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P S Feldman

Publications and source records attributed to P S Feldman.

At least 19 recordsLinked to original sources
PubMed1993

Intraoperative fine needle aspiration of pancreatic and extrahepatic biliary masses.

Intraoperative fine needle aspiration (IFNA) of masses of the pancreas and extrahepatic biliary system provides a method of rapid tissue diagnosis with a much lower complication rate than either wedge or large bore needle biopsies. Few series include IFNA of extrahepatic biliary system masses in their analyses. We retrospectively evaluated all IFNA of pancreatic, extrahepatic biliary and ampullary masses at the University of Virginia from March 1981 to December 1991 to assess the diagnostic accuracy of this procedure. Ninety-nine IFNA were performed--75 of the pancreas, 17 of the extrahepatic biliary system and seven of the ampulla. All aspirations were performed with direct visualization or palpation of the tumor, or both, using several passes with a 22 gauge needle. A diagnostic "positive" or "negative" reading was rendered in 90 of 99 IFNA. Carcinoma was confirmed by positive tissue diagnosis or clinical course consistent with cancer. Benign disease was confirmed by negative pathologic factors from a resected specimen or confirmatory clinical course of at least 18 months. Diagnosis was confirmed by these criteria in 82 patients. Thirty-four of 43 patients with confirmed carcinoma of the pancreas had positive cytologic factors by IFNA. Three pancreas IFNA were deemed as "suspicious" and six as "unsatisfactory." Two patients with "suspicious" findings had pathologically confirmed well-differentiated carcinoma. Carcinoma of the ampulla and extrahepatic biliary tract was detected by IFNA in 17 of 18 confirmed patients. The overall sensitivity of positive or negative IFNA in this series in 90 percent, with 100 percent specificity and 92 percent accuracy. IFNA has a positive predictive value of 100 percent and negative predictive value of 74 percent. We conclude that IFNA is a highly accurate diagnostic procedure and represents the preferred technique of obtaining an intraoperative tissue diagnosis in masses of the pancreas, extrahepatic biliary tract and ampulla. Positive IFNA may definitively guide surgical decision-making; however, we caution that negative IFNA cannot be relied on definitively to exclude the diagnosis of carcinoma.

Ampulla of Vater↗
PubMed1992

Ciliary body adenoma in a 10-year-old girl who had a rhabdomyosarcoma.

A retrolenticular fibrovascular membrane occurred in the setting of a ciliary body mass in a 10-year-old black girl who had been successfully treated for a rhabdomyosarcoma of the lung. The results of a transscleral biopsy of the mass demonstrated it to be a pigmented adenoma of the ciliary body. A lensectomy and membranectomy were performed to aid in the follow-up and rehabilitation of the eye. At 9 months after surgery, the patient had 20/25 vision with no evidence of tumor growth. This case demonstrates an unusual cause of cyclitic membrane formation and suggests that transscleral biopsy may be a useful adjunct in the management of selected ciliary body masses.

Adenoma↗
PubMed1992

Ultrasound guidance for biopsy of omental abnormalities.

We review our two-year experience with ultrasound-guided fine needle aspiration biopsy of omental pathology. Eleven patients were referred for biopsy of omental abnormalities. Biopsy was performed without complication in all cases and the aspirates were positive for malignancy in 9. The discharge diagnosis was ovarian carcinoma in 6 patients, adenocarcinoma of unknown origin in 1, lymphoma in 1, and carcinoma of the colon in 1. The technique requires the use of a linear array transducer for biopsy guidance, and is safe, rapid, and easy to perform.

Aged↗
PubMed1992

Lung tumor incidence after intrabronchial administration of the nonionic contrast agent metrizamide.

RATIONALE AND OBJECTIVES: Metrizamide has been used for examination of the gastrointestinal tract and tracheobronchial tree of infants. Contrast agents may enter the lungs during such examinations. The current study was undertaken to determine whether there would be any later pulmonary effects when metrizamide was administered to the lungs of weanling mice. METHODS: One hundred fifty mice (18-21 days old), divided into groups, received either 75 microL of metrizamide, using the manufacturer's diluent (190 mg iodine [I]/mL), or saline solution administered to the lungs by injection into the trachea. The mice were observed for the duration of their lives. Moribund animals were killed. At death, all animals underwent necropsy. The lungs were fixed in formalin, and histologic sections were examined for pathologic changes. RESULTS: The incidence of lung tumors was increased (P less than .05) in the lungs of mice receiving metrizamide compared with those receiving saline. Eighteen percent of the lung tumors in the metrizamide-treated mice were lymphomas, a histologic type not found in the saline-treated controls. CONCLUSIONS: A hypothesis proposing that metrizamide may be an initiator of carcinogenic transformation rather than a carcinogen was developed.

Adenocarcinoma↗
PubMed1988

Role of fine needle aspiration in the diagnosis of lesions of the oral cavity, oropharynx, and nasopharynx.

The oral cavity, oropharynx and nasopharynx are readily accessible to fine needle aspiration (FNA). This study reviews the author's experience with 93 FNA from these sites: 76 from the oral cavity, eight from the oropharynx, and eight from the nasopharynx. Thirty-nine (42%) of the FNA were positive for malignancy with no false-positive diagnoses. In 15 cases the FNA provided the initial diagnosis of cancer and in 24 cases documented recurrence. Five (5%) of the FNA interpreted as suspicious for malignancy were subsequently proven malignant by biopsy. There were 33 (36%) negative FNA with seven false-negative diagnoses confirmed by biopsies. Fifteen FNA (16%) were unsatisfactory and malignancy was found by biopsy in two of these cases. These results emphasize the importance of repeating the FNA or recommending biopsies in negative and unsatisfactory FNA when clinically indicated to assure accuracy in diagnosis. A positive FNA may be regarded as a definitive diagnostic test and treatment instituted accordingly. No complications resulted from these FNA. This study demonstrates the application, safety, and accuracy of FNA in these anatomic sites.

Adolescent↗
PubMed1988

Small-cell carcinoma of the parotid gland with neuroendocrine features.

An 82-year-old woman had a small-cell carcinoma of the parotid gland with cells containing neuroendocrine secretory granules. To our knowledge, these dense-core granules have been identified in only three other major salivary gland small-cell carcinomas. The findings of histologic and ultrastructural evaluations of this neoplasm suggested a salivary duct cell origin. The tumor appears to arise from cells of the salivary duct system that differentiate into cells with either neuroendocrine or epithelial features. Electron microscopy to determine the type of small-cell carcinoma should be performed, as this may have prognostic significance. Aggressive therapy should be undertaken, since small-cell carcinomas of the major salivary glands appear to have a better prognosis than bronchogenic or laryngeal small-cell carcinomas have.

Aged↗
PubMed1988

Aspiration cytology and immunohistochemistry of an orbital aspergilloma.

The results of fine-needle aspiration (FNA) cytology combined with immunohistochemical staining of an orbital aspergilloma are presented. The cytologic findings included a tangled mass of hyphal elements and acute inflammation consistent with fungal disease. The slides were stained by the peroxidase-antiperoxidase method for Aspergillus sp. Positive staining confirmed the diagnosis of an orbital aspergilloma, and appropriate therapy was started.

Aged↗
PubMed1988

Fine-needle aspiration cytology of an adult rhabdomyoma of the head and neck.

The cytologic features of a multifocal adult rhabdomyoma of the head and neck, as observed in a fine-needle aspiration specimen, are described. Cross-striations and characteristic cytoplasmic "crystals" were conspicuous in the cytologic preparations and also during ultrastructural examination. The cytologic features of adult rhabdomyoma are distinctive, allowing a rapid specific diagnosis.

Aged↗
PubMed1987

Cytomegalovirus infection initially diagnosed by skin biopsy.

The reported cases of cutaneous involvement by cytomegalovirus (CMV) are mostly limited to descriptions in immunocompromised patients who had other evidence of systemic CMV infection or in patients whose disseminated infection was not diagnosed until autopsy. However, three cases of CMV infection initially diagnosed from antemortem biopsy of skin lesions have been documented in the literature. The authors review in depth one of these three cases and describe two new cases of CMV infection first identified by skin biopsy. The latter two are the first detailed descriptions of this infection in the skin of burned patients. Review of the literature describing cutaneous CMV involvement reveals protean epidermal and dermal manifestations with consistent histologic findings. Recently, however, there has been documentation of histologically occult CMV in patients with disseminated CMV infection. Skin biopsy of cutaneous lesions in immunocompromised patients is important in the diagnosis of systemic CMV infection.

Adult↗
PubMed1986

Chordoma: diagnosis by fine-needle aspiration biopsy with histologic, immunocytochemical, and ultrastructural confirmation.

Five cases of chordoma, diagnosed by fine-needle aspiration (FNA) biopsy, are presented. Four cases were histologically confirmed, and in one, immunocytochemical and ultrastructural studies were performed on both the aspirate and tissue specimen. Four cases presented as sacral masses, while in the fifth case, a destructive lesion of the clivus extended into the soft tissues of the lateral neck. A spectrum of cytomorphologic features was encountered including the presence of abundant microtissue fragments and cells in a dissociate pattern, often with abundant metachromatic extracellular matrix. Stellate and cuboidal cells often contained intracytoplasmic vacuoles of varying sizes. Intranuclear inclusions, mitotic figures, and anisonucleosis were prominent features of several cases. Immunoperoxidase studies on a single case demonstrated cytoplasmic staining for low- and high-molecular-weight cytokeratins, vimentin, and epithelial membrane antigen, while glial fibrillary acidic protein and carcinoembryonic antigen were negative. Ultrastructural features included the presence of mitochondrial endoplasmic reticulum complexes, occasional desmosome-like junctions, and abundant extracellular matrix adherent to the tumor cells. We believe the cytomorphologic findings are characteristic and, when taken in concert with immunocytochemical and ultrastructural studies, allow differentiation of chordoma from other primary or metastatic neoplasms occurring in bone. As demonstrated in our series, chordoma is often an unsuspected diagnosis. We believe that FNA biopsy of these lesions can lead to a correct preoperative diagnosis and may also be utilized to document recurrence and thus facilitate the evaluation and management of patients with these lesions.

Aged↗
PubMed1986

The clinical outcome of needle aspirations of the lung when cancer is not diagnosed.

One hundred thirty-two of 397 consecutive percutaneous fine needle aspirations done at the University of Virginia between January, 1979, and December, 1984, for pulmonary lesions showed no evidence of cancer on cytological examination. We reviewed the presenting symptoms, radiographic findings on the day of needle aspiration, and the descriptive cytological terms to determine if it was possible to distinguish benign from malignant disease in these 132 patients. We found a specific benign diagnosis in only 16 (12%) of the 132 patients, and 1 of them ultimately was found to have cancer. In the remaining 116 patients, analysis of age, sex, smoking history, presenting symptoms, radiographic findings at the time of needle aspiration, and cytological terms other than malignancy did not enable distinction of benign from malignant disease as the cause of the radiographic finding. In the group of 132 patients without suggestion of cancer on initial cytological study, 38 (29%) were subsequently found to have a malignant process.

Adolescent↗
PubMed1984

Fine needle aspiration cytology in lieu of open biopsy in management of primary breast cancer.

Fine needle aspiration (FNA) can be used in place of open breast biopsy in most patients with primary breast cancer. This report summarizes our experience with 398 patients who had FNA of the breast. There was a total of 136 cancers, of which 100 (74%) were diagnosed by FNA. Seventy-one patients had mastectomy without frozen section. Thirteen had an excisional biopsy before mastectomy by preference of the surgeon. These cases occurred early in this series, before the surgeons became confident in the technique. The presence of locally advanced disease was confirmed by FNA in 12 patients and metastases to the breast were confirmed in four. There were no false-positives. Fine needle aspiration was interpreted as "suspicious" but not diagnostic of malignancy in 31 patients and open biopsy was requested. Biopsies demonstrated primary breast carcinoma in 22 patients and metastatic cancer in one. There were 103 patients with FNA negative for cancer who had open biopsy; 102 were confirmed negative, and one was positive for cancer. Fine needle aspiration yielded insufficient material in 38 patients, and 12 of these were found to have carcinoma with open biopsy. Advantages of FNA: It is safe, atraumatic and rapid, and permits definitive discussion about treatment planning at the initial office visit. It obviates the need for frozen section, reducing anesthesia and operative time. Our experience shows that FNA is highly accurate in the diagnosis of breast malignancy if rigorous criteria are used. Although a negative FNA requires biopsy to exclude malignancy, a FNA that is positive for cancer eliminates the need for open biopsy and allows the surgeon to proceed to mastectomy with confidence.

Biopsy↗
PubMed1983

Fine-needle aspiration in squamous cell carcinoma of the head and neck.

Cytological examination of fine-needle aspiration (FNA) specimens from patients with known or suspected squamous cell carcinoma of the head and neck at the University of Virginia, Charlottesville, between 1979 and 1982 was reviewed. Of 229 aspirates, 187 were of cervical or submandibular sites and 42 were of oral cavity sites. The accuracy of cytological diagnoses was determined by histological comparison and clinical follow-up. There were no false-positive aspirates (specificity, 100%) and one false-negative aspirate (sensitivity, 99%). Twenty-one (9%) contained insufficient cellular material for adequate cytological diagnosis. Seventy-eight percent of histologically confirmed aspirations were malignant. Proper use requires close communication between an experienced cytologist and a head and neck surgeon knowledgeable in the indications and limitations of the technique. This study demonstrates that FNA is a highly accurate, safe, predictive, and valuable technique in the management of squamous cell carcinoma of the head and neck.

Adult↗