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L J Layfield

Publications and source records attributed to L J Layfield.

At least 73 records · Page 4Linked to original sources
PubMed1996

Correlation of DNA ploidy and histologic diagnosis from prostate core-needle biopsies: is DNA ploidy more sensitive than histology for the diagnosis of carcinoma in small specimens?

DNA ploidy has been shown to have prognostic value in adenocarcinoma of the prostate. While occasional benign lesions of the prostate may be associated with a DNA aneuploid status, most aneuploid epithelial proliferations of the prostate are carcinomas. Because of the relationship between aneuploidy and malignancy, DNA ploidy analysis might improve detection of adenocarcinoma in small core-needle biopsy specimens. In this study, DNA ploidy analysis was performed on 186 fresh core biopsies from 32 patients who had undergone transrectal, ultrasonographically directed core-needle biopsies. Ploidy level was determined by Feulgen staining and image analysis with a CAS 200 image analyzer (Becton Dickinson-Cellular Imaging Systems, San Jose, CA). The resultant DNA ploidy levels were compared with the initial histologic diagnosis and subsequent clinical and pathologic follow-up. Nondiploid DNA patterns correlated with a diagnosis of carcinoma on core biopsy in 11 of 16 nondiploid cases and with a final diagnosis of malignancy in 13 of 16 nondiploid cases. Two patients with biopsy proven carcinoma had DNA diploid tumor patterns. Ploidy analysis had a sensitivity of 86.6% and a specificity of 73.7% in predicting the final diagnosis of malignancy. One case interpreted as DNA tetraploid by image analysis revealed seminal vesicle tissue on both the cytologic preparations and the core biopsy. Two DNA aneuploid specimen associated with cores initially read as benign or atypical demonstrated adenocarcinoma either on review of the original core biopsy or the prostatectomy specimen. The final DNA aneuploid specimen revealed acute prostatitis in the core biopsy. DNA ploidy analysis of core biopsy specimens appears to have relatively good specificity and sensitivity for the detection of prostatic carcinoma. Sampling errors appear to be the major cause of false negative results. Inappropriate measurement of seminal vesicle tissue and acute prostatitis can result in false positive results.

Adenocarcinoma↗
PubMed1996

Fine-needle aspiration of a primary right atrial myxoma.

Cardiac myxomas are rare neoplasms usually diagnosed by echocardiography. Preoperative tissue diagnosis is usually not obtained because of the location of these neoplasms. Their cytologic appearance has only been reported from touch imprints of operative specimens or aspirates of metastatic deposits. We report the cytologic appearance of a right atrial myxoma characterized by bland spindle cells and fragments of myxoid debris.

Adult↗
PubMed1996

Epithelial-myoepithelial cell carcinoma of the parotid gland: a case report and comparison of cytologic features with other stromal, epithelial, and myoepithelial cell containing lesions of the salivary glands.

The salivary glands are the site of many neoplasms characterized by a mixture of epithelial and myoepithelial cells and stomal fragments. Cytologic distinction of these neoplasms may be very difficult but careful attention to cellular details and the interaction between the cells and stroma can correctly classify these neoplasms as monomorphic or pleomorphic adenomas, adenoid cystic carcinomas, or epithelial-myoepithelial cell carcinomas.

Adult↗
PubMed1996

Fine-needle aspiration of low grade adenosquamous carcinoma of the breast.

Low-grade adenosquamous carcinoma is an unusual variant of mammary carcinoma. This malignancy generally presents as a palpable mass without mammographic microcalcifications, and fine-needle aspiration may be the initial technique selected for diagnosis. To our knowledge, the cytologic findings associated with this neoplasm have not been reported. We report a case of low-grade adenosquamous carcinoma of the breast in a 57-yr-old woman, initially studied by fine-needle aspiration cytology and confirmed by excisional biopsy. The aspiration biopsy smears were characterized by low cellularity and small disoriented clusters containing uniform cells of small to medium size. Bipolar cells were not seen in the background. The diagnostic features and differential diagnosis of this unusual neoplasm are reviewed.

Biopsy, Needle↗
PubMed1996

Fine-needle aspiration of primary gallbladder carcinoma.

Primary carcinoma of the gallbladder is a rare neoplasm that is frequently difficult to diagnose preoperatively. The obstacles to diagnosis include vague symptoms and the relative inaccessibility of the gallbladder and cystic duct to biopsy. Cytological descriptions of gallbladder carcinoma are sparse and are largely confined to malignant cells identified in aspirated bile. Examination of bile is a fairly insensitive technique for diagnosing carcinoma, partially due to the degradative effect of biliary salts on cellular morphology. In the following, we report the findings of three cases of primary carcinoma of the gallbladder examined by fine-needle aspiration cytology.

Aged↗
PubMed1996

Gouty tophus presenting as a soft-tissue mass diagnosed by fine-needle aspiration: a case report.

We present a case in which a primary diagnosis of gout was made by fine-needle aspiration. The patient had a right distal ulnar mass, and the initial clinical and radiological diagnoses were that of giant cell tumor of tendon sheath. While tophi are the hallmark of gout, they rarely undergo aspiration because of the known clinical history. This case demonstrates that a tophus may mimic a soft-tissue neoplasm. Whenever an aspiration yields amorphous or granular material, the cytopathologist should be aware of and consider gouty tophus as a diagnostic possibility and perform compensated polarized microscopy on the specimen smears.

Aged↗
PubMed1996

Cytologically low grade malignancies: an important interpretative pitfall responsible for false negative diagnoses in fine-needle aspiration of the breast.

Failure to diagnose breast carcinoma by fine-needle aspiration (FNA) is a major obstacle to expanded use of that technique. While the majority of false negative diagnoses are due to inadequate sampling and insufficient specimens, a significant minority of false negative cases result from inaccurate interpretation of adequate material. Low grade carcinomas including lobular, tubular, low grade adenosquamous, and papillary carcinomas appear to account for many of these diagnostic errors. Careful attention to nuclear detail, monomorphism of cell population and the presence of neoplastic cells with retained cytoplasm should allow the recognition of the majority of these neoplasms as malignant by cytologic examination.

Adenocarcinoma↗
PubMed1996

Fine-needle aspiration of inflammatory carcinoma of the breast.

Inflammatory carcinoma of the breast is an uncommon clinicopathologic entity which is characterized by a distinctive clinical appearance and poor prognosis. Histopathologically, it is characterized by plugging of dermal lymphatics with tumor emboli. Because this lesion usually does not form a discrete palpable mass, it is not as amenable to diagnosis by fine-needle aspiration (FNA) as other breast lesions. In the following, we report our experience with establishing the diagnosis of inflammatory carcinoma by FNA. Three patients underwent FNA for confirmation of clinically suspected inflammatory carcinoma. All aspirations were performed by a cytopathologist and required multiple passes to obtain diagnostic material. Aspirates were paucicellular and contained fragments of fibrous or adipose tissue. Malignant cells were predominantly distributed in tight, three-dimensional clusters and were identifiable as tumor cells based on large size, nuclear irregularity, and increased nuclear to cytoplasmic ratio. Unlike aspirates from conventional breast carcinoma, individual dispersed cells and cellular discohesiveness were not prominent features. Subsequent histologic material from these patients revealed the characteristic tumor emboli plugging dermal lymphatics. We conclude that in the appropriate setting, the diagnosis of inflammatory carcinoma can be established by FNA.

Adenocarcinoma↗
PubMed1996

Fine-needle aspiration cytology of ganglion cysts.

Ganglion cyst is a relatively common lesion resulting from mucoid, cystic degeneration of soft tissues adjacent to a joint space. Aspiration of cyst contents has been increasingly advocated as a diagnostic and, in some instances, therapeutic modality. We report the fine-needle aspiration cytologic (FNAC) findings from seven cases of ganglion cyst. These include the aspiration of thick, gelatinous fluid and a smear comprised of rare histiocytes embedded in a mucoid matrix. Although these findings are nonspecific, we believe that in the appropriate clinical setting, the diagnosis of ganglion cyst can be made with confidence by FNA.

Adult↗
PubMed1996

Squamous cells in fine-needle aspiration biopsies of salivary gland lesions: potential pitfalls in cytologic diagnosis.

A spectrum of neoplastic and non-neoplastic lesions of the salivary glands may contain squamous cells. These include chronic sialadenitis, lymphoepithelial cyst, pleomorphic adenoma, Warthin's tumor, mucoepidermoid carcinoma, and squamous cell carcinoma. The squamous cells may be a defining feature of the lesion, or an occasional and thus unexpected finding, with a consequent potential for misdiagnosis. Clinical management of these lesions differs significantly, and careful evaluation of the squamous elements, along with attention to other cellular and background components, facilitates accurate diagnosis.

Adenolymphoma↗
PubMed1996

Lymph node recovery from colorectal resection specimens removed for adenocarcinoma. Trends over time and a recommendation for a minimum number of lymph nodes to be recovered.

Recovery of pericolorectal lymph nodes from colectomy specimens has long been part of colorectal cancer staging. Recently, adjuvant therapy has been added for high stage carcinomas, providing further impetus for performing careful lymph node dissections. Pericolorectal lymph nodes were examined to determine if there has been a change over time in the number of lymph nodes recovered and proportion of specimens with pericolonic lymph node metastases from colorectal carcinoma resection specimens. Also, the authors attempted to establish a recommendation for a minimum number of lymph nodes that should be recovered before a colon can be considered free of metastases. Slides and reports of the first 20 consecutive pT3 colorectal carcinoma resections in each year from 1955 to 1995 at William Beaumont Hospital that did not have known metastases at the time of surgery were reviewed (750 specimens total). The mean number of lymph nodes recovered per specimen and incidence of detected lymph node metastases increased over the 41-year period, with the greatest increase occurring during 1992-1995. The greatest proportion of patients with lymph node metastases detected occurred in the 17 to 20 lymph nodes recovered per specimen group. Specimens with more than 20 lymph nodes did not have a higher proportion of lymph node metastases detected compared to specimens with 17 to 20 lymph nodes. Approximately 20% of the specimens with metastases had more than 17 lymph nodes recovered. These results suggest that pathologists should retrieve all the lymph nodes that can be recovered, but at least 17 lymph nodes should be recovered to insure accurate documentation of nodal metastases when present.

Adenocarcinoma↗
PubMed1996

Detection of Kaposi's sarcoma-associated herpesvirus-like DNA sequence in angiosarcoma.

The partial DNA sequence of a putative new herpesvirus has recently been isolated from almost all cases of Kaposi's sarcoma (KS), from a small subset of AIDS-related lymphomas, and from a high proportion of multicentric Castleman's disease. The presence of this KS-associated herpesvirus, which is also known as human herpes virus 8 (KSHV/ HHV8), has not been reported in vascular tumors other than KS. We therefore examined a series of vascular neoplasms of both endothelial and pericyte derivation using polymerase chain reaction to detect a 233-hp segment of the viral DNA. KSHV/HHV8 sequences were found in 7 of 24 (29%) angiosarcomas and 1 of 20 (5%) hemangiomas but not in any hemangiopericytomas (0 of 6). The presence of the virus in angiosarcoma was confirmed by direct sequencing of the polymerase chain reaction product and Southern blotting in one case each. Only one of the affected patients was known to be immunocompromised. By detecting its presence in a significant proportion of angiosarcomas, this study extends the number of tumors associated with KSHV/HHV8, further tightens its association with malignancy, and suggests a tropism of the virus for endothelial cells. The presence of KSHV/HHV8 in angiosarcomas in addition to classical KS also indicates that immunosuppression is not a requisite for viral infection.

Adolescent↗
PubMed1996

Fine-needle aspiration of the head and neck.

Fine-needle aspiration cytology is a valuable technique in the work-up of nodules and masses arising within the head and neck. Squamous cell carcinoma is present most often, and because of this relative frequency, the primary utility of needle-aspiration cytology is in the confirmation or exclusion of this diagnosis. FNA is particularly helpful in the work-up of cervical masses and nodules because biopsy of cervical adenopathy should be avoided unless all other diagnostic modalities have failed to establish a diagnosis. As such, needle-aspiration cytology represents an accurate, inexpensive, and rapid technique for elucidation of the etiology of cervical adenopathy. The majority of aspirates from cervical lymph nodes will disclose either reactive lymphadenopathy or metastatic squamous cell carcinoma. Occasional nodules will be due to lymphoma. While primary diagnosis of lymphoma by needle-aspiration cytology is generally not considered definitive, it is helpful in clarifying the nature of the process and the direction additional diagnostic tests should take. Similarly, establishing the presence of carotid body tumors, brachial cleft cysts or epidermal inclusion cysts excludes metastatic carcinoma and negates the need for open biopsy as well as allaying concerns on the part of both clinician and patient. Fine-needle aspiration of lesions within the mouth, oral pharynx, nasopharynx, and nasal sinuses has similar diagnostic goals, in that eliminating squamous cell carcinoma is its paramount objective. Fine-needle aspiration cytology can also establish a specific diagnosis for many lesions within this area. This technique can make specific diagnoses of angiofibroma, primary adenocarcinoma of the nasal sinuses, rhabdomyoma, granular cell tumor, and rhabdomyosarcoma. Each of these represents an important clinical entity with a specific therapy. Utilizing electron microscopy and immunohistochemical techniques, along with flow cytometry, can greatly broaden the diagnostic range and specificity of needle-aspiration cytology. Flow cytometry and immunohistochemistry are particularly useful in the establishment of monoclonality in lymphoproliferative processes and, hence, aid in the separation of reactive from lymphomatous lymphadenopathy. Immunohistochemistry can establish the precise nature of lesions as variable as rhabdomyosarcoma, olfactory neuroblastoma, and granular cell tumor. The prudent use of these techniques can be cost-effective and negate the need for more invasive diagnostic procedures. Needle-aspiration cytology represents a cost-effective and rapid technique for the assessment of nodules and masses within the head and neck area. Limitations in accuracy exist. In particular, the separation of reactive atypia in benign squamous epithelium from well-differentiated squamous cell carcinoma may be exceedingly difficult, if not impossible. Nonetheless, the technique has a high degree of accuracy for the diagnosis of both primary and metastatic disease.

Biopsy, Needle↗
PubMed1995

Mucinous cystic tumor of the pancreas: an analysis of FNA characteristics with an emphasis on the spectrum of malignancy associated features.

Previously, pancreatic mucinous cystic tumors were classified as either benign (cystadenoma) or malignant (cystadenocarcinoma). Descriptions of the fine-needle aspiration (FNA) findings of these neoplasms have heretofore emphasized malignant cytologic characteristics. In the following, we present a summary of a study of FNA characteristics from ten patients with cystic mucinous neoplasms, four of whom have correlating histologic material. In this study, we found a spectrum of cytologic features ranging from completely benign appearing to obviously malignant. We discuss cystic mucinous pancreatic tumors and the associated FNA findings helpful in diagnosis and categorization of these neoplasms. Also, we suggest the inclusion of a new entity in the mucinous neoplasm category.

Adenoma↗
PubMed1995

Prognostic indicators for neuroblastoma: stage, grade, DNA ploidy, MIB-1-proliferation index, p53, HER-2/neu and EGFr--a survival study.

Neuroblastoma, a tumor of the sympathetic nervous system, is one of the most common solid malignancies in infants and represents 7% of all cases of childhood cancer outside of the central nervous system. Thirty-five samples of neuroblastoma from 31 patients were obtained from Duke University Medical Center between 1979 and 1991 and studied to determine the relative prognostic value of a number of clinical, histologic, nuclear, and oncogenic features. The features studied were: stage, Shimada classification, DNA ploidy, MIB-1-proliferation index and status for HER-2/neu, p53 and epidermal growth factor receptor (EGFr). Only age (P = .03), HER-2/neu (P = .01), and p53 (P = .02) reached statistical significance as prognostic indicators. The median survival for patients with HER-2/neu expression was 12 months; median survival for patients with no HER-2/neu expression was 138 months. Similarly, the median survival for patients with p53 expression was 12 months; patients with no p53 expression had a median survival was 144 months. The combination of either HER-2/neu or p53 positivity was especially strong as a prognostic indicator (P = .002).

Antibodies, Monoclonal↗
PubMed1995

Diagnostic utility of K-ras mutational analysis on bile obtained by endoscopic retrograde cholangiopancreatography.

BACKGROUND: Because K-ras oncogene mutations are present in more than 90% of pancreaticobiliary tumors, we tested prospectively whether K-ras mutational analysis of bile samples obtained during ERCP was superior to conventional bile cytology for diagnosis of malignancy. METHODS: Bile samples from 20 patients undergoing ERCP for evaluation of jaundice were examined by both cytologic study and the polymerase chain reaction for the presence of K-ras oncogene mutations. RESULTS: Polymerase chain reaction products were amplified from the bile of 8 of 12 patients with malignancy and 3 of 8 with benign disease; K-ras oncogene mutations were present in 4 of 8 polymerase chain reaction products from malignant samples but absent in all 3 from benign samples. No cytologic results were positive for malignancy. CONCLUSIONS: Bile obtained during ERCP can yield positive results in K-ras mutational analysis, even when results of conventional bile cytology are negative. In this study, K-ras mutational analysis had a sensitivity of 33% (4 of 12), a specificity of 100%, and a positive predictive value of 100% for diagnosis of malignancy.

Bile↗
PubMed1995

Atypical glandular cells of undetermined significance. Cytologic criteria to separate clinically significant from benign lesions.

Histologic follow-up of the cervical-vaginal smear diagnosis of atypical glandular cells of undetermined significance (AGUS) shows a broad spectrum of clinically significant (preneoplastic or neoplastic) and benign lesions. There are few statistical studies that have attempted to separate these AGUS categories based on select cytologic criteria. The authors retrospectively reviewed 116 AGUS without concurrent squamous dysplasia smears (66 clinically significant and 50 benign lesions), and used logistic regression analysis to identify the cytologic criteria of irregular nuclear membranes, atypical single cells, and decreased cytoplasm as useful in separating clinically significant from benign lesions. Using contingency tables, these criteria in combination had a sensitivity 29% and a specificity of 94% in the diagnosis of clinically significant lesions. If any single criterion was present, the sensitivity and specificity were 100% and 28%, respectively. In conclusion, by using key cytologic criteria, a percentage of benign AGUS lesions can be separated from clinically significant AGUS lesions.

Diagnosis, Differential↗