Fine‐needle aspiration biopsy of prostate synovial sarcoma: A case report and review of the literature

We describe a case of synovial sarcoma originating from prostate gland. The diagnosis was confirmed by fluorescent in situ hybridization analysis (FISH) for SYT rearrangement on the cell block. Synovial sarcoma is a high grade soft tissue malignancy with exceedingly rare involvement of genitourinary tract. However this entity should be considered in the differential diagnosis when dealing with aspiration biopsies of particularly deep seated lesions with spindle cell or small round blue cell cytomorphology. Diagn. Cytopathol. 2017;45:168–172. © 2016 Wiley Periodicals, Inc.     

Fine‐needle aspiration features of ossifying fibromyxoid tumor in the breast: A case report and literature review

Ossifying fibromyxoid tumor (OFT) is a very rare soft tissue tumor which is characterized by incomplete peripheral mature bone shell. To date, cytological features of OFT have been poorly studied with only seven case reports. In this study, an additional case of OFT investigated by fine‐needle aspiration is presented. A 75‐year‐old man with advanced nasopharyngeal carcinoma presented with peripherally calcified right breast mass. Smears were hypercellular and stroma‐rich. Tumor cells were mainly dispersed, with epithelioid morphology and eccentrically located nuclei. In the background, there was abundant eosinophilic myxoid secretion. No necrosis, atypia, or mitotic activity was found. The tumor showed diffuse S‐100, CD10, STAT6 expression and focal desmin, estrogen receptor (ER), and progesteron receptor (PgR) expression. Fluorescence in situ hybridization study revealed PHF1 rearrangement in 9% of cells. Cytological characteristic of OFT is quite distinctive and precise diagnosis can be made, especially when it is coupled with compatible radiological findings.     

Fine‐needle aspiration cytology of solid papillary carcinoma of the breast

We report a case of solid papillary carcinoma (SPC) of the breast, of which the cytologic findings of the nipple discharge and the fine needle aspiration (FNA), and the pathology of the resected tumour are described in detail. Imaging studies demonstrated an intra‐ductal tumour of the breast, which seemed responsible for the bloody nipple discharge. The cytologic features of the nipple discharge and the FNA targeted to the intra‐ductal tumour suggested low‐grade carcinoma. Additional findings of mucin production and rosette‐formation (possibly neuroendocrine differentiation) indicated SPC as a major differential diagnosis. Histologically, the lesion consisted of mainly ductal proliferation of low‐grade carcinoma associated with prominent rosette formation within the tumour and mucin production. Permeation of mucin with cancer cell clusters into the adjacent adipose tissue was also noted. Immunohistochemically, the tumour cells, especially those forming rosettes, were partially positive for CD56. Histological diagnosis was SPC with invasion. SPC is a rare tumour, and its cytologic and pathologic features have only been sporadically reported. Our case was unique in that there was a good correlation between cytologic and histologic findings. The cytologic findings that are important to predict the histologic diagnosis are emphasized. A brief review of the relevant literature is also included.     

Fine‐needle aspiration of the Warthin‐like variant of papillary thyroid carcinoma: A report of three cases

In English literature, there are only few reports of Warthin‐like papillary thyroid carcinoma. We presented three cases and provided clinical, grossing, cytological, and histological correlation. In our point of view, the diagnosis of Warthin‐like papillary thyroid carcinoma is feasible based on cytomorphological aspects. Usually those cases present moderately or highly cellular smears with many atypical Hürthle cells showing obvious papillary thyroid carcinoma nuclear features and without papillary structures, even if the inflammatory background is mild.     

Well‐differentiated papillary mesothelioma,possibly giving rise to diffuse malignant mesothelioma: A case report

Well‐differentiated papillary mesothelioma (WDPM) is a distinct subtype of mesothelial tumor from diffuse malignant mesothelioma (DMM), with an uncertain malignant potential. The relationship between WDPM and DMM, with regard to the ability of the former to develop into the latter, is also unknown. A 58‐year‐old woman, diagnosed with a rectal carcinoid tumor, underwent removal of the lymph nodes via the abdomen in 2004. A large number of white miliary nodules were identified on the mesentery and peritoneum, which were histologically diagnosed as WDPM. No further therapy was administered, but the patient was followed‐up using imaging methods. Seven years later, an abdominal wall mass was discovered using positron emission tomography‐computed tomography, and a laparotomy biopsy was performed. DMM was diagnosed, because mesothelioma with extended invasion had been histologically identified. Mesothelioma similar to papillary proliferation was present on the outer layer of the peritoneum, and an infiltrating lesion with continuous restiform or solid‐like structures was noted. WDPM was believed to have undergone malignant transformation. Compared to DMM, WDPM has a good prognosis and is considered a benign or borderline neoplasm. Our findings suggest that WDPM does have malignant potential, however, because histological findings indicated a malignant transformation of WDPM to DMM.     

Cytomorphologic features of well-differentiated papillary mesothelioma in peritoneal effusion: a case report

Well-differentiated papillary mesothelioma (WDPM), a distinct subtype of diffuse malignant mesothelioma, usually occurs in the peritoneum and is seen most commonly in women of reproductive age. Histologic features of WDPM include papillary growth and stout fibrous cores surrounded by a single layer of tumor cells. We present the case of a 73-year-old woman without subjective symptoms who showed signs of peritoneal effusion during a routine examination and for whom cytologic examination of the ascitic fluid was performed. Many spherical clusters, with a smooth external surface composed of a single layer of uniform cuboidal cells, were observed. Within each cluster, a collagenous ball showed light green Papanicolaou staining. Immunohistochemistry of surgical specimens showed tumor cells positive for calretinin, D(2)-40, and HBME-1 staining. The histologic diagnosis was WDPM. The identification of a collagenous ball within these clusters is a useful cytologic finding for the diagnosis of WDPM. WDPM should be suspected when numerous collagenous balls are present by effusion cytology and isolated cells are not.     

Fine‐needle aspiration of the diffuse sclerosing variant of papillary thyroid carcinoma masked by florid lymphocytic thyroiditis; A potential pitfall: A case report and review of the literature

The diffuse sclerosing variant of papillary thyroid carcinoma (DSV–PTC) is a rare tumor with aggressive behavior that requires aggressive treatment. Despite characteristic clinical and histological features that easily permit diagnosis, pre‐operative fine‐needle aspiration cytology (FNAC) diagnosis is often challenging and thus delays diagnosis. We describe the cytological features of a case of DSV–PTC diagnosed by FNAC in a 30‐year‐old woman presenting with an ill‐defined mass in her neck lasting for 2 months. Ultrasonograpy revealed a heterogeneous enlargement of both thyroid lobes suspicious for a lymphoproliferative syndrome. Flow cytometry showed a suspect B‐lymphocyte population. FNAC showed in five out of six slides an overwhelming presence of slightly atypical monomorphic small lymphocytes. The remaining slide showed syncytial tissue fragments of follicular cells with nuclear enlargement and pleomorphism, irregular nuclear membrane, grooves with scattered intranuclear inclusions, squamous metaplastic epithelium, and abundant psammoma bodies. A diagnosis of DSV–PTC was rendered and confirmed by total thyroidectomy and lymph node dissection. Our report supports the possibility of obtaining a preoperative diagnosis of DSV–PTC by FNAC. In the case of diffuse thyroid enlargement, adequate sampling of the thyroid and the presence of the combination of features described in our case permitted the diagnosis of this PTC variant. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Fine‐needle aspiration in myxofibrosarcoma: Experience of Institut Curie

Myxofibrosarcoma (MFS) is a well‐established nosologic entity different from the myxoid variant of malignant fibrous histiocytoma. In an attempt to better define the representative cytologic criteria of MFS, we undertook a review and a reanalysis of a series of 14 cytology samples in 12 patients whose tumors were diagnosed as MFS. Using FNA technique and reviewing the original diagnoses, 11 cases were diagnosed as malignant and three as benign tumors. The cytologic diagnosis of MFS was accurate in seven cases (2 primary tumors, 4 recurrences, and 1 metastasis). Four cases were classified malignant myxoid sarcoma (1 primary and 3 recurrences), whereas three cases (2 primary and 1 recurrence) were false‐negative. The smears were cell‐rich in 12 cases and cell‐poor in two cases. They were constantly composed of isolated and regular small spindle‐shaped and stellated cells with elongated nuclei containing small inconspicuous nucleoli. Cytoplasm was pale with elongated processes. Clusters of wavy spindle‐shaped cells, round cells without specific pattern, moderate cytonuclear atypia, and abundant myxoid background as well as curvilinear vascular structures were always seen. In the vast majority of cases, the cytologic distinction of MFS from other low‐grade myxoid lesions is difficult. Entities such as myxoid MFH, myxoid liposarcoma (MLP), myxoid DFSP, and myxoma should be considered in the differential diagnosis. The cytological misdiagnosis is of limited clinical consequence because FNA findings suggestive of a myxoid tumor will be indicative for a surgical removal followed by the histopathological analysis. Diagn. Cytopathol. 2010. © 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 cytology of a mammary myofibroblastoma: A case report on the role of immunohistochemistry and cell block preparations and a review of the literature

Myofibroblastoma (MFB) is a benign tumor of the mammary stroma with predominant myofibroblastic differention. The cytologic reports of MFB are very few in the available literature. From the cytodiagnostic point of view about 21 cases of MFB with cytological evaluation by fine‐needle aspiration cytology (FNAC) have been encountered in the English‐language literature: A 35‐year‐old woman presented with lump in the left breast. FNAC showed mild degree of pleomorphism with occasional groups with fibrous stroma and tumoral cells. A few benign epithelial cell groups were seen. Hematoxylin–eosin‐stained sections of cell block preparation from the aspirate showed fascicles of spindle cells forming whorl structures. Three months later, excision biopsy was performed. The diagnosis was a classic variant of MFB. On immunohistochemical examination, sections were found to be highly positive for vimentin, CD34, and bcl‐ 2. In light of these findings, cell block material was retrospectively reviewed both morphologically and immunhistochemically. The findings of resection and cell block material were found to be very similar. MFB may cause a potential diagnostic pitfall while interpreting FNAC due to its wide differential diagnosis spectrum. We concluded that cytology and cell block findings complement each other. Diagn. Cytopathol. 2016;44:1064–1069. © 2016 Wiley Periodicals, Inc.     

Fine‐needle aspiration cytology of endometriosis

Endometriosis commonly involves the pelvis, but may also present as a palpable mass in extrapelvic sites, such as the abdominal wall or inguinal region, where it can be evaluated by fine needle aspiration (FNA). In this report, we illustrate the findings seen in seven cases of endometriosis diagnosed by FNA in patients with a chief complaint of pain associated with an abdominal wall or pelvic mass, occurring in a setting of prior pelvic surgery. The most common previous surgery was Cesarean section (n = 6), followed by hysterectomy (n = 2), and hernia repair (n = 1). In all cases, cytologic examination revealed a glandular component composed largely of orderly fragments of cohesive epithelial cells, a spindle cell stromal component presenting either as loosely organized tissue fragments or single cells, and rare hemosiderin‐laden macrophages. Four cases showed focal cytologic atypia in the glandular component with extreme nuclear atypia identified in two of these cases. Atypical features included nuclear crowding and disorganization, nuclear enlargement, hyperchromasia with irregular chromatin distribution and anisonucleosis, raising the possibility of a coexistent malignancy and recommendation for excision. Although malignancy was not identified in follow‐up surgical excision specimens, the wide range of cytomorphologic changes that can be seen in FNA specimens of endometriosis should be recognized. Diagn. Cytopathol. 2017;45:359–363. © 2016 Wiley Periodicals, Inc.     

Fine‐needle aspiration diagnosis of sclerosing hemangioma (pneumocytoma): Report of a case and review of the literature

Sclerosing hemangioma (pneumocytoma) is a rare benign lung tumor with uncertain histogenesis but characteristic histology. Reports of the cytopathology of this tumor are even rarer with only a handful of cases in the literature—many of these incorrectly diagnosed by cytology initially. Herein, we describe a case of sclerosing hemangioma diagnosed prima facie by fine‐needle aspiration cytology. A cell block preparation with accompanying immunohistochemistry was instrumental in making the diagnosis. A review of the literature is also presented. Diagn. Cytopathol. 2014;42:242–246. © 2012 Wiley Periodicals, Inc.     

Benign chondroblastoma on fine‐needle aspiration smears: A seven‐case experience and review of the literature

We report seven cases of chondroblastoma (CB) of bone, diagnosed by Fine‐Needle Aspiration Cytology (FNAC), and confirmed by histomorphological examination. The concurrence of some cytomorphologic findings — mononucleated cells, multinucleated cells, and intercellular chondroid substance — unequivocally suggested the cytological diagnosis of CB. We also reviewed the literature on this topic in order to discuss morphological criteria and the importance of needle size. The differential diagnosis between CB, Giant Cell Tumor of Bone, and Eosinophilic Granuloma is further discussed. Diagn. Cytopathol. 2015;43:734–738. © 2015 Wiley Periodicals, Inc.     

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 cytology of extraskeletal myxoid chondrosarcoma: A case report

Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue tumor arising in extremities. We report a typical case of EMC in left inguinal region of a 71‐year‐old man, which was first approached by fine‐needle aspiration, followed by surgical excision and subsequently diagnosed by microscopic examination and immunohistochemical study. We discuss briefly the differential diagnosis. It is important to separate EMC from other myxoid soft tissue tumors. We point out that although cytologic features may be orientating to a myxoid tumor, may not be completely distinctive. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

Fine-needle aspiration of adult rhabdomyoma: a case report with review of the literature

The cytologic features of adult rhabdomyoma, a rare benign tumor of skeletal muscle origin, have been infrequently reported in the literature. We present here a case of a rhabdomyoma involving the floor of the mouth of a 78-year-old man initially diagnosed by fine-needle aspiration cytology. Cytologic features seen on Papanicolaou-stained smear preparation included cohesive clusters of skeletal muscle cells having abundant eosinophilic cytoplasm and often peripherally located nuclei. Although cross-striations and elongated intracytoplasmic inclusions were not identified in the smears, they were noted in the cell block preparation of the aspirated specimen and in the touch preparation and histologic sections of the surgically resected specimen. The cytologic differential diagnosis of this tumor is discussed.     

Fine‐needle aspiration cytology in the diagnosis of malignant proliferating trichilemmal tumor: Report of a case and review of the literature

Malignant proliferating trichilemmal tumor is a rare cutaneous neoplasm derived from the outer root sheath of the hair follicle. Fine‐needle aspiration cytology is being increasingly used in the investigation of primary and metastatic cutaneous tumors. However, there are few reports on the cytology of trichilemmal tumors in the literature. We describe the cytological features of this uncommon adnexal tumor presenting as a scalp mass in a 58‐year‐old woman. In view of its aggressive biological behavior, it is crucial for cytologists to be aware of this rare lesion and distinguish it from primary cutaneous squamous‐cell carcinoma. The differences on fine‐needle aspiration cytology can be subtle and pose problems in diagnosis. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Fine‐needle aspiration cytology of metastatic eccrine porocarcinoma

Eccrine porocarcinoma (EP), although rare, is widely recognized as the most common malignant sweat gland tumor. EP typically grows slowly and usually is cured by surgical excision with clear margins. An elevated mortality rate, however, is observed when regional lymph nodes are involved. We herein describe cytohistologic findings in a case of metastatic EP. An 86‐year‐old man with a history of EP of the left lateral ankle and squamous cell carcinoma in situ (Bowen's disease) of the penis presented with enlarged left inguinal lymph nodes. A superficial fine‐needle aspiration (FNA) was performed and demonstrated a hypercellular sample with discohesive clusters and/or individual tumor cells. The tumor cells were round or oval with most of the cells showing dense, refractile cytoplasm. Intracytoplasmic vacuoles were readily appreciated in some of the cells. Nuclear enlargement, high N/C ratio, nuclear hyperchromasia, bi‐ and multinucleation, and prominent nucleoli were seen. A diagnosis of metastatic eccrine porocarcinoma was rendered. Enlarged retroperitoneal lymph nodes were detected and CT‐guided left retroperitoneal core biopsy was performed 1 week later. The biopsy revealed features consistent with metastatic eccrine porocarcinoma. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.