Claudin-7 is highly expressed in chromophobe renal cell carcinoma and renal oncocytoma

Claudin-7 has recently been suggested to be a distal nephron marker. We tested the possibility that expression of claudin-7 could be used as a marker of renal tumors originating from the distal nephron. We examined the immunohistochemical expression of claudin-7 and parvalbumin in 239 renal tumors, including 179 clear cell renal cell carcinoma (RCC)s, 29 papillary RCCs, 20 chromophobe RCCs, and 11 renal oncocytomas. In addition, the methylation specific-PCR (MSP) of claudin-7 was performed. Claudin-7 and parvalbumin immunostains were positive in 3.4%, 7.8% of clear cell RCCs, 34.5%, 31.0% of papillary RCCs, 95.0%, 80.0% of chromophobe RCCs, and 72.7%, 81.8% of renal oncocytomas, respectively. The sensitivity and specificity of claudin-7 in diagnosing chromophobe RCC among subtypes of RCC were 95.0% and 92.3%. Those of parvalbumin were 80.0% and 88.9%. The expression pattern of claudin-7 was mostly diffuse in chromophobe RCC and was either focal or diffuse in oncocytoma. All of the cases examined in the MSP revealed the presence of unmethylated promoter of claudin-7 without regard to claudin-7 immunoreactivity. Hypermethylation of the promoter might not be the underlying mechanism for loss of its expression in RCC. Claudin-7 can be used as a useful diagnostic marker in diagnosing chromophobe RCC and oncocytoma.     

Aspiration biopsy cytology of secretory carcinoma of the breast

Aspirate from a secretory carcinoma of the breast showed malignant epithelial cells present singly or in large sheets with strong cellular cohesiveness. Tumor cells displayed ill-defined, granular, or vacuolated cytoplasm. Intracytoplasmic globular material was periodic acid-Schiff positive and resistant to prior diastase digestion. The cytologic differential diagnosis with other breast cancers is briefly discussed.     

Aspiration cytodiagnosis of metastatic merkel-cell carcinoma

A case of metastatic Merkel-cell carcinoma to lymph nodes on the left side of the neck and left parotid is described. the primary was at the left side of the cheek and bridge of the nose. the cytologic features in needle aspirates of metastases included increased cellularity, discohesive or loose groups of small-to-medium size malignant cells with uniform, round-to-oval nuclei, delicate nuclear membranes, fine chromatin, multiple micronucleoli, and scanty cytoplasm. Additionally, rare intermediate filament “buttons” and frequent mitotic figures were found. the primary tumour showed similar features. On immunostaining, although a positivity for chromogranin was noted in the primary tumour, it was found to be negative in the cytologic material. All other histochemical and immunostains were found to be negative in both the primary and metastatic neoplasm. the problems in differential diagnosis from other small cell tumours and the features of this unique tumour that may be helpful in the diagnosis are discussed. © 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.     

Fine-needle aspiration cytology of sarcomatoid renal cell carcinoma: A morphologic and immunocytochemical study of 15 cases

Sarcomatoid renal cell carcinoma (SRCC), which accounts for 5% of all renal cell carcinomas (RCC), has a worse prognosis than conventional nonsarcomatoid RCC. making accurate diagnosis important. This study reports on the morphologic and immunocytochemical features of 15 cases of SRCC (9 primary tumors and 6 metastases) diagnosed by fine-needle aspiration (FNA) biopsy. All but three cases showed a dimorphic cell population consisting of varying proportions of a high-grade epithelial component, either clear or granular-cell type and a spindle cell (sarcomatoid) component, of either fibrosarcomatous, malignant fibrous histiocytoma (MFH), or unclassified types. The sarcomatoid component in the biphasic and monophasic tumors stained positively for cytokeratin in 12 of 14 (85%) cases, for vimentin in 10 of 11 (91 %) cases, and for muscle-specific action in 4 of 11 (36%) cases. Of note, the three cases that demonstrated a purely sarcomatoid morphology stained positively for cytokeratin. Unlike in studies performed on surgically resected specimens, neither the proportion of the sarcomatoid component nor the presence of necrosis had prognostic significance, the discrepancy most likely being related to the sampling. We conclude that SRCC, both primary and metastatic, can be accurately diagnosed by FNA when cytologic features are evaluated in conjunction with immunocytochemical findings.     

Pigmented microcystic chromophobe renal cell carcinoma

We report a case of a 60-year-old female with a pigmented microcystic chromophobe renal cell carcinoma (PMCRCC). The tumor was 4.5cm in diameter, and was located in the right kidney. Grossly, on cross section, the tumor was light gray with multiple small brown to black pigmented foci up to 0.2cm in diameter. Histologically, the tumor showed a microcystic arrangement with cribriform areas and formation of adenomatous structures. The microcystic and cribriform areas were composed of larger pale cells and smaller eosinophilic cells, with cytological features of conventional chromophobe renal cell carcinoma (CRCC). The cytological features of the cells within the adenomatous structures were different. These cells were mostly columnar with nuclei at the base, and had a variable amount of pale to eosinophilic cytoplasm. There were foci of ample brown pigmentation located in the cytoplasm of the tumor cells and extracellularly. In addition, microscopic calcifications were present. Immunohistochemically, the tumor cells were positive for EMA, E-cadherin, cytokeratin CAM5.2, and cytokeratin AE1/AE3. Cytokeratin 7 was positive only focally. S-100 protein, melan A, HMB 45, vimentin, and CD117 were negative. PMCRCC is a rare tumor. To the best of our knowledge, only one series containing 20 cases of this variant of CRCC has been described to date. The important feature is that PMCRCC seems to have a relatively benign biological behavior, and distant metastases and sarcomatoid transformation are absent.     

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.     

LMP2, a novel immunohistochemical marker to distinguish renal oncocytoma from the eosinophilic variant of chromophobe renal cell carcinoma

LMP2 is a subunit of the immunoproteasome that is overexpressed in oncocytic lesions of the thyroid gland. This study was designed to assess the expression profile and diagnostic utility of LMP2 in two renal oncocytic tumors that share similar morphologic features but have different clinical outcomes: renal oncocytoma (RO) and the eosinophilic variant of chromophobe renal cell carcinoma (CHRCC-EO). A total of 56 RO, 38 classic CHRCC, and 7 CHRCC-EO cases, as well 84 normal kidney controls, were selected from the Johns Hopkins surgical pathology archive and stained for LMP2 using a standard immunohistochemical protocol. Sections were scored for cellular location (nuclear versus cytosolic), intensity (from 0 to 3), and percent of area involved (from 0 to 100%), and an H score was calculated multiplying the intensity by the extent of the staining signal. The cytoplasmic expression of LMP2 was similar among the renal lesions, being present in 44 of 56 (79%) ROs, 27 of 38 (71%) CHRCCs, and 7 of 7 (100%) CHRCC-EO cases. The nuclear expression of LMP2, however, was more informative. All CHRCC-EO cases (7 of 7, 100%) strongly showed nuclear LMP2 staining, as opposed to only 2 of 56 (4%, P < 0.0001) ROs and 9 of 38 (24%, P = 0.0001) classic CHRCCs. These results suggest that the nuclear LMP2 expression can be used in clinical scenarios where histological distinction between RO and CHRCC-EO remains challenging.     

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 cytology of retinoblastoma: light and electron microscopic correlations

A series of 16 cases of retinoblastoma diagnosed by fine-needle aspiration biopsy (FNAB) and confirmed by histologic examination is reviewed, and the salient cytomorphologic features are described. Two types of cells were encountered in the aspiration smears; type I cells were undifferentiated while type II cells showed more differentiation and frequently revealed cytoplasmic processes that are probably indicative of early photoreceptor differentiation. Flexner-Wintersteiner rosettes characteristic of retinoblastoma were found in 10 of 16 cases. These findings were further correlated with ultrastructural examination of the tumors in nine cases. It is concluded that the presence of rosettes and type II cells with cytoplasmic processes are the two features that are most helpful in the FNAB diagnosis of retinoblastoma.     

A renal cell carcinoma with components of both chromophobe and papillary carcinoma

We report a case of a morphologically unusual renal cell carcinoma with features of both chromophobe and papillary carcinoma. Immunohistochemical analysis of high molecular weight cytokeratins (HMWCK), cytokeratin 7 (CK7), cytokeratin 19 (CK19), c-Kit, and α-methylacyl-CoA racemase (AMACR) demonstrated differential profiles for the two components of the tumor, consistent with the respective patterns commonly observed for pure chromophobe and papillary renal cell carcinomas. Specifically, the chromophobe tumor cells expressed CK7 and c-Kit weakly, while HMWCK, CK19, and AMACR were not detectable. In contrast, the papillary tumor cells expressed uniformly HMWCK, CK7, and c-Kit and focally CK19 and AMACR. Fluorescence in situ hybridization analysis of nuclei isolated from paraffin-embedded tumor tissue detected monosomy 1, disomy 7, and monosomy 17, a common and characteristic finding in chromophobe carcinomas, in a majority of, but not all tumor cells, whereas a population characterized by disomy 1, trisomy 7, and trisomy 17, a frequent finding in papillary carcinoma, was not identifiable. Electron microscopic analysis revealed numerous characteristic small cytoplasmic vesicles in the chromophobe areas, which were absent in the papillary component. This case illustrates the rare coexistence of two distinct and admixed histologic types of renal cell carcinoma.     

Aspiration cytology and immunohistochemistry of an orbital aspergilloma

The results of fine-needle aspiration (FNA) cytology combined with immunohistochemical staining of an orbital aspergilloma are presented. The cytologic findings included a tangled mass of hyphal elements and acute inflammation consistent with fungal disease. The slides were stained by the peroxidase-antiperoxidase method for Aspergillus sp. Positive staining confirmed the diagnosis of an orbital aspergilloma, and appropriate therapy was started.     

Aspiration cytology of cystic carcinoma of the breast

Cystic carcinomas of the breast are rarely encountered in fine-needle aspiration (FNA) biopsies. The most common entities comprise intracystic papillary adenocarcinoma, ductal adenocarcinoma with cystic degeneration including comedo forms of ductal adenocarcinoma in situ, medullary carcinoma, squamous carcinoma, and cystic hypersecretory ductal adenocarcinoma. The cytologic diagnosis is often hampered by sparse cellularity, abundant obscuring blood, necrotic debris, and degenerative changes in diagnostic cells. We report on the cytologic features of 10 cases of cystic carcinoma, including 12 FNA biopsies with radiologic and surgical correlation. The original cytologic diagnoses for these cases were: benign (2 cases), atypical (2 cases), suspicious (3 cases), and positive for malignant cells (3 cases). On repeat FNA, one benign case and one atypical case were reclassified, respectively, as atypical and suspicious for carcinoma. The follow-up diagnoses were 5 intracystic papillary adenocarcinomas and 5 cystic ductal adenocarcinomas. Despite 2 false-negative cases, all cases were adequately managed. Correlation with clinical and radiologic findings and direct sampling of any solid component of these cystic neoplasms are crucial in diagnosis and management.     

Fine-needle aspiration cytology of a metastatic Merkel-cell carcinoma

The cytologic features of Merkel-cell carcinoma metastatic to inguinal lymph nodes are described. The primary tumor was in the buttocks. The cytologic smears from the inguinal lymph node were highly cellular, with small to medium-sized cells in a predominantly discohesive or single-cell pattern, as well as large clusters surrounding segments of capillary-sized blood vessels. The nuclei were uniform, round to oval, with delicate nuclear membranes. The chromatin pattern was fine and "powdery" with multiple small micronucleoli. The cytoplasm was very scanty. Intermediate filament "buttons" were abundant. Rosette formation was very rare. Frequent mitotic figures and individual cell necrosis were observed. These features are helpful in the differential diagnosis from other small-cell tumors that may involve the skin.     

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.     

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 metastatic basal cell carcinoma of the skin to the lung

Metastatic basal cell carcinomas of the skin are rare. We present the cytologic features of a metastatic basal cell carcinoma to the lung diagnosed by fine-needle aspiration biopsy. Cytologic examination revealed syncytial groups of relatively small cells with hyperchromatic, oval to spindle-shaped nuclei having high nuclear to cytoplasmic ratios. Immunocytochemical studies performed on the cell block sections revealed the malignant cells to be positive for cytokeratin (AE1/3) and negative for neuroendocrine markers, [neuron specific enolase (NSE) and chromogranin (Phe-5)]. We reviewed the literature related to metastatic basal cell carcinoma of the skin and discuss risk factors and mechanisms of metastatic spread. In addition, a discussion of the other entities that can enter into the differential diagnosis is presented along with the role of ancillary studies. To the best of our knowledge, we believe this is the first case report of the fine-needle aspiration (FNA) cytology of a basal cell carcinoma metastatic to the lung. © 1994 Wiley-Liss, Inc.     

Aspiration cytology of palpable lesions of the scrotal content

To date, we have studied 89 palpable lesions of the scrotum, testicle, and epididymis using fine-needle aspiration cytology (FNAC). Cystic lesions (48.3%) and inflammatory pathology (25.8%) were the most frequent findings. Tumors accounted for 11.2% of results, with a slight predominance of the malignant varieties. In this article, we describe the cytopathology of the main entities and discuss the principal problems of differential diagnosis, especially among inflammatory processes, seminomas, and embryonal carcinomas. The cytopathological pattern of the neoplasias is highly characteristic, and this permits their diagnosis with great precision. FNAC is essentially nontraumatic and easy to carry out, but it requires considerable practice in its execution and in the interpretation of the aspirates. We believe FNAC to be the technique of choice for the study of the pathology of the scrotal content, and we think that it should be employed on the patient's very first visit. The main advantage of FNAC is avoiding delays in diagnosis.     

Fractal dimension of microvasculature in renal oncocytomas and chromophobe renal cell carcinomas

The aim of this study was to evaluate and compare the microvascular architectural complexity in oncocytomas and chromophobe renal cell carcinomas (ChRCCs) by fractal box-counting on CD34-labeled slides.     

Needle aspiration cytology of an oncocytic carcinoma of the parotid gland

A needle aspirate biopsy of a parotid neoplasm yielded uniform benign oncocytic cells consistent with oncocytoma. The subsequent surgical specimen demonstrated an oncocytic carcinoma with vascular and perineural invasion. These findings are analogous to those of oxyphilic tumors of the thyroid gland where cytologic features often do not allow for distinction between benign and malignant lesions.