Fine-Needle Aspiration Biopsy in Primary Malignant and Metastatic Bone Tumors

Size: px

Start display at page:

Download "Fine-Needle Aspiration Biopsy in Primary Malignant and Metastatic Bone Tumors"

Mark Matthews
6 years ago
Views:

1 Applied Pthology Editor-in-Chief: A. Ascenzi, Rom Mnging Editor: G. Coggi, Milno Reprint Pulisher: S. Krger AG, Bsel Printed in Switzerlnd Appl, Pthol. 1: (1983) e 1983 S. Krger AG, Bsel /83/00 12"'{)076$2. 75/0 Fine-Needle Aspirtion Biopsy in Primry Mlignnt nd Metsttic Bone Tumors L. Plomini», D. Mrino>, A. Vetrni», F. Fulciniti=! 'Cytopthology Service, Institute of Antomie Pthology nd Clinic of Orthopedics nd Trumtology, 2nd Fculty of Medicine nd Surgery, University of Nples, ltly Key Words. Aspirtion iopsy. Bone tumor. Cytology Astrct. 56 mlignnt one neoplsms (15 primry nd 41 metsttic), dignosed y fine-needle spirtion iopsy, re reported. 100% dignostic ccurcy ws chieved. The resuits indicte tht fine-needle spirtion iopsy cn e sustitute for open surgicl iopsy in selected cses. Introductìon It is well known tht comined clinicl, rdiologicl nd pthologicl study is the optiml procedure in one pthology [14]. Trditionlly, open surgicl iopsy hs een prerequisite for pthologicl dignosis. Since mny primry nd metsttic one tumors tend to e Iytic, dequte mteril cn often e otined y needle spirtion iopsy [4, 6-8, 10-12, 15, 18,20,22]. Yet severl uthors oject to the doption of needle iopsy techniques [I, 3, 9]. This study ws un dertken to demonstrte the fesiility nd role of fine-needle spirtion iopsy in the dignosis of mlignnt one tumors. The uthors wish to thnk Prof. Nicol Missi who mde this dignostic project possile. Mteril nd Methods This report is sed on the nlysis of 56 consecutive cses of mlignnt one tumors (15 primry nd 41 metsttic) studied from Jnury l, 1978, to Decemer 31, Figure 1 shows the sites of the spirtion iopsies. The method of co11ection nd preprtion of the cytologic specimens used in our lortory hs een outlined in detil elsewhere [18, 21). We would only like to point out tht we use n ordinry 22-guge spinl needle fitted with n oturtor with length vrying etween 25 nd 80 mm. Longer needles tend to end nd must never e used. On li occsions, spirtion hs een performed under TV fluoroscopic control, fter locl nesthesi, y tem composed of n orthopedic surgeon nd cytopthologist. With the needle dimeter we used, the trjectory of the needle does not hve to tke into considertion the locl ntomy, nd the shortest wy to puncture the lesion my thus e tken. Nevertheless, lrge lood vessels nd especi11y nerves must e voided (fig. 2-5).

Fine-Needle Aspirtion Biopsy in the Dignosis of Bone Mlignncies 77 We generlly work on smered mteril stined with My-Griìnwld-Giems nd Ppnicolou, which re complementry stins.

2 Fine-Needle Aspirtion Biopsy in the Dignosis of Bone Mlignncies 77 We generlly work on smered mteril stined with My-Griìnwld-Giems nd Ppnicolou, which re complementry stins. Any residul mteril is further fixed in picric cid-lcohol, emedded in prffin s celi utton, step-sectioned nd stined with hemtoxylin-eosin. Results A sufficient quntity of cells hs lwys een otined y spirtion. Only twice ws it necessry to repet it ecuse sufficient cells were not ville. The dignosis ws sed 53 times on smers nd only 3 times on cell uttons. We dignosed mlignncies in li of the 56 cses; typing of the primry mlignnt one tumors hs een don e ccording to Hjdu nd Hjdu [7], while the celi typing of metstses followed the criteri estlished y Tkhshi [19] (tles I, II; fig. 2-5). No serious complictions were encountered; locl discomfort ws the only common complint. Tumor spreding through the needle trct ws not encountered nd, relying on other reports [2,5, 13, 17], we feel we cn exclude this possiility, while it is well known tht this does not hold true in respect of surgicl iopsies [1]. Fig. 1. Antomicl distriution of the lesions. Right: metstses; left: primry lesions. Discussion The purpose of open surgicl one iopsy is to otin mteril for histopthologicl exmintion in order to ssess the nture of the lesion prior to initition of definitive therpy [14]. Bone surgicl iopsy, usully incisionl iopsy, my led to contmintion of neighoring tissues y the tumor, requires generi nesthesi in most instnces, nd furthermore in some cses my e n elorte procedure (i.e., shoulder, pelvis, spine). More- over, one must relize tht tretment following tissue exmintion cn e quite different not only depending on whether the tumor is primry or metsttic tumor ut lso ccording to the kind of primry one tumor. Thus n incisionl iopsy my e too little or too much s fr s the susequent tretment (surgicl or nonsurgicl) is concerned. On the other hnd, the frozen-section technique, which my lso present technicl difficulties [16, 23] in this field of ppliction, requires surgicl iopsy thus shring with it the ove-mentioned limittions.

78 Plom inilmrino/v etrni/f ulciniti Fig. 2. 58-yer-old mle. Femur. Metstses. Rdiologicl ppernce. Clusters ofmetsttic modertely differentited lung crcinom. Ppnicolou. X 112. Fig. 3. 22-yer-old femle.

3 78 Plom inilmrino/v etrni/f ulciniti Fig yer-old mle. Femur. Metstses. Rdiologicl ppernce. Clusters ofmetsttic modertely differentited lung crcinom. Ppnicolou. X 112. Fig yer-old femle. Fiul. Osteosrcom. Rdiologicl ppernce. Dissocited spindle cells with hyperchromtic round or ovi nuclei nd intermingled multinucleted cells re the chrcteristics ofthis mlignnt tumor. Note the significnt vrition in size, shpe nd nucler structure. Ppnicolou. X 112.

Fine-Needle Aspirtion Biopsy in the Dignosis of Bone Mlignncies 79 Fig. 4. 31-yer-old femle. Femur. Gint celi tumor. Rdiologicl ppernce.

4 Fine-Needle Aspirtion Biopsy in the Dignosis of Bone Mlignncies 79 Fig yer-old femle. Femur. Gint celi tumor. Rdiologicl ppernce. Multinucleted gint cells with ttched clusters of uniform, hyperchromtic, ovoid cells re the sic microscopic pttern of this tumor. Ppnicolou. X 112. Fig yer-old femle. Puis. Lymphosrcom. Rdiologicl ppernce. The cytologic specimen is chrcterized y monotonous round, smll, mononucleted, nucleolted, dissocited mlignnt Iymphocytes. In the upper left corner enign multinucleted osteoclst cn e oserved. Ppnicolou. X 112.

Fine-Needle Aspirtion Biopsy in the Dignosis of Bone Mlignncies 81 We would like to point out tht fine-needle spirtion iopsy cn e performed s n multory procedure, it is well ccepted y most ptients,

6 Fine-Needle Aspirtion Biopsy in the Dignosis of Bone Mlignncies 81 We would like to point out tht fine-needle spirtion iopsy cn e performed s n multory procedure, it is well ccepted y most ptients, cn e repeted if needed nd, ccording to our experience, it is prcticlly free of moridity nd mortlity s well s of ny risk of spreding the tumor. Cytologicl dignosis of mlignnt one tumors on mteril otined y needle iopsy is rel chllenge nd requires experience. It must never e regrded s sustitute for tissue exmintion ut, in selected instnces, it my yield meningful nd dependle informtion for therpeutic purposes. References Ackermn, L.V.; Del Regto, I.A.: Cncer (Mosy, St. Louis 1970). 2 Berg, I.; Roins, G.: A lte look t the sfety of spirtion iopsy. Cncer 15: (1962). 3 Dhlin, D.: Bone tumors (Thoms, Springfield 1978). 4 de Sntos, L.; Lukemn, I.; Wllce, S.; Murry, I.; Ayl, A.: Percutneous needle iopsy of one in the cncer ptient. Am. I. Roentg. 130: (1978). 5 Engzell, U.; Esposti, P.; Ruio, c.; Sigurdson, À.; Zjicek, 1.: Investigtion on tumor spred in connection with spirtion iopsy. Act rdiol. ther. phys. iol. 10: (1976). 6 Hjdu, S.: Aspirtion iopsy ofprimry mlignnt one tumors. Front. Rdit. Ther. Onc., voi. IO, pp (Krger, Bsel 1975). 7 Hjdu, S.; Hjdu, E.O.: Cytopthology of srcoms nd other nonepithelil mlignnt tumors (Sunders, Phildelphi 1976). 8 Hjdu, S.; Melmed, M.: Needle iopsy ofprimry mlignnt one tumors. Surgery Gynec. Ostet. 133: (1971). 9 Lichtestein, L.: Tumori delle oss (Verduci, Rom 1973). IO Lopes Crdozo, P.: Atls of clinicl cytology (Leyden University Press, Leyden/Heinemnn, London/Lippincott, Phildelphi/Edition Medizin Chemie Verlg, Weinheim, 1975). II Plomini, L.; Vetrni, A.; Mrinò, D.: Aspirtion iopsy cytology (ABC) in metsttic osteolytic lesions (Astrct No. 233). 70th Int. Congr. Cytol. Miinchen Plomini, L.; Vetrni, A.; Mrinò, D.: Citologi su gospirto d lesioni osteolitiche mligne. Atti 2 Congr. Nz. SAPOI, Bergmo Roins, G.; Brothers, I. III; Eerhrt, W.; Qun, S.: Is spirtion iopsy of rest cncer dngerous to the ptient? Cncer 7: (1954). 14 Schjowicz, F.; Ackermn, L.L.; Sissons, H.A.; Soin, L.H.; Torloni, H.: Histologicl typing of one tumors. Interntionl Histologicl Clssifiction of tumors No.3 (WHO, Genev 1972). 15 Schjowicz, F.; Derqui, I.: Puncture iopsy in lesions of the locomotor system: review of results in 4,050 cses, including 941 verterl punctures. Cncer 21: (1968). 16 Schricker, K.Th.; Hermnek, P.: Intropertive histology or cytology? Virchows Arch. At. A Pth. Ant. Histol. 362: (1974). 17 Sinner, W.; Zjicek, I.: Implnttion metstsis fter percutneous trnsthorcic needle spirtion iopsy. Act rdiol. (Dig.) 17: (1976). 18 Stormy, N.; Àkermn, M.: Cytodignosis ofone lesions y mens of fine-needle spirtion iopsy. Act cytol. 17: (1973). 19 Tkhshi, M.: Color tis of cncer cytology (Thieme, Stuttgrt 1971). 20 Thommesen, P.; Frederiksen, P.; Lowhgen, T.; Willems, 1.: Needle spirtion iopsy in the dignosis of Iytic one lesions in histiocytosis X, Ewing's srcom nd neurolstom. Act rdiol. oncol. 17: (1978). 21 Zjicek, I.: Aspirtion iopsy cytology. I. Cytology ofsuprdiphrgmtic orgns (Krger, BseI1974). 22 Zjicek, 1.: The spirtion iopsy smer; in Koss, Dignostic cytology nd its histopthologic ses (Lippincott, Phildelphi 1979). 23 Zugie, F.T.: Dignostic histochemistry (Mosy, St. Louis 1970). Received: Jnury 29, 1982 Accepted: My 5, 1982 Prof. L. Plomini, Cytopthology Service, Institute of Antomie Pthology 2nd Fculty of Medicine nd Surgery, University of Nples, Vi S. Pnsini 5, Nples (Itly)

27 June Bmnly L. WALTER ET AL.: RESPONSE OF CERVICAL CANCERS TO IRRADIATION

27 June Bmnly L. WALTER ET AL.: RESPONSE OF CERVICAL CANCERS TO IRRADIATION 27 June 1964 Bmnly MEDICAL JOURNAL L. WALTER ET AL.: RESPONSE OF CERVICAL CANCERS TO IRRADIATION x 1,638.) FIG. 2.-Foci of sme tumour s in Fig. 1 contining vible tumour cells with scnty cytoplsm, reltively