Fine-needle aspiration cytology of the adrenal gland. Fifty biopsies in 48 patients.
ABSTRACT Fine-needle aspiration biopsy of 50 adrenal masses from 48 patients was performed between 1984 and 1991. The series consisted of 28 males and 20 females, with an age range of 12 months to 79 years (mean age, 55 years). Clinical and/or pathologic follow-up was available in 37 patients. Fine-needle aspiration was diagnostic in all 29 malignant cases having follow-up, with no false-positive diagnoses. There were six primary malignancies (three neuroblastomas, two pheochromocytomas, and one adrenal cortical carcinoma) and 23 metastatic lesions. Of these, the lung was the most frequent primary malignancy (60%), followed by melanoma and renal cell carcinoma (8.6% each). The remaining nonmalignant fine-needle aspiration diagnoses were adrenal cortical neoplasms (most likely adenoma), adrenal cortical hyperplasia, myelolipoma, benign adrenal tissue, and abscess. Based on clinical follow-up, three other adrenal adenomas were not diagnosed by fine-needle aspiration. Six biopsy specimens (12%) were insufficient for diagnosis. Ancillary studies including electron microscopy and/or immunocytochemistry were performed on 13 malignant aspirates and provided additional confirmation of the cytology diagnosis in 12 cases. This study confirms that fine-needle aspiration is a sensitive and highly specific procedure for the evaluation of primary and metastatic malignancies involving the adrenal gland. The technique is less useful in the workup of benign processes but, in some instances, can provide specific diagnostic information.
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ABSTRACT: BACKGROUND The morphologic similarities between renal cell carcinoma (RCC) and hepatocellular carcinoma (HCC) can cause diagnostic difficulty in fine-needle aspiration biopsy (FNAB) specimens. In the authors' prior study of liver FNAB, peripherally wrapping endothelium (PE) and arborizing transgressing endothelium (TE) were 100% specific for HCC relative to metastatic tumors, which included only three RCCs. In this study, the vascular patterns of RCC in FNAB were reviewed for comparison with HCC, to determine their usefulness in the differential diagnosis of HCC and RCC.METHODSFNAB of 49 RCCs (26 primary and 23 metastatic) from 46 patients were reviewed. Four vascular patterns were assessed: PE, TE, papillary endothelium (PAP) in fibrovascular cores of papillary fragments, and short nonbranching endothelium (SE) in small cell clusters. Each pattern was given a semiquantitative score: absent (0), focal (1), or extensive (2). Cellularity was categorized as low (< 20 groups), moderate (20-50 groups), or high (> 50 groups).RESULTSVessels were present in 19 of 26 (73%) primary and 9 of 23 (39%) secondary RCC. PE was not identified. TE was observed in 11 primary (42%) and 7 metastatic (30%) RCC. SE was present in 5 primary (19%) and 1 metastatic (4%) RCC. The TE and SE patterns were distributed among the clear cell, granular cell, and chromophobe RCC. PAP was observed in all four papillary RCC. The majority of the TE and all of the PAP were present in moderately to highly cellular FNABs, whereas SE was usually observed in FNABs with low cellularity.CONCLUSIONSFNAB specimens of RCC commonly contain TE, as in HCC, but lack PE. TE was less frequent in metastatic than primary RCC. Other vascular patterns (SE, PAP), absent in HCC, were observed infrequently. Vascular patterns, especially PE, are useful in distinguishing HCC from RCC. Cancer (Cancer Cytopathol) 1997; 81:45-50. © 1997 American Cancer Society.Cancer 02/1997; 81(1). · 5.20 Impact Factor
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ABSTRACT: Résumé Cette revue générale décrit les difficultés et les limites diagnostiques les plus fréquemment rencontrées par le cytopathologiste qui examine des ponctions à l’aiguille fine, guidées sous échoendoscopic digestive. En fonction du tableau clinique et radiologique et du diagnostic qui est suspecté, l’accent est mis sur ce que doit faire l’échoendoscopiste pour optimiser le prélèvement. Des conseils spécifiques pour limiter le nombre d’erreurs diagnostiques ou de diagnostics non contributifs sont proposés pour chaque lésion en passant en revue tous les organes qu’il est possible de ponctionner à l’aiguille fine, provenant aussi bien du thorax que de l’abdomen et du pelvis. Un diagnostic précis conduisant à une prise en charge appropriée du patient n’est possible que par la mise en œuvre d’une corrélation entre les données cliniques, endosonographiques, l’examen macroscopique du prélèvement, une préparation adaptée à ce type de matériel au laboratoire, une bonne connaissance de la cytopathologie (cytologie conventionnelle par étalement et en milieu liquide) aidée par les colorations histochimiques et immunohistochimiques faites sur les coupes en paraffine et la pratique des techniques de cytométrie ou de biologie moléculaire si un diagnostic de lymphome est suspecté. Summary In this review, the more common diagnostic difficulties and limitations of cytopathologist confronted with EUS-guided FNA will be described. Emphasis will be placed on what the endosonographer should be aware of according to the suspected clinical and imaging diagnosis. Specific advices to limit the number of diagnostic pitfalls or nondiagnostic samples will be proposed for each lesion including the diagnosis of all FNA specimens obtained from the thoracic, abdominal and pelvic cavities. The correlation between clinical and sonographic data, gross appearance of the aspirate after the puncture, adequate lab processing, and cytopathological knowledge (conventional smears, liquid-based cytology) helped by histochemical and/or immunostains on paraffin sections and/or by cytometry/molecular analysis for a suspicion of lymphoma allows for a precise diagnosis of different lesions and leads to appropriate patient management.Acta Endoscopica 02/2006; 36(1):41-68. · 0.16 Impact Factor
Article: Pigmented PheochromocytomaActa Cytologica - ACTA CYTOL. 01/2005; 49:421-423.