Chondroid syringoma diagnosed by fine-needle aspiration: A case report

We describe a case of an 82-yr-old woman presenting with a thyroid nodule and axillary mass thought to be a metastasis. Fine-needle aspiration (FNA) revealed the axillary nodule to be a chondroid syringoma. We report here the cytologic features of chondroid syringoma and recommend the use of FNA in the evaluation of cutaneous and subcutaneous lesions in general. © 1994 Wiley-Liss, Inc.     

Nodular fasciitis: Spontaneous resolution following diagnosis by fine-needle aspiration

Nodular fasciitis can be histologically mistaken for a sarcoma. Typical cases are less than 5 cm and enlarge rapidly over days or weeks before diagnosis. The natural history of nodular fasciitis is unknown, since the diagnosis is usually based on excised lesions. Fine-needle aspiration of nodular fasciitis has been described, and features benign-appearing spindle cells (singly and in groups), collagen, and myxoid material. We describe 11 cases in which nonsurgical observation led spontaneously to complete resolution. Our study includes 7 males and 4 females (24 to 73 years of age; median = 42). Lesions were located in the arm (4), thigh (3), temporal area (2), breast (1) and the parotid (1) and ranged from 0.5 to 5.0 cm. (median = 1.5). They had been present for from less than 1 to 4 weeks (median = 2). In 9 cases, spontaneous resolution occurred in from 3 to 8 weeks (median = 4). Two other patients were lost to follow-up for up to 11 months, after which resolution was noted. Small palpable masses in the subcutaneous soft tissues which evolve over a short period of time and show the cytologic features of nodular fasciitis should be managed nonsurgically. If resolution does not occur within a few weeks, surgery can then be performed. Diagn Cytopathol 1993;9:322-324.     

Mycoses of the breast: Diagnosis by fine-needle aspiration

Fungal infections of the breast are unusual and may clinically mimic carcinoma. When studied by fine-needle aspiration (FNA), such masses may yield necrosis, granulomatous inflammation, reactive histiocytes, and atypical epithelial cells. Cohesive groups of atypical epithelial cells featured nuclear enlargement and overlapping, as well as prominent nucleoli. the organisms may be widely scattered, so that careful evaluation was required for their identification. in concert with provocative clinical findings, these features may lead to an erroneous diagnosis of malignancy. We describe three women with mycotic masses of the breast initially studied by FNA. the first patient presented at age 31 with a large, firm breast mass, chest wall extension, and radiographic evidence of vertebral bone involvement. FNA was requested to confirm the clinical diagnosis of advanced breast carcinoma. in addition to the atypia described above, the smears showed yeast forms indicative of blastomycosis surrounded by neutrophils. She remains well, following antifungal treatment. the second case of Blastomycosis was diagnosed by FNA of a breast mass in a 64-yr-old woman, who also responded to treatment. the third patient's preoperative needle aspiration showed granulomas, but no organisms were identified, even with special stains; silver stains of surgically excised tissue showed histoplasmosis.     

Pulmonary mycetomas in immunocompetent patients: diagnosis by fine-needle aspiration.

Mycetomas usually grow within preexisting cavities and frequently lead to pulmonary hemorrhage. We describe four males, aged 38 to 72 years, in whom myceotomas were diagnosed by FNA. Preexisting cavitary lesions resulted from tuberculosis, anaerobic abscess, and bullous lung disease (two cases). Fine needle aspiration yielded tangled mats of fungal hyphae (large and grossly visible in three cases) and acute inflammatory cells. The atypical cells often seen in the walls of such lesions were not identified. Cultures showed Aspergillus (3 cases) Pseudoallescheria boydii (1 case). The diagnosis was surgically confirmed in two cases. Two patients were too ill for surgery and the fourth refused. At 7 and 10 months, the two remaining individuals have pulmonary hemorrhage but no evidence of progression or malignancy. In poor surgical candidates, conservative management of mycetomas diagnosed by fine needle aspiration is appropriate. Excluding mycetoma secondary to cavitary lung carcinoma requires careful correlation of historical, clinical, radiographic, cytologic, and follow-up data.     

Lipomas of anterior neck simulating thyroid nodules: diagnosis by fine-needle aspiration.

The anterior neck is an unusual location for lipomas. Cervical lipomas can be mistaken for non-functioning thyroid nodules. We report eight cases from our files diagnosed by fine needle aspiration (FNA). Our purpose is to call attention to this simple technique in establishing an accurate diagnosis and how it can contribute to better patient management by avoiding unnecessary thyroid suppressive therapy and/or surgery. We advocate using FNA as the initial diagnostic test on palpable masses in the neck. The differential diagnosis must include thyroid lipomatosis, thyrolipoma or adenolipoma, amyloid goiter with fatty infiltration, and fat-containing thyroidal neoplasms (papillary carcinoma and follicular neoplasms).     

Adenoid cystic carcinoma of the breast: Diagnosis by fine-needle aspiration

Adenoid cystic carcinoma rarely occurs as a primary breast malignancy. When seen in fine-needle aspiration (FNA) material, it is identical to its counterpart in the salivary glands. We report six cases diagnosed by aspiration in patients aged 32-82 yr. The smears were highly cellular and featured extracellular spheres of metachromatic material. These were surrounded by small, uniform cells with bland nuclei and very little cytoplasm. Numerous similar cells occurred singly in the background. The cytologic differential diagnosis of adenoid cystic carcinoma includes other entities that produce extracellular metachromatic spheres including collagenous spherulosis. We describe and illustrate similar material originating in inspissated secretions or stromal fragments from fibrocystic change and fibroadenoma, as well as infiltrating ductal carcinoma. Diagnostic criteria for adenoid cystic carcinoma and the clinical relevance of distinguishing this rare tumor from typical infiltrating ductal carcinoma are discussed.     

Primary spindle-cell sarcomas of the breast: diagnosis by fine-needle aspiration

Primary breast sarcomas (excluding cytosarcoma phyllodes and its sarcomatous recurrences) are rare neoplasms. Few have been described in the aspiration cytology literature. We report the cytologic features of two cases of stromal sarcoma (both with the pattern of malignant fibrous histiocytoma) and two cases of angiosarcoma. The dominant cytologic features included individual atypical spindle cells and fragments of collagenous stroma. Tumor giant cells were present in one stromal sarcoma. Features of possible significance in the diagnosis of angiosarcoma include obvious vessel formation by atypical spindle cells, bridging of adjacent tumor fragments by spindle cells, and microacinar structures lined by atypical spindle cells. The differential diagnostic considerations in spindle-cell breast aspirations are discussed.     

The reliability of fine-needle aspiration biopsy in the diagnosis of deep lesions of the lung and mediastinum: experience with 250 cases using a modified technique

Two-hundred and fifty discrete lesions of the lung and mediastinum were sampled by a modified fine-needle aspiration biopsy (FNAB) technique. Aspirates were collected directly into 15 ml of Saccomanno's fixative, and all preparative work was carried out in the cytopathology laboratory. Only seven aspirates were "insufficient for diagnosis," giving a productivity rate of 97%. Five insufficient aspirates later proved to be neoplasms. Of the 243 cases with a primary FNAB diagnosis, 21 had insignificant disease, 29 had benign neoplasms or nonneoplastic disease, and 193 had malignant tumors. Most malignancies could be assigned to a specific histologic type by FNAB; those that proved difficult by FNAB were usually difficult on histopathologic examination. There were no false-positive diagnoses of malignancy and only eight false-negative results. Of 12 results interpreted as "suspicious," 10 proved to be malignant on follow-up. This modified method has proven to have a low complication rate and to be both highly productive and reliable in the diagnosis of malignant and nonmalignant disease.     

Nodular pulmonary amyloidosis: Diagnosis by fine-needle aspiration cytology and a review of the literature

Solitary nodular pulmonary amyloid tumor is an uncommon benign lesion which is seldom diagnosed prior to surgical extirpation. We present a case of unsuspected nodular pulmonary amyloid tumor diagnosed by fine needle aspiration cytology. A 52-yr-old-black woman presented with a 3-cm right middle lobe mass. Percutaneous fine-needle aspiration cytology (FNA) of the mass revealed waxy amorphous material that demonstrated apple green birefringence on Congo Red Stain. Thoracotomy for diagnosis may be avoided by using FNA to diagnose these unusual lesions.     

Diagnosis of cutaneous leishmaniasis by fine-needle aspiration biopsy: report of a case

A case of cutaneous leishmaniasis diagnosed by fine-needle aspiration biopsy is presented. The cytologic smears revealed lymphocytes, plasma cells, and macrophages. Large numbers of Leishmania organisms were present within the macrophages and in the intercellular spaces. Part of the material was used for a microbiologic culture, which revealed large numbers of promastigotes. These were studied by light, transmission, and scanning electron microscopy.     

Sialadenosis of the parotid gland: Report of four cases diagnosed by fine-needle aspiration cytology

Four patients presented with a history of recurrent bilateral swellings of parotid glands. Fine-needle aspiration (FNA) specimens showed highly cellular smears containing clusters of enlarged acini and numerous naked nuclei. A diagnosis consistent with sialadenosis was made considering the distinct morphologic appearance: micrometric measurements in all cases, in addition to histology and electron microscopy in two cases confirmed this hypothesis. A review of clinical histories revealed hormonal, nutritional and neurogenic disorders, which are known to be associated with sialadenosis. In the work-up of salivary gland swellings, it is important to recognize cytologicaliy this underestimated entity, which does not necessarily require surgical treatment.     

Benign spindle and inflammatory lesions of the breast: Diagnosis by fine-needle aspiration

We describe fine-needle aspiration (FNA) findings in 7 patients with breast masses showing numerous spindle cells in smear material. the benign nature of these lesions was confirmed by clinical follow-up (n = 4) or surgical excision with histologic examination (n = 3). the final diagnosis included one case each of myofibroblastoma, juvenile hypertrophy, post-FNA reactive stromal proliferation, stromal induction in proliferative fibrocystic disease, and subareolar abscess. There were two instances of granulation tissue. the case of stromal induction was initially felt to be suspicious for phyllodes tumor. the post-FNA stromal reaction was considered sufficiently atypical to warrant histologic investigation. the importance of historical and physical examination findings in accurate interpretation of these uncommon cases is emphasized. Some will require histologic assessment for final diagnosis. © 1995 Wiley- Liss, Inc.     

Subcutaneous masses of the scalp and forehead: Diagnosis by fine-needle aspiration

We report our cytologic findings and clinical correlations in benign (N = 2) and malignant (N = 16) subcutaneous masses of the scalp (N = 15) and forehead (N = 3), studied by fine-needle aspiration (FNA). Diagnoses were divided in 3 groups: (1) Scalp plasmacytoma (as a manifestation of multiple myeloma) (6 cases) was the most frequent diagnosis. in one patient it was the presenting manifestation of the disease. (2) Miscellaneous malignancies included 8 carcinomas, 1 melanoma, and 1 malignant lymphoma. the scalp or forehead mass was the initial presentation and FNA was the initial diagnostic approach in five patients. (3) A single case each of pilar-type keratinous cyst and hematoma were the only benign masses encountered. in conclusion, a significant number of subcutaneous masses of the scalp or forehead represent metastatic or systemic malignancies, and they may be the initial manifestation of the disease. Rapid and accurate diagnosis by FNA provides guidelines for appropriate therapy, especially in those patients who present with advanced disease. © 1995 Wiley- Liss, Inc.     

Diagnosing bone lesions: A practical non-pathology centric formulaic approach

Bone lesions are perceived to be some of the most difficult lesions that pathologists encounter. The reasons for this are multiple and include lack of experience/familiarity, the need to rely heavily on non-pathology information and data, and the fact that many lesions are associated with either procedures or treatments with significant moribidity. However, in fact, the majority of bone lesions can be accurately assessed on the basis of data not directly related to traditional pathologic based assessment. In order to acheive this state, the pathologist must understand the consistent clinical parameters of most bone lesions, including their clinical presentation, the bone involved, particularly the anatomic site of the bone involved, and a fundamental, basic understanding of imaging studies, especially the plain radiograph. Once these priniciples are understood and mastered, the pathologist can easily diagnose most bone lesions, using traditional pathologic assessment to confirm the diagnosis.     

Spindle-cell lesions of the liver: diagnosis by fine-needle aspiration biopsy

Rarely, spindle-cell lesions in liver fine-needle aspiration biopsies (FNABs) are encountered. A retrospective review of our experience with lesions that are mesenchymal in origin or appearance was undertaken to elucidate the frequency and spectrum of these lesions. Image-guided liver FNABs performed over a 3-year period (n = 585) at our institution (1996-1998) were retrospectively evaluated. Cytologic smears, cell block preparations, and clinical follow-up of lesions with spindle-cell morphology were reviewed. Twenty-nine of 585 cases were of spindle-cell morphology (5%). Hemangiomas (n = 12, 41%) and metastatic sarcomas (n = 6, 21%) comprised the largest categories, followed by granulomatous inflammation (n = 3, 10%). Other cases included primary angiosarcoma and fibrolamellar hepatocellular carcinoma. The most frequent spindle-cell liver lesion encountered is hemangioma, followed by metastatic leiomyosarcoma and granulomatous hepatitis. Awareness of diagnostic possibilities, special attention to specimen adequacy, and use of ancillary procedures can maximize diagnostic yield.     

Course of cerebral lesions in a patient with periarteritis nodosa studied by magnetic resonance imaging

Summary The course is reported of a patient with periarteritis nodosa who initially presented with neurological symptoms. Multiple cerebral lesions were documented by the first magnetic resonance imaging (MRI) investigation. The majority of these had disappeared completely in the follow-up MRI studies. In contrast to neurological improvement the patient eventually died due to multiorgan failure. Postmortem histological examination revealed no pathological findings in the brain except one single necrotic area already known from MRI. Remissions of histological and angiographic alterations in periarteritis nodosa have been described as local healing leading to fibrosis and scarring. Our findings suggest that restitutio ad integrum may occur, at least in cerebral lesions.Abbreviations PAN panarteritis nodosa - MRI magnetic resonance imaging - CT computerized tomography - CNS central nervous system     

Differential diagnostic dilemmas in malignant fine-needle aspirates of liver: A practical approach to final diagnosis

We retrospectively reviewed two hundred malignant fine-needle aspirates of liver. of these 49.5% were metastatic neoplasms, 32% were hepatocellular carcinomas, and 18.5% presented with diagnostic dilemmas. in less than half of these diagnostic challenges, differential diagnosis was between hepatocellular carcinoma and metastatic adenocarcinoma. the remainder of cases involved a variety of metastatic neoplasms. Cytomorphology in association with immunocytochemistry resolved the diagnostic problems in about half of the problematic cases. Three cases were undifferentiated and remained unclassifiable. We conclude that approximately 80% of malignant lesions of liver can be correctly diagnosed by thorough cytomorphologic analysis and good clinical correlation, and 20% pose differential diagnostic dilemmas. © 1995 Willey- Liss, Inc.     

Cytomorphology of cystic parathyroid lesions: Report of four cases evaluated preoperatively by fine-needle aspiration

Cystic parathyroid lesions (CPL) account for 1–5% of neck cysts. They are seldom palpable; however, they may present as neck swellings that are mistaken both clinically and cytologically for thyroid nodules and subsequently referred for evaluation by fine-needle aspiration. We present 4 cases of histologically confirmed CPL (one simple cyst, one hyperplasia, and two adenomas), 2 of which were misdiagnosed as adenomatoid thyroid nodules by fine-needle aspiration. Aspirated fluid from one patient was clear and colorless, a classic finding for parathyroid cysts, and contained high levels of C-terminal/midmolecule parathyroid hormone (CMPH). Fluids obtained from the remaining 3 patients were bloody to brown, resembling thyroid cyst fluid. In only 1 of the 3 patients, the fluid was analyzed and contained high levels of CMPH. Though cytologic features of parathyroid epithelium overlap with those of thyroid epithelium, distinguishing features such as unusual cytoplasmic vacuolization and granularity, and the absence of colloid, should raise suspicions of a parathyroid lesion. Fluid from CPL may not possess the classic appearance; however, identification of the subtler cytologic features with knowledge of relevant clinical data should prompt analysis of cyst fluid for CMPH, thus confirming the diagnosis and avoiding inappropriate therapy. Diagn Cytopathol 1996;15:306–311. © 1996 Wiley-Liss, Inc.     

Cytospins—an alternative method for fine-needle aspiration cytology of the breast: A study of 148 cases

The aim of this study was to evaluate the cytospin technique as an alternative method to prepare fine-needle aspiration (FNA) specimens of the breast. To do so, the cytology of 148 breast FNAs that had been prepared by the cytospin technique and that had histologic correlation, was reviewed. All the cases that were diagnosed as malignant by cytology were proved malignant after surgical excision, and there were no false-positive results. All but two cases diagnosed as benign by cytology proved to be benign on excision. The two false-negative cases were missed due to sampling error. The cytological features seen on cytospins were similar to those seen on conventional direct smears. The major advantage of this method is that no aspirate is unsatisfactory due to unskilled direct smear technique. This, along with its good correlation with histology, proves that the cytospin method is an effective alternative to conventional direct smears for breast FNA. © 1995 Wiley-Liss, Inc.