Use of electron microscopic evaluation for the diagnosis of adrenal cortical carcinoma in fine needle aspiration cytology: a case report and review of the literature

Bilateral adrenal tumors were detected in a 72-year-old man who had a history of hepatic inflammatory pseudotumor. Computet tomography (CT)-guided fine needle aspiration cytology (FNAC) of the adrenal glands was performed. The cytologic findings were similar to the previous diagnosis of "inflammatory pseudotumor" in the liver. However, the origin of some aggregated large atypical cells observed in the adrenal FNAC specimens was not known. Immunocytochemically, these large atypical cells were positive for vimentin and negative for cytokeratin and chromogranin A. An electron-microscopic study showed that these large atypical cells contained mitochondria with tubulovesicular cristae and smooth endoplasmic reticulum arranged in whorled and laminated patterns, and these findings confirmed diagnosis of primary adrenal cortical carcinoma. The histopathological diagnosis of the resected bilateral adrenal tumor was adrenal cortical carcinoma. The patient died 7 months after surgery, with recurrence of the bilateral adrenal cortical carcinoma and extensive metastases. A diagnosis of primary adrenal cortical carcinoma with extensive metastases was finally demonstrated by autopsy. Retrospectively, the previous liver tumor was determined to be a metastatic lesion.     

Cytodiagnosis of secretory carcinoma of the breast: a report on two cases

Secretory carcinoma of the breast is a rare (<1%) low grade breast carcinoma which shows distinct features at histology. Diagnosis of this carcinoma at fine needle aspiration cytology (FNAC) is difficult. Two cases of secretory carcinoma of the breast presenting as a breast mass, one in a 24-year-old female and the other in a 40-year-old female are reported, highlighting their appearance at FNAC. In both the cases the aspirates were cellular and consisted of clusters and single cells with uniform round nuclei showing minimal nuclear atypia. Most of the cells had moderate to abundant cytoplasm with prominent intracytoplasmic vacuoles. Many cells showed a plasmacytoid appearance and others were binucleate. A typical amphophilic bubbly cytoplasm of the tumor cells was observed. Both cases were confirmed as secretory carcinoma on histology. The differences in cell morphology at FNAC of secretory carcinoma of the breast from other breast carcinomas, and its utility of making a preoperative diagnosis are discussed.     

Granular cell tumour: a pitfall in FNA cytology of breast lesions

Granular cell tumours of the breast are rare lesions that may mimic an invasive carcinoma. The fine needle aspiration cytology (FNAC) findings in five cases are presented with specific attention to the pitfalls in the cytological diagnosis of these lesions.     

Fine‐needle aspiration cytology of adenoid cystic carcinoma of the breast

Adenoid cystic carcinoma (ACC) of the breast is a rare variant of breast malignancy and has a better prognosis than its counterpart in the salivary glands. In this communication, our experience with seven cases of ACC of the breast is presented in which the diagnosis was established on fine‐needle aspiration cytology (FNAC). The cytologic samples in all cases were cellular and featured three‐dimensional clusters of uniform ductal epithelial cells with cystic spaces, bland nuclei, fine chromatin, and scanty cytoplasm arranged around spheres or cores of homogenous material. The cytodiagnosis of ACC in all cases correlated with subsequent examination of cell blocks of the aspirate and tissue. The cytodiagnostic criteria for ACC of the breast which are useful in a correct FNAC diagnosis are discussed. Diagn. Cytopathol. 1999;20:82–84. © 1999 Wiley‐Liss, Inc.     

Adrenal histoplasmosis: a diagnosis on fine needle aspiration cytology

Histoplasmosis is a fungal disease endemic in central and eastern states of United States, South America, Africa, and Asia. It may present as chronic pulmonary infection or in disseminated form of infection. The disseminated form of histoplasmosis frequently affects the adrenal gland and is more likely to affect immunocompromised patients as compared to immunocompetent individuals. There are very few cases of adrenal histoplasmosis diagnosed on fine needle aspiration cytology. In the present era when fine needle aspiration has become popular modality for diagnosis, adrenal fine needle aspiration is still a less commonly practiced technique. We report eight cases of adrenal histoplasmosis diagnosed on fine needle aspiration cytology in patients with bilateral adrenal masses. The present case series supports the role of fine needle aspiration cytology of adrenal gland infections where surgery can be prevented and a definitive diagnosis can be made on which treatment can be offered.     

Adenomyoepithelioma of the breast: a potential diagnostic pitfall on fine needle aspiration cytology

Adenomyoepithelioma is a rare myoepithelial cell-rich tumour of the breast. We report a case of adenomyoepithelioma in a 60-year-old female, where it evoked the suspicion of a carcinoma on fine needle aspiration cytology (FNAC) smears and also review the literature on FNAC diagnosis of this rare tumour.     

Basal cell adenoma: a diagnostic dilemma on fine needle aspiration cytology

Basal cell adenoma (BCA) is a rare neoplasm which is one of the basaloid tumors of salivary gland. Basaloid tumors are the most difficult problem in salivary gland fine needle aspiration cytology (FNAC). There are various benign and malignant tumors such as; cellular pleomorphic adenoma, basal cell adenocarcinoma, adenoid cystic carcinoma, metastatic basal cell carcinoma, metastatic basaloid squamous carcinoma and small cell carcinoma in differential diagnosis. We present a case of BCA, membranous type in a 39-year-old female with right submandibular swelling misinterpreted as adenoid cystic carcinoma (ACC) on FNAC.     

经B超引导FNAC在淋巴结结核诊断中的应用

探讨经B超引导针吸穿刺细胞学检查(FNAC)对淋巴结结核(TB)的诊断价值.在B超引导下对淋巴结进行FNAC,以鉴别淋巴结结核.FNAC诊断淋巴结肉芽肿及反应性增生病变80例,41例经病理组织学证实.FNAC诊断结核36例,肉芽肿性淋巴结炎2例,反应性增生3例.结论:经B超引导FNAC是淋巴结结核病理诊断的有效方法之一...     

Is fine needle aspiration cytology (FNAC) useful in skin adnexal masses? A study on 5 cases of pilomatixoma

Superficial cutaneous/subcutaneous nodules, caused by a variety of inflammatory, benign and malignant pathology of diverse origin, are tempting lesion for fine needle aspiration cytology (FNAC). Amongst these, adnexal tumor show considerable overlap, both in clinical manifestation as well as in histopathology. Archieval records of clinical findings, FNAC smears and reports pertaining to 5 histologically proved cases of pilomatricoma (PMX) were analyzed. Different cytological findings were graded + to +++. Pre FNAC clinical diagnoses were sebaceous cyst, tuberculous lymphadenopathy, dermatofibroma, reactive lymphadenopathy and lipoma. PMX was diagnosed on FNAC in 3 cases on finding groups of basaloid cells, ghost epithelial cells, pink fibrillary material and calcium deposits. Other cases were diagnosed as epidermal inclusion cyst with the differential diagnosis of well differentiated squamous cell carcinoma and skin appendageal tumor of undetermined origin in one case each. In all the cases, FNAC established epithelial nature of the lesion, excluding clinically mimicking inflammatory/neoplastic lesions of other origin. FNAC should be followed by excision biopsy to accurately type the epithelial neoplasm.     

Bilateral adrenal histoplasmosis in immunocompetent patients

Histoplasmosis is a fungal infection caused by Histoplasma capsulatum, which commonly presents as transient pulmonary infection that usually subsides without treatment. Disseminated histoplasmosis may affect almost all systems, including the reticuloendothelial system, lungs, gastrointestinal tract, renal tract, central nervous system, bone marrow, and adrenal glands. Adrenal gland is frequently involved in disseminated histoplamosis but commonly present as unilateral mass; bilateral involvement is rare. It is also rare in immunocompetent hosts and only few cases have been reported in past. We report four cases of adrenal histoplasmosis with bilateral involvement. These cases were initially diagnosed cytopathologically on fine needle aspirations performed on adrenal glands. All these patients were immunocompetent and two of them also had associated adrenal insufficiency. Diagnosis of adrenal histoplasmosis can be easily made on fine needle aspiration cytology. Adrenal histoplasmosis can occur in immunocompetent individuals and should be considered in differential diagnosis of bilateral adrenal masses in immunocompetent individuals. Diagn. Cytopathol. 2011;39:294–296. © 2010 Wiley‐Liss, Inc.     

Cytology of Hürthle cell neoplasms of thyroid gland

Hürthle cell neoplasms (HCN) are an uncommon group of tumors of the thyroid gland. Fine needle aspiration cytology (FNAC) is an important diagnostic tool in solitary nodules of the thyroid gland. A 5-year retrospective analysis of all cases diagnosed as HCN on cytology was performed and correlated with the corresponding histopathology wherever available. There were 13 cases diagnosed as HCN out of which 6 cases had subsequent histopathologic examination. Four were adenomas and two were carcinomas. In addition, 3 cases that were adenomas on histopathology were reported on cytology as colloid goiter with cystic degeneration in 2 cases and as follicular adenoma in 1 case. There was extensive cystic degeneration in the former two cases whereas poor cellular preservation led to misdiagnosis in the third case. There were no specific cytomorphological features that distinguished adenoma from carcinoma. FNAC has a high specificity for a diagnosis of HCN, but the sensitivity is not as high because of sampling error.     

Fine‐needle aspiration cytology of non‐small cell lung carcinoma: A paradigm shift

Lung carcinoma is one of the commonest causes of cancer related death. Fine‐needle aspiration cytology (FNAC) is a well‐established technique in the diagnosis of various malignant tumors. FNAC is now an important technique in classifying lung carcinomas and also detecting salient mutational changes in lung carcinomas. The judicious use of the various immunological markers such as TTF‐1, p40, CK 5/6, CK 7 and Napsin may help in sub‐classification of non‐small cell lung carcinomas (NSCLC). The mutational changes in epidermal growth factor receptor (EGFR) and ALK genes are needed in targeted therapy of adenocarcinoma of lung. With the help of immunocytochemistry, polymerase chain receptor, fluorescent in situ hybridization and next generation sequencing, one can detect various mutational changes in NSCLC. In this review article, we have discussed the role of cytology and other ancillary techniques to classify lung carcinomas. The important mutational changes in lung carcinoma for targeted therapy have also been discussed in detail.     

Hepatocellular carcinoma metastasizing to the orbit diagnosed by fine needle aspiration cytology

Hepatocellular carcinoma (HCC) rarely metastasizes to the orbit. We report a case of a 78-year-old man with a past history of HCC, who presented with a periorbital mass, which was diagnosed as metastatic HCC by fine needle aspiration cytology (FNAC) and subsequently confirmed on excision biopsy. The cytological, histopathological and immunohistochemical findings are presented and the differential diagnosis is discussed. To our knowledge there has been no previously reported case of HCC metastatic to the orbit diagnosed by FNAC.     

Cutaneous and subcutaneous metastases from internal malignancies: an analysis of cases diagnosed by fine needle aspiration

Cutaneous and subcutaneous metastases from internal malignancies are rare and indicate a dismal outcome for the patient. This study is designed to analyze cases of cutaneous and subcutaneous metastases from a known or unknown primary and evaluate usefulness of fine needle aspiration cytology as a diagnostic modality. The present study is a retrospective analysis of 83 patients who were diagnosed with metastatic skin deposits on fine needle aspiration cytology. Seventy-four patients were previously diagnosed cases of malignancy and nine patients had metastatic deposits simultaneously with the primary tumor. The commonest malignancies showing cutaneous metastases were from breast, colon and rectum, lung, ovary, and thyroid. The differential diagnoses are from primary cutaneous tumors. FNAC provides a rapid diagnosis and should be used as a preferred first line diagnostic modality in such patients. In our study, FNAC yielded a sensitivity and specificity of 100% as a microscopic method for confirmation.     

Fine-needle aspiration cytology of Sister Mary Joseph's (paraumbilical) nodules

During a period of 5 years (2001-2005), six cases of Sister Mary Joseph's nodule (umbilical metastasis) were diagnosed by fine needle aspiration cytology (FNAC). In all the cases, FNAC of umbilical nodules was the first investigation and subsequently the patients were investigated for the primary tumor. The primary carcinoma was found in the stomach in three cases, ovary in two cases and one case was of non-Hodgkin's lymphoma. Based on our findings, we suggest FNAC as an initial diagnostic procedure in cases suspected of umbilical metastasis. It is not only simple, fast, accurate and inexpensive but can also save the patient from other invasive diagnostic procedures.     

Aspiration cytology of extramammary tumours metastatic to the breast

This study was undertaken to highlight the use of fine needle aspiration cytology (FNAC) to distinguish tumours metastatic to the breast from primary breast malignancies. A total of 1866 fine needle aspirates of the breast were performed during a period of 7 years. Three hundred and fourteen cases of breast malignancies were diagnosed and 5 (1.5%) out of these cases were metastatic in origin. The metastatic tumors included, 2 cases of malignant melanoma (chest wall and left arm), 1 case each of haematolymphoid malignancy, adenocarcinoma of the ovary, and squamous cell carcinoma (left leg). FNA diagnosis of metastasis to the breast is essential in order to avoid unnecessary mastectomy and to ensure appropriate chemotherapy and/or irradiation treatment.     

Artificial neural network in diagnosis of lobular carcinoma of breast in fine‐needle aspiration cytology

In this study, we applied artificial neural network (ANN) for the diagnosis of lobular carcinoma in fine‐needle aspiration cytology (FNAC) material. We selected a total of 64 cases of histology proven breast lesions consisting of 20 fibroadenomas, 28 infiltrating ductal carcinomas (IDC), and 16 infiltrating lobular carcinomas (ILC). Detailed cytomorphological features were studied on representative Haematoxylin–Eosin (H&E) and May‐Grunwald Giemsa stained slides. Image morphometric analysis was performed on Haematoxylin–Eosin stained smears to study nuclear area, diameter, perimeter, roundness, convex area, and convex perimeter. Both the qualitative cytological features and objective morphometric data were collected and a total of 18 variables were studied. Back propagation ANN was designed and this data were used as input values. ANN network was designed as 34‐17‐3. There were a total of 34 first layers neurons, 17 hidden neurons and three output neurons. The total cases were randomly divided automatically by the program into three groups: training set (40), validation set (8), and test set (16). After the successful training, the program was able to differentiate all the benign and lobular carcinoma cases and majority of the ductal carcinoma cases. In test set, the ANN program successfully classified all the cases of benign, and ILC cases and six of seven IDC cases. A suitably designed ANN may be able to diagnose the lobular carcinoma of breast on FNAC material. ANN is an efficient software program with immense potential. Diagn. Cytopathol. 2013. © 2011 Wiley Periodicals, Inc.     

对乳腺肿物针吸细胞学诊断标准的探讨——951例细胞学与组织学的对照分析

目的：探讨乳腺肿物针吸细胞学检查（FNAC）的基本形态学要素及拟定的诊断标准的可靠性与局限性。方法：对4309例患者行FNAC检查,其中951例获得组织病理学核对。结果：413例针吸涂片中,多数性质相同的病例显示具有相对一致的形态学变化特征。732例恶性肿瘤诊断的敏感性为97．3％,219例良性病变诊断的特异性为97．7％,总准确率为97．4％;假阴性率为2．7％,潜在假阳性率为2．3％,无1例假阳性,总误诊率为2．6％。结论：（1）导管上皮细胞分化、排列方式以及良性裸核细胞的数量是分析乳腺肿物FNAC形态学变的3个基本要素。（2）拟定的乳腺肿物FNAC诊断标准检查结果可靠性很强;但仍存在一定的局限性,需要通过病理组织学诊断解决。     

A comparison of the use of the 'Tru-Cut' needle and fine needle aspiration cytology in the pre-operative diagnosis of carcinoma of the breast

Two methods of obtaining a pre-operative diagnosis of carcinoma of the breast are compared. Tru-Cut needle biopsy was carried out on 368 consecutive patients with palpable breast lumps, and both Tru-Cut biopsy and fine needle aspiration cytology were performed during part of this study on 163 of the patients. A final histological diagnosis was obtained in each patient, at excision biopsy or mastectomy. There were 278 patients with carcinoma and 90 with benign breast disease. A correct positive diagnosis of carcinoma was made by the Tru-Cut method in 73.5% of cases, but in only 52% of cases by aspiration cytology. More importantly, there were no false positive diagnoses of carcinoma with Tru-Cut biopsy, but five cases of benign breast disease were incorrectly diagnosed as carcinoma by aspiration cytology. It is concluded that Tru-Cut biopsy is sufficiently reliable to be able to proceed direct to mastectomy following a positive diagnosis of carcinoma, in distinction to aspiration cytology with which an unacceptably high number of false positives occurs. The benefits of a pre-operative Tru-Cut biopsy diagnosis are identified.     

Papillary carcinoma of the thyroid and its variants: a cytohistological correlation

Fine-needle aspiration cytology (FNAC) is considered highly specific for the diagnosis of papillary carcinoma of the thyroid (PCT). In recent years, several variants of PCT have been described. An attempt was made to gauge the accuracy of classification of variants of PCT on aspirates. Cytology smears from 124 of 150 cases of histologically proven PCT with a prior FNAC were reviewed over a 16-yr period. A diagnosis of papillary carcinoma on FNAC was made in 93 cases. Further subclassification of these cases was done on cytology and tissue sections independently. The variants of PCT classified on FNAC were classical PCT (PCT-CL), 76 cases; Hurthle-cell variant (PCT-HCV), 3 cases; follicular variant (PCT-FV), 6 cases; tall-cell variant (PCT-TCV), 2 cases; high-grade variant (PCT-HG), 2 cases; and 2 cases each which were debatably PCT-CL/PCT-FV and PCT-CL/PCT-HG. Cytology typing was accurate in 65 of the 72 classical variants, while only 7 of the 22 follicular variants were correctly identified on cytology. Two of the 3 high-grade papillary carcinomas (PCT-HG) were identified on FNAC, and the solitary case of tall-cell variant could readily be classified on cytology. In conclusion, identification of the various variants of PCT is possible, though difficulty is encountered in correctly categorizing the follicular variant, which is often mistaken for a follicular neoplasm. Also, identification of the solid variant and the papillary carcinoma with nodular fasciitis-like stroma was a problem on cytology. Another interesting observation in our series is that an admixture of various cell types was seen in the smears and corroborated on histology to be present in focal areas.