RESUMEN
OBJECTIVE: To establish cytomorphologic criteria that might facilitate the identification of malignant melanoma (MM) cells with epithelioid (nevoid) morphology, in fine needle aspiration biopsy material from the liver. STUDY DESIGN: Aspirated material from 18 cases of MM with epithelioid features and 24 cases of benign liver lesions (BLL) were examined. The cases were selected based on the availability of corresponding tissue biopsies, adequate cell block material or sufficient number of direct smears to perform immunocytochemical staining. The presence or absence of 7 cytologic criteria were reviewed, and the results were evaluated by multivariate regression analysis. RESULTS: All evaluated criteria were significant for identifying MM cells and differentiating them from reactive hepatocytes (P < .001). Uniform atypia, cell dyscohesion, eccentric nuclei and irregular nuclear membranes supported MM, whereas, monolayered sheets or cordlike arrangement; coarse, granular cytoplasm; and occasional transgressing endothelium in true tissue fragments were evidence of BLL. CONCLUSION: A systematic evaluation of the cytomorphologic features described in this study, in conjunction with the clinical and radiologic findings, can be used to render an immediate, confident and accurate diagnosis of MM metastatic to the liver.
Asunto(s)
Biopsia con Aguja/métodos , Biopsia con Aguja/normas , Neoplasias Hepáticas/secundario , Melanoma/secundario , Neoplasias Cutáneas/patología , Antígenos de Neoplasias , Biomarcadores de Tumor/metabolismo , Núcleo Celular/patología , Citoplasma/patología , Diagnóstico Diferencial , Neoplasias del Ojo/patología , Hepatocitos/patología , Humanos , Inmunohistoquímica , Antígeno MART-1 , Proteínas de Neoplasias/metabolismo , Valor Predictivo de las Pruebas , Reproducibilidad de los ResultadosRESUMEN
The Wisconsin State Laboratory of Hygiene's Cytology Program has contributed to the success of the Pap smear in substantially decreasing the number of cervical cancers in the United States. In addition to providing testing services to the Cervical Cancer Control Program of Wisconsin, the Department of Health and Family Services, and Planned Parenthood of Wisconsin, the Wisconsin State Laboratory of Hygiene (WSLH) maintains one of the largest schools of cytotechnology in the United States, which helps train individuals into a profession experiencing severe shortages. The Cytology Program has actively evaluated the new liquid-based testing technology to provide data to improve laboratory performance. Staff at the WSLH have participated in the evolution of cytopathology by serving on governmental committees and on professional cytopathology organizations. The WSLH Cytology Program is now evaluating the role of molecular technology, including human papilloma virus testing, to improve the diagnosis and treatment of cervical cancers.
Asunto(s)
Laboratorios/organización & administración , Administración en Salud Pública , Neoplasias del Cuello Uterino/prevención & control , Biología Celular/normas , Femenino , Humanos , Tamizaje Masivo/métodos , Control de Calidad , Gobierno Estatal , Neoplasias del Cuello Uterino/epidemiología , Wisconsin/epidemiologíaRESUMEN
To determine the clinical significance of rare atypical squamous cells of undetermined significance (ASCUS) in cervical screening, we studied 748 ASCUS cases prospectively noted to have rare abnormal cells. Comparing the rare ASCUS (RASC) group (defined as five or fewer abnormal cells) statistically to cases diagnosed as within normal limits (WNL), ASCUS unqualified as to number of cells low-grade squamous intraepithelial lesion (LGSIL), and high-grade SIL (HGSIL), we found that the probability of the RASC patients having an abnormal cytology (ASCUS/SIL) or biopsy (dysplasia) result within 1 yr was greater than that of the WNL group, but less than that for ASCUS unqualified, LGSIL, or HGSIL. When only ThinPrep specimens or cases with subsequent definitive SIL/dysplasia were considered, the RASC group was not significantly different from the WNL group. We conclude that RASC increases the risk of a subsequent abnormal cytology/biopsy result in conventional smears, but only when the threshold for abnormality is a subsequent ASCUS. It did not predict dysplasia (SIL/CIN) in those conventional samples. RASC did not have the power to predict any subsequent abnormality and did not appear to be clinically significant in ThinPrep samples.