Plasmacytoma of the larynx diagnosed by fine-needle aspiration cytology: a case report

Extramedullary plasmacytoma is a rare lesion. The use of fine-needle aspiration for diagnosis of plasmacytoma has been described in a few sporadic reports. To the best of our knowledge, none of these reports described the cytologic findings from plasmacytoma of the larynx. We report on a case of laryngeal plasmacytoma in a 79-yr-old man diagnosed by fine-needle aspiration cytology. The patient had a history of a plasmacytoma involving the sixth thoracic vertebra diagnosed in 1996, which progressed to multiple myeloma in 1997. He received treatment in the form of local radiation to the skeletal vertebrae and chemotherapy. Two years later, the patient presented with a large neck mass. Computed tomography (CT) was done at an outside facility, and the radiologic impression was of a large right glottic carcinoma with invasion into the right thyroid cartilage. Because of the history of multiple myeloma, a fine-needle aspiration (FNA) biopsy was performed of the laryngeal mass. Cytologic examination demonstrated atypical plasma cells arranged in a dissociative fashion, consistent with a plasmacytoma. Although there are previous surgical pathology reports of laryngeal plasmacytoma, to the best of our knowledge, this is the first report of plasmacytoma of the larynx diagnosed by FNA cytology.     

Cervical thymoma

A 45-year-old woman presented with a five-year history of neck swelling and occasional difficulty in swallowing. The clinical impression was of a thyroid nodule, and fine-needle aspiration biopsy cytology revealed a monotonous lymphoid population, raising the suspicion of Hashimoto's thyroiditis. At surgery, the mass was identified at the level of the cricoid cartilage, displacing the right lobe of the thyroid gland superiorly and extending posteriorly to the prevertebral fascia. Although a frozen-section diagnosis of malignant lymphoma had been suggested at the time of surgery, permanent sections favored a diagnosis of thymoma. Surface marker studies showed the majority of cells to be of thymic T-cell phenotype, and ultrastructural examination demonstrated a dual population of lymphoid and epithelial cells, thus confirming the presence of thymoma. Cervical thymomas are extremely rare and this case report illustrates the difficulties in diagnosis; we speculate that cervical thymoma may be an underdiagnosed entity.     

Fine-needle aspiration biopsy features in a case of giant cell fibroblastoma of the chest wall

Giant cell fibroblastoma is an unusual tumor of childhood, primarily occurring in the superficial soft tissues. We describe the fine-needle aspiration biopsy features of a case of giant cell fibroblastoma of the chest wall in a 3-year-old child. The aspirates comprised bland spindle to oval cells entrapped in a metachromatic matrix, accompanied by rare multinucleated giant cells with wreathlike nuclei. Although we were unable to render a definitive diagnosis on fine-needle aspiration biopsy, surgical resection of the mass established the diagnosis of giant cell fibroblastoma. We review the distinctive cytologic features of some common soft tissue tumors arising in this age group that may give rise to a diagnostic conundrum on fine-needle aspiration biopsy.     

Diagnosis of chondroid lipoma by fine-needle aspiration biopsy

Chondroid lipoma is a rare, recently described soft tissue tumor that mimics extraskeletal chondrosarcoma and myxoid liposarcoma. Reports regarding its cytologic and radiological features are sparse. In this report, we describe the cytologic features of this unusual tumor, which include mixed mature lipocytes and lipoblast-like cells embedded in chondromyxoid matrix. We also describe the "target sign appearance" of this tumor in magnetic resonance imaging studies, resembling a neurogenic tumor. More importantly, we demonstrate that a definitive diagnosis of this unusual tumor can be made by fine-needle aspiration biopsy. The usefulness of cell block in fine-needle aspiration biopsy diagnosis of soft tissue tumors is emphasized.     

Fine-needle aspiration of dedifferentiated chondrosarcoma of the larynx

We present a case of dedifferentiated chondrosarcoma of the larynx in which the dedifferentiated component was initially diagnosed by fine-needle aspiration (FNA). The patient was a 74-yr-old man who presented with difficulty breathing and an anterior neck mass. A CT scan demonstrated a 4.5-cm cartilaginous lesion involving the left thyroid cartilage, with an anterior soft-tissue component. Nine years prior, the patient had an incomplete resection of a low-grade chondrosarcoma at the same site. FNA was performed on the current lesion, demonstrating a high-grade spindle-cell sarcoma with a storiform pattern. The cytomorphology together with immunocytochemistry and electron microscopy were diagnostic of malignant fibrous histiocytoma (MFH), and synthesis of the clinical, radiographic, and cytomorphologic features resulted in a diagnosis of dedifferentiated chondrosarcoma. The cytologic diagnosis was histologically confirmed by laryngectomy. Although rare, dedifferentiated chondrosarcoma should be included in the differential diagnosis of high-grade sarcomas of bone and cartilage assessed by FNA.     

Cytopathological features of solitary fibrous tumor of the pleura: A study of 5 cases

Solitary fibrous tumor is a rare lesion of serosal membranes. In a pleural location, it may be confused clinically with a localized mesothelioma or a peripheral lung tumor. A transthoracic needle aspiration can be done to obtain material for a diagnosis in these easily accessible tumors. In the literature, there are only sporadic reports of cytology of solitary fibrous tumor in pleural fluid or in material obtained by percutaneous fine-needle aspiration.^1,2 We had the opportunity to study five such cases by cytology and biopsy and in four cases we could study the resected specimen as well. We want to emphasize the possibilities of approaching diagnosis by cytologic material. A more precise diagnosis can be made if immunohistochemistry can be applied on a cell block or a concomitant biopsy specimen. We shall discuss the differential diagnosis of these tumors on cytologic material and/or biopsy and the usefulness of the CD34 antibody. Diagn. Cytopathol. 1998;18:118–124. © 1998 Wiley-Liss, Inc.     

Malignant Myoepithelioma of the Larynx with Massive Metastatic Spread to the Liver: An Ultrastructural and Immunocytochemical Study

A malignant myoepithelioma arising in the submucosal glands of the larynx of a 71-year-old man is reported. The patient presented with a neck mass and massive metastatic involvement of the liver. Light microscopy of a liver biopsy specimen and fine-needle aspiration sample of the neck mass revealed a poorly differentiated carcinoma. Electron microscopic study of a second liver biopsy specimen demonstrated unequivocal features of myoepithelial differentiation; this was further confirmed by the strong cytokeratin and S-100 protein positivity and carcinoembryonic antigen negativity of the tumor cells. Myoepitheliomas are rare tumors, and most reported cases have been benign or of low-grade malignancy. The present case is unique because of its mode of presentation and fulminant course. It also underscores the usefulness of electron microscopy as a diagnostic modality in the work-up of metastatic lesions.     

Fine-needle aspiration biopsy of primary osteosarcoma of the thyroid: report of a case and review of the literature

Primary osteosarcoma of the thyroid is an extremely rare tumor, with only 27 well-documented cases reported in the literature, including only one in the cytology literature. We describe here an additional case with fine-needle aspiration biopsy findings. A 60-year-old woman presented with a 1-month history of progressive midline neck swelling. CT and ultrasound demonstrated a large thyroid mass with tracheal compression. Fine-needle aspiration biopsies were performed and showed pleomorphic spindle and epithelioid neoplastic cells, multinucleated giant cells, and scant metachromatic extracellular matrix material. Cell block sections contained minute tissue fragments with neoplastic spindle cells. Immunohistochemical stains showed the tumor cells to be positive for vimentin and negative for cytokeratins, TTF-1, calcitonin, synatophysin, chromogranin, and S-100 protein, suggesting a sarcoma; however, the differential diagnosis also included anaplastic thyroid carcinoma and medullary thyroid carcinoma. Tissue biopsy revealed a high-grade spindle cell neoplasm with osteoid production, consistent with osteosarcoma of the thyroid. The patient developed a large pulmonary embolus and superior vena cava syndrome and no further surgical intervention was performed. She died 5 weeks after the initial diagnosis. Upon retrospective review, the cytologic features resemble osteosarcoma in other areas. Although cytologic features on fine-needle aspiration biopsy may suggest a diagnosis of this rare entity, definitive diagnosis should be deferred to histologic examination.     

Fine-needle aspiration cytology of a lipoblastoma: a case report

A lipoblastoma is a rare benign tumor of immature white fat, and more than 90% of lipoblastomas occur before the age of 3 years. The diagnosis of a lipoblastoma is mostly dependent on a histopathological examination of a surgically excised specimen. However, an accurate preoperative diagnosis is essential for the planning of surgery, particularly for a lesion of the head and neck area. We experienced a case of a cervical lipoblastoma of a 23-month-old boy. A preoperative fine-needle aspiration biopsy showed the sample as moderately cellular and showed fragments of mature and immature adipose tissues containing a large number of capillary vessels. There were numerous lipoblast-looking cells with a multivacuolated cytoplasm, and the nuclei were small, compressed by vacuoles, and centrally located. According to the cytological findings, the lesion was diagnosed as a benign adipose tumor suggestive of a lipoblastoma. Subsequent surgical excision confirmed the diagnosis of the fine-needle aspiration biopsy. The cytologic features of lipoblastoma are not well known because of the rarity of the lesion. However, the fine-needle aspiration cytological features of a lipoblastoma are sufficiently characteristic to make a specific preoperative diagnosis.     

Adenolipomas of the head and neck: analysis of 6 cases

Adenolipomas are rare benign neoplasms composed of mature adipose tissue and glandular elements. We report 6 patients with adenolipomas of the head and neck region: 3 in the parathyroid, 2 in the thyroid, and 1 in the parotid gland. The patients were 4 women and 2 men, ranging in age from 21 to 70 years (mean, 62.5 years). The patients with parathyroid adenolipomas manifested signs and symptoms of hyperparathyroidism, whereas the others complained of a mass in the neck. Computed tomography and magnetic resonance imaging are useful tools for the preoperative diagnosis of adenolipomas of the head and neck. The findings of adipose tissue and benign glandular elements by fine-needle aspiration biopsy should prompt consideration of adenolipoma in the differential diagnosis. Complete surgical excision is curative.     

Diagnostic accuracy in cytopathology

Metastases from pituitary carcinomas are rare lesions that can mimic other tumors on fine-needle aspiration biopsies. Two patients with primary pituitary neoplasms developed cervical lymph node metastases, which were sampled and diagnosed correctly using the fine-needle aspiration biopsy technique. These two cases demonstrate the varied cytologic patterns of pituitary neoplasms, ranging from uniform bland cells to cells with striking anaplastic features. The time period between the onset of symptoms and subsequent metastases is unpredictable as well, underscoring the need for an accurate clinical history before a meaningful cytologic interpretation is made. Diagn Cytopathol 1994; 11:68–73. © 1994 Wiley-Liss, Inc.     

Identification of papillary carcinoma in a thyroglossal cyst by fine-needle aspiration biopsy

Papillary carcinoma was diagnosed in a fine-needle aspirate from a cystic upper-cervical midline lesion attached to the hyoid bone. Histological examination of the excised specimen verified the diagnosis. Carcinoma arising in thyroglossal cysts, though rare, should be considered in patients presenting with an anterior midline mass in the upper neck; fine-needle aspiration may be useful in the preoperative diagnosis.     

Infarcted myxoid fibroadenoma following fine-needle aspiration

Infarction of breast fibroadenomas is very rare and is frequently associated with physiologic changes, such as pregnancy and lactation. We report a case of an infarcted fibroadenoma following fine-needle aspiration. The patient presented with an asymptomatic breast mass, which was clinically difficult to evaluate. Excisional biopsy was performed 7 days after a nondiagnostic fine-needle aspiration of the mass. Microscopically, the nodule showed features of a classic fibroadenoma of the intracanalicular type with myxoid or mucinous stromal changes, as well as extensive areas of acute infarction. This report provides another example of the changes that may be observed in biopsy specimens obtained after fine-needle aspiration of the breast.     

Cytomorphology of yolk sac tumor of the liver in fine-needle aspiration: a pediatric case

Yolk sac tumors (YST) in extragonadal locations are rare. Cytologic diagnosis of YST on fine-needle aspiration (FNA) smears may be a challenge to the cytopathologist. Further neo-adjuvant therapy may be based on cytologic diagnosis making accuracy important. We studied FNA material from a hepatic mass in a pediatric patient to further define the cytomorphologic features of hepatic YST. Features include large pleomorphic balls of tumor cells with high nuclear to cytoplasmic ratios, papillary or microglandular pattern of growth, cytoplasmic and intranuclear vacuoles, and prominent nucleoli. Positive immunohistochemical studies included alpha-fetoprotein, cytokeratin AE1/AE3, and CAM 5.2, which are useful in supporting the diagnosis. We report a pediatric patient in whom the diagnosis of hepatic YST was made by cytologic, histologic, and immunohistochemical studies. The subsequent liver biopsy was consistent with the FNA diagnosis. Our findings may further help to characterize the cytomorphologic features of this rare lesion.     

Metastatic ovarian Sertoli-cell tumor: FNA findings with immunohistochemistry

A malignant Sertoli cell tumor of the ovary is a rare sex-cord stromal derived neoplasm. Sertoli cell tumors account for approximately 4% of Sertoli-stromal cell tumors (Hsu et al., J Histochem Cytochem 1981;29:577-580). The diagnosis of this entity by fine-needle aspiration and needle core biopsy can be difficult when the differential also includes a metastatic renal cell carcinoma, due to the overlap of both cytological and histological features. Here, we show that immunohistochemical staining on cytological material including alpha-inhibin can be used to differentiate between these two malignant tumors.     

Extraskeletal myxoid chondrosarcoma: Fine-needle aspiration biopsy findings

Extraskeletal myxoid chondrosarcoma (EMC) is a malignant soft tissue tumor which typically presents as an enlarging mass in an extremity. In this location it is amenable to sampling and diagnosis by fine-needle aspiration biopsy. We present our experience with three cases of EMC and discuss the differential diagnosis of myxoid soft tissue tumors. Diagn Cytopathol 1994; 11:363–366. © 1994 Wiley-Liss, Inc.     

Disseminated blastomycosis diagnosed by fine-needle aspiration of the thyroid

Blastomycosis is an uncommon disease caused by the dimorphic fungus Blastomyces dermatitidis. It can manifest as chronic pulmonary symptoms or disseminated disease. Only three previous cases of blastomycosis involving the thyroid have been reported, of which two were diagnosed by fine-needle aspiration. We present a case of disseminated blastomycosis initially diagnosed by thyroid fine-needle aspiration. Our case was a 47-year-old man with past medical history significant for diabetes, hyperlipidemia, and chronic pancreatitis who presented with a 2-week history of fever, chills, rigors, constipation, and 10 pound weight loss. Abdominal CT revealed chronic pancreatitis and a calcified mass in the pancreas. Chest CT revealed a single 1.5-2 cm thyroid mass and innumerably small 2-3 mm pulmonary nodule bilaterally. Fine-needle aspiration of the thyroid demonstrated 10-20 μm broad-based budding yeasts with thick-walled, refractile capsules amidst a background of granulomatous inflammation, and was diagnosed as a fungal infection consistent with blastomycosis. The patient was started on treatment with itraconazole based upon the FNA diagnosis. Concurrent lung biopsy demonstrated rare possible yeast forms on histology. A specimen from the lung was sent for culture, and was positive for B. dermatitidis, confirming the diagnosis. Disseminated blastomycosis rarely involves the thyroid. However, the thyroid is amenable to fine-needle aspiration. Fungal and mycobacterial cultures and special stains for fungal organisms should be requested on all thyroid fine-needle aspiration biopsies with granulomatous inflammation.     

Pulmonary carcinoid with papillary structure: Report of a case with fine-needle aspiration cytology

Fine-needle aspiration biopsy of a peripheral lung mass in a 44-yr-old man revealed a papillary tumor. Histologic examination of the mass, removed by lobectomy, demonstrated a pulmonary carcinoid tumor with papillary structure. Most papillary tumors of the lung are malignant. Pulmonary carcinoid and pulmonary sclerosing hemangioma—benign tumors—have papillary variants. Both have been described in fine-needle aspiration specimens and should be included in the differential diagnosis of papillary lung tumors. The cytologic features of pulmonary carcinoid are described. Diagn Cytopathol 1994;11:178–181. © 1994 Wiley-Liss, Inc.     

Fine-needle aspiration cytology and immunocytochemistry of soft-tissue tumors and osteo/chondrosarcomas of the head and neck

The purpose of the study was to present the clinical and cytological findings of 28 cases of malignant or borderline mesenchymal tumors of the head and neck, of which 22 originated from soft tissue and 6 were found in bone or cartilage. The basic procedures employed involved a cytologic review and subclassification of fine-needle aspiration (FNA) smears from the tumors, which were diagnosed as: pleomorphic sarcomas (5 poorly differentiated, 1 angiosarcoma, and 1 epithelioid sarcoma), spindle-cell sarcomas (2 leiomyosarcomas, 2 malignant mesenchymal tumors, and 1 malignant schwannoma), myxoid sarcomas (2 liposarcomas and 1 high-grade tumor), round-cell tumors (1 malignant histiocytic tumor and 1 chloroma), osteosarcomas (3), chondrosarcomas (3), and borderline tumors (2 pleomorphic lipoma, 1 myxolipoma, 1 cranial fasciitis, and 1 fibromatosis). Histological correlation and problems in subtyping on both cytologic and histological material are discussed. It is concluded that FNA cytology can be used with high accuracy to diagnose musculoskeletal tumors in rare sites such as the head and neck.     

Light and electron microscopic examination of fine-needle aspirates in the preoperative diagnosis of cartilaginous tumors

Twenty-eight patients with chondrogenic tumours--2 chondroblastomas, 4 chondromas, 18 chondrosarcomas, 1 clear-cell chondrosarcoma, and 3 mesenchymal chondrosarcomas--underwent fine-needle aspiration biopsy (FNAB) in the preoperative investigation. The cytologic features in smears were compared with the histopathologic findings in the surgical specimens; in 14 cases they were also compared with the light and electron microscopic findings in resin-embedded fine-needle aspirates. The smears of the vast majority of the classical chondrosarcomas presented features that made possible the FNAB diagnosis of a chondrogenic tumor to be made. In the case of the low-grade chondrosarcomas in particular, which were poorly or moderately cellular in smears and showed chondroblastic cells often in lacunary structures of hyaline matrix, consideration of the clinical presentation, size, location, and roentgenographic appearance was essential for the diagnosis of chondrosarcoma. On the other hand, the high-grade chondrosarcomas presented cytologic features that clearly indicated their malignancy and they usually had a myxoid matrix. The possible differential diagnoses that may arise from the FNAB diagnosis of cartilaginous tumors are discussed. The resin-embedding technique for the light and electron microscopic examination of FNABs, along with the histochemical analysis for the demonstration of sulphated glucosaminoglycans and the immunocytochemistry applied to smears, was found to be of value in the definite diagnosis, especially in the distinction of chondrogenic tumors from chordoma and metastatic mucous-producing carcinoma.