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D F Fischler

Publications and source records attributed to D F Fischler.

13 recordsLinked to original sources
PubMed1998

Cerebrospinal fluid cytology: an 11-year experience with 5951 specimens.

OBJECTIVE: Cerebrospinal fluid (CSF) diagnoses encompass a wide spectrum of conditions. The authors review one institution's CSF cytology results over an 11-year period. DESIGN AND SETTING: A retrospective study of 5951 CSF specimens generated between 1985 and 1995. Specimens from pediatric patients (<19 years of age) from the same time period were separately identified. RESULTS: A total of 5561 adult and 390 pediatric CSF specimens were interpreted. A diagnosis of "negative for malignant cells" was assigned in 5171 (93%) of the adult cases and in 351 (90%) of the pediatric cases. Specific infectious organisms were identified in 26 adult specimens and one pediatric specimen. Cryptococcus was the most common infectious agent observed (n = 23 adults), and Toxoplasma was the sole pediatric infectious agent. Two hundred seventy-six (5%) adult cases and 31 (8%) pediatric cases were positive for malignant cells. Diagnoses included metastatic tumors (adult, 140 [51%]; pediatric, 0); lymphoma/leukemia (adult, 112 [41%]; pediatric, 4 [13%]); malignant unclassified neoplasms (adult, 9 [3%]; pediatric, 0); and primary central nervous system neoplasms (adult, 12 [4%]; pediatric, 27 [87%]). Medulloblastoma was the most common pediatric neoplasm (n = 21). There were 105 (2%) adult cases and 8 (2%) pediatric cases with atypical cells present. Atypical lymphoid cells were the most common type in adult cases (53%). CONCLUSIONS: In our experience, infectious agents were rarely identified in pediatric CSF specimens. In adult specimens, the most commonly identified organisms was Cryptococcus. Primary central nervous system neoplasms accounted for a higher percentage of CSF specimens in the pediatric population than in the adult population. The most commonly identified malignancy in adults was metastatic neoplasms, and in children, medulloblastoma.

Adenocarcinoma↗
PubMed1997

Aspergillus in cytology specimens: a review of 45 specimens from 36 patients.

OBJECTIVE: To assess the clinical significance associated with the identification of fungal elements consistent with Aspergillus in cytology specimens. MATERIALS AND METHODS: For all cytology specimens with reported fungal elements consistent with Aspergillus, reported over a 9 yr and 8 mo period at The Cleveland Clinic Foundation, the patient's medical charts were reviewed with particular attention to underlying disease, presentation, treatment, and clinical course. Cytology results were compared with available microbiologic cultures and tissue specimens in all of the patients. RESULTS: Forty-five cytology specimens with Aspergillus fungal forms, from 36 patients, were identified. Twenty-six patients had concurrent specimens sent for culture in whom II grew Aspergillus species (10 Aspergillus fumigatus), eight grew organisms other than Aspergillus, and seven were no growth. A total of 16 patients (44%) were treated with antifungal treatment (Amphotericin B). Treatment with Amphotericin B was significantly associated with a concurrent growth of Aspergillus species (9/11 patients with Aspergillus culture positive vs. 7/25 patients without a positive culture for Aspergillus, P value = 0.004 (ODDS ratio = 11, 95% confidence interval:#1.6-104, 2-tailed Fisher exact test.) CONCLUSIONS: The presence of fungal forms consistent with Aspergillus in cytology specimens is neither specific nor sensitive for significant infection due to Aspergillus. Treatment with Amphotericin B is more likely to be instituted when a concurrent clinical specimen grows Aspergillus species in culture.

Adult↗
PubMed1997

Cytologic specimens from the eye: a clinicopathologic study of 33 patients.

Cytologic specimens from the eye (CSE) (fine-needle aspirates and intraocular [vitrectomy] washings) are uncommon in most cytology practices. We reviewed our experience and diagnostic accuracy in lesions from this site over a 13-yr period. Thirty-three patients (12 males, 21 females, age 7-85 yr; mean 56 yr) were identified. Eighteen specimens were submitted to rule out malignancy. Of these, four CSE were positive, including melanoma (n = 1), large-cell lymphoma (n = 2), and carcinoma (n = 1). None of the 14 patients with negative cytology showed clinical evidence of malignancy over a 1-28-mo follow-up period (mean, 8.4 mo). Fourteen specimens were submitted to rule out infectious agents. Cytology material contained culture-proven organisms in one case each of Candida and Aspergillus. Of serology-confirmed specimens, four CSE failed to reveal toxoplasma, and three lacked herpes viral inclusions. One case each of culture-positive P. acnes and C. albicans lacked the organisms in the CSE. Twelve specimens were submitted to rule out inflammatory lesions. CSE showed chronic inflammation (n = 5), acute and chronic inflammation (n = 1), macrophages (n = 5), and nonnecrotizing granulomas (n = 1). Of 3 patients with sarcoidosis, CSE contained mature lymphocytes in all 3 cases, but no granulomas. Although the numbers are small, there is greater sensitivity in the detection of malignancy than of infectious agents.

Adolescent↗
PubMed1997

Endocervical adenocarcinoma in situ: an analysis of cellular features.

Cytologists increasingly encounter atypical endocervical cells, because of the increasing incidence of endocervical adenocarcinoma and the use of improved endocervical sampling devices. These atypical endocervical cells can cause diagnostic problems, especially in recognizing adenocarcinoma in situ (AIS) and distinguishing it from a variety of nonneoplastic changes. We analyzed 33 cervical smears from 22 patients with confirmed AIS and compared these to 19 cervical smears from 17 patients having atypical endocervical cells of undetermined significance and negative follow-up, including at least one tissue biopsy per case, to further investigate the cytologic features of AIS. The AIS smears typically had crowded three-dimensional cellular aggregates, with markedly hyperchromatic nuclei having altered polarity. Frequently, a minor component of AIS formed strips of distinctly columnar cells or sheets. Individual AIS cells occurred in 22 (67%) smears, but these were usually inconspicuous. The AIS smears also had increased nuclear to cytoplasmic ratios (100%), enlarged nuclei (94%), feathering (88%), rosettes (85%), nucleoli (76%), apoptosis (73%), mitoses (64%), multiple nucleoli (18%), and ciliated atypical cells (3%). Cytologic features occurring significantly (P < or = 0.001) more often in AIS cases were a predominance of three-dimensional crowded aggregates (79% vs. 32%), altered nuclear polarity in most groups (88% vs. 16%), marked hyperchromasia (91% vs. 16%), apoptosis (73% vs. 26%), an increased nuclear to cytoplasmic ratio (100% vs. 63%), feathering (88% vs. 26%), and individual atypical cells (67% vs. 16%). In summary, we identified a number of architectural and cellular features that occurred significantly more often in AIS cases than in cases having atypical endocervical cells of undetermined significance and negative follow-up.

Adenocarcinoma↗
PubMed1997

Prospective evaluation of fine needle aspiration of small, solid renal masses: accuracy and morbidity.

OBJECTIVES: To determine the accuracy and clinical utility of fine needle aspiration (FNA) of small, solid renal masses. METHODS: A total of 25 patients with small (less than 5.0 cm), solid, clinically localized renal masses were prospectively identified and evaluated with computed tomography guided FNA with analysis for presence of malignant cells and determination of nuclear grade. The final pathologic findings were used for comparison in each case. All patients had renal cell carcinoma and were managed with radical or partial nephrectomy; 3 had low-grade lesions (Fuhrman's grade 1/4), 2 had high-grade lesions (Fuhrman's grade 4/4), and all other patients had intermediate-grade lesions (Fuhrman's grade 2/4 or 3/4) on final histopathologic assessment. RESULTS: Overall, 10 aspirations yielded diagnostic malignant cells, and 9 were read as rare as rare atypical cells suspicious for malignancy. The remainder were negative (n = 6). Correlation with final nuclear grade was observed in eight instances and discordance in two instances. Subcapsular hematomas were observed at the time of surgery in 10 patients, but in no instance was the operation adversely affected. CONCLUSIONS: The diagnostic yield of FNA of small, solid renal masses appears to be too low to justify the potential morbidity of the procedure.

Biopsy, Needle↗
PubMed1996

Dedifferentiated chondrosarcoma with rhabdomyosarcomatous differentiation.

Dedifferentiated chondrosarcomas are primary bone tumors characterized by the presence of both low-grade cartilaginous and high-grade sarcomatous components. The high-grade component usually shows histologic features of either malignant fibrous histiocytoma or fibrosarcoma. We are aware of only 10 published cases in which the high-grade component showed rhabdomyosarcomatous differentiation. To further clarify the clinical, radiographic, and pathologic features of this unusual variant, we report three additional cases of dedifferentiated chondrosarcoma with rhabdomyosarcomatous differentiation. The patients included two men and one woman; their mean age was 63 years. Tumors originated in the pelvis (ilium), scapula, and tibia. Two patients presented with radiographic findings typical of dedifferentiated chondrosarcoma, including a geographic, lytic lesion with areas of mineralization suggestive of cartilage in close association with a permeative component. The third patient presented with a primarily lytic, destructive lesion of the right iliac wing. Histologically, the tumors contained lobules of well-differentiated chondrosarcoma associated with a high-grade sarcoma with prominent rhabdomyoblasts. Immunohistochemical stains for actin and desmin were positive in all three tumors, and electron microscopy revealed evidence of skeletal muscle differentiation. All three patients died with metastatic disease, 1, 6, and 12 months postoperatively. This histologic variant of dedifferentiated chondrosarcoma is rare, but it shows radiographic and clinical features similar to "conventional" dedifferentiated chondrosarcoma, including a very poor prognosis.

Aged↗
PubMed1994

Tubular carcinoma of the breast: cytologic features in fine-needle aspirations and application of monoclonal anti-alpha-smooth muscle actin in diagnosis.

Twenty fine-needle aspirations (FNAs) of histologically proven tubular carcinoma of the breast (TCB) were reviewed, and the staining distribution of alpha-smooth muscle actin (SMA) was evaluated to see if this improved FNA sensitivity. In 18 cases, the aspirates were cellular, consisting predominantly of epithelial cells arranged in cohesive tubular structures that appeared angular or twisted. Single epithelial cells were present in varying numbers in 14 cases (70%). Cribriform fragments corresponding to in situ ductal carcinoma were noted in 9 cases (45%). Individual, bare nuclei were present in seven cases (35%). The initial cytologic diagnoses were 10 carcinomas, eight suspicious for carcinoma, and two cases were misinterpreted as fibroadenoma. In 8 of 14 cases, the epithelial fragments stained negatively for SMA, whereas in six cases some fragments (< 10%) stained positively. These findings were in contrast to a reticulated staining pattern noted in almost all of the epithelial fragments in nine fibroadenomas and three fibrocystic changes. Eighteen well-differentiated invasive ductal carcinomas stained negatively, whereas four had occasional positively staining fragments. We conclude that TCB displays distinct cytomorphologic features that can be recognized or at least suggested by FNA. Awareness of the cytologic characteristics--angulated tubular structures with or without single epithelial cells--coupled with mammographic/ultrasound findings, is necessary to avoid a misdiagnosis. Alpha-smooth muscle actin staining may help in selected cases.

Actins↗
PubMed1994

DNA content by image analysis. An accurate discriminator of malignancy in pericardial effusions.

DNA analysis was performed on 20 cytologically equivocal pericardial effusions to determine if it would be a useful ancillary technique in identifying malignancy. Ploidy determination by interactive image analysis showed single diploid DNA peaks, with no cells > 5c, in all eight reactive cases studied. The reactive cases had a mean proliferation index of 1.3. All 12 malignant cases studied had cells with DNA content > 5c. A dominant DNA peak at 2c was present in 25%, dominant aneuploid stem lines were present in 25%, and multiple stem lines were present in 50% of the malignant cases. By image analysis, the presence of DNA content > 5c was both sensitive and specific for detecting malignancy in the group of pericardial effusions evaluated.

Cell Count↗
PubMed1992

Adrenal carcinosarcoma presenting in a woman with clinical signs of virilization. A case report with immunohistochemical and ultrastructural findings.

An adrenal carcinosarcoma is reported in a 29-year-old female presenting with clinical signs of virilization. This is the first reported case of a functioning adrenal carcinosarcoma in the English language literature. The tumor measured 12.5 cm in greatest dimension, weighed 610 g, and consisted of large areas of typical adrenal cortical carcinoma that was, however, interspersed with multiple foci of sarcoma. Rhabdomyosarcomatous elements were identified and confirmed both immunohistochemically and ultrastructurally. After radical resection, the patient received adjuvant mitotane therapy but developed rapid local and metastatic recurrence. Systemic chemotherapy was unsuccessful, and the patient died 8 months after surgery.

Adrenal Cortex Neoplasms↗
PubMed1992

Tissue reactivity of anti-Leu19.

Monoclonal antibody anti-Leu19, is a marker of natural killer cells. Since reactivity between anti-Leu7, another natural killer cell marker, and small cell neuroendocrine carcinomas has been described, we evaluated the reactivity of anti-Leu19 in 92 neuroendocrine tumours. Frozen sections in each case were immunostained using the avidin-biotin-peroxidase complex method with monoclonal anti-Leu19. We found Leu19 expression in 93% of the cases. We also evaluated 149 other tumours, including adenocarcinomas, undifferentiated large cell carcinomas, lymphomas, melanomas and soft tissue tumours. We found Leu19 expression in 36% (by liberal interpretative criteria), or 29% (by conservative interpretative criteria) of these cases. Thus, while anti-Leu19 appears to be a sensitive marker for neuroendocrine tumours, a lack of specificity limits its practical application in diagnostic histopathology.

Antigens, CD↗
PubMedDate not supplied

Nongynecologic cytology utilizing the ThinPrep Processor.

OBJECTIVE: To assess the utility of the ThinPrep Processor (TP) for nongynecologic cytology. STUDY DESIGN: We reviewed the number of unsatisfactory specimens from the esophagus, common bile duct, hepatic duct, pancreas, gastric, bronchial wang, vertebra, submandibular area and neck over a one-year period, before and after TP implementation. For a one-year period after TP implementation, the cytologic diagnoses of selected TP specimens with corresponding surgical tissue diagnoses were compared, and the TP slides were reviewed in discrepant cases. RESULTS: The number of unsatisfactory specimens was reduced from 17% to 1% after TP implementations. The cytologic diagnoses of 145 TP specimens were in agreement with surgical tissue diagnoses. However, in 43 cases the cytology and tissue diagnoses were discordant. On review of 26 of the discrepant cases, the majority of TP slides were cellular, with good nuclear and cytoplasmic detail. Discrepancies resulted from sampling errors in 19 cases and TP interpretation errors in 7 cases. CONCLUSION: In our laboratory, TP is a reliable processor for nongynecologic specimens.

Cell Nucleus↗