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Bronchioloalveolar carcinoma in progressive systemic sclerosis. Report
of a case diagnosed by fine needle aspiration cytology.
Acta Cytol. 1995
Nov-Dec;39(6):1182-6.
BACKGROUND:
Progressive systemic sclerosis (PSS) is a systemic disorder involving
many internal organs, including the lungs. The occurrence of a
pulmonary tumor has occasionally been reported, especially in
long-standing cases. Bronchioloalveolar carcinoma is the most
prevalent histologic type. CASE: A 35-year-old male with a 12-year
history of PSS presented with exertional dyspnea and pain in the left
side of the chest. Fine needle aspiration cytology (FNAC) showed
abundant cellular material with large, monolayered sheets and
papillary structures. The neoplastic cells had uniform round to oval
nuclei and spacious cytoplasm. Some had intranuclear vacuoles.
Phosphotungstic acid-hematoxylin (PTAH) stain revealed structures in
the form of prominent cell membranes rimming the free surfaces of the
tumor cells. The overall cytologic picture was interpreted as
consistent with bronchioloalveolar carcinoma. The patient's condition
did not permit surgery. CONCLUSION: In this case the development of
bronchioloalveolar carcinoma occurred over a 12-year period following
the diagnosis of PSS. This case emphasizes diagnosis of the tumor
solely by FNAC. PTAH stain was also helpful in the cytologic
diagnosis.
Differentiating
cytological features of bronchioloalveolar carcinoma from
adenocarcinoma of the lung in fine-needle aspirations: a statistical
analysis of 27 cases.
Diagn Cytopathol. 1997 Mar;16(3):253-7.
Bronchioloalveolar carcinoma (BAC) is an uncommon type of lung
carcinoma that is important to distinguish from adenocarcinoma (adenoCA)
because of its different biological behavior. Although the features of
BAC have often been described in cytological material other than
fine-needle aspirations (FNA), they have rarely been detailed in FNA
specimens. We undertook to delineate the differentiating cytological
features of 13 cases of BAC (7 of the nonsecretory type and 6 of the
secretory type) and of 14 cases of bronchogenic adenoCA in FNA
material, looking at 17 cytological criteria and using statistical
analysis. When statistically analyzed with chi-square and Pearson's
correlation, only 3 of the 17 features were found to be good
discriminants for distinguishing nonsecretory BAC (NS-BAC) from
adenoCA: prominence of monolayered tumor sheets, fine chromatin
pattern, and mild cellular pleomorphism correlated significantly with
NS-BAC. On the other hand, only the prominence of nuclear grooves and
the abundance of extracellular mucin correlated significantly with
secretory BAC (S-BAC) when compared to adenoCA. When using a logistic
regression analysis, NS-BAC and S-BAC were best discriminated from
adenoCA by the prominence of monolayered tumor sheets and by the
abundance of extracellular mucin, respectively. We conclude that, in
most instances, it is possible to make an accurate diagnosis of BAC
and to distinguish it from adenoCA of the lung in FNA material.
Fine-needle
aspiration biopsy of bronchioloalveolar carcinoma.Cancer.
2001 Feb 25;93(1):29-34.
BACKGROUND:
The purpose of the current study was to determine the accuracy of the
cytologic diagnosis of bronchioloalveolar carcinoma (BAC) by
fine-needle aspiration biopsy (FNAB). METHODS: During a 4-year period
(1994-1998), 1664 lung FNABs were performed. Forty-nine patients with
BAC diagnosed by FNAB and/or surgical biopsy formed the basis of this
study. RESULTS: Twenty-four patients diagnosed with BAC by FNAB had
histologic confirmation. Surgical pathology revealed BAC in 15
patients with a cytologic diagnosis of large cell carcinoma (LCA) or
adenocarcinoma (ACA). Nine patients diagnosed with BAC by FNAB were
found to have ACA histologically. One unsatisfactory aspirate was
diagnosed as BAC by surgical pathology. Review of 15 FNAB specimens
with a diagnosis of LCA or ACA revealed cytologic features typical of
BAC. In six aspirates, additional features such as pronounced nuclear
crowding and overlapping, variation in nuclear size, and increased
number of pleomorphic cells interfered with the FNAB diagnosis of BAC.
Nine FNABs with a diagnosis of BAC were found histologically to have
ACA with a focal BAC growth pattern. One unsatisfactory FNAB aspirate
diagnosed as BAC histologically was due to sampling error.
CONCLUSIONS: A diagnosis of BAC by FNAB is possible using conventional
cytologic criteria. Some BACs show pronounced nuclear crowding and
overlapping, variation in nuclear size, and an increased number of
pleomorphic cells cytologically, which may interfere with an FNAB
diagnosis of BAC. FNABs from ACA cases with a focal BAC pattern remain
a diagnostic dilemma due to the nature of the lesion. In addition,
sampling error by FNAB can be a diagnostic pitfall.
Differential
expression of cytokeratins 7 and 20 and thyroid transcription factor-1
in bronchioloalveolar carcinoma: an immunohistochemical study in
fine-needle aspiration biopsy specimens.Am
J Clin Pathol. 2004 Mar;121(3):350-7.
We studied the
staining patterns of bronchioloalveolar carcinoma (BAC) with
antibodies to cytokeratin (CK) 7, CK20, and thyroid transcription
factor-1 (TTF-1) to determine the diagnostic usefulness of this panel
in differentiating BAC from metastatic adenocarcinoma in material
obtained by fine-needle aspiration biopsy (FNAB) of the lung. We
identified 16 cases of BAC. Of these, 6 were mucinous, 4 were
nonmucinous, and 6 were mixed with focal mucinous differentiation.
Immunohistochemical analysis with antibodies to CK7, CK20, and TTF-1
was performed on cell-block sections. Of the 6 mucinous BACs, 4 (67%)
were CK7+, CK20+, and TTF-1-. All 4 nonmucinous BACs were CK7+ and
CK20-, and 2 (50%) were TTF-1+. All 6 mixed BACs were diffusely
positive for CK7 and focally positive for CK20; 5 (83%) were TTF-1+.
Nonmucinous BACs display CK7, CK20, and TTF-1 immunoreactivity similar
to conventional pulmonary adenocarcinoma. Mucinous and mixed BACs have
an immunohistochemical phenotype that is different from that of
conventional pulmonary adenocarcinoma. Knowledge of these staining
patterns is crucial for distinguishing mucinous and mixed BACs from
metastatic adenocarcinoma involving the lungs.
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