Aspiration cytology of ovarian cysts

Silvana Audy-Jurkovic¹, Vesna Mahovlic¹, Ana Ovanin-Rakic¹, Damir Babic², Mihajlo Strelec³, Ana Barisic¹ 

¹Institute of Gynecological Cytology, ²Department of Gynecological and Perinatal Pathology and ³Human Reproduction Unit, Department of Gynecology and Obstetrics, School of Medicine, University of Zagreb, Zagreb, Croatia.

Objective: To assess the diagnostic value of aspiration cytology in cystic lesions of the ovary. Methods: Between January 1989 and December 2000 cytospin preparations of cystic fluid stained by Papanicolaou and May-Grünwald-Giemsa methods were analysed in 271 patients with 276 non-neoplastic and neoplastic lesions of the ovary. In 31 cases, ultrasound-guided aspiration biopsy was preoperatively performed, whereas in 245 cases aspirates were obtained during the procedure of laparoscopy or laparotomy. Histologic diagnosis was used as a gold standard in the assessment of the diagnostic value of cytology. Results: According to the cytological criteria of the specimens adequacy there were 170 (61,6%) adequate samples (specific cells: epithelial, granulosa, etc.), 101 (36,6%) inadequate samples (macrophages only) and 5 (1,8%) unsuitable samples (acellular, etc.). Histologic analysis revealed 123 (44,6%) tumour like lesions, 110 (39,9%) benign tumours, 20 (7,2%) atypically proliferating tumours, and 23 (8,3%) malignant tumours. On classifying the cytologic findings into benign and malignant ones, the specificity (Sp) and negative predictive value (PV-) of the cytologic diagnosis for 271 ovarian cyst aspirates was 93 %, sensitivity (Se) 68% and positive predictive value (PV+) 67%. When the group of atypically proliferating tumours was included in the cytologic classification, the values of Sp and PV- were 93%, but the values of Se and PV+ were lower, i.e. 64%. Classification of the cytologic findings into non-neoplastic and neoplastic lesions, with only adequate samples (n=170) taken into consideration, yielded the values of 100% for Se and PV-, 93% for Sp, and 97% for PV+. Conclusion: Aspiration cytology can be a part of a multidisciplinary approach in the differential diagnosis of ovarian cysts. Classification of the cytologic findings into non-neoplastic and neoplastic lesions with only adequate samples taken into consideration produces the best results, thus providing a conservative management of non-neoplastic ovarian lesions in young women.

Computer-assisted image analysis in differential diagnosis of hyperplastic and neoplastic follicular nodules of the thyroid.

Mira Halbauer; Mario Medvedec; Brzac Hrvojka Tomic; Damir Dodig

Dept Nucl Med Radiat Protect, Univ Hosp Zagreb, Polyclinic For Thyroid Disease, Zagreb, Croatia

Objective: In order to assess the possible value of morphometric parameters in distinguishing between nodular hyperplastic goiter (NHG) and neoplastic follicular nodules in the thyroid, fine needle aspirates were morphometrically analyzed under an Olympus BH2 microscope, using a PC based image analysis system (VAMSTEC, Zagreb) and CCD camera (JVC TK 1270). Study design: The nuclear area and perimeter were measured in at least 100 nuclei per smear in aspirates of 10 pathohistologically confirmed NHG, 10 follicular adenomas (FA) and 10 follicular carcinomas (FC). Form factor, equivalent radius and volume were calculated from the measured values. Results: NHG (N=10) FA (N=10) FC (N=10) ------------------ ----------------- ----------------- Area (um2) 73.8+/-24.3 83.9+/-12.6 102.0+/-26.8 Perimeter (um) 33.7+/-5.4 36.1+/-2.8 39.4+/-5.1 Form facor . 796+/-.024 . 802+/-.023 . 810+/-.018 Radius (um) 4.8+/-0.8 5.1+/-0.4 5.6+/-0.7 Volume (um3) 499.9+/-251.2 590.4+/-131.5 809.0+/-333.9 Nuclear area and volume appeared as the most important factors of differentiation. The result of oneþway analysis of variance among the groups was probably significant (p<0.05), while the result of comparison of two samples was highly significant for NHG vs. FC (p<0.01) and probably significant for FA vs. FC (p<0.05). Conclusion: The main limitation of FNAB diagnosis is encountered in differentiation between FA and FC as well as between NHG and neoplastic lesions (FA and FC). Morphometry, however, appears to provide very useful information for the proper differentiation between these two entities.

Value of fine needle aspiration cytology and intraoperative imprints in the diagnosis of medullary thyroid carcinoma

Mira Halbauer¹; Brzac Hrvojka Tomic¹; B. Sarcevic²; Matio Medvedec³; M. Radetic; Damir Dodig¹

¹ Dept. of Nuc. Med. Radiat. Protect., Univ. Hosp. Zagreb, Polyclinic for Thyroid Disease, Zagreb; ² Dept. of Pathology, Univ. Clinic Hosp. for Tumors, Zagreb, Croatia; ³ Orl. Dept., Gen. Hosp. "Sv. Duh", Zagreb, Croatia

The growth of medullary carcinoma of the thyroid (MCT) is very slow but progressive, requiring easy and reliable diagnostic method in the early stage of the disease. The variable cytologic features of MCT which reflect the histology of different subtypes this neoplasm, may produce diagnostic problems. The aim of our study was to correlate preoperative and intraoperative cytologic diagnoses of MCT with pathohistology, to assess the value of both techniques. During an 8-year period, 108 fine needle aspiration biopsies under ultrasound guidance were performed in 43 patients (30 F and 13 M). In 3 patients tumor had familial occurrence. Preoperative cytologic diagnosis was based on a specific cytologic morphology of MCT in fine needle aspirates. In most patients, additional use of cytochemical method with silver nitrate stain resulted in positive argyrophilia. In 40/43 patients, cytologic diagnosis of MCT was consistent with pathohistology; in 2 patients, cytology pointed to papillary carcinoma, and in one patient to follicular carcinoma. However, intraoperative imprint diagnoses were positive for MCT in all our patients. Accordingly, cytology was concluded to be an excellent method for preoperative and intraoperative diagnosis of MCT. Therefore, we strongly recommend combined use of both methods in the early diagnosis of disease.

Types and frequency of appearence of metastatic tumours in thyroid gland

Anka Knezevic-Obad; Zdenka Bence-Zigman; Irena Bracic; Ratimir Petrovic; Ivana Knezevic; Damir Dodig

Clinical Department of Nuclear Medicine and Radiation Protection, University Hospital Rebro, Kišpaticeva 12, 10000 Zagreb, Croatia.

It is very rare in the literature to find a description of metastatic tumours of other organs in the thyroid gland. In the period of four years (1994-1997), ultrasound examination in our Clinic was performed on 10.336 patients. Because of the alterations diagnosed by US, a total of 22.336 ultrasound-guided fine needle aspiration biopsies (UG-FNAB) were done. In 596 aspirates (450 patients, or 4.4% of the patients treated) a diagnosis of a malignant disease in the thyroid gland was set. Primary thyroid carcinoma were found in 406 patients (3.9%), while 44 patients (0.4%) had metastatic processes. As compared to the primary thyroid carcinoma, metastatic tumours in thyroid were present in 9.8% of all the patients studied. Percentage is even significantly lower when the metastatic tumours found in the nearby neck region lymph nodes are excluded. There were only 12 such patients, 0.1% of all cases the primary tumour was breast carcinoma, in two cases the carcinoids were diagnosed, while there was one adenocarcinoma of the colon, one adenosquamous carcinoma of uterus, one anaplastic lung carcinoma and one squamous cell carcinoma. In two cases we were unable to find localisation of the primary carcinoma. So, our findings suggest that the metastatic carcinoma in the thyroid gland itself, without penetration in the surrounding lymph nodes of the neck, mainly originate from distant organs primary tumours. Especially, secondary head and neck tumours were never found in the thyroid gland only, but were always accompanied by metastatic tumours in the lymph nodes too.

The value of cytological, echographic and immunological diagnostic procedures of lymphomatous goiter

B. Pauzar¹, M. Halbauer², B. Loncar¹, M. Pajtler¹, B. Staklenac¹

¹ Department of Clinical Cytology, Clinical Hospital Osijek, Croatia, ² Clinical Department of Nuclear Medicine, University Hospital Rebro, Zagreb, Croatia

The aim of the study was to determine whether there was a correlation among the levels of microsomal (Ms) and thyroglobulin (Tg) antibodies, echographic findings and particular lymphocyte groups in cytologic smears of aspirates in patients with lymphomatous goiter ( LG ), what might have a diagnostic value in the various stages of the disease. Ultrasound-guided FNAB was performed in 280 patients suspected of LG. MGG-stained smears were divided into four lymphocyte groups ( lys ), according to the predominant type of lymph cells. Echographic findings were divided into the groups having isoechogenic, hypoechogenic and hyperechogenic lobe images. The titer of Ms antibodies of 1:(<100) and the titer of Tg antibodies of 1:(<500) were treated as negative. The lysI was found in 2,4%, lysII in 30,49%, lysIII in 37,09% and lysIV in 29,9% cytological smears. Hypoechogenic echographic findings were predominantly found in 94,8% patients, what was statistically significant. However, hypoechogenicity of the lobe did not appear to be significant parameter in determining of the lymphocyte group. Statistical analysis of antibodies titer levels according to the lymphocyte groups showed no statistically significant differencies among the frequencies of titer groups according to particular lys either, indicating that Ms and Tg titers did not suggest what particular lys was. Therefore, the combination of morphological methods and immunology appears to improve the diagnosis and differential diagnosis of LG, whereas aspiration cytology is the best indicator of the various stages of the disease.

Moc 31 and cytokeratin in the differentiation between adenocarcinoma and reactive mesothelial cells in body cavity fluids

Suncica Ries, Koraljka Gjadrov-Kuvezdic, Mirna Sucic, Dubravka Boban, Mirjana Markovic-Glamocak

Clinical Institute of Laboratory Diagnosis, Division of Cytology, Zagreb University School of Medicine and Zagreb Clinical Hospital Center, Zagreb, Croatia

Cytological slides of body fluids of 16 adenocarcinomas and 8 reactive effusions were immunostained with monoclonal antibodies MOC 31 and cytokeratin. All malignant effusions showed strong positivity for MOC 31. No MOC 31 staining was present in reactive effusions. Anticytokeratin antibodies showed positivity in 12 malignant effusions, while the other 4 were negative. Half of the reactive effusions were positive on anticytokeratin antibodies. Immunocytochemical staining with MOC 31 seems to be more specific, compared to anticytokeratin antibodies, in distinguishing reactive mesothelial cells from adenocarcinoma cells in body fluids.

Simultaneous appearance of breast cancer in a pregnant woman and her elder sister

Blazenka Staklenac; Karmen Trutin-Ostovic; Irena Hihlik-Babic; Marija Pajtler; Damir Margaretic; Branko Dmitrovic

Department of Clinical Cytology, Clinical Hospital, Osijek

OBJECTIVE: Breast cancer is very rare in pregnancy and the postnatal period. FNA cytology is very useful for distinguishing benignant and malignant lesions. STUDY DESIGN: Ultrasound guided FNAC of hypoechogenic left axillary node in a 34-year old woman in a 30 week pregnancy was performed. Cytological diagnosis of adenocarcinoma metastaticum lymphonodi was established. It was histologically confirmed. Ablactation was made after delivery. After ablactation FNAC of clinically, mammographically and ultrasound suspicion lesion in outer lateral quadrant of left breast was perfumed. The cytological diagnosis of breast cancer was histologically confirmed (negative for estrogen and progesteron expression, Katepsin D 66). At the same time her 5 year elder sister had nonpalpable breast lesion which was pathologically diagnosed as adenocarcinoma (estrogen 15, negative for progesteron expression, Katepsin D 102). Flow cytometric DNA analysis of the breast tumors of two sisters were prepared from paraffin – embedded samples. According to the DNA histograms samples of the pregnant woman were diploid and the percentage of cells in the S phase was normal (14,1%). Samples of her sister were aneuploid with two peaks in GO phase and percentage of cells in the S phase was high (27,6%) indicating unregulated proliferation. CONCLUSION: The combination of FNAC and flow cytometric DNA analysis can be very useful for improving cytological diagnosis and therapy of breast cancer especially in pregnancy and postnatal period.

Flow cytometric dna analysis of various prostatic lesions in comparison with fnac

Trutin Ostovic, Karmen; Miletic Zorana; Znidarcic Zeljka; Bedalov Goran; Heinzl Renata; Petrovecki Mladen.

Departments of Clinical Cytology and Cytometry and Department of Urology; Clinical Hospital "Dubrava", Zagreb. Croatia

Objective: FNAC of prostate is a very important method for establishing diagnosis and for follow-up. The aim of this study was to investigate whether flow cytometric DNA analysis improve or complement cytological diagnosis of various prostatic lesions, especially hyperplasia and carcinoma. Methods: Between 1997 and 2000 we examined 192 FNA of prostate by conventional cytology and by flow cytometry. We have analysed ploidy and proliferative activity of samples from patients with cytological diagnosis of glandular hyperplasia, atypical glandular hyperplasia and carcinoma. Results: We obtained adequate samples from 160 (83,3 %) patients. Aneuploidy was found in 29 (15%) lesions: 68,4% of 38 cancers, 7,4% of 27 normal prostate and 1,9% of 51 atypical glandular hyperplasia. High proliferative activity was found in 79 (49,3 %) lesions: 81,6 % of 38 cancers, 72,5% of 51 atypical glandular hyperplasia, 20,4% of 44 glandular hyperplasia and 14,8% of 27 normal prostate. Aneuploidy correlated positively with carcinoma (88% of poorly differentiated carcinoma is aneuploid). High proliferative activity correlated positively with atypical glandular hyperplasia (85% of severe hyperplasia has high proliferation) and carcinoma (100% of poorly differentiated carcinoma has high proliferation). We have used Fisher' s exact probability test (p < 0,001). Conclusion: It is better to use combination of FNAC and flow cytometric DNA analysis than only cytology. It enables different protocol of follow-up according to DNA data especially for atypical glandular hyperplasia and modifies standard therapy of prostatic carcinoma (based on morphology) due to DNA ploidy and proliferation. Besides, this combination enables more accurate diagnosis.

Diagnostic value of synovial fluid cytoanalysis

Trutin Ostovic, Karmen, Morovic-Vergles Jadranka; Skoro Mirko; Petris Marija

Department of Clinical Cytology and Cytometry and ", Clinic of Internal Medicine, Clinical Hospital "Dubrava", Avenija Gojka Suska 6, Zagreb; Croatia

Objective: Cytological analysis of the synovial fluid gives important diagnostic and prognostic information about joint diseases. Methods: 104 synovial effusions were obtained by FNAC with or without ultrasound guidance. Cytological examination consists of macroscopic analysis (volume, color, clarity, viscosity, mucin clot test, presence of crystals or tissue fragments, count of nuclear cells), cytological recognition and quantification of cell types. Results: According to the type of cells present in the synovial fluid, it is possible to classify them into three cytological types. The smears of cytological type I (32 samples) have neutrophils, some of which have picnotic nuclei as a sign of duration of the effusion in the joint. The smears of cytological type II (37 samples) have numerous lymphocytes together with neutrophils and isolated cells of local origin. The smears of cytological type III (35 samples) contain cells of local origin like serosa cells and occasionally a few inflammatory cells. When we compared definitive clinical diagnosis with cytological one, we saw that in 71,1% of all cases, a more or less accurate diagnosis was made by conventional cytology of the synovial fluid alone. In further 28,9% of patients was correctly identified as having either an inflammatory (cytological type I or II) or non-inflammatory (cytological type III) arthropathy. Conclusion: According to our results we can conclude that cytology gives the exact diagnosis or differentiates inflammatory and non-inflammatory joint disease. Therefore it should be the first, and in some cases needed to be the only, diagnostic investigation.