Biomedical subjects
Publications and source records attributed to D Whitaker.
The success of cytologic examination in the diagnosis of malignant lymphoma of the cervix is at present limited. The generally accepted cytologic criteria for the identification of malignant lymphoma may have to be applied with caution when examining material obtained by abrasive technique; the diagnosis should not be entirely excluded, even in the presence of cell aggregates.
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The finding in cell block sections of a central core of collagen within tumour aggregates in 4 out of 12 cases of effusions due to malignant mesothelioma is statistically significant (P greater than .01) when compared with its incidence in 2 of 80 cases of effusion due to metastatic carcinoma. It is suggested that this observation may be of diagnostic value in the cytologic evaluation of effusions when malignant mesothelioma is suspected.
The cytology of malignant mesothelioma seen in 12 patients associated with the mining of crocidolite asbestos in Western Australia is described. Two main patterns of mesothelioma were observed: the spindle cell and epithelial varieties. In the more common epithelial variety, five features were found to be of particular value in making a cytologic diagnosis. These include the finding of cell aggregates, multinucleation, the presence of brush-like borders, the close apposition of cell borders, and a characteristic cytoplasm. A diagnosis of malignant mesothelioma may be established by cytologic examination of effusions. The awareness of the possible occurrence of such a primary malignant neoplasm with the features outlined may be helpful in this regard.
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The results of fine needle aspiration (FNA) cytology in 19 cases of malignant mesothelioma are presented. Adequate material for a diagnosis of malignancy was obtained in 17 cases, and in 8 cases a specific diagnosis of mesothelioma could be made. In four other cases, the findings were either consistent with or suggestive of mesothelioma; in four, accurate distinction from other neoplasms was not possible, and in two cases, adenocarcinoma was suggested. The spectrum of cytologic findings ranged from neoplasms of purely epithelial appearance through more pleomorphic biphasic neoplasms to anaplastic tumors. A combination of epithelial-like cell clusters, pavement-like sheets of epithelial cells with well-defined cell borders and prominent cell separation, dispersed angular cells with dense cytoplasm and some spindle-cell forms was the most specific cytologic pattern for mesothelioma. In four neoplasms, ultrastructural examination of aspirated material provided the additional evidence for a definitive diagnosis. The identification of hyaluronic acid within intracytoplasmic vacuoles, either in smears or in cell blocks, confirmed the diagnosis in three tumors. Only in one case, with a strong clinical background suggesting mesothelioma, was the cytologic preparation sufficient for diagnosis without ancillary diagnostic methods. FNA is of particular value in the diagnosis of pleural mesothelioma in patients who do not present with a pleural effusion. Obtaining material for cell block preparations, cytochemistry or ultrastructural study is generally necessary for definitive tumor typing.
Mesotheliomas were induced in rats by the intrapleural injection of Western Australia crocidolite asbestos. Over a two-year period, 10 of 18 animals in which implants were established developed mesotheliomas, for a 56% success rate. Histologically, most mesotheliomas were biphasic although predominantly spindle celled. Pleural fluid was examined in five of these malignant cases: three had a papillary epithelial picture, one had mainly anaplastic cells, and one contained predominantly spindle-shaped cells. Three types of cell aggregates occurred: classical collagen-containing papillary clusters, spindle-cell aggregates and cystlike spheres. These last structures corresponded to microcystic or adenomatoid growth present in four mesotheliomas. Two of the effusions were cultured successfully; the growth pattern was typically mesothelial, with in vitro production of collagen. Ultrastructurally, long, slender microvilli, cell junctions and intermediate filaments confirmed the mesothelial nature of these asbestos-induced rat malignancies.