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Clinical significance of atypical glandular cells of undetermined significance in postmenopausal women
Chhieng DC; Elgert P; Cohen JM; Cangiarella JF
BACKGROUND: Glandular atypia in Papanicolaou (Pap) smears from postmenopausal women is encountered frequently. This finding can be the result of artifactual alterations such as drying artifacts and inflammatory changes or may represent a squamous or glandular, preneoplastic or neoplastic process. Therefore, it is important to determine the clinical implication of a diagnosis of atypical glandular cells of undetermined significance (AGUS) in postmenopausal patients. METHODS: A total of 30,036 Pap smears were obtained from postmenopausal women between 1995 and 1997. Among these smears, 154 (0.51%) had a diagnosis of AGUS. Follow-up was available for 133 patients (86.4%); 110 patients (82.7%) had histologic follow-up (including cervical biopsy, endocervical [EC] curettage, and/or endometrial [EM] biopsy) and 23 patients (17.3%) had repeat smears. RESULTS: Thirty-six of 110 patients (32.7%) were found to have a clinically significant lesion (defined as a preneoplastic or neoplastic, glandular or squamous lesion) on subsequent histologic follow-up. Nineteen patients (53%) had glandular lesions (15 EM adenocarcinoma [ACA] cases, 2 EC ACA cases, 1 EC adenocarcinoma is situ case, and 1 EM hyperplasia case). Seventeen patients (47%) had a squamous intraepithelial lesion (SIL) (6 cases of low-grade SIL, 9 cases of high-grade [HGIL], and 2 cases of squamous cell carcinoma). Among those patients with repeat Pap smears, five patients had persistent AGUS/atypical squamous cells of undetermined significance and one patient had an SIL. CONCLUSIONS: The incidence of AGUS among postmenopausal patients was similar to that of the general population (0.51% vs. 0.56%; P > 0.05). A significant percentage of these patients were found to have a clinically significant lesion on subsequent follow-up. Furthermore, a majority of these lesions were ACA (53%) or HGSIL (26%). The findings of the current study strongly suggest the need for the close follow-up of postmenopausal patients with a diagnosis of AGUS. Cancer (Cancer Cytopathol)
PMID: 11241259
ISSN: 0008-543x
CID: 34930
Cytology and immunophenotyping of low- and intermediate-grade B-cell non-Hodgkin's lymphomas with a predominant small-cell component: a study of 56 cases
Chhieng DC; Cohen JM; Cangiarella JF
Diagnosis of non-Hodgkin's lymphomas based on cytologic evaluation of fine-needle aspirates and body cavity fluids has gained increasing acceptance. However, the accurate diagnosis and classification of low- and intermediate-grade B-cell lymphomas with a predominant small-cell population still present a diagnostic challenge. In this study, we reviewed the cytology and immunophenotype of 56 cases of low- and intermediate-grade non-Hodgkin's B-cell lymphomas composed of predominantly small cells, with histologic correlation in all cases. These cases consisted of 23 small lymphocytic lymphomas (SLL), 15 follicular center lymphomas (FCL), grade I (small cell predominant), 8 lymphoplasmacytoid lymphomas (LPL), 6 mantle-cell lymphomas (MCL), and 4 marginal zone lymphomas (MZL) including mucosa-associated lymphoid tissue (MALT) lymphoma. Histologic comparison was available in all cases. A cytologic diagnosis of malignant lymphoma was made in 46 (82%) cases. Based on cytomorphology and immunophenotyping of cytologic material, 39 (85%) cases were correctly classified using the Revised European and American Lymphoma classification. In 7 (11%) cases, which included 3 FCLs, 2 MALT lymphomas, and 2 SLLs, the findings were atypical but not diagnostic of lymphoma. There were 3 (5%) false-negative cases. They were 2 SLLs and a FCL. Immunophenotyping done in 4 'atypical' cases was noncontributory. No marker studies were done in the remaining 'atypical' case and all false-negative cases. We conclude that cytology, when used in conjunction with immunophenotyping, can accurately diagnose and in most instances subclassify low- and intermediate-grade B-cell non-Hodgkin's lymphoma with a predominant small-cell population
PMID: 11169886
ISSN: 8755-1039
CID: 34931
Mammotome core biopsy for mammary microcalcification: analysis of 160 biopsies from 142 women with surgical and radiologic followup
Cangiarella J; Waisman J; Symmans WF; Gross J; Cohen JM; Wu H; Axelrod D
BACKGROUND: Although stereotaxic fine-needle aspiration biopsy or core biopsy (14-gauge) have proven to be accurate techniques for the evaluation of mammographically detected microcalcification, the development of the Mammotome Biopsy System (Biopsys Medical, Inc., Irvine, CA) has led many medical centers to use this vacuum-assisted device for the sampling of microcalcification. METHODS: One hundred forty-two women underwent 160 stereotaxic Mammotome core biopsies of mammographic calcification over a 1-year period. The stereotaxic procedure was performed by radiologists using the Mammotome Biopsy System. Microcalcification was evident on specimen radiographs and microscopic slides in 99% of the cases. Excisional biopsy was recommended for diagnoses of atypia or carcinoma. Patients with benign diagnoses underwent mammographic followup. RESULTS: One hundred thirty-two benign, 12 atypical, and 15 adenocarcinoma diagnoses (comprising 1 lobular adenocarcinoma in situ [LCIS], 1 invasive ductal adenocarcinoma [IDC], and 13 intraductal adenocarcinomas [DCIS]: 10 comedo, 1 cribriform, 2 mixed cribriform and micropapillary) were rendered. Surgical excision in eight patients with atypia on Mammotome biopsy (two refused surgery, two were lost to followup) showed ductal hyperplasia in three, atypical ductal hyperplasia (ADH) in three and DCIS (low grade, solid) in two patients. Surgical excisions in 14 patients diagnosed with carcinoma (1 patient lost to followup) showed ADH in 3, ADH and LCIS in 1, residual DCIS in 8, IDC in 1, and microinvasive carcinoma in 1 patient. CONCLUSIONS: A diagnosis of atypia on Mammotome biopsy warranted excision of the atypical area, yet the underestimation rate for the presence of carcinoma remained low. The likelihood of an invasive component at excision was low for microcalcification diagnosed as DCIS on Mammotome biopsy. Mammotome biopsy proved to be an accurate technique for the sampling and diagnosis of mammary microcalcification
PMID: 11148574
ISSN: 0008-543x
CID: 26637
Cytologic findings in 43 cases of mammary intraductal adenocarcinoma (DCIS) diagnosed by aspiration biopsy [Meeting Abstract]
Cangiarella, J; Waisman, J; Simsir, A
ISI:000166622400281
ISSN: 0893-3952
CID: 55156
Atypia in aspiration smears of fibroadenomas: Cytohistologic correlations [Meeting Abstract]
Simsir, A; Waisman, J; Cangiarella, J
ISI:000166634900364
ISSN: 0023-6837
CID: 55185
Radial sclerosing lesion: correlation between mammotome core biopsy and surgical excision [Case Report]
Cangiarella, J; Waisman, J; Cohen, J M; Chhieng, D; Symmans, W F; Axelrod, D; Gross, J
PMID: 11348419
ISSN: 1075-122x
CID: 97085
Atypia in aspiration smears of fibroadenomas: Cytohistologic correlations [Meeting Abstract]
Simsir, A; Waisman, J; Cangiarella, J
ISI:000166622400359
ISSN: 0893-3952
CID: 55160
Cytologic findings in 43 cases of mammary intraductal adenocarcinoma (DCIS) diagnosed by aspiration biopsy [Meeting Abstract]
Cangiarella, J; Waisman, J; Simsir, A
ISI:000166634900286
ISSN: 0023-6837
CID: 55181
Aspiration cytology of six cases of the oncocytic variant of papillary adenocarcinoma of the thyroid: Comparison with other oncocytic neoplasms
Cangiarella, Joan; Moreira, Andre; Wu, Horace; Symmans, W Fraser; Waisman, Jerry
BIOSIS:200000508589
ISSN: 0001-5547
CID: 15795
Granular Cell Tumor Presenting as an Axillary Mass: Correlation Between Clinical, Radiologic, and Cytologic Findings
Chhieng DC; Cangiarella JF; Hummel P; Gottlieb S; Guilbaud D; Cohen JM
PMID: 11348401
ISSN: 1075-122x
CID: 20672