Malignant lymphoma of the thyroid: a report of two cases diagnosed by fine-needle aspiration

Two cases of primary malignant lymphoma of the thyroid were diagnosed by fine-needle aspiration biopsy. In addition to morphologic evaluation performed on direct smears, immunophenotyping, flow cytometry, and molecular studies were performed on the aspirated material. These additional studies made a clear distinction between lymphoma and Hashimoto's thyroiditis, which may present a similar cytologic picture.     

Cytodiagnosis of primary lymphoma of bone on fine-needle aspiration cytology specimens: review of 25 cases

Diagnosis of nodal lymphomas on fine-needle aspiration (FNA) cytologic specimens has been well established. However, cytodiagnosis of primary lymphoma of bone has not been well documented because of its rarity. We undertook a retrospective study of 25 cases of FNA cytologic specimens of primary lymphoma of bone. The slides were available for review in 20 cases; each case was evaluated with 15 cytologic features in conjunction with immunophenotyping and available surgical materials. Three diagnostic categories were assigned, including nondiagnostic (4/16%), suspicious (3/12%), and malignant (18/72%). Among the 18 malignant lymphoma, all were diagnosed on the basis of cytologic materials together with immunocytochemistry, except that two cases also relied on the cell blocks. The nondiagnostic and suspicious cases were subsequently confirmed to be malignant lymphoma on the surgical core biopsies. Of the 25 cases, 23 cases were large B-cell lymphoma, one follicular lymphoma large cell type, and one small lymphocytic lymphoma. False-positive or false-negative cases were not present in this study series. In conclusion, the vast majority of primary lymphoma of bone can be accurately diagnosed and classified on FNA cytologic specimens in conjunction with immunocytochemistry. The nondiagnostic and suspicious categories can be further reduced or eliminated by improving FNA techniques or by recommendation of surgical core biopsies together with other techniques such as flow cytometry and molecular analysis.     

Lacrimal gland lymphoma: A cytomorphologic and immunophenotypic study

The cytomorphology of lacrimal gland lymphoma has not been specifically described. Herein we present six cases of histologically proven lacrimal gland lymphoma which we analyzed using fine-needle aspiration cytology, cell suspension immunophenotype analysis, and immunoglobulin gene rearrangement studies. Fine-needle aspiration cytology revealed atypical populations of cells comprised of either monomorphic small round lymphocytes with or without plasmacytoid features (4 cases), a mixed population of small and large irregular lymphocytes (1 case), or a population of large irregular lymphocytes (1 case). the initial cytologic diagnosis was malignant lymphoma in all six cases. Cell suspension immunophenotype analysis demonstrated that the lesions were composed predominantly of B-cells that expressed monotypic surface immunoglobulin. Three cases demonstrated an immunoglobulin heavy chain gene rearrangement. the atypical cytologic features and the abnormal immunophenotype were consistently predictive of malignant lymphoma. Given that these lesions are small and biopsy material is often limited, fine-needle aspiration offers the advantage of providing tissue that is ideal for cytologic and cell suspension immunophenotype evaluation, obviating the need to provide surgical biopsy material for this purpose. We conclude that fine-needle aspiration can identify malignant lymphoid lesions of the lacrimal gland and may serve as a valuable adjunct in the assessment of these lesions. Additional study is warranted to determine whether fine-needle aspiration can reliably distinguish between benign and malignant lymphoid proliferations of the lacrimal gland. © Wiley-Liss, Inc.     

Hodgkin's disease mimicking suppurative lymphadenitis: a fine-needle aspiration report of five cases.

Spontaneous, suppurative-necrotizing changes associated with Hodgkin's disease (HD) are not infrequent. They are mostly observed in the nodular sclerosis variant of HD and can cause an erroneous histologic diagnosis of suppurative lymphadenitis. Few cytologic reports describing this presentation of HD are available. We describe 5 cases of HD that showed cytologic abscess-like smears dominated by a massive neutrophilic infiltrate and necrosis. Since therapy can induce similar changes, this study did not include patients with known HD. In 2 cases erroneously diagnosed as suppurative lymphadenitis, the presence of neoplastic cells was minimal and only detected after revision. A third case was misdiagnosed as abscessified metastasic carcinoma. Two cases were correctly identified as HD, although in one, the possibility of anaplastic large-cell lymphoma could not be ruled out. In conclusion, necrosis and massive neutrophilic infiltrates can occur spontaneously and can be prominent findings in smears from patients with HD, mainly the nodular sclerosis variant. The cytopathologist should always consider this possibility in the presence of an abscessified, suppurative, lymphadenitis-like aspirate. A detailed search for the characteristic neoplastic cells of HD is mandatory in these cases.     

Thyroid tumors: cytomorphology of medullary, clinically anaplastic, and miscellaneous thyroid neoplasms

Of 2,012 fine-needle aspirations (FNAs) of the thyroid performed between the years 1984 and 1988, detailed cytomorphologic analysis of 95 cases diagnosed as neoplastic on histology and/or cytology and those that received an equivocal cytodiagnosis are presented in this article. Discussed are medullary thyroid carcinomas (nine cases), clinically anaplastic thyroid tumors (CATT; eight cases), two cases of non-Hodgkin's lymphoma (NHL), and one primary leiomyosarcoma of the thyroid, for a total of 20 cases. Included in the category of CATT are all the thyroid tumors presenting clinically with an anaplastic growth pattern. The cytomorphology of these tumors varied, but the giant- and spindle-cell pattern was predominant. An accurate cytodiagnosis was possible, as per cytohistologic correlation, in seven cases, while in one case histological material was not available for study. Medullary carcinoma of the thyroid (MCT) showed a mixed spindle-cell and round-cell population in eight cases and an entirely spindle-cell population in one case. All cases of MCT were correctly diagnosed on cytology, and amyloid could be demonstrated in the cytologic smears in three cases. The cases of NHL and leiomyosarcoma could also be correctly interpreted on cytology.     

Pregnancy-associated anaplastic large-cell lymphoma of the breast: a rare mimic of ductal carcinoma

Anaplastic large-cell lymphoma (ALCL) is a rare T-cell lymphoma typically seen in children and young adults. It has been described in numerous sites; however, the breast is one of the least common locations. We herein report a case of ALCL arising in the breast of a 36-yr-old pregnant woman. To our knowledge this is the second such case in the English literature. We would like to highlight the cytologic and histologic features of ALCL, as this case was initially misdiagnosed as a ductal carcinoma. Differential diagnosis with other tumors is also discussed. This case serves to emphasize the importance of the triple test, and the need for correlation of fine-needle aspiration findings with core biopsy findings in breast tumor management.     

Oncocytic variant of medullary thyroid carcinoma; a rare tumor with numerous diagnostic mimics by fine needle aspiration

Oncocytic variant of medullary thyroid carcinoma is rare form of thyroid carcinoma that is easily misdiagnosed on fine needle aspiration specimens due to it is low incidence and cytomorphologic overlap with other more common Hurtle cell lesions. A correct initial diagnosis by fine needle aspiration is imperative as the clinical treatment for medullary carcinoma differs significantly from the mimickers. We present a case of this rare variant tumor that on initial fine needle aspiration was described as a Hurthle cell lesion and was subsequently correctly classified on the resection specimen. In this brief review, we describe the cytomorphologic features of medullary carcinoma, oncocytic variant of medullary carcinoma and it is most common mimickers, and we discuss the ancillary studies required to confirm the diagnosis. This case highlights the importance of a complete clinical history and radiologic correlation, which in conjunction with a careful attention to the cytologic features of the fine needle aspiration sample, should in most cases ensure a correct initial diagnosis.     

颈部淋巴结针吸细胞学580例诊断分析

目的 探讨颈部淋巴结针吸细胞学诊断的准确率及误诊原因.方法 分析580例颈部淋巴结针吸细胞学检查结果.其中161例在原部位取活检,分析针吸细胞学与组织学诊断符合率及误诊原因.结果 580例中淋巴结反应性增生226例,特异性炎202例,恶性淋巴瘤45例,转移癌107例.161例针吸细胞学与组织学诊断符合率为94.4%.107例转移癌中96例经临床及病理检查确定了原发灶.细胞学与组织学对照结果显示,细胞学检查有9例误诊,针吸细胞学误诊主要原因是吸取组织量少,对病变了解不全面;误诊病例结合病史及临床表现均有考虑到其他疾病的可能性.结论 颈部淋巴结针吸细胞学诊断准确率较高,但对可疑病变及原发肿瘤的分型,针吸细胞学仅可给予提示件初步诊断,需经组织学活检,必要时免疫组织化学诊断分型.     

Isolated Langerhans cell histiocytosis of the thyroid: a report of two cases with nuclear imaging-pathologic correlation

We describe two cases of isolated langerhans cell histiocytosis (LCH) of the thyroid gland, one of which was found in conjunction with an incidental papillary carcinoma. The first case was that of a 43-year-old man who presented with a 1- to 2-cm nodule within the left lobe of the thyroid. Fine-needle aspiration cytology revealed atypical cells with convoluted nuclei in a background of eosinophils and lymphocytes. The findings prompted a recommendation for excision secondary to the high suspicion of a hematologic malignancy. Histologic sections demonstrated LCH in association with a small focus of papillary carcinoma. The second case involved a 43-year-old woman who presented with a 1.8-cm nodule within the right lobe of the thyroid. Fine-needle aspiration in this case demonstrated abundant hemosiderin-laden macrophages, occasional lymphocytes, and a single benign sheet of follicular cells. No eosinophils were seen; however, a single group of atypical histiocytic cells with cleaved nuclei was noted. The nodule was subsequently resected. Histologic examination demonstrated LCH in association with follicular nodular hyperplasia with cystic degeneration. Immunohistochemical studies were performed in both cases, revealing CD1a and S100 immunoreactivity in the Langerhans' cells. Although LCH may occur as a manifestation of systemic disease, its occurrence as an isolated finding in the thyroid is rare. Its occurrence in association with papillary carcinoma of the thyroid is even more uncommon. We present two cases of isolated LCH of the thyroid, one of which was found in association with papillary carcinoma of the thyroid. The cytologic, histologic, immunohistochemical, and radiologic features are described in each case. The ultrastructural findings from the first case are also presented.     

Fine-needle aspiration cytology diagnosis of non-hodgkin lymphoma of thyroid: A report of four cases

Four cases of non-Hodgkin lymphoma of thyroid, diagnosed by fine-needle aspiration (FNA) cytology during a period of 3% yr constituted 0.2% of 1,716 thyroid FNAs and 3.4% of 118 thyroid neoplasms. The age of the patients ranged from 42 to 78 yr with an average of 63 yr and all were females. Three cases had thyroid swellings, and one case had cervical lymphadenopathy and fullness in the thyroid region. The lymphomas were categorized as mixed small and large cell lymphomas, large cell lymphoma, small noncleaved lymphoma (non-Burkitt-type), and plasmacytoid lymphoma. Histopathology as well as immunohistochemistry confirmed the cytodiagnosis of lymphoma in the first and fourth cases. In the second case where possibility of anaplastic carcinoma could not be ruled out altogether at initial cytotogic examination, the histopathology report was undifferentiated carcinoma but immunohistochemically it was proved to be a B-cell neoplasm.     

Value of cytologic diagnosis of pulmonary carcinoid tumors. A morphologico-clinical analysis

14 centrally and 16 peripherally located carcinoid tumors of the lung were included in the study. For the centrally situated carcinoids the cytological interpretation of imprints or smears from the surface of the biopsy specimens turned out to be superior to the histological diagnosis based on the same endoscopic bronchial biopsy. 10 out of 12 cytologically investigated cases were correctly diagnosed. In the remaining 2 cases one was misdiagnosed as a small cell carcinoma and the other one raised suspicion of malignancy (Pap-III-finding), but no definitive diagnosis could be made. By contrast, out of 11 histologically investigated endoscopic biopsies from central carcinoids 5 were misdiagnosed as small cell carcinomas and in one case the material obtained endoscopically was inadequate. Out of the 16 peripheral carcinoid tumors only 5 were diagnosed cytologically: 3 by catheter aspiration and 2 by transthoracic needle biopsy. The characteristic cytologic feature of carcinoid tumors and the cytological differential diagnosis are described in detail.     

Aspiration biopsy cytology of lymph nodes in malignant lymphoma

The cytologic findings of needle aspiration biopsy of lymph nodes in malignant lymphoma are presented. In 42 of 49 cases, a correct cytologic diagnosis was rendered. There was one false-positive diagnosis. The diagnostic accuracy of needle aspiration cytology is high. It helps to select patients for further investigation and treatment, thereby avoiding unnecessary surgery in patients who present with lymphadenopathy. The technique is also useful in the staging work-up of patients with lymphoma and the diagnosis of recurrent disease during the follow-up period.     

Fine-needle aspiration biopsy of Ki-1-positive anaplastic large-cell lymphoma.

Five cases of Ki-1-positive anaplastic large-cell lymphoma diagnosed by fine-needle aspiration biopsy are reviewed, and cytologic, histologic, and ultrastructural findings in these cases are correlated. In all cases, the diagnosis of anaplastic large-cell lymphoma was suggested on the basis of the morphological appearance in aspiration smears. This diagnosis was confirmed by immunohistochemistry, which revealed strong positivity of most of the cells by Ki-1 antibody. Two of the lymphomas were T-cell type, one was B-cell type, and the remaining 2 were composed of null cells. In 2 cases, intracytoplasmic inclusions were seen in some of the tumor cells in aspiration smears. These were ultrastructurally correlated with large lysosomal bodies of variable morphology. Fine-needle aspiration combined with immunohistochemistry may be an effective technique for diagnosing this neoplasm.     

涎腺细针吸取细胞学分类诊断价值和存在问题

目的 分析涎腺疾病细针吸取细胞学（FNAC）形态学特点和准确分类,探讨涎腺FNAC的诊断价值和存在问题。方法 回顾113例涎腺FNAC形态学特征、免疫表型和分类诊断,并结合临床、组织病理学分析。结果 FNAC失败2例,诊断非肿瘤12例、肿瘤99例（良性肿瘤82例,恶性17例）。富于细胞多形性腺瘤、腺样囊性癌和基底细胞腺瘤相似,鉴别诊断困难。腮腺淋巴上皮癌与未分化型鼻咽型鳞状细胞癌转移完全一致,鉴别需结合临床分析。与组织学比较发现,FNAC误诊3例,分别为淋巴结反应性增生疑为非霍奇金淋巴瘤、黏液表皮样癌诊为“少量异型细胞”和淋巴上皮癌疑为良性淋巴上皮病变。FNAC区分良、恶性准确率97．4％（110／113）,良性病变99．0％（95／96）,恶性肿瘤88．2％（15／17）。总体分类准确率90．3％（102／113）,特异性91．9％（102／111）;良性病变准确率91．7％（88／96）,特异性92．6％（88／95）;恶性肿瘤准确率82．4％（14／17）,特异性87．5％（14／16）。结论 FNAC诊断涎腺良、恶性病变敏感、可靠,可提供准确的分类诊断,但诊断某些肿瘤仍有局限性,需要活检证实。     

Concomitant lymphoma and metastatic carcinoma in a lymph node: Diagnosis by fine-needle aspiration biopsy in two cases

Concomitant lymphoma and metastatic carcinoma are an unusual occurrence in a lymph node. We report two patients in whom synchronous malignancies were diagnosed by fine-needle aspiration biopsy (FNAB). In one case, the FNAB diagnoses of both small lymphocytic lymphoma and metastatic breast carcinoma were the initial diagnoses. In the second case, metastatic poorly differentiated squamous carcinoma was an unexpected finding in a patient with a history of small lymphocytic lymphoma. The aspirates in both cases showed two distinct cell populations, one consisting of a dispersed population of small uniform lymphoid cells and the other comprising large atypical single cells and cohesive clusters of epithelial cells. In both cases, the cytologic diagnoses were supported by immunohistochemical and flow cytometric studies. Diagn. Cytopathol. 1997;17:287–291, 1997. © 1997 Wiley-Liss, Inc.     

Accuracy of cytologic diagnoses made from touch imprints of image-guided needle biopsy specimens of nonpalpable breast abnormalities

We investigated the diagnostic utility and accuracy of touch imprints (TIs) prepared from core-needle biopsy (CNB) specimens of nonpalpable breast abnormalities. We reviewed air-dried, Diff-Quik-stained TIs prepared from 172 consecutive CNB specimens obtained with stereotactic or sonographic guidance. Using criteria established for fine-needle aspirates, TIs were categorized as benign, atypical, suspicious, malignant, or unsatisfactory (i.e., showing fewer than six benign epithelial cell clusters or cell distortion). Cytologic diagnoses of TIs were then correlated with the histologic diagnoses of corresponding CNB specimens. CNB specimens were histologically diagnosed as carcinoma (102 cases), benign (59 cases), low-grade phyllode tumor (six cases), and atypical ductal hyperplasia (five cases). TIs were cytologically diagnosed as malignant (63 cases), benign (35 cases), suspicious (19 cases), atypical (18 cases), and unsatisfactory (37 cases). Correlation of the cytologic and histologic diagnoses showed that five TIs diagnosed as benign were false-negative results for histologically diagnosed carcinomas (four cases) and phyllodes tumor (one case). False-negative results were attributed to poor representation of malignant cells. Two TIs diagnosed as suspicious were false results for two histologically diagnosed fibroadenomas. The false suspicious findings resulted from TIs with high cellularity, cytologic atypia, or no familiar (i.e., as seen on fine-needle aspirates) smear pattern. Unsatisfactory TIs were noted in both benign (44%) and malignant (11%) CNB specimens. When lesions categorized as suspicious were grouped with the malignant cases and those classified as atypical were grouped with the negative cases, TI sensitivity and specificity, were 83% and 95%, respectively. Fibroadenomas are difficult to identify on TIs and are likely to be misdiagnosed as suspicious. While high- and intermediate-grade carcinomas are easily categorized using TIs, low-grade carcinomas are best categorized as suspicious because of overlapping cytologic features with proliferative breast lesions. Increased experience with cytologic analysis of TIs improves the accuracy of cytologic diagnoses.     

Endoscopic ultrasound-guided fine needle aspiration diagnosis of metastatic sex cord tumor with annular tubules: a case report

The cytologic findings of a paratracheal metastasis from a malignant sex cord tumor with annular tubules (SCTATs) diagnosed by endoscopic ultrasound guided fine needle aspiration are described. Cytologic features of SCTATs include the presence of highly cellular aspirates forming simple and complex rosette-like structures around central rounded hyaline material, small nucleoli, and prominent nuclear grooves. These cytologic findings are clearly distinct from the poorly formed rosette-like structures of granulosa-cell tumors and are reminiscent of the low-power appearance of the cribriform variant of adenoid cystic carcinoma. The fine needle aspiration cytologic features of only two other cases have been previously described and, to the best of our knowledge, this is the first case reporting the cytologic diagnosis of a distant metastasis of a SCTATs by endoscopic ultrasound-guided fine needle aspiration. In this case, the distinctive and characteristic cytologic features have allowed the proper diagnosis of a distant metastasis of SCTATs.     

Subacute thyroiditis: fine-needle aspiration cytology of 14 cases presenting with thyroid nodules

Subacute thyroiditis (SAT) is usually diagnosed clinically without the need for fine-needle aspiration. The cytologic literature on this condition is therefore rare. We report on 14 cases of SAT presenting with thyroid nodules. The majority of patients were women with a mean age of 46 yr. All had pain/tenderness in the thyroid area accompanied by fever or an elevated ESR. The salient cytologic features included cellular smears; multinucleated giant cells in 100% of cases, some ingesting colloid or neutrophils; fibrous fragments with enmeshed inflammatory cells were a constant feature; follicular cells were scant to absent in most cases. Granulomas were rare. Colloid, when present was thick, with central cracks and frayed edges. One case was suspicious for malignancy. We conclude that the cytologic features of SAT are predictable, particularly, in the appropriate clinical setting. FNA is also helpful in ruling out concomitant neoplastic conditions.     

Fine-needle aspiration cytology of extranodal natural killer/T-cell lymphoma

Extranodal NK/T-cell lymphoma, nasal type, is a predominantly extranodal lymphoma characterized histologically by prominent necrosis, angiocentric growth, and vascular destruction. Only one report describing its fine-needle aspiration (FNA) cytologic features is available and shows highly unusual findings for a lymphoma. The present case concerns a 58-yr-old patient that presented with a soft tissue mass of the thigh in addition to an ulcerative lesion of the palate and nodular hepatic and splenic lesions. FNA cytology of the thigh tumor was interpreted as a malignant mesenchymal lesion (sarcoma). The subsequent pathologic study revealed an NK/T-cell lymphoma. Our findings are very similar to those previously reported. They were highly unusual for a lymphoma and consisted of polymorphic, round to spindle neoplastic cells distributed in irregular aggregates, and single cells. No significant number of lymphoglandular bodies were present.     

Cytologic findings of primary thyroid MALT lymphoma with extreme plasma cell differentiation: FNA cytology of two cases

We report fine‐needle aspiration cytology (FNAC) obtained from two cases of mucosa‐associated lymphoid tissue (MALT) lymphoma with extreme plasma cell differentiation. The patients were 61‐year‐old and 69‐year‐old Japanese women presenting with thyroid swelling. The smears contained numerous plasma cells, lymphocytes with plasma cell differentiation and scattered centrocyte‐like (CCL) cells. In addition, one case demonstrated occasional atypical giant plasma cells. Occasional intranuclear inclusions (Dutcher bodies) of the plasma cells were observed in the other case. A few cytologic lymphoepithelial lesions‐clusters (originating from lymphoepithelial lesions in histology) were also observed in one case. Plasma cells occupied ～10% in all of the lymphoid populations in FNAC specimens of Hashimoto thyroiditis, whereas, both cases demonstrated ～45% plasma cells and lymphocytes with plasma cell differentiation of all lymphocytes. The cytomorphologic findings of both cases were similar to those of plasmacytoma of the thyroid. However, immunohistochemical and flow cytometry studies demonstrated that both cases were MALT lymphoma with extreme plasma cell differentiation. From a therapeutic perspective, it is important to discriminate MALT lymphoma from plasmacytoma. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.