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H Ehya

Publications and source records attributed to H Ehya.

At least 37 records · Page 2Linked to original sources
PubMed1994

Interobserver variability of cervical smears with squamous-cell abnormalities: a Philadelphia study.

The reproducibility of reporting squamous lesions by the Bethesda System (TBS) was evaluated by distributing 20 slides to be classified among 5 panelists considered experts in the field of cytopathology. Four cases were chosen for their classic morphology and the remainder were foreseen to produce possible discrepancies within one diagnostic category. For 7/20 (35%) cases there was unanimous agreement. Participants disagreed within one category of magnitude for seven (35%) cases. In six (30%) cases there was a range of more than one category disagreement. However, additional written comments modifying TBS diagnoses often diminished the clinical significance of these discrepancies. We conclude that despite the important role of TBS in standardization of Pap smear reports, a great degree of subjectivity exists in classifying squamous abnormalities without "classic" morphology. The lack of reproducibility should be taken into account in cytology proficiency testing.

Carcinoma, Squamous Cell↗
PubMed1994

Utility of polyclonal and monoclonal antibodies against carcinoembryonic antigen in hepatic fine-needle aspirates.

To assess the usefulness of polyclonal and monoclonal antibodies against carcinoembryonic antigen (CEA) in the differential diagnosis of hepatocellular carcinoma (HCC) vs. metastatic adenocarcinoma (MA), we studied 25 cases of fine-needle aspirates (FNA) of hepatic lesions. The material consisted of 9 primary HCCs, 8 MAs, and 8 benign hepatic aspirates. For immunostaining, the avidin-biotin complex technique was performed on paraffin sections of cell blocks, using a standardized automatic immunostainer. Specific bile canalicular immunostaining with polyclonal CEA (pCEA) antibody was present in five of eight (5/8) benign hepatic aspirates and eight of nine (8/9) HCCs. Diffuse cytoplasmic immunostaining with pCEA antibody was present in four of eight (4/8) MAs. None of the aspirates showed any positive immunostaining with monoclonal CEA (mCEA) antibody. We conclude that: (1) pCEA antibody is useful in the evaluation of hepatic FNAs. Diffuse cytoplasmic staining is seen in MAs, whereas canalicular immunostaining pattern is an indication of benign or malignant hepatocytes. (2) Paraffin-embedded cell blocks made from hepatic aspirate material are suitable for immunostaining with polyclonal CEA antibody. (3) mCEA antibody has no value in the diagnosis of HCC.

Adenocarcinoma↗
PubMed1994

Ureteroscopic biopsy in the upper urinary tract.

OBJECTIVES: To determine the optimal instruments and techniques for biopsy of upper urinary tract lesions through the small working channel in flexible and small semirigid ureteroscopes. METHODS: Urinary tract filling defects and other lesions were accessed with rigid or flexible ureteroscopy and biopsies were done using one or more devices: a 3 F cup biopsy forceps, 2.5 F and 3 F baskets, 2.5 F and 3 F graspers, 3 F snare, brush, and aspiration catheters. All samples, including the cup forceps samples, were sent for cytopathologic study, with those containing grossly visible tissue particles processed as a cell block. Only those specimens reported definitely positive or negative were considered diagnostic, whereas the others were grouped as nondefinitive. Not all sampling techniques could be used in every patient because of the size of the lesion and the technical limitations, including bleeding and instrument position during biopsy. RESULTS: There were 55 procedures in 43 patients. The indications included hematuria, filling defect, abnormal cytology, and periodic surveillance. A basket was used in 22 procedures and gave unequivocal results in 15. The other samples were equivocal, nondiagnostic, or unsuitable. The biopsy forceps provided a definitive result in 16 of 21 samples and the grasper was definitive in 5 of 6 samples. We could not obtain a suitable specimen using a snare in 2 cases and the brush gave a definitive result in only 5 of 11 cases. Samples of aspirate and washings were definitive in less than 50% of instances but detected some tumors for which other techniques were equivocal. CONCLUSIONS: For the best results, the largest biopsy specimen possible should be obtained. Aspiration or wash alone is often not diagnostic but can give a diagnosis in some patients. Tissue sampling devices, such as the forceps and basket, have an advantage in obtaining a larger sample. Cytopathologic techniques are particularly useful for handling and interpreting the small specimens obtained with ureteroscopic biopsy techniques.

Adenocarcinoma, Clear Cell↗
PubMed1993

Detection of growth fraction in tumors by Ki67 monoclonal antibody in cytologic smears: a prospective study of 40 cases.

The monoclonal antibody (MAb) Ki67 detects a nuclear antigen in cycling tumor cells. Quantitation of proliferating cells is helpful in predicting the recurrence and metastatic potential of tumors as previously reported. We conducted a prospective study on 40 benign and malignant tumors by performing Ki67 immunocytochemical stains on cytologic smears and their corresponding frozen tissues. Quantitation of Ki67 positive cells was done by counting 300 cells in 5-7 high-power fields in cytologic smears and tissues. Only nuclear or nucleolar immunostaining was considered positive for MAb Ki67. The number of Ki67 positive tumor cells in cytologic smears correlated well with Ki67 positive cells from corresponding tissues. On the average, cytologic smears showed 1.9% higher Ki67 positivity in malignant tumors as compared to their corresponding frozen tissues (P < 0.001). The Ki67 positivity in malignant tumors was found to be significantly higher when compared with benign tumors (P < 0.001). We conclude that cytologic smears can be used for the determination of growth potential in tumors by MAb Ki67. Additionally, cytologic preparations can be used during intraoperative consultations when adequate tissue is not available for the above mentioned study.

Adult↗
PubMed1993

Flow cytometric DNA analysis of interleukin-2 responsive renal cell carcinoma.

Adoptive immunotherapy using interleukin-2 (IL-2) based therapy can result in marked tumor regression in some patients with metastatic renal cell carcinoma. DNA flow cytometry has not been previously studied as a predictor of outcome of this therapy. Archival paraffin embedded tumors were studied in 23 IL-2 treated patients with metastatic renal cell carcinoma. Eleven patients were complete responders (CR) and 12 were nonresponders (NR). In the CR group, 4/11 (40%) were diploid and 7/11 (60%) were aneuploid. In the NR group, 9/12 (75%) were diploid and 3/12 (25%) were aneuploid. Although there was a trend that patients with an aneuploid DNA pattern were more likely to undergo a complete response, ploidy pattern alone was not significantly predictive of response (p2 = 0.10, Fischer's exact test). When combining ploidy pattern with other variables that were predictive for complete response, such as good performance status and a higher pretreatment weight, prediction of complete response was not improved by including ploidy. This preliminary report suggests that DNA ploidy does not appear to provide any additional information concerning responsiveness to IL-2 based immunotherapy beyond that obtained by performance status and pretreatment weight in this patient population.

Carcinoma, Renal Cell↗
PubMed1993

Fine-needle aspiration biopsy of suspected intraocular tumors. The 1992 Urwick Lecture.

BACKGROUND: Fine-needle aspiration biopsy recently has been used as a diagnostic modality for selected intraocular tumors and simulating conditions. However, the value of fine-needle aspiration biopsy for intraocular tumors previously has not been clarified. METHODS: Transocular fine-needle aspiration biopsy was performed on selected patients who had intraocular lesions that were suspected clinically to be neoplasms but in which there was diagnostic uncertainty based on noninvasive clinical evaluation. These cases were analyzed to determine accuracy, complications, and limitations of the technique. RESULTS: Of 6500 patients referred to the Oncology Service for evaluation of possible intraocular tumor, transocular fine-needle aspiration biopsy was used clinically in 159 cases (2.4%). It proved to be a reliable diagnostic method for intraocular malignancies such as uveal melanoma, uveal metastasis, retinoblastoma, lymphoma, and leukemia. In the 140 cases (88%) in which adequate cytologic material was obtained, the sensitivity rate was 100% and the specificity rate was 98%. In 19 cases where the cytologic material was too scant to render a diagnosis, the sensitivity rate was 84% and the specificity rate was 98%. The problem of insufficient material for cytologic diagnosis has been greatly minimized with the recent use of a 22-gauge needle. The main complication was localized intraocular hemorrhage. Retinal detachment and tumor recurrence have not been observed. CONCLUSIONS: Transocular fine-needle aspiration biopsy is a safe and reliable diagnostic method for suspected intraocular tumors and inflammatory conditions in which noninvasive diagnostic modalities have failed to establish the diagnosis and in which cytologic verification of the diagnosis is necessary to institute appropriate treatment. Although the authors have had few complications with fine-needle aspiration biopsy, the technique should be reserved for selected cases where the diagnosis has not been established by less-invasive diagnostic measures.

Anterior Eye Segment↗
PubMed1992

Needle aspiration cytology of the irradiated breast.

During a 3-year period (1987-1989), 60 fine-needle aspiration biopsies (FNAs) were obtained from new breast lesions in patients previously treated by radiation and surgery for breast carcinoma. The lesions occurred at or near the site of previous excision, 3-117 months after initiation of radiotherapy. FNAs were classified as follows: acellular (11); negative (29); atypical (13); suspicious (4); and positive (3). For statistical analysis, acellular, negative, and atypical diagnoses were considered negative findings, and suspicious and positive diagnoses were considered positive findings. On the basis of subsequent biopsy and/or patient follow-up, FNA yielded a sensitivity of 86%, a specificity of 98%, a positive predictive value of 86%, a negative predictive value of 98%, and an efficiency of 97%. Excluding cystic lesions, the most reliable criterion for distinguishing malignant from benign lesions was the abundance of epithelial cells, both singly and in large clusters. Cellular characteristics were less helpful, since nuclear atypia was seen in both benign and malignant lesions. It is concluded that (1) FNA is a reliable technique in the evaluation of the irradiated breast; (2) when performed by an experienced operator, an acellular aspirate may be interpreted as evidence against recurrent carcinoma; and (3) epithelial atypia must be interpreted with caution to avoid a false-positive diagnosis.

Adult↗
PubMed1991

Effusion cytology.

Cytologic evaluation is the best way to detect the presence of malignancy in body cavity fluids. Although a positive diagnosis is highly reliable, a negative result does not rule out a malignant cause. Adenocarcinomas, well-differentiated squamous carcinomas, small-cell carcinomas, malignant melanomas, large-cell lymphomas, and acute leukemias are accurately classified when present in effusions. The definitive diagnosis of malignant mesothelioma, small-cell lymphomas, and chronic leukemias, and subclassification of sarcomas and poorly differentiated neoplasms are difficult and may require additional diagnostic techniques. With a few exceptions, the exact causes of benign effusions cannot be determined by cytologic methods.

Ascitic Fluid↗
PubMed1990

Brush cytology in the diagnosis of colonic neoplasms.

During a three-year period (1986-1988), 234 colonic brush specimens were received in the authors' laboratory. Nine samples (4%) were deemed unsatisfactory for evaluation because of inadequate cellularity and/or poor fixation. In 11 cases concomitant or follow-up histologic specimens were not available. The remaining 214 specimens included 82 malignant neoplasms, 88 neoplastic polyps (adenomas), and 44 nonneoplastic lesions. Sixty-seven (82%) of malignant neoplasms were correctly diagnosed by brush cytology. Three cases of adenoma with severe dysplasia or in situ carcinoma were diagnosed as adenocarcinoma by cytology. No false-positive diagnoses were made of nonneoplastic lesions. Brush cytology was found to be a more sensitive technique in the diagnosis of colon cancer than endoscopic biopsy (82% and 74% sensitivity, respectively). The combination of the two techniques increased the sensitivity to 90% and improved the overall accuracy of the test. Seventy-one (82%) of the colonic adenomas were correctly diagnosed by cytology. Brush cytology is a convenient, safe, and accurate technique which should be used concurrently with endoscopic biopsy or polypectomy.

Adenoma↗
PubMed1990

Liesegang rings in renal cyst fluid.

Peculiar ring-like structures identified as Liesegang rings (LRs) were found in renal cyst fluid from three patients with benign renal cysts. They ranged in size from 5 to 820 mu. Most had a double-layer outer wall with equally spaced radial cross-striations and an amorphous central nidus. Special stains were performed in one case, and the results are discussed. Reports of LRs in cystic or inflamed tissues have recently appeared in the literature. Some LRs have been mistaken for eggs or mature components of the giant kidney worm, Dioctophyma renale. We propose that cytologic assessment of renal cyst fluid in conjunction with histologic examination decreases the likelihood of misdiagnosis of LRs.

Aged↗
PubMed1990

Aspiration cytology of papillary cystic neoplasm of the pancreas.

The authors present a case of papillary and cystic neoplasm of the pancreas (PCN) in which fine-needle aspiration was performed intraoperatively. Only a few reports of fine-needle aspiration of this rare tumor have been published. The features most helpful in reaching a diagnosis of PCN were a monotonous population of tumor cells, round to oval bland-appearing nuclei, scanty to moderate ill-defined cytoplasm, and the presence of numerous capillaries. Despite the lack of branching papillary clusters described in previous reports, it was possible to suggest the correct diagnosis by identifying these other characteristic features. In addition, estrogen and progesterone receptor levels were measured and found to be negligible. A review of the literature with emphasis on cytologic features also is presented.

Adult↗
PubMed1990

Detection of Chlamydia trachomatis in cervical smears from pregnant population.

Specimens were obtained for chlamydial cultures and for routine cytologic studies from 281 consecutive pregnant women who presented for their first prenatal visit. Forty patients (14%) had positive cultures for Chlamydia trachomatis. The cervical smears from all patients with positive cultures and from an equal number of age-matched patients with negative cultures were screened for cytologic features reported to be associated with Chlamydia infection. The following features were noted to be more common in the patients with positive cultures: squamous metaplasia, cytoplasmic vacuolation, nuclear abnormalities, human papillomavirus-associated changes, and a greater degree of inflammation. Cytoplasmic inclusions were present in only a single cell in each of 4 (10%) of the patients with positive cultures. None of the cytologic findings was considered to be specific enough to allow a diagnosis of Chlamydia infection. In our experience, the evaluation of cervical smears is of limited value in the detection of Chlamydia infection in pregnant women.

Chlamydia Infections↗
PubMed1988

Multiple myeloma involving the iris.

Intraocular invasion by neoplastic plasma cells is a rare ophthalmic manifestation of plasma cell dyscrasias. A 67-year-old man who had documented multiple myeloma presented with an infiltration of the iris that simulated a nongranulomatous uveitis. Cytologic examination of the aspirate obtained by anterior chamber paracentesis demonstrated that the infiltrate was composed of neoplastic plasma cells.

Aged↗
PubMed1986

Cytology of granulosa cell tumor of the ovary.

Granulosa cell tumor of the ovary may create a diagnostic challenge in cytologic preparations. Our experience with needle aspiration material, ascitic fluid, and peritoneal washings indicates that in fluids, despite some similarity between the tumor cells and reactive mesothelial cells, a correct diagnosis can be achieved by careful examination. The paucity of the cytoplasm and an intense indentation of nuclear membrane are the most helpful features in distinguishing the granulosa cells from mesothelial cells. The literature is reviewed, and the controversies regarding needle aspiration of ovarian neoplasms are discussed.

Ascitic Fluid↗