JoAnne Jensen

HIV and HHV-8 Negative Primary Effusion Lymphoma in a Patient with Hepatitis C Virus-related Liver Cirrhosis

Primary effusion lymphoma (PEL) or body cavity-based lymphoma (BCBL) is a unique subgroup of B-cell lymphomas that exhibits exclusive or dominant involvement of serous body cavities without a detectable tumor mass. We present a case of a PEL/BCBL that exclusively involved the peritoneal cavity of a 58-year-old immunocompetent male with hepatitis C virus (HCV)-related liver cirrhosis. The lymphoma cells were large, highly atypical and expressed CD19, CD20, CD22, CD10, HLA-DR, and CD45 with κ light chain restriction. Unlike typical PEL/BCBL, human herpesvirus type 8/Kaposi sarcoma herpes virus (HHV-8/KSHV) genomic sequence was not present in the lymphoma cells and there was no serologic evidence of human immunodeficiency virus (HIV) infection. This is the fourth reported case of HHV-8 negative, HIV negative PEL/BCBL in a patient with associated HCV-related cirrhosis and review of these cases showed some consistent clinicopathological features, i.e. exclusive involvement of the peritoneal cavity and phenotypic expression of B-cell associated antigens in contrast to the generally null phenotype PEL/BCBL. The occurrence of these cases suggests that HCV may play an etiological role in a subcategory of PEL/BCBL not associated with HHV-8.

Synovial metastasis: diagnosis by fine-needle aspiration cytologic investigation.

Synovial metastases are a rare occurrence. Only 28 cases have been reported in the literature, 10 of which were diagnosed by fluid cytologic evaluation. We discuss 2 additional cases in which the diagnosis was made by fine‐needle aspiration cytologic investigation. The first case is of a 47‐yr‐old man with small‐cell carcinoma of the lung metastatic to the right knee joint; the second is of a 71‐yr‐old man with non‐Hodgkins mixed‐cell nodular lymphoma also involving the right knee joint. The clinical features of these cases are similar to previously published instances of secondary synovial tumor, namely in regard to sex distribution (14 male and 16 female patients), age range (13–96 yr, mean 59 yr), and histologic types (adenocarcinoma, 13 cases; squamous‐cell carcinoma, 4; lymphoma, 3; renal clear‐cell carcinoma, 3; unknown origin, 2; rhabdomyosarcoma, 1; melanoma, 1; chordoma, 1; pulmonary clear‐cell carcinoma, 1; and Ewings sarcoma, 1). The condition usually has poor prognosis, with average patient survival of <5 mo. Diagn Cytopathol 1996;15:334–337.

Breast and cutaneous mycobacteriosis: Diagnosis by fine-needle aspiration biopsy

The breast and skin are considered to be rare sites of extrapulmonary mycobacterial infection, comprising 0.1% to 0.5% of all tuberculosis cases, respectively. Fine‐needle aspiration biopsy (FNAB) is a rapid and minimally invasive approach to diagnose extrapulmonary tuberculosis, and has been used successfully in identifying tuberculous lesions in the lymph nodes, thyroid, kidney, pancreas, vertebrae, and testis.

Fine-needle aspiration cytology of extraskeletal Ewing's sarcoma

Extraskeletal Ewings sarcoma (EES) is a round‐cell malignancy that manifests most commonly in the paravertebral and intercostal regions. It occurs predominantly in adolescents and young adults, between the ages of 10 and 30 yr, and follows an aggressive course with a high recurrence rate. Distant metastasis is also common. The tumor is often confused with other round, small‐cell neoplasms, including primitive neuroectodermal tumor, neuroblastoma, embryonal rhabdomyosarcoma, and lymphoma.

Metastasis of unknown origin: The role of fine‐needle aspiration cytology

Metastasis of unknown origin (MUO) manifests either as a tumor deposit in an organ, often cervical lymphadenopathy, or as a multiorgan carcinomatosis. As a diagnostic and therapeutic challenge, the definition of its cell type and possibly its origin is imperative, although a limited diagnostic investigation is usually recommended. At Hines VA Hospital, from 1986 to 1994, there were 116 cases with admitting clinical diagnosis of MUO, evaluated by fine‐needle aspiration cytology (FNAC). The ages of patients ranged from 29 to 82 years (mean 56 years). All were male; Caucasians predominated. The FNAC examination with Diff‐Quik and Papanicolaou smears were complemented with special and immunostains in 48 cases (41%) and electron microscopy in 93 cases (80%). The FNAC involved lymph nodes in 57 cases (49%), liver in 27 cases (23%), skin in 22 cases (19%), bone in six cases (5%), lung in three cases (3%), and pleura in one case (1%). The neoplasm was generally cell typed, and there were 60 adenocarcinomas/poorly differentiated carcinomas, 26 small‐cell carcinomas (SCC), 23 squamous‐cell carcinomas (SQCC), and six undifferentiated large‐cell carcinomas. The primary source was defined in 30 cases (26%), consisting of lung in 11 cases, prostate in nine, kidney in four, colon in four, pleura in one, and peritoneum in one. Clinical correlation also supported a lung origin for the SCC, while the majority of the SQCC in upper and middle cervical lymph nodes were considered head‐and‐neck tumors. Our results affirm that FNAC is a viable and simple procedure in MUO investigations. Diagn. Cytopathol. 1998;18:319–322.

Cytopathologic evaluation of lung carcinomas presenting as brain metastasis

Brain metastasis is an uncommon initial presentation of lung carcinoma. One arm of this analysis is a retrospective review of 137 cases of surgically diagnosed solitary brain metastasis, which were eventually found to be of lung origin, encountered at Hines VA Hospital during the period 1958 to 1996. The second arm is composed of fine‐needle aspiration biopsy specimens of primary lung tumor in 23 patients with an initial clinical diagnosis of brain metastasis and without the benefit of surgery, seen from 1981 through 1996. Our results in both analyses indicate that pulmonary adenocarcinoma is the predominant primary tumor that initially manifests as a brain metastasis, approaching 76% (107 and 17 cases, respectively), followed by small‐cell carcinoma at 20% (24 and five cases, respectively) and large‐cell undifferentiated carcinoma and squamous‐cell carcinoma at 2% each. The predominance of adenocarcinoma as a source of brain metastasis in lung cancer patients probably reflects its rising incidence overall of late. Collateral findings also suggest that surgical resection of a solitary and small brain metastasis as well as of a discrete lung primary, whenever feasible, as the most effective procedure to improve survival and quality of life of patients. Diagn. Cytopathol. 1999;20:325–327.

Parotid abscess due to salmonella enteritidis: A case report.

BACKGROUND Salmonella infection of the parotid gland is rare. CASE An instance in a 50-year-old man of Salmonella enteritidis parotiditis initially recognized by microbial culture of a fine needle aspiration cytology material is described. The identified predisposing factor was chronic alcoholic abuse. For the infection source, a carrier state of salmonella parotitis was postulated, which progressed to focal abscess and was subsequently complicated by bacteremia and hematogenous spread to the liver, spleen and lungs. CONCLUSION Salmonella should be included in the differential consideration of head and neck abscesses in immunocompromised individuals and treated aggressively.

Multivesiculated macrophages: their implication in fine-needle aspiration cytology of lung mass lesions.

Alveolar macrophages are almost invariably present in percutaneous fine‐needle aspiration cytology of the lung. They may predominate, appear foamy and finely vesiculated, or may reflect the cellular composition of the lung mass lesion. In a review of 172 cases of “negative for malignant cells” from the percutaneous lung fine‐needle aspiration cytology file in an 8‐year period at Hines VA Hospital, the vacuolated macrophages were evaluated qualitatively and quantitatively. Among the 53 cases (34%) showing vacuolated macrophages, only 5–25% of the cells were multivesiculated, the cytoplasmic vacuoles were few, focal, and occasionally global, and the majority of the vacuolated macrophages contained anthracotic or hemosiderin pigments. One case exhibited striking multivesiculation in at least 95% of macrophages and also in bronchial and alveolar cells, fibroblasts, and endothelial and inflammatory cells, a finding consistent with amiodarone toxicity (index case 1). The diagnosis was confirmed on subsequent transbronchial lung biopsy. In another patient with clinical HIV infection, the multivesiculation was also seen in 95% of the macrophages with associated acute inflammatory exudate, coccobacilli, and a positive culture for Rhodococcus equi (index case 2). In most cases, the vacuolated macrophages are reactive and inflammatory. Occasionally, as in our index cases they may actually indicate a specific diagnosis. Diagn. Cytopathol. 1998;19:98–101.

Utilization of fine-needle aspiration cytology in the diagnosis of neoplastic superior vena caval syndrome.

Superior vena caval syndrome often presents as an acute or subacute oncologic emergency that requires immediate action, usually with high‐dose radiotherapy. With improved chemotherapeutic regimens for various malignancies, prompt and appropriate treatment of the syndrome is possible. Tissue diagnosis, therefore, is pursued, but invasive procedures are commonly associated with technical difficulties and complications. We find fine‐needle aspiration biopsy a rapid, highly reliable, and well‐tolerated procedure in selected situations and herein report 17 patients with initial presentation of superior vena caval syndrome efficaciously diagnosed with fine‐needle aspiration cytology. The cell types were eight lung small‐cell carcinomas, four poorly differentiated adenocarcinomas, two undifferentiated large‐cell carcinomas, and one each of malignant large‐cell lymphoma, myxoid liposarcoma, and thymic large‐cell neuroendocrine carcinoma. Further experience, however, is warranted with this widely available procedure. Diagn. Cytopathol. 1998;19:84–88.

Adenocarcinoma of the lung: Electron microscopy of fine-needle aspiration biopsy specimens—a review of 73 cases

During a 10‐yr period, 128 consecutive cases of pulmonary adenocarcinoma of varying differentiation were diagnosed with percutaneous fine‐needle aspiration biopsy. Sediments from the needle and syringe washings with 3% glutaraldehyde were obtained and processed for electron microscopic evaluation in 73 cases. Our results showed three types of adenocarcinoma: 62 cases of nonciliated bronchiolar cell origin, 6 cases of bronchioloalveolar cell origin, and 3 cases of mucous cell origin. In addition, there was an example of combined adenosquamous carcinoma and an instance of amphicrine carcinoma. Our study provided a more precise definition of the cytologic diagnosis and insight into the heterogeneity of lung adenocarcinoma. However, prognostic differences between cell types of lung adenocarcinoma were not observed. Diagn. Cytopathol. 1999;20:257–260.