Primary thymic epithelial neoplasms are unusual tumors that have been the subject of much interest and debate, and their natural behavior has been difficult to determine. In this chapter the authors review current concepts on the classification and criteria for diagnosis of thymic carcinoma.
In patients with a palpable or radiographically identified pancreatic lesion, FNA is a safe and accurate procedure for procuring diagnostic tissue. Complications of the procedure are rare, and the morbidity and mortality are considerably less than that associated with open laparotomy and wedge biopsy. The most common complication associated with pancreatic FNA is acute pancreatitis. Contraindications to FNA include an uncorrectable bleeding diathesis, marked ascites, and suspected hydatid cyst. The accuracy of FNA for diagnosing pancreatic adenocarcinoma is about 80%, and the overall sensitivity can be increased by multiple needle passes. Close communication and collaboration among the clinician, radiologist, and pathologist can help assure that suitable tissue is obtained and maximize the diagnostic yield of the procedure. To this end, the presence of the pathologist or a cytotechnologist at the FNA procedure is desirable to assess the tissue as it is procured. The vast majority of malignant pancreatic neoplasms are ductal adenocarcinomas. Thus, the primary diagnostic problem facing the pathologist is differentiating adenocarcinoma from benign and/or inflammatory processes. The three key cytologic features that aid in this distinction are anisonucleosis, increased nuclear size, and nuclear molding. When all three of these features are present, the sensitivity of the procedure approaches 98%, and its specificity approaches 100%.
Fine-needle aspiration is increasingly used in community practices for the diagnosis of salivary gland lesions, and it often renders an unequivocal diagnosis. This chapter discusses in detail the technical considerations of FNA, non-neoplastic and inflammatory conditions, benign neoplasms, common malignant neoplasms, and rare malignant neoplasms.
Because the list of interstitial lung diseases is so extensive, encompassing more than 180 chronic lung diseases in which the interstitium is altered by inflammation and/or fibrosis, this chapter focuses on several inflammatory lung diseases of unknown etiology: usual interstitial pneumonitis, respiratory bronchiolitis, idiopathic bronchiolitis obliterans with organizing pneumonia, pulmonary Langerhans' cell granulomatosis, hypersensitivity pneumonitis, and lymphangioleiomyomatosis.
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