Ronald T. Grenko

Variance in the Interpretation of Cervical Biopsy Specimens Obtained for Atypical Squamous Cells of Undetermined Significance

We sought to determine whether the variability in dysplasia rates in cases of atypical squamous cells of undetermined significance (ASCUS) reflects variability in interpretation of cervical biopsy specimens. In phase 1, 124 biopsy specimens obtained because of a cytologic diagnosis of ASCUS were reviewed independently by 5 experienced pathologists. Diagnostic choices were normal, squamous metaplasia, reactive, indeterminate, low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL). The rate of dysplasia ranged from 23% to 51%. All pathologists agreed in 28% of cases. In 52% of cases, the diagnoses ranged from benign to dysplasia. The overall interobserver agreement was poor. In phase 2, 60 cervical biopsy specimens (21 obtained for ASCUS, 22 for LSIL, and 17 for HSIL) were evaluated using the same diagnostic choices. Agreement was better in biopsies performed for HSIL and LSIL compared to those for ASCUS. Intraobserver reproducibility in the interpretation of biopsies performed for ASCUS ranged from poor to excellent. We conclude that variability in the interpretation of biopsy specimens plays an important role in the differences in rates of dysplasia reported for the follow-up of ASCUS.

Pilot trial of cryoprobe-assisted breast-conserving surgery for small ultrasound-visible cancers

Background: Stereotactic and ultrasonography-guided large core needle biopsy has replaced wire localization biopsy as the diagnostic method of choice. Lumpectomy alternatives are being sought to eliminate the need for preoperative wire localization, to facilitate easier and more accurate resection, and to decrease positive margin rates. Cryoprobe-assisted lumpectomy (CAL) was investigated as an alternative.Methods: Patients with ultrasonographically visible breast cancers that otherwise would have required wire localization participated. Before lumpectomy, a cryoprobe (Visica; Sanarus, Pleasanton, CA) was inserted through a 3-mm skin incision and directed by ultrasonography through the center of the tumor. An ice ball was created that enveloped the tumor plus an adjacent 5–10 mm of sonographically normal breast tissue.Results: Twenty-four CAL procedures were performed and all lesions were successfully localized. Mean (±SD) tumor size was 1.2 ± .4 cm (range, .7–2.0 cm). Mean dimensions of the ice ball before excision were 3.9 ± .3 cm by 2.5 ± .5 cm, and the ice margin around the tumor was 8 ± 2 mm. The size of the ice ball was controlled to the millimeter, and the ice ball itself provided a precise template around which to dissect. The margin re-excision rate was 5.6% among patients with an ice margin greater than 6 mm.Conclusions: CAL is a superior alternative to wire localization. Ultrasonographic visualization of the ice ball allows the size of the margin and tissue resected to be individually tailored and accurate within millimeters. The created template allows a precise lumpectomy, adding a dimension of control not previously realized with any other technology.

Capillary versus aspiration biopsy: Effect of needle size and length on the cytopathological specimen quality

PurposeTo test the value of the nonaspiration, or capillary, biopsy technique by experimental comparison with the conventional fine-needle aspiration technique using various needle gauges and lengths.MethodsOn fresh hepatic and renal tissue from five autopsies, multiple biopsy specimens were taken with 20, 22, and 23-gauge Chiba needles of 5, 10, 15, and 20-cm length, using the aspiration technique and the capillary technique. The resultant specimens were graded on the basis of a grading scheme by a cytopathologist who was blinded to the biopsy technique.ResultsThe capillary technique obtained less background blood or clot which could obscure diagnostic tissue, although not significantly different from the aspiration technique (p=0.2). However, for the amount of cellular material obtained, retention of appropriate architecture, and mean score, the capillary technique performed statistically worse than aspiration biopsy (p<0.01). In addition, with decreasing needle caliber (increasing needle gauge) and increasing length, the capillary biopsy was inferior to the aspiration biopsy.ConclusionThe capillary biopsy technique is inferior to the aspiration technique according to our study. When the capillary technique is to be applied, preference should be given to larger caliber, shorter needles.

Cytologic features of deep juvenile xanthogranuloma

Juvenile xanthogranuloma (JXG) is a rare lesion of the skin and deep tissues whose cytologic features have not previously been published. We report on 2 cases of JXG in patients aged 5 days and 5 yr who presented with an axillary mass and enlarged supraclavicular lymph node, respectively. Fine‐needle aspiration and touch imprints made from the surgical biopsies yielded cellular specimens composed of histiocytes, multinucleated Touton‐type giant cells, and variable admixtures of lymphocytes and eosinophils. One lesion was composed primarily of benign‐appearing histiocytes with admixed multinucleated giant cells and a few lymphocytes. The second lesion consisted of a few histiocytes, occasional Touton giant cells, many lymphocytes, and scattered fibroblasts. The histiocytes were CD68‐positive and S100‐negative. Histologic follow‐up confirmed the diagnosis of juvenile xanthogranuloma. One patient was lost to follow‐up; the other is alive without evidence of recurrence 1 yr after surgery. We conclude that deep JXG has characteristic and diagnostic cytologic features. Diagn Cytopathol 1996;15:329–333.

Dopamine‐secreting glomus vagale: A case report and histopathologic correlation

Catecholamine secretion by head and neck paragangliomas is uncommon. Dopamine secretion by these tumors has not routinely been assessed. This case report describes a dopamine‐secreting glomus vagale and evaluates seven other paragangliomas immunohistochemically for their ability to synthesize dopamine.

Aortic dissection in a weight lifter with nodular fasciitis of the aorta

We report a case of spontaneous aortic dissection in a young weight lifter without aortic medial disease but with a myofibroblastic proliferation of the aortic adventitia consistent with nodular fasciitis. Successful treatment included ascending aorta replacement with Dacron graft and aortic valve resuspension. We believe that the underlying aortic pathology most likely contributed to the development of the aortic dissection.

Neural cell adhesion molecule, cathepsin D and p53 in adenoid cystic carcinoma

Tumor growth, invasiveness, and neovascularization occur via a complex of interactions between tumor cells and endothelial cells. Tumor cell invasion and endothelial cell neovascularization require both cellular motility and adherence to other cells and extracellular matrix, as well as the ability to degrade matrix components. This in-vitro study was designed to define the co-dependency that tumor cells and endothelial cells have in determining angiogenic and invasive potential in human head and neck squamous cell carcinoma. The results from this study suggest that endothelial cells and the soluble factors that they produce stimulate the adhesion of tumor ceils to extracellular matrix components. Adhesion was enhanced to fibronectin and vitrinectin and, to a lesser extent, to collagen and laminin. Exposure to soluble factors derived from endothelial cells resulted in significant increases in the expression of [~-1 and 13-4 integrins on tumor cell surfaces. Soluble factors derived from the tumor cells in turn significantly increase [~-1 iutegrin expression and, to a lesser extent, increase 13-4 integrin expression on endothelial cell surfaces. The soluble factors from tumor cells also significantly increase endothelial cell migration and proliferation when compared with migration and proliferation in the absence of tumor cells or tumor cell-derived factors. These results suggest that tumor invasion and neovascularization of tumors are mediated bidirectionally via complex functional and physiological interactions between the tumor and endothelial cells as well as surrounding extracellular matrix components.