Intramedullary hydatid cyst of the cervical spine

Hydatid disease (Echinococcosis) is a common parasitic infection caused by Echinococcus granulosus mainly in sheep-raising areas of the world. Liver, lungs and brain are the predominantly involved organs. However, 0.5–1% of the hydatid disease involves the spine and in 90% of the cases it is confined to the bone and the epidural space. Although intramedullary involvement is extremely rare, in this report, we present a 55-year-old female patient who was diagnosed with a cervical intramedullary hydatid cyst during magnetic resonance imaging of the cervical vertebrae. Accordingly, we imply that particularly in endemic areas, hydatid cyst disease should be kept in mind for the differential diagnosis of spinal mass lesions.     

Echinococcosis (hydatid disease) in Missouri: diagnosis by fine-needle aspiration of a lung cyst

Echinococcus granulosus was diagnosed by fine-needle aspiration cytology of a lung cyst in a 6-yr-old white female in central Missouri. No adverse reaction occurred following the aspiration. The cytologic sample yielded clear fluid containing numerous clearly identifiable protoscoleces diagnostic for echinococcosis using routine PAP staining. Since hydatid disease is extremely uncommon in the Midwest, it had not initially been considered in the differential diagnosis. The infection was probably not indigenous to Missouri, since the patient lived the first 3 1/2 yr of life in Alaska, where the organism is endemic. This can only be speculative, however, since echinococcal organisms are found in wildlife in the Midwest.     

Renal hydatid cyst: Urinary cytological diagnosis

Echinococcal disease is endemic in many areas of Asia, Europe, South America, the Near East, Australia, and New Zealand. Hepatic and pulmonary cysts are the most common presentation. Isolated renal hydatid cyst is an uncommon presentation of echinococcal disease, since renal involvement occurs in only 2–3% of cases. We present the case of a young man with renal colic, in whom the diagnosis of renal hydatid disease was established cytologically. Urine cytology, performed because of persistent hematuria, revealed scolices of Echinococcus granulosus and prompted further imaging investigation, and, ultimately, surgical treatment. © 1995 Wiley- Liss, Inc     

Role of fine-needle aspiration biopsy in the assessment of renal masses

Clinical and histological control of fine-needle aspiration biopsy (FNAB) diagnosis of 72 kidney masses observed between 1981 and 1988 confirmed 34 benign and 33 malignant lesions, but did not confirm four malignant and one benign lesions, giving a total diagnostic accuracy of 93.05%. The role of FNAB in selecting cases to be sent to surgery was investigated by comparing the incidence of useful surgery (for benign and primary malignant neoplasias) and the incidence of useless surgery (for nonneoplastic lesions and secondary malignant neoplasias) in nephrectomized patients who either had (group A, 27 patients) or didn't have (group B, 198 patients) preoperative FNAB. The differences were highly significant (P less than 0.001). Furthermore, patients operated for malignant neoplasias (20 in group A; 117 in group B) displayed highly significant differences (P less than 0.001) with respect to renal vein infiltration (1 in group A versus 22 in group B) and local-regional lymph node metastases (1 in group A versus 15 in group B). In conclusion, FNAB is a reliable method for selecting cases for surgery and for aiding in the diagnosis of malignant neoplasias.     

Diagnosis of cutaneous leishmaniasis by fine-needle aspiration biopsy: report of a case

A case of cutaneous leishmaniasis diagnosed by fine-needle aspiration biopsy is presented. The cytologic smears revealed lymphocytes, plasma cells, and macrophages. Large numbers of Leishmania organisms were present within the macrophages and in the intercellular spaces. Part of the material was used for a microbiologic culture, which revealed large numbers of promastigotes. These were studied by light, transmission, and scanning electron microscopy.     

Hodgkin's disease mimicking suppurative lymphadenitis: a possible pitfall in fine-needle aspiration biopsy cytology

We report one case of nodular sclerosing Hodgkin's disease with uncommon pseudosuppurative presentations in fine-needle aspiration biopsy (FNAB) samples and on histopathologic material. The criteria for cytologic diagnosis include atypical mononuclear cells and diagnostic SR cells in the purulent exudate. This lesion is considered a possible pitfall in FNAB cytology of Hodgkin's disease.     

Retrorectal cystic hamartoma diagnosed by fine-needle aspiration biopsy

A 17-yr-old postpartum female presented with a large multicystic mass posterior to the rectum, thought clinically to be an abscess. Fine-needle aspiration biopsy revealed numerous squamous cells. The diagnosis of retrorectal cystic hamartoma was considered and subsequently confirmed by the surgical resection specimen. The cytologic and histologic findings are presented along with a discussion of the entity "retrorectal cystic hamartoma," including a differential diagnosis of presacrococcygeal cysts.     

A history of aspiration biopsy with special attention to prostate biopsy

The history of needle biopsy is outlined from the early 19th century when the first use of needles for biopsy was recorded. The development of aspiration biopsy, largely at Memorial Hospital in New York in the 1930s, followed by its virtual disappearance in the 1940s and 1950s, and its reemergence in the 1960s, is traced. Special attention is given to the history of aspiration biopsy of the prostate from its origins up to the present day.     

Intraoperative diagnosis of hydatid cyst of the ovary masquerading as tumor

Hydatid disease, caused by the larval stage of Echinococcus granulosus, is found most commonly in the liver and lungs, but no organ is immune. The ovarian involvement is often secondary to a cyst's dissemination localized in a different site. Occasionally, the cyst enlarges, thus mimicking an ovarian tumor. Patients with hydatid cysts at unusual locations present with atypical presentations and pose a diagnostic dilemma. A high index of suspicion is required in order to make a correct diagnosis pre‐operatively to prevent spillage of the cyst contents during surgery. We report a case of hydatid cyst in the ovary in a young female. Diagn. Cytopathol. 2017;45:267–269. © 2016 Wiley Periodicals, Inc.     

Infantile myofibromatosis: diagnosis suggested by fine-needle aspiration biopsy

A newborn male infant presented with multiple subcutaneous and parenchymal lesions. These lesions, thought clinically to represent disseminated neuroblastoma, were assessed via fine-needle aspiration biopsy. The spindled cells and associated collagen were interpreted as a type of fibromatosis, most probably infantile myofibromatosis. This diagnosis was subsequently confirmed histologically, and the patient experienced spontaneous involution or regression of all lesions by 18 mo of age. To our knowledge, this is the first documented case of this entity initially suggested on the basis of a fine-needle aspiration biopsy specimen.     

Hydatid cyst: primary diagnosis by fine-needle aspiration biopsy

Two cases of soft-tissues echinococcosis are presented in which the definitive diagnosis was established by identifying laminated layer remnants on fine-needle aspiration smears. Large polygonal pieces of acellular material with delicate parallel striations were seen, while neither scolices nor hooklets were found. The cases reported most likely represent the occurrence of sterile hydatid cysts. A diagnosis of echinococcosis should be considered when fragments suggestive of laminated layer are identified on smears, even in unusual sites and without evidence of hooklets and/or scolices.     

Hydatid cyst of mediastinum

We report a case of hydatid cyst of the mediastinum in a 32-year-old female patient who was admitted with chest pain. CT scan reported posterior mediastinal mass towards the right side. Surgical exploration revealed a loculated cyst in posterior mediastinum on the right side, adherent to the overlying lung and underlying bone. Posterolateral thoracotomy was performed for cyst aspiration and excision. The patient was discharged on albendazole.     

Utilization of fine-needle aspiration biopsy in the diagnosis of metastatic tumors to the pancreas

There is relatively little information concerning the use of fine-needle aspiration biopsy (FNAB) to diagnose a mass in the pancreas that is secondary to metastatic tumor. This study reviews the incidence and types of neoplasms which metastasize to the pancreas and assesses the contribution FNAB can make in their diagnosis. of 117 radiologically guided FNABs of the pancreas, 11% (n = 13) showed metastatic malignancy. Nine patients had a previous history of malignancy while four patients presented with a pancreatic mass and were subsequently found to have widespread malignant disease. the majority of metastatic lesions were epithelial (77%, n = 10). Patient outcomes were generally poor (mean survival 2.8 mo). Metastases to the pancreas occur from a variety of primary sites and should be considered in patients with a pancreatic mass and a history of prior malignancy. FNAB is useful in diagnosing these metastases and this is clinically important because of their poor prognosis.     

Reliability of fine-needle aspiration biopsy in the initial diagnosis of soft-tissue lesions

We retrospectively reviewed fine-needle aspiration biopsy (FNAB) specimens of 301 soft tissue lesions of the extremities and trunk. Final diagnoses were 137 benign and 86 malignant neoplasms and 78 nonneoplastic lesions. Of the 301 FNAB samples, 279 (93%) were adequate for cytologic diagnosis. The adequate FNAB specimens were initially grouped into three broad categories: benign (197 cases), malignant (57 cases), and suspicious for malignancy (25 cases). Sensitivity and specificity for diagnosis of a malignant lesion were 92% and 97%, respectively. The specimens were cytomorphologically classified into nine categories: small round (14 cases), spindle cell (77 cases), epithelioid/polygonal (16 cases), pleomorphic (29 cases), myxoid (19 cases), lipomatous (37 cases), epithelial (23 cases), inflammatory lesions (28 cases), and others (36 cases). Specific FNAB diagnoses were correct in 151 of 279 cases (54%) in combination with clinical and radiologic findings. FNAB is a valuable technique for the primary diagnosis of soft-tissue lesions.     

Role of immunocytochemistry,electron microscopy,and DNA analysis in fine-needle aspiration biopsy diagnosis of Wilms' tumor

We reviewed the cytologic features and results of ancillary studies in eight fine-needle aspiration biopsies (FNAB) performed by posterior approach in 8 patients with unresectable Wilms' tumor (WT). Chemotherapy was given following the FNAB diagnosis of WT, which was confirmed subsequently by histologic examination of surgically resected specimens. Indications for FNAB included: unresectable tumor, bilateral disease, initial presentation with metastatic disease, uncertainty regarding tumor site, and documentation of recurrence. Cytologic examination revealed blastemal cells (8/8 aspirates), spindle cells (3/8 aspirates), and epithelial differentiation or tubules (3/8 aspirates). There was no cytologic evidence of anaplasia in any of the cases. Immunocytochemical studies on cell blocks and/or smears showed cytokeratin positivity in 5/8 and vimentin positivity in 5/5 of the aspirates in which these studies were performed. Focal positivity for neuron-specific enolase (NSE) was seen in 3/3 aspirates. Stains for actin and leukocyte-common antigen were negative (0/3 and 0/2 aspirates, respectively). DNA ploidy analysis of the aspiration material by flow cytometry revealed near-diploid populations in three aspirates. Electron microscopic findings helpful for diagnosis included: cell junctions, microvilli, flocculent basement membrane-like material, cilia, autophagolysosomes, and lack of neuroectodermal differentiation. Diagnostic morphologic pitfalls for an incorrect diagnosis of neuroblastoma included nuclear molding (all aspirates), pseudorosette formation (one aspirate), and focal NSE positivity (3/3 aspirates). None of the tumors showed anaplasia on histologic examination. Cytologic recognition of the triphasic cellular components of WT (blastemal cells, spindle cells, and epithelial cells) can be helpful for a correct diagnosis; however, in 5/8 aspirates in this study, only the blastemal component was present. In these cases, immunocytochemical stains and electron microscopy proved useful in arriving at a correct FNAB diagnosis of WT. However, NSE positivity can be a pitfall for a diagnosis of neuroblastoma if the radiologic, clinical, and other cytologic features are not clearly delineated. Presence of cytokeratin and vimentin positivity would be helpful in the diagnosis of WT in such instances. Diagn Cytopathol 1996; 14:101–107. © 1996 Wiley-Liss, Inc.     

Leiomyosarcoma of the breast: a difficult diagnosis on fine-needle aspiration biopsy

Leiomyosarcoma of the breast is rarely encountered in fine-needle aspiration (FNA) cytologic material. We report a case of primary leiomyosarcoma of the breast in a 52-yr-old female. Aspiration cytology showed large, dissociated round to spindle cells with abundant vacuolated cytoplasm, pleomorphic nuclei, prominent nucleoli, and occasional intranuclear cytoplasmic invaginations. Mitotic figures, osteoclast-like giant cells, and stromal fragments were identified. A diagnosis of malignant neoplasm representing either a sarcoma, a poorly differentiated carcinoma, or a metaplastic carcinoma was made. The patient underwent a wide excision of the lesion after negative work-up. Histologic examination and immunohistochemical studies established the diagnosis of leiomyosarcoma. This case is presented here because we feel that, although FNA cytology with eventual ancillary studies is a valuable diagnostic tool to evaluate any breast mass, malignant spindle cell neoplasms of the breast still represent a diagnostic challenge for the cytopathologist. Recognition of all cytologic features of leiomyosarcoma may help to formulate a correct diagnosis.     

The place of fine-needle aspiration in the preoperative diagnosis of the congenital sublingual teratoid cyst

The term "teratoid cyst" was first used by Meyer in his classification of dysontogenetic cysts of the cervicofacial region, which was based on the type of germinative layers included in the cyst wall. Sublingual location of a dermoid cyst is not common, with an incidence of 1.6%. The teratoid cyst is the least common, accounting for 1.8% of sublingual dermoid cysts, and such lesions are extremely rare in infancy. In our case, a 7-mo-old male infant was referred with a sublingual mass. Ultrasonography yielded a cystic mass with internal echoes but no specific diagnosis. The smears obtained from fine-needle aspiration (FNA) displayed sheets of large, benign-appearing, anucleated and nucleated squamous cells. There were a number of neutrophils, which had no significant importance. No atypical cells were observed. According to the clinical picture and FNA findings, it appeared to be a cystic structure of keratogenous origin and could have been any type of dermoid cyst. The cyst was excised completely by the oral approach. On histopathological examination, the presence of skin appendages along with mature cartilage and respiratory epithelium confirmed the final diagnosis of a teratoid cyst. In conclusion, although FNA is not comparable with computed tomography (CT) and magnetic resonance imaging (MRI), it might be valuable for the diagnosis of lesions occurring in this anatomical location. It is safe, cost-effective, and reliable. FNA is not only able to help selecting the most appropriate surgical method, but also be used as a therapeutic modality in some emergencies or during surgery.