Merle L. Greenberg

The histologic diagnosis of adenocarcinoma in situ and related lesions of the cervix uteri. Adenocarcinoma in situ

Seventy‐two cases of in situ adenocarcinoma (AIS) of the cervix were reviewed. Forty‐five cases had associated cervical intraepithelial neoplasia and 20 cases had changes of wart virus infection. Five cases had associated microinvasive squamous cell carcinoma and one cases showed frankly invasive squamous cell carcinoma (SCC). Of the 72 cases, 41 showed an endocervical type of AIS and three cases an endometrioid type. There was no case of pure intestinal type AIS. Twenty‐eight cases showed a mixed pattern. Architectural patterns characterized by tunnel clusters, cribriform glands, glandular budding and papillary formations were assessed. Most cases showed varying combinations of these patterns but in ten cases significant changes were absent. Both cellular apoptosis and mitotic activity were seen in varying degrees in all cases of AIS. The significance of these and other features of AIS are discussed as well as the conditions involved in the differential diagnosis.

Percutaneous biopsy of bladder-drained pancreas transplants

Percutaneous biopsy is a valuable investigation in the management of allograft rejection for all solid organs. Pancreas transplants have not been biopsed percutaneously, though open and percystoscopic biopsies have proved useful. We have compared percutaneous needle core biopsy with fine-needle aspiration cytology for the diagnosis of rejection in 18 patients receiving combined kidney and pancreas transplants and in one who was transplanted with the pancreas alone. Percutaneous needle core biopsy was successful in 37 of 40 attempts (93%), while fine-needle aspiration yielded diagnostic material on 33 of 47 attempts (70%). Transient hyperamylasemia occurred in 29%, returning to baseline in three days. One patient twice developed transient macroscopic hematuria. There was agreement between needle core biopsy and fine-needle aspiration on the diagnosis of rejection on six occasions and for the absence of rejection on 16. There was an 8% false-positive rate for fine-needle aspiration. In 13 instances of histologically proved renal rejection, concurrent pancreas biopsy revealed rejection in 69%. Pancreas rejection was not, however, seen in the absence of renal rejection. In this pilot study, percutaneous biopsy of the bladderdrained pancreas allograft was shown to be a practicable and valuable investigation without major complications.

Absence of progesterone receptor associated with secondary breast cancer in postmenopausal women.

SummaryThe relationship between expression of receptors for oestrogen and progesterone (ER and PR) and disease progression in breast cancer was investigated by comparing immunocytochemical determinations of ER and PR in fine needle aspirates from primary and secondary breast tumours. Rates of receptor expression were significantly higher in primary than in secondary lesions: for ER 63.3% (n = 689) compared with 45.3% (n = 223), and for PR 53.7% (n = 443) compared with 33.1% (n = 121). The effect of menopausal status was examined by subdividing the patient cohort into those over or under the age of 50 years. In both instances, ER expression in secondary tumours was relatively low; however, only postmenopausal patients had significantly lower rates of PR expression in secondary tumours. Consistent with this, an increase in the ER+PR– profile in secondary tumours compared with primary cases from postmenopausal patients was seen, and in a multivariate analysis, a specific absence of PR expression in secondary tumours was revealed. Comparison of ER and PR expression in simultaneously sampled primary tumours and lymph node metastases from the same patient showed that receptor expression was stable with progression to a metastatic site as results were concordant for ER in 92% (n = 88) and PR in 93.8% of cases (n = 65). These results suggest that absence of PR expression in primary breast cancer is associated with disease progression and may be a marker of an aggressive tumour phenotype.

Unusual presentation of granulocytic sarcoma in the breast : A case report and review of the literature

This is a case of granulocytic sarcoma presenting as bilateral breast masses in a 40‐yr‐old woman with concurrent unsuspected chronic myeloid leukemia diagnosed by fine‐needle aspiration. The granulocytic differentiation was recognized on Diff‐Quik‐stained cytology smears and confirmed rapidly on flow cytometry on the same day. The breast has been reported to be an uncommon site for granulocytic sarcoma. We found that 38.8% of granulocytic sarcomas diagnosed by fine‐needle aspiration in the English‐language literature occurred in the breast. In the absence of clinical history or hematological abnormality, granulocytic sarcoma may be misdiagnosed, depending on the degree of myeloid differentiation present within the tumor. The differential diagnosis includes large‐cell non‐Hodgkins lymphoma, lobular carcinoma of the breast, undifferentiated carcinoma, malignant melanoma, extramedullary hemopoeisis and inflammation. The key morphological features and useful ancillary tests are discussed. Diagn. Cytopathol. 2001;24:53–57.

Simultaneous pancreas and kidney transplant rejection: separate or synchronous events?

The results of simultaneous pancreas and kidney transplantation (SPK) cannot be matched by pancreas transplantation alone (PTA), in part because an independent diagnosis of pancreas graft rejection remains difficult. The relationship between rejection of the pancreas and rejection of the kidney is poorly understood, and it is not known whether simultaneous transplantation of both organs confers true protection to either graft. To study these questions, reliable canine allotransplant models of kidney transplantation alone (KTA), PTA, and SPK were established. Sixty-seven mongrel dogs received KTA (n=21), PTA (n=23), or SPK (n=23) with either no immunosuppression, low-dose cyclosporine (CsA)-based immunosuppression, or high-dose CsA-based immunosuppression. Needle core biopsy (NCB) and fine needle aspiration biopsy (FNAB) were performed at 0, 2, 4, 7, 9, 11, 14, 21, and 30 days or at the time of graft failure. Pancreas and kidney graft survival after SPK was significantly shorter in dogs given low-dose CsA than in dogs given high-dose CsA (pancreas, P<0.04; kidney, P<0.03). Concurrent NCBs and FNABs were performed on 227 occasions in pancreas grafts and 229 occasions in kidney grafts. The time to initial evidence of rejection by NCB was not different in any immunosuppressed group. Synchronous rejection occurred in 73% of immunosuppressed SPK biopsies. Kidney-only rejection occurred in 23% of biopsies and pancreas-only rejection occurred in only 3% after SPK. All markers of pancreas graft rejection were poor, with the most sensitive being NCB of the simultaneously transplanted kidney. In summary, recipients of SPK required more immunosuppression than recipients of PTA, and improved PTA survival should be achievable with more sensitive markers of rejection. Markers of kidney rejection were the most sensitive indicators of pancreas rejection, and independent pancreas rejection was uncommon after SPK.

The value of exfoliative cytology in the diagnosis of oral herpes simplex infection in immunosuppressed patients

Conventional exfoliative cytology was effective in confirming a clinical suspicion of oral mucosal infection by herpes simplex virus in nineteen out of twenty (95%) immunosuppressed patients who were studied.

Is there a role for fine‐needle aspiration in radial scar/complex sclerosing lesions of the breast?

The fine‐needle aspiration cytology (FNA) from 12 mammographically detected, histologically confirmed radial scar/complex sclerosing lesions (RS/CSL) and their corresponding mammography were reviewed. Six aspirates were obtained by palpation, four by ultrasound guidance, and two by stereotactic guidance. Of the eight lesions with sufficient material, five (62.5%) were reported as benign, two (25%) as atypical, and one (12.5%) as suspicious. It is proposed that FNA for RS/CSL should not be performed, and lesions require excision for histologic assessment. Diagn. Cytopathol. 16:537–542, 1997.

Complex sclerosing lesion: the lesion is complex, the management is straightforward.

Background: Complex sclerosing lesion (CSL) and its smaller counterpart, the radial scar (RS), are frequently seen pathological entities. They are clinically asymptomatic and, prior to the implementation of mammographic screening, were most commonly found incidentally during pathological examination of other biopsied lesions. Complex sclerosing lesions are being detected regularly on mammograms due to widespread screening; many of their features resemble those of malignancy. Management varies and has been controversial.

FNB diagnosis of breast carcinoma associated with HIV infection: A case report and review of HIV associated malignancy

&NA; A 48 yr old HIV seropositive female presented with a right breast mass and bilateral axillary lymphadenopathy. Fine needle biopsy (FNB) revealed an adenocarcinoma with abundant mucin production and features suggestive of a cribriform and micropapillary ductal carcinoma in situ (DCIS). Histopathological examination of the tumor confirmed an invasive mixed colloid carcinoma with extensive DCIS. There have been 4 previous reports in the literature of breast carcinoma associated with HIV seropositivity. This case initially diagnosed by FNB is the first case reported in Australia. In spite of the somewhat more favourable histological type of breast carcinoma, this tumor shows numerous unfavourable prognostic factors and has had an aggressive clinical course with relapse of disease in the contralateral breast and distant metastases within 4 wks of surgery, probably related to the patients immunodeficiency.

Histiocytic necrotizing lymphadenitis (Kikuchi's disease): cytologic diagnosis by fine-needle biopsy.

A cytologic diagnosis of histiocytic nerotizing lymphadenitis (Kikuchis lymphadenitis) was made in a 14-yr-old female with cervical lymphadenopathy, Fever, neutropenia, and hepatosplenomegaly. A predominance of reticulum cells, foamy macrophages, and karyorrhectic debirs are cluse to the diagnosis in the fine-needle biopsy smears. Subsequent histology confirmed the diagnosis of Kikuchis lymphadenitis. The differential diagnoses are discussed including malignant lymphoma, which was excluded by morphology as well as flow cytometry and polymerase chain reaction (PCR) studies.