Fine needle aspiration cytology in the diagnosis of head and neck masses: accuracy and diagnostic problems

PURPOSE

Fine needle aspiration (FNA) cytology is an established technique associated with minimal complications compared with more invasive techniques such as wide core needle biopsy or open biopsy, and as such, very suitable for obtaining material in the delicate region of head and neck (H&N). The aim of this study was to assess the diagnostic accuracy of FNA cytology H&N masses.

METHODS

Aspirations were performed by cytologists using 25 or 27G needles with 20 ml syringes attached, and smears were stained with May-Grunwald-Giemsa. Four hundred and ninety-four patients with palpable H&N masses underwent FNA during the study period of 2 years.

RESULTS

Based on cytology alone, the most common findings were reactive lymphoid hyperplasia (28.5%), metastatic carcinoma (22.7%) and lymphoma (13.4%). Sixty-four (12.6%) FNA specimens were inadequate for diagnosis. Histological correlation was available in 164 (33.2%) patients who went on to have surgical excision of the mass. Nondiagnostic aspirate was in 16 (9.75%) patients, so the final group for cyto- histological correlation included 148 patients. The overall accuracy rate of FNA cytology, whether malignant or benign, was 91.89%, while the diagnostic accuracy for the exact type of tumor was 87.16%. There were 3 (2%) false-positive (FP) and 9 (6.1%) false-negative (FN) cytological diagnoses. The sensitivity and specificity of FNA cytology in determining a malignant diagnosis were 91.5% and 92.85%, respectively. Positive (PPV) and negative predictive value (NPV) were 97 and 81.25%, respectively.

CONCLUSION

Our results showed that FNA cytology is a simple, safe, and cost-effective diagnostic method, suitable as a first-line investigation in palpable H&N masses. The main causes of the wrong diagnoses were sampling errors, inexperience and misinterpretation.

Hodgkin's lymphoma of the parotid gland: report of a case and literature review

Hodgkin's lymphoma with its primary manifestation in the parotid gland is a very rare entity. In previously published reports the diagnosis was established by postoperative histopathological examination. The present report describes a case of primary Hodgkin's lymphoma of the parotid gland, diagnosed by fine needle aspiration (FNA) cytology, and includes a short review of the diagnostic approaches to the parotid gland tumors.

Papillary thyroid carcinoma in intrathoracic goiter

Intrathoracic goiter (more than 80% of tissue in the thoracic cavity) represents very rare clinical entity (less than 1% of total number of thyroid gland surgical procedures). Cancer incidence in these goiter is 0-5%. The aim of this article is to present a case report of intrathoracic thyroid papillary carcinoma with multiple compressive syndrome and review of compressive intrathoracic syndrome of thyroid etiology. In our patient we have found: tracheal and oesophageal deviation and compression, superior vena cava syndrome, downhill varices, chylothorax, pericardial effusion, compress of the left a. subclavia, unilateral lesion of recurrent and phrenic nerve, and brachial plexopathy. This was a unique case with multiple compressive syndrome between 3000 patients surgically treated for all kinds of thyroid deceases. Intrathoracic goiter can cause all the known symptoms and syndromes of intrathoracic compression with possibility of rapid deterioration and fatal end.

Correlation of imprint cytology and histopathologic findings in bone tumors

PURPOSE

The aim of this study was to show that imprint cytology is a valuable method in the evaluation of bone tumors.

MATERIALS AND METHODS

Fifty-six surgical specimens of bone tumors imprints were air-dried and stained by the May-Grunwald-Giemsa method. A cytologist gave a detailed description of the smears, concluded whether the lesion was benign or malignant and suggested a final diagnosis. Results were compared with the corresponding histopathologic diagnoses.

RESULTS

In 2 cases the material was too scarce for cytologic diagnosis. Out of 19 cases with primary malignant bone tumors the cytologist recognized malignancy in 18 of them and in 10 suggested the final diagnosis. In 14 patients with metastases (11 with squamous-cell carcinoma, 1 with anaplastic carcinoma, 2 with malignant melanoma) the cytologic and histopathologic diagnoses correlated in all cases. In 21 patients with benign bone lesions, the cytologist defined as benign 19 of them and in one case had suspicion of fibrosarcoma. In one patient with a histopathologic diagnosis of bone necrosis, groups of clearly malignant cells were found in the imprint. After revision of the case, the cytologist confirmed the diagnosis of malignancy.

CONCLUSION

Cytological analysis of the imprints of bone lesions is valuable for an early orientation of the clinicians. It is very important, since the final histopathologic diagnosis needs time because of the decalcification procedure.

Fungus-like hyphochytrids associated with human disease

We report two cases, with liver and brain abscess, respectively, where fungus-like organisms belonging to the Hyphochytriomycota were found at the site of inflammation together with Peptococcus in the first and Cysticercus cellulosae in the second case. This is the first time these groups of organisms have been reported in human material. The role of hyphochytrids in human pathology remained uncertain as they were found together with already known human pathogens.

The correlation of cytologic degree of differentiation of infiltrative ductal breast carcinoma and cytochemical activity of glucose-6-phosphate dehydrogenase

The semiquantitative cytochemical activity of glucose-6-phosphate dehydrogenase in imprints of surgical biopsies of 55 patients with invasive ductal breast carcinomas was compared to the cytologic degree of differentiation. All carcinomas cytologically designated as well differentiated had a low enzyme activity. Approximately half of moderately differentiated carcinomas were characterized with low score of enzyme activity and only 2 out of 26 poorly differentiated tumors had the low enzyme activity. The estimation of cytochemical activity of this enzyme may be valuable as the morphologic parameter for cytologic evaluation of malignant cells.

[Correlation of cytologic and pathohistologic findings in ultrasonically-guided thin-needle biopsy of abdominal and retroperitoneal organs]

The ultrasonically guided fine needle biopsy is cheap, very sensitive and specific method for the diagnosis of nonpalpable deep-seated lesions. During 1992 in the institute of Radiology of Military Medical Academy in Belgrade 87 biopsies of abdominal and 81 biopsies of retroperitoneal organs were performed for the cytological and histopathologic analysis. Deficient material was obtained in 15.4% of the cases. A good correlation between cytologic and histopathologic findings was observed, with diagnostic concordance in 90.8%. In 9 cases with falsely positive cytological diagnosis at the first examination, the diagnosis of malignancy was later confirmed by other diagnosis procedures. Diagnostic difficulties and the significance of adequate biopsy were particularly stressed.

[Comparative analysis of agreement between cytologic diagnosis by examination of tissue imprints and pathohistologic findings in intraoperative breast biopsy]

In 34 benign and in 31 of malignant breast tumors, the touch preparations (imprints) were made concomittantly with frozen sections. In the comparison with the pathohistological findings, there were neither false positive nor false negative cytologic diagnoses. In three cases of benign breast tumors and in one carcinoma, the number of cells in imprints was not sufficient for cytologic diagnosis. The cytologic and pathohistologic diagnoses were in accordance in 98.8% of benign breast tumors and in 100% of carcinomas.

[Cytologic characteristics of cerebrospinal fluid in patients with serous meningitis caused by enteroviruses, mumps virus or Koch's bacillus]

The qualitative and quantitative analysis of the cytogram of cerebrospinal fluid (CSF) was performed in the acute phase of enteroviral meningitis (ENTERO MGT. 31 patients), mumps meningitis (MUMPS MGT, 25 patients) and tubercular meningoencephalitis (TBC ME, 15 patients), to observe the basic characteristics and answer the question whether the cytological response of the central nervous system (CNS) is ethyologically determined. The CSF sediment was obtained in Saykov chamber and was dyed according to Pappenheim. In the group of ENTERO MGT the significant representation of neutrophils with the presence of basophile was observed. The main characteristic of MUMPS MGT was mononuclear response with various morphological forms of lymphocyte cells and neglectable presence of neutrophils. TBC ME was characterized by the neutrophilia in the first 12 days of illness; till the end of the fourth week there was an equal representation of neutrophils and mononuclear cells, followed by a significant lymphocytosis. The cells of the monocytemacrophage system and the plasma-cells were constantly present. It could be concluded that differences in cytological response of CNS between ENTERO and MUMPS group were mainly quantitative and dynamic, probably caused by the various pathogenesic mechanisms of inflammation. The cytological picture of CSF during TBC ME in relation to other two groups had certain qualitative, quantitative and dynamic characteristics which could indicate the diagnosis of the specific meningoencephalitis, making this analysis very useful in the early diagnostics of this illness.

[Personal experience with ex tempore diagnosis of neurosurgical biopsies using the smear method]

The results obtained by the use of the smear method were analyzed in ex tempore diagnostics of 240 neurosurgical biopsies, done in the period from 1991 to 1993. Thirty three different pathologic lesions were found that had their special morphology on smears, indicating the high specificity of this method. In 226 cases (94.17%) the diagnosis was established correctly, but in 14 cases (5.83%) it was not: in three cases the diagnosis was falsely negative and in 11 falsely positive. The main causes of the diagnostic errors were analysed and they included the subjective factors and uncommonness of the analyzed tissue samples. The accuracy of 94.17% enabled sufficiently reliable use of this method in ex tempore diagnostics of neurosurgical biopsies.

Semiquantitative cytochemical estimation of glucose-6-phosphate dehydrogenase activity in benign diseases and carcinoma of the breast

The level of glucose-6-phosphate dehydrogenase (G6PDH) activity was semiquantitatively evaluated in fresh imprints of infiltrative ductal carcinoma, fibrocystic disease and fibroadenoma of the breast. A significantly higher level of G6PDH activity was found in the carcinomas. The results suggest that the estimation of G6PDH activity could be a valuable method for evaluating the cells in benign and malignant breast lesions. It is possible that the intensification of G6PDH activity in carcinomas is a sign of the shift of the carbohydrate metabolism from an aerobic path or that the activity of the pentose shunt is higher because of the increased need for nucleic acid precursors in tissues with faster growth rates.

Cytology and histopathology of metastatic malignant melanoma involving a polyp on the uterine cervix. A case report

A case of unusual localization of metastatic malignant melanoma on the cervix uteri, which was diagnosed by cytologic examination of a Papanicolaou smear is reported. The cells contained no pigment, but they had the characteristic appearance that suggested the possibility of a metastatic malignant melanoma, which was confirmed by histopathologic examination of an excised polyp.