Joan F. Cangiarella

Use of thyroid transcription factor 1, PE‐10, and cytokeratins 7 and 20 in discriminating between primary lung carcinomas and metastatic lesions in fine‐needle aspiration biopsy specimens

The distinction of a primary lung carcinoma from a metastatic lesion is important, because the treatment and prognosis differ for patients with these malignancies. Such a distinction can be difficult because of overlapping cytologic features. It has been shown that antibodies to thyroid transcription factor 1 (TTF‐1) and PE‐10 are fairly specific markers for primary lung tumors in histologic specimens. TTF‐1 regulates the expression of surfactant protein production, and PE‐10 is a monoclonal antibody against components of human surfactant proteins. The combination of cytokeratin 7 (CK7) and cytokeratin 20 (CK20) immunoprofiling has been helpful in the identification of the primary site of origin of lung tumors.

Transthoracic fine-needle aspiration biopsy of pulmonary spindle cell and mesenchymal lesions: a study of 61 cases.

Spindle cell and mesenchymal lesions of the lung encompass a wide variety of benign and malignant conditions. However, to the authors knowledge, because of their rarity, few reports concerning their cytologic findings are available in the literature. The current review emphasizes the cytomorphologic features, differential diagnosis, and potential pitfalls associated with these lesions.

A prospective comparison of stereotaxic fine-needle aspiration versus stereotaxic core needle biopsy for the diagnosis of mammographic abnormalities

Confidence in a negative stereotaxic breast biopsy result allows for safe clinical and mammographic follow‐up, whereas a positive or equivocal diagnosis leads to excision. Direct comparison of stereotaxic core needle biopsy (SCBX) and fine‐needle aspiration (SFNA) is needed, and should be based on the use of appropriate current methods of practice, and address the indication of each for different types of mammographic lesions.

Fine‐needle aspiration of spindle cell and mesenchymal lesions of the salivary glands

Fine‐needle aspiration (FNA) biopsy can accurately diagnose epithelial lesions of the salivary gland. Its role in the evaluation of salivary gland lesions containing a significant spindle cell component is less clear. We describe the cytologic features of 25 spindle cell lesions of the salivary gland and discuss the differential diagnosis and potential diagnostic pitfalls. Twenty‐five aspiration smears (3.0%) containing a significant spindle cell or mesenchymal component were identified out of 844 salivary gland FNAs performed over a 5‐year period. These aspiration smears were from 25 patients. The smears were classified into three categories: 1) reactive or inflammatory conditions, including one granulation tissue and four granulomatous sialoadenitis; 2) benign neoplasms, including one schwannoma, one fibromatosis, four lipomas, and nine pleomorphic adenomas; 3) malignant neoplasms, including one recurrent malignant fibrous histiocytoma (MFH), two metastatic melanomas, and two metastatic osteosarcomas. There was one false‐negative biopsy. The metastatic desmoplastic malignant melanoma was initially interpreted as a reactive lymph node with fibrosis. A specific diagnosis was rendered in 21 (84%) cases. The schwannoma was diagnosed cytologically as benign spindle cell lesion, not otherwise specified (NOS), fibromatosis as an atypical cellular proliferation, and MFH as poorly differentiated malignant neoplasm. Salivary gland lesions with a significant spindle cell component are rarely encountered on FNA and constitute a heterogeneous group. A specific diagnosis can be rendered in the majority of cases by correlating clinical and cytologic findings. Diagn. Cytopathol. 2000;23:253–259.

Cytology and immunophenotyping of low- and intermediate-grade B-cell non-Hodgkin's lymphomas with a predominant small-cell component: a study of 56 cases.

Diagnosis of non‐Hodgkins lymphomas based on cytologic evaluation of fine‐needle aspirates and body cavity fluids has gained increasing acceptance. However, the accurate diagnosis and classification of low‐ and intermediate‐grade B‐cell lymphomas with a predominant small‐cell population still present a diagnostic challenge. In this study, we reviewed the cytology and immunophenotype of 56 cases of low‐ and intermediate‐grade non‐Hodgkins B‐cell lymphomas composed of predominantly small cells, with histologic correlation in all cases. These cases consisted of 23 small lymphocytic lymphomas (SLL), 15 follicular center lymphomas (FCL), grade I (small cell predominant), 8 lymphoplasmacytoid lymphomas (LPL), 6 mantle‐cell lymphomas (MCL), and 4 marginal zone lymphomas (MZL) including mucosa‐associated lymphoid tissue (MALT) lymphoma. Histologic comparison was available in all cases. A cytologic diagnosis of malignant lymphoma was made in 46 (82%) cases. Based on cytomorphology and immunophenotyping of cytologic material, 39 (85%) cases were correctly classified using the Revised European and American Lymphoma classification. In 7 (11%) cases, which included 3 FCLs, 2 MALT lymphomas, and 2 SLLs, the findings were atypical but not diagnostic of lymphoma. There were 3 (5%) false‐negative cases. They were 2 SLLs and a FCL. Immunophenotyping done in 4 “atypical” cases was noncontributory. No marker studies were done in the remaining “atypical” case and all false‐negative cases. We conclude that cytology, when used in conjunction with immunophenotyping, can accurately diagnose and in most instances subclassify low‐ and intermediate‐grade B‐cell non‐Hodgkins lymphoma with a predominant small‐cell population. Diagn. Cytopathol. 24:90–97, 2001.

Fine-needle aspiration biopsy of peripheral T-cell lymphomas. A cytologic and immunophenotypic study of 33 cases.

Peripheral T‐cell lymphoma (PTCL) accounts for 10–20% of all non‐Hodgkin lymphomas in the United States. In this study, the authors reviewed the cytologic and immunophenotypic findings of 33 fine‐needle aspirations (FNAs) of PTCL.

Clinical implications of atypical glandular cells of undetermined significance, favor endometrial origin.

The Bethesda System recommends qualifying atypical glandular cells with regard to their possible origin: endocervical versus endometrial. This study was undertaken to determine the clinical significance of atypical glandular cells of undetermined significance that favor an endometrial origin (AGUS‐EM).

Utility of fine‐needle aspiration in the diagnosis of salivary gland lesions in patients infected with human immunodeficiency virus

Fine‐needle aspiration (FNA) has been increasingly utilized as a diagnostic tool in evaluating salivary gland masses, primarily to differentiate nonneoplastic from neoplastic lesions. Patients infected with human immunodeficiency virus (HIV) frequently present with salivary gland lesions. In this study, we reviewed the cytology of salivary gland lesions in HIV‐infected patients and assessed the value of FNA in the diagnosis of salivary gland lesions in HIV‐infected patients. One hundred and three FNAs of salivary gland lesions from 78 HIV‐infected patients (63 males and 15 females) were included in our study. The patients ages ranged from 7–65 yr, with a mean age of 40.9 yr. FNAs were classified into three categories: benign lymphoepithelial lesions (BLL) (77 cases or 74.8%), inflammatory processes (14 cases or 13.6%), including 3 reactive lymphoid hyperplasia, and neoplastic lesions (6 cases or 5.8%). The latter included three malignant lymphomas, a multiple myeloma, a metastatic adenocarcinoma from a lung primary, and a direct extension of basal‐cell carcinoma. Six (5.8%) aspirates were nondiagnostic. No false‐positive or false‐negative cases were noted during follow‐up of these patients. In conclusion, FNA is a simple and cost‐effective procedure for the diagnosis of HIV‐related salivary gland lesions. The majority of these lesions are cystic BLL and can be managed conservatively. Malignant lesions are rarely encountered and are readily recognized by FNA. Diagn. Cytopathol. 1999;21:260–264.

Cytomorphologic features of papillary lesions of the male breast: a study of 11 cases.

Breast masses occur in men far less commonly than women and are infrequently subjected to fine‐needle aspiration (FNA) biopsy. Papillary lesions of the male breast are rare and are comprised of a spectrum of lesions ranging from papillary hyperplasia in gynecomastia to invasive papillary carcinoma. The following study describes the cytomorphology of papillary breast lesions in 11 men. The patients ranged in age from 23 to 78 years old and each presented with an unilateral subareolar or periareolar breast mass that varied in size from 0.5 to 3 cm. Two patients presented with bloody nipple discharge.