Biomedical subjects

R L Katz

Publications and source records attributed to R L Katz.

At least 55 records · Page 3Linked to original sources

PubMed1995

Significance of peritoneal cytology in patients with potentially resectable adenocarcinoma of the pancreatic head.

BACKGROUND: Recurrence in the peritoneum occurs in up to 50% of patients after a potentially curative pancreaticoduodenectomy. Previous authors have implicated preoperative fine-needle aspiration (FNA) as a cause of intraperitoneal tumor dissemination, although prior studies of peritoneal cytology findings have largely involved patients with locally advanced disease. METHODS: A consecutive series of patients referred to our institution between 1991 and 1993 with suspected or biopsy-proven adenocarcinoma of the pancreatic head was studied prospectively. All patients fulfilled criteria for resectability as assessed by computed tomography: no metastatic disease, no encasement of the superior mesenteric or hepatic arteries, and a patent superior mesenteric-portal venous confluence. Peritoneal washings were obtained at the time of staging laparoscopy and/or at subsequent laparotomy. Data regarding peritoneal cytology results, previous FNA, preoperative chemoradiation, eventual resection, pattern of disease recurrence, and survival were collected. RESULTS: A total of 80 peritoneal washings from 60 consecutive patients were prospectively examined. Forty-nine (82%) of 60 patients underwent FNA before peritoneal washings were obtained. A total of four patients (7%) had positive peritoneal cytology findings: three (6%) of 49 who underwent prior FNA and one (9%) of 11 with no prior FNA. Similarly, no differences in eventual peritoneal failure or short-term survival were observed for patients who underwent prior FNA compared with patients who did not. All four patients with positive peritoneal cytology findings had metastatic disease (liver, three; peritoneum, one) at a median of 4.8 months after diagnosis; three of the four died of disease at a median of 8 months. CONCLUSIONS: Positive peritoneal cytology findings are rare in patients with radiologically resectable adenocarcinoma of the pancreas. When found, positive peritoneal washings are an indicator of advanced disease characterized by unresectability, early metastasis, and short survival. Computed tomographic-guided FNA does not appear to increase the risk for positive peritoneal washings and represents a valid approach to the pretreatment diagnosis of patients with suspected pancreatic malignancy.

Adenocarcinoma↗

PubMed1995

Relationship between DNA ploidy level, nuclear size, and survival in large cell lymphoma.

Intermediate and high grade subtypes of non-Hodgkin's large cell (LCL) and immunoblastic lymphomas exhibit considerable variability, and histologic morphology alone may not adequately characterize those features important for prognosis. The relationship between nuclear morphology and survival was assessed in a series of 50 cases of large cell lymphomas in which ploidy, proliferation, and nuclear area (NA) were measured. Ploidy was calculated by both DNA index (DI) and DNA histogram type (DHT). Proliferation was calculated from the proportion of S phase (SPF) cells present in the DHT. These four parameters were measured using image cytometry of Feulgen-stained nuclei from fine-needle aspirations. To characterize the relationship with survival, these parameters were associated with the clinical follow-up of the patients. The results show that of the 50 LCL cases, only 5 were clearly aneuploid, whereas the remaining 45 were either diploid (29 cases), tetraploid/hypotetraploid (13 cases), or weakly aneuploid (hyperdiploid, 3 cases). Of the 34 patients who died from their disease, both smaller NA and DI correlated with longer survival in an equivalent fashion; neither conferred greater sensitivity when combined with the other. The SPF did not correlate with survival. In LCL, aneuploidy seems to be a relatively uncommon event, but when present ploidy measurement appears useful to define prognosis.

Adult↗

PubMed1995

Image analysis--derived morphometric differences in fine needle aspirates of ductal and lobular breast carcinoma.

The differentiation of ductal and lobular carcinoma (including lobular carcinoma in situ) of the breast has important prognostic implications; thus, preoperative differentiation of these entities via fine needle aspiration could have a substantial impact on the therapeutic options offered to patients. However, well-defined, reliable light microscopic criteria do not currently exist for their distinction in cytologic preparations, particularly when the differential diagnosis of lobular versus low nuclear grade ductal carcinoma is considered. In this study we utilized a morphometric image analysis system to identify distinct nuclear features useful in the differentiation of these two entities and found that a number of significant differences do exist. Although some features (i.e., nuclear size) may be detected in traditional cytologic preparations, others may not be detected by the human observer, supporting a role for automated morphometric analysis as a useful adjunct in the distinction of lobular and low nuclear grade ductal carcinoma in fine needle aspirates of the breast.

Biopsy, Needle↗

PubMed1994

Correlation of two AgNOR counts with Ki-67 labeling index: a study in fine-needle aspirates of lymphoproliferative disorders and breast carcinoma.

The Ki-67 antibody binds to nonresting cells where Ki-67 labeling index (KLI) reflects proliferative activity (PA). The argyrophilic nucleolar organizer regions (AgNOR) counts have been correlated to ploidy and/or PA. Two AgNOR counting methods distinguish ploidy from PA. The first count is the mean AgNOR count (mAg-NOR) which correlates with ploidy. The second is the percentage of nuclei with > or = 5 AgNORs/nucleus (pAgNOR) which reflects PA. To explore this relationship, we separately stained smears of 20 fine-needle aspirates (FNAs) of lymphoproliferative disorders (n = 12) and breast carcinomas (n = 8) for AgNOR and Ki-67. We also double-stained 10 of the smears for both AgNOR and Ki-67. The correlation of pAgNOR counts and KLI was statistically significant (P < 0.0001) whereas it was not between mAgNOR and KLI (P = 0.13). Additionally, using the double stain, the Ki-67 negative cells had an AgNOR granule range of 1-3/nucleus with a mean of 1.33 (+1.86 SD). The Ki-67 positive cells showed an AgNOR granule range of 2-12/nucleus with a mean of 4.15 (+/- 1.02 SD) (P < 0.0002). We thus conclude that pAgNOR is a more reliable indicator of PA than mAgNOR and that four AgNORs/nucleus is an acceptable number differentiating proliferating from resting cells.

Biopsy, Needle↗

PubMed1994

Fine-needle aspiration of pancreatic extramedullary plasmacytoma: possible confusion with islet cell tumor.

We report two cases of extramedullary plasmacytoma (EMP) of the pancreas, diagnosed by fine-needle aspiration (FNA). Plasmacytoma of the pancreas is a rare neoplasm with only 12 cases recorded in the literature. Because of its scarcity and the cytomorphologic similarity between plasma cells and endocrine cells, EMP of the pancreas may be confused with neuroendocrine (islet cell) tumors of the pancreas. Immunohistochemical staining for light chain and/or neuroendocrine markers will prevent diagnostic error when interpreting plasmacytoid neoplasms of any site susceptible to endocrine tumors, including the pancreas.

Adenoma, Islet Cell↗

PubMed1994

Fine-needle aspiration cytology of recurrent and metastatic mixed mesodermal tumors.

We report the cytological and clinical findings of 16 fine-needle aspirates (FNAs) performed on recurrent (n = 6) and metastatic (n = 10) mixed mesodermal tumors (MMMTs). The median interval between the primary diagnosis and FNA was 16 mo. Primary sites were the endometrium (n = 11), the ovary (n = 3), the cervix (n = 1), and pelvic soft tissue (n = 1). Primary tumors showed carcinoma with homologous mesenchymal components in 13 cases and focal heterologous elements in three (two chondrosarcomas and one rhabdomyosarcoma). The FNAs showed carcinoma in all 16 cases, with adenocarcinoma differentiation in three. Mesenchymal elements were identified in aspirates of three recurrent and two metastatic lesions. They were all homologous. aspirates. We conclude that mesenchymal components in FNAs of MMMTs are less likely to be seen in metastatic lesions, and that heterologous mesenchymal components are rarely seen in these aspirates even in recurrent disease. These findings confirm that the epithelial component is responsible for the malignant behaviour of MMMTs, and suggest that these lesions may need to be classified as sarcomatoid carcinomas rather than true carcinosarcomas.

Adenocarcinoma↗

PubMed1994

Immunotyping of lymphoma by fine-needle aspiration. A comparative study of cytospin preparations and flow cytometry.

Immunotyping is an essential adjunct to cytomorphology for the diagnosis of lymphoma by fine-needle aspiration (FNA). Two independent techniques, cytospin preparations and flow cytometry, were used for immunotyping studies on 71 patients with histologically confirmed non-Hodgkin's lymphoma (63 B-cell lymphomas and 8 T-cell lymphomas). Diagnostic concordance between the two methods was obtained in 69 patients (97%). kappa, lambda, and CD3 (Leu-4) markers were routinely measured on all cytospins, and additional markers were requested when indicated. The standard panel measured by flow cytometry included 14 markers. In general, mean values of light-chain (kappa and lambda) immunoglobulins were consistently slightly higher by cytospin analysis than by flow cytometry. Light-chain immunoglobulin ratios (kappa/lambda or lambda/kappa) obtained by both methods proved to be reliable independent predictors of polyclonality or monoclonality. Correlation studies using the Spearman rank coefficient revealed good concordance among values of kappa, alpha, CD3, and CD5 obtained by the two techniques, suggesting that subjective quantitation by cytospins yields similar results to objective quantitation by flow cytometry. Cytospin analysis and flow cytometry appear equally capable of immunotyping aspirated lymphoid samples reliably. The advantages of each method are discussed.

Biopsy, Needle↗

PubMed1994

Intraperitoneal adoptive immunotherapy of ovarian carcinoma with tumor-infiltrating lymphocytes and low-dose recombinant interleukin-2: a pilot trial.

A pilot study was conducted in patients who had advanced epithelial ovarian carcinoma, and who were refractory to platinum-based chemotherapy, to determine the feasibility and clinical effects of a schedule of intraperitoneal (IP) tumor-infiltrating lymphocytes (TIL) expanded in recombinant interleukin-2 (rIL-2), and low-dose rIL-2 IP. TIL were expanded from solid metastases or malignant effusions in serum-free AIM V medium supplemented with low concentrations (600 IU/ml) or rIL-2 using a four-step method of expansion that included a hollow fiber bioreactor (artificial capillary culture system). Patients received IP TIL suspended in dextrose 5% in sodium chloride 0.2% containing 0.1% human albumin and 6 x 10(5) IU rIL-2 on day 1, followed by 6 x 10(5) IU rIL-2/m2 body surface area, administered daily by bolus IP injection, on days 2-4, 8-11, and 15-18. In the absence of disease progression, two additional 4-day cycles of IP rIL-2 were administered. Patients (n = 3) whose TIL failed to grow in vitro received IP IL-2 alone. Eight patients received rIL-2 expanded TIL (10(10)-10(11) range) plus rIL-2 followed by several cycles of rIL-2 alone. One of these patients was treated twice with TIL plus rIL-2. Expanded TIL were primarily CD3+CD4+TCR alpha beta+ (eight TIL-derived T-cell lines). One TIL-derived T-cell line was comprised mostly of CD3+CD8+TCR alpha beta+ cells. Eleven patients (eight treated with TIL plus rIL-2 and three patients treated with rIL-2 alone) received a total of 38 cycles of rIL-2 without TIL. Grade 3 clinical toxicity (peritonitis) occurred in 1 of 9 cycles of TIL plus rIL-2 and 1 of 38 cycles of rIL-2 alone. Each cycle was 4 days long. Grade 3 anemia occurred in 1 of 9 TIL plus rIL-2 cycles and 3 of 38 cycles of rIL-2 alone. There were no measurable responses; however, four of eight patients treated with IP TIL plus rIL-2 had some indication of clinical activity: ascites regression (two patients), tumor and CA-125 reduction (one patient), and surgically confirmed stable tumor and CA-125 values (one patient). The schedule of IP TIL plus low-dose rIL-2 shows manageable toxicity and is worthy of further evaluation in patients with epithelial ovarian cancer who have less tumor burden.

Adult↗

PubMed1994

Morphonuclear comparison of the mantle zone and diffuse subtypes of mantle cell lymphoma.

Mantle cell lymphoma (MCL) is a distinct type of non-Hodgkin's lymphoma, which, based on the architectural pattern, has been divided into mantle zone (MCL-MZ), allegedly associated with longer survival, and diffuse (MCL-D) subtypes. To determine whether there are morphonuclear differences between MCL-MZ and MCL-D, 37 fine needle aspirates (FNAs) obtained from 32 patients with MCL (21 cases of MCL-MZ and 11 of MCL-D) were evaluated using digital cell image analysis. Twenty-one morphometric parameters related to geometry, color, texture and densitometry were evaluated on 100 cells from each case. Aspirated material was stained with either the Diff-Quik or Feulgen method. Statistical analysis (student's t test and nonparametric Mann-Whitney test) was performed. No significant differences between MCL-MZ and MCL-D were found in any of the 21 studied morphonuclear parameters. The morphometric analysis results were similar using the Diff-Quik and Feulgen techniques. This study confirmed the overlapping cytologic spectrum of MCL-MZ and MCL-D and indicated that histologic specimens demonstrating a specific architectural pattern are necessary to differentiate these two variants of MCL. Either Diff-Quik- or Feulgen-stained tissues may be used for morphonuclear measurements in FNAs of MCL since both give similar results.

Biopsy, Needle↗

PubMed1994

DNA content by image analysis. An accurate discriminator of malignancy in pericardial effusions.

DNA analysis was performed on 20 cytologically equivocal pericardial effusions to determine if it would be a useful ancillary technique in identifying malignancy. Ploidy determination by interactive image analysis showed single diploid DNA peaks, with no cells > 5c, in all eight reactive cases studied. The reactive cases had a mean proliferation index of 1.3. All 12 malignant cases studied had cells with DNA content > 5c. A dominant DNA peak at 2c was present in 25%, dominant aneuploid stem lines were present in 25%, and multiple stem lines were present in 50% of the malignant cases. By image analysis, the presence of DNA content > 5c was both sensitive and specific for detecting malignancy in the group of pericardial effusions evaluated.

Cell Count↗

PubMed1994

Estrogen receptor immunostaining patterns imaged in breast cancer fine needle aspirates.

Fine needle aspirates (FNA) after estrogen receptor (peroxidase-antiperoxidase) immunostaining were imaged using a SAMBA system. Integrated optical density (IOD) and mean optical density (MOD) was measured in individual nuclei. Receptogram R Analytic software on a remote VAX computer was used to generate log-log scatter, contour and three-dimensional perspective plots of bivariate MOD vs. IOD relationships and for count-dependent Gaussian smoothing of the univariate log histograms. The findings revealed four types of staining patterns among otherwise estrogen receptor immunostaining-positive patients: (I) a discrete, homogeneous subpopulation with unimodal MOD and IOD distributions; (II) coexistent subpopulations of ER+ and ER- cells, revealed by bivariate MOD and IOD distributions; (III) multiple, discrete subpopulations of ER+ cells, revealed in perspective plots of MOD vs. IOD vs. scatter density; and (IV) highly skewed distributions forming a continuum over a broad MOD and IOD range with or without an ER-negative subpopulation. FNA ER-ICA-positive specimens were indistinguishable based upon average nuclear MOD (AV-MOD) or AV-MOD x (% ER-positive cells). Previous evaluation of such patterns in tissue sections revealed failure of tamoxifen response in types II and IV. Staining mosaicism (IV) may correspond to a failure of receptor modulation within defined limits when ER is rendered nonfunctional due to various structural modifications of receptor domains--events that would not affect immunostaining. Failure in type II is ascribed to ascendancy of estrogen-independent ER-negative subpopulations.

Biopsy, Needle↗

PubMed1993

Diagnosis of eosinophilic granuloma of bone by fine-needle aspiration with concurrent institution of therapy: a cytologic, histologic, clinical, and radiologic study of 27 cases.

Twenty-seven patients with eosinophilic granuloma (EG) of bone seen at our institution between 1979 and 1991 underwent fine-needle aspiration (FNA) with or without concurrent Tru-Cut biopsy. The 16 males and 11 females ranged in age from 2 1/2 to 61 years (median, 10 yr). Twenty-four patients had monostotic lesions. The clinicoradiologic differential diagnosis included osteomyelitis and Ewing's sarcoma (young patients) and primary and metastatic malignancies (older patients). Twenty-four of 28 FNAs (one patient had two FNAs) were diagnostic of EG, and 10 cases were diagnosed by FNA alone. Smears in these cases showed histiocytes, often with grooved or infolded nuclei, and abundant eosinophils. Multinucleated giant cells, foamy histiocytes, neutrophils, lymphocytes, and plasma cells were present in variable numbers. Four FNAs were misdiagnosed: two as osteomyelitis where smears contained abundant neutrophils, sparse eosinophils, and histiocytes misinterpreted as foamy histiocytes, and two as metastatic carcinoma (in adults) where histiocytes in a scant specimen (one case) and skin appendiceal structures without lesional tissue (one case) were misinterpreted. These cases were correctly diagnosed on repeat FNA (one case), Tru-Cut (two cases), or excisional biopsy (one case); however, three cases diagnosed by FNA had nondiagnostic concurrent Tru-Cut biopsies. Treatment consisted of intralesional injection of 125 mg of methylprednisolone (22 cases). Progressive or complete healing of all lesions occurred. FNA is a rapid and useful technique for the immediate diagnosis of EG that allows concurrent institution of therapy.

Adolescent↗

PubMed1993

Fine-needle aspiration cytology of sarcomatoid renal cell carcinoma: a morphologic and immunocytochemical study of 15 cases.

Sarcomatoid renal cell carcinoma (SRCC), which accounts for 5% of all renal cell carcinomas (RCC), has a worse prognosis than conventional nonsarcomatoid RCC, making accurate diagnosis important. This study reports on the morphologic and immunocytochemical features of 15 cases of SRCC (9 primary tumors and 6 metastases) diagnosed by fine-needle aspiration (FNA) biopsy. All but three cases showed a dimorphic cell population consisting of varying proportions of a high-grade epithelial component, either clear or granular-cell type and a spindle cell (sarcomatoid) component, of either fibrosarcomatous, malignant fibrous histiocytoma (MFH), or unclassified types. The sarcomatoid component in the biphasic and monophasic tumors stained positively for cytokeratin in 12 of 14 (85%) cases, for vimentin in 10 of 11 (91%) cases, and for muscle-specific action in 4 of 11 (36%) cases. Of note, the three cases that demonstrated a purely sarcomatoid morphology stained positively for cytokeratin. Unlike in studies performed on surgically resected specimens, neither the proportion of the sarcomatoid component nor the presence of necrosis had prognostic significance, the discrepancy most likely being related to the sampling. We conclude that SRCC, both primary and metastatic, can be accurately diagnosed by FNA when cytologic features are evaluated in conjunction with immunocytochemical findings.

Adult↗

PubMed1993

Quality-assurance study of simultaneously sampled, non-correlating cervical cytology and biopsies.

As part of a quality assurance study, we reviewed 223 cases of simultaneously sampled cervical smears and biopsies that showed a significant lack of correlation for squamous dysplasia or carcinoma. In 153 of the 223 cases (68.6%), the cytology was negative and the biopsy positive. After review of the specimens, errors in this group were found to be of the following types: sampling 64%, interpretive 29%, and combined sampling and interpretive 7%. In the remaining 70 cases (31.4%), the biopsy was negative and the Papanicolaou smear positive. In these cases, the following types of errors occurred: sampling 54%, interpretive 33%, and combination 13%. Twenty-nine of these 70 patients showed dysplasia on follow-up material. These findings indicate there are a significant number of false-negative Papanicolaou smears, mostly because of sampling problems. There are few false-positives. In cases of positive Papanicolaou and negative biopsy, dysplasia is likely to be present in subsequent samples.

Biopsy↗

PubMed1993

Fine-needle aspiration of intra-abdominal desmoplastic small cell tumor.

The cytologic features of four cases of histologically confirmed intra-abdominal desmoplastic small cell tumor (DSCT) that occurred in males between 18-27 yr of age are presented. Smears showed small cells with scant cytoplasm which were primarily arranged in loosely cohesive clusters. Nuclei were oval to round with evenly distributed, finely granular chromatin and inconspicuous nucleoli. As is typical of DSCT, the cells strongly expressed keratin and desmin in all cases. In the one case studied by electron microscopy, it was demonstrated that the cells were joined by small junctions and contained paranuclear aggregates of intermediate filaments. The absence of the characteristic desmoplastic stroma in DSCT aspirates and the nonspecific cytologic features of this small round-cell tumor (SRCT) made cytologic interpretation difficult. Cytopathologists should be aware of this entity so that DSCT is included in the differential diagnosis of SRCTs that occur in intra-abdominal sites. A panel of markers that includes keratin and desmin should be used to assist in the identification of DSCT.

Abdominal Neoplasms↗

PubMed1993

Fine-needle aspiration cytology of the male breast in a cancer center.

All fine-needle aspirates (FNA) performed on the male breast at The University of Texas M. D. Anderson Cancer Center from 1985 to 1992 were reviewed, totaling 64. The patients' ages ranged from 19 to 86 years, with a mean of 56 years. Thirty-three patients had a history of an extramammary malignancy. The diagnoses established by FNA were gynecomastia (45), mammary carcinomas (6), neoplasms metastatic to the breast (5), suspicious for carcinoma (1), intra-mammary lymph node (1), and lipoma (1). In five cases the aspirates were nondiagnostic. Two of these proved to be gynecomastia on subsequent histologic examination. Of the six FNA cases initially thought to represent primary breast carcinomas, two were found to be secondary because of involvement of the underlying chest wall by mesothelioma (1), and mucinous adenocarcinoma, unknown primary (1). No false-positive diagnosis was rendered. We conclude that fine-needle aspiration of the male breast is a reliable means of assessment; however, unique problems may be encountered compared with aspiration of the female breast. These include the epithelial hyperplasia frequently associated with gynecomastia, the relatively equal frequency of primary and metastatic breast lesions when a malignant process is discovered, and chest wall lesions masquerading as breast lesions.

Adult↗

PubMed1993

Anaphylactic reaction to intravenous cefazolin.

Allergic responses to cefazolin occur in approximately 3% to 5% of patients. The responsibility of the health care professional includes developing an awareness that histamine release in varying degrees can occur with the administration of a variety of drugs utilized throughout the perioperative period. The authors discuss the cardiopulmonary manifestations resulting from the release of histamine during an allergic reaction. Differentiation of diagnosis of the causative agent, the effective treatment of the anaphylactic response during anesthesia, and preventive measures to reduce anesthesia morbidity are examined.

Anaphylaxis↗

PubMed1993

Comparative analysis of DNA ploidy and proliferative index in fine needle aspirates of non-Hodgkin's lymphomas by image analysis and flow cytometry.

To determine the application of image analysis (IA) to fine needle aspiration (FNA) of non-Hodgkin's lymphomas, 78 cases, categorized according to the Working Formulation, were analyzed and compared with those analyzed by flow cytometry (FCM). Aspirated material was immediately fixed in either IA fixative (31 cases) or acetone, stored at -70 degrees C (47 cases) for periods up to 48 months and postfixed in IA fixative. IA assessed DNA index (DI), ploidy balance, degree of hyperdiploidy and proliferation index (PI). DNA index, % S + G2M and RNA index were obtained by acridine orange FCM. There were no significant differences in measured variables between fresh and stored cases. Statistically significant differences between low, intermediate and high grade lymphomas were present in all evaluated variables except DNA ploidy (DI) (P = .074) measured by IA. DI, however, showed a very high correlation with the DI obtained by FCM (r = .94). PIs, although generally lower, also had a high correlation with S + G2M (r = .85). We conclude that results obtained by IA were comparable to results by FCM and that frozen material can be used to retrospectively evaluate ploidy and proliferation. IA is especially suitable for the evaluation of low-volume specimens obtained by FNA.

Biopsy, Needle↗