Nonneoplastic Entities Research Articles

Role of fine-needle aspiration in clinical management of transplant patients.

Fine-needle aspiration (FNA) of superficial and deep seated lesions has been used with high sensitivity and specificity in the diagnosis of neoplastic and non-neoplastic entities. However, studies of FNA in post-transplant patients are virtually absent. Six hundred and seventy-four allograft recipients (cardiac 288, renal 250, lung 131 and heart-lung 5) were reviewed. A total of 30 (25 heart, 4 lungs and 1 renal transplant) patients underwent an FNA procedure. There were 26 males and 4 females. Ages ranged from 18-63 yr (mean 48 yr). The most common entity aspirated was post-transplant lymphoproliferative disorder (PTLD) in 12 cases, followed by inflammatory lesions in 10 cases, malignant epithelial neoplasms in 3 cases, and 1 case each of malignant mesenchymal tumor, pulmonary infarction, hamartoma of liver, fatty changes of liver, and a benign vascular lesion. Surgical or autopsy tissue was available in 19 cases (63.3%). There was an agreement between tissue diagnosis and FNA material in 18 cases (94.7%). One (5.2%) false negative case was recorded. This was a liver aspirate showing benign liver elements, which a surgical biopsy proved to be a bile duct hamartoma. No false positive cases were recorded. FNA is a highly sensitive and specific diagnostic tool in the management of post-transplant patients.

Non-neoplastic causes of high signal intensity at T2-weighted MR imaging after treatment for musculoskeletal neoplasm.

The objective of this study was to describe a variety of non-neoplastic causes of high-signal-intensity areas seen on T2-weighted magnetic resonance (MR) images obtained after treatment for malignant musculoskeletal neoplasm. MR examinations obtained after treatment for malignant musculoskeletal neoplasm in 11 patients were reviewed. The examinations of these patients were selected because at least one MR study of each patient showed high-signal-intensity areas on T2-weighted images at or near the site of the original tumor. The MR imaging findings were correlated with results of biopsy in four patients, and with information from follow-up radiologic examinations and the patients' medical records in all cases, to determine the cause of the high-signal-intensity areas. Non-neoplastic entities responsible for high-signal-intensity areas included postsurgical seroma, hematoma, postradiation therapy changes, fat necrosis and seroma, surgical hemostatic packing material, intercalary bone allograft, strut bone graft, atrophic muscle, and herniated colon and bladder. Knowledge of details of the surgical procedure and the time interval since surgery or irradiation aided in accurate interpretation of the findings, but did not allow immediate biopsy to be deferred in every case. High-signal-intensity areas on T2-weighted images in patients previously treated for malignant musculoskeletal neoplasm may represent a variety of entities other than residual or recurrent neoplasm, even in the presence of a mass. The MR imaging findings should be interpreted in conjunction with details of the specific clinical circumstances to prevent misdiagnosis and unnecessary biopsy.

Fine-needle aspiration cytology of cystic ovarian lesions.

A 4-year study (January 1986 through December 1990) was performed to evaluate the cytomorphologic features of cystic ovarian lesions. Fluid from 103 cases was obtained either during surgical removal of the ovary (48 cases; mean age 50 years) or by fine needle aspiration (55 cases; mean age 32 years). Of the 48 cystic lesions with histologic correlation, 30 (62.5%) were neoplastic and 18 (37.5%) were non-neoplastic. Ten (18%) of the 55 aspirates were unsatisfactory. The remaining 45 cases (82%) were benign, predominantly non-neoplastic entities which included follicle, corpora luteal, and endometriotic cysts. Neoplastic cystic lesions included serous, mucinous, and Brenner tumors, germ cell neoplasms, a sex cord-stromal tumor, and an undifferentiated carcinoma. Follicle and corpora luteal cysts were composed of loose cell clusters of granulosa cells and/or luteinized granulosa cells. Endometriotic cysts contained hemosiderin-laden macrophages and endometrial cells. Serous and mucinous cystadenomas were composed of cohesive sheets and/or papillary clusters of epithelial cells. A cystic Brenner tumor showed sheets of cells with grooved nuclei, and a benign cystic teratoma contained mature squamous cells admixed with vacuolated cells of presumed sebaceous origin. Although the distinction between benign and malignant entities posed few diagnostic difficulties, borderline tumors could not be distinguished from well-differentiated cystadenocarcinomas. The results of this study indicate that the majority of cystic ovarian lesions can be diagnosed accurately on cytology. Cytologic evaluation of non-neoplastic ovarian cysts is important for women who want to retain their fertility and in the clinical management of women with neoplastic lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Differentiation of radiation fibrosis from recurrent neoplasia: a role for 31P MR spectroscopy?

Recent reports have suggested that recurrent tumors can be differentiated from posttreatment fibrosis by use of T2weighted MR imaging [1 -5]. Fibrosis has been shown to have low signal intensity on such images [1-5] and to be distinguishable statistically from recurrent tumor on this basis [4, 5]. Fibrosis in patients 1 year or more after therapy, in particular, has been well differentiated from recurrent tumor [5]. However, not all authors have reported such good results [6], and it appears that other abnormalities such as inflammation and necrosis can produce changes on MR images that are indistinguishable from recurrent tumor [3, 5, 6]. The metabolic information provided by 31P MR spectroscopy seems potentially useful in differentiation of recurrent tumor from nonneoplastic entities. We report a case that exemplifies this possibility.