Pediatric fine-needle aspiration biopsy.

A total of 135 fine-needle aspiration (FNA) biopsies from varying sites were performed in 123 children (mean, 10.5 years; range, one day to 18 years) over a five-year period. One hundred thirty (96.3%) biopsy specimens were satisfactory for evaluation. Seventy-nine cases were nonneoplastic (60.8%); among these cases, a specific diagnosis of infectious disease was made in 17 (13.1%). A diagnosis of neoplastic disease was made in 50 (38.5%) cases, of which 14 (10.8%) were benign, 28 (21.5%) were malignant, and 8 (6.2%) were neoplasms of uncertain biologic potential. The sensitivity of pediatric FNA biopsies was 90.6%, specificity 100%, positive predictive value 100%, negative predictive value 94.7%, and efficiency of the test 96.5%. There were no false-positive diagnoses and there were four false-negative diagnoses, three of which involved aspirates of the central nervous system (CNS). Ancillary studies, including immunocytochemistry (20 cases), electron microscopic examination (18 cases), microbiologic culture (8 cases), cytogenetic studies (7 cases), and flow cytometry (3 cases), were performed on the aspirated material, enabling a more specific diagnosis or supplying additional information in many cases. Definitive diagnosis by FNA biopsy enabled radiation therapy and/or chemotherapy to be administered for unresectable malignant neoplasms, provided material for culture of infectious lesions, identified benign lesions not needing surgery, and aided the surgeon in planning the extent of surgery in resectable malignant neoplasms. These results support the greater use of FNA biopsy in the pediatric population.     

Thyroid fine-needle aspiration biopsy in children and adolescents: experience with 218 aspirates

To evaluate the role of fine-needle aspiration (FNA) biopsy of thyroid nodules in pediatric and adolescent patients, the cytology reports of 218 thyroid FNA biopsies performed on children and adolescents ranging from 10 to 21 yr of age were reviewed. The cytology diagnoses were categorized into four groups: unsatisfactory, benign, suspicious, and malignant. One hundred nineteen (54%) of the aspirates were diagnosed as "benign," 20 (9%) were diagnosed as suspicious for malignancy; and 17 (8%) were diagnosed as malignant. Sixty-two (28%) of the aspirates were read as unsatisfactory for interpretation. Sensitivity of thyroid FNA in diagnosing thyroid malignancy relative to final histological diagnoses was 100%, and specificity was 65%. FNA of thyroid nodules in the pediatric and adolescent population is comparably as sensitive and specific as in the adult population. The acceptance of this procedure in the routine evaluation of young patients' thyroid nodules should reduce the number of unnecessary surgeries for benign thyroid disease.     

Diagnosis and subclassification of primary and recurrent lymphoma. The usefulness and limitations of combined fine-needle aspiration cytomorphology and flow cytometry

The primary diagnosis of non-Hodgkin lymphoma/leukemia by fine-needle aspiration (FNA) is still controversial and relatively underused. We evaluated our FNA experience with lymphomas using the revised European-American classification of lymphoid neoplasms to determine the reliability of FNA when combined with flow cytometry in the diagnosis of lymphoma, the types of diagnoses made, and the limitations of this technique. Slides and reports from all lymph node and extranodal FNAs performed during the period January 1, 1993, to December 31, 1998, with a diagnosis of lymphoma or benign lymphoid process were reviewed. There were 290 aspirates from 275 patients. These included 158 cases of lymphoma, of which 86 (54.4%) were primary and 72 (45.6%) were recurrent. There were 44 aspirates suggestive of lymphoma and 81 benign/reactive diagnoses. With diagnoses suggestive of lymphoma considered as positive for lymphoma, levels of diagnostic sensitivity and specificity were 95% and 85%, respectively. Specificity was 100% when only definitive diagnoses of lymphoma were considered. Clearly, FNA and immunophenotyping by flow cytometry are complementary and obviate a more invasive open biopsy for many patients with lymphadenopathy.     

The cytopathology of soft tissue mxyomas: ganglia, juxta-articular myxoid lesions, and intramuscular myxoma

We studied the practicality of issuing a cytologic diagnosis of myxoma/juxta-articular myxoid lesion/ganglion (MJG) by reviewing all fine-needle aspiration (FNA) biopsy specimens of soft tissue masses in our files with diagnoses of myxoma, myxoid cyst, myxoid lesion, ganglion, or ganglion cyst. The control group was soft tissue aspirates with abundant myxoid stroma. Of 39 cases with a cytologic diagnosis of soft tissue MJG, 15 had subsequent tissue biopsy or complete resection of the mass; 24 had clinicoradiologic follow-up. All cases except 1 (fat necrosis) were diagnosed correctly as benign myxoid lesions. We grouped MJG aspirates into 3 subtypes based on clinicoradiologic features: soft tissue ganglion/ganglion cyst (12 cases), juxta-articular myxoid lesion (16 cases), and intramuscular myxoma (11 cases). MJG aspirates showed few, subtle cytopathologic differences among subtypes. They characteristically had a viscous, gelatinous quality when expressed from the needle onto the glass slide. The typical smear contained a film of paucicellular, often finely granular, myxoid stroma, that contained few cells, usually macrophages or bland spindle cells. Control group aspirates always contained cellular components that allowed distinction from MJGs. The cytopathologic diagnosis of MJG lesions is accurate; FNA biopsy can be used to subtype MJGs into 3 categories when clinicoradiologic features are known.     

Fine-needle aspiration cytology of hematopoietic lesions from multiple sites

We reviewed 130 fine-needle aspiration (FNA) biopsies from 118 patients with a variety of benign and malignant hematopoietic lesions. There were 74 (57%) malignant, 45 (35%) benign, and 11 (8%) atypical diagnoses. Immunocytochemistry of the aspirated material was performed in 47 (36%) and electron microscopy in 4 (3%) of the cases. FNA cytology was utilized to make a primary hematopoietic malignant diagnosis in approximately half of the cases and to confirm recurrence in the remainder. The malignant cases included non-Hodgkin's lymphoma. Hodgkin's disease, medullary and extramedullary plasmacytoma, and granulocytic sarcoma. Forty-two malignant cases had either previous or follow-up surgical biopsy with no false-positive diagnoses. Of the 11 atypical cases, seven had surgical confirmation with five malignant and two benign diagnoses. The benign hematopoietic lesions correctly identified included acute and chronic lymphadenitis, granulomatous processes, and eosinophilic granuloma. Only 5 of the 45 benign FNA biopsies had surgical pathology follow-up, with no false-negative diagnoses. The most commonly aspirated sites were lymph nodes (71%), although hematopoietic lesions were correctly identified in a number of extranodal locations, including soft tissue (8%), abdominal viscera (6%), lungs (5%), mediastinum (2.5%), bone (3%), and thyroid, salivary gland, and breast (1.5% each). This study demonstrates the clinical utility and diagnostic accuracy of FNA cytology in the evaluation of benign and malignant hematopoietic disorders from multiple sites. Ancillary studies performed on the aspirated material aided in making a specific and accurate diagnosis.     

Fine‐needle aspiration in pediatric patients 12 years of age and younger

Fine‐needle aspiration (FNA) is a well‐established diagnostic tool in adult patients, and while in recent years it has gained popularity in the pediatric population, it is still far less universally accepted in children than in adults. A computerized search of our tertiary medical center's laboratory information system was performed for the 20‐year period from 1992 to 2012. All FNAs in children 12 years of age and younger and all related surgical pathology reports were identified. Cytologic and histologic diagnoses were stratified into six diagnostic categories—benign, atypical, suspicious, malignant, cyst contents, and nondiagnostic—and then compared to determine the utility of FNA in this patient population. Four hundred and three FNAs in 389 patients were included in this study, of which there were 288 benign (71.5%), 8 atypical (2.0%), 10 suspicious (2.5%), 42 malignant (10.4%), 12 cyst contents (3.0%), and 43 nondiagnostic (10.6%) cases. The most common benign diagnoses were reactive lymph node and inflammatory infiltrate/abscess, while the most common malignant diagnoses were leukemia/lymphoma, rhabdomyosarcoma, and neuroblastoma. Of the 127 FNAs (31.5%) with histologic follow‐up, we identified just one false positive and one false negative case. Like FNA in adults, this study shows that the technique is both sensitive (97.2%) and specific (98.5%), and has high positive predictive (97.2%) and negative predictive (98.5%) values for diagnosing malignancy in childhood. As FNA is a simpler, less invasive, and more cost‐effective procedure when compared with surgical biopsy, it represents a valuable diagnostic tool in the pediatric population. Diagn. Cytopathol. 2014;42:600–605. © 2013 Wiley Periodicals, Inc.     

Fine-needle aspiration cytology of the adrenal gland. Fifty biopsies in 48 patients.

Fine-needle aspiration biopsy of 50 adrenal masses from 48 patients was performed between 1984 and 1991. The series consisted of 28 males and 20 females, with an age range of 12 months to 79 years (mean age, 55 years). Clinical and/or pathologic follow-up was available in 37 patients. Fine-needle aspiration was diagnostic in all 29 malignant cases having follow-up, with no false-positive diagnoses. There were six primary malignancies (three neuroblastomas, two pheochromocytomas, and one adrenal cortical carcinoma) and 23 metastatic lesions. Of these, the lung was the most frequent primary malignancy (60%), followed by melanoma and renal cell carcinoma (8.6% each). The remaining nonmalignant fine-needle aspiration diagnoses were adrenal cortical neoplasms (most likely adenoma), adrenal cortical hyperplasia, myelolipoma, benign adrenal tissue, and abscess. Based on clinical follow-up, three other adrenal adenomas were not diagnosed by fine-needle aspiration. Six biopsy specimens (12%) were insufficient for diagnosis. Ancillary studies including electron microscopy and/or immunocytochemistry were performed on 13 malignant aspirates and provided additional confirmation of the cytology diagnosis in 12 cases. This study confirms that fine-needle aspiration is a sensitive and highly specific procedure for the evaluation of primary and metastatic malignancies involving the adrenal gland. The technique is less useful in the workup of benign processes but, in some instances, can provide specific diagnostic information.     

Fine-needle aspiration in the management of peripheral lymphadenopathy in a developing country.

Fine-needle aspiration (FNA) is a simple, cheap, and well-tolerated procedure that is well-established as a method of definitive diagnosis of palpable masses. This review reports the role of FNA in the investigation of peripheral lymphadenopathy as an alternative to expensive surgical excision biopsy in developing countries, where there are limited funds and facilities. All lymph node aspirates done in the FNA clinic at the Department of Pathology, University College Hospital, Ibadan, between 1995-1997 were reviewed. The aspirates were obtained using 21- or 22-gauge needle with a 5- or 10-ml disposable plastic syringe, smeared on standard microscopic slides and stained with Giemsa and/or Papanicolou stains. The most common diagnosis was reactive change/nonspecific inflammation, constituting 33.4%; tuberculosis and metastatic lesions made up 25. 7% and 22.4%, respectively, while lymphoma constituted 16.9% of cases. The commonly aspirated nodes were cervical. Tuberculosis was the most frequent diagnosis in these nodes and was the most commonly diagnosed infective condition, particularly in those under age 20 years. The sensitivity and specificity of lymph node FNA in the diagnosis of tuberculosis were 79.5% and 100%, respectively. The overall accuracy rate of lymph node aspiration was 89.5%. Our study showed that FNA is a simple, cost-effective procedure which offers a reliable method of diagnosis in distinguishing reactive lymphadenopathy, tuberculosis, and malignant conditions. Diagn. Cytopathol. 1999;21:159-162.     

Pancreatic fine‐needle aspiration cytology in patients < 35‐years of age: A retrospective review of 174 cases spanning a 17‐year period

Pancreatic lesions in young patients are relatively rare and, to our knowledge, the clinical value of pancreatic fine needle aspiration (FNA) in patients < 35 years of age has not been previously established by any other large retrospective studies. All pancreatic endoscopic ultrasound‐guided FNA (EUS‐FNA) cases performed on patients < 35 years of age were identified for a 17‐year period (1994–2010). All FNAs and all available correlating surgical pathology reports were reviewed. There were a total of 174 cases of pancreatic FNA performed on 109 females and 65 males under the age of 35 (range: 8–34, mean: 27 years). The FNA diagnoses included 37 malignant, 114 negative, nine atypia/suspicious, and 14 cases that were nondiagnostic. Of the 37 malignant FNA cases, the diagnoses included 18 pancreatic neuroendocrine tumors (PanNeT), 11 solid pseudopapillary neoplasms (SPN), five adenocarcinomas and three metastatic neoplasms. Histologic follow‐up was available in 22 of the 37 malignant cases diagnosed by FNA, and the diagnosis was confirmed in 21 cases. One pancreatoblastoma was misclassified as SPN on EUS‐FNA. False negative diagnoses were noted in three cases of low‐grade mucinous cystic neoplasm and one case of PanNeT. The most common type of neoplasms diagnosed by EUS‐FNA in patients < 35‐year old is PanNeT, followed by SPN with both tumors accounting for 75% of all the neoplasms encountered in this age group. The sensitivity and specificity for positive cytology in EUS‐FNA of the pancreas to identify malignancy and mucinous neoplasms were 90% and 100%, respectively. Diagn. Cytopathol. 2014;42:297–301. © 2013 Wiley Periodicals, Inc.     

Fine-needle aspiration biopsy of the salivary gland: Problem cases

Among 582 fine-needle aspiration (FNA) biopsies of major and minor salivary glands performed between 1974 and 1990, lack of cytological histologic correlation was noted in 21 cases. Of these, the cause in 10 FNAs was inadequate cytological sampling of the lesion. [One case of malignant hemangiopericytoma was tentatively diagnosed as a monomorphic adenoma on FNA, a polymorphic T-cell lymphoma was diagnosed as granulomatous inflammation on aspiration biopsy, a benign lymphoepithelial lesion was diagnosed as a reactive lymph node, a branchial cleft cyst was called benign mixed tumor (BMT), one case of chronic sialoadenitis was called BMT by FNA, two cases of benign lymphoepithelial lesion (BLEL) were diagnosed as cystic Warthin's tumor, two low-grade mucoepidermoid carcinomas were called BMT, and a BMT was cytologically diagnosed as a Warthin's tumor with squamous metaplasia versus low-grade mucoepidermoid carcinoma. One case of low-grade mucoepidermoid carcinoma was diagnosed only as a “cyst.”] Review of these cases identifies constant features that permit differentiation between Warthin's tumor and BLEL, and among BMT, mucoepidermoid carcinoma, and chronic sialoadenitis. Despite a few problem cases, FNA of the salivary gland is accurate in the preoperative diagnosis and classification of salivary gland neoplasms.     

Fine-needle aspiration of granulocytic sarcomas: a morphologic and immunophenotypic study of seven cases

Granulocytic sarcoma is an uncommon extramedullary, solid tumor of myeloid cells. Only rarely has this entity been diagnosed by fine-needle aspiration (FNA) cytology. This report encompasses the cytologic findings of FNAs from seven patients with granulocytic sarcomas, including four male and three female patients with a mean age of 52 years (range, 12 to 77 years). The aspirates were obtained from skin or subcutaneous tissue (four cases), testis (one case), posterior ileum (one case), lymph node (one case), and abdominal washing (one case). Morphology of the aspirates varied from well-differentiated to poorly differentiated cells showing little or no evidence of myeloid differentiation. Thorough search for evidence of myeloid differentiation and a high index of suspicion of granulocytic sarcoma are of paramount importance. In three cases, flow cytometric and immunocytochemical studies were applied to the FNA materials to confirm the myeloid lineage of the cells and the diagnosis. In the other four cases more than one site was involved by the tumor; once the diagnosis of granulocytic sarcoma was established with a biopsy, the FNA sufficed to confirm the diagnosis at another location. This study demonstrates that FNA cytology in conjunction with appropriate immunophenotyping can provide an accurate diagnosis of granulocytic sarcoma. Fine-needle aspiration can reduce the need for surgical intervention when combined with immunophenotypic studies and when additional anatomic sites are involved.     

Fine-needle aspiration cytology of the male breast in a cancer center

All fine-needle aspirates (FNA) performed on the male breast at The University of Texas M. D. Anderson Cancer Center from 1985 to 1992 were reviewed, totaling 64. The patients' ages ranged from 19 to 86 years, with a mean of 56 years. Thirty-three patients had a history of an extramammary malignancy. The diagnoses established by FNA were gynecomastia (45), mammary carcinomas (6), neoplasms metastatic to the breast (5), suspicious for carcinoma (1), intra-mammary lymph node (1), and lipoma (1). In five cases the aspirates were nondiagnostic. Two of these proved to be gynecomastia on subsequent histologic examination. Of the six FNA cases initially thought to represent primary breast carcinomas, two were found to be secondary because of involvement of the underlying chest wall by mesothelioma (1), and mucinous adenocarcinoma, unknown primary (1). No false-positive diagnosis was rendered. We conclude that fine-needle aspiration of the male breast is a reliable means of assessment; however, unique problems may be encountered compared with aspiration of the female breast. These include the epithelial hyperplasia frequently associated with gynecomastia, the relatively equal frequency of primary and metastatic breast lesions when a malignant process is discovered, and chest wall lesions masquerading as breast lesions.     

Cutaneous and subcutaneous masses of the chest wall: A fine-needle aspiration study

Primary cutaneous and subcutaneous neoplasms of the chest wall are uncommon. However, metastatic tumors involving this region may be seen in local recurrence, widespread metastases, or as the first manifestation of an occult malignant neoplasm. We report a series of 81 fine-needle aspirations (FNA) of cutaneous and subcutaneous masses involving the chest wall of 45 males and 36 females (age range 32–89 yr, mean 63 yr). Sixty-nine patients (85%) have a previous history of malignancy. The most common sites of the primary malignancy are breast (n=32, 46%), lung (n=19, 26%), head and neck (n=6, 9%). Of these 69 aspirates, 65 (94%) are malignant and consistent with patients' primaries; two (3%) are benign aspirates, and two (3%) are unsatisfactory for cytologic evaluation. The remaining 12 (15%) aspirates from patients with no previous history of malignancy reveal 10 (84%) occult malignancies, and two (16%) benign entities. The malignant cases consist of nine (90%) metastatic epithelial neoplasms of unknown primary origin, and one (10%) primary soft-tissue sarcoma. In summary, this study demonstrates that the majority of cutaneous and subcutaneous masses of the chest wall subjected to FNA are neoplastic. FNA is an effective technique for primary assessment of these lesions. Diagn Cytopathol 1996;15:374–376. © 1996 Wiley-Liss, Inc.     

Metachronous soft-tissue masses in children and young adults with cancer: correlation of histology and aspiration cytology

We describe a series of 28 fine needle aspiration biopsies (FNAB) of soft tissue from 22 patients. Four patients had two separate FNABs, and one had three aspiration procedures. The patient population was limited to children and young adults (age range, 2 months to 29 years; mean, 16 years) who were known to have diverse forms of cancer, and who subsequently developed a mass in the peripheral soft tissues (including breast). The interval between the time of diagnosis of the primary malignant neoplasm and FNAB ranged from 1 day to 17 years (mean, 39 months). All FNAB diagnoses were confirmed by subsequent surgical open biopsy or clinical follow-up greater than 1 year. No complications occurred from the procedure. The cytomorphology is presented in selected cases and correlated with the patient's original tissue histopathology. Twenty aspirates were diagnosed as cytologically malignant, one as suspicious for malignancy. Seven were considered benign. None were unsatisfactory. One false-positive and no false-negative cytologic diagnoses were obtained. The overall accuracy of FNAB diagnoses was 96%, while sensitivity was 100% and specificity 88%. Sites of aspiration included soft tissues of the head and neck (seven cases), trunk (eight cases), breast (four cases), and extremities (nine cases). Malignant cytologic diagnoses included sarcoma (thirteen), seminoma (two), lymphoma/leukemia (two), melanoma (one), undifferentiated neoplasm (one), and neuroblastoma (one). Electron microscopy of aspirated cells was used to confirm the diagnosis in two cases. Fine needle aspiration biopsy of soft tissue masses from children and young adults with cancer demonstrates a high diagnostic accuracy, and its use is justified in this population.     

Transthoracic fine-needle aspiration vs concurrent core needle biopsy in diagnosis of intrathoracic lesions: a retrospective comparison of diagnostic accuracy

To assess the value and limitations of fine-needle aspiration (FNA) and core needle biopsy (CNB) in the diagnosis of intrathoracic lesions, we retrospectively compared the diagnostic accuracy of 362 FNA and concurrent CNB procedures performed on 350 patients. Based on the final diagnoses that were determined based on combined information from biopsy, resection, clinical, radiologic, and microbiologic findings, the study cases were grouped into 188 malignant, 161 benign, and 13 inconclusive lesions. FNA and CNB yielded similar diagnostic accuracy for malignant tumors (85.1% vs 86.7%) and epithelial malignant neoplasms (86.4% vs 85.2%), whereas CNB yielded better diagnostic accuracy (96%) than FNA (77%) for nonepithelial malignant neoplasms. Combined FNA and CNB substantially improved the rate of malignancy diagnosis (95.2%). Of 161 benign cases, 50 were proven to be benign-specific lesions; FNA provided specific diagnosis in 20 (40%) and CNB in 46 (92%). The remaining 111 benign lesions yielded benign-nonspecific findings on both specimens. These results indicate that CNB should be obtained when clinical or radiologic findings do not match the cytologic findings or nonepithelial lesions and benign lesions are considered likely.     

Fine-needle aspiration of spindle cell and mesenchymal lesions of the salivary glands

Fine-needle aspiration (FNA) biopsy can accurately diagnose epithelial lesions of the salivary gland. Its role in the evaluation of salivary gland lesions containing a significant spindle cell component is less clear. We describe the cytologic features of 25 spindle cell lesions of the salivary gland and discuss the differential diagnosis and potential diagnostic pitfalls. Twenty-five aspiration smears (3.0%) containing a significant spindle cell or mesenchymal component were identified out of 844 salivary gland FNAs performed over a 5-year period. These aspiration smears were from 25 patients. The smears were classified into three categories: 1) reactive or inflammatory conditions, including one granulation tissue and four granulomatous sialoadenitis; 2) benign neoplasms, including one schwannoma, one fibromatosis, four lipomas, and nine pleomorphic adenomas; 3) malignant neoplasms, including one recurrent malignant fibrous histiocytoma (MFH), two metastatic melanomas, and two metastatic osteosarcomas. There was one false-negative biopsy. The metastatic desmoplastic malignant melanoma was initially interpreted as a reactive lymph node with fibrosis. A specific diagnosis was rendered in 21 (84%) cases. The schwannoma was diagnosed cytologically as benign spindle cell lesion, not otherwise specified (NOS), fibromatosis as an atypical cellular proliferation, and MFH as poorly differentiated malignant neoplasm. Salivary gland lesions with a significant spindle cell component are rarely encountered on FNA and constitute a heterogeneous group. A specific diagnosis can be rendered in the majority of cases by correlating clinical and cytologic findings.     

Pancreatic masses: A multi-institutional study of 364 fine-needle aspiration biopsies with histopathologic correlation

Only 15% of primary malignant tumors are confined to the gland at the time of presentation. Fine-needle aspiration (FNA) is valuable in confirming the malignant nature of these unresectable lesions. Benign pancreatic lesions and metastatic neoplasms can also be evaluated by fine-needle aspiration. We undertook a retrospective study to evaluate the efficacy of FNA in assessing pancreatic masses. Three hundred and sixty-four radiologically guided FNAs of the pancreas performed between 1986–1996 were reviewed. Surgical material was also evaluated when available and compared to the FNA material. There were 223 men and 141 women. Their ages ranged from 23–90, with a mean of 64 yr. Two hundred and twelve patients (58%) had primary malignant tumors, 183 had adenocarcinomas, 15 had mucinous cystadenocarcinomas, 12 had neuroendocrine tumors, and 2 had pleomorphic giant-cell carcinomas. Ninety-one (43%) had available surgical material which showed adenocarcinoma. Ninety-one patients (25%) had benign aspirates, including 53 showing benign ductal epithelium, 23 showing pancreatitis/inflammation, 10 showing pseudocysts, and 7 showing serous cystadenomas. Surgical material was available in 24 (26%) of these patients. Two of these showed adenocarcinoma. Sixteen aspirates (4%) were suspicious for malignancy, 13 (81%) of which showed adenocarcinoma on follow-up biopsies. Twenty-two aspirates (6%) showed metastatic neoplasms. Twenty-three (6%) had unsatisfactory specimens. Ten (43%) of these had follow-up biopsies, 3 of which were malignant. FNA of primary benign and malignant pancreatic masses is highly sensitive (98%) and specific (100%). Eighty-one percent of the suspicious lesions showed adenocarcinoma on follow-up biopsy. FNA of metastatic neoplasms to the pancreas is also very accurate. This technique can be useful in avoiding unnecessary surgery. Diagn. Cytopathol. 1998;19:423–427. © 1998 Wiley-Liss, Inc.     

Diagnostic pitfalls in fine needle aspiration biopsy of the spleen

Fine needle aspiration (FNA) of the spleen is rarely performed, due to fear of procedure complications. The objective of this study is to review the cytologic diagnoses of aspiration biopsy of the spleen performed in a cancer center.Archival material (9-year period) was reviewed and correlated with histologic and ancillary test results, when available.Forty-one splenic FNA specimens were identified. There were no reported procedure complications. Nineteen cases were diagnosed as malignant. Of these, 11 were lymphomas. Nineteen cases were diagnosed as benign. There was one false-negative case and four false-positive cases. Primary splenic neoplasms were rare and misinterpreted as malignant.It is important to be familiar with the normal cytology of this uncommonly aspirated organ in order to successfully identify neoplastic and malignant processes. The use of ancillary studies is important in the definitive classification of benign and malignant splenic lesions.     

Cytomorphologic findings of hemangiopericytoma of the meninges: a case report

Hemangiopericytomas (HPCs) are tumors, constituting 2.5%, of soft tissue neoplasms. Meningeal hemangiopericytomas are rare non meningothelial mesenchymal tumors of the dura. They were classified as angioblastic meningiomas because of their similarity to meningiomas. However, these tumors are now regarded as distinct entities, akin to hemangiopericytoma elsewhere in the body. Few reports have addressed the fine needle aspiration (FNA) cytology of HPC. We present the cytological findings of one such rare case ofprimary meningeal hemangiopericytoma which metastasized to the lymph node. A 47 years male presented with cervical lymphadenopathy of 2 months duration. He was operated twice in the last 4 years and diagnosed atypical meningioma both times. The patient now also had spinal metastasis producing nerve root compression. Aspiration cytology of the node revealed cellular aspirate demonstrating round to oval cells with ample cytoplasm, round nuclei and inconspicuous nuclei. They showed a characteristic ferning out of blood vessels. Occasional mitosis was present. A diagnosis of malignant tumor of vascular origin was offered. Lymph node biopsy showed a characteristic histological picture of hemangiopericytoma described in other soft tissues. The cytology of this tumor is characteristic, but the rarity of the lesion, especially in metastatic sites makes diagnosis difficult unless a high index of suspicion is present. The recognition of the distinct cytological findings makes this possible. The case documents the role of FNA cytology in confirming HPC.     

Fine needle aspiration cytology diagnosis of malignant lymphoma and reactive lymphoid hyperplasia.

AIMS: To assess the diagnostic accuracy of lymph node fine needle aspiration (FNA) cytology to distinguish reactive lymphoid hyperplasia from malignant lymphoma, and to evaluate the contribution of ancillary techniques applied to cytological material. METHODS: Two hundred and seventy seven consecutive lymph node FNA specimens reported to be consistent with reactive lymphoid hyperplasia (n = 213) or suggestive/diagnostic of malignant lymphoma (n = 64) were reviewed. Follow up data were obtained by case record review or by histological correlation. The value of immunocytochemistry, in situ hybridisation for immunoglobulin light chain mRNA, and polymerase chain reaction (PCR) towards the final clinicopathological diagnosis was assessed in 92, 61, and 45 cases, respectively. RESULTS: Sixty one of 67 lymphomas and 207 of 209 reactive lymph nodes were accurately diagnosed by FNA cytology. There were six false negative aspirates including three cases of follicular lymphoma, two cases of Hodgkin's disease, and one chronic lymphocytic leukaemia. Two FNA specimens considered suspicious of lymphoma proved reactive on histology or clinical follow up. One metastatic small cell carcinoma was wrongly diagnosed as lymphoma. Ancillary studies contributed to the correct diagnosis in most cases although occasional misleading results were obtained, particularly with PCR. CONCLUSIONS: FNA cytology accurately distinguished reactive lymphoid hyperplasia from malignant lymphoma in 97% of cases. However, occasional wrong diagnoses occurred owing to sampling error or misinterpretation. Ancillary studies can be applied to cytological samples and contribute to the diagnosis in most cases.