Aims-To review the results of 73 consecutive fine needle aspirations (FNAs) that were collected by a pathologist and analysed by immunoflow cytometry. Material for a cell block was also collected from some of these lesions. Methods-The setting was a large general hospital in rural New Zealand. The FNAs were performed by a pathologist, or a radiologist for image guided localisations. Material for immunoflow cytometry was collected into RPMI and, when required, material for a cell block was collected into formalin. In the past, the cytological diagnosis of lymphomas from fine needle aspiration (FNA) samples has been particularly diYcult. Usually, one obtains a sample that is either obviously malignant but equivocally lymphoid or, conversely, a sample that is obviously lymphoid but equivocally malignant. However, recently FNA diagnosis of lymphoid lesions has been made easier by the arrival of immunoflow cytometry in most large pathology laboratories. Immunoflow cytometry has been used mainly for the analysis of haematological diseases, but increasingly it is being used by cytologists. Early studies of FNAs and immunoflow cytometry used a limited range of antibodies and were not able to perform dual staining. Recently, there have been substantial advances in the sophistication of the methods and equipment used for flow cytometry. It is accepted that FNA cytology with immunolabelled flow cytometry can, in some circumstances, serve as a replacement for open biopsy and conventional histology and immunohistochemistry. Results-Of1 2 However, FNA with immunoflow cytometry is not always successful. Scanty cellularity in the sample can prevent a satisfactory analysis, and even with an adequate sample the results might be misleading. In particular, non-lymphoid malignancies can be hard to distinguish from lymphoid lesions if the sample also contains reactive lymphoid cells; B cell lymphomas sometimes do not exhibit light chain restriction; and T cell lymphomas can have a large population of reactive B cells.The aim of our study was to review the results of 73 consecutive FNAs that were collected by a pathologist and analysed by immunoflow cytometry. Material for a cell block was also collected from some of these lesions. The setting was a large general hospital in rural New Zealand. The FNAs were performed over a two year period. In this time, approximately 800 FNAs of non-breast lesions were performed together with approximately 1400 breast FNAs. MethodsThe FNAs were performed by one of two mobile pathologists with an interest in FNA cytology, except for image guided FNAs, in
Aims-To review consecutive cell block preparations of cytological specimens in a large general hospital. Methods-50 cell blocks were made over an 18 month period in which about 1900 fine needle aspirations (FNAs) were performed. The aspirator was a cytologist or, for image guided FNAs, a radiologist with a cytologist at hand to collect the specimen. Forty eight cell blocks were from FNAs and two were from serous fluids. Results-The cellularity of the cell blocks was inadequate in only four preparations. The main motive for making cell blocks was to obtain tissue for immunohistochemistry. This was performed on 28 cases and a total of 107 immunostained sections were produced. The most common diagnostic dilemma was between carcinoma and melanoma, and the second most common between carcinoma and lymphoma. Consequently cytokeratin, S-100, and LCA were the most frequently used antibodies. At least one ofthese three antibodies was positive in 17 cases. Five cases were immunostained only for prognostic breast markers. Conclusions-The use of cell block immunohistochemistry is a reliable and technically unsophisticated aid in the cytological examination of tumours other than lymphomas. Success depends on having highly experienced aspirators that reliably obtain sufficiently cellular material. (C Clin Pathol 1997;50:985-990) Keywords: cell block; immunohistochemistry; fine needle aspiration cytology; audit Cytology cell blocks are made by centrifuging cytology specimens to form solid pellets. Paraffin wax embedded sections can be cut for haematoxylin and eosin histology and special stains, including immunohistochemistry. This study reviewed 50 consecutive cell block preparations of cytological specimens in a large general hospital. Patients and methodsThe vast majority of cell block specimens were obtained from fine needle aspirations (FNAs). These were performed as part of a near-patient rapid diagnosis FNA service. A second FNA was used to collect the specimen for the cell block after the initial diagnosis had been made on the first specimen. The image guided FNAs (17 cases) were performed by a consultant radiologist with a cytologist at hand to collect the specimen. A variety of needles was used depending on the site. The manually guided FNAs (31 cases) were performed with a 23 gauge 3.75 cm needle using a "needle only" technique and the operator was always a consultant pathologist with a special interest in FNA cytopathology. Maximum material was collected by extensive agitation of the needle in the lesion. Ten per cent formal saline was drawn up though the needle into an attached syringe and then gently ejected back into a specimen container.
The histogenesis of carcinosarcomas has intrigued pathologists for a long time and remains unresolved. Two main theories have been put forward, one suggesting that they are monoclonal, another suggesting that they are biclonal. Our study examined p53 immunostaining in 17 uterine carcinosarcomas (mixed Müllerian tumours) and found positivity in five (30%). There was no disparity in immunostaining between the epithelial and the stromal components in any of the 17 tumours. This concordance in every tumour would be very unlikely if carcinosarcomas are biclonal. However, it would be expected if carcinosarcomas are monoclonal.
Aims: Fine needle aspiration (FNA) cytology is an accepted means of diagnosing and typing common forms of lymphoma, particularly small lymphocytic lymphoma, follicular lymphoma, and large B cell lymphoma. However, its usefulness for diagnosing less common forms of lymphoma is not clearly established and this study was designed to examine this. Methods: The study reviewed the FNAs of suspected lymphomas collected over a period of approximately five years. Results: FNA samples were available for 138 definite lymphomas; most were common forms of B cell lymphoma. However, there was also one Burkitt lymphoma (BL), two Burkitt-like large B cell lymphomas, 15 classic Hodgkin lymphomas (HLs), two nodular lymphocyte predominant Hodgkin lymphomas, four mantle cell lymphomas, two mediastinal (thymic) large B cell lymphomas (MLBCLs), 11 peripheral T cell lymphomas (PTCLs), and five T cell rich large B cell lymphomas (TCRLBCLs). Conclusions: FNA diagnosis of BL was possible with immunoflow cytometry (IFC), cell block immunohistochemistry (IHC), and cell block fluorescent in situ hybridisation for c-myc alteration. It was difficult to make a definite diagnosis of HL and MLBCL on FNA alone. Both tend to be sclerotic tumours and FNA tends to yield scanty neoplastic cells. The FNA diagnosis of PTCL depended on cell block IHC; IFC was not usually useful. TCRLBCL did not show light chain restriction on IFC of FNA samples, probably because of frequent reactive B cells in the tumour. Thus, HL, MLBCL, and TCRLBCL are often difficult to diagnose accurately on FNA cytology, even when using IFC and cell block IHC. I n the past 10 years, fine needle aspiration (FNA) cytology has become accepted as a means of diagnosing and typing common forms of lymphoma, particularly small lymphocytic lymphoma, follicular lymphoma, and large B cell lymphoma.1-8 These types of lymphoma alone make up approximately 70% of all lymphomas. The usefulness of FNA cytology in the diagnosis of these lymphomas is reliant on immunoflow cytometry (IFC) and cell block immunohistochemistry (IHC). It is also reliant on the pathologist making ''near patient'' provisional assessment of the nature of the specimen and then collecting appropriate specimens.However, the usefulness of FNA cytology in the diagnosis of less common forms of lymphoma is not clearly established, and our study set out to examine this issue. METHODSThe method was similar to that described in a previous study from our department. 6 The study was set in a large tertiary referral hospital in rural New Zealand. We reviewed the FNAs of suspected lymphomas collected over a period of approximately five years. Most of these were either benign or were common forms of lymphoma that were not the focus of our present study. The cases selected for further examination were those with a final diagnosis of Burkitt lymphoma, Burkitt-like large B cell lymphoma, classic Hodgkin lymphoma, nodular lymphocyte predominant Hodgkin lymphoma, mediastinal (thymic) large B cell lymphoma, peripheral T cell lymphoma, and T cell ...
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