Faculty Bibliography

Fine needle aspiration biopsy is a widely used technique for the initial diagnosis of mammary lesions. The majority of patients undergoing fine needle aspiration biopsy of a breast lesion will have a benign disease of the breast. This article provides a review of the cytomorphologic features in a variety of benign breast lesions,and discusses the commonly encountered differential diagnoses on aspiration biopsy. Topics discussed include inflammatory and reactive conditions, treatment-induced changes, pregnancy-related changes, benign proliferative lesions, and benign neoplasms of the breast

The cytologic diagnosis of primary conventional renal-cell adenocarcinoma (cRCC) is usually straightforward; however, metastatic cRCC must be distinguished from a variety of neoplasms with clear-cell features. CD10, a cell membrane-associated neutral endopeptidase, and renal-cell carcinoma marker (RCCma), an antibody against human proximal tubular brush border antigen, have recently been shown to be useful in the diagnosis of cRCC. We compared CD10 and RCCma in cell block material from fine-needle aspiration biopsies (FNABs) to assess their utility in the diagnosis of metastatic cRCC, in cytologic specimens. Seven primary and sixteen metastatic cRCCs were immunostained with CD10 and RCCma. The immunoreactivity results were compared with those of a variety of neoplasms originating from other sites such as the liver, lungs, breast, and the gastrointestinal tract. The sensitivity and specificity of CD10 for cRCC were 100% and 59%, respectively. The sensitivity and specificity of RCCma for cRCC were 35% and 100%, respectively. We conclude that CD10 has limited value in confirming the diagnosis of cRCC because of its low specificity. RCCma, when positive, is highly specific for cRCC, but its low sensitivity hinders its diagnostic usefulness. Diagn. Cytopathol. 2005;33:3-7. (c) 2005 Wiley-Liss, Inc

Metastases to the kidney from extrarenal primary tumors are uncommon and may mimic renal-cell carcinoma clinically when presenting as a single mass with hematuria. Fine-needle aspiration biopsy (FNAB) is a useful diagnostic method for the evaluation of primary renal tumors. Only a few studies have investigated the value of cytological evaluation of secondary renal tumors. We report our experience with these tumors. Eleven cases of extrarenal primary tumors metastatic to the kidney, diagnosed by aspiration biopsy with histological correlation, are discussed. The diagnosis of metastatic disease to the kidney was accurately made by aspiration biopsy. Knowledge of the patients' history, histological correlation with the primary tumor, and the radiological characteristics of the renal masses were helpful in achieving a correct diagnosis. FNA cytology (FNAC) is an accurate method for the diagnosis of tumors metastatic to the kidney. Distinction between primary and secondary tumors of the kidney is crucial to guide management and prevent unnecessary surgery. Diagn. Cytopathol. 2005;32:325-329. (c) 2005 Wiley-Liss, Inc

Nodular pseudoangiomatous stromal hyperplasia (PASH) of the breast is rare and often indistinguishable from fibroadenoma, clinically and on aspiration biopsy smears. We report our observations in 10 patients with PASH, evaluated by fine-needle aspiration (FNA) biopsy and core biopsy.We retrospectively reviewed the clinical, radiographic, cytologic, and histologic findings in 10 cases of pure nodular PASH.Ten patients with a presumed clinical and radiologic diagnosis of fibroadenoma underwent aspiration biopsy. The aspiration smears were diagnosed as fibroadenoma (4 cases), cellular fibroadenoma (1 case), schwannoma versus neurofibroma (1 case), fibrocystic change (3 cases; 2 with atypia), and 'not specific for a lesion' (1 case). A diagnosis of PASH was not suspected in any case. A discrepant or imprecise cytologic diagnosis and /or the presence of dissociated spindle or epithelial cells, or cellular stromal fragments prompted a surgical excision in 7 of 10 patients (70%). The remaining 3 patients exhibited cytologic features of fibroadenoma and were diagnosed as such; however, surgical excision was recommended. Three patients underwent a subsequent core biopsy, with a diagnosis of PASH being made in 1 patient.FNA biopsy could not discriminate PASH from fibroadenoma in 4 of 10 patients (40%) or suggest a diagnosis of PASH in any case. On retrospective review, the finding of plump, spindle-shaped mesenchymal cells may be a cytologic clue to suggest a diagnosis of PASH. Diagn. Cytopathol. 2005;32:345-350. (c) 2005 Wiley-Liss, Inc

We assessed the usefulness of revised Bethesda System reporting of exfoliated benign endometrial cells (EMs) in postmenopausal women. Cervicovaginal cytology specimens with benign EMs in postmenopausal women and 'out-of-phase EMs' in premenopausal women 40 years and older were identified. Cases with histologic follow-up within 12 months were selected. There was tissue follow-up for 130 postmenopausal women: 10 (7.7%) had significant findings (endometrial adenocarcinoma, 6 [2 (33%) in asymptomatic women]; complex atypical endometrial hyperplasia [CAH], 3; leiomyosarcoma, 1); 20 were receiving hormone replacement therapy (HRT; n = 15) or tamoxifen (n = 5); 2 (10%) had significant pathology (endometrial adenocarcinoma, 1; CAH, 1). Eight not taking hormones (7.3%) had significant pathology (adenocarcinoma, 5; CAH, 2; leiomyosarcoma, 1). There were follow-up data for 96 premenopausal women; only 1 (who had vaginal bleeding) had significant pathology (CAH). The difference in incidence of preneoplastic and neoplastic conditions after a cytologic interpretation of 'benign EM' between postmenopausal and premenopausal women was significant (P pound .025); There was no difference between postmenopausal women receiving or not receiving HRT (P > .05). Reporting benign EMs for premenopausal women 40 years and older has no clinical significance but does for postmenopausal women, regardless of HRT and symptoms