Thoracic splenosis diagnosed by fine-needle aspiration cytology: a case report

A case of thoracic splenosis diagnosed by fine-needle aspiration (FNA) of subpleural lung lesions is presented. The patient, a 49-yr-old male with a history of gunshot wound to his trunk with splenic rupture and splenectomy several years previously, presented with recent hemoptysis and multiple subpleural solid nodules shown in the left lung field by CT scan. As the possibility of a metastatic malignancy vs. mesothelioma was entertained, an FNA was performed on one of these lesions, revealing lymphoid tissue with abundant vascularity simulating the structure of splenic tissue. In view of this finding, supported by the absence of splenic outline in the CT radiograph, the diagnosis of splenosis was made. This is the fourth reported case of thoracic splenosis in which FNA cytology was utilized for diagnosis, yet the first in which the diagnosis was based exclusively on the FNA cytologic findings. Clinical, pathologic, and diagnostic aspects of this entity are discussed.

Serous fluid cytology as a means of detecting hemophagocytosis in Epstein-Barr virus-induced autoimmune hemolytic anemia

The case of a 22-yr-old male who after a brief febrile episode developed autoimmune hemolytic anemia and right pulmonary infiltrate with pleural effusion is presented. Cytologic examination of the pleural fluid revealed lymphocytosis and hemophagocytosis, primarily of red blood cells (RBCs) by mature histiocytes. There was accompanying splenomegaly, laboratory evidence of hepatic dysfunction, and retroperitoneal lymphadenopathy. Besides profound reduction of red blood cells in the peripheral blood, there was reduction of lymphocytes and platelets. As a neoplastic process was ruled out by bone marrow and pleural biopsies, the disease was considered to be virus-induced and was halted and progressively regressed with early institution of vigorous antiinflammatory therapy with adrenocortical steroids. Upon reviewing the case, examination of the bone marrow biopsy disclosed limited hemophagocytosis of RBCs and lymphocytes by histiocytes and considerable viral cytopathic effect on hematopoietic cells (red and white cell precursors and megakaryocytes), which by appropriate immunolabelling was identified as induced by Epstein-Barr virus. A virus-related acquired hemophagocytic syndrome in its early stages was probably present, yet an undesirable clinical outcome was averted by early institution of vigorous steroid therapy. The need to recognize early hemophagocytic changes in cytologic specimens for early institution of appropriate therapy is emphasized. The possibility of erythrophagocytosis, also manifested during the course of an autoimmune hemolytic process and unrelated to hemophagocytic syndrome, is discussed.

Carcinoma of temporal bone, base of the skull: diagnosis by needle aspiration cytology

We report on a 68-yr-old male with a destructive bone lesion involving the temporal bone at the skull base extending to surrounding osseous structures and the infratemporal fossa, defined by needle aspiration cytology as carcinoma in association with inflammatory reaction, bacterial type, and bone destruction. The technique of the aspiration, which was performed by a cytopathologist directing a spinal needle into the region of the destroyed temporal bone as outlined in the radiographs of prior magnetic resonance imaging (MRI), is discussed. The application of this technique in the cytologic sampling of deeper lesions usually of soft or osseous tissues not accessible to ordinary fine-needle aspiration is presented. There is also a brief discussion of neoplastic lesions involving the temporal bone at the skull base and the anatomic concerns in sampling lesions in this difficult-to-approach region of the body.

Fine-needle aspiration cytology of hemangiopericytoma: report of two cases

The fine-needle aspiration biopsy (FNAB) findings in two cases of hemangiopericytoma (HP), arising in the parotid gland and on the inner chest wall, respectively, are reported. Smear preparations in each case showed cytologic features of an undifferentiated spindle-cell neoplasm, whereas a core needle biopsy specimen of the chest wall mass showed a spindle-cell tumor with a "staghorn-like" arrangement of endothelium-lined vascular channels. Immunostains performed on this core biopsy, and on the surgical resection specimens in both cases, showed positive staining of tumor cells for vimentin and CD34, with negative staining for a variety of smooth muscle, epithelial, neural, and neuroendocrine markers. Electron microscopy performed in one case further supported the diagnosis of HP. With adequate sampling and appropriate use of ancillary studies, a diagnosis of HP can be reliably suggested on the basis of FNAB and core biopsy of a soft-tissue mass.

Diagnostic challenges in the fine-needle aspiration diagnosis of carotid body paragangliomas: report of two cases

Two cases of carotid body paragangliomas sampled by fine-needle aspiration (FNA) cytology prior to other medical diagnostic studies are presented. In the first case, the presence of an ipsilateral ulcerative lesion of the nasopharynx along with pronounced atypia of the specimen posed a challenge to the correct cytologic interpretation, which was initially sidetracked in favor of a metastatic epithelial lesion. In the second case, a tumor mass of unusually large size and extension which included the pharynx, coupled with a large amount of profusely hemorrhagic aspirate, presented a diagnostic problem, which was overcome by processing part of the specimen as a cell block, which by its histologic and immunochemical features provided a definitive pathologic diagnosis. In handling these two clinically complex cases of carotid paraganglioma, two learning principles became clear on how to reach a correct FNA diagnosis in such lesions: 1) The anatomic location of the lateral neck mass with its prolonged history, along with a hemorrhagic FNA specimen exhibiting at least some cytologic features reminiscent of endocrine neoplasm, are among the factors that help in arriving at a suggestive diagnosis of paraganglioma, when other clinical features tend to sidetrack from interpretation of the cytologic changes. 2) In the practice of FNA cytology, if the possibility of paraganglioma arises, processing part of the specimen as a cell block with accompanying histology and immunohistochemistry can provide a definitive diagnosis of such lesion.

Malignant ovarian sex cord tumor with annular tubules in a patient with Peutz-Jeghers syndrome: a case report

The majority of ovarian sex cord tumors with annular tubules (SCTAT) are benign neoplasms that arise sporadically. In patients who have Peutz-Jeghers syndrome (PJS), ovarian SCTAT is often an incidental finding. Malignant behavior in SCTAT has heretofore been reported only in sporadic cases. We report a case of bilateral, malignant SCTAT developing in a 47-year-old woman who had PJS, originally diagnosed as adenocarcinoma on cervicovaginal cytology. Cervicovaginal and peritoneal fluid cytologic preparations were characterized by pseudopapillary clusters and three-dimensional tubes of tumor cells with scanty cytoplasm and high nuclear: cytoplasmic ratio. Examination of surgical resection specimens revealed bilateral, solid ovarian tumors composed of simple and complex annular tubules with hyaline cores, typical of SCTAT. Tumor emboli were present within salpingeal lymphovascular spaces and in both right and left pelvic lymph nodes. Flow cytometry of tumor cells demonstrated a diploid phenotype. This case represents the first documented example of bilateral, malignant SCTAT arising in a patient who had PJS, presenting with an atypical cervicovaginal smear.

Incidental sampling of branchial remnants: a potential source of error in fine-needle aspiration of neck lesions-a case report

Remnants of the branchial apparatus can produce lesions in the head and neck region in later life, often amenable to fine-needle aspiration (FNA) diagnosis. Yet such remnants or rudimentary lesions can remain clinically undetected and can later interfere with the cytologic interpretation of other deep lesions of the neck, as the present case demonstrates. In this case the lesion, which by a subsequent resection turned out to be a neurilemmoma, had been adequately sampled by the FNA, yet the cytologic diagnosis was sidetracked by the presence in the specimen of immature squamous epithelial tissue fragments and other elements (multinucleated histiocytes, calcifications), on the basis of which the diagnosis of an epithelial lesion, likely malignant, was made. The neck surgery and a preceding endoscopic examination of the mouth, pharynx, and larynx did not identify such a lesion, but a detailed microscopic examination of the fibroadipose tissue between the tumor and the peripharyngeal region revealed the presence of epithelial microfragments with morphology partly corresponding to that of the FNA cytology, highly indicative of a branchiogenic lesion in the peripharyngeal region. The basic embryology of the branchial apparatus resulting in such defects is presented, as well as tentative guidelines for recognizing material deriving from accidental sampling of such lesions during FNA investigations of deep-seated masses of the neck. Diagn. Cytopathol. 2000;22:157-160.

Demonstration of parasites in toxoplasma lymphadenitis by fine-needle aspiration cytology: report of two cases

Two cases of toxoplasma lymphadenitis diagnosed by fine-needle aspiration (FNA) cytology, in which the microorganisms were identified in the cytologic preparations, are presented. The first case was that of an 8-yr-old boy with bilateral cervical lymphadenopathy of 2-mo duration, in which an FNA specimen of one of the lymph nodes in a Papanicolaou-stained smear disclosed a toxoplasma cyst, and in Wright-Giemsa preparation, dispersed tachyzoites and a pseudocyst. The second case was that of a 52-yr-old man with enlargement of a single lymph node in the neck, of 3-mo duration, FNA of which in Wright-Giemsa preparation disclosed numerous tachyzoites dispersed free in exudate, and also within cells, forming pseudocysts. In both cases, immunocytochemistry by the peroxidase method for Toxoplasma gondii antigen was positive. The tachyzoites seen in Wright-Giemsa preparations, when subjected to fluorescence microscopy, emitted autofluorescence, facilitating their identification. While the presence of parasites in toxoplasma lymphadenitis is quite unusual, having been reported occasionally in histologic preparations and only rarely in cytologic FNA materials, our 2 cases suggest that in active disease, tachyzoites may not be so uncommon in FNA specimens. Besides the use of immunocytochemistry in the diagnosis of the disease, air-dried preparations stained by the Wright-Giemsa method are valuable for the demonstration of such parasites through careful search, along with the possible use of fluorescence microscopy.

Fine-needle aspiration cytologic diagnosis of lymphocutaneous sporotrichosis: a case report

A case of lymphocutaneous sporotrichosis initially diagnosed by fine-needle aspiration (FNA) cytology and confirmed by tissue biopsy and culture study is presented. Asteroid bodies and yeast cells with budding, highly suggestive of the disease, were seen in the cytologic and histologic preparations. The pathology of this unusual fungal disease and the role of cytology in the diagnosis are discussed. This is the first case of lymphocutaneous sporotrichosis reported in the cytologic literature as diagnosed by FNA cytology.

Membranous lamellar cytoplasmic inclusions in histiocytes and mesothelial cells of serous fluids. Their relationship to phagocytosis of red blood cells

OBJECTIVE

To define the composition of cytoplasmic inclusions forming stacks and concentric whorls in histiocytes and mesothelial cells of serous fluids, imparting to them a resemblance to Gaucher cells, and to draw conclusions on the mechanism of their formation.

STUDY DESIGN

Three serous fluids (one pleural and two pericardial) containing a fair number of the cells referred to were progressively subjected to the following studies: (1) cytochemistry for mucopolysaccharides, proteins, phospholipids and hemoglobin; (2) immunocytochemistry for immunoglobulins IgA, IgG, IgM and lysozyme; (3) transmission electron microscopy (TEM), and (4) scanning electron microscopy-based energy dispersive X-ray microanalysis (SEM-EDAX).

RESULTS

All three specimens were blood stained and contained large numbers of histiocytes and mesothelial cells, arranged singly and in groups, with abundant cytoplasmic inclusions. The inclusions stained strongly positive for phospholipids, weakly positive for hemoglobin and negative for all other substances examined by cytochemistry and immunocytochemistry. By TEM the inclusions had a concentric lamellar membranous structure, reminiscent of myelinosomes or lamellar bodies of lipid-forming or -storing cells. There was also phagocytosis by histiocytes and mesothelial cells of red blood cells, which were mostly in a degenerated state. SEM-EDAX of inclusion-bearing cells showed a modest peak for phosphorus and a variable but small peak for iron, which corroborated the cytochemical and TEM findings.

CONCLUSION

Since there was not metabolic or other systemic disease in the patients to account for these cells, we posit that phospholipids derived from cell membranes of phagocytized cells, especially red blood cells, provide the building blocks for the formation of such inclusions as they enter the metabolic pathway of phagocytic cells (mesothelial cells and histiocytes) and appear in their lysosomal structures. It is advantageous for cytologists to be familiar with significance of such changes and not to mistake them for metabolic or other systemic disease.

Nuclear protrusions in cells from cytologic specimens. Mechanisms of formation

OBJECTIVE

To explore the mechanisms of formation of nuclear protrusions (NPs) encountered in cytologic specimens and specifically the possibility of their being the result of an aberrant division of the cell and to determine how widespread the NP phenomenon is in cells from various tissues.

STUDY DESIGN

Six hundred fifty-four cervical smears out of 5,000 with abundant cervical columnar epithelium examined were found to have many cells with NPs (group A). These cells were studied: (A) by light microscopy to define the structure and stages of formation of NPs, (B) by transmission electron microscopy (TEM), (C) by tubulin immunostaining for detection of mitotic spindle-associated microtubular structures, (D) by fluorescence in situ hybridization (FISH) utilizing X chromosome probes to monitor chromosomal movement into NPs, and (E) by direct fluorescence microscopy to examine autofluorescence patterns in cells with NPs. Also, tissue sections of 240 cervical cone biopsies, many including intraepithelial neoplasia (group B), were examined for NPs, and sections containing NPs were subjected to TEM. Last, 390 nongynecologic cytologic specimens from various lesions and organs obtained by fine needle aspiration or brushing methods were examined for the presence of NPs.

RESULTS

NPs were found in a variety of tissues, epithelial and nonepithelial. Their formation in the cases examined appeared to be related to cell division, as indicated by: the light microscopic findings; the TEM findings (centriole at their tip, indication of spindle formation, nucleolar movement into the NP and suggestion of chromosomal movement as well); positive tubulin immunostaining of centrosome-centriole in NPs and also of the underlying region of the nuclear pole, indicating the presence of microtubules consistent with mitotic spindle; and movement of one X chromosome into NPs, as shown by FISH.

CONCLUSION

NPs are formed in cells from a variety of tissues, epithelial and nonepithelial. In many cases they appear to result from aberrant cell division--namely, unipolar mitosis--occurring before prophase events are completed. Another possible mechanism of NP formation not involving cell division is through alteration or remodeling of the cytoskeleton of the cell; that was shown experimentally to produce nuclear volume and shape changes, including formation of protrusions.

Disseminated Histoplasma capsulatum infection presenting as genital ulcerations

BACKGROUND

Histoplasma capsulatum infection in adults is most often subclinical but can result in disseminated disease with weight loss, fever, hepatosplenomegaly, and oropharyngeal ulcerations. Genital ulceration as the presenting sign of the disease has been reported rarely.

CASE

A 63-year-old woman presented with multiple vaginal ulcerations due to chronic disseminated H capsulatum infection. Initial diagnosis was made by Papanicolaou and Giemsa-stained vulvar smears. Ketoconazole therapy resulted in clearing of the lesions in 5 weeks.

CONCLUSION

Chronic disseminated histoplasmosis is an insidious and potentially fatal disease that can present rarely as genital mucocutaneous ulcerations in women. Prompt presumptive diagnosis can be accomplished by examination of smears obtained by ulcer abrasion, permitting institution of appropriate therapy.

Cytologic diagnosis of syphilitic pleuritis: a case report

We report on a case of a 68-yr-old man with secondary syphilis diagnosed by biopsy of skin lesions, who concomitantly suffered from left lower lobe pneumonia with associated pleuritis. Cytologic examination of the pleural fluid was diagnostic of syphilis, not only by the characteristic cytomorphology but also by demonstration of spirochetes by the May-Grünwald-Giemsa (MGG) and Steiner staining methods. This suggests that the pneumonia was also syphilitic. The patient was seropositive for HIV-I, but this probably did not contribute to the thoracic manifestations of syphilis, as there was no evidence of immunodeficiency by the CD4/CD8 T lymphocyte count. This is the second reported demonstration of Treponema pallidum in a pleural fluid, and the first diagnosed by cytopathologic examination.

Aspiration cytology of a case of tumoral calcinosis

The fine-needle aspiration (FNA) cytologic findings in a case of non-familial tumoral calcinosis are described. These include abundant calcific amorphous deposits, mononuclear histiocytes, osteoclast-type multinucleated giant cells, and fragments of tissue consisting of osteoblast-type cells with atypical epithelial-like features mimicking an epithelial malignancy. This is the first reported case describing the cellular morphology of tumoral calcinosis in an FNA specimen. A previously reported case described the evacuation of acellular calcific fluid only. In the present case, vigorous aspiration of the solid portions of the lesion yielded cellular material representative of the histology of the lesion. Points of caution for a correct interpretation of the cytologic findings are discussed.

Matrix crystals in cytologic urine specimens: observations on their mineral composition by energy dispersive X-ray microanalysis and morphologic scanning electron microscopy

Crystals consisting by light microscopy of organic matrix (matrix crystals) encountered in cytologic urine specimens of 8 patients were examined for mineral phase components by scanning electron microscopy with energy dispersive X-ray microanalysis (SEM-EDX) and by morphologic scanning electron microscopy (SEM) performed separately in four of the eight cases. Whenever possible (three cases) mineralized crystals present in these specimens were examined separately by SEM-EDX for comparison of mineral phase composition with that of the corresponding matrix forms. Although by SEM-EDX components of matrix, glass and slide preparation media interfere with the precise estimation of the mineral phase components, the results of this method supported by the SEM morphology suggest that crystals consisting of organic matrix include a mineral phase, the lattice structure of which provides them from the early stages of formation with the characteristic morphology of the fully mineralized forms. This also suggests that organic matrix plays a role in the nucleation of minerals during the formation of certain urinary crystals.

Fine-needle aspiration cytology in fibromatoses

Fine-needle aspiration (FNA) cytology was performed in seven cases of fibromatosis of variable types with tumorous clinical presentation. These included: four cases of musculoaponeurotic fibromatosis, two in posterior neck muscles, one in anterior neck muscles and one in intercostal muscles; one case of fibromatosis of the breast; and two cases of fibromatosis colli in neonates. In all cases the specimens contained connective tissue with many fibroblast-like cells, lacking features which could indicate a malignant lesion. The findings in these cases indicate that, although by FNA cytology in fibromatoses a specific diagnosis for each pathologic entity may not be easily reached, in the proper clinical setting the cytologic findings can be of sufficient relevance to offset the need for an open tissue biopsy, where there are valid reasons against a surgical intervention.

Interobserver variability in the interpretation of brush cytologic studies from head and neck lesions

A study was conducted to evaluate the usefulness of brush cytology as a diagnostic tool for lesions of the head and neck. Brush specimens were obtained from patients for whom surgical biopsy was recommended by the Otolaryngology Service of the University of Texas Medical Branch Hospitals, Galveston. Specimens were interpreted independently by three cytologists, and interobserver variability was calculated. If a surgical biopsy was performed, histopathologic diagnosis was used as the reference standard to assess the accuracy of each cytologic interpretation. Correspondence of cytopathologic interpretation with histologic diagnosis was sufficient to conclude that brush biopsy is a useful screening technique for unsuspected or clinically undetected malignant tumors of the upper aerodigestive tract. Because of its ability to sample large surface areas with minimal tissue trauma, brush biopsy can be a useful screening technique in combination with selective surgical biopsy for the detection of cytologic changes of malignant neoplasia. Brush cytology costs less than surgical biopsy, yet its relatively high sensitivity and specificity for both benign and malignant grades support its utility. Brush cytology, furthermore, has a low interobserver variability for the benign and malignant grades, suggesting that in the hands of an experienced cytopathologist it can be relied on with confidence. For grades 2 or 3 (inconclusive), brush cytology, however, demonstrated much higher interobserver variability. Based on the findings of this and other studies, brush cytology can be effective in identifying clinically unsuspected malignant tumors of the upper aerodigestive tract, especially in patients with mucosal changes suggestive of "field cancerization."

Cytomegalovirus endocervicitis diagnosed by cervical smear

Cytomegalovirus (CMV) cytologic changes were found in a routine cervical smear of a 21-yr-old HIV-negative woman, 4 wk post partum. The CMV changes were associated with columnar cervical epithelium. The case is reported because of the rarity of such an occurrence in cervical smears.

Extramedullary hand mirror cells in pathologic conditions of lymphoid tissue

The hand mirror (HM) cell phenomenon, which usually affects pathologic cells of lymphoid tissue in bone marrow, especially in acute lymphoblastic leukemia (ALL), was seen in B-cell lymphoma cells in cerebrospinal fluid (CSF). It was subsequently detected not only in the bone marrow, but also in extramedullary sites of the lymphoma. Subsequent phase-contrast microscopic study of 45 consecutive specimens of CSF revealed lymphoid cells with HM features in a case of ALL (in which HM cells were subsequently found in the bone marrow) and in a case of acute viral meningoencephalitis. These observations demonstrate that the HM cell phenomenon, which is considered to be a cellular alteration resulting from incorporation in the cell of antigen-antibody complexes, is not unique to bone marrow. It can be present in extramedullary sites and can be seen in exfoliated cells in CSF, where its detection is facilitated by the use of phase-contrast microscopy.

Matrix crystals in cytologic urine specimens

Three cytologic urine specimens from separate patients seen over a period of 3 mo were prepared by the Papanicolaou method. They contained crystals (uric acid type in two and magnesium ammonium phosphate in one) that incorporated variable amounts of organic (mucoprotein) matrix; many appeared by light microscopy to be made exclusively of matrix. Scanning electron microscopy performed in one of the specimens containing uric acid crystals suggested that the matrix forms were in progressive stages of mineralization. These cases, plus a similar one reported recently by us, demonstrate that the detection by urine cytology of organic matrix incorporated in the structure of urinary crystals is not rare and that the Papanicolaou staining method facilitates such detection.

Interobserver variability in the interpretation of fine-needle aspiration biopsy of head and neck masses

Fine-needle aspiration biopsy is gaining acceptance as a clinically useful tool. We set out to evaluate the accuracy of fine-needle aspiration biopsy at our institution by measuring the interobserver variability in cytopathologic interpretation, and by measuring the agreement between cytopathologic and histologic diagnosis. In a prospective study, 253 aspirations were performed on head and neck masses by the otolaryngology service. Specimens were interpreted independently by two cytopathologists (V.J.S. and P.Z.), and interpretations were compared with the surgical histopathologic diagnosis when available. The interobserver variability between cytopathologists was 8% with a specificity of 96% and a sensitivity of 97%. We conclude that fine-needle aspiration biopsy is a safe and useful tool in the diagnosis of head and neck masses. In the diagnosis of epithelial cysts and squamous epithelial malignancies, fine-needle aspiration biopsy is as accurate as open biopsy.

Multiseptate bodies in systemic phaeohyphomycosis diagnosed by fine needle aspiration cytology

Fine needle aspiration of a lung nodule in an immunosuppressed adult man revealed numerous dematiaceous (pigmented) fungi with both hyphal and spherical forms. Multiseptate bodies ("muriform" cells) were also present in small numbers. Fonsecaea pedrosoi was cultured from the aspirate. The cytomorphologic features of the fungus in tissue are described, and the significance of finding fungal cells that divide both by budding and fission is discussed.

Hemoglobin crystals in fluid specimens from confined body spaces

Hemoglobin crystals phagocytized by polymorphonuclear leukocytes were seen in cytologic preparations of a cerebrospinal fluid and two pleural fluids. In the last two cases, the crystals were seen within erythrocytes and also free in the background. Intraerythrocytic crystallization of hemoglobin is the result of polymerization of the hemoglobin molecules; it occurs in peripheral blood in certain hemoglobinopathies, being more pronounced in hemoglobin C disease. In our three cases, in which the crystallization occurred not in peripheral blood but in fluids of confined body spaces, there was no clinical evidence of hemoglobinopathy and blood hemoglobin electrophoresis performed in one of the cases revealed normal hemoglobin. Under laboratory conditions, we produced intraerythrocytic crystallization of hemoglobin in hemorrhagic pleural fluid specimens by subjecting them to agents that induced decreased oxygen concentration and osmotic dehydration of the cells. We suggest that similar processes operative in fluid accumulated in confined body spaces produce crystallization of the hemoglobin of extravasated red blood cells in the absence of hemoglobinopathy.

Hematoidin crystals in cervicovaginal smears. Report of two cases

Cervicovaginal smears obtained from two women, one at the 32nd week of pregnancy and the other at the immediate postpartum period, contained hematoidin crystals. These crystals were of a golden color and appeared as radially arranged fine needles forming cockleburrs or as aggregates of small irregular particles, spherules or rhomboids, in most instances associated with or within histiocytes. Hemosiderin pigment was associated with them in small amounts. The presence of hematoidin crystals is not an uncommon finding in cytologic specimens, particularly those obtained by fine needle aspiration of walled-off, necrotizing lesions with a component of hemorrhage. It is a very unusual finding in cervicovaginal smears, probably because of the ability of the uterus to promptly rid itself of blood. Certain aspects of the formation and identity of hematoidin are discussed.

Crystalline bodies in cervicovaginal smears. A cytochemical and immunochemical study

Of 35,000 consecutive cervicovaginal smears examined, 111 were found to contain crystalline bodies with a radiate structure. Ninety-seven of these 111 smears had been obtained from pregnant women. The crystalline bodies were generally found in the cervical mucus portion of the smears and were evoking a considerable inflammatory reaction around them. Histochemical and immunochemical stains indicated that they are primarily composed of protein-carbohydrate complexes of a nonimmune type. In an attempt to determine the site of formation of the crystalline bodies during pregnancy, cervical biopsies available in six of the above cases were examined for crystalline bodies, with positive results in one nonpregnant case. Furthermore, 500 endometria from cases of interrupted pregnancies were examined for the presence of such structures, with negative results. It appears that crystalline bodies in smears from pregnant women are formed from products of degenerated inflammatory and other exfoliated cells within stagnating cervical secretions and primarily within dilated cervical glands. In this respect, they are similar or identical to the pseudoactinomycotic radiate granules or pseudosulfur granules reported in histologic sections of the uterus and other regions of the body. Further studies are needed to conclusively determine the site and mechanisms of formation of these structures.

Diagnosis of herpes simplex virus in routine smears by an immunoperoxidase technique

Routine Papanicolaou-stained cervicovaginal smears from 59 patients were cytologically screened for herpetic infection. Forty-one of the smears were positive for herpes, 2 were suspicious and 16 were negative. All 59 slides were then destained and restained by a commercial immunoperoxidase kit for the detection of herpes simplex virus (HSV). The immunoperoxidase stain was positive in 23 of the 41 cytologically positive slides. One of the 2 cytologically suspicious slides was also immunoperoxidase positive, as was 1 of the 16 cytologically negative slides. This study indicates that immunoperoxidase staining is very specific but not quite as sensitive as routine Papanicolaou-stained smears in the detection of HSV. The immunoperoxidase method is thus recommended for the confirmation of HSV cases rather than for the routine diagnosis of HSV infection.

Cytologic diagnosis of rhinoscleroma

The cytologic diagnosis of a case of rhinoscleroma was made on brushing specimens of a laryngeal lesion. The cytologic picture included aggregates of the characteristic Mikulicz cells, large, rounded histiocytes with an eccentric nucleus and vacuolar cytoplasm containing the short rods of Klebsiella rhinoscleromatis. Although the diagnosis of this chronic infectious disease involving the upper respiratory tract is routinely made by tissue biopsy and bacteriologic study of the lesions, the present report indicates that cytology has a definite place in its diagnosis.

Cytologic features on needle aspiration of Wilms' tumor in an adult. A case report

A needle aspiration specimen from a left kidney mass in a 28-year-old woman was submitted for cytologic evaluation. Malignant cells were found, and the cytologic appearance was suggestive of a poorly differentiated sarcoma, with the possibility that it was a nephroblastoma. Important cytologic features of the needle aspiration specimen included round or oval blastomatous cells mixed with spindle or elongated sarcomatous cells, rare tubulelike formations of cells that appeared epithelial and a pronounced tumor diathesis. Histologic study of the nephrectomy specimen showed a Wilms' tumor, with anaplastic blastomatous and undifferentiated sarcomatous elements.

Cytomorphology of the variants of small-cell carcinoma of the lung

Cytologic classification of subtypes of small-cell carcinoma of the lung (SCCL) was retrospectively performed on respiratory material of 90 cases of lung carcinoma cytologically diagnosed as SCCL. Additionally, the cytologic material was reexamined for the presence of variants of SCCL in 68 cases of lung carcinoma whose types had not been conclusively defined by cytology. The type of lung cytology specimens reviewed were sputa, bronchial washings and brushings and fine needle aspirations. The study included review of pretreatment tumor histology, when present, and examination of the ultrastructure of the tumor in selected cases whose type had not been well defined by histology. Subtype recognition depended on the adequacy of the specimens rather than on the type of cytologic material examined. The cytologic subtyping was generally in agreement with the histologic subtyping of the tumor, except for cases in which SCCL was combined with other types of lung carcinoma, where certain discrepancies were noted.

Endometrial stromal sarcoma: cytology of pulmonary metastasis including ultrastructural study

An endometrial stromal sarcoma metastatic to the lung produced positive sputum cytology. A definitive characterization of the pulmonary lesion was made by ultrastructural study of cytologic material obtained by fine needle aspiration of the lung. The histologic grading and corresponding ultrastructural morphology of the endometrial stromal malignancy in relation to its propensity to spread to distant organs, such as the lung, are discussed.

Follicular carcinoma of the thyroid metastatic to the kidney 37 years after resection of the primary tumor

A case is described of thyroid carcinoma presenting as renal metastases 37 years after initial resection of the primary. Thyroid carcinoma metastatic to the kidney detected during life is rare, only 2 cases having been reported to date. An additional feature of this case is that the patient had donated the contralateral kidney for transplantation before discovery of the metastases. Metastatic thyroid carcinoma is reviewed and the implication of organ donation in patients with thyroid carcinoma is discussed.

Identification of crystals in joint fluids

The inflammatory process present in synovial arthritic specimens can be diagnosed by crystal-type identification performed in cytopathology laboratories by the use of simple methods. These methods involve wet coverslipped preparations of fresh fluid specimens or sediments and compensated polarizing microscopy, which can be performed with a routine microscope equipped with polarizing filters and a substitute compensator. Details of the methodology are described. The morphologic characteristics of the crystals are described in cases of gout, pseudogout and arthritis of other types in which secondary calcifications are present.

Peutz-Jeghers syndrome with intestinal carcinoma: report of the association in one family

The Peutz-Jeghers Syndrome is a rare, genectically inherited disorder. There are insufficient data to establish this syndrome as a precancerous condition, but documented cases of gastrointestinal cancer arising in this syndrome have been reported with an incidence of 2--3%. Since the syndrome is transmitted as an autosomal dominant and is associated with cancer, family members so afflicted may show an increased cancer risk. This is the first reported case of a father and son with both Peutz-Jeghers Syndrome and colonic carcinoma.