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L J Layfield

Publications and source records attributed to L J Layfield.

At least 37 records · Page 2Linked to original sources
PubMed1999

Fine-needle aspiration of neural lesions.

The cytomorphologic features of 13 neural lesions sampled by fine-needle aspiration (FNA) are reviewed. The frequencies at which various architectural features including Verocay bodies, filamentous background, and vascular arcades were present was recorded, along with the frequencies of cytologic findings including the presence of spindle cells, wavy nuclei, intranuclear inclusions, fishhook nuclei, nuclear pleomorphism, filamentous cytoplasm, and mitotic figures. Verocay bodies were a rare finding, present in only 1 of 11 cases. Vascular arcades were similarly infrequent (1/11 cases). Spindle-shaped cells along with wavy nuclei were the most frequent findings, with fishhook-shaped nuclei and a filamentous background of high frequency (9/11 cases). Our study indicates that some of the characteristic features recorded in the literature are rarely seen in needle aspiration smears, but features such as spindle-shaped cells, wavy and fishhook-shaped nuclei, and a filamentous background are relatively frequent findings.

Actins↗
PubMed1999

Logistic regression analysis of small round cell neoplasms: a cytologic study.

The diagnosis of small round cell neoplasms (SRCN) in children is difficult by both histologic and cytologic methods. These neoplasms are unified morphologically by the scanty cytoplasm surrounding relatively round nuclei containing a primitive chromatin pattern. Further categorization is achieved histologically by the recognition of architectural differentiation and cytoplasmic features. Numerous series and case reports documenting the cytologic features of SRCN have been published in the English-language literature, but relatively few studies have statistically analyzed the diagnostic utility of these features. Our logistic regression analysis of 59 cases of SRCN indicates that the presence of an extremely scanty cytoplasm favors the diagnosis of Ewing's sarcoma (P = 0.004), as does the positive expression of cytoplasmic vacuoles (P = 0.02). Strap or tadpole cells closely correlate with the diagnosis of rhabdomyosarcoma (P < 0.001). The positive expression of rosettes strongly supports the presence of a neuroblastoma (P < 0.001). The diagnosis of Wilms' tumor is confirmed by the expression of tubules (P < 0.001). The presence of lymphoglandular bodies strongly favors the diagnosis of lymphoma (P < 0.001). While some cytologic features are highly correlated with specific SRCN, these features are not invariably present, and definitive diagnosis may require immunohistochemical or ultrastructural analysis performed on cell block material.

Carcinoma, Small Cell↗
PubMed1999

Radiologically-determined diameter, pathologic diameter, and reactive zone surrounding pulmonary neoplasms: implications for transthoracic fine-needle aspiration of pulmonary neoplasms.

To determine the relationship between radiologically determined tumor diameter and true pathologic tumor diameter and correlate radiologically determined diameter with the size of reactive zone surrounding pulmonary neoplasms, radiographs and surgical pathology specimens were obtained from 57 patients with pulmonary neoplasms. The tumor size on plane films and CT-scans was measured, as was the size of the neoplasm on gross specimen and surgical pathology slide. The width of the reactive zone was also measured on H&E stained microscopic slides. These findings were correlated along the histopathologic type of neoplasm present. On average, the reactive zone represented approximately 11% of the overall diameter of the neoplasm. However, there was considerable variation in this percentage, with reactive zone thickness varying between 2% and 48% of total tumor diameter. Bronchioloalveolar cell carcinomas generally lacked a reactive zone, while the other types of carcinomas frequently contained reactive zone. Approximately half of all carcinomas displayed a reactive zone of 1 mm in thickness or more. The present study demonstrates that a majority of carcinomas contain a reactive zone. This reactive zone is of variable thickness, but in approximately 50% of carcinomas it is at least 1 mm in thickness. The thickness of the reactive zone represents approximately 11% of total tumor diameter. Diagn. Cytopathol. 1999;21:250-252.

Biopsy, Needle↗
PubMed1999

Middle ear carcinoid: an indolent tumor with metastatic potential.

BACKGROUND: Neuroendocrine tumors of the head and neck region may present problems in diagnosis. Middle ear carcinoid is a rare, recently recognized tumor, which to date has not been reported to metastasize. METHODS: We report the case of a 64-year-old man with a 9-year history of recurrent middle ear neoplasm and ipsilateral cervical lymphadenopathy. A microscopic parathyroid tumor was also identified. The approach to the diagnosis of this unusual combination is presented. RESULTS: The patient had a neuroendocrine tumor metastatic to multiple unilateral cervical lymph nodes, which was morphologically identical to his recurrent middle ear neoplasm. The neoplasm had the morphologic, immunohistochemical, and ultrastructural features of a carcinoid tumor. CONCLUSIONS: This case illustrates that middle ear carcinoids may metastasize. We suggest that immunohistochemical studies be performed on all biopsy specimens from neoplasms of the middle ear, as distinction from the more common paraganglioma may be difficult on morphologic grounds alone.

Carcinoid Tumor↗
PubMed1999

Diagnostic accuracy in fine-needle aspiration of soft tissue and bone lesions. Influence of clinical history and experience.

Interpretation of soft tissue and bone lesions with fine-needle aspiration (FNA) is difficult. We determined whether clinical history or experience improves diagnostic accuracy of FNA interpretation of these lesions. Four cytopathologists with varying degrees of experience retrospectively reviewed 89 soft tissue and bone lesions, initially without knowledge of clinical history and subsequently with knowledge of clinical history. Each time, the pathologist rendered a precise diagnosis (histogenetic classification, e.g., angiosarcoma, lipoma) for each case and classified the lesion into one of 4 categories: benign, probably benign, probably malignant, or malignant. The proportion of correct precise diagnoses was calculated. Also, the numbers of correct and incorrect classifications of malignancy were used in standard relative operating characteristic (ROC) curve analysis. The area under the ROC curve was estimated to give an indicator of diagnostic accuracy. Knowledge of clinical history increased the proportion of correct diagnoses and the accuracy of the classification for all observers. Experienced observers more accurately classified lesions, and knowledge of clinical history particularly improved the diagnostic accuracy of less experienced observers.

Biopsy, Needle↗
PubMed1999

Pseudoanaplastic giant cell tumor of bone.

Marked nuclear atypia can be found in a variety of benign mesenchymal tumors, including ancient schwannomas, symplastic leiomyomas, osteoblastomas, and chondromyxoid fibromas. Such nuclear atypia is believed to represent a degenerative phenomenon and does not indicate aggressive behavior. Separation of these pleomorphic but benign lesions from true sarcomas may be difficult. We are aware of only one prior description of such degenerative atypia in benign giant cell tumor of bone. We report a benign giant cell tumor of bone arising in the sacrum of a 21-year-old white female. Preoperative embolization of this lesion had been performed, and subsequent curetting revealed marked atypia suggestive of an anaplastic malignancy. However, only very rare mitotic figures were present, and the radiographs were consistent with a benign giant cell tumor. A diagnosis of benign giant cell tumor was made, and no recurrence or metastases have been observed during the 4-year postoperative period.

Adult↗
PubMed1998

Surgical control of clinically localized prostate carcinoma is equivalent in African-American and white males.

BACKGROUND: Few studies have compared the outcome of radical prostatectomy between African-American males (AAM) and white males, and the results of the few studies that have are conflicting. Therefore, the authors examined the impact of radical surgery on localized prostate carcinoma in both patient populations, and assessed whether stratification by pathologic extent of local disease would yield an equivalent outcome. METHODS: Prostate specific antigen (PSA) failure and carcinoma-associated death rates were assessed in 1319 patients (115 AAM and 1204 white males), 872 of whom had a pretreatment serum PSA level taken. The percent of prostate involved by tumor, tumor wet weight, and DNA ploidy status were available in 755, 522, and 638 patients, respectively. RESULTS: AAM were diagnosed at an earlier age than white males (62.8 years vs. 65.4 years; P = 0.0001). The distribution of pathologic extent of local disease was similar in both races, and AAM had a statistically higher rate of tumors with a Gleason sum of 7-10 at surgery than white males (64% vs. 46%). Race did not play a role in the outcome of patients with organ-confined or specimen-confined tumors. However, in patients with positive surgical margins, the median time to PSA failure and the median carcinoma-associated survival were less in AAM compared with white males. Tumor volume was significantly larger in AAM compared with white males. After multivariate adjustment for the pathologic extent of local disease, tumor grade at surgery, preoperative PSA, tumor volume, and age, African-American race was not a significant prognostic indicator for carcinoma-associated death and PSA failure (P = 0.17 and 0.14, respectively). CONCLUSIONS: The outcome of radical prostatectomy was similar in both racial groups, although AAM with positive surgical margins tended to fail earlier than white males, suggesting greater biologic aggressiveness of residual disease. Because local extent of disease impacts on PSA failure and survival, and because the disease appears to present earlier in AAM, the AAM population may benefit from early detection programs.

Adult↗
PubMed1998

Fine-needle aspiration: comparison of smear, cytospin, and cell block preparations in diagnostic and cost effectiveness.

We compared the results of smears to those of cytospin and cell block preparations from fine-needle aspirations to determine the cost effectiveness of each and to determine which should be routinely obtained. We reviewed 844 cases, 361 of which had both smears and cytospins, and 483 of which had both smears and cell blocks. Smears alone were diagnostic in 94% of cases (796/844 cases), cytospins alone diagnostic in 43% of cases (154/361 cases), and cell blocks alone diagnostic in 57% of cases (277/483 cases). Cytospins contributed additional information beyond that obtained from smears in 2% (7/361) and cell blocks in 12% (57/483) of cases. When smears were nondiagnostic, cytospins contributed additional information in 10% (2/21) of cases and cell blocks contributed additional information in 44% (12/27) of cases. The cost of providing a diagnosis from smear alone is $212, from cytospin alone is $352, and from cell block alone is $392. The cost for additional information established by cytospin is $7,736 and by cell block the cost is $1,906. Smears are superior to either cytospins or cell blocks in providing a diagnosis. It is not cost-effective to obtain either cytospins or cell blocks in addition to smears on all cases. However, it is cost-effective to obtain cell blocks when the immediate smear evaluation is nondiagnostic.

Biopsy, Needle↗
PubMed1998

Demonstration of myxoid change in fine-needle aspiration of synovial sarcoma: a case report.

We report a case of synovial sarcoma with extensive myxoid change diagnosed by fine-needle aspiration. The patient is a 46-year-old woman who presented with a right paratibial mass. Aspiration cytology demonstrated a spindle cell neoplasm consistent with a synovial sarcoma but containing a prominent myxoid matrix. The clinical suspicion and cytologic diagnosis of a synovial sarcoma was confirmed by histologic and immunohistochemical findings. The cytologic differential diagnosis of spindle cell neoplasms with extensive myxoid change should be broadened to include synovial sarcoma.

Biomarkers, Tumor↗
PubMed1998

Not by blood alone: diagnosis of hemangiomas by fine-needle aspiration.

Hemangiomas are common vascular neoplasms which are being radiographically detected and biopsied with increasing frequency during the workup of patients with malignant disease. The increasing confidence of radiologists in biopsying these lesions is in contrast to the reluctance of pathologists to make a specific diagnosis of hemangioma. Eleven cases of hemangioma, from both hepatic and superficial sites, were reviewed and the fine-needle aspirate findings discussed and illustrated. Three-dimensional arcades composed of bland elongated spindle cells or compact dense coils of spindle cells associated with scattered spindle-shaped cells were identified in 10 of 11 cases. In conclusion, recognition of the cellular pattern of hemangiomas combined with the radiologic information can enable a positive diagnosis of hemangioma to be made.

Biopsy, Needle↗
PubMed1998

Reporting fine-needle aspirates of breast: a survey of preferences among surgeons.

BACKGROUND: The optimal format for reporting results of breast fine-needle aspiration cytology is controversial, with some experts favoring a five-category system and others recommending a four-category format. METHODS: A survey of 200 surgeons was performed to determine their preference for a four- or five-category report format. They were also questioned concerning the number of patients per year in whom they diagnosed breast cancer, if they used fine-needle aspiration cytology (FNAC) regularly, and why they favored one category over the other. RESULTS: Eighty-five complete responses were received. Fifty-eight percent of these surgeons (49) routinely used FNAC for the diagnosis of breast nodules. There was no strong preference for either report format. Twenty-four of 49 routine users of FNAC favored a four-category format, and another four had no preference. CONCLUSION: Surgeons who routinely used FNAC in the diagnosis of breast disease do not have a preference for the five-category probabilistic system.

Biopsy, Needle↗
PubMed1998

Logistic regression analysis of myxoid sarcomas: a cytologic study.

The objective of this study was to identify key diagnostic cytologic criteria for the most common myxoid sarcomas studied by fine-needle aspiration cytology. We reviewed 27 myxoid malignant fibrous histiocytomas, 8 chordomas, 16 chondrosarcomas, and 12 myxoid liposarcomas in which both cytologic specimens and final histopathologic diagnoses were available. All specimens were coded as to the presence or absence of the following variables: high cellularity, low cellularity, tissue fragments, epithelial fragments, pale/loose ground substance, dense ground substance, chondroid fragments, large amount of myxoid material, small amount of myxoid material, capillary vessel networks, pleomorphism, binucleate cells, multinucleate cells, physaliphorous cells, cells in lacunae, signet ring cells, lipoblasts, fibroblast-like cells, histiocyte-like cells, stellate cells, long filamentous cells, short spindle cells, osteoclastic giant cells, nuclei with pointed ends, nuclei with cigar-shaped ends, fish-hook nuclei, round/ovoid nuclei, naked nuclei, large nucleoli, small nucleoli, mitotic figures, abnormal mitotic figures, intracytoplasmic hemosiderin deposits, background cells, fat, cytoplasmic vacuoles, and pleomorphic giant cells. A logistic regression analysis was performed to identify the variables predictive of myxoid malignant fibrous histiocytoma, chordoma, myxoid chondrosarcoma, and myxoid liposarcoma. The statistical analysis selected pleomorphic giant cells and the presence of fibroblast-like cells as most predictive of malignant fibrous histiocytoma, physaliphorous cells as most closely associated with chordoma, chondroid fragments as most predictive of chondrosarcoma, and lipoblasts as most predictive of liposarcoma. While myxoid lesions have many overlapping cytologic features, key criteria including the presence of lipoblasts, physaliphorous cells, chondroid fragments, and pleomorphic giant cells are useful in subclassifying these neoplasms.

Adipocytes↗
PubMed1998

"Dedifferentiated" chordoma: a case report of the cytomorphologic findings on fine-needle aspiration.

Chordomas are relatively rare neoplasms occurring at both ends of a neuro axis. The majority follow an indolent course of multiple local recurrences, ultimately leading to the patient's death. Rare examples have been associated with sarcomatous components, usually resembling malignant fibrous histiocytoma, fibrosarcoma, or osteosarcoma. These tumors have followed a more aggressive course, with poor response to treatment and death following a relatively short time course. Cytologic material from a single case obtained by fine-needle aspiration revealed a high-grade malignancy composed of short atypical spindle cells containing modest amounts of granular cytoplasm. Physaliphorous cells were absent, and myxoid material was not a significant component of the smears. Rare polygonal cells with foamy cytoplasm were identified. Histologic study revealed a high-grade spindle-cell sarcoma in which were scattered small aggregates of vacuolated cells resembling physaliphorous cells. Anaplastic giant cells were present, and the overall appearance of the neoplasm resembled a malignant fibrous histiocytoma. Despite the radiographic appearance of a conventional chordoma in this case, the cytologic findings were indicative of a high-grade sarcoma consistent with a dedifferentiated chordoma.

Adult↗
PubMed1998

Placental pathology in patients using cocaine: an observational study.

OBJECTIVE: Although retroplacental hemorrhage is a major cause of fetal death, its etiology often remains obscure. In some reports, cocaine use by pregnant women has been associated with retroplacental hemorrhage and clinical abruptio placentae. This study was designed to assess the occurrence of chorionic villus hemorrhage, an entity shown recently to be associated with retroplacental hemorrhage, in the placentas of cocaine users. METHODS: Twenty-nine placentas from cocaine users and 15 placentas from drug-free controls, as determined by questionnaire and urine toxicology screen, were examined prospectively, and pathological findings documented. The prevalence of retroplacental hemorrhage, chorionic villus hemorrhage, edema, chorioamnionitis, funisitis, infarction, fetal vessel thrombosis, and intervillus hemorrhage was examined in the two groups. RESULTS: Chorioamnionitis was the most frequent finding in both groups (58% of cocaine users, 66% of controls). Edema of moderate severity or greater was found only in the cocaine-using group (17%). The prevalence of chorionic villus hemorrhage among women using cocaine also was 17%. CONCLUSION: Cocaine use during pregnancy may be associated with chorionic villus hemorrhage and villus edema, even in the absence of clinical abruptio placentae. The relationship between abnormal placental morphology and adverse perinatal outcomes remains to be determined.

Adult↗
PubMed1998

Tissue heterogeneity of immunohistochemically detected estrogen receptor. Implications for image analysis quantification.

The increasingly popular immunohistochemical techniques for assay of the estrogen receptor (ER) allow localization of receptor positivity to specific cell populations. Heterogeneity of the ER in tumor cell populations may have important implications for analytic cell selection and for prognosis in ER-positive carcinomas. We studied 84 tissue blocks for level-to-level and geographic heterogeneity within level of the ER and cytokeratin by staining alternate serial sections for ER and cytokeratin. Distribution of ER and cytokeratin positivity was manually assessed. Homogenous positive staining was seen in 63 of 84 cases for ER and 71 of 84 cases for cytokeratin. Distinct geographic variability constant from level to level was seen in 7 cases for ER. In each of these cases, the cell populations stained uniformly for cytokeratin. Artifactual heterogeneity seemed to be uncommon for ER. Automated image analysis and manual ER estimation resulted in more positive cases than did the dextran-coated charcoal (DCC) technique. Interobserver correlation for the manual method seemed high, as did correlation between the manual method and image analysis. Because a majority of the immunohistochemical staining heterogeneity for ER seemed to be biologic, we believe it may mark carcinomas that are less responsive to tamoxifen and more likely to progress than would be predicted by more traditional methods of ER analysis.

Humans↗