Biomedical subjects

S R Granter

Publications and source records attributed to S R Granter.

At least 37 records · Page 2Linked to original sources

PubMed1998

Cytologic analysis of papillary renal cell carcinoma.

BACKGROUND: The papillary variant of renal cell carcinoma has distinctive pathologic and clinical features. Because the prognosis of patients with papillary renal cell carcinoma differs from that of patients with other variants of renal cell carcinoma, accurate diagnosis based on cytologic material may be important for appropriate clinical disease management. METHODS: A retrospective analysis of cytologic material from 17 papillary renal cell carcinomas and 52 other renal neoplasms with histologic follow-up was performed to identify the relative sensitivity and specificity of different cytologic criteria for papillary carcinoma. RESULTS: Foamy macrophages and intracytoplasmic hemosiderin were the most sensitive and most specific criteria for the diagnosis of papillary renal cell carcinoma. Foamy macrophages were present in 14 of 17 cases (82%), and intracytoplasmic hemosiderin was present in 13 of 17 cases (76%). Foamy macrophages and intracellular hemosiderin were each present in only 2 of 52 (4%) of nonpapillary tumors examined. Malignant cells were arranged in papillary groups with fibrovascular cores in only 6 of 17 cases (35%), including only 1 of 7 high grade tumors. Nuclear grooves were present in 9 of 17 cases (53%) but were common in only 2 cases. Psammoma bodies were present in only 1 case. Nucleoli and pleomorphism were prominent in high grade tumors. These features, in association with frequent abundant vacuolated cytoplasm, made it difficult to distinguish high grade papillary carcinoma from the clear cell variant of renal cell carcinoma. However, as with low grade tumors, the presence of intracytoplasmic hemosiderin and foamy macrophages were important clues to the diagnosis of 6 of 7 high grade tumors (86%). CONCLUSIONS: Intracytoplasmic hemosiderin and foamy macrophages are the most sensitive and specific markers for both high and low grade papillary renal cell carcinoma, and they allow for the correct diagnosis in most cases.

Adolescent↗

PubMed1998

Effusion cytology of renal cell carcinoma.

BACKGROUND: Effusions in patients with renal cell carcinoma are rare; the clinicopathologic features of these patients have not been described fully. METHODS: All effusions from patients with renal cell carcinoma obtained between 1986 and 1997 at the study institution were reviewed. RESULTS: Twelve effusions from 9 patients were benign, and 8 effusions from 7 patients were malignant. Patients with sarcomatoid tumors presented early with benign effusions, and patients with papillary tumors presented later with malignant effusions. Patients with clear cell tumors were intermediate. The majority of patients who developed malignant effusions had tumors that were classified as T3 or higher (according to the American Joint Committee on Cancer) at the time of resection. Tumor cells had abundant clear to vacuolated cytoplasm, large nuclei, and prominent nucleoli. Cells from clear cell and papillary tumors could not be distinguished in effusion specimens unless papillae were present. At last follow-up 13 of 15 patients were dead of disease within 2 years of the onset of effusion (median 24 weeks; range, 1-93 weeks), including 7 of 9 patients with benign effusions. CONCLUSIONS: Malignant effusions due to renal cell carcinoma most commonly occur in patients with papillary and clear cell tumors. Malignant effusions from these two tumor types are difficult to distinguish unless papillae are present. Effusions associated with renal cell carcinoma confer a poor prognosis.

Aged↗

PubMed1998

Adenocarcinoma in situ in cervical smears with a small cell (endometrioid) pattern: distinction from cells directly sampled from the upper endocervical canal or lower segment of the endometrium.

Adenocarcinoma in situ (AIS) with small, endometrioid cells in cervicovaginal smears, is a source of false-negative diagnoses because of the difficulty in distinguishing these cells from endometrial cells of the lower uterine segment or benign cells from the upper endocervical canal. This study was designed to elucidate the most useful criteria for this distinction. Three observers blinded to the actual diagnoses reviewed 29 preselected cases (AIS, 17; benign, 12) that had originally caused diagnostic difficulty. Each observer made a diagnosis and evaluated 15 preselected diagnostic criteria. All 3 observers agreed on the correct diagnosis in 19 (66%) of 29 cases, and at least 2 observers agreed on the correct diagnosis in 27 (93%) of 29 cases. No case was misdiagnosed by all 3 observers. The most useful criteria for the diagnosis of AIS are a predominance of groups with marked crowding, focal feathering, nuclear hyperchromatism with coarsening of chromatin, and occasional mitotic figures. Sheets of cells, endometrial tubules, and endometrial stroma favor a benign diagnosis. Although 12 (14%) of 87 possible diagnoses were erroneous, well-preserved, small, endometrioid AIS cells can be identified correctly on cervical smears and distinguished from epithelium from the lower uterine segment and high endocervical canal in most cases using the aforementioned criteria.

Adenocarcinoma↗

PubMed1998

Bile duct brushing cytology: statistical analysis of proposed diagnostic criteria.

Recent studies based on multivariate analysis have identified cytologic features that may be of value in the diagnosis of malignancy in bile duct brushings. We sought to assess the reproducibility and accuracy of these criteria. Three different observers used 4 sets of criteria that included 9 cytologic features to review 165 bile duct brushing specimens with available follow-up data. An overall assessment of malignancy and evaluation for the presence of chromatin clumping had excellent reproducibility (3-way kappa values of 0.708 and 0.629, respectively). Evaluation for the presence of enlarged nuclei, increased nuclear:cytoplasmic ratio, nuclear molding, and loss of honeycombing showed moderate reproducibility. An overall assessment of malignancy was a better predictor of the presence of malignancy than any other criteria, with a sensitivity of 36.2% and a specificity of 95%. Retrospective analysis demonstrated that the criteria of chromatin clumping, increased nuclear:cytoplasmic ratio, and either nuclear molding or loss of honeycombing had similar sensitivity and specificity as the overall assessment of malignancy (sensitivity = 35.2%, specificity = 95%). An overall assessment of malignancy or the criteria of chromatin clumping, increased nuclear:cytoplasmic ratio, and either nuclear molding or loss of honeycombing are reproducible cytologic criteria that accurately predict malignancy in bile duct brushings.

Adenocarcinoma↗

PubMed1998

Myofibromatosis in adults, glomangiopericytoma, and myopericytoma: a spectrum of tumors showing perivascular myoid differentiation.

The clinicopathologic features of 24 tumors showing perivascular myoid differentiation are described. These included tumors with histologic features of "infantile-type" myofibromatosis occurring in adult patients (8 cases), tumors with composite features of "hemangiopericytoma" and glomus tumor (9 cases), and tumors with a distinctive concentric perivascular proliferation of spindle cells (7 cases). Evidence of morphologic overlap among these groups suggests they are closely related neoplasms that form a single spectrum. Age of patients with lesions resembling infantile-type myofibromatosis ranged from 23 to 67 years (median, 37 years). Clinicopathologic manifestations of this disease included multicentricity (4 cases), local recurrence (3 cases), persistence of congenital lesions into adulthood (4 cases), and tumors that were multifocal within the confines of one anatomic region (7 cases). Histologically, all cases showed a biphasic pattern that consisted of fascicles of spindle cells with abundant eosinophilic cytoplasm that resembled smooth muscle, in addition to a population of more primitive spindled cells associated with a hemangiopericytomalike vascular pattern. Six cases showed reversal of the typical zonation seen in pediatric cases in that the primitive component surrounded the more mature fascicular areas. Also described are nine tumors with features that are intermediate between glomus tumor and hemangiopericytoma, which we have designated glomangiopericytoma. These tumors are characterized by prominent branching vessels lined by a single row of endothelial cells surrounded by epithelioid cells with a glomoid appearance. In other areas, the tumors showed typical hemangiopericytomatous foci similar to those in the myofibromatosis cases. The principal points of distinction were a lack of myoid nodules and an absence of small primitive cells with basophilic cytoplasm. Ages of these patients ranged from 17 to 78 years (median, 35 years). All tumors were located in the subcutaneous tissue and the superficial soft tissue of the extremities. Recurrence developed in one of six patients with follow-up information. The recurrent tumor had features of angiomatoid malignant fibrous histiocytoma. Finally, we describe a subset of tumors characterized by concentric periluminal proliferation of bland, round to ovoid cells, which we have designated as myopericytoma. Patient age ranged from 10 to 66 years (median, 40 years). All were located in subcutaneous and superficial soft tissue of distal extremities. One patient had two recurrences in 3 years after initial excision. Our study suggests that these three lesional groups comprise a histologic continuum of tumors that share clinical similarities and that, perhaps, are designated more appropriately as perivascular myomas. The relationship of this family of tumors to so-called hemangiopericytoma is discussed.

Actins↗

PubMed1998

Postpartum and vulvar necrotizing fasciitis. Early clinical diagnosis and histopathologic correlation.

OBJECTIVE: To review the clinical course and correlate histopathologic findings of obstetrics and gynecology patients with necrotizing fasciitis STUDY DESIGN: Seven-teen patients with postpartum or vulvar necrotizing fasciitis were identified from 1981 to 1996. Medical records were retrospectively reviewed. Information was available for all patients until death or discharge from the hospital. Histopathologic material on 15 patients was available for review. RESULTS: Five postpartum patients were diagnosed and surgically debrided one to nine days after cesarean delivery, with no mortality. Twelve patients with vulvar necrotizing fasciitis were diagnosed and surgically debrided <1-10 days after presentation to a physician, with three deaths (25%). On histopathologic review, all cases had prominent lobular and septal panniculitis. Thirteen cases had histologic evidence of fasciitis. CONCLUSION: Early diagnosis and aggressive surgical debridement in patients with postpartum and vulvar necrotizing fasciitis may improve the outcome. Histopathologic findings are remarkably consistent and may help to confirm the diagnosis.

Adult↗

PubMed1998

The pericentromeric inversion, inv (6)(p25q13), is a novel diagnostic marker in chondromyxoid fibroma.

Chondromyxoid fibroma is a benign bone tumor that arises most commonly in the metaphysis of long bones in young adults. The cytogenetic features of this tumor are not well known. In this study, four chondromyxoid fibromas were karyotyped after short-term cell culture. All of the tumors contained clonal rearrangements of chromosome 6, and each of these rearrangements involved band 6q13. Two tumors contained a pericentromeric inversion, inv (6)(p25q13), which was described recently in chondromyxoid fibroma. 6q13 rearrangements are not associated with other types of bone and soft tissue tumors, and the inv (6)(p25q13) is reported only in chondromyxoid fibroma. Hence, this cytogenetic marker might be helpful in distinguishing chondromyxoid fibroma from chondrosarcoma and other histologic mimics. The consistent occurrence of 6q13 rearrangements suggests a specific oncogenic mechanism in chondromyxoid fibroma, most likely involving oncogene activation.

Adolescent↗

PubMed1998

A comparison of A103 and inhibin reactivity in adrenal cortical tumors: distinction from hepatocellular carcinoma and renal tumors.

Distinguishing adrenal cortical neoplasms from either hepatocellular carcinomas or renal tumors can be difficult. Two recently described antibodies, A103 and inhibin A, are most often reported to be reactive with adrenal cortical neoplasms but with neither hepatocellular carcinoma nor renal cell carcinoma. To compare the sensitivity and specificity of these two antibodies in the diagnosis of adrenal cortical tumors, we stained 22 adrenal cortical adenomas, 4 adrenal cortical carcinomas, 25 hepatocellular carcinomas, and 43 renal tumors, including 33 renal cell carcinomas and 8 oncocytomas, with the A103 and inhibin A using an avidin-biotin complex technique. Fifteen (68%) of 22 adrenal adenomas and 2 (50%) of 4 adrenal cortical carcinomas were reactive with A103. Nineteen (86%) of 22 adrenal adenomas and 3 (75%) of 4 adrenal cortical carcinomas were reactive for inhibin A. None of the renal tumors or hepatocellular carcinomas reacted with A103, but 1 (4%) of 25 hepatocellular carcinomas (a high-grade pleomorphic tumor) and 1 (2%) of 43 renal tumors (a clear-cell renal cell carcinoma) were reactive with inhibin A. The cytoplasmic reactivity for A103 in adrenal tumors was coarsely granular and most common in clear-cell areas. Reactivity for inhibin was either cytoplasmic or membranous and stained both clear-cell and granular areas. We conclude that both antibodies are useful in the immunohistochemical diagnosis of adrenal cortical neoplasms and that A103 is slightly more specific and inhibin slightly more sensitive.

Adenoma↗

PubMed1997

Use of statistical analysis of cytologic interpretation to determine the causes of interobserver disagreement and in quality improvement.

BACKGROUND: Disagreements in cytologic interpretation can have several causes, including differences in diagnostic threshold and diagnostic accuracy. These can be distinguished by a combination of statistical analyses. METHODS: For demonstration purposes, a nonrandom collection of 80 cervicovaginal smears, the majority of which (74) were originally diagnosed as atypical cells of undetermined significance (ASCUS), were reviewed by 3 separate observers and classified as either negative, negative and reactive, ASCUS favor reactive, ASCUS not otherwise specified, ASCUS suggestive of a squamous intraepithelial lesion (SIL), low grade SIL, or high grade SIL. The results were compared with corresponding biopsies and analyzed with distribution analysis, the kappa statistic, threshold analysis, and receiver operating characteristic (ROC) curve analysis. RESULTS: Distribution analysis of diagnoses from the three observers demonstrated statistically significant differences in how cases were classified and a low level of agreement. Kappa analysis confirmed a very poor interobserver agreement. Threshold analysis revealed that one observer used a threshold between negative and ASCUS that was statistically more specific but less sensitive than the other observers. ROC curve analysis showed that another observer was more accurate than this observer. CONCLUSIONS: Variation in cytologic interpretation may have several causes. Distribution, threshold, and ROC analysis allow distinction between differences in diagnostic accuracy and diagnostic thresholds. This approach to analyzing cytologic interpretation may be useful for quality improvement efforts.

Cytological Techniques↗

PubMed1997

Fine-needle aspiration of chromophobe renal cell carcinoma. Analysis of six cases.

BACKGROUND: The chromophobe variant of renal cell carcinoma is a recently described and frequently unrecognized tumor. Because the prognosis of the chromophobe variant appears to be intermediate between that of oncocytoma and the clear cell variant of renal cell carcinoma, accurate diagnosis may be important for appropriate clinical management. METHODS: A retrospective analysis of fine-needle aspirations of four primary and two metastatic chromophobe renal cell carcinomas (five typical and one eosinophilic variant) with histologically confirmed primary tumors was performed. Hale's colloidal iron stain was strongly positive in a diffuse cytoplasmic pattern in all resected primary tumors. RESULTS: All fine-needle aspirations were characterized by cellular smears comprised of single cells and small groups of cells. The cytoplasm varied from granular to flocculent. A characteristic feature was the presence of occasional markedly enlarged, bizarre, often multinucleated cells, within a background of moderately atypical cells. Nuclear enlargement, hyperchromasia, pleomorphism, and outline irregularity were noted in all cases. These features imparted a koilocyte-like appearance to many of the cells. Intranuclear pseudoinclusions were present in four cases and were numerous in two. CONCLUSIONS: Both primary and metastatic chromophobe renal cell carcinomas have unique cytologic features that allow for their distinction from oncocytoma and other variants of renal cell carcinoma.

Adenoma, Oxyphilic↗

PubMed1997

Fine-needle aspiration of the adult kidney.

BACKGROUND: Fine-needle aspiration (FNA) of the adult kidney is an excellent diagnostic tool in the appropriate clinical setting. The indications, cytologic criteria, and therapeutic implications of renal FNA may be changing. METHODS: A review of the English language literature concerning the indications, utility, and criteria for renal FNA was performed. RESULTS: The indications for renal FNA are changing as radiologic imaging allows better assessment of cystic lesions and incidentally identifies an increasing percentage of renal lesions. Cytologic criteria and pitfalls for the diagnosis of a wide variety of benign and malignant lesions have been delineated and refined. The increasing use of partial rather than radical nephrectomy for some renal lesions suggests that accurate distinction between these lesions may have important therapeutic implications. CONCLUSIONS: Renal FNA provides important information that can affect the management of patients with renal masses.

Adult↗

PubMed1997

Aggressive angiomyxoma: reappraisal of its relationship to angiomyofibroblastoma in a series of 16 cases.

Aggressive angiomyxoma is a distinctive soft tissue tumor associated with a high risk of local recurrence but lacks metastatic potential. This tumour occurs nearly exclusively in the soft tissues of the pelvis and perineum of adult women. The line of differentiation is not firmly established, but a fibroblastic/myofibroblastic origin has been proposed. We report 16 new cases of aggressive angiomyxoma of the pelvic soft tissue in women. In all cases bundles of cells, most often adjacent to vessels, with histological features of smooth muscle cells were identified. In 11 of 14 cases the myoid bundles were immunoreactive for desmin; they were also positive for smooth muscle actin in 10 of 11 cases. In 13 of 14 cases lesional stromal cells showed immunoreactivity for desmin. Three cases showed areas with histological features similar to those of angiomyofibroblastoma of the vulva, thus representing previously undescribed morphological overlap between these two entities. We conclude that aggressive angiomyxoma and angiomyofibroblastoma are related neoplasms in a spectrum of tumours showing myofibroblastic origin. Furthermore, the demonstration of immunoreactivity for desmin in aggressive angiomyxomas implies that this antibody is not helpful in discriminating between these two tumours, and the principal means of distinction remains histomorphological analysis.

Adult↗

PubMed1997

Cytologic findings in thyroid nodules after 131I treatment of hyperthyroidism.

Findings in seven cytologic specimens obtained with fine-needle aspiration biopsy were described in three patients in whom thyroid nodules developed after iodine 131 treatment of hyperthyroidism. In two patients, the presence of large bizarre cells with hyperchromatic nuclei, coarse chromatin, and prominent nucleoli suggested the possibility of malignancy, and in particular, anaplastic carcinoma. These bizarre nuclear changes were diffuse in one patient and focal in the other. In the third patient, nuclei with chromatin clearing, grooves, and nuclear pseudoinclusions suggested papillary carcinoma. At follow-up, lesions were benign in all three patients. We conclude that nuclear changes suggestive of either anaplastic carcinoma or papillary carcinoma may be seen in thyroid nodules after 131I treatment. Clues to the benign nature of these nodules include architectural arrangement of cells in cohesive clusters and flat sheets; presence of lymphocytes, histiocytes, colloid, cytoplasmic vacuoles, and Hürthle cells; and a clinical history of treatment with radioactive iodine.

Adult↗

PubMed1997

Papanicolaou smear sensitivity for adenocarcinoma in situ of the cervix. A study of 34 cases.

The sensitivity of cervical smears for adenocarcinoma in situ (AIS) is not known, nor is it known whether false-negative smears are due to sampling or to screening or interpretive errors. In 16 of 34 patients with AIS, 38 negative smears were reported 2 weeks to 7 years before biopsy. Thirty-one of these negative smears were rescreened, and 17 (55%) were retrospectively diagnosed as abnormal. Ten of the 17 had numerous well-preserved AIS cells: 5 with very small, crowded AIS cells, possibly originally mistaken for endometrial cells, and 5 with large groups in which AIS cells resembled reactive endocervical cells. Four smears were confirmed sampling errors. The sensitivity of cervical smears for AIS was 55% to 72%. Improved sampling of the endocervical canal offers cytologists the opportunity to diagnose AIS. This study demonstrates that this opportunity may not be fully exploited. Small "endometrioid" AIS cells and AIS cells resembling reactive endocervical cells may be mistaken for benign cells, thus decreasing sensitivity.

Adenocarcinoma↗

PubMed1997

Leukemic vasculitis: a feature of leukemia cutis in some patients.

Cutaneous involvement is common in certain subtypes of acute leukemia and may be a reflection of a capacity of these tumors for tissue infiltration. We have recently noted that leukemia cutis can be accompanied by vasculitis in a subset of patients. We describe six cases of such leukemic vasculitis with findings ranging from mild microvascular injury to necrotizing arteritis. All cases were seen in patients with acute leukemia with myelomonocytic or monocytic features. In one patient, cutaneous leukemic vasculitis represented the initial manifestation of leukemia. In most cases, leukemic infiltration of the dermal blood vessels was the predominant pattern of involvement with minimal dermal infiltration. Vascular injury seemed to be mediated by leukemic blasts and not by reactive inflammatory cells. We propose the term leukemic vasculitis to describe such lesions.

Adult↗

PubMed1997

Appropriate follow-up interval for biopsy confirmation of squamous intraepithelial lesions diagnosed by cervical smear cytology.

Correlation of gynecologic cytology and histology is a routine component of quality assurance in all cytology laboratories. However, the appropriate interval for histologic follow-up has not been studied. We analyzed all cases with a cytologic diagnosis of squamous intraepithelial lesion (SIL) during a 1-year period that had histologic follow-up within 1 year of cytologic sampling. Six hundred ninety-six Papanicolaou smears with 811 corresponding biopsy specimens were identified. Of the cytologic diagnoses of SIL, 68% were confirmed by biopsy. Biopsy specimens were obtained most often at two times, one at the time of cytologic diagnosis and another 40 days later. The ratio of biopsy specimens with a diagnosis of SIL to those without was highest during the first 60 days. Approximately 1% of diagnoses took almost 1 year to be confirmed. A follow-up interval of 100 days detected 78% of all SIL diagnoses yet still permitted time to affect subsequent patient treatment in most cases if desired. We conclude that for clinical purposes, the interval for histologic follow-up of a cytologic diagnosis of SIL should be less than 60 days, but for quality assurance purposes, the interval should be approximately 100 days.

Adolescent↗

PubMed1997

Cytologic and cytogenetic analysis of metanephric adenoma of the kidney: a report of two cases.

Metanephric adenoma is a recently described renal neoplasm. Because follow-up to date has been benign, accurate diagnosis on fine-needle aspiration material may be important for appropriate clinical management. A retrospective analysis of fine-needle aspiration material from two metanephric adenomas was performed. The aspirates were cellular and composed of many small to large tightly packed clusters of cells and short papillae. Occasional tubules, rosettes, and glomeruloid-like structures were seen. The tumor cells had very scant cytoplasm; small, oval to round, uniform, overlapping nuclei with fine delicate chromatin; and minute or absent nucleoli. Rare psammoma bodies were noted. Atypia, pleomorphism, necrosis, and mitoses were absent. Cytogenetic analysis showed normal karyotypes in both cases. The cytologic differential diagnosis included Wilms' tumor, renal-cortical adenoma, papillary renal cell carcinoma, and neuroendocrin, and metastatic tumors. We conclude that metanephric adenoma has unique cytologic features that may allow distinction from other renal neoplasms on fine-needle aspiration material. In difficult cases, ancillary studies may be helpful.

Adenoma↗

PubMed1997

Cellular angiofibroma: a benign neoplasm distinct from angiomyofibroblastoma and spindle cell lipoma.

Four cases of a distinctive soft-tissue tumor of the vulva are described. They were characterized by occurrence in middle-aged women (39-50 years), small size (< 3 cm), and a usually well-circumscribed margin. The preoperative clinical diagnosis was that of a labial or Bartholin gland cyst in three of the four cases. The microscopic appearance was remarkably consistent and was characterized by a cellular neoplasm composed of uniform, bland, spindled stromal cells, numerous thick-walled and often hyalinized vessels, and a scarce component of mature adipocytes. Mitotic activity was brisk in three cases (up to 11 mitoses per 10 high power fields). The stromal cells were positive for vimentin and negative for CD34, S-100 protein, actin, desmin, and epithelial membrane antigen, suggesting fibroblastic differentiation. Two patients with follow-up showed no evidence of recurrence. The differential diagnosis of this distinctive tumor includes aggressive angiomyxoma, angiomyofibroblastoma, spindle cell lipoma, solitary fibrous tumor, perineurioma, and leiomyoma. The designation of "cellular angiofibroma" is chosen to emphasize the two principal components of this tumor: the cellular spindle cell component and the prominent blood vessels.

Adipocytes↗