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Biomedical subjects

L J Layfield

Publications and source records attributed to L J Layfield.

At least 145 records · Page 8Linked to original sources
PubMed1987

Cytological grading of prostatic aspiration biopsy: a comparison with the Gleason grading system.

Cytological grade determined by fine needle aspiration of the prostate was compared to histological grade in 30 patients undergoing subsequent radical prostatectomy. The degree of cytological pleomorphism determined by the consensus grade of 3 observers predicted correctly the Gleason grade sum range in 80 per cent of the cases. The cytological grade was reasonably reproducible with agreement among all 3 observers in 50 per cent of the cases and between 2 of 3 observers in the remainder. The accuracy of predicting the Gleason grade sum of the radical prostatectomy specimen by cytological examination compared favorably with that achieved by histological examination of cutting needle biopsy and transurethral resection specimens reported in the literature.

Adenocarcinoma↗
PubMed1987

Fine-needle aspiration of salivary gland lesions. Comparison with frozen sections and histologic findings.

The results of 171 salivary gland fine-needle aspirates, with subsequent histologic correlation, were compared with those from previous head and neck series and analyzed for diagnostic accuracy. Cytologically, 118 cases were diagnosed as benign; 51, malignant; and two, insufficient for diagnosis. The false-negative rate was 4.7%, and the false-positive rate was 3.5%. Pleomorphic adenoma, mucoepidermoid carcinoma, chronic sialadenitis, and malignant lymphoma were the lesions most frequently misdiagnosed. Corresponding frozen sections (available in 38 cases) showed an exact correlation with the final surgical pathologic diagnosis in 58% of the cases, with no false-positive diagnoses but an 11% false-negative rate.

Adenoma, Pleomorphic↗
PubMed1986

Fine-needle aspiration of primary soft-tissue lesions.

This study presents the cytologic findings of fine-needle aspiration (FNA) in a series of 136 primary soft-tissue tumors. The cytologic appearances of some rare mesenchymal lesions are presented, including the first (to our knowledge) published descriptions of fibrous hamartoma of infancy and myositis ossificans. Fine-needle aspiration showed high diagnostic sensitivity (95%) and specificity (95%) for the determination of malignancy, approaching that obtained with frozen-section interpretation. Problems encountered with the diagnosis of mesenchymal lesions, including nodular fasciitis, Kaposi's sarcoma, and spindle cell lipoma, are discussed. Based on these findings, recommendations for aspiration cytology of soft-tissue tumors are presented.

Adolescent↗
PubMed1985

Clinical and pathologic findings of the liver in the acquired immune deficiency syndrome (AIDS).

Clinical data and histologic sections of the liver, including immunohistochemical studies for hepatitis B surface and core antigens, were reviewed in 42 autopsy cases of the acquired immune deficiency syndrome (AIDS). Hepatomegaly, elevation of serum transaminases, and mild elevation of alkaline phosphatase were commonly observed clinical and biochemical abnormalities. Mildly elevated alkaline phosphatase and normal bilirubin levels were present in patients with Mycobacterium avium-intracellulare (MAI) infection, cytomegalovirus (CMV) infection, and Kaposi's sarcoma (KS). Histologic sections demonstrated liver involvement by MAI in eight cases; KS in six cases; cryptococcus in three cases; and CMV in two cases. One case of MAI infection was associated with marked central vein sclerosis, a finding previously unreported. Thirty-two (76%) of 42 cases had serologic or pathologic evidence of hepatitis exposure. Two patients had histologic evidence of chronic active hepatitis. The pathologic processes involving the liver appeared to be secondary to the infections and neoplasms for which this population is susceptible and did not significantly contribute to morbidity or mortality. No findings specific or pathognomic for AIDS were identified in the liver.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Adrenal pathology in the acquired immune deficiency syndrome.

Adrenal pathology was examined in 41 autopsied patients with the acquired immune deficiency syndrome. This represents the largest series and the first study with quantitation of adrenal cortical necrosis. In 32 cases clinical data were analyzed for features of adrenal insufficiency. Common clinical findings included vomiting, diarrhea, fever, hypotension, and hyponatremia. None of the 32 patients showed characteristic skin hyperpigmentation. Two patients were suspected premortem to have adrenal insufficiency. In one of these patients, adrenocorticotrophic hormone (ACTH) stimulation resulted in an adequate rise in plasma cortisol values. In the other patient, the baseline plasma cortisol value was elevated and failed to rise significantly after ACTH stimulation. Pathologic findings included widespread lipid depletion, infection by cryptococcus, and acid-fast organisms consistent with Mycobacterium avium-intracellulare, involvement by Kaposi's sarcoma, and necrotizing adrenalitis due to cytomegalovirus (CMV). A point-counting method was used to quantitate adrenal cortical and medullary necrosis. Necrosis due to CMV was greater in the medulla than the cortex. The maximum amount of adrenal cortical necrosis in any case was 70%. The degree of cortical necrosis was less than that usually associated with adrenal insufficiency.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Fine-needle aspiration of lymphadenopathy of suspected infectious etiology.

We present a protocol for culture of lymph node find-needle aspirations in a series of 44 patients. Clinical indications for inclusion in the protocol included fever, localized erythema, pain or heat, an independent clinical diagnosis of infection by the referring physician, or a grossly purulent appearance of the initial aspirate material. Organisms (fungi, bacteria, or mycobacteria) were isolated in 13 (30%) of the aspirates. The probable contamination rate was 9%. These figures approached the culture yields obtained from open biopsy specimens as reported in the literature. A notable discrepancy existed between the cytologic appearance of the aspirates and culture results in three cases of mycobacteria. Six unsuspected malignancies were diagnosed. There were no complications from the procedure in this series. Based on this study, we present recommendations for culture of fine-needle aspirates from lymph nodes.

Adolescent↗
PubMed1979

Coronary ostial embolus and mitral vegetation simulating a left atrial myxoma: a case of probable cryptococcal valvulitis.

A 56 year old man died with disseminated cryptococcosis after immunosuppressive therapy for a hematologic disorder of unknown etiology. The immediate cause of death was cardiogenic shock, probably resulting from a large right coronary ostial embolus and subsequent ischemic myocardial injury. The embolus originated from a bulky mitral vegetation (possibly cryptococcal) demonstrated ante mortem by echocardiography and cardiac angiography, and at autopsy. The differential diagnosis of such an echocardiographic pattern is discussed.

Coronary Disease↗
PubMedDate not supplied

MR imaging-guided interstitial Nd:YAG laser phototherapy: dosimetry study of acute tissue damage in an in vivo model.

A dosimetry study of acute tissue damage induced by interstitial application of the neodymium-yttrium-aluminum-garnet (Nd:YAG) laser was performed with magnetic resonance (MR) imaging. The MR appearance of the lesion was correlated with gross and histopathologic findings. Seventy-six lesions were induced in rabbit muscle with laser power outputs of 5-20 W and exposure times of 20-600 seconds. MR imaging was performed immediately after laser exposure. T2-weighted spin-echo images clearly showed the acute thermal injuries caused by laser energy deposition and correlated best with histopathologic findings. These images showed three distinct layers, corresponding to central ablation, coagulative necrosis, and interstitial edema, respectively, in the pathologic findings. Lesion diameters measured on MR images showed a linear correlation with those in gross sections. Lesion volume increased not only with increasing total energy delivered but with increasing power output for a fixed total energy delivered. MR imaging is an accurate modality for dosimetry studies of laser-induced acute lesions.

Animals↗
PubMedDate not supplied

Protein leakage in the lungs of mice exposed to 0.5 ppm nitrogen dioxide.

Forty-four mice were continuously exposed to 0.47 ppm nitrogen dioxide for ten, 12, and 14 days. The protein content of homogenized lung tissue was assayed fluorometrically after the animals had received intravenous injections of fluorescamine, a new reagent for protein assay. The mean protein value of all exposed animals was higher than that of the control animals (P less than .025). No correlation was noted between serum fluorophor levels and those in the lung homogenate.

Animals↗
PubMedDate not supplied

Logistic regression analysis of low grade spindle cell lesions. A cytologic study.

OBJECTIVE: To identify key diagnostic cytologic criteria for various low grade spindle cell lesions. STUDY DESIGN: We reviewed 20 synovial sarcomas, 18 benign neural tumors, 10 reparative lesions, 24 other benign and 27 additional malignant low grade spindle cell lesions. All specimens were coded as to the presence or absence of the following variables: high cellularity, tissue fragments, tissue culture appearance, epithelial fragments, vessel fragments, vascular arcades, fibrillar ground substance, myxoid background, microcystic areas, parallel arrangement of nuclei, naked nuclei, single cells, binucleate cells, multinucleate cells, long filamentous cells, short spindle cells, stellate cells, lipoblasts, nuclear pleomorphism, nuclei with pointed ends, comma/fishhook nuclei, cigar-shaped nuclei, ovoid/round nuclei, small nucleoli, large nucleoli, mitotic figures, intranuclear vacuoles and background histiocytes. A logistic regression analysis was performed to identify the variables predictive of malignant lesions, specifically synovial sarcomas, benign neural tumors and reparative lesions. RESULTS: Statistical analysis selected high cellularity, short spindle cells, small nucleoli and absence of tissue culture appearance as the main criteria for malignant neoplasms. Tissue fragments and high cellularity were selected as the primary criteria and absence of long filamentous cells and of myxoid background as the secondary criteria for synovial sarcomas. It selected fibrillar ground substance and absence of ovoid/round nuclei as the key criteria for benign neural tumors. The presence of a tissue culture appearance was the major criterion for reparative lesions. CONCLUSION: There are many previously described cytologic criteria, but we found that when subjected to statistical analysis, only a few features were significant in the evaluation of low grade spindle cell lesions.

Biopsy↗
PubMedDate not supplied

Cytomorphologic features of angiosarcoma on fine needle aspiration biopsy.

OBJECTIVE: To present the cytomorphologic features of angiosarcomas identified on fine needle aspiration biopsy, review the literature, and discuss the differential diagnosis and pitfalls involved in such cases. STUDY DESIGN: Fine needle aspirate smears from 11 cases (1 hepatic, 3 breast and 7 subcutaneous/soft tissue lesions of angiosarcomas from eight patients were reviewed. All cases had histologic confirmation of angiosarcoma. RESULTS: All aspirates were hypocellular, with predominantly single cells in a background of moderate to abundant amounts of blood. Nine cases had scattered inflammatory cells, primarily neutrophils, in the background. Six of the cases had rare small clusters of cells. The cells were oval, round or spindled, with eccentric, round to spindle-shaped nuclei and moderate to abundant amounts of pale blue-gray, vacuolated cytoplasm. The cells ranged from two to nine times the size of the background red blood cells. In four cases, malignant cells demonstrated intracytoplasmic hemosiderin deposits. Small nucleoli were identified in five cases, large nucleoli in one case and hyperchromasia in seven cases. Mitotic figures, erythrophagocytosis, acinarlike or vascular structures, and necrosis were not identified in any of the studied cases. In four cases, a definitive diagnosis of angiosarcoma was rendered on the fine needle aspiration specimen. In three other cases, the differential diagnosis remained between angiosarcoma and radiation change. CONCLUSION: The presence of scarce single pleomorphic cells in a bloody background should raise the diagnostic possibility of angiosarcoma. A definitive diagnosis of angiosarcoma is often difficult to render due to the paucity of diagnostic cells unless intracytoplasmic hemosiderin deposits can be identified. Multiple aspirations are often needed in order to obtain diagnostic material. In the setting of radiotherapy, it may be impossible to distinguish angiosarcoma from radiation change, and biopsy should be recommended.

Aged↗
PubMedDate not supplied

Logistic regression analysis of high grade spindle cell neoplasms. A fine needle aspiration cytologic study.

OBJECTIVE: To identify primary diagnostic cytologic criteria for various high grade spindle cell neoplasms. STUDY DESIGN: We reviewed 30 osteosarcomas, 29 malignant fibrous histiocytomas (MFH), 26 malignant melanomas, 13 chondrosarcomas, 12 leiomyosarcomas, 7 angiosarcomas and 5 liposarcomas. All specimens were coded as to the presence or absence of the following variables: high or low cellularity, tissuelike fragments, glandlike fragments, single cells, binucleated cells, multinucleated cells, lipoblastlike cells, histiocytelike cells, fibroblastlike cells, signet-ring cells, short spindle cells, long filamentous cells, stellate cells, osteoclastic giant cells, malignant giant cells, background cells, pointed nuclei, cigar-shaped nuclei, fishhook-shaped nuclei, round or ovoid nuclei, intranuclear vacuoles, macronucleoli, small nucleoli, mitotic figures, abnormal mitotic figures, pleomorphism, nuclear/cytoplasmic ratio (mild, moderate, marked increase), amount of cytoplasm (scant, moderate, abundant), fine or coarse granular cytoplasm, intracytoplasmic hemosiderin deposits, melanin, cytoplasmic vacuoles, fat, capillary vessel fragments, storiform pattern, necrosis, large or small amount of myxoid material, filamentous stroma, dense collagenous stroma, osteoid, chondroid and cells in lacunae. A logistic regression analysis was performed to identify the variables predictive of each diagnostic category. RESULTS: The statistical analysis selected positive expression of osteoid, osteoclastic giant cells and low cellularity as the primary criteria associated with osteosarcomas. Positive expression of fibroblastlike cells, large amount of myxoid material and multinucleated cells were identified to be the key criteria for MFH. The analysis selected the presence of melanin as the major criterion for malignant melanomas, cells lying in lacunae for chondrosarcomas, fishhook nuclei for leiomyosarcomas, intracytoplasmic iron deposits for angiosarcomas and lipoblastlike cells for liposarcomas. CONCLUSION: From the previously described cytologic criteria, statistical analysis helped identify several key features that are significant in the evaluation of pleomorphic spindle cell neoplasms.

Biopsy, Needle↗
PubMedDate not supplied

Effects of chemotherapy and tamoxifen on cervical and vaginal smears in bone marrow transplant recipients.

OBJECTIVE: To clarify the importance of squamous and glandular atypia in the genital tracts of women undergoing high-dose chemotherapy and receiving tamoxifen. STUDY DESIGN: The pathology records of 769 female bone marrow transplant recipients from a five-year period at Duke University Medical Center were reviewed. One hundred fifteen cervicovaginal smears from 78 patients were available for evaluation; of these, 85 smears from 61 patients were selected. Only cases from patients with a complete medical history, including menopausal status and therapeutic regimen, were included in this study. Forty-five cases were from patients treated with chemotherapy alone, and 40 were from patients treated with a combination of chemotherapy and tamoxifen. RESULTS: A normal cellular pattern was the most common finding. Reactive cellular changes associated with therapy effect were identified in 21% of cases. In patients treated with chemotherapy alone, an atrophic smear pattern in a premenopausal woman was identified in 27% of cases. Squamous epithelial cell abnormalities were identified in approximately the same proportion of patients whether they received chemotherapy alone or with tamoxifen. Glandular changes were uncommon. CONCLUSION: The most common finding was a normal smear pattern. An atrophic smear was more commonly found in patients treated with chemotherapy alone than in those treated with both chemotherapy and tamoxifen. Squamous epithelial cell abnormalities are most probably independent of treatment effect. Glandular changes were rare in patients treated with chemotherapy, alone or in combination with tamoxifen.

Adult↗
PubMedDate not supplied

Fine needle aspiration of osteogenic sarcoma metastatic to the lung. A report of four cases.

BACKGROUND: Osteogenic sarcoma (OGS) is a relatively rare, highly malignant neoplasm of bone with a tendency to metastasize to the lung. Resection of pulmonary metastases in selected instances can increase survival and likelihood of a cure. To date, fine needle aspiration (FNA) of OGS had been well characterized in primary sites of bone and soft tissue. CASES: Four patients with a history of OGS presented with lung nodules suspected to be metastatic disease. All were evaluated initially by radiographically assisted FNA. In all cases FNA showed spindled or osteoblastlike cells. Two cases demonstrated stromal elements: chondroid or osteoid matrix in one case each of chondroblastic and conventional OGS. All four cases had histologic confirmation of metastatic OGS in the form of subsequent surgical resection of the lung nodules. CONCLUSION: New pulmonary nodules in a patient with known malignancy is almost always metastatic disease. In a patient with a history of OGS, the diagnosis is extremely likely to be metastatic OGS, but a few other entities may occur. Although these entities are rare, their occasional occurrence could argue for preoperative confirmation of the lung lesion as malignant prior to subjecting the patient to pulmonary resection. Our findings show FNA features of OGS that have been previously observed in primary sites. These findings are specific enough to diagnose metastases if the patient has known primary OGS.

Adult↗
PubMedDate not supplied

Endoscopic brush cytology of the upper urinary tract. Evaluation of its efficacy and potential limitations in diagnosis.

OBJECTIVE: To evaluate the efficacy of endoscopic brush cytology in diagnosing transitional cell carcinoma of the upper urinary tract. STUDY DESIGN: Sixty-three endoscopic brush cytology specimens from 48 patients were compared with corresponding cytologic specimens obtained by irrigation and catheterization as well as histologic specimens. RESULTS: Twenty patients (25 brushes) had histologically documented transitional cell carcinoma (TCC) or carcinoma in situ (CIS) of either the ureter or renal pelvis. Among these, 8 (32%) of the brush samples were reported as positive for TCC, 10 (40%) atypical or suspicious, and 7 (28%) negative. The seven negative cases were ultimately shown to be low grade (I-II/IV) TCC. Combining atypical and positive diagnoses, the calculated sensitivity for diagnosis of TCC by this technique was 72%. The irrigations or catheterized urines from these same patients yielded lower sensitivity, 48%, and detected only higher grade lesions. Ten patients were proven histologically to have nonneoplastic disease (hydroureter, obstruction, inflammation). Sixteen of the 17 brush specimens from these patients were negative, resulting in a specificity of 94%. In the remaining 18 patients (21 brushes) there were 17 negatives and 4 atypicals. Concomitant cytology supported the brush diagnosis in all but one sample. CONCLUSION: Brush cytology is a specific and more sensitive sampling method than irrigation or catheterized urine in detecting TCC of the upper urinary tract. Brush cytology does not appear to be successful in diagnosing dysplasia or CIS. As with urinary cytology in general, the technique is less effective in diagnosing low grade (I and II) lesions.

Carcinoma in Situ↗
PubMedDate not supplied

Transthoracic fine needle aspiration biopsy. Sensitivity in relation to guidance technique and lesion size and location.

OBJECTIVE: To obtain site- and size-specific data on transthoracic fine needle aspiration (TFNA) and determine the sensitivity in relation to guidance technique and lesion size and location. STUDY DESIGN: Data on 112 patients undergoing TFNA between 1992 and 1993 were analyzed for accuracy rates, stratified according to lesion size and location within the lung. The series included 13 benign lesions, 53 metastatic neoplasms and 46 primary carcinomas. RESULTS: Overall sensitivity was 90%, with 92% specificity. There was a clear relationship between nodule size and sensitivity of TFNA, with a sensitivity of 60% for lesions < 1 cm but 93% sensitivity for nodules > or = 2 cm in diameter. Similarly, lesion location affected sensitivity. Sensitivity was 100% for peripherally located nodules but was as low as 82% for nodules in the centrobasal portion of the lung. Sensitivity was higher for fluoroscopy (97%) than computed tomography (80%). CONCLUSION: The guidance technique as well as lesion location and size affect diagnostic accuracy.

Biopsy, Needle↗
PubMedDate not supplied

Bone tumor radiograph review by pathologists prior to pathologic diagnosis: a receiver operator curve analysis of diagnostic utility.

Radiologic-pathologic correlation has long been considered a prerequisite for the accurate diagnosis of bone lesions. We investigated using receiver-operating characteristic analysis the accuracy of histopathologic diagnoses with and without pathologist review of radiographs. While accuracy of diagnosis did improve when the radiographs were reviewed by the pathologist, this increase did not reach statistical significance (P=0.1311). Potential reasons for this finding including case selection and reviewer expertise are discussed. Based on our study, the review of radiographs did not result in a statistically significant difference in accuracy of the pathologic diagnosis of bone tumors. However, our data suggest that there may be a difference particularly in selected cases and among certain observers.

Bone Neoplasms↗