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W J Frable

Publications and source records attributed to W J Frable.

At least 19 recordsLinked to original sources
PubMed1992

Fine-needle aspiration cytology of localized fibrous tumor of pleura.

Fine-needle aspiration (FNA) biopsy findings are presented in three cases of localized fibrous tumor of pleura (LFTP). Clinically, two of the tumors behaved benignly, although one showed frequent mitoses and foci of necrosis. The third tumor exhibited local aggressiveness as evidenced by rib destruction. Cytologically, these tumors exhibited a wide range of cellularity, composed mainly of small, bland oval to spindle cells with moderate numbers of stripped nuclei. Small bits of collagen were seen in the smears. In all cases, cell blocks were instrumental in making the diagnosis. Previous cytologic descriptions of the tumor are briefly reviewed and the cytologic differential diagnosis is discussed. The peripheral location of this uncommon tumor makes it an ideal target for FNA biopsy.

Aged↗
PubMed1992

"Tree-barking" of the ascending aorta. Syphilis or systemic lupus erythematosus?

A case of unsuspected classical aortitis with "tree-barking" of the ascending aorta in a young woman with systemic lupus erythematosus and inconclusive syphilitic serologic results is presented. At autopsy, no definite diagnostic clues as to syphilitic or lupic aortitis could be obtained. Although infrequent today, the possibility of complicated cardiovascular syphilis still should be considered. Involvement of the ascending aorta by other systemic diseases is well known and can imitate syphilitic aortitis. Although the possibility of two concomitant diseases cannot be ruled out, the young age of the patient, the weak syphilitic serologic result, and active systemic lupus erythematosus demonstrated in other organs favor a diagnosis of lupic aortitis of the ascending aorta.

Adolescent↗
PubMed1992

Immunocytochemical staining of fine-needle aspiration biopsies of the liver as a diagnostic tool for hepatocellular carcinoma.

Fine-needle aspiration biopsy (FNAB) under ultrasonographic or computerized tomographic guidance is a useful diagnostic procedure for hepatic neoplasms. However, cytologic criteria alone may not allow for the distinction of hepatocellular carcinomas (HCC) from cholangiocarcinomas (CC) and metastatic adenocarcinomas (MA). In an effort to refine the FNAB diagnosis of hepatic malignancies, a panel of immunocytochemical stains was applied to aspiration specimens from primary and metastatic carcinomas in the liver. Anticytokeratin antibodies with different specificities (Cam 5.2 and AE1) were used in conjunction with antibodies to carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), and alpha-1-antitrypsin (AAT). All HCC, CC, and MA were immunoreactive with the antikeratin antibody Cam 5.2. However, only three (15%) HCC were positive with AE1, in contrast to 100% of CC and MA. Antibodies to CEA and AFP were also helpful diagnostic aids, especially for the three HCC that were immunoreactive with AE1. Canalicular staining for CEA was present in 47% of HCC, but in none of the CC or MA. AFP positivity occurred in 45% of HCC, but only one CC and none of the MA. AAT was not a useful marker for HCC due to low sensitivity and specificity. Immunocytochemistry is an effective adjunct to the cytodiagnosis of malignant liver tumors sampled by FNAB.

Biopsy, Needle↗
PubMed1991

Cellular follicular cyst of the ovary: fluid cytology mimicking malignancy.

We report three ovarian cysts studied by aspiration cytology. The fluids obtained were highly cellular, with numerous groups of atypical cells featuring a high nuclear-cytoplasmic ratio, nuclear hyperchromasia, and prominent nucleoli. In each case, these features were considered evidence of a low-grade malignant neoplasm. All three patients underwent oophorectomy, which revealed benign follicular cysts. Possible means of resolving the diagnostic dilemma posed by these cellular follicular cysts are discussed.

Adult↗
PubMed1991

Fine-needle aspiration cytology of adrenal cryptococcosis: a case report.

A case of adrenal cryptococcosis diagnosed by fine-needle aspiration biopsy cytology in a 58-yr-old man is presented. The organisms were easily seen with routine modified Wright stain (Diff-Quik) as variably sized yeasts, some with a brightly eosinophilic capsule. The diagnosis was confirmed with mucicarmine and silver stains. The identification of fungi with routine cytologic stains allows a rapid presumptive diagnosis of the infectious agent, collection of material for confirmatory special stains, and prompt initiation of therapy.

Adrenal Gland Diseases↗
PubMed1991

Fine-needle aspiration cytology of an unusual primary lung tumor, chondrosarcoma: case report.

A case of primary chondrosarcoma of the lung diagnosed by fine-needle aspiration biopsy (FNAB) cytology in a 78-yr-old male is presented. A mass detected on chest x-ray and defined by CT scan was subjected to a preoperative percutaneous fine-needle aspiration under fluoroscopic guidance. The distinctive cytologic features of pleomorphic cells nestled in lacunae surrounded by a chondromyxoid background resulted in a diagnosis of chondrosarcoma. The left upper lobectomy specimen confirmed the FNAB diagnosis and identified the tumor as arising from the left upper lobe bronchus.

Aged↗
PubMed1991

Extrapulmonary inflammatory myofibroblastic pseudotumor: a potential cytologic trap in childhood.

A previously healthy 20-mo-old infant presented with a right leg limp and was discovered to have a palpable intra-abdominal mass. Radiographic studies showed the mass arising from the right psoas muscle. Preoperative clinical diagnosis was probable sarcoma. Percutaneous fine-needle aspiration biopsy of the mass was interpreted as a sarcoma based on the abundant cellularity of spindled shaped mesenchymal cells. Exploratory laparotomy showed the mass to be unresectable. Histologic and ultrastructural examination of biopsy fragments, however, revealed an inflammatory myofibroblastic pseudotumor. Radiographic follow-up showed a gradual disappearance of the mass. The infant was clinically well at a clinic visit one year following surgery. This case serves to illustrate the aspiration cytology of an uncommon benign tumor-like proliferation that, when located in an unusual anatomic site, has the potential to mislead the cytopathologist into a malignant interpretation.

Biopsy, Needle↗
PubMed1991

Fine-needle aspiration biopsy of salivary glands.

Between January 1, 1973, and December 31, 1988, the authors or their associates performed 552 fine-needle aspiration biopsies on patients with clinically significant masses of the salivary glands. All patients presented at the Medical College of Virginia Hospitals or Clinics of Virginia Commonwealth University; they were followed for periods ranging from 1 to 16 years. When available, the fine-needle aspiration diagnoses were correlated with histologic diagnoses and long-term patient outcomes. The sensitivity for a neoplasm was 93.3%; the specificity for the absence of a neoplasm was 99%. Diagnostic efficiency was 96.4%, and predictive value of a positive aspiration for a neoplasm was 98.3%. With fine-needle aspiration, surgical excision of salivary gland masses is often unnecessary. In patients with primary and metastatic neoplasms involving the salivary glands, fine-needle aspiration aids the surgeon in mapping the extent of the surgical procedure and in preoperatively preparing the patient. The procedure is cost-effective.

Adolescent↗
PubMed1990

Fine-needle aspiration cytology of granulocytic sarcoma and myeloid metaplasia.

The fine-needle aspiration (FNA) cytology of two cases of granulocytic sarcoma involving the breast is reported along with the FNA cytology of one case of myeloid metaplasia (extramedullary hematopoiesis) involving an axillary lymph node. Two patients had known myeloproliferative disorders, while granulocytic sarcoma of the breast was the initial presentation of an unsuspected acute granulocytic leukemia in the other patient. Diff-Quik-stained preparations aided in the diagnosis of all three cases. Immunoperoxidase stains for factor VIII-related antigen helped confirm the megakaryocytic differentiation of the cells in the FNA cytology of myeloid metaplasia. Electron microscopic (EM) examination performed on the aspirated material also showed megakaryocytic differentiation of the bizarre cells. FNA cytology can make a specific diagnosis of granulocytic sarcoma and myeloid metaplasia. The workup of these unusual extramedullary myeloproliferative masses was aided when immunocytochemistry and EM were performed on the aspirated material.

Adult↗
PubMed1990

Metachronous soft-tissue masses in children and young adults with cancer: correlation of histology and aspiration cytology.

We describe a series of 28 fine needle aspiration biopsies (FNAB) of soft tissue from 22 patients. Four patients had two separate FNABs, and one had three aspiration procedures. The patient population was limited to children and young adults (age range, 2 months to 29 years; mean, 16 years) who were known to have diverse forms of cancer, and who subsequently developed a mass in the peripheral soft tissues (including breast). The interval between the time of diagnosis of the primary malignant neoplasm and FNAB ranged from 1 day to 17 years (mean, 39 months). All FNAB diagnoses were confirmed by subsequent surgical open biopsy or clinical follow-up greater than 1 year. No complications occurred from the procedure. The cytomorphology is presented in selected cases and correlated with the patient's original tissue histopathology. Twenty aspirates were diagnosed as cytologically malignant, one as suspicious for malignancy. Seven were considered benign. None were unsatisfactory. One false-positive and no false-negative cytologic diagnoses were obtained. The overall accuracy of FNAB diagnoses was 96%, while sensitivity was 100% and specificity 88%. Sites of aspiration included soft tissues of the head and neck (seven cases), trunk (eight cases), breast (four cases), and extremities (nine cases). Malignant cytologic diagnoses included sarcoma (thirteen), seminoma (two), lymphoma/leukemia (two), melanoma (one), undifferentiated neoplasm (one), and neuroblastoma (one). Electron microscopy of aspirated cells was used to confirm the diagnosis in two cases. Fine needle aspiration biopsy of soft tissue masses from children and young adults with cancer demonstrates a high diagnostic accuracy, and its use is justified in this population.

Adolescent↗
PubMed1990

Dendritic reticulum cells and immunophenotype in aspiration biopsies of lymph nodes. Value in the subclassification of non-Hodgkin's lymphomas.

Twenty-seven lymph node aspirates were identified for which histologic confirmation of non-Hodgkin's lymphoma was subsequently obtained. Fifteen aspirates interpreted as reactive hyperplasia were also examined. All aspirates were studied by immunoperoxidase on cytospin preparations with the use of antibodies DRC1, kappa, lambda, CD3, CD5, and CD20. The follicular lymphomas could not be identified reliably by morphologic examination of aspirate smears. Clusters of DRC1-positive (DRC1+) cells were present in seven of seven follicular lymphomas, one of one mantle zone lymphoma, and one of seven small lymphocytic lymphomas. Rare DRC1+ cells were present in one of one diffuse mixed and one of seven large cell lymphomas. One lymphoblastic, one Burkitt's, and two diffuse small cleaved cell lymphomas had no DRC1+ cells. None of the seven follicular lymphomas was CD5 positive (CD5+), whereas five of the seven small lymphocytic lymphomas were CD5+. Conversely, all seven follicular lymphomas were CD20-positive (CD20+), but only one of seven small lymphocytic lymphomas was CD20+. Nineteen of the lymphomas, including all 7 of the follicular lymphomas, were either kappa or lambda positive. The other eight lymphomas were T-cell (1), B-cell (1), true histiocytic (1), or "null" cell (5). The reactive aspirates had both kappa- and lambda-positive B-cells. Seven of the 15 had clusters of DRC1+ cells. To further evaluate these antibodies, the authors studied 29 additional, surgically biopsied, non-Hodgkin's lymphomas that had not been aspirated. Similar results were obtained, except that three of five diffuse small cleaved cell lymphomas had DRC1+ cells. DRC1, in conjunction with antibodies to CD5, CD20, kappa, and lambda, helps to distinguish follicular lymphoma from small lymphocytic lymphoma. DRC1 is not useful in separating reactive hyperplasia from follicular lymphoma.

Antibodies, Monoclonal↗
PubMed1990

Fine needle aspiration biopsy cytology of hepatoblastoma.

Fine needle aspiration biopsy (FNAB) from four patients with histologically proven hepatoblastoma (HB) is reviewed. Patient ages ranged from 5 mo to 19 mo; two were male and two were female. Initial cytologic diagnoses were hepatoblastoma in two cases, malignant neoplasm consistent with liver cell tumor in one case, and probable Wilm's tumor in a fourth case. Cytologic features were similar in all cases and included highly cellular smears composed of a uniform population of small to intermediate sized round to oval cells. Extramedullary hematopoietic cells were obvious in smears of one patient. Neither bile nor extracellular stroma was seen. Immunohistochemical stains performed in two cases demonstrated positive staining for low-molecular-weight cytokeratins expressing polypeptides 8 and 18 of the Moll classification. Staining for vimentin, carcinoembryonic antigen, and epithelial membrane antigen was negative. alpha-Fetoprotein and alpha 1-antitrypsin stains were equivocal because of high background staining. Electron microscopy from three cases showed cells with features of immature hepatocytes. Three tumors were subsequently examined histologically by surgical biopsy, and one at autopsy. All were epithelial-type HB containing a mixture of "fetal" and "embryonal" hepatocytes. These results demonstrate the successful mimicry of FNAB cytology of hepatoblastoma to its histologic counterpart and its clinical utility in the diagnosis of intrahepatic masses of children.

Biopsy, Needle↗
PubMed1990

Fine needle aspiration biopsy of extramedullary plasma cell tumors.

Fourteen fine needle aspiration (FNA) biopsies of extramedullary plasma cell tumors (PCT) from 11 patients were reviewed and correlated with histology in eight patients. This series comprised seven men and four women ranging in age from 46 to 83 yr (median 69 yr). Discrete masses were located in lymph nodes (three patients), pleura (one patient), soft tissues of the neck (two patients), thorax (six patients), axilla (one patient), and inguinal region (one patient). A spectrum of cytologic findings was demonstrated which led to the clinical confirmation of myeloma in four of 11 patients and of solitary plasmacytoma in two of 11 patients. In addition, FNA biopsies confirmed the presence of extramedullary disease in four of 11 patients with previously diagnosed myeloma. In another patient with a poorly differentiated plasma cell neoplasm, excisional biopsy was recommended to confirm the presence of a plasma cell tumor. Clinical follow-up was available on ten patients; of these, nine were treated with aggressive chemotherapy and, in five instances, additional radiotherapy. The 10th patient succumbed to infection prior to treatment. Nine of the ten patients were dead of disease 3 days to 4 yr following clinical diagnosis of a plasma cell dyscrasia. One patient (Case 1) was lost to follow-up after biopsy confirmation of plasmacytoma. The cytomorphologic appearance of neoplastic plasma cells in FNA of solitary masses necessitates clinical evaluation for bone marrow disease, i.e., myeloma.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Fine needle aspiration biopsy in the management of children and young adults with peripheral lymphadenopathy.

To determine the effectiveness of fine needle aspiration (FNA) of the lymph node in the management of young patients with peripheral lymphadenopathy, all patients 30 years of age and under who had a lymph node aspirate and who then had subsequent excisional biopsy, autopsy, or clinical follow-up for a minimum of one year were examined. One hundred twenty-seven aspirates from one hundred twenty-six patients fulfilled the criteria of the study. Diagnoses of eighty-three benign and thirty-seven malignant lymphadenopathies were confirmed. There were three false negative and four false positive diagnoses. Sensitivity, specificity, and positive and negative predictive values were 0.93, 0.95, 0.90, and 0.97%, respectively. Of the one hundred twenty-six patients, twenty-five had a previous history of malignancy. Results of aspiration biopsy in this group were examined to determine FNA ability to predict recurrent disease. In this group the sensitivity, specificity and positive and negative predictive values were 0.95, 0.80, 0.95, and 0.80 respectively. Finally, the group of patients with clinically suspicious primary lymphadenopathy without an antecedent history of malignancy were examined to determine the effectiveness of the technique for selecting patients for surgical biopsy. This group included a total of one hundred two patients. Sensitivity, specificity, and positive and negative predictive values were 0.93, 0.96, 0.90, and 0.97, respectively. Based on the data from this retrospective study, we conclude that fine needle aspiration provides a useful tool in the management of young patients with peripheral lymphadenopathy, both in monitoring recurrent disease and in triaging patients with clinically suspicious primary lymphadenopathy to determined the next appropriate step in management.

Adolescent↗
PubMed1989

Fine-needle aspiration cytology of postirradiation sarcomas, including angiosarcoma, with immunocytochemical confirmation.

Postirradiation sarcomas are an unusual but well-recognized late effect of cancer therapy. In this article, a fine-needle aspiration (FNA) series of four cases is presented. There were three female patients and one male patient, with an age range of 28-55 yr (mean, 41). Two of the patients were irradiated for uterine cervical carcinoma while the other two received irradiation for malignant lymphoma. The time interval to the development of the postirradiation sarcoma ranged from 10 to greater than 20 yr. There were a postirradiation synovial sarcoma of the buttock region, malignant fibrous histiocytoma of the bone (femur), and rhabdomyosarcoma and angiosarcoma of the retroperitoneum. A spectrum of cytologic findings was encountered, reflecting the specific types of sarcomas. Immunocytochemical studies performed on the aspirated material from the angiosarcoma demonstrated the utility of immunoperoxidase stains for ULEX europaeus agglutinin-1 (UEA-1) and, to a lesser degree, factor VIII-related antigen antibody, confirming the vascular nature of this malignancy. The FNA findings from all four cases demonstrated cytologic features that allowed recognition of this unusual complication of irradiation treatment. This article confirms the utility of FNA cytology in following patients with previous malignancies and differentiating a postirradiation sarcoma from recurrent carcinoma.

Adult↗