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Acne rosacea is a common dermatologic condition which is usually diagnosed by its clinical presentation. This article describes an unusual presentation of acne rosacea and the diagnosis of this condition using fine-needle aspiration biopsy. To our knowledge, the fine-needle aspiration findings of acne rosacea have not been previously described and illustrated in the cytology literature.

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Nuclear grooves have been described as a cytologic feature in a variety of extrathyroid lesions. When a cytologic specimen demonstrates prominent longitudinal nuclear grooving, a wide range of pathologic lesions should be considered. To our knowledge, the two cases presented are the first report of longitudinal nuclear grooving described in cytologic preparations of malignant melanoma.

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Cytologic features of the cell-stroma interface are useful in distinguishing between monomorphic adenomas of the basal cell type and adenoid cystic carcinoma. In basal cell adenomas, the collagenous stroma interdigitates with adjacent cells, whereas in adenoid cystic carcinoma, the two are separated by a sharp smooth border. Furthermore, the stroma of basal cell adenomas can contain rare spindle cells or capillaries, but the cylinders of adenoid cystic carcinoma are acellular. The authors review their experience with five cases of basal cell adenoma, and three cases that were designated "minimally pleomorphic adenomas." The latter group showed the small blue cell pattern of basal cell adenoma at the time of fine-needle aspiration, and histology revealed only small foci of typical pleomorphic adenoma. With the exception of one cystic case, the cell-stroma interface of basal cell adenoma was observed in all eight cases. These cases are contrasted with three adenoid cystic carcinomas with extensive solid (anaplastic) areas. All showed the small blue cell pattern and cell-stroma interface features of basal cell adenoma. Neither showed the smooth-bordered cylinders of adenoid cystic carcinoma. Two of these three were incorrectly interpreted as benign at the time of fine-needle aspiration. The authors suggest that the stroma aspirated from solid adenoid cystic carcinoma represents desmoplastic tumor stroma that mimics the pattern of basal cell adenoma in smear material. Distinction between basal cell adenoma and the solid type of adenoid cystic carcinoma at the time of fine-needle aspiration remains a very difficult problem.

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We reviewed the clinical and fine-needle aspiration (FNA) findings in 20 patients with poorly differentiated carcinomas presenting initially as parotid or as submandibular masses. There were 11 primary tumors and nine metastatic malignancies in 14 males and six females ranging in age from 39 to 89 yr (median = 66). The tumor types included three primary carcinomas with oncocytic features, three additional cases of high-grade parotid carcinoma, one case of primary neuroendocrine carcinoma, two examples of malignant mixed tumor, one high-grade mucoepidermoid carcinoma, and a single example of malignant lymphoepithelial lesion. Six patients with metastatic carcinoma had previous diagnoses of malignancy. In the three remaining individuals, primary carcinomas of the lung (two cases), and an unknown primary site presented initially as parotid masses. Five examples of metastatic squamous cell carcinoma, one metastatic basal cell carcinoma, and two metastatic renal cell carcinomas were identified. One parotid lymphoepithelioma was interpreted cytologically as an atypical lymphoproliferative process suggestive of Hodgkin's disease. Nineteen cases (95%) were correctly classified as carcinoma at the time of FNA. High-grade carcinomas aspirated from the parotid may be primary, but are frequently metastatic to either the gland, or to an intraparotid lymph node. Our experience indicates that some metastatic carcinomas present at this site, without a previous history of malignancy. Distinguishing primary from metastatic lesions has important therapeutic implications.

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We compared the effectiveness of selectively screening pharmacy data bases to identify patients with hypercholesterolemia with that of mass cholesterol screening. Screening data bases of four community pharmacies yielded 426 patients filling prescriptions for beta-blockers, thiazide diuretics, oral hypoglycemics, insulin, sublingual nitroglycerin, nicotine gum, or nicotine patches. They were invited to attend a cholesterol screening. Eighty-eight of the contacted patients attended, as did 97 walk-in persons. Cholesterol readings were higher in the contacted group (p = 0.017). Borderline-high cholesterol levels (200-239 mg/dl) were reported in 36.3% of the contacted group and 29.8% of the walk-in group. High cholesterol levels (> 239 mg/dl) were reported in 31.8% and 18.6%, respectively. Targeting certain drugs that directly contribute to raising cholesterol or indicate other risk factors for coronary artery disease (e.g., diabetes mellitus) was an effective method of identifying patients with hypercholesterolemia.

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Papillary hidradenoma of the vulva, also know as hidradenoma papilliferum, is an uncommon lesion which occurs in post-pubertal women. Review of the literature yielded no fine-needle aspiration reports of the cytologic features of vulvar papillary hidradenoma.

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Diabetic fibrous mastopathy, also known as lymphocytic mastitis, is an uncommon lesion of the breast that occurs in women with long-standing insulin-dependent diabetes mellitus (IDDM). To my knowledge, the fine-needle aspiration findings of a histologically confirmed case of diabetic fibrous mastopathy have not been previously described and illustrated in the cytology literature.

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The histologic features of adenopathy associated with intramuscular injections of gold sodium thiomalate in a woman with rheumatoid arthritis are presented. We believe that the light microscopic features of the above process are sufficiently distinctive that a diagnosis of gold-associated lymphadenopathy could be rendered. A review of the literature revealed no descriptions of the light microscopic appearance of gold in lymph nodes. In this case, the diagnosis of gold-associated lymphadenopathy was confirmed by scanning electron microscopic studies.

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Thyrolipoma, or adenolipoma of the thyroid gland, is an uncommon neoplasm and thus not recognized by many cytopathologists. This is the first article to describe the fine-needle aspirate findings of a histologically confirmed thyrolipoma. The gross morphologic and computerized tomographic features of this entity are also discussed, and the literature is reviewed.

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Nine patients with chronic lymphocytic leukemia (CLL), with pulmonary involvement confirmed by biopsy, presented with progressive cough and/or shortness of breath and had interstitial infiltrates on chest radiographs. Biopsies showed a dense lymphocytic infiltrate that followed bronchovascular bundles. We considered CLL the predominant finding, and the cause of the patient's pulmonary disease, in eight cases; in one, a histologically nonspecific organizing pneumonia was the main lesion and CLL was an incidental finding. Culture results were available in six cases and were negative except in one case with presumed contaminants. A granulomatous reaction was present in five cases and was necrotizing in two, although culture results were negative. The only case with a recognizable organism had noninvasive fungal hyphae growing in many of the small airways. All of the patients' respiratory symptoms improved after chemotherapy and/or steroid therapy, and the chest radiographs also showed clearing.

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The cytologic features are described in a case of squamous cell carcinoma and small cell cancer of the lung concurrently diagnosed by a single transthoracic fine needle aspiration specimen. The value of diagnostic cytology in the detection of dually differentiated lung malignancies is discussed, and the importance of identifying the small cell component in order to direct appropriate therapy is emphasized.

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