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Biomedical subjects

G Leiman

Publications and source records attributed to G Leiman.

At least 19 recordsLinked to original sources
PubMed2000

Pemphigus vulgaris of the uterine cervix revisited: case report and review of the literature.

Pemphigus vulgaris is an autoimmune disease characterized by acantholytic blisters and erosions involving the oral mucosa, skin, and less frequently other mucosal surfaces. Although the cytology of scrapings from the cutaneous and oral lesions has been well-documented, there are relatively few reports in the literature of the cytologic appearance of pemphigus on cervicovaginal smears. This report documents a case of pemphigus involving the cervix, in which the diagnosis was not known at the time of the cervical smear and biopsy. The cytologic features of this case and those in the literature are described in detail, highlighting the necessity of awareness of the disease and its presentation on cervicovaginal smears, in preventing an overdiagnosis of neoplasia.

Adult↗
PubMed1999

The cytomorphology of papillary serous carcinoma of the endometrium in cervical smears.

BACKGROUND: An investigation into the determination of cytomorphologic criteria that may distinguish papillary serous carcinoma of the endometrium (PSC) from typical endometrioid carcinoma (TEC) in cervical smears was undertaken. Preoperative identification of this poor prognostic variant of endometrial carcinoma may influence the surgical management of these cases and the choice of adjuvant therapy. METHODS: The cervical smears of 12 cases of histologically confirmed PSC; 12 cases of TEC, including 2 villoglandular/papillary variants, and 6 cases of mixed PSC and papillary endometrioid carcinoma were reviewed. In all cases an initial diagnosis of malignancy had been made on the cervical smears. Twenty-seven criteria were evaluated and the relation between the cytologic characteristics and the type of adenocarcinoma, the degree of association, and the intergroup homogeneity were tested. RESULTS: Features strongly associated with PSC were hypercellular smears with a background tumor diathesis, papillae, bare nuclei, and cells with large pleomorphic nuclei and bulky dense cytoplasm. In contrast, TEC showed a relatively monomorphic population of cells with moderately enlarged oval nuclei and delicate cytoplasm. In the mixed tumors, the features were similar to those of PSC, suggesting preferential exfoliation of the PSC component of the tumor. CONCLUSIONS: Assessment of the cytomorphology of PSC and TEC of the endometrium in Papanicolaou stained cervical smears is possible using statistically significant diagnostic criteria.

Carcinoma, Endometrioid↗
PubMed1999

Thin-layer cytology meets viral hybrid capture.

This commentary addresses the benefits of liquid-based thin-layer cervical cytology, and the applicability of residual samples for human papilloma virus assay. The potential for use of this technology in wide-scale screening as well as the many unanswered issues, in particular cost-benefit ratio and financing, are also discussed.

Carcinoma, Squamous Cell↗
PubMed1998

Natural killer cell lymphoma in cytology: breaking all the rules--a case report.

A testicular mass aspirate was received from a 22-yr-old patient with known non-Hodgkin's lymphoma. The cells were large and pleomorphic, occurring in syncytial fragments and demonstrating abundant cytoplasm. No lymphoglandular bodies were seen. As characteristic lymphoma criteria were not present, a cytodiagnosis of germ-cell tumor was suggested, and testicular biopsy advised. The final histopathology report, however, was of a CD 56-positive (large-cell) T-natural killer cell lymphoma, of which this appears to be the first example described and illustrated cytologically.

Adult↗
PubMed1997

Cytopathology of follicular dendritic cell tumors.

Follicular dendritic cell tumors are rarely described entities, arising from antigen-presenting immune accessory cells, found within B-lymphocyte follicles in nodal and extranodal sites. We report two cases, one associated with Castleman's disease, in whom fine-needle aspiration biopsy was performed followed by surgical biopsy. The diagnosis was confirmed using immunoreactivity with CD21 and CD35 antibodies and by ultrastructural demonstration of interdigitating cell processes with desmosomes. Both the cytologic and histologic findings are presented, and the differential diagnoses are discussed. Awareness of this entity and recognition of the pathologic features may lead to a presumptive diagnosis which must be confirmed using imunohistochemistry and/or electron microscopy.

Adolescent↗
PubMed1997

Exuberant fibroadenomatoid proliferation in a pulmonary mesenchymoma (hamartoma): report of a lesion mimicking a sclerosing pneumocytoma.

We report the cytologic and histopathologic features of an unusual peripheral primary lung tumor in a 61-year-old female. The central portion showed features of typical pulmonary chondroid hamartoma (mesenchymoma). Arising from the peripheral margin of this tumor, however, was an exuberant proliferation of papillary mesenchymal structures lined by type 2 pneumocates, mimicking papillary sclerosing hemangioma (pneumocytoma). This extreme example of fibroadenomatoid proliferation shares histologic features with other pulmonary neoplasms characterized by mesenchymal cores lined by type 2 pneumocytes. We propose that such lesions be unified under the term "alveolar mixed tumor".

Connective Tissue↗
PubMed1995

Metastases to the thyroid gland: diagnosis by aspiration cytology.

The purpose of this study was to document the incidence, nature and source of neoplasms metastatic to the thyroid gland, which were diagnosed by fine needle aspiration (FNA) cytology. In the seven year period from 1986 to 1992, 21 cases were identified with metastatic malignancies in FNA specimens from the thyroid. This represented 7.5% of neoplastic thyroid lesions aspirated in this unit. All patients presented clinically with thyromegaly or discrete nodules. Only five patients were known to have malignancies of other sites prior to FNA. The majority of metastatic nodules were bronchogenic in origin (nine). The gastrointestinal tract (five) and melanomas (two) were the next most frequent sources in the series. Single cases arose in the prostate, larynx, kidney (all carcinomas), and uterus (a leiomyosarcoma). One patient had a thyroid deposit of acute myeloblastic leukemia. This large study demonstrated that tumors of many histological types may involve the thyroid gland, and furthermore, may masquerade as primary thyroid malignancies. Recognition of an alien cell type not only prevents inappropriate thyroid surgery, but may also direct the search for the unsuspected or unknown primary. Metastases to the thyroid gland occur more frequently than is generally appreciated. FNA is the procedure of choice for evaluation of thyroid nodules in general, and thyroid metastases in particular.

Adenocarcinoma↗
PubMed1991

The prevalence and age distribution of peripheral pulmonary hamartomas in adult males. An autopsy-based study.

This autopsy-based study defined the prevalence and age distribution of peripheral pulmonary hamartomas in 47,635 southern African miners examined between 1975 and 1988. The prevalence rate for white miners was 7.5/1,000 and for black miners 1.1/1,000. When directly standardised to the white men in the general population, the rates for white and black miners were 7.2 and 5.5/1,000, respectively. The prevalence of peripheral pulmonary hamartomas in both groups increased with age, from 0.8/1,000 in the third decade to 12.0/1,000 in the eighth decade. The study showed a much higher prevalence of peripheral pulmonary hamartomas for whites than previously reported. Furthermore, it documented the occurrence of these benign lung tumours in blacks, a fact that has previously been questioned. There appeared to be no significant difference in prevalence and age distribution between white and black miners, although the database for the black group was deficient for the later decades of life.

Adult↗
PubMed1991

Fine needle cytodiagnosis of renal tuberculosis.

A total of 8 patients in whom renal tuberculosis was suspected on clinical or radiological grounds but in whom confirmation could not be achieved by urine culture underwent renal fine needle aspiration. Immediate cytodiagnosis was accomplished in 7 of 8 patients by the finding of Langhans' giant histiocytes, epithelioid histiocytes and necrotic debris. Later confirmation was obtained in all 8 cases by radiometric culture of aspiration material or saline rinses of the fine needles. This experience introduces fine needle aspiration cytology as a diagnostic modality in renal tuberculosis.

Adult↗
PubMed1990

Audit of fine needle aspiration cytology of 120 renal lesions.

Solid renal masses in 120 patients were assessed by percutaneous fine needle aspiration cytology, performed under radiographic guidance. Follow-up was obtained in all but seven cases. Diagnostic sensitivity for 83 tumours in the series was 91.6%, while two false positive reports resulted in a specificity of 93.8%. Positive and negative predictive values were 97.4% and 81.1% respectively. One advantage of the procedure was the ability to cell type neoplasms accurately, which enabled administration of pre-operative chemotherapy in childhood tumours, and selection of appropriate surgical procedures in adults. The technique offered a non-surgical means of confirming primary renal tumours in patients presenting initially with distant metastases, and documenting renal secondaries in cases with malignancy at other sites. The diagnosis of benign or inflammatory lesions permitted institution of definitive therapy.

Adolescent↗
PubMed1989

Transthoracic fine-needle aspiration cytology. An analysis of 500 cases.

Existing cytological and radiological services enabled the introduction of transthoracic fine-needle aspiration (FNA) in Johannesburg in 1983. The results achieved in the first 500 patients subjected to this procedure are presented, together with histological and clinical correlation. Of a total of 330 malignant tumours in this series, 306 were successfully sampled by FNA. Sensitivity of the technique in malignant disease was 92.7%, with 98.8% specificity. Positive and negative predictive values were 99.4% and 85% respectively. FNA was less accurate in the assessment of 24 benign thoracic tumours, only 75% of which were adequately sampled. Similarly, definitive cytological diagnosis of specific non-neoplastic pulmonary lesions, including granulomatous disease, was possible in only 78.6% of cases. The problem of aspirates in which no cellular abnormality (benign or malignant) was observed is discussed in relation to accuracy of needle placement. The special advantages of this technique included non-surgical verification of malignancy in radiologically or clinically inoperable cases; documentation of metastases; and detection of those tumour types (small-cell undifferentiated carcinoma and lymphoma) more appropriately treated by chemotherapy than by surgery. Pneumothorax requiring intercostal drain insertion occurred in 24 patients (4.8%). The advantages of rapid, accurate, inexpensive, non-operative diagnosis of thoracic masses was felt to outweight this single major complication.

Adolescent↗
PubMed1989

Fine-needle aspiration of the liver: out of the ivory tower and into the community.

This study of 160 consecutive fine-needle aspirates of localized hepatic masses analyzed the efficacy of the technique when extended into a multicenter setting. The aspirates were processed and interpreted by a single cytology service, but they were performed, under radiographic imaging, in eight different hospitals by at least 20 radiologists, few of whom had had the opportunity to acquire long-term experience. Of 108 malignancies, 101 were correctly sampled (sensitivity, 93.5%), including 30 primary hepatocellular carcinomas, 70 metastatic tumors, and 1 lymphoma. Specific benign pathologic lesions in 12 cases were amenable to cytodiagnosis. The problem of the remaining 47 samples, which contained exclusively blood, necrotic material, or normal and reactive hepatic constituents, was addressed at length. These were considered "nondiagnostic" samples in the context of aspirating focal masses. The majority had benign lesions on further study, but tumors were found in seven, all of which had been sampling errors, resulting in a negative predictive value of 82.5%. Fine-needle sampling of localized lesions, particularly neoplasms, can thus perform well in transition from single-center studies to more widespread usage in daily practice. Confident reliance on the procedure can be maintained if appropriate radiologic and cytologic facilities exist, provided that the limitations of nonneoplastic aspirates are fully understood.

Adolescent↗
PubMed1989

The aspiration cytology of pulmonary hamartomas.

Cytodiagnosis of pulmonary hamartomas (PHs) by transthoracic fine-needle aspiration (FNA), successful in 11 of a series of 14 cases, has been found to rely less on the presence of mature cartilage than on the recognition of fibromyxoid fragments. These fragments, wispy yet discrete, consisting of variable numbers of fibroblasts embedded in fibrillary ground substance, can be distinguished from fibrous tissue and mucus, both of which they may resemble. Mature cartilage is distinctive when present, but it is seen in a minority of cases. Bronchial cells and adipocytes, integral components of PHs, are of no diagnostic value unless associated with fibromyxomatous tissue or cartilage. Chest wall "contaminants" that may cause pitfalls in diagnosis, such as bone, skeletal muscle, and fibrous tissue, are described and illustrated. The differential diagnosis of biphasic lesions containing epithelial cells and mesenchyme, including dermoids and blastomas, is discussed. With knowledge of the radiologic appearance of target lesions, confident cytodiagnosis of PHs is possible if attention is paid to subtle, yet specific, background features in aspirated material.

Aged↗
PubMed1989

Aspiration cytology of neuroendocrine tumors below the diaphragm.

In a series of 630 transabdominal fine-needle aspirates, 24 neuroendocrine tumors (NETs) presenting below the diaphragm were encountered. Of these, 10 were classic small-cell undifferentiated carcinomas (SCUCs). Recognition of SCUC in abdominal aspirates has major directive value, pointing to bronchogenic origin, possibly unsuspected, in most cases (eight of 10 in this series). The other 14 NETs were 10 pancreatic islet-cell tumors and four intestinal carcinoids, both diagnosed more frequently in metastatic than in primary sites (10 of 14 in the liver in this series). The cytologic presentation of these non-SCUC neoplasms has received little literature attention, and it is described and illustrated here, with discussion of cytologic pitfalls and differential diagnoses. Diagnostic specificity was 100%, and sensitivity was also 100%, exclusive of two sampling errors. The purpose of this article is to establish a broader view of the range of morphological features of the extended neuroendocrine group of tumors in aspiration cytology.

Adenoma, Islet Cell↗
PubMed1987

Cervical endometriosis: facilitated diagnosis by fine needle aspiration cytologic testing.

Regarded as infrequent, endometriosis of the cervix probably occurs more commonly than is generally realized. The lesion's apparent rarity may be ascribed to limited awareness of the clinical appearance, combined with technical difficulty in obtaining suitable biopsy material for confirmation. A consequence of previous cervical trauma, endometriosis of the cervix can be expected to increase in incidence with more widespread use of invasive cervical procedures. Clinical recognition and tissue confirmation thus become essential. This paper refocuses attention on cervical endometriosis by documenting the clinical, colposcopic, and histopathologic findings in 16 cases seen at a single colposcopy clinic over a 6-month period. Diagnosis in these patients was facilitated and improved by fine needle aspiration cytologic testing. This technique, not previously used for documentation of endometriosis in this location, is outlined in detail, together with a full description and illustration of the cytologic features.

Adult↗