Halliday B E, Silverman J F, Finley J L
Department of Pathology and Laboratory Medicine, East Carolina University School of Medicine, Greenville, North Carolina, USA.
Diagn Cytopathol. 1998 Apr;18(4):270-5. doi: 10.1002/(sici)1097-0339(199804)18:4<270::aid-dc4>3.0.co;2-g.
To assess the value of fine-needle aspiration (FNA) cytology for the diagnosis of amyloid, we retrospectively studied all FNA cases diagnosed as having amyloid during a 6-yr period (1990-1996). FNA was performed on both superficial and deep locations. A total of 6 cases containing amyloid was studied, including primary medullary thyroid carcinoma, metastatic medullary thyroid carcinoma to a vertebrae, multiple myeloma, squamous-cell carcinoma of the lung metastatic to a hilar lymph node, primary pulmonary amyloid, and amyloid tumor in a vertebral body in a patient with primary systemic amyloidosis. Despite the location or disease association, the cytologic appearance of amyloid in all cases was similar. On Diff-Quik stain, amyloid appeared as amorphous, irregular, waxy basophilic to metachromatic clumps of material. Papanicolaou stain revealed cyanophilic to organophilic clumps of material with occasional prominent fissures. In all 6 cases, amyloid was confirmed by Congo red stain and in 3 cases by a thioflavin T stain. In 4 of the 6 cases (67%), amyloid was associated with an underlying malignancy. In 3 cases malignant cells were admixed with the amyloid, and in another case malignancy was present at a distant site. We conclude that FNA biopsy is a helpful initial procedure for the evaluation of patients with amyloid deposits. The clinical implications of amyloid found in any particular body site include both benign and malignant conditions. The presence of an associated neoplasm must be especially considered in the differential diagnosis of amyloid deposits.
为评估细针穿刺（FNA）细胞学检查对淀粉样变诊断的价值，我们回顾性研究了1990年至1996年这6年间所有诊断为淀粉样变的FNA病例。FNA在浅表和深部部位均进行。共研究了6例含淀粉样变的病例，包括原发性甲状腺髓样癌、甲状腺髓样癌转移至椎体、多发性骨髓瘤、肺鳞状细胞癌转移至肺门淋巴结、原发性肺淀粉样变以及一名原发性系统性淀粉样变性患者椎体中的淀粉样瘤。尽管病变部位或疾病关联不同，但所有病例中淀粉样变的细胞学表现相似。在Diff - Quik染色中，淀粉样变表现为无定形、不规则、蜡样嗜碱性至异染性的物质团块。巴氏染色显示嗜蓝至嗜有机性的物质团块，偶尔有明显裂隙。在所有6例病例中，刚果红染色证实为淀粉样变，3例经硫黄素T染色证实。6例中的4例（67%）淀粉样变与潜在恶性肿瘤相关。3例中恶性细胞与淀粉样变混合存在，另一例远处部位存在恶性肿瘤。我们得出结论，FNA活检是评估淀粉样变沉积患者的一种有用的初始检查方法。在任何特定身体部位发现的淀粉样变的临床意义包括良性和恶性情况。在淀粉样变沉积的鉴别诊断中必须特别考虑是否存在相关肿瘤。
