Kim R. Geisinger

Positron emission tomography of patients with head and neck carcinoma before and after high dose irradiation

Background. Positron emission tomography (PET) with labeled fluorodeoxyglucose (FDG) demonstrates in creased tracer uptake in many neoplasms. This study was undertaken to define the patterns of FDG uptake in head and neck neoplasms before and after high dose irradiation.

Utilization of ancillary studies in thyroid fine needle aspirates: A synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference†‡

The National Cancer Institute (NCI) sponsored the NCI Thyroid Fine Needle Aspiration (FNA) State of the Science Conference on October 22–23, 2007 in Bethesda, MD. The 2‐day meeting was accompanied by a permanent informational website and several on‐line discussion periods between May 1 and December 15, 2007 (http://thyroidfna.cancer.gov). This document summarizes matters regarding the utilization of ancillary studies in thyroid FNA (http://thyroidfna.cancer.gov/pages/info/agenda/). Diagn. Cytopathol. 2008;36:438–441.

Relationship of DNA ploidy to histology and prognosis in rhabdomyosarcoma. Comparison of flow cytometry and image analysis

Background. Although DNA ploidy correlates with prognosis in certain childhood cancers, e. g., neuro‐blastoma, its significance in rhabdomyosarcoma (RMS) is unclear and controversial.

nm23-Relationship to the metastatic potential of breast carcinoma cell lines, primary human xenografts, and lymph node negative breast carcinoma patients

Since the discovery of nm23 (nonmetastatic) by Steeg et al. in 1988, a number of tumor cohort studies have shown an inverse relationship between the levels of expression of the nm23‐H1 protein and disease aggressiveness and tumor metastatic potential.

Spindle-cell lesions of the mediastinum : Diagnosis by fine-needle aspiration biopsy

Spindle cells seen in fine‐needle aspiration biopsy (FNAB) of the mediastinal lesions can be a component of a wide variety of benign and malignant conditions. Few of these conditions, however, are described in the FNA cytopathology literature. This review discusses the cytopathologic features, differential diagnoses, and potential pitfalls of a variety of lesions with a significant component of spindle cells encountered in mediastinal FNAB. The cytopathology files from four institutions were searched for cases of mediastinal FNAB containing a spindle‐cell component that was a key or predominant cytologic feature of the diagnostic specimen. The cytomorphologic features of these cases were analyzed, and their differential features are discussed. Of 196 mediastinal FNABs, 22 (11%) were lesions with significant spindle‐cell component: granulomatous inflammation (four); benign nerve sheath tumor (four); thymic cyst (two); spindle‐cell thymoma (two); large‐cell non‐Hodgkins lymphoma with sclerosis (two); nodular sclerosing Hodgkins disease (two); liposarcoma (two); spindle‐cell squamous carcinoma possibly arising in a teratoma (one); unspecified high‐grade sarcoma (one); spindle‐cell malignant melanoma (one); and nonspecific fibrous tissue (one). The cytologic features of each lesion were analyzed as an aid for accurate classification. These findings were correlated with radiologic and clinical information when available. The value of ancillary studies performed on aspirated material in selected cases was also reviewed. FNA of mediastinal lesions with significant spindle‐cell morphology represents an infrequent and heterogeneous group of entities that may pose significant diagnostic challenges. This review presents the salient cytopathologic features of various spindle‐cell lesions of the mediastinum with particular emphasis on differential diagnosis and pitfalls. The pathologist must use caution when interpreting these lesions and ancillary studies may be of significant value in selected cases. Diagn. Cytopathol. 1997;17:167–176.

Angiocentric glioma: A case report and review of the literature

Angiocentric glioma (AG) is a rare central nervous system (CNS) neoplasm that was only recently recognized by the World Health Organization (WHO). AG occurs in a broad age range, shows no gender predilection, and arises superficially in the cerebrum, usually resulting in medically intractable seizures. Most cases are cured by surgical excision alone, consistent with a WHO grade I neoplasm. We report a case of an AG in the right frontal lobe of a 57‐year‐old female, emphasizing the cytologic and immunohistochemical features, including confirmation and comparison with the surgical specimen. To our knowledge, this is the first report detailing the cytology of AG, including demonstration of important diagnostic findings that were only appreciated in the cytologic preparations and not in the smears or the surgical specimen. We also compare and contrast AG to other entities in the differential diagnosis and include a review of the literature. Diagn. Cytopathol. 2010.

Diagnostic pitfalls in fine-needle aspiration biopsy of the mediastinum

A retrospective review of 189 fine‐needle aspiration (FNA) biopsies of the mediastinum from four university medical centers was performed. Review of Diff‐Quik‐ and Papanicolaou‐stained direct smears was performed from a series of 189 FNA biopsies along with surgical pathology correlation obtained in 42% of the cases. There were 28 (14.8%) nondiagnostic or unsatisfactory for diagnosis cases. Of the satisfactory FNA specimens with histologic correlation, 12 cases (6%) were discordant. These errors primarily involve subclassification of small‐cell malignancies involving the mediastinum, including a misdiagnosis of small‐cell carcinoma for lymphoma. Large‐cell lesions that were problematic included the accurate diagnosis of Hodgkins lymphoma including the separation from non‐Hodgkins lymphoma. Large‐cell lymphoma with sclerosis was misinterpreted in two cases due to distortion of cells by the mesenchymal tissue and sparsely cellular smears. In two cases classification of primary germ‐cell tumors and separation from metastatic carcinoma was a problem. In general, FNA of the mediastinum is an accurate procedure, but can be challenging in a minority of cases due to sparse cellularity of the lesions and accurate classification of a variety of neoplasms that occur in this region. These 12 discordant cases serve as the basis of our report. Diagn. Cytopathol. 17:121–126, 1997.

Chondroblastoma of bone: Use of fine-needle aspiration biopsy and potential diagnostic pitfalls

Chondroblastoma of bone is a well‐characterized entity. When the radiographic features are classic and the lesion is present in typical locations (i.e., epiphysis of a long bone), the diagnosis is often easily established by fine‐needle aspiration biopsy and/or surgical curettage. Tumors in unusual locations, in older patients, or when complicated by aneurysmal bone cysts may pose more diagnostic difficulty. We report four examples (three primary and one recurrent) of chondroblastoma of bone diagnosed by fine‐needle aspiration biopsy. All patients were men, ranging from 18 to 28 yr of age. Sites of involvement included the acromion process of the scapula, left humerus, right ischium, and left distal femur. Three of the tumors were diagnosed as chondroblastoma on fine‐needle aspiration cytology; the fourth case, involving the scapula, consisted mostly of a large aneurysmal bone cyst and remained unrecognized until surgical curettage was performed. Typical‐appearing chondroblasts were present in three of the cases; osteoclast‐type giant cells were observed in all four cases. Matrix material consistent with chondroid was also identified in all cases. We believe that in the absence of inflammatory cells, the presence of classic‐appearing chondroblasts, even without chondroid matrix, is sufficient for a diagnosis of chondroblastoma of bone. Diagn. Cytopathol. 16:65–71, 1997.

Fine-needle aspiration biopsy of gouty tophi: lessons in cost-effective patient management.

Gout, a disease resulting from the effects of hyperuricemia and a crystal‐induced arthropathy, may produce soft tissue masses (tophi), which mimick neoplasia clinically and radiographically. We have recently diagnosed three cases of gouty tophus, two of which were clinically suspected to represent sarcomas, by fine‐needle aspiration biopsy (FNAB) after extensive radiologic and clinical evaluation. There were two women and one man, aged 71, 73, and 50 yr, with palpable soft tissue masses that involved the right forearm, right hand, and right foot, respectively. Biopsies were obtained by using 25‐gauge needles without the aid of general anesthesia. Morphologically, aggregates and disassociated slender, needle‐shaped crystals were abundant and easily recognized on both Diff‐Quik and Papanicolaou stains. By using a polarizing microscope with a first‐order red compensator, the crystals showed negative birefringence, characteristic of sodium urate. Benign‐appearing histiocytes, foreign‐body‐type giant cells, neutrophils, and amorphous debris were scattered among the diagnostic crystals. The diagnosis of gouty tophus can be easily established with FNAB in conjunction with compensated polarizing microscopy. Application of FNAB in the initial evaluation of appropriate soft‐tissue masses provides a cost‐effective diagnostic method, preventing more costly and often unnecessary clinical and radiologic tests. Diagn. Cytopathol. 17:30–35, 1997.

Leukemic infiltration of the esophagus

Background. Leukemic infiltrates of the esophagus have been described occasionally in autopsy series, but there are no reports of antemortem diagnosis.