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The cytological diagnosis of Pneumocystis carinii by fluorescence microscopy of Papanicolaou stained bronchoalveolar lavage specimens erectile dysfunction causes agent orange 100 mg aurogra order with mastercard. Evaluation of the sensitivity, specificity and predictive value of monoclonal antibody 3F6 for the detection of Pneumocystis carinii pneumonia in bronchoalveolar lavage specimens and induced sputum. Cytology of treated and minimal Pneumocystis carinii pneumonia and a pitfall of the Grocott methenamine silver stain. Sputum examination for Pneumocystis carinii in the acquired immunodeficiency syndrome. Pneumocystis carinii pneumonia: relationship between cyst size and response to treatment. Trichomonads in the respiratory tract: a case report and review of the literature. Diagnosis of pulmonary toxoplasmosis by bronchoalveolar lavage in cardiac transplant recipients. Pulmonary paragonimiasis: report of a case with diagnosis by fine needle aspiration cytology. Rupture of echinococcal cysts: diagnosis, classification and clinical implications. Definitions of emphysema, chronic bronchitis, asthma and airflow obstruction: 25 years on from Ciba Symposium. Transbronchial fine needle aspiration cytology in the diagnosis of mediastinal sarcoidosis. The pathology and terminology of fibrosing alveolitis and the interstitial pneumonias. International Multidisciplinary Consensus Classification of the idiopathic interstitial pneumonias. Value and limitations of transthoracic and transabdominal fine needle aspiration cytology in clinical practice. Cytology of bronchoalveolar lavage in some rare pulmonary disorders: pulmonary alveolar proteinosis and amiodorone pulmonary toxicity. Multivesiculated macrophages: their implications in fine needle aspiration cytology of lung mass lesions. Cellular mechanisms of acute lung injury: implications for future treatment in the adult respiratory distress syndrome. Nonasbestos ferruginous bodies in sputum from a patient with graphite pneumoconiosis.

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Occasionally foci of well-differentiated thyroid carcinomas may be observed amongst the anaplastic carcinoma suggesting that these tumours arise by dedifferentiation of all the major subtypes of carcinoma impotence young adults discount aurogra 100 mg. Immunocytochemically, there is usually lowmolecular-weight cytokeratin expression, although this may be lost during the course of dedifferentiation. Vimentin expression and coexpression with cytokeratins is common, particularly in spindle cell areas. Cytological findings: anaplastic carcinoma Elderly patients with a rapidly advancing hard mass in the neck Bizarre giant, squamoid or spindle cells Necrosis may be present. The cellularity of the specimen is variable: the spindle cell variant may be paucicellular due to the fibrosis associated with this subtype. Necrosis and neutrophil polymorphs may be observed and this material may predominate. Occasionally elements of betterdifferentiated areas are present and if sampling is poor only these areas might be aspirated, giving a tumour diagnosis which may be at odds with the aggressive clinical behaviour. In the differential diagnosis pleomorphic and spindle cells may also be seen in medullary carcinoma. Occasional bizarre cells may be seen as a degenerative change in multinodular goitre, in follicular adenomas and following irradiation or chemotherapy but in the appropriate clinical and cytological setting there should be no difficulty with diagnosis. Lymphoma Lymphomas of the thyroid may either originate in that site or affect the thyroid secondarily as a manifestation of systemic disease. This tumour occurs predominantly in middle-aged and elderly women presenting with a rapidly enlarging firm mass. Local compression effects with dysphagia, stridor and voice change are not uncommon and hence the mode of presentation is very similar to that of anaplastic carcinoma. The lymphoid cells characteristically invade the lumina of thyroid follicles giving rise to lymphoepithelial lesions. At presentation the majority of cases are high-grade diffuse large B-cell lymphomas often seen together with low-grade marginal zone lymphoma. The prognosis for localised disease is good with approximately 75% 10-year survival. These appearances usually present no difficulty in distinguishing anaplastic carcinoma and lymphoma but, given the very different prognosis and treatment, immunostaining for leucocyte common antigen and the absence of cytokeratin staining is usual for confirmation. The low-grade lymphomas are more difficult to diagnose, particularly if the aspirates also harvest cells from the surrounding autoimmune thyroiditis. There may, therefore, be a mixed cell population of reactive and neoplastic lymphoid cells together with Hürthle cells.

Specifications/Details

In frankly malignant cases erectile dysfunction drugs buy cheap aurogra 100 mg buy on-line, pleomorphic, high-grade spindle cells are seen, with a fibrosarcoma-type pattern. Rarely, heterologous sarcomatous elements are present in the form of lipoblasts or malignant cartilage with abundant ground substance. Even histological assessment is subjective in this regard and the extent of infiltration that is important in histological assessment is obviously not apparent on the smears. Cytological findings: borderline (low-grade malignant) phyllodes tumour Cellular smears with occasional large sheets of benign epithelium Numerous plump, single stromal cells with moderate cellular pleomorphism Occasionally bizarre, degenerative type nuclear abnormalities Occasional mitoses. Diagnostic pitfalls: borderline (low-grade malignant) phyllodes tumour May be mistaken for a fibroadenoma Fibroblastic proliferative entities as fibromatosis and nodular fasciitis Spindle cell sarcomas Malignant myoepithelioma Bizarre degenerative nuclear atypia may be interpreted as a feature of malignancy. Cytological findings: high-grade malignant phyllodes tumour of carcinoma on clinical and mammographic assessment. The aspirate is usually scanty, yielding bland, isolated spindle cells and small groups of benign ductal cells. Properly taken aspirates are generally abundantly cellular Large atypical stromal cells, often in cohesive groups Sometimes overtly sarcomatous elements or fragments of densely cellular stroma with obvious mitoses are seen the epithelial content is variable but tends to be particularly sparse in frankly malignant phyllodes tumours. Malignant breast tumours General criteria for malignancy No single morphological feature can be relied upon to distinguish benign from malignant cells at any site. Diagnostic pitfalls: high-grade malignant phyllodes tumour Obvious malignancy in a phyllodes tumour may be misdiagnosed as carcinoma, particularly metaplastic carcinoma. Cellularity of the specimen Fibromatosis (desmoid tumour) Breast is an uncommon location for desmoid tumours. Also, many benign lesions found in younger women may provide intensely cellular smears. Dispersal of cells Lack of cell-to-cell cohesion is a characteristic malignant feature, but it is not diagnostic of an invasive lesion. Also, some benign lesions may show discohesion, either genuinely or as an artefact due to too much pressure when smearing the material. Absence of biphasic pattern with myoepithelial cells In most invasive carcinomas, myoepithelial cell nuclei are missing, both in the background and in the periphery of the tumour cell groups and aggregates. Tubular carcinomas and some low-grade ductal carcinomas are an exception where a few myoepithelial cells may still be found. Careful attention to the quality of the chromatin and the appearance of the nucleoli should avoid this pitfall. Some malignant aspirates also contain hyperplastic but benign tissue resulting in a population of bipolar cells that distract attention from the population of malignant cells. Extranuclear chromatin is very much a malignant feature but tends to be seen more commonly in higher grade carcinomas where diagnosis is not a problem. Nuclear/cytoplasmic ratio and cytoplasmic features this is of less help than at any other site in the body as normal breast epithelial cells can have scanty cytoplasm and carcinoma cells showing apocrine differentiation may have a great abundance. Intracytoplasmic lumina are an occasional feature of both lobular and ductal carcinoma cells but are only very rarely seen in benign breast epithelium.

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Customer Reviews

Curtis, 62 years: Utilisation of fine needle aspiration in the diagnosis of metastatic tumours to the kidney.

Kirk, 39 years: Transrectal aspirates are usually performed in conjunction with examination of the patient under general anaesthesia.

Ismael, 36 years: Although it is a non-specific feature,9 lacunae are useful for locating atypical cells, especially for evaluation of non-immunoreactive cells in immunostained sections under lower magnification.