Turkish Journal of Pathology - 2002; 18(3-4)

FINE NEEDLE ASPIRATION CYTOLOGY OF SALIVARY GLANDS (39 CASES WITH CYTO-HISTOPATHOLOGIC CORRELATION)

[Sevgiye |KA�AR �ZKARA|1][K�r�at |YILDIZ|1] — 2001-12-01

In this study, our aim was to find out the role of fine needle aspiration cytology in the diagnosis and treatment of salivary gland lesions in our institution. We also searced for the cyto-histopathological correlation of our cases. A total number of 120 salivary gland fine needle aspiration cytology cases which had been examined in the Pathology Department of Kocaeli University Medical Faculty for the last five years were retrospectively reviewed. Thirty nine of these were correlated with their histopathology. A cytopathologic diagnosis were not given in 42 out of the total 120. Twenty seven were interpreted as non-neoplastic benign lesions (like sialadenitis, sialadenosis...) Twenty-seven were diagnosed as pleomorphic adenomas while 9 Warthin tumors, 2 acinic cell carcinomas and 1 mucoepidermoid carcinoma were diagnosed. Five cases were reported to be malignant while 3 were suspicious for malignancy. Four cases were interpreted as “tumoral lesion of salivary gland origin” without benign or malignant discrimination. Cyto-histopathologic correlation of the cases which have tissue specimens were resulted in concordance in 94.44 % of pleomorfic adenomas (17/18) and 85.71 % of Warthin tumors (6/7). Of the four cases that were diagnosed as “malignant” cytologically, two were carcinoma ex pleomorfic adenoma while two were acinic cell carcinomas. One of the 3 cases that were suspicious cytologically was found out to be a Warthin tumor with cystic degeneration. Another suspicious case was diagnosed as carcinoma ex pleomorfic adenoma. Histopathological examination revealed lymphoma in the cytopathologically “suspicious lymphoproliferative lesion.” In two cases that benign-malignant differentiation could not be made, 1 adenoid cystic carcinoma and one pleomorfic adenoma was detected. Two cases which were “normal” cytopathologically were also reported to be “normal” histopathologically. Of the 2 unsatisfactory cases, one resulted in the diagnosis of basal cell adenocarcinoma while the other was adenoid cystic carcinoma. In the differentiation of benign from malignant lesions of salivary glands in our institution, sensitivity rate is 87.5%, specificity is 92.86 % and the accuracy is 91.67 %. FNAC has successfully been used in the diagnosis and treatment of salivary gland lesions. If high inadequacy rate can be minimized by considering fine needle aspiration cytology as a team work, reperating in case of insufficient material and providing close clinicopathological relations; the success rate will increase.

FINE NEEDLE ASPIRATION CYTOLOGY OF SOFT TISSUE AND BONE LESIONS; EXPERIENCE OF KOCAELI UNIVERSITY (FIFTY-SIX CASES WITH CYTO-HISTOPATHOLOGIC CORRELATION).

In this study, our aim was to find out the role, benefits and limitations of fine needle aspiration cytology in the preoperative interpretation of soft tissue and bone lesions in our institution. Soft tissue and bone fine needle aspiration cytology cases that have been interpreted at the Pathology Department of Kocaeli University Medical Faculty for the last five years were reviewed retrospectively. The cases were grouped into six categories according to their diagnoses as 1-”benign-inflammatory”, 2-”benign-tumoral”, 3-”suspicious”, 4-“malignant-primary”, 5-”malignant- recurrent”, 6-”malignant-metastatic”. The cases that have histopathological examination done were correlated with their fine needle aspiration cytology. “Suspicious” cases were regarded as “positive” in the statistical analysis. Twenty-seven fine needle aspiration cytology cases out of the total 116 were unsatisfactory. Those that a cytopathological diagnosis was given were 89 cases. Twenty-four were reported in the “benign-inflammatory lesion” group while 30 were in the “benign-tumoral lesion” group. Fourteen cases were put in to the “suspicious lesion” category. A total of 21 cases were reported in the “malignant lesion” group of which 9 were primary, 2 were recurrent and 10 were metastatic. Fifty-six of the cases had histopathological verification and 7 of these had unsatisfactory fine needle aspiration cytology. Cyto-histopathological correlation resulted in 100% concordance in the “benign-inflammatory”, “benign-tumoral” and “malignant” categories. Histopathological examination resulted in benign diagnosis in 42.86% (6/14); in borderline diagnosis in 7.14% (1/14) and in malignant diagnosis in 50% (7/14) of the “suspicious” lesions. In the differantiation of benign from malignant lesions of soft tissue and bone in the fine needle aspiration cytology at our department, the sensitivity rate is 100%, specificity is 76.92%, positive predictive value is 79.31%, negative predictive value is 100% and the accuracy is 87.75%. In the diagnosis of primary benign and malignant lesions, in the detection of the local recurrences and for the confirmation of the metastatic tumors of soft tissue and bone, fine needle aspiration cytology is useful before the invasive methods. Fine needle spiration cytology results will be more successfull if it is regarded as a team work, the interpretations are made together with the clinical and radiological data, fine needle aspiration is repeated when necessary and the cases are followed with close clinicopathological interaction.

“TRUE GRAY ZONE” IN FINE NEEDLE ASPIRATION CYTOLOGY OF BREAST

A “gray zone“ exist in fine needle aspiration cytology of breast; there an unequivocal diagnosis can not be made. Previous studies have reported an “atypical and suspicious” cytologic category incidence of 2-19%, which is also defined as “gray zone”. We reviewed 1019 fine needle aspirations of the breast performed at our institution to determine the incidence of the “true gray zone” and establish guidelines to minimize the size of the gray zone. 107 cases (10,5%) were initially interpreted as suspicious category. The cytologic smears from all 107 equivocal cases and histopathologic sections from 60 of these patients who underwent a biopsy or mastectomy were reviewed. The causes of the equivocal diagnoses were divided into three categories: (1) technical problems (limited cellularity or poorly preserved specimens); (2) inexperience, which included cases that were reclassified by the reviewing cytopathologist as benign or malignant; (3) the overlap of cytologic features of benign and malignant lesions due to the nature of the lesion; justifying a confirmational biopsy. Excluding the first two factors resulted in a true gray zone of approximately 4,5%. The majority of cases in the true gray zone were confirmed as well differantiated low grade carcinoma.

CORRELATION OF c-erbB-2 (HER-2/neu) EXPRESSION WITH OTHER PROGNOSTIC FACTORS IN BREAST CARCINOMA

Several factors have been identified in breast carcinoma which affect the biologic behavior, therapy and the prognosis of the tumor. Among these, c-erbB-2 (HER-2/neu) oncogene encodes a transmembrane tyrosine kinase receptor with extensive homology to the Epidermal Growth Factor receptor. In the literature, studies regarding the prognostic role of c-erbB-2 oncoprotein overexpression and gene amplification with and without other parameters are controversial. In this study, paraffin sections from 60 female breast samples were analyzed. Immunohistochemistry was used to detect estrogen receptor status and c-erbB- 2 protein expression. We compared the prognostic impact of c-erbB-2 overexpression with conventional prognostic factors (age, histologic type and size of the tumor, grade, lymphatic invasion, lymph node involvement and estrogen receptor status). Our results showed that c-erbB-2 expression in breast carcinoma is significantly related to the number of metastatic lymph nodes, poor histologic grade and lymphatic invasion. Age, histologic type, tumor size and estrogen receptor status did not correlate with c-erbB-2 status in our study. This study confirmed the importance of c-erbB-2 overexpression as a single and combined prognostic parameter together with conventional factors. Still further studies need to show the prognostic dependency of c-erbB-2 to the other prognostic parameters.

MUCINOUS COMPONENT IN COLORECTAL CARCINOMAS

2001-12-01

It is known that mucinous carcinoma (MC) which is special type of colorectal carcinoma has worse prognosis. It has many differences about clinical and pathological characteristic from nonmucinous type. In this study the data of 149 patients in our department between years 1997-2001 were reviewed. On histopathologic examination tumors with mucin content higher than 50% were named as MC while the ones with mucin content lesser than 50% were named as nonmucinous carcinoma (NMC). The characteristics such as age, sex, location of tumor, grade, stage and prognosis in both groups were compared. Mean age of our cases was 49.41�14. There were 23.4% MC and 76.5% NMC. 13.4% (20 cases) patients with MC were female and 35% (7 cases) of than younger than 40 years old. The most common location was rectosigmoid followed by right colon in both tumor (p<0.01). Overall 5 years survial was worse in-patients with MC than NMC (p<0.05). When the content of mucin in a colorectal carcinoma is high the physician should evaluate that factor with such as location of tumor, depth of invasion, grade and stage the other prognostic criteria and plan on extensive treatment protocol.

RETINOBLASTOMAAND IT’S RELATIONSHIP WITH CLINICOPATHOLOGICAL PROGNOSTIC PARAMETERS

Retinoblastoma, is one of the most common childhood malignancies. Fifty five patients with retinoblastoma (44 unilateral, 11 bilateral) have been examined, between 1984-1996 in Cerrahpa.a Medical School Pathology Deparment. We examined the parameters as tumor size, growth patern, sclera, choroid, optic nerve invasion and DNA ploidy pattern and S-phase fraction were evaluated by flow-cytometry. Many clinicopathologic studies have been made in an attempt to determine which gross and microscopic features of retinoblastoma have prognostic value. These studies have yielded conflicting conclusions. Reported risk factors for metastasis from retinoblastoma include orbital invasion, optic nerve invasion, and possibly choroidal invasion of retinoblastoma. In conclusion, our results showed that the optic nerve, choroid, sclera invasion were poor prognostic factors.

INTRODUCTION TO CELL SAMPLING FOR MOLECULAR ANALYSIS: LASER CAPTURE MICRODISSECTION AND A DOWN-STREAM APPLICATION

2001-12-01

The need for high-level molecular knowledge in modern pathology applications is rising everyday. Related data yield very rapidly by applying complex molecular techniques to the diagnostic biologic materials. The accurate application of methods in pathology depends on optimum material sampling. If the chosen technique is a molecular level application such as micro-hybridization, genomic expression, or mutation screening, the sampling target goes as small as a single specific cell. The value of most sophisticated molecular testing methods will be limited if the input DNA, RNA or protein is not derived from pure population of target cells or is contaminated by non-target cells. In this article, the microdissection technique for even the smallest cell of the human body or the functional units such as gland, follicle and glomerulus in prepared material from the biologic material sampled for rutin cyto/histo-pathologic diagnosis under the visual control is detailed, and subsequent DNA-probe preparation for insitu hybridization following DOP-PCR amplification of extracted DNA is demonstrated.

POST-INFANTILE GIANT CELL HEPATITIS

Giant cell hepatitis is a pathology which has been described in newborn. When it is seen in adult patients, the term “post-infantile giant cell hepatitis” is used to describe it. Even though autoimmunity, some viruses and some drugs have been reported as etiologic factors, in the literature, there are cases, of which the etiologic factors could not be identified. In this article, we report three adult patients we diagnosed as giant cell hepatitis in our department. In the liver biopsy of all three cases, the giant cell transformation was observed either widespread or predominantly in zone 1. Portal and lobular inflammatory cell infiltrates composed predominantly of mononuclear cells, hepatocye necrosis and collapse were observed. As the clinical and laboratory investigations for etiology were negative, these patients were considered as cryptogenic hepatitis. As the clinical features and the etiologic factors are variable, and it is not possible to gain any information about etiology of this condition in the histopathological examination, the histological findings should be evaluated together with the patients’ clinical and serological findings to achieve the diagnosis. The post-infantile giant cell hepatitis is a histopathological condition rather than a specific disease.

LOW-GRADE FIBROMYXSOID SARCOMA: A REPORT OF 3 CASES

[Mustafa |K�SEM|1] — 2001-12-01

Low-grade fibromyxoid sarcoma is a recently recognized, uncommon soft tissue neoplasm with a tendency to develop in deep soft tissue of young adults. Macroscopically, the tumor is described as having a well circumscribed contour and a fibrous to myxoid cut surface. Microscopically, a pseudocapsule surrounds the tumor; however, focal infiltration into the adjacent soft tissue is identified. Tumor is comprised of bland, fibroblastic spindle cells arranged in a whirling growth pattern within a fibromyxoid background. In this report we describe fine-needle aspiration biopsy and pathological examination findings of low-grade fibromyxoid sarcoma in three patients.

EPITHELIAL-MYOEPITHELIAL CARCINOMA OF PAROTID GLAND, INITIALLY DIAGNOSED AS PLEOMORPHIC ADENOMA: CASE REPORT

2001-12-01

Epithelial-myoepithelial carcinoma is a rare, low grade malignant tumor of salivary glands, with a propensity for local invasion and recurrence. Histologically, it has a biphasic cellular composition. Considering that the histologic appearance of epithelial-myoepithelial carcinoma has some features resembling to the other salivary gland tumors, the differential diagnosis should include a number of tumors; pleomorphic adenoma being the first. Our case represents a 72-year-old female presented with a growing and painful mass in her left cheek and with a history of previous parotid mass, resected and diagnosed as a pleomorphic adenoma five years ago. We present this case to remind once more that epithelial-myoepithelial carcinoma, previously reported under a variety of names, is a new and specific entity, and to emphasize the importance of its differential diagnosis.

LEIOMYOMA OF THE OVARY: A CASE REPORT

2001-12-01

Leiomyoma is a benign tumor of smooth muscle and is rarely seen in ovary. A 46-year-old woman was performed on total abdominal hysterectomy and bilateral salpingo-oophorectomy because of the ovarian mass. Macroscopically, a tumor mass which is 3.5x2x2 cm in size was recognized in the ovary. In the microscopic examination, the tumor consisted of packets or bundles of smooth muscle fibers without significant cellular pleomorphism, necrosis and mitotic activity. The tumor was stained yellow colour with van Gieson stain. Immunohistochemically, smooth muscle actin (SMA) and desmin was positive but S-100 protein was negative in tumor cells. This case was evaluated as leiomyoma with these findings. There was not uterine leiomyoma. In this report, the diagnosis and differential diagnosis of ovarian leiomyoma was discussed in view of the literature.

FIBRO-ANGIO-LIPOMATOUS HAMARTOMA: A CASE REPORT

Hamartoma is growth of normal tissues in a region in a disordered and dispropotionate way. It may be composed of different components. A 64-year old man presented to our hospital with a complaint of right postauricular mass. When the resection material was examined, it had been observed that the lesion was well-circumscbrided. Histomorphologically, the lesion was composed of fibroadipose tissue and thick-walled vessels like an angiomyolipoma. When the immunohistochemical stains were performed, there was no immunoreactivity for actin. These findings led us to the diagnosis of fibro-angio-lipomatous hamartoma, which is a very rare entity. The relevant literature was reviewed, histopathological features and differential diagnosis of the lesion were discussed.