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47. CYTOLOGY OF AMIODARONIC LUNGS

Roglić M,  Pongrac I, Smojver Ježek S

Clinic of  Pulmonary  Diseases "Jordanovac", Zagreb

The pulmonary changes can be developed  in patients treated by amiodarone: enlargement of intraalveoral septa accompained by   infiltration with lymphocytes and neutrophiles, as well as fibrosis of   abundantly foamy macrophages mainly intraalveolary, proliferation and atypia of pneumocytes typed II. Apart form macrophages, the accumulation of phospholipids is observed in epithelial cells, too. The cytological analysis comprises the samples of bronchoalveolar lavage (BAL) and imprint of transbronchal lung biopsy (TBB).

The BAL analysis can display different findings although the characteristic ones are described as  the abundance of foamy macrophages accompained by an  increased number of lymphocytes and neutrophilic granulocytes.

In the TBB imprint slides, pronaunced changes in pneumocytes, together with foamy macrophages, are characteristic not only in evident proliferation, but specially in hypertrophy and atypia: cellular polymorphism, hypertrophy and nuclear multiplication, occasionally vaculisation of cytoplasma as the reflex of lipidic sheets. Sometimes,  connective fragments  are also found.

The TBB cytological analysis complements the histological one, and, in particular,  it is important in the cases when bioptic material is not sufficient for histological analysis.

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48. ASPIRATIONAL CYTODIAGNOSTICS IN

THE PROSTATE DISEASES - WHY?, WHEN?. HOW?

Znidarčić Ž

A frequent incidence of pathologic changes in the prostate, in particular carcinoma, being a specific  problem in its treatment and prognosis, was the reason of significant application of aspirational cytology in the diagnosis and following the treatment in the prostate diseases.

For the last few years, fine-needle aspiration has been tried to be replaced by a thicker needle biopsy in order to take not only aspirational advantages, but  the ones  of  histological diagnostics as well. Furthermore, some new technologies for the soonest possible detection of the prostate cancer and for assessment of its prognosis (as ultrasound, PSA, DNA-analysis, image-analysis, AgNOR and so on) have been developed, too..

Based on the 30-year experience in aspirational cytodiagnostics of the prostate diseases, with 2745 cytological diagnosis rendered during that period, its position, specially in the the prostate cancer diagnostics, could be evaluated.

By the correlation of cytological diagnosis and clinical data, in particular in longer-term monitoring of the patient, together with pathohistological results when it was possible (9,4% patients), and by other technological methods (DNA-flow  cytometry, PSA, PAP, image-analysis of nucleus and AgNOR), the importance of well-established team could be seen: urologist-cytologist-pathologist. Aspirational cytodiagnostics of the prostate disease has an important role in the future and it cannot be eliminated from the complete diagnostical procedure. It is necessary to maximally develop its possibilities - by larger application and appropriate team work.

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49. TARGETED  FINE-NEEDLE ASPIRATIONS OF

ABDOMINAL ORGANS GUIDED BY

ULTRASOUND OR COMPUTERIZED TOMOGRAPHY

Kardum-Skelin I¹ , Šušterčić D¹ , Borovečki A¹ , Knežević G¹ ,

Drinković I² ,   Brkljačić B² ,  Škegro D² ,  Odak D² ,    Anić P² ,

Ostojić S¹ ,   Planinc-Peraica A¹ ,    Tičak M¹ ,  Čolić-Cvrlje V¹ ,

Papa B¹ , Jakšić B¹

Clinic of Internal Diseases1 and Department of Radiology

KB "Merkur"², Zagreb

Non-palapble lesions in the abdominal area and localized lesions of abdominal organs have become approachable to visualisation and cytology FNA under the ultrasound control or computerized tomography.

The aim of the work was to: 1. analyse the usibility of cytological material obtained by FNA; 2. analyse the prevalance of malignant lesions, and 3. analyse the possibility of determination of metastatic lesion primary focus. 

The aspiration was performed by CHIBA needle with mandrin under the ultrasound or CT control, and the smears were cytologically porcessed by standard, cytochemical and immunocytochemical analyses. The cytological analysis was performed in 1251 patients. The results demonstrated a high percentage of adequate specimens 97,4%. In 54,2% cases it was a malignant process. There  were 46,7 localized lesions in liver, out of which 61% malignant ones. It is very difficult to determine the primary tumorous focus in majority of metastatic changes regardless to the determination of cellular origin. A good correlation was found in 15,1% lesions, if  primary tumours are eliminated, i.e. 30% if hepatocellular tumours are taken into account. Out of 119 lymph nodes, 69,5% were malignant lymphomas, and 21,8% metastatic processes, and in 11/26  the primary focus could be predicted.

A change in abdomen and abdominal organs does not have to necessary indicate malignant nature of the disease, and, if there are not any contraindications, the morphological verification is necessary. A cytological picture,  completed by cellular markers, can help in the determination of primary focus of metastatic tumour in liver or lymph nodes.

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50. CYTOLOGICAL ASPIRATION OF FOCUSS

CHANGES IN LIVER AND PANCREAS

Ćurić-Jurić S, Maričević I, Šokčević M, Žokvić E,

Vasilj A, Novak-Bilić G, Hrabar D

Clinical Hospital "Sestre milosrdnice"

The work demonstrates   findings of ultrasoundly guided cytological liver and pancreas FNAs in a ten-year period  (1990-1999). The indication for examination was established in   focuss  and diffusive changes suspectible of neo-processes. There were 339  liver FNAs with 95% (322) adequate specimens. Out of 180 pancreas FNAs, 74% (134) were adequate specimens. Malignant diagnoses were more prevailing in the aspirated liver fragments - 70% (226), while in the pancreas fragments they were 39,5% (53). In malignant tumors, very often, it was not possible to determine whether it was  primary or metastatic tumor.

The approachable pathohistological diagnoses were presented in the work. In 1998 and 1999, 139 cytological FNAs were performed, and 34 relevant pathohistological findings were obtained from the Archiv. Out of that, 20 diagnoses were made on bioptic (2) and resectional (18) material of the liver and pancreas. The rest 14 were the specimens from the digestive tract which indirectly confirmed the cytological diagnosis. The comparison of the results demonstrates a total correspondence in differing benign from malignant changes. Non-correspondence of the results was found in differing primary from metastatic tumors and in attempts to determine the type of original tumor from metastasis.

Although the cytological diagnosis is not considered as the final one, in the liver and pancreas FNAs,  very often, it is the only  morphological diagnosis. For a small number of patients, there is a pathohistologic diagnosis from the intraoperative and/or autopsy material. The comparison to the findings of visualisation examinations, intraoperative finding and clinical course of the disease provides the control of accuracy for other patients.

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51. CYTOLOGICAL  PICTURE OF ADRENAL GLAND

CARCINOMA - DIFFERENTIAL DIAGNOSIS

VERSUS RENAL CARCINOMA

Kardum-Skelin I¹,   Šušterčić D¹ ,    Borovečki A¹ ,   Škegro D¹ ,

Dolenčić P² ,   Čolić-Cvrlje¹ ,    Škurla B¹ ,   Prskalo M¹ ,

Papa B¹ ,  Čačić M³

Clinics of Internal Diseases¹   and Department of Radiology

KB "Merkur"², Department of Pathology KBC "Rebro"³ , Zagreb

In March,2000,  a patient, 74- year old was admitted to the Clinic. During Febraury of the same year, he was processed because of accelerated  sedimentation, sense of heaviness in the epigaster, subfebrile temperatures and dysphagia. A physical examination and routine laboratory finding, except for the increased sedimentation, did not show significant deviations from the normal. An ultrasound examination revealed an expansive formation  of  most likely left adrenal gland,  and enlarged lymph nodes along aorta and left renal arteria. The same result was confirmed by abdomenal CT.

The diagnosis of adrenal gland carcinoma was made by cytological FNA based on morphology, cytochemical and immunocytochemical analysis (cells positive on vimentin, partly EMA, and negative on chromogranin, NSE, S 100 and Oil red).

During the surgical operation the left kidney was intact, and for pathological analysis we collected a specimen of lymph node infiltrated with malignant glandular epithelial cells,  and tumorous tissue where the pathohistological finding suggested carcinoma.

Adrenal gland carcinoma differs from  adenoma by generally accepted criteria of malignancy: pleomorphism of nuclei and cells, large nucleoli, multinuclear cells, mitoses, possible necrosis and metastatic prevalence.

Majority of them is functional, 50% is combined with Cushing´s syndrome and virilization, 30% with virilization, 12% with feminization, and 4% with aldosteronic hypersecretion.

Feminizing tumors (70% of these are carcinomas) are  associated with the loss of lipides, bilareal gynecomasty and genital atrophy in male.

A differential diagnosis of adrenal gland carcinoma is extremely difficult when based on the cellular appearance itself. Cytochemical and immunocytochemical analyses, together with the determination of cellular markers, is a great contribution. In majority of cases, besides a clinical finding, it can help in the differentiation of these two tumor types.

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52. CYTOMORPHOLOGY OF MALIGNANT

MESOTHELIOMA IN PLEURAL EFFUSION

Hihlik - Babić I, Dmitrović B, Staklenac B

Clinical Hospital Osijek

Pleural mesothelioma is   rare tumor. Recent researches have demonstrated its prevalance in persons disposed to  asbestos substances.

Mesotheliomas can be localized, the most frequently  benign tumors with mesenchymal appearance and diffusive malignant ones with epithelial appearance.

A patient, ĐB, 60 years old  was admitted to the Pulmonological Unit because of the RTG proved effusion in the right thorax. Among  laboratory examinations the increased ones were: L - 17,9 , SE 51/86, alcal phosphotasis 268, gama GT 90, kreatinin 141 and urea 18,6. The performed pleural effusion FNA  collected about 400 ccm of turbid serous content. After two days at the Unit, the patient expired.

The collected liquid material was cytocentrifugally sedimented, dried in the air and stained by the May Grunwald-Giemsa method.

Separated  and less friable sheets of malignant mesothelial cells were detected by cytological analysis of medium cellular sediment of pleural effusion. The cells were polymorphic and varied from mononuclear to polynuclear with  expressed  anisonucleosis and with 1-2 pronaunced nucleoli pointed out. The cytoplasma is abundant, eosinophilic and occasionally vacuolated.

By pathohistological verification of pleural non-necrotic material, we detected  tumorous tissue constituted of papillary and tubular formations coated with   cubic and flattened cells, uniform vesicular nuclei with 1-2 perceptible  nucleoli, and eosinophilic cytoplasma that is occasionally vacuolated.

Immunohistochemically Alzian positive, and completely PAS negative reaction.

The described tumorous tissue, except in pleura, was detected in lungs, lymph nodes, liver, adrenal gland and peritoneum.

This case presentation suggests that cytomorphological diagnostics is useful in rapid diagnosing of malignant mesothelium in pleural effusion.

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53. EARLY DETECTION OF TUBULAR DAMAGES

IN PATIENTS WITH TRANSPLANTED KIDNEY

Rogić D, Čvorišćec D, Kralik S, Bubić Lj

KBC Zagreb, Clinic of Laboratory Diagnostics

In patients with a transplanted kidney, which is very important, is the early prevention of transplant rejection and maintainance of therapeutical dose of cyclosporine below the non-frotoxical borders. Current laboratory methods are not sensitive enough in detection of initial renal lesions. Therefore, the aim of this research is to establish  whether the  detection  of the initial damage of transplated kidney by quantitive measuring of total proteins, albumin and almicroglobuline in the urine, together with kreatin, microscopically reviewed urinary sediment, and qualitative examinations of the urine by testing-strip is possible.

Fresh specimens of the second morning urine were collected in 92 patients with transplanted kidney. Albumin and almicroglobulin were determined by nephelometry, and the total amount of proteins by colorimetric method with pyrogallol.  The  "urine protein expert system" (UPES) programme was used in the interpretation of results. The preparation of urinary sediment was carried out in a  standardized way, with supravital staining according to the Sternheimer-Malbinu method. All the patients in this examinaiton had normal or slightly increased kreatinin in serum (63-139, median 78~.mol/L,). The majority of patients, 89% had normal appearance of the urinary sediment and normal results of qualitative urinary examinaiton by test-strip. However, in 43 patients (47%), certain degree of tubular damage was revealed which is, according to the UPES, defined as boundery, slight and pronounced (9 patients). It is not clear whether the cause of tubular damage  is toxicologic or immunologic.

The UPES has demonstrated to be a simple and useful programme in the result interpretation of urinary protein determination and it is used further on in the following of these patients.

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54. PILOMATRIXOMA - CASE PRESENTATION

Branka Lončar, Blaženka Staklenac, Branko Dmitrović, Mladen Marcikić

Clinical Hospital Osijek