Follicular adenoma with squamous metaplasia and cystic change: report of a case with fine needle aspiration cytological and histological features

Squamous metaplasia (SM) of thyroid follicular epithelium is known to occur in a variety of non-neoplastic lesions as well in thyroid neoplasms, notably papillary carcinoma (PC). In follicular thyroid tumors, on the other hand, SM is very rare. This case describes cytological and pathological findings in a follicular adenoma (FA) that presented as a cystic lesion with extensive SM. The fine needle aspiration (FNA) cytology sample in this case yielded only necrotic material from the cystic area and squamous cells, which being mostly of immature type, were not recognised as squamous in the cytological smears. The needle missed the solid (neoplastic) component of the lesion and on the whole the cytological picture was considered to be equivocal. FA can now be added to the spectrum of thyroid lesions that can show SM. Awareness of this will enable cytopathologists to consider non-papillary lesions in the differential diagnosis of thyroid nodules that yield squamous cells.     

Diagnosis of metastases from testicular germ cell tumours using fine needle aspiration cytology.

The cytological features of testicular germ cell tumours were established in smears from 15 freshly resected tumours. These features were applied to the fine needle aspiration cytology diagnosis of metastases in 27 patients referred for chemotherapy. There were 16 positive reports in 32 aspirates of which 13 were taken before chemotherapy and three in patients with residual or new masses after chemotherapy. Teratomas and typical seminomas showed certain characteristic morphological features in cytological preparations which when present in fine needle aspiration cytology material enabled tumour types to be diagnosed. Spermatocytic and anaplastic seminoma were not represented in this series. It is unlikely that these could be distinguished from malignant teratoma undifferentiated (MTU) in the fine needle aspiration cytology material. Metastases from carcinomatous areas in MTU and malignant teratoma intermediate (MTI) may not be distinguishable in fine needle aspiration cytology material from metastatic adenocarcinoma or undifferentiated carcinoma from a different primary site. Positive cytological findings are of value to the oncologist in the management of patients with metastases from testicular germ cell tumours; negative cytology does not exclude the presence of viable tumour. The sampling of small foci of viable tumour in large necrotic masses persisting after chemotherapy is a problem for radiologists, cytologists, and histopathologists. This paper does not advocate the use of fine needle aspiration cytology for the diagnosis of primary testicular tumour.     

Retroperitoneal ectopic brain: Case report and literature review

Heterotopic neural tissue (HNT) has been identified in many sites. In our literature review, we have found only two cases of HNT located in the retroperitoneum. As far as we know, cytological features of HNT have not been described. We here report a case of retroperitoneal HNT diagnosed by fine‐needle aspiration (FNA) cytology and subsequent resection. Our patient was a male infant born at 26 weeks’ gestation. A retroperitoneal solid‐cystic lesion measuring 3.8 cm was identified by abdominal ultrasound. FNA was performed and cytology showed highly cellular smears with single cells and masses of fibrillary material. Cells were small with rounded irregular nuclei and variable cytoplasm. Multinucleated cells, cells with neuronal morphology, calcifications, and hemosiderophages could also be seen. The lesion was excised and histology showed fibrillary areas, glial cells, neurons, and ependymal cells. Synaptophysin, GFAP, and EMA were expressed in distinct areas and cell types. No recurrences were observed.     

Cytological diagnosis of adenoid cystic carcinoma breast--a case report.

The cytologic features of a case of adenoid cystic carcinoma of breast diagnosed on fine needle aspiration cytology (FNAC) in a 52 years old female are described. FNAC was carried out on outer quadrant of breast. The characteristic cytological features were numerous single to branching small round to Avoid cells at places forming microacini. Numerous pink hyaline globules of variable sizes were seen along with finger like projections containing basement membrane material.     

Cryptococcal parotitis presenting as a cystic parotid mass: report of a case diagnosed by fine-needle aspiration cytology

We report the fine needle aspiration (FNA) cytology findings that allowed us to diagnose cryptococcal parotitis in a 31-year-old HIV positive patient. The patient presented with painful and enlarged right parotid gland and a CT scan showed a cystic lesion with rim enhancement. The FNA cytology revealed yeasts of variable size, some of which had bright eosinophilic capsules in Diff-Quik stained preparations. Mucicarmine and silver stain supported the diagnosis of cryptococcal parotitis, which was later confirmed by fungal culture of the aspirated material. We thus show that fungal infection can present as a cystic parotid mass in an immunosuppressed patient and that the diagnosis can be made by FNA cytology.     

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.     

Clear‐cell hidradenoma in a child: A diagnostic dilemma for the cytopathologist

Primary cutaneous tumors are infrequently subjected to fine needle aspiration cytology. As a result, the cytological reports of skin adnexal tumors like hidradenoma are scarce in the available literature. A young boy with a painless nodule on forehead underwent fine needle aspiration. The smears showed clusters of epithelial cells containing blue cytoplasm, some of which had vacuolated cytoplasm with mild nuclear pleomorphism and occasional larger hyperchromatic nucleus. The cytological features, in conjunction with the clinical examination, suggested a skin appendageal tumor. Though nuclear pleomorphism and occasional larger nucleus posed a cytological diagnostic challenge, a diagnosis of benign appendageal tumor was suggested, considering the young age of the patient. This was later confirmed as a clear‐cell hidradenoma on excision biopsy. The cytopathologist should consider skin appendageal tumors during evaluation of cutaneous nodules. An accurate diagnosis requires a close clinico‐pathologic correlation. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Fine‐needle aspiration of cystic pancreatic mucinous tumor: Oncotic cell as an aiding diagnostic feature in paucicellular specimens

In juxtaposition with imaging studies, endoscopic ultrasound‐guided fine‐needle aspiration has gained popularity in the initial evaluation of pancreatic masses, especially cystic lesions of pancreas. Cystic pancreatic mucinous tumors include mucinous cystic neoplasm and intraductal papillary mucinous tumor, both of which have been known to have a low malignant potential and a high rate of association with invasive adenocarcinoma. As such, preoperative diagnosis is of great significance in guiding patient management. Although fine‐needle aspiration cytological diagnosis of pancreatic tumor in cellular specimens has been well described, as with other cystic lesions, the yield of diagnostic cells from needle aspiration of cystic pancreatic mucinous tumors is typically low. Cytological diagnosis from these paucicellular specimens remains challenging. An additional compounding problem is the high frequency of gastrointestinal mucin and epithelial contamination. The diagnostic morphology and criteria in these paucicellular specimens have not been well addressed in the literature. The cytopathologists' ongoing efforts tend to improve the diagnostic accuracy. In this current study, oncotic cells, characterized by cytoplasmic swelling and karyolysis, were analyzed from 17 cases of cystic pancreatic mucinous tumor, of which the diagnosis was either confirmed by surgical resection or supported by cell block and/or increased CEA. Oncotic cells were found in variable amounts in almost all the cystic pancreatic mucinous tumors in this series. None of the five fine‐needle aspirations intended for aspirations of hypoechoic nonlesional pancreas, which yielded either gastrointestinal tract material only or admixture of gastrointestinal and normal pancreatic components, was found to contain oncotic cells, evidencing the utility of oncotic cell as a surrogate morphologic marker in aiding the diagnosis of cystic pancreatic mucinous tumor as well as its differentiation from gastrointestinal contaminant, particularly in paucicellular specimens. Diagn. Cytopathol. 2009. © 2008 Wiley‐Liss, Inc.     

Effusion cytology of hepatocellular carcinoma with in situ hybridisation for human albumin.

While the cytological features of hepatocellular carcinoma on fine needle aspiration cytology are well described, cases of hepatocellular carcinoma with malignant cells in ascitic fluid and their characteristics are not. A patient is described with cirrhosis resulting from chronic hepatitis B virus infection, ascites, and hepatocellular carcinoma diagnosed by effusion cytology. The malignant cells in the effusion were shown to be positive for alpha fetoprotein using immunocytochemistry, and for human albumin using in situ hybridisation, confirming the diagnosis of hepatocellular carcinoma. Further investigations in a terminally ill patient were thus avoided.     

Evaluation of leprosy lesions by skin smear cytology in comparison to histopathology

Cytological evaluation of leprosy skin lesion was done to evaluate cytohistological correlation. Twenty five clinically suspected patients of leprosy were evaluated by performing fine needle aspiration (FNA) in nodular lesions and slit skin smear technique in flat lesions to classify across R-J scale. May-Grunwald-Giemsa (MGG) and Ziehl-Neelsen stain were employed on slit skin smears and fine needle aspiration material. Histopathological assessment of slides from same lesion was done. The overall diagnostic accuracy of fine needle aspiration was 76.1% and that of slit skin smear 50%. However, on adequate material diagnostic accuracy of slit skin smear was high, 100% as compared to 81.8% of fine needle aspiration smears. In cases of polar leprosy cytological findings paralleled histopathological diagnosis. Within the constraints of cytological interpretation the cases in borderline unstable spectrum of leprosy can be classified broadly.     

Fine needle aspiration cytology in two cases of chondromyxoid fibroma of bone and review of literature

We report the cytological features of two cases of chondromyxoid fibroma (CMF) confirmed by histopathology examination. First case was a 40‐year‐old male who presented with a foot swelling, and the second case was a 16‐year‐old male with a lesion at the angle of jaw. A fine needle aspiration cytology (FNAC) was performed in both the cases. In first case, a correct diagnosis of CMF could be offered on FNAC. In the second case, though the cytology diagnosis was a sarcoma considering the cytological, radiological and clinical features, the histopathological examination confirmed the same to be a CMF. The cases are being discussed to highlight the usefulness of FNAC to diagnose these uncommon benign bone lesions and the potential pitfalls in the cytological diagnosis of chondroid lesions. Diagn. Cytopathol. 2013;41:904–908. © 2012 Wiley Periodicals, Inc.     

Fine needle aspiration cytology of the thyroid--a review of experience in 1853 cases

1853 thyroid lesions subjected to cytological sampling (either by the fine needle aspiration or fine needle capillary sampling technique) from January 1992 to December 1997 at the University Hospital, Kuala Lumpur, were reviewed. Nodular goitre was the most common thyroid lesion needled (67.35%). Among the neoplastic lesions, follicular neoplasms predominated (64%), followed by papillary carcinoma (29.4%). In 325 cases, partial or total thyroidectomy had been done, providing material for histological review and cyto-histological correlation. Cytological diagnosis was found to have high sensitivity and specificity rates of over 75%. Besides, most non-neoplastic thyroid lesions could be diagnosed on cytology. The scope of cytology in the diagnosis of lymphomas, anaplastic and metastatic tumours rendered diagnostic biopsies (or thyroidectomy) unnecessary in these cases. Being a cost-effective technique and having the capacity to provide exact morphological diagnosis in a large variety of thyroid lesions, cytology is obviously the method of choice in the assessment of thyroid nodules.     

Thyroid metastasis of clear cell renal carcinoma: Report of a case

Renal cell carcinoma can recur many years after diagnosis and nephrectomy metastasizing even in uncommon sites, including thyroid gland. Thyroid metastases are extremely rare, the most frequent site of origin are renal tumors. Metastases in thyroid gland appear as painless nodules or masses, “cold” at scintiscan. We report the case of a 67‐year‐old male patient affected by clear cell renal carcinoma, diagnosed by fine‐needle aspiration cytology procedures, and treated with anticancer medical therapy, who noticed after some months a mass in the neck‐thyroid region requiring deeper medical investigations. By this way, thyroid fine‐needle aspiration cytology reported a lesion made of malignant epithelial cells compatible with metastases of renal carcinoma (clear cell). Clinical and pathological data, together with immunostaining, supported the diagnosis of metastatic clear cell renal carcinoma. The diagnosis of metastatic disease, although difficult clinically and pathologically, should be suspected in patients with a clinical history of cancer, particularly in case of renal cell carcinoma, but fine‐needle aspiration cytology can provide the clue for diagnosis. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Mediastinal seminoma: A case report with special emphasis on SALL4 as a new immunocytochemical marker

Cytological diagnosis is a valuable method for detection of mediastinal tumors, and recent reports have shown the usefulness of fine‐needle aspiration cytology for diagnosis of mediastinal tumors, including germ cell tumors. We report a case of mediastinal seminoma diagnosed intraoperatively by cytological examination of cystic fluid containing tumor cells. An anterior mediastinal tumor with cystic component was incidentally found in a 28‐year‐old Japanese male. Cytological examination of the cystic fluid at the time of tumor resection showed single and loose aggregates of large round to polygonal cells with large round nuclei, vesicular chromatin and nucleoli, and mild to moderate amounts of PAS‐positive cytoplasm admixed with mature lymphocytes. A diagnosis of seminoma was made intraoperatively. On subsequent immunostaining, the tumor cells showed nuclear positivity for SALL4, a recently recognized germ cell marker that, in the appropriate setting, can be helpful to distinguish germ cell tumors from other mediastinal neoplasms, such as malignant lymphoma, thymoma, and thymic carcinoma. Diagn. Cytopathol. 2013;41:821–824. © 2012 Wiley Periodicals, Inc.     

Granular cell tumour: a pitfall in FNA cytology of breast lesions

Granular cell tumours of the breast are rare lesions that may mimic an invasive carcinoma. The fine needle aspiration cytology (FNAC) findings in five cases are presented with specific attention to the pitfalls in the cytological diagnosis of these lesions.     

Reliability of cytological grading of prostatic carcinoma compared with histological grading

Thirty prostatic carcinomas diagnosed simultaneously by fine needle aspiration cytology and punch biopsy were graded into three groups according to their cytological and histological appearances. Among them 23 carcinomas were graded equally by both methods. Cytological examination appears to be suitable for grading prostatic carcinoma, thus being a possible indicator of the patient's prognosis and response to hormonal therapy. In addition to the results obtained here, fine needle aspiration cytology has many advantages such as simplicity, quickness and safety. With increase of attention of urologists and pathologists to fine needle aspiration cytology, this evaluation will become comparable to the histological examination not only as a routine diagnostic tool.     

Diagnostic findings of ultrasound-guided fine-needle aspiration cytology for gastrointestinal stromal tumors: Proposal of a combined cytology with newly defined features and histology diagnosis

Recently, endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) has been applied for diagnosis of gastrointestinal submucosal tumors. There have been no definite criteria, however, for the adequate cytological diagnosis of gastrointestinal stromal tumor (GIST) in practice. To facilitate this a novel method is proposed that combines cytology and histology. For 49 cases of submucosal tumor of gastrointestinal tract, EUS-FNA was performed. The aspirated materials were processed for cytology and histology. Both cytological and histological findings were examined on immunocytochemical and immunohistochemical staining of c-kit. Of 49 cases, 40 (81.6%) proved adequate for cytological and/or histological examination. On cytology, cluster types were classified into type A (piled clusters with high cellularity showing a fascicular pattern), type B (thin layered clusters with high cellularity showing a fascicular pattern), and type C (mono-layered clusters or scattered cells). Types A and B were strongly associated with histological diagnosis of GIST. Type C clusters needed confirmation on c-kit positivity and histology. Thus, the combined cytology with newly defined features, and classification and histological diagnostic method for EUS-FNA materials can contribute to improved routine diagnosis for GIST.     

Influence of cancer histology on the success of fine needle aspiration of the breast.

Fine needle aspiration (FNA) cytology carried out on 1318 primary breast cancers from 1980 to 1986 inclusive showed that 198 were well recognised, histological special types. These included medullary, mucoid, tubular, cribriform and lobular invasive cancers, and non-invasive cancers. Excluding these special histological types, the overall number successfully identified (malignant plus suspicious) by fine needle aspiration was 940 (84%), although in only 820 (73%) was malignancy definitely diagnosed. The results for the special types were variable, the mucoid and medullary cancers being consistently identified while the other types were not. For tubular and cribriform, lobular and non-invasive ductal cancers a malignant diagnosis was made in 30% to 40% of cases, although inclusion of suspicious results gave identification figures of 60% to 70%. Particular cytological patterns are characteristic of some special histological cancer types but lesion cellularity, size, and physical definition are all intrinsic factors influencing success of FNA diagnosis. About 10% of all primary breast cancers seem to have certain histological properties which further reduce the success of fine needle aspiration.     

Thyroid aspiration cytology: a "cell pattern" approach to interpretation

The key to the interpretation of thyroid fine needle aspiration is largely dependent on the recognition of various morphologic patterns of epithelial cells, usually follicular cells, and background elements, such as colloid. These morphologic patterns consist of 3 parts: 1) The arrangement of cells with respect to one another, 2) The cytologic features of individual cells, and 3) The presence of background elements. The cellular arrangements generally encountered in fine needle aspiration of the thyroid include the follicular patterns (macro-/normo-follicular and micro-follicular), the papillary pattern, the syncytial pattern, the dispersed cell pattern, and the cystic pattern. This article approaches some of the differential diagnostic challenges encountered while interpreting thyroid aspiration cytology by focusing first on the overall cellular arrangement to generate a differential diagnosis and then narrowing that differential by assessing cellular features of individual cells and the presence of background elements.