Hyalinizing clear cell carcinoma of the parotid gland: Report of a recurrent case with aggressive cytomorphology and behavior diagnosed on fine‐needle cytology sample

A case of recurrent hyalinizing clear cell carcinoma (HCCC) of the parotid gland in a 46‐year‐old female is here introduced. The patient had undergone a left superficial parotidectomy 6 months ago in another institution for an alleged benign, circumscribed mass 2.4 cm in diameter of the left parotid gland. Histopathological examination revealed a poorly differentiated HCCC bearing a EWSR‐1 translocation on FISH examination. Fine Needle Cytology (FNC) was performed on three separate soft tissue masses in the pre‐masseterine area and a cytological diagnosis of recurrent, poorly differentiated, possibly aggressive variant of HCCC, was rendered. FISH performed on a destained Diff Quik stained smear demonstrated an ESWR‐1 translocation, which supported the cytopathological diagnosis. The cytomorphologic features and the differential diagnosis of this aggressive variant of HCCC are briefly discussed. Diagn. Cytopathol. 2014;42:63–68. © 2013 Wiley Periodicals, Inc.     

Cytological diagnosis of osteoblastoma of cervical spine: A case report with review of literature

Osteoblastomas are rare benign but sometimes aggressive primary bone tumors (1%), usually seen in males in the 2nd decade. Osteoblastomas, occurring in the spine, constitute a medical emergency due to impending cord compression. Hence a rapid and simple diagnostic modality, such as fine‐needle aspiration (FNA) plays an important role in clinical decision making. Cytological diagnosis of osteoblastoma is rare. We report a case of a young female patient presenting with a swelling in the left cervical paravertebral region. The X‐ray findings were non‐diagnostic and the patient was sent for an FNA. Aspiration yielded moderately cellular hemorrhagic smears with plasmacytoid cells, spindle cells, and osteoclastic giant cells in a background of matrix material. A diagnosis favoring osteoblastoma was made. The CT scan findings were in agreement with the cytological diagnosis and the lesion was excised. Histopathological examination confirmed the same. We describe here, the clinical and cytological features of osteoblastoma with their differential diagnosis, along with review of the literature. FNA can be used as an important tool in the pre‐operative diagnosis of osteoblastoma. Diagn. Cytopathol. 2015;43:218–221. © 2014 Wiley Periodicals, Inc.     

Fine needle aspiration cytology in two cases of chondromyxoid fibroma of bone and review of literature

We report the cytological features of two cases of chondromyxoid fibroma (CMF) confirmed by histopathology examination. First case was a 40‐year‐old male who presented with a foot swelling, and the second case was a 16‐year‐old male with a lesion at the angle of jaw. A fine needle aspiration cytology (FNAC) was performed in both the cases. In first case, a correct diagnosis of CMF could be offered on FNAC. In the second case, though the cytology diagnosis was a sarcoma considering the cytological, radiological and clinical features, the histopathological examination confirmed the same to be a CMF. The cases are being discussed to highlight the usefulness of FNAC to diagnose these uncommon benign bone lesions and the potential pitfalls in the cytological diagnosis of chondroid lesions. Diagn. Cytopathol. 2013;41:904–908. © 2012 Wiley Periodicals, Inc.     

Isolated cysticercosis of tongue: A case report

Cysticercosis of the tongue is a rare disease caused by infestation with the larval stage of the pork tapeworm (Taenia solium) in which man acts as a secondary host rather than a primary host. Most of these lesions are asymptomatic. The patient usually reports to the physician with the complaint of swelling. The solitary swelling in the tongue of this young 12‐year‐old girl was not suspected clinically for cysticercosis. Fine needle aspiration cytology, used for pre‐operative diagnosis, suggested the possibility of cysticercosis. Detailed medical evaluation was carried out which ruled out neural cysticercosis and other extraneural lesions. The complete removal of the lesion was achieved by simple excision. The histopathological examination confirmed the diagnosis of lingual cysticercosis. Diagn. Cytopathol. 2014;42:716–718. © 2014 Wiley Periodicals, Inc.     

Chondroid syringoma diagnosed by fine needle aspiration cytology

Chondroid syringoma is a rare benign skin adnexal tumor of eccrine/apocrine origin affecting commonly the head and neck region. It used to be previously called as mixed tumor of skin because of the presence of both the epithelial and mesenchymal components. There are only few case reports describing the fine needle aspiration cytologic features of chondroid syringoma for diagnosis. We studied a 20‐year‐old male case from Taplejung district of Nepal came to Otorhinolaryngology out patient department with the complaints of painless, progressively enlarging swelling on the dorsum of nose. On examination, 2.0 × 2.0 cm, firm, non‐tender swelling was seen on the right side of dorsum of nose. Overlying skin was normal, and the swelling was fixed to the skin but freely mobile over underlying structure. A clinical diagnosis of dermoid cyst was entertained, and the case was subjected to FNAC. FNA yielded mucoid material which on microscopy showed clusters of round cells with moderate to abundant cytoplasm embedded in chondromyxoid ground substance. The nuclei were monomorphic, centrally to eccentrically located and had fine chromatin. On the basis of these cytologic features, a diagnosis of chondroid syringoma was made. We concluded that Chondroid syringoma may be considered as a rare differential diagnosis in the swelling of head and neck region and the diagnosis can be easily confirmed or ruled out by means of fine needle aspiration cytology. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

Pure neuritic leprosy with nerve abscess presenting as a cystic,soft tissue mass: Report of a case diagnosed by fine needle aspiration cytology

Pure neuritic leprosy (PNL) with nerve abscess manifesting as a huge, cystic, soft tissue mass is highly uncommon. Fine needle aspiration cytology can serve as an important initial diagnostic modality in such an instance. We report a case of 28‐year‐old male, who presented with a huge swelling in the lower, medial aspect of the right upper arm. The clinical diagnosis was schwannoma. Fine needle aspiration (FNA) yielded 80 ml of sticky, turbid, pale brown fluid. Cytologic examination revealed abundant, caseous, necrotic material and many degenerated neutrophils in a thin proteinaceous background. Stain for acid fast bacilli (AFB) was negative. Based on an AFB negative, caseous, necrotic material obtained from the soft tissue mass located in the ulnar nerve region, a cytodiagnosis of tuberculoid PNL with nerve abscess was given, and this was confirmed by the subsequent histopathologic examination. Our case emphasizes the major role of minimally traumatic, FNA technique in the diagnosis of rare cases of clinically unsuspected neuritic leprosies. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Fine‐needle aspiration biopsy as an initial diagnostic modality in a clinically unsuspected case of invasive maxillary fungal sinusitis: A case report

Cases of invasive fungal lesions involving the paranasal sinuses are generally diagnosed either on histologic examination or on fungal culture. Here, we report a case of invasive fungal sinusitis diagnosed primarily by a fine‐needle aspiration biopsy (FNAB). Our patient was a 36‐year‐old male who presented with a history of slowly progressive, painless swelling over the left cheek. The only positive clinical finding was a bony hard swelling in the left maxillary region, which was clinically interpreted as “fibrous dysplasia.” A computed tomographic (CT) examination of the paranasal sinuses showed a soft tissue attenuation lesion involving the bilateral maxillae, with the destruction of multiple bones and involvement of multiple sinuses and the bilateral orbits. FNAB of the maxillary swelling showed several giant cells, many of them exhibiting ingested organisms with a morphologic resemblance to the Aspergillus species of fungi. Strikingly, no significant inflammatory cells were seen on cytologic smears. Unfortunately, owing to a lack of initial clinical suspicion, as well as the patient's loss to further follow‐up, a culture/histopathologic examination could not be carried out. This case is presented chiefly to highlight the clinical utility of a simple FNAB procedure, as an initial diagnostic modality in cases of fungal sinusitis, which can masquerade clinically as a neoplastic lesion. In addition, if radiologic findings are also available at the time of cytologic examination, a pretherapeutic comment on the invasive nature of the lesion can also be made. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

Tumoral calcium pyrophosphate dihydrate crystal deposition disease: A rare diagnosis by fine‐needle aspiration

Calcium pyrophosphate dihydrate crystal deposition disease (CPPD) is a well‐recognized inflammatory joint disorder characterized by presence of calcium pyrophosphate dihydrate crystals in intraarticular and periarticular tissue. We report here a case of a 48‐year‐old male who presented with painless right hand swelling. Clinical suspicion was that of malignant soft tissue tumor. Fine‐needle aspiration (FNA) yielded chalky white gritty material. Microscopic examination showed large areas of basophilic calcified material, histiocytes, giant cells and characteristic rhomboid shaped crystals. At places, chondroid material was also identified, hence, diagnosis of CPPD was made. This was confirmed on histopathological examination. Tophaceous/ tumoral pseudogout is a rare form of CPPD and it is important to recognize that this form can be diagnosed in FNA cytology (FNAC) and misdiagnosis of benign or malignant cartilaginous lesions can be avoided. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

Isolated lingual cysticercosis: A rare case diagnosed on cytology

Cysticercosis is caused by larval stage of Taenia solium called cysticercus cellulosae. Cysticercosis most commonly infects skeletal muscles, subcutaneous tissues, brain and ocular tissue. On extensive search of literature, only around 64 cases of lingual cysticercosis have been reported till date. We report a case of cysticercosis of tongue in a 35‐year‐old male who presented with a painless, slowly growing swelling over the lateral border of tongue. Fine needle aspiration cytology revealed wavy integument of cysticercus cellulosae alongwith inflammatory cells. The findings were confirmed on histopathology. No other cystic swelling was encountered in the body on retrospective examination and investigations. This case is being presented on account of its rarity as well as the utility of FNAC as a primary diagnostic technique in evaluation of parasitic lesions.     

Parotid or carotid? Misled by site

We present an interesting scenario where a 64 years old male presented with a long standing painless, infra‐auricular swelling, which had progressively increased in size. Based on the site, the clinical impression was of a salivary gland lesion and FNAC was performed. The smears were unusually cellular and had necrotic background. The cytological diagnosis was a cystic neoplasm of salivary gland, possibly mucoepidermoid carcinoma. Warthin's tumor was also kept in differential. However, the radiological investigations, which were made available after the FNAC report were conflicting with cytological diagnosis of a malignancy and were characteristic of a carotid body tumor, generally a benign neoplasm. Surgical excision of the tumor with regional lymph node sampling was done and histopathological examination solved the puzzle by revealing metastasis of paraganglioma to right posterior triangle lymph nodes. This case is unique because of the unusual presentation of a malignant paraganglioma as an infra‐auricular swelling, which was clinically considered as a parotid tumor. The clinician as well as the pathologist need to be aware of such diagnostic pitfall. Diagn. Cytopathol. 2017;45:569–573. © 2017 Wiley Periodicals, Inc.     

Hypercalcitoninemia and thyroid nodules

Medullary thyroid carcinoma (MTC) can assume various cytomorphological and architectural forms, mimicking other thyroid and extra‐thyroid tumors and rendering the cytological and histological diagnosis challenging. Consequently, measurement of calcitonin (CT) levels is generally considered to be more accurate than cytology in diagnosing MTC. Here, we report on a patient with a multinodular goiter and significantly elevated basal CT levels; based on cytology examination and CT immunocytostains, neither MTC nor C‐cell hyperplasia was detected upon final histopathological examination. CT testing has a high false‐positive rate and low positive predictive value for detecting clinically relevant MTC. Judicious integration of cytological examination with immunocytochemical stains (when needed) may be useful for selecting the most appropriate therapy and avoiding overtreatment (i.e., central neck lymph node dissection in the present case). This case demonstrates that cytological examination with ancillary techniques is still valuable in patients with thyroid nodules and suspicious MTC. Diagn. Cytopathol. 2014;42:970–973. © 2014 Wiley Periodicals, Inc.     

Prominent oncocytic metaplasia in pleomorphic adenoma: A potential diagnostic pitfall

Pleomorphic adenoma (PA) is the most common salivary gland tumor. The cytological features of PA are well recognized, and its diagnosis is straightforward in most cases. Some metaplastic changes in PA are well known; however, occurrence of oncocytic metaplasia in PA is very rare. In this report, we describe the first cytological case of prominent oncocytic metaplasia in PA identified based on immunocytochemical analysis. We report the case of a 62‐year‐old Japanese female who presented with swelling of the left neck region. A fine‐needle aspiration cytologic examination was performed followed by surgical resection. The Papanicolaou smear revealed the presence of discohesive neoplastic cells in a myxoid background. These neoplastic cells had a relatively rich, granular cytoplasm, and round nuclei with moderate pleomorphism. Initial cytodiagnosis revealed carcinoma ex PA (CXPA). Immunocytochemical analysis showed that abundant mitochondria were present in the cytoplasm of these neoplastic cells. Histopathological examination of the resected tumor demonstrated proliferation of oncocytic neoplastic cells within a myxoid material and the presence of conventional PA components. A final diagnosis of prominent oncocytic metaplasia in PA was made. Oncocytic metaplasia showed nuclear atypia and pleomorphism; therefore, CXPA, which presents with severe nuclear atypia and necrotic background, must be differentiated from oncocytic metaplastic PA. Recognition of oncocytic metaplasia in PA is important for correct diagnosis.     

Cytomorphological diagnosis of malignant eccrine tumors: report of two cases

Though FNAC has been successfully used in diagnosing various neoplastic and nonneoplastic cutaneous lesions, there is a paucity of case reports describing the cytomorphological features of adnexal tumors. We hereby describe the cytological features of two histologically confirmed cases of malignant eccrine tumors. Case number 1 presented with an ulcerated infraclavicular swelling whereas case number 2 presented with a cystic swelling over left foot. FNA and histological examination of the resected specimens was performed using standard techniques. A cytological diagnosis of low grade papillary adenocarcinoma arising from skin adnexal structures was given in case number 1. Aspirate from case number 2 was reported as positive for malignant cells, and histological examination was advised. Histological examination revealed the presence of malignant eccrine acrospiroma in case number 1 and papillary digital adenocarcinoma in case number 2. Careful cytological examination displayed the characteristic of two cell population seen in eccrine tumors in both the cases. Diagnosis of malignant eccrine tumors cannot be made with certainity on cytology alone, hence the need to document the cytological features of these entities is emphasized.     

Cytological features of dedifferentiated adenoid cystic carcinoma of the trachea

Adenoid cystic carcinoma (AdCC) is a distinct type of carcinoma, and cytological examination has been recognized as a useful tool in its diagnosis. Dedifferentiation is defined as the abrupt transformation of a low‐grade tumor into a tumor with high‐grade components. Albeit extremely rare, dedifferentiated AdCC has been reported: however, the cytological features of this tumor have not been documented. We observed a case in which a 66‐year‐old Japanese male had stenosis and thickness of the lower tracheal and bronchial walls. Cytological smears of a bronchial brush specimen revealed features typical for low‐grade AdCC. However, a few cohesive epithelial cell clusters composed of large, atypical polygonal cells with large nuclei and conspicuous nucleoli also were present. This component was considered to represent dedifferentiated carcinoma. Histopathological study of the resected bronchial tumor revealed dedifferentiated AdCC. The cytological diagnosis of conventional low‐grade AdCC is straightforward in most cases, although extremely rare, dedifferentiated carcinoma can occur within the conventional AdCC, and detection of a dedifferentiated component is possible in a cytological specimen because of obvious nuclear atypia. Therefore, careful observation is needed because cytologic diagnosis of dedifferentiated AdCC can help expedite treatment of this highly aggressive tumor. Diagn. Cytopathol. 2014;42:880–883. © 2013 Wiley Periodicals, Inc.     

Myeloid leukemia in a urine specimen: A case report and review of the literature

Urinary tract cytology has a long history of utilization for the diagnosis and follow‐up of tumors involving the urothelial tract. As expected, the most common tumor encountered in exfoliative urine cytology is urothelial carcinoma. While the sensitivity of urinary tract cytology for the diagnosis of low‐grade urothelial carcinomas is low, its sensitivity and accuracy for high grade urothelial carcinomas is much higher. However, nonurothelial malignancies, such as hematopoietic malignancies, can also be encountered in urine specimens. Leukemic cells in urine can be diagnosed readily by cytological examination in cases where more invasive procedures are difficult to perform. Additionally, cell block sections can be utilized to determine the immunocytochemical profile of the tumor cells to confirm the diagnosis. Herein we report a case of a 75‐year‐old man with a past medical history of acute myeloid leukemia (AML), who presented with congested heart failure and painless macroscopic hematuria. AML relapse was diagnosed. Cytological examination of the urine using a ThinPrep® smear, cytospin preparation, and immunohistochemical stains performed on the cell block sections were examined. Findings were consistent with leukemic cells of myeloid origin in the bladder washing specimen. Diagn. Cytopathol. 2014;42:700–704. © 2013 Wiley Periodicals, Inc.     

Neuroprotective effects of argatroban and C5a receptor antagonist (PMX53) following intracerebral haemorrhage

Intracerebral haemorrhage (ICH) is a subtype of stroke that associated with neurological dysfunction and inflammation, which may be ameliorated by a neuroprotective strategy targeting the complement cascade. The protective effect of C5a‐receptor antagonist (PMX53) solely and in combination with thrombin antagonist (argatroban) was investigated in the ICH mouse model, respectively. Adult male C57BL/6J wild‐type (WT) mice and C3^–/– mice were randomized to receive PMX53/argatroban 1, 3 and 5 days after ICH. A double injection technique was used to infuse 25 μl of autologous whole blood into the right striatum. Mice in the sham group received only needle insertion. Brain water content and mRNA of inflammatory factors were measured on the first, third and fifth days after ICH, respectively. Neurological dysfunction was assessed using a 28‐point neurological scoring system in the three cohorts, namely, on days 1, 3 and 5 following ICH. Animals treated with PMX53/argatroban demonstrated significant improvements in neurological function and fewer neurological apoptosis detected by TUNEL [terminal deoxynucleotidyl transferase (TdT)‐mediated dUTP nick end‐labelling] and βIII‐tubulin dual‐staining compared with vehicle‐treated animals. Compared with sham‐treated mice, the brain water content in argatroban/PMX53‐treated mice was decreased significantly in both the ipsilateral cortex and ipsilateral striatum. Administration of PMX53/argatroban provided a synergistic neuroprotective effect via reducing inflammatory factors and brain oedema, leading to improvements in neurofunctional outcome. The results of this study indicated that simultaneous blockade of the thrombin and C5a receptors represent a promising neuroprotective strategy in haemorrhagic stroke.     

Cytologic diagnostic pitfall of dermatofibrosarcoma protuberans masquerading as primary parotid tumor: A case report

We report the cytology of a rare case of dermatofibrosarcoma protuberans (DFSP) involving the parotid region. Our patient was a 55‐year‐old female who presented with a swelling in the right parotid region, which was clinically interpreted as a “recurrent parotid tumor.” Fine needle aspiration revealed a moderate cellular yield with spindle cell component, seen discretely as well as, embedded loosely within a fibrillary magenta matrix. A few cellular spindle cell fascicles and several discrete, naked, spindly nuclei were also noted. Neoplastic cells exhibited a minimal pleomorphism with a relatively bland chromatin and inconspicuous nucleoli. A differential diagnosis of the benign spindle cell tumor/low, or intermediate grade myxoid, spindle cell sarcomas was considered. Owing to its clinical presentation simulating a parotid tumor, possibility of “spindle cell myoepithelioma” was suggested. However, histopathologic examination with immunohistochemistry showed it to be a DFSP. A precise diagnosis of DFSP is not always possible on cytology alone. Owing to its location, as well as the spindle cell morphology, DFSP occurring in the parotid region is likely to be mistaken for a spindle cell myoepithelioma, in which case, an appropriate panel of immunomarkers is required for resolving the diagnostic dilemma. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Smear cytological features of large cell neuroendocrine carcinoma of the uterine cervix in pregnancy: A case report and review of the literature

Large‐cell neuroendocrine carcinoma (LCNEC) of the uterine cervix is a rare aggressive tumor. The examination of a cervicovaginal smear from a 31‐year‐old patient diagnosed with LCNEC after a cervical polypectomy during the 32nd week of pregnancy was carried out. The observed atypical cells had large cytoplasm, increased nucleus: cytoplasm ratio with the nucleus containing coarse, dispersed chromatin, and were arranged in a pseudorosette formation, which all confirmed the diagnosis. In addition, adenocarcinoma in situ (AIS) was determined in the histopathological examination of the subsequent hysterectomy material. Given the rarity of this condition, we present and discuss the case herein.     

Bladder carcinoma with shadow cell differentiation: a case report with immunohistochemical analyses

A peculiar case of bladder carcinoma showing shadow cell differentiation (SCD) in a 72-year-old man is presented. The tumor histologically revealed high grade urothelial carcinoma (UC) and partially contained squamous component with a transition to shadow cell nests, similar to those seen in cutaneous pilomatricoma (PMX). Immunohistochemically, the modes of cell death in the component of SCD were identical to those in PMX. The present case as well as 10 cases of cutaneous PMX showed nuclear expression of beta-catenin, whereas 10 cases of bladder UC with squamous differentiation revealed membranous localization without nuclear expression. These results suggest that nuclear accumulation of beta-catenin may play an important role for SCD in the present case. SCD in extracutaneous tumor is extremely rare and, in the literature, the present case is the second one as for bladder carcinoma.