RESUMEN

PURPOSE: To determine whether diagnostic testicular fine needle aspiration (TEFNA) sampling needs to be performed in azoospermic men prior to obtaining testicular sperm cells for IVF-ICSI procedures. METHODS: Ten azoospermic patients underwent TEFNA in 1993-1996. During 1997, all patients underwent testicular sperm aspiration (TESA) and/or testicular sperm extraction (TESE) to retrieve spermatozoa for IVF-ICSI cycles. The results of the two procedures performed in two separate hospitals were compared. RESULTS: Diagnostic TEFNA revealed spermatozoa in five patients; identical results in four were found during IVF-ICSI cycles. In three patients, only Sertoli cells were found on TEFNA, in two of them TESA/TESE showed identical results, and in one, two spermatozoa were detected by Cyto-SEM. In the remaining two patients, spermatids or spermatocytes were found on both procedures. CONCLUSIONS: There was a very good correlation between the diagnostic and therapeutic procedures. We suggest that in azoospermic patients, diagnostic TEFNA is valuable in order to avoid unnecessary controlled ovarian hyperstimulation in the female partner for IVF. In patients in whom spermatozoa are detected, cryopreservation may be performed for later IVF-ICSI cycles.

Asunto(s)

Asunto(s)

RESUMEN

BACKGROUND: Concern over the adequacy of histologic diagnosis of endoscopic duodenal biopsies in children prompted this comparative study on the histologic quality of endoscopic versus capsule biopsies. We found this problem addressed in only six previous reports. METHODS: Blind examinations of the histologic sections of 48 duodenal biopsies obtained by gastrointestinal endoscopy in children aged 2-18 years were compared to 52 biopsies obtained by the small bowel suction method (from children aged 1-16 years). RESULTS: Although 87.5% of endoscopic biopsies and 94.2% of capsule biopsies were adequate for histologic diagnosis, fragmentation or squashing was seen in 83.3% of endoscopic biopsies and only in 25% of capsule biopsies. CONCLUSIONS: Biopsies obtained by suction are of better quality than those obtained by endoscopy. If endoscopy is preferred for technical reasons, the following conditions should be observed: the patients should be aged over 2 years, and a minimum of four biopsies should be obtained with forceps of a diameter greater than 2 mm. Adequate histologic criteria for diagnosis should include at least one full-thickness mucosal specimen more than 3 mm in length, vertically oriented, and not fragmented. In children under age 2, duodenal or jejunal capsule biopsies are preferred, since the specimens are usually larger and less fragmented. Endoscopy is technically more difficult in the very young patient.

Asunto(s)

RESUMEN

OBJECTIVE: The immunohistochemical staining patterns characteristic of hepatocellular carcinoma (HCC) using CD34 and factor VIII antibodies were compared with those of other hepatic lesions to determine if these stainings can be used as a diagnostic criterion. STUDY DESIGN: We reviewed 44 fine needle aspirates from the liver to evaluate the immunoperoxidase staining patterns on cell block preparations using CD34 and factor VIII and to determine whether this could distinguish HCC from the other lesions. These included HCC (14 cases), metastatic tumor (14 cases) and nonneoplastic liver lesions (16 cases). RESULTS: This retrospective study showed that in the nine documented cases of HCC, staining for CD34 and/or factor VIII was positive. The pattern of staining was either peripheral, around small clusters of tumor cells, or linear, diffuse and sinusoidal. In all the documented cases (27) of metastatic carcinoma and nonneoplastic lesions staining for CD34 and factor VIII was negative. In addition, there were eight problematic cases. In 7 cases the cytologic diagnosis on Papanicolaou-stained smears was inconclusive about HCC or metastatic carcinoma. CD34 and factor VIII confirmed the final diagnosis on the cell blocks. Based on this staining, 4 were HCC, 2 were metastatic carcinoma and 1 was equivocal, most probably HCC. In one case the differential diagnosis between well-differentiated HCC and a nonneoplastic liver lesion could not be made on cytologic smears, and here, also, CD34 and factor VIII aided in the correct diagnosis of a nonneoplastic liver lesion. CONCLUSION: We suggest immunoperoxidase staining with CD34 and factor VIII be performed on the cell block sections from FNAs in any problematic hepatic case.

Asunto(s)

RESUMEN

It has been suggested that differences in the frequency of the t(14;18) translocation in follicular lymphoma might explain ethno-geographic variation in the incidence of these tumors. We tested Israeli follicular lymphoma patients for the frequency of the t(14;18) translocation, and reviewed the published literature, comparing the frequency in our series with data from different parts of the world. Tissue specimens from 36 Israeli follicular lymphoma patients were tested for presence of the translocation by PCR amplification of the MBR breakpoint. Twenty-two of the 36 patients (61%) tested positive. A systematic search of the literature yielded 35 papers reporting the frequency of the t(14;18) translocation in follicular lymphoma. We analyzed cytogenetic data and molecular data separately. For each method, data were pooled from all studies within each of three geographical regions - USA, East Asia and Europe. Pooled data from cytogenetic studies show a low frequency of the translocation in the Far East (38%) compared to the USA (71%), with an intermediate frequency found in Europe (61%). Molecular studies show a similar frequency of the translocation in the Far East and Europe, significantly lower than the frequency in pooled data from American studies. The frequency in our Israeli series is relatively high, comparable to that detected in the USA. We suggest that the apparent geographical differences we describe are unlikely to be caused by a difference in the biology of the tumor, and are more likely due to technical and methodological factors. We conclude that it is unlikely that differences in the frequency of the t(14;18) translocation explain the difference in the epidemiology of lymphoma between East and West.

Asunto(s)

RESUMEN

We determined whether a single testicular specimen is sufficient to represent qualitatively the spermatogenic process within the testes of azoospermic or severely oligospermic infertile men. In 191 testes of azoospermic patients and in 26 of those with severe oligospermia, fine needle aspirations at 3 different sites of each testis were performed. Aspirated material from each puncture was stained and in each smear all spermatogenic cells, as well as Sertoli cells, were identified. Testes were classified according to the most mature spermatogenic cell type present, or the presence of only Sertoli cells. The homogeneity of the testicular spermatogenic process was then evaluated. There was an overall intratesticular difference between aspirates in 14.1% of azoospermic testes and in 26.9% of severely oligospermic testes with regard to the most mature spermatogenic cell type. When spermatozoa were the most mature cell type, they were detected in all of the 3 aspirates in 71.4% of the testes. In 18.4% or 10.2% of this group of testes they were retrieved in only 1 or 2 of the aspirates, respectively. In testes in which spermatids or spermatocytes were the most mature spermatogenic stage, these cell types were detected in all 3 aspirates in only 36.4% and 68.0%, respectively. In azoospermic patients with full testicular spermatogenesis, the likelihood of retrieving spermatozoa from the testes was 84.3%, 92.7% and 100% in 1, 2 and 3 specimens, respectively. The following conclusions were drawn: There is a wide range of testicular heterogeneity in azoospermia or very severe oligospermia for diagnosing the testicular spermatogenic pattern. In azoospermia, specimens from several testicular sites are required. It is strongly recommended that no assisted fertilization be offered to azoospermic patients unless prior evaluation of the spermatogenic pattern in the seminiferous tubules is determined.

Asunto(s)

RESUMEN

The aim of this study was to determine whether testicular volume can serve to predict patterns of spermatogenesis in azoospermia. In 27 tests of azoospermic infertile men, cytological specimens from several sites from each testis were obtained by fine needle aspiration. Testes were classified according to the most mature spermatogenic cell type. Classifications were testes with spermatozoa, with arrested spermatogenic development, and with only Sertoli cells. Prior to fine needle aspiration the 3 dimensions of each testis were determined ultrasonically and its volume calculated. Mean testicular volume (+/- SD) was 7.71 (+/- 5.95) ml for testes with spermatozoa and 7.55 (+/- 2.35) and 7.31 (+/- 4.42) ml for testes with spermatogenic maturation arrest and with only Sertoli cells, respectively (differences not significant). It is concluded that testicular volume can not be used as a predictive parameter, neither for the presence of spermatozoa nor for the cytological pattern of the testes of azoospermic infertile men.

Asunto(s)

RESUMEN

Follicle-stimulating hormone (FSH) is considered to be the most important plasma hormone correlated with spermatogenesis. Elevated FSH plasma levels were shown to be associated with complete damage to testicular seminiferous tubule germinal epithelium. Recently, there have been conflicting reports with regard to the value of FSH plasma levels in predicting seminiferous tubule histology in the azoospermic patient and hence, as a guide for therapy in assisted reproduction using testicular sperm retrieval. The aim of this study was to evaluate whether FSH plasma levels can predict spermatogenic pattern in the testes of the azoospermic infertile patient. 69 infertile men with non-obstructive azoospermia and 18 with very severe oligospermia were studied. In all, plasma levels of testosterone, free testosterone, prolactin, luteinizing hormone and follicle-stimulating hormone were measured by enzyme immunoassay. In the azoospermic patients the seminiferous tubule spermatogenic pattern was determined in testicular aspirates obtained by multiple fine needle aspiration and categorized according to the most mature spermatogenic cell type in the aspirates: Sertoli cells only, spermatogenic maturation arrest or full spermatogenesis. There were no significant differences in plasma levels of any hormone measured except in very severely oligospermic and azoospermic patients. Both normal and elevated levels were detected in all, regardless of seminiferous tubule cytological pattern or plasma FSH in azoospermic patients. It is concluded that plasma levels of FSH can not be used as a predictive parameter, neither for the presence of spermatozoa nor for any other seminiferous tubule cytological pattern in azoospermic infertile men. They cannot serve as guides for selection of azoospermic men for trials of testicular sperm retrieval in assisted reproduction.

Asunto(s)

RESUMEN

We determined spermatogenic patterns of seminiferous tubules in azoospermic infertile men and evaluated the prevalence of bilateral testicular homogeneity. 185 azoospermic men underwent bilateral testicular fine-needle aspiration (TFNA) in which each testis was punctured at 3 different positions. Aspirated material was stained and classified according to the most mature spermatogenic cell type present or whether only Sertoli cells were present. 35.7% had spermatozoa in their testes, 36.2% had spermatogenic maturation arrest, and 28.1% had only Sertoli cells in their seminiferous tubules. In 15.6% of all patients, the diagnosis in 1 testis differed from that in the other. In only 73.2% of those with testicular spermatozoa was it bilateral. In the remaining 26.9%, only Sertoli cells, spermatocytes or spermatids were found as the most mature cell type in the other testis. The study definitely indicates that fertilization with retrieved testicular spermatozoa should not be offered to azoospermic patients without prior evaluation of the seminiferous tubuespermatogenic pattern in both testes.

Asunto(s)

RESUMEN

BACKGROUND: Lipid-rich carcinoma and primary malignant fibrous histiocytoma (MFH) of the breast are rare tumors. Cytologically the presence of cells with foamy cytoplasm can cause diagnostic difficulties in both tumors. CASES: Fine needle aspiration was performed on two females with breast masses. The lipid-rich carcinoma showed cells with fine, variably sized vacuoles in the cytoplasm. The MFH smears showed large, histiocytelike cells with foamy cytoplasm, both mononucleated and multinucleated. CONCLUSION: When presented with cytologic smears showing foamy cells, in addition to the nature of the nucleus one must pay attention to the size and character of the cytoplasmic vacuoles to differentiate between sarcoma versus carcinoma.

Asunto(s)

RESUMEN

A case of nodular hidradenoma presenting on the forearm of a 36 year old woman is reported. The diagnosis was made on fine-needle aspiration biopsy (FNAB). The cytologic features of the lesion are described. This is the first case to be diagnosed cytologically.

Asunto(s)

RESUMEN

Merkel cell carcinoma is a relatively rare neoplasm of the skin. The present study describes three cases of Merkel cell carcinoma diagnosed by fine-needle aspiration cytology and reviews their histologic, cytologic, and ultrastructural features. The advantages of using fine-needle aspiration to diagnose Merkel cell carcinoma (and other cutaneous neoplasms) are emphasized.

Asunto(s)

RESUMEN

OBJECTIVES: To determine the efficacy and safety of short chain fatty acids (SCFA) in the treatment of refractory distal ulcerative colitis (UC). METHODS: Ten patients with distal UC who had failed to respond to rectal and oral therapy with 5-ASA and corticosteroids were treated with twice daily enemas containing sodium acetate 60 mM, sodium propionate 30 mM, and sodium butyrate 40 mM titrated to a pH of 7. Patients were assessed clinically (rectal bleeding, tenesmus, bowel motions), endoscopically, and histologically before and after 6 wk of therapy. In addition, patients gave a self-assessment of the efficacy of treatment. RESULTS: Five of the 10 patients responded clinically, and four of these had a clinical remission as reflected by a decrease in degree of bleeding (2.2 vs. 1.2, p < 0.05) and tenesmus (1.6 vs. 0.3, p < 0.05) and by global self-assessment. Endoscopic improvement occurred in five (6.78 +/- 0.83 vs. 4.44 +/- 2.7, p < 0.05). Histologically, no improvement was noted. No side effects were noted, and no patient's condition deteriorated. CONCLUSIONS: In this open-labeled study in patients with highly refractory distal UC, 50% had an overall clinical and endoscopic response. Forty percent of the patients assessed the treatment to be superior to previous treatments and expressed a desire to continue. This trial confirms other studies as to the efficacy of this treatment and further confirms the need for controlled trials of this promising therapy.

Asunto(s)

RESUMEN

It was shown recently that testicular fine-needle aspiration (TFNA) can replace biopsy as a diagnostic tool in male infertility. The aim of this study was to determine whether a method of quantitative analysis of spermatogenesis can be developed based on the cytological elements in the aspirates. TFNA aspirates from markedly oligospermic and azoospermic patients were studied. All spermatogenic cells (spermatogonia, spermatocytes, spermatids and spermatozoa, as well as Sertoli cells) in the aspirates were identified and counted. It was found that: 500 consecutive cells were needed to reach conclusions about the spermatogenic process; the number of Sertoli cells in aspirates was constant in each individual's smears; each spermatogenic cell type could therefore be related to the number of Sertoli cells; the cell type index (CTI: the ratio between the number of cells of each given cell type and the number of Sertoli cells in the count of 500 consecutive cells) indicated the relative appearance of each cell type in the spermatogenic process. Determination of a spermatogenic process index (SPI), reflecting the ratio of the CTI for a given spermatogenic stage to its previous one, may be used in a flow sheet of the spermatogenic process. Assessing these indices for all the spermatogenic cell types in testicular aspirates provides a method for quantitative evaluation of the process of spermatogenesis. It enables expression of testicular pathology quantitatively and it defines various testicular fertility disorders. It can also be used as a guide for surveillance of therapy.

Asunto(s)

Asunto(s)

RESUMEN

OBJECTIVE: We objectively evaluated the testicular sperm cell morphology. METHODS: The spermatozoa head morphology was evaluated by image analysis as presented on testicular fine-needle aspiration cytology smears. RESULTS: 2,356 spermatozoa heads were classified into six groups, according to different morphology parameters. CONCLUSIONS: This objective method of morphologic assessment of testicular spermatozoa provides an important tool for the evaluation of testicular spermatozoa and can serve as a guide for therapy in male infertility.

Asunto(s)

RESUMEN

OBJECTIVE: To assess the relationship between plasma levels of gonadotropins, androgens, and PRL with testicular spermatogenic pattern. DESIGN: Patient series. SETTING: University affiliated medical center. PATIENTS: One hundred twenty azoospermic infertile men. INTERVENTIONS: Testicular fine needle aspirations and determination of plasma levels of FSH, LH, T, free T, and PRL. MAIN OUTCOME MEASURES: Gonadotropins, androgens, and PRL plasma levels as a diagnostic criterion of testicular spermatogenic patterns. RESULTS: No statistically significant differences were detected in plasma levels of LH, androgens, and PRL among patients with Sertoli cell only, spermatogenic arrest, or full spermatogenesis. Elevated plasma levels of FSH threefold above the upper normal limit preclude, with a probability of 95%, the existence of full testicular spermatogenesis, but are not valid for the diagnosis of either Sertoli cell only syndrome or spermatogenic arrest. CONCLUSIONS: Luteinizing hormone, androgens, and PRL plasma levels are of no diagnostic value in predicting any specific spermatogenic pattern, and plasma FSH levels can not be used for diagnosing Sertoli cell only syndrome.

Asunto(s)

RESUMEN

The relationship between stages of the spermatogenic maturation process and male hormone levels was evaluated in 41 azoospermic, infertile men. Patients were categorized into groups according to the most mature spermatogenic cell type present in testicular aspirates: spermatocytes, spermatids or spermatozoa. High FSH and LH plasma levels were found in those with spermatocytes. Their hormone levels differed statistically (p < 0.005) from those in patients with maturation arrest at the spermatid stage, or those with spermatozoa in their testes. No statistically significant differences were found between the 3 groups with regard to plasma levels of testosterone, free testosterone and prolactin. However, there were positive correlations, higher for free testosterone than for testosterone, with stage of spermatogenic maturation.

Asunto(s)

RESUMEN

Intrathoracic amyloidosis affecting the lungs or mediastinum is rare, and mediastinal lymphadenopathy in the absence of pulmonary involvement is even more rare. The case history is presented of a previously healthy man who developed nodular mediastinal amyloidosis without pulmonary involvement. Diagnosis was made by percutaneous fine needle biopsy.

Asunto(s)

RESUMEN

OBJECTIVE: To investigate whether quantitative analysis performed on one testicular specimen is adequate for quantitative evaluation of spermatogenic process. DESIGN: Comparison of quantitative analysis of spermatogenic cell types in testicular cytologic aspirates of various sites of each testis. SETTING: In each aspirate, a total of 500 Sertoli cells and cells at each of the spermatogenic stages were identified, counted, and grouped according to cell type. A quantitative cell type index was calculated for each type of cell in each aspirate. Mean cell type indexes then were calculated for each of the cell types in the three aspirates of each patient, and variations of a given sample from its mean were compared. PATIENTS: Azoospermic or severely oligospermic infertile men. INTERVENTIONS: Fine needle aspiration performed on the upper, middle, and lower poles of each testis. RESULTS: Each of the aspirates showed wide deviations from the mean of the three aspirates for that patient. The deviation ranges of the cell type indexes of each of the spermatogenic stages were as follows: spermatogonia, 0.8% to 200%; spermatocytes, 1.4% to 94.3%; spermatids, 2.9% to 200%; and spermatozoa, 0.7% to 128%. In the majority of the patients, at least one of the three aspirates showed a cell type index score that was statistically different from the others. CONCLUSIONS: These results suggest that more than one testicular specimen is needed to evaluate quantitatively the spermatogenic process.

Asunto(s)