfactory, suboptimal, average, good or excellent. RESULTS Of smears continuously fixed in ethanol, 96.6% were graded as excellent. Of smears fixed in ethanol followed by spray fixation, 93.2% were excellent irrespective of fixation time; 64.4% of spray-fixed smears were excellent and 27.1% good. Of air dried smears, 93.2% were unsatisfactory or suboptimal; 83.0% of smears fixed in ethanol for 30 minutes and 74.6% of smears fixed for 4 hours prior to air drying were unsatisfactory or suboptimal. CONCLUSION Fixation of smears in 95% ethanol followed by spray fixation produces excellent results, comparable to those with continuous fixation in ethanol. Spray fixation is generally good but not consistently excellent. Air drying or fixation in ethanol followed by air drying yields unsatisfactory or suboptimal results in most cases.

Contribution of transmission electron microscopy to fine-needle aspiration biopsy diagnosis : Comparison of cytology and combined cytology and transmission electron microscopy with final histological diagnosis

This report evaluates 74 fine‐needle aspiration biopsies processed for transmission electron microscopy with subsequent surgical procedure. The specificity of diagnosis obtained by cytology alone was compared to that obtained by cytology and electron microscopy, using histologic diagnosis as the gold standard. When cytology gave a diagnosis of malignancy but could not give tumor category or type, electron microscopy could correctly give both. When cytology could give tumor category but not type, electron microscopy correctly identified type in the majority of cases. When cytology gave tumor category and type, electron microscopy confirmed the diagnosis. Transmission electron microscopy is very helpful when the cytopathologist can diagnose malignancy but cannot give tumor category and/or type. When the cytopathologist is specific in his/her diagnosis, TEM is not as helpful. Diagn Cytopathol 1996;15: 282–287.