Thyroid gland: tall cell variant of papillary carcinoma and papillary oncocytic carcinoma

M. HALBAUER, H. TOMIĆ-BRZAC, B. ŠARCEVIĆ, M. MEDVEDEC, D. DODIG AND Z. SPERANDA

Department of Nuclear Medicine and Radiation Protection, Policlinic for Thyroid Disease, University Hospital Rebro, Zagreb, Department of Patology, University Clinical Hospital for Tumors, Zagreb, General Hospital, Pozega, Croatia

Three cases of thyroid gland carcinomas diagnosed by FNA are presented: two tall cell variants of papillary carcinoma (TCP) and one papillary case of oncocytic carcinoma (POC), infrequent thyroid carcinomas with varying biological behavioural patterns. While the evolution of the POC is unpredictable, the TCP presents more aggressiveness than the classical papillary carcinoma (CPC). Both tumors con­sisted of true papillae lined, in contrast to the CPC, by cell with abundant granu­lareosinophilic cytoplasm (histologically) and eosinophilic (cytologically by MGG technique). The TCP cases showed nuclei with clear chromatin, nucleargrooves and intranuclear cytoplasmic inclusions (similar to CPC) and sometimes a lymphocytic infiltrate in the papillary core. In the POC the nuclei showed pleomorphism, gran­ulaichromatin and prominent nucleoli as in the traditional Hurthle cell tumours.

To conclude, the importance of pre-operative cytological diagnoses of both types of neoplasms lies in their different biological behaviour, which determines the type of treatment for the two entities.

Cytopathology, 2000.; 5 (11): 369-70, (Abstract No. 6.)

The comparison of thyroid blood flow velocity and peer thyroid artery diameter with cytological findings f FNAB in patients with hyperthyroidism

A.     KNEŽEVIĆ-OBAD, Z. BENCE-ŽIGMAN, B. PAUZAR-SUBOTIĆ AND D. DODIG

Clinical Development of Nuclear Medicine, University Hospital Rebro, Zagreb, Croatia

Our intention was to establish connection between blood flow velocity and upper thyroid artery diameter in patients with various cytological findings of FNAB dur­ing treatment of hyperthyroidism.

In this study we observed ten patients. The blood flow velocity and the diameter of upper thyroid artery were estimated by Color Doppler, before, during and after the treatment. The results were compared with cytological findings and serum hor­mone levels. Ultrasound-guided FNAB was performed in all patients in the middle third of both thyroid lobes. MGG-stained smears were analysed semiquantitatively regarding the following parameters: cellularity, thyroid cells morphology, the pres­ence of lymphocytes, histiocytes and colloid.High blood flow velocity and greater diameter of upper thyroid artery were cor­related with morphological changes of thyroid cells (the signs of cell hyperactivity) and persisted longer than high levels of thyroid hormones in serum. Withdrawl of treatment at this stage leads to the relapse of the disease.Only blood flow velocity normalization and diminishing of upper thyroid artey diameter, followed by normalization of thyroid cell morphology, indicates the com­plete remission of the disease and means that treatment is no longer necessary.

Cytopathology, 2000.; 5 (11): 409, (Abstract No. 066.)

Atypical medullary carcinoma of the breast

K. TRUTIN-OSTOVIĆ, D. KOZJAK, S. LAMBAŠA, Z. MILETIĆ AND P. MARTINAC

Dubrava Clinical Hospital, Zagreb, Croatia

Background Atypical medullary carcinoma of the breast is rare (less than 5%). We wanted to see whether there are cytological criteria for this type of tumour. Study design A 43-year-old woman presented with hypoechogenic indistinct lesion in cystic tissue in the upper outer quadrant of the left breast. Ultrasound-guided FNAC was performed. The smears were cellular. Large poorly differentiated cells were distributed in sheets and individually among benign cells. The malignant cells had oval to pleomorphic nuclei with prominent macronucleoli. Cytological diagno­sis of poorly differentiated carcinoma was made. The patient has undergone surgery and histological diagnosis of atypical medullary carcinoma was established (tra­beculae of large eosinophilic cells with indistinct cell borders and large areas of dense fibrous stroma with small numbers of lymphocytes). Seventeen axillary lymph nodes were free of tumour. Tumour was oestrogen receptor negative and cathepsin D slightly positive. Flow cytometric DNA analysis showed aneuploidy with three peaks in GO phase and normal proliferative activity. The patient remains free of tumour 1 year after surgery.

Conclusion Ultrasound-guided FNAC of impalpable lesions of the breast is very useful in diagnosing carcinoma. At present there are no distinct cytological criteria for distinguishing atypical medullary and poorly differentiated invasive ductal car­cinoma of the breast.

Cytopathology, 2000.; 5 (11): 429, (Abstract No. 94.)

Evaluation of cytomorphological, morphometric and flow-cytometric analyses in the differentiation of atypical hyperplasia and adenocarcinoma of the prostate

Ž. ZNIDARČIĆ, G. KAIĆ, K. OSTOVIĆ-TRUTIN, T. ŠTOOS-VEIĆ,

Z. MILETIĆ, R. HEINZL, Z. BARTOLIN, S. MATULIĆ, G. BEDALOV, I. SAVIĆ AND M. PETROVEČKI

Dubrava Clinical Hospital, Zagreb, Croatia

Background The greatest problem in the prostatic cytodiagnosis is the differenti­ation of atypical hyperplasia and adenocarcinoma. To help in this differentiation, various technologies are investigated, including nuclear and AgNOR image analy­sis as well as DNA-ploidy and S-phase flow-cytometry.

Materials and methods Cytological smears of fine-needle aspirates or touch prepa­rations of transurethral prostatic resections were morphologically analyzed in 25 patients. Cytodiagnostic criteria were evaluated by a scoring system to make sta­tistic correlation with other investigated results possible. Nuclear and AgNOR mor­phometry was done by an automated image analyser and a number of various parameters was investigated. Mean nuclear area and standard deviation of nuclear area as well as AgNOR cluster number and AgNOR cluster area were chosen as the most discriminant variables for further statistical use. DNA-ploidy and S-phase estimation were made by flow-cytometry on EPICS-C cytometer. The Wilcoxon test was used for statistical analyses.

Results Cytological diagnosis of atypical hyperplasia was made in 12 patients, and adenocarcinoma was diagnosed in 13 patients. Statistically significant difference was found between morphological scores in two different groups of patients. The correlation of morphological scores of both groups with the results of other inves­tigated techniques showed no statistical significance.

Conclusions Our results show that cytomorphological criteria in the differentia­tion between atypical hyperplasia and adenocarcinoma cannot be significantly improved by morphometric and flow-cytometric analyses. 

Cytopathology, 2000.; 5 (11): 436, (Abstract No. 102.)

Prevalence of human papillornavirus and cervical squamous lesions in adolescents and young women detected by cytology in three time periods

S. AUDY-JURKOVIĆ, V. MAHOVLIĆ AND V. ŠIMUNIĆ

Institute of Gynecologic Cytology, Department of Gynecology and Obstetrics, University Hospital Center, Zagreb, Croatia

Background To determine the prevalence of human papiliomavirus (HPV) and cervical squamous lesions in vaginal, cervical and endocervical (VCE) smears from adolescents and young women during three time periods.

Materials and methods During periods A (Jan 1, 1977 - June 1 1983), B (Jan 1 - Dec 31 1988) and C (Jan 1 - Dec 31, 1998), 1946, 514 and 876 VCE samples from adolescents (age 14--19) and 18054, 6470 and 5173 from young women (age 20-25) were analysed.

Results Cytological analysis of VCE samples obtained from the population aged 1~1--25 years during periods A, B and C revealed 2.4%, 4.6°l° and 8.2% of HPV and 5.2%, 10.9% and 14.3% of squamous lesions, respectively (P < 0.001 both).

During periods A, B and C HPV was detected in 3.4%, 6.0% and 8.0% of adoles­cents, and in 2.3%, 4.5% and 8.2% of young women, respectively. The respective figures for the finding of squamous lesions according to age groups were 6.0%, 9.7°/ and 13.2% and S.1%, 11.0% and 14.5%. There was no statistically significant difference in the prevalence of HPV and squamous lesions between the age groups in any of the study periods, with the exception of the higher HPV prevalence in ado lescents recorded for period A (P < 0.01).

Conclusion The increase in the prevalence of HPV and squamous lesions in VCE smears of adolescents and young women over the last two decades supports the use of cytology in combination with HPV DNA typing aimed at identifying the segment of female population at a high risk of cervical cancer.

Cytopathology, 2000.; 5 (11): 449, (Abstract No. 120.)

Primary multicentric mixed carcinoma of the same breast

B.     STAKLENAC, K.TRUTIN-OSTOVIĆ, Z. MILETIĆ, I. HIHLIK-BABIĆ, M. PAJTLER, D. MARGARETIĆ AND V. BLAŽIČEVIĆ

 Department of Clinical Cytology, Department of Oncology, Department of Pathology Clinical Hospital Osijek and Department of Clinical Cytology and Cytometry, Dubrava Clinical Hospital

Objective Multicentric-mixed carcinoma of the same breast is not frequent and FNA cytology is a very useful for distinguishing different type.

Study design In a 48-year-old woman FNAC of clinically, mammographicaily and ultrasound suspicious lesions (one tumour 1 cm in medial quadrant and another 1 cm inframammary of the right breast) was perfomed. Cytological diagnosis of breast cancer, of two different types was established. Pathologically the first tumour was diagnosed as ductal (negative for EP expression, Katepsin D 24), and second as mixed carcinoma-lobular and ductal (Estrogen six, Progesteron 13, Katepsin D 24). Flow cytometric DNA analysis of breast tumour were done from paraffin­embedded samples. According to the DNA histograms, samples of ductal carci­noma were aneuploid with two peaks in GO phase and proliferative (S = 21.7%). Samples of mixed carcinoma (lobular and ductal) were diploid with high prolifera­tive activitiy (S = 30.8%).

Conclusion The combination of FNAC and flow cytometric DNA analysis can be very useful for improving cytological diagnosis of breast cancer.

Cytopathology, 2000.; 5 (11): 451-2, (Abstract No. 124.)

Cytology of sexually transmitted diseases agents in adolescents and young women during three periods

V. MAHOVLIĆ, S. AUDY-JURKOVIĆ AND A. OVANIN-RAKIĆ

Institute of Gynecological Cytology, Department of Obstetrics and Gynecology, Medical School, University of Zagreb, 10000 Zagreb, Petrova 13, Croatia

Background To determine the prevalence of cytologically identified agents of sex­ually transmitted diseases (STDs) in vaginal-cervical-endocervical (VCE) smears in the population of adolescents (14-19y) and young women (20-25y) during three periods.

Patients and methods VCE smears were analysed in 20000, 6984 and 6089 ado­lescents and young women during three periods (A, B, C), with regard to cytolog­ically diagnosed agents of STDs. XZ test was applied to determine the differences among the groups, and statistical significance was assessed at P = 0.05 level. Results The prevalence of cytologically diagnosed microorganisms increases with regard to the period studied (A-~B-.C), as for the whole group so too for adoles­cents and young women separately (P < 0.05). This primarily refers to the inci­dence of HPV and yeast infections (P < 0.05), while the prevalence of Gardnerella vaginalis and Trichomonas vaginalis (TV) shows a decreasing tendency (A~-BBC). HPV and TV are cytologically more frequently identified in adolescents than in young women of A-period (P < 0.05), while in the later periods (B and C), STDs agents are equally present in both age groups (P > 0.05), except for TV (C-period) which is also more frequently diagnosed cytologically in adolescents (P < 0.05). Frequency of abnormal cytological findings increases with the period studied (A->B-~C) in adolescents, as well as in young women, with cytologically most fre­quently diagnosed HPV infection, particularly in C-period (P < 0.05):

Conclusion Sexually active adolescents should be by all means under gynaecolog­ical surveillance, including with cervical screening programme on carcinoma and its precursors, the infection treatment and prevention of its further complications.

Cytopathology, 2000.; 5 (11): 461, (Abstract No. 138.)