Cytopathology provides diagnostic evaluation of cytology specimens that direct patient management and treatment. The Cytopathology Section provides complete diagnostic service in cytopathology for the various clinical protocols of the NIH. We specialize in the application of ancillary diagnostic techniques (i.e., immunoperoxidase, flow cytometry, and, most recently, molecular testing) to patient material for the confirmation of morphologic diagnoses and collaborative investigations. The Cytopathology Section has a distribution of specimens as follows: fine needle aspiration (FNA), 26 percent;central nervous system, 29 percent;effusions, 6 percent;respiratory, 9 percent;genitourinary, 6 percent;cervical/vaginal, 10 percent;breast, 6 percent;miscellaneous, 8 percent. The section has a high rate of malignancy--15 percent of all accessioned specimens. Due to the nature of the specimen material, a large number of our cases require immunoperoxidase studies (19 percent). The immunosuppressed nature of the patient population dictates that a significant proportion of our cases require special studies for pathologic organisms (14 percent). The relatively high rate of pathologic findings combined with the diversity of types of exfoliative and FNA specimens provide a broad experience in diagnostic cytopathology for residency and fellowship training. The Cytopathology Section is involved in numerous clinically related research studies, many of which utilize FNA with immunocytochemistry and molecular techniques to provide ancillary diagnostic information. A partial listing of such studies includes: (1) evaluation and quantitation of expression of malignant melanoma antigens (MART-1 and gp100) and HLA antigens through the utilization of monoclonal antibodies in ex-vivo FNAs from malignant melanoma patients;(2) evaluation and quantitation of expression of epithelial markers (CK AE1/AE3 and CK 8/18)) and HLA antigens through the utilization of monoclonal antibodies in ex-vivo FNAs from gastrointestinal carcinoma patients;(3) evaluation of tumor infiltrating lymphocytes samples for possible tumor cell contamination prior to therapy;(4) FNA material for subsequent polymerase chain reaction (PCR), microarray, and proteomics technologies;(5) evaluation of numerous protocol-driven neoplasms for possible therapy;and (6) evaluation of breast ductal lavage samples from high-risk populations for morphology and eventual biomarkers.
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