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Aspiration pneumonia is defined as pulmonary infiltration caused by inhaled material, either solid or liquid, that is inherently toxic or that initiates a toxic response. We present the case of a solitary lung mass of unknown etiology in which cytology of a fine needle aspiration provided a definitive diagnosis of this disorder.
We describe one case of Rosai-Dorfman disease (RDD) localized in the breast and one case of breast malacoplakia (MPK) both diagnosed by fine-needle aspiration cytology (FNAC). In RDD the cytologic features were lymphocytophagocytosis, large histiocytes with slight nuclear atypia, and lymphohistiocytic aggregates in a polymorphous background which included frequent plasma cells. In MPK the key diagnostic feature was the presence of Michaelis-Gutmann bodies (M-G bodies), in various stages of evolution, intermingled with vacuolized medium-sized histiocytes, other inflammatory cells, and debris. Pap staining is the technique of choice to show lymphocytophagocytosis and M-G bodies and there is no need to resort to special staining methods. RDD and MPK share a common cytologic background: the presence of numerous benign reactive histiocytes, either engulfing apparently intact lymphocytes, or phagocytizing M-G bodies. The cytologic findings seen in both cases suggest that the presence of histiocytes in a breast aspirate is far from being nonspecific and can represent an important lead to disparate diseases such as RDD and MPK.
This study, comparing transvaginal ultrasound-guided follicle aspiration with laparoscopic-guided follicle aspiration for in vitro fertilization confirms that the use of laparoscopy appears to have no advantage for oocyte recovery over the ultrasonically directed technique. The latter offers potential benefits of less trauma, less risk, less morbidity, avoidance of general anesthesia, decreased operating room and personnel time, decreased expense, and in general, greater acceptance.
Primary prevention of breast cancer requires identification and elimination of cancer-causing agents, which is an incredibly difficult task to follow. Secondary prevention involves screening individuals who are at increased risk for breast cancer in hopes that early intervention will affect survival. In the 1980s, chemoprevention received serious attention. This approach was aimed at reducing cancer risk by administration of natural or synthetic clinical compounds that prevent, reverse, or suppress carcinogenesis in individuals at increased risk for cancer. It was not until 1998, however, when the first report from the National Surgical Adjunct Breast and Bowel Project (Breast Cancer Prevention Trial BCPT; P-1) randomized clinical trial appeared in the literature supporting the hypothesis that breast can-cer can be prevented. This study showed that administration of tamoxifen reduced the risk for invasive and noninvasive breast cancer by almost 50% in all age groups. With the current availability of tamoxifen as a chemopreventive agent and with the increasing emphasis on early breast cancer detection and prevention, more women seek consultation to determine their risk for breast cancer. However, in the absence of any detectable breast lesion, clinically and mammographically, only a few women may volunteer to have their breasts sampled by surgical biopsy for risk assessment. Other non-surgical procedures include fine needle aspiration biopsy (FNAB), nipple aspirate fluid (NAF), and the recently introduced procedure, ductal lavage. These techniques may provide better alternatives. These minimally invasive procedures are capable of recruiting cellular material for cytomorphologic interpretation and biomarker studies.
OBJECTIVE/HYPOTHESIS: Fine needle aspiration (FNA) is an accurate, cost-effective tool for the study of salivary gland lesions. Although complications are extremely rare, salivary gland FNA can lead to hemorrhage, facial nerve injury, and cellulitis at the needle puncture site. Some studies suggest that FNA can cause infarction or metaplastic transformation of benign Warthin's tumors. We review our recent experience with FNA of the parotid gland, focusing on possible complications and pitfalls. STUDY DESIGN AND SETTING: The medical records of all patients who underwent FNA of the parotid gland from 2000 to 2002 in the Department of Otolaryngology-Head and Neck Surgery of a major tertiary-care referral center were reviewed. Cytological results were compared to the histological diagnosis and complications were recorded. RESULTS: Of the 256 lesions aspirated, 99 patients (39%), were cytologically diagnosed as benign tumors, including 31 (12%) Warthin's tumors, of which 16/17 resected and confirmed histologically. Five patients with Warthin's tumor had post-FNA parotitis and were treated accordingly. CONCLUSIONS: The combination of cystic spaces surrounded by oncocytic cells and a poor blood supply makes the tumor susceptible to infarction and inflammation. Our findings indicate that FNA is a strong and reliable tool in the investigation of the salivary glands. Nevertheless, when Warthin's tumor is clinically suspected on the basis of its location (tail of the parotid gland), cystic texture, patient sex (male) and age, one should consider parotitis as a possible complication. EBM RATING: C-4.
This paper examines women's acceptability of and experiences with manual vacuum aspiration (MVA) as compared with electric vacuum aspiration (EVA) for first trimester abortion. Women requesting pregnancy terminations were randomly assigned to either MVA (n = 64) or EVA (n = 63). Participants completed questionnaires before and after their abortions and approximately 2-4 weeks later. We observed some differences by group in participants' ratings of the importance of method characteristics and in their perceptions of their abortion methods after their abortions. The two groups did not, however, differ in their reports of pain, anxiety or bleeding or in the acceptability of their method.
We report a case of tumor dissemination via needle aspiration of a solid hypovascular renal mass. This case emphasizes how needle aspiration of these masses does not always lead to proper management and may be detrimental to the patient.
The aim of this paper was to verify the hypothesis that large needle biopsy performed preoperatively can refine preoperative fine needle aspiration (FNA) cytological diagnoses of microfollicular nodules. Since 1980 we have been using FNA and aspiration needle biopsy (ANB) (18 or 16 gauge needles) to select for surgery all euthyroid patients with palpable thyroid nodules referred to our department. From 1980 to 1994, 6,124 patients (12% male, 88% female) with thyroid nodules (71% single, 29% multiple) were examined by FNA; 29% of these patients were also examined preoperatively by ANB histology. Of all the nodule patients examined, 371 received a preoperative FNA diagnosis of microfollicular nodule. Two hundred and fifty-four of these nodules (68%) were also examined preoperatively by ANB. Unsatisfactory ANB specimens constituted 17% of cases; pure microfollicular structure was confirmed by ANB in 36% of the nodules; ANB showed the remaining 47% to contain a macrofollicular component, thus suggesting a benign hyperplastic lesion. Twelve nodules which were found to be microfollicular at FNA cytology and micro-macrofollicular at ANB were excised and were subsequently determined as benign at definitive postoperative histology. These data indicate the utility of ANB in refining the preoperative FNA diagnosis of microfollicular nodule and in preoperatively identifying benign hyperplastic mixed micro-macrofollicular lesions which can be followed by observation.
From 1980 to 1996, 1,907 consecutive euthyroid subjects with palpable thyroid nodules were examined by fine needle aspiration (FNA) cytology plus large needle aspiration biopsy (LNAB) histology. There were 1,630 (85%) women and 277 (14.5%) men aged from 17 to 80 years. A single nodule was palpated in 1,419 subjects (74.4%) while 488 (25.6%) showed multiple nodules. The nodule size ranged between 1 and 7.5 cm. The number of inadequate specimens at the first examination, FNA cytology of LNAB histology, were 261 (13%) or 398 (20.8%), respectively. LNAB performed on the 261 nodules with nondiagnostic cytology showed findings which were adequate for diagnosis in 130 (49.8%) and inadequate in 131 (50.2%). Among the 261 patients with inadequate initial cytological findings 61 were subjected to repeated FNA and 36 repeated LNAB. More than 60% of the nodules on which FNA was repeated achieved a cytological diagnosis; more than 80% of the nodules reinvestigated by LNAB were finally diagnosed by histology. The mean nodule size was larger in the group with inadequate result than in that with adequate FNA or LNAB result. Among the 261 patients with inadequate cytological finding at the first FNA 28 were operated on; 20 were in the group with adequate LNAB histological findings and eight in the group with an inadequate LNAB. Two papillary cancers, one per group, were found at postoperative histology. However, one was diagnosed by LNAB and one at the second FNA. The remaining 26 nodules were all found to be benign postoperatively. This study shows that the addition of LNAB to FNA leads to a histological diagnosis in 50% of the palpable thyroid nodules with inadequate cytology at the first FNA and that LNAB can be used even for those nodules which remain uncharacterized after repeat FNA.
There are many selected small series or case reports of FNAs in patients with HIV infection, but large series are rare and epidemic's characteristics have evolved over time. The current study, from a large public hospital in the USA, included women as well as men, hetero- and homosexuals, in-patients and out-patients, and deep radiologically guided aspirates as well as superficial masses. Of 655 FNAs, reactive or benign changes were present in 37% confirmed or suspected malignancy in 13%, specific infection with stainable organisms in 14%, and inflammation in 16%. Twenty percent of cases were inadequate for diagnosis. Most of the identifiable infections were associated with Mycobacterium tuberculosis, with fewer atypical mycobacteria, fungi and other bacteria. Clinically significant diagnoses were correlated with deep aspirate location and lesion size > 2 cm, confirming other studies which also identified tenderness and recent enlargement as important indicators. The liberal use of FNA in our HIV+ population has greatly reduced the necessity for surgical nodal resection, reassured clinicians in continuing observation of reactive lymphadenopathy, and allowed immediate therapy for specific infection, cyst or malignancy.
BACKGROUND AND STUDY AIMS: It would be desirable to develop minimally invasive methods of tissue diagnosis from lymph nodes as well as solid lesions in the mediastinum. The aim of the present study was to test the combined method of transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the evaluation of mediastinal lesions. PATIENTS AND METHODS: EUS-FNA and EBUS-TBNA were compared in 33 patients, for the staging of lung cancer in patients with an established diagnosis of non-small-cell lung cancer (n = 20) or for diagnosis of a suspicious mediastinal lesion in patients with suspected lung cancer (n = 13). EBUS-TBNA and EUS-FNA were unsuccessful in one patient each. The diagnoses were verified in 28 of the remaining 31 patients either at thoracotomy (n = 9) or during the clinical follow-up (n = 19). RESULTS: A total of 119 lesions were sampled by EUS-FNA (n = 59) and EBUS-TBNA (n = 60). EUS-FNA and EBUS-TBNA demonstrated cancer in 26 and 28 lesions, respectively, and benign cytology in 30 and 28 lesions, respectively. Suspicious cells were found in three and four lesions by EUS-FNA and EBUS-TBNA, respectively. When the 60 EBUS-TBNA samples were compared with the 59 EUS-FNA samples, 11 additional cancer diagnoses and three samples with suspicious cells were obtained by EBUS-TBNA that had not been obtained by EUS-FNA. Conversely, EUS-FNA diagnosed 12 additional cancer diagnoses, one suspicious and one specific benign diagnosis (sarcoidosis) in addition to EBUS-TBNA. With a combined approach (EUS-FNA + EBUS-TBNA) in 28 of the 31 patients in whom a final diagnosis was obtained in the evaluation of mediastinal cancer, 20 patients were found to have mediastinal involvement, whereas no mediastinal metastases were found in eight patients. The accuracy of EUS-FNA and EBUS-TBNA, in combination, for the diagnosis of mediastinal cancer was 100 % (95 % CI, 83 - 100 %). CONCLUSIONS: EUS-FNA and EBUS-TBNA appear to be complementary methods. A combined approach with both EUS-FNA and EBUS-TBNA may be able to replace more invasive methods for evaluating lung cancer patients with suspected hilar or mediastinal metastases, as well as for evaluating unclear mediastinal or hilar lesions.
Speech segments are highly context-dependent and acoustically variable. One factor that contributes heavily to the variability of speech is speaking rate. Some speech cues are temporal in nature-that is, the distinctions that they signify are defined over time. How can temporal speech cues keep their distinctiveness in the face of extrinsic transformations, such as those wrought by different speaking rates? This issue is explored with respect to the perception, in Icelandic, of Voice Onset Time as a cue for word-initial stop voicing, word-initial aspiration as a cue for [h], and Voice Offset Time as a cue for pre-aspiration. All the speech cues show rate-dependent perception though to different degrees, with Voice Offset Time being most sensitive to rate changes and Voice Onset Time least sensitive. The differences in the behaviour of these speech cues are related to their different positions in the syllable.
A total of 37 percutaneous epididymal sperm aspiration (PESA) and/or testicular sperm aspiration (TESA) procedures were performed under local anaesthesia (LA) on 34 men between June and November 1996. Local anaesthesia was achieved by injecting 10 ml of 1% lignocaine solution along the sides of the vas deferens near the external inguinal ring (spermatic cord block). Sperm retrieval was successful in 92% of the procedures. Of the 37 procedures, in 29 the patients felt either no pain or mild discomfort while in six they experienced moderate but tolerable pain. Analgesia was incomplete in two procedures and was supplemented with i.v. sedation. Vasovagal reflex in two procedures was reversed by i.v. atropine. In 24 procedures patients felt relaxed, whilst in 13 they felt anxious. In 32 procedures the patients expressed overall satisfaction. If the procedure was to be repeated, after 29 procedures the patients requested LA again, while after four procedures they preferred i.v. sedation and after four were undecided. LA is adequate for PESA and TESA in a large proportion of patients. Prior discussion of LA technique with the patient is necessary. Back-up facilities for i.v. sedation and atropine should be available.
The preoperative fine-needle aspiration (FNA) cytologic diagnoses of microfollicular nodule and suspected cancer include nodules that yield histologic results of typically benign lesions, nodular hyperplasia and follicular adenomas, and differentiated thyroid cancer postoperatively. We reviewed the clinical and pathologic data for patients with palpable thyroid nodules with these two cytologic diagnoses; nodules were also examined by large-needle aspiration biopsy (LNAB) to assess whether the distinction achieved by LNAB in pure microfollicular or mixed microfollicular-macrofollicular nodules could be used preoperatively to better predict the diagnosis of follicular adenoma. One hundred fourteen nodules of this type were excised. Postoperative results were grouped in nodular hyperplasia (90 nodules), follicular adenoma (8), and differentiated carcinoma (16). The prevalence of the follicular adenoma and thyroid carcinoma postoperative findings was 33% among the microfollicular nodules and 5.9% among the microfollicular-macrofollicular nodules at preoperative LNAB, (p = 0.0004). Within the postoperatively benign nodules, the prevalence of follicular adenoma was 14.3% among the microfollicular nodules and 2% among the microfollicular-macrofollicular nodules at LNAB (p = 0.028). These data indicate that histologic examination of the LNAB specimen can be used to identify those thyroid nodules diagnosed by FNA as microfollicular nodules or suspected cancer, which are most likely to be follicular adenomas postoperatively.
Among 145 cases of spontaneous thalamic hemorrhage, stereotactic aspiration of the hematoma was done in 75 cases in which the hematoma was greater than 6 ml and the limbs on the affected side could not be elevated. Thirty-one of 40 operated cases with a long axis greater than 3.3 cm were capable of returning to useful activity 6 months postoperatively (excellent to fair). The results 6 months from onset in the 145 cases were as follows: 43% excellent or good, 32% fair, 11% poor and 13% dead. These results appear to indicate that stereotactic aspiration can produce improvements in therapeutic results for cases of thalamic hemorrhage.
OBJECTIVE: To assess the efficacy of the nucleic acid amplification (NAA) technique for Mycobacterium tuberculosis (MTB) complex from archival fine needle aspirate (FNA) smear scrapings of confirmed cases of extrapulmonary tuberculosis (EPTB) for a retrospective diagnosis of EPTB as compared to NAA from fresh FNA material from the same cases. STUDY DESIGN: Smear scrapings from 51 cases; 33 cases of tuberculous lymphadenitis (from patients who had undergone NAA 1 year before for MTB from fresh FNA material); 13 negative controls from nontuberculous, archival FNA smears; and 5 known acid-fast bacilli (AFB)-positive sputum smears, were subjected to NAA using the IS6110 primer sequence of M tuberculosis. Ziehl-Neelsen staining was done in all the smears. RESULTS: Of the 33 cases of tuberculous lymphadenitis, 15 (45.4%) were AFB positive and 18 (64.5%) AFB negative. MTB NAA was positive in 73.3% (11 of 15 AFB-positive cases) in the freshly aspirated material and was observed in 60% (9 of 15 AFB-positive cases) when done on DNA extracted from the archival smear scrapings of the same cases. Similarly, in the 18 AFB-negative cases, MTB NAA positivity was 72.2% (13 of 18) on fresh material and 44.4% (8 of 18) on archival smear scrapings from the same AFB-negative cases. Overall NAA positivity was 51.5% for archival smear scrapings as compared to 71% for fresh FNA of the same cases. CONCLUSION: Low NAA sensitivity of MTB DNA in archival material of known tuberculous cases limits the routine use of NAA based retrospective molecular diagnosis of MTB complex.
BACKGROUND: Medigstinal seminoma ia an uncommon tumor that occurs primarily in young males. We present a case of mediastinal seminoma in an elderly male diagnosed on fine needle aspiration (FNA) tytology. CASE: A 62-year-old male was admitted to our hospital because of anterior chest pain for 2 weeks. Chest computed tomography revealed a huge, lobulated mass in the anterior mediastinum. Aspirate smears were highly cellular. The tumor cells appeared singly or in loose groups of a few cells in a markedly necrotic background without lymphocytic or tigroid characteristics. Well-preserved cells were relatively uniform, large and polygonal, with round or ovoid nuclei, 2 1 prominent nucleoli and a mild to moderate amount of clear, occasionally vacuolated cytoplasm. The chromatin wasfinely granular. Mitotic figures were frequently found. The cell block section showed solid nests of tumor cells with cytologic features similar to those in the smears, supported by loose, fibrous stroma infiltrated by some lymphocytes. Immunocytochemically the tumor showed diffuse reactivity for c-kit and appearedfocally positive for placentalike alkaline phosphatase and was uniformly negative for pancytokeratin, CAM 5.2 low-molecular-weight cytokeratin, CD5, CD30, alpha-fetoprotein and leukocyte common antigen. CONCLUSION: A confident diagnosis of mediastinal seminoma can be established by FNA cytology, cell block and immunocytochemistry.
The palpable thyroid nodules with a fine-needle aspiration (FNA) diagnosis of microfollicular nodule or suspected cancer usually are excised; however, most of them are proved benign by postoperative histologic examination. We reviewed the clinical and pathologic data for patients with thyroid nodules with an FNA diagnosis of microfollicular nodule or suspected cancer; nodules also were examined by large-needle aspiration biopsy (LNAB) to assess whether the distinction achieved by LNAB into pure microfollicular or mixed microfollicular-macrofollicular nodules could be used preoperatively to better predict malignancy. One hundred fourteen nodules of this type were excised. The prevalence of cancer was 22% (14/63) among the microfollicular and 4% (2/51) among the microfollicular-macrofollicular nodules at LNAB. These data indicate that histologic examination of the LNAB specimen can be used for preoperative selection of thyroid nodules diagnosed by FNA as a microfollicular nodule or suspected cancer.