Biomedical subjects

L J Layfield

Publications and source records attributed to L J Layfield.

At least 163 records · Page 9Linked to original sources

PubMedDate not supplied

Aspiration biopsy smear pattern as a predictor of biologic behavior in adenocarcinoma of the breast.

Fine needle aspiration cytology (FNAC) is increasingly used for the initial diagnosis of breast carcinoma, yet few studies have investigated the prognostic importance of cytologic features seen in breast FNAC. We studied the relationship between prognosis and smear morphology in 26 patients with breast carcinoma for whom information from long-term follow-up was available. Specifically, we attempted to correlate nuclear grade and smear pattern with hormonal receptor status, lymph node status, breast recurrence and distant metastasis. In an additional five patients (on whom insufficient follow-up information was available), smear pattern and nuclear grade were correlated with hormonal status. Smears were classified into three patterns: typical (sheets and clusters), individual cell predominant and cluster predominant. The individual cell predominant pattern was associated with an increased incidence of distant metastasis when compared with the other two smear patterns (P less than .05). No statistically significant association was observed between smear pattern and the other factors studied. Nuclear grade 2 (of 3) was also associated with an increased incidence of distant metastasis. However, most grade 2 tumors (10/12) were of the individual cell predominant pattern. Smear pattern classification, along with DNA ploidy analysis and hormone receptor analysis of FNAC-derived material, may yield valuable prognostic information.

Adenocarcinoma↗

PubMedDate not supplied

Spontaneous infarction of a parotid gland pleomorphic adenoma. Report of a case with cytologic and radiographic overlap with a primary salivary gland malignancy.

Pleomorphic adenoma is the most common neoplasm of the parotid gland, generally presenting as a slowly enlarging, firm, well-circumscribed, painless nodule. Occasional cases have presented after a short period of rapid growth or have been associated with pain. The vast majority of these tumors are solid, but rare examples have been associated with cystic degeneration or hemorrhage. Spontaneous and tumor-associated infarction of the parotid has been reported, but these examples have been limited to infarctions of Warthin's tumors and postoperative infarctions of salivary glands. We present the case of a 48-year-old male with a one-year history of a painful, enlarging, left parotid mass associated with paresthesia of the tongue. Computed tomographic examination of the parotid demonstrated a left superficial lobe mass with a rim of enhancement and low attenuation center. Fine needle aspiration yielded necrotic debris and atypical squamous elements that were thought to be compatible with carcinoma. A superficial parotidectomy with intraoperative frozen section revealed a pleomorphic adenoma with extensive central necrosis. To our knowledge, this represents the first reported case of an infarcted pleomorphic adenoma and illustrates the potential for misinterpretation of these cytologic and radiologic findings as indicative of malignancy.

Adenoma, Pleomorphic↗

PubMedDate not supplied

Endoscopically directed fine needle aspiration biopsy of gastric and esophageal lesions.

Endoscopically directed fine needle aspiration (FNA) has been reported to be a valuable adjunct to forceps biopsy in the evaluation of gastric and esophageal lesions. In our series of 38 cases with endoscopically detected mucosal and submucosal abnormalities, FNAs were obtained with a Stifcor transbronchial aspiration needle. Four cases were reported as insufficient. Five aspirates correctly documented the presence of a neoplasm, but three failed to identify a subsequently histologically confirmed adenocarcinoma. Two cases were falsely suspicious for adenocarcinoma. FNA correctly excluded lymphoma in 12 patients with thick gastric folds clinically suspicious for lymphoma. FNA is a useful adjunct to forceps biopsy of neoplastic and inflammatory lesions in both mucosal and submucosal locations within the upper gastrointestinal tract.

Biopsy, Needle↗

PubMedDate not supplied

Thyromegaly secondary to simultaneous papillary carcinoma and histiocytosis X. Report of a case and review of the literature.

The cytologic and histologic findings are reported in a case of papillary carcinoma arising within a thyroid gland pathologically enlarged by histiocytosis X. Fine needle aspiration (FNA) biopsies of a thyroid nodule in a patient with longstanding histiocytosis X produced a scanty amount of colloid, a moderately dense mixed inflammatory infiltrate and numerous small papillary fragments lined by cuboidal-to-columnar cells. Both the inflammatory cells and the epithelial cells showed nuclear grooves; the two populations of neoplastic cells were distinguished, and the correct diagnosis of the nodule was made, by recognizing the greater amount of granular cytoplasm of the mononucleated Langerhans' cells. The rare involve-of the thyroid by histiocytosis X is reviewed; this case, which appears to be the first reported instance of the co-occurrence of histiocytosis X and papillary carcinoma of the thyroid, indicates that patients with histiocytosis X should be observed for the development of thyroid carcinoma and that FNA biopsy can make the distinction between the two conditions.

Adult↗

PubMedDate not supplied

Necrosis in thyroid nodules after fine needle aspiration biopsy. Report of two cases.

Two cases of infarction of thyroid neoplasms following fine needle aspiration (FNA) biopsy are reported. Histologic study of a 2.5 x 2.5 cm nodule excised 18 days after FNA had diagnosed a Hürthle-cell neoplasm showed mainly necrotic debris and granulation tissue. While FNA made the diagnosis of a papillary carcinoma in the second case, which had had an FNA biopsy of the same nodule six years earlier, most of the nodule was fibrotic and necrotic. These two cases demonstrate the potential problems in such cases: (1) post-FNA infarction may obscure the nature of a cytologically diagnosed neoplasm, making histologic confirmation difficult, and (2) FNA of an infarcted nodule may have difficulties in obtaining diagnostic material, potentially resulting in a false-negative diagnosis. Review of the literature on thyroid infarction shows it to be a rare event, with most reported cases occurring after FNA biopsy of a neoplasm. The finding of necrosis and fibrosis in an aspirate or surgical specimen should thus suggest the presence of a neoplasm.

Adult↗

PubMedDate not supplied

Fine needle aspiration cytology of cystic parathyroid lesions. A cytomorphologic overlap with cystic lesions of the thyroid.

Three cases of palpable cystic parathyroid nodules examined by fine needle aspiration (FNA) cytology are reported. Two of the three aspirates were incorrectly identified as thyroid neoplasms due to the presence of papillary clusters or microfollicles and grossly golden-brown cyst fluid. Histologic examination of these two nodules revealed partially cystic parathyroid adenomas. Aspirated material from the third patient yielded clear watery fluid, which was correctly identified as consistent with a parathyroid cyst. The diagnostic difficulties in the differentiation of parathyroid adenoma from thyroid carcinoma or adenoma are discussed, as is the utilization of assays for parathyroid hormone in making the FNA diagnosis of parathyroid lesions.

Adenoma↗

PubMedDate not supplied

Lipomatous lesions of the parotid gland. Potential pitfalls in fine needle aspiration biopsy diagnosis.

Nine cases of benign fatty tumors of the parotid studied initially by fine needle aspiration (FNA) biopsy and subsequently diagnosed by open biopsy were reviewed. All lesions presented as enlargements of the parotid gland. The cytologic diagnoses were correct in only five of the nine cases. While four of six FNA samples from lipomas were correctly diagnosed by cytology, the other two samples were classified as inadequate. Three cases of diffuse infiltration of the parotid by mature-appearing adipose tissue were cytologically characterized as "no diagnostic change" in two cases and sialosis in one case. The clinical, radiologic, cytologic and histologic features of these tumors are described to increase the familiarity of cytologists with these lesions, which may prevent unnecessary surgical intervention in some patients.

Adult↗

PubMedDate not supplied

Fine needle aspiration cytology: utilization in pediatric pathology.

Fine needle aspiration can serve as the initial diagnostic modality for a wide variety of lesions within the pediatric age group. The utility of the technique depends on the clinical setting and histologic type of tumor under study. FNA is most valuable for staging and conformation of metastatic spread in small round cell malignancies. The use of aspiration cytology as the initial diagnostic procedure for these neoplasms is more controversial since this technique may deprive the clinician of valuable information (histologic subtype, oncogene status) now available only by examination of large tissue biopsies. Similarly, FNA can serve as a triage technique for the separation of patients harboring thyroid nodules or enlarged lymph nodes into operative candidates and non-operative candidates. As cytopathologists become more familiar with the appearance of pediatric neoplasms, this diagnostic technique will become more widely used, reducing the need for operative intervention in the diagnosis of many benign and reactive lesions.

Aneuploidy↗

PubMedDate not supplied

Fine needle aspiration cytologic findings in a case of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman syndrome).

The clinical, fine needle aspiration (FNA) cytologic and histologic findings in a case of sinus histiocytosis with massive lymphadenopathy (SHML) in a five-year-old boy are presented. The FNA smears showed a proliferation of plasma cells, lymphoid cells and histiocytes demonstrating emperipolesis that is characteristic of this benign disorder; these cytologic findings were reported as a reactive lymphoid infiltrate with a high content of benign histiocytes. The diagnosis was made on a subsequent open biopsy performed on the persistent lymphadenopathy. The differential diagnosis of lymph nodes containing a prominent component of histiocytes is discussed.

Biopsy, Needle↗

PubMedDate not supplied

Fine needle aspirate smear morphology in metastatic melanoma.

Cytologic smear preparations of fine needle aspirates obtained from 71 patients with biopsy-proven metastatic malignant melanoma were morphologically analyzed. Cell diameter, percentage of cells lying individually, smear cellularity, mitotic rate, percentage of cells with nuclear inclusions and number of giant cells were quantitated. Qualitative estimates of degree of pigmentation, background composition, presence of macrophages, presence of contaminating blood, cell shape, amount and appearance of cytoplasm, prominence of Golgi apparatus, reactivity with the antibody NKI/C-3 and eccentricity of the nuclei were made. While eccentric nuclei, cytoplasmic vacuoles, intranuclear inclusions, high cellularity and cells with abundant cytoplasm were found frequently in smears from malignant melanomas, the presence of reactivity with NKI/C-3, pigment, giant cells, a bloody background and a lack of cell cohesion were the features most commonly associated with smears obtained from patients harboring metastatic melanoma.

Antigens, Neoplasm↗

PubMedDate not supplied

Fine needle aspiration cytology of a trabecular adenoma of the parotid gland.

What is believed to be the first description of the cytologic presentation of a trabecular adenoma of the parotid gland in a fine needle aspirate is reported in the case of a 52-year-old woman. The cytologic findings included translucent spherical bodies surrounded by small round cells with a thin rim of cytoplasm and round-to-oval nuclei in Papanicolaou-stained specimens. The cells, which varied little in size, formed densely packed clusters. In May-Grünwald-Giemsa-stained preparations, mucoid globules were seen surrounded by palisading tumor cells. Nuclear anaplasia was not seen. The aspiration cytologic and even the histologic appearance of trabecular adenoma can closely mimic that of adenoid cystic carcinoma, which was the preoperative diagnosis in this case. Because the treatment of these two entities is different, it is important that trabecular adenoma be considered in the differential diagnosis. The observations in this case indicate that tinctorial properties of the intercellular substance may aid in differentiating between these two neoplasms in fine needle aspirates.

Adenoma↗

PubMedDate not supplied

Aspiration cytology and immunohistochemistry of a pheochromocytoma-ganglioneuroma of the adrenal gland.

The results of fine needle aspiration (FNA) cytology, immunohistochemical staining and electron microscopy of combined pheochromocytoma-ganglioneuroma are presented. The cytologic findings included clusters of neoplastic cells with features of a neuroendocrine tumor and aggregates of spindle-shaped cells with interspersed ganglionlike cells. Aspirated material was tested for a panel of hormones by the peroxidase-antiperoxidase method. The neoplastic cells showed positive staining for neuron-specific enolase (NSE) and vasoactive intestinal polypeptide (VIP). Electron microscopy demonstrated granules similar to those of a pancreatic VIPoma in the nerve processes of the ganglioneuroma component. This appears to be the first description of the FNA cytology of a combined pheochromocytoma-ganglioneuroma. The value of immunohistochemical staining in the study of FNA material for making a specific diagnosis and the clinical implications of a preoperative diagnosis in the management of this lesion are discussed.

Adrenal Gland Neoplasms↗

PubMedDate not supplied

Fine needle aspiration cytology of primary bone lesions.

Fine needle aspiration (FNA) cytologic findings were compared with the results of conventional histology in a series of primary bone lesions to determine the diagnostic accuracy of FNA cytology. The series included 12 osteogenic sarcomas, 4 Ewing's sarcomas, 3 chordomas, 3 myelomas, 2 chondrosarcomas, 2 undifferentiated sarcomas and 1 case each of normal bone and marrow elements, lymphoma and giant-cell tumor. All aspirates yielded adequate material for smear diagnosis, and all 29 cases were correctly identified as benign or malignant by cytology. In 19 cases (66%), specific cytologic diagnoses were rendered and histologically confirmed. This series is compared with other published series of bone aspirations in terms of technique, accuracy and ability to obtain diagnostic material. The importance of technique, radiographic investigations and experience in performing the aspirations in achieving a high diagnostic yield is emphasized.

Adolescent↗

PubMedDate not supplied

Fatal septic shock after fine needle aspiration of a pancreatic pseudocyst.

Fatal septic shock due to Streptococcus sanguis developed eight days after fine needle aspiration (FNA) of a pancreatic pseudocyst. The pseudocyst was adherent to the transverse colon (as is often the case with pseudocysts), and contamination of cyst fluid with colonic bacteria most likely initiated the infection. The patient had not received prophylactic antibiotics, even though the needle had been observed to pass through the bowel at the time of the CAT-scan-guided aspiration. Although the literature documents the safety and usefulness of FNA in the diagnosis of pancreatic tumors, this case suggests that prophylactic antibiotics be considered at the time of aspiration of pseudocysts or necrotic tumors.

Anti-Bacterial Agents↗

PubMedDate not supplied

Fine needle aspiration diagnosis of malignant lymphoma with confirmation by immunoperoxidase staining.

Cytospin preparations of fine needle aspirates in 14 cases of suspected lymphoma were studied by immunoperoxidase techniques. The combination of cytologic smears and immunoperoxidase studies resulted in a working diagnosis in 13 of the 14 cases. The immunologic markers in conjunction with the cytologic appearance of the aspirates were reliable and consistent in differentiating between malignant and benign lymphoproliferative lesions and in determining the B-cell or T-cell nature of the process.

Adult↗

PubMedDate not supplied

Neuropathologic findings in the acquired immunodeficiency syndrome (AIDS).

The acquired immunodeficiency syndrome (AIDS) is characterized by a severe idiopathic deficiency in T-cell mediated immunity. Homosexuals, intravenous drug abusers and Haitians are predominantly affected, predisposing them to opportunistic infections and neoplasms. In this study, the central nervous system (CNS) was examined at autopsy in 29 AIDS patients. Significant CNS complications occurred in 55%, mainly related to opportunistic infections similar to those seen in patients with other causes of immunosuppression. Progressive multifocal leukoencephalopathy (three cases), cytomegalovirus (CMV) encephalitis (five cases), cryptococcal meningitis (four cases), Mycobacterium avium-intracellulare (three cases), and toxoplasmosis (one case) were found. Widespread microglial nodules were observed in 20 patients, 80% of whom had CMV inclusions elsewhere at autopsy. Primary cerebral lymphoma (one case) and lymphomatoid granulomatosis (one case) were present. Subarachnoid (five cases) and intraparenchymal (three cases) hemorrhage was seen although these were not usually clinically significant. A single case of embolic arterial obstruction with cortical infarction was due to non-bacterial thrombotic endocarditis.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Accuracy and morphologic aspects of pancreatic and biliary duct brushings.

One hundred eight brushing cytology specimens with adequate follow-up were obtained from strictures of the biliary and pancreatic ducts. The material was classified as benign, reactive, low grade dysplasia, high grade dysplasia or adenocarcinoma. A diagnosis of carcinoma was made in 18 patients, high grade dysplasia in 12, low grade dysplasia in 6 and benign, nonneoplastic in the remaining cases. The diagnostic sensitivity for carcinoma was 44%, with a specificity of 98%. Ten of 12 patients with high grade dysplasia demonstrated other evidence of carcinoma. No complications were encountered. Brushing cytodiagnosis of extrahepatic biliary and pancreatic duct strictures appears to be a safe procedure, with high specificity but only modest sensitivity.

Adenocarcinoma↗

PubMedDate not supplied

Aspiration biopsy cytology of primary cutaneous tumors.

Primary cutaneous neoplasms may undergo fine needle aspiration during the workup of patients with suspected metastatic disease. Such aspirates present a wide range of epithelial and nonepithelial proliferations that must be separated from more common metastatic deposits. The majority of primary cutaneous tumors are composed of squamous or basaloid cells that can be confused with metastatic squamous cell carcinoma. In addition, primary cutaneous lymphomas and mesenchymal tumors morphologically overlap their more common systemic or metastatic counterparts in appearance. Both clinical and cytologic features aid in the differentiation of pilomatrixomas, basal cell carcinomas, sebaceous carcinomas, primary squamous cell carcinomas, Merkel cell tumors and epidermal inclusion cysts from metastatic squamous cell carcinomas. The presence of small basaloid cells in an aspiration smear favors the diagnosis of a primary neoplasm, such as pilomatrixoma or basal cell carcinoma. Clinical findings and cell marker studies are important in the cytologic diagnosis of primary cutaneous lymphomas. Complex convolutions in the nuclei of neoplastic lymphoid cells favor a primary cutaneous origin. We report the cytologic features of 94 primary cutaneous tumors seen in a series of 558 aspirates of subcutaneous and cutaneous nodules.

Adenocarcinoma↗