Cytology Cell Block Research Articles

Value of EUS-FNA cytological preparations compared with cell block sections in the diagnosis of pancreatic solid tumours

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is performed in order to achieve a definite tissue diagnosis of pancreatic lesions. This in turn is a guide to the appropriate treatment for the patient. Tissue samples collected by the same needle for cytological preparations and cell block histological sections (often referred to as FNA-cytology and FNA-biopsy, respectively) are handled differently. The specific contribution of each of these tests was evaluated. One hundred and two consecutive patients underwent EUS-FNA while being investigated for pancreatic solid lesions. Diagnosis was made by cytology, cell block sections or both. The diagnosis was confirmed by clinical outcome. Male/female ratio was 61/41. Mean age was 65±12 years (range, 22-94). Mean lesion size was 3.1±1.8 cm (range, 0.6-10 cm); 68% were >2 cm and 75% were located in the pancreatic head. The average number of needle passes was two (range, 1-4 passes). Final tissue diagnosis was malignant in 66 (65%) patients. Sensitivity, specificity and accuracy were 73%, 94% and 81%, respectively, for cytology alone, and 63%, 100% and 78%, for cell blocks alone. Eighty-two patients (80%) had cytology and cell blocks, which matched in 64 (78%) patients. EUS-FNA results that relied on both techniques had 84% sensitivity, 94% specificity and 88% accuracy. Cytology revealed 13 malignancies not diagnosed on cell blocks, while cell blocks revealed five malignancies not diagnosed by cytology. Malignant lesions were more common in men; they were larger in size and located in the pancreatic head. EUS-FNA cytology was more sensitive than cell blocks but less specific for the diagnosis of solid pancreatic lesions. The two methods are complementary and implementing both improves the diagnostic value of EUS-FNA.

Incremental Diagnostic Yield of On-site Quick-prep Smear versus Cell-block Cytology in EUS-FNA of Solid and Cystic Masses

Purpose: In many centers that perform a high volume of endoscopic ultrasound-fine needle aspiration (EUS-FNA), cytology from both on-site quick prep smears (QPS) and from a centrifuged cell-block (CB) are evaluated. The additive value of performing both instead of one of these tests, however, has not been well studied. The aim of this study is to evaluate the independent diagnostic performance of QPS and CB in specimens obtained from EUS-FNA, and to assess the incremental yield of each test. Methods: A retrospective review was conducted of all EUS-FNA procedures performed at a tertiary referral hospital between August 2006 and July 2008. Procedures in which either QPS or CB was not performed were excluded. All FNAs were performed using a 22 gauge needle (Cook Medical, Bloomington IN). Mass location and size, number of needle passes, cytology adequacy and diagnosis from both QPS and CB were recorded. Diagnoses were categorized as non-neoplastic, atypical, and neoplastic. Data were analyzed with Student's t-test and Chi-Square test where appropriate. Results: Specimens from 442 EUS-FNA procedures met the inclusion criteria and were evaluated. 306 masses were solid (70% pancreatic, 30% other) and 136 were pancreatic cysts. The mean patient age was 65 and the mean mass size was 2.8 cm. The overall diagnostic yield of EUS-FNA (i.e., percentage of procedures in which cytology was adequate to make a diagnosis) was 76.5%, but differed significantly between solid and cystic masses (88.2% vs. 50%, P < 0.0001). When examined independently, the diagnostic yield of QPS did not differ from CB (72.6% vs. 70.1%). For all masses diagnosed as neoplastic based on EUS-FNA, the sensitivity of QPS was significantly greater than CB (97.3% vs. 92.4% P<0.05). In 59 (13.4%) of the 442 cases, the diagnosis between QPS and CB was discordant. In this group, QPS was more likely to make an additional diagnosis (36 cases, incremental yield 8.1%) than CB (23 cases, incremental yield 5.2%; P<0.05). This difference was seen only in solid but not cystic masses. Conclusion: On-site quick prep smears (QPS) from EUS-FNA specimens are more sensitive for diagnosing neoplasia than cell block (CB) and provide a higher incremental diagnostic yield, highlighting the importance of this practice. Prospective studies evaluating the incremental cost effectiveness of processing the CB in the setting of a diagnostic QPS should be considered.

Estimation of hormone receptor status and HER2 in cytologic cell blocks from breast cancer using the novel rabbit monoclonal antibodies (SP1, SP2, and SP3)

The determination of estrogen (ER) and progesterone (PR) receptor status has become standard practice in the evaluation of patients with invasive breast cancer, having important prognostic and therapeutic implications. HER2 assessment is important to evaluate the response to Herceptin (Trastuzumab) therapy for primary and metastatic breast cancer. This study is undertaken to compare rabbit monoclonal antibodies (RabMAb) for ER, PR, and HER2 against FDA-approved monoclonal and polyclonal antibodies (FDAMpab). Cell blocks from primary and metastatic/recurrent breast carcinomas of 52 breast cancer patients were used. Immunohistochemistry was performed, following optimized epitope retrieval, with a polymer based detection system using RabMAb: ER (SP1), PR (SP2), and HER2 (SP3). FDA approved Mpab (Dako) used were: ER (1D5); PR (PgR636); and HercepTest kit according to manufacturer's instructions. HER2 immunostain is correlated with FISH results. Overall, positive, and negative agreement is as follows: 88.5, 88.9, and 88.2% for ER; 84.6, 70.5, and 91.4% for PR; 58.3, 100, and 50% for HER2. There is substantial to moderate agreement between RabMAb and FDAMpab for ER (kappa = 0.75) and PR (kappa = 0.64), respectively. There is poor agreement (kappa = 0.25) between RabMAb (SP3) and FDApab (HercepTest). SP3 shows better concordance (93.8%) than HercepTest (46.9%) with FISH results. RabMAb SP clones are almost comparable with FDA-approved ER and PR, with fair to moderate agreement. Both are as sensitive as their FDA-approved clones. SP3, on the other hand, is superior to HercepTest for detecting HER2 overexpression, with an excellent concordance with FISH.

Evaluation of aspiration cytology of the liver space occupying lesions by simultaneous examination of smears and cell blocks

This study was undertaken to compare the efficacy of cytologic smears and histological sections from cell blocks in diagnosis of space occupying lesions (SOLs) of the liver and to classify the lesions on the basis of combined cytohistologic diagnosis. The study was conducted on 50 patients who had radiologically detected SOL/SOLs in the liver and ultrasound-guided fine needle aspiration of liver was done. In all the cases, both smears and cell blocks were made. Forty-seven cases were diagnosed as malignant and three as benign on both cytologic smears and cell blocks. Hepatocellular carcinoma was diagnosed in 8 (16%) cases and metastasis in 39 (78%) cases. The subtyping of malignancy could not be done on 11 (22%) cytologic smears and 8 (16%) cell block sections. However, on combined cytohistologic correlation, 17 (34%) out of these 19 (38%) cases could be subtyped. Sensitivity of cytologic smears and cell blocks in subtyping of malignancy was 72.3% and 82.9%, respectively. Combined cytohistologic diagnosis was found to be significantly better than isolated cytologic and cell block diagnosis (P < or = 0.05). To conclude, FNA of the SOLs of the liver is an effective procedure for diagnosing malignancy. However, cytological examination alone may fail to pinpoint the type of the tumor. Concomitant examination of cell block not only confirms the malignancy but also helps in subtyping it.

Morphological quality and nucleic acid preservation in cytopathology

Background:Fixation is a chemical or physical procedure to prevent the degradation of proteins and tissue morphology. To optimise molecular analysis of archival tissues, it is essential that fixation preserves morphology...

The significance of cell block and fine needle aspiration cytology in diagnosing a rare presentation of hepatocellular carcinoma

The significance of cell block and fine needle aspiration cytology in diagnosing a rare presentation of hepatocellular carcinoma

Immunocytochemistry and Fluorescence in Situ Hybridization in HER-2/neu Status in Cell Block Preparations

Recent studies have validated the use of cytologic materials to determine HER-2/neu status. Good concordance has been shown between results obtained by immunocytochemistry (ICC), immunohistochemistry (IHC), fluorescence in situ hybridization (FISH) on cytologic and surgical specimens. However, the utility of cytologic cell block material in determining HER-2/neu status has not been reported and is the subject of this study.HER-2/neu status was determined in 25 cases of primary or metastatic breast carcinoma by IHC and FISH. All cases were formalin-fixed, paraffin-embedded (FPPE) cell block preparations. ICC was performed using monoclonal antibodies TAB250 (Zymed) and CB11 (Novacastra Laboratories). FISH analysis was performed using the PathVysion HER-2 probe kit (Vysis, Inc.). Results of ICC and FISH were compared in each case.Of 25 cases studied, 17 showed no protein overexpression or amplification. Five cases showed protein overexpression and amplification. The remaining 3 cases showed 2+ staining intensity by ICC in 10, 20, and 50% of carcinoma cells, respectively, and all demonstrated lack of amplification.Immunocytochemistry performed on FFPE cell block material is a reliable method for determining HER-2/neu status in cytologic specimens. We recommend routine preparation of FFPE cell block material in instances of suspected primary of metastatic breast carcinoma.

The Utility of Immunohistochemical Staining with CEA, CA19-9, P53, and MIB to Improve the Diagnostic Yield of Endoscopic Ultrasonography Guided Fine Needle Pancreatic Aspirates

In a study of 100 specimens obtained by EUS-FNA, P53, MIB, CA19-9 and CEA were used in an analysis of 71 samples to determine if tumor markers increased the diagnostic yield of cytologically atypical or benign samples. A prospective analysis was performed of all patients undergoing EUS-FNA of pancreatic lesions. Methods: Four antibodies were used for immunohistochemical labeling: p53 (DO-7)- Zymed and MIB (Ki-67)- Zymed, CEA (monoclonal ab) – Zymed and CA19-9. Cytology smears and cell blocks were reviewed by two cytopathologists who were blinded to the tumor markers and the final diagnoses.

P63 immunostaining in destained bronchoscopic cytological specimens

The p53 homologous squamous stem-cell regulatory protein p63 is expressed in squamous carcinomas but is not characteristically detected in small-cell carcinomas (SCCs). A panel of thyroid transcription factor (TTF) 1 and p63 has been shown to be useful in distinguishing SCCs from poorly differentiated squamous carcinoma of the lung (PDSLC) in small biopsies and cytological cell blocks. Because tumor samples frequently are limited to cytological smears, we attempted to detect p63 in destained slides from a spectrum of pulmonary malignancies. Archival alcohol-fixed smears from 60 cases of cytologically diagnosed malignancies in bronchoscopically (n = 59) or fine-needle aspiration-obtained specimens (n = 1) were destained in acid alcohol, postfixed in 10% formalin, subjected to citrate-based antigen retrieval, and immunostained by exposure to anti-p63 monoclonal antibody 4A4, followed by reagents from a streptavidin-biotin immunoperoxidase kit, and diaminobenzidine as the chromogen. Postfixation in 10% formalin was found to be necessary for immunostaining. Normal ciliated and goblet cells were p63 negative, but reserve cells were p63 positive. All cases of squamous-cell carcinoma were positive for p63. Of 10 tumor samples originally diagnosed as SCC, only 6 samples were p63 negative and 4 samples exhibited positive staining. However, proper interpretation of the immunohistochemical (IHC) staining pattern and careful scrutiny of the cytological features and biopsy specimens in three of four cases led us to reclassify three cases into PDSLC. All adenocarcinomas (ACAs; n = 12), large-cell carcinomas (n = 4), and metastatic ACAs (n = 5) were p63 negative. Positive staining was seen in 9/16 tumors designated as non-SCCs; these tumors were not classified further into distinct histological categories.p63 staining in destained slides may be of value in facilitating the differential diagnosis between PDSLC and SCC. Criteria for conservative interpretation of results are discussed and include examination of reserve cells and ciliated cells on the same slide as internal positive and negative controls.

Cytologic Features of Granulosa Cell Tumors in Fluids and Fine Needle Aspiration Specimens

To describe the cytologic features of granulosa cell tumors in fluids and fine needle aspiration specimens, with histologic confirmation. Histologically confirmed granulosa cell tumors, 6 adult type and 1 juvenile type, were identified. All patients had local recurrences or metastases. Eleven specimens from 7 patients, including cytologic samples, cell blocks and histology, were reviewed. Inhibin immunostaining was performed on cell blocks to aid identification of this group of tumors in the cytologic and histologic samples. The patients were 22-72 years old. Sites included ovary and peritoneum; there were pelvic recurrences and metastatic lesions in the spleen, liver, perirectum and cervical lymph node. Cytologic features of adult granulosa cell tumors included 3-dimensional clusters, resettes loose monolayers and individual cells. Other features were Call-Exner bodies, vacuolated cytoplasm, exuberant capillaries associated with papillarylike fronds, a second population of elongated theca cells, and prominent or rare nuclear grooves. In juvenile granulosa cell tumor the features observed were monolayers, loosely cohesive sheets, single cells, occasional larger pleomorphic cells with nuclear clefting and nuclear protrusions, vacuolated cytoplasm, finely granular chromatin and frequent mitoses. The overall cytologic and histologic correlation was good. Inhibin was focally positive in one peritoneal fluid, correlating with the focal pattern of staining seen on histology. A definitive cytologic diagnosis of granulosa cell tumor can be made based on the above criteria. Aggressive tumors are discohesive and show pleomorphism and nuclear protrusions. Inhibin stain may be helpful in identifying granulosa cell tumors in cell block specimens.

P63 and TTF-1 Immunostaining

We studied the usefulness of p63 and thyroid transcription factor–1 (TTF-1) immunostains for differentiating poorly differentiated squamous cell carcinoma (PDSCC) from small cell lung carcinoma (SCLC). We used monoclonal antibodies reactive to p63 or TTF-1 to stain 4-μm-thick sections from 30 formalin-fixed, paraffin-embedded lung biopsy and resection specimens and 7 alcohol-fixed, formalin-postfixed, paraffin-embedded cell blocks from lung fine-needle aspirations (FNAs). For p63, we used a streptavidin-biotin kit, diaminobenzidine as the chromogen, and a hematoxylin counterstain. We used automated immunostaining for TTF-1. The 37 cases included 23 SCLCs, 13 PDSCCs, and 1 carcinoma initially diagnosed as PDSCC. All 23 SCLCs were negative or, rarely, equivocal for p63; 20 (87%) of 23 were TTF-1+; nuclear staining ranged from strong and/or frequent to weak and/or uncommon. All 13 PDSCCs were TTF-1–/p63+ with intense staining of 50% to 100% of tumor cells. One case originally diagnosed as PDSCC was TTF-1+/p63–, suggestive of SCLC; after morphologic reexamination and immunostaining for neuroendocrine markers, it was reclassified as intermediate-type SCLC. TTF-1 immunostaining showed equal or increased sensitivity in alcohol-fixed cytologic cell block samples compared with formalin-fixed biopsy material; in 1 SCLC case, the biopsy specimen was TTF-1–; however, the FNA cell block stained positively. p63 and TTF-1 appear to be useful for differentiating SCLC from lung PDSCC in formalin-fixed and alcohol-fixed, formalin-postfixed material.

Cytologic findings of angioimmunoblastic T-cell lymphoma: analysis of 16 fine-needle aspirates over 9-year period.

Peripheral T-cell lymphoma often represents an important diagnostic pitfall in fine-needle aspiration biopsy due to the heterogeneous cell population present. A classic example of this group is angioimmunoblastic T-cell lymphoma (AILD-T). The fine-needle aspiration cytology of this relatively well-defined histologic subtype of T-cell lymphoma is rarely described in the literature. The authors reviewed 16 fine-needle aspirates of AILD-T from 9 patients in Queen Mary Hospital and Pamela Youde Nethersole Eastern Hospital, Hong Kong, over a 9-year period from early 1993 to mid-2001. The morphologic features seen in cytology smears and/or cell block sections were correlated with histologic and immunohistochemical findings of excisional biopsy specimens. The smears and cytospin preparations showed a heterogeneous population of hematolymphoid cells, including small lymphocytes; nondescript, medium-sized lymphoid cells; immunoblasts; plasma cells; eosinophils; and reticulum cells, including follicular dendritic cells. In general, tingible body macrophages were not identified. Conversely, follicular dendritic cells were discernible easily in most cases and sometimes were admixed intimately with lymphoid cells, forming dendritic cell-lymphocyte complexes. There also were large lymphoid tissue fragments containing a scaffold of arborizing small vessels. Pleomorphic cells with high mitotic activity or lymphoid cells with clear cytoplasm were not identified. The cell block sections often showed an intimate admixture of small lymphocytes, plasma cells, eosinophils, and reticulum cells amid a background of reticulin fibers. Lymphoid follicles with well-developed germinal centers were never found. The features seen in cytologic preparations were reminiscent of those seen in histologic sections of the corresponding lymph node excisional biopsies. though ancillary investigative methods, including flow cytometry and molecular study, are of limited value in fine-needle aspiration cytology assessment of AILD-T due to the heterogeneous cell population present, recognition of the peculiar combination of cytologic features, especially in the right clinical setting, should provide a clue about the diagnosis. A high index of suspicion is essential to avoid a false negative diagnosis of reactive lymphadenopathy.

Absence of SV-40 large T antigen (Tag) in malignant mesothelioma effusions: an immunocytochemical study.

Simian Virus 40 (SV 40) was recently implicated in the pathogenesis of malignant mesothelioma. The oncogenic capacity of SV-40 is a function of a nuclear protein, the large T antigen (Tag). SV-40 Tag DNA sequences are detected by the polymerase chain reaction in 40-80% of malignant mesothelial proliferations. However, the role of immunohistochemistry (IHC) in demonstrating the nuclear localization of Tag is controversial. We sought to determine the clinical utility of SV-40 Tag IHC in pleural effusion cytology as an ancillary tool in the cytologic diagnosis of malignant mesothelioma (MM). Formalin-fixed, paraffin-embedded cell block sections from 100 pleural effusions (32 MMs, 25 benign reactive, 43 metastatic adenocarcinomas) were immunostained for the SV-40 anti-Tag, using two primary monoclonal SV-40 Tag antibodies: clone Pab 416 and clone Pab 101. Despite strong and consistent immunoreactivity in positive controls, no nuclear immunostaining was observed in any case. We believe the small sample size in cytology cell block sections, the low viral copy number in infected cells, and the effect of formalin fixation may have resulted in absence of immunoreactivity. The role of SV-40 Tag IHC in diagnostic cytopathology remains unclear unless further studies reliably show its detection.

Application of an immunodiagnostic method for improving preoperative diagnosis of nodular thyroid lesions

Thyroid cancer is the most common endocrine malignant disease, but preoperative diagnosis remains a challenge. Fine-needle aspiration cytology has greatly improved the clinical management of thyroid nodules, but the preoperative characterisation of follicular lesions is very difficult. Many patients are thus referred to surgery more for diagnosis than for therapeutic necessity. We undertook an international multicentre study to assess the usefulness of immunohistocytochemical staining for two potential markers of malignant thyrocytes. Expression of galectin-3 and CD44v6 was tested on 1009 thyroid lesions (tissue specimens and cytological cell-blocks) and 226 fresh cytological samples obtained preoperatively by ultrasound-guided fine-needle aspiration of thyroid nodules (prospective analysis). The test used monoclonal antibodies specific for CD44v6 and galectin-3, the indirect avidin-biotin complex immunoperoxidase method, and 3-amino-9-ethyl-carbazole as substrate. The sensitivity, specificity, positive predictive value, and diagnostic accuracy of this test method (for coexpression of the two markers) in the prospective analysis were 88%, 98%, 91%, and 97%, respectively. The sensitivity and specificity of galectin-3 immunodetection alone in discriminating benign from malignant thyroid lesions were more than 99% and 98% respectively, and the positive predictive value and diagnostic accuracy were 92% and 99%. The integration of galectin-3 immunostaining with conventional cytomorphological and clinical diagnostic procedures represents a sensitive and reliable diagnostic approach for preoperative identification of thyroid carcinomas. This test method improves the diagnostic accuracy of conventional cytology and provides the molecular basis for a new nosological assignation of the not yet classified thyroid neoplasms of indeterminate malignant behaviour.

Diagnostic utility of calretinin immunohistochemistry in cytologic cell block preparations

Calretinin (CR) is a valuable marker in the immunohistochemical distinction between malignant mesothelioma (MM) and adenocarcinoma (ACA) in tissue sections. However, there is limited and conflicting data regarding the utility of CR in this differential diagnosis on cytologic material, especially cell block preparations. Also, the possible role of CR in the distinction of papillary serous borderline tumor (SBT) cells from reactive mesothelial cells in peritoneal washings has not been examined. Formalin-fixed paraffin-embedded cell block specimens of cytologic fluids, washings, and aspirates with a suspicious or positive cytologic diagnosis and a confirmed diagnosis of MM (29 cases), ACA (39 cases), and SBT (10 cases) were used for CR immunohistochemistry (IHC). Moderate to strong staining in > 50% of tumor cells was noted in 26 of 29 (90%) MMs but in only 3 of 39 (8%) ACAs and 1 of 10 (10%) SBTs. Admixed reactive mesothelial cells (when present) were strongly positive in all fluid specimens, but the staining pattern of benign non-reactive mesothelial cells in washing specimens was less reliable. CR is both a sensitive and specific marker of reactive and neoplastic mesothelial cells in cytologic cell block preparations and is thus useful in the differential diagnosis of MM and metastatic ACA in malignant effusions. However, CR IHC does not appear to allow definitive identification of SBT in peritoneal washings.

Diagnostic utility of calretinin immunohistochemistry in cytologic cell block preparations

Diagnostic utility of calretinin immunohistochemistry in cytologic cell block preparations

Biopsy diagnosis of malignant versus benign liver "nodules": new helpful markers. An update.

Improved imaging techniques have led to an increased detection of suspicious "nodules" in the cirrhotic and noncirrhotic liver. Although the histologic diagnosis of clearly benign or clearly malignant lesions is usually straightforward, problems arise in the differential diagnosis of benign "nodules" and dysplastic lesions or well-differentiated hepatocellular carcinomas. This is especially so in limited diagnostic material, such as cytologic preparations from fine-needle aspirates and needle-core tissue biopsies. Recently, additional helpful markers have been described that may help to establish a conclusive diagnosis even on such material. Two of these, the reticulin stain and immunohistochemical staining for CD34, have been found to be useful also in cytologic cellblock material. Telomerase, a complex enzyme that is active in most malignant tumors, has also been found to show strong activity in most hepatocellular carcinomas. Mention is made of an immunohistochemical marker (MOC-31), reported to be useful in the differentiation between metastatic adenocarcinoma and hepatocellular carcinoma.

Epithelial cells and other cytologic features of pseudomyxoma peritonei in patients with ovarian and/or appendiceal mucinous neoplasms: a study of 12 patients including 5 men.

Pseudomyxoma peritonei (PP) is a rare condition. Cytologic evaluation of peritoneal fluid often is an initial diagnostic test for possible ovarian and/or appendiceal primary tumors. Previous studies suggest that patients with PP who have epithelial cells (ECs) in their peritoneal fluid usually have a less favorable prognosis than patients with acellular PP. To the authors' knowledge, few reports of PP in the cytologic literature cite the presence of ECs. Twelve cases of PP diagnosed by cytologic examination at the University of Texas M. D. Anderson Cancer Center over 15 years were identified. In all cases, primary tumors were confirmed histologically. All available cytologic smears and cell block sections were reviewed for cytomorphology, with particular attention given to the presence of ECs. A correlation between the presence of ECs and patient outcome also was sought (median follow-up, 26 months). Two patients had ovarian neoplasms, six patients (one female and five males) had appendiceal neoplasms, and four patients had synchronous ovarian and appendiceal tumors. Cytologic features included mucin pools (12 of 12 patients), ECs (11 of 12 patients), mesothelial or mesothelial-like cells (10 of 12 patients), histiocytes (11 of 12 patients), and fibroblast-like or spindle cells (6 of 12 patients). ECs were columnar with mucinous features in the majority of cases, and the number of ECs in each case was variable, ranging from 1+ (rare) to 3+ (many). Of the 11 patients with available follow-up data, 6 had recurrent disease, 4 had persistent disease, and 1 patient with acellular PP was alive without clinical evidence of disease after 24 months of follow-up. Unlike previous PP cytology reports, the current study frequently identified ECs (92%). Because of the potential prognostic implication of ECs in patients with PP, a diligent search for ECs is warranted. Indication of the presence or absence of ECs in the cytology report may be useful when PP is diagnosed.

Detection of cancer cells in effusions from patients diagnosed with gynaecological malignancies. Evaluation of five epithelial markers.

The detection of malignant cells in pleural, peritoneal, and pericardial fluids of cancer patients marks the presence of metastatic disease and is associated with a grave prognosis. We evaluated five epithelial markers for the detection of cancer cells in 94 fresh pleural, peritoneal and pericardial effusions. Eighty-four of the samples were regarded as adequate for analysis after evaluation of cytological smears, including 61 samples from patients known to have gynaecological neoplasms. The other 23 samples were from patients with various non-gynaecological malignancies or tumours of unknown origin. Our control cases were 10 fallopian tubes not affected by any malignancy and 12 malignant mesotheliomas. Cell blocks from all cases were stained for CA-125, BerEP4, carcinoembryonic antigen (CEA), BG8 (Lewis Y blood antigen), and B72.3 (TAG-72). Fifty-one of 84 cases were diagnosed as malignant or suggestive of malignancy in cytological smears and/or cell block sections. However, staining for epithelial markers highlighted the presence of malignant cells in 7 additional cases. When membrane staining was evaluated, the sensitivity of the markers studied in detecting malignant cells was as follows: CA-125: 88%, BerEP4: 78%, CEA: 26%, BG8: 86%, B72.3: 79%. Membrane positivity for CEA, B72.3 and BerEP4 was not detected in reactive mesothelial cells. However, membranous staining in mesothelial cells was evident in 13% and 31% of cases with the use of BG8 and CA-125, respectively. Weak cytoplasmic staining for CEA was observed in mesothelial cells in 2 cases. When Ber-EP4, B72.3, and BG8 staining results in cancer cells were combined, the following sensitivity levels were observed: BG8+B72.3: 91%; BG8+Ber-EP4: 90%; B72.3+Ber-EP4: 93%; BG8+Ber-EP4+B72.3: 95%. The detection of malignant cells in effusions is facilitated by the use of immunocytochemistry using a wide panel of antibodies. BerEP4 and B72.3 appear to be the best markers when both sensitivity and specificity are considered, followed by BG8, while CEA and CA-125 have a limited role in the detection of metastases from gynaecological tumours owing to the low sensitivity of the former and the low specificity of the latter. Analysis of all staining results should be based on a thorough morphological examination.

Fine Needle Aspiration Cytodiagnosis of Sialadenitis with Crystalloids

To assess the utility of fine needle aspiration cytology in the diagnosis of sialadenitis with crystalloid formation in four patients that presented with a swelling of the parotid gland. The swelling was aspirated in all the cases using a 22-gauge needle, and aspirates were submitted as needle and syringe washings in a cytology fixative (30% ethyl alcohol in physiologic saline). From these washings filter preparations were made on Sartorius or Gelman filters (pore size, 3 microns) and stained by the Papanicolaou method. Additionally, cell block preparations were made from the aspirate. After processing, sections were cut and stained by hematoxylin-eosin, Prussian blue, alcian blue, mucicarmine, and Von Kossa and congo red stain. No air-dried smears were made, and no electron microscopic studies were done. Stained cytologic preparations and cell blocks showed numerous nonbirefringent crystalloids of varying sizes and shapes appearing as rectangles, needles, squares and rods mixed with neutrophils and rare multinucleated giant cells. No salivary gland components were seen, and all special staining was negative. Fine needle aspiration cytology not only provided an accurate diagnosis of sialadenitis with crystalloids but also resulted in adopting conservative management and avoiding unnecessary surgery.