G. Berry Schumann

Reliability of urinary cytodiagnosis in urothelial neoplasms

A retrospective study was done to explore the reliability of urinary cytologic examination of 117 cases of transitional cell carcinoma seen at this institution for the period 1980 to 1984. A specificity of 99%, sensitivity of 85%, false‐positive rate of 11%, and false‐negative rate of 10% were obtained. A single blind review of cytologic and histologic material from 66 of the cases was also performed for evaluation of the cytologic criteria employed for the grading of tumors. Cytohistologic correlation of grade I lesions was poor, whereas correlation of grades II and III was reasonably good. Carcinoma in situ was cytologically recognized in all instances but was difficult to distinguish from grade III carcinoma. Cancer 56: 2041‐2045, 1985.

Acute leukemic infiltration of the vitreous diagnosed by pars plana aspiration.

A 30-year-old man with acute lymphoblastic leukemia, null cell, L2 type developed a unilateral dense cellular vitreous infiltrate while in apparent remission. Cytopathologic examination of material aspirated from the vitreous established the diagnosis of lymphoblastic infiltration. Prompt radiotherapy and chemotherapy rapidly reduced the vitreous infiltration and cleared cells from the cerebrospiral fluid. Intraocular involvement by the leukemic process was the initial sign of central nervous system involvement. Acute lymphoblastic leukemia should be added to the list of lymphoproliferative disorders capable of vitreous infiltration, and which can be identified by vitreous aspiration and cytopathologic examination.

Identification of fungal casts in a patient with renal candidiasis

Since the treatment of fungal infections with amphotericin B may result in significant nephrotoxicity, better methods for discriminating between life-threatening and more benign fungal infections are needed. Recently numerous fungal casts were identified in the urine of a patient who had undergone renal allograft transplantation. The recognition of fungal casts permitted an unequivocal diagnosis of systemic fungal infection. Successive examinations of the patients urinary sediment provided an excellent monitor of the response to treatment. The cytologic features of fungal casts are described. Since systemic fungal infections often involve the kidney, screening for fungal casts may have significant clinical applicability.

Urinary cytodiagnostic abnormalities in 50 patients with non-Hodgkin's lymphomas

Urinary cytodiagnostic evaluation was performed on 50 consecutive patients with non‐Hodgkins lymphomas. In 14 patients (28%) the urine sediment contained characteristic lymphoma cells. The groups with or without a positive urine cytology were comparable with respect to type of lymphoma, stage and course of disease, and recent treatment with chemotherapy. However, those with a positive urine cytology were more likely to have clinical evidence of kidney disease (43% vs 8%), although this was rarely attributed to disseminated lymphoma. In fact, in three patients, a positive urine cytology was the sole or presenting evidence for disseminated lymphoma. Although the groups with or without a positive cytology were similar with regard to physicochemical urinary findings, there were marked differences in the frequency of microscopic abnormalities. All patients with a positive cytology had evidence of renal parenchymal necrosis, renal tubular injury, or pathologic cast formation as compared with only 56% of those with a negative cytology. Thus, urinary cytodiagnostic evaluation may provide an important adjunct in the staging and evaluation of patients with malignant lymphomas.

The Clinical Significance of Candidal Casts

Examination of the urinary sediment for fungal casts is a new and simple approach for assessing renal involvement in fungal infections. Identification of candidal casts was used to diagnose renal fungal involvement in five immunocompromised patients. In three cases, the examination of the urinary sediment permitted the diagnosis of early and presumably noninvasive renal candidal infections that cleared easily with relatively low doses of antifungal therapy. In two other cases, the recognition of candidal casts confirmed renal involvement in patients with disseminated disease.

Primary cytodiagnosis of peritoneal extramedullary hematopoiesis.

Cytologic examination of peritoneal fluid in a patient with known myelofibrosis and previous splenectomy revealed mega‐karyocytes along with erythroid and myeloid precursors. These findings were consistent with extramedullary hematopoietic (EMH) implants of the peritoneum. A few similar cases have been occasionally reported in the literature. This case represents an additional example of a primary diagnosis of peritoneal EMH in which therapy was based on the cytologic findings and sequential cytologic observations were made. Diagn Cytopathol 1986;2:241 243.

Needle aspiration cytology of low‐grade transitional cell carcinoma of the renal pelvis

Five cases of histologically confirmed grade 1 papillary transitional cell carcinoma of the renal pelvis investigated by needle aspiration biopsy cytology were reviewed. In all cases the needle aspirates were hypercellular. Abundant benign‐appearing urothelial cells in thick clusters, in small aggregates, and singly were seen in two cases. Numerous single and loosely aggregated urothelial cells with cytoplasmic extensions and slightly pleomorphic nuclei were noted in one case. In two patients numerous urothelial fragments of variable sizes showing defined cytoplasm and mildly nuclear pleomorphism were the main cellular findings. Diagn. Cytopathol. 16:437–441, 1997.

Needle aspiration cytology of metastatic high-grade transitional-cell carcinomas of the urinary tract†

We reviewed 4 cases of high‐grade transitional‐cell carcinoma (TCC) of the urinary tract with solitary pulmonary metastases that were studied by transthoracic needle aspiration biopsy cytology. There were two grade II and two grade III TCCs. The two grade II tumors yielded, in needle aspirates, syncytial tumor‐cell clusters showing ill‐defined, granular cytoplasm and slightly pleomorphic nuclei with inconspicuous nucleoli. In one case the tumor‐cell clusters showed a focal acinar arrangement, mimicking cells of an adenocarcinoma. In both cases the electron microscopy (EM) study of aspirated tumor cells revealed epithelial cells with well‐formed cell junctions, intracytoplasmic vesicles, apical short microvilli, and focal interdigitation of lateral cell membranes, suggesting a urothelial neoplasm. The two grade III TCCs yielded, in needle aspirates, pleomorphic malignant cells singly and in small clusters, showing well‐defined, granular cytoplasm and pleomorphic nuclei containing prominent nucleoli, suggesting a poorly differentiated adenocarcinoma or an anaplastic large‐cell carcinoma. By EM examination the aspirated tumor cells from one case revealed well‐formed cell junctions, intracytoplasmic vesicles, poorly formed microvilli, and focal interdigitation of lateral cell membranes, suggesting a urothelial differentiation. In the other case the tumor cells were pleomorphic cells with occasional cell junctions and no ultrastructural features as seen in the other 3 cases of TCC. The tumor cells from the two grade II TCCs showed strong immunopositive reaction with keratin 7 antibody and weakly positive reaction with carcinoembryonic antigen antibody (CEAA), while those of the two grade III TCCs displayed only a weak and focal immunopositive staining with keratin 7 antibody and strong reaction with CEAA. Diagn. Cytopathol. 1998;18:409–415.

Response:Proliferative Breast Disease: Diagnosis and Implication

M. H. Skolnick et at. (1) obtained specimens by multiple fine-needle aspiration from the breasts of women with and without a family history of breast cancer. They assessed the prevalence of certain cytologic changes in these groups of women, which they labeled proliferative breast disease (PBD). Skolnick et al.s use of this term is unfortunate because PBD is a well-recognized histologic diagnosis (2, 3) of changes that bear only a slight and untested resemblance to the cytologic findings in (1). In order to avoid confusion, we will hereafter use PBD in its conventional sense. Although PBD is consistently associated with increased breast cancer risk (4), studies have not been performed which show that cytologic abnormalities or similarly defined patterns have such an association. Skolnick