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Fine-needle aspiration biopsy of small round blue cell tumors of childhood
Abstracts
ELLIOT ABEMAYOR,
MD, PHD, EDITOR
Fine-Needle Aspiration Biopsy of Small Round Blue Cell Tumors of Childhood. BE McGahey, AT Moriarty, 69:1067-1073,
WA Nelson, 1992
MT Hull.
Cancer
Fine needle aspiration biopsy (FNA) is widely accepted for diagnosing head and neck lesions in adults. However, acceptance of this modality in pediatric patients has been slow. Little data exists on the evaluation of small round blue cell tumors of childhood by FNA. The current paper reports a large pediatric series of FNA collected over a g-year period. During that time, only 6% of the FNAs were considered inadequate. Eighty percent of the malignant aspirates were small round blue cell tumors. These consisted of lymphomas, various sarcomas, medulloblastomas, and other tumors. Thirty eight percent of the aspirates were obtained to render a primary diagnosis and 62% documented a recurrence. Various combinations of electron microscopy, immunocytochemistry, and other special stains were used to confirm the diagnosis in 28% of cases. Various sites were aspirated, including the maxilla, mandible, parotid, etc. FNA was extremely valuable in establishing a primary diagnosis documenting recurrent disease or staging pediatric patients. FNA is effective in retrieving material which can be studied by special staining techniques. FNA is cost-effective and can potentially obviate the need for surgery. As in other studies, FNA is highly dependent on the skill of the pathologist for effective specimen gathering and interpretation. The authors conclude that FNA of small round blue cell tumors is a safe, accurate technique in pediatric patients. A major deficit of this paper is the lack of breakdown of the aspirated sites. With the use of ultrasound-guided and CTand MRI-guided FNA, few lesions of the head and neck are inaccessible. This paper warrants careful study in order to use FNA more effectively in the pediatric population.
Diagnosis of Nasopharyngeal Carcinoma by DNA Amplification of Tissue Obtained by FineNeedle Aspiration. R Feinmesser, I Miyazaki, R Cheung, JL Freeman, Engl J Med 326:17-21,
AM Noyek, HM Dosch. N 1992
The diagnosis of nasopharyngeal carcinoma (NPC) can be difficult because of difficulties in visualizing the nasopharynx and the fact that some lesions
120
American
Journal
of Otolaryngology,
may be entirely submucosal. Epstein-Barr virus (EBV) has been associated with lymphoid and nonlymphoid tumors but rarely with squamous cell lesions. This well-known relationship between NPC and EBV is based on the findings of serum viral antibodies and identification of viral DNA in epithelial tumor cells. The present paper investigated the relation between EBV and nasopharyngeal carcinoma with neck metastases. The polymerase chain reaction, which can detect low levels of DNA, was employed to detect cells positive for EBV. Samples of metastatic squamous cell carcinoma of the neck obtained by fine needle aspiration and open biopsy of lymph nodes were tested for the presence of EBV genomes. Of 41 malignant lesions examined, 9 nasopharyngeal carcinomas contained EBV genomes. None of the 20 nodes with other types of cancer, the 10 disease-free nodes, or any of the 105 normal control samples contained detectable EBV. In patients with suspected NPC, fine needle aspiration can provide tissue for the diagnosis of DNA amplification of EBV genomes. The presences of EBV in cervical metastases from an occult primary is predictive of the development of overt nasopharyngeal carcinoma. This paper is rather important in that it shows the use of sensitive molecular biologic techniques to detect small amounts of DNA in cervical lymph node material obtained by fine needle aspiration or open biopsy. It is particularly important if the primary tumors are not seen and in patients with an undiscovered primary cancer. If demonstrated to be specific, the finding of EBV genomes in cervical lymph node metastases may indicate the need for aggressive treatment to the nasopharynx.
Sinusitis
in Children.
326:319-323,
ER Wald.
N Engl J Med
1992
One of the most common clinical problems in primary care is the treatment of upper respiratory tract infections (URIS) in children. It is estimated that 5% to 10% of URIS in early childhood are complicated by acute sinusitis. This paper is an excellent review of this problem by a respected pediatric otolaryngologist. The anatomy and physiology of the sinuses are reviewed, particularly as they relate to the pediatric population. The author emphasizes that the presentation of sinusitis in children may be very subtle. URIS that don’t improve with time should be suspected of being sinusitis. Standard imaging techniques are probably not as helpful as
Vol 13, No 2 (March-April),
1992: pp 120-123
ELLIOT ABEMAYOR,
MD, PHD, EDITOR
Fine-Needle Aspiration Biopsy of Small Round Blue Cell Tumors of Childhood. BE McGahey, AT Moriarty, 69:1067-1073,
WA Nelson, 1992
MT Hull.
Cancer
Fine needle aspiration biopsy (FNA) is widely accepted for diagnosing head and neck lesions in adults. However, acceptance of this modality in pediatric patients has been slow. Little data exists on the evaluation of small round blue cell tumors of childhood by FNA. The current paper reports a large pediatric series of FNA collected over a g-year period. During that time, only 6% of the FNAs were considered inadequate. Eighty percent of the malignant aspirates were small round blue cell tumors. These consisted of lymphomas, various sarcomas, medulloblastomas, and other tumors. Thirty eight percent of the aspirates were obtained to render a primary diagnosis and 62% documented a recurrence. Various combinations of electron microscopy, immunocytochemistry, and other special stains were used to confirm the diagnosis in 28% of cases. Various sites were aspirated, including the maxilla, mandible, parotid, etc. FNA was extremely valuable in establishing a primary diagnosis documenting recurrent disease or staging pediatric patients. FNA is effective in retrieving material which can be studied by special staining techniques. FNA is cost-effective and can potentially obviate the need for surgery. As in other studies, FNA is highly dependent on the skill of the pathologist for effective specimen gathering and interpretation. The authors conclude that FNA of small round blue cell tumors is a safe, accurate technique in pediatric patients. A major deficit of this paper is the lack of breakdown of the aspirated sites. With the use of ultrasound-guided and CTand MRI-guided FNA, few lesions of the head and neck are inaccessible. This paper warrants careful study in order to use FNA more effectively in the pediatric population.
Diagnosis of Nasopharyngeal Carcinoma by DNA Amplification of Tissue Obtained by FineNeedle Aspiration. R Feinmesser, I Miyazaki, R Cheung, JL Freeman, Engl J Med 326:17-21,
AM Noyek, HM Dosch. N 1992
The diagnosis of nasopharyngeal carcinoma (NPC) can be difficult because of difficulties in visualizing the nasopharynx and the fact that some lesions
120
American
Journal
of Otolaryngology,
may be entirely submucosal. Epstein-Barr virus (EBV) has been associated with lymphoid and nonlymphoid tumors but rarely with squamous cell lesions. This well-known relationship between NPC and EBV is based on the findings of serum viral antibodies and identification of viral DNA in epithelial tumor cells. The present paper investigated the relation between EBV and nasopharyngeal carcinoma with neck metastases. The polymerase chain reaction, which can detect low levels of DNA, was employed to detect cells positive for EBV. Samples of metastatic squamous cell carcinoma of the neck obtained by fine needle aspiration and open biopsy of lymph nodes were tested for the presence of EBV genomes. Of 41 malignant lesions examined, 9 nasopharyngeal carcinomas contained EBV genomes. None of the 20 nodes with other types of cancer, the 10 disease-free nodes, or any of the 105 normal control samples contained detectable EBV. In patients with suspected NPC, fine needle aspiration can provide tissue for the diagnosis of DNA amplification of EBV genomes. The presences of EBV in cervical metastases from an occult primary is predictive of the development of overt nasopharyngeal carcinoma. This paper is rather important in that it shows the use of sensitive molecular biologic techniques to detect small amounts of DNA in cervical lymph node material obtained by fine needle aspiration or open biopsy. It is particularly important if the primary tumors are not seen and in patients with an undiscovered primary cancer. If demonstrated to be specific, the finding of EBV genomes in cervical lymph node metastases may indicate the need for aggressive treatment to the nasopharynx.
Sinusitis
in Children.
326:319-323,
ER Wald.
N Engl J Med
1992
One of the most common clinical problems in primary care is the treatment of upper respiratory tract infections (URIS) in children. It is estimated that 5% to 10% of URIS in early childhood are complicated by acute sinusitis. This paper is an excellent review of this problem by a respected pediatric otolaryngologist. The anatomy and physiology of the sinuses are reviewed, particularly as they relate to the pediatric population. The author emphasizes that the presentation of sinusitis in children may be very subtle. URIS that don’t improve with time should be suspected of being sinusitis. Standard imaging techniques are probably not as helpful as
Vol 13, No 2 (March-April),
1992: pp 120-123