Fine-needle aspiration cytology diagnosis of tuberculosis

Fine-needle aspiration cytology of lymph nodes and extranodal swellings in 160 cases showed granulomatous reaction with or without caseation necrosis in 83%. The material was acellular or predominantly composed of necrotic material, polymorphs, and lymphocytes in 17%. The age of the patient ranged from 1.5 to 72 yr. The male to female ratio was 1:1.3. Acid-fast bacilli (AFB) could be demonstrated in 40.6% of cases. In cases associated with cellular reaction and necrosis. AFB positivity was 50.0%, while it was 66.7% in cases with acellular necrotic material.     

Fine-needle aspiration cytology of pilomatrixoma: a case report

The cytological appearance of breast lesions has been well-studied. However, skin lesions occurring as breast nodules have less often been studied by fine-needle aspiration. In addition. skin tumors occurring over the breast may be clinically mistaken for breast carcinoma owing to their fixity to the skin. This article presents one such case and describes its cytologic appearance.     

Fine-needle aspiration cytology of epithelioid angiosarcoma: a diagnostic dilemma

A 28-year-old woman with a 2-yr history of unilateral chronic leg swelling, initially thought to be secondary to deep vein thrombosis, later thought to be due to congenital venous malformation, eventually developed a pelvic mass, which was biopsied by fine-needle aspiration. On the basis of cytologic features on smears, high-grade sarcoma was reported. The patient underwent surgery to resect the pelvic mass, which showed anastomosing vascular channels arising from external iliac vein in histology. However, the tumor cells unexpectedly showed strong and diffuse immunohistochemical expression of cytokeratin and epithelial membrane antigen. The case was sent for expert consultation, and the expert's opinion was epithelioid angiosarcoma. The expert's diagnosis was confirmed 2 yr later by local recurrence. The clinical presentation, cytology, histology, and immunohistochemistry of the current case and 15 other cases of epithelioid angiosarcoma found in the cytology literature are summarized. This case illustrates that morphology with clinicopathologic correlation tends to be a better guide than available special techniques.     

Fine-needle aspiration of a primary right atrial myxoma

Cardiac myxomas are rare neoplasms usually diagnosed by echocardiography. Preoperative tissue diagnosis is usually not obtained because of the location of these neoplasms. Their cytologic appearance has only been reported from touch imprints of operative specimens or aspirates of metastatic deposits. We report the cytologic appearance of a right atrial myxoma characterized by bland spindle cells and fragments of myxoid debris. Diagn Cytopathol 1996;14:162–164. © 1996 Wiley-Liss, Inc.     

Fine-needle aspiration cytology in azoospermic males

Bilateral testicular fine-needle aspiration cytology (FNAC) was performed in 100 males, including 10 controls with normal fertility and 90 infertile azoospermic males. The various seminiferous tubular cells were easily identified in smears. It was possible to give a cytological diagnosis in histologic terms by analysis of the combinations of various cell types. The cytohistologic correlation in 25 cases was nearly 100%. FNAC is particularly useful in cases of obstructive azoospermia, where mature spermatozoa are seen in smears.     

Fine-needle aspiration cytology of a primary ectopic meningioma

Meningiomas are benign tumors derived from arachnoid cells. Most commonly an intracranial lesion, meningiomas may be found extracranially in various anatomic sites. A 23-yr-old white female presented with left-sided palpable mass located submucosally in the floor of the mouth. CT scan revealed no evidence of mass elsewhere in the head and neck region. Fine-needle aspiration cytology (FNAC) showed loose and cohesive cellular fragments with lobular growth pattern and uniform round or ovoid cells. The diagnosis of low-grade salivary gland neoplasm, not further classified, was made. The tumor was locally excised. The differential diagnoses of an extracranial meningioma and pleomorphic adenoma were discussed at the frozen section. Based on light microscopic, immunohistochemical, and electron microscopic (EM) findings, the final diagnosis of an ectopic meningioma was rendered. Ectopic meningiomas may pose a diagnostic challenge to clinicians and cytopathologists. It is easily forgotten in the list of differential diagnosis at an ectopic site. Primary ectopic meningioma in a region containing salivary gland(s) may mimic benign and low-grade malignant salivary gland tumors in FNAC.     

Fine-needle aspiration cytology of sacrococcygeal chordoma

The fine-needle aspiration cytology (FNAC) of four cases of chordoma that were diagnosed preoperatively is presented. One of the cases showed anaplastic components along with the classical features of chordoma; this is probably the second case diagnosed with these features on FNAC. The cytologic features of classical chordoma include conspicuous extracellular matrix in the background. Polygonal cells, dissociated and in small groups, were identified in all cases. Physaliphorous cells were also prominently found in these cases. In addition, the case with anaplastic features showed very bizarre cells with profound multinucleation and the presence of intranuclear cytoplasmic inclusions. The diagnosis of chordoma was possible because of a high index of suspicion on clinical grounds and the use of special staining for confirmation.     

Fine-needle aspiration cytology of meningiomas with unusual presentations

Meningiomas are not often aspirated unless they erode the skull, occur intraorbitally, or present as swelling in the head and neck region. We describe the cytologic findings of fine-needle aspiration cytology (FNAC) in four cases of meningioma that presented with swellings in the head and neck region. The patients underwent surgery, and the diagnosis of meningioma was confirmed. Three of the four cases were reported as aggressive meningiomas on histopathology.     

Fine-needle aspiration cytology of umbilical nodules: Sister Joseph's nodule.

Metastatic tumor deposits in the umbilicus are not uncommon. Fine-needle aspiration cytology is an important, simple, cost-effective diagnostic tool for delineating the value of umbilical nodules. However, only a few reviews and case reports of diagnosis of umbilical metastases by fine-needle aspiration cytology are available. A review of 52 cases of umbilical nodule aspirates over a 16-yr period forms the basis of this brief report.     

Fine-needle aspiration cytology of tubular carcinoma of the breast in a young woman

The fine-needle aspiration cytology (FNAC) findings in a case of rare tubular carcinoma of the breast in a young woman are presented. The rarity of occurrence of tubular carcinoma in the breast and the bland and mostly orderly appearance of cells in the FNAC sample, as in tissue, were considered to cause the difficulty in the diagnosis of this tumor; also, these were features also found in other conditions of the breast. Furthermore, cytologists have limited experience with the diagnosis of this neoplasm from FNAC samples. It is therefore felt that (1) a cautious attitude is necessary when commenting on FNAC samples until more specific criteria are forthcoming for the diagnosis of this neoplasm; and (2) if cellular atypias are seen in FNAC samples, these should be reported with a recommendation for removal of the breast lump and a detailed tissue examination.     

Fine-needle aspiration cytology with histological correlation of chordoma metastatic to the lung: a diagnostic dilemma

Chordoma is an uncommon tumor initially believed to be benign due to the rarity of its metastasis. Cytological, morphological, and immunohistochemical features of chordoma, relating to its origin from notochordal remnants, allows for its accurate diagnosis. A 75-year-old man with a known history of tuberculosis (TB) presented with shortness of breath and a dry cough. A chest X-ray demonstrated a diffuse, infiltrative miliary pattern in both lungs. Bronchial washings submitted for culture and cytological examination did not identify any tuberculous bacilli. Fine needle aspiration cytology (FNAC) showed focal areas of myxoid regions with small, round, uniform mononuclear cells. There was a documented past history of chordoma arising from the L2 vertebrae. Because of the rarity of this lesion in the lung and the limited diagnostic material available with a clinical history of TB and lumbar chordoma, the pathological report rendered on the FNAC was "atypical cells suspicious for metastatic chordoma." A wedge biopsy of the lung confirmed the presence of metastatic pulmonary chordoma. Despite palliative treatment, he died within a year. Although the metastatic potential of chordomas has been recognized and documented, to the best of our knowledge, metastasis of chordoma to the lung diagnosed by FNAC with cytohistological correlation has not been previously reported in the English literature.     

Fine-needle aspiration cytology of myositis ossificans: A case report

This report describes the cytological findings of a case of myositis ossificans in a 16-yr-old girl. Clinically and radiologically she was suspected to have a malignant soft tissue tumor. This was not confirmed by fine-needle aspiration cytology and a diagnosis of benign lesion, probably myositis, was given. This diagnosis was confirmed by histological examination. © 1994 Wiley-Liss, Inc.     

Fine-needle aspiration cytology of sarcoma: Retrospective review of diagnostic utility and specificity

Fine-needle aspiration cytology (FNA) is useful because of its low cost, quick turn around time, and low incidence of complications. This study investigates the role FNA plays in the evaluation of sarcoma. We reviewed all the pathologic material from patients with sarcoma or a FNA diagnosis suggestive of sarcoma at the University of California-Davis Medical Center (1985–1994). Fifty-two of 196 patients identified (26.5%) were evaluated with FNA exhibiting 46 soft tissue and 6 bone lesions located in the extremities (19), trunk (19), head and neck (8), retroperitoneum (3), and abdominal cavity (3). Among 196 patients identified, those evaluated by FNA had soft tissue rather than bone lesions (P < .001) and primary sites other than in the extremities (P < .001). The primary neoplasms for the 52 FNA patients included 47 sarcomas (10 malignant fibrous histiocytomas and 16 other types), I intramuscular myxoma, 2 lymphomas, and 2 spindle cell (sarcomatoid) carcinomas. In 43 patients (22% of total), FNA was used first, before a primary diagnosis. The FNA report showed the correct specific neoplasm in only 20.9%. However, the FNA reports reflected an effective positive diagnosis leading to appropriate diagnostic biopsy in 88.4%, while only 7.0% were misleading (benign or inflammatory) and 4.6% inadequate. Review of FNA slides for 32 of 43 patients in which FNA was used first, in a blinded fashion, exhibited 21.9% specificity for the specific neoplasm, and 88.4% effective positive diagnoses. In 9 patients, FNA was utilized to investigate recurrence. Five out of 5 instances of recurrent sarcoma were identified by FNA. However, FNA misidentified recurrence in 3/4 instances, exhibiting suspicious cells from regenerating skeletal muscle (2) and a traumatic neuroma (I). The specific diagnosis for sarcomas is challenging even with surgical material. FNA usually does not provide a specific diagnosis (only in 20.9% of cases) and review of routinely prepared slides showed the same specificity as reflected by the original FNA report, at times formulated with the benefit of immunohistochemistry or electron microscopy. FNA effectively evaluated lesions in 45 of 52 patients (86.5%), confirming the useful screening role for this technique in sarcomas. Diagn Cytopathol 1996;15:23–32. © 1996 Wiley-Liss, Inc.     

Fine-needle aspiration diagnosis of giant cell tumour of bone presenting at unusual sites

Giant cell tumour (GCT) of bone is a distinctive neoplasm, which has only recently been included within the diagnostic purview of the cytopathologist. Four cases of GCT of bone diagnosed primarily and exclusively by fine needle aspiration cytology (FNAC), presenting at unusual sites, are presented with a view to highlight the cytomorphologic features of this tumour and its differential diagnosis on FNAC. Each of these cases were distinctive by virtue of their localisation, but presented as classical expansile osteolytic lesions roentgenologically. Despite the paucity of literature regarding the cytodiagnosis of these lesions, the authors nevertheless recommend FNAC as a primary tool in the diagnosis of these lesions.     

Fine-needle aspiration cytology of metastatic transitional cell carcinoma

In this article we described the fine-needle aspiration cytology (FNAC) of five cases of metastatic transitional cell carcinoma (TCC). There were four cases of metastatic lymph nodes and one case of metastatic skin lesion. All of the TCC cases were primarily in the urinary bladder and were high grade on histopathology (grade 3). Three cases showed bladder muscle involvement and two cases showed superficial TCC at the time of primary diagnosis. FNAC smears showed abundant cellularity. The cells were present in discrete and small syncytial clusters. Nuclear position of the cell was central to eccentric. Many cells showed prominent nucleoli. Cercariform cells (CCs) were noted in four cases. These cells are malignant cells with a nucleated globular body and a unipolar nontapering cytoplasmic process. Two cases showed intranuclear inclusions. Prominent cytoplasmic vacuoles were noted in three cases. In addition, cell cannibalism and attempted pearl formations were noted in two cases.In conclusion, clinical history along with the certain cytological features such as the presence of CCs, cells with eccentric nuclei, and intranuclear inclusions are helpful to diagnose metastatic TCC on FNAC material.     

Fine-needle aspiration cytology of glycogen-rich carcinoma of breast: report of a case and review of literature

Glycogen-rich carcinoma (GRC) of the breast is a rare histological subtype of breast cancer having a poor prognosis. There are very few case reports describing the cytological features of GRC on fine-needle aspiration cytology (FNAC). In this report we present the case of a 34-yr-old woman who underwent FNAC of a clinically palpable breast lump. The aspirate was cellular showing tumor cells in groups, clusters and lying singly. The tumor cells had abundant eosinophilic, finely granular to vacuolated cytoplasm with moderate to marked nuclear pleomorphism. With a cytological diagnosis of carcinoma, a wide local excision was performed. On histology a diagnosis of GRC was made with the tumor cells showing abundant glycogen. The presence of cells with abundant granular to finely vacuolated cytoplasm in a case of breast carcinoma, should point toward the possibility of GRC and other clear cell tumors of the breast. Demonstration of glycogen is required to make a definite diagnosis on cytology.     

Fine-needle aspiration cytology of breast: its impact on surgical practice with an emphasis on the diagnosis of breast abnormalities in young women

Fine-needle aspiration cytology (FNAC) of the breast is a minimally invasive yet maximally diagnostic method, often precluding the need of an open biopsy. In young women, in whom breast cancer is a rare disorder, it is also important that carcinoma is recognized without delay so that an appropriate plan of management can be adopted. In this study, we reviewed our experience in a total of 3,226 needle aspirates of breast with particular emphasis on the diagnosis of carcinoma in women under the age of 30.     

Fine-needle aspiration diagnosis of intra-thoracic and intra-abdominal lesions: Review of experience in the pediatric age group

Review of fine-needle aspiration (FNA) smears from 121 pediatric patients with intra-thoracic and intra-abdominal lesions revealed 42 (34.7%) cases of neoplasms, 35 (28.9%) cases of tuberculosis, 12 (9,9%) cases of non-tuberculous inflammations, 4 (3.3%) cases of benign cystic lesions, and 28 (23.1%) inadequate/inconclusive cases. The age of the patients ranged from 20 days to 18 yr. Ultrasound and/or CT study done in 105 cases localized the lesions in following common sites: lungs (19 cases), mediastinum (22 cases), liver (14 cases), intestines (11 cases), and lymph nodes (17 cases). The neoplastic lesions consisted of 39 malignant, one suspicious, and two benign neoplasms. Among the neoplasms, the small round cell tumors were the most frequent (27 cases), followed by germ cell tumors (eight cases) and miscellaneous neoplasms (seven cases). The common small round cell tumors were non-Hodgkins lymphoma (eight cases), hepatoblastoma (seven cases), neuroblastoma (five cases), and nephroblastoma (three cases). A combined clinical, imaging, and FNA cytology approach was found to be useful in arriving at a tissue diagnosis.     

Fine-needle aspiration cytology of Sister Mary Joseph's (paraumbilical) nodules

During a period of 5 years (2001-2005), six cases of Sister Mary Joseph's nodule (umbilical metastasis) were diagnosed by fine needle aspiration cytology (FNAC). In all the cases, FNAC of umbilical nodules was the first investigation and subsequently the patients were investigated for the primary tumor. The primary carcinoma was found in the stomach in three cases, ovary in two cases and one case was of non-Hodgkin's lymphoma. Based on our findings, we suggest FNAC as an initial diagnostic procedure in cases suspected of umbilical metastasis. It is not only simple, fast, accurate and inexpensive but can also save the patient from other invasive diagnostic procedures.     

Myofibroblastoma of the male breast: a diagnostic problem on fine-needle aspiration cytology

Myofibroblastoma is an uncommon neoplasm of the male breast. Herein, we describe the cytologic features seen in the fine-needle aspirate of a 45-year-old man. The smears were cellular with intimate association of tumor cells with extracellular matrix material. The cells were spindle to polygonal and were without significant atypia. Numerous mast cells were observed. Nuclear grooving was present only occasionally, although this was conspicuous histologically. The presence of hyaline bands in between tumor cells, another interesting feature, was appreciated retrospectively. This neoplasm was initially misinterpreted as a malignant soft tissue tumor. Awareness of the cytologic features coupled with mammography should prevent a misdiagnosis of this tumor.