Maxillary odontogenic myxoma: a diagnostic pitfall on aspiration cytology

A painless, slow-growing cheek swelling in a young male clinically considered a salivary gland mass was aspirated. Cytology smears were hypocellular. The striking feature was abundant myxoid material with a few monomorphic oval cells, interpreted as myxoid variant of pleomorphic adenoma. Subsequent CT scan was suggestive of a malignant tumor but biopsy confirmed it as myxoma. Myxoma of the jaw is a rare benign tumor that has a tendency for bone destruction, invasion into surrounding structures, and a relatively high recurrence rate. Maxillary myxoma is less frequent but behaves more aggressively than in the mandible, as it spreads through the maxillary sinus. Cytologically, it should be differentiated from other tumors showing predominant myxoid change. Awareness of potential diagnostic pitfalls and careful evaluation of clinical and radiological data is necessary to narrow the differential diagnosis.     

Aspiration cytology of focal xanthogranulomatous pyelonephritis: a diagnostic challenge

A case of focal xanthogranulomatous pyelonephritis presenting as a circumscribed mass in a functioning kidney of a young male is described. Clinical, radiological, and cytological features closely mimicked renal cell carcinoma leading to radical nephrectomy. Peroperative findings and gross pathological features also corroborated preoperative diagnosis. The final diagnosis was a histologic surprise. It is an uncommon entity with cortical location, no pelvic communication, and progressively destroying the kidney. It should be considered in the differential diagnosis of any mass lesion at any age during preoperative clinicoradiological and cytological evaluation. A correct preoperative diagnosis can save unnecessary nephrectomy.     

Psammoma body and its precursors in papillary thyroid carcinoma: a study by fine-needle aspiration cytology

Psammoma bodies (PBs) form an important diagnostic criterion of papillary thyroid carcinoma (PTC), but their mechanism of formation is not clear. Following our observation in a case of PTC that laminated hyaline globules may be the precursor form of PBs, the present study was undertaken to find out their relation to PBs in PTC cases. Fifty-four cases of PTC and 14 follicular neoplasms, diagnosed by fine-needle aspiration (FNA) cytology, were studied by one of the investigators (DKD) to find out the PBs, irregular calcifications, hyaline globules, and other forms made of similar material. PBs along with irregular calcification were present in five PTC cases, PB alone was present in 1 case, and irregular calcification alone was present in 4 cases. Large hyaline globules (LHGs), small hyaline globules (SHGs), branching hyaline cylinders (BHCs), and irregular hyaline deposits (IHDs) were identified in 10, 14, 6, and 9 cases, respectively. One or more of these four forms were present altogether in 18 (33.3%) of PTC cases and none of the follicular neoplasms (P=0.0142). These forms were present in 80.0% of cases with PB/irregular calcifications as opposed to 22.7% in cases without them (P=0.0012). Our observations suggest that LHGs, SHGs, and BHCs are precursors of PBs and IHDs serve as a nidus for irregular calcification.     

Fine-needle aspiration cytology of chondromyxoid fibroma: a case report

The cytologic presentation of a case of chondromyxoid fibroma studied by fine-needle aspiration in a 17-yr-old black male is described. The cytologic features of chondromyxoid fibroma are presented, and the differential diagnosis of intraosseous cartilaginous neoplasms is reviewed, emphasizing the cytomorphologic differentiation of chondromyxoid fibroma from chondrosarcoma, enchondroma, and chondroblastoma.     

Hyaline globules and papillary fragments in cytologic smears from two intra‐abdominal tumors (ovarian and hepatic) in female patients: A diagnostic pitfall with histologic correlation

Hyaline globules and papillary fragments in cytologic samples from two intra‐abdominal tumors in young females are presented including the cytological features and the correlation with the histopathologic and immunohistochemical findings. In the first case a cytologic study from an ovarian mass showed papillary structures and isolated tumor cells with epithelioid morphology, irregular reniform‐like nuclear contour, pale or vacuolated cytoplasm, abundant hyaline globules and occasional glomeruloid structures resembling Schiller‐Duval bodies. Yolk sac tumor (YST) was the diagnosis on the histological slides. Tumor cells showed positivity for cytokeratin (AE1/AE3), epithelial membrane antigen (EMA), alpha‐fetoprotein (AFP) and Sal‐like protein 4 (SALL4). In case number two the cytologic study from a liver metastasis displayed papillary and rosette‐like clusters composed of uniform and bland cells showing occasional long cytoplasmic tails, hyaline globules and nuclear grooves. A diagnosis of hepatic metastasis from solid pseudopapillary neoplasm of the pancreas (SPNP) was rendered from the histology. Tumor cells revealed immunoreactivity for cytokeratin (AE1/AE3), Vimentin, Galectin‐1 (GAL‐1), Neuron specific‐enolase, CD10, progesterone and β‐catenin (nuclear stain). Regarding differential diagnosis, in the patient with the ovarian mass an ovarian clear cell carcinoma was considered, as well as other germ cell tumors or metastatic carcinoma, while in the patient with a liver metastasis a neuroendocrine carcinoma was taken into account. YST and SPNP share some cytological findings, including hyaline globules, papillary structures, clear cells and intercellular eosinophilic basement membrane deposits. Thus, a detailed study and careful interpretation of the cytological, histological and immunohistochemical findings may be worthwhile to avoid a potential misdiagnosis, particularly in the cytologic specimens of the ovarian and/or intra‐abdominal mass, when involving young females. Diagn. Cytopathol. 2016;44:935–943. © 2016 Wiley Periodicals, Inc.     

Aspiration cytology of primary thyroid paraganglioma

Thyroid paragangliomas are extremely rare tumors arising from the inferior laryngeal paraganglia. Most patients are female and present as asymptomatic thyroid nodule. Diagnosing thyroid paraganglioma can be difficult on fine‐needle aspiration (FNA) since it could be misdiagnosed as medullary thyroid carcinoma, calcitonin‐negative neuroendocrine tumor of the thyroid gland (CNNETT), metastatic neuroendocrine tumor, and intrathyroid parathyroid proliferation. We describe the cytologic features and immunohistochemical staining pattern of thyroid paraganglioma from a 60‐year‐old woman with a gradually enlarging neck mass for several months. An ultrasound guided fine‐needle aspiration was performed which revealed epithelioid, plasmacytoid to occasionally spindle‐shaped cells with ovoid to elongated nuclei, fine chromatin pattern and inconspicuous nucleoli. The cells were arranged singly, in sheets, and focally in acinar pattern. Occasional nuclear overlapping, crush artifact, and binucleated cells were identified. Neither colloid nor amyloid was seen. Immunohistochemical stains performed on the cell block showed the tumor cells were positive for neuroendocrine markers and negative for cytokeratin (AE1/AE3), calcitonin, CEA, thyroglobulin, and TTF‐1. There were rare S‐100 positive cells. Given the difference in management of paragangliomas compared to its cytology mimics and association with familial cancer syndromes in some cases, awareness of this rare tumor, and use of immunohistochemical stains are critical in arriving at the diagnosis. Diagn. Cytopathol. 2015;43:838–843. © 2015 Wiley Periodicals, Inc.     

Juvenile ossifying fibroma diagnosed on fine needle aspiration cytology: A diagnostic challenge

Preoperative diagnosis of jaw lesions is not always possible on the basis of clinico‐radiological findings alone and needs to be confirmed before attempting any surgical intervention. Fibro‐osseous lesions of the jaw comprise a spectrum of diseases which include cement‐osseous dysplasia, fibrous dysplasia, and ossifying fibroma. The cytomorphological distinction between these individual entities is difficult. We present a case of maxillary fibro‐osseous lesion in an adolescent girl diagnosed and categorized as juvenile ossifying fibroma preoperatively on cytology and confirmed on histopathology. Although aspirates are usually paucicellular in fibro‐osseous lesions, certain cytological features if present in cellular cytosmears can offer further categorization and a definitive diagnosis may be possible in light of clinico‐radiological correlation. Diagn. Cytopathol. 2015;43:75–79. © 2014 Wiley Periodicals, Inc.     

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.     

Aspiration cytology of maxillary myxoma

Fine-needle aspiration was used to diagnose a case of maxillary myxoma. Abundant mucoid material was obtained. Microscopic examination showed three-dimensional fibrillary myxoid fragments entangling spindle-shaped, stellate, and fusiform cells with round to oval monomorphic nuclei. A striking feature was delicately branching capillaries. The diagnosis was subsequently con-finned on histology and histochemistry.     

Aspiration biopsy cytology of extraabdominal desmoid tumor concurrently occurring in a patient with tumoral calcinosis

Extraabdominal fibromatosis or desmoid tumor (DT) is a slow growing locally aggressive soft tissue tumor that can occur anywhere in the body. We report the aspiration biopsy cytology features of a case of DT of the right neck area in a 35-year-old man who had a long standing history of tumoral calcinosis. The aspirate was interpreted as "benign spindle cell lesion" and confirmed as DT on histologic examination of the resected mass. We discuss the possible differential diagnoses of other benign or malignant lesions on fine-needle aspiration (FNA) biopsy and especially discuss the aspiration cytology features of DT compared with those of tumoral calcinosis. We also discuss the value of immunohistochemical markers that help in differentiating DT from other entities.     

Aspiration cytology of a case of tumoral calcinosis

The fine-needle aspiration (FNA) cytologic findings in a case of non-familial tumoral calcinosis are described. These include abundant calcific amorphous deposits, mononuclear histiocytes, osteoclast-type multinucleated giant cells, and fragments of tissue consisting of osteoblast-type cells with atypical epithelial-like features mimicking an epithelial malignancy. This is the first reported case describing the cellular morphology of tumoral calcinosis in an FNA specimen. A previously reported case described the evacuation of acellular calcific fluid only. In the present case, vigorous aspiration of the solid portions of the lesion yielded cellular material representative of the histology of the lesion. Points of caution for a correct interpretation of the cytologic findings are discussed. © 1995 Wiley-Liss, Inc.     

Aspiration cytology and immunocytochemistry of sacral chordoma with liver metastases: a case report

We present the cytologic features and immunocytochemical profile of a case of sacrococcygeal chordoma metastatic to the liver. Cytologic diagnosis was suspected from the aspiration biopsy smears of the primary sacrococcygeal tumor and confirmed by histology. Further aspirates failed to reveal diagnostic physaliferous cells, and only undifferentiated spindle cells were obtained. Chordoma may lack physaliferous cells: in such cases, immunocytochemistry studies can greatly facilitate the diagnosis. This study confirms the utility of immunocytochemistry in the differential diagnosis of chordoma and tumors with similar cytologic characteristics.     

Mixed medullary-follicular carcinoma of the thyroid: diagnostic dilemmas in fine-needle aspiration cytology

Mixed medullary-follicular carcinoma (MMFC) of thyroid is an extremely rare tumor, characterized by coexistence of morphological and immunohistochemical features of both medullary carcinoma and follicular (or papillary) carcinoma. We herein present fine needle aspiration (FNA) findings of a histology-confirmed MMFC along with a review of literature. The patient was a 64-year-old woman who had a history of Hashimoto's thyroiditis and presented with enlargement of preexisting right thyroid nodule. An US-guided FNA of the thyroid nodule was performed and conventional smears were prepared. A cytologic diagnosis of "positive for malignancy, consistent with medullary thyroid carcinoma (MTC)" was rendered based on the presence of features characteristic for MTC, and the absence of components of follicular neoplasm (adenoma and carcinoma) or papillary carcinoma. However, microscopic examination of the follow-up total thyroidectomy specimen with the aid of immunocytochemical study detected minor portion of follicular carcinoma in addition to MTC. A histologic diagnosis of MMFC was then established. While specific identification of MMFC by FNA may be difficult, it should be emphasized that adequate sampling in conjunction with the proper immunostaining panel could have highlighted the different aspects of the mixed tumor.     

Fine-needle aspiration cytology of salivary glands: diagnostic pitfalls--revisited

Fine needle aspiration cytology (FNAC) of salivary gland lesions is a safe, effective diagnostic technique. Several amply illustrated reviews are available in the English literature. The reported diagnostic accuracy varies between 86% to 98%. The sensitivity ranges from 62% to 97.6% and specificity is higher from 94.3% to 100%. In this present study, we have analyzed 172 cases of salivary gland aspirates and the histopathological diagnosis was available in 45 cases. There was discordance in cytological and histopathological diagnosis in nine cases. Five cases had discrepancies in benign versus malignant diagnosis with four cases being false negative. The errors in these FNA diagnoses were due to sampling error, observational error and interpretational error. Therefore, this study illustrates high diagnostic accuracy of FNAC in salivary gland lesions and shows that FNAC offers valuable information that allows the planning of subsequent patient management.     

Pseudoglandular schwannoma mimicking alveolar rhabdomyosarcoma: A diagnostic challenge on fine‐needle cytology

Pseudoglandular schwannoma (PGS) is a rare morphological variant of benign schwannoma. PGS is quite distinct from the somewhat better characterized glandular schwannoma variant. PGS is characterized by the presence of gland‐like structures lined with pseudocolumnar or cuboidal‐like neoplastic Schwann cells lining variably sized cystic space cells. Herein, we describe a rare case of PGS in a 17‐year‐old adolescent boy with a neck mass 8.5 cm in diameter present for 2 years with a recent increase in size. Fine‐needle aspiration (FNA) demonstrated abundant rhabdoid‐like cuboidal cells, plasmacytoid cells, binucleation, clusters of round to oval cells with scant cytoplasm, and a lack of stromal cells with spindle or oval nuclei. These findings were challenging and were reminiscent of alveolar rhabdomyosarcoma on FNA. Magnetic resonance imaging was also suggestive of malignancy. However, the histologic picture and the immunohistochemical analysis of the resected mass were consisted with PGS. The numerous rhabdoid‐like cuboidal neoplastic Schwann cells with a plasmacytoid appearance, paving cystic spaces, and the lack of blunt‐ended proliferating stromal cells on smears mimicked alveolar rhabdomyosarcoma on FNA. To our knowledge, cytological features of PGS have not been previously reported. This is the first published report of an unusual PGS case located in the neck region causing a diagnostic dilemma on cytology.     

Diagnostic challenge of lobular carcinoma on aspiration cytology

Lobular carcinomas are among the most difficult to type correctly on aspiration cytology. The inherent cytologic traits such as small size and bland appearance of cells in scanty aspirates may lead to false-negative diagnoses. Due to the low incidence of this form of breast carcinoma, there are few studies solely on lobular carcinoma, and the cytomorphologic features are not well defined. To delineate the cytomorphologic features and to assess their utility in correctly typing an aspirate as lobular carcinoma, we undertook a retrospective review of fine-needle aspirates from 31 cases of lobular carcinoma. The cytologic features of monomorphic cells, with scant cytoplasm, central vesicular nuclei, and inconspicuous nucleoli were found most helpful in correct typing of the cases. Intracytoplasmic vacuoles, nuclear grooves, and “Indian-file” arrangement of cells were corroborating features. We postulate that a combination of cytologic features makes the diagnostic delineation of lobular carcinomas possible on aspiration cytology. Diagn. Cytopathol. 1998;18:179–183. © 1998 Wiley-Liss, Inc.     

Aspiration biopsy cytology of malignant papillary breast neoplasms.

Papillary carcinoma of the breast is a rare neoplasm characterized by a low grade of malignancy. From the files of the Department of Histopathology of Conegliano Veneto City Hospital, Conegliano Veneto, Italy, 16 cases of papillary breast carcinoma diagnosed by fine-needle aspiration cytology have been selected. A multiparametric morphologic study has been performed in order to contribute to the cytologic characterization of this rare group of breast malignancies. The authors believe that aspiration biopsy cytology is able to provide an accurate preoperative diagnosis.     

Flow cytometry in diagnostic cytology

Flow cytometry (FCM) is a useful adjunct to cytologic examination, because the quantitative biochemical information it provides complements the morphologic information gained during visual examination. It aids in the interpretation of bladder washings, and is particularly useful for the assessment of lymphoid lesions, whether they originate from fine-needle aspiration, cerebrospinal fluid, or effusions. Optimal use of FCM frequently requires assessment of more than one parameter; simultaneous use of cell differentiation markers and nuclear DNA quantitation is often significantly more useful than either alone. Despite the utility of FCM, however, the potential for future development appears to be limited. Improvements in image cytometry allow reasonable assessment of ploidy and S-fraction to be made from specimens prepared on glass slides. Multiparameter measurements may also be accomplished with imaging techniques, which allow the further advantage of visual identification of cells with equivocal morphologic changes. The development of artificial intelligence methods for use with imaging technology has also significantly exceeded that of FCM. Finally, image cytometry is often more useful for samples with few cells. Other challenges are posed by immunocytochemical methods which compete with flow cytometry as tools for assessment of proliferation. Given the relatively high cost of FCM instrumentation, survival of FCM as an ancillary technique in cytopathology will require further technical refinements to offset the advantages currently associated with image cytometry and immunocytochemistry. Diagn. Cytopathol. 1998;18:41–46. © 1998 Wiley-Liss, Inc.