On the American scene: the American Society of Cytopathology and the Papanicolaou Society of Cytopathology.
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Cytodiagnosis↗
Biomedical subjects
S M Selvaggi
Publications and source records attributed to S M Selvaggi.
Neovaginal cytology after total pelvic exenteration for gynecological malignancies.
Vaginal reconstruction has become an established method to restore sexual function in women who have undergone ultraradical surgery and/or irradiation for the treatment of gynecologic malignancies. Cytologic evaluation of the neovagina serves a major role in the detection of recurrent disease. The purpose of this retrospective 6-yr study (January 1987-December 1993) was to evaluate the cytologic features of vaginal smear specimens from neovaginas constructed utilizing split-thickness skin grafts. Thirty-four vaginal smears were obtained at regular intervals from nine women (mean age: 51 yr) who underwent total pelvic exenteration with vaginal reconstruction for recurrent malignancies of the vagina and the cervix. Anucleated, keratinizing squames were a constant finding in each smear. Over a 4-mo-6-yr postoperative period, superficial and intermediate squamous cells were present in the majority of the smears and the maturation index showed a shift to the right. In two cases, a squamous cell carcinoma of the cervix recurred within the neovagina. Knowledge of the cytologic features associated with neovaginas is important in order to distinguish normal changes from neoplastic lesions.
Adenocarcinoma↗
Reporting of atypical squamous cells of undetermined significance on cervical smears: is it significant?
A retrospective 7-mo study (June 1, 1993-December 31, 1993) was performed to evaluate the significance of reporting atypical squamous cells of undetermined significance (ASCUS) on cervical smears. During this period 114 (0.7%) of 17,330 smears were diagnosed as ASCUS, 62 of which resulted in either follow-up cervical biopsies and/or endocervical curettages (61%) or repeat smears (39%), and form the basis of this study. Tissue specimens (38 cases) were negative in 24 cases (63%) and were positive in 14 cases (37%). Of the positive specimens, there were 9 low grade squamous intraepithelial lesions (LSIL) and 5 high grade squamous intraepithelial lesions (HSIL). Repeat smears (24 cases) were negative in 19 cases (79%) and were persistent for a lesion in 5 cases (21%). The persistent lesions consisted of 2 ASCUS and 3 LSIL. Overall, of the 62 cases, 43 (69%) were negative and 19 (31%) showed a lesion on follow-up tissue specimens or smears. Of the 62 cases, ASCUS diagnoses included cellular changes suggestive of human papillomavirus infection in 17 (27%) cases, nondiagnostic cellular changes in 16 (26%) cases, atypical squamous metaplasia vs. a squamous intraepithelial lesion (SIL) in 15 (24%) cases, inflammatory cell changes vs. a LSIL in 5 (8%) cases, 2 of which contained candida, and atrophic cellular changes in 1 (2%) case. In the remaining 8 (13%) cases, proper cytologic analysis was hampered by partially obscuring acute inflammation (3 cases) and low cellularity (5 cases). The results of this study would indicate that the reporting of ASCUS on cervical smears does lead to the detection of SILs in a significant number of cases (31% in this study). Therefore, further evaluation of the patient is suggested.
Adolescent↗
Fine-needle aspiration cytology of cystic ovarian lesions.
A 4-year study (January 1986 through December 1990) was performed to evaluate the cytomorphologic features of cystic ovarian lesions. Fluid from 103 cases was obtained either during surgical removal of the ovary (48 cases; mean age 50 years) or by fine needle aspiration (55 cases; mean age 32 years). Of the 48 cystic lesions with histologic correlation, 30 (62.5%) were neoplastic and 18 (37.5%) were non-neoplastic. Ten (18%) of the 55 aspirates were unsatisfactory. The remaining 45 cases (82%) were benign, predominantly non-neoplastic entities which included follicle, corpora luteal, and endometriotic cysts. Neoplastic cystic lesions included serous, mucinous, and Brenner tumors, germ cell neoplasms, a sex cord-stromal tumor, and an undifferentiated carcinoma. Follicle and corpora luteal cysts were composed of loose cell clusters of granulosa cells and/or luteinized granulosa cells. Endometriotic cysts contained hemosiderin-laden macrophages and endometrial cells. Serous and mucinous cystadenomas were composed of cohesive sheets and/or papillary clusters of epithelial cells. A cystic Brenner tumor showed sheets of cells with grooved nuclei, and a benign cystic teratoma contained mature squamous cells admixed with vacuolated cells of presumed sebaceous origin. Although the distinction between benign and malignant entities posed few diagnostic difficulties, borderline tumors could not be distinguished from well-differentiated cystadenocarcinomas. The results of this study indicate that the majority of cystic ovarian lesions can be diagnosed accurately on cytology. Cytologic evaluation of non-neoplastic ovarian cysts is important for women who want to retain their fertility and in the clinical management of women with neoplastic lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenocarcinoma↗
Small-cell carcinoma of the ovary in peritoneal fluid.
Two cases of small-cell carcinoma of the ovary in the ascitic fluid and peritoneal/pelvic washings of a 30- and 28-yr-old woman, respectively, are presented and discussed. Smear preparations from the ascitic fluid showed loose clusters and single malignant cells with scant cytoplasm and nuclei with smooth to irregular nuclear membranes, granular chromatin, and small nucleoli. In the second case peritoneal/pelvic washing specimens contained clusters and single malignant cells with a moderate amount of cytoplasm and nuclei with smooth nuclear membranes, granular, clumped chromatin, and prominent nucleoli. Hisology confirmed the diagnosis of small-cell carcinoma of the ovary. These are the first reported cases of this rare ovarian neoplasm present on fluid cytology. Its differentiation from other small-cell neoplasms on peritoneal fluid cytology from young women is discussed.
Adult↗
Morphologic assessment of endometrium overlying submucosal leiomyomas.
The effect of submucosal leiomyomas on endometrial structure in women with symptomatic clinical findings was studied retrospectively. The endometrial histology from 13 hysterectomies for uterine leiomyomas was examined using three 2-mm sections of endometrium (one overlying a submucosal leiomyoma and two without underlying leiomyomas). Endometrial thickness, gland number and appearance, vessel number and diameter, and stromal inflammation were assessed. The thickness of the myometrium between the leiomyoma and the overlying 2-mm section of endometrium analyzed was also evaluated. The control group consisted of seven nonmyomatous uteri removed for benign disease. Analysis of the endometrium with underlying submucosal leiomyomas identified two groups using endometrial gland number as the criterion for this division. Five cases (group A) were found to have no endometrial glands, while the remaining eight (group B) had an average gland number of 74.5 per 2-mm section of endometrium. The mean gland number for the control group was 82.6, showing no significant difference from group B. Group A had an average endometrial area (2-mm thickness) of 0.38 mm2, and group B had an average area of 4.47 mm2, for a significant difference (t = -3.76, P = .007). Comparison of the two groups with the control group (mean area, 4.71 mm2) showed a significant difference in endometrial area only with group A (t = -7.64, P < .0005). A significant difference (t = -2.93, P = .019) was observed in the analysis of the thickness of the myometrium between the leiomyoma and overlying endometrium between groups A (mean thickness, 0.53 mm) and B (mean thickness, 1.70 mm).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Diagnostic accuracy of fine-needle aspiration cytology in persistent or recurrent gynecologic malignancies.
A retrospective 7 1/4-yr study was performed to evaluate the diagnostic accuracy of fine-needle aspiration (FNA) cytology in the cell typing of persistent or recurrent gynecologic malignancies. A total of 202 aspirates were obtained from 163 patients with documented malignancies of the cervix, uterus, ovary, vulva, and vagina. Information concerning the primary tumor was obtained from surgical reports and/or medical records. In 168/202 cases (83%), the histological diagnosis, including primary tumor cell type and subtype (ex. squamous cell carcinoma, large cell keratinizing), were available. In 12/202 cases (6%), only the tumor cell type (ex. squamous cell carcinoma) was known, and in the remaining 22 cases (11%), only the location of the primary neoplasm was attainable. Aspirated sites included pelvic wall and organs (77 cases), lymph nodes (51 cases), thoracic organs (18 cases), and abdominal wall and organs (56 cases), including liver (33 cases). Of the 168 cases with known histologic diagnoses, the FNA results were positive in 109 (65%). The positive results were divided into three groups: group I, the cytologic findings were predictive of the histologic diagnoses (84 cases, 77%); group II, tumor cell subtyping was not possible on cytology (17 cases, 16%); group III, neither tumor cell typing nor subtyping was possible on cytology (8 cases, 7%). Of the 34 cases in which only the histologic tumor cell type or primary tumor location was known, 13 (38%) were positive on FNA.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Factors influencing fine-needle aspiration cytology in the management of recurrent gynecologic malignancies.
Over a period of 6.5 years (January 1983 through August 1989) 124 fine-needle aspirations (FNAs) were performed on 95 patients with prior documented primary malignancies of the cervix, ovary, endometrium, and vulva. The significance of clinicopathologic factors which influenced the FNA results was analyzed by statistical methods. The factors studied included the initial patient clinical stage, the time interval between staging and disease recurrence, the treatment modalities, the neoplasm type, the aspiration site, the target lesion size, and the type of radiologic guidance. Primary aspiration sites were pelvic wall and organs (40%), lymph nodes (36%), and liver (21%); 64% were positive, 5% suspicious, 15% negative, and 16% unsatisfactory. The specificity was 100%; sensitivity, 96.3%; predictive value of a positive test, 100%; and predictive value of a negative test, 84.2%. Statistically significant clinicopathologic factors which influenced the FNA results included the target lesion size (P = 0.026) and the aspiration site (P = 0.033). The primary neoplasm type, the time interval between staging and disease recurrence, the initial patient clinical stage, the treatment modalities, and the type of radiologic guidance were not statistically significant. FNA is a reliable procedure in the management of gynecologic malignancy and its results are influenced by clinicopathologic factors.
Adult↗
Cytologic features of malignant ovarian monodermal teratoma with an ependymal component in peritoneal washings.
A case of malignant neuroectodermal tumor of the ovary (monodermal teratoma) with a predominant ependymal component in the peritoneal washings of a 27-year-old woman obtained on second-look laparotomy is presented and discussed. The smear and cell block preparations showed sheets and clusters of cells containing oval nuclei with finely granular chromatin and small nucleoli. The cell nuclear/cytoplasmic ratio was within normal limits, and minimal cytologic atypia was observed. The clusters were rimmed by columnar-oriented cells lined by cilia. This is the first reported case of this rare ovarian neoplasm present on fluid cytology. Its bland cytologic appearance could be confused with endosalpingiosis.
Adult↗
Goblet-cell carcinoid tumor in peritoneal fluid: a case report.
An unusual case of goblet-cell carcinoid in the peritoneal fluid of a 49-yr-old woman with a prior history of carcinoid tumor of the appendix is presented and discussed. Cytologic findings included clusters of uniform small cells containing nuclei with finely granular chromatin, small prominent nucleoli, and scant cytoplasm admixed with signet-ring cells. Peritoneal biopsies contained acini and small glands lined by malignant cells with features of a carcinoid tumor. Prominent signet-ring cells were interspersed within tumor nests. The signet-ring cells and small glandular lumens showed strong mucin positivity. Endocrine tumor cells were argyrophil- and argentaffin-positive. The histologic findings confirmed the diagnosis of goblet-cell carcinoid involving peritoneal fluid.
Adenocarcinoma, Mucinous↗
Fine-needle aspiration cytology of ovarian follicle cysts with cellular atypia from reproductive-age patients.
The cytologic features of four luteinized ovarian follicle cysts with cellular atypia, obtained by fine-needle aspiration, are presented and discussed. The three patients, ages 31, 32, and 34, underwent laparoscopy for workup of unilateral or bilateral ovarian cysts. In each case, the aspirates were cellular and composed of atypical cells arranged in glandular clusters and papillary configurations. The cells showed an increased nuclear/cytoplasmic ratio and contained nuclei with prominent chromocenters, granular chromatin, and prominent nucleoli, some irregular in shape. Cell borders were indistinct, and the cytoplasm was finely vacuolated. In each case, the smears were interpreted by the cytotechnologist as showing cellular features compatible with malignancy. In addition to the atypical cells, the cytopathologist noted a few sheets of well-preserved small granulosa cells. A thorough review of the clinical histories revealed the patients to be 8, 6, and 6 mo postpartum, respectively, at the time of needle aspiration. In conjunction with the clinical histories, the cytologic findings supported a diagnosis of follicle cysts containing atypical luteinized granulosa cells. It is postulated that hormonal stimulation may have played a role in the development of the cellular atypia present within the luteinized cells. When analyzing ovarian cyst fluid from reproductive-age patients, this entity should be considered so as not to make an erroneous diagnosis of malignancy.
Adult↗
Sampling accuracy of the modified Ayre spatula/Zelsmyr Cytobrush versus the modified Ayre spatula/bulb aspirator in the collection of cells from the uterine cervix.
An 8-mo (August 1988 through April 1989) study was performed to evaluate the efficacy of the modified Ayre spatula/Zelsmyr Cytobrush versus the modified Ayre spatula/bulb aspirator in the collection of cells, both normal and abnormal, from the uterine cervix. The majority (78%) of the 192 patients, ranging in age from 18 to 82 yr, were referred to the gynecologic/oncologic clinic for follow-up of an atypical Papanicolaou smear or of a previously diagnosed and treated cervical, vulvar, or endometrial lesion. Of the 192 patients, 149 were premenopausal (15 of whom were pregnant), 12 were perimenopausal, and 31 were postmenopausal. Patients were randomized into one of two groups based on the collection of samples for their cervical smears: 1) modified Ayre spatula (exocervix) plus Zelsmyr Cytobrush (endocervix: 90 cases) and 2) modified Ayre spatula (exocervic) plus bulb aspirator (endocervix; 102 cases). Of the smears prepared with the spatula/Cytobrush (90 cases), only 2 (2.2%) lacked endocervical cells. Within this group, the smears of 5 of 5 pregnant patients (100%) and 13 of 13 postmenopausal patients (100%) contained endocervical cells. Cytologic abnormalities were present in 15 of these cases; koilocytosis in 4, cervical intraepithelial neoplasia (CIN)-I in 5, CIN-II in 4, and CIN-III in 2. Five of the 15 cytologically positive cases had histologic verification; the cytologic findings were predictive of the histologic findings in all. Of the smears prepared using the spatula/bulb aspirator (102 cases), 26 (25.5%) lacked endocervical cells. Within this group, the smears of only 4 of 10 pregnant patients (40%) and 14 of 18 postmenopausal patients (78%) contained endocervical cells.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Multiple peritoneal cytologies collected during laparotomy for gynecologic malignancy.
Review of an 18-mo experience with peritoneal cytology specimens showed that 760 peritoneal washings and 177 diaphragmatic smears were collected during 300 laparotomies on patients known to have or suspected of having gynecologic malignancy. One hundred three patients were eventually shown to have benign gynecologic disease. The remaining 197 procedures were done on patients undergoing primary operations for gynecologic malignancy or laparotomies for previously treated gynecologic malignancy. Of the 197 laparotomies for gynecologic malignancies, 168 had washings separately collected from multiple intra-abdominal sites, and these fluids were interpreted as either all positive or all negative in all but seven (4%) patients. The location and extent of the gross or microscopic disease did not correlate with the site of positive washings. Only three of the 177 diaphragmatic smears were positive for malignant cells; these were collected from three patients undergoing primary treatment of ovarian carcinoma, two of whom had extensive peritoneal involvement by carcinoma. Only 35 of the 197 patients with gynecologic malignancy had positive peritoneal cytologies; 32 of these patients had gross or microscopic peritoneal involvement by malignancy, and one additional patient had metastatic carcinoma in pelvic lymph nodes. The analysis of multiple peritoneal washings separately collected from various intra-abdominal sites and the analysis of diaphragmatic smears collected in the absence of gross diaphragmatic disease appear to be of benefit in few cases.
Diaphragm↗
Cytologic features of atypical mesothelial cells in peritoneal dialysis fluid.
From February 1988 through October 1988, 23 samples of peritoneal dialysis fluid from 20 patients with end-stage renal disease were cytologically analyzed in an attempt to determine the effect of the dialysate on the mesothelial cells lining the peritoneal cavity. The patients, five female and 15 male, ranging in age from 26 to 75 yr, had been on continuous ambulatory peritoneal dialysis (CAPD) from 1 mo to 6 yr, 4 mo. The patients had no history of cirrhosis, neoplastic disease, radiation and/or chemotherapy, or current findings of infection. Smears and cytosieve filter preparations were made. Smear analysis included the mesothelial cell pattern, the degree of mesothelial cell atypia, and the presence of atypical multinucleated cells and mitoses. In the majority of the fluid samples, reactive mesothelial cells were arranged singly and in sheets. Moderately and severely atypical mesothelial cells were glandular and papillary in configuration. All samples contained at least a few reactive mesothelial cells; in six, the highest degree of cellular atypia was moderate; in 17, it was severe. The development of severe cellular atypia did not appear to be time dependent (a finding noted in samples from patients on dialysis for 6 mo up to 6 yr). When present, multinucleated mesothelial cells showed moderate to severe atypia. In four cases mitotic figures were present. On the basis of these findings, it is proposed that peritoneal dialysis plays a role in the development of mesothelial cell atypia.
Adult↗
Cytology of nonneoplastic cysts of the ovary.
From March 1986 through September 1988, cytologic material from 13 nonneoplastic ovarian cysts collected at the time of surgical removal of the ovary was compared with the histologic follow-up of these lesions in an attempt to characterize the cytologic features of benign ovarian cysts. In 22 additional nonneoplastic cysts, cellular material was obtained by the clinician with fine-needle aspiration. The 32 patients ranged in age from 18 to 64 yr (mean, 36.8; median, 35.5); of these, 24 were premenopausal, 6 were perimenopausal, and 2 were postmenopausal. Cytologically, follicular cysts (two cases) showed clusters of granulosa cells, some containing mitotic figures. Luteinized follicular cysts (11 cases) were composed of granulosa cells admixed with luteinized granulosa cells. Hemorrhagic corpora lutei (five cases) were characterized by fresh blood containing hemosiderin-laden macrophages and luteinized granulosa cells. Hemorrhagic corpus luteal cysts (10 cases) showed the presence of luteinized granulosa cells, fibroblasts, hemosiderin-laden macrophages, fresh blood, and abundant fibrin. In addition to these findings, regressing corpora lutei (two cases) contained macrophages with yellow hematoidin pigment. Endometriotic cysts (three cases) were composed of fresh blood, hemosiderin-laden macrophages, and scattered endometrial cells. In two cysts, subclassification was not possible due to scanty cellularity. An understanding of the cytologic features of nonneoplastic ovarian cysts may encourage aspiration as opposed to surgical ovarian removal. This has important implications, particularly in women of child-bearing age who wish to preserve their fertility.
Adolescent↗
Metastatic metaplastic carcinoma of the breast: diagnosis by bronchial brush cytology.
Metaplastic carcinoma of the female breast is an uncommon lesion that may metastasize to body sites. To our knowledge, this is the first reported case of pulmonary metastasis diagnosed on bronchial brush cytology. The patient presented with pulmonary symptomatology 1 yr and 3 mo after a left modified radical mastectomy for breast carcinoma. Bronchoscopic examination revealed an endobronchial lesion partially obstructing the bronchus intermedius. Bronchial brush cytology showed the presence of nonkeratinizing squamous tumor cells admixed with a few scattered clusters of tumor cells with glandular features. Histologic review of the original breast lesion showed a metaplastic carcinoma of the breast with a predominant squamous-cell component. Accurate knowledge of a patient's clinical history is necessary to differentiate a second primary lesion from a metastatic one, particularly when the original lesion is so uncommon.
Aged↗
Spatula/cytobrush vs. spatula/cotton swab detection of cervical condylomatous lesions.
Human papillomavirus is widely implicated as a primary etiologic factor in cervical carcinoma. This study compared the sampling accuracy of the modified Ayre spatula/Zelsmyr cytobrush versus the modified Ayre spatula/cotton swab in the detection of cervical lesions with koilocytotic features. The histologic categories consisted of koilocytotic lesions (flat condylomas) with minimal cellular atypia and cervical intraepithelial neoplasia (CIN) I, II and III with surface koilocytes showing cellular atypia (atypical koilocytosis). Using the spatula/cytobrush there was 88% concurrence (118/134 cases) between the cytologic/histologic diagnosis of flat condyloma and CIN with atypical koilocytosis. Using the spatula/swab there was a cytologic/histologic concurrence of 68% (71/104 cases). Statistical analysis confirmed the difference between the two techniques to be significant. In addition, a higher percentage of CIN II and III lesions with koilocytotic features was detected with the spatula/cytobrush--54% (19/35 cases) as compared to 30% (14/46 cases) for the spatula/swab. The results of this study support the use of the spatula/cytobrush in the detection of cervical lesions with koilocytotic features.
Carcinoma in Situ↗
Cytologic indicators of condylomatous lesions of the uterine cervix with histologic correlation: an outpatient laboratory's experience.
Human papillomavirus (HPV) is widely implicated as a primary etiologic factor in cervical carcinoma. Cytology plays an important role as the initial screening tool in the early detection of cervical lesions with koilocytotic features. The purpose of this study was to describe the various cytologic indicators of condylomatous lesions of the uterine cervix with histologic correlation. Cervical smears and biopsy specimens from 278 women seen in an outpatient clinical setting between January 1, 1985; and January 1, 1987, were reviewed. The histologic categories consisted of (1) flat condylomas with minimal cellular atypia; and (2) cervical intraepithelial neoplasia (CIN), I, II, or III with atypical koilocytosis. Cytologically in 57 cases, flat condylomas were composed predominantly of koilocytes containing large perinuclear halos and dyskeratotic cells. In the 221 cases of CIN with atypical koilocytosis, the cervical smears were composed predominantly of atypical koilocytes with large hyperchromatic nuclei and small perinuclear halos; a variable number of koilocytes with large perinuclear halos; pleomorphic dyskeratotic cells; and abnormal multinucleated cells. Mild, moderate, or severely dysplastic/carcinoma-in-situ cells (CIS) were also present. An understanding of the cytologic features associated with condylomatous lesions of the cervix will enable the cytopathologist to alert the clinician of the need to perform colposcopy with the appropriate follow-up treatment.
Adolescent↗