Cytological features of malignant metastatic ameloblastoma: A case report and differential diagnosis

In this report, the cytological features and differential diagnosis of the metastasis from and subsequent local recurrence of an unusual case of malignant (metastatic) ameloblastoma are described, with histological confirmation. Characteristic cytological findings included fibrovascular central cores surrounded by palisading crowded basaloid or columnar cells or both and rosette-like structures of tumor cells with central fibrillary material. Keratin debris in the background and cystic cavities were prominent components of the metastatic ameloblastoma. The basaloid cells showed scant-to-absent cytoplasm, round-to-oval to tear-shaped nuclei, rare longitudinal nuclear grooves, single or multiple nucleoli, and smooth-to-clefted nuclear contours. No features to predict malignant behavior were identified (abundant mitotic activity, necrosis, nuclear pleomorphism). The cytological features of ameloblastoma appear to be characteristic enough to allow definitive diagnosis. However, since the cytology of this tumor is underreported in the literature, the unwary observer could easily misdiagnose it, especially at metastatic sites. Diagn. Cytopathol. 1998; 18:125–131. © 1998 Wiley-Liss, Inc.     

Fine‐needle aspiration cytology of ameloblastoma and malignant ameloblastoma: A study of 12 cases

Ameloblastoma is an odontogenic tumor with aggressive biological behavior, high recurrence rate, and a complex microscopic appearance with many different histologic patterns. Primary ameloblastoma is also described in extragnathic locations. Because of its wide morphologic spectrum, which is mirrored also in cytologic smears, a thorough study of distinctive features is required to reach a reliable diagnosis. Twelve cases of ameloblastoma were examined both cytologically and histologically. The patients were seven women and five men 24–85 years old, mean age being 64 years. Eleven cases were primary tumors of the mandible and maxilla, and one case was a lung tumor metastatic from the tibia. The epithelial element in the cytologic smears of the various cases was morphologically diverse. The basaloid pattern and minimal nuclear atypia were rather constant findings, and the most helpful features toward reaching a cytological diagnosis. However in most cases, careful consideration of the clinical, radiological, cytological, and occasionally immunocytochemical data was required to rule out other entities with similar cytological findings. In some cases, the final diagnosis was only possible by histologic examination. Due to their variable microscopic morphology, ameloblastomas are quite often misdiagnosed for other entities, both benign and malignant. Nevertheless, when one is aware of their distinctive features, an accurate diagnosis can be made by fine‐needle aspiration cytology, in conjunction with clinical and radiological findings. Both the preoperative surgical planning and the postoperative follow‐up of the patients benefit significantly from this method. Diagn. Cytopathol. 2013. © 2011 Wiley Periodicals, Inc.     

Fine needle aspiration of malignant melanoma with myxoid features: A case report with molecular analysis

Malignant melanoma with myxoid features (MMM) is a rare melanoma variant in which tumor cells are embedded within a basophilic myxoid stroma. The stromal matrix is composed of acidic mucopolysaccharides, which are thought to be produced by mesenchymal stromal cells in response to melanoma invasion. Interestingly, this myxoid matrix is more often seen in metastasis from a primary tumor that does not have a myxoid stroma. The diagnosis of MMM on fine needle aspiration (FNA) can be confused with other myxoid tumors. Herein, we present a case of MMM diagnosed by FNA of a peri‐auricular lymph node in an 89‐year‐old man with a history of resected malignant melanoma. We describe the clinical, cytohistological, and immunohistochemical findings, and present the unique molecular alterations that were identified. We also discuss the differential diagnosis and potential diagnostic pitfalls associated with MMM.     

Fine needle aspiration cytology of cylindroma of scalp: A case report

Cylindromas are uncommon benign adnexal tumor. Multiple cylindromas are commonly genetically inherited and also known as “turban tumor.” Cytology of dermal cylindroma is rarely discussed in previous literature. We have diagnosed a case of dermal cylindroma of scalp in an elderly female patient by fine needle aspiration cytology of the lesion and further confirmation was done by histopathology. Cytology consists of many clusters of small round to oval basaloid cells surrounded and attached with magenta coloured acellular hyaline material. The cells have very scanty cytoplasm and dark, round to oval hyperchromatic nuclei without any nuclear membrane irregularity. Histopathology revealed nests of tumor cells separated by dense pink, PAS positive basement membrane material with a jigsaw puzzle appearance. Cytology of cylindroma should be differentiated from adenoid cystic carcinoma and other benign adnexal tumor like spiradenoma. We have discussed the case of cylindroma of scalp diagnosed by cytology and confirmed by histopathology. Diagn. Cytopathol. 2016;44:1082–1084. © 2016 Wiley Periodicals, Inc.     

Fine needle aspiration biopsy of intraparotid spindle cell lipoma: A case report

Intraparotid spindle cell lipoma (SCL) of the salivary gland is a rare entity. Review of the literature revealed only two previous reports describing its cytological features. We report a case of a 44‐year‐old man who complained for a slowly growing, asymptomatic mass in the left parotid gland that since 12 months. Fine needle aspiration biopsy (FNAB) showed a loose collections of bland‐appearing spindle cells in a myxoid background admixed with capillary fragments and some mature fat cells suggesting a diagnosis of SCL. A cytological diagnosis of mesenchymal myxoid spindle cell tumor with lipomatous differentiation, possibly an intraparotideal SCL was performed. Histological examination of the mass and the positive immunostaining for CD34 and negativity for S‐100, CK‐cocktail, and actin confirmed the diagnosis of SCL. The diagnosis of intraparotid SCL can be made by examining cytologic material containing mature fat with bland spindle cells in a myxoid background. FNAB diagnosis on SCL also allows to rule out other primary salivary gland tumors that may be clinically and instrumentally indistinguishable and thereby permits an appropriate surgical procedure to ensue. Diagn. Cytopathol. 2013. © 2011 Wiley Periodicals, Inc.     

Riedel thyroiditis: Fine needle aspiration findings of a rare entity

Riedel thyroiditis is a rare fibrosing disorder characterized by extension of the fibroinflammatory process beyond the thyroid capsule. Due to the nature of this lesion, fine‐needle aspiration often yields scant material and may be interpreted as non‐diagnostic. In this report, we describe cytologic features that allow the cytopathologist to favor a diagnosis of Riedel thyroiditis, thereby guiding appropriate further work‐up and management. Diagn. Cytopathol. 2015;43:747–750. © 2015 Wiley Periodicals, Inc.     

Malignant teratoma of the thyroid: A difficult diagnosis by fine‐needle aspiration

Primary thyroid teratomas are rare, usually benign, and typically occur in children. We report the unusual occurrence of a malignant thyroid teratoma in a young man. Initial ultrasound and CT studies revealed an 8.5 heterogeneous mass involving the entire right thyroid lobe causing tracheal compression and deviation. Fine‐needle aspiration (FNA) revealed malignant cells with possible neuroendocrine features. Similar findings have been previously reported, with an occasional interpretation as possible medullary thyroid carcinoma. In no report, as with our case, has the correct diagnosis been suggested with FNA. The surgical specimen contained abundant primitive neuroepithelium with a very minor component of mature ectodermal tissue in one area. Like this case, an abundance of immature neuroepithelium has been reported in essentially all previous reports of primary malignant thyroid teratoma, sometimes creating a challenge to find another type of germ cell tissue. Array comparative genomic hybridization studies in this case revealed a markedly complex karyotype including gain of chromosome 12 and loss of 17p. Amplification of MYCN, EWSR1 rearrangement and isochromosome 12p were not identified, providing no evidence for neuroblastoma or Ewing sarcoma/peripheral neuroectodermal tumor, both of which have also rarely been reported as primary thyroid tumors. With the use of cisplatinum‐based chemotherapy combined with radiation, survival times have increased dramatically. Our patient is now disease free and back to his normal activities after relatively short follow‐up. Although rare, it is important to be aware that teratomas may present as a thyroid nodule. Recognition by FNA is challenging, and requires multiple modalities for full identification.     

Fine needle aspiration in intraocular metastasis from pleuropulmonary blastoma. A case report and a review of the literature

Pleuropulmonary blastoma (PPB) is a rare primitive intrathoracic malignant neoplasm that occurs almost exclusively in children and adolescents. PPB is classified into three types according to the presence of cystic and solid areas. We report a case of PPB with an intraocular metastasis diagnosed by fine needle aspiration (FNA): 3‐year‐old female was treated for type II PPB by neoadjuvant chemotherapy and surgery. Four years later, she presented with an intraocular lesion. To differentiate between metastasis or other malignancy, a transcleral FNA was performed and showed two cellular populations represented by roundish malignant cells and spindle‐shaped cells. The patient was treated with chemotherapy and diode laser ablation. A year later, the patient had enucleation and rare residual cells were found on the histological specimen. Patient remains disease‐free 66 months after the last surgical treatment. Diagn. Cytopathol. 2017;45:156–160. © 2016 Wiley Periodicals, Inc.     

Fine needle aspiration cytology in a case of fibrous dysplasia of jaw

Fibro‐osseous lesions of the jaw comprise of a spectrum of diseases which include osseous dysplasia, fibrous dysplasia, and ossifying fibroma. The differentiation amongst these individual pathological lesions is difficult and a combined clinico‐radiological and histological correlation is essential for exact categorization. Fine needle aspiration cytology (FNAC) is frequently carried out to distinguish between benign and malignant lesions of the jaw as is a quick and reliable modality of investigation which guides in further management. We report, a case of a jaw swelling in a young male, diagnosed as fibrous dysplasia on FNAC. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Paratesticular congenital malignant rhabdoid tumor diagnosed by fine-needle aspiration cytology. a case report

We report the FNA features of a congenital malignant extrarenal rhabdoid tumor (MERT) located in the right paratesticular area of a newborn full-term boy (39 wk gestation), with disseminated metastases in the liver and right parietal region. The diagnosis was suggested two days after birth by fine-needle aspiration biopsy (FNAB) of the parietal mass, which demonstrated an atypical large cell proliferation with vesicular nuclei, prominent nucleoli, and abundant cytoplasm exhibiting paranuclear dense inclusions. The diagnosis was confirmed by histopathologic and immunohistochemical examination of the primary paratesticular tumor. To the best of our knowledge, this is the third MERT reported in the paratesticular region, one of the few congenital extrarenal non-central nervous system cases, and the third congenital case (renal or extrarenal) primarily diagnosed by FNAB. We emphasize the characteristic cytologic features of a congenital rhabdoid tumor, which must be known by pathologists because of the clinical and prognostic implications. Diagn. Cytopathol. 2004;30:46-50.     

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.     

Adult ocular medulloepithelioma diagnosed by transscleral fine needle aspiration: A case report

Ocular medulloepithelioma (ME) is a rare congenital tumor which occurs usually during childhood but is also reported in adults. They have seen an intraocular tumor in an 89 years‐old female with a history of small cell lung carcinoma. Transscleral fine needle aspiration was performed. Aspirates were rich and composed of two distinctive populations of cells. The first consisted of epithelioid large cohesive cells with rare rosettes. Nuclei were oval and chromatin was delicate with small nucleoli. The second population consisted of smaller and dispersed cells with regular nuclei and dusty chromatin. Immunohistochemistry performed on paraffin‐embedded cell block sections showed that the larger cells and rosettes were cytokeratin AE1/AE3, Synaptophysin, Chromogranin A, CD56, NSE, and EMA positive, whereas the smaller cells were always negative. Interestingly smaller cells expressed only weak nuclear positivity for TTF1, whereas larger cells were TTF1 negative. Melanocytic markers were negative in both populations. Morphological patterns and immunohistochemical staining confirmed ocular ME and allowed to exclude pulmonary metastasis or primary malignant melanoma. The patient was successfully treated by brachytherapy alone and is alive and well 10 months after treatment. Diagn. Cytopathol. 2017;45:561–564. © 2017 Wiley Periodicals, Inc.     

Fine needle aspiration in retroperitoneal lesions

The retroperitoneal space is a potential space extending from lumbar to the pelvic region, behind the peritoneum. It encloses many vital organs like adrenals, kidneys, ureters, pancreas, aorta and its branches, inferior vena cava and its tributaries and many lymph nodes along with loose connective tissue and fat. The literature regarding role of fine needle aspiration cytology (FNAC) for diagnosis of retroperitoneal lesions as a whole, is exceedingly limited. The present study was conducted to elucidate the spectrum of retroperitoneal lesions and to determine the diagnostic accuracy of fine needle aspiration cytology, presenting to a tertiary care referral centre. A total of 389 aspirates from retroperitoneal lesions were reviewed for clinical and radiological details. The smears were studied for the cytological diagnosis. Cytological–histological correlation was assessed and the causes for discordant diagnoses were determined. The patients’ age ranged from 1 to 88 years. There were 234 (60.2%) males and 155 (39.8%) females. In 61 (15.7%) aspirations, the yield was inadequate for reporting and 328 were satisfactory. About 113 (29.0%) aspirates were from pancreatic masses alone, 97 (24.9%) from the retroperitoneal lymph nodes, 70 (17.9%) from the kidneys, 45 (11.5%) from the adrenals, 41 (10.5%) from the retroperitoneal soft tissues and 23 (5.9%) from retroperitoneal segments of the gut. There were 249 (64.0%) neoplastic lesions and 79 (20.3%) non‐neoplastic lesions, the ratio being 3.1:1. Eight (2.0%) aspirates were reported as suspicious for malignancy, and 5 (1.2%) aspirates were reported as neoplastic but could not be categorized as benign or malignant. Of the neoplastic lesions, malignant neoplasms (n = 216; 87.1%) were much more common than the benign (n = 20; 8.0%), the ratio being 10.8:1. Of all the satisfactory aspirates, subsequent histopathology was available only in 33/327 (10%) cases. A positive correlation between cytological and histological diagnosis was observed in 27/33 (81.8%) cases. We believe FNAC is a useful method for an early, rapid, minimally invasive and reliable pre‐operative diagnosis for retroperitoneal lesions and can often obviate the need for open surgical biopsy.     

Fine needle aspiration biopsy of epithelioid hemangioendothelioma of the oral cavity: report of one case and review of literature

Epithelioid hemangioendothelioma (EHE) is an uncommon vascular tumor with biological behavior intermediate between hemangioma and angiosarcoma. It rarely occurs in the oral cavity. We report a case of an 81-yr-old woman with a 2-mo history of a 2 x 2 cm2 submucosal buccal mass. Fine needle aspiration (FNA) smears were paucicellular and showed mainly single atypical large epithelioid cells in a bloody background. The atypical cells had abundant dense cytoplasm, some with fine vacuoles. Occasionally, cells with large cytoplasmic lumina were seen. Cytology preparations from fresh tissue received for frozen section revealed numerous neoplastic cells with large intracytoplasmic lumina, some of which contained red blood cells. In addition, cells with distinct intranuclear inclusions were present. Histologic sections and immunohistochemical stains confirmed the diagnosis of EHE. Although the histologic features of EHE are well recognized, reports of FNA cytology findings are sparsely existent in the literature as several case reports. The characteristic cytological features of EHE are reviewed in this report. We believe that the diagnosis of this rare tumor can be suggested when an adequate FNA specimen is obtained.     

Fine‐needle aspiration biopsy of a papillary thyroid carcinoma involved by malignant plasma cell disease: A case report

We described the fine‐needle aspiration biopsy findings in a case of papillary thyroid carcinoma involved by a malignant plasma cell disease of the thyroid gland in a 54‐year‐old female. Although papillary thyroid carcinoma is the most common malignant tumor of the thyroid gland, involvement by plasma cell disease is exceptionally unusual. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Fine‐needle aspiration cytologic diagnosis of lymphocutaneous sporotrichosis: A case report

A case of lymphocutaneous sporotrichosis initially diagnosed by fine‐needle aspiration (FNA) cytology and confirmed by tissue biopsy and culture study is presented. Asteroid bodies and yeast cells with budding, highly suggestive of the disease, were seen in the cytologic and histologic preparations. The pathology of this unusual fungal disease and the role of cytology in the diagnosis are discussed. This is the first case of lymphocutaneous sporotrichosis reported in the cytologic literature as diagnosed by FNA cytology. Diagn. Cytopathol. 1999;20:74–77. © 1999 Wiley‐Liss, Inc.     

Fine needle aspiration of renal cortical lesions in adults

The role of fine needle aspiration (FNA) biopsy of renal cortical lesions was controversial in the past because the result of the FNA did not affect clinical management. All renal cortical lesions, except metastasis, were subject to surgical resection. However, with the advances in neoadjuvant targeted therapies, knowledge of the renal cortical tumor histological subtype is critical for tailoring clinical trials and follow‐up strategies. At present, there are clinical trials involving the use of novel kinase inhibitors for conventional (clear cell) and papillary renal cell carcinoma. We studied 143 consecutive cases of renal cortical lesions, evaluated after radical or partial nephrectomies over a 2‐year period. An air‐dried smear and a Thinprep® slide were prepared in all cases. The slides were Diff‐Quick and Papanicolaou stained, respectively. The cytology specimens were reviewed and the results were then compared with the histologic diagnosis. Cytology was highly accurate to diagnose conventional RCC, while the accuracy for papillary RCC, chromophobe RCC, and papillary urothelial carcinoma was much lower. Our results indicate that ancillary studies might have an important role in the subclassification of renal cortical neoplasms for targeted treatment. Diagn. Cytopathol. 2010;38:710–715. © 2009 Wiley‐Liss, Inc.     

Fine needle aspiration of metastatic prostate carcinoma simulating a primary adrenal cortical neoplasm: A case report and review of the literature

Adrenal metastases usually occur in prostate cancer patients with widespread bone and visceral disease. Autopsy studies have shown that adrenal metastases may be found in up to 23% of these patients. However, the finding of an isolated adrenal metastasis without the involvement of other organs in a patient with prostate cancer is exceedingly rare. Thus, it may cause a diagnostic dilemma on FNA cytology. We report a patient with a history of prostate cancer, status post radiation, and hormonal therapy 4 years before, who presented with a new, single adrenal mass on abdominal imaging studies. The ultrasound‐guided FNA cytology of the adrenal mass revealed cytomorphological features that were suggestive of a primary adrenal cortical neoplasm, but overlapped with those of a prostate metastasis. To our knowledge, FNA findings of metastatic prostate cancer simulating an adrenal cortical neoplasm have not been previously reported in the English literature. The purpose of our study is to discuss the differential diagnosis of these entities. The accurate diagnosis is important because of different prognosis and treatment implications for the various diseases. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.