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M W Stanley

Publications and source records attributed to M W Stanley.

At least 19 recordsLinked to original sources
PubMed2000

Cytology of angiosarcoma. Findings in fourteen fine-needle aspiration biopsy specimens and one pleural fluid specimen.

We report the cytologic features of 15 cases of angiosarcoma from various sites and include 14 fine-needle aspiration (FNA) biopsy specimens and 1 pleural fluid specimen. Six were initial diagnoses with histologic confirmation; an additional case in the liver was an initial diagnosis without tissue confirmation. One case represented lymph node metastasis from a primary prostatic epithelioid angiosarcoma. In 10 cases, immunohistochemical staining for factor VIII-related antigen, CD34, CD31, or Ulex europaeus agglutinin I was performed on the cytology or histology specimen. The aspirates varied in cellularity, and the degree of nuclear atypia ranged from relatively bland in a case of low-grade angiosarcoma of the prostate to highly pleomorphic in a lymph node metastasis from a facial cutaneous angiosarcoma. Vasoformative features such as intracellular RBCs, well-formed vessels, attempts at microacinar/lumen formation, and intracytoplasmic lumens were variably present. The background was bloody in all specimens, with necrosis in rare cases. This cytologic series emphasizes that the cytologic features are heterogeneous but that the diagnosis can be suggested by fine-needle aspiration (FNA) when vasoformative features are present. The diagnosis can be made conclusively by FNA with immunocytochemical confirmation of endothelial differentiation.

Aged↗
PubMed1999

Syndecan-1 expression is induced in the stroma of infiltrating breast carcinoma.

Loss of expression of the heparan sulfate proteoglycan syndecan-1 leads to reduced cell adhesion, increased invasive potential, and dysregulated growth of mammary epithelial cells in vitro. We compared syndecan-1 expression in malignant and nonmalignant breast tissues using immunohisto-chemistry with monoclonal antibody B-B4. Staining for syndecan-1 is greatly diminished on malignant cells within infiltrating ductal carcinomas (n = 20) as compared with ductal epithelium of both normal breast (n = 14) and stromal-epithelial neoplasms (n = 10), which exhibit extensive basolateral epithelial staining. Surprisingly, comparison of malignant and nonmalignant breast tissue also reveals a striking difference in expression of syndecan-1 within the stromal compartment. In infiltrating ductal carcinomas, strong staining for syndecan-1 is present both within the connective tissue and on stromal cell surfaces, whereas syndecan-1 expression is absent in the stroma of both normal breast and stromal-epithelial neoplasms. Because syndecan-1 interacts with heparin-binding growth factors such as FGF-2, accumulation of syndecan-1 within the tumor stroma may contribute to the extensive angiogenesis and stromal proliferation characteristic of infiltrating breast carcinoma. Moreover, the induction of syndecan-1 within the stroma, coupled with the loss of syndecan-1 on malignant cells, suggests that changes in syndecan-1 expression are critical in promoting the metastatic phenotype of infiltrating ductal carcinoma of the breast.

Breast Neoplasms↗
PubMed1999

Cost benefit and outcomes analysis for fine-needle aspiration. Why do we know so little?

In many areas of anatomic pathology, there have been little application of health services research methods. Diagnostic fine-needle aspiration has been performed for decades in the United States, but there is still little knowledge of the benefits and limitations of this procedure. This article examines some of the research regarding fine-needle aspiration cytology and hypothesizes why there has been so little evaluation.

Biopsy, Needle↗
PubMed1998

Urine cytology of primary and secondary urinary bladder adenocarcinoma.

BACKGROUND: Primary and secondary adenocarcinomas of the urinary bladder are uncommon, and the urine cytology of these tumors has rarely been described. Familiarity with the cytomorphology of these neoplasms may facilitate their detection in urine cytology specimens. METHODS: The authors reviewed 46 urine samples (19 voided, 19 instrumented, and 8 bladder washings) from 41 patients with biopsy-proven primary urinary bladder adenocarcinoma (n = 11) or metastatic adenocarcinoma (n = 35) from the prostate (n = 17), colon (n = 10), breast (n = 3), kidney (n = 3), or uterus (n = 1), or from unknown origin (n = 1). Cytomorphology, the role of cytology, and causes for negative diagnoses were evaluated. RESULTS: Cytologic diagnoses of malignancy, adenocarcinoma not otherwise specified, and adenocarcinoma of a specific type were given in 87%, 28%, and 39% of cases, respectively. Columnar cells, coarse chromatin, and necrosis were found in adenocarcinoma of the colon. Syncytial and acinar arrangements, round or oval nuclei, vesicular chromatin, and prominent nucleoli were commonly found in adenocarcinoma of the prostate. These features permitted us to make a specific diagnosis in 90% of cases of adenocarcinoma of the colon and 41% of cases of adenocarcinoma of the prostate. Cytologic examination failed to lead to a diagnosis of malignancy in 18% of primary adenocarcinoma cases. CONCLUSIONS: A large number of adenocarcinomas of the colon and prostate have sufficient cytologic features to suggest the correct diagnosis in urine samples. The cytomorphology of primary bladder adenocarcinoma is not as easily characterized. The submucosal nature of some metastatic deposits and tumor differentiation influence the diagnostic accuracy.

Adenocarcinoma↗
PubMed1998

Aspiration cytology of malignant neoplasms associated with granulomas and granuloma-like features: diagnostic dilemmas.

BACKGROUND: Malignant lymphomas and solid tumors that mimic or are associated with epithelioid granulomas are widely recognized in surgical pathology, but have received little attention in the cytopathology literature. In this study the authors present their experience with six such cases in which the presence of granulomas or granuloma-like features posed a diagnostic difficulty on fine-needle aspiration cytology (FNAC). METHODS: Clinical data, FNAC, and follow-up surgical specimens from six patients presenting with neck masses were reviewed. RESULTS: Only one case was diagnosed confidently as metastatic squamous cell carcinoma with an extensive granulomatous response; the other five were interpreted as "atypical" with descriptive cytology and a differential diagnoses including granulomatous inflammation, in addition to a caveat of "cannot exclude malignancy." Biopsy studies in these cases were recommended in view of the atypical cytologic findings and strong clinical suspicion of malignancy in each case. The histologic findings in two cases revealed Hodgkin's disease with exuberant granulomatous response. The remaining three cases were found to be malignant neoplasms with epithelioid morphologic features and included one example each of diffuse large cell lymphoma, anaplastic carcinoma of the thyroid, and lymphoepithelial carcinoma. CONCLUSIONS: Malignancies associated with granulomas and tumor cells mimicking epithelioid histiocytes may be difficult to diagnose accurately on FNAC. The cytologic differential diagnosis of a "granulomatous" process should include malignant neoplasms. Excisional biopsy studies may be required for definitive diagnosis.

Adult↗
PubMed1998

Diagnostic value of brush cytology in the diagnosis of duodenal, biliary, and ampullary neoplasms.

Endoscopy is a valuable tool in the diagnosis and management of duodenal lesions and biliary strictures. We assessed the value of cytology in the evaluation of these lesions and analyzed the causes of discrepancy among clinical, histologic, and cytologic parameters. The study included 118 patients with duodenal ulcers, ampullary neoplasms, or biliary strictures who were examined between 1975 and 1995; 120 cytologic examinations were performed. The specimens included brushings of the duodenum (DB, n = 50), ampulla (AB, n = 32), and biliary ducts (BB, n = 38). Endoscopic biopsies performed concurrently included the duodenum (n = 37), the ampulla (n = 22), and the biliary ducts (n = 23). Comparison of cytologic and histologic results showed the following sensitivity and specificity: DB, 40% and 97%, respectively; AB, 100% each; BB, 75% and 93%, respectively. The DB, AB, and BB revealed malignant neoplasms in 2 of 5, 7 of 7, and 6 of 8 cases, respectively. Twenty-three duodenal neoplasms were diagnosed by either modality and included 11 adenocarcinomas, 9 villous tumors, 2 metastatic renal cell carcinomas, and 1 large cell non-Hodgkin's lymphoma. Endoscopic brush cytology is an effective means of diagnosing ampullary neoplasms, and it complements tissue biopsy in cases of bile duct stricture. Location, predominance of tumor-induced stroma, an extramucosal growth pattern, sampling error, and interpretative experience influence the diagnostic evaluation. Cytologic diagnosis of an adenoma does not exclude an underlying malignant neoplasm in ampullary tumors. In some instances, it may be difficult to distinguish between villous tumors with severe dysplasia and adenocarcinomas by cytology alone.

Adenocarcinoma↗
PubMed1998

Interobserver variability of a Papanicolaou smear diagnosis of atypical glandular cells of undetermined significance.

The interobserver variability of a Papanicolaou smear diagnosis of atypical glandular cells of undetermined significance (AGUS) has not been measured. Four expert cytopathologists retrospectively reclassified 100 smears originally diagnosed as AGUS; on follow-up examination, 54 had a clinically significant lesion and 46 had a benign lesion. The mean sensitivity and specificity of reclassification were 86% and 21%, respectively. The kappa statistic for pairwise cytopathologist comparison varied from 0.16 to 0.27. In 45% of cases the cytopathologists all used different Bethesda System diagnoses, and in no case did all the cytopathologists use the same diagnosis. There was little agreement on which cytologic criteria were important in separating clinically significant and benign lesions. We conclude the following: interobserver agreement in reclassifying AGUS lesions is very poor; the AGUS category is poorly understood, and there is no agreement on diagnostic cytologic criteria; and when reclassifying slides, cytopathologists make a number of false-negative diagnoses.

Adenocarcinoma↗
PubMed1997

Diagnostic pitfalls of aspiration cytology of salivary duct carcinoma.

BACKGROUND: Salivary duct carcinoma (SDC) is a highly aggressive primary salivary gland neoplasm that resembles intraductal and infiltrating breast carcinoma histologically. The purpose of this study was to review the cytologic features of histologically proven salivary duct carcinomas and to identify the potential pitfalls in cytologic diagnosis. METHODS: Fine-needle aspiration cytology of nine histologically proven salivary duct carcinomas was reviewed. RESULTS: The patients' age ranged from 62 to 89 years (median, 69 years). There were eight males and one female. The cytologic diagnoses of these cases were as follows: pleomorphic adenoma (PA) (three cases), high grade carcinoma, not otherwise specified (three cases), mucoepidermoid carcinoma (MEC) (two cases), and atypical cytology with differential diagnosis including MEC, oncocytoma, and acinic cell carcinoma (one case). The spectrum of cytologic findings included broad flat sheets and three-dimensional clusters. There was mild to severe cellular pleomorphism and nuclear atypia. Papillary clusters and cribriforming occasionally were identified. Bland cytologic features and prominent hyaline stroma, shown to represent the dense fibrosis on histologic sections, were identified in three cases cytologically interpreted as PA. CONCLUSIONS: Fine-needle aspiration of SDC may be difficult to interpret accurately, and bland cytomorphologic features in some cases may lead to a false-negative interpretation; several clinically important pitfalls are demonstrated in our series.

Adenoma↗
PubMed1997

Cytology of germ cell tumors: extragonadal, extracranial masses and intraoperative problems.

BACKGROUND: Germ cell tumors (GCTs) and their metastases may be found in numerous sites that are accessible to cytologic sampling, and many are responsive to chemotherapy. METHODS: The authors reviewed 20 examples of GCT cytology from 16 males and 3 females ranging in age from 1.5 to 61 years (median, 34 years). With two exceptions, one benign cystic ovarian teratoma in which intraoperative cytology was used to diagnose an associated adult-type carcinoma and one undescended testis in which seminoma presented as an abdominal mass, the material reviewed included no examples of primary gonadal GCT. RESULTS: The authors studied 7 primary and 13 metastatic GCTs; these studies were based on 13 in vivo aspirations, 4 intraoperative preparations, and 3 samples of body cavity fluids. All samples were correctly interpreted as malignant, and only one was incorrectly classified as a non-GCT malignancy. CONCLUSIONS: Clinical and cytologic findings are useful in the diagnosis of GCTs and their metastases. Incorrect interpretation of these neoplasms as poorly differentiated malignancies of other types may deprive the patient of effective chemotherapy. Air-dried, Romanowsky-stained smear material and cell block sections may contribute to the resolution of diagnostic dilemmas.

Adolescent↗
PubMed1997

Basal cell carcinoma metastatic to the salivary glands: differential diagnosis in fine-needle aspiration cytology.

A disparate group of salivary gland neoplasms is characterized by small, uniform, hyperchromatic, basaloid cells. This "small blue cell" pattern is most common in non-Warthin's types of monomorphic adenoma, or in adenoid cystic carcinoma. Small cell anaplastic carcinoma (primary or metastatic), metastatic basaloid squamous cell carcinoma, basal cell adenocarcinoma, and metastatic nasopharyngeal carcinoma are rarely encountered but may present a cytologically similar appearance. We report one female and two male patients (median age = 84 yr) with cutaneous-type basal cell carcinoma (BCC) aspirated from metastatic deposits in the parotid (2 cases) or the submandibular (1 case) gland. One was correctly classified at the time of aspiration, based on a previous history of multiple facial BCC. One was interpreted as carcinoma, the previous history being unavailable at the time of FNA. Smears in these two cases show necrosis and rare keratotic cells. The third cases was mistaken for pleomorphic adenoma (PA); the smears showed metachromatic fragments of collagenous tumor stroma that were misinterpreted as the matrix material typical PA. Similar material was identified in the other two cases. When the "small blue cell" pattern is encountered in salivary bland cytology, one should consider BCC, especially if necrosis is identified. The desmoplastic tumor stroma of BCC may mimic the chondroid matrix of PA. Careful consideration of previous history is very important.

Aged↗
PubMed1997

Syncytial variant of nodular sclerosing Hodgkin's disease: fine-needle aspiration findings in two cases.

The syncytial variant is a recently described, uncommon form of nodular sclerosing Hodgkin's disease that was previously termed "sarcomatoid." In addition to foci of typical sclerosis, it is characterized histologically by sheets or clusters of mononuclear Reed-Sternberg variants. These may be arranged around areas of necrosis with variable numbers of neutrophils. In excised material, differential diagnostic considerations include non-Hodgkin's malignant lymphoma, granulocytic sarcoma, malignant melanoma, metastatic carcinoma, thymoma, and metastatic germ cell tumor. We describe the fine-needle aspiration cytologic finding in two examples of this entity. Cohesive clusters and sheets of malignant cells with clear cytoplasm, vesicular nuclei, and prominent nucleoli are easily mistaken for metastatic carcinoma or germ cell tumor. Ancillary tests useful in this differential diagnosis are discussed.

Adult↗
PubMed1997

Quality and liability issues with the Papanicolaou smear: the role of professional organizations in reform initiatives.

The professional societies of cytotechnologists, cytopathologists, and general pathologists have recognized growing problems that attend medicolegal issues in gynecologic cytology practice. Current trends imply two factors may soon adversely affect society's effort to stop deaths due to cervical cancer. First, the cost of gynecologic cytology services may rise sharply owing to extraordinary increases in the cost of malpractice coverage and the expenses entailed in growing quality assurance programs. Second, many practitioners and institutions may seek to avoid gynecologic cytology practice altogether as the malpractice burden increasingly becomes intolerable. The result of these trends would be increased numbers of deaths from largely preventable cervical carcinomas. After outlining these and related issues, this article seeks to provide some educational and medicolegal suggestions for concerted action by our societies. The goal remains unaltered from the time when Papanicolaou tests were new; we have the most effective cancer prevention screening tool ever devised and must make it widely available to all who may benefit from it.

Female↗
PubMed1996

Exfoliative respiratory cytology in the diagnosis of leukemias and lymphomas in the lung.

Leukemias and lymphomas involving the lung were diagnosed by means of exfoliative cytology in 31 specimens from 20 patients. Initial diagnostic categorizations included 29 specimens "positive for malignancy," including two thought to represent "carcinoma vs. lymphoma," and two considered suspicious for lymphoma. Previous diagnoses of lymphoma (13 patients) and acute myelogenous leukemia (AML) (2 patients) were available. In 5 additional patients, exfoliative respiratory cytology yielded the first diagnosis of hematopoietic malignancy. Cytologic diagnosis included nine large-cell and six small-cell non-Hodgkin's lymphomas (NHL), three Hodgkin's lymphomas (HD), and two AML. Key cytologic features included markedly pleomorphic and monomorphic cell populations in HD and NHL, respectively, as well as lack of tumor cell cohesion and necrosis in all cases. Cytologically, acute leukemia may be difficult to differentiate from large-cell NHL, and small-cell NHL from reactive/benign small lymphocytes. Blood, scant cellularity, crush artifacts, and apparent molding may affect diagnostic accuracy. Immunocytochemistry in cell block sections of sputa and washings is useful in the diagnostic workup in selected cases. Although involvement of the respiratory system by leukemias and lymphomas is uncommon and not always preceded by a history of malignancy, cytologic diagnosis is usually prompt, reliable, and accurate.

Adult↗
PubMed1996

Secondary pericardial malignancies: a critical appraisal of the role of cytology, pericardial biopsy, and DNA ploidy analysis.

The authors studied 112 pericardial fluids (45 malignant, and 67 benign) from 63 men and 33 women. All cytologic (n = 112) and histologic (n = 61) specimens were reviewed. Statistical analysis was conducted in 61 paired cytology and histology specimens (45 malignant and 16 benign) and correlated with available ploidy analysis of fluid specimens (n = 34). In cases of malignancy (41 patients), the primary site was known in 34 patients, whereas no origin for metastatic disease was apparent in 3 patients. Pericardial cytology yielded the initial diagnosis in four patients. After careful review of all cytology and histology specimens, seven truly discrepant cases were noted, six of which had positive cytology. Tissue biopsy sampling error was the cause for such discrepancies. DNA diploidy obtained by flow cytometry correlated with benign cytology, whereas aneuploidy was associated with malignant cytology in a total of 32 of 34 cases (94%). Cytologically malignant effusions rendered diploid DNA in 2 of 10 cases (20%). In conclusion, cytology is the single most important parameter in the evaluation of secondary pericardial malignancy and should be considered the gold standard. Causes for false-negative cytologic diagnoses include scant cellularity and obscuring blood. Hence, careful screening is recommended. The low sensitivity of flow cytometric DNA analysis does not favor its routine use.

Adolescent↗
PubMed1996

Basal cell (monomorphic) and minimally pleomorphic adenomas of the salivary glands. Distinction from the solid (anaplastic) type of adenoid cystic carcinoma in fine-needle aspiration.

Cytologic features of the cell-stroma interface are useful in distinguishing between monomorphic adenomas of the basal cell type and adenoid cystic carcinoma. In basal cell adenomas, the collagenous stroma interdigitates with adjacent cells, whereas in adenoid cystic carcinoma, the two are separated by a sharp smooth border. Furthermore, the stroma of basal cell adenomas can contain rare spindle cells or capillaries, but the cylinders of adenoid cystic carcinoma are acellular. The authors review their experience with five cases of basal cell adenoma, and three cases that were designated "minimally pleomorphic adenomas." The latter group showed the small blue cell pattern of basal cell adenoma at the time of fine-needle aspiration, and histology revealed only small foci of typical pleomorphic adenoma. With the exception of one cystic case, the cell-stroma interface of basal cell adenoma was observed in all eight cases. These cases are contrasted with three adenoid cystic carcinomas with extensive solid (anaplastic) areas. All showed the small blue cell pattern and cell-stroma interface features of basal cell adenoma. Neither showed the smooth-bordered cylinders of adenoid cystic carcinoma. Two of these three were incorrectly interpreted as benign at the time of fine-needle aspiration. The authors suggest that the stroma aspirated from solid adenoid cystic carcinoma represents desmoplastic tumor stroma that mimics the pattern of basal cell adenoma in smear material. Distinction between basal cell adenoma and the solid type of adenoid cystic carcinoma at the time of fine-needle aspiration remains a very difficult problem.

Adenoma↗
PubMed1996

Sialolithiasis. Differential diagnostic problems in fine-needle aspiration cytology.

Sialolithiasis with obstruction of major salivary gland ducts can lead to clinical tumefaction related to cystic dilatation. In addition to mucus accumulation, these pseudoneoplasms feature hyperplasia and squamous metaplasia of the ductal lining epithelium, with varying degrees of inflammation. The authors report five examples of this lesion aspirated from two males and three females ranging in age from 45 to 80 years (median 65 years). Three were in the submaxillary gland, and two were in the parotid. In three cases, stone fragments were identified, and diagnoses of sialolithiasis were rendered; two of these patients underwent surgical excision. The remaining two cases showed prominent foam cells and metaplastic squamous cells in a mucoid background that mimicked low grade mucoepidermoid carcinoma. Stone fragments were not identified and a differential diagnoses of sialolithiasis versus low grade mucoepidermoid carcinoma were suggested. Surgical excision revealed sialolithiasis in both instances. When stone fragments are identified in aspirated material, these cases pose little diagnostic difficulty. However, when this material is not present, epithelial changes and mucus accumulation may be difficult to distinguish from low grade mucoepidermoid carcinoma. Cautious interpretation is suggested in this setting.

Adolescent↗