Meeri Apaja-Sarkkinen

Immunohistochemical study of basement membrane proteins and type III procollagen in myelofibrosis

In this study the distribution of type IV collagen in the marrow is compared with that of laminin, another basement membrane protein. In addition, incompletely processed type III procollagen is identified with specific antibodies.

Breast Sonography in Localizing the Cause of Nipple Discharge Comparison With Galactography in 52 Patients

The purpose of this study was to evaluate breast sonography in localizing abnormalities in the discharging duct in patients with spontaneous nipple discharge.

Ultrasound-Guided Aspiration Cytology of the Spleen

The cytologic results of ultrasound-guided fine-needle biopsies (FNB) of the spleen in 42 patients were analyzed retrospectively. A focal lesion was punctured in 28 of them, splenomegaly in 12, and an enlarged accessory spleen in 2. Sufficient material was aspirated for cytologic analysis in 41 (97.6%) cases. A final diagnosis of malignancy was made in 16 (38%), and a benign condition diagnosed in 26 (62%) patients. The sensitivity, specificity, and accuracy of the method for differentiating malignancy from benign conditions were 68.8%, 100%, and 88.1%, respectively. No complications occurred. We conclude that ultrasound-guided FNB is a safe, highly specific, but relatively insensitive method of defining splenic pathology.

Combined CT-guided biopsy and cytology in diagnosis of bony lesions

The results of 44 trephine (OD 1.4–4 mm) biopsies and 39 fine needle (0.7–0.9 mm) aspirations of skeletal, mainly vertebral, lesions performed under CT-guidance in 54 patients were evaluated. The fine needle sample was aspirated through the trephine as a complementary procedure in 29 patients and a fine needle aspiration only was performed in 10 patients. Trephine biopsy only was performed in 15 patients. Sufficient material for histologic and cytologic analyses was obtained in 93% (41/44) and 97% (38/39) and a correct benign or malignant diagnosis was obtained in 84% (37/44) and 90% (35/39), respectively. Among the combined examinations the fine needle aspiration alone was diagnostic in 2 cases while the trephine specimen alone provided diagnostic material in 2 cases. In 24 cases both the cytologic and histologic samples were adequate for diagnostic purposes. In one case both methods gave false-negative results. The combined use of cytologic and histologic samples in CT-guided bone biopsies increased diagnostic accuracy. The aorta was perforated once with a 1.4-mm needle but without sequelae. CT-guided bone biopsy was found to be a safe, reliable and cost-efficient method.

Percutaneous ultrasound-guided biopsy. Fine needle biopsy, cutting needle biopsy, or both?

The results of 155 US-guided cutting needle biopsies, mainly of abdominal and transthoracic lesions, were reviewed to assess the diagnostic accuracy of the method. A fine needle biopsy (FNB) was additionally performed in 99 of the patients. Sufficient material for histologic and cytologic analysis was obtained in 88% (137/155) and 98% (97/99), and a correct benign or malignant diagnosis was made in 87% and 88%, respectively. Among the 99 combined biopsies the corresponding figures were 100% and 97%, respectively. The proportions of inconclusive and false-negative results among histologic samples were 0% and 4% (2/57), in FNBs 7% (7/99) and 5% (3/56), and in combined examinations 3% (3/99) and 0%. One major complication, Streptococcus faecalis sepsis, occurred. The combined use of FNB and histologic biopsy increases the proportion of correct diagnoses about 10% without increasing the complications.

Radiologic Findings in Renal Oncocytoma

The imaging findings of 36 renal oncocytomas in 32 patients were evaluated retrospectively. Twenty-two patients underwent ultrasound (US), 16 CT, 25 angiography, 19 urography, and 6 fine-needle biopsy. At US 8 of the oncocytomas were isoechoic, 7 hyperechoic, and 7 hypoechoic. The structure was homogeneous in 59% and nonhomogeneous in 41 %. At plain CT 12 oncocytomas were homogeneously hypodense, 3 isodense, and one hyperdense. Contrast enhancement was homogeneous in 10 and inhomogeneous in 4 cases. A stellate scar was detected in one case, and in one case a contrast study was not performed. At angiography the oncocytomas were hypervascular in 21, hypovascular in 3 cases, and one was not detected. Nineteen of the tumors were well delineated. A spoke-wheel arterial pattern was detected in 3 tumors. The cytologic diagnosis was benign renal oncocytoma in 4 cases and highly suggestive of oncocytoma in 2 cases. We conclude that the homogeneity of a renal tumor at US and at CT may suggest the possibility of oncocytoma. US-guided fine-needle biopsy is a useful diagnostic tool in patients who need a precise presurgical diagnosis.

Accuracy of Adrenal Biopsy Guided by Ultrasound and CT

We reviewed the results of fine needle biopsy of the adrenal glands guided by ultrasonography or CT in 56 patients. The final diagnoses, obtained at operation, autopsy or follow-up were: metastasis (n = 22), adenoma (n = 21), adrenal cyst (n = 6), hematoma (n = 3), lymphoma (n = 1), pheochromocytoma (n= 1), lymph node (n = 1), and amyloid mass (n= 1). Sufficient cytologic material was obtained in 96.4% (54/56). The overall accuracy to differentiate benign from malignant disease was 85.7% (48/56), 2 were false-negative, one was false-positive. The biopsy was inconclusive (“possibly malignant”) in 3 patients, 2 of whom had an additional cutting needle biopsy yielding a correct positive finding. No complications occurred. We conclude that in disseminated malignant disease with suspected adrenal metastases diagnostic results can be obtained with guided fine needle biopsy. Biopsy in primary adrenal lesions is helpful, especially if the aspirate of the lesion turns out to be composed of something other than adrenal cells.

Distribution of laminin and types IV and III collagen in fetal, infant and adult human spleens

SummaryThe immunohistochemical distribution of the basement membrane (BM) proteins, laminin and type IV collagen, and interstitial type III collagen was investigated in 12 fetal spleens at the 15th–38th gestational weeks (g.w.) and in spleens of 8 infants from term to 4 years. The results were compared with the distribution of the same proteins in adult human spleen. BM proteins were found to be abundantly present in the red pulp of all spleens during the whole of development. The content of type III collagen gradually decreased with advancing age and, in adult spleen, there were only occasional positively staining fibers in Billroths cords. This finding indicates that the composition of reticular fibers in the red pulp of spleen is different from the reticular fibers elsewhere in lymphoreticular tissue. Early signs of ring fiber formation in the walls of venous sinuses were detectable at the 15th–19th g.w., although their more complete development occurred relatively late from the 36th g.w. onwards. Ring fibers contained both laminin and type IV collagen in all the investigated spleens. They never stained for type III collagen. The developing white pulp was positive for BM proteins, but showed no staining for type III collagen at the 15th g.w. At later ages, the white pulp stained similarly for both BM proteins and type III collagen.

Ultrasound-Guided Aspiration Cytology of Enlarged Lymph Nodes

Cytological results of US-guided fine needle aspiration biopsies of enlarged lymph nodes from 179 patients were analyzed retrospectively. The final diagnoses were benign lymphadenopathy in 90 cases, metastasis in 56, and malignant lymphoma in 33 cases. The material was sufficient for cytological analysis in 174 cases (97.2%). Correct diagnosis of malignant (C IV—V) and benign (C I—II) lymphadenopathy in the whole material was possible in 80 percent of cases. Correct subtyping of lymphoma was possible in 63.6 percent of the cases. There was one (0.6%) false positive (C IV), 6 (8.5%) false negative (C I—II), and 24 (13.8%) suspicious (C III) cytological findings. All but one of the false negative cytological findings were from superficial lymph nodes. No complications occurred. US-guided lymph node aspiration biopsy is safe and accurate in the superficial, anterior mediastinal, abdominal, and retroperitoneal lymphonodal areas. Lymph nodes with a C 0 cytological result should undergo rebiopsy and suspicious (C III) or clinically doubtful cases should be referred for a surgical biopsy.

Parathyroid adenomas: pre-operative localization with ultrasound combined with fine-needle biopsy.

Sixteen patients with biochemically proven primary hyperparathyroidism (PHPT) underwent ultrasonography (US), fine-needle aspiration (FNA) for cytologic sampling (n = 9), or intact parathormone assay (n = 3) before operation (n = 15) in order to determine the accuracy of the methods. Pre-operative US was found sensitive (100 per cent), but two thyroid lesions were initially diagnosed as parathyroid tumours by US (i.e. false positives). Parathyroid cells were detected in six cytologic specimens, one sample was insufficient and another inconclusive, while one was diagnosed as thyroid tissue. Parathormone assay revealed a high hormone content in all three patients who underwent the procedure. We conclude that US is sufficiently sensitive to detect enlarged parathyroid tumours. Specificity can be improved by US-guided FNA for cytology or parathormone assay prior to neck exploration.