Fine-needle aspiration cytology of superficial lymph nodes

A series of 244 enlarged superficial lymph nodes was examined by fine-needle aspiration cytology. Twenty-nine smears (11.9%) were inadequate for study. Of the remaining 215, 108 were negative, 13 suspicious for malignancy, and 94 positive. Forty-five excisional biopsies were performed correlating the cytologic and histologic findings. There were two cytologic false-negative results; both were patients who had been treated for carcinoma and whose aspirates were cytologically negative. Of the 13 samples reported as suspicious for malignancy, there were three epidermoid carcinomas, nine reactive hyperplasias, and one non-Hodgkin's lymphocytic lymphoma. Of the positive cases, 83 were metastatic tumors, and 11 were malignant lymphomas (two non-Hodgkin's lymphomas and nine Hodgkin's lymphomas). The criteria used in the interpretation of these aspirates and the problems of differential cytological diagnosis are discussed. In spite of the drawbacks of inadequate and false-negative smears, fine-needle aspiration cytology is valuable in preliminary diagnosis of diseased lymph nodes and subsequent management.     

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.     

Fine-needle cytology of the breast: a controlled study of aspiration versus nonaspiration

We report on 534 breast masses examined by fine-needle aspiration cytology. Two samples were obtained from each mass, one with aspiration and the other without. Aspiration, equivalent to that obtained by a 20-ml syringe on full aspiration, was obtained by an automatic aspirator. The two sampling modalities did not differ apart from aspiration and were compared in terms of inadequate sampling rates. The inadequacy rate was the same in 166 cancers (6.6%), whereas a significant difference was recorded in favor of aspiration (13.6 versus 24.4%) in 368 benign masses. When inadequate results were excluded, the accuracy of the two modalities was almost the same. Sensitivity was 97.4% and 96.7% and specificity was 99.4% and 99.3% for sampling with and without aspiration, respectively. Reducing the rate of inadequate sampling from benign masses seems to be the major advantage of aspiration. Double sampling, independent of the specific techniques, reduced inadequacy rates to very low levels (1.2% for cancers; 5.9% for benign masses) and may be useful as a routine policy.     

Fine-needle aspiration cytology of breast masses in pregnant and lactating women

Eleven pregnant women with breast masses that arose during pregnancy or in the postpartum period underwent fine-needle aspiration biopsies. Cytologic examination demonstrated a spectrum of morphologic features, including (1) a pattern of dissociated epithelial cells stripped of their cytoplasm along with small clusters of cells having a frayed secretory type of cytoplasm; (2) larger epithelial groups with nuclear pleomorphism, prominent irregular nucleoli, and abundant vacuolated cytoplasm; (3) cellular smears, often with an inflammatory background and proteinaceous debris; and (4) microtissue fragments showing features of lobular hyperplasia. This article illustrates the clinical utility of fine-needle aspiration biopsy in evaluating breast masses in pregnant and lactating women and discusses the potential hazards for a false-positive diagnosis of malignancy in these patients.     

Fine-needle aspiration cytology of histiocytosis X: a case report

The cytologic features of a case of histiocytosis X diagnosed by fine-needle aspiration biopsy of a right cervical lymph node in a 15-mo-old girl are reported. Characteristic reticuloendothelial cells with abundant cytoplasm and grooved nuclei were observed. Electron microscopy of the aspiration-derived specimen revealed Birbeck granules. The cytologic pattern and electron microscopic demonstration of Birbeck granules allowed definite diagnosis of lymph node involvement by histiocytosis X, negating the need for open biopsy. The cytologic differential diagnosis and current diagnostic criteria for histiocytosis X are discussed.     

Fine-needle aspiration cytology of angiolymphoid hyperplasia with eosinophilia: a case report with electron microscopy and immunohistochemistry

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon vascular inflammatory lesion usually involving the dermis or subcutaneous tissue of the head-neck region of middle-aged women. Histologically, this lesion shows a florid proliferation of vessels lined by particular endothelial cells and an inflammatory infiltrate composed of lymphocytes and eosinophils. The fine-needle aspiration (FNA) cytology of a nodular lesion in the retroauricolar region of a 18-yr-old woman showed spindle-shaped and polygonal cells with vesicular nuclei and deeply eosinophilic cytoplasm containing well-defined vacuoles in a background of eosinophils and lymphocytes. These features were consistent with a proliferation of epithelioid endothelial cells, and a diagnosis of ALHE was suggested. The histology confirmed the preoperatory diagnosis, and ultrastructural and immunohistochemical studies further demonstrated the endothelial nature of epithelial-appearing cells. Because the clinical appearance of the lesion may mimic a large number of benign and malignant diseases, a preoperatory diagnosis of ALHE is rarely made. The FNA cytology may represent a simple and reliable method with which to study and diagnose proliferations of epithelioid endothelial cells.     

Glycogen-rich clear cell carcinoma of the breast: Report of a case with fine-needle aspiration cytology and immunocytochemical and ultrastructural studies

Fine-needle aspiration cytology, immunocytochemistry, and electron microscopic findings are described in a case of glycogen-rich clear cell carcinoma of the breast. the aspirate contained many small and large papillary cell groups and numerous single tall columnar cells with apical cytoplasmic projections and mild to moderate degree of nuclear pleomorphism. Cytochemical localisation of glycogen and immunostaining on air-dried smears with CEA and actin monoclonal antibodies permitted the correct identification and differential diagnosis of the tumor. Electron microscopic examination of the resected specimen confirmed the diagnosis of glycogen-rich clear cell carcinoma. the differential diagnosis and potential diagnostic pitfalls are discussed, and recommendation are offered to prevent misdiagnosis.     

Chondromyxoid fibroma: A fine-needle aspiration diagnosis

A 25-yr-old female presented with a slowly progressive swelling, occurring over an 8-yr period, in the right lower leg. The swelling was tender and fixed to the underlying bone. Clinical and radiological diagnosis was giant cell tumor (GCT) of the bone. Aspiration cytology smears were cellular showing an admixture of chondroid, stellate, and fibrocytic cells against a chondroid background. On cytomorphology, a diagnosis of chondromyxoid fibroma (CMF) was made. It was confirmed on histologic examination.     

Fine-needle aspiration cytology of mammary adenomyoepithelioma: Report of a case with intranuclear cytoplasmic inclusions

Adenomyoepithelioma of the breast is an uncommon lesion which may recur and rarely metastasizes. We report the fine-needle aspiration (FNA) findings in one case of mammary adenomyoepithelioma in which this tumor's unusual cytomorphology led to a cytologic diagnosis of malignancy, possibly metastatic to the breast. Large, atypical, polygonal cells, some with intranuclear cytoplasmic inclusions, were most worrisome cytologically, but corresponded in the biopsied specimen to cells immunohistochemically documented to be of myoepithelial origin. Nests of epithelium and myoepithelial cells sometimes embedded in fibrous, stromal fragments were suggestive of an infiltrating pattern. Recognition of such unusual features in breast FNA is most important since definitive therapy may follow an FNA diagnosis of carcinoma in some clinical settings. In cases with unusual morphology, surgical biopsy should be recommended to clarify the nature of the lesion. © 1994 Wiley-Liss, Inc.     

Fine-needle aspiration cytology of adrenal cryptococcosis: a case report.

A case of adrenal cryptococcosis diagnosed by fine-needle aspiration biopsy cytology in a 58-yr-old man is presented. The organisms were easily seen with routine modified Wright stain (Diff-Quik) as variably sized yeasts, some with a brightly eosinophilic capsule. The diagnosis was confirmed with mucicarmine and silver stains. The identification of fungi with routine cytologic stains allows a rapid presumptive diagnosis of the infectious agent, collection of material for confirmatory special stains, and prompt initiation of therapy.     

Diagnosis of thymoma by fine-needle aspiration cytology: light and electron microscopic study of a case

A case of thymoma was diagnosed by fine-needle aspiration cytology based on an intimate admixture of a biphasic cell population consisting of epithelial cells and lymphocytes from an intrathoracic mass. The diagnosis was later confirmed by light and electron microscopic examination of the tissue.     

Fine-needle aspiration cytology diagnosis of non-hodgkin lymphoma of thyroid: A report of four cases

Four cases of non-Hodgkin lymphoma of thyroid, diagnosed by fine-needle aspiration (FNA) cytology during a period of 3% yr constituted 0.2% of 1,716 thyroid FNAs and 3.4% of 118 thyroid neoplasms. The age of the patients ranged from 42 to 78 yr with an average of 63 yr and all were females. Three cases had thyroid swellings, and one case had cervical lymphadenopathy and fullness in the thyroid region. The lymphomas were categorized as mixed small and large cell lymphomas, large cell lymphoma, small noncleaved lymphoma (non-Burkitt-type), and plasmacytoid lymphoma. Histopathology as well as immunohistochemistry confirmed the cytodiagnosis of lymphoma in the first and fourth cases. In the second case where possibility of anaplastic carcinoma could not be ruled out altogether at initial cytotogic examination, the histopathology report was undifferentiated carcinoma but immunohistochemically it was proved to be a B-cell neoplasm.     

Carcinoma of the breast in a fibroadenoma: diagnosis by fine-needle aspiration cytology.

A case of carcinoma of the breast concurrent with a fibroadenoma in a 49-yr-old female is described in which the diagnosis was made on fine-needle aspiration cytology. Reports of such an occurrence are few, and to our knowledge none has previously documented the cytologic findings in detail.     

Biphasic intraabdominal desmoplastic small round cell tumor: Fine-needle aspiration cytology findings

The present report describes the case of a 9-yr-old boy with an abdominal desmoplastic small round cell tumor (DSRCT) which on fine-needle aspiration cytology and histology revealed a biphasic pattern, making initial diagnosis difficult. Epithelial-like clusters of cells and loosely-arranged poorly-differentiated cells with scant cytoplasm associated with cells having a larger nucleus and multinucleated larger cells represented the smears' counterpart of epithelial clusters and lobules and sarcomatous-like tissue recognized in the histologic sections. Multinucleated cells were common in the sarcomatous-like areas of the tumor. The biphasic pattern was highlighted by immunohistochemistry. Keratin and epithelial membrane antigen stained predominantly or only the epithelial component, while desmin diffusely decorated the sarcomatous areas and the epithelial cells as a paranuclear cytoplasmic dot. Immunosera 013 mainly stained the sarcomatous component. © 1995 Wiley-Liss, Inc.     

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.     

Fine-needle aspiration cytology of mammary fibromatosis: Report of two cases

The purpose of this study is to evaluate cytologically two cases of mammary fibromatosis (MF). Prior to FNAC, clinical and mammographic suspicion of carcinoma and fibroadenoma were present. In both cases cytology disclosed the presence of numerous spindle cells admixed with epithelial cells. In the first case, carcinoma was excluded and the diagnosis of “spindle-cell proliferative lesion” was established. The second case was erroneously diagnosed as “cellular fibroadenoma” due to the presence of monolayered ductal epithelial groups and stromal tissue. In both cases local excision of the lesion was recommended. Although in a strict sense fibromatosis is a pure stromal lesion, the frequent presence of epithelial groups in the smears should raise a differential diagnosis with other more frequent mixed (epithelial and stromal) lesions such as fibroadenoma, cystosarcoma phyllodes, and metaplastic carcinoma. Due to the fact that clinically and mamographically MF is frequently confused with malignancy, preoperative recognition is essential since in many cases it would avoid unnecessary radical surgery. In this sense cytology offers very important preoperative information. Diagn. Cytopathol. 1997;17:363–368. © 1997 Wiley-Liss, Inc.     

Fine-needle aspiration cytology of adenoid (Acantholytic) squamous-cell carcinoma

Adenoid squamous-cell carcinoma (ASCCa) is an uncommon cancer which occurs most frequently in the skin of the head and neck region of elderly, sun-exposed individuals. Histologically, ASCCa is characterized by gland-like, “adenoid” cell groups with a central, detached acantholytic cellular component and an intact peripheral rim of cells. the cytological features of five fine-needle aspiration cytology (FNAC) samples from four patients with primary or metastatic ASCCa are presented. These were assessed for features which would allow distinction of this variant from conventional squamous carcinoma. the adenoid component was represented in FNAC by intact, sometimes three-dimensional cell groups simulating glandular structures. Also present were cells in short chains of two or three in single cell files and scattered, individual dyskeratotic cells. Individual cells had rounded, accentuated borders, cytoplasmic keratinization, and often pyknotic nuclei, representing acantholytic cells from the adenoid “lumens.” Features of malignancy, including cellular atypia and increased mitotic rate, were present allowing for distinction between ASCCa and benign acantholytic processes such as pemphigus. © 1995 Wiley- Liss, Inc.     

Fine-needle aspiration cytology of cystic ovarian lesions

A 4-year study (January 1986 through December 1990) was performed to evaluate the cytomorphologic features of cystic ovarian lesions. Fluid from 103 cases was obtained either during surgical removal of the ovary (48 cases; mean age 50 years) or by fine needle aspiration (55 cases; mean age 32 years). Of the 48 cystic lesions with histologic correlation, 30 (62.5%) were neoplastic and 18 (37.5%) were non-neoplastic. Ten (18%) of the 55 aspirates were unsatisfactory. The remaining 45 cases (82%) were benign, predominantly non-neoplastic entities which included follicle, corpora luteal, and endometriotic cysts. Neoplastic cystic lesions included serous, mucinous, and Brenner tumors, germ cell neoplasms, a sex cord-stromal tumor, and an undifferentiated carcinoma. Follicle and corpora luteal cysts were composed of loose cell clusters of granulosa cells and/or luteinized granulosa cells. Endometriotic cysts contained hemosiderin-laden macro-phages and endometrial cells. Serous and mucinous cystadenomas were composed of cohesive sheets and/or papillary clusters of epithelial cells. A cystic Brenner tumor showed sheets of cells with grooved nuclei, and a benign cystic teratoma contained mature squamous cells admixed with vacuolated cells of presumed sebaceous origin. Although the distinction between benign and malignant entities posed few diagnostic difficulties, borderline tumors could not be distinguished from well-differentiated cystadenocarcinomas. The results of this study indicate that the majority of cystic ovarian lesions can be diagnosed accurately on cytology. Cytologic evaluation of non-neoplastic ovarian cysts is important for women who want to retain their fertility and in the clinical management of women with neoplastic lesions. Diagn Cytopathol 1994; 11:9–14. © 1994 Wiley-Liss, Inc.     

Fine-needle aspiration cytology of alveolar soft-part sarcoma

Alveolar soft-part sarcoma (ASPS) is a rare soft-tissue tumor. Few cases have been reported in the aspiration cytology literature. We discuss the fine-needle aspiration (FNA) cytologic features of ASPS in four patients. The smears were characterized by single cells and clusters of cells associated with thin-walled vasculature, resulting in a distinct pseudoalveolar pattern. The cells had abundant granular cytoplasm and large round nuclei with prominent central nucleoli. Binucleated and occasional multinucleated cells were present. Numerous stripped tumor nuclei were a consistent feature. Periodic acid-Schiff (PAS)-positive diastase-resistant granules were demonstrable within the intact and fragmented cytoplasm. Electron microscopy of aspirated material identified granules and crystals with the characteristic lattice pattern. To conclude, the FNA cytologic features of ASPS are characteristic. Confirmation by special stains and electron microscopy of FNA material is possible. The differential diagnostic considerations include renal cell carcinoma, paraganglioma, granular cell tumor, clear cell sarcoma, and epithelioid sarcoma.     

Ductal carcinoma-in-situ of the breast: Fine-needle aspiration cytology of 12 cases

Aspiration specimens from 12 patients with histologically documented ductal carcinoma-in-situ (DCIS) of the breast (seven patients) or DCIS with minute foci of stromal invasion (five) were evaluated. Five patients presented with palpable masses, 1.5–4.0 cm, and four patients presented with localized thickening, associated with nipple erosion and discharge in two of them. One patient had nipple inversion, and one patient had bilateral nipple discharge. In one patient, no apparent abnormality of the breast was present. Mammography was either suspicious for or strongly suggestive of carcinoma in 10 patients and negative in two. Aspirates from all patients were composed of fragments of atypical ductal epithelium and numerous single epithelial cells. In nine cases, the smears were hypercellular and similar to aspirates of typical invasive ductal carcinoma. Calcifications were present in six cases. In four of these, associated tumor necrosis was evident. Cytologic features separating DCIS patients from those showing minimal stromal invasion or common types of invasive ductal carcinoma (IDC) were not identified. We conclude that fine-needle aspiration cytology of DCIS is identical to that of IDC. If preoperative radiotherapy or chemotherapy is considered in the management of invasive breast carcinoma, cutting-needle biopsy for confirmation of tumor invasion is necessary.