Cellular congenital mesoblastic nephroma in a newborn

Typical nephroblastoma (Wilms'tumor) is uncommon within the first 6 months of life. Renal tumors most commonly found in this age constitute of two groups which have a better and worse prognosis, respectively, than typical nephroblastomas. The group of tumors with a better prognosis encompasses congenital mesoblastic nephroma (CMN), fetal rhabdomyomatous nephroblastoma and cystic, partially differentiated nephroblastoma. The group of tumors with a worse prognosis consists of rhabdoid tumor of the kidney and bone metastasizing renal tumor (clear cell sarcoma) of childhood. Adequate therapy for these two neoplasms has as yet to be developed. Among the low-grade malignant tumors congenital mesoblastic nephroma can be successfully treated with simple nephrectomy. There, are however, variants of CMN which may differ in clinical behavior from the typical form of CMN. These variants include the cellular CMN2 and, possibly, the malignant mesenchymal nephroma of infancy. A case of cellular congenital mesoblastic nephroma is presented here. Its clinical and pathologic features are discussed.     

Cytological diagnosis of mesoblastic nephroma: A report of three cases with summary of prior published cases

Congenital mesoblastic nephroma (CMN) is a rare pediatric renal neoplasm, occurring most commonly in the first few months of life, with a favourable clinical outcome. Accurate pre‐operative cytological diagnosis of this entity is important as pre‐operative chemotherapy is not recommended and surgery is the treatment of choice. Cytodiagnosis of this rare tumor is discussed in only a few case reports. Here two cases of CMN and one case of cellular congenital mesoblastic nephroma (CCMN) diagnosed on FNAC along with their morphological differential diagnoses has been reported. They also take this opportunity to compare the cytological features of CMN with cellular CMN. Diagn. Cytopathol. 2016;44:823–827. © 2016 Wiley Periodicals, Inc.     

Cytodiagnosis of congenital mesoblastic nephroma: A case report

Mesoblastic nephroma (MN) is the most common renal tumor diagnosed in infancy. A case of congenital MN was diagnosed in a 6‐month old child by fine‐needle aspiration cytology. The smears were cellular and consisted of plump spindle cells arranged in clusters along with scattered naked nuclei in the background. Blastemal, epithelial, or glomeruloid structures were not seen. Considering the age and the cytomorphology, a diagnosis of cellular variant of MN was offered which was confirmed on histopathology. Unlike Wilms tumor, preoperative chemotherapy is not required for MN. Hence cytologic diagnosis is important. Diagn. Cytopathol. 2013. © 2011 Wiley Periodicals, Inc.     

Prenatal sonographic diagnosis of a fetal renal mesoblastic nephroma occurring after transfer of a cryopreserved embryo.

Here we report the first case of prenatally diagnosed fetal renal mesoblastic nephroma occurring after transfer of a cryopreserved embryo. A 37 year old woman, having immunological infertility, was treated by in-vitro fertilization (IVF) and embryo transfer. Following unsuccessful IVF using fresh embryos, the patient conceived after transfer of cryopreserved-thawed embryos. The chromosomal analysis identified a normal karyotype at 16 weeks' gestation when amniocentesis was performed. The pregnancy course was uneventful until 28 weeks' gestation when polyhydramnios associated with fetal renal tumour was detected using ultrasonography. A male infant weighing 2564 g was born via Caesarean section at 34 weeks' gestation. A left nephrectomy was performed 5 days after delivery and the tumour was identified histologically as a mesoblastic nephroma. The postoperative course was uncomplicated to this point.     

Fine-needle aspiration diagnosis of carotid body tumor: Report of a case and review of experience with cytologic features in four cases

A 45-yr-old female presented with a left upper cervical swelling of 4 yr duration. The clinical suspicion of carotid body tumor (CBT) was confirmed by imaging findings, fine-needle aspiration (FNA) cytology, and histology of the resected tumor. Review of our experience with four cases including the present one during 10 yr (1984–1994) showed that the age of the patients ranged from 35 to 45 yr with a mean of 40.8 yr. All four cases were females and had left-sided upper cervical swelling. Clinically one case was diagnosed as cervical lymphadenopathy and there was clinical suspicion of CBT in two cases. Findings of digital subtraction angiogram in four cases and ultrasonography including Doppler ultrasound vascular imaging in three cases were consistent with CBT. The cytodiagnosis was CBT in three cases and inadequate (blood only) in one case. The analysis of detailed cytologic features in three cases revealed blood-rich aspirate with poor to moderate cellularity, indistinct cell outline, and acinar formation. Giant bare nuclei, spindle-shaped tumor cells, and cytoplasmic granulations were observed in two cases each. Histopathology of the resected tumors in two cases confirmed the cytodiagnosis of CBT. FNA cytology played a useful role in arriving at a tissue diagnosis of this rare neoplasm. Diagn. Cytopathol. 17:143–147, 1997. © 1997 Wiley-Liss, Inc.     

Perineal nodule due to enterobiasis: an aspiration cytologic diagnosis

Subcutaneous swelling due to Enterobious vermicularis infection is rare. Their presence in perineal subcutaneous tissue is unusual and a clinical curiosity. A case of subcutaneous nodule in the perineum due to E. vermicularis infection diagnosed on fine-needle aspiration is described. Tissue reaction was granulomatous with neutrophils and eosinophils. Lack of familiarity with the morphology of parasites or its eggs, degeneration, and inadequate sampling may make the diagnosis difficult. This case report provides the morphologic clues to cytopathologists toward rendering a diagnosis and alerts them to the possibility of parasitic infection in unusual locations.     

Glomus tumor of the stomach: cytologic diagnosis by endoscopic ultrasound-guided fine-needle aspiration

The glomus tumor is usually a benign solitary neoplasm that arises from modified smooth muscle cells of the glomus body, a type of neuromyoarterial receptor that plays a role in the regulation of arterial blood flow. We report a case of gastric glomus tumor diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Smears exhibited groups of cohesive, uniform, small, round to polygonal cells with scant cytoplasm, indistinct cell borders, and round, hyperchromatic nuclei with homogeneous chromatin. The cell block contained fragments of cells with similar morphologic features and immunohistochemical staining exhibited positivity for smooth muscle actin and vimentin. The diagnosis was confirmed by the surgically resected specimen. Ultrastructural examination revealed prominent pinocytotic vesicles lining the plasmalemma. In this report, we discuss the differential diagnosis of gastric glomus tumor and compare the cytologic features of this case with two others reported in the literature.     

Granular-cell tumor of the esophagus: Report of a case with a cytologic diagnosis based on esophageal brushing

We report a case of granular-cell tumor (GCT) in the esophagus. This is a rare location for this tumor and only 80 cases have been described. The tumor was diagnosed in a 24-yr-old woman with epigastralgia. Endoscopic examination revealed a submucosal ulcerated lesion. The smears derived from esophageal brushings contained clusters of granular cells. Histologic examination of the endoscopic biopsy provided diagnostic confirmation of GCT. To our knowledge, this is the first reported case of esophageal GCT in which the characteristic tumor cells were seen in the endoscopic brushing material. This case demonstrates that a cytologic diagnosis of GCT is possible if the lesion is ulcerated and/or brushing is subsequent to taking the biopsy. Although rare in the esophagus, GCT should be considered in the differential diagnosis of esophageal neoplasms. Diagn. Cytopathol. 1998;19:455–457. © 1998 Wiley-Liss, Inc.     

Multicystic nephroma: Report of a case with fine-needle aspiration findings

This report presents the fine-needle aspiration biopsy (FNAB) findings of a multicystic renal tumor in a 52-yr-old woman. The aspirate smears contained clusters of cells with large, irregular nuclei and cytoplasmic vacuoles. Subsequent nephrectomy revealed a multicystic nephroma (MCN). Although most common in childhood, MCN should always be considered in the FNAB differential diagnosis of a multicystic renal mass in adult patients. Even in cases where the diagnosis of MCN is considered, it may be difficult to distinguish from cystic renal cell carcinoma on the basis of radiographic and FNAB findings. Diagn Cytopathol 1996;14:60–63. © 1996 Wiley-Liss, Inc.     

Ancient neurilemmoma: a pitfall in the cytologic diagnosis of soft-tissue tumors

A case of ancient neurilemmoma (Schwannoma) is presented that, owing to a severe cell pleomorphism, was falsely interpreted as a malignant spindle-cell sarcoma by fine-needle aspiration cytology. Cytological features of the tumor are given together with its histopathology and electron microscopy findings. The usefulness of electron microscopy on material obtained by fine-needle aspiration biopsies in the diagnosis of soft-tissue tumors is discussed.     

Aspiration cytology diagnosis of a primary amyloid tumor of thoracic vertebra: a case report

Isolated primary amyloid tumor of bone is rare; however, preoperative diagnosis can be rewarding because the prognosis is excellent. There are no clinical or roentgenographic criteria that can establish this diagnosis. There are few previous reports of fine-needle aspiration (FNA) where diagnosis of amyloidoma was made retrospectively. They describe the presence of extracellular hyaline material along with plasma cells and lymphocytes. A 35-year-old female was referred to the FNA clinic with swelling in the right upper chest wall. Radiologic findings revealed a destructive lytic lesion involving the bodies of D1 and D2 vertebrae with extension into surrounding soft tissue. Repeated FNA smears were hypocellular but had abundant homogeneous flocculent material, which stained positive with Congo red. A few plasma cells and foreign-body giant cells were also seen. We conclude that preoperative FNA cytology diagnosis of amyloid tumor is possible. Hypocellular smears with flocculent material, plasma cells, and foreign-body giant cells in absence of granulation tissue should suggest the diagnosis.     

Sensitive cytologic criteria for the identification of follicular variant of papillary thyroid carcinoma in fine-needle aspiration biopsy

The cytologic diagnosis of follicular variant of papillary thyroid carcinoma (FVPTC) can be extremely challenging and may be associated with false negative diagnoses. The purpose of this study was to determine the minimal cytologic criteria needed to identify FVPTC. We examined sixty-nine fine-needle aspiration (FNA) cases, processed with Diff-Quik and Papanicolaou stains, that were either diagnostic or suspicious of FVPTC. All cases had histologic confirmation. These cases included 29 FVPTC, 18 classic papillary thyroid carcinoma (PTC), 17 follicular neoplasm (6 adenomas, 10 carcinomas, 1 neoplasm NOS), 2 lymphocytic thyroiditis and 3 nodular goiter. Seven of the most commonly cited cytomorphologic features, including flat syncytial sheets, nuclear enlargement, fine chromatin, nuclear grooves, nuclear pseudoinclusions, and amount of colloid and cytoplasm, were evaluated. A diffuse distribution of fine chromatin, nuclear grooves, and colloid was seen more often in FVPTC than in follicular neoplasm (p<0.01). The combination of flat/syncytial sheets, nuclear enlargement, and fine chromatin was observed in all our cases of FVPTC, and is therefore considered a sensitive marker in detecting FVPTC. Logistic regression analysis revealed colloid to be the only positive predictor in favor of FVPTC over classic PTC.     

Carcinoid tumors of the lung: cytologic differential diagnosis in fine-needle aspirates

Pulmonary carcinoid tumors presenting as peripheral or coin lesions are rare and radiologically may resemble other primary or metastatic neoplasms in the lung. This study consisted of the cytologic evaluation of fine-needle aspirates from five peripheral carcinoid tumors of the lung with particular reference to the differences between the cytologic manifestations of this neoplasm and of small-cell carcinoma and well-differentiated adenocarcinoma. Aspirates of typical carcinoid tumors are characterized by isolated cells and loose aggregates of cells; spindle- and oval-shaped cells of uniform size with scanty, pale eosinophilic cytoplasm; and nuclei with evenly dispersed finely granular chromatin and usually prominent single micronucleoli with occasional macronucleoli. In contrast, the cells of small-cell carcinoma are pleomorphic and arranged in noncohesive loose aggregates, their cytoplasm is scanty, and they show nuclear molding. Their nuclei are hyperchromatic with fine to coarsely granular chromatin. The cells of well-differentiated adenocarcinoma are arranged in three-dimensional clusters or loose aggregates of relatively uniform cells with a columnar configuration. The nuclei are uniformly round and hyperchromatic with finely granular chromatin. Macronucleoli are usually prominent. This study demonstrates that cytologic analysis of fine-needle aspirates can play a significant role in the evaluation and management of peripheral lung tumors.     

Fine-needle aspiration cytology of renal angiomyolipoma: Report of a case with immunocytochemical and electron microscopic findings

A case is presented in which the diagnosis of renal angiomyolipoma was made by computed tomography (CT)-guided, fine-needle aspiration cytology and the examination of a cell block. The tumor was characterized by epithelioid smooth muscle cells, blood vessels and fat in the cytologic material. The cytodiagnosis was further substantiated by positive staining of the epithelioid muscle cells for markers of muscle-specific actin, HMB45, and trace positivity for vimentin but not with S100 protein, desmin, or cytokeratin. Further studies for the recently described crystalloids were also performed by using the periodic-acid Schiff stain with and without diastase treatment and electron microscopy on the cytologic material. However, no such crystalloids were found. A preoperative cytologic diagnosis of renal angiomyolipoma was considered to be of value due to the difference in management between angiomyolipoma and a renal carcinoma, both of which can present as a renal mass on imaging. Diagn. Cytopathol. 1998;18:297–300. © 1998 Wiley-Liss, Inc.     

Ossifying fibromyxoid tumor: Report of a case with cytomorphologic description

Ossifying fibromyxoid tumor (OFMT) is a rare soft tissue neoplasm with uncertain histogenesis. Most cases behave in a clinically benign fashion; however, a small percentage of tumors may locally recur or metastasize. Herein we present a case of a 56‐year‐old man who presented with an enlarging left groin mass, left inner thigh numbness, burning paresthesia and discomfort in his left groin. The mass sampled by fine‐ needle aspiration and needle core biopsy. Cytology showed bland‐appearing epithelioid cells with round nuclei and fine chromatin, with fragments of fibromyxoid stroma in the background. Immunohistochemical stains performed on the core biopsy showed that the lesional cells were focally positive for S100 protein and negative for desmin, smooth muscle actin, CD34 and cytokeratin AE1/AE3. A benign neoplasm was favored with ossifying fibromyxoid tumor as the main entity in the differential diagnosis. A subsequent resection showed a well‐circumscribed 5 cm mass with firm consistency and focal areas of calcifications. Histologically, the tumor had a nodular growth pattern with relatively bland spindle cells containing round to oval nuclei suspended in a variably collagenous to myxoid stroma. Significant ossification and bone formation was also noted. There was no significant atypia, necrosis or increased mitoses. Ossifying fibromyxoid tumors have distinct cytologic features and should be considered in the differential diagnosis of soft tissue tumors with prominent ossification. Diagn. Cytopathol. 2015;43:646–649. © 2015 Wiley Periodicals, Inc.     

Spindle‐cell rhabdomyosarcoma of the thumb: Rare site,rare tumor in a child

Spindle‐cell rhabdomyosarcoma (RMS) is a relatively recently recognized favorable variant of embryonal RMS occurring mainly in the paratesticular and head and neck regions. Cytological reports of spindle‐cell RMS have been sparse in the literature and the awareness of its cytological features is not very wide among cytopathologists. A 2‐year‐old girl was brought to clinical attention for a progressively enlarging swelling of right thumb. Imaging studies showed it to be a soft‐tissue tumor in the subcutaneous region. Fine‐needle aspiration yielded moderately cellular smears composed of small, round cells and few spindle cells with tapered cytoplasm. A cytological impression of RMS was rendered, which was later confirmed as spindle‐cell RMS on excision biopsy. Spindle‐cell RMS, a favorable prognostic variant of embryonal RMS, should be considered in the cytologic diagnosis of soft‐tissue tumors with round cell and spindle cell morphology. This is especially true for tumors occurring in hitherto unreported sites. Diagn. Cytopathol. 2016;44:1094–1097. © 2016 Wiley Periodicals, Inc.