Cytologic features of small-cell carcinoma on ThinPrep

The use of ThinPrep (TP) technology for fine-needle aspiration (FNA) cytology has become widely accepted. However, some literature suggests that small-cell carcinoma may present a diagnostic pitfall due to morphologic alterations. In this study, we retrospectively compared 14 FNA of small-cell carcinoma prepared using TP with corresponding conventional smears (CS). We also examined the TP appearance of 23 other small round-cell lesions in order to determine if differential diagnostic features were preserved. TP and CS were evaluated semiquantitatively for background, architecture, chromatin quality, nuclear molding, nuclear smearing, nucleolar prominence, amount of cytoplasm, nuclear size, and single-cell necrosis. The data were analyzed using the McNemar chi(2) test. TP slides of small-cell carcinoma showed a cleaner background than CS (P < 0.005). Although some degree of nuclear molding was preserved, it was decreased in amount (P < 0.025) and subtler in quality. Similarly, nuclear smearing was present but decreased in amount (P < 0.05), and less prominent qualitatively. The amount of discernible cytoplasm was greater on TP (P < 0.005). No significant differences were found for any of the other parameters studied. The presence of nuclear molding was the single most useful feature in differentiating small-cell carcinoma from other small round-cell tumors on TP. Small-cell carcinoma may be diagnosed with confidence by FNA using TP. However, pathologists should be aware of certain morphologic alterations in order to avoid diagnostic pitfalls.     

Cytologic features of angioleiomyoma: cytologic-histologic study of 10 cases

Fine-needle aspiration (FNA) features in 10 angioleiomyomas (ALM) were evaluated and correlated to histological features and clinical data. The tumors developed in the skin or subcutaneous tissue of the lower extremities (eight), the shoulder (one), and the lower arm (one). Eight tumors were painful or tender. Cytological specimens showed moderate or sparse cellularity. The most frequent findings were uniform spindle cells, seen in nine smears. In eight of these, the spindle cells were admixed with smooth muscle cells and fragments of collagenous tissue in varying proportions. The occurrence of macrophages and fat cells was less specific, being present in three of nine smears. One aspirate contained some "ganglion-like" cells and a multinucleated giant cell. Smears from ALM are not sufficiently characteristic to permit a histotype diagnosis, but together with typical clinical data (painful or tender nodule) may help to exclude other skin or subcutaneous lesions.     

Cytologic features of insular carcinoma of the thyroid: a case report

Fine-needle aspiration of the thyroid has been accepted as one of the initial diagnostic tools in the evaluation of thyroid nodules. As its use becomes more widespread, the demand for more precise diagnosis has increased. The histopathology of insular carcinoma of the thyroid is now well recognized. However, the cytologic diagnostic criteria are not well established. The reported series have been small (4-6 cases), which is not surprising because of the rarity of this tumor. They consist of retrospective reviews of the aspirates (after the histologic diagnosis had been made from the thyroidectomy specimens). Also, the case reports do not provide uniform cytologic criteria; this could be due to limited sampling of these tumors (which are usually large). A cytologic diagnosis of insular carcinoma can be suggested if multiple samples of a thyroidal mass are markedly cellular, with a cytologic pattern reminiscent of a follicular variant of papillary carcinoma. However, the follicular cells are arranged predominantly in rosettes, their nuclei appear more monotonous, some "intranuclear cytoplasmic pseudoinclusions" are seen, and there is an occasional large cell with a pleomorphic nucleus.     

Primary intraosseous (central) salivary gland neoplasms in jaw bones: report of a mucoepidermoid carcinoma of the mandible diagnosed by fine-needle aspiration cytology

A case of intraosseous (central) mucoepidermoid carcinoma of the mandible diagnosed by fine-needle aspiration (FNA) cytology, with the diagnosis confirmed by surgical resection of the tumor is presented. Mucoepidermoid carcinoma is the most common histotype of malignant and benign salivary gland tumors, which occasionally arise within the facial bones of mandible and maxilla, besides their ordinary derivation from the major and minor salivary glands of the head and neck regions. This case is unusual in that although tumors of the jaws abound, only rare reports of intraosseous salivary gland-type lesions sampled by FNA exist. The current concepts exploring the intraosseous derivation of salivary gland tumors are presented and certain points on FNA technic for adequate sampling of such lesions are related.     

Cytologic perspectives on neoteric B‐cell lymphoproliferative disorders

The 2008 World Health Organization (WHO) classification of hematopoietic and lymphoid tissues has been recently revised, and publication of the updated 2016 version is expected soon. Given that cytopathologists are often involved in the diagnosis of primary, recurrent, and transformed lymphoproliferative disorders, knowledge of updates to the WHO lymphoma classification, including terminology, pathogenesis, ancillary techniques, and targeted therapies is necessary. Herein, we reference the last decade of cytology specific literature for seven newer B‐cell disorders and provide illustrative examples of each entity from our files.     

Cytologic features of meningiomas on crush preparations: a review

Meningiomas are rarely subjected to aspiration, however, since they may occur outside the central nervous system, it is important to recognize their cytologic features. The goal of this study was to examine the cytologic features of meningiomas in crush preparations and cytologic imprints prepared at the time of frozen section. A total of 97 cases of meningiomas evaluated intraoperatively by frozen section with concomitant crush preparation and cytologic imprint were reviewed to assess their cytologic features. The cytologic features of meningiomas identified in our study are cohesive syncitial clusters of cells with ill-defined boundaries. The nuclei are oval and may be eccentrically placed, along with small central nucleoli. The cytologic features may not reflect the histologic subtype. The psammomatous variant can however be easily recognized in touch preps/imprints. The presence of nuclear anaplasia, macronucleoli, mitotic activity, and sheet-like growth may suggest an atypical meningioma. In conclusion, the cytologic features identified would be helpful in diagnosis of meningiomas, especially in unusual locations.     

Histologic and fine-needle aspiration cytologic features of polycystic disease of the parotid glands: case report and review of the literature

Polycystic disease of the parotid glands is a rare disorder, with only eight examples to our knowledge being reported in the literature. The disease presents as a painless enlargement of one or both parotid glands and does not appear to be associated with other disease processes within the head and neck, or with polycystic disease of the kidney, pancreas, or congenital fibrosis of the liver. The histology has been well described. The overall glandular architecture is preserved but the lobules are markedly distended by cysts whose lining appears to be intercalated duct in differentiation. Characteristic eosinophilic laminated spheroliths lie in many of the cystic spaces. Aspirate smears are characterized by a relatively clean background in which are distributed histiocytes, red blood cells, and small clusters of ductal epithelial cells. Polycystic disease of the parotid glands must be differentiated cytologically from mucous retention reaction, mucoceles, benign lymphoepithelial cysts, and cystic neoplasms, including Warthin's tumor, low-grade mucoepidermoid carcinoma, cystadenoma, and papillary cystadenocarcinoma.     

Fine‐needle aspiration of brown tumor of bone: Cytologic features with radiologic and histologic correlation

We report the case of a 40‐year‐old man with tertiary hyperparathyroidism due to end stage renal disease who initially presented with acute‐onset paraplegia, elevated serum parathyroid hormone, and multiple bone abnormalities, including a large extradural intraspinal mass seen by magnetic resonance imaging. In contrast with imaging features, fine‐needle aspiration cytology showed numerous benign‐appearing multinucleated osteoclast‐type giant cells that are the characteristics of either brown tumor or benign giant cell tumor of bone. Sheets of mononuclear spindled stromal cells were also noted. A core‐needle biopsy confirmed the diagnostic features of brown tumor of hyperparathyroidism. Diagn. Cytopathol. 2009. © 2008 Wiley‐Liss, Inc.     

Myofibroblasts in central giant cell granuloma of the jaws: an ultrastructural study

The ultrastructure of stromal mononuclear cells and giant cells were studied in two cases of central giant cell granuloma of the jaws. The majority of stromal cells superficially resembled fibroblasts, but also contained intracytoplasmic myofilaments with electron dense bodies similar to smooth muscle cells. These cells were referred to as myofibroblasts. The other type of mononuclear cells resembled macrophages. Many of the myofibroblast type cells appeared close to giant cells and signs of early fusion between them could be demonstrated. It is suggested from these results that the giant cells in central giant cell granuloma form and increase in size through fusion of these cells.     

Cytologic features of alveolar soft part sarcoma: report of three cases

Alveolar soft part sarcoma (ASPS) is a rare, high-grade, epithelial-like sarcoma that shows characteristic histopathologic findings. Although a chromosomal anomaly that seems specific has been recently described, its diagnosis is based on histologic and ultrastructural features. The tumor shows no specific immunohistologic findings. Cytologic features of three cases of ASPS are presented. Preoperative fine-needle aspiration (FNA) of the primary soft tissue tumor was performed in two cases. In another two, mediastinal and pulmonary and subcutaneous metastatic lesions were aspirated. In all cases the cytologic image was identical with numerous, dissociated, large neoplastic cells with round-to-plasmocytoid morphology. Cytoplasmic fragility and granularity with abundant, atypical, naked nuclei were present. In one case, FNA material was available for ultrastructural studies. It disclosed the characteristic cytoplasmic crystalline structures. A specific cytologic diagnosis of ASPS was given in all cases. In conclusion, ASPS is a rare neoplastic entity that shows a characteristic cytologic image. When accompanied by an adequate clinical context it permits specific preoperative recognition. While immunocytologic studies are helpful to exclude other neoplasms, ultrastructure may result in an exact diagnosis.     

Cytomorphologic features of fine‐needle aspiration of liposarcoma

The cytomorphologic features of fine‐needle aspirates (FNA) of liposarcomas have not been fully characterized. In the current study, we attempted to identify cytological attributes of liposarcoma in FNA. Twelve FNAs of histologically proven liposarcomas were used for this study. They included 10 myxoid and two well‐differentiated liposarcomas. Four cytological criteria were chosen for evaluation. These included a complex capillary network, increased cellularity, the presence of a metachromatic stroma for myxoid liposarcoma, and finally the identification of lipoblasts. Eighteen FNAs of lipomas and 17 FNAs of nonlipomatous soft‐tissue sarcomas were used as controls for evaluation of the same features. The diagnosis of liposarcoma had been rendered on FNA in 7 cases (58%). The diagnosis was suggested in 3 cases (25%), and a suggestion of sarcoma was rendered in 2 cases. Complex capillary networks were identified in 9 of 12 cases (75%); this was seen in 8 of the 10 myxoid liposarcomas and 1 of the 2 well‐differentiated neoplasms. Increased cellularity was seen in 7 of 12 cases (58%), metachromatic stroma was seen in 3 of 12 cases (25%), and lipoblasts were identified in 4 of 12 cases (33%). None of the lipomas or sarcomas exhibited a complex capillary network. When capillaries were identified in lipomas, they were straight, with minimal branching. The lipomas did not show evidence of increased cellularity in any cases. Metachromatic stroma was more frequently seen in the nonlipomatous sarcomas than in the liposarcomas. No lipoblasts were identified in any of the control FNAs. Diagn. Cytopathol. 1999;20:67–69. © 1999 Wiley‐Liss, Inc.     

Mammary carcinoma with osteoclast-like giant cells: a study of four cases and a review of literature

Mammary carcinoma with osteoclast-like giant cells (OGCs) is an extremely rare tumor. To the best of our knowledge, only 45 cases have been reported in the literature. Here we report four additional cases of this tumor. The fine-needle aspiration cytology was performed in all four cases, showing an abundance of giant cells and mononucleated stromal cells in intimate association with low- or medium-grade malignant epithelial clusters. Histologically, cribriform patterns predominated in three cases. In one case, OGCs were more pronounced in the vicinity of ductal carcinoma in situ accompanied by marked stromal angiogenesis. This study, as well as review of the literature, underlines the characteristic features of this rare histologic type of carcinoma.     

Cytologic aspect of brown tumor of hyperparathyroidism. Report of a case affecting the hard palate

The cytologic and histologic findings of one brown tumor (BT) of hyperparathyroidism located in the hard palate, at first misdiagnosed as peripheral giant-cell granuloma, are described. Poor communication between cytopathologist and ear nose and throat specialist was responsible for the error. The overriding cytologic finding was the presence of numerous multinucleated giant cells (MGCs) of the osteoclastic type. MGC-rich aspirates pose the same diagnostic dilemmas as those of histologic sections of MGC-containing lesions of bone: these cells are not diagnostic by themselves and can be seen in several benign and malignant conditions. Clinical history, X-ray films and biochemical findings, particularly serum parathormone levels, are essential to diagnose a BT and to rule out other MGC-rich bone lesions.     

Giant cell‐rich osteosarcoma of the parotid gland: An exceptionally rare entity at an unusual site

Giant cell‐rich osteosarcoma is a rare histologic variant of conventional osteosarcoma that affects mainly the extremities. Extraskeletal giant cell‐rich osteosarcoma is therefore exceedingly rare. Here, we report the first case of this uncommon tumor involving the parotid gland in a 62‐year‐old male who presented with initial right jaw swelling. Radiologic work‐up revealed a 6.2 cm mass involving the right parotid gland. Fine‐needle aspiration cytology showed numerous multinucleated giant cells in a background of dyshesive epithelioid cells and rare clusters of spindle stromal cells, suspicious for malignancy. The subsequent excisional biopsy showed histopathologic features diagnostic for giant cell‐rich osteosarcoma. Diagn. Cytopathol. 2016;44:1107–1111. © 2016 Wiley Periodicals, Inc.     

Atypical plasmacytoid monomorphic adenoma of salivary glands of the tongue: Cytologic,histologic, immunohistochemical,and ultrastructural findings

We describe the case of an 11‐yr‐old boy with a 2.5‐cm‐diameter soft tumor superficially located at the dorsal aspect of the tongue. Fine‐needle aspiration cytology smears showed plump epithelioid cells with round to mildly oval nuclei and open chromatin. One or two nucleoli of intermediate size were noticed in each nucleus. These cells appeared singly or in small groups. The findings were interpreted as containing plasmacytoid cells coming from an adenoma of salivary gland origin. The histologic examination of the surgical specimen revealed noncohesive, pleomorphic polygonal cells combining plasmacytoid/rhabdoid cytoplasmic features, with mild to moderate nuclear pleomorphism. One mitotic figure was observed per 10 high‐power fields. Immunoreactivity was strongly positive for vimentin and S‐100 protein, less intense for the cytokeratins, and negative for smooth muscle actin, muscle‐specific actin, myoglobin, and GFAP. No ultrastructural evidences of myogenous differentiation were found. We propose that this case represents an unusual atypical variant of plasmacytoid monomorphic adenoma. Diagn. Cytopathol. 1999;20:29–33. © 1999 Wiley‐Liss, Inc.     

Noonan syndrome associated with central giant cell granuloma

We report a case of Noonan syndrome associated with central giant cell granuloma. The patient was a 101/2-year-old boy with the chief complaint of proptosis of the right eye. He also had various malformations such as short stature, webbed neck, pectus excavatum, cubitus valgus, pulmonary valve stenosis and patent foramen ovale, a characteristic face appearance and cryptorchidism and so on. Chromosome analysis showed a 46, XY karyotype. A computed tomographic scan and magnetic resonance imaging showed a mass originated from the lateral wall of the right maxillary sinus. The patient underwent Caldwell-Luc operation. Histological examination of the mass showed the characteristics of central giant cell granuloma. This case report describes a patient with the features of the recently described Noonan-like/multiple giant cell lesion syndrome.     

Cytologic diagnosis of osseous lesions: A review with emphasis on the diagnosis of primary neoplasms of bone

Fine‐needle aspiration has been utilized as the initial diagnostic technique at a large number of body sites for over three quarters of a century. As early as the 1930s, fine‐needle aspiration (FNA) was used to investigate lesions of the musculoskeletal system. In many early reports, FNA was most frequently and successfully used for the diagnosis of metastatic disease to bone. Less emphasis was placed on its utility for the investigation of primary neoplasms of bone and soft tissue. Current utilization of FNA continues to de‐emphasize its application to the diagnosis of primary lesions of the musculoskeletal system. Recent advances in imaging techniques, immunohistochemistry, and molecular diagnostics along with an increasing familiarity among pathologists with the cytologic appearance of primary osseous tumors has led to reevaluation of the technique for investigation of these tumors. The diagnostic accuracy of FNA along with its relatively low cost and high degree of safety makes it a desirable technique for the investigation of primary lesions of the musculoskeletal system. This article reviews issues of diagnostic accuracy, optimal practice procedures, and benefits of the technique including cost reduction. The article will review criteria for selection of appropriate tissue targets for FNA to reduce the number of unsatisfactory specimens. Cytomorphologic features of the more common primary neoplasms of bone will be summarized along with recommendations for the utilization of immunohistochemistry and molecular diagnostics in the work‐up of primary neoplasms of bone. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.