Fine-Needle Biopsy of Superficial and Deep Masses (eBook)
XX, 208 Seiten
Springer Italia (Verlag)
978-88-470-1433-6 (ISBN)
Needle biopsy is a simple, reliable, inexpensive, well-tolerated, and minimally invasive procedure for the diagnosis of tumors, both in superficial and in deep sites. Today, following the shift to a more conservative approach to tumor treatment, and in this era of 'tailored' or 'targeted' oncological therapies, the use of needle biopsy in the diagnosis of neoplasia, at all phases of the disease, is expected to increase dramatically. The efficacy of this technique is, however, strongly influenced by the experience of the physician performing the technique and by the pathologist's ability to interpret the results derived from the minimal cellular harvest. The aim of this volume is to provide all of the information and insight needed to obtain a correct diagnosis based on needle biopsy evaluation. In a problem-oriented approach, the author describes the optimal interventional maneuver and biopsy-sample triage for all types of lesions. The reader is then guided through the interpretation of all possible cytological findings based on a pattern-analysis methodology. The integration of this information with clinical and preanalytical data is the best approach to obtain a correct diagnosis.
Needle biopsy is a simple, reliable, inexpensive, well-tolerated, and minimally invasive procedure for the diagnosis of tumors, both in superficial and in deep sites. Today, following the shift to a more conservative approach to tumor treatment, and in this era of "e;tailored"e; or "e;targeted"e; oncological therapies, the use of needle biopsy in the diagnosis of neoplasia, at all phases of the disease, is expected to increase dramatically. The efficacy of this technique is, however, strongly influenced by the experience of the physician performing the technique and by the pathologist's ability to interpret the results derived from the minimal cellular harvest. The aim of this volume is to provide all of the information and insight needed to obtain a correct diagnosis based on needle biopsy evaluation. In a problem-oriented approach, the author describes the optimal interventional maneuver and biopsy-sample triage for all types of lesions. The reader is then guided through the interpretation of all possible cytological findings based on a pattern-analysis methodology. The integration of this information with clinical and preanalytical data is the best approach to obtain a correct diagnosis.
Foreword 6
Foreword 7
Preface 8
Table of Contents 11
1 Methods 17
1.1 Sampling 17
1.1.1 The Interventional Pathologist 17
1.1.2 Preanalyitical Evaluation and Requirements 17
1.1.3 Needles 18
1.1.4 Aspiration vs.Non-Aspiration Technique 19
1.1.5 Core-Needle Biopsy Devices 20
1.1.6 Sampling Procedures 20
1.2 Specimen Triage 22
1.2.1 Direct Smears and Smearing Techniques 22
1.2.2 Fixation 23
1.2.3 Cytospin Preparation 23
1.2.4 Cell-Block Preparation 25
1.2.5 Direct Smear vs. Cell-Block Preparation for Immunohistochemistry 26
1.2.6 Staining Methods 26
1.3 Microscopic Evaluation 29
1.3.1 Pattern Recognition Approach 29
1.3.2 Diagnostic Accuracy 30
References 31
2 Breast 33
2.1 Introduction 33
2.2 Non-Operative Diagnosis of Breast Cancer 33
2.3 Fine-Needle vs. Core-Needle Sampling 34
2.4 Diagnostic Terminology 36
2.5 Diagnostic Approach 38
2.6 Basic Principles of Cytological Evaluation 40
2.6.1 Background 40
2.6.2 Cellularity 40
2.6.3 Aggregation Patterns of Epithelial Glandular Cells 40
2.6.3.1 Two-Dimensional Aggregates 40
2.6.3.2 Three-Dimensional Aggregates 42
2.6.4 Cellular Dissociation 42
2.6.5 Ancillary Elements 43
2.6.5.1 Bipolar Bare Nuclei 43
2.6.5.2 Fibrous Stromal Fragments 43
2.6.5.3 Adipocytic Stromal Fragments 43
2.6.5.4 Foam Cells 44
2.6.5.5 Apocrine Cells 44
2.6.6 Fine Cytomorphological Features of Epithelial Glandular Cells 44
2.6.6.1 Nuclear Size and Shape 44
2.6.6.2 Chromatin Texture 44
2.6.6.3 Nucleolus 45
2.6.6.4 Mitotic Figures 45
2.6.6.5 Non-Bipolar Bare Nuclei 45
2.6.6.6 Cytoplasmic Changes 45
2.7 Primary Diagnosis of Common Benign or Premalignant Breast Lesions 46
2.7.1 Benign Fibroepithelial Lesions 46
2.7.1.1 Fibroadenoma and its Variants 46
2.7.1.2 Benign and Borderline Phyllodes Tumor 47
2.7.1.3 Intraductal/Intracystic Papilloma 48
2.7.2 Sclerosing Lesions Following Fat Necrosis 48
2.7.3 Intramammary Lymph Nodes 49
2.7.4 Proliferative Breast Lesions 49
2.8 Diagnosis of Carcinoma 50
2.8.1 Specimens with Adequate Cellularity 50
2.8.1.1 Major Criteria 51
2.8.1.2 Minor Criteria 51
2.8.1.3 Construction of the Diagnostic Algorithm 52
2.8.2 Samples with Minimal to Low Cellularity 55
2.8.3 Limitations and Pitfalls 55
2.9 Variants of Carcinoma 56
2.9.1 Mucinous Carcinoma 56
2.9.2 Tubular Carcinoma 57
2.9.3 Medullary Carcinoma 58
2.9.4 Triple-Negative “Basal-Like” Carcinoma 58
2.9.5 Micropapillary Carcinoma 58
2.9.6 Carcinoma with Apocrine-Type Differentiation 59
2.9.7 Adenoid Cystic Carcinoma 60
2.9.8 Metaplastic Spindle Cell Carcinoma 60
2.10 Differential Diagnosis and Possible Misdiagnoses 61
2.10.1 Fibroepithelial Lesions 61
2.10.2 Intraductal/Intracystic Papilloma 61
2.10.3 Mucocele-Like Lesions 62
2.10.4 Retroareolar Abscess 62
2.10.5 Hypercellular Sample in the Elderly 62
2.10.6 Complex Sclerosing Lesion/Radial Scar 62
2.10.7 Angiosarcoma After Breast-Conserving Therapy 63
References 63
3 Thyroid 66
3.1 Introduction 66
3.2 Indications for FNB 66
3.2.1 Palpable Nodule 66
3.2.2 Non-Palpable Nodule Discovered via Imaging 67
3.3 FNB Sampling Technique 67
3.4 The Cold Nodule: Histopathological Findings and ClinicopathologicalCorrelates 67
3.4.1 Nodular Hyperplasia 67
3.4.2 Follicular Adenoma 68
3.4.3 Hyaline Trabecular Adenoma 68
3.4.4 Thyroiditis 69
3.4.4.1 Autoimmune Thyroiditis 69
3.4.4.2 De Quervain’s Thyroiditis 70
3.4.4.3 Riedel’s Thyroiditis 70
3.4.5 Papillary Carcinoma 70
3.4.6 Follicular Carcinoma 71
3.4.7 Medullary Carcinoma 72
3.4.8 Poorly Differentiated Follicular (“Insular”) Carcinoma 72
3.4.9 Poorly Differentiated Carcinomas with Papillary, Hürthle Cell, or Medullary Carcinoma Cell Features 73
3.4.10 Undifferentiated (Anaplastic) Carcinoma 73
3.4.11 Intrathyroid Parathyroid Tumors 73
3.5 Immunohistochemistry of Thyroid Lesions 74
3.6 Analytical Approach to the Cytological Sample 74
3.6.1 Background 74
3.6.1.1 Blood 74
3.6.1.2 Colloid 74
3.6.1.3 Stromal Fragments 75
3.6.1.4 Inflammatory Cells and Crystals 76
3.6.2 Proper Thyroid Cell Types 77
3.6.2.1 Follicular Thyrocytes 77
3.6.2.2 Oxyphil Cells 77
3.6.2.3 Miscellaneous Cell Types 77
3.6.3 Specimen Adequacy 77
3.7 Towards a Uniform Diagnostic Terminology: The National Cancer Institute (NCI) Classification Scheme, 2008 79
3.8 Pattern Profiling of FNB Samples 80
3.8.1 Benign and Non-Neoplastic Follicular Lesions 80
3.8.1.1 Colloid Nodule 80
3.8.1.2 Hypercellular Colloid Nodule 80
3.8.1.3 Chronic Lymphocytic Thyroiditis 81
3.8.2 Potentially Neoplastic Lesions 81
3.8.2.1 Follicular Lesion of Undetermined Significance 82
3.8.2.2 Follicular Proliferation/Neoplasm 83
3.8.3 Malignant Lesions 86
3.8.3.1 Papillary Carcinoma 86
3.8.3.2 Poorly Differentiated Follicular(“Insular”) Carcinoma 92
3.8.3.3 Poorly Differentiated Hürthle Cell Carcinoma 92
3.8.3.4 Medullary Carcinoma 93
3.8.3.5 Anaplastic Carcinoma 93
3.8.3.6 Intrathyroid Parathyroid Tumors 95
3.8.3.7 Metastatic Malignancies and Malignant Lymphoma 96
References 97
4 Lymph Nodes:Diagnosis of Malignant Lymphoma 100
4.1 Introduction 100
4.2 Histological vs. Cytological Approach to Lymphoid Lesions 100
4.3 Indications for Fine-Needle Biopsy of Lymph Nodes 102
4.4 Evaluation of the Cellular Sample 102
4.4.1 Cellularity 102
4.4.2 Lymphoglandular Bodies 102
4.4.3 Identification of Cell Type 102
4.4.3.1 Lymphoid Cells 103
4.4.3.2 Ancillary Cellular Components 107
4.5 Pattern Profiling of FNB Samples 108
4.5.1 Polymorphous Small- and Large-Cell Pattern, Tingible-Body Histiocytes Present 109
4.5.2 Polymorphous Small- and Large-Cell Pattern, Tingible-Body Histiocytes Absent 110
4.5.2.1 Non-Specific Reactive Lymph Node Hyperplasia 110
4.5.2.2 Reactive Lymph Node Hyperplasia with Florid Immunoblastic Proliferation 111
4.5.2.3 Necrotizing Histiocytic Lymphadenitis, Kikuchi Type 111
4.5.2.4 Non-Hodgkin’s Lymphomas, B-Cell Type 111
4.5.2.5 Nodular, Lymphocyte-PredominantHodgkin’s Lymphoma 112
4.5.3 Polymorphous Cell Pattern, Large Cells Prevalent 112
4.5.3.1 Diffuse Large B-Cell Non-Hodgkin’s Lymphoma 113
4.5.3.2 Burkitt’s Lymphoma 114
4.5.3.3 Lymph Node Involvement by Plasma Cell Myeloma 114
4.5.4 Polymorphous Cell Pattern, Small Cells Prevalent, with Scattered Large Atypical Blasts 115
4.5.4.1 Classical Hodgkin’s Lymphoma 115
4.5.4.2 T-Cell/Histiocyte-Rich Large B-Cell Lymphoma 116
4.5.4.3 Peripheral T-Cell Lymphoma, Anaplastic Large-Cell Type 116
4.5.5 Monomorphic, Small Lymphoid Cell Pattern 116
4.5.5.1 Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma 117
4.5.5.2 Lymphoplasmacytic Lymphoma/Waldenstrom ‘s Macroglobulinemia 117
4.5.5.3 Mantle Cell Lymphoma, Classical Variant 118
4.5.5.4 Follicular Lymphoma, Grades 1 and 2 118
4.5.5.5 Marginal Zone Lymphoma 119
4.5.5.6 Nodular Lymphocyte-PredominantHodgkin’s Lymphoma 119
4.5.5.7 Diffuse Reactive Lymphoid Hyperplasia 120
4.5.6 Pleomorphic, Small- and/or Large-Cell Pattern 120
4.5.6.1 Peripheral T-Cell Lymphoma,Unspecified 120
4.5.6.2 Peripheral T-Cell Lymphoma, Anaplastic Large-Cell Type 121
4.5.6.3 Precursor B- and T-Lymphoblastic Leukemia/Lymphoma 122
4.5.6.4 Mantle Cell B-Cell Lymphoma, Blastoid Variant 122
4.6 Concluding Remarks 122
References 125
5 Cytological Pattern Profiling of Tumors from Different Visceral Sites 128
5.1 Preliminary Remarks 128
5.2 Glandular-Cell Morphology 128
5.2.1 Tubulo-Acinar Pattern 128
5.2.2 Tubulo-Papillary Pattern 130
5.2.3 Mucinous Pattern 131
5.2.4 Solid, Three-Dimensional (Structureless) Pattern 132
5.2.5 Non-Cohesive Cell Pattern 133
5.2.6 Immunohistochemical Identification of the Primary Tumor Site 133
5.3 Squamous or Squamoid Cell Morphology 135
5.3.1 Keratinizing Pattern 135
5.3.2 Non-Keratinizing Pattern 136
5.4 Basaloid-Cell Morphology 137
5.4.1 Basaloid Squamous Cell Carcinoma Pattern 137
5.4.2 Adenoid Cystic Carcinoma Pattern 137
5.5 Transitional-Cell Morphology 138
5.6 Small-Cell Morphology 140
5.6.1 Monomorphous Cell Pattern with Tendency to Aggregation and Mild Nuclear Atypia 140
5.6.2 Pleomorphic Cell Pattern with Tendency to Aggregation and Marked Nuclear Atypia 141
5.6.3 Pleomorphic Cell Pattern with Marked Cellular Dissociation 142
5.7 Large-Cell Morphology 143
5.7.1 Monophasic Pattern 143
5.7.2 Biphasic Pattern 145
5.8 Clear-Cell Morphology 145
5.8.1 Immunohistochemistry of Clear-Cell Tumors 146
5.9 Oxyphil/Oncocytic- or Oncocytoid-Cell Morphology 147
5.10 Epithelioid- and Spindle-Cell Morphology 148
References 150
6 Abdomen 153
6.1 Focal Liver Lesions 153
6.1.1 Hepatocellular Carcinoma 153
6.1.1.1 Clinicopathological Correlates 153
6.1.1.2 Cytomorphology 153
6.1.1.3 Diagnosis of Hepatocellular Carcinoma 157
6.1.2 Cholangiocarcinoma 158
6.1.3 Carcinoma of the Gallbladder Involving the Liver 158
6.2 Pancreatic Tumors 158
6.2.1 Ductal Adenocarcinoma 158
6.2.1.1 Clinicopathological Correlates 158
6.2.1.2 Cytomorphology 159
6.2.2 Acinar Cell Carcinoma 160
6.2.3 Mucinous Cystic Neoplasms 161
6.2.3.1 Clinicopathological Correlates 161
6.2.3.2 Cytomorphology 161
6.2.4 Serous Cystic Neoplasms 162
6.2.5 Tumors of the Endocrine Pancreas 162
6.2.5.1 Clinicopathological Correlates 162
6.2.5.2 Cytomorphology 162
6.2.6 Undifferentiated and Spindle Cell Carcinoma 162
6.3 Renal Tumors 163
6.3.1 Clear-Cell Carcinoma 163
6.3.1.1 Clinicopathological Correlates 163
6.3.1.2 Cytomorphology 164
6.3.2 Papillary Carcinoma 165
6.3.2.1 Clinicopathological Correlates 165
6.3.2.2 Cytomorphology 165
6.3.3 Chromophobe-Cell Carcinoma 166
6.3.4 Collecting-Duct (Bellini’s) Adenocarcinoma 166
6.3.5 Oncocytoma 166
6.3.5.1 Clinicopathological Correlates 166
6.3.5.2 Cytomorphology 166
6.3.6 Angiomyolipoma 167
6.3.7 Special Problems in the Differential Diagnosis of Renal Tumors 167
6.4 Adrenal Gland Tumors 168
6.4.1 Adenoma of the Adrenal Cortex 168
6.4.1.1 Clinicopathological Correlates 168
6.4.1.2 Cytomorphology 168
6.4.2 Carcinoma of the Adrenal Cortex 168
6.4.2.1 Clinicopathological Correlates 168
6.4.2.2 Cytomorphology 169
6.4.3 Pheochromocytoma 169
6.4.4 Metastatic Malignancies 170
6.5 Ovarian Tumors 170
6.5.1 Serous Tumors 171
6.5.2 Mucinous Tumors 171
6.5.3 Endometrioid Carcinoma 172
6.5.4 Clear-Cell Carcinoma 172
6.5.5 Mixed Mesodermal Tumors 172
6.5.6 Transitional Cell Tumors 173
6.5.7 Granulosa Cell Tumor 173
6.5.7.1 Clinicopathological Correlates 173
6.5.7.2 Cytomorphology 174
6.5.8 Undifferentiated Small-Cell Carcinoma 174
6.5.9 Dysgerminoma 174
6.5.10 Squamous Cell Carcinoma Arisingin a Mature Teratoma 174
6.5.11 Metastatic Malignancies 175
6.6 Tumors Growing into the Peritoneal Cavity 175
6.6.1 Gastrointestinal Stromal Tumors 175
6.6.1.1 Clinicopathological Correlates 175
6.6.1.2 Cytomorphology and Immunohistiochemistry 175
6.6.2 Intra-Abdominal (Mesenteric) Fibromatosis 176
6.6.3 Peritoneal Lesions 177
6.6.3.1 Multicystic Mesothelioma 177
6.6.3.2 Malignant Mesothelioma 177
6.6.3.3 Desmoplastic Small Round-Cell Tumor 177
6.7 Tumors of the Abdominal Wall 177
6.8 Tumors of the Retroperitoneal Space 178
6.8.1 Malignant Lymphomas 178
6.8.2 Soft-Tissue Tumors 178
6.8.3 Germ Cell Tumors 179
References 182
7 Lung, Mediastinum, and Pleura 187
7.1 Introduction 187
7.1.1 Indications for FNB 187
7.1.2 Contraindications and Complications 188
7.1.3 Diagnostic Accuracy 188
7.1.4 Technical Considerations 188
7.2 Lung 189
7.2.1 Classification and Clinical Presentation of Pulmonary Epithelial Malignancies 189
7.2.2 Adenocarcinoma 190
7.2.2.1 Bronchioloalveolar Carcinoma 192
7.2.2.2 Poorly Differentiated Adenocarcinoma 194
7.2.2.3 Mucinous (Colloid) Carcinoma 196
7.2.2.4 Immunohistochemical Findings 196
7.2.3 Adenosquamous Carcinoma 196
7.2.4 Squamous Cell Carcinoma 197
7.2.5 Large-Cell Carcinoma 198
7.2.6 Basaloid Cell Carcinoma 199
7.2.7 Spindle Cell Carcinoma 200
7.2.8 Pleomorphic Carcinoma 200
7.2.9 Neuroendocrine Tumors 201
7.2.9.1 Typical Carcinoid 201
7.2.9.2 Poorly Differentiated and Small-Cell Neuroendocrine Carcinoma 201
7.2.9.3 Large-Cell Neuroendocrine Carcinoma 204
7.2.10 Pulmonary Metastatic Malignancies 204
7.2.11 Benign Lesions 205
7.2.11.1 Hamartoma 205
7.2.11.2 Inflammatory Conditions 205
7.2.12 Rare Tumors 206
7.3 Mediastinum 207
7.3.1 Tumors of the Thymus 208
7.3.1.1 Thymoma 208
7.3.1.2 Thymic Carcinoma 208
7.3.1.3 Neuroendocrine Tumors 209
7.3.2 Germ-Cell Tumors 210
7.4 Pleura and Chest Wall 210
7.4.1 Malignant Mesothelioma 210
7.4.2 Solitary Fibrous Tumor 211
References 212
Subject Index 215
| Erscheint lt. Verlag | 14.8.2010 |
|---|---|
| Zusatzinfo | XX, 208 p. 250 illus. in color. |
| Verlagsort | Milano |
| Sprache | englisch |
| Themenwelt | Medizin / Pharmazie ► Medizinische Fachgebiete ► Chirurgie |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Laboratoriumsmedizin | |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Onkologie | |
| Medizinische Fachgebiete ► Radiologie / Bildgebende Verfahren ► Radiologie | |
| Studium ► 1. Studienabschnitt (Vorklinik) ► Biochemie / Molekularbiologie | |
| Studium ► 2. Studienabschnitt (Klinik) ► Pathologie | |
| Schlagworte | biopsy • Cytological diagnosis • Diagnosis • fine-needel biopsy • Interventional Radiology • Pattern Analysis • Tumor • tumor diagnosis |
| ISBN-10 | 88-470-1433-6 / 8847014336 |
| ISBN-13 | 978-88-470-1433-6 / 9788847014336 |
| Haben Sie eine Frage zum Produkt? |
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