Diagnostic Fine-needle Aspiration Biopsy Research Articles

Thyroid fine needle aspiration biopsy results before and during the COVID-19 pandemic: From a single centre perspective

Aim: One of the effects of the COVID-19 pandemic on the healthcare system has been the postponement of elective procedures. We aimed to investigate how the COVID-19 pandemic has affected our thyroid fine-needle aspiration biopsy (FNAB) results. Method: The distribution of cytology results during the 16.5 months of the pandemic was compared with the pre-pandemic period by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) diagnostic categories. Results: The number of FNABs performed during the pandemic period decreased by 27.3% compared to the pre-pandemic period in our center, in line with the recommendations (1197 to 327 diagnostic FNABs). Benign biopsy results decreased during the pandemic period compared to the pre-pandemic period (77.3% to 49.5%, p<0.001), and indeterminate biopsy results (AUS/FLUS, FN/SFN, and SUS) increased from 19.5% to 45.9 %, p<0.001. Malign biopsy rates did not differ between pre-pandemic and pandemic periods (3.3% to 4.6%, p=0.25). Conclusion: Although the number of FNAB decreased due to pandemic measures, we found a decrease in benign cytology and an increase in indeterminate for malignancy. The pandemic period allowed us to be more selective when deciding on a biopsy for FNABs. We recommend that the risk assessment of nodules be done carefully when making the biopsy decision in the next period. Although it is recommended not to delay FNAB for nodules at risk for malignancy, it should not be forgotten that the surgical decision should not be hasty in indeterminate results, and follow-up can be continued, or biopsy can be performed again under appropriate conditions.

Тонкоигольная аспирационная биопсия внутриглазных образований

Purpose: To present our experience of fine needle aspiration biopsy (FNAB) of intraocular tumors. Material and methods: Within 3 years FNAB was performed in 154 eyes (154 patients) for prognostic (n= 121) and diagnostic purposes (n=33). The mean tumor thickness in group of diagnostic FNAB was 6.0 mm (range, 2.3-10.5 mm), in prognostic – 5.5 mm (range, 2.0-11.3 mm). Transscleral, transvitreal and transcorneal FNABs were performed using our new custom designed thin-wall 25 and 27G needles by our improved FNAB technique. All samples were analyzed cytologically.In cases of uveal melanoma (UM) genetic testing (GT) was performed to estimate prognosis. Cytogenetic and molecular-genetic tests on cells and remnant liquid were held in cases of UM. Results: Cytologycally informative materials was obtained in 136 of 154 (88%) FNAB samples. Diagnostic FNAB yield was revealed to be 97% (n=32): in 20 cases UM was detected, in 8 – metastases, in 3 – intraocular lymphoma and in 1 – subretinal hemorrhage. Prognostic FNAB revealed either spindle or round-shaped cells of UM in 104 of 121 cases (informative value – 86%). No signs of tumor growth within the scleral track were seen. In 2 cases vitreous hemorrhage was seen that required vitrectomy. The average follow-up period was 11 months (3 to 41 months). No severe complications were detected. Conclusion: Our FNAB improved technique allows to provide excellent tissue samples suitable for differential diagnosis and estimating prognostic with no severe complications.

Long Lasting Response in Metastatic Pancreatic Exocrine Cancer: Abnormality or Diagnostic Miss? A Case Report with Brief Literature Review

Pancreatic exocrine cancer (PEC) is a challenging disease with a very low of curability rate, even when disease is at early stage and surgically treated, with dismal 5-years survival rates. Advanced disease is always a fatal disease and case of long lasting survivors are very few and doubts on the faithfulness of the diagnosis are more than justifiable. There are some benign illness that can mimic radio-logically and clinically an advance pancreatic cancer? We describe a case of clinically and radio-logically advanced pancreatic cancer who had non diagnostic fine needle aspiration biopsy (FNAB) with a long lasting remission after a short course of therapy with gemcitabine. The atypical outcome after systemic therapy and doubts on reliability of the clinical diagnosis carry us to review literature in search of similar cases, under the point of view of positive outcome and misleading clinical presentation.

Abstract A24: Early-stage pancreatic cancer patient derived xenograft (PDX) models established from endoscopic ultrasound (EUS) fine needle aspiration (FNA) biopsies

Abstract Background: We developed and characterized PDX models generated from FNA endoscopic biopsies at the time of diagnosis of pancreatic ductal adenocarcinoma (PDAC). Our goal was to determine if an FNA-PDX model could be established within a clinically relevant time frame to inform treatment decisions prior to disease recurrence in patients with early stage, localized disease. Methods: Patients presenting with a localized mass in the pancreas and no metastatic disease were considered for EUS/FNA biopsy. Under sonographic guidance FNA biopsies were obtained. On-site cytopathology confirmed a histologic diagnosis of PDAC. The diagnostic FNA specimen was sent to pathology for formalin fixed paraffin embedded tissue block analysis per standard institutional pathologic protocols. Additional endoscopic FNA passes from the primary tumor were obtained during the index procedure by EUS guidance. The cell specimen was washed in cold DMEM and centrifuged. The cell pellet was rapidly transplanted into a subcutaneous pocket within the flank of a single NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ (NOD scid gamma, NSG) mouse. Tumor growth was monitored with calipers and engrafted tumors were passaged to subsequent mice when they reached a diameter of 10mm2. Growth kinetics and immunohistochemical staining for human cells with antibody against the human HLA Class 1 ABC antigen were obtained. Treatment groups were established from the F3 passage and randomized for in vivo chemosensitivity testing using FDA-approved chemotherapeutics: gemcitabine, cisplatin, docetaxel, irinotecan and fluorouracil. Results: The warm ischemia time was negligible. The average cold ischemia time, defined as the time from the endoscope to transplantation in the mouse, was 39 minutes. Engraftment was successful in 9 of 24 (37.5%) individual FNA patient specimens. Engraftment however increased with the number of FNA biopsy passes: 3/12 (25%) engraftment from one pass and 6/12 (50%) from two passes. Tumor size and surgical resectability status by CT imaging did not correlate with engraftment success. Procedural variables such as needle gauge and cytopathologic features such as degree of differentiation and percent tumor cellularity also did not correlate with rate of engraftment. PDX tumor morphology was maintained between F0 and F4 mice by H&E and human HLA immunohistochemical staining. The initial engrafted PDX tumors took 12 weeks (average) to grow to a diameter of 5 mm. The rate of engraftment for subsequent passaged mice was faster, averaging 6 weeks for the F1 development and stable for passaged tumors to the F5 generation. As expected, in vivo chemosensitivity was variable between FNA-PDX tumors from different patients as depicted in patient model #048 which was resistant to oxaliplatin, intermediate to docetaxel and fluorouracil but sensitive to cisplatin, irinotecan and gemcitabine. Conclusions: Pancreatic cancer PDX models can be generated from the diagnostic FNA biopsy specimen obtained during a patient's EUS procedure. The rate of engraftment doubles with the number of endoscopic passes suggesting that the amount of biopsy specimen tissue is important for engraftment while cytopathologic features associated with aggressive tumor growth such as tumor cellularity and tumor cell differentiation did not. Chemosensitivity was variable between FNA-PDX models. In patients with early stage disease the FNA-PDX model is stable and results from chemosensitivity assays can be obtained in a clinically meaningful window. Citation Format: Kerrington Smith, Dawn Fischer, Timothy Gardner, Stuart Gordon, Vijayalakshmi Padmanabhan, Thomas Colacchio, Richard Barth, Arief Suriawinata. Early-stage pancreatic cancer patient derived xenograft (PDX) models established from endoscopic ultrasound (EUS) fine needle aspiration (FNA) biopsies. [abstract]. In: Proceedings of the AACR Special Conference: Patient-Derived Cancer Models: Present and Future Applications from Basic Science to the Clinic; Feb 11-14, 2016; New Orleans, LA. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(16_Suppl):Abstract nr A24.

CHOROIDAL MELANOMA INITIALLY TREATED AS HEMANGIOMA: DIAGNOSTIC AND THERAPEUTIC CONSIDERATIONS.

To describe and analyze cases of circumscribed choroidal melanoma initially treated as circumscribed choroidal hemangioma. A retrospective case series including five eyes of five patients with choroidal melanoma that were originally diagnosed and treated as choroidal hemangioma. Four men and 1 woman (26-61 years) were included. All patients were white and presented with nonspecific symptoms (visual field defect, decreased visual acuity, and metamorphopsia) and visual acuity ranging from 20/30 to 20/80. Four of the five tumors were yellow and/or orange and one was partially melanotic. All tumors were dome shaped (one bilobed) and had associated subretinal fluid overlying the lesion. Two tumors had high internal reflectivity on standardized A-scan ultrasonography, whereas others had low internal reflectivity. Three tumors were hypofluorescent on early phases of indocyanine green and intrinsic vasculature was also observed in two of these three. Four of five patients who were initially treated by photodynamic therapy did not respond to treatment. However, they did respond to radiation therapy (after revised diagnosis), with documented regression and no evidence of detectable metastasis (mean follow-up 24.2 months). Differentiating between amelanotic melanoma and choroidal hemangioma can be challenging. Relying solely on ophthalmoscopic features can be misleading. Ancillary studies such as indocyanine green and standardized A-scan ultrasonography bring clarity in differentiating circumscribed choroidal hemangioma from choroidal melanoma. Although cytology or histopathology is the only definitive method of establishing the diagnosis, careful emphasis on key diagnostic features can obviate the need for diagnostic fine-needle aspiration biopsy in most cases.

Pretreatment MicroRNA Level and Outcome in Sorafenib-treated Hepatocellular Carcinoma.

Sorafenib represents the first effective targeted therapy for advanced stage hepatocellular carcinoma (HCC); however, adequate patient stratification regarding sorafenib-responsiveness is still missing. Our aim was to analyse the association between the pretreatment microRNA profile of HCC and patient survival under sorafenib treatment. Total RNA was extracted from diagnostic fine-needle aspiration biopsy (FNAB) cytological smears of 20 advanced stage HCC patients collected between June 2008 and July 2012. All patients underwent sorafenib administration after FNA. Clinicopathological and survival data were recorded. Fourteen frequently deregulated miRNAs in HCC (miR-17-5p, miR-18a, miR-21, miR-34a, miR-122, miR-195, miR-210, miR-214, miR-221, miR-222, miR-223, miR-224, miR-140, miR-328) were tested by qRT-PCR. NormFinder software was used to select proper miR (mir-140) as a reference. Satisfactory amount of total RNA was obtained from all the considered samples (mean 10.8 ± 9.3 µg, range 0.2-32.2 µg). Among the analysed miRNAs, high miR-214 expression was associated with smaller tumor size (p=0.019), whereas high miR-17-5p expression correlated with better Eastern Cooperative Oncology Group performance status (p=0.003). The survival analysis revealed that high miR-224 expression was associated with increased progression-free and overall survival (PFS p=0.029; OS p=0.012). Pretreatment microRNA profiling, especially miR-224 expression, might serve as an ancillary tool for the better assessment of expected survival rates for patients under sorafenib treatment.

Cutaneous sinus formation is a rare complication of thyroid fine needle aspiration biopsy.

Fine needle aspiration biopsy (FNAB) is essential in the diagnosis and management of thyroid nodules. In this paper, we report a rare complication, cutaneous sinus formation, after diagnostic FNAB guided by palpation. Sixty-three-year-old female patient was admitted with the complaints of hoarseness and discharge from the anterior neck wall which were present for the last 6 months. The patient underwent a near total thyroidectomy 17 years ago. Recurrent nodular goiter was detected six months before and a diagnostic FNAB guided by palpation was performed. Two weeks later the patient had wound discharge and hoarseness. Physical examination of the patient revealed a sinus, which was located superior to the thyroidectomy incision. A 1 cm nodule was palpated in the left side of her neck. A cervical ultrasonography (USG) showed a 9 × 7 mm nodule in the remnant thyroid and a 9.5 × 3.5 mm fistulized fluid collection. The patient underwent sinus tract and remnant thyroid removal. This case report presents a cutaneous sinus formation deriving from the granulation tissue, probably due to the silk suture reaction in the previous surgery, by the FNAB guided by palpation procedure. We suggest USG guided FNAB to achieve more accurate and safe diagnosis in evaluating the thyroid nodules.

Intrapancreatic accessory spleen: A case report and review of literature

Intrapancreatic accessory spleen is not an uncommon entity and usually located in the tail of the pancreas. Most of them are asymptomatic and incidental findings on radiologic study or at autopsy. On imaging study, it appears to be a well-defined, solitary, and hypervascular lesion; therefore, it may be confused with pancreatic neoplasms, such as neuroendocrine neoplasm, well-differentiated adenocarcinoma, solid pseudopapillary tumor, or metastatic tumor to the pancreas. As such, the diagnostic fine-needle aspiration biopsy of the lesion may be performed. Several case reports describing cytological features of the lesion have been published in recent years. Among them, the most commonly identified cytological findings are sheets of a heterogeneous population of lymphocytes and prominent traversing blood vessels. Herein, we report an unusual EUS-FNA case of intrapancreatic accessory spleen. In addition to above previously well-described cytological features, our case revealed many cells with fine granular chromatin and areas with pseudo rosette-like architecture, mimicking and engendering the differential diagnosis of pancreatic neuroendocrine tumors. Although cytological findings of our case are rare, they may extend our current knowledge and provide additional differential diagnostic information for this entity.

Diagnostic Fine-Needle Aspiration Biopsy of an Intrathyroidal Parathyroid Gland and Subsequent Eucalcemia in a Patient with Primary Hyperparathyroidism

To present the clinical course of a patient with persistent primary hyperparathyroidism (PHPT) whose intrathyroidal parathyroid gland was diagnosed by ultrasound-guided fine-needle aspiration biopsy (FNAB). We describe the clinical course and laboratory, radiographic, and microscopic findings of a patient with persistent PHPT due to an intrathyroidal cystic parathyroid gland and review the relevant literature. A 74-year-old man with PHPT (presenting serum calcium concentration, 16.2 mg/dL; intact parathyroid hormone [PTH] concentration, 341 pg/mL) had surgical excision of the right superior, right inferior, and left inferior parathyroid glands, but the left superior parathyroid gland remained unidentified. Microscopic examination revealed parathyroid hyperplasia. Technetium Tc 99m sestamibi single-photon emission computed tomography imaging showed uptake in 2 foci, 1 on each side of midline in the neck. Reoperation with attention to the left neck failed to locate another parathyroid gland. Neck ultrasonography demonstrated a complex nodule within the right lower lobe of the thyroid. Results from FNAB of the solid component were consistent with parathyroid cells, and cystic fluid PTH concentration was greater than 1800 pg/mL. Nine months later, neck ultrasonography showed a hypoechoic area located posterior to the inferior pole of the right thyroid. The patient remained eucalcemic 16 months postprocedure. Autoinfarction of the parathyroid gland and aspiration of cystic fluid may explain resolution of hypercalcemia. Although PHPT due to functioning parathyroid cysts is rare, and PHPT due to cystic parathyroid hyperplasia has been described, this is the first case report of a patient with persistent PHPT due to a functional parathyroid cyst whose diagnosis by FNAB was followed by eucalcemia.

Surgical Treatment of Solitary Thyroid Nodules Via Fine-Needle Aspiration Biopsy and Frozen-Section Analysis

Fine-needle aspiration biopsy (FNAB) and frozen-section analysis of managing solitary thyroid nodules continue to generate considerable controversy. This study was a retrospective review of 619 patients with solitary thyroid nodules who underwent thyroidectomy. Of 540 FNABs, 35 (6.5%) were positive for malignancy, 276 (51.1%) were benign, and 229 (42.4%) were suspicious. Only 5.1% were false negative, and 11.4% were false positive. Diagnostic FNAB sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for malignancy were 86.1%, 59.7%, 33.0%, 94.9%, and 64.6%, respectively. Of 569 patients analyzed by frozen section, diagnosis was deferred in 86 (15.1%) patients, and results were positive for malignancy in 92 (16.2%) and benign in 391 (68.7%). No false-positive results were noted, but 2.3% (391) were false negative. Of 86 deferred frozen sections, 11 (12.8%) patients had malignant tumors confirmed by permanent section. Diagnostic frozen-section sensitivity, specificity, PPV, NPV, and accuracy for carcinoma were 82.1%, 100%, 100%, 95.8%, and 96.5%, respectively. Sensitivity, specificity, PPV, NPV, and accuracy for frozen-section analysis for diagnosis of carcinoma in patients with suspicious FNAB were 83.9%, 100%, 100%, 94.9%, and 96.0%, respectively. FNAB is a sensitive diagnostic modality in selecting patients who require surgery. Routine use of frozen-section analysis is unwarranted for benign FNAB results. Frozen section is specific and cost-effective in determining the extent of surgery in patients with suspicious or malignant FNABs.

Ultrasonography for the endocrine surgeon: A valuable clinical tool that enhances diagnostic and therapeutic outcomes

Surgeon-performed ultrasonography (U/S) has revolutionized many subspecialties by broadening the diagnostic and interventional scope of practice. We report our experience on the impact of surgeon-performed U/S in an endocrine surgery practice. Prospectively maintained records of patients from November 1999 to November 2004 were reviewed to establish patterns and outcomes of U/S practice. Surgeon-performed neck U/S was done routinely at the initial clinic visit and incorporated into resident/fellow education. A total of 5703 U/S were performed on endocrine patients with thyroid 42%, parathyroid 57%, and adrenal 1% disorders. Diagnostic fine-needle aspiration biopsy (FNA) was achieved with low sampling errors (<7%). When U/S identified thyroid nodules coexisting with hyperparathyroidism, preoperative FNA correctly established benign thyroid diagnosis and minimized need for thyroidectomy. U/S successfully imaged abnormal parathyroid glands when (99)Tc-sestamibi scans were negative. U/S data significantly changed treatment plans in nearly two thirds of thyroid cancer patients. Surgical residents readily mastered essential U/S skills. Surgeon-performed U/S is a highly specific tool for identification of endocrine disease in the neck. It is learned readily and performed accurately, and functions as an informative extension of physical examination. Because it substantially benefits patient care and impacts surgical decision making, neck U/S is recommended highly as a valuable adjunct to endocrine surgical practice.

Fine needle aspiration biopsy (FNAB) for retinoblastoma.

To determine the incidence of diagnostic fine needle aspiration biopsy (FNAB) in eyes with retinoblastoma (RB) as well as its indications and potential complications. A retrospective study by survey was designed and a questionnaire inquiring on FNAB use in RB diagnosis during the past 15 years was submitted to 12 high-volume ocular oncology clinics. A total of 3,651 patients with RB have been diagnosed and treated in 12 clinics since 1985. During the same period, eight biopsies were obtained for diagnostic purposes and six of these proved to be RB by cytology; the other two showed inflammatory cells and benign retinal cells. The median age for the biopsied patients was 46 months; 6 of the biopsied children were older than 4 years of age. The average age at the time of biopsy was 46 months. Most of the cases were biopsied with clinical diagnosis of uveitis/endophthalmitis through the limbus and pars plana with 25- and 27-gauge needles. Five of six cases of RB had enucleation and one patient had cryotherapy and I-125 brachytherapy after FNAB. The average follow-up time for biopsy-proven RB cases was 10.8 years with no recurrent disease. The results of this survey suggest that FNAB indication for RB diagnosis is rare; the majority of cases can be diagnosed and treated by ocular oncologists without invasive procedures.

The Role of Fine-Needle Aspiration Biopsy in the Evaluation of Head and Neck Masses

Purpose: The purpose of this study is to evaluate the role of diagnostic fine-needle aspiration biopsy (FNAB) of head and neck masses and to calculate the sensitivity and specificity of this method. Materials and Methods: The records of 219 patients who had undergone an FNAB of head or neck masses were reviewed. FNAB results were correlated with the histopathologic findings observed after surgery in 96 of 219 patients. Sensitivity, specificity and positive predictive value of FNAB for the detection of malignancy were calculated. Results: Four false-negative, 4 false-positive and 22 unsatisfactory results were obtained using FNAB, according to histopathologic findings. The overall sensitivity, specificity, accuracy and positive predictive value for malignancy were 87.5, 93.8, 91 and 87.5%, respectively. Conclusions: FNAB is a useful diagnostic tool for head and neck masses. However, FNAB results by themselves could be insufficient in the management of head and neck masses; therefore, they should be combined with clinical and radiologic findings.

Neoplasms of the retinal pigment epithelium: the 1998 Albert Ruedemann, Sr, memorial lecture, Part 2.

Neoplasms of the retinal pigment epithelium (RPE) are rare, and little is known about their clinical variations, clinical course, and prognosis. Although most are benign, they can simulate choroidal melanoma. To evaluate the clinical characteristics, management, pathological features, and prognosis of acquired neoplasms of the RPE (adenoma and adenocarcinoma) and to define clinical features that help differentiate them from uveal melanoma. The medical records of patients with acquired tumor of the RPE were reviewed retrospectively, and the clinical features, management, and histopathologic findings were studied. Of 13 affected patients, 10 were women and 3 were men. Ten were white and 3 were African American. The mean age at diagnosis was 53 years (range, 28-79 years). All patients were referred with the diagnosis of suspected choroidal melanoma. All tumors were solitary, unilateral, and ranged from a small, asymptomatic lesion measuring 2 x 2 x 1 mm to a massive neoplasm that measured 17 x 17 x 17 mm. There was no predilection for retinal location or laterality. The tumors were dark brown to black in 11 patients and only minimally pigmented in 2. Prominent retinal feeder vessels were visualized in 8 patients, 5 of whom had an exudative retinal detachment. Two patients had recurrent vitreous hemorrhage. Transillumination generally revealed blockage of light by the tumor. Fluorescein angiography showed early hypofluorescence and late minimal hyperfluorescence of the tumor, without visibility of choroidal vessels. Ultrasonography typically demonstrated the tumor to be abruptly elevated and to have medium to high internal reflectivity and acoustic solidity. Results of diagnostic fine needle aspiration biopsy, performed on 4 patients, disclosed cells compatible with a pigment epithelial origin. Treatment ultimately included observation in 4 patients, enucleation in 3, local tumor resection in 3, irradiation in 2, and laser therapy in 1. Microscopic verification of the diagnosis was available in 3 eyes after fine needle aspiration biopsy, 3 eyes after local resection, 3 eyes after enucleation, and 1 eye post mortem. The microscopic diagnosis was adenoma in 8 patients and adenocarcinoma in 2. Microscopically, the lesions were composed of a neoplastic proliferation of RPE cells. Tumors arising from the anterior portion of the RPE had a vacuolated pattern, and those in the posterior portion of the RPE had a glandular or tubular configuration. Neoplasms of the RPE show considerable clinical variation. In contrast to melanoma, they generally are darker, more abruptly elevated, and more likely to have retinal feeder vessels and exudative retinal detachment; show early hypofluorescence and mild late hyperfluorescence on angiographic findings; and have high internal reflectivity on ultrasonographic findings. Although most acquired tumors of the RPE are benign cytologically, they can exhibit aggressive clinical behavior.

Use of fine-needle aspiration biopsy and frozen section in the management of the solitary thyroid nodule

Background. This study evaluates the indication for frozen section (FSx) in the management of the solitary thyroid nodule given the increasing use of fine-needle aspiration biopsy (FNAB). Methods. The charts of 561 patients who underwent thyroidectomy for a solitary nodule were reviewed. Each patient underwent either FNAB, FSx, or both. Results were compared to the final diagnosis to evaluate their effectiveness in predicting malignancy. Results. The sensitivity and specificity for FNAB alone (162 patients) were 86% and 91%, respectively, and for FSx (494 patients) 79% and 99%, respectively. The routine use of FSx with diagnostic FNABs did not improve the accuracy over either test alone. Sensitivity, specificity, and accuracy were essentially unchanged when the use of FSx was limited to just atypical FNAB but dropped significantly when FSx was not used. Conclusions. When results of FNAB and FSx are interpreted as benign or malignant, both are highly accurate predictors of malignancy. Routine use of FSx and FNAB does not improve the sensitivty or specificity in the detection of malignancy over that of either examination alone. FSx proved useful in determining the extent of operation only when results of the FNAB were atypical.

Clonal karyotypic evolution in a pediatric neurofibrosarcoma

A retroperitoneal neurofibrosarcoma infiltrating the spine of a 2-year-old boy was investigated cytogenetically three times over a 5-month period. The first sample, from a diagnostic fine-needle aspiration biopsy, had a supernumerary i(1)(q10) as the sole clonal aberration; two cells showed monosomy 18 in addition to the isochromosome. The second sample, obtained at tumor resection 3 weeks later, had the karyotype 47,XY,+i(1)(q10), −18, +21/45,XY,−18. After 5 months, a large local recurrence was resected. The chromosome analysis showed further clonal evolution: 45,XY, +1,der(1;11)dic(1;11)(q44;q13)i(1)(q10), inv(6)(p21q12), −17. The findings indicate that formation of i(1)(q10) and loss of chromosome 18 may be early genetic events in neurofibrosarcoma development.

Giant Adrenal Myelolipoma

The clinicopathologic features of a giant adrenal myelolipoma (diameter 16 cm, weight 900 g) are presented. The ultrasonographic and the computed tomographic appearance of adrenal myelolipoma are reviewed. Diagnostic fine-needle aspiration biopsy is recommended for avoidance of unnecessary surgical treatment.

Fine Needle Aspiration Biopsy in the Diagnosis of Intraocular Cancer: Cytologic-Histologic Correlations

Fine needle aspiration biopsy was used as an investigational procedure in the evaluation of 71 eyes harboring a suspected intraocular malignancy between January 8, 1981, and January 21, 1983. Twenty-seven of these 71 biopsies were performed prior to any treatment as a diagnostic procedure and the others were performed following enucleation or tumor excision to provide specimens for cytologic-histologic correlation. The histologic findings confirmed the cytologic diagnosis of malignancy or benignancy in 94.3% of the 53 cases in which a corresponding tissue specimen was available for histologic evaluation. None of the eight eyes with a cytologically confirmed diagnosis of malignancy that were managed conservatively following the biopsy has experienced visual loss attributable to the biopsy. There have been no instances of documented needle tract seeding by tumor cells or orbital tumor recurrence to date in the 27 cases in which diagnostic fine needle aspiration biopsy had been performed prior to treatment.