Biomedical subjects
Publications and source records attributed to S Orell.
Rigorous techniques of fine-needle sampling, smearing and staining are mandatory for optimizing the value of thyroid cytopathology. As on frozen sections, follicular lesions should be interpreted with caution.
Over a 42 month period 133 patients underwent 148 CT guided biopsies of 104 pulmonary lesions (78%), 21 mediastinal/hilar masses (16%) and 8 pleural lesions (6%). There were 48 cases (32%) complicated by a pneumothorax, of which 13 (9%) required a chest drain. Two cases each of minor haemopneumothorax (1.4%) and haematoma (1.4%) were found, and haemoptysis occurred in a single patient (0.7%). This low complication rate reflects the use of the 22 gauge Chiba needle, the small number of passes undertaken at each sitting and the wide range of lesion size. In four cases no diagnosis was established either at the time of biopsy or subsequently. There were 100 cases proven to be malignant, of which 81 were diagnosed at the first biopsy. Three further cases were regarded as suspicious of malignancy. Of the 29 patients with benign disease, a specific diagnosis was made in 10 (34%) and nonspecific inflammation was seen in 17 (59%) further patients. Fine needle aspiration under CT control is a useful and accurate diagnostic technique. It has widened the scope of lesions which can be biopsied, enabling small, deep or necrotic parenchymal lesions to be targeted accurately. A precise placement of the needle tip into pleural or mediastinal lesions is a further advantage. However, if an inadequate sample is obtained, the biopsy may need to be repeated.
A rare case of pre B-lymphoblastic lymphoma of the testes and adrenal glands is presented. No lymph node, central nervous system or bone marrow involvement was demonstrated at diagnosis. The primary presentation was of acute unilateral pain and swelling, mimicking simple orchitis. The diagnosis was made using aspiration cytology and the lymphoma characterized using immunohistochemical, electron microscopic and karyotype analysis techniques. Pre B-cell markers were clearly demonstrated by all criteria used. Monoclonal antibodies (FMC 29 and FMC 31) were used to define the early B-cell nature of the lymphoma. Confirmation using karyotype analysis in addition to immunoglobulin and T-cell beta-receptor gene rearrangement was obtained. Intrathecal chemotherapy was used prophylactically. Combination chemotherapy produced regression of the primary lymphomatous lesions, but subsequent bone marrow spread led to death.
The use of fine needle aspiration (FNA) cytology in the management of patients with lymphadenopathy was investigated. The cases of non-Hodgkin's lymphoma were classified using the Kiel classification, which is based strictly on cytological criteria. Of the 59 cases of biopsy confirmed lymphoma, FNA of nodes showed lymphoma in 53 (90%), no definite diagnosis in five (8%), and false negative diagnosis in one (2%). During the follow-up of patients FNA was positive in seven of the eight cases with a suspected recurrence which was later confirmed by lymph node biopsy. Results suggest that FNA is useful on the initial presentation of a patient with lymphadenopathy. If the diagnosis is unequivocal it helps in planning staging procedures and in selecting involved nodes for biopsy. In some cases with intra-abdominal disease it may obviate laparotomy. However, because false negative diagnoses do occur and because cytological classification of lymphoma is not always accurate FNA should not replace lymph node biopsy at initial presentation, but it can be used as the only investigation to confirm suspected recurrence.
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Three cases of nonpapillary carcinoma of the thyroid are reported in which intranuclear vacuoles or (pseudo)inclusions were observed in fine needle aspiration smears. Two of the cases had medullary carcinoma; one had a poorly differentiated follicular carcinoma. The cytologic, histologic and ultrastructural appearances of intranuclear vacuoles and of the so-called ground-glass nuclei of papillary carcinoma are described, and the diagnostic significance of these findings is discussed briefly. Intranuclear vacuoles are distinct and different from ground-glass nuclei.