Fine-needle aspiration cytology of metastatic nasopharyngeal carcinoma

Cytological features of nasopharyngeal carcinoma (NPC) were reviewed in an attempt to select cytological criteria that permit a specific recognition of metastases. For this purpose, 54 fine-needle aspiration (FNA) procedures from 43 patients with NPC were analyzed. Thirty-two (59.3%) procedures were performed before the histological diagnosis. In 25 (46.3%) procedures, smears showed many neoplastic single cells, clusters, and abundant lymphoid cells (mixed pattern). A dissociated (single cell) pattern consisting of individual neoplastic and lymphoid cells was seen in 18 (33.3%) cases. Finally, 11 (20.4%) cases showed cohesive epithelial clusters (cohesive pattern) without relevant cellular dissociation or lymphoid cells. Squamous-cell differentiation was seen in three of these cases. Most single neoplastic cells presented as large, pleomorphic naked nuclei. Other interesting findings were granulomas (n = 3), prominent eosinophilic infiltrates (n = 4), and suppurative changes (n = 5). In most smears with mixed and dissociated patterns, a nasopharyngeal origin could be suggested. On the contrary, those smears with a cohesive pattern were indistinguishable from other head and neck carcinomas.The presence (on cervical lymph nodes) of a dissociated or mixed (single cells and groups) architectural pattern of large, anaplastic cells and naked nuclei accompanied by an abundant lymphoid component is highly suggestive of undifferentiated NPC. Cytology offers a rapid diagnosis, establishes the necessity of a complete cavum examination, and helps in avoiding unnecessary and harmful biopsies.     

Fine-needle aspiration cytology of bronchial acinic cell carcinoma: a case report

Salivary gland-type carcinomas of the lung are rare but well-known tumors. Among them, acinic cell carcinoma (ACC) is extremely rare and its cytological features have not been reported. We present a case of bronchial ACC and describe its cytological characteristics. The tumor occurred in a 58-yr-old man as a 15-mm polypoid lesion at the right middle lobar bronchus and filled its lumen. Transbronchial brush cytology and a biopsy failed to collect tumor cells but transbronchial fine-needle aspiration (FNA) cytology was successful. The smear obtained was richly cellular and a large number of thick-layered or monolayered sheet-like tumor cell clusters and dissociated tumor cells were observed. Cribriform globular spaces were common and a lobulated acinar structure was found focally. The tumor cells had a fine granular large polygonal cytoplasm and rather uniform round or ovoid nuclei. The nuclei were situated eccentrically or centrally and the nuclear/cytoplasmic ratio was consistently low. These cytological features were essentially similar to those of ACC of the head and neck region. The patient underwent a lobectomy and the tumor was resected completely. Transbronchial FNA cytology was useful for diagnosing bronchial ACC and differentiating it from other conventional and salivary gland type carcinomas.     

Fine-needle aspiration cytology of a lipoblastoma: a case report

A lipoblastoma is a rare benign tumor of immature white fat, and more than 90% of lipoblastomas occur before the age of 3 years. The diagnosis of a lipoblastoma is mostly dependent on a histopathological examination of a surgically excised specimen. However, an accurate preoperative diagnosis is essential for the planning of surgery, particularly for a lesion of the head and neck area. We experienced a case of a cervical lipoblastoma of a 23-month-old boy. A preoperative fine-needle aspiration biopsy showed the sample as moderately cellular and showed fragments of mature and immature adipose tissues containing a large number of capillary vessels. There were numerous lipoblast-looking cells with a multivacuolated cytoplasm, and the nuclei were small, compressed by vacuoles, and centrally located. According to the cytological findings, the lesion was diagnosed as a benign adipose tumor suggestive of a lipoblastoma. Subsequent surgical excision confirmed the diagnosis of the fine-needle aspiration biopsy. The cytologic features of lipoblastoma are not well known because of the rarity of the lesion. However, the fine-needle aspiration cytological features of a lipoblastoma are sufficiently characteristic to make a specific preoperative diagnosis.     

Fine-needle aspiration cytology of metastatic carcinoid tumor: report of a case and review of the literature

While carcinoid tumor is a relatively common neoplasm in surgical pathology, fine-needle aspiration (FNA) cytology as a method of primary diagnosis has only been reported in the literature a few times. We report on the case of a 42-yr-old female with multiple large metastatic tumor deposits in her liver, pelvic adnexae, bones, and lungs, with an unknown primary. FNA was performed on one of the liver masses, and was diagnosed using routine histochemical and immunohistochemical stains as carcinoid tumor. No follow-up tissue diagnosis has been obtained. However, the patient is still alive with her tumor 1 yr later. Fine-needle aspiration cytology can be a useful and safe tool in the diagnosis of metastatic carcinoid tumors, avoiding the need for surgery which would not otherwise be indicated for treatment.     

Fine-needle aspiration cytology of small-cell carcinoma of the parotid

Small-cell carcinomas arise uncommonly in extrapulmonary sites and are rare primary neoplasms in the salivary glands. We report on the aspiration cytology and immunohistochemical findings of a small-cell carcinoma of the parotid gland in an 81-yr-old man.     

Fine-needle aspiration cytology of lobular carcinoma in situ

Fine-needle aspiration cytology (FNAC) plays a key role in the preoperative diagnosis of breast carcinoma but is less reliable in the diagnosis of in situ lesions. The objective of the present study was to investigate the cytological features of lobular carcinoma in situ (LCIS), regarding which little data is available to date. Cytological features of FNAC of the breast from 21 patients with histology-proven LCIS were described and compared with surgical specimens. Aspirates from 8/21 cases had cell groups diagnostic for or compatible with LCIS. Aspirates from an additional two cases demonstrated hypercellular, dissociated, and more pleomorphic tumor cells, which were originally diagnosed as invasive lobular carcinoma (ILC). The remaining 11 aspirates were diagnosed as benign or nondiagnostic. FNAC from the eight diagnostic specimens were characterized by loosely cohesive cell groups composed of uniform cells with occasional intracytoplasmic lumina, slightly irregular and eccentric nuclei. We conclude that the main difficulty in diagnosing LCIS by FNAC is sampling rather than recognition of the lesions. However, one should be aware of the cytological features of LCIS in order to reach a correct diagnosis. There are no reliable cytological criteria that help in differentiating pleomorphic and dissociated LCIS from ILC.     

Fine-needle aspiration cytology of extramammary neoplasms metastatic to the breast

Fine-needle aspiration (FNA) biopsy is the first-line investigation in any breast lump and hence cytomorphological recognition of nonmammary metastatic tumors to the breast and their distinction from primary tumors is important.Metastatic breast neoplasms diagnosed over a 6-yr period from 1997 to 2002 were retrieved from the database of the Department of Cytopathology and the clinical, cytopathological, histochemical, and immunohistochemical findings were correlated with the histopathology of the primary tumor.Fifteen cases of metastatic breast neoplasms were encountered constituting 1.47% of all malignant tumors of the breast diagnosed on FNA. There were 14 female patients and one male patient aged 13-80 yr. The preaspiration clinical diagnosis was either a benign breast lump or a malignancy (primary vs. metastatic). The breast lump was the initial presentation in four cases and the cytodiagnosis of a metastatic malignancy lead to the subsequent detection of the primary malignancy. These included one case each of melanoma, myeloma, rhabdomyosarcoma, and small-cell carcinoma of the lung. There were five pediatric cases that included four cases of rhabdomyosarcoma and one case of leukemic deposit. The adult cases included two cases each of melanoma, small-cell carcinoma, and myeloma; one case of choriocarcinoma; and three cases of soft-tissue sarcomas. These included two cases of malignant fibrous histiocytoma (MFH) and one case of leiomyosarcoma.The presence of unusual cytomorphological patterns on breast FNA should alert the cytopathologist to the possibility of a metastatic breast neoplasm, even if not suspected clinically. A detailed history of the patient, clinical correlation, and immunocytochemistry helps in establishing an accurate diagnosis, which avoids unnecessary surgery and ensures appropriate treatment.     

Fine-needle aspiration cytology of recurrent granulosa cell tumor: case report with differential diagnosis and immunocytochemistry

We report a case of an adult-type granulosa cell tumor of the ovary which was diagnosed in a 20-yr-old woman. After a 21-yr disease-free interval, she developed a pelvic recurrence, followed by a splenic metastasis and, more recently, omental masses. This report is concerned with the fine-needle aspiration (FNA) diagnosis of the granulosa cell tumor in the latter site and corroboration of the interpretation by immunocytochemistry. Only one previous case is similar to the present one documenting the role of immunocytochemistry in the evaluation of suspected metastatic granulosa cell tumor. The cytopathologic features of metastatic granular cell tumor have been described in a limited number of previous reports.     

Fine-needle aspiration cytology of Castleman disease: case report with review of the literature

Organs involved by Castleman disease (CD) may be investigated by fine-needle aspiration cytology. No specific cytomorphological criteria are currently described for a definitive diagnosis. The cytological features of three fine-needle aspirations from three different lymph nodes of a patient with histologically confirmed CD of the hyaline-vascular type are herein reported, with a review of the literature. The fine-needle aspirations showed branching capillaries associated with fragments of germinal center. Review of the literature yielded 12 other case reports with over half describing similar findings. Because branching hyalinized small blood vessels penetrating follicular germinal center are characteristic of CD of the hyaline-vascular type on histology, this finding in fine-needle aspirates should raise that diagnostic possibility.     

Fine-needle aspiration cytology of metastatic ovarian carcinoma to the breast

Metastatic ovarian carcinoma to the breast is rare. It represents a diagnostic challenge to the cytologist. It usually signifies a progressive widespread metastatic ovarian tumor with a poor prognosis. This report evaluates the breast fine-needle aspiration (FNA) cytomorphologic features of six cases of metastatic ovarian carcinoma and compares them to those reported in the literature. The cytologic features included hypercellularity, abundant papillary fragments, and necrotic background. The tumor cells showed high nuclear/cytoplasmic ratio, anisonucleosis, prominent nucleoli, and psammoma bodies in cases of serous papillary carcinoma. In addition, the clear-cell carcinoma had prominent finely vacuolated and clear cytoplasm, multinucleated giant cells, and papillary fragments with hobnail nuclei. Recognition of these unusual patterns in a breast FNA cytology should raise the suspicion of a metastatic ovarian tumor. Direct comparison between the breast FNA cytology and the original primary ovarian tumor should confirm the diagnosis. The proper diagnosis of metastatic ovarian cancer to the breast will prevent unnecessary surgical treatment and ensure the appropriate therapy. Diagn Cytopathol 1996;15:1–6. © 1996 Wiley-Liss, Inc.     

Fine-needle aspiration cytology of pancreatoblastoma

Pancreatoblastoma is a rare pancreatic neoplasm seen most commonly in the pediatric age group. We report on the aspiration cytology and immunohistochemical findings of a pancreatoblastoma in a 16-yr-old male.     

Fine-needle aspiration cytology of thymic basaloid carcinoma: case studies and review of the literature

We report the features in fine-needle aspiration biopsy (FNAB) of thymic basaloid carcinomas. This is a rare neoplasm, of which there are only three documented in our hospital files. To the best of our knowledge, this is the first fine-needle aspiration (FNA) report on basaloid carcinoma of the thymus. This is a tumor in which the FNA diagnosis is difficult and the differential diagnosis is broad. We describe the cytologic features encountered in the three cases, and immunohistochemical and ultrastructural findings so as to raise awareness of this entity in the differential diagnosis of thymic neoplasms on FNABs. The cases studied included three male patients, aged 73, 65, and 50, who presented with anterior mediastinal masses, with no primary tumor elsewhere. FNAB was performed on two cases, followed by thymectomy. One case, additionally, had metastasis to a cervical lymph node, and the other two were associated with thymic cysts. The diagnoses on all three cases were thymic basaloid carcinoma.     

Fine-needle aspiration cytology of a metastatic Merkel-cell carcinoma

The cytologic features of Merkel-cell carcinoma metastatic to inguinal lymph nodes are described. The primary tumor was in the buttocks. The cytologic smears from the inguinal lymph node were highly cellular, with small to medium-sized cells in a predominantly discohesive or single-cell pattern, as well as large clusters surrounding segments of capillary-sized blood vessels. The nuclei were uniform, round to oval, with delicate nuclear membranes. The chromatin pattern was fine and "powdery" with multiple small micronucleoli. The cytoplasm was very scanty. Intermediate filament "buttons" were abundant. Rosette formation was very rare. Frequent mitotic figures and individual cell necrosis were observed. These features are helpful in the differential diagnosis from other small-cell tumors that may involve the skin.     

Aspiration biopsy of osseous metastasis of occult hepatocellular carcinoma: Case report, literature review, and differential diagnosis

Fine-needle aspiration (FNA) cytology is a reliable technique for rapid diagnosis in virtually every organ of the body, including bone lesions. We report on the FNA findings in a 61-yr-old male of an osteolytic sacral lesion, which determined the diagnosis of an unsuspected metastatic hepatocellular carcinoma. In this case, the diagnosis was confirmed by FNA biopsy without resorting to surgical biopsy.     

Fine-needle aspiration cytology of unusual germ cell tumors of the mediastinum: atypical seminoma and parietal yolk sac tumor

To assess the efficacy of fine-needle aspiration biopsy (FNAB) of axillary lymph nodes (ALN), we retrospectively analyzed 140 FNAB of ALN at Memorial Sloan-Kettering Cancer Center, examining technique and cytologic-histologic correlation. Of the 140 FNAB, 124 were performed by the conventional method and 16 by ultrasound guidance (USG). The diagnoses included: unsatisfactory, 20; negative, 38; positive, 72; suspicious, 6; and indeterminate, 4. Positive diagnoses included: carcinoma, 44.4%; melanoma, 43.0%; lymphoma, 5.6%; sarcoma, 5.6%; and mesothelioma, 1.4%; one of which was false-positive, attributed to misinterpretation. All indeterminate and most false-negative cases were due to lymphoproliferative conditions. The sensitivity and specificity of FNAB of ALN were 94.7% and 97.1% and the adequacy rate was 85.7%. The sensitivity, specificity, and adequacy rates of USG FNAB were 100%. Our study shows that FNAB of ALN is an excellent method for diagnosing reactive conditions as well as neoplasms.     

Fine-needle aspiration of hepatocellular carcinoma: False-negative result due to epithelioid cells

The presence of epithelioid cells in fine-needle aspirations of a liver nodule is rare, but may complicate the diagnosis of the nodule. We report on a case of a liver nodule in hepatitis C cirrhosis. Results of fine-needle aspiration mainly revealed the presence of epithelioid cells, without any recognizable tumor cells. Histological examination of the nodule after surgical resection showed a hepatocellular carcinoma with numerous epithelioid and gigantocellular granulomas, without necrosis.     

Diagnostic utility of CD10 in differentiating hepatocellular carcinoma from metastatic carcinoma in fine-needle aspiration biopsy (FNAB) of the liver

The differential diagnosis between hepatocellular carcinoma (HCC) and metastatic carcinoma, especially in moderate-poorly differentiated (MPD) HCC and poorly differentiated carcinoma, can be challenging in fine-needle aspiration biopsy (FNAB) of the liver. Recent studies demonstrate that canalicular staining for CD10 appears to be a highly specific marker for hepatocytic differentiation. The objective of this study was to test the utility of CD10 in differentiating HCC from metastatic carcinoma in FNAB of the liver. Formalin-fixed, paraffin-embedded cell blocks of 55 cases (22 HCC, 23 metastases, and 10 benign hepatic lesions) of FNAB of the liver were immunostained using monoclonal antibody against CD10, with microwave oven antigen retrieval, followed by a standard ABC method. Nineteen (86%) of 22 HCC cases were positive for CD10 with a canalicular staining pattern. Among them, 9 (82%) of 11 well-differentiated (WD) HCC and 10 (91%) of 11 MPD HCC were positive for CD10. Three (13%) of 23 metastatic carcinomas were positive for CD10, demonstrating a contrasting cytoplasmic and membranous staining pattern. The three positive cases were metastatic renal cell carcinoma (RCC), choriocarcinoma, and adenocarcinoma of the lung. All 10 cases of benign hepatic lesions showed positivity for CD10 with a canalicular and focal membranous staining pattern. In conclusion, CD10 appears to be a useful marker in discriminating between HCC and metastatic carcinoma when applied to FNAB of the liver. CD10 does not provide discrimination between WD HCC and benign hepatocytes.     

Discriminating hepatocellular carcinoma from metastatic carcinoma on fine‐needle aspiration biopsy of the liver: The utility of immunocytochemical panel

The cytomorphologic features of hepatocellular carcinoma (HCC) in fine‐needle aspiration (FNA) biopsy are well described. However, correctly diagnosing HCC on cytologic features alone and differentiating it from metastatic adenocarcinoma (MAC) remains a challenge. Studies have recommended the use of various immunocytochemical (ICC) stains to aid in the diagnosis and distinction of these tumors with variable success rates. In this study, we evaluated a panel of seven ICC stains, HepPar1, glypican‐3, polyclonal and monoclonal carcinoembryonic antigen (pCEA, mCEA), MOC‐31, CK7, and CK20, in 42 FNA cases of HCC and 48 FNA cases of MAC. The aim was to identify the most sensitive and specific markers and the best panel for accurate diagnosis. Overall, 38 of 42 HCC and 44/48 MAC tumors were correctly identified by a panel of four markers, CK7, MOC‐31, HepPar1, and glypica‐3, with accuracy rate of 90.5 and 91.7%, respectively. In the HCC group, glypican‐3 was most sensitive and detected in 34/42 (81%), whereas HepPar1 and pCEA were less sensitive and detected in 30/42 (71.4%) and 21/42 (50%), respectively. In the MAC group, MOC‐31 was most sensitive and detected in 38/48 (79.2%), followed by CK7 in 20/48 (41.7%). Stepwise logistic regression analysis showed that a panel of glypican‐3, HepPar1, MOC‐31, and CK7 is most helpful in diagnosing and accurately differentiating HCC from MAC on FNA biopsies of the liver. We conclude that a panel of HepPar1, glypican‐3, MOC‐31, and CK7 accurately and statistically significantly differentiates these two malignancies (P < 0.05). Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Fine-needle aspiration cytology of a case of HIV-associated anaplastic myeloma

Plasma cell neoplasia occurs much less frequently than high-grade B-cell non-Hodgkins lymphoma in HIV-infected patients, but is nevertheless an AIDS-associated malignancy. In this report, we describe the fine-needle aspiration (FNA) findings of a mass in the left parotid region with plasmablastic features that occurred in a 41-yr-old HIV-infected homosexual man whom we diagnosed as having anaplastic myeloma. The patient had normochromic, normocytic anemia with a hematocrit of 21%, a white blood count of 2.2 x 10(9)/l with 76% neutrophils, and a CD4 count of 31%. He also had elevated levels of calcium (13.2 mg/dl), alkaline phosphatase (25,400 IU/l), blood urea nitrogen (2,600 mg/dl), and creatinine (2.5 mg/dl). Serum protein electrophoresis showed polyclonal hypergammaglobulinemia without any monoclonal component. A bone survey revealed multiple punched-out lytic lesions. FNA smears showed large plasmacytoid cells with eccentrically placed nuclei, prominent nucleoli, and moderate amounts of basophilic cytoplasm. By immunocytochemical staining, tumor cells were negative for CD19, CD20, and leukocyte-common antigen (LCA), but strongly positive for CD38 and kappa light chain. Anaplastic myeloma and plasmablastic lymphoma were considered in the differential diagnosis. Although the cytomorphologic and immunophenotypic findings of our case overlapped with those of plasmablastic lymphoma, the pattern of bone involvement with punched-out lytic lesions and absence of localization of the tumor to the mucosa of the oral cavity led us to a diagnosis of anaplastic myeloma. The patient initially received antiretroviral therapy followed by thalidomide and pulse dexamethasome therapy, but his response was poor. His HIV load increased, and his malignancy rapidly progressed with the development of multiple vertebral lesions, extraosseous extension, and eventually cord compression. He died of the disease less than 2 mo after presentation.