Aneurysmal bone cyst: fine-needle aspiration findings in 23 patients with clinical and radiologic correlation

Aneurysmal bone cyst (ABC) is an osseous mass lesion that accounts for 1% of primary bone tumors. We describe 23 cases of ABC initially evaluated by fine-needle aspiration biopsy (FNAB). In 4 cases, the ABC was secondary to another primary tumor. Aspirates from 6 cases (26%) were insufficient. Twelve aspirates diagnosed as ABC by FNAB were confirmed as ABC by histologic examination. The accuracy of FNAB was 82% when cases insufficient for evaluation were excluded. One case diagnosed as ABC cytologically was subsequently found to be metastatic carcinoma. In another, the specimen was interpreted as ABC vs giant cell tumor. In the remainder, a diagnosis of ABC was favored cytologically. Owing to the nonspecific findings, ABC cannot be definitively diagnosed by FNAB. However, the presence of typical clinical and radiographic features in conjunction with a blood-rich, mesenchymal cell containing aspirate devoid of overtly malignant cells strongly suggests the diagnosis of ABC.     

Utilization of fine-needle aspiration biopsy in the diagnosis of metastatic tumors to the pancreas

There is relatively little information concerning the use of fine-needle aspiration biopsy (FNAB) to diagnose a mass in the pancreas that is secondary to metastatic tumor. This study reviews the incidence and types of neoplasms which metastasize to the pancreas and assesses the contribution FNAB can make in their diagnosis. of 117 radiologically guided FNABs of the pancreas, 11% (n = 13) showed metastatic malignancy. Nine patients had a previous history of malignancy while four patients presented with a pancreatic mass and were subsequently found to have widespread malignant disease. the majority of metastatic lesions were epithelial (77%, n = 10). Patient outcomes were generally poor (mean survival 2.8 mo). Metastases to the pancreas occur from a variety of primary sites and should be considered in patients with a pancreatic mass and a history of prior malignancy. FNAB is useful in diagnosing these metastases and this is clinically important because of their poor prognosis.     

Cytologic patterns of metastatic thymoma: Diagnosis by fine-needle aspiration biopsy

Thymomas are the most frequent primary tumors of the anterior mediastinum. These lesions are slow growing and can be locally invasive, but extrathoracic metastases are rare, occurring in less than 2% of cases. Fine-needle aspiration biopsy (FNAB) may be helpful in making the diagnosis of metastatic thymoma, with or without a clinical history of primary mediastinal thymoma. We report three cases of metastatic thymoma diagnosed by FNAB. Each case illustrates a distinctive cytologic pattern. While two of the patients had a history of histologically confirmed thymoma 11 and 13 years previously, a third patient presented with an enlarged supraclavicular lymph node and pulmonary nodules, and no prior diagnosis of thymoma. These cases demonstrate that based on distinctive cytologic patterns and features, a diagnosis of metastatic thymoma can be made with FNAB. Ancillary studies will often confirm the diagnosis. Diagn Cytopathol 1994;11:182–187. © 1994 Wiley-Liss, Inc.     

Fine-needle aspiration biopsy as an adjunct to the diagnosis of a rare adnexal tumor of hair follicle origin: trichoblastoma

Fine-needle aspiration biopsy (FNAB) is a technique used increasingly for the investigation of primary and metastatic cutaneous tumors. Trichoblastoma is a rare benign skin appendage tumor of hair germ origin. We report the diagnosis by FNAB of a rare giant subcutaneous tumor, trichoblastoma, from an 81-yr-old woman with a subcutaneous mass in the interscapular area of her back. The cytologic characteristics of the tumor are discussed in detail in this report. The findings have been compared with the histologic features of the tumor after surgical excision. We have characterized several distinctive cytologic features that may aid in the diagnosis of this rare neoplasm. While most reported cases have been diagnosed from surgical excisional biopsy specimens, FNAB may also be a valuable tool for the accurate diagnosis of trichoblastoma in the proper clinical context.     

Ductopapillary apocrine carcinoma of the eyelid metastatic to the parotid gland: Report of a case diagnosed by fine‐needle aspiration biopsy

Ductopapillary apocrine carcinoma (DPAC) of the eyelid is a rare malignant neoplasm in the periocular region. The relative rarity of this tumor is a diagnostic challenge to the cytopathologist, especially when present as a metastatic lesion to an intraparotid lymph node, where the differential diagnosis includes primary parotid neoplasms, as well as various other metastatic malignancies. There are only a few reported cases of recurrent and metastatic DPAC of the eyelid, and to our knowledge, metastatic DPAC diagnosed by fine‐needle aspiration biopsy (FNAB) has not been described. We report a case of a 65‐year‐old African‐American male with a history of ductopapillary apocrine adenocarcinoma of the eyelid, diagnosed 6 weeks ago now presenting with a recurrence in the same area. Magnetic resonance imaging of the head and neck revealed an intraparotid mass also. FNAB of the parotid mass showed a well‐differentiated papillary adenocarcinoma with a cystic component, similar to a previously excised ductopapillary apocrine adenocarcinoma of the eyelid. Diagn. Cytopathol. 2009. © 2008 Wiley‐Liss, Inc.     

Malignant melanoma with a myxoid stroma: a diagnostic pitfall on fine-needle aspiration biopsy

Malignant melanoma (MM), both primary and metastatic, may be associated with a prominent myxoid stromal reaction causing diagnostic confusion on fine-needle aspiration biopsy (FNAB), most often with sarcomas that demonstrate a myxoid stroma, particularly malignant peripheral nerve sheath tumor (MPNST). We present a case of a 32-yr-old man with no past medical history who presented with a unilateral neck mass clinically suspicious for lymphoma. FNAB produced a specimen composed of large sheets of anaplastic cells encased in a myxoid stroma that was S100 and vimentin-positive but HMB-45-negative. A diagnosis of MPNST was made. Excision demonstrated a metastatic MM of unknown primary, with a prominent myxoid stromal reaction. A repeat HMB-45 was again negative. Electron microscopy demonstrated intracytoplasmic melanasomes and cisternae of rough endoplasmic reticulum with intracisternal parallel tubules, confirming the diagnosis. Although HMB-45 is typically negative in both tumors, S100 should be strongly positive in myxoid MM and only focal in MPNST.     

Cerebellar medulloblastoma in the elderly

Although medulloblastoma is the most common central nervous system malignancy in children, cases are much less common in adults. Moreover, this tumor is exceedingly rare in patients older than 65 years. Analysis of previous case reports reveals that medulloblastoma in the elderly is more commonly seen in males in a lateral location; histologically, medulloblastomas in aged individuals usually belong to the classic subtype. During intraoperative consultation, the pathologist should consider medulloblastoma in the differential diagnosis of a cerebellar mass in the elderly because cytologic features may overlap with metastatic small cell carcinoma or lymphoma. We present a case of medulloblastoma in a 66-year-old man and review the literature on the subject.     

Cerebellar medulloblastoma presenting with skeletal metastasis

Medulloblastomas are highly malignant brain tumours, but only rarely produce skeletal metastases. No case of medulloblastoma has been documented to have produced skeletal metastases prior to craniotomy or shunt surgery. A 21-year-old male presented with pain in the hip and lower back with difficulty in walking of 3 months' duration. Signs of cerebellar dysfunction were present hence a diagnosis of cerebellar neoplasm or skeletal tuberculosis with cerebellar abscess formation was considered. MRI of brain revealed a lesion in the cerebellum suggestive of medulloblastoma. Bone scan revealed multiple sites of skeletal metastases excluding the lumbar vertebrae. MRI of lumbar spine and hip revealed metastases to all lumbar vertebrae and both hips. Computed tomography-guided biopsy was obtained from the L3 vertebra, which revealed metastatic deposits from medulloblastoma. Cerebrospinal fluid cytology showed the presence of medulloblastoma cells. A final diagnosis of cerebellar medulloblastoma with skeletal metastases was made. He underwent craniotomy and histopathology confirmed medulloblastoma.     

Fine-needle aspiration cytology of an unusual primary lung tumor,chondrosarcoma: Case report

A case of primary chondrosarcoma of the lung diagnosed by fineneedle aspiration biopsy (FNAB) cytology in a 78-yr-old male is presented. A mass detected on chest x-ray and defined by CT scan was subjected to a preoperative percutaneous fine-needle aspiration under fluoroscopic guidance. The distinctive cytologic features of pleomorphic cells nestled in lacunae surrounded by a chondromyxoid background resulted in a diagnosis of chondrosarcoma. The left upper lobectomy specimen confirmed the FNAB diagnosis and identified the tumor as arising from the left upper lobe bronchus.     

FNAB cytology of chordoma masquerading as adenocarcinoma: case report

We report a lesion of the mobile spine in a 77-yr-old white male who presented with lower back pain, radiating bilaterally to the legs, with numbness on walking and standing. Magnetic resonance imaging showed a large mass within L3-L4 vertebral bodies; however, chordoma was not suspected or suggested. Fine-needle aspiration biopsy (FNAB) of the mass revealed mostly blood with isolated flat clusters of polygonal rounded epithelial-like cells in a myxoid background. Immunohistochemistry could not be performed on the FNAB specimen due to inadequate material for cell-block. A limited immunocytochemistry panel was performed on one cytology smear. The tumor cells were immunoreactive for cytokeratin. During primary and expert evaluation, these features were interpreted as metastatic adenocarcinoma. Prostate and thyroid were suggested as possible primary sites. An extensive clinical and radiological search did not reveal a primary lesion. Four years later, the patient underwent surgical decompression and stabilization of his lumbar spine to avoid a catastrophic collapse of spine with neurological deficit. Histomorphological features and immunohistochemical studies at this time confirmed the lesion as chordoma. This case highlights the significance of considering chordoma in the differential diagnosis of FNAB cytology of spinal column lesions suggestive of adenocarcinoma, especially when the clusters of low-grade epithelioid cells with vacuolated cytoplasm in a myxoid background do not show epithelial structures such as papillae, glands, or acini.     

Papillary carcinoma of the breast in a male patient with a treated prostatic carcinoma diagnosed by fine-needle aspiration biopsy: a case report and review of the literature

Papillary carcinoma of the male breast is very rare. In this case report, we describe the cytologic, histologic, immunohistochemical, and radiological findings of a papillary carcinoma of male breast. A 67-yr-old man, who had a previous history of prostatic adenocarcinoma, presented with a retroareolar painless mass. There was no known history of breast cancer in his family. A fine-needle aspiration biopsy (FNAB) was performed. Cytological examination revealed a cellular aspirate with three-dimensional papillary clusters. A diagnosis of papillary lesion favoring papillary carcinoma was rendered. Immunohistochemical staining of the cell-block of the FNAB revealed the presence of mammaglobin, and the absence of prostatic specific antigen. The patient underwent lumpectomy, which showed a moderately differentiated infiltrating papillary carcinoma with adjacent areas of ductal carcinoma in situ. FNAB is a useful technique in identifying male breast carcinoma. In conjunction with ancillary studies, this procedure can effectively differentiate between a primary versus metastatic lesion.     

Metastases to the kidney: eleven cases diagnosed by aspiration biopsy with histological correlation

Metastases to the kidney from extrarenal primary tumors are uncommon and may mimic renal-cell carcinoma clinically when presenting as a single mass with hematuria. Fine-needle aspiration biopsy (FNAB) is a useful diagnostic method for the evaluation of primary renal tumors. Only a few studies have investigated the value of cytological evaluation of secondary renal tumors. We report our experience with these tumors. Eleven cases of extrarenal primary tumors metastatic to the kidney, diagnosed by aspiration biopsy with histological correlation, are discussed. The diagnosis of metastatic disease to the kidney was accurately made by aspiration biopsy. Knowledge of the patients' history, histological correlation with the primary tumor, and the radiological characteristics of the renal masses were helpful in achieving a correct diagnosis. FNA cytology (FNAC) is an accurate method for the diagnosis of tumors metastatic to the kidney. Distinction between primary and secondary tumors of the kidney is crucial to guide management and prevent unnecessary surgery.     

Metastatic renal cell carcinoma,clear cell type,of the parotid gland

Renal cell carcinoma (RCC), clear cell type, is a commonly encountered metastatic tumor that can present at unusual anatomic sites many years after the primary tumor resection. Noncutaneous metastasis to the parotid gland is unusual; however, a number of cases of parotid RCC metastasis have been reported. Fine‐needle aspiration biopsy (FNAB) is regularly utilized during the evaluation of salivary gland lesions, where it has a high sensitivity, specificity, and accuracy; however, the identification and definitive diagnosis of primary and metastatic clear cell neoplasms is a potential diagnostic pitfall for salivary gland FNAB. Here, we describe a case of RCC, clear cell type, metastatic to the parotid gland that was diagnosed entirely from FNAB cell block material, which is the first such reported case to our knowledge. We review the literature for cases of parotid RCC metastasis and focus on the utility of FNAB for synchronous versus metachronous presentations. Finally, we evaluate the differential diagnosis of clear cell parotid lesions, including ancillary histologic studies, and propose an algorithmic approach to clear cell neoplasms of the salivary gland. Diagn. Cytopathol. 2014;42:974–983. © 2014 Wiley Periodicals, Inc.     

Mycobacterium avium complex infection in a neck abscess: A diagnostic pitfall in fine‐needle aspiration biopsy of head and neck lesions

Fine‐needle aspiration biopsy (FNAB) is a useful tool in the diagnosis of mycobacterial disease, especially Mycobacterium tuberculosis. However, nontuberculous mycobacterial infection diagnosed with FNAB material is much rarer, with Mycobacterium avium complex being the most common. In this report, we present the case of a 21‐year‐old HIV positive man, who presented with a unilateral, tender, enlarging cervical neck mass. FNAB had revealed acute inflammation. Mycobacterium avium complex grew in culture from the material that was aspirated and was confirmed by DNA probe. Because of the paucity of articles on this subject in the cytology literature, it is important to reiterate the value of the material aspirated at the bedside and the clinic in the diagnosis of infectious disease. When faced with antibiotic‐resistant cellulitis and abscesses, the FNAB material must be sent for acid fast bacteria smears and culture. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Fine-needle aspiration cytology and differential diagnoses of fibrolamellar hepatocellular carcinoma metastatic to the mediastinum: case report

We report a case of fibrolamellar hepatocellular carcinoma (FL-HCC) that metastasized to the posterior mediastinum. The diagnosis was made on fine-needle aspiration biopsy (FNAB). The cytologic features were characterized by the presence of large, dishesive, polygonal cells with granular cytoplasm and well-defined cell outlines resembling oncocytes. Groups of neoplastic hepatocytes containing bile pigment were also noted. The diagnosis of FL-HCC in a metastatic site can pose diagnostic challenges on FNAB. The cytologic features overlap with a variety of tumors that have oncocytic features and also with melanoma and paraganglioma. Recognition of specific cytologic features of FL-HCC can facilitate accurate diagnosis in a metastatic site. The cytologic findings and differential diagnoses of FL-HCC that metastasized to the posterior mediastinum are discussed.     

Melanotic neuroectodermal tumor of infancy in the soft tissues of the arm: fine needle aspiration biopsy and histologic correlation-a case report

A case of melanotic neuroectodermal tumor of infancy (MNTI) presenting as a soft tissue mass in the right arm of a 6-mo female child is discussed. The mass was diagnosed by fine-needle aspiration biopsy (FNAB) and confirmed by histological examination. This communication emphasizes the characteristic cytology of MNTI and discusses its significance in the context of this tumor occurring in the soft tissues. The cytology smears were distinctive in showing a dual population of small, rounded, undifferentiated cells and larger melanin-containing epithelial-like cells. It is the identification of the latter cells in the smears which differentiates this tumor from other round cell tumors of infancy and helps in the correct diagnosis by FNAB.     

Fine-needle aspiration biopsy diagnosis of intrathoracic extramedullary hematopoiesis presenting as a posterior mediastinal tumor in a patient with sickle-cell disease: Case report

Extramedullary hematopoiesis (EMH) is a rare cause of an intrathoracic mass. Fine-needle aspiration biopsy (FNAB) has been only occasionally documented as a useful tool in diagnosing EMH tumor. We report a case of posterior mediastinal extramedullary hematopoietic mass in an 80-yr-old man with sickle-cell anemia. The mass was revealed incidentally on chest X-ray. The definitive diagnosis of this mass lesion was achieved by FNAB. The cytologic smears showed hematopoietic elements with erythroid hyperplasia. A correct cytologic diagnosis can thus help to avoid unnecessary surgical intervention, particularly in an asymptomatic patient.     

Thyroid spindle epithelial tumor with thymus‐like differentiation (SETTLE): Is cytopathological diagnosis possible?

Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a rare tumor of the thyroid gland which occurs predominantly in children, adolescents, and young adults. It usually presents as a painless neck or thyroid mass and only exceptionally as a diffusely enlarged thyroid gland, without metastatic disease at diagnosis. We report on the case of 12-yr-old girl who had diffusely enlarged thyroid gland for about 1 yr and was initially treated for thyroiditis. Fine-needle aspiration biopsy (FNAB) was performed 8 mo after the first admission. Cytological examination of smears showed unusual morphological features. FNAB smears were cellular, with dissociated cells, naked oval nuclei, aggregates, and groups. Three main cell types were observed: spindle, epithelioid, and epithelial. These cells were uniform, cytologically bland, with few mitotic figures. The distinction between these cells was not always unequivocal. In the background of the smears abundant red extracellular material in the form of fine, dust-like granules and irregular patches were present. It was also observed in some aggregates and groups of tumor cells. Spindle and epithelioid cells were immunocytochemically diffusely pan-cytokeratin-positive. In the differential diagnosis, medullary thyroid carcinoma and SETTLE were suggested. The final histological diagnosis was SETTLE. In cases of SETTLE presented as a diffuse thyromegaly the correct diagnosis may be delayed because clinically and ultrasonographically thyroiditis is suspected. To avoid such a delay, FNAB should be used preoperatively. It can provide specific cytological diagnosis based on morphological features and certain immunocytochemical characteristics of the tumor.     

Use of fine-needle aspiration biopsy in the evaluation of splenic lesions in a cancer center

Fine-needle aspiration biopsy (FNAB) of the spleen was performed on 50 patients, of whom 40 had had a previous diagnosis of malignancy (23 lymphoproliferative disorders, 13 carcinomas, 3 melanomas, and 1 sarcoma). The cytologic diagnoses included 22 cases positive for malignancy (10 lymphomas, 9 metastatic carcinomas, 2 metastatic melanomas, and 1 sarcoma), 18 cases negative for malignancy, 4 cases suspicious for malignancy, and 6 nondiagnostic specimens. No major complications were associated with the FNAB procedure; however, one patient did develop a pneumothorax that resolved spontaneously. Subsequent splenectomy was performed in 10 of the 50 cases. There were no false-positive diagnoses, and only one false-negative diagnosis, which was attributed to sampling error. The aspirate, showing only benign splenic parenchyma, was from a patient with splenomegaly and no previous diagnosis; subsequent splenectomy showed acute myelogenous leukemia. In our study, FNAB proved to be a safe and valuable diagnostic tool for evaluating splenic lesions in oncologic patients. Diagn. Cytopathol. 16:312–316, 1997. © 1997 Wiley-Liss, Inc.     

Neutrophil-rich Ki-1-positive anaplastic large cell lymphoma: a study by fine-needle aspiration biopsy

Fine-needle aspiration biopsy (FNAB) is an accurate, cost-effective method of evaluating lymphomas. The neutrophil-rich variant of anaplastic large cell lymphoma (NR-ALCL) is a rare non-Hodgkin lymphoma. To our knowledge, we present thefirst study of NR-ALCL by FNAB cytology. Histologic confirmation was available for both patients. Both cases were positive for Ki-1 (CD-30) and were either T-cell or null-cell phenotype. FNAB specimens were highly cellular with a single-cell pattern composed of pleomorphic tumor cells, "hallmark" tumor cells, and a background rich in neutrophils that occasionally obscured tumor cells. Diagnosis on FNAB is difficult owing to the rarity of this tumor, its resemblance to Hodgkin lymphoma and other non-Hodgkin lymphomas that express CD30, its similarity to an infectious process, and its occasional confusion with metastatic carcinoma and melanoma. Reproducible cytologic features usually are present, and the diagnosis can be made conclusively by FNAB in conjunction with ancillary studies.