Tilde S. Kline

Lymphadenopathy and aspiration biopsy cytology. Review of 376 superficial nodes

The results of aspiration biopsy from 376 superficial lymph nodes were reviewed. Diagnosis of metastatic carcinoma based on “alien” cells and melanoma was easily made with an accuracy of 95%. The results of aspiration biopsy from lymphoma was much less accurate, and led to retrospective analysis of aspirates from 51 histologically verified cases of benign lymphadenopathy and lymphoma. Features suggestive of lymphoma included large immature lymphocytes, large histiocytes, abundant mitoses, and Reed‐Stenberg cells. Thus, this safe office procedure, which immediately differentiates the lymph node from a cyst, inflammatory mass, or mesenchymal tumor, provides an important tool for diagnosis.

Final diagnosis by fine-needle aspiration biopsy for definitive operation in breast cancer

This work has been based on 15 years experience with more than 10,000 needle aspiration biopsies of the breast. Fine-needle aspiration biopsy was used in place of open breast biopsy for definitive operation in breast cancer. Our experience with 2,623 aspiration biopsies over a 3 year period has been reviewed. There was a total of 323 cancers, of which 257 (80 percent) were unequivocally diagnosed by fine-needle aspiration biopsy. Definitive operation was performed in 244 of these patients (95 percent) without open biopsy. Thirteen had an excisional biopsy before definitive operation at the request of the referring physician. The sensitivity was 80 percent and the specificity was 98 percent. There were no false-positive diagnoses. The positive predictive value was 100 percent. False-negative diagnoses were made in 9 percent of the patients, half of whom had nonpalpable carcinomas. Our experience shows that fine-needle aspiration biopsy is accurate in the diagnosis of breast cancer, and when the finding is positive, it can be used for definitive breast operation, eliminating the need for open biopsy. A management algorithm has also been presented herein.

The male breast and malignant neoplasms : diagnosis by aspiration biopsy cytology

Fine‐needle aspiration biopsy is now an established procedure for the evaluation of breast masses in women. On the other hand, there are only occasional reports of aspirates from male breast masses. During the past 19 years from more than 14,000 mammary aspirates, the authors examined the aspiration biopsy cytology (ABC) from 14 cases of malignant mammary tumors in men. There were ten infiltrating ductal carcinomas, one mucinous carcinoma, two metastatic carcinomas, and one leiomyosarcoma. The cytologic and clinicopathologic feature of these cases are presented. Because these specimens can be readily differentiated from gynecomastia, aspiration biopsy is recommended as the initial procedure for all breast masses in men.

Myocarditis in senescence

Abstract Myocarditis is not rate in the aged. Among 1,629 consecutive autopsies of patients over the age of 60, there were 23 cases of myocarditis, an incidence of 1.4 per cent. Among 925 autopsies of patients 70 years and older, myocarditis was found 13 times (1.4 per cent). Most patients had cardiovascular symptoms which were diagnosed as acute myocardial infarction. All patients had characteristic clinical signs which, in retrospect, could be interpreted as having been caused by myocarditis. Comparing the degree of coronary artery disease and resulting myocardial changes with the degree and extent of the myocarditides, we believe that myocarditis was the main cause of death in 10 patients, and that it played a contributing role in the death of 7 patients. It was an incidental finding in 6 patients. Four myocarditides were typical of hypersensitivity, and 2 were due to a toxic substance, norepinephrine. These cases were discussed in more detail. Eight patients had evidence of old myocardial infarction or scattered fibrosis of the myocardium. In all hearts the anatomic changes due to coronary artery disease and infarction were distinct from the lesions of myocarditis. It was stressed that myocarditis is a specific entity of old age, as it is in younger individuals, that on critical evaluation of the patient the characteristic signs may be present, and that hypersensitivity plays an important role in the myocarditis of the aged.

Malignant lymphoma involving the stomach.

Five cases of malignant lymphoma involving the stomach are presented, and the importance of gastric cytology is stressed. Four of our five cases were first diagnosed as lymphoma by this method. The cytologic findings included single malignant cells only slightly larger than lymphocytes, with a central hyper‐chromatic nucleus, thickened nuclear membrane and prominent nucleolus. In distinction, cells which exfoliate from gastric carcinoma occur in clusters, are somewhat larger, and may have eccentric nuclei as well as mucin production. All our cases were discovered in a one‐year period in a 450‐bed general community hospital. The significance of this upsurge of gastric lymphomas is not apparent.

Atypical parakeratosis: A marker of dysplasia?

The Bethesda System categorizes atypical parakeratosis (APK) as “ASCUS or SIL depending on the degree of cellular abnormalities.” APK, however, is not well‐defined. We retrospectively reviewed 68 cervicovaginal specimens with follow‐up material to identify specific criteria and clinical significance of APK. APK cells were small cells, 2–3 times the diameter of a neutrophil, with dense, orangeophilic cytoplasm, high nuclear cytoplasmic ratio, dense, often uneven chromatin, and irregular nuclear contour. Of 62 cases with APK, 37 had accompanying dysplastic cells. Of 25 cases with APK alone, follow‐up revealed 12 with squamous intraepithelial lesion (5 HSIL and 7 LSIL) and 13 with benign changes. A major diagnostic pitfall of APK was inflammation with degeneration. Abundant APK cells, minimal inflammation and degeneration, and previous history of dysplasia frequently were associated with follow‐up SIL. The findings of this study identify APK as an important marker for dysplasia that warrants careful evaluation and follow‐up. Diagn Cytopathol 1996;15:288–291.

Medullary carcinoma of the breast: an unusual cytologic finding in cyst fluid aspirates

Cystic medullary carcinoma of the breast is unusual. This report describes five patients with medullary carcinoma who presented clinically with a breast cyst. Fine‐needle aspiration biopsy (NAB) was performed as part of the initial physical examination and the retrieved cyst fluid was examined cytologically. Four of the five patients were premenopausal, more typical of benign cystic disease and significantly younger than the average (60+ years) for other forms of cystic breast carcinoma. Only three of the five patients demonstrated suspicious findings of hemorrhagic cyst fluid, a residual mass after NAB, or refilling of the cyst. Due to the relatively young age of most patients, the innocuous clinical presentation, and the abundant inflammatory component noted in the aspiration biopsy cytologic study (ABC), misinterpretation as an inflamed cyst is possible. The ABC of cystic medullary carcinoma is presented with histologic correlation.

Monoclonal antibody b72.3. an adjunct for evaluation of suspicious aspiration biopsy cytology from the breast

Monoclonal antibody B72.3 (MoAb B72.3) is a potentially valuable diagnostic adjunct when applied to aspiration biopsy cytology (ABC). In this prospective study, its reactivity was tested on the ABC from 25 breast lesions interpreted as suspicious. The stain was applied directly to the Papanicolaou‐stained specimen by the avidin‐biotin peroxidase methodology at a concentration of 40 μg/ml. In 11 aspirates from invasive carcinomas, the reactivity to MoAb B72.3 was strongly positive in nine cases and weakly positive in two. Ten of these tumors were homogeneous or heterogeneous infiltrating lobular neoplasms, tumors causing special diagnostic pitfalls by ABC. The cells from seven of the nine benign lesions were nonreactive, and in two cases from fibrocystic change, weakly reactive. The ABC from five patients with noninvasive carcinomas or atypical lobular hyperplasia showed a variety of responses. The findings indicate that in select circumstances, MoAb B72.3 used in conjunction with clinical and cytologic findings may be a useful diagnostic adjunct.

ASCUS, Mature Metaplastic Type

OBJECTIVE To study the cytologic criteria for follow-up of mature metaplastic cells within the atypical squamous cells of undetermined significance (ASCUS) category. STUDY DESIGN Squamous epithelial abnormalities between January 1994 and June 1997 at our institution totaled 2,632 and included squamous carcinoma (1), high grade squamous intraepithelial lesions (278), low grade squamous intraepithelial lesions (875) and ASCUS (1,478). From the ASCUS group, 134 (9.06%) were metaplastic; 89 were selected for review. Criteria for case selection were follow-up with tissue biopsy or at least two Pap smears and no previous epithelial abnormality. Patients ranged from 27 to 70 years of age. Parameters tabulated included number of abnormal cells per slide, their architecture, cell size, shape, cytoplasmic hue and texture, nuclear size and contour, chromatin pattern and nucleoli. Additionally, specimens were reviewed for hormonal status and inflammation. The findings were correlated with follow-up data. RESULTS Cells generally appeared single or in loose, monolayered sheets of three to seven cells per group. The cells were well demarcated, polygonal or oval and ranged from 11 to 30 microns with cyanophilic or eosinophilic thickened cytoplasm. The round to oval nuclei with slight irregularity showed a minimally increased nuclear/cytoplasmic ratio with stippled chromatin. Upon review, 69 smears were confirmed as ASCUS-M. Follow-up revealed 42 with benign findings, 9 with persistent ASCUS/ASCUS-M and 18 with low grade squamous intraepithelial lesions. CONCLUSION In mature metaplastic cells with minimal atypia in patients with no previous or concurrent dysplasia, the follow-up details were similar to those described for ASCUS-superficial/immediate squamous cells. These patients could be followed conservatively.

Role of needle aspiration biopsy in diagnosis of carcinoma of the breast.

Needle aspiration of a breast mass, a procedure widely employed in Scandinavia but neglected in the United States, has an imporant role in the diagnosis of carcinoma of the breat. Five hundred and ninety-seven patients has aspirations from 706 lesions, 415 solid and 291 cystic. There were 83 malignancies, with abnormal cells in 73. In the majority the diagnosis could be made readily. There is no known contraindication to the procedure. Aspiration at the initial visit may alert the physician to malignancy, thus avoiding undue delay in treatment.