Rounded atelectasis: diagnosis by fine-needle aspiration cytology.

Rounded atelectasis, a rare, benign mass lesion, is most often seen in association with asbestos-related pleural changes. Often a presumptive diagnosis can be made on the basis of characteristic CT and chest radiographic findings. However, not infrequently radiographic imaging fails to differentiate rounded atelectasis from primary bronchogenic carcinoma, a disease which is seen with increased frequency in patients with asbestos exposure. We describe two cases where the diagnosis of rounded atelectasis was made by fine-needle aspiration (FNA) cytology. The cytologic features included abundant pulmonary parenchymal material with thickened alveolar walls containing pulmonary macrophages and connective tissue. It is important to realize that this is a useful positive finding indicating rounded atelectasis, rather than a negative finding suggesting the absence of neoplasm. Needles with a cutting action may be necessary to obtain sufficient material to make the diagnosis of rounded atelectasis.     

Retroperitoneal ganglioneuroma: A report of diagnosis by fine-needle aspiration cytology

Ganglioneuroma is a rare benign tumor composed of nerve fibers and mature ganglion cells. Because it shares morphologic features with other neural tumors, both benign and malignant, accurate preoperative diagnosis is often difficult, but nonetheless, critical for proper management. The use of fine-needle aspiration (FNA) cytology in the diagnosis of ganglioneuroma has been rarely documented. In this report, a 25-yr-old man presented with a large retroperitoneal ganglioneuroma that was initially diagnosed by FNA cytology. This case illustrates the utility of FNA cytology in the diagnosis of ganglioneuroma and supports the routine incorporation of FNA cytology in the evaluation of retroperitoneal masses. Diagn. Cytopathol. 1998;19:385–387. © 1998 Wiley-Liss, Inc.     

Adrenal myelolipoma: preoperative diagnosis by fine-needle aspiration cytology

Fine-needle aspiration (FNA) was performed under ultrasonographic guidance on a suprarenal mass in a 52-yr-old Japanese man. Preoperatively, the diagnosis of adrenal myelolipoma was easily established from the cytologic findings of the aspirates. FNA is a very useful technique for the differential diagnosis of this tumor, and it is particularly valuable for many hospitals that are not equipped with computed tomography.     

Flow cytometry immunophenotyping of fine-needle aspiration specimens: utility in the diagnosis and classification of non-Hodgkin lymphomas

Barrena S, Almeida J, García‐Macias M D C, López A, Rasillo A, Sayagués J M, Rivas R A, Gutiérrez M L, Ciudad J, Flores T, Balanzategui A, Caballero M D & Orfao A
(2011) Histopathology  58 , 906–918
Flow cytometry immunophenotyping of fine‐needle aspiration specimens: utility in the diagnosis and classification of non‐Hodgkin lymphomas Aims: To establish the utility of flow cytometry (FCM) for screening and diagnosis of B cell non‐Hodgkin lymphoma (B‐NHL) from lymphoid tissue samples obtained by fine‐needle aspiration (FNA). Methods and results: We compared prospectively FCM versus cytology/histology analysis of FNA samples for the diagnostic screening and further World Health Organization (WHO) subclassification of B‐NHL. FCM and cytology showed a high degree of agreement (93%); however, diagnosis of reactive processes (RP), B‐NHL and T‐NHL by FCM showed higher sensitivity than cytology (92–100% versus 64–94%, respectively), without false positive NHL cases. The antibody combination used did not allow a positive diagnosis of Hodgkin lymphoma as distinct from a RP. A high concordance rate was found between FCM and histopathology (74%) in subtyping B‐NHL. In this regard, mantle‐cell lymphoma and chronic lymphocytic leukaemia/small lymphocytic lymphoma showed the highest degree of agreement (100% concordant rates). In turn, FCM showed higher sensitivity/specificity in classifying follicular lymphoma (FL) and large B cell lymphomas, while the opposite occurred for marginal‐zone and lymphoplasmacytic lymphomas. Conclusions: FCM enhances the diagnostic ability of FNA cytology, playing a crucial role in a rapid and accurate differential diagnosis between RP, B‐NHL and T‐NHL. In addition, immunophenotyping of FNA samples contributes to a more precise subclassification of B‐NHL when combined with histopathology and genetic/molecular data.     

Utility of fine-needle aspiration cytology in the classification of leprosy

The role of fine-needle aspiration cytology (FNAC) in the diagnosis of benign skin lesions has been restricted primarily to the evaluation of bacteriologic and morphologic indices in leprosy. This study was undertaken to evaluate the efficacy of FNAC in the diagnosis and classification of lepromatous lesions. Aspirates of 94 newly diagnosed cases of leprosy were studied, and the bacterial load was determined by modified Ziehl-Neelsen (ZN) stain. A skin biopsy was taken from the same site at the same sitting. Frozen and paraffin sections stained with hematoxylin-eosin (H&E) and ZN stains were examined from the biopsy specimen. In 61 of 94 cases (64.9%), the aspirates were satisfactory. Both diagnosis and classification of leprosy were possible in 40 of these 61 cases; the rest of the aspirates showed nonspecific chronic inflammation. The 39 cases of leprosy where a biopsy was available from the same site were classified on FNAC into tuberculoid (TT and BT), lepromatous (LL and BL), and midborderline (BB) subtypes. Taking the histologic diagnosis and Ridley-Jopling classification to be the gold standard, a strong concordance in tuberculoid leprosy cases (18 of 20 cases, 90%) and in lepromatous cases (15 of 16 cases, 93.7%) was observed. Midborderline cases of leprosy posed a problem, and a correct cytohistological correlation was observed in only one of the three cases.     

Extramedullary plasma cell tumors: diagnosis by fine-needle aspiration cytology

Nine cases of plasma cell tumors were diagnosed by fine-needle aspiration cytology, the sites of aspiration being soft-tissue swellings in five cases, lymph nodes in three cases, and both soft-tissue swelling and lymph node in one case. The age of the patients ranged from 33 to 74 yrs, with a median of 52 yrs. Only three of these nine cases were clinically diagnosed as multiple myeloma. Unequivocal demonstration of myeloma cells was possible in eight cases. The smear in ninth case showed mostly undifferentiated blast cells with a few cells showing plasmacytoid differentiation. Giant myeloma cells with monstrous segmented nuclei were encountered in two cases. M-component could be demonstrated in serum and/or urine samples in all seven cases in which it was sought.     

Transbronchial fine-needle aspiration. Reliability and limitations

Transbronchial needle aspiration is a new method of sampling pulmonary, paratracheal, and mediastinal masses. A total of 116 aspirations of the lung performed during a two-and-a-half-year period were reviewed. The results were compared with those of bronchial wash, bronchial brush, sputum, transbronchial forceps biopsy, and histologic material subsequently obtained during surgery or at autopsy. Clinical information was also reviewed. Transbronchial needle aspiration was performed on 104 patients, yielding 116 specimens. With the use of a combination of aspiration, wash, brush, sputum, and forceps biopsy, malignancy was detected in 48 patients. Open biopsy, mediastinoscopy, and transcutaneous needle aspiration increased the number of malignant neoplasms detected to 72. The tumors were detected in 67% of these 72 cases by a combination of all bronchoscopic methods. Transbronchial aspiration correctly identified 36% of malignant cases compared with 35% identified by wash, 39% by brush, 25% by sputum, and 59% by forceps biopsy. The overall accuracy of the techniques was 56% for aspiration, 48% for wash, 56% for brush, 35% for sputum, and 71% for forceps biopsy. Malignant cases were associated with cellular transbronchial aspirates, good preservation of cell detail, and a high degree of cytologic/histologic correlation regarding cell type. Transbronchial fine-needle aspiration has the potential for improving the diagnostic ability of bronchoscopy. However, the high incidence of false negative diagnoses is the main limitation for the technique, and the responsible factors are discussed.     

A review of the fine-needle aspiration cytology findings in human immunodeficiency virus infection.

Patients infected with the human immunodeficiency virus (HIV) are subject to infections and neoplasms, which frequently result in palpable or radiologically identified masses. Fine-needle aspiration (FNA) offers a rapid, simple, and cost effective approach for diagnosis of these masses. During a 2-yr period, 396 aspirates were performed on 362 HIV-infected patients within the LAC-USC Medical Center. Adequate material was obtained from 84% of the FNA, allowing the etiology of the mass to be determined in 90% of the cases by means of a combination of cytologic, microbiologic, and immunocytochemical procedures. Significant pathologic processes identified in these patients by means of FNA included reactive lymphoid proliferations (35%), abnormal lymphoid proliferations (12%), infections (12.5%), cystic (5.5%) and inflammatory processes (5%), nonlymphoid malignancies (4%), and salivary gland pathology (1%). We conclude that FNA is an appropriate initial diagnostic procedure in HIV positive patients presenting with mass lesions.     

Carcinoma of the breast in a fibroadenoma: diagnosis by fine-needle aspiration cytology.

A case of carcinoma of the breast concurrent with a fibroadenoma in a 49-yr-old female is described in which the diagnosis was made on fine-needle aspiration cytology. Reports of such an occurrence are few, and to our knowledge none has previously documented the cytologic findings in detail.     

Superficial and deep-seated tuberculous lesions: fine-needle aspiration cytology diagnosis of 574 cases.

Over a period of 2 yr (1987-1988), FNA smears in 574 cases were found to have cytologic features suggestive of or consistent with tuberculous lesions. The age of the patients ranged from 6 mo to 75 ye, with a median of 24 yr. The male to female ratio was 273:301. Sites of FNA were superficial lymph nodes (SLN) in 440 (76.7 percent) cases, superficial extranodal sites (SENS) in 50 (8.7 percent), both SLN and SENS in 7 (1.2%), the thoracic cavity in 16 (2.8%), and the abdominal cavity in 61 (10.6%). Cytologic features were described under 3 major cytologic patterns, i.e., type I: epithelioid granuloma without necrosis, type II: epithelioid granuloma with necrosis, type III: necrosis without epithelioid granuloma. Type I, II, and III reactions were observed in 181 (31.5%), 183 (31.9%), and 210 (36.6%) cases, respectively. The overall AFB positivity was 30.8%. The AFB positivities for type I, II, and III cytologic reactions were 5.4%, 32.0%, and 48.5%, respectively. The AFB positivity was low (less than 30.0%) in swellings of the body surface (23.8%) and abdominal organs (18.9%). High positivity (greater than 60.0%) was observed in lesions of the thorax (63.6%) and thyroid (62.5%).     

Mucinous cystadenocarcinoma of the pancreas: diagnosis by fine-needle aspiration cytology

Two cases of mucinous cystadenocarcinoma of the pancreas are described in which the diagnosis was made from the material obtained by a computed tomography-guided fine-needle aspiration cytology examination. It is strongly felt that aspiration cytology, when performed under imaging guidance, is sensitive and specific in the diagnosis of mucinous cystadenocarcinoma and allows for a relatively simple yet confident diagnostic interpretation of this uncommon pancreatic tumour.     

Parotid gland fine-needle aspiration cytology: an approach to differential diagnosis

Parotid glands can undergo a wide range of pathologic changes that may be difficult to characterize by clinical features alone. No single diagnostic modality is currently accepted unequivocally as the definitive approach to parotid gland enlargement or tumors. Although it is generally accepted that fine-needle aspiration (FNA) biopsy is useful in the preoperative setting, the accuracy is highly dependent on both operator experience and the interpretative skills of the cytopathologist. Results of FNA biopsy must be considered in a global context, in conjunction with clinical and radiographic findings. The objectives of this paper are threefold: (1) to define the clinical role of parotid FNA, such that pathologists performing and/or interpreting such specimens have a clearer understanding of the expectations of our surgical colleagues; (2) to clearly describe a protocol for the performance of parotid FNA biopsy, including a discussion of complications and pitfalls; and (3) to present the cytologic differential diagnoses of diverse clinicopathologic parotid gland processes that may present as generalized enlargement, cystic lesions, or discrete masses.     

Lymphoid cell aggregates: A useful clue in the fine-needle aspiration diagnosis of follicular lymphomas

Among the various types of lymphoma, follicular lymphoma (FL) is known to have significant limitations in cytologic diagnosis by the fine-needle aspiration (FNA) method. The diagnostic accuracy (DA) for non-Hodgkin's lymphoma (NHL) by FNA was evaluated by review of 82 cases of histologically proved NHL after prior FNA. The DA for all NHLs was 66% (54/82), and that for low-grade lymphomas, including small lymphocytic lymphoma, follicular small-cleaved cell lymphoma, and follicular mixed cell lymphoma, was 71% (12/17). The DA for FL was 69% (11/16). Review of individual surgical and cytologic materials from FLs revealed a tendency to show fibrosis in the cytologically false-negative group and diffuse areas of lymphoma in the true-positive group. The presence of “aggregation” of uniform lymphoid cells, probably due to cell adhesions with the support of dendritic reticulum cells, was seen in 55% of true-positive FL (6/11). In contrast, only 28% of true-positive diffuse large cell lymphomas (5/18) showed a mild degree of aggregation, and none of 7 cases of true-positive diffuse small-cleaved cell lymphoma showed this feature. The aggregation of cells was not pathognomonic of FL, but its presence with a homogeneous cellular constituent and the paucity of tingible-body macrophages helped us to predict FL. Also, it was a feature distinguishing FL from diffuse small-cleaved cell lymphoma (P = 0.025). Diagn. Cytopathol. 1997;17:467–471. © 1997 Wiley-Liss, Inc.     

Leiomyosarcoma of the orbit: diagnosis of its recurrence by fine-needle aspiration cytology.

An 8 1/2-yr-old boy with proptosis was diagnosed to have low-grade leiomyosarcoma of the orbit following lateral orbitotomy and histology of an incompletely excised intraconal mass. He received chemotherapy but had recurrence of proptosis at the age of 12 yr. Ultrasonography revealed a solid mass and its fine-needle aspiration cytology features were consistent with recurrence of leiomyosarcoma. A year later, the cytodiagnosis was confirmed by histology of the excised tumor from a second lateral orbitotomy. Masson's trichrome stain confirmed the smooth muscle nature of the neoplasm and ultrastructural features were in favor of leiomyosarcoma. The patient received intermittent chemotherapy, and is clinically free from disease at the age of 17 yr.     

Ultrasound-guided fine-needle aspiration cytology diagnosis of gallbladder lesions: A study of 82 cases

Carcinoma of the gallbladder (GB) is among the five most common forms of cancers and tops the list of gastrointestinal malignancies in females of the Delhi region. Lack of specific signs and symptoms prevents early detection of GB carcinoma. However, in recent years ultrasonographically (US)-guided fine-needle aspiration (FNA) cytology has been found to be a reliable procedure for its diagnosis. The present study was carried out during a period of 5 yr (1986–1990) in 64 female and 18 male patients to find out the diagnostic utility of US-guided FNA cytology in gallbladder lesions. Ultrasonography in these 82 cases revealed a mass in the gallbladder/GB area in 74 (90.2%), a mass in the GB/pancreas in 1 (1.2%), gallstones in 32 (39.0%), and miscellaneous gallbladder lesions in 4 (4.9%). The other findings included space-occupying lesions in liver in 18 (22.0%), portal lymphadenopathy in 12 (14.6%), and infiltration in other organs in 7 (8.5%). The initial cytodiagnosis was malignancy in 48 cases, inflammatory in 12, and inadequate in 22. Following review of the smears by one of the investigators (D.K.D.), the number of malignant cases remained 48 (58.5%). There were 10 (12.2%) inflammatory and 24 (29.3%) inadequate cases. Adenocarcinoma was the most common malignancy (83.3%), followed by squamous-cell and adenosquamous carcinoma (12.5%) and small round cell tumors (4.2%). The 10 inflammatory lesions showed slight (+) to excessive (+++) neutrophilic infiltration and included one case each of xanthogranulomatous cholecystitis and a necrotizing granulomatous lesion likely to be of tuberculous etiology. Diagn. Cytopathol. 1998; 18:258–264. © 1998 Wiley-Liss, Inc.     

Cystic nephroma: cytologic findings in fine-needle aspiration cytology.

This report presents the fine-needle aspiration cytology (FNAC) findings of a multicystic renal tumor found in a 3-year-old child. The smears contained benign epithelial cells isolated or arranged in sheets of uniform cells strongly suggesting the lining of the cysts. The combination of the imaging data with the FNAC findings favoured the diagnosis of cystic nephroma (CN), a benign renal tumor that is cured by surgery. Surgical pathology confirmed the diagnosis. CN should be added to the list of tumors of the kidney in infancy that appear to be diagnosable by FNAC/biopsy.